MAYO CLINIC HEALTH LETTER To o l s f o r H e a l t h i e r L i v e s VOLUME 26 NUMBER 7

JULY 2008

Inside this issue HEALTH TIPS . . . . . . . . . . . . . 3 What to eat when your system is upset. NEWS AND OUR VIEWS . . . . . 4 Exercise — even without much weight loss — benefits heart. Larger waistline equals greater risk of Alzheimer’s later. CHRONIC INFLAMMATION . . . . . . . . . . 4 For some, a cardiovascular risk. JUST DESSERTS . . . . . . . . . . . 6 Tasty and healthy.

Edema: Reduce the swelling

Edema can have causes ranging from inactivity as you sit or stand for a prolonged period of time, to moreserious conditions such as heart failure or kidney diseases. Identifying the cause of your edema is an important first step in developing a plan to treat it and its underlying cause.

First, find the cause At first, you chalked up your tightfitting shoes, puffy ankles and tight-feeling calves to a long day on your feet. But that was a week ago, and your feet and legs are still swollen. Could this be something more serious? It’s hard to say without a thorough examination by your doctor. Edema is a medical term for swelling. It can affect any part of your body — or even your entire body — but it’s most commonly noticed in the legs.

OSTEOPOROSIS QUIZ . . . . . 7 A question of bone health.

Out of balance Fluids circulate throughout your body in the bloodstream. Fluids move through the walls of your blood vessels into body tissue to hydrate and nourish cells. Some fluids are removed from tissue by way of the lymph channels, which transport the fluid to your lymph nodes, where it’s Less pressure

Increased pressure

Coming in August STRESS INCONTINENCE Surgical treatments.

Artery

TRIGLYCERIDES AND HEART RISK Healthy diet and exercise a must. COPD Coping with breathlessness.

Vein

Capillary

Edema in legs

PREVENTING KYPHOSIS Reducing your risk of getting a hunched back.

Elevate legs

Edema commonly begins when your body’s tiniest blood vessels (capillaries) leak water into body tissues. Increased pressure within the capillaries prevents fluids from being absorbed back into the bloodstream. Elevating the legs can help reduce the pressure and swelling.

www.HealthLetter.MayoClinic.com

Visit us on the Internet at the address listed to the left, where you’ll find more health information, great offers and more!

cleansed of waste material and potentially harmful substances, such as bacteria. Your kidneys play a critical role in determining how much fluid is in your body. When there’s too much fluid in your bloodstream, the kidneys filter it out. When there’s not enough, your kidneys retain fluids, as well as sodium. Edema commonly begins when your body’s tiniest blood vessels (capillaries) leak water into body tissues, such as in your feet. Increased pressure within the capillaries prevents fluids from being absorbed back into the bloodstream. When water is unable to return to your bloodstream, it causes the kidneys to retain water and sodium to compensate for the lack of fluid in the bloodstream. This leads to a cycle of more leaking and swelling, and thus more fluid retention by the kidneys. The result can range from a little puffiness in the affected area to severe swelling.

Ordinary causes Many ordinary factors can cause edema. Sitting or standing for a long time causes blood to pool in the legs, increasing pressure in the capillaries. Hot weather can make your blood vessels expand, making it easier for fluid to leak out. Eating too much salty food, or the hormone fluctuations associated with menstruation also can cause swelling. Weakened or damaged leg veins (chronic venous insufficiency) impair blood flow out of the legs, allowing pressure within them to build. Having large blood clots in the leg veins (deep vein thrombosis) is a common risk factor for chronic venous insufficiency. Edema may also be a side effect of a number of commonly used drugs, such as certain blood pressure medications, medications that open blood vessels (vasodilators), hormones and nonsteroidal anti-

2

www.HealthLetter.MayoClinic.com

Weakened or damaged leg veins — called chronic venous insufficiency — impair blood flow out of the legs, allowing pressure within them to build.

inflammatory drugs (NSAIDs). Some herbal supplements also can play a role in edema. If no underlying cause has been identified, these cases often resolve without causing harm through the use of simple treatments such as elevating the feet, adjusting your diet by consuming less salt or working with your doctor to switch drugs.

Greater problem In some cases, edema may be a sign of more-serious medical conditions, including: ■ Blood clots — Deep vein thrombosis can impair blood flow in the legs, causing pressure buildup. This may be especially suspected if swelling occurs only in one leg. ■ Heart failure — Many things can cause the right side of the heart’s pumping system to weaken, losing its ability to effectively pump blood. This creates back pressure in the leg veins, leading to swelling. It is often accompanied by shortness of breath. ■ Liver damage (cirrhosis) — When liver tissue is damaged, levels of important proteins — such as albumin — that are manufactured in the liver may decrease, leading to edema. The flow of blood through the liver can get backed up and increase pressure on blood vessels. Swelling caused by liver damage often first occurs in the abdomen and is called ascities (uh-SI-teze). ■ Kidney disease — Damaged kidneys may not properly remove water and sodium from your blood. In addition, damaged kidneys may July 2008

filter out too much albumin from the blood. Having a low albumin level in the blood can let fluids leak from blood vessels. Kidney problems often result in swelling throughout the entire body. Many other problems are less common causes of edema, including tumors, heart conditions such as cardiomyopathy or pericarditis, an overactive or underactive thyroid, and malnutrition or the inability of your intestines to properly absorb nutrients (malabsorption).

Should you see your doctor? Most ordinary episodes of edema are short-lived and have a cause that you may be able to identify, such as sitting for a long time or eating a salty meal. If the swelling isn’t accompanied by other signs and symptoms, and it goes away within about 24 hours, MAYO CLINIC HEALTH LETTER Managing Editor Aleta Capelle

Medical Editor Robert Sheeler, M.D.

Associate Editors Carol Gunderson Joey Keillor

Associate Medical Editor Amindra Arora, M.D.

Medical Illustration Michael King Customer Service Manager Ann Allen

Editorial Research Deirdre Herman Proofreading Miranda Attlesey Donna Hanson Administrative Assistant Deborah Adler

EDITORIAL BOARD Shreyasee Amin, M.D., Rheumatology; Amindra Arora, M.D., Gastroenterology and Hepatology; Brent Bauer, M.D., Internal Medicine; Tracy Berg, R.Ph., Pharmacy; Julie Bjoraker, M.D., Internal Medicine; Bart Clarke, M.D., Endocrinology and Metabolism; William Cliby, M.D., Gynecologic Surgery; Diane Dahm, M.D., Orthopedics; Mark Davis, M.D., Dermatology; Timothy Hobday, M.D., Oncology; Lois Krahn, M.D., Psychiatry; Michael Mahr, M.D., Ophthalmology; Lance Mynderse, M.D., Urology; Suzanne Norby, M.D., Nephrology; Robert Sheeler, M.D., Family Medicine; Phillip Sheridan, D.D.S., Periodontics; Peter Southorn, M.D., Anesthesiology; Ronald Swee, M.D., Radiology; Farris Timimi, M.D., Cardiology; Aleta Capelle, Health Information. Exofficio: Carol Gunderson, Joey Keillor. Mayo Clinic Health Letter (ISSN 0741-6245) is published monthly by Mayo Foundation for Medical Education and Research, a subsidiary of Mayo Foundation, 200 First St. SW, Rochester, MN 55905. Subscription price is $27 a year, which includes a cumulative index published in December. Periodicals postage paid at Rochester, Minn., and at additional mailing offices. POSTMASTER: Send address changes to Mayo Clinic Health Letter, Subscription Services, P.O. Box 9302, Big Sandy, TX 75755-9302.

you probably don’t need to visit your doctor. However, longer lasting or recurring edema — even if it’s fairly slight — typically warrants a visit with your doctor. In addition, seek prompt medical care if leg swelling is sudden, painful, in only one leg, warm or inflamed, or is accompanied by fever, shortness of breath or chest pain.

Wringing it out If the cause of your edema can be identified, treatment often involves treating the underlying cause. Edema itself can be treated with: ■ Sodium restriction — Reducing consumption of salt, and thus the sodium that it contains, is the mainstay of edema therapy, and helps decrease the amount of fluid that your body retains. ■ Diuretic drugs — One or more of these may be prescribed to increase your kidneys’ output of water and sodium. However, diuretics won’t have their full effect if you’re also eating a diet high in sodium. They’re also not as effective for those with edema due to venous insufficiency, lymphatic insufficiency or deep vein thrombosis. Additional measures that your doctor may recommend include: ■ Exercise — Moving and using the muscles of the affected area can help blood and body fluids circulate back to the heart. However, exercise can also increase the amount of fluid that leaks into your tissues across blood vessel walls. Therefore, it’s important to seek medical advice if your swelling becomes worse with exercise. ■ Elevation — Elevating the affected limb above the level of your heart for about 30 minutes, up to three times a day — or for longer periods while sleeping — helps blood and excess fluids circulate back to the heart. ■ Compression stockings or elastic bandages — These keep pressure

Health tips

Fluid movement

What to eat when your system is upset Lymph nodes in arm Fluid movement can be blocked after lymph node removal

Lymph node removed causing edema A type of edema called lymphedema occurs when lymph channels are unable to properly remove fluid. In the United States, lymphedema most commonly occurs after a lymph channel has been damaged due to lymph node removal or radiation treatment during the course of treating cancer.

on your limbs to prevent fluid from collecting in tissue. As a preventive measure, these are most effective if you put them on before you get out of bed in the morning. Unless you’re instructed otherwise, it’s usually best to keep the stockings or bandages below the knees.

Don’t let it linger No matter the cause of your edema, it’s best not to let the swelling go unchecked. Long-standing, untreated edema can become painful and uncomfortable, causing itchy rashes and reddish-brown skin discoloration. It can also lead to permanent stiffening of tissues in the affected area, as well as increasing the risk of infection and sores that won’t heal. The risk of these complications rises if diabetes, cancer or immunesuppressing drugs impair your ability to heal wounds. ❒ July 2008

After gastrointestinal (GI) system upset — such as vomiting or diarrhea — the following may be helpful: ■ Stay hydrated — Take small sips of beverages that contain no caffeine — try clear soft drinks, such as ginger ale or a lemon-lime soda, or sports drinks, which may also help replenish your body’s electrolytes. For the first hour or so, wait 15 minutes between sips to see if your system is settled enough to take another sip or two before increasing amounts. Don’t drink diet beverages or plain water. ■ Introduce bland foods — If you’re doing OK with liquids, slowly introduce solids. Start with simple crackers, such as soda crackers, and dry toast. If these seem agreeable, you might work your way up to eating a plain baked potato, rice, banana, applesauce or pretzels. ■ Hold off on certain foods until you’re feeling better — Avoid spicy foods. Foods high in fat, such as doughnuts, pastries and butter, or high in protein, such as meat, cheese and eggs, are best avoided until you’re noticeably improved. Avoid milk or milk products until a few days after you’re feeling better. GI upsets can deplete your GI system of enzymes needed to digest milk. Given a little time, these enzymes can generally be re-established in your system. ❒

www.HealthLetter.MayoClinic.com

3

News and our views Exercise — even without much weight loss — benefits heart It seems counterintuitive: You exercise regularly in hopes of losing weight, but the scale just doesn’t reflect your hard efforts. So is exercise a waste? Not in terms of heart health. What the scale can’t measure are reductions in other cardiovascular risk factors — particularly a reduction in inflammatory markers in the blood and an improvement in blood pressure. Those factors, according to a recent study, are where the payoff from regular exercise is really visible in terms of reducing risk of cardiovascular disease. The study found that together they accounted for 60 percent of the risk reduction. In terms of weight, body mass index (BMI) changes were only responsible for 10 percent of the reduced risk. The study, published in the November 2007 issue of Circulation, a Journal of the American Heart Association, evaluated the exercise habits of more than 27,000 women age 45 and older. When the study began, none of the women had cardiovascular disease. Participants provided blood samples and regularly filled out questionnaires on their physical activity over the course of more than 10 years. Researchers found that even moderate physical activity — burning at least 600 calories a week, which is the equivalent of walking 20 minutes a day at a brisk pace — was associated with a cardiovascular risk reduction of 30 to 40 percent. ❒

Larger waistline equals greater risk of Alzheimer’s later Carrying excess fat around your abdominal organs — in other words, having a “belly” — greatly increases your risk of developing a number of diseases. According to a study published in the March 26, 2008, online issue of Neurology, you can now add dementia to that list. The study involved about 6,500 middle-aged adults from California who about 40 years ago had the diameter of their bellies measured. Those with larger bellies were considered to have central obesity. By the time members of this group reached their 70s and 80s, about 16 percent had been diagnosed with dementia. Compared with those who were a healthy body weight and without central obesity, those who were overweight or obese — but didn’t have central obesity — had an 80 percent higher risk of dementia. But for those who were overweight and also had central obesity, dementia risk was 234 percent higher. For those who were obese and also had central obesity, dementia risk was 360 percent higher. Several factors may contribute to this increase in risk. It’s possible that central obesity has a particular role in promoting brain disease. But Mayo Clinic experts suspect that larger bellies — generally those with waists more than 40 inches around for men and 35 inches around for women — may be an outward sign of other dementia risk factors such as diabetes, sedentary lifestyle and an unhealthy diet. Exercise, in particular, has been shown to significantly reduce dementia and Alzheimer’s risk even when begun late in life. ❒

4

www.HealthLetter.MayoClinic.com

July 2008

Chronic inflammation For some, a cardiovascular risk If you’ve had a cut or skin abrasion that’s become swollen and red, even warm — all typical of acute inflammation — then you’ve watched your body’s natural defenses in action. With time and proper care, your body’s immune system settles things down and returns them to normal as the injury heals. Problem solved. There’s another type of inflammation that’s attracting attention in the medical community. Low-grade inflammation (chronic inflammation) plays a part in many disorders affecting different areas of the body. It’s a long list, and it includes cardiovascular disease. Chronic inflammation’s relationship to cardiovascular disease is on the order of the chicken-andegg question. Does smoldering inflammation cause the buildup of fatty deposits in arteries (atherosclerosis), or is the inflammation simply part of the disease process of atherosclerosis itself? Although the answer is uncertain, there are some steps you can take to possibly reduce your risk of vascular inflammation.

Tubular trouble Under normal circumstances, blood flows unimpeded through the body’s vascular system. However, for reasons that aren’t always clear, it’s thought that atherosclerosis may begin with damage or injury that occurs in the inner layer of an artery. Any number of factors may play into the initial artery wall damage, including high blood pressure, high cholesterol levels, diabetes or even an irritant such as nicotine. There’s

even research indicating bacterial or viral infection may contribute to or possibly cause atherosclerosis. Whatever the cause, once the artery wall is damaged the inflammatory response kicks into gear and white blood cells are attracted to the injured artery site where they enter the arterial wall as part of the repair process. Over time, fatty deposits (plaques) also accumulate and harden, narrowing the artery space. It’s thought that inflammation factors may also contribute to the eventual rupture of plaques into the bloodstream. The result may be a clot that leads to a heart attack or damage to another organ in the

body, such as the brain, where a clot can cause a stroke.

A measure of inflammation After you cut your hand, signs of inflammation are pretty straightforward and even visible. Is there a way to identify inflammation associated with atherosclerosis? One measure that’s generated considerable interest is C-reactive protein (CRP). This protein circulates in the blood and is produced by the liver as part of your immune system response to injury or infections. It’s also produced by muscle cells in the arteries that supply blood to the heart (coronary arteries).

Lifestyle choices that may increase inflammation Can you influence your potential risk of chronic inflammation? In some respects, it appears you can — certain dietary and lifestyle choices are associated with increased chronic inflammation. With that in mind, here are some lifestyle choices that are best avoided: ■ Excessive alcohol intake

Smoking ■ A diet high in saturated fats (primarily animal fats) and trans fats (hydrogenated or partially hydrogenated oils) ■ A diet high in foods that can be quickly converted by the body to glucose (high glycemic index foods), such as white breads, potatoes and pastries ■

Lifestyle choices that may reduce inflammation Just as lifestyle choices can increase inflammation, they can also help reduce it. Here are some choices that may help curb or reduce risk of chronic inflammation: ■ Choosing monounsaturated fats — such as olive oil and canola oil — over other, less healthy fats ■ Aiming for or maintaining a healthy body weight because high levels of inflammatory marker C-reactive protein (CRP)

are associated with obesity and are known to go down with weight loss ■ Eating whole grains, legumes, nuts, and a variety of fruits and vegetables ■ Eating fatty fish, such as salmon and mackerel, which are high in omega-3 fatty acids ■ Consuming alcohol in moderation may lower CRP ■ Staying physically active –– lower CRP numbers are associated with physical fitness

July 2008

Although CRP can be measured with a simple blood test, interpreting the results is less certain. Elevated CRP is a sign that inflammation is present somewhere. A more sensitive test of CRP levels may be used if other risk factors for heart disease are present. The test is called a high-sensitivity C-reactive protein (hs-CRP) assay, and it may provide additional predictive information about the risk of heart disease. Factoring in hs-CRP test results with other blood tests and your risk factors for heart disease can help create an overall picture of your heart health. Studies have found that high levels of hs-CRP in people who have already had a heart attack may indicate increased risk of another heart attack. In addition, studies have also found that the higher the levels of hs-CRP in this group of people, the lower the survival rates if another heart attack does occur. In addition to these risk factors, studies also indicate that higher levels of hs-CRP may be associated with any of the following: ■ Increased risk of re-closure (restenosis) of coronary arteries after angioplasty ■ Increased risk of stroke recurrence ■ Repeat episodes of peripheral arterial disease (PAD), causing arteries that supply blood to your legs to become clogged or partially blocked

Bottom line The American Heart Association isn’t recommending CRP screening for the general public. But its recommendations do direct doctors to measure CRP levels in people who are considered to be at intermediate risk of heart disease. Elevated CRP levels for those at intermediate risk may suggest a need for aggressive treatment of established risk factors for heart disease. ❒ www.HealthLetter.MayoClinic.com

5

Just desserts Tasty and healthy In a diet-focused culture, desserts often get a bad rap. But some desserts, such as a bowl of plump blueberries served with luscious lemon cream, can actually be good for you. Healthy and flavorful desserts can add a new dimension to a balanced meal — one you may have been missing for too long.

Blueberry and lemon cream parfait Ingredients 6 ounces low-fat, vanilla yogurt sweetened with low-calorie sweetener 4 ounces fat-free cream cheese 1 teaspoon honey 2 teaspoons freshly grated lemon zest 3 cups fresh blueberries, lightly rinsed Directions Drain the liquid from the yogurt. In a medium bowl, combine the yogurt, cream cheese and honey. Use an electric mixer to beat at high speed until the mixture is light and creamy. Stir the lemon zest into the mixture. Layer the lemon cream and blueberries in dessert dishes or wineglasses. If not serving immediately, cover and refrigerate. Makes four servings. Nutritional analysis (per serving): Calories 121, carbohydrates 22 grams (g), fat 1 g, saturated fat 0.3 g, monounsaturated fat 0.4 g, protein 6 g, cholesterol 3 milligrams (mg), dietary fiber 3 g, calcium 125 mg, potassium 229 mg, sodium 180 mg

6

www.HealthLetter.MayoClinic.com

Dessert naturals When it comes to healthy ingredients for an after-dinner treat, fruit is ideal. Fruits are nature’s natural sweetener. Take advantage of in-season favorites for flavorful punch, and go for variety. Frozen fruits — preferably not in syrup — and even canned fruits in natural fruit juices can be a perfect ending to a meal. If you like a little cream with your fruit, try substituting a dollop of fat-free plain or vanilla yogurt. If you like nuts, use them in small quantities as a flavorful dessert condiment. Not only do they generally pack in a good amount of nutritious omega-3 fatty acid, but they also provide added protein. Consider embellishing with walnuts, pecans or almonds, but savor nuts in small quantities. A little goes a long way as far as calories are concerned. Warming them lightly in a pan — just until they give off a toasted aroma — intensifies their flavor.

Chocolate twists And what about chocolate? If you can’t resist, you might indulge yourself with an individually wrapped square of your favorite type — the darker the better when it comes to antioxidant content. When grated, a small amount provides intense flavor as a dessert topping. Flavored chocolates can be sweet, savory and even spicy hot. You can literally explore the world by trying the many different chocolates available. Recipe calls for: Whole milk Evaporated milk Sour cream Cream cheese Butter, shortening or oil

July 2008

In the case of baked goods, you may find that some of your favorite recipes can be remade using much less fat and sugar. Modifications that work for many recipes include: ■ Reducing the sugar by onethird to one-half. ■ Enhancing the sweetness by increasing the amount of vanilla, cinnamon or nutmeg. ■ Reducing the fat by one-third to one-half. ■ Using reduced-fat or fat-free ingredients instead of high-fat products. However, fat-free sour cream and fat-free cream cheese aren’t intended for baking, and results may not be satisfactory.

A few short takes Grilling out tonight? Sweeten the end of your meal with grilled fruit slices. Cut apples, pineapple, pears or peaches into chunks. Brush them lightly with canola oil and sprinkle with cinnamon. You can slide the fruit onto skewers, or wrap it in foil, and then grill it over low heat for three to five minutes. If fruit dips are more to your liking, mix together 1/2 cup of low-fat, sugar-free lemon yogurt, 1 teaspoon fresh lemon juice and 1 teaspoon lime zest. Serve cold as a dip for fruits such as grapes or sliced strawberries, pineapple, kiwi or bananas. If you enjoy smoothies, try a blueberry-banana version. In a blender, add two fresh or frozen bananas, 1/2 cup fresh or frozen blueberries, and 1 cup low-fat vanilla yogurt. Blend until smooth. ❒

Try substituting: Fat-free, 1%, 2% or evaporated milk Evaporated fat-free milk Fat-free plain yogurt or low-fat sour cream Light cream cheese or low-fat cottage cheese puréed until smooth (When baking) half the fat with an equal amount of applesauce, mashed banana, prune purée or commercial fat substitute

Osteoporosis quiz A question of bone health Osteoporosis is a disease that causes your bones to become weak, brittle and prone to fracture. Bone loss that leads to osteoporosis can often be slowed by getting adequate calcium and vitamin D, engaging in weight-bearing exercise and strength training, limiting alcohol consumption and, if you smoke, stopping. For some, certain medications can help slow, stop or even reverse the course of osteoporosis. Test your osteoporosis knowledge:

True or false? 1. Being overweight reduces your risk of osteoporosis. 2. Taking testosterone isn’t effective at warding off osteoporosis in older men. 3. Taking a prescription osteoporosis drug doesn’t take the place of adequate calcium intake. 4. Good results from a bone density test at age 60 basically puts you in the clear in terms of osteoporosis risk.

The answers: 1. True. The hormone estrogen plays an important role in the development and maintenance of bone density. Fat tissue produces estrogen, even if you’re postmenopausal — or a man. In addition, weight has a powerful impact on bone mass. Because weight increases the load on your skeleton, your bones compensate by growing stronger to support the weight. However, this isn’t an excuse to gain weight or not lose weight if you’re overweight. The risks to your overall health from being overweight or obese far outweigh the small gain of reduced osteoporosis risk.

The take-home message is that thinner or smaller adults — in other words, those who have weighed less than 127 pounds for much of their life — tend to have lower bone density. This group may want to place extra emphasis on weight-bearing exercises such as walking or jogging to increase their skeletal load. In addition, thinner or smaller women may want to have bone density screening before menopause if they’ve had past fractures or strong risk factors for osteoporosis. It’s recommended that most women first get screened for osteoporosis after menopause. 2. False. Men with very low testosterone levels (hypogonadism) are at increased risk of osteoporosis and may be able to improve their bone density with testosterone replacement. In addition, testosterone replacement may help men with low testosterone gain muscle strength, which may help reduce the risk of falling. Testosterone appears to be an important factor in the development and maintenance of bone strength in men, although the exact way this occurs is unclear. Yet, as men age, their bodies naturally produce less testosterone, although the rate of this decline varies greatly. If your testosterone levels are low, you and your doctor may want to weigh the potential benefits of testosterone replacement against potential risks, such as increased cholesterol levels or increased risk of prostate cancer or heart disease. 3. True. No osteoporosis drug will help shore up weak bones if you’re not getting adequate daily calcium. You also need vitamin D to help your body absorb calcium. In the battle against bone loss, calcium is the brick and the osteoporosis drug is the mortar. The drug helps hold the bricks together, but without bricks, the mortar is useless. Take your prescription osteoporosis medication in addition to July 2008

the recommended amounts of calcium and vitamin D given by your doctor. For postmenopausal women and men over 65 who have osteoporosis, it’s reasonable to have a total intake of 1,500 milligrams of calcium a day through your diet and supplements, taking in no more than about 500 milligrams at a time. Getting about 800 to 1,000 international units of vitamin D is a typical daily goal. 4. False. A test showing strong bones at age 60 is great, but any bone density test is just a snapshot in time. That’s because bone tissue continuously changes. New bone is made and old bone is replaced in a process called remodeling. After about age 30, the remodeling process causes you to lose slightly more bone than you gain. For women, bone loss results from the dramatic decrease in estrogen production by the ovaries after menopause. Although you may still have fairly strong bones at age 60, bone loss continues. It may even be accelerating, because as you age, vitamin D isn’t produced as well by skin from sunlight exposure. In addition, calcium isn’t as well absorbed from the small bowel and isn’t retained as efficiently by the kidneys. Even if your bone density was normal at the initial test, plan to be retested in about five years. Your doctor may recommend more frequent testing if you have one or more osteoporosis risk factors. These include having had a past fracture or a family history of hip fracture or osteoporosis. Other risk factors include taking certain medications such as corticosteroids, some antiseizure drugs and blood thinners, and several strong blood pressure drugs in the diuretic class, such as furosemide (Lasix). In addition, osteoporosis may be associated with thyroid diseases, rheumatoid arthritis and type 1 diabetes — and with poor health habits. ❒ www.HealthLetter.MayoClinic.com

7

Second opinion Questions and our answers Q: Can Viagra really cause hearing and vision loss? If so, is this a reason to avoid using it? A:

In a few instances, men have experienced a sudden decrease or loss of vision or hearing — typically in one eye or in one ear — after taking certain erectile dysfunction drugs, such as sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra). However, these incidents have been so uncommon that a direct link between these drugs and hearing or vision loss hasn’t been established. With vision loss, virtually all known cases have occurred in men who had cardiovascular risk factors — such as high blood pressure or diabetes. Even without taking these drugs, these men were already at risk of an uncommon condition that results in a sudden decrease or loss of vision due to blocked blood flow to the optic nerve. If a man has experienced a sudden loss or decrease in vision in one or both eyes, an evaluation by an ophthalmologist is appropriate before sildenafil, tadalafil or vardenafil is prescribed. An ophthalmologist can evaluate the relative risk of any further vision loss. So far, there’s no common denominator among men who have experienced sudden hearing loss in conjunction with the use of erectile dysfunction drugs. The potential risk of hearing or vision loss is so small that most men don’t need to avoid these drugs.

However, sudden vision or hearing loss from any cause requires prompt medical attention. If you’ve experienced sudden hearing or vision loss in one ear or one eye — whether it seemed to coincide with taking an erectile dysfunction drug or not — it’s probably best to talk to your doctor about your other options for treating erectile dysfunction. ❒

Q: Do mushrooms have any nutritional value? A:

Yes, they do. Although mushrooms are often considered just a flavor enhancer, they are actually quite nutritious. For starters, mushrooms are low in calories, and have virtually no fat, cholesterol or sodium. Putting a grilled portobello mushroom in your hamburger bun in place of an equivalent-sized, 95 percent lean hamburger patty is a great way to make a meal healthier, yet still satisfying. In addition, mushrooms contain a surprising array of nutrients. In a dish or stir-fry containing 1 cup of chopped, white, raw mushrooms, the mushrooms will contribute about 2.2 grams of protein, almost a gram of fiber and modest amounts of several minerals, including potassium and selenium. As for vitamins, mushrooms contain fair amounts of niacin and riboflavin. Laboratory studies have shown that phytochemicals and other bioactive substances in several common varieties of mushroom may have anti-cancer properties.

Use the above chart to compare the amounts of select nutrients contained in 1 cup of chopped, raw broccoli — a notoriously nutritious vegetable — with 1 cup of chopped, white, raw mushrooms. ❒ Have a question or comment? We appreciate every letter sent to Second Opinion but cannot publish an answer to each question or respond to requests for consultation on individual medical conditions. Editorial comments can be directed to: Managing Editor, Mayo Clinic Health Letter, 200 First St. SW, Rochester, MN 55905, or send e-mail to [email protected] For information about Mayo Clinic services, you may telephone any of our three facilities: Rochester, Minn., 507-284-2511; Jacksonville, Fla., 904-953-2000; Scottsdale, Ariz., 480-301-8000 or visit www.MayoClinic.org

Check out Mayo Clinic Health Solution’s Web site, at www.MayoClinic.com

Copyright

Mailing lists

Customer Services

Purpose

Correspondence

© 2008 Mayo Foundation for Medical Education and Research. All rights reserved.

We make our Mayo Clinic Health Letter mailing list available to carefully selected companies and organizations. If you do not wish to receive such mailings, please write us at the address shown at right and enclose your mailing label.

For subscription information from locations within United States and Canada, call Customer Services at: 866-516-4974. From other countries call: 903-636-9029. Subscription prices in United States: $27; in Canada: $45; all other countries: $46 (U.S.). Single copies are available for $4 plus shipping, handling and taxes. Proceeds, after expenses, help strengthen Mayo Clinic programs in medical education and research.

To help our subscribers achieve healthier lives by providing useful, reliable, easy-to-understand health information that’s timely and of broad interest.

Send subscription inquiries to:

MAYO, MAYO CLINIC, MAYO CLINIC HEALTH SOLUTIONS, the triple-shield Mayo logo, and TOOLS FOR HEALTHIER LIVES are marks of Mayo Foundation for Medical Education and Research.

8

www.HealthLetter.MayoClinic.com

July 2008

Mayo Clinic Health Letter supplements the advice of your personal physician, whom you should consult for personal health problems. We do not endorse any company or product.

Mayo Clinic Health Letter Subscription Services P.O. Box 9302 Big Sandy, TX 75755-9302 MC2019-0708 100708

Printed in the USA