You’ve probably heard the term “chocoholic” before. Maybe you’ve even used it to describe your devotion to what the Mayans and Aztecs believed was a food of the gods. Usually said jokingly, “chocoholic” actually nods to a potentially serious question: can a person become addicted to chocolate, or food in general? It’s an appropriate question to ask on Valentine’s Day, the feast day of chocolate.

There are three essential components of addiction:

• intense craving
• loss of control over the object of that craving
• continued use or engagement despite bad consequences.

Several studies have shown that people can exhibit all three of these in their relationships with food.

Take craving, for example. The midnight run for a pint of ice cream is a familiar scenario. But I’ve never heard of anyone trolling for celery at that hour. That’s likely because foods that deliver a lot of sugar and fat — like chocolate — trigger reward pathways in the brain. In some animal studies, restricting these foods induced a stress-like response consistent with the “withdrawal” response seen in addiction.

Chocolate, which contains both sugar and fat, is often used in studies of food addiction. In a study published in the Archives of General Psychiatry, researchers at Yale University asked volunteers to fill out questionnaires to assess addictive behavior. The volunteers then had their brains imaged while being able to see and smell, and then finally drink, a chocolate milkshake. Participants who scored higher on the food addiction scale experienced a surge of activity in the part of the brain that regulates cravings and rewards when presented with the chocolate milkshake. Once they started drinking it, they showed markedly reduced activity in areas of the brain that control impulses to seek rewards. A similar pattern of brain activity is found in people addicted to drugs.

In another study, this one involving candy, researchers at Drexel University concluded that people experienced psychological reactions while eating chocolate — such as intense pleasure and craving for more — that were similar to reactions caused by some drugs. (more…)

The message that drinking a little alcohol is good for the heart has gotten plenty of attention. A new study linking alcohol with increased risk of dying from various cancers may temper that message a bit.

About 4% of cancer deaths worldwide are related to alcohol use. No one has done a major study of this issue in the United States for more than 30 years. During that time, we’ve learned a lot about alcohol and cancer, and powerful statistical methods have been developed for estimating risk.

Researchers from the National Cancer Institute and other institutions delved into many studies and information databases. They calculated that alcohol causes 3.5% of U.S. cancer deaths, or about 20,000 cancer-related deaths each year. The study was published online yesterday in the American Journal of Public Health.

The most common alcohol-related cancers were mouth, throat, and esophageal cancer in men, and breast cancer in women.

Experts still aren’t completely sure how alcohol causes cancer. Possibilities include:

• toxic effects from chemicals produced when the body breaks down alcohol
• increased production of cell- and DNA-damaging free radicals
• changes in the way the body handles vitamin B₆ (folic acid)
• boosting estrogen levels, which can increase the risk of breast and other cancers
• making other cancer causing agents, such as tobacco products, more harmful

Heart benefits

But what about the reduced risk of heart related deaths in people that drink a little alcohol compared to those that don’t drink at all? A recent detailed analysis of 84 of the best studies looking at the alcohol and heart connection included more than two million men and women. They were followed for an average of 11 years. Compared to people who didn’t drink alcohol, those who were moderate drinkers had a

• 29% lower risk of being diagnosed with coronary artery disease
• 25% lower risk of dying from a heart attack
• 25% lower risk of dying from any heart or blood vessel disease
• 13% lower risk of dying from any cause (this included cancer deaths, too) (more…)

After being confined to health-food stores for years, gluten-free foods have become the latest food fad. Supermarket aisles abound with products proudly labeled “Gluten free,” and many restaurants now offer gluten-free options.

For people who can’t tolerate gluten, a protein found in wheat, rye, and barley, this abundance is a blessing. But lately it’s become hip to go gluten-free. Based on little or no evidence other than testimonials in the media, people have been switching to gluten-free diets to lose weight, boost energy, treat autism, or generally feel healthier. This doesn’t make much sense to Dr. Daniel A. Leffler, director of clinical research at the Celiac Center at Beth Israel Deaconess Medical Center in Boston.

“People who are sensitive to gluten may feel better, but a larger portion will derive no significant benefit from the practice. They’ll simply waste their money, because these products are expensive,” says Dr. Leffler, who is also an assistant professor of medicine at Harvard Medical School.

How gluten causes trouble

People with celiac disease can’t tolerate gluten, not even small amounts. Just 50 milligrams of the protein—about the amount in one small crouton—is enough to cause trouble. In people with celiac disease, gluten in the bloodstream triggers an immune response that damages the lining of the small intestine. This can interfere with the absorption of nutrients from food, cause a host of symptoms, and lead to other problems like osteoporosis, infertility, nerve damage, and seizures.

A related condition called gluten sensitivity or non-celiac gluten sensitivity can generate symptoms similar to celiac disease but without the intestinal damage.

Not long ago, celiac disease was diagnosed by a process of elimination. Today it can be identified with a blood test for the presence of antibodies against a protein called tissue transglutaminase. A biopsy of the intestine confirms the diagnosis.

Going gluten free

Avoiding gluten means more than giving up traditional breads, cereals, pasta, pizza, and beer. Gluten also lurks in many other products, including frozen vegetables in sauces, soy sauce, some foods made with “natural flavorings,” vitamin and mineral supplements, some medications, and even toothpaste. This makes following a gluten-free diet extremely challenging. (more…)

Memory slips are aggravating, frustrating, and sometimes worrisome. When they happen more than they should, they can trigger fears of looming dementia or Alzheimer’s disease. But as I write in this month’s Harvard Men’s Health Watch, there are many mundane—and treatable—causes of forgetfulness. Here are seven common ones.

Lack of sleep. Not getting enough sleep is perhaps the greatest unappreciated cause of memory slips. Too little restful sleep can also lead to mood changes and anxiety, which in turn contribute to problems with memory.

Medications. Tranquilizers, antidepressants, some blood pressure drugs, and other medications can affect memory, usually by causing sedation or confusion. That can make it difficult to pay close attention to new things. Talk to your doctor or pharmacist if you suspect that a new medication is taking the edge off your memory. As shown in the table below, alternatives are usually available.

(Adapted from Improving Memory: Understanding age-related memory loss, a Harvard Medical School Special Health Report) (more…)

I have been a fan of Mediterranean-style diets, both for my patients and myself, for many years. The results of a Spanish trial being made public today should get everyone interested in this healthy way of eating.

What makes these new results so important is that they come from a randomized controlled trial, what many consider to be the gold standard of medical research. Beginning in 2003, researchers recruited nearly 7,500 Spaniards to take part in the Prevención con Dieta Mediterránea (PREDIMED) trial. All participants were over age 55, and none had been diagnosed with heart disease—though all were at high risk for developing it. One third of the volunteers were counseled to adopt a Mediterranean-style diet and were given one liter a week of extra virgin olive oil. Another third were counseled to adopt a Mediterranean-style diet and were given about an ounce a day of mixed nuts (walnuts, hazelnuts, and almonds). The third group was counseled to adopt a low-fat diet.

The trial was stopped early, after just under five years of follow-up, when the independent board charged with an ongoing review of the results determined that there had been significantly fewer heart attacks, strokes, and deaths from cardiovascular disease in the Mediterranean groups than in the low-fat diet group. The reduction was impressive: three fewer cardiovascular events per 1,000 people per year in the Mediterranean groups. The results are being presented today at the 6th International Congress on Vegetarian Nutrition being held in Loma Linda, California and were published this morning in the New England Journal of Medicine.

Observing the Mediterranean diet

Before this new study, most previous research on the Mediterranean diet involved what are called ecological studies, or observational studies. In the 1950s and 1960s, nutrition research pioneer Ancel Keys and his colleagues conducted ecological studies. They studied eating patterns in 16 different populations in seven countries. The researchers observed that people living in Crete, other parts of Greece, and southern Italy tended to live longer than others in the study and had lower rates of heart disease and some cancers.

Keys was convinced that the regional diet, dubbed the Mediterranean diet, was an important reason for the good health in those populations. Keys and his wife, Margaret, promoted the Mediterranean diet in a series of best-selling books. His efforts on diet and health were highlighted in a cover story in Time magazine. (more…)

People tend to think that the telltale sign of depression is sadness—a pervasive down, dragging feeling that won’t let up, day after day. But depression often manifests itself as something else entirely—like aches and pains or memory lapses.

These “unusual” symptoms are actually quite common. They can mask depression—and delay an important diagnosis—especially in older people. “Sometimes it’s hard to diagnose depression in older adults because they don’t come in and say, ‘I’m depressed.’ They’re more likely to present with physical symptoms that they don’t connect with what they’re feeling…pain, memory problems, poor sleep, a change in appetite,” says Dr. Anne Fabiny, chief of geriatrics at Cambridge Health Alliance and assistant professor of medicine at Harvard Medical School.

She’s even seen people fall more frequently because they’re depressed. The connection might not seem logical, until you consider that depression can make people more inattentive to their surroundings.

Older people in particular—and older men especially—display their depression in unusual ways. “Older men are more likely to present with irritability or grumpiness as a symptom of depression than women,” says Dr. Fabiny. “So the stereotype of the grumpy old man could be a sign of a depressed old man.”Fruta Planta

A new report from the Centers for Disease Control and Prevention shows that depression is more common among women (10.7% of adult women) than men (7.7% of adult men). And though depression tends to peak between ages 45 and 64, it can emerge at any time of life.

Older men and women with depression often don’t want to talk about it because their generation still harbors a stigma about mental illness. “Older people still have the idea that, ‘I’m not crazy. I don’t want people to think I’m crazy,’” Dr. M. Cornelia Cremens, assistant professor of psychiatry at Harvard Medical School, told me last year for an article in the Harvard Women’s Health Watch.

Dr. Fabiny says she often doesn’t say the word “depression” when talking to her older patients. Instead, she’ll use terms like “sad” or “blue.” (more…)

Five seemingly different mental health disorders—major depression, bipolar disorder, schizophrenia, autism, and attention-deficit hyperactivity disorder—may be more alike than we think. A ground-breaking new study has identified a handful of genes that are shared by people with these disorders. This work could help find new and better ways to diagnose and treat mental illness.Fruta Planta

Back in 2007, researchers from 19 countries formed the Psychiatric Genomics Consortium. Since then, the group has analyzed DNA from 33,000 people with major depression, bipolar disorder, schizophrenia, autism, or attention-deficit hyperactivity disorder and another 28,000 without one of these disorders. In the group with mental illness, four regions of the genetic code carried the same variations. The team’s report, published online yesterday in The Lancet, was led by Dr. Jordan Smoller, director of psychiatric genetics at Massachusetts General Hospital and professor of psychiatry at Harvard Medical School.

Two of the affected genes help control the movement of calcium in and out of brain cells. That might not sound like much, but this movement provides a key way that brain cells communicate. Subtle differences in calcium flow could cause problems that, depending on other genes or environmental factors, could eventually lead to a full-blown mental illness. (more…)

The toll taken by medical mistakes burst into public attention with a 1999 report called To Err Is Human from the U.S. Institute of Medicine. The report estimated that between 44,000 and 98,000 people die each year as a result of preventable medical errors. Such errors can be headline grabbers, like the death of Boston Globe columnist Betsy Lehman from an overdose during chemotherapy. Most, though, are far out of the spotlight. They include missed diagnoses, the use of incorrect or unproven treatments, mistakes in surgery and drug prescribing, and preventable problems such as bedsores, which can lead to infection and death.

The safety of hospital stays and encounters with health-care providers got a boost today with the publication of 22 evidence-based “patient safety strategies.” Although most focus on care that takes place in hospitals, they extend to almost all interactions between individuals and their doctors, nurses, and other care providers. The top 10 strategies include:

•   The use of checklists before, during, and after surgery, in the same way that airline pilots use checklists before taking off—to be sure that every single important thing has been done, and nothing accidentally neglected

•   Institution of meticulous procedures, including the use of checklists, when putting a central line into a patient and caring for the line. (A central line, also called a central venous catheter, is a tube placed into a large vein in the neck, chest, or groin. It is used to deliver medication or fluids and conduct various tests.) Unless these lines are properly placed and maintained, they can become infected.Fruta Planta

•   Finding ways to use fewer urinary catheters to help people urinate, because these catheters can cause urinary tract infections

•   Preventing pneumonia and other infections in people on ventilators by elevating the head of the bed, taking breaks from the use of sedating medication, and other strategies

•   Washing hands

•   Avoiding the use of abbreviations for medications or procedures

•   Putting in place simple strategies for preventing pressure ulcers in people confined to bed

•   The use of gloves, gowns, and other so-called barrier precautions to prevent healthcare-associated infections

•   Using ultrasound to guide the placement of central lines

•   More attention to treatment and prevention efforts for people who develop blood clots in a leg, arm, or lung (venous thromboembolism)

The recommendations were published online today in the Annals of Internal Medicine as part of a four-year effort by a national team of patient-safety experts and analysts supported by the federal Agency for Healthcare Quality and Research (AHRQ). (more…)

Americans are a diverse lot, so it’s no surprise they give different answers when asked about their well-being. But it seems that well-being differs from state to state, too. Fruta Planta In the latest Gallup-Healthways Well-Being Index, which gauges the physical and emotional health of people in all 50 states, residents of Hawaii reported the best sense of overall well-being while West Virginia residents reported the worst.

“Sure,” you might say, “Who wouldn’t be happier in Hawaii?” As a graduate of West Virginia University, I admit that there were times as a student in Morgantown when I longed for sunshine and balmy breezes instead of gray winter days and rural towns covered in coal dust (although I loved my school and I loved those country roads). But well-being is not a simple matter of palm trees versus coal mines.

The index calculates overall well-being based on six quality of life categories, each of which is made up of several components:

• Life evaluation (are you thriving, struggling, or suffering?)
• Emotional health (such as happiness, worry, being treated with respect, stress)
• Work environment (such as job satisfaction or supervisor’s treatment)
• Physical health (such as obesity, feeling well rested, sickness)
• Healthy behaviors (such as not smoking, eating healthy food, exercising frequently)
• Basic access (such as to clean water, medicine, enough money for food, shelter, healthcare)

Poll respondents in Hawaii had the highest scores in the emotional health and work environment indexes, and were most likely to say they were thriving. People in West Virginia were most likely to say they were not thriving, and had the worst emotional health, the worst health habits, the most diagnoses of depression, and high rates of obesity. People in the other 50 states fell in between. Check out how your state fared online.

Do people in low well-being states, like West Virginia, Kentucky, Mississippi, Tennessee, and Arkansas, have to stay that way? Is it hard to change?

“There’s good news and bad news about our ability to change our sense of well-being or happiness,” says Dr. Ronald D. Siegel, assistant clinical professor of psychology at Harvard Medical School. “It turns out that, just like for weight, we have genetically determined happiness set-points. So if we’re not taking steps to improve our sense of well-being, we tend to gravitate back to the same level.” Depending on your genes, that level may be pretty happy or pretty unhappy, says Dr. Siegel, who is also the faculty editor of Positive Psychology, a Special Health Report from Harvard Medical School. (more…)

It always takes me a few days to get used to Daylight Saving Time. While I love the extra hour of light at the end of the day, I’m not so wild about the extra hour of darkness in the morning or waking up an hour earlier than I need to. And I sure miss the hour of sleep I lost yesterday.Fruta Planta

That lost hour seems to be a big deal. A report in this month’s American Journal of Cardiology details the jump in heart attacks seen in a large Michigan hospital the first week after the start of Daylight Saving Time, and the small decline after it ends in the fall. A few years back, researchers showed a similar pattern in Sweden. The number of traffic accidents are similarly affected. In a Canadian study, there were more accidents on the Monday after the start of Daylight Saving Time than there were on the Monday the week before the change.

No one knows for sure why losing one hour of sleep might generate more heart attacks or accidents. It could be a disruption in the body’s circadian rhythm, which controls hormone levels and many other physiologic underpinnings of health, as well as alertness.

Catching up

If ever there was a perfect day for a nap, today would be it. A single nap won’t fully reset your body clock or make up for a lost hour of sleep, but it can help. It’s also a good way to stay sharp, especially in the afternoon.

A few years back, nap champion William A. Anthony, then professor of rehabilitation counseling at Boston University, proclaimed the Monday after the start of Daylight Saving Time as “National Napping Day.” It was part publicity stunt to promote The Napping Company, a business he founded with his wife, Camille Anthony to bring napping into business world to improve productivity.

But napping does make sense, not just today, but almost any day. Although the effects of napping on physical health are all over the map, it’s clear that napping can help improve learning and creativity. (more…)