Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

Can the insoles inside of shoes help prevent or stop back pain.

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Unfortunately, no, according to a new review of six studies by the Cochrane Collaboration, an international nonprofit organization that evaluates medical research.
In the review, researchers at Hebrew University in Jerusalem examined three prevention studies involving 2,061 participants and three other studies of both prevention and treatment involving 256 participants. Led by Dr. Tali Sahar, a family practitioner, the team concluded that “there is strong evidence that the use of insoles does not prevent back pain.” The team also concluded that “there is limited evidence that insoles alleviate back pain or adversely shift the pain to the lower extremities.”

Dr. Carol Hartigan, a rehabilitation specialist at the Spine Center at New England Baptist Hospital, said that the theory had been that insoles might protect the back by increasing shock absorption, thereby diminishing the impact on spinal discs.
“This was not an unreasonable theory,” she added. But recent evidence suggests that “back pain is part of the human condition.” Moreover, many problems with the spongy discs that act like cushions between the vertebrae in the spine are hereditary.

“They’re not harmful if they make you feel better,” she said. But don’t count on insoles to protect your back.
What does help prevent and treat back problems, she said, is exercise. Many people fear exercise if their backs are hurting, thinking they’re better off lying down. While that may help for a day or two, as soon as possible, you should get moving again.

Does Chinese herbal medicine work for menstrual cramps?

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Well, if you believe the results of a recent review by the Cochrane Collaboration, an international nonprofit organization that evaluates medical research, the answer would be yes.
But its new analysis of pooled data from 39 studies, which included 3,475 women, is difficult to interpret because many of the studies did not test Chinese herbs against placebos, harmless look-alikes. Moreover, because of methodological weaknesses, studies conducted in China, which many of these were, typically come up with positive findings, when more rigorous studies might not, said Ted Kaptchuk, an associate professor of medicine at Harvard Medical School who is also a practitioner of Chinese medicine.

Even the authors of the Cochrane review, a team based at the University of Western Sydney in Australia, cautioned that their analysis “should be interpreted with caution due to the generally low methodological quality of the included studies.”

Unlike in Western medicine, where chronic menstrual cramps are lumped into one diagnosis, in Chinese medicine, practitioners consider a wider array of symptoms, and the herbs used vary according to the different diagnoses. While western medicine focuses on lower abdominal pain, for instance, Chinese medicine also includes symptoms such as “retention of cold” and “stagnation of Qi and blood.” (Qi is the energy force that, when blocked, is believed in Chinese medicine to cause all manner of ills.)

Dr. Isaac Schiff, chief of obstetrics and gynecology at Massachusetts General Hospital, said that while he is “a fan of trying to use alternative medicine,” many studies of herbs for menstrual cramps have proved “very disappointing.” By contrast, there is ample evidence that ibuprofen and oral contraceptives are quite effective against cramps.

Until there is more solid evidence for the safety and efficacy of herbal remedies, he said, “I’d go with our usual medicines, for which we have knowledge of benefits, risks, and side effects.”

I’m a working mother; how can I maximize my 3 workouts per week?

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Since you’re presumably young, you should use almost all of your limited time getting aerobic exercise like running, biking, or brisk walking, said William J. Evans, director of the Nutrition, Metabolism, and Exercise Laboratory at the University of Arkansas for Medical Sciences. That’s because “regular aerobic exercise increases life expectancy by decreasing the risk of a host of chronic diseases,” he added in an e-mail.

But if you were over 40 and especially if you were over 60, “an increasing amount of the three hours per week should be spent in strength training,” he said. Research shows that strength training is important for offsetting the age-related weakness that can limit normal activities, like climbing stairs. So if you’re between 30 and 40, you should aim for 120 minutes a week of aerobic exercise, plus 60 minutes (that is, a 30-minute session, twice a week) of weight lifting to build strength. After 40, you should divide your 180 minutes equally – 90 minutes for aerobics, 90 for strength training.

Even though your thrice-weekly program is less ideal than exercising at moderate intensity at least five days a week, you’re probably doing “enough to get a healthful dose” of exercise, said Steven Blair, professor of exercise science and epidemiology at the University of South Carolina. And take heart, he added. “Carrying kids is resistance training” because, like lifting weights in a gym, it builds muscle.

“The best exercise,” added Blair, “is what you will do, not what you can do.”

When should you see a registered dietitian?

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A lot more often than you might think.

The American Dietetic Association (eatright.org) suggests seeing a registered dietitian if you have diabetes, cardiovascular problems, or high blood pressure. You should also consult a registered dietitian if you are contemplating gastric bypass surgery, if you have chronic digestive problems, if you’re an athlete seeking to improve performance, or if your child is having growth problems, said Emily Werner, a registered dietitian at the Joslin Diabetes Center in Boston. Many pregnant women also benefit from a consult with a registered dietitian.

A registered dietitian, by the way, is not the same as a “nutritionist.” Anyone can call him- or herself a “nutritionist,” but registered dietitians are credentialed only after passing an exam and fulfilling an internship. In many states, including Massachusetts, registered dietitians must be also licensed to receive third party insurance.

Some insurance companies may insist upon a referral from your doctor because of a medical condition, such as diabetes or obesity, to cover the visit. If you pay out of pocket, the fee is typically $50 to $250 for the first visit, then less afterward.

It’s actually cost-effective for insurers to pay for dietitian visits, at least for obese patients with diabetes, according to a study published this year in the Journal of the American Dietetic Association.

Joan Salge Blake, a registered dietitian and clinical assistant professor at Boston University’s Sargent College of Health and Rehabilitation Sciences, said, “With over 60 percent of Americans overweight, seeing

Can you literally die of a broken heart?

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Yes.

In the last few years, researchers at Brown University, Johns Hopkins University and elsewhere have begun keeping track of people whose hearts have stopped – or almost stopped -after intense emotional or physical stress, a problem Japanese researchers began noticing in the 1990s.

In America, it’s called “broken heart syndrome” or “stress cardiomyopathy.” In Japan, it’s “Takotsubo cardiomyopathy.” That’s because “takotsubo” is the name of a pot used to trap octopus, and in these cases, the heart walls squeeze together abornomally, taking on the shape of this pot.

“The heart muscle becomes weak after sudden stress,” said Dr. Ilan Wittstein, a cardiologist at Johns Hopkins, probably because of the sudden flood of stress hormones – adrenalin and noradrenalin – into receptor molecules on heart muscle cells, causing the hear to become “stunned….the heart is unprepared for the large surge of adrenalin.”

In rare cases, broken heart syndrome can be fatal, said Dr. Richard Regnante, a cardiologist at Brown University.

But if a patient makes it through the first 48 hours – often in the intensive care unit – prognosis is excellent, with complete recovery of heart muscle function in two to three weeks, said Wittstein.

The key, for doctors, is to figure out whether a person who has just suffered a terrible stress – like suddenly losing a loved one or having a major medical trauma like a stroke or a severe flare-up of asthma or even major surgery – is having a heart attack or stress cardiomyopathy. Once doctors know to look for them, the differences are clear. In a heart attack, heart muscle cells are permanently killed. Heart attack patients also typically have blockages in the arteries supplying the heart; people with broken heart syndrome – the vast majority of whom are postmenopausal women – do not.

No one knows why postmenopausal women are at greater risk, though in the cases studied so far, most patients have not been taking estrogen supplements. While giving estrogen to older women has not been shown to reduce the risk of coronary events, estrogen may help protect the heart muscle from the effects of adrenalin and other stress hormones. But the gender discrepancy could also be because men who have severe emotional or physical stress may actually have real heart attacks under those circumstances.

So, if you have had a severe emotional or physical shock and then develop chest pain, shortness of breath, lightheadedness and low blood pressure, call 911 and get to the hospital immediately. Ninety-nine percent of the time, a real heart attack is probably in progress. Even if it’s “only” broken heart syndrome, immediate treatment is necessary.

Do emotions affect cancer patients’ rate of survival?

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No, according to the latest and one of the best-designed studies on the subject, which is being released today by the journal Cancer.

Researchers from the University of Pennsylvania School of Medicine looked at data from two studies involving 1,093 patients with head and neck cancer. After 10 years, they found that neither a positive nor a negative emotional state had any effect on cancer survival or progression of disease.

“We left no stone unturned. If there had been a link between emotional state and survival, we would have found it because the study was so large and because all patients had advanced cancer and received very similar treatment,” said lead author Dr. James Coyne, a professor of psychiatry.

The study comes on the heels of another important finding announced in July, that group therapy does not extend survival among breast cancer patients, as many people had hoped.

Both studies are important because they further debunk a popular but false belief that the mind can conquer cancer, said psychologist and medical sociologist Barrie Cassileth, chief of the integrative medicine department at Memorial Sloan-Kettering Cancer Center in New York.

“It’s a popular mythology, particularly in the United States, that if you try hard enough, you can overcome anything, that if you really will it and have the right emotional and mental perspective on life, you can conquer your cancer,” said Cassileth.

“It’s a completely false notion, and it’s very destructive because it imposes on people with cancer yet another burden – the burden of guilt.” While stress and emotional state can influence some cardiac risk, “it’s not the same thing when it comes to a genetic abnormality, which is what cancer is,” she said.

Previous studies suggesting that better mental health was linked to better cancer survival were methodologically flawed, said the University of Pennsylvania authors, adding that the idea that there is a link “has been remarkably resilient in the face of contrary data.”

Is dieting or exercise better for weight loss?

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It’s a bit complicated, but basically, it’s the net calorie deficit – expending more energy than you consume – that counts, said Eric Ravussin, a physiologist at the Pennington Biomedical Research Center in Baton Rouge, La.
In a small, randomized, controlled clinical trial, Ravussin divided three dozen overweight but healthy men and women into three groups. One group reduced their calorie intake by 25 percent. Another group cut calories by half as much (12.5 percent) while increasing energy output through exercise by 12.5 percent; and the third group made no diet or exercise changes.

The researchers looked at weight loss, body composition, and measures of superficial and deep fat. They found that it doesn’t matter whether people lose weight by diet or by exercise or a combination, although exercise has the important benefit of improving cardiovascular health.

“So long as the energy deficit is the same, body weight, fat mass, and abdominal fat will all decrease the same way,” said Ravussin, in an e-mail.

It’s a good idea to include exercise in any weight control program, said William J. Evans, director of the Nutrition, Metabolism and Exercise Laboratory at the University of Arkansas for Medical Sciences.

“When you exercise during weight loss, you lose more fat from the visceral stores – around the waist because this fat is very metabolically active and turns over more rapidly,” he said in an e-mail. There’s some evidence that this fat is used first by the body.

How do should older women get bone density testing for osteoporosis?

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Unfortunately, there’s no one-size-fits-all answer. The National Osteoporosis Foundation recommends that all women 65 and over get a bone density test once. Bone loss is typically so slow that repeating a bone density test more often than every two years is not necessary. Most insurers, including Medicare, will pay for testing every two years.

Assessing a woman’s risk for more rapid bone loss is too complex for blanket recommendations, said Dr. Robert Neer [cq], director of the Osteoporosis Center at Massachusetts General Hospital in an email. And some women – as well as some men – need a bone density X-ray test to look for signs of bone thinning even before age 65 if they have certain medical problems,

People who need earlier or more frequent testing include women with early menopause (before age 42) and men with androgen deficiency, because both these hormonal conditions can lead to bone-thinning. Anyone who gets a fracture after minimal trauma and people with rheumatoid arthritis should also ask their doctors about earlier or more frequent testing. So should people who take cortisone or prednisone, which can adversely affect the bone, and people with sprue or cystic fibrosis or inflammatory bowel disease.

The trouble is, it can be tough to get insurance coverage for earlier or more frequent testing. In theory, Medicare will pay for more frequent testing when it’s “medically necessary.” But in nearly all cases, Medicare does “not accept a letter from a physician as proof of medical necessity,” said Neer. This makes it difficult to assess whether a newly-prescribed medication has stopped bone loss, he added. Medicare has also reduced its payments for the bone X-rays and plans to do so again next year. “As a result, many small providers have stopped or will stop performing bone density tests,” said Neer.

Even so, it makes sense to ask your doctor about bone density testing even before age 65 if you think you are at higher-than-normal risk of osteoporosis.

What exactly is the condition normal-pressure hydrocephalus?

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An estimated 375,000 Americans have a condition called normal-pressure hydrocephalus, or NPH, which is often misdiagnosed as either Alzheimer’s disease because memory is impaired in both cases or as Parkinson’s because gait is affected in both, said Dr. Peter Black, chief of neurosurgery at Brigham and Women’s Hospital. Even CT and MRI scans often can’t tell the difference between these conditions and NPH.
Many doctors don’t know about it, but there is a way to tell the difference between Alzheimer’s and Parkinson’s, for which there is no curative treatment, and NPH, which can be reversed.

In NPH, cerebrospinal fluid fails to drain properly from spaces in the brain called ventricles. This excess fluid then pushes on brain regions that control walking, memory, and bladder control, creating the three hallmark symptoms of NPH: a shuffling gait in which the person feels as though his feet are glued to the floor, dementia, and incontinence.

If a doctor suspects NPH, he or she can place a tiny tube in the lower region of the back to drain fluid from the central nervous system. This drain is left in place for three days. If the symptoms, especially gait problems, get better, that suggests that the patient has NPH and that a shunt permanently placed in the brain to drain excess fluid will help. The shunt takes fluid from the ventricle and sends it through a tube into the abdomen, where the fluid is then absorbed. The entire system is under the skin.

Debbi Fields, executive director of the National Hydrocephalus Foundation, has had a shunt for 20 years and is grateful for it. Though shunts can sometimes get clogged or need to be reprogrammed to drain less or more fluid, they can return many people to normal lives, she said.

“The only time you realize you have a shunt,” she added, “is when you wash your hair and can feel the reservoir for fluid that is under the skin in the scalp. And if you go to a new hairdresser, you have to warn them.”

I’ve heard that a chemical formed in the cooking of French Fries and chips can cause cancer. Is that true?

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There is probably no link between levels of acrylamide, a chemical commonly found in certain cooked foods, and breast cancer risk, according to a large, new study presented recently in Boston at a meeting of the American Chemical Society.

The research, presented by Harvard School of Public Health epidemiologist Lorelei A. Mucci, involved 100,000 women already participating in the ongoing Nurses’ Health Study. The researchers administered three separate food intake questionnaires over the 16 years during which they followed the women and correlated their dietary consumption of acrylamide with development of breast cancer. Mucci’s previous research had already shown no link between acrylamide and colo-rectal cancer, bladder cancer and renal cancer. A different study by Mucci published in 2005 that followed 43,000 Swedish women also found no link between dietary acrylalmide and breast cancer.

“This is good news,” said Dr. Michael Thun, who heads epidemiological research for the American Cancer Society. “But I’m sure these studies won’t end the concern about acrylamide and cancer because I have never seen concern about an environmental contaminant go away because of two or three studies.” On the other hand, he noted, there are other health reasons to avoid lots of French fries, including consumption of excess fat and calories in general. “If there were the same level of concern about the other health effects of French Fries as there has been about acrylamide, we’d all be thinner and healthier.”

The concern about acrylamide in the diet surfaced in 2002 when Swedish researchers first reported that acrylamide is formed naturally when foods, such as potatoes, which are rich in an amino acid called asparagines, are cooked at high temperatures in the presence of sugars. Interestingly, said Mucci, boiling potatoes does not raise temperatures enough to form acrylamide, but baking and frying do. Baked breads, cereal and coffee also contain acrylamide.

Acrylamide is classified by the World Health Organization and others as a probable human carcinogen. But animal studies used doses 1,000 to 100,000 higher than those in the human diet. At levels humans are exposed by diet, acrylamide “is not sufficient to cause cancer,” concluded Mucci.