Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

Is there any way to predict the onset of schizophrenia?

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There may be a way of predicting which teenagers at high risk for full-blown schizophrenia will go on to develop the disease.

Researchers at Columbia University led by Dr. Scott A. Small used MRI scanning to look at the brains of 18 normal adolescents, 18 youths who had schizophrenia, and 18 with preliminary symptoms. These symptoms included paranoid thinking, such as subjects believing someone was looking at them in a troubling way while knowing that’s not a realistic perception. In full schizophrenia, which affects about 1 percent of the population, people are so disconnected from reality that they believe paranoid thoughts are real.

The researchers scanned the high-risk subjects and then followed them for two years. When they looked back at the scans of those who went on to develop psychotic disorders like schizophrenia, they found 70 percent of them had shown unusually high activity in a particular part of the hippocampus, a key brain structure dealing with memory.

“We don’t know if this is diagnostic yet,” said Small, meaning that it’s too soon for the scans to be used as a test. But it does mean, he said, that this hippocampal area, called CA1, is clearly a “hot” spot of extra activity and that this hyperactivity begins several years before the onset of full-fledged schizophrenia. In addition to using brain scans to detect hyperactivity in this area, scientists studying the CA1 region, which is known to be sensitive to an excitement-inducing brain chemical called glutamate, may be able to develop new drugs, as at least one pharmaceutical company is already doing.

“The next step down the road is to understand exactly what is different in the brains of schizophrenics,” said Dr. Bruce Cohen, psychiatrist in chief emeritus at McLean Hospital in Belmont.

If more research shows this type of scanning can detect those likely to develop schizophrenia, it could allow doctors to intervene with medications sooner, he said.

Does swearing relieve pain?

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Holy @//!#!, does it ever! Or so concludes a British study published recently in the journal NeuroReport.

The idea for the study first occurred to psychologist Richard Stephens of Keele University in North Staffordshire, when he hit himself on the finger with a hammer and let loose with a few choice words. It solidified when his wife swore gustily during a breech delivery of their daughter and one of the midwives “mentioned that women often swear in childbirth, which I found intriguing,” said Stephens in an e-mail.

So he set up an experiment in which he compared the pain tolerance of 67 male and female undergrads when they uttered neutral words and when they cursed as they endured a painful stimulus, in this case, putting one hand into icy water and leaving it there as long as possible. In most people, swearing increased pain tolerance – they could keep their hands in the ice water much longer – and decreased perceived pain compared with not swearing.

“It seems to [work] via the emotional content of swearing – people appear to shock themselves into a state of emotional arousal (the fight or flight response), which is known to have a pain-lessening effect,” Stephens said. Women and men both benefit from swearing, he added, but it’s likely that the more a person swears habitually, the less shock value it has during pain.

All this makes sense to Jamie L. Rhudy, director of the Human Psychophysiology Laboratory at the University of Tulsa. “Swearing could reflect the activation of brain circuits involved in emotional processing,” said Rhudy. The emotion circuits connect to “descending” circuits – nerve signals that travel down from the brain to the spinal cord – which could alter the way in which pain is processed, he added.

So should you swear when you’re in pain? Go for it, said Stephens. “What’s the harm in swearing if it helps you cope? Provided there are no children around, of course.”

Is there a link between heart disease and gum disease?

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There is growing evidence that there is, indeed, such a link, and if you have either condition, you should pay extra attention to treating the other as well. That’s the conclusion of a “consensus” statement written by leading gum disease specialists and cardiologists published online earlier this year in the American Journal of Cardiology and the Journal of Periodontology.

“The mechanism of the relationship strongly points to inflammation” as the culprit in both cardiovascular disease and periodontitis, or gum disease, says Dr. Thomas E. Van Dyke, a professor of periodontology and oral biology at the Boston University School of Medicine.

It’s possible, he notes, that the bacteria that cause gum disease directly trigger the inflamed plaques in blood vessels that can rupture and cause heart attacks. But it’s more likely that local inflammation in the gums “spills over” and causes body-wide inflammation. Chronic inflammation is an underlying cause of a number of diseases.

Dr. Paul Ridker, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital, notes that “cardiologists now understand that inflammation is a major risk factor for heart disease. Patients with periodontal disease, rheumatoid arthritis, and psoriasis all have chronic inflammation, and all turn out to have higher cardiac risk than previously appreciated.”

The gum disease specialists and cardiologists now recommend that if you have periodontitis and at least one risk factor for heart disease (such as smoking, a family history of heart disease, or cholesterol problems), you should get a medical evaluation if you have not had one in the past year.

People with known cardiovascular disease should also consider getting a periodontal evaluation if they have symptoms of gum disease, significant tooth loss, or unexplained high scores on a test called hs-CRP, which is a marker for inflammation.

Does vitamin D prevent the swine (H1N1) and seasonal flu, or the common cold?

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It’s not clear whether vitamin D specifically protects against H1N1, a novel virus, but there’s growing evidence that it does protect against a number of respiratory infections – and that many Americans do not get enough of the vitamin.

One study showed that people taking supplements containing 2,000 international units of vitamin D a day suffered fewer respiratory infections than those not taking supplements. Another study showed the obverse – that people with low blood levels of vitamin D were somewhat more likely to have had a recent upper respiratory tract infection than people with higher levels (24 percent vs. 17 percent). Vitamin D boosts the activity of a gene that makes cathelicidin, a natural antimicrobial compound that is part of the body’s defenses against infections, says Dr. Carlos A. Camargo, an associate professor of medicine and epidemiology at Harvard Medical School.

When there’s lots of sunshine, people make vitamin D naturally. But in New England, most people have low levels of vitamin D, especially in winter. The problem is a national one as well: A study being published today in Pediatrics shows that about 20 percent of children ages 1 to 11 have suboptimal levels of vitamin D.

You can get a blood test to determine your vitamin D level. People with darker skin are at extra risk because highly pigmented skin requires more sun exposure to obtain a healthy level.

The vitamin has so many benefits – including lowering the risk of osteoporosis, heart attacks, and colon cancer – that “I am encouraging everyone to increase their vitamin D intake, especially children,” says Dr. Michael F. Holick, a professor of medicine, physiology, and biophysics at Boston University. He suggests that children take a minimum of 400 IUs a day and preferably 1,000. “Adults should take at least 1,000 IUs and preferably 2,000 IUs a day,” he says.

Daniel Perlman, a senior scientist at Brandeis University, says 2,000 IUs a day is safe: “In the summer sun, the body itself is known to produce far higher levels.”

Is there a link between migraines and breast cancer?

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There seems to be, and the good news, such as it is, is that women who get migraines actually seem to be at lower than normal risk of breast cancer. Nobody can quite explain why.

In a study published recently in the journal Cancer Epidemiology, Biomarkers and Prevention, cancer epidemiologist Christopher Li of the Fred Hutchinson Cancer Research Center in Seattle studied the records of nearly 5,000 women with breast cancer and roughly the same number without. He found that women with a history of migraine headaches had a 26 percent lower risk of breast cancer. The study was a follow-up to a preliminary study by Li that produced similar findings last year.

“The data are really quite consistent,” said Li. The link, he said, is probably hormonal since it’s well known that some breast cancers are driven by estrogen and many women with migraines tend to get the headaches when estrogen levels fall, such as just before a menstrual period. “Women with migraines suffer quite a bit, so the silver lining here is that there is a reduced risk of breast cancer,” he said. “This is important because there are not that many factors that reduce the risk of breast cancer and here is a new one.”

No one, of course, is suggesting that migraines are a good thing, even if they are linked to lower breast cancer risk. Nor is the putative hormonal link between migraines and breast cancer well established. “The association is an interesting one that I cannot explain easily based on what I know about migraine pathophysiology,” said Dr. Michael A. Moskowitz, a neurologist at Massachusetts General Hospital. Both migraines and breast cancer “are relatively common and in some way, ovarian hormones are probably implicated. I doubt a simple explanation awaits.”

There are no clear implications for treatment from this finding. But at the very least, women who get migraines may get some comfort from knowing that their headaches may carry a medical benefit.

Does it help to take non-steroidal anti-inflammatory drugs like ibuprofen for colds?

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Yes, they can reduce some cold symptoms. But don’t expect miracles. And do take these medications – dubbed NSAIDS – judiciously, because they carry significant side effects such as gastrointestinal bleeding.

In a recent review of nine randomized, controlled studies of NSAIDS published by the Cochrane Collaboration, an international nonprofit that analyzes health care information, researchers from the Kangdong Sacred Heart Hospital in South Korea concluded that NSAIDS can help with the aches and pains of the common cold, though not the pain of sore throats. The review, which involved 1,064 patients, showed that NSAIDS don’t help with coughs and runny noses, but they may reduce sneezing.

This somewhat-baffling picture makes sense to Dr. J. Owen Hendley, a rhinovirus specialist and professor of pediatrics at the University of Virginia School of Medicine. NSAIDS probably don’t help with sore throats, he said, because sore throats are caused by irritating substances that drip down directly from the nose and thus may not be affected by systemic medications like NSAIDS, which circulate to the whole body through the blood.

Even so, he said it’s reasonable to take them if you have a cold because they do help with other aches and pains. “The evidence is pretty good that NSAIDS are good for these analgesic effects, the ‘feel bads,’ ” he said.

Dr. Kimon Zachary, an infectious disease specialist at Massachusetts General Hospital, agreed that NSAIDS can help with some symptoms of colds. The Cochrane finding that NSAIDS did seem to help reduce sneezing is somewhat surprising, he added, but may be related to the reduction of inflammation in the nasal passages. The main effect of NSAID medications is to reduce inflammation.

“However, NSAIDS are not completely safe,” he said, “and I would argue that certain individuals should not take them, including those with cardiovascular disease, kidney disease, gastrointestinal disease with risk of bleeding, those on anticoagulation [blood thinning] therapy.”

Can Chinese herbal medicine combat endometriosis?

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It may, according to a new review published by the Cochrane Collaboration, an international nonprofit that analyzes health care information.

The review, which looked at results of two randomized studies of Chinese herbal medicine involving 158 women, suggested that Chinese herbs may provide better relief of pelvic pain and other symptoms than one of the prescription drugs normally used in the West, Danazol.

Endometriosis occurs when tissue from inside the uterus escapes to other parts of the body. Outside the uterus, this tissue is seen as “foreign” by the immune system, which means that the body mounts an inflammatory response that can cause pain and scarring.

In the review, researchers at the University of Southampton in England found that Chinese herbs – which were not specified and which typically vary from patient to patient in Chinese medicine – were better at relieving menstrual pain than Danazol, a testosterone-derived drug, and were also better at shrinking endometrial masses. They did not prove better for other types of endometrial discomfort, such as rectal pain.

Dr. Aaron Styer, a reproductive endocrinologist at the Massachusetts General Hospital Fertility Center, noted that in the West, the first line of treatment for endometriosis is birth control and other hormonal drugs, which suppress secretion of estrogen by the ovaries. Although the Chinese herbal study is not conclusive, he said, “if a patient has not done well with traditional therapy or doesn’t want to proceed with it, she should investigate these approaches more completely, as long as there’s no potential health risk of taking these herbs.”

Dr. Hope Riccotti, clinical director of obstetrics and gynecology at the Dimock Community Health Center, cautioned that “herbs are drugs and drug interactions can be dangerous,” which makes it important for women to tell their health care providers if they are taking these herbs.

Does keeping one’s balance get harder with age?

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A. It certainly does, according to a study from Johns Hopkins University, and the inner ear problems that trigger balance problems are far more widespread than doctors thought.

In the new study, ear specialist Dr. Yuri Agrawal and her team examined government health data on more than 5,000 Americans ages 40 or older. They found – to their astonishment – that more than one-third (35 percent) had vestibular dysfunction, an inability of the delicate balance system in the inner ear to function properly. Many people did not know they were at increased risk of falls because they had not yet experienced dizziness or suffered serious falls. Complications from falls are a major cause of death and disability in older people.

The study, published in the Archives of Internal Medicine, shows that “balance problems are a big public health problem,” said Dr. Steven Rauch, an ear specialist at the Massachusetts Eye and Ear Infirmary. “To realize such a high proportion of the population is heading in that direction is a real eye-opener,” he added, noting that good balance is actually a function of three bodily systems: the inner ear, the eye, and the proprioceptor nerves in muscles and joints that let a person know the position of the body at any given time.

There is not much – so far – that doctors can do to treat some underlying causes of vestibular dysfunction, such as damage to delicate hair cells in the inner ear from infections and antibiotics, said Agrawal of Hopkins. But doctors can help patients manage diabetes, a major contributor to damage in nerves and blood vessels in the balance system. And physical therapists can offer vestibular rehabilitation – essentially retraining the balance system to reduce dizziness.

People can reduce the risk of falls by making homes safer – removing scatter rugs, improving lighting in halls, installing handrails – and doing balance exercises such as tai chi that “challenge the very system that’s down,” said Agrawal.

Does it ease a child’s anxiety to have a parent around before receiving general anesthesia?

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Not necessarily, but “clown doctors” and video games do help, according to a review published recently online by the Cochrane Collaboration, an international nonprofit that provides up-to-date information on health care research.

Dr. Allan M. Cyna, an anesthesiologist at Women’s and Children’s Hospital in Adelaide, Australia, and his team pooled data from 17 studies involving 1,796 children ages 10 months to 17 years, their parents, or both.

Children about to get general anesthesia can be given drugs to calm them down, but the drugs can have side effects. New research was done to see if non-drug methods could also reduce children’s anxiety.

Video games and clowns probably reduced anxiety by “focusing the child’s attention,” as hypnosis does, said Cyna in an e-mail. But “parental presence has neither been shown to be harmful, nor beneficial,” he added.

In one small but intriguing US study included in the review, giving acupuncture to parents – not kids – reduced both parental anxiety and increased the cooperation of the children.

Dr. Mary Ellen McCann, an anesthesiologist at Children’s Hospital in Boston, said, “I routinely tell parents who do not want to be present for the start of their child’s anesthesia, that the literature does not show a benefit from them being there. . . . If a parent is very anxious, the child picks up on that and it may make them more anxious.”

Children’s Hospital has clowns in the holding area outside the operating room “to entertain parents, children, and doctors,” which reduces everybody’s anxiety, says McCann. Children are allowed to choose what flavor they would like put on the mask that goes over their nose and mouth for inhalation of the anesthesia gas. In a frightening situation like being put to sleep for surgery, she says, even “the illusion of control is pretty important.”

Do garlic supplements reduce the risk of the common cold?

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Maybe. Australian researchers combed the literature and found only one study with good enough methodology to evaluate. The team, from the University of Western Australia, published its findings online in the July issue of the Cochrane Collaboration, an international nonprofit that analyzes health care information.

That study, in which 146 participants were randomly assigned to take a daily garlic supplement or a placebo, found that those taking the supplement got fewer colds over the three-month study period than those taking the dummy supplement. They also got over their colds faster.

Even the authors, in the article and in e-mail interviews, said that this evidence is too slim to make firm recommendations about garlic’s effectiveness.

“My advice is that if you feel it is helpful, go ahead and use it,” said Dr. J. Owen Hendley, an infectious disease specialist at the University of Virginia School of Medicine who studies the common cold.

If garlic is useful for the common cold, said Dr. Kimon Zachary, an infectious disease specialist at Massachusetts General Hospital, it’s probably more effective as a preventive than as a treatment once a person has a cold.

There are few risks to taking a garlic supplement. Garlic can interfere with an anti-HIV medication called saquinavir and can reduce the ability of the blood to clot, a potential concern for surgical patients, according to the National Center for Complementary and Alternative Medicine.

But while more research is needed, the Cochrane analysis shows that “you can’t dismiss garlic as a potential preventive” for colds, said Mark Blumenthal, executive director of the American Botanical Council, a nonprofit group that is partially supported by the herbal products industry.

Since garlic may have other health benefits as well – the research is still evolving – I figure, why not take it to ward off colds as well? At the very least, the smell might keep germy people away!