The Scoop On the Dangers of Snow Shoveling

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Urban legend warns shoveling snow causes heart attacks, and the legend seems all too accurate, especially for male wintery excavators with a family history of premature cardiovascular disease. However, until recently this warning was based on anecdotal reports.

Two of the most important cardiology associations in the US include snow -shoveling on their websites as a high risk physical activity, but all the citation references indicate that this warning was based one or two incidents.

"We thought that this evidence should not be enough to convince us that snow -shoveling is potentially dangerous, " says Adrian Baranchuk, a professor in Queen's School of Medicine and a cardiologist at Kingston General Hospital.

Dr. Baranchuk and his team retrospectively reviewed KGH patient records from the two previous winter seasons and discovered that of the 500 patients who came to the hospital with heart problems during this period, 7 per cent (35 patients) had started experiencing symptoms while shoveling snow.

"That is a huge number," says Dr. Baranchuk. "7 per cent of anything in medicine is a significant proportion. Also, if we take into account that we may have missed some patients who did not mention that they were shoveling snow around the time that the episode occurred, that number could easily double."

The team also identified three main factors that put individuals at a high risk when shoveling snow. The number one factor was gender (31 of the 35 patients were male), the second was a family history of premature coronary artery disease (20 of the 35 patients), and the third was smoking (16 out of 35 patients). The second two factors may carry much more weight than the first, however, since the team could not correct for high rate of snow shoveling among men in their sample.

A history of regularly taking four or more cardiac medications was found to be preventative.

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Lower Antioxidants = Higher Skin-Cancer Rate In Males

Men are three times more likely than women to develop a common form of skin cancer but medical science doesn’t know why. A new study may provide part of the answer.

Researchers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) have found that male mice had lower levels of an important skin antioxidant than female mice and higher levels of certain cancer-linked inflammatory cells.

The antioxidant, a protein called catalase, inhibits skin cancer by mopping up hydrogen peroxide and other DNA-damaging reactive-oxygen compounds that form during exposure to ultraviolet B light (UVB), a common source of sunburn and cancer-causing skin damage. Studies by others have linked low catalase activity to skin cancer progression.

The research is published online in the Journal of Investigative Dermatology.

The findings suggest that women may have more natural antioxidant protection in the skin than men,” say study co-leaders Gregory Lesinski and Tatiana Oberyszyn, both of the OSUCCC – James.

“As a result, men may be more susceptible to oxidative stress in the skin, which may raise the risk of skin cancer in men compared to women,” says Lesinski, an assistant professor of molecular virology, immunology and medical genetics;.

The study also found that UVB exposure caused a unique inflammatory white blood cell population called ‘myeloid-derived suppressor cells’ to migrate from the bone marrow into the exposed skin. Furthermore, higher numbers of these cells moved into the skin of male mice than female mice.

“To our knowledge, we’ve shown for the first time that UVB exposure causes a migration of systemic myeloid-derived suppressor cells, and it suggests that these cells might be a novel source of UVB-induced immune suppression,” says first author Nicholas Sullivan, a research scientist in the Oberyszyn lab in the Department of Pathology.

This, in turn, might mean that these UVB-induced inflammatory cells contribute to the genesis of skin tumors and perhaps other tumors rather than simply facilitating cancer progression, as generally thought, Sullivan notes.

Normally, the body mobilizes the suppressor cells to limit immune responses to infection, sepsis or trauma so that healing can begin, Lesinski says.

“However, in the cancer setting, repeated UV light exposure or after other chronic or repeated inflammatory stimuli, these cells persist and become immunosuppressive,” he says. “They can render helpful immune cells such as T cells or natural killer cells unable to recognize and eliminate cancer cells in the skin.”

Lesinski, Oberyszyn, Sullivan and their colleagues conducted the study using a strain of hairless mice that develops squamous cell carcinoma of the skin – the second most common skin cancer in humans – when exposed to UVB.

The investigators also found that treating mice with topical catalase inhibited the migration of the suppressor cells into UVB-exposed skin, suggesting that the influx of these cells in males might be due to the relatively lower skin-catalase activity.

In fact, male mice with UVB-induced skin tumors had 55 percent more of the suppressor cells in the skin than did their female counterparts.

“This is the first report to our knowledge of a sex discrepancy in this group of inflammatory cells in tumor-bearing mice, and it suggests that our findings might translate to other types of cancer,” says Oberyszyn, associate professor of pathology. “Men face a higher risk of numerous types of cancers, and relatively higher levels of inflammatory myeloid cells might contribute to this susceptibility.”

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Vegetables, fruits, grains reduce stroke risk in women

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Swedish women who ate an antioxidant-rich diet had fewer strokes regardless of whether they had a previous history of cardiovascular disease, in a study reported in Stroke: Journal of the American Heart Association.

"Eating antioxidant-rich foods may reduce your risk of stroke by inhibiting oxidative stress and inflammation," said Susanne Rautiainen, M.Sc., the study's first author and Ph.D. student at the Karolinska Institutet in Sweden. "This means people should eat more foods such as fruits and vegetables that contribute to total antioxidant capacity."

Oxidative stress is an imbalance between the production of cell-damaging free radicals and the body's ability to neutralize them. It leads to inflammation, blood vessel damage and stiffening.

Antioxidants such as vitamins C and E, carotenoids and flavonoids can inhibit oxidative stress and inflammation by scavenging the free radicals. Antioxidants, especially flavonoids, may also help improve endothelial function and reduce blood clotting, blood pressure and inflammation.

"In this study, we took into account all the antioxidants present in the diet, including thousands of compounds, in doses obtained from a usual diet," Rautiainen said. Researchers collected dietary data through a food-frequency questionnaire. They used a standard database to determine participants' total antioxidant capacity (TAC), which measures the free radical reducing capacity of all antioxidants in the diet and considers synergistic effects between substances.

Researchers categorized the women according to their TAC levels — five groups without a history of cardiovascular disease and four with previous cardiovascular disease.

For women with no history of cardiovascular disease who had the highest TAC, fruits and vegetables contributed about 50 percent of TAC. Other contributors were whole grains (18 percent), tea (16 percent) and chocolate (5 percent).

The study found:

Higher TAC was related to lower stroke rates in women without cardiovascular disease.
Women without cardiovascular disease with the highest levels of dietary TAC had a statistically significant 17 percent lower risk of total stroke compared to those in the lowest quintile.
Women with history of cardiovascular disease in the highest three quartiles of dietary TAC had a statistically significant 46 percent to 57 percent lower risk of hemorrhagic stroke compared with those in the lowest quartile.
"Women with a high antioxidant intake may be more health conscious and have the sort of healthy behaviors that may have influenced our results," Rautiainen said. "However, the observed inverse association between dietary TAC and stroke persisted after adjustments for potential confounders related to healthy behavior such as smoking, physical activity and education."

For the study, researchers used the Swedish Mammography Cohort to identify 31,035 heart disease-free women and 5,680 women with a history of heart disease in two counties. The women were 49-83 years old.

Researchers tracked the cardiovascular disease-free women an average 11.5 years and the women with cardiovascular disease 9.6 years, from September 1997 through the date of first stroke, death or Dec. 31, 2009, whichever came first.

Researchers identified 1,322 strokes among cardiovascular disease-free women and 1,007 strokes among women with a history of cardiovascular disease from the Swedish Hospital Discharge Registry.

"To the best of our knowledge, no study has assessed the relation between dietary TAC and stroke risk in participants with a previous history of cardiovascular disease," Rautiainen said. "Further studies are needed to assess the link between dietary TAC and stroke risk in men and in people in other countries, but we think our results are applicable."

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Eating fish reduces risk of Alzheimer's disease

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People who eat baked or broiled fish on a weekly basis may be improving their brain health and reducing their risk of developing mild cognitive impairment (MCI) and Alzheimer's disease, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).

"This is the first study to establish a direct relationship between fish consumption, brain structure and Alzheimer's risk," said Cyrus Raji, M.D., Ph.D., from the University of Pittsburgh Medical Center and the University of Pittsburgh School of Medicine. "The results showed that people who consumed baked or broiled fish at least one time per week had better preservation of gray matter volume on MRI in brain areas at risk for Alzheimer's disease."

Alzheimer's disease is an incurable, progressive brain disease that slowly destroys memory and cognitive skills. According to the National Institute on Aging, as many as 5.1 million Americans may have Alzheimer's disease. In MCI, memory loss is present but to a lesser extent than in Alzheimer's disease. People with MCI often go on to develop Alzheimer's disease.

For the study, 260 cognitively normal individuals were selected from the Cardiovascular Health Study. Information on fish consumption was gathered using the National Cancer Institute Food Frequency Questionnaire. There were 163 patients who consumed fish on a weekly basis, and the majority ate fish one to four times per week. Each patient underwent 3-D volumetric MRI of the brain. Voxel-based morphometry, a brain mapping technique that measures gray matter volume, was used to model the relationship between weekly fish consumption at baseline and brain structure 10 years later. The data were then analyzed to determine if gray matter volume preservation associated with fish consumption reduced risk for Alzheimer's disease. The study controlled for age, gender, education, race, obesity, physical activity, and the presence or absence of apolipoprotein E4 (ApoE4), a gene that increases the risk of developing Alzheimer's.

Gray matter volume is crucial to brain health. When it remains higher, brain health is being maintained. Decreases in gray matter volume indicate that brain cells are shrinking.

The findings showed that consumption of baked or broiled fish on a weekly basis was positively associated with gray matter volumes in several areas of the brain. Greater hippocampal, posterior cingulate and orbital frontal cortex volumes in relation to fish consumption reduced the risk for five-year decline to MCI or Alzheimer's by almost five-fold.

"Consuming baked or broiled fish promotes stronger neurons in the brain's gray matter by making them larger and healthier," Dr. Raji said. "This simple lifestyle choice increases the brain's resistance to Alzheimer's disease and lowers risk for the disorder."

The results also demonstrated increased levels of cognition in people who ate baked or broiled fish.

"Working memory, which allows people to focus on tasks and commit information to short-term memory, is one of the most important cognitive domains," Dr. Raji said. "Working memory is destroyed by Alzheimer's disease. We found higher levels of working memory in people who ate baked or broiled fish on a weekly basis, even when accounting for other factors, such as education, age, gender and physical activity."

Eating fried fish, on the other hand, was not shown to increase brain volume or protect against cognitive decline.

More on Alzheimer's:

According to statistics from the National Institute on Aging, Alzheimer’s disease is the most common form of dementia in older people. Alzheimer’s is a progressive brain disease; it is irreversible and causes a decline in memory and cognitive skills.
Alzheimer’s disease is the seventh leading cause of death in the United States. It is the only cause of death among the top 10 that cannot be prevented, cured or even significantly arrested. Two-thirds of people over the age of 65 who have the disease are women. This is a startling statistic, and one that requires increased attention and research.

“Clearly, this is an illness of women more than men,” said Victor Henderson, MD, MS, Professor of Epidemiology and Neurology and Neurological Sciences at Stanford University. “In part, it has to do with the fact that women live longer than men. There are real differences in longevity.”

Researchers have long studied the relationship between the hormone estrogen and Alzheimer's disease, but the results have been inconclusive thus far. “There are other risk factors that may come into play,” said Henderson, “which can further explain why women may be predisposed to Alzheimer’s disease.” Some of these factors include: family history, genetics, and some evidence suggests heart disease.

One of the first signs of Alzheimer’s disease may be forgetfulness and difficulty remembering newly learned information. But the disease gradually gets worse. According to the National Alzheimer’s Association in Chicago, other symptoms develop over time and may include:
• Challenges in planning or problem solving.
• Difficulty completing familiar tasks at home, at work, or at leisure.
• Confusion with time or place.
• Trouble understanding visual images and spatial relationships.
• New problems with words in speech or writing.
• Misplacing objects and losing the ability to retrace steps.
• Decreased or poor judgment.
• Withdrawal from work or social activities.
• Changes in mood and personality.

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Anti-inflammatory polyphenols in apple peels

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Here's another reason why "an apple a day keeps the doctor away"—according to new research findings published in the Journal of Leukocyte Biology, oral ingestion of apple polyphenols (antioxidants found in apple peels) can suppress T cell activation to prevent colitis in mice. This study is the first to show a role for T cells in polyphenol-mediated protection against an autoimmune disease and could lead to new therapies and treatments for people with disorders related to bowel inflammation, such as ulcerative colitis, Crohn's disease and colitis-associated colorectal cancer.

"Many people with colitis use some form of dietary supplement to complement conventional therapies, but most of the information on the health effects of complementary medicine remains anecdotal. Also, little is known about exactly how these therapies work, if they work at all," said David W. Pascual, Ph.D., a researcher involved in the work from the Department of Immunology and Infectious Diseases at Montana State University in Bozeman, Montana. "Our results show that a natural product found in apple peels can suppress colonic inflammation by antagonizing inflammatory T cells to enhance resistance against autoimmune disease."

To make this discovery, scientists used a chemically induced model of colitis with Dextran sulfate sodium (DSS), researchers administered an oral placebo to one group of mice, and the other group of mice was given an oral dose of apple polyphenols every day during the course of the disease. Results showed that mice treated orally with apple polyphenols were protected from colitis. Importantly, scientists also found that the treated mice had fewer activated T cells in their colons. In mice lacking T cells, apple polyphenols were unable to protect against colitis or suppress proinflammatory cytokine expression, indicating apple polyphenols protect against colitis via the suppression of T cell activation and/or recruitment.

"It appears that the old adage rings true in more ways than one," said John Wherry, Ph.D., Deputy Editor of the Journal of Leukocyte Biology, "In addition to the obvious health benefits of the nutrients and fiber in fruits and vegetables, this study indicates that even something as relatively common as the apple contains other healthy ingredients that can have serious therapeutic value."

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Frequent 'heading' in soccer can lead to brain injury and cognitive impairment

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Using advanced imaging techniques and cognitive tests, researchers at Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center , the University Hospital and academic medical center for Einstein, have shown that repeatedly heading a soccer ball increases the risk for brain injury and cognitive impairment. The imaging portion of the findings was presented today at the annual meeting of the Radiological Society of North America (RSNA) in Chicago.

The researchers used diffusion tensor imaging (DTI), an advanced MRI-based imaging technique, on 38 amateur soccer players (average age: 30.8 years) who had all played the sport since childhood. They were asked to recall the number of times they headed the ball during the past year. (Heading is when players deliberately hit or field the soccer ball with their head.) Researchers ranked the players based on heading frequency and then compared the brain images of the most frequent headers with those of the remaining players. They found that frequent headers showed brain injury similar to that seen in patients with concussion, also known as mild traumatic brain injury (TBI).

The findings are especially concerning given that soccer is the world's most popular sport with popularity growing in the U.S., especially among children. Of the 18 million Americans who play soccer, 78 percent are under the age of eighteen. Soccer balls are known to travel at speeds as high as 34 miles per hour during recreational play, and more than twice that during professional play.

After confirming the potentially damaging impact of frequent heading, "Our goal was to determine if there is a threshold level for heading frequency that, when surpassed, resulted in detectable brain injury," said lead author Michael Lipton, M.D., Ph.D. , associate director of Einstein's Gruss Magnetic Resonance Research Center and medical director of MRI services at Montefiore. Further analysis revealed a threshold level of approximately 1,000 to 1,500 heads per year. Once players in the study exceeded that number, researchers observed significant injury.

"While heading a ball 1,000 or 1,500 times a year may seem high to those who don't participate in the sport, it only amounts to a few times a day for a regular player," observed Dr. Lipton, who is also associate professor of radiology, of psychiatry and behavioral sciences ), and of the Dominick P. Purpura Department of Neuroscience at Einstein.

"Heading a soccer ball is not an impact of a magnitude that will lacerate nerve fibers in the brain," said Dr. Lipton. "But repetitive heading may set off a cascade of responses that can lead to degeneration of brain cells."

Researchers identified five areas, in the frontal lobe (behind the forehead) and in the temporo-occipital region (the bottom-rear areas) of the brain that were affected by frequent heading – areas that are responsible for attention, memory, executive functioning and higher-order visual functions. In a related study, Dr. Lipton and colleague Molly Zimmerman, Ph.D. , assistant professor in the Saul R. Korey Department of Neurology at Einstein, gave the same 38 amateur soccer players tests designed to assess their neuropsychological function. Players with the highest annual heading frequency performed worse on tests of verbal memory and psychomotor speed (activities that require mind-body coordination, like throwing a ball) relative to their peers.

"These two studies present compelling evidence that brain injury and cognitive impairment can result from heading a soccer ball with high frequency," Dr. Lipton said. "These are findings that should be taken into consideration in planning future research to develop approaches to protect soccer players."

Heading is an essential part of soccer and is unlikely to be eliminated from practice or play.

As there appears to be a safe range for heading frequency, additional research can help refine this number, which can then be used to establish heading guidelines. As in other sports, the frequency of potentially harmful actions in practice and games could be monitored and restricted based on confirmed unsafe exposure thresholds.

"In the past, pitchers in Little League Baseball sustained shoulder injuries at a rate that was alarming," Dr. Lipton noted. "But ongoing research has helped shape various approaches, including limits on the amount of pitching a child performs, which have substantially reduced the incidence of these injuries."

"Brain injury due to heading in children, if we confirm that it occurs, may not show up on our radar because the impairment will not be immediate and can easily be attributed to other causes like ADHD or learning disabilities," continued Dr. Lipton. "We, including the agencies that supervise and encourage soccer play, need to do the further research to precisely define the impact of excessive heading on children and adults in order to develop parameters within which soccer play will be safe over the long term."

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Mediterranean Diet and Exercise Can Reduce Sleep Apnea Symptoms

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Eating a Mediterranean diet combined with physical activity can help to improve some of the symptoms of sleep apnea, according to new research. The study, which is published online in the European Respiratory Journal, looked at the impact a Mediterranean diet can have on obese people with sleep apnea, compared to those on a prudent diet.

Obstructive sleep apnea syndrome (OSAS) causes frequent pauses of breathing to occur during sleep, which disrupts a person's normal sleeping pattern. It is one of the most prevalent sleep-related breathing disorders with approximately 2-4% of the adult population experiencing the condition. This percentage increases up to 20-40% with obesity, and weight loss is often an essential part of the recommended treatment plan.

The researchers, from the University of Crete in Greece, examined 40 obese patients suffering from OSAS. Twenty patients were given a prudent diet to follow, while the other 20 followed a Mediterranean diet. Both groups were also encouraged to increase their physical activity, mainly involving walking for at least 30 minutes each day.

In both groups, the patients also received continuous positive airway pressure (CPAP) therapy which involves wearing a mask that generates an air stream, keeping the upper airway open during sleep.

The researchers monitored the patients during a sleep study, known as polysomnography. This involved monitoring several markers for OSAS, including electrical activity in the brain, eye movements and snoring. The patients were examined at the start of the study and again 6 months later.

The results showed that people following the Mediterranean diet had a reduced number of disturbances, known as apneas, during the rapid eye movement (REM) stage of sleep, which usually accounts for approximately 25% of total sleep during the night.

The findings also revealed that people following the Mediterranean diet also showed a greater adherence to the calorie restricted diet, an increase in physical activity and a greater decrease in abdominal fat.

The results of this small sample did show an improvement during one stage of sleep for people with sleep apnea, however it did not show an overall improvement in severity of the condition. The authors suggest that further studies in a larger sample are required to fully understand the benefits of this diet.

Christopher Papandreou, lead author for the research, said: "This is the first study examining the impact of the Mediterranean diet in combination with physical activity on OSAS via changes in the human body. Our results showed that the number of disturbances during REM sleep was reduced more in the Mediterranean diet group than the other group. Recent reports have related an increase in disturbances during REM sleep with the risk of developing significant systemic consequences like diabetes type II. However, its clinical significance remains unclear. Finally, more studies are needed to examine the effect of the above diet on this sleep-related breathing disorder taking into account its anti-inflammatory and antioxidant properties."

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