The Driving Danger That You’re Ignoring

by Carole Jackson, Bottom Line Health

Would you let a friend get behind the wheel of a car if he’d just been drinking and wasn’t steady on his feet? The answer is certainly “No.” But if you’re like most people in the US, you wouldn’t hesitate to let a friend drive when he’s incapacitated for another reason — drowsiness. It’s time to wake up to a danger that causes nearly 5,500 deaths a year.

Surprisingly, drowsy driving has gotten little attention compared with other driving dangers, including speeding, drinking alcohol, failing to fasten seat belts or being distracted by cell phones and other devices. That’s why the AAA’s recent campaign against drowsy driving caught my attention.

I phoned J. Peter Kissinger, head of the AAA Foundation for Traffic Safety, who told me that, in his opinion, drowsy driving is the largest unrecognized problem on the highways. In a recent AAA survey of 2,000 drivers age 16 and older, 32% said that they had driven while on the verge of falling asleep at some point in their lives, and 41% admitted to actually falling asleep at the wheel at some point in their lives. And that’s despite the opinion of 96% that it’s unacceptable to drive while drowsy! So why don’t we practice what we preach?


The 96% have it right. According to the National Sleep Foundation (NSF), drowsiness is very similar in its effects to drunkenness. It causes slower reaction times, vision impairment, lapses in judgment and delays in processing information. In fact, NSF, which has joined AAA in publicizing the problem, says that being awake for more than 20 consecutive hours results in impairment equal to that caused by a blood alcohol concentration of 0.08%, which is the legal limit for driving in all states. And if you’ve undergone stress or slept poorly the night before, you don’t have to be awake for even that long to experience this level of impairment.

So why are we just now learning about this? As Kissinger put it, traffic safety experts have focused on “belts, booze and speed” and more recently on distractions by cell phones and other electronic devices. Also, statistics, he said, have downplayed the role of drowsiness in fatal crashes because it’s often difficult for investigators to determine if the cause of a crash was drowsiness, drunkenness, distraction or a combination of factors — in other words, there’s no breathalyzer or blood test for drowsy driving. If a driver veers off the road and hits a tree, for instance, there’s often not any way to tell whether he fell asleep or instead was distracted when he tried to change the station on the radio.

As a result, US traffic statistics typically show that drowsiness is involved in only about 3.6% of fatal crashes, compared with more than 30% for alcohol. AAA has now recalculated the statistics by extrapolating data from accident reports and adjusting for unknown or missing data (like drowsiness). New calculations, Kissinger said, show that nearly 17% of fatal car crashes result from drowsy driving — that’s on a par with distracted driving, which is thought to account for 16% of crashes. Plus, he added, 60% of people who “nod off” at the wheel do so when driving for less than one hour. “Drowsy driving doesn’t just occur on a long trip,” he said. “It can also happen on a shorter trip, such as driving home after a date night with your significant other.”


To prevent an accident caused by drowsiness, Kissinger urges us to…

  • Take a 30-minute break from driving every two hours or 100 miles to drink coffee or another caffeinated beverage. It takes about 30 minutes for caffeine to enter the bloodstream.
  • Sleep at least seven hours the night before a long trip.
  • If possible, travel with an alert and well-rested passenger who will help keep you awake.
  • Stay somewhere overnight instead of extending your drive time beyond the length of your typical day.

In addition, he said, besides the obvious case where you have trouble keeping your eyes open or your head up, you are too sleepy to drive when you…

  • Can’t remember how far you’ve traveled or what you’ve recently passed.
  • Find yourself tailgating or drifting out of your lane.
  • Daydream or have disconnected thoughts.
  • Often yawn or rub your eyes.
  • Miss signs or drive past your exit.
  • Veer off the road and hit the rumble strips on the shoulder.
  • Have to blast the radio and/or roll down the windows in an attempt to stay alert.

What can you say to friends who insist on driving drowsy? Try to talk them out of driving, and if possible, offer to drive them where they’re going. If that fails, take away their keys, and don’t be afraid if they become angry. They’ll likely thank you later on, Kissinger said, especially after you mention the statistics on fatalities caused by drowsy driving. A look at the stats will tell them that you may have saved their lives.

 J. Peter Kissinger, president and chief executive officer of the AAA Foundation for Traffic Safety in Washington, DC.

A Second Chance for Middle Agers

by Carole Jackson, Bottom Line Health

A large group of people now get another whack at having a healthier heart, according to findings from a new study. If you are between the ages of 31 and 64 and are currently overweight or obese — perhaps you’ve even been heavy for decades — you might think, if someone suggests that you lose weight, “What’s the point? The damage has been done.” But it turns out that, when it comes to cardiovascular risk, the number of years that you’ve been carrying excess pounds isn’t as important as whether you are overweight or obese during middle age. In fact, what we have just learned is that shedding extra weight in middle age can actually cancel out your increased risk for heart disease. If you’ve ever wished for a second chance — a real second chance — at good health, this is it.

Now, it’s important to note that being overweight or obese at any point in your life is still not advisable. Beyond raising your risk for heart disease, it raises your risk for a myriad of other health problems, such as osteoarthritis, breast and colon cancers and type 2 diabetes — many of which you may not be able to “cancel out” later. But since heart disease is the number-one cause of death in the US, getting rid of your risk for that particular health problem in middle age is still a big deal. And, believe it or not, no study until now had followed subjects over decades to explore whether losing weight in middle age would have this effect. To find out more about the study, which was published in the October 24, 2011 issue of Archives of Internal Medicine, I called the author, I-Min Lee, MD, MPH, ScD, an associate professor in the department of epidemiology at the Harvard School of Public Health.


For this analysis, nearly 19,000 male Harvard alumni were studied. The men were first measured with a college physical exam around age 18 and then were given a follow-up medical questionnaire when their ages ranged from 31 to 64. Researchers gathered health measurements that included body mass index (BMI) — a ratio of body weight to height that determines whether you’re “underweight,” “normal weight,” “overweight” or “obese” — and death certificates that recorded the causes of mortality for any alumni who died through 1998.

Results: Those who were overweight or obese teens but managed to attain a normal weight during middle age were not at any higher risk of dying from heart disease compared with those of normal weight in middle age who were a normal weight as students. Like I said, a second chance at good health!


I asked Dr. Lee why this amazing benefit occurs even as late as middle age. The reason, she said, is that being overweight or obese negatively affects all sorts of physiological processes in our bodies, including blood pressure, cholesterol and the ability to process glucose and insulin. “But if you lose weight, no matter when you lose it,” Dr. Lee said, “all of those parameters improve, because your body doesn’t have to work as hard.” The surprise is that the potentially cumulative effects of gaining weight over time before losing it doesn’t appear to leave behind any lingering effects — at least when it comes to cardiovascular risk. In other words, if you’re healthy in middle age — that’s what matters most. Talk about a myth buster! If you thought that it was too late to start eating healthier and exercising more because you are “over the hill,” then think again.

I asked Dr. Lee how this finding might apply to women, since only men were studied. She told me that she would expect the results to be very much the same for women because excess weight has essentially the same adverse physiological effects in women as it does in men.

My final question was whether this wonderful result was likely to hold true for people who wait until even later in life to achieve a normal weight — such in their 60s, 70s or even later. Dr. Lee said that it’s tough to predict, but prior studies have shown that taking up physical activity at any age is beneficial.

Again, keep in mind that this research looked only at the effect of weight loss in middle age on one aspect of overall health — cardiovascular risk — so it’s not a free pass to eat cheeseburgers and fries every day throughout your 20s and early 30s. Being overweight, even for just a few months or years, can still be detrimental to your health. But this sure is promising news for people who have made mistakes and are ready to correct them — don’t lose hope, lose pounds!


I-Min Lee, MD, MPH, ScD, associate professor in the department of medicine at Harvard Medical School and in the department of epidemiology at the Harvard School of Public Health, both in Boston. She is also an associate epidemiologist at Brigham and Women’s Hospital, Boston.

Easy Trick That May Prevent Glaucoma

by Carole Jackson, Bottom Line Health

As you get older, you may be OK with the fact that your vision just isn’t what it used to be. But losing sight altogether is something that nobody — myself included — ever wants to imagine. That’s why I was pleased when I heard that there may be a simple new way to prevent glaucoma. Because it’s something that anybody can do — exercise!

The new study, published in the October issue of Investigative Ophthalmology & Visual Science, came from University College London Institute of Ophthalmology in England. To learn more, I called an expert who carefully examined the study, Harry A. Quigley, MD, an ophthalmologist, the director of the Glaucoma Center of Excellence at the Wilmer Eye Institute at Johns Hopkins University School of Medicine in Baltimore and author of Glaucoma: What Every Patient Should Know.


Before we jumped into the research, Dr. Quigley gave me some background about how glaucoma develops. In glaucoma, there is slow, progressive damage to the optic nerve that can gradually lead to blindness if not treated. About 90% of glaucoma cases, he told me, are called open-angle. The scariest part about open-angle glaucoma is that there are no symptoms until irreversible damage happens, so if the person doesn’t get regular eye exams, then he won’t realize that he has glaucoma until blindness begins to set in. Some people who develop glaucoma (but not all) have what’s called high intraocular pressure (IOP), which is pressure in the eye.

This new study, Dr. Quigley told me, focused on a measurement of something called ophthalmic perfusion pressure (OPP), which is the difference between your blood pressure and your IOP. So if your IOP is low, as you want it to be, then your OPP is higher (better). That means that your eyes are probably receiving more nourishing blood. But when your OPP is low, it means that circulation to and in the eyes is slowing — which could raise your risk for glaucoma or worsen existing glaucoma. Keep in mind, said Dr. Quigley, that you can have a low OPP from either higher-than-normal IOP or lower-than-normal blood pressure (or both).

Researchers investigated the relationship between physical activity and OPP. They looked at self-reported information from 5,650 adult men and women from about 15 years ago. Participants were grouped into one of two categories — “active” or “less active.” Researchers cross-referenced each participant’s level of physical activity with a measurement of OPP that was taken from the same people between 2006 and 2010.

Results: Participants who had been “active” in the past had a 25% lower risk of having low OPP — suggesting that they also had a lower risk of later developing glaucoma. What is especially uplifting about this discovery is that unlike taking drugs or having surgery, there is little risk involved in being active and exercising — and it provides many other benefits that are well-documented!


Now, of course, we all already know that exercise is, well, out of sight, but I found it intriguing that just someone’s general level of activity, as opposed to some fancy specific eye exercises, can have such a pronounced effect on your eye health. Dr. Quigley noted that exercise improves overall circulation, which brings better blood flow everywhere, including to the eyes. And, he added, this doesn’t mean that you have to hit the gym for vigorous workouts — moderate activity, such as brisk walking that raises your heart rate for 20 minutes, is sufficient as long as you do it most days of the week.

Besides moving around more, don’t forget to see an eye doctor regularly. Dr. Quigley advises everyone to start getting exams from an ophthalmologist (a medical doctor who can provide the full spectrum of eye care) at age 40, and depending on what your doctor advises, probably at least every one to two years after that. When you reach age 60, he said, you should get an eye exam annually, because age is a risk factor for glaucoma. And, he added, “It’s especially critical for those with a family history of glaucoma, those who are of certain ethnic origins (African American, Irish, Russian, Japanese, Hispanic, Inuit and Scandinavian) and/or those who are severely nearsighted, because these are also risk factors.”


Harry A. Quigley, MD, director of the Glaucoma Center of Excellence at the Wilmer Eye Institute at Johns Hopkins University School of Medicine, Baltimore.

How a Quick Massage Can Help You Live Longer

by Carole Jackson, Bottom Line Health

No one wants to be overweight, have diabetes or grow old prematurely. Well, a new study shows that there’s a simple strategy that may help prevent all three that is actually quite fun and relaxing.

A massage might do the trick!

And I’m not talking about an expensive, hour-long massage, either—the latest research shows that an inexpensive massage lasting just 10 minutes can be beneficial.


Researchers were interested in studying massage immediately after exercise for two reasons. For one thing, practically speaking, that’s a common time for people to get a massage, since many people say that massage helps reduce muscle soreness from exercise. Another reason is that, biologically, it’s easier to measure differences in the effect of massage on cells after exercise, because exercise puts the body into a state of temporary stress.

Volunteers in the study included 11 healthy, active men in their 20s who provided a bit of muscle tissue from one thigh for a baseline biopsy. Then researchers had the volunteers do 70 minutes of fast-paced cycling on a stationary bike. The volunteers rested for 10 minutes and then had a 10-minute massage on one thigh only. Immediately after the massage, researchers took second muscle biopsies, but this time from both thighs in order to compare massaged tissue versus nonmassaged tissue. Two and a half hours after the second biopsies, the volunteers underwent a third set of biopsies on both thighs to capture any changes that might have occurred a bit later after their massages.

To learn about the findings, I called Mark Tarnopolsky, MD, PhD, a professor of medicine and head of neuromuscular and neurometabolic disease at McMaster University in Canada, who was a coauthor of the study published in Science Translational Medicinethis past February.


Dr. Tarnopolsky told me that the researchers found two very interesting differences in the muscles that had been massaged…

  • A gene pathway that causes muscle inflammation was “dialed down” in these muscles both immediately after the massage and 2.5 hours after the massage. (Specific genes can be present in our tissues but not always active.) Dr. Tarnopolsky said that this is helpful knowledge because muscle inflammation is a contributor to delayed-onset muscle soreness, so it confirms biologically what we’ve always believed through anecdotal observation—a post-exercise massage can help relieve muscle soreness.
  • Conversely, another sort of gene was “turned on” by the massage—this is a gene that increases the activity of mitochondria in muscle cells. You probably know that mitochondria are considered the “power packs” of our muscles for their role in creating usable energy. Now, it’s true that better mitochondrial functioning has been shown by other studies to help decrease insulin resistance (a key risk factor for type 2 diabetes) and obesity and even to slow aging. When I asked Dr. Tarnopolsky about whether or not it’s a stretch to link post-exercise massage to these benefits, he said that it’s not unreasonable—there is a potential connection, and future research will need to be done to confirm it.


The massage type that Dr. Tarnopolsky and his colleagues used was a standard combination of three techniques that are commonly used for post-exercise massage—effleurage (light stroking)…petrissage (firm compression and release)…and stripping(repeated longitudinal strokes). It’s easy to find massage therapists in spas, salons, fitness centers and private practices who use these techniques. Or you could ask your spouse or a friend to try some of these moves on you (even if his or her technique isn’t perfect) because there’s a chance that it could provide the benefits, said Dr. Tarnopolsky—he just can’t say for sure, since that wasn’t studied.

Dr. Tarnopolsky studied massage only after exercise, so that’s when he would recommend getting one, but it’s possible that massaging any muscles at any time may have similar benefits—more research will need to be done to find out.

Remember, you don’t have to break the bank on a prolonged 60-minute massage—a simple 10- or 20-minute rubdown (which usually cost $10 to $40) can do the trick.

Source: Mark Tarnopolsky, MD, PhD, professor of medicine, department of kinesiology, McMaster University, Ontario, Canada.

Forget the Second Helping: Link Discovered Between Calories and Memory

by Carole Jackson, Bottom Line Health

If I had a nickel for every time I heard someone say, “Oh man, I ate too much. I shouldn’t have had that second serving,” I would have quite a few nickels!

Obviously, excessive eating is no good for your waistline…neither are all of the associated ailments of obesity. But, it gets worse. All that overeating actually may be making you forgetful. According to a new study—it can double the risk for memory loss. In other words, how much you put into your stomach greatly affects your brain.

I checked out the research to find out just how many extra calories put us at risk…


While past studies have suggested that caloric intake is linked to Alzheimer’s disease, this report was one of the first to examine whether there is a link between high-caloric intake and a less severe form of memory loss called mild cognitive impairment (MCI). MCI is more than just age-related forgetfulness—it’s a bit more serious. People with MCI are generally able to function normally, but they might occasionally forget an event from the recent past or a future engagement. People with MCI, for example, may not be able to recall what they had for dinner the night before or they may forget about a planned trip later in the day.

The study included 1,233 men and women without Alzheimer’s between the ages of 70 and 90. Participants completed a questionnaire, which asked how much of specific foods and drinks they consumed and how often they consumed them, on average. Researchers used that information to calculate the caloric quantity each person consumed—they did not examine caloric quality (carbs, fats, protein, etc). Then researchers divided the participants into three equal-sized groups that represented the lowest, moderate and highest calorie intake. Each group contained both men and women. The first group consumed between 600 and 1,525 calories per day (the low-intake group)…the second group consumed between 1,526 and 2,142 calories per day (the moderate-intake group)…and the final group consumed more than 2,142 calories per day (the high-intake group). Later, an expert panel reviewed the brain function of the participants and 163 were classified as having MCI.

The researchers found that people in the high-intake group (those who ate more than 2,142 calories per day) had a significantly higher risk for MCI, with double the risk compared to the low-intake group. The results remained the same even after accounting for gender, body mass index, history of stroke and other risk factors. People in the low-intake and moderate-intake groups did not have a significantly higher risk for MCI.

To learn more about the findings, I called the lead author, Yonas E. Geda, MD, an associate professor of neurology and psychiatry at the Mayo Clinic in Scottsdale, Arizona. His research was presented in April at the annual meeting of the American Academy of Neurology in New Orleans.


Dr. Geda explained that although the study didn’t try to answer the question of why more calories raise the risk for memory loss, one possibility is that consuming more calories increases the body’s production of reactive oxygen species (molecules containing oxygen). These cause damage to cell structure (oxidative stress), and that can lead to changes in the brain that affect memory.

So what’s the magic number of calories that you should try to stay under each day?

You might look at this study and assume that it’s 2,143 calories, but it’s important to remember that the study was looking only at people over the age of 70. Your age andyour activity level—as well as your gender, height and weight—can all affect how many calories you need, said Dr. Geda, so it’s best to figure out how many you need for energy and then make sure that you don’t go over that maximum. To figure out how many calories you need, follow this link from the Baylor College of Medicine:

Source: Yonas E. Geda, MD, associate professor, neurology and psychiatry, Mayo Clinic, Scottsdale, Arizona.

A Grapefruit a Day Helps Keep Stroke Away

by Carole Jackson, Bottom Line Health

Mmm, citrus. There’s nothing like a refreshing orange, a tangy tangerine or a sweet pink grapefruit. It really does taste like sunshine.

But these juicy fruits aren’t just delicious—they may actually help you ward off a stroke, according to new research.

And you may be surprised to hear that it’s not because of the vitamin C…


A zillion studies have shown the health benefits of eating fruit, including studies that have shown that people who eat five or more servings of fruits and vegetables have a 25% lower risk for stroke (both ischemic and hemorrhagic) compared with those who eat three or fewer servings. Researchers have suspected that flavonoids, antioxidant compounds found in many fruits and vegetables, are one key to their power since they reduce inflammation and improve blood vessel function.

But there are six different types of flavonoids found in foods, and each has a subtly different chemical structure. Given the variety, researchers from England, Italy and the US wanted to learn which specific flavonoids and which fruits or vegetables, in particular, are most beneficial for preventing stroke.

To learn more about the study, I spoke to one of the authors—Kathryn M. Rexrode, MD, MPH, a physician in the division of preventive medicine at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, both in Boston.


The researchers used information from 70,000 women who were followed for 14 years as part of the Nurses’ Health Study. Every two years, the participants completed questionnaires that covered their medical histories and lifestyles. And every four years, the women completed food questionnaires, which asked how much of certain foods and drinks they consumed and how often they consumed them.

The women’s diets were analyzed for the six different types of flavonoids, and their medical histories were reviewed for the number and type of strokes that the women had. What they found was that high consumption—more than about 63 milligrams per day of a certain subclass of flavonoids called flavanones (the amount found in about one to two servings of citrus per day)—was associated with a 19% reduced risk for ischemic stroke (the type caused by a clot, not by a bleed), compared with low flavanone consumption (under 13.7 milligrams per day). And this was after adjusting for other stroke risk factors, such as smoking, age, body mass index and others. The other five flavonoids studied reduced stroke risk, too, but not by as much (only by 4% to 13%).

Dr. Rexrode said that one reason that the flavanones may have been associated with decreased risk for ischemic stroke is that flavanones may inhibit platelet function and clotting factors. The researchers didn’t study whether citrus affected risk for hemorrhagic stroke, but Dr. Rexrode said that it’s unlikely that eating citrus would lead to an increased risk for hemorrhagic stroke. She said that it takes a relatively small amount of clotting to cause an ischemic stroke, but, on the other hand, it takes a relatively large amount of excessive bleeding to cause a hemorrhagic stroke.

Although this study, which was published this past February in Stroke, looked only at women, Dr. Rexrode said that there is no reason to think that these findings wouldn’t apply to men, too.


Dr. Rexrode said that you can get all the flavanones you need (about 63 milligrams) from eating one or two servings of citrus each day. Whole fruits are always better than juices or smoothies, she said, because the bulk of the flavanones are found in the inner membranes of the fruit and the pith or white part of the fruit. The pith is generally removed when the fruit is juiced or cleaned for smoothies.

The USDA provides information about the amount of flavanones in every 100 grams of edible fruit, so to save you the trouble of weighing your fruits, here are estimates of the flavanone content for some common citruses:

Grapefruit (one-half of a four-inch diameter) 47 milligrams
Orange (2⅝ inch diameter) 42 milligrams
Tangerine (2½ inch diameter) 18 milligrams

Dr. Rexrode doesn’t recommend supplements—she said sticking to whole fruit is best. And don’t overdo it on citrus, or else your stomach or teeth might suffer from the acid. Just a serving or two a day is all you need!

Source: Kathryn M. Rexrode, MD, MPH, physician, division of preventive medicine, Brigham and Women’s Hospital, and associate professor of medicine, Harvard Medical School, both in Boston.

Exercise—When Less Is More

by Carole Jackson, Bottom Line Health

How many times have you said, “I don’t have time to exercise”? I’m sorry to tell you, but after you read this story, that excuse won’t work anymore.

A new study found that just three 30-minute sessions a week of a fancy-sounding type of activity called Modified High-Intensity Interval Training (MHIT) is an effective way to strengthen your cardiovascular system, which can lead to increased fitness, strength and weight loss. (It’s a lot like regular interval training, which you’ve surely heard of, but the intervals are even shorter.)

If it sounds hard, don’t sweat it. Researchers found that even cardiac rehab patients can handle MHIT—and gain from it.


The gist of MHIT is that it requires just three 30-minute sessions a week, ideally spaced a few days apart. So each workout is quick, but you work very hard during those short spans. Beyond a five-minute warm-up and a five-minute cool-down, it always involves some sort of aerobic activity, generally running, cycling or rowing. You alternate going at an easy pace for one minute with going “all-out” the following minute, repeating that two-minute pattern 10 times in a row.

Researchers in Canada were curious to see if a three-month regimen of short bursts of MHIT might help people who were in cardiac rehab (for either heart disease or heart attack) strengthen their cardiovascular systems more than they would by following a longer, standard exercise program done at a more moderate pace.

Here’s how the study worked: Researchers placed 22 male cardiac patients in either an MHIT program or a standard “moderate endurance” program. Both groups focused on stationary cycling, but the MHIT group did three weekly 20-minute sessions that consisted of the intervals described above, while the traditional exercise group did three longer weekly sessions (30 to 50 minutes) at a consistent moderate pace the entire time. Each group did a five-minute warm-up and a five-minute cool-down before and after each exercise session.

The findings: By the end of three months, both groups of exercisers showed virtually equal improvement. Blood flow improved by 41% in the MHIT group and 42% in the endurance group, and oxygen consumption improved 27% in the MHIT group and 19% in the endurance group. But the interesting part is that the MHIT group did it with just 90 total minutes of exercise per week, while it took the moderate exercise group a total of 120 to 180 minutes a week to achieve the same goal.

To discuss the study results, I called the study author, Maureen MacDonald, PhD, associate professor in the kinesiology department at McMaster University in Hamilton, Ontario. She explained that when your heart is forced to work at a higher-intensity level during MHIT, you can reap the same benefits in less time. I was surprised that cardiac rehab patients could handle such intensity, but Dr. MacDonald said that MHIT actually does not put any more stress on the heart than the standard exercise routine, because the “rest” intervals allow the heart to recover, so the heart doesn’t get overworked.


If you’re interested in trying MHIT yourself but you have a serious health condition, Dr. MacDonald advises that you check with your doctor first. (Dr. MacDonald did not include people with chronic heart failure in her study due to the severity of the condition.) Otherwise, why not give MHIT a shot? MHIT needs to be done only three days a week, so you still can do strength training and stretching on other days of the week.

To try MHIT, choose your favorite aerobic exercise—whether it’s jogging, cycling or rowing—and follow these guidelines from Dr. MacDonald…

  • Warm up for five minutes by lightly doing whatever aerobic activity you choose, so your breathing is light.
  • For the one-minute intensity cycles, either increase your speed, increase your incline (such as running uphill) or increase the resistance if you are using gym equipment such as a stationary bicycle or elliptical machine. If you can keep track of your heart rate, either through a monitor that you wear or through a monitor on the machine that you’re using, increase your heart rate to 80% to 90% of your maximum rate. To determine your maximum heart rate, subtract your age from 220. It should be very difficult to carry on a conversation at this pace, and your muscles should feel like they are working very hard.
  • For the one-minute recovery cycles, do not stop the activity, but simply slow your speed or reduce your incline or resistance back to normal. Your heart rate should be about 10% of your maximum (or about your “warm-up” pace). You should be able to carry on a conversation easily at this pace.

After 10 of these two-minute cycles, cool down for about five minutes (or until your heart rate goes below 100 beats per minute) by lightly continuing the aerobic exercise to bring your heart rate down.

Source: Maureen MacDonald, PhD, associate professor, department of kinesiology, McMaster University, Hamilton, Ontario, Canada.

Is Your Doctor Checking Your Blood Pressure Wrong?

by Carole Jackson, Bottom Line Health

At your annual physical, after your doctor wraps that blood pressure cuff around one of your arms, does he or she then wrap it around your other arm?

If your physician is anything like mine, then he probably doesn’t.

So what? Well, a new British study adds to the growing body of research showing that blood pressure measurements inboth arms are critical, because each arm may have a different measure—and the size of that difference can play a large role in your risk for cardiovascular problems.


Researchers at the Peninsula College of Medicine & Dentistry in England analyzed data from more than 20 studies on blood pressure monitoring. What they found: After five to 16 years of follow-up, researchers found that a difference of 15 mmHg of systolic pressure (the top blood pressure reading) between the two arms indicated 2.5 times the risk for peripheral artery disease…a 60% higher risk for stroke…and a 70% higher risk of dying of heart disease, compared with those whose left- and right-arm systolic pressure differed by less than 15 mmHg. And the risk for these events increased as the difference in systolic blood pressure increased over 15 mmHg.

Those particular increased risks were the same whether a patient’s two systolic numbers were, say, 115 and 100 or 170 and 155. But hypertensive patients, those with blood pressure readings over 140/90, are still at more overall risk, the researchers noted.


Here’s what had me baffled… If so many studies keep showing that the difference in blood pressure between the two arms matters, then why aren’t more doctors measuring both arms? I called lead study author Christopher E. Clark, MD, clinical academic fellow at the college, to hear his thoughts on the topic.

If your systolic pressure varies between arms, what’s likely going on? Dr. Clark said that, just like with past research, he and his coauthors suspect that there is a narrowing of the arteries (or a full-on blockage) on one side of the body compared to the other—the result of arterial disease—and that this narrowing can cause the systolic blood pressure to drop on that side.

Dr. Clark said that doctors in Europe and in the US are taught that taking blood pressure on both sides is a good idea, but it’s not mandatory in either place. In fact, fewer than half of doctors in Britain say that they regularly measure blood pressure in both arms, said Dr. Clark. He doesn’t have statistics for the US, but he speculates that the data is probably similar here. “Most doctors probably perceive taking a second measurement in the other arm as needlessly time-consuming. And, until now, the importance of doing so hasn’t been well-publicized,” he said. Hopefully, since his findings were published in January in The Lancet, the practice will become more widespread.


You could be at higher risk for cardiovascular problems than you realize. So on your next trip to the doctor, ask that your blood pressure be measured in both arms, said Dr. Clark. And in case the nurse or your doctor asks why, bring this article with you.

If you do have a dangerous difference in the measurements between arms, knowing early matters, because the sooner you are aware of your risk, the sooner you can start discussing lifestyle changes with your doctor, such as quitting smoking, exercising more and eating healthier foods—and possibly, pursuing cardiovascular medical treatment.

So don’t be shy—be a proactive patient!

Source: Christopher E. Clark, MBChB, MSc, FRCP, FRCGP, clinical academic fellow, Primary Care Research Group at the Peninsula College of Medicine & Dentistry, University of Exeter and Plymouth, England.

Sleeping Pills Are Just Plain Dangerous

by Carole Jackson, Bottom Line Health

It’s bad enough that people are so desperate for sleep that they resort to taking any of a long list of pharmaceuticals in an effort to help them get a good night’s rest. Even worse is that these theoretical helpers come with a long list of associated dangers, including addiction.

Well guess what? The list of dangers just got longer.

Research, conducted by physicians at the Scripps Clinic Viterbi Family Sleep Center in San Diego and Jackson Hole Center for Preventive Medicine (JHCPM) in Wyoming, has shown that use of sleeping pills has been associated with an increased risk for cancer and death.

The most troubling part is that this study found that it’s not just daily users who are at risk—those who use them less than twice a month may even be at risk.


I called Robert Langer, MD, MPH, principal scientist and medical director at JHCPM, to learn more about these frightening findings. He told me that most studies on the safety of sleeping pills last only six months or less. “That’s not enough time to examine the risk for many serious health consequences, such as cancer or death,” said Dr. Langer. “Our research is more long-term, and we didn’t just look at whether or not people were taking sleeping pills. We also looked at which type they were using and how often they were taking the pills.”

The researchers looked at the electronic medical records of the population served by the Geisinger Health System (GHS) in Pennsylvania, the largest rural integrated health system in the US. Subjects (mean age 54 years) were 10,529 male and female patients who received prescriptions of sleeping pills as sleep aids (on-label), and 23,676 matched controls with no prescriptions of sleeping pills. They were followed for an average of 2.5 years.

The researchers found that the more sleeping pills that subjects took, the greater their risk for death from all causes and, shockingly, even people who were taking them only sporadically were at higher risk for death. For example, compared with those who did not take sleeping pills, people who took…

  • One to 18 sleeping pills a year were 3.6 times more likely to die within the 2.5-year follow-up period.
  • 19 to 132 sleeping pills a year were 4.4 times more likely to die.
  • 133 or more pills a year were 5.3 times more likely to die.

These results did not differ whether the subjects were using older sleeping pills, such as temazepam (Restoril), or newer ones, such as zolpidem (Ambien), eszopiclone(Lunesta) and zaleplon (Sonata), which are marketed as being shorter-acting and safer.

Researchers also found an increased risk for all major cancers among moderate and heavy users of any sleeping pill. There was a 20% increased risk among any users who took 19 to 132 pills a year and a 35% increased risk among any users who took more than 132 pills a year.

It’s important to note that none of these results prove cause and effect, but they certainly reveal an unsettling association.


I asked Dr. Langer whether the results could simply be due to the fact that patients who take sleeping pills are usually in worse health—for example, perhaps they don’t eat well or exercise as much as they should or maybe they’re more stressed. His response was no. “We controlled for every possible variation, matching subjects and controls by age, gender and health history, yet the results remained the same,” Dr. Langer said.

So why the increased risk for death and cancer? The authors did not have adequate information to assess possible mechanisms. However, based on prior studies, potential mechanisms include increases in sleep apnea, accidents related to sleep walking/driving, aspiration pneumonia and depression of respiratory function.


This is a finding of major consequence, because 6% to 10% of American adults took a sleeping pill in 2010, the most recent year for which statistics are available. But the complicating factor is that sleeping pills do provide health benefits. In other words, not taking a sleeping pill and potentially not getting enough sleep comes with its own set of risks—for instance, insomnia can raise the risk for heart disease, stroke, diabetes, obesity, depression and other serious health conditions. So if you’re taking sleeping pills, what do you do?

First, consult your prescribing physician, said Dr. Langer. “Don’t stop cold turkey, because that can cause withdrawal symptoms and agitation, as well as sleepless nights. Figure out a plan with your doctor about how to taper off,” he said. And then ask your doctor about safer alternatives, such as melatonin or manipulating light exposure, he said. You can also try cognitive behavioral therapy from an informed primary care doctor, behavioral therapist or sleep medicine physician, he added. And check out these lifestyle tips on how to get a good night’s sleep from the February 1, 2011 issue of a Bottom Line sister publication Bottom Line/Health “Can’t Sleep? A Pill Is Not the Answer”.

Source: Robert Langer, MD, MPH, principal scientist and medical director, Jackson Hole Center for Preventive Medicine, Wyoming.