Cataract Surgery: Safe, Effective & Very Common

Here’s an eye-opening statistic from the July issue of Mayo Clinic Women’s HealthSource: By age 80, more than half of all Americans either have a cataract or have had cataract surgery.

A cataract occurs when the normally clear lens in the eye becomes cloudy, blurring vision and preventing the lens from focusing an image on the retina, the light-sensitive tissue at the back of the eye. While cataracts don’t spread from one eye to another, both eyes are commonly affected.

The only effective treatment for a cataract is surgery to remove the clouded lens. Typically, it’s replaced with an artificial lens known as an intraocular lens. Made from clear plastic, acrylic or silicone, intraocular lenses become a permanent part of the eye.

Cataract surgery is one of the safest and most effective surgical procedures performed in the United States. In years past, it was often recommended that patients wait for a cataract to turn white before having it removed. Today, there are no set recommendations on the best time to remove a cataract. The standard is to have one cataract removed at a time, allowing the eye to heal prior to the second surgery.

Most cataracts don’t disturb vision in the early stages, but as the clouding progresses, a cataract can interfere with everyday life. After successful surgery, patients notice a vision improvement within days. Complete healing generally takes four to six weeks.

Regular eye exams remain the best way to detect cataracts early and monitor their progression. Adults of any age can develop a cataract, but age is the single greatest risk factor. For people over 65, an eye exam at least every other year is recommended.

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Folic Acid and Vitamin B-12: Get Enough of Both

Folate, or its synthetic form, folic acid, is good for brain health. But there’s concern that this brain booster could mask deficiencies in vitamin B-12, which can result in mental decline and other nerve problems. The July issue of Mayo Clinic Health Letter covers why it’s important to have enough of both.

Numerous studies have determined that high levels of folate intake, up to 800 micrograms (mcg) a day, may help ward off cognitive decline, possibly lower the risk of Alzheimer’s disease, and even improve mental sharpness in areas such as memory and mental processing speed.

Folate is also important during pregnancy for the developing fetus, which is why the Food and Drug Administration in 1998 mandated folic acid fortification of grain products sold in the United States.

Vitamin B-12 plays an essential role in red blood cell formation, cell metabolism and nerve function. Where there’s a deficiency, symptoms include persistent tingling in the hands and feet, confusion and forgetfulness.

An estimated 15 percent of older adults are deficient in vitamin B-12. This deficiency can be caused by age-related changes in the digestive tract, which blunt the body’s ability to digest and absorb vitamin B-12 from food. Vegetarians who avoid all animal products and people who have digestive diseases such as celiac disease or Crohn’s disease may also be at increased risk of vitamin B-12 deficiency.

While folic acid offers benefits, there are concerns about how it chemically reacts with vitamin B-12 within the body. It’s suspected that high folic acid intake can correct the anemia — but not the nerve and cognitive deterioration — that would normally occur with vitamin B-12 deficiency. Without the indication of anemia, vitamin B-12 deficiency may not be suspected and neurological deterioration may continue unabated.

More study is needed to fully explore the relationship between folate and vitamin B-12 and how it may affect brain health. Until then, the safest bet is to ensure intake of adequate amounts of both. Most older adults can do this by taking a multivitamin supplement that contains 100 percent of the recommended daily allowance of both folate and vitamin B-12. For folic acid, that’s 400 mcg a day and for vitamin B-12, it’s 2.4 mcg a day.

A healthy diet that includes daily servings of fortified breads, grains or cereals and a wide variety of fresh and natural foods such as fruits, vegetables, beans and nuts can boost daily intake of folate or folic acid to the higher levels that may benefit brain health.

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Staying Mentally Sharp Takes Brain Work

Research is increasingly showing that aging doesn’t automatically result in a steady erosion of brain cells. Rather, older adults who work their brains can develop new connections between brain cells.

A brain workout — using the mind in a wide variety of new and challenging ways — can activate cells throughout the brain. The July issue of Mayo Clinic Health Letter offers these suggestions to stimulate the mind:

Working the left brain — Language, number and reasoning activities are often considered left-brain activities. Reading, writing, learning a new language, completing number or work games, balancing a checkbook without a calculator and fixing broken objects are left-brain activities.

Working the right brain — Music, art and using the imagination are considered right-brain activities. Options to stimulate this side include reviving a musical talent, singing in a choir, knitting, quilting or taking art classes.

Breaking a routine — Long-familiar daily routines can become so ingrained that little thought is required. When one breaks up routines, meets a new person, learns a skill or takes a different route to the store, the brain is engaged.

Remembering or memorization — Brain-building ideas include memorizing phone numbers, the words to a poem or people’s names.

Trying meditation — Studies have shown that meditation activates the parts of the brain associated with happiness and contentment and reduces stress and anxiety. This effect can occur even in those new to meditation, and grows more robust with practice.

Engaging in social activity — Engaging in conversation or activity with a wide variety of people — family, friends or strangers — can be one of the most complex and varied tasks that the mind undertakes. Social engagement has been linked in many studies to the reduction of mental decline.

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Web Tool for Estimating Risk of Five Major Diseases

A few clicks of the mouse tell visitors to the "Your Disease Risk" Web site their risk for cancer, heart disease, diabetes, stroke and osteoporosis. The Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis recently launched this easy-to-use tool, which offers a wealth of information about risk factors and prevention strategies for five prominent diseases affecting millions of Americans.

On the Web site (http://www.yourdiseaserisk.wustl.edu), users can answer a series of simple questionnaires about their medical history, eating habits, exercise and other behaviors and then get a personalized estimate of their risk for 12 different cancers plus heart disease, diabetes, stroke and osteoporosis. Users will also find tips on how to lower their disease risk and convenient Web links to fact sheets that describe the origins and symptoms of each disease.

"The key message is that we already have information to prevent much of the chronic disease that affects the population," says Graham Colditz, M.D., Dr.P.H., the Niess-Gain Professor and associate director of Prevention and Control at the Siteman Cancer Center. "If we can spread the word about prevention strategies, people can start early in life to prevent disease later. We know that it can be hard to decide among all the health claims in the media, and we established this site to make it easy for people to find reliable recommendations for better health and to identify strategies that are best for them."

It is estimated that healthy lifestyles could prevent over half of cancers, 70 percent of strokes and 80 percent of heart disease and diabetes. In addition to detailing the impact of well-known risk factors like smoking, lack of exercise and being overweight, "Your Disease Risk" offers many other important health tips, such as the benefits of calcium and vitamin D for both colon and bone health, the increased risk of diabetes from eating too many refined grains and the increased risk of stroke in apple-shaped people who carry extra fat around the waist.

The site's developers tested its usability with focus groups to make sure all the components are streamlined and understandable. Visitors to the site can choose to investigate just one of the diseases, but answers given in one area carry over to all other areas to avoid the need to repeat answers when learning about more than one disease. A Spanish language version will soon be available on the site's home page.

"We think the site is very accessible and attractive," Colditz says. "We sincerely hope that people make good use of it and feel they come away with a practical, personalized list of what they can do to improve their health."

"Your Disease Risk" reflects recent evidence from the medical community to assure that users are up to date. "We have a system of review that looks at published scientific research on disease risk and makes additions or changes when significant new data become available," Colditz says. "As we go forward, the prevention and control team at the Siteman Cancer Center will continue to ensure the accuracy and relevancy of the site."

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Moderate Drinkers Report Better Health

Moderate drinkers are more likely to report above-average health than lifetime abstainers, light drinkers and heavy drinkers, a new study reveals.

“Our results suggest that a moderate amount of drinking is not necessarily dangerous for most people and may actually be health-enhancing,” said study coauthor Michael French, Ph.D.

However, it is unclear whether moderate drinking leads to better health or whether moderate drinkers simply lead healthier lifestyles, he said.

This finding confirmed much of the clinical evidence on this topic. However, previous research has focused on objective health indicators such as cardiovascular disease, injuries and mortality. “We wanted to see if moderate drinkers are actually feeling better by their own assessment,” said French, professor of health economics at the University of Miami.

The study appears in the July/August issue of the American Journal of Health Promotion.

The study used 2002 data from a representative survey of U.S. households, representing more than 31,000 adults. The U.S. Census Bureau conducts the survey for the Centers for Disease Control and Prevention.

Participants answered questions about alcohol consumption, health behaviors and chronic health conditions. Researchers defined moderate drinking as four to 14 drinks weekly for men and four to seven drinks weekly for women.

Compared with lifetime abstainers and former light drinkers, moderate-drinking men were 1.27 times more likely to report above-average health. Women who were moderate drinkers were more than twice as likely to report above-average health as abstainers were.

Arthur Klatsky, M.D., a researcher and cardiology consultant at the Kaiser Permanente Medical Care Program in Oakland, Calif., suggests that the study’s results for moderate drinkers probably have something to do with healthy lifestyles. “By and large, the same people that work out and eat healthy are probably more likely to be moderate drinkers instead of heavier drinkers,” he said.

One major health benefit of moderate drinking is the ability to ward off cardiovascular disease, particularly hardening of the arteries and stroke caused by blockages in blood vessels, Klatsky added.

Both French and Klatsky warn that heavy drinking contributes to poor health. “Heavy drinking by everybody’s reckoning is bad business for health and social outcomes,” Klatsky said.

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Secondhand smoke = potent carcinogen absorbed

New research on secondhand smoke discovers nonsmoking workers immediately absorb potent carcinogen

Offering alarming new evidence on the dangers of permitting smoking in the workplace, scientists have found that nonsmoking restaurant and bar employees absorb a potent carcinogen—not considered safe at any level—while working in places where they had to breathe tobacco smoke from customers and co-workers. The carcinogen, NNK, is found in the body only as a result of using tobacco or breathing secondhand smoke.

In a study to be published in the August 2007 edition of the American Journal of Public Health, investigators at the Multnomah County Health Department and Oregon Department of Human Services report that elevated levels of NNK showed up in the urine of nonsmoking employees shortly after they encountered secondhand smoke during their shifts. Moreover, levels of NNK, which is known to cause lung cancer, increased by 6 percent for each hour of work.

“This is the first study to show increases in NNK as a result of a brief workplace exposure, and that levels of this powerful carcinogen continue to increase the longer the person works in a place where smoking is permitted. NNK is a major cancer causing agent from tobacco products—and workers should not have to be exposed to any dose of this very dangerous chemical,” said Michael Stark, PhD, of the Multnomah County Health Department and the study’s lead author. “The science shows that the threat of disease from secondhand smoke is no longer a distant threat. The amount of this carcinogen increases even within a single work shift.”

In a related study in the same issue of the Journal, experts in public health law note that across the country employers already are being held legally liable for exposing workers to secondhand smoke, even if state or local laws permit workplace smoking. They warn that as scientists continue to provide evidence of harm, employers could soon face a clear choice: either voluntarily ban smoking in their workplace or face an increasing wave of costly legal actions.

“When employers who allow smoking have scientists telling them that as soon as workers get on the job, they’re breathing in some of the most dangerous carcinogens around, it’s time to think about whether they want to deal with that kind of liability,” said Marice Ashe with the Public Health Law Program at the Public Health Institute in Oakland, CA. and the lead author of the legal analysis. “The science is making it easier and easier to persuade courts to sanction employers who continue to allow smoking.”

The Stark study on the effects of workplace smoking, “The Impact of Clean Indoor Air Exemptions and Preemption on the Prevalence of a Tobacco-Specific Lung Carcinogen Among Nonsmoking Bar and Restaurant Workers,” was funded by the Robert Wood Johnson Foundation’s Substance Abuse Policy Research Program (SAPRP).

It followed 52 nonsmoking employees of bars and restaurants in Oregon communities where smoking is still permitted in such establishments and compared them to 32 nonsmoking bar and restaurant employees from other Oregon municipalities where smoking is prohibited by local ordinance. Researchers collected urine samples from both groups before and after their work-shifts and tested them for the tobacco produced lung carcinogen NNK.

What they found is that three out of four employees who worked in an establishment where smoking was permitted had detectable levels of NNK compared to fewer than half of the unexposed workers. In addition, exposure to tobacco smoke was associated with a three-fold increase in levels of the carcinogen. The study also notes that the amount of NNK in employees exposed to tobacco smoke went up in direct relationship to the number of hours worked—by 6 percent an hour on average—giving the researchers “confidence that the levels (of NNK) reported in this study do, indeed, reflect workplace exposure.”

The investigators also note that their research supports the notion that the risks of secondhand tobacco smoke in the workplace are borne disproportionately by an already vulnerable group. Employees who participated in their study are typical of foodservice workers nationwide in that the majority were women, under age 30, had relatively low household incomes, and more than one third of them lacked health insurance.

“This is already a population that tends to have fewer resources to deal with health problems than many other groups so the least we can do is protect them from harmful cigarette smoke,” Stark said. “For young women in particular, secondhand smoke can increase the risk of having breast cancer and of giving birth prematurely or having low-birth weight babies.”

In their analysis of the legal and liability issues raised by workplace smoking hazards—“Legal Risks to Employers Allowing Smoking in the Workplace”—Ashe and her colleagues said employees harmed by secondhand smoke already are using worker compensation laws, state and federal disability laws and an employer’s legal responsibility to “provide a safe workplace” to take action against secondhand smoke. While in the past such cases have not always met with success, the study notes that as the scientific evidence mounts, employers will increasingly be on the losing end.

“Employers are always talking about high costs of insurance and the need to reduce their potential liabilities,” Ashe said. “Voluntarily banning smoking and supporting state and local legislation mandating smoke-free workplaces is a relatively cheap and easy way of removing a cumbersome and costly liability.”

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Exercise stimulates formation of new brain cells

Exercise has a similar effect to antidepressants on depression. This has been shown by previous research. Now Astrid Bjørnebekk at Karolinska Institutet has explained how this can happen: exercise stimulates the production of new brain cells.

In a series of scientific reports, she has searched for the underlying biological mechanisms that explain why exercise can be a form of therapy for depression and has also compared it with pharmacological treatment with an SSRI drug.

The experiment studies were conducted on rats. The results show that both exercise and antidepressants increase the formation of new cells in an area of the brain that is important to memory and learning. Astrid Bjørnebekk’s studies confirm previous research results, and she proposes a model to explain how exercise can have an antidepressant effect in mild to moderately severe depression. Her study also shows that exercise is a very good complement to medicines.

“What is interesting is that the effect of antidepressant therapy can be greatly strengthened by external environmental factors,” she says.

Previous studies have shown that drug abusers have lowered levels of the dopamine D2 receptor in the brain's reward system. It has been speculated that this may be of significance to the depressive symptoms drug abusers often suffer from. These rat studies show that genetic factors may influence how external environmental factors can regulate levels of the dopamine D2 receptor in the brain.

“Different individuals may have differing sensitivity to how stress lowers dopamine D2 receptor levels, for example. This might be significant in explaining why certain individuals develop depression more readily than others,” she says.

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