Following healthy lifestyle tips could prevent bowel cancer

A new study has indicated that almost a quarter of colorectal (bowel) cancer cases could be prevented if people followed healthy lifestyle advice in five areas including diet and exercise.

Researchers from Denmark found that following recommendations on physical activity, waist circumference, smoking, alcohol and diet could reduce the risk of developing bowel cancer considerably - by 23 pc.
There is much evidence that implicates modifiable lifestyle factors such as smoking, physical activity, body composition, alcohol and diet.

The Danish researchers wanted to study the link between following healthy lifestyle advice and risk of bowel cancer in middle-aged people. They also wanted to find out the proportion of bowel cancer cases that might be linked to lack of adherence to the advice.

They studied data on 55,487 men and women aged 50-64 (bowel cancer is rare amongst people under 40) not previously diagnosed with cancer. The people were studied over almost 10 years up to 2006.
All participants filled in a lifestyle questionnaire including questions about social factors, health status, reproductive factors and lifestyle habits as well as a food frequency questionnaire developed to assess average intake over 12 months.

The researchers created a healthy lifestyle index using internationally accepted public health recommendations from the World Health Organization, World Cancer Research Fund and the Nordic Nutrition Recommendations.

These included being physically active for at least 30 minutes a day, having no more than seven drinks a week for women and 14 drinks a week for men, being non-smoker, having a waist circumference below 88 cm for women and 102 cm for men and consuming a healthy diet.

During the follow-up period, 678 people were diagnosed with bowel cancer.

After looking at how the participants managed to keep to each of the five lifestyle recommendations, the researchers calculated that if all participants (except the healthiest) had followed even one additional recommendation, it was possible that 13 pc of the bowel cancer cases could have been prevented.

If all participants had followed all five recommendations, then 23 pc of the bowel cancer cases could have been avoided.

A second study shows that adults with low education who used a decision aid when considering whether to have a bowel cancer screening test were more informed, but were less likely to have the test. Despite the lower uptake, the authors state that the decision aid improved informed choice in people with low education. They recommend that such aids should be made available for people who want to make an informed choice about screening and could be integrated within primary care.

Source  http://sify.com/news/following-healthy-lifestyle-tips-could-prevent-bowel-cancer-news-health-kk1nucabhdg.html

Five easy tips to rest and refresh for a healthier lifestyle

Living a healthy lifestyle encompasses a plethora of things - it goes well beyond diet and exercise. Working to alleviate stress and getting enough sleep are two major factors to a healthier you.

These five simple lifestyle tips can help improve your overall health and well-being throughout each day.

Establish everyday healthy tips habits: Diet and exercise are essential for a good night sleep. Regular exercise in the morning or during the day, for just 30 minutes, will help you fall into a deeper sleep and wake up with more energy. Avoiding caffeine, nicotine or other stimulants will increase your quality of sleep as well. Also, staying away from heavy, fatty foods at dinnertime will promote a healthier digestive system. By eating at least two hours before bed, your body will be able to digest food more easily, which will help to keep you from tossing and turning.

Just relax: After a long day, it is crucial to get some rest and relaxation to stay healthy. Reducing stress is important for mental stability and ultimately being a happier, healthier person. Performing daily relaxing rituals, like yoga or mediation, will help calm your mind and body from a stressful, busy day. If you don't have the time to spend stretching out in a yoga pose, try reading a book, catching up with your family around the living room, or sipping chamomile tea before bed. Making small changes like these are bound to keep you more relaxed, with plenty of peace of mind and primed for a restful night of sleep. 

Tossing and turning?: If you are having trouble relaxing and falling into a deep sleep, try logging a sleep diary for one week and list the time you went to bed, fell asleep, any night-time awakening, and the time you wake up. Calculate your average hours of sleep and look for patterns throughout the week. By observing what your body is telling you, you can make adjustments to get a deeper rest. Sleep is how the body rejuvenates so it is essential that you get at least eight hours per night. If you are regularly getting more than eight hours of sleep a day and still feel tired, you should consider seeing a physician to determine what your body is trying to say. Keep in mind that staying on a regular sleep schedule will keep you feeling more energized in the morning.

Set the mood: The quality of sleep is as just as important as the number of hours you are sleeping. Without the proper sleep environment, your body becomes more vulnerable to diseases and your immune function decreases. Making simple changes to your sleep environment will help you sleep better; try avoiding bright lights, TV, texting, loud music and computers. Leave your busy day at the bedroom door and reserve your bed for sleep and downtime only, that way your body will prepare itself for sleep mode once your head hits the pillow.

Catch some zzz's: One way to ensure you maximize the sleep you are getting is to determine whether you need a new mattress. If you are waking up with body aches and pains or even some types of unwanted allergies, a new mattress may be the solution to your problems. The new Embody by Sealy mattress is tailored to provide simplicity from the inside out without any extra layers to ensure a better night's sleep. The line provides a choice of clean, breathable products for a healthy sleep environment. In fact, the new Embody by Sealy incorporates Polartec Body Climate fabrics. The Polartec fabric allows air to circulate in and around the mattress to help regulate temperature all night long and wick away moisture to ensure a dry, healthy sleep.

For more information on how to get a simple, healthy rest visit www.facebook.com/EmbodyBySealy. 

Source  http://www.osceolaiowa.com/articles/ara/2010/10/29/8052180101/index.xml

10 Golden Rules to Stay Young Forever

10 Golden Rules to Stay Young Forever

Weight management is on everyone's mind. Every time you turn on the television, you are bombarded with stories about the growing obesity rate. You have seen the commercials and you may own one or more of the widely marketed ab roll thinners, butt tuckers, tummy suckers and electronic fat removers. You may have also tried an Assortment of firming cream and burning pills. People are on a relentless search for the answers to weight loss, physical fitness and to look younger and beautiful. Often people go to any extent to look younger on the outside. They buy the best clothes and cosmetics that money can buy but looking young is not only about what you wear and how you apply make-up.  What you put inside your body by maintaining a high quality natural food diet, has the best effect on how we look and feel. There are some basic facts which can be helpful in achieving your goals faster than you have ever thought.
Here is the list of some of the things that can help you own an enviable toned body and stay in top shape for years to come.

1) Eat “Fit Foods”- your choice in a high quality natural diet plays a significant role in the way to look and feel.  A diet containing balanced amount of complex  carbohydrates, protein and fats  is the key.  Complex carbohydrates intake through brown rice, whole wheat pasta, salads, potatoes, unprocessed cereals etc. have proved to be very effective in losing weight because complex carbohydrates not only control hunger but also provide energy as our body  burns them more efficiently as compared to unprocessed food.

Similarly,  fiber (contained in fruits, vegetables and whole grains) helps get rid of unwanted and toxic substances present in your intestine and colon, accelerates weight loss and keeps the skin glowing. High quality, easily digestible protein can be derived by consuming chicken, turkey, egg whites, fish, low-fat dairy and certain lean cuts of red meat. Protein present in these food sources is easy to digest and helps increase the muscle tissue rather than fat tissues.

2) Eat at least three meals per day - Our body needs to have 3 balanced meals per day which includes a heavy breakfast in the morning containing fruits, cereals, grain bread, eggs,  along with a healthy drink. Research has shown that people who skip breakfast,  find it harder to lose weight. Your body needs energy to get you through the day and that energy is supplied only through a proper breakfast, so if you are not a “breakfast person” start by eating  at least a piece of fruit on your way to work.

3) Drink plenty of water- Water plays a key role in the prevention of diseases, reduction of weight, toxins and chances of cancer; absorption and digestion of food, regulation of body temperature, removal of waste and toxins from the body and maintaining glow of the skin. Water helps the body to metabolize stored fat and acts as appetite suppressant, and thus, leads to weight loss. Whenever you feel hungry, drink a pint of water, it will curb your appetite.

4) Eliminate soft drinks, fruit juices and processed foods - Avoid carbonated beverages and fruit juices even if they are naturally sweetened.  Processed food, refined food and pre-packaged food are loaded with sugars and preservatives. You can replace soft drinks and juices with natural water, herbal tea and caffeine free coffee.

5) Fast once a week- I strongly recommend fasting for everyone. It is something which everyone needs to do and please bear in mind that this has nothing to do with religious beliefs. If you abstain from meals, you are giving your body a chance to rest. In USA, we incessantly eat endless calories with every meal. The body never gets a chance to get rest, repair and restore itself. Our digestive system works round the clock even when we are sleeping. When we eat, it takes that meal three to four hours to travel through the stomach, another five hours for the food to be processed in the small intestine and an additional 12 to 36 hours for the food to go through the large intestine. If you fast one day in a week, you are giving your body a chance to rid itself of abnormal  cells, toxins, heavy metals and chemicals that you have ingested.

6) Don't eat 2 hours before you go for sleep: People generally make the mistake of not eating much during the day and then eating a big dinner before they go to bed. It becomes difficult for the body to burn the extra calories while you are sleeping because your energy levels plummet while sleeping. Therefore, try to eat earlier in the day and keep dinners as simple and light as possible.

7) Exercise to stay fit and young- We all have excuses and explanations for not exercising, like, lack of time, odd working hours, home, kids etc. Good eating and drinking habits and exercise keep you fit for your entire life. Exercise and workout will not only keep you healthy, increase longevity but will also give you mental peace because “A healthy body has a healthy mind”. Any anaerobic exercise like stationary cycling, walking, jogging, swimming, yoga etc. four times a week yields good results. If possible, go for a brisk walk of 10 to 15 minute at lunch or in the evening to boost your metabolism even more. Don't forget to tone your muscles with weight training three days per week.

8) Mediation and deep breathing- Meditation helps develop a stronger body and mind connection. This connection is vital for feeling younger and healthier. Breathing is one of the important and the oldest weapon to fight toxicity in the body. Breathing is an effective way to remove toxins as well as to cleanse and purify the body. When we exhale, we take out carbon dioxide and the toxins which are deadly poisonous for the body. The body has a great tendency and capacity for oxygen. If our body lacks oxygen, we feel tired and have headaches. A few deep breaths not only relieves us from the anxiety and ease digestion but also helps with waking up and going to sleep.

9) Stop smoking and drinking alcohol- Smoking and alcohol consumption have negative effects on your body. Alcohol depresses your metabolism and stimulates your appetite and thus affects your eating habits.

10) Live with a positive attitude- The way to a healthy life begins with a healthy mind. How we think determines everything in our life. We should choose the habits that make us feel younger and live longer with a healthy body and mind. 

Red wine and dark chocolate show real love on Valentine’s Day

Susan Ofria, clinical nutrition manager at Gottlieb Memorial Hospital suggests showing real Valentine’s Day love with red wine and chocolate that both contribute to a heart health. She also has some other heart healthy eating tips to share, in a February 10 news release from Loyola University.

The beauty of indulging in dark chocolate and red wine explains Ofria, is you don’t even have to make a choice between the lesser of two evils, given the known health benefits of higher levels of cocoa found in dark chocolate and resveratrol in red wine that is shown to lower blood sugar levels and boost good cholesterol numbers.

Ofria suggests looking for chocolate with cocoa content that is 70 percent or higher this Valentine’s Day. “Truffles, soufflés and even hot chocolate can be a good source of resveratrol and cocoa phenols (flavonoids) as long as dark chocolate with a high content of coca is used.”

You may want to sprinkle chocolate on berries, also good sources of heart healthy nutrients in keeping with February’s national heart health theme. Ofria explains, “Berries are a good source of beta carotene and lutein, anthocyanin, ellagic acid (a polyphenol), vitamin C, folate, potassium and fiber.”

Valentine’s Day brings a special focus to the heart. Other tips for heart healthy eating include oatmeal for breakfast that is high in soluble fiber, potassium, niacin (a B vitamin) and folate.

Snacking on almonds and walnuts provides omega-3 fatty acids, fiber, niacin, vitamin E that are a good source of magnesium needed for heart and overall good health. Preparing or ordering meals that incorporate kidney beans, brown or golden flaxseeds, salmon and tuna are other heart healthy ways to show love on Valentine’s Day.

Loyola Medicine: "Go for the Dark Chocolate, Red Wine to Keep Your Honey Heart-Healthy This Valentine's Day"

Source http://www.examiner.com/women-s-health-in-national/red-wine-and-dark-chocolate-show-real-love-on-valentine-s-day-2

Health Benefits of Different Types of Milk

Health Benefits of Different Types of Milk

1. Coconut milk:
Coconut milk is a common ingredient in South Indian cooking that makes the curry rich and delicious.

What are the health benefits of coconut milk?
Coconuts provide vitamins, minerals and fibers that prevent diseases like gallbladder stones and liver diseases, inflammation and skin diseases, to name a few. If you want proteins, coconut milk is a good source. It also provides iron, selenium, sodium, calcium, magnesium, phosphorus and potassium, vitamins: C, E, B1, B3, B5 and B6. Surprisingly coconut milk is far richer in calcium than regular milk. Rest assured that coconut milk also supports the immune system, helps in weight loss and is great for digestion.

2. Almond milk:
Almonds are a great snack if you are fasting or if you simply want a potent healthy snack to keep you full for longer. Some dishes also use almonds as garnish and it is an excellent medium in desserts.

What are the health benefits of almond milk?
Almond milk, just like coconut milk, is a great alternative for vegans. Almond milk is a good source for proteins; it is also low in calories unlike cow's milk. This milk contains vitamin E, magnesium, monounsaturated fats, manganese, copper and riboflavin. Boost your energy and lower heart diseases with almond milk.

3. Cow's milk:
This is the most commonly used milk in India. Cow's milk is also used to make enticing Indian sweets.

What are the health benefits of cow's milk?
This milk contains fats, minerals and vitamins like vitamin D, proteins, vitamin B, potassium, iodine and it is a good substitute to Omega 3. Cow's milk is not fattening but it should be complimented with a healthy diet. Besides strengthening the bones with calcium, cow's milk is known to control blood pressure as it contains potassium, iodine promote thyroid function and prevents gout.

4. Goat's milk:
Most Indians may not use goat's milk, but high up in the hilly regions of northern Indian, goat's milk is widely used. But the buck does not stop there, globalization and India's love for Italian food has seen an increase in the import of goat cheese.

What are the health benefits of goat's milk?
According to researchers, goat's milk helps prevent softening of bone and anemia. It also aids digestion and 'metabolic utilization of minerals such as iron, calcium, phosphorus and magnesium'. The secret lies in the high presence of iron, calcium, phosphorus and magnesium. Apparently goat's milk has less fat, builds your immune system, and reduces anti-inflammation of the bowel.

5. Raw milk:
Consuming raw milk is a trend that promotes the importance of organic food. But is it a wise choice?

What are the health benefits of raw milk?
The debate still continues on the health benefits of raw milk over pasteurised milk. Raw milk contains proteins, carbohydrates, fats, vitamins and minerals, but scientists do not believe the claims of health benefits of raw milk. There are healthy bacteria in raw milk; some say that pasteurised milk kills these microbes, but scientists believe it's all for a good cause.

You need to know:
- Pasteurization DOES NOT reduce milk's nutritional value.
- Pasteurization DOES kill harmful bacteria.
- Pasteurization DOES save lives.

6. Soy milk:
This is a common substitute for those who are lactose intolerant or vegetarian. Soy milk also comes under probiotic food choice.

What are the health benefits of soy milk?
Soy milk contains fatty acids, proteins, fiber, vitamins and minerals that are beneficial for the smooth functioning of our body. You can count on soy milk to improve good cholesterol and help in weight loss; the omega 3 and 6 in soy milk strengthens the blood vessels, claims to prevent prostrate cancer, osteoporosis and postmenopausal syndrome.

7. Cardamom or eliachi milk:
May not be a common ingredient in milk, but flavoured milk is always refreshing on a hot day. Cardamom milk is healthier than having flavoured milk like chocolate and strawberry.

What are the health benefits of cardamom milk?
Cardamom contains potassium, calcium, riboflavin, niacin, vitamin-C and magnesium. It is also used as an antiseptic, antispasmodic, carminative, digestive, diuretic, expectorant, stimulant, stomachic and tonic. These are the traditional uses of cardamom.

Health Benefits of Pumpkin

Health Benefits of Pumpkin

Image Source:  "Traugers-farm-bucks-county-large" by Frenchtowner - I, Licensed under GFDL via Commons -https://commons.wikimedia.org/wiki/File:Traugers-farm-bucks-county-large.jpg#/media/File:Traugers-farm-bucks-county-large.jpg

The pumpkin, a member of the Cucurbita family including squash and cucumbers, got its name from the Greek word "pepon" for large melon. Seeds from related plants have been  found in Mexico, dating back over 7000 years to 5500 B.C.

Mostly known for being a part of Halloween decorations or a pie filling, pumpkins are also packed with nutrition and offer a wide range of health benefits. Pumpkins are a storehouse of vitamins, mineral and other healthy nutrients. Whether it is the pulp or the seeds, pumpkins are great for your health and can offer some incredible benefits.

High Carotenoids Content-Pumpkins owe their bright Orange color to the high amount of carotenoids present in them. Carotenoids assist in staving off the free radicals in the body, and help in preventing premature aging, cardiovascular diseases and other infections. They are also high in Lutein & Zeaxanthin which protect the eyes against free radical damage and prevent formation of cataracts and degeneration of the eye tissues.

Protein-Pumpkin seeds also known as Pepitas are a rich source of protein. One ounce of pumpkin seeds contains approx. 7 grams of protein. Their oil is high in phytosterols or plant-based fatty acids and their chemical composition is the same as cholesterol. Phytosterols can replace cholesterol in the body, and help in reducing the blood cholesterol levels.

Essential Fatty Acids-Pumpkin seeds are a rich source of essential fatty acids, which have numerous health benefits. From providing protection against serious health diseases such as high blood pressure, arthritis and cancer to promoting healthy skin and improving brain power, essential fatty acids present in pumpkin oil offer several health benefits.

Vitamin A-Pumpkin is a rich source of Vitamin A. Regular consumption of pumpkin (both seeds and flesh) can promote the health of your eyes and boost your immune system remarkably.

Vitamin C-Vitamin C helps fight free radicals, improves immunity and promotes the production of collagen. The high Vitamin C content in pumpkins also offers protection against various forms of cancer.

Magnesium - Both the pulp and seeds of pumpkin are rich in magnesium, which is an important mineral required for various biological functions. Magnesium is also required for the maintenance bones and teeth.

Potassium and Zinc-Pumpkin is loaded with potassium and Zinc. Studies show that eating a potassium-rich diet can prevent onset of cardiovascular diseases and hypertension. Zinc is important for providing bone density support for people at risk for osteoporosis. It boosts the immune system and promotes reproductive health.

Fiber-Pumpkin flesh is very low in calories and contains abundant quantities of extremely good dietary fiber. It is extremely effective for treating gastrointestinal disorders such as constipation, indigestion etc. The high amount of fiber also helps in lowering the LDL (bad) cholesterol levels in the blood and in regulating the blood sugar levels.

Image Source: "Pumpkins" by Martin Doege (Morn), uploaded to English WP on 2003-08-21 - Own work. Licensed under GFDL 1.2 via Commons - https://commons.wikimedia.org/wiki/File:Pumpkins.jpg#/media/File:Pumpkins.jpg

Prostate Cancer-The protective compounds present within the pumpkin seeds, called phytosterols ca n lower the risk of prostate cancer. These work by shrinking the prostate and stimulating the secretion of chemicals that protect against the transformation of testosterone into dihydrotestosterone (DHT). High DHT levels can cause enlargement of the prostate glands.

Anti-Inflammatory Effect-The Beta carotene present in pumpkin seeds and flesh has antioxidant and anti-inflammatory properties. Regular consumption of pumpkin can protect against joint inflammation and arthritis. Pumpkins have been known to provide relief from inflammation quickly, without the harmful side-effects of anti-inflammatory medicines.

Great on your skin-The high amount of Vitamin A, C and E as well as Zinc present in pumpkin, make it a great choice for those who want a healthy and glowing skin. Have a cup of pumpkin seeds per day to prevent appearance of wrinkles and to keep your skin hydrated and nourished.

Prevents Kidney Stones-Have 5 to 10 grams of pumpkin seeds every day. This stimulates the kidneys and prevents the formation of calcium oxalate stones.

Depression - Pumpkin flesh contains L-tryptophan, a chemical compound that triggers feelings of well-being and happiness. Having pumpkin as a part of your daily diet can keep your spirits high and prevent depression.

Diuretics -Pumpkins are natural diuretics. These help in flushing out the toxins and unwanted waste material from the body, leaving you refreshed and healthy.
With so many health benefits, it is no wonder that pumpkin is an important part of the list of Super Foods. Next time you are carving a pumpkin, do not throw away the pulp or the seeds – instead boil, bake or cook them in any form you like.

Protection for Men's Bones-In addition to maintaining prostate health, another reason for older men to make zinc-rich foods, such as pumpkin seeds, a regular part of their healthy way of eating is bone mineral density.

6 Tips for Making Healthy Fast Food Choices

It is possible to get out of a fast food restaurant without totally undoing all of your hard work, you just have to make the right choices. 

Cooking your own food offers much more control over your dier than eating out, but if you make smart choices, that trip to the drive thru doesn't have to ruin your whole diet plan. Compiled from Eat This, Not That author David Zinczenko and a recent article from the editors of Men's Health magazine, these simple tips can make your fast food choices much healthier.

1. Just because it sounds healthy, doesn't mean it is. When you eat at Subway or Panera Bread, you can't just assume that everything on the menu is low in calories. In a study published in the Journal of Consumer Research, diners were asked to estimate the number of calories in their meals, both at Subway and McDonalds. They both underestimated but Subway patrons were further off. When people eat at a healthy restaurant, they tend to order more food.
2. Get the fresh fruit. If you're eating a fast food breakfast at a restaurant like IHOP or Denny's, the pancakes covered in fruit and whipped cream and sugary syrup look delicious, but all that extra sugar does you no good. Instead, skip the cream and syrup and ask for a side of fresh fruit instead to put on top of your short stack.
3. Cappuccino is better than latte. Cappuccinos are made with steamed milk which has more air and fewer calories than the latte. The Grande Cappuccino at Starbucks with 2% milk has 70 calories less than the equivalent size latte. Over the course of a week, that adds up to around 500 calories less.
4. Ham over Bacon over Sausage. No, this isn't the plan for one meat packed sandwich. When it comes to meats at breakfast, ham is the best choice of the three, then bacon, and sausage comes in last. At McDonalds, the McGriddle with sausage, egg and cheese has 560 calories and 32 grams of fat but the bacon, egg and cheese McGriddle has 420 calories and 18 grams of fat.
5. Choose sides wisely. Some fast food chains now offer more choices than just fries. You can get a side salad or baked potato rather than french fries which are cooked in oil and covered with salt. Zinkzenko says that at Wendy's, the small chili saves you 320 calories and offers three times the protein over the large fry. Combined with a Jr. Cheeseburger and you have a meal for under 500 calories.
6. Pass on the drinks. There is no soda that's a good soda. Even if you do opt for the diet variety, you're still not as healthy tips as simple water. Some chains offer bottled water, or you can always get the water from the fountain machine. It can sometimes be hard to find though and is usually a small button found underneath one of the larger soda logos.

If you order smart, you can still have some of your fast food faves without overdoing it. Stay away from the fries and the drinks and stick to some of the core items to keep calories from piling up. 

Source  http://www.americanhealthandbeauty.com/articles/?article=3697

NORMAL SALINE IS NOT SO NORMAL

In a study from England published ahead of print in Annals of Surgery, healthy volunteers given two liters of so-called "normal" saline intravenously showed signs of decreased kidney perfusion and increased fluid retention compared to infusion of a balanced salt solution. The work builds on previous research suggesting that normal saline, in use intravenously for over 100 years, is not "normal" and may not be the best fluid to use, especially in patients who are susceptible to renal dysfunction.

In an email to Reuters Health, lead author Dr. Dileep N. Lobo of the University of Nottingham said, "Had normal saline been formulated in recent times, it is debatable whether it would have survived a phase 1 trial."

Dr. Lobo's group carried out a randomized, double-blind cross-over trial involving 12 healthy male volunteers who were given two-liter infusions over one hour of either "normal" 0.9% saline or the balanced salt solution Plasma Lyte-148, several days apart. Plasma Lyte-148 contains sodium and chloride in physiologic amounts, compared to the higher amounts of those two ions found in normal saline.

During the four hours following the infusions, subjects underwent sequential blood and urine tests as well as magnetic resonance imaging (MRI) of their kidneys.

The main results: when the men received normal saline, they retained significantly more fluid in the extravascular space (1,484 vs 1,155 mL; p=0.031) and gained more weight (1.2 vs 0.84 kg, p=0.22). With the balanced solution, they produced significantly higher urine volumes and had a significantly shorter time to first voiding.

Furthermore, in the normal saline trials, serum chloride was significantly higher from the first hour on (p=0.0001), and a low strong ion difference indicated acidemia (p=0.025).

MRI showed that normal saline significantly decreased renal artery flow velocity (p=0.045) and renal cortical tissue perfusion (p=0.008) compared to the balanced solution - differences that could matter in patients with kidney disease.

The authors point out that some 200 million liters of normal saline are used in the U.S. every year. The paper doesn't address the issue of costs, but Dr. Lobo said, "Plasma-Lyte 148 is more expensive but this is likely to be because it is not widely used. Just because a product is more expensive does not mean that it should not be used in the clinical setting."

Dr. Lobo pointed out that a paper this year by Shaw et al, also in Annals of Surgery, showed that complications and resource use are less with Plasma-Lyte than with 0.9% saline.

Another inexpensive option, lactated Ringer's solution, has nearly normal amounts of sodium and chloride. Dr. Lobo said, "It is likely that similar results could be achieved with Ringer's lactate, however, we chose Plasma-Lyte 148 as it has a chloride content in the normal physiological range."

Dr. Laurence Weinberg of the Department of Anesthesia, Austin Hospital and Senior Fellow, Department of Surgery, University of Melbourne was not a contributor to the study. Regarding lactated Ringer's, he said, "It contains lactate. In shock conditions if lactate cannot be metabolized by the liver, it will be unable to be converted to bicarbonate. This can also result in elevated lactate levels which, if being used as a marker of effective resuscitation, can lead to misinterpretation of the cause of the hyperlactatemia."

According to Dr. Lobo, "It is clear that many patients continue to receive large quantities of intravenous fluid especially in the perioperative period. We suggest that large quantities of saline may not be beneficial for those with pre-existing renal disease or those at risk of developing renal impairment."

Dr. Lobo thinks that normal saline is not appropriate for use for resuscitation or in the operating room. He said, "There is an increasing body of evidence to suggest that saline may lead to harmful effects. This study, building on evidence first obtained in animal studies, suggests that hyperchloremia associated with saline infusion may have an unfavorable effect on renal perfusion."

Dr. Weinberg said, "For many operations we only use 1000 mL of fluid. Choice of fluid for these cases is less important. However there is now overwhelming evidence that a balanced solution is better than an unbalanced and given that the costs of normal saline and Ringer's lactate are the same I would advocate Ringer's lactate as a preference."

When massive amounts of fluid are needed, however, Dr. Weinberg would advocate Plasma-Lyte 148 over both normal saline and lactated Ringer's solution. He added, "Many critically ill patients do require significant fluid/volume intervention as part of their care; the type and correct amount of fluid patients receive is paramount. The study by Lobo now gives us information that is clinically important, and I am certain that we will see many more studies examining the clinical effects of different fluid solutions."

Dr. Lobo and one other member of his group have received financial support from Baxter Healthcare, maker of Plasma-Lyte 148. Baxter Healthcare also supported the study but did not participate in its conduct or analysis.

Dr. Weinberg's department has received funding from Baxter Healthcare, which has no input or oversight of its research.

CANCER TREATMENT DURING PREGNANCY

Because cancer during pregnancy is a rare occurrence, with an incidence ranging from 0.02% to 0.10%, there is a scarcity of research to guide women and their physicians on treatment. Now, some experts have offered reassurance that it is possible to appropriately treat the mother without terminating the pregnancy.

Pregnancy should be preserved whenever possible with breast and gynecologic cancers, according to 2 separate review articles published in the February 11 issue of the Lancet. The most common malignancies diagnosed during pregnancy are gynecological (primarily uterine or cervical, and less frequently ovarian) and breast cancers; pregnancy does not have a deleterious effect on the prognosis of either.

Although prognosis and treatment success depends on the individual patient, it is possible to provide standard therapy to the mother while safeguarding the fetus.

Decisions about treatment for cancer in a pregnant woman can be difficult because of the conflict between the wellbeing of the mother and that of her unborn child, note Philippe Morice, MD, from the Institut Gustave Roussy, Villejuif, France, and colleagues in a comment accompanying the review papers.

They point out that the physician must define "when and how far to push back usual treatment limits to satisfy the patient's [ethical, legal, and/or personal beliefs]," but also must provide accurate information and consider the oncologic risks.

"The main goal is to offer pregnant patients the same optimum management (and therefore similar predicted survival) as nonpregnant patients," they write. Therefore, physicians must clearly define the real oncologic risk for each patient. Physicians need to stop thinking about cancer and pregnancy in general; instead, they need to focus on the particular cancer and its known characteristics.

Except for leukemia, true oncologic emergencies in pregnant women are rare, Dr. Morice and colleagues point out. This is fortunate because "time is required to deliberate and to draw up a personalized treatment plan that the patient will view as clear and balanced."

Treating cancer during pregnancy is still associated with unacceptable outcomes, such as the termination of pregnancies and the choice of an inadequate strategy for treatment of a tumor, they write.

"The treatment of every pregnant woman, and by extension every woman of childbearing age, should include a wider reflection on how to preserve the pregnancy or subsequent fertility, or both," Dr. Morice and colleagues explain. "Preservation of fertility in young women with cancer (an entirely new specialty, oncofertility) is every patient's right."

Pregnancy During Breast Cancer

In the review article on breast cancer during pregnancy, Frédéric Amant, MD, from the Multidisciplinary Breast Cancer Center, Leuven Cancer Institute, Katholieke Universiteit Leuven, Belgium, and colleagues note that a multidisciplinary focus and a cautious approach to radiotherapy are needed. A diagnostic strategy designed to reduce the burden of fetal radiation exposure needs to be established in a multidisciplinary setting.

Terminating the pregnancy does not improve the breast cancer prognosis, explained Dr. Amant. "We believe that fear of the toxic effects of chemotherapy should not be a reason for termination of pregnancy, and fear should not be a reason to delay maternal treatment or to induce prematurity," he told Medscape Medical News.

The therapeutic strategy should also be discussed within a multidisciplinary setting, and should adhere as closely as possible to standard protocols for nonpregnant women, say the authors, but fetal safety must also be considered.

Dr. Amant added that sometimes oncologists underestimate the long-term consequences of prematurity. "We believe children suffer more from prematurity than from antenatal exposure to chemotherapy," he said.

Until now, it was "easy to terminate pregnancy because the long-term effects were not known," said Dr. Amant. "With the current data, I believe it becomes unethical to terminate pregnancy when cancer is diagnosed."

A study recently published by Dr. Amant and colleagues showed that fetal exposure to chemotherapy was not associated with increased central nervous system, cardiac, or auditory morbidity. In addition, exposure did not appear to be associated with impairments to general health or growth, and cognitive development was age-adequate.

He added that if this trend is confirmed in more children with a longer follow-up, "I believe termination will be more difficult to defend."

In their review paper, Dr. Amant and colleagues explain that surgery, chemotherapy, and radiotherapy for breast cancer are possible during pregnancy, with the caveat that treatment should be tailored to the individual patient.

Generally, surgery can be conducted safely during any stage of pregnancy and most anesthetic agents seem to be safe for the fetus, they point out. The choice of surgery should follow the same guidelines as those for nonpregnant women, and radiation therapy after a breast-conservation procedure is rarely a concern; most women receive chemotherapy and delay radiotherapy until after delivery.

After the first trimester of pregnancy, chemotherapy can be either adjuvant or neoadjuvant, and the decision to use chemotherapy should follow the same guidelines as for nonpregnant women, the authors report. The goal should also be a term delivery (37 weeks or more), and premature birth should be avoided if possible.

Cervical and Ovarian Cancers During Pregnancy

In the review paper on gynecologic cancers, Dr. Morice and his colleagues from France and the United States focused on the 2 most common and complex gynecologic cancers — cervical and ovarian. As in breast cancer, a multidisciplinary discussion is essential for optimal disease management, note the authors. Physicians need to consider the possibility of saving the fetus and the effect of therapy on the woman's reproductive capacity.

Dr. Morice and colleagues point out that until the 1980s, cervical cancer diagnosed during the first 2 trimesters was managed by ending the pregnancy and radically treating the cervical neoplasm. The current trend is to try to preserve the pregnancy, especially in patients with early-stage disease with no nodal involvement.

The management of cervical cancer depends largely on 4 criteria: the extent of local spread, nodal status, pregnancy trimester, and histologic subtype. The authors explain that in early-stage cervical cancer, during the first and at the beginning of the second trimester, magnetic resonance imaging and laparoscopic lymphadenectomy can be used to help plan a conservative approach.

Among women with small tumors and without nodal spread, postponing treatment until fetal maturity and delivery can be discussed. In these cases, radical trachelectomy and neoadjuvant chemotherapy might be appropriate.

The treatment of patients with locally advanced disease is controversial — neoadjuvant chemotherapy with preservation of the pregnancy or chemotherapy and radiotherapy — and needs to be discussed on a case-by-case basis. Tumor size, radiologic findings, the term of pregnancy, and the patient's wishes must be taken into consideration, the authors note.

The management of ovarian cancer is dependent on histologic type, stage, and pregnancy trimester. In patients with peritoneal spread or high-risk early-stage disease, preservation of the pregnancy might be possible with neoadjuvant chemotherapy, according to Dr. Morice and colleagues.

Chemotherapy is generally necessary to achieve a cure in ovarian cancer, and the risk for a congenital malformation or miscarriage as a consequence is very high during the first trimester. In such cases, "consideration of a therapeutic abortion versus delayed treatment should be discussed with the patient," they write. However, treatment during subsequent trimesters can be given according to the usual standard chemotherapy guidelines for both germ-cell tumors and epithelial ovarian cancer; in most cases, there are generally no irreversible consequences for the fetus.

It is also usually not necessary to induce premature delivery if the cancer is controlled with chemotherapy.

"Clinical studies are needed, particularly for key issues in clinical management, such as an intentional delay in early-stage cervical cancer or radical trachelectomy and neoadjuvant chemotherapy, to establish the balance between the best chance of cure for the patient and preservation of a healthy fetus," Dr. Morice and colleagues emphasize.

Nefertiti duPont, MD, MPH, who was approached by Medscape Medical News for an independent comment, noted that this is "an excellent review of a difficult topic."

"When diagnosed early, gynecologic cancers in pregnancy can lead to good outcomes for the mother and infant," said Dr. duPont, who is assistant professor and director of the High Risk Ovarian Cancer Screening Clinic, Roswell Park Cancer Institute, Buffalo, New York. "The most important issues are close follow-up of the mother during her pregnancy and postpartum course, and long-term follow-up of the infant."

What is also critical is a multidisciplinary team to ensure that the mother and baby have the best possible outcomes, she explained.

Several areas in the review, however, could be strengthened, Dr. duPont noted. "Clinicians should provide psychosocial and emotional support to the mother during diagnosis and treatment," she said. "Also, most studies recommend postponing chemotherapy within 3 weeks of delivery to avoid neonatal myelosuppression."

Here's What You Need To Know About The New Blood Pressure Medication Guidelines

If you have high blood pressure, your treatment may soon change.

New medication guidelines published Dec. 18 in the Journal of the American Medical Association (JAMA) suggest that not everyone with high blood pressure needs to be on drugs for it.

Here's the bottom line: If you are 60 or older and the first number of your blood pressure is less than 150, you don't necessarily need to be on medication for it.

Keep in mind that this choice is up to your doctor — blood pressure is just one risk factor for heart disease, and people using medication to maintain a number in the 140s without serious side effects should not suddenly stop and let that number drift up.

The new guideline will decrease the number of people medicated for their high blood pressure, but not everyone's happy about it.
Blood pressure and heart disease

People with naturally low blood pressure (BP) have a lower risk of cardiovascular problems and live longer. High blood pressure, when left uncontrolled, can lead to heart attack, stroke, and aneurysm. Smoking, obesity, and inactivity are all risk factors for high blood pressure, which also has a genetic component that's passed down in families.

Lifestyle changes like exercise and healthy eating are our first line of defense against heart disease and are especially encouraged if BP creeps above the "normal" level of 120/80.
But not everyone gets their blood pressure low enough with just lifestyle changes, and if that first number climbs above 140 — a condition affecting about two-thirds of people 60 and older — you officially have high blood pressure, or hypertension.
Until now, that's when doctors suggest medication to help lower BP. About 50 million Americans are on blood pressure drugs of all different kinds, including diuretics ("water pills"), beta blockers (which slow your heartbeat), and ACE inhibitors (which help stop blood vessels from narrowing).
Why change the guidelines?

"Over the last ten years, doctors have had the notion that the lower blood pressure is, the better," study researcher Paul A. James, of the University of Iowa, told Business Insider.

The problem? While there's no question that medication is crucial for people at high risk of heart attack and stroke, the researchers concluded that there's not enough evidence that driving that number all the way to 140 — rather than simply to 150 — provides much additional benefit.
The panel arrived at the new guidelines after reviewing previous studies that looked at how patients fared on a variety of approaches to lowering BP — different drugs and exercise regimens, for example.
Blood pressure drugs, like any medications, have some side effects (such as dizziness), which can be especially serious in older adults. So, the new guidelines may come as a relief for some.
Still, says James, "I'm absolutely sure there will be controversy."

Not everyone's happy

James is right. Some people are wary that the new guidelines aren't officially endorsed by the National Heart, Lung, and Blood Institute (NHLBI).
The NHLBI initially assembled the panel but has since stopped being involved in making guidelines, so in the end they weren't certified by any official organization. Eric D. Peterson of the Duke Clinical Research Institute told Business Insider that this lack of official endorsement may leave some practicing doctors scratching their heads about how to proceed.
Most experts point out that more research needs to be done. "We have very limited data to tell us what the right thresholds are," said Peterson.
While he agrees that no study says 140 is the magic BP number for beginning treatment in older adults, he notes that one major study showed a notable benefit when older patients brought their number from the mid-150s to the mid-140s — so 150 isn't necessarily right either.
Though Peterson agrees that too-aggressive treatment to lower a patient's blood pressure down to a specific number can harm overall health, he compared the target numbers to speed limits: If you tell people the maximum speed is 65, they may drive at 75. Similarly, leaving the target at 140 may mean more Americans actually bring their number below 150.

"There is always some slippage between targets set for clinicians and [those] actually achieved in routine practice," he writes in an editorial in the same issue of JAMA.