Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

Aquatic water therapy for chronic pain: Myth or reality?

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AQUATIC THERAPY FOR PAIN: Fact or fiction Author: Anil Minocha of Shreveport, LA

Aquatic therapy also known as Water aerobic therapy or pool therapy refers to the physical therapy and rehabilitation performed in water without the need for weights.

• Scientific data and expert opinions indicate that it provides therapeutic benefit in fibromyalgia. 
• Aquatic therapy has potential for benefit in patients with other types of chronic pain disorders and cancer and neuro-rehabilitation.
• Human trials suggest that aquatic therapy also provides short-term benefit in patients with osteoarthritis.

A variety of hydrofitness devices are available and can be individualized.

Principles of aquatic or water therapy

Water provides resistance and is believed to be healthier than the use of weights. The hydrostatic pressure produces forces perpendicular to the bodys surface Water buoyancy helps support the weight of the patient.

The combination of water resistance and  buoyancy reduces weight bearing and stress placed on the joints allowing low impact exercises with reduced joint stress as compared to exercises on land.

A decrease in stress on joints makes it easier for patients to get benefits of exercise with lesser pain/stress.

Types of aquatic therapy

Water enthusiasts have many options regarding not only depth of water, i.e.shallow versus deep water therapy but also the format of exercises that they may enjoy and find easy to perform consistent with their health. Various types of aquatic therapy are available:

Ai Chi: Developed by Jun Konno of Japan, it combined deep breathing associated with slow movements of limbs and torso. 

Ai Chi Ne: This is a partner requiring 2-person exercise program involving breathing and stretch exercises.

BackHab: This may be undertaken as an individual or a group. It is specially tailored for patients with physical impairments including back problems. It includes walking in water and a variety of limb movements tailored to the patient’s health problems.

Bad Ragaz: Initially developed in Germany, it is described as  the Bad Ragaz Ring Method targeting  muscle re-education via utilizing particular ways of resistance, endurance, and  range of motion.

The Burdenko Method: The Burdenko Method combines land and water exercise therapy for athletic training as well as physically challenged subjects.

Feldenkrais: Created by nuclear physicist Moshe Feldenkrais, it is based on principle that our movements etc depend upon the way we think and feel. Thus exercises of combining breathing and flexibility of movement are undertaken in context of awareness of old patterns and concerted effort to modify them to improve the overall other aspects of life. Touch and tissue manipulation by the therapist may be involved.

Halliwick: It is a 10-point program of motor learning and mental adjutments that specializes in teaching patients with a variety of physical or mental disabilities to get involved with water activities exercises with the goal of getting them to move about and swim in water independently in water, and to swim.

Wassertanzen: Wassertanzen means water dance. This type of aquatic therapy is a dynamic movement therapy that involves exercises below the water surface utilizing nose clips. This form of therapy is unique in the sense that it involves the patient surrendering control of his/her breath to go under water.

Water Yoga: Yoga exercises are performed with subject in waist- to chest-depth water. 

Watsu: Created by Harold Dull, watsu as the name suggests is a combination of water and shiatsu wherein the subject is held in warm water by the therapist and moved around using water resistance as the source of massage. Watsu aims to integrate massage, muscle stretching and dance. It has been described as especially suited for elderly and pregnant.

Yogalates: It uses a combination of yoga, Pilates, and Ai Chi. 

Miscellaneous aquatic therapies: Other modifications/styles include Lyu Ki Dou and Water Pilates

Contraindications to aquatic/water therapy

• Significant cardiac or respiratory disease
• Fever and active  infections
• Urinary or stool incontinence
• Consult your physician prior to any exercise program 

Significance in of aquatic therapy in health and sickness

• While there is lack of data on the role of aquatic therapy in digestive health, data on its beneficial effect in chronic pain disorders like fibromyalgia indicates that it may have potential for therapeutic benefit in chronic functional bowel disorders. 
• Randomized controlled trials indicate that an exercise program thrice a week in a warm pool improves symptoms of fibromyalgia.
• Thomas and Blotman conclude that aerobic-only exercise provides improves physical function and may be therapeutic for tender points and pain in fibromyalgia.

Bottomline: Aquatic therapy is well suited for healing as well as health maintenance for diverse patient populations. Besides wide margin of therapeutic safety, the therapist can easily develop a specifically targeted therapeutic program for diverse clinical conditions.

An interesting topic: Is fasting good or bad for health?

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Prevent motion sickness during travel

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Thanks to globalization, the world is a small place and getting smaller everyday. As the socioeconomic status of people improves, they tend to travel far and wide (driving, sea voyage and flying), both for business and pleasure.

Whether it is driving long distance, sea journey or flying, one must be aware of health risks associated with travel.  Many of these risks can be ameliorated by being proacative. Motion sickness also known as travel sickness is one of them.

Following is a list of some of measures you may take to prevent motion sickness:

1. Minimize motion effect and thus risk of motion sickness by positioning yourself at the site of least shakiness or motion. The possibilities of least motion include getting a room in the middle of ship or having a seat over the wings in the airplanes.

2. Try taking a nap rather than reading.

3. Abstain from alcohol intake! Alcohol induced nausea, vomiting will only add on to risk effect of motion and disequilibrium to worsen symptoms of motion sickness.

4. Eat only small amount of food (avoid no fried or junk foods). A banana or yogurt are good examples. All yogurts are not created equal.

5. Drink water while minimizing carbonated beverages.

6. Avoid eating before short flights.

7. Those at high risk for motion sickness may take over the counter (OTC) medications like other preventative drugs like Benadryl, scopolamine or meclizine an hour before departure. Skin patches are available for some drugs. Be sure to talk to your physician prior to using these or any other drugs because they have potential for major side effects especially among elderly individuals.

8. Ginger is effective in nausea and vomiting of pregnancy and may be effective in motion/travel sickness. Take ginger powder/capsules or chew fresh ginger root slice. Dose 1g every 4-6 hours as needed.

9. Acupuncture has also been shown to be effective in preventing nausea vomiting.

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Are you prone to nausea and vomiting during travel etc. What strategies do you use? Please share with us.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Above all, relax and be safe. Plan so you don't rush have to rush.

 Motion sickness and healthy travel

Modern medicine is joke of the future

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Modern and ancient medicine

 

 

--Just a thought from physician-comic

"Modern" medicine frequently is educated guess. Don't laugh at medical practices of past, Current practices may be butt of jokes in future (no pun intended).

 

 

Doctors are human too!

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Doctors are not superhuman. In fact, half of them graduated in the bottom half of the class!

    Author unknown

Coconut oil repairs your skin naturally and heals

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Coconut oil for a healthy shining and vibrant skin

Coconutoil is widely used for skin and hair care in Eastern cultures especially India and is believed to have skin healing and nurturing properties.

Nevin et al from University of Kerala examined the skin wound healing properties of topical (local) application virgin coconut oil in animals.

Design of coconutoil skin study: Skin wound injury model in rats was used. Skin wound injury was created experimentally. 24 hours later the wound was treated with 0.5 or 1 ml of the virgin cocnut oil for 10 days. There no application on the skin wounds of control rats.

Results of coconutoil skin study: Examination of skin wounds indicated a much rapid epithelization and healing of the wounds in the coconut oil group. This was accompanied by a greater collagen cross-linking and higher turnover of collagen.The level of antioxidant enzyme activities was higher at 10 days and returned to normal by day 14 in the coconut oil treated group.

Antioxidant enzyme activities, and reduced glutathione and malondialdehyde levels were found to be increased on the 10th day after wounding, which were found to have returned to normal levels on day 14 in the treated wounds. In addition, the treated wounds had lower lipid peroxide levels as compared to controls.

Histopathological examination of the wound tissue showed that wounds treated with coconut oil had higher fibroblast proliferation and neovascularization.

Conclusions of coconutoil skin study: The beneficial skin caring effect of virgin coconut oil is due to the overall effect of multiple biologically active compunds present in it.

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CT scan and risk of cancer

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CT or CAT scans are not risk free

Written by: Anil Minocha MD, Shreveport, La

There has been a massive increase in the use of computed tomography over recent years. Radiation dose from CT scan is significantly higher than than that from conventional radiography. CT scan is an extremely useful diagnostic modalilty, frequently superior to conventional radiography and is increasingly being used for assistance in guided invasive procedures.

Few realize that with this positive benefit comes the increased risk of cancer. Radiation exposure results in DNA damage that can usually be repaired by body's defences. Misrepair can and does occur and can result in changes leading to cancer.

A study published in the New England Journal of Medicine estimated that based on CT scan use in the 1990s, as many as 0.4% cancers may be attributed to radiation exposure due to CT scans. However, considering the significant increase in CT scan in the last decade, as many as 1.5-2 percent of cancers may be related to CT scan induced radiation exposure.

Authors recommend the following:

• Reduce the CT-related radiation dose in individual patients. The automatic exposure-control on the latest generation of scanners is helping to address this concern.
• Use more of ultrasound and MRI in lieu of CT scans as much as possible.
• Reduce the decrease the number of CT studies ordered. While benefits outweigh risks in most cases, estimates suggest that as many as one-third of CT scans may not be justified could be avoided.

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Behavioral therapy and hypertension

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While hypertension is a common problem with a variety of remedies. Despite that, blood pressure is effectively controlled only in a minority of patients. Healthy life style measures are an important part of treatment in addition to medications and these have to be tailored to each individual. Motivational strategies and complex interventions hold promise.

Bosworth and colleagues studied the effect of self-management interventions on blood pressure control in hypertensive patients over a two year period.  The subjects were randomized to receive usual care, a behavioral intervention (bimonthly tailored, nurse-administered telephone intervention targeting hypertension-related behaviors), home BP monitoring 3 times weekly, or the behavioral intervention plus home BP monitoring.

The investigators found that a regimen of combined home blood pressure monitoring and tailored behavioral telephone intervention improved control of systolic as well as diastolic pressure at 24 months as compared to usual care.

Reed and colleagues  studied the economic impact of various startegies of multicomponent interventions. They concluded interventions like telephonic behavioral lifestyle measures are cost-additive to the health-care system in the short term and that patients' time costs are nontrivial.

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Cognition and consciousness in unconscious,vegetative state

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There may be a gray line between consciousness and unconsciousness. Our ability to assess that can be challenging as is evident by high error rate. This brings back memories of the famous and some might call the sensational Terry Schiavo case that had varying diagnosis made by her physicians in contrast to physicians from representing varying parts of political spectrum and which ultimately reached the U.S. Supreme court for adjudication.

Monti and colleagues from Europe conducted a study at two major referral centers. The study titled, “Willful Modulation of Brain Activity in Disorders of Consciousness” was published in the New England Journal of Medicine.

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Study involved 54 subjects with varying degree of none to minimal consciousness as diagnosed by standard techniques. Mental imagery tasks were assessed by examining neuroanatomically specific responses as seen on functional MRI. Yes and NO responses to verb al cues were examined.

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The investigators found that 5 of the 54 subjects could deliberately transform or alter their brain activity as assessed by functional MRI. In fact, one of the subjects who had been in persistent vegetative state for about 5 years as a result of an auto accident could communicate Yes and No in response to questions using these techniques although not communicate as assessed on clinical exam. The patient correctly to 5 of the six questions as monitored by neural activity see on fMRI.

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The authors concluded that a small number of patients in vegetative or minimally conscious state may actually have significantly more residual awareness, cognition and responsiveness than may be evident grossly on clinical exam alone. Thus advanced techniques may have potential for assessing the state of consciousness and also to communicate with such patients.

Learn more about the Native Remedies range of homeopathic, herbal remedies.

While the results of this study is likely to raise a lot of medical and legal questions related to unconscious state, the results of this study should not be over-interpreted since ability to respond occurs only in a small subset of such patients. In addition, while responses to simple questions was possible, the current techniques do not allow assessment of feelings and thoughts.

What are your thoughts about this posting? Do you believe it is possible and what are the implications in real world?

 

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Is homeopathy safe or effective?

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While many people in eastern cultures and even Europe swear by the effectiveness of homeopathy, it is generally looked own upon by many involved in Western medicine.

A recent report from Germany led by Dr. Bernhoft and colleagues provides an overview of evidence for effectiveness of homeopathy based on published literature. The authors systematically searched all the medical literature and found many high-quality pre-clinical and clinical studies proving positive effects of homeopathy.

They report that 20 of 22 systematic reviews demonstrated at least a trend in favor of homeopathy with five of the studies demonstrating definitive evidence for effectiveness of homeopathic treatment.

They concluded that homeopathy is clearly effective, safe and essentially devoid of side effects based on scientific evidence.

What do you think about alternative and complimentary medicine therapies? Have you visited the National Center for complimentary and Alternative Medicine web site. Have you used any one of them or would you consider using them under certain circumstances? What are your thoughts about homeopathy?

Here is some more on homeopathy.

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Exercise makes radiation therapy easier

Radiation therapy is frequently undertaken as part of treatment of breast cancer. However, these beneficial effects come with a price. Sometimes the side effects can make the therapy intolerable and reuire additional medications to combat the unwanted adverse effects.

A recent study by Dr. Drouin and colleagues published in the journal Cancer  suggests that aerobic exercise during therapy would help make this otherwise toxic treatment more tolerable.

They conducted a randomized controlled trial to study the impact of aerobic exercise twenty sedentary females with breast carcinoma during radiation therapy.

These investigators found that moderate intensity aerobic exercise maintains red blood cell counts and hemoglobin levels better during radiation treatment of breast cancer compared with the declines observed in patients who were not doing moderate level of exercise.

They concluded that exercise is a safe and cost-effective method to improve fitness and maintain hemoglobin levels in women during radiation treatment of breast cancer.

Do you exercise regularly? Do you do it with a trainer, in a group or by yourself?

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Does breast-feeding makes kid smarter

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Breast-feeding is associated with numerous health benefits for the kids including enhanced immunity against infections, but does it also enhance their intelligence?

Study: Der and colleagues from United Kingdom studied the impact of maternal intelligence and breast feeding on child's intelligence and published their findings in the British Medical Journal (November 2006).

Results: Mother's IQ was better predictor of breastfeeding status than age, race or education. Looked at in isolation, breast-feeding had positive impact on a child's IQ.

However, after adjusting for maternal IQ, breast-feeding was found to have little impact intelligence in children.

Conclusion: Breast-fed children are more intelligent because their mothers are more intelligent, better educated and provide better living environment.

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Can exercise prevent colds?

The answer is an unequivocal yes, at least among older women according to a recently published study.

Dr. Chubak and colleagues from the Fred Hutchinson Cancer Research Center in Seattle, Washington studied the impact of a regular, moderate intensity exercise program on prevention of colds and upper respiratory infections. They published their findings in the American Journal of Medicine.

These investigators studied 115 overweight and obese, sedentary, postmenopausal women. The subjects were divided into the moderate-intensity exercise group or the control group. The exercise program consisted on 45 minutes of moderate-intensity exercise 5 days per week for one year. Control subjects attended weekly stretching sessions.

During the study period, the risk of colds was significantly lower in the exercise group. The cumulative effect of exercise appeared to be greatest towards the end of the study when the risk of colds in the last 3 months was 3 times less in the exercise group.

These results add to the growing body of evidence that exercise may improve the immunity to ward of infections like colds. While the study was conducted only in older women, it is likely that the beneficial effects would apply to men also and probably at all ages.

Do you do regular exercise? Is your exercise program focussed on strength or endurance? What other benefits do you think you could be getting from your exercise program?

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Heartburn drugs treat heart too!

I am sure you or someone you know has raised the question, is it heartburn or heart attack? Now comes a report that heartburn and ulcer medications of the H2 histamine blocker type may actually help strengthen the heart in heart failure patients. While the data is preliminary, it is indeed exciting and of course ironic that heart and heartburn have crossed paths again.

Dr. Kim and colleagues from National Cardiovascular Center in Japan recently conducted a retrospective analysis and then a small prospective study to evaluate the effects of famotidine (Pepcid) in patients with heart failure. They published their findings in the Journal of American College of Cardiology.

For their retrospective study, these investigators identified 159 patients who received famotidine among symptomatic congestive heart failure (CHF) patients and compared them to age-sex matched controls. They also conducted a prospective study in 50 symptomatic CHF patients who were treated with either famotidine or teprenone.

These investigators found that addition of Pepcid to standard treatment of heart failure reduces blood pressure, heart rate and the plasma B-type natriuretic peptide levels. In addition, the treatment improved the severity of heart failure. The patients on Pepcid had also fewer hospital admissions for heart failure.

I would like to emphasize that these results suggest a role for histamine in the pathogenesis of heart function and failure. Thus although proton pump inhibitors or PPIs (Nexium, Protonix, Prevacid, Aciphex) are more potent than histamine-2 blockers or antagonists (Tagamet, Zantac, Pepcid, Axid) for blocking acid secretion, the PPIs are unlikely to help the heart.

Do you take heartburn or ulcer medications? Do you usually get the over the counter medications or the prescription only. What are your thoughts on the TV commercials for these drugs?

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Drink tea for better heart!

Some of us drink coffee whereas others are fans of tea. While green tea has a lot of proponents, black tea is not far behind in health benefits. Tea is known to help heart we don't know how.

Dr. Steptoe and colleagues from the University College in London (UK) indirectly examined the effect of drinking black tea on coronary artery disease and recently published their findings in the journal Atherosclerosis. White blood cell with platelet aggregates and C-reactive protein levels were used as markers for increased risk for coronary artery disease.

Seventy-five healthy non-smoking men participated in study. They were randomized to drinking black tea or placebo for a period of six weeks.

The authors found that at the end of six-week period, tea drinkers had much less platelet aggregation and lower C-reactive protein levels than the subjects drinking placebo.

Several studies have since been published with results consistent with above findings.

Just imagine, next time you are sipping a cup of tea, you are also doing your heart some good!

What beverage do you prefer? Do you drink it more for taste or the perceived health benefits? I drink both coffee ad teas although my favorite is tea.

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Cola fizz versus bone fizzle and weak bones? Your choice!

There has been an ongoing debate on the health effects of consumption of carbonated beverages. Colas contain caffeine and phosphoric acid that can have adverse health consequences.

Dr. Tucker and colleagues from the Tuft University in Boston examined if the cola consumption is associated with bone density in women. They published their findings in the American Journal of Clinical Nutrition.

Bone density was measured at the spine and 3 hip sites in 1413 women and 1125 men. Food-frequency questionnaire was used to assess dietary consumption.

These investigators found that women who drank cola daily had lower bone density than those who did not. Bone density was low whether or not you drank diet cola or regular cola. There was also significant impact of decaffeinated cola although to a lesser degree.

The effect of cola is gender specific. No adverse effect of cola on bone density was seen for men in this study.

It should also be noted that there was no significant impact of non-cola carbonated beverage consumption and bone density.

So ladies, next time you go for your daily cola fizz, think of your bones.

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Breast feeding merits, alternatives	Yoga improves sex in both sexes
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Uncontrolled diabetes, less brain

Diabetes tends to cause problems throughout body and glucose is a fuel for the brain. Question arises if too much blood glucose is bad for the brain function?

Dr. Yaffee and colleagues from the University of California in San Francisco wished to examine the impact of poorly controlled diabetes on the mental function especially in older persons and the potential for developing dementia.

These authors studied 1983 women including 53 diabetics. In this cohort, they examined relationship between the control of blood glucose (HbA1C level) and the risk for developing dementia.

They found that in women with HbA1C level of 7% or greater, the risk for developing mild cognitive impairment (MCI) was increased nearly 4-fold. Overall, the risk for developing MCI or dementia was enhanced almost three-fold.

Take home message: We should consider HbA1C monitoring in elderly patients at risk for mild cognitive impairment or dementia.

Do you or someone close to you has diabetes mellitus? Do you try to control the blood glucose compulsively? Are you convinced of the significance of the good blood glucose control?

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Second opinion in medicine

The issue of second opinions in health profession frequently sparks a debate. The thoughts are diverse depending upon if you are a patient, versus his/her physician versus health policy maker.

Dr. Scott Haig at the Columbia University College of Physicians and Surgeons issues a strong indictment of medical profession by arguing that large number of physicians are quick to refer patients to another doctor rather than managing the situation themselves. This, according to him, is not only inefficient medicine but bad medicine.

Dr. Haig may be on to something that is not frequently verbalized by many of us. We all see such occurrences not too infrequently where the health care provider has made his/her money doing the easy part including the expensive procedures and then sends over the patient to someone else for second opinion to deal with issues that actually required some thinking.

On the other hand, what is the patient to do, especially when faced with a life-threatening diagnosis like cancer and/or complicated set of options?

Like it or not, second opinion with all its disadvantages is a fact of life and we should all be thankful that we have that option.

What do you think? Did you think it was a good exercise or do you feel you had to do out of frustration with your health care provider. Have you had occasions where you considered a second opinion? Did you think it was worth the cost and effort?

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Obese men are less fertile

Dr. Salmen and colleagues from the National Institute of Environmental Health Sciences, Research Triangle Park, NC recently examined the association between male body mass index and infertility in couples and published their findings in the journal Epidemiology .

They found that more the excess weight, the more likely the infertility. Every 3-unit increase in BMI may cut a man's fertility by about 10 percent, Erectile dysfunction does not explain the discrepency since the relationship was similar for older and younger men.

So if you are an overweight male and would like to have children, losing weight might be a cheaper option compared to cost of infertility clinics.

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Eat chilli for a healthy heart

Do you like hot chilli? I like it but I avoid it. Why? I enjoy it while eating, but it really hurts while exiting!.

Drs. Ahuja and colleagues from University of Tasmania, Launceston, Australia sought to examine the effects of regular chilli ingestion on metabolic and vascular function in a randomized cross-over dietary intervention study. They published their findings in European Journal of Clinical Nutrition (August 2006).

Thirty-six participants (22 women and 14 men) consumed 30 g/day of a chilli blend or a bland diet for 4 weeks each. Multiple parameters were measured.

While there was no difference in metabolic parameters studied, these authors found that regular chilli consumption reduces resting heart rate and increase effective myocardial perfusion pressure time in men.

Bottomline, chilli may be good for your heart too! By the way, do you like Chilli?

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Green tea heals breast cancer

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Numerous studies have documented the beneficial effects of green tea on health including prevention of breast cancer. You might ask, what about the patients who already have breast cancer?

Here is a recent study that shows that the combination of green tea and tamoxifen (a common chemotherapeutic agent used for certain breast cancers) is better than either agent alone.

Dr. Sartippour and colleagues from the from the University of California Los Angeles Medical Center in Los Angeles published in the journal Carcinogenesis (June 2006).

These investigators found green tea potentiated the inhibitory effects of tamoxifen on human breast cells in vitro. In addition, the mice treated with both green tea and tamoxifen had the smallest tumor size as compared to use of either agent.

This study gives us one more reason to sing praises of green tea. Do you drink green tea? I do.

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Kid getting frequent infections? Probiotics may help	Botox is not just for wrinkles on face: Useful for anal fissures?
Bacteria inside gut are a microuniverse with health and disease implications.	Treatment of internet sex addiction
Causes and treatment of hiccups	Glutamine and immune system
Natural aphrodisiac foods	Diet as risk for Crohn's disease
Cancer risk of artificial sweeteners	Cognitive behavioral therapy CBT for Irritable Bowel Syndrome
GERD acupuncture treatment	Placebo pain relievers and price

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