In This Issue

Potential Migraine Relief

More on Migraines

Inflammation and Heart Attacks

Cholesterol Lowering Duo

Irritable Bowel Syndrome

Build Fitness With Your Kids

For those who suffer from migraine headaches, here is an update on an old drug -- sumatriptan (Imitrex). Sumatriptan has been known as an effective medication for fighting migraines for years, but a recent Mayo Clinic study found it especially effective in a special form, and in a special setting -- injections in your office. Having a migraine in your office can ruin your day, it can be a nightmare; but there may be help. Self-injecting sumatriptan may provide quick relief, or so the study found. You may be able to turn what looked to be a pretty bleak day into a productive one. This obviously won't work for everyone, but it's worth a try if you don't have a better option than throwing yourself off the roof.

Those who will respond best to this treatment are those with a rapid onset of a headache, and with other disabling symptoms like nausea or vomiting, in addition to intense pain.

A benefit, if this treatment works for you, is that your productivity won't suffer as it might without quick, effective relief. For many people with migraine pain at work, productivity suffers regardless of the intensity. Those who aren't completely disabled, may choose to stay at work, to "stick it out" instead of going home, but they fall into a category called "presenteeism," in the study. That is an individual who stays at work, but in pain, and is likely to be less than normally efficient (they are "there," but they aren't, you know). A quick acting medication may prevent presenteeism.

Sumatriptan also comes in tablet form and as a nasal preparation, which might work without having to stab yourself, but the injection form is quick, which can be critical. Other meds -- rizatriptan, zolmitriptan, and naratriptan work similarly to sumatriptan. Even quiet, sleep, or warm compresses may help. As you have heard before, start treatment as fast as you can to have the best chance for success against migraines.

It seems that I can't avoid migraine updates, they just keep rolling in, so I guess the migraine issue must be important (as if there was ever any doubt). Here is a bit more for you to cogitate over, if you happen to be a migraineur.

There are a number of foods that are implicated as possible triggers for migraines, even though a dietary-migraine link has not been proven to date; although abundant anecdotal evidence has led us to suspect that aged cheeses, red wine, chocolate, nuts, sourdough bread, smoked meats preserved with nitrites, MSG, excessive coffee or alcohol, and more, can cause migraines. But they are not likely caused by one thing. It may be that several things, acting in concert, lead to migraines; including foods, pollutants like cigarette smoke or exhaust fumes, bright lights, loud noises, mental conditions like stress, depression, hormonal changes, or fatigue -- an almost infinite variety of factors.

Migraines are not something to try to take care of yourself. Current thinking is that a migraine should be attacked at the highest level appropriate, which commonly means prescription drugs. It is important to see a doctor rather than try to self-diagnose and self-medicate. A doctor can rule out problems like a sinus infection, or even a brain tumor; and start you on an appropriate therapy.

Drugs are the normal approach to resolving migraine pain, although there are some other alternatives. The drug approach might start with O-T-Cs if the severity of pain isn't extreme: medications like aspirin, acetaminophen, Excedrin Migraine, caffeine (Although I seem to recall that it can exacerbate a headache -- maybe a little helps, but a little more makes it worse?).

For more severe migraines, prescription meds are the normal choice. Some of the many prescription drugs available are summarized in Table 1.

For more migraine information contact the National Headache Foundation at: www.headaches.org, or call toll free: 1-888-NHF-5552.

[Adapted from the April 2000, TUFTS University Health and Nutrition Letter.]

Inflammation and heart attacks; is there a link? So it seems. In the past few years it has been learned (using molecular biology techniques) that atherosclerosis (hardening of the arteries -- implicated in heart attacks) is an inflammatory disease.

Inflammation is an immune system response to injury. It is unknown as to what triggers the response in blood vessels, but may include high blood cholesterol, infections, and tobacco smoke.

A problem is that inflammation doesn't occur only from infection, so the exact cause of the inflammatory response leading to atherosclerosis is currently unknown, but is an area of intense research. Also, the level of inflammation is quite low, so a person under siege by the condition is unaware of it.

The mechanism by which inflammation leads to a heart attack is fairly clear. An injury in an artery wall (of unknown origin) provokes the immune system into sending cells to repair the damage, and eventually "plaques" -- consisting of immune cells, cholesterol, and muscle cells -- develops into a "cap" separating it from the blood. Some of these plaques are relatively unstable and rupture. A blood clot forms at that site and interrupts blood flow, causing either a stroke or heart attack depending on where the vessel is going.

When the plaque ruptures it is because of an inflammatory response that eats away at the cap.

What is significant about inflammation being linked to heart disease, you may ask? And the answer is that it is the first time that other than high levels of cholesterol are considered as a significant factor (except for homocysteine, Lp(a), and C-reactive protein, recently in the spotlight). Measuring inflammation may provide physicians with another tool for assessing risk for heart attacks/strokes; but that doesn't mean that cholesterol is no longer considered important. It is a good indicator of how much plaque is accumulating in your arteries.

Measuring "markers" of inflammation, the best of which seem to be high sensitivity C-reactive protein (hs-CRP), along with cholesterol, improves the ability to predict heart attacks/strokes. Over half of heart attack victims don't have high cholesterol, so knowing your hs-CRP may be important.

An interesting aspect of the inflammatory response is that it varies from individual-to-individual (i.e., some people naturally have a lower inflammation response than others), which may explain why some people with severe atherosclerosis don't have heart attacks/strokes. Of course the reverse is also found -- little atherosclerosis in an artery, but it ruptures just the same, leading to a heart attack/stroke.

What can you do if you have a high hs-CRP level? Some steps to take that might help are:

• eat a diet low in saturated fat and cholesterol
• lose weight if you need to
• control blood pressure
• stop smoking, if applicable
• take aspirin, an anti-inflammatory medication, as well as being a clot reducer
• take a cholesterol-lowering drug like pravastatin, which also lowers hs-CRP

For the obese, they should work on reducing their fat level, since obesity is, itself, a major risk factor for heart attacks; at least partly because it increases the inflammatory response. And it is important to note that merely being over-fat, but not obese, is a risk factor. One positive note is that EXERCISE (that universal palliative) reduces hs-CRP.

[Adapted from an article in the September 2000 issue of the Nutrition Action Health Letter.]

For those with high cholesterol, who need to turn to medication to help, a combination of two drugs has been found effective at lowering cholesterol -- extended release niacin (vitamin B3), and Levastatin.

Participants in a study group given this drug combination for up to a year were found to have their HDL raised by an average of 41%, LDL was lowered by 45%; and triglycerides dropped by 42%.

This was a preliminary finding -- final results are expected next year -- but, the encouraging aspect is that LDL was lowered while HDL was raised. Currently many treatments are available that lower LDL, but also lower HDL -- not a good tradeoff.

BUT, this combo isn't for everyone, so check with your doctor. [That comment is kind of superfluous since you need a doctor to prescribe the pair of drugs, but let's not quibble.]

Irritable Bowel Syndrome (IBS) is one of those irritating conditions that can upset your life, but not one that can kill you. It can be relatively mild, in which case there is very little impact; on-the-other-hand, it can be serious enough to cause absenteeism from work or school, or otherwise disrupt your life.

Symptoms of IBS include abdominal cramps, constipation and diarrhea, and maybe abdominal bloating, flatulence, a growling stomach, or mucous in the stools. This condition was known as "spastic colon" or "colitis," but no longer.

IBS is caused by abnormal, uncoordinated contractions of the large intestine, but "why" is unknown; but common speculation says that it is a deficiency of fiber in the diet. The thought is that early man evolved to the point of eating a very high fiber diet; and that as our food gets more highly processed, the fiber content has been severely decreased, resulting in IBS. [That seems like a real stab in the dark since we all have evolved in much the same way, but not everyone gets IBS. Anyway...]

There is no diagnostic test to identify the presence of IBS. The large intestine displays no abnormal characteristics. Tests run (like Hemocult slides or x-rays) are only intended to eliminate other possible causes of the symptoms.

Initial treatment is commonly an increase in fiber intake. One suggested way to do that is to take one teaspoon of fiber per day for three days, then increase to two teaspoons for three days, then three teaspoons for three more days. The ultimate goal is to take two to three heaping tablespoons a day. The fiber can be taken with orange juice, water, or whatever you like . Note that fiber can be increased by eating more high fiber foods, but a commercial preparation like Metamucil is often recommended. The daily amount of fiber normally suggested is 20-35 grams, which may be difficult to achieve through food alone, at least for some people. In addition to the increased fiber intake, you need to drink plenty of water, and exercise.

There are some factors that may help with IBS:

1. The aforementioned increase in dietary fiber.
2. Drink 6-10 glasses of fluids per day (excluding alcoholic or carbonated beverages. [I amend this to say 8-10 eight ounce glasses of WATER, and add coffee to the excluded list, although I know there are some who would die before giving up coffee.]
3. Add moderate exercise to your life if it isn't already there; moderate, not strenuous (it can worsen the problem). Try for 30 minutes a day, and not necessarily all at once.
4. Avoiding some foods may help some people, but sometimes just the act of eating, rather than what you eat, results in the problem -- maybe eating too fast, or... The foods include raw milk products, high fat meals, fructose from apple or grape juice, or figs, dates, prunes, soda sweetened with corn syrup or pears, legumes, broccoli, or sorbitol.

How about a little editorial rambling? Good, I'm glad you are up for it because there is no holding it back.

Some time ago I was approached about writing an article about what parents and their kids could do together at a park that would be both fun and improve their fitness. Unfortunately I had to turn down the offer because they required that I go to Los Angeles for an interview -- they hadn't realized that Sunnyvale and LA aren't exactly next door to each other. Anyway, I was thinking about what I would have written, and, for better or worse, decided to pass it along to those of you who have young children.

The first thing is to acquire some equipment, although you can improvise and get along without it.

First, some cones -- you know, like what road repair crews use, only smaller. About eight inches will do unless your kids are older or are especially gifted athletically. Then a jump rope or two, and finally a plyoball or two (these are modern variations on the old medicine balls -- now in different sizes/weights, colors, and covered with neoprene so they are waterproof. Now I'll explain what to do with them, and you can decide whether you need to buy some new "stuff," or can just substitute from "stuff" you already have at home. Oh, I almost forgot -- a hoppi ball. I don't know if that's its real name or not, but that's its function. You have probably seen exercise balls (sometimes called Balance balls) -- they are like thick (but pliable) beach balls, and they come in sizes from about 16 inch diameter to three feet in diameter, so they can be used by kids or adults. The hoppi ball is similar, but with a plastic handle attached, and you need it or you'll get bucked off.

OK, gather your kids, and whoever else you can get involved -- the more the merrier, and your stuff, and lets go to the park -- preferably one with one of those old PAR Courses that were so popular a few years ago. Unfortunately most of them were allowed to deteriorate to the point of being unusable, but as with everything else, you can get along without it.

For today's adventure, let's assume we have all the equipment, and a nice stretched out, well-maintained Par Course -- at least 20 yards between exercise stations.

I'm going to get pretty non-specific now about what to do at the exercise stations -- just do what the posted signs tell you to do. The creative part involves the stuff you brought along. Midway between stations one and two let's set up the first cone station. Line them up close enough so everyone can hop over them in one hop. Now go to the midpoint between the third and fourth stations, with some more of your endless supply of cones. This time arrange them in a zig-zag pattern, but again, close enough so everyone in the group can hop the cones diagonally in one hop. Now on to the next station, where you will deposit the jump rope(s). Then to the next station where you will leave the balls.

Okay, back to station #1 and let's start. Do the appropriate exercise, then jog to the first set of cones. Stand in front of the first cone, then hop over it, and immediately hop over the second one, and stop. Now hop back one. Then continue the two forward and one back pattern until you get past the last cone, at which point you will jog on to station #2. The next person can start after a few seconds -- allow enough time so the line doesn't get jammed up. Make it clear that the point of all this is not to catch the person ahead of you -- this is not a race.

At station #2, do the exercise, then skip (the kids know how to skip, and the adults probably will remember how they once did it) to station #3. At this station, do the exercise, then jog to the cones. Just as before you will hop over each cone in one hop, but diagonally this time; and you don't have to go backwards. At the end, jog to station #4.

Do the exercise noted and then pick up a jump rope and go to it. About 10 repetitions should do. Now walk or jog backwards to station #5.

At this point wait for the group to catch up. Line up one person right behind the next. The person at the front of the line (with a ball) passes it overhead to the next person and then runs to the back of the line. Whoever now has the ball passes it back between his/her legs to the next person, and runs to the end of the line. This over-under pattern and running to the end of the line is repeated until the ball has cycled through everyone three times (totally arbitrary, do what you want). [If you have enough participants you can form two lines, and have a race.] Bound on to station #6.

Do the exercise, then form your plyoline and do as before, except this time you will pass the ball by twisting and handing the ball back at about waist level. The next person will take the ball and twist the other way to pass it back. And as before, go to the end of the line after passing on the ball, and go through the cycle three(?) times. Resume the intervals between the participants, and frog hop (You know, you squat down and touch the ground, then hop, just like a frog.) to the next station.

And now it's time to stop. You have the basic program, now those of you who might want to try it can apply the parts, and create your own "fitness at the park" plan. Oops, the hoppi ball kind of fell through a crack, but you can add it anywhere in your own personal plan, or substitute it for something else, like frog hops, or backward running. Once this program you are going to develop gets translated into action, you can (should) make some minor changes each time you go out to play.

Keep in mind that you don't need any of the equipment mentioned: you can hop all over the place without cones or a hoppi ball. And if you don't have easy access to a Par Course, make your own stations, and do push-ups, Jumping Jacks, crunches, squats, walking lunges; or maybe some monkey bars are available -- be creative. Fitness and fun, that's the combo you're striving for.

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