Boost in calcium intake lowers women's stroke risk

The health benefit associated with raised calcium intake ''was not restricted to milk but was also observed for yogurt, hard cheese, and ice cream,'' according to Dr. Hiroyasu Iso and colleagues at Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts. Their findings are published in the September issue of Stroke: Journal of the American Heart Association.

Over 86,000 women -- participants in the ongoing Nurses' Health Study -- completed detailed dietary questionnaires in 1980. The women were between 34 to 59 years of age at the time of enrollment. To determine the incidence of stroke among the study participants, researchers followed the group over the next 14 years.

According to the investigators, increased dietary or supplemental calcium was associated with a decrease in stroke risk, even after adjusting for high blood pressure and other cardiovascular risk factors.

Women who took supplements greater than or equal to 400 milligrams per day (mg/d) were most likely to have a lowered risk for stroke. The researchers stress, however, that ``intakes above 600 mg/d did not appear to reduce risk of stroke (any) further.''

Calcium might reduce risks for stroke by reducing cholesterol levels, or by inhibiting the formation of dangerous clots, the authors theorize.

Two other nutrients -- magnesium and potassium -- appeared to have no significant impact on stroke risk. However, the researchers do not rule out a possible benefit from magnesium or potassium on ischemic stroke because, as they point out, several prior studies have found such links.

SOURCE: Stroke 1999;30:1772-1779.

High blood pressure accelerates bone thinning

High blood pressure is associated with increased loss of calcium, the main mineral in bone. While these losses may result in thinning of the bones, direct evidence in humans had not been discovered previously, according to Dr. Francesco Cappuccio from St. George's Hospital Medical School in London, UK, and colleagues. The results of their groundbreaking study are published in the September 18th issue of The Lancet.

The investigators measured the bone density of the ``femoral neck'' -- a part of the thighbone close to the hip joint -- in 3,676 white women aged 65 years or older using a special technique called dual-energy x-ray absorptiometry. By taking measurements 3 to 4 years apart, the report indicates, they were able to determine changes in bone density and relate them to blood pressure.

On average, women lost bone mineral at a rate of 0.5% per year, the authors report. Women who smoked had almost 80% more annual bone loss than women who did not smoke, while women who received hormone replacement therapy showed slower annual losses (0.28%) than those who did not (0.54%).

Higher blood pressures were clearly associated with more rapid decreases in bone density. According to the results, women with the highest systolic (the first number in a blood pressure recording) blood pressures lost bone at nearly twice the rate of those with the lowest systolic pressures (0.64% per year compared to 0.35% per year). Similarly, when diastolic (the second number in a blood pressure recording) blood pressures were compared, women with the highest pressures lost bone mineral at the rate of 0.55% per year, compared to 0.24% per year in women with the lowest diastolic blood pressures.

``The increased rate of bone loss (associated with high blood pressure) is not because of differences in age, bodyweight, or weight changes with time, initial bone-mineral density, smoking, or use of hormone-replacement,'' the investigators write.

``Higher blood pressure in elderly white women is associated with increased bone loss,'' the researchers conclude. ``This association may reflect greater calcium losses associated with high blood pressure, which may contribute to the risk of hip fractures.'' p. 971, abstract, interpretation

Because women can stop smoking, take estrogen replacement therapy, and control their blood pressure, the investigators believe that osteoporosis and its attendant fractures are preventable.

SOURCE: The Lancet 1999;354:971-975.

Herbal remedies popular for arthritis

Some drugs for the type of arthritis known as rheumatoid arthritis suppress the immune system, and may interact in a harmful way with alternative remedies, say researchers reporting in Tuesday's issue of the Annals of Internal Medicine.

Approximately two thirds of the 232 arthritis patients surveyed by Dr. Jaya K. Rao of Durham Veterans Affairs Medical Center in Durham, North Carolina, and colleagues reported use of an alternative remedy, including herbs, chiropractor visits, high-dose vitamins, and elimination diets.

The researchers described this finding as ``remarkable given that our definition of CAM (complementary and alternative medicine) excluded biofeedback, exercise, meditation, or prayer, which were considered types of CAM in other investigations.''

More than half of the alternative remedy users did not tell their doctors, and most cited their doctors' failure to ask rather than their own fear of disapproval as the reason why, the investigators found.

Of the 45% who did inform their doctors of alternative therapy use, ``surprisingly,'' 71% reported doctor support for its continued use, they noted.

Of the respondents who relied on a single alternative method, 73% said that chiropractors were helpful, 75% cited spiritual healers, 21% copper bracelets, and 22% vinegar preparations.

The people participating in the study had suffered from arthritis for an average of 10 years, and over half of them reported experiencing severe pain. In addition, nearly half of the respondents reported turning to alternative therapy ''because their prescribed medications were ineffective,'' Rao and colleagues note.

Common arthritic conditions such as osteoarthritis, rheumatoid arthritis, and fibromyalgia have no known cause or cure, and are characterized by chronic pain that can impair daily functioning.

``The lack of cure for and the unpredictable nature of some chronic illnesses may lead to a sense of personal helplessness in some patients; these patients may consider complementary and alternative medicine to be a 'risk-free supplement' to conventional therapy. For other patients, the costs or side effects of conventional therapies may be additional concerns,'' write Rao and colleagues.

Consumers had approximately $27 billion in out-of-pocket expenses for alternative therapies in 1997, a figure comparable to out-of-pocket expenses for physician services, according to the report.

SOURCE: Annals of Internal Medicine 1999;131:409-416.

FDA reviews policy on animal drug residue levels in food

This is the first time the agency has considered the issue since establishing ADI levels in 1993. According to Andre Beaulieu, deputy director of the FDA's Center for Veterinary Medicine, the agency is considering revising the ADIs in light of new data collected by two FDA contractors.

The agency asked these two organizations -- TechLab Inc. of Blacksburg, Virginia, and the Agence Francaise de Securite Sanitaire des Aliments of Fougeres, France -- to study the fe asibility of using new, more sensitive tests to detect antimicrobial res idues in the flesh of animals such as cows and pigs. When eaten by humans, the residue has the potential to kill beneficial bacteria in the intestine and colon, or cause them to become resistant to antibiotics.

The FDA recommended in 1993 that humans take in no more than 1.5 mg a day of the drugs. Currently, animal drug manufacturers must run a battery of tests to establish if their product meets the ADI level.

Researchers at the FDA meeting said the new tests may be more sensitive, and thus would more accurately assess residue levels and their effects on intestinal bacteria. TechLab used a ``cont inuous flow one-chamber chemostat system'' to assess the effects on intestinal flora in human fecal material. According to Robert Carman of TechLab, his group found that the antibiotic erythromycin had almost no effect at any ADI, while tetracycline -- at v ery high ADI levels -- did cause some resistance. The most deleterious effect was seen with ciprofloxacin, even at minim al ADI levels.

In the French study, which used germ-free mice inoculated with human fecal matter containing antimicrobials, tetracy cline was again found to have little effect on intestinal flora, and cip rofloxacin to have a potentially devastating effect.

The FDA says both of these test systems seem to be valid ways of determining if a drug will exceed current ADI levels. With the new data generated by TechLab and the French agency, the FDA might change those levels. But Beaulieu told Reuters He alth that he could not definitely say when the agency would issue a new policy.

Dr. Richard Carnevale, vice president for regulatory, scientific and international affairs for the Animal Health Ins titute, said the group, which represents animal drug makers, is satisfied with the current FDA policy. But, he told Reuters Heal th, residue rules are stricter in Europe and Japan, and the FDA is under pressure to harmonize its policy with that of overseas agencies.

``We want an appropriate level of concern on this issue,'' said Carnevale, noting that the new data presented at the meeting was likely to confirm the FDA's policy as ``sound.''

Many unaware of folic acid's role in preventing birth defects

More than 65% of new mothers recently surveyed by Loyola University researchers were unaware of folic acid's role in preventing birth defects such as spina bifida, Dr. Robert J. Bielski told attendees recently at the annual meeting of the American Academy of Cerebral Palsy and Developmental Medicine.

In the study, Bielski and colleagues at the Maywood, Illinois campus questioned 200 new mothers who gave birth at a university hospital to determine their use of prenatal vitamins and their knowledge of folic acid's link to the prevention of birth defects. They found that only 69 of the 200 mothers (34.5%) reported any knowledge of folic acid.

Seventy-five percent of those who were aware of folic acid's benefits also knew that folic acid supplementation is linked to the prevention of spina bifida. However, only 16% took vitamins within the first 3 to 4 weeks of pregnancy, Bielski said.

The researchers found that more than 90% of the study population used prenatal vitamins, although very few used the vitamins during the first month of pregnancy.

Bielski believes that daily multivitamin supplements are necessary for all women of childbearing age. At a minimum, ``all women planning pregnancy should take multi-vitamins,'' he said. ''Adequate folic acid intake is almost impossible to get through diet.''

``The evidence of the protective effects of folic acid are overwhelming,'' Bielski told Reuters Health, ``yet the average woman does not know anything about it.''

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