Health Report:
Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough
Acupuncture & Hot Flashes in Women with Breast Cancer
Physical Activity & the Risk of Death
Mediterranean Diet & Mortality

By, Robert A. Wascher, MD, FACS


"A critical weekly review of important new research findings for health-conscious readers..."


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Last Updated: 12/16/2007

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author.  Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.

HONEY vs. DEXTROMETHORPHAN vs. NO TREATMENT FOR KIDS WITH NIGHT-TIME COUGH

Recent research has suggested that over-the-counter cough and cold medicines may potentially cause more harm than benefit, especially in younger children.  Based upon recent compelling research, long-time manufacturers of these children’s drugs are, increasingly, withdrawing them from the market, fearing increased exposure to liability in the aftermath of research calling into question the safety and efficacy of these products.  But staying up all night with a sick little one who cannot sleep because they cannot stop coughing is a trying experience for both parents and the sick child.

In this study, just published in the Archives of Pediatric & Adolescent Medicine, 105 children, ages 2 to 18, with upper respiratory infections were given either honey, honey-flavored dextromethorphan (a cough suppressant), or no treatment at all 30 minutes before bedtime.  The children and parents receiving the honey and dextromethorphan were not told which of these two interventions their children were assigned to receive.  A survey was administered to all parents, asking them to assess their children’s coughing over two consecutive nights.

Based upon the assessments of their parents, children receiving honey alone experienced the greatest relief of their night-time coughing when compared to dextromethorphan or no treatment.  In fact, no difference was observed between those kids receiving dextromethorphan and those who received no treatment at all.  While the results of this study are based upon the subjective assessment of their parents, it does at least offer parents a safe and possibly effective alternative to the increasingly questionable (and increasingly less available) over-the-counter cough and cold medications that most of us have used for years.  In fact, I intend to try a little honey in our home the next time one of our younger children develops a respiratory infection with a cough.  (Please remember, however, that honey should not be given to any child under the age of 12 months; and that any child with symptoms of a respiratory system lasting more than 48 hours, or associated with a fever greater than 101.5 degrees, or with yellow- and green- colored sputum, should be seen by a pediatrician.)

 

ACCUPUNCTURE & HOT FLASHES IN WOMEN WITH BREAST CANCER

Women undergoing treatment for breast cancer often experience symptoms of menopause, either due to the loss of ovarian function from chemotherapy, or as a side effect of drugs used to block receptors for the female hormone estrogen.  Physicians and patients are increasingly reluctant to use hormone replacement therapy (HRT) to treat these symptoms, in light of recent research demonstrating an increased risk of developing breast cancer and stroke among women taking certain combinations of HRT.  

Numerous prescription and non-prescription remedies have been proposed for hot flashes, the most troubling symptom associated with menopause.  Primrose oil, flaxseed, black cohosh, soy products, antidepressants, and other treatments have been touted by various advocates, with variable success.  A new research paper, just published in the Journal of Clinical Oncology, reports on the study of acupuncture as a possible treatment for hot flashes in women with breast cancer.  A total of 72 women enrolled in the study, and were subjected either to acupuncture or to simulated acupuncture by a licensed acupuncture therapist. 

This study revealed a rather modest improvement in the frequency of hot flashes following acupuncture, although patients receiving the simulated acupuncture appeared to experience approximately the same modest level of benefit as was seen in the acupuncture group. 

This study involved only a small number of patients, and so it is difficult to categorically state whether or not acupuncture is beneficial in the treatment of hot flashes in women undergoing treatment for breast cancer.  Moreover, the small but comparable improvement seen in both groups of women in this study actually suggests that the subjective reduction in the number of hot flashes experienced by these women was most likely due to a well-known phenomenon known as the “placebo effect,” and not because acupuncture, itself, was an effective treatment.  Perhaps larger studies, in the future, might still uncover evidence of a beneficial effect with acupuncture.  Based upon the modest findings of this small study, however, it is difficult to ascribe any significant effects of acupuncture on menopause-associated hot flashes at this time.

 

PHYSICAL ACTIVITY LEVELS & THE RISK OF DEATH

Current health guidelines recommend at least 30 minutes of moderate physical activity 4 to 5 days per week, or at least 20 minutes of vigorous exercise 3 times per week.  However, the true impact of these guidelines on morality risk, when they are followed, is not clear.  A new study, just published in the Archives of Internal Medicine, attempts to address this very issue.  Over 250,000 retirees (ages 50 to 71) participated in this long term National Institutes of Health-American Association of Retired Persons Diet & Health Study.  Upon entering this study, all participants completed an extensive questionnaire regarding their dietary and exercise habits.  The study volunteers were then closely observed over time.

Based upon the data collected so far, increased levels of physical activity appeared to be linked with improved survival in this large group of retired folks.  Among those participants reporting at least 30 minutes of moderate physical exercise on most days of the week, the relative risk of dying during the course of this study was 27% less than was observed among people who were mostly inactive.  Similarly, those who engaged in vigorous exercise for at least 20 minutes, 3 times per week, experienced a 32% relative reduction in the relative risk of death when compared to their sedentary fellow retirees.  For those retirees who combined moderate daily exercise with at least 20 minutes of vigorous exercise 3 days out of every week, the reduction in mortality was even greater, reaching a 50% reduction in the relative risk of dying from any cause when compared to inactive retirees.  On the other hand, even those people who engaged in some level of mild-to-moderate exercise, even if it did not meet either of the recommended exercise guidelines, still appeared to obtain a survival benefit, achieving a 19% reduction in the relative risk of death!

This study appears to corroborate previous data linking regular and frequent exercise with a reduction in the risk of dying from cardiovascular disease and cancer (the two most common causes of death in the developed world).  One potential weakness of this epidemiological study, however, is that it does not clearly identify co-existing illnesses that might have contributed to increased levels of inactivity among this large group of older persons.  For example, people with serious or life-threatening illnesses tend not to be as physically active as otherwise healthy people.  Obviously, if reduced levels of exercise are the direct result of serious co-existing ailments, then one would expect to see an increased mortality rate in this group of study participants based upon their serious illnesses, primarily, rather than their lack of exercise alone. 

 

MEDITERRANEAN DIET & MORTALITY

The generally lower risk of death due to cardiovascular disease in Mediterranean Europe, when compared to the rest of the developed world, has often been attributed to differences in diet and, specifically, to the beneficial effects of the so-called Mediterranean Diet.  Features of the Mediterranean Diet include vegetables (not including potatoes or other starchy vegetables), fruit, nuts, whole grains, fish, unsaturated fats (think olive oil, here), and alcohol taken in moderation.  At the same time, this regional diet includes lesser amounts of dairy products and red meat than is typical in other western cultures.  People who adhere to the Mediterranean Diet generally have lower levels of cholesterol in their blood, and have a lower incidence of obesity when compared to those who indulge in the high-calorie, high-fat diet that is so familiar to most of us here in the United States.

A new study, in the Archives of Internal Medicine, takes a look at the health impact of the Mediterranean Diet in the United States.  In fact, the data used for this study was collected from the very same National Institutes of Health-American Association of Retired Persons Diet & Health Study discussed above.  During the 5 years of data collection for this study (encompassing 214,284 men and 166,012 women), 27,799 deaths occurred among study participants, and the causes of these deaths were analyzed.  When the researchers separated out those study participants who followed the Mediterranean Diet and those who did not, some interesting results were identified.

Among the men who followed the Mediterranean Diet, the overall risk of death due to all causes, the risk of death due to cardiovascular diseases, and the risk of death due to cancer, when compared to men who did not follow the Mediterranean Diet, was reduced by 21%, 22%, and 17%, respectively.  Similar findings were found among women participants favoring a Mediterranean Diet, ranging from a 12% reduction in deaths due to cancer, up to a 20% reduction in deaths due to any cause.

Multiple other studies have come to similar conclusions, particularly after comparing US populations with Mediterranean populations.  This is one of the few studies that has looked at followers of the Mediterranean Diet in the US, and compared them with “non-followers” in the same country. 

 

Eat healthy and exercise at least moderately… these are the fundamental lessons of the last two studies presented here today.

 


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

 


Dr. Robert Wascher is an oncologic surgeon, professor of surgery, and a widely published author.  He is the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center. 

Send your feedback to Dr. Wascher at rwascher@doctorwascher.net
 


http://www.sbhcs.com/hospitals/newark_beth_israel/mservices/oncology/surgical.html
  


Copyright 2007.  Robert A. Wascher, MD, FACS.  All rights reserved.


Dr. Wascher's Archives:
12-11-2007:  Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease

12-2-2007:  Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer 



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