WASHINGTON — One pill makes you larger and one pill makes you small. And the ones that mother gives you soon will control your cholesterol.Childhood long ago ceased to involve idyllic hours chasing small animals through the field or even careening around the neighborhood on a bicycle. But do we really need to liven it up with Lipitor?

To the cocktail of drugs young children already are taking, the American Academy of Pediatrics is now recommending that some kids as young as 8 might benefit from cholesterol-reducing medication. The reasons are too familiar: Our kids are growing too fat (just like their parents), eating lots of the wrong foods (just like their parents), getting insufficient exercise (just like their parents), and showing the warning signs of serious future health problems — high cholesterol levels — that are precursors to heart attacks (just like they are for their parents).

So, after detecting an unnerving jump in cholesterol levels among the young, the pediatrics profession is suggesting that some kids with high cholesterol and a family history of early heart disease should “be considered” as candidates to take the drugs now prescribed mostly to those who are in middle age or older. Screening for cholesterol levels, according to recommendations listed in the journal Pediatrics, should begin for some children when they are as young as 2. Can cholesterol-drug commercials on the Disney Channel be far behind?

There’s no wonder the medical profession is concerned about overweight kids who are developing life-threatening health conditions. The pediatric profession long ago recommended that children 2 and older eat less sugary food, consume whole-grain breads instead of processed, white baked goods and drink skim or low- fat milk. The children’s doctors say kids should get “60 minutes of moderate to vigorous play or physical activity daily.” And by vigorous, they don’t mean thumbing to victory in a video game or racing to get a snack during a television commercial.

“It’s appalling what we’ve let happen to our children,” says Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University. “And the fact that the children have such high cholesterol levels is a sign of the environment we have created for them.”

Another part of what Brownell calls our “environment” is the reliance on medication as the answer to the poor conditions we’ve created for ourselves. “As a culture, we’re very prone to creating unhealthy environments and then trying to use medicine to mop up the damage.”

The epidemic of obesity among children is real, and already it is leading to the onset of serious — and expensive to treat — diseases such as diabetes at ever-younger ages. But like another serious problem much in the news lately — sky-high energy prices — this is one that is largely of our own making.

We’ve allowed the food industry to market directly to kids, overwhelming them with a tsunami of sugary inducements in cereal ads alone. We’ve allowed vending machines full of junk food in the schools. We’ve somehow made the social activity of sitting around eating pizza while watching a sporting event as acceptable as playing the sport itself. As schools have come under increasing pressure to teach — and test — more, physical education programs and even recess for elementary-school kids often have been cut.

Just as we have a decades-long history of all the wrong habits when it comes to energy consumption, we’ve got a decades-long history of saying we want to be fit, while conscientiously ignoring most of the good advice that’s been out there for years. “The fact that young kids may need statin drugs now is a sign of how bad we’ve made it,” Brownell says. “If anything, this study should have sounded the loudest possible alarm bell that something needs to be done to provide better conditions for our children.”

When the U.S. surgeon general first reported that smoking cigarettes was a killer habit — and hardly the glamorous lifestyle choice portrayed in television and the movies — people began to quit in droves. Eventually, tobacco use became a social taboo. Schools and parents go to great lengths now to keep kids from smoking. After all, there’s no prescription drug that can cure lung cancer.

How loudly does the siren about our children’s unhealthy eating habits have to sound before we get the message that the response has to come from us — and not the pharmaceutical industry?

(c) 2008 Tulsa World. Provided by ProQuest Information and Learning. All rights Reserved.

If you’ve always thought that research claiming health benefits from things like being happy is a bunch of unsupported hooey, you might want to look at a study out of New England in the current Annals of Family Medicine.Doctors asked 2,816 adults over age 35 with no history of a heart attack: “Compared with persons of your own age and sex, how would you rate your risk of having a heart attack or stroke in the next 5 years?”

Nearly half the men who rated their own risk as “low” would have been classified by objective medical tests as being at high risk. Yet when researchers checked the accuracy of their predictions against death records 15 years later, it turned out that men who believed they were at lower-than-average risk actually had a three times lower rate of death from heart attacks and strokes even after smoking, cholesterol and a dozen other factors were considered.

No such link was found for women, which the researchers speculate may be because the study began in 1990, when heart disease was seen as a threat mainly for men.

So why should optimism make such a difference?

The authors’ working theory has to do with perception of risk. When a healthy outcome can be achieved by a simple behavior, such as getting a shot, a heightened sense of risk can be a motivating factor, they write.

But preventing cardiovascular disease involves complicated interrelationships among diet, exercise, drugs, monitoring, and knowledge of constantly changing medical theory. With progress hard to achieve, a heightened sense of risk is less likely to motivate and more likely to cause stress and fear, the researchers say — and to trigger unhealthy coping behaviors like overeating, alcohol abuse and avoiding the doctor.

Believing you are at less risk may actually make it so.

“It is not clear whether we should seek to disabuse people of optimistic ‘misperceptions’ in pursuit of changing behavior,” the lead author, University of Rochester Medical Center researcher Robert Gramling, said in a statement.

“Perhaps we should work on changing behaviors by instilling more confidence in the capacity to prevent having a heart attack, rather than raising fears about having one.”

Contact staff writer Don Sapatkin at 215-854-2617 or dsapatkin@phillynews.com.

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If you visit New York City these days, you’ll notice that major chain restaurants are complying with a new ordinance requiring the posting of calorie counts on menu items.Visitors to the city may be surprised to see just how high the calorie counts on some of these meals are. A chicken fajita omelette at IHOP, for instance, weighs in at 1,360 calories. According to the Food and Drug Administration, recommended daily calorie intakes for adults run from 1,600 calories a day to 2,800 a day. So eating that omelette takes a huge bite out of one’s recommended calorie intake.

As Americans dine out more and more, one can understand why the the percentage of obese people is increasing. Between 1997 and 2005 in Los Angeles County, the percentage of obese adults went from 14.3percent to 20.9 percent.

And childhood obesity, which affects 16percent of the nation’s youth, is becoming so common that many children suffer from diseases previously limited to adults, such as high cholesterol and blood pressure and type 2 diabetes. The American Academy of Pediatrics recently recommended that doctors consider administering powerful cholesterol-reducing statin-class drugs to children as young as 8 years old.

To combat these negative trends, some lawmakers advocate policies such as restricting the number of fast-food restaurants in certain areas. We prefer a different approach, however. Senate Bill 1420 by Alex Padilla, D-Los Angeles, proposes that restaurant chains with 14 or more outlets in the state place information on calories, saturated fat, trans-fat, carbohydrates and sodium content of meals on their menus or menu boards.

A county Department of Public Health study released in May found that calorie postings would cause 10 percent of diners to order reduced-calorie meals - a significant step in controlling average annual weight gains in the county.

Last month, the American Journal of Public Health published a study on Subway customers. It found that those customers who see the calorie information on menu items order meals with 52 fewer calories than customers without such information.

An analysis of SB 1420 concludes that if a change in eating patterns led to a 1 percent reduction in the costs associated with obesity - such as cancer, heart disease, diabetes and workers’ compensation - California could save $30 million annually.

A menu-labeling law, we think, will not only steer people toward healthier eating habits, but it will encourage restaurants to rethink some of their calorie-laden entrees. SB 1420, which passed the state Senate and is now moving through the Assembly, provides consumers with helpful information but doesn’t restrict the diner’s freedom to choose. We hope it passes the Assembly and eventually gets the governor’s signature.

(c) 2008 Daily Breeze. Provided by ProQuest Information and Learning. All rights Reserved.

It may not feel like it while you are completing a gruelling work out at the gym but exercise makes you happy.Of course, it is a proven fact that exercise is good for you. Just a 30 minute brisk walk every day can benefit the circulatory system, help to remove toxins from the body and reduce the risk of heart disease and high blood pressure.

But regular physical activity promotes a sense of wellbeing beyond these effects too.

“There are a two main ways in which exercise can directly make you happy,” says Richard Keegan, lecturer in sports psychology at the department of sport, coaching and exercise at the University of Lincoln.

“Firstly, when you exercise, chemicals are released in the body which have a positive effect on mood.

“Exercise may be linked to increases in serotonin, endorphines, adrenaline and dopamine, which are all chemicals which either release energy or say ‘well done’ or both.”

When these chemicals are released into the body they lead to what experts refer to as a ‘runner high’ or a sense of euphoria that occurs after a workout.

Exercise also burns up Cortisol, which is produced in the body during stressful periods. Secondly, exercise also has an effect on self esteem,” says Richard.

“There is an absence of self esteem in lots of conditions which are associated with unhappines including depression and fatigue. Achieving goals through exercise promotes self esteem.”

And research suggests that the type of exercise you do doesn’t affect the quality of your ‘high’.

“In team sports there is an element of being in a group and that could be factored in to how happy you are but it depends on your personality,” says Richard.

“If you enjoy running then you will have a similar experience to someone who enjoys rugby.”

(c) 2008 Lincolnshire Echo. Provided by ProQuest Information and Learning. All rights Reserved.

I joined some friends in a deep-water fitness class a few weeks ago. It was a balmy, 85-degree morning with the usual suffocating Richmond humidity. But when I got in the water, submerged to the neck and afloat only because I wore an Aqua Jogger belt around my waist, it couldn’t have been more pleasant.For 45 minutes, I worked every major muscle group in my body without one drop of sweat trickling down my face. I can’t think of another time in the summer that I would describe an outdoor workout as refreshing, but this truly was.

And there were other benefits, too. I didn’t feel one pinch of joint pain during the class because there was no pounding.

Plus, there was no need for weights or any other props. The water made the resistance for us.

Instructor Nicole Unice explained that phenomenon as we pushed our arms out to the side, then back in to the front.

“The awesome thing about the water,” she said, “is there is four to 20 times more resistance than the air.”

Unice taught this particular class at Kanawha Recreation Association in Henrico County. She used to teach water fitness at Southampton Recreation Association in Richmond and also has instructed land and water classes at the YMCA.

But she’s quick to remind you that you don’t need a class — or an Aqua Jogger, or any other fancy apparatus -to make the most out of the water.

“You can straddle a noodle and do a lot of these same exercises,” she said.

Merely walking in the water is good exercise. Running in the water will get your heart rate going even more. And, of course, swimming is excellent cardiovascular work.

So don’t just sit there by the pool, lake, river or ocean. Get in the water this summer. Move around, cool off and get a workout at the same time.

If you simply can’t motivate yourself to jump in, find a class to join. There are plenty of classes at pools throughout the area.

Woodlake Swim & Racquet Club, for instance, offers about 20 water classes a week. Many of the classes move to the outside pools in the summer, said Sarah L. Hyatt, the club’s sales and marketing director.

The water classes at Woodlake have names such as Aqua Stretch & Flex, Yoqua, Cool Run, Wet Intensity, and Sea Strides. There also is a Kids H20 water fitness class.

Traditionally, we think of water aerobics as an exercise format that appeals largely to the retired set. But that’s not necessarily so.

At Woodlake, Hyatt said, “These water classes appeal to all age groups, not just the seniors.”

Maria Howard is a group exercise instructor for the YMCA of Greater Richmond. Her column runs every other week in Sunday Flair. Contact her at .

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Physical disabilities often present an exercise challenge, but an adapted exercise program still can bring results.”We always start and maximize the function they have,” said Katrina Hird, a physical therapist with BroMenn Regional Medical Center. “A huge component is looking at what is the task they want to do.”

Healthy eating also plays a role, said Kim McClintic, a registered dietitian with the Center for Healthy Lifestyles at OSF St. Joseph Medical Center, and keeping a food diary can help control emotional eating.

Hird said a key to exercise for Domonica Hilt and others suffering from multiple sclerosis is keeping cool during exercise. Heat can exacerbate flare-ups.

“Have the opportunity to cool off,” she said. “Have cool rags and ice water available. Start in a place that’s cooler or where there is air conditioning. Have a bike with a fan.”

Another key for Hilt and others with limited mobility is gradually building up their core strength, especially trunk stability, Hird said.

Sitting unassisted on the side of the bed to get dressed, for instance, is a step up from sitting in a chair with back support. The next step would be standing up to button a shirt.

Other daily tasks also help build muscle strength. “Putting away groceries works the arms and the trunk,” Hird said.

Exercise is no different.

“Start small and work on progressing up,” she said. “Lie flat to do exercise, then work up to lying on your side and lifting your leg. Use gravity to your advantage.”

Another key is eliminating unnecessary tasks, she said. Have someone set out your clothes in the morning so you can save your energy for getting dressed.

Hilt also suggests making a daily schedule and splitting up activities so tasks can be accomplished.

Meanwhile, a food diary can help keep tabs on what McClintic refers to as “mindless eating.”

“You don’t realize how much you nibble or graze throughout the day,” she said.

A food diary helps track emotional eating episodes. She suggests writing down what you eat, the time of day, the mood you’re in when you eat and who is around when you’re eating.

To combat emotional eating, do something with your hands when you feel the urge to munch, she said.

“Clean out a drawer, fold laundry, do your nails or brush your teeth,” McClintic said. “Get sidetracked, and sometimes the urge will go away or be less.”

Don’t drink calories unless it’s skim or lowfat milk, 100 percent juice or unsweetened tea. Water is the best choice.

“Eat as many fruits and vegetables as possible,” she said.

Frozen fruits and vegetables are not only easy, but because they are frozen at the moment they are picked, they still have their majority of vitamins and minerals, she said. Another easy option is canned fruits and vegetables as long as the fruit is in its own juice and the vegetables are low sodium if you need to watch salt content.

But eating healthy shouldn’t allow you to overeat — portion sizes still are key.

McClintic suggested looking at labels to determine serving sizes.

“If a boxed dinner says three servings per box, the box isn’t just for you,” she said.

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Diet/exercise help

If you need help with your diet or exercise plan, Twin City registered dietician Kim McClintic recommends the U.S. Department of Agriculture Web site: .

The site offers personalized eating plans and helps provide a balance between your food intake and your physical activity. You will find such things as a menu planner, an in-depth assessment of your diet and physical activity, dietary guidelines and tips and resources.

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Copyright (c) 2008, The Pantagraph, Bloomington, Ill.

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A LACK of sunshine could help explain high levels of obesity in Scotland.Studies showed that levels of vitamin D - of which sunlight is the most natural source - tend to be lower in the bodies of overweight people.

Insufficient vitamin D in the blood interferes with the hormone leptin, which signals to the brain when the stomach is full.

Statistics show that more than one in five Scots adults are now obese. The research was carried out by Aberdeen University.

Between 1998 and 2000, data was gathered on 3,100 women living in the north east of Scotland.

Estimates were taken of how long they had been exposed to sunlight the previous year and the amount of vitamin D they obtained from food such as eggs and oily fish.

Researchers found that those with an average body mass index of 34 - which is above the BMI measure of clinical obesity - produced 10% less vitamin D than those of average weight.

(c) 2008 The Journal - Newcastle-upon-Tyne. Provided by ProQuest Information and Learning. All rights Reserved.

MILWAUKEE _ It’s just before noon, and the emergency room already is filling with patients.John Whitcomb, a lanky, high-octane physician, scurries from exam room to exam room, keeping pace with an onslaught of people coming in with chest pain, ankle injuries, seizures and stomachaches. The ER at Aurora Sinai Medical Center in Milwaukee isn’t the most likely place to get a friendly lecture about vitamin D.

But Whitcomb, one of a small but growing number of physicians who think deficiency of the sunshine vitamin is its own public health emergency, preaches to anyone who will listen.

A growing body of research suggests that inadequate vitamin D can substantially increase the risk of a variety of diseases, including several cancers, heart disease, high blood pressure, diabetes, depression and multiple sclerosis as well as the risk of falling and infections.

In northern regions like Wisconsin, where vitamin D levels are low, the concern is even more pronounced because of a lack of ultraviolet radiation during much of the year.

Now pockets of physicians here and around the country are making vitamin D a high priority.

SPREADING THE WORD

Steve Trapp, 38, was on a bus from Chicago to Seattle last month when he began vomiting at the Milwaukee bus station. He was taken to the ER at Aurora Sinai. Whitcomb diagnosed the problem as a bout of stomach flu and dispensed nausea medicine _ and an ample dose of vitamin D advice.

As Trapp lay in an exam room, Whitcomb rattled off a few recent research findings on how vitamin D can reduce the risk of various diseases. He told the couple how there really is no food source that can provide ample levels of the vitamin.

He said the sun’s angle drops in winter, and with that shift, vitamin D levels in the blood decrease from an average of about 40 nanograms per milliliter to less than 20 ng/ml.

“When the level drops below 32, many of the body’s functions don’t work right,” he said.

Only supplements or ultraviolet light can prevent that from happening.

Over the past two years, Whitcomb estimates that he has talked to more than 1,000 patients about vitamin D in the ER or other urgent care facilities in the area. He’s written about vitamin D in newsletters and given talks to other doctors.

He’s even tested the blood of ER patients to find out their vitamin D levels. Invariably, the levels are extremely low.

While there is not unanimous agreement on what is the optimal vitamin D blood level, many researchers say it should be at least 30 ng/ml and preferably between 40 and 60.

NO LARGE CLINICAL TRIALS

Exposure to intense sunlight was mostly a year-round occurrence for our prehistoric ancestors who, for thousands of years, existed naked near the equator.

It has been only in relatively recent human evolutionary history that people moved north, began wearing clothing and spent more time indoors, resulting in vitamin D deficiencies.

The vitamin actually is a hormone that plays a role in the regulation of more than 100 genes, many of which are involved in preventing diseases.

However, while that theory sounds attractive to vitamin D advocates, much of the research pointing to the vitamin’s disease-preventing ability is observational in nature. While most of those studies show a benefit, some do not.

Nevertheless, observational studies pointing to potential health benefits from the vitamin continue to pile up.

A study released late last month found higher rates of death from all causes and from cardiovascular disease among a group of 3,258 heart patients with low levels of vitamin D in their blood, compared with heart patients with higher levels of vitamin D.

Also in June, a study involving 18,225 men found that those with vitamin D levels below 15 ng/ml were 2.4 times more likely to have a heart attack than those with levels above 30 ng/ml.

Last year, an analysis involving 1,760 women found a 50 percent reduction in breast cancer risk in those whose vitamin D levels were more than 52 ng/ml, compared with levels of less than 13.

After reading a variety of vitamin D studies, Tara Rakowski, a family practice physician with Columbia St. Mary’s hospital in Milwaukee, began testing for the vitamin in her patients. In more than 60 percent of the approximately 500 patients, vitamin D levels were less than 20 ng/ml, she said. Now, “there isn’t a patient I don’t check it on,” she said.

Typically she will put patients with low vitamin D levels on a prescription regimen of 50,000 international units of vitamin D a week. After that, they usually take 2,000 IU a day in the form of vitamin D3, which is inexpensive. That’s the dose many vitamin D proponents now are recommending, although it is considerably more than the current recommended intake, which ranges from 200 IU in children to 600 IU in the elderly.

Rakowski said her patients often feel better after boosting their vitamin D levels.

Jaishree Hariharan, an internal medicine physician who practices at Froedtert Hospital, said she had checked vitamin D levels in about 200 patients in the past year. Most have levels below 20 ng/ml, she said.

“The big misnomer that most physicians are worried about is vitamin D toxicity,” said Hariharan, an associate professor of medicine at the Medical College of Wisconsin. However, with doses of 2,000 IU a day, “there is no downside,” she said.

UPPING HER DOSE

Alice Carter, a 63-year-old from Milwaukee, is lying on a bed with chest pain in the ER at Sinai Medical Center.

After Whitcomb determines the Milwaukee woman is having a bout of angina, he begins telling her about vitamin D.

He seems pleasantly surprised when she tells him that she started taking 1,000 IU a day about a year ago, but he says she should up the dose to 2,000.

“Your skin pigment protects you from sunburn, but it also means you need to get three to four times as much sunlight to make the same amount of vitamin D,” he tells Carter, who is African-American.

He tells her that many African-Americans he has tested have vitamin D levels of less than 10, but blacks living near the equator in Africa have levels near 60, he says.

“So are you saying I need to move down South?” she jokes.

Whitcomb says that won’t be necessary if she increases her summertime dose to 2,000 IU and her wintertime dose to 4,000.

“I’ll take the 2,000,” she says.

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GETTING ENOUGH VITAMIN D

Getting 2,000 IU of vitamin D from the diet alone is impractical for most people.

The only food source that contains high levels is cod liver oil, which contains about 1,400 IU in a tablespoon.

A cup of vitamin D-fortified milk contains about 100 IU.

Researchers say the only other ways to get high levels is through supplements and exposure to ultraviolet light.

Some research suggests that five to 30 minutes of sun exposure twice a week between 10 a.m. and 3 p.m. on the face, arms, legs and back without sunscreen is enough to produce adequate vitamin D levels. However, too much sun exposure increases the risk of skin cancer.

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(c) 2008, Milwaukee Journal Sentinel.

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Most food items aimed specifically at children have a poor nutritional content because of high levels of sugar, fat or sodium, Canadian researchers say.Charlene Elliott of the University of Calgary says that only 11 percent of the products evaluated provided good nutritional value in line with the criteria laid down by the Center for Science in the Public Interest, a non-profit agency based in Washington.

The CSPI nutritional standards state that healthy food should not derive more than 35 percent of its calories from fat — excluding nuts and seed and nut butters — and should have no more than 35 percent added sugar by weight and sodium levels should be limited to 230 mg per portion for snacks and 770 mg per portion for pre-prepared meals.

The 367 products included in the study were bought from a national supermarket chain and each product was subjected to a 36-point analysis.

The study, published in Obesity Reviews, found just under 70 percent of the products studied — which excluded confectionery, soft drinks and bakery items — derived a high proportion of calories from sugar, about 23 percent of the products had a high fat content and 17 percent had high sodium levels.

Findings suggest that young adults should try to keep their blood pressure below 120/80 mmHgACP

Steve Majewski, 215-351-2514

smajewski@acponline.org

Logo: http://www.annals.org/

A new study published in Annals of Internal Medicine finds that prehypertension–systolic blood pressure 120 to 139 mmHg or diastolic blood pressure 80 to 89 mmHg– during young adulthood is common and associated with coronary atherosclerosis.

Researches analyzed blood pressure measurements of 3,560 adults aged 18 to 30 over the course of 20 years and found that nearly 20 percent of the study participants had developed prehypertension before the age of 35. Although blood pressure levels between 120/80 and 139/89 are below the cutoff for hypertension, the young adults with prehypertension were more likely than those with lower blood pressure to have coronary calcium later in their lives. Coronary calcium is a marker of atherosclerosis and a predictor of future heart attacks and strokes.

Prehypertension was most common in young adults who were black, male, overweight, and of low socioeconomic status. Participants with low annual income (less than $25,000) and no college education were about twice as likely to have had early prehypertension as were participants with postgraduate education and an annual income greater than $100,000. Prehypertension before the age of 35 also was associated with having diabetes, low HDL cholesterol levels, and higher exposure to blood pressure elevation later in life.

Annals of Internal Medicine (www.annals.org) is one of the most widely cited peer-reviewed medical journals in the world. The journal has been published for 80 years and accepts only 7 percent of the original research studies submitted for publication. Annals of Internal Medicine is published by the American College of Physicians, the nation’s largest medical specialty society.

Video: American College of Physicians ‘Internal Medicine Report’ on Prehypertension in Young Adults.(Video: Business Wire)

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