health

Recent Study Suggests Possible Link Between Stroke and Diet Soda

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | August 21st, 2017

Dear Doctor: A recent news report said that diet sodas may be tied to stroke or dementia risk, but it didn't provide a possible cause. What's your take?

Dear Reader: You're referring to a 2017 study published in the journal Stroke. The study followed two groups of people: one over age 45 (2,888 people) and one over age 60 (1,484 people). The participants filled out food questionnaires three times: between 1991 and 1995, between 1995 and 1998, and between 1998 and 2001. Participants were asked about the type and frequency of their beverage intake. The groups of beverages included sugar-sweetened soft drinks, fruit juice, sugar-sweetened fruit drinks and artificially sweetened soft drinks. After the last questionnaire, researchers assessed the rates of stroke and dementia in the subsequent 10-year period.

People who drank artificially sweetened soft drinks one to six times per week had a 59 percent increased risk of stroke compared to those who did not drink artificially sweetened soft drinks. This rate increased to 79 percent among people who drank one or more of these drinks per day. The rate was even higher among people who reported this higher use most recently (between the years 1998 and 2001).

In regards to dementia, people who drank artificially sweetened soft drinks one to six times per week had a 30 percent increased risk of dementia compared to those who drank no artificially sweetened soft drinks, while people who drank one or more per day had a 70 percent increased risk.

These numbers seem significant, but the study's many confounding factors decrease their strength. For one, the number of people suffering strokes or developing dementia was limited, making it difficult to draw overarching conclusions.

Also, consider that -- according to the data -- people who drank sugar-sweetened soft drinks more than three times per week actually had a 20 percent reduction in the risk of strokes compared with those who drank none -- and a 23 percent decreased risk of dementia. My kids might disagree, but I really don't think that a greater number of sugar-sweetened soft drinks would be good for you.

Further, even before the study began, 22 percent of those who drank artificially sweetened sodas had diabetes, while 7 percent who didn't drink them had diabetes. Diabetes itself is a risk factor for both stroke and dementia, so the increased risk found in the study may have nothing to do with the sodas. The authors said they adjusted for this, but with such small numbers, that's difficult to do.

Don't get me wrong: Artificially sweetened sodas are certainly not healthy. They trick the brain and the body into believing it has had something sweet and thus may cause a greater overall craving for sweet foods or drinks. A 2012 evaluation of two large studies with 127,456 people found a 12 percent increased risk of stroke among people who drank one or more sugar drinks per day -- and a 9 percent increased risk of stroke among people who drank one or more artificially sweetened drinks per day. These results were more significant than the current study due to the large population of people involved.

So while there may be a link between diet sodas and stroke, it doesn't seem to be to the degree that this news report suggested.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Tips on Soothing Your Teething Baby

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | August 19th, 2017

Dear Doctor: My son has started teething, and I'd like to ease his discomfort. I see that several homeopathic teething products have been recalled. Could they really be dangerous? If so, what are my options?

Dear Reader: It's six months into your baby's first year. Chances are, you've finally got a good parental rhythm going. Your sleep deficit is manageable, and your child is increasingly engaged in the world around him. Just as you're thinking that maybe you've got this parenting thing figured out, here come the joys of teething.

Babies enter the world with 20 primary teeth ready to emerge from their jawbones and through their gums. Six months is the average age at which that momentous first tooth makes its appearance, but it can happen anywhere between 3 and 12 months of age. And while plenty of babies breeze right through with minimal fuss, for others it's prime time for more than a little crankiness.

As the rough surface of the tooth advances, it can make the gums swell and ache. Some babies will drool freely, which can cause skin rash and irritations. And because Mother Nature apparently has a wry sense of humor, the process of tooth eruption -- that's when the tooth breaks through the gum -- tends to be more active at night. Say hello again to sleepless nights.

With multiple teething stages to deal with as lower and upper teeth, canines and molars emerge in the next two-plus years, parents want safe and effective ways to smooth (and soothe) this time of transition.

One remedy, available since the early 1900s, has been the herbal teething tablet. However, tests recently performed by the Food and Drug Administration on tablets by Hyland, a well-known maker of homeopathic products, revealed inconsistent amounts of belladonna, sometimes more than was listed on the label. Belladonna is an herbal ingredient with sedative effects that, in excessive quantities, can be toxic. Symptoms include lethargy, muscle weakness, constipation, excessive sleepiness, flushed skin, breathing difficulty and seizures.

The FDA asked Hyland to voluntarily recall its teething tablets and gels, which it did. The FDA has since also warned consumers that all homeopathic teething products may pose health risks for infants and children.

So how can you safely help your teething baby?

Although over-the-counter soothers like Orajel are an option, the American Academy of Pediatrics says that topical preparations wash away within minutes. For extreme discomfort, you may opt for an infant pain reliever. Always check with your pediatrician for proper dosage and duration of use.

After that, it's the age-old basics: pressure, massage, cold and cuddling.

-- Teething toys: Find an array of smooth, solid (not liquid-filled) toys for your baby to chew on. Rings are a nice option because they're easy for little hands to hold.

-- Massage: Use a clean finger and gentle pressure on baby's tender gums.

-- Ice: Freeze the toys for another element of pain relief. A wet washcloth, wrung out and then frozen, offers both cold and texture.

-- And don't forget the power of a soothing cuddle. Chances are that during the stress of teething time, the benefits will go both ways.

Do you have a great teething remedy to share? We'd love to hear from you!

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Treatment Options for Peripheral Artery Disease

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | August 18th, 2017

Dear Doctor: Could you please tell me about peripheral artery disease? I have it and recently underwent angiograms of both legs, including insertion of one stent. One leg is now normal, but the other is back to square one. Do I just suffer through the sleepless nights of pain while waiting for the inevitable stroke or heart attack?

Dear Reader: Think of peripheral artery disease as being like any other arterial disease. Arteries transfer oxygenated blood from the heart throughout the body. The carotid arteries provide blood to the brain, the coronary arteries provide blood to the heart, and the iliac and femoral arteries provide blood to the legs. The inside of each of these arteries is lined with a thin layer of cells called the endothelium. This smooth layer allows blood to move freely within the artery without sticking or clotting.

Injury to the lining of the arteries leads to a mixture of cholesterol and fibrous plaques accumulating on the walls of the artery. This buildup is known as atherosclerosis and, over time, causes the arteries to narrow. In peripheral artery disease of the legs, the narrowing causes decreased blood flow to the legs. The first sign is cramps, usually in the calves, with walking. As the narrowing increases, the cramps can occur simply while lying down, because blood flow decreases without the benefit of gravity. Your worries about strokes and heart attacks are understandable. As with other arterial disease, such plaques can break off and lead to those potentially fatal conditions.

Smoking cigarettes is the biggest risk factor for peripheral artery disease. In fact, chronic smoking is a risk factor for all arterial disease. Other risk factors include diabetes, high blood pressure, kidney disease, high LDL cholesterol and the unavoidable risk factor of being older than 70.

The first course of action should be controlling any risk factors. If people smoke, they should stop. If they have diabetes, they should make sure to keep their blood sugar low. And if they have high cholesterol, they should lower it with medication and diet.

Second, taking a blood thinner, such as aspirin or clopidogrel, will lower the likelihood of clots forming within the blood vessels.

Third, a gradual course of exercise therapy can improve blood flow and decrease calf pain with walking. People without access to a supervised exercise program should walk three days per week for 30 to 45 minutes. A slow start is fine; a more rapid pace can come later.

Fourth, the medication Cilostazol, which works by dilating the blood vessels and not allowing platelets to clot in the arteries, has been shown to increase the distance that people with peripheral artery disease can walk without pain.

As you have experienced, when symptoms are severe or when blood flow to the foot is severely compromised, surgery may be advised. This can be done by angioplasty and stenting, as you had, or, if symptoms are still unrelieved or if the blockage is too long, a bypass graft can be created to skirt the blocked area so that blood can move through unimpeded.

All that said, speak to your doctor. It's possible that not all your pain at night is related to peripheral artery disease. But if it is, controlling your risk factors, using the medications described above and possibly a bypass procedure (if you are a candidate) may help your symptoms. Your physician is in the best position to recommend next steps.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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