1 healthy aging
 2 three 80y olds
 3 glands
 4 anti-ageing pills
 5 eyes (AMD)
 6 arteriosclerosis
 7 aspirin benefits
 8 ASSISTED LIVING OR NURSING HOME?
 9 Balance is Essential - Dizzy Spells
 10 Blueberries May Reduce Effects of Aging
 11 Oiling the Gears for the Body's Clock
 12 Boning Up on Calcium-Supplement
 13 Osteoperosis
 14 tumors

\1 healthy aging

or Older Adults - Preventing Disease and Improving Quality of Life Among Older Americans. The US is on the brink of a longevity revolution. By 2030, the number of older Americans will have more than doubled to 70 million, or one in every five Americans. The growing number and proportion of older adults places increasing demands on the public health system and on medical and social services.

Chronic diseases exact a particularly heavy health and economic burden on older adults due to associated long-term illness, diminished quality of life, and greatly increased health care costs. Although the risk of disease and disability clearly increases with advancing age, poor health is not an inevitable consequence of aging.

Much of the illness, disability, and death assoc with chronic disease is avoidable through known prevention measures. Key measures include practicing a healthy lifestyle (eg, reg physical activity, healthy food, and avoiding tobacco) and the use of early detection practices (eg, preventive medicine exams.).

Critical knowledge gaps exist for responding to the health needs of older adults. For chronic diseases and conditions such as Alzheimer's disease, arthritis, depression, psychiatric disorders, osteoporosis, Parkinson's disease, and urinary incontinence, much remains to be learned about their distribution in the population, associated risk factors, and effective measures to prevent or delay their onset.

Developmental Paths of Psychological Health From Early Adolescence to Later Adulthood (Constance J. Jones, Dept of Psy, CA State Univ, Fresno William Meredith, Dep of Psy, UC, Berkeley)

ABSTRACT - Developmental paths of psychological health were examined for 236 participants of the Berkeley Growth Study, the Berkeley Guidance Study, and the Oakland Growth Study. A clinician-reported aggregate index, the Psychological Health Index (PHI), based on California Q-Sort ratings, was created for subsets of participants at 14, 18, 30, 40, 50, and 62 years of age. Latent curve analysis was then used to explicate the life span development of psychological health. Psychological health development could be successfully modeled via 2 piecewise latent growth curves. Psychological health appears to be stable in adolescence and to steadily increase from 30 to 62 years of age. A moderately strong positive correlation between the 2 developmental curves indicates that those with greater psychological health in adolescence show more improvement in adult psychological health tend to also. Results illustrate the value of the PHI and the power of latent curve analysis to explicate longitudinal stability and change. 

Clinically oriented researchers suggest there exist periods of the life span when individuals' psychological health may temporarily (or permanently) decline as they reorient (or fail to reorient) themselves to new roles and responsibilities. Adolescence, midlife, and the retirement period are suggested times of lowered psychological health for some individuals. Others, however, point to the general stability of many aspects of personality, including characteristics such as neuroticism and self-confidence.

Clearly, one reason for differing opinions regarding the stability o  psychological health lies in the fact that the concept incorporates a vastaarray of partially overlapping terms. Sociologists, psychologists, and psychiatrists each have unique terms and favorite measures to elucidate psychological health. Even within the narrower field of psychology per se, the number of views and measures of mental health is staggering.

We first give a brief overview of the range of measures of psychological health available for nonclinical community samples, organized by how scores appear to vary with respect to age. We then discuss our selected measure of psychological health, a clinician-reported aggregate index. Finally, we detail the advantages of our selected statistical technique, latent curve analysis ( Meredith & Tisak, 1990 ), for explicating change and stability in psychological health across the life span. 

Decreased Psychological Health With Age

When psychological health is measured with mental health symptom checklists, such as the Hopkins Symptom Checklist ( Derogatis, 1983 ), the Beck Depression Inventory ( Beck, 1967 ), the Center for Epidemiological Studies Depression Scale ( Radloff, 1977 ), and the Cornell Medical Index ( Brodman, Erdman, & Wolff, 1956 ), there is some evidence that psychological health decreases with age. Although cross-sectional studies have produced inconclusive findings with respect to age differences (e.g., Feinson & Thoits, 1986 ; Gatz, Hurwicz, & Weicker, 1986 ), a large longitudinal study of 2,041 men involving the Cornell Medical Index used across an average period of 17 years indicated decreased psychological health with age ( Aldwin, Spiro, Levenson, & Bouss?, 1989 ). Using hierarchical linear modeling ( Bryk & Raudenbush, 1987 ), Aldwin et al. found an average increase in number of psychological symptoms reported per year of 0.036, or 1 new symptom every 28 years (as opposed to an average increase of 0.340 for physical symptoms, or 1 new symptom every 3 years). A curvilinear relation was found between rates of symptom reporting and age; young adult men reported a new symptom every 10 years, middle-aged men reported essentially no new symptoms, and older men again reported increases in symptoms, with 80-year-old men reporting 1 new symptom every 5 years. Whether the same pattern of results would hold for women is unknown. 

Lack of Association Between Psychological Health and Age. When psychological health is measured with single broad items (e.g., "In general, how do you feel about your life these days?") or instruments such as the Philadelphia Center Morale Scale ( Lawton, 1975 ) to tap concepts such as happiness, life satisfaction, and morale, there is little evidence for a systematic association between age and subjective well-being after control for such confounding factors as physical health and financial resources ( Larson, 1978 ). More recent multidimensional work suggests that underlying the lack of overall significant age differences or changes are differential patterns of differences or changes, depending on the facet of well-being considered ( Keyes & Ryff, 1999 ), but results are inconclusive at this time. 

Increased Psychological Health With Age. Finally, other measures of psychological health produce evidence of increasing psychological health with age. For example, measures of positive and negative affect ( Mroczek & Kolarz, 1998 ); positive emotionality, negative emotionality, and constraint ( Helson & Klohnen, 1998 ); and impulse strength, positive expressivity, negative expressivity, and control ( Gross et al., 1997 ) show increases in psychological health with age. 

In a cross-sectional survey of 2,727 individuals between 25 and 74 years of age, Mroczek and Kolarz (1998) found a nonlinear relation between age and positive affect for women (lowest for women at the age of 35 years and higher for women at 25 years of age and older than 35 years) and a positive linear relation between age and positive affect for men. Gender differences were similarly found for negative affect. There was no systematic association between age and negative affect for women, and there was a negative linear relation between age and negative affect for men. 

Helson and Klohnen (1998) essentially replicated and extended these results in a longitudinal study of women; from the age of 27 years to the ages of 43 and 52 years, women's positive emotionality increased, negative emotionality decreased, and constraint increased. And in a multisample study including African Americans, Chinese Americans, Norwegians, and American nuns, Gross et al. (1997) also found a general pattern indicating that older respondents showed fewer negative emotional experiences and more emotional control than younger respondents. 

When the personality trait of neuroticism has been used as an indicator of poor mental health, some evidence of increased psychological health with age has also been found. Large cross-sectional studies of neuroticism show very small correlations with age; longitudinal studies of the same trait show relatively strong stability across time. More recent work, however, indicates a decrease in neuroticism with age.

Similarly, Jones and Meredith (1996) found that among a sample of men and women studied longitudinally, self-confidence, a measure similar to (lack of) neuroticism, increased from 18 to 60 years of age when patterns were examined with latent curve analysis ( Meredith & Tisak, 1990 ). 

At a higher level of complexity and abstraction, terms such as ego development and psychological defense have been used to describe psychological health. These concepts are generally measured with more than single-item indicators and often explicitly incorporate theoretical assumptions. Loevinger's (1976) stages of ego development incorporate ideas of increasing maturity and psychological health. A meta-analysis of 65 studies involving the use of the Washington University Sentence Completion Test, a measure of ego development ( Loevinger & Wessler, 1970 ), with participants ranging in age from early adolescence to older adulthood revealed that both male and female participants showed increased ego development with age. Sex differences were apparent, however, with girls showing greater maturity than boys in junior and senior high school. These sex differences disappeared by adulthood ( Cohn, 1991 ). 

Vaillant's (77) classification of 18 defense mechanisms, ranging from psychotic (e.g., delusional projection) to mature (eg, sublimation), also gives a richness to the idea of psychological health that does not appear in previously discussed operationalizations of the term. Explicitly focusing on the variety of experiences men face through the life span, both pleasant and painful, and the fact that negative life experiences may not necessarily predict poor psychological health, Vaillant (76, 77) found some evidence for the maturing of men's defenses across the life span. 

Our measure of psychological health, described in more detail subsequently is also a broad measure. examining women from 14 to 50 years of age, found individuals who showed essentially stable levels of psychological health across that time period and others who showed significant improvement across that period. Supporting others' related work, women who showed lower psychological health in adolescence and young adulthood had early adopted less traditional gender roles. Although these less traditional women demonstrated lower psychological health during age periods associated with heavy investment in gender-assoc roles, their psychological health improved later, when roles became more flexible. 

Our Measure of Psychological Health: The Psychological Health Index (PHI)

It is no surprise that different measures give different portraits of change across time, ranging from less psychological health with age (more psychological symptoms with age) to no change with age (subjective well-being) to more psychological health with age (more positive affect, less negative affect, less neuroticism, more mature ego development, and more healthy defense mechanisms with age). Clearly, the range of measures available to assess psychological health reflects the complexity of the concept itself. The PHI addresses the complexity in that it is a clinician-reported and aggregate measure. 

One possible difficulty of many psychological health measures is that they rely on self-reported responses to relatively transparent items (e.g., "I hate myself" from the Beck Depression Inventory). A systematic lack of convergence between self-reported and clinician-reported psychological health has been found by some researchers. Clearly, clinician report of individuals' psychological health is less contaminated by a potentially self-inter- ested, defensive reporter. We argue that, given the posi- tive social value of psychological health, a clinician- reported score is very useful to examine. 

In addition, our measure of psychological health is based on ratings of 73 different aspects of personality after clinicians had examined extensive interview material from our participants in adolescence and adulthood. Participants' responses to interview questions at each of five assessment points were transcribed and were then read and rated by at least two trained psychologists using the 100-item California Q-Sort ( Block, 1961 ). For each of the 100 California Q-Sort items, ratings could range from 1 ( least characteristic ) to 9 ( most characteristic ); for each individual, the set of scores was forced to fall into the same essentially normal distribution. Such ipsative scoring is said to reduce response bias and may force raters to more carefully consider scores given to individuals ( Ozer, 1993 ). At least two trained clinicians read all of the available material for a given period and made independent ratings, with no clinician rating an individual for more than a single period. When the correlation between two clinicians across the 100 items was .45 or greater, the score were averaged for that participant. If this correlation was not achieved, additional raters (up to four) were obtained. The mean interrater reliability varied by assessment age, but the median reliability was .67. Psychologists' ratings were composited to obtain a final Q-sort profile for each participant. 

The PHI was constructed by N. Livson and Peskin (1967) to take advantage of the powerful nature of the California Q-Sort. The index was created by having four highly experienced clinical psychologists independently provide a 100-item California Q-Sort profile of an "ideally psychologically healthy" individual. The average interrater reliability between psychologists was .82, and thus a highly reliable psychological health composite Q-sort profile was obtained. 

For N. Livson and Peskin's (1967) original PHI, the composite idealized 100-item California Q-Sort profile was correlated with each individual's actual composite 100-item California Q-Sort. 1 A PHI score of 1.00 was obtained for a participant who showed a personality profile identical in patterning to that of the idealized psychologically healthy person, and, conversely, a PHI score of - 1.00 was obtained for a participant who showed a personality profile identical in patterning to the idealized psychologically unhealthy individual. In this way, a clinician-based aggregate index of psychological health was obtained. 

The PHI has been shown to be not only reliable but also a valid measure of psychological health. It is strongly positively related to healthy peer and family relation- ships; marital satisfaction, effective parenting, and job satisfaction and self-confidence and competence. 

For the current examination of psychological health, we revised the original PHI in two ways. First, a previous reanalysis of the 100 California Q-Sort item scores revealed a set of items with relatively low interrater reliability at some time points ( Haan, Millsap, & Hartka, 1986 ). The pool of 100 items was thus narrowed to 73 that were parallel in content across all assessment ages and showed more consistent and adequate interrater reliability. To most effectively assess psychological health across the life span, we retained only those 73 California Q-Sort items for our analyses (see Table 1 ). 2 To obtain our PHI for each age considered, then, we correlated the composite idealized 73-item California Q-Sort profile with each individual's actual composite 73-item California Q-Sort profile at that particular age.

Second, before submitting the 73-item PHI to analyses, we performed a Fisher's r -to- z transformation. We did so because the PHI is a correlation coefficient and we therefore expected a skewed distribution of nontransformed data ( Hays, 1981 ). 

Latent Crrve Analysis Given the complexity of previous research findings, a statistical technique able to correctly capture and model possible interindividual differences in intraindividual change is needed. Here we selected latent curve analysis ( Meredith & Tisak, 1990 ). Unlike repeated measures analysis of variance and correlation coefficients, both of which assume similar change across time for all individuals in a sample, latent curve analysis models each individual's unique pattern of change across time as the sum of products of individual coefficients (analogous to factor scores) with "basis curves" that represent similarity in development. The essential notion is that development is lawful (basis curves), but people differ in the respect to which they manifest that development (individual coefficients). 

Latent curve analysis is similar to hierarchical linear modeling ( Bryk & Raudenbush, 1987 ) in its statistical intent, but it allows for greater flexibility in that developmental curves may be preestablished (e.g., linear or quadratic), as is required with hierarchical linear modeling, or the curves may be estimated from the data ( MacCallum, Kim, Malarkey, & Kiecolt-Glaser, 1997 ). In our current investigation, we allowed the curves of psychological health from 14 to 62 years of age to be estimated from empirical data. 

Note that although we use the term latent basis curves, we estimated the ordinates of the curves only at those points for which data were available. The actual curves between those points could be step functions, piecewise linear functions, or smooth continuous curves. This is even true when, for example, a linear model is invoked. 

Method Participants

For this investigation, we used data from three longitudinal studies based at the Institute of Human Development, University of California, Berkeley. Each study was begun between 1928 and 1931 and is still ongoing. 

The first study, the Berkeley Growth Study (BGS), began in 1928. Study members, selected from infants born in local hospitals, were extensively observed from infancy through 18 years of age were subsequently interviewed as adults when they were approximately 40 and 50 years old. 

The second study, the Berkeley Guidance Study (GS), also began in 1928. Study members were selected from the population of every third infant born in Berkeley between January 1928 and June 1929. Half of the GS participants' mothers were offered guidance by the principal investigator about general issues of childhood behavior and development, and the other half were not. For the purposes of this study, we separated these two subgroups of participants. Those given guidance were termed the Guidance group; those not given guidance were termed the Control group. The Guidance group was interviewed twice in adolescence, at approximately 14 and 18 years of age, and three times in adulthood, at approximately 30, 40, and 50 years of age. The Control group was interviewed only three times in adulthood, at the same ages as the Guidance group. Born in 1929, both BGS and GS members experienced the Great Depression as children; many suffered their family's attendant poverty powerlessly ( Elder, 1974 ). 

The third study, the Oakland Growth Study (OGS), began in 1931, when the study members were approximately 11 years old. Members were children planning to attend one particular junior high school in Oakland. Members were interviewed at approximately 14 and 18 years of age in adolescence and again at approximately 40, 50, and 62 years of age. Born in 1921, OGS members are about 8 years older than the BGS and GS members. OGS members experienced the Great Depression as adolescents; many were able to assist their families by obtaining part-time jobs ( Elder, 1974 ). A vast majority of OGS men entered World War II as young adults and subsequently experienced delayed parenthood and careers ( Elder, 1986 ). Fewer OGS women than BGS or GS women entered the workforce, and those who entered the workforce were older than their counterparts when they did so ( Clausen & Gilens, 1990 ; for considerably greater detail about these three studies, see Eichorn, 1981 ). 

The initial GS and OGS samples were reasonably representative of children living in Berkeley and Oakland, respectively, in the 1920s, at the beginning of these investigations. The initial BGS members were probably less representative of infants at the time. Participants of all three studies are almost exclusively Caucasian, reflecting the composition of the sampled communities at the time. As would be expected, however, the samples contain an approximately equal number of men and women. 

Instruments

The primary data analyzed here were derived from participants' interview responses, rated by judges using the California Q-Sort ( Block, 1961 ). Q-sort data are available for BGS members at approximately 14, 18, 40, and 50 years of age; for the Guidance group of the GS at approximately 14, 18, 30, 40, and 50 years of age; for the Control group of the GS at approximately 30, 40, and 50 years of age; and for the OGS members at approximately 14, 18, 40, 50, and 62 years of age. Participants were included in analyses only if they had at least one of two adolescent data points and at least two of three adulthood data points. 3 

As discussed previously, each individual's reduced 73-item California Q-Sort profile for a particular age was correlated with the reduced 73-item California Q-Sort "idealized psychologically healthy" profile to obtain the PHI for that individual for that age. The obtained PHI was then transformed, using Fisher's r -to- z formula ( Hays, 1981 ), so that the data would be less skewed. Before PHI data were submitted to latent curve analysis, the groups' PHI means, variances, and covariances were corrected via Little and Rubin's (1987) estimation-minimization algorithm for missing data. 

Results - Descriptive Demographic Findings

Throughout our analyses, we separate results by group (Berkeley, Control, Guidance, and Oakland samples) and gender. Although this procedure results in smaller subsample sizes, we believe that it best fits the exploratory nature of our research question. 

To place later obtained results in perspective, we first describe some general demographic characteristics of our sample. Separated by original study and gender, it is clear that participants in this study are similar to members of other long-running longitudinal studies, in that they appear relatively well educated and intelligent (see Table 2 ). As of the most recent extensive follow-up of a subsample of our participants in 1982, the majority were still married to their first spouse, had two or three children, and had high levels of education. The groups' Wechsler Adult Intelligence Scale—Revised IQ means ( Wechsler, 1981 ) run nearly two standard deviations above the overall population mean and indicate that our results may not generalize to less gifted individuals. 

Descriptive PHI Findings

Next, to allow an understanding of general trends in the psychological health data, PHI means, standard deviations, and covariances were examined by group and gender. Results indicate a mixed trend toward increasing mean PHI scores with time and fairly consistent variability in scores across time (see Tables 3 and 4). 

Latent Curve Analysis

To submit the PHI data to latent curve analysis with LISREL, we first faced a modeling complication in that we desired cross-time curves, yet no individual had PHI data for all six time points considered here (14, 18, 30, 40, 50, and 62 years of age). To account for this, we placed "marker" or "phantom" variables, which take on the value of 0 for each individual and consequently have a mean and variance of 0, into the subsamples' mean and dispersion vectors at points when data were not collected. 4 Phantom variables contribute no empirical information; they merely allow growth curves to be estimated across the entire age range for all subsamples (e.g., McArdle, 1994 ). We introduced one phantom variable for the BGS group at 62 years of age, two for the Control group at 14 and 18 years of age, one for Guidance group at 62 years of age, and one for the OGS group at 30 years of age. 

Finally, using LISREL 8 ( J?reskog & S?rbom, 1996 ), we performed latent curve analysis with maximum-likelihood estimation procedures. The latent curve model takes the following form: x it = a t + g t 1 w i 1 + g t 2 w i 2 + ... + g tr w ir + e it . In this case, x it is the PHI score for individual i at time t ; a t is an additive constant, which may be set to 0 or allowed to vary by time point, and g tj are the ordinates of the growth curve(s). The g tj can be connected over t to form the curve(s). The multiplying coefficients w ij are analogous to individuals' factor scores in ordinary factor analysis. Thus, the w ij for each individual for each curve indicates how an individual's data are unique with respect to the generalized curve. For example, given one underlying increasing linear growth curve, a first individual's large positive w would indicate that his or her data showed a steeper than average increase across time. A second individual's large negative w would indicate that his or her data showed a linear decrease across time. 

It is important to note that latent curve analysis can correctly model data such that no underlying curve is obtained, illustrating that no systematic pattern of change is shared among those in the sample. Conversely, one or more than one underlying curve can be obtained, with curves illustrating systematic patterns of change shared by those in the sample. 

For all latent curve models attempted, we set a t to 0, to force elevations of PHI into our growth curves. The only group and gender differences we allowed were in the means of the latent variable(s) and in the variances and covariances of the latent variable(s). The unique variances for each time point–variances not accounted for by the obtained growth curves–were allowed to vary by time point but not by group or gender. Thus, our implicit assumption (which could be rejected by a poorly fitting model) is that the basic developmental path of psychological health does not vary by group or gender, but the elevation of the path (latent variable means) and the amount of individual variability in the shape of the path (latent variable variances) might reasonably vary by group and gender. It would be possible to carry out numerous statistical tests on group and gender differences in elevations and variabilities (and covariances) of latent variables, but, given the exploratory nature of our work, we believed that these tests would be unwarranted. 

We first attempted a one-curve solution, fixing the first ordinate of the growth curve at 14 years of age to 1 but allowing all other ordinates to be estimated with the data. Such a solution clearly did not fit, c 2 (133, N = 236) = 225.07, p = .000. 

We then made the decision to separate adolescent from adult psychological health development. This can be considered a "piecewise model," with the form of development different for different portions of the life span. We created the first curve to represent psychological health at 14 and 18 years of age. Stability in psychological health in adolescence was modeled by creating a curve with ordinates 1 1 0 0 0 0 to represent the ages of 14, 18, 30, 40, 50, and 62 years, respectively. We created a second curve to represent psychological health level at the ages of 30, 40, 50, and 62 years, with adolescent ordinates of 0 and 0 and an age 30 ordinate of 1, to fix the scale of measurement for the curve. Ordinates at 40, 50, and 62 years of age were estimated with the data. 

Group and gender differences are apparent, however, in the latent variables' means, variances, and covariances (and correlations). Focusing first on the adolescent status curve, here held constant across 14 and 18 years of age, it can be seen that the BGS men and women showed higher psychological health levels (.40 and .38, respectively) than the remaining groups with data in adolescence. The variances appear similar across the eight groups (ranging from .04 to .11), however, indicating the groups' approximately equivalent amounts of individual variability with respect to level of adolescent psychological health. Focusing second on the adult development curve, here anchored at 30 years of age and then empirically estimated to steadily increase to 62 years of age, it can be seen that the control women had higher adult psychological health (.24) than the remaining groups. Allowing the addition of a constant in the latent curve model for the control women only at 40 years of age improved the fit of our model. However, we could not justify this addition substantively. The variances of the curves across adulthood were nearly numerically identical across the eight groups (ranging from .01 to .02). 

Finally, because two curves were extracted from the data, the covariance or correlation between the two curves can be examined by group and gender. A wide range of correlations can be seen, from .28 for Berkeley men to 1.00 for Berkeley women. 5 Excluding the Berkeley men, remaining correlations were moderate to strong and positive (ranging from .42 to 1.00), indicating that those with the highest adolescent psychological health tended to show the greatest increase in psychological health across adulthood. 

Discussion

Developmental paths of psychological health were examined for 236 male and female participants of a lifelong longitudinal study of human development. A clinician-reported aggregate index of psychological health, the PHI, was examined for various subsamples of individuals at 14, 18, 30, 40, 50, and 62 years of age, and life span trajectories were modeled via latent curve analysis ( Meredith & Tisak, 1990 ), a statistical technique able to detect and model individual differences in intraindividual change. 

We found that a single life span curve could not be successfully modeled. We chose to continue our analyses in a piecewise fashion, examining adolescent psychological health separately from adult psychological health. This approach resulted in a model of reasonable fit and meaning. The adolescent status curve indicates that psychological health, as operationalized via the PHI, can be modeled to be stable from 14 to 18 years of age. Although group and gender differences may exist with respect to the level and variability of psychological health in adolescence, there are no important group or gender differences with respect to the fact that stability exists. 

Many believe that adolescence is an important and sometimes abrupt transitional period, allowing for the possible development of psychological disturbance. It seems our samplings of data, at the ages of 14 and 18 years, were too late to capture the transition from childhood to adolescence. Instead, our results suggest that, once in adolescence, individuals' level of psychological health does not systematically increase or decrease. Our results fit with those of Ge, Lorenz, Conger, Elder, and Simons (1994) , for example, in their study of boys' and girls' depressive symptoms from 9 to 20 years of age. For girls, the increase in number of symptoms was seen chiefly before 14 years of age. For boys, symptoms increased after 14 years of age but resumed age 14 levels by 18 years of age. Such results remind us that, despite the fact that the amount of longitudinal data analyzed here was impressive, we certainly are not capturing all points along the life span. Important changes may have taken place before or between assessment ages. 

Previous work indicates that girls may differ from boys with respect to levels of psychological health in adolescence. Ge et al. (1994) and Petersen et al. (1991) , for example, found higher levels of depression in adolescent girls than boys. In contrast, Cohn (1991) , in his meta-analysis of studies of ego development, found that adolescent girls showed more mature ego development than adolescent boys. Inspection of the means of the adolescent status curve indicates that our data show neither systematically higher nor lower levels of adolescent psychological health for girls versus boys. This may, in part, be a reflection of the very generalized operationalization of psychological health used. 

It is important to note, however, that we did find some interesting group differences in the level of latent psychological health in adolescence. The reason that the Berkeley samples' means were higher than those of the remaining groups may have been that fewer raw interview and observational data were available for Q-sorting for the Berkeley group for these time periods (only), positively biasing evaluations. Note that, even with such possible biasing, evidence of stability is still seen. Inspection of the variances of the adolescent status curve reminds us that individual differences in adolescent psychological health level clearly exist. 

The adult development curve indicates that, in general, psychological health, as operationalized via the PHI, is not stable in adulthood but instead shows a steady increase from 30 years of age to 40, 50, and 62 years of age. As is the case with the adolescent status curve, although group and gender differences may exist with respect to the level of psychological health in adulthood, there are no group or gender differences in the shape of the adult development curve. Overall, then, no group or gender differences in the patterns of psychological health development from 14 to 62 years of age were found. 

Means for the adult development curve indicate few systematic differences in level of adult psychological health by group or gender, supporting Cohn's (1991) results. Our measure of psychological health, the PHI, is more similar to Cohn's ego development than other researchers' indexes of psychological health; therefore, similarity of results may not be surprising. 

Inspection of the variances of the adult development curve reminds us that individual differences in adult psychological health do exist. Although the "average" participant showed moderately increased psychological health, some individuals showed dramatic increases, and some showed little or no increase in psychological health. Clearly, a next step in this line of research is to explore these individual differences with respect to degree of change in psychological health in adulthood. 

An important additional finding involves the correlation between adolescent status and adult development psychological haalth curves. With the exception of data for Berkeley men (again, note that the adolescent data for Berkeley men and women were slightly unusual), all other groups and both genders showed a moderately to extremely strong positive correlation between the two curves. In other words, those with greater psychological health in adolescence tended to show a more positive acceleration of psychological health in adulthood than those with less psychological health in adolescence. Thus, although even those with low psychological health eventually showed improvement, those beginning adulthood with greater psychological health were more able to achieve near peak psychological health by late adulthood. Our results conflict, in part, with those of Clausen and Jones (1998) , who found that those with greater "planful competence" (a measure similar to psychological health) in adolescence showed greater stability of personality in adulthood than those with less "planful competence." Clausen and Jones's (1998) results indicate that those who enter adulthood competent experience few internal or external pressures to change. Our data, in contrast, indicate that those who enter adulthood psychologically healthy continue to move toward greater psychological health. We suspect that the more specific focus on psychological health, rather than personality overall, explains the divergent findings. Many aspects of personality are "neutral"; a given level of gregariousness or pace of personal tempo, for example, can be easily incorporated in a variety of lifestyles. In contrast, there are many intrinsic and external rewards for positive psychological health. 

Of course, several cautions should be noted when interpreting our results. First, our sample size and sample characteristics do not allow for unlimited generalization. Our overall sample size of 236 was good, but subsample sizes by gender and group were relatively small. We also would have liked to analyze complete life span data for all groups. Remember that each group contributed data for a slightly different portion of the life span: Berkeley for the ages of 14, 18, 40 and 50 years; Control for the ages of 30, 40, and 50 years; Guidance for the ages of 14, 18, 30, 40, and 50 years; and Oakland for the ages of 14, 18, 40, 50, and 62 years. Although the developmental trajectories for each group were successfully equated, note that only one group provided data for 62 years of age. 

A second constraint is that our sample consisted of educated, successful, very intelligent people, a biasing typical of long-term longitudinal studies. Our participants are fortunate in that they are the type of people more likely to find and hold challenging careers, create and maintain good marriages, find and keep supportive friends, and afford therapists. Clearly, a replication of results with less advantaged individuals is needed. 

Third, our data cannot represent other cohorts with different educational, occupational, or social opportunities. Although we found no significant differences with respect to change in psychological health for the two cohorts considered here, born in 1921 and 1929, respectively, these cohorts together may significantly differ from later-born cohorts. Some suggest that "prebomb" generations may experience vastly different cultural environments than "postbomb" generations, influencing personal changes, including changes in psychological health ( Fiske & Chiriboga, 1985 ). 

Fourth, our measure of psychological health, the PHI, may be criticized on several grounds. Although we consider it a strength, the fact that data were derived from clinicians, rather than directly from participants themselves, makes results difficult in some ways to interpret. How our results fit with self-perceptions of psychological health, either retrospectively or prospectively collected, is unclear. Also, although we consider it a strength, the multidimensional nature of the PHI makes results difficult to square with other studies with a more detailed focus on depression or positive affect, for example. A fascinating hint that the PHI may mask interesting, more narrow aspects of psychological health comes from work conducted by Peskin (1998) . He found that temporary decreases in late adolescence in such positive characteristics as dependability, lack of defensiveness, and productivity for men and lack of submissiveness, autonomy, and lack of reluctance to act for women positively predict psychological health at 60 years of age. He suggested that the capacity to experiment with such negative aspects of personality in later adolescence may bode well for longer term adjustment. Clearly, we cannot detail such specific aspects of psychological health with our global index of psychological health. 

Finally, it may be argued that "ideal" psychological health should change with age (particularly across such a wide age range as 14 to 62 years), and thus the profile used to create the PHI is faulty. We agree that some items might change with age (e.g., rebellious may be a positive item for a 14-year-old and a negative item for a 30-year-old). However, given the large number of items incorporated, differences in results should be insignificant. Further evidence that the PHI has cross-time structural stability comes from work conducted by Haan et al. (1986) . Analyzing the same 73 California Q-Sort items across an even broader time span, incorporating childhood data, they found the items could be represented by the same six principal components at each time point considered. 

It should also be noted that, as with any other study involving structural equation modeling techniques, other, equally reasonable models could have fit the data. We do not suggest that the model presented here is the only one that could be usefully obtained and interpreted with these data. 

Despite the preceding caveats, the power of these data should be recognized. These longitudinal studies, systematically and extensively tracking men and women from either birth or early childhood through to older adulthood, give a rare picture of how individuals actually mature across a lifetime. Our broad, clinically oriented measure of psychological health, examined across a period of nearly 50 years, indicates that as our 236 men and women made their way through life (certainly not lacking challenges and difficult times, despite their general intelligence and stability), they became slowly more psychologically healthy. Like Vaillant's (1977) analogy, most seemed to use the irritating sand of life to create pearls. Such findings provide insight into many important areas of human development. 

Strategies for Energetic Aging Susan M. Kleiner, PhD, RD THE PHYSICIAN AND SPORTSMED - NOV 98 

Getting older can mean you're getting better. At 40, 50, or 60, you probably know more, work smarter, and have more confidence than when you were 20. But no one wants to feel old. To minimize the pitfalls of aging, you can't just sit back and "grow old gracefully." Making changes in your diet and exercise routines may be your key to staying active and vital well into old age. (See "A Checklist for Energetic Aging," below.) 

Exercise is Essential - Until recently, weight gain and declining physical ability were mostly blamed on aging. We now know that much of this decline starts with inactivity. This leads to loss of muscle mass and increased weight, and eventually to disease and loss of independence. 

Most of the calories you consume are burned by your muscles, so if you don't exercise to maintain muscle mass, your body will burn fewer calories. If you continue to be active, you maintain muscle mass, aerobic capacity, and fat-burning potential, and you keep your weight down. At the same time, you reduce your risk of developing many diseases. This will help you continue to be active into your seventh and eighth decades, and even beyond. 

General Diet Strategies - When you stay active you can eat more without gaining weight, which means you can get more of the nutrients that help preserve health. Here are some helpful diet strategies: 

Maintain a healthy weight. Obesity has been linked with increased death rates from many types of cancer. To help maintain a healthy weight, you may want to try changing your pattern of eating. A study at Tufts University in Boston found that postmenopausal women who ate fewer than 1,000 calories per meal burned fat at virtually the same rate as younger women. But with larger meals of 1,000 calories each, the older women's ability to burn fat was greatly reduced. And when dietary fat is not burned as fuel, it is stored as body fat. 

To improve your burning of fat, then, try eating four to five smaller meals rather than three large ones each day. Besides helping you with weight control, smaller, more frequent meals and snacks will also provide energy throughout the day. 

Keep your fat intake low. No more than 20% to 25% of your calories should come from fat. High-fat diets increase the risk of heart disease and cancer. Avoid foods high in saturated fats like fried foods, chpps, desserts, high-fat meats, and full-fat dairy products, dressings, dips, and sauces. 

Fill up on fiber. Fiber keeps food moving through your system. It decreases your risk of constipation, diverticulosis, and hemorrhoids. It can help lower your cholesterol level and remove carcinogens. 

Eat a plant-based diet. If your diet consists mostly of fruit, vegetables, grains, and plenty of protein-rich beans, nuts, and seeds, it will almost certainly be low in fat and high in fiber. In addition, you'll be eating foods that are high in antioxidants and phytochemicals--natural substances that may help prevent cancer and slow some aging processes. 

Four Vitamins and a Mineral - The foll nutrients become increasingly important as you age: Folic acid. Folic acid, or folate, helps prevent heart disease and stroke by limiting the blood level of an amino acid called homocysteine (high levels of which are linked with an increased risk of cardiovascular disease). If you eat a diet rich in fruits, vegetables, and beans, you should be getting enough folate. But if you want to make sure, take a supplement with 400 micrograms of folic acid. Beware though! Too much folic acid can mask evidence of a vitamin B12 deficiency. 

Vitamin B12. Insufficient stomach acid (atrophic gastritis) inhibits the separation of vitamin B12 from food. This condition occurs in 10% to 30% of people over age 60, and may cause a vitamin B12 deficiency. To prevent the problem, a daily supplement containing 25 micrograms of vitamin B12 is recommended. B12 also helps limit homocysteine levels. 

Vit-E has been linked to lower risks of heart disease and prostate cancer. An antioxidant, it also may help decrease inflammation that occurs after strenuous exercise in people over 55 years old. 

Since vit-E is fat-soluble and found primarily in vegetable oils, nuts, and seeds, low-fat diets are notoriously deficient in this nutrient. Make sure to include some of these foods in your diet. A 100- to 400-IU supplement is also recommended. If you have high blood pressure or take coumadin or other medicines that prevent blood clots, check with your doctor before taking these supplements--vitamin E may raise the risk of stroke and interfere with the action of the drugs. 

Vitamin D. Vitamin D deficiency accelerates bone loss. Between 30% and 40% of adults over 50 may have a borderline or pronounced vitamin D deficiency. 

Milk and fortified breakfast cereals are good sources of vitamin D. Though your skin makes vitamin D when exposed to sunlight, older skin can be up to 50% less productive.

Recently, the National Academy of Sciences recommended daily vitamin D intakes of 200 IU for ages 50 or younger, 400 IU for ages 51 to 70, and 600 I  for ages 71 and older. Most older people don't get enough by sun exposure, so if you don't get enough in your diet, you need to take a supplement. 

Calcium. In clinical trials, people given calcium or calcium plus vitamin D had fewer fractures than people given a placebo. Women aged 19 to 50 and those aged 50 to 64 who take estrogen need about 1,000 mg a day; women older than 50 who are postmenopausal and not taking estrogen should consume 1,500 mg per day. Men aged 25 to 64 should consume about 1,000 mg daily, and those older than 65 need about 1,500 mg daily. You can get enough calcium from three to four servings of low-fat milk, yogurt, or cheese each day, or from fortified foods or supplements. 

Drink Up! Our thirst mechanism gets worse as we age. That means you need fluids, but your body can't tell you. If you take medications it is essential to stay well hydrated. Drink at least eight 8-ounce cups of noncaffeinated, nonalcoholic fluids every day, and one to two 8-ounce cups of water or a sports beverage before you exercise. During exercise, especially in the heat, drink 4 to 8 ounces every 15 minutes, and at least two 8-ounce cups after exercise. 

Aging With Advantages - We know more today than ever before about the influence of diet and exercise on the aging process. Take advantage of that knowledge, take action, and you'll increase your chances of staying healthy and strong for many years. 

 A Checklist for Energetic Aging When combined with a good exercise program, these nutrition habits and strategies will help you stay healthy and active well into old age: 

Maintain a healthy weight; smaller, more frequent meals may help. Keep your fat intake low. Fill up on fiber. Eat a plant-based diet. Get enough minerals and vitamins, especially calcium, folic acid, and vitamins B12, E, and D. Drink at least eight 8-oz glasses of noncaffeinated, nonalcoholic fluids daily. 

 Remember: You, your physician, and your nutritionist need to work together to discuss nutrition concerns. The above information is not intended as a substitute for appropriate medical treatment.

Dr Kleiner is owner of High Performance Nutrition and a nutrition consultant to athletes in the Seattle area. She is a member of the American College of Sports Medicine; a member of the American Dietetic Association and its practice group, Sports, Cardiovascular, and Wellness Nutritionists (SCAN); and a fellow of the American College of Nutrition.

\2 three 80yr olds
 The Body May Creak, but the Brain Hums Along

OLDER but wiser is a phrase not heard much anymore, as attention has focused on time's less-kind effect on the brain. But are there advantages to having lived a lot, seen a lot and — maybe thought a lot? Dr Oliver Sacks, the neurologist and author, thinks so, though he is a mere 68. "The amount of info one has," he said. "And the varied experiences one has been through, which may include betrayals and abandonments, fallings in love and out of love and wars and lies. One is driven to some sort of synthesis just to try to make sense of it." In his opinion, the brain doesn't slow down that much in old age, except in "a trivial sense."

The following four distinguished octogenarians, none of whom seem to have considered retiring for even a moment, are cases in point. They are people whose force of ambition, personality and thinking defined slices of American culture for at least the last half-century. Despite their now-creaky bodies, they are still working. Their mental journeys have not slackened one bit.

But have they achieved wisdom? Most agreed they have achieved a specific wisdom — mainly about what to expect from other people and themselves. All modestly suggest that wisdom, however — the Platonic kind at least — is still as elusive as their short-term memories, which are now pretty much shot.

SAUL BELLOW - "I avoid slabs," said Saul Bellow, chuckling quietly as he reclined in a chair in his brown-on-brown professorial office at Boston University, where he teaches a seminar, "An Idiosyncratic Survey of Modern Literature," every Wednesday afternoon. Though the 87-year-old Nobel laureate was alluding to a scientist's examination of the brain on a plate, the slab he's really referring to, of course, is the one at the morgue. Mr. Bellow, who has spent a fair share of his literary life writing about a certain type of American Jewish man's preoccupation with ambition, women, ideas and death, is still preoccupied with all of the above, and still writing about them daily, working on what he says are a number of unspecified projects.

Mr Bellow acknowledges that his ambition has mellowed with age, as has his desire for self-improvement, which fled when he hit 60. Now, Mr Bellow says he is "trying to find out what accounts for the things I carry around in my mind which have persisted for reasons of their own." He is not in a hurry for revelation. "I realize," he said of the process of discovery, "that there is a certain sort of persistent blindness in people, that they know much more. There is more knowledge than is apparent even to them. So that gradually they come to expect certain disclosure of something that's been concealed until now. You have to somehow cast off the restraints of the veil and you can see."

This is not real wisdom — "Nobody intelligent ever claims wisdom," he said — but a new understanding. Age helps nudge the process along. "There's some important conclusions that you can reach," he said, "not through intense effort, but by being laid-back,aas yo  tend to be as you grow older. The haste and urgency of youth give you some relief when they depart."

But Mr. Bellow's intellectual journey is still driven by a trait more common in the young — optimism. "Sometimes," he said, "you have projects that you carry around for many decades and, lo and behold, you've become an old guy and you ask yourself, `Will I still be able to do this?' I learned early that a man can do anything he wishes to do, regardless of his age. I suppose so much of your job is delusional, that you can as easily have delusions when you're in old age as in your youth." 

Then, quietly, Mr. Bellow weaves another filament through the web melding memory with the future: "My mind is a storehouse of old wacky sayings, and one of them is `Dum spiro spero.' While I breathe, I hope."

DAVID BROWN - takes his coffee black and his Scotch on the rocks, at least at lunchtime. At dinner, he adds a dash of Pernod to his cocktail and lets his wife of 42 years, the former Cosmopolitan editor in chief, Helen Gurley Brown, sip it while he orders another. The alcohol is a fitting closure to the long workdays that Mr. Brown still puts in at his Midtown Manhattan office, where he burrows for the next blockbuster to produce either on screen or on the stage.

Mr. Brown, the 86-year-old producer of "Jaws," "The Sting" and "Chocolat," says that "life is no different than it was at age 30 or 25," except that now that he's old, "we don't have to please anyone except ourselves." But then, he readily admits, he is lying.

Speaking by phone a month before the opening night of his newest Broadway production, the musical version of "The Sweet Smell of Success," Mr. Brown is dogged by his decades-old demon, the aching need for critical acclaim. Age and experience have not helped him weather the emotional roller coaster one iota. 

"Any time I have a movie or play or book coming out, I am as full of angst and dread as to how it will be received as though I couldn't pay the rent if it didn't work out," he said. 

Occasionally, when he lets them, vivid, filmic memories of Mr. Brown's youth in Woodmere, N.Y., can crowd his consciousness. The day in 1927 he spent watching a total eclipse of the sun, while calculating how old he would be at the millennium, is one of them. 

Nighttime is different. Mr. Brown says that when he is falling asleep, he listens to Joe Franklin's songs of the 20's on WOR-AM and contemplates. "I think about all the people who are no longer here," he said. "During the waking day, I think about the future." He takes that future in small chunks. "You can't really indulge credibly in long-range planning, you just go from day to day and year to year, astonished that you are still alive." 

Still, Mr. Brown is not ready to stop working, even when circumstances suggest he may be pushing it. He recalled one moment of doubt: it is 4:30 a.m., dark and cold, and he is on location in France for the filming of "Chocolat." The questions start. "I wonder what the hell I'm doing there. And my conclusion is, who would have lunch with me if I weren't doing this sort of thing?"

Despite the anxiety that work still engenders, Mr. Brown's life has been nothing short of operatic, and he says he is not ready for the finale. "Life is more important to me now. I don't want to leave the party."

MIKE WALLACE - "Dead man walking," said Mike Wallace of Yasir Arafat, pausing between each word. Mr Wallace, 83, was in his office at "60 Minutes" in NYC, four days from a trip to Ramallah to have, perhaps, one last conversa- tion with Mr. Arafat. They have butted heads seven times in 25 years, and Mr. Wallace is rehearsing, planning to chalk up another point for high drama on "60 Minutes," where he has been a host since its inception in 1968.

Sitting below a shelf so crowded with Emmy Awards they look like a flock of birds, Mr. Wallace is the oldest news guy at CBS, ever. While he is known for his dramatic, confrontational style, he says that he no longer puts a high price on the drama. "When I was starting out, it was quite apparent that it was heat — `Are you after heat or are you after light?' " he said of the dirge he played to himself before each interview. Now, he says, he is after "illumination." 

Though Mr. Wallace says he still works on 20 pieces a year, his style is different than it used to be. By his own admittance, he is less of a "lone operator," depend- ing more than ever on the researchers and producers at the show to help him prepare for interviews. He says he's content with the change, but sees it as a signal of the passage of time. Relying on others has led him to ask himself some uneasy questions. 

"I don't have the same kind of psychic energy that I used to have, and I'm sad about that," he said. "I'm frustrated because I'm of a certain age, and I want to keep working, and you can say, `If you don't have the psychic energy and you don't do it the way you used to do, why not leave?' " 

Just this year, Mr. Wallace says he has been asking himself that question, the first time it has really cropped up. But staying relevant is too alluring. "Can you imagine Arafat at this moment?" he said. 

JULIA CHILD - It's 1pm in Santa Barbara, CA, and Julia Child is already thinking about dinner. She's dining alone tonight, in the two-bedroom condominium she recently moved to from her home in Cambridge, MA. She donated the three-story house in Cambridge to her alma mater, Smith College, "as a tax write-off" all except for the famous kitchen, which was dismantled, to be rebuilt and dspyd in an exhibit at the Smithsonian Inst.

Mrs. Child has donated most of her cookbooks to Harvard, let her nieces have their dibs on the rest of her cooking things and gotten rid of most of her possessions. For many other almost-90-year-olds (she'll be 90 in 2002), letting go of one's possessions is the beginning of the end. But Mrs. Child, whose condominium is located in a retirement community where breakfast, including "the best bacon," is served to her in a communal dining room, says the change is the beginning of her future.

"I don't think about it," Mrs. Child said, speaking by phone of her waning years. Nor does she spend much time thinking about the past. "I remember nice things that happened. I don't dwell on the past at all, I dwell more on what I'm going to do, the future and the present." 

One month after an operation to remove what she called "nubbins" on her spine, Mrs. Child is 30 pounds lighter as a result of the painkillers that nauseated her and prevented her from enjoying food. Now, she is recovering more slowly than she would like to be, and talks of taking up golf again, a pastime she once enjoyed but which her late husband, Paul, did not. "I probably have to use one of those golf carts now," she said, as if this were as improbable a tool for a 90-year-old to use as an electric beater might have been when she began her TV career in 1961. (Mrs. Child, in fact, used a balloon whisk to beat eggs to make an omelet on her first TV appearance.)

Despite her plans to hit the links, Mrs. Child says retirement is definitely not in the picture. "What would I do?" she asked. In mid- February, she spent an hour writing an article, pleased that the words poured out with ease. She just sat down and got right to work at it. That has always been her style.

Now, Mrs. Child says she is "readying the decks" for her next project, a memoir. The book has been rumored to be in the works for at least two years. And she's still talking to chefs, learning new things. "I did learn something new just the other day, some dumb small bit of information I hadn't heard before." Mrs. Child couldn't recall what the tidbit was, and allowed that remembering the little things and names were not as easy as they once were.

As for her dinner? "A baked potato, a chicken thigh and maybe some asparagus I have from the farmer's market." Asparagus is in season in California, and Mrs. Child is busy enjoying the bounty and the sun, cooking and writing.

\2 glands

Once there was a medical slogan that "Man is as old as his arteries". Now it has changed and the slogan is "Man is as old as his glands".

There are seven major Endocrine glands. Each one generating its special variety of activities which include the production of hormones and types of energy for definite purposes and functions within the body. These glands are set near to the spinal column and work closely with its intricate network of nerves. The gland at the base of the spine is known as the Gonads, which control the life impulse, the will to survive. 

The gland at the Sacral Centre is called Adrenals, which run the sex life and which embody the will to create on the physical plane. The gland which is situated in the Solar Centre (plexus) is known as Pancreas which takes care of man's animal nature. The gland which is situated in the Heart Centre is known as the Thymus. 

This gland is usually recessional, because of the under developed condition of the man. The Thyroid gland is in the throat centre with its four Para glands (Parathyroid). This gland is the secret of the potential basis for human creativity, leaving the spine and rising up into the head we find the two remaining glands Pituitary and Pineal gland. The Pituitary gland gives the tune to all other gland while the pineal keeps the functions of the Endocrine System harmonious and effective.
  The general name for sex glands testicles and ovaries is Gonads. The testicle is a gonad, so is the ovary. Hydra grows both and is therefore Hermaphrodite. 

Hermaphroditism is quite common among the lower animals, but usually development of the gonads is so timed and arranged that self fertilisation is discouraged. The eggs of one animal are fertilised by the sperms of the another, not by its own. After fertilization of a hydra egg by a hydra sperm, the resulting zygote divides and forms a ring of cells which nourish the gonads. Hydra is a tube lined with cells, the endoderm and covered with a second layer, the Ectoderm. Between the two layers is the third sheet of jelly like material. 

The body and the germ cells in the fresh water polypre- mitive animals known as the Hydra, reproduces both sexually through fertilization of the Ovum, by sperm from another hydra and sexually by budding. It is herma- phrodite but not self fertility. 

Since the gonads are the basis of life, they are responsible for making our personality, radiant and magnetic. Hence they need proper training. Sparkling eyes, luminosity, self-reliance are always an indication that the gonads are functioning properly. Their hormones create the inner warmth in the system, preventing all tendencies for inflexibility, hardening and stiffening. 

If by reason of the severe illness, over indulgence in food, and alcohol, combined with too little exercise, sexual excess and advanced years, the secretion of gonads fails, then we get a picture of senility and old age. The condition called age is nothing but a gradual waning of the endocrine functions with the accompanying reduced cellular activity and Toxaemia, which finally over burdens the body and causes the vital organs to fail.

On the top of each kidney is a small gland called the Adrenal. These glands produce small quantities of specialised chemical substances which mingle into the blood stream and are distributed to all parts of the body. The amount of the secretion is largely influenced by our emotional status. These secretions either stimulate or co-operate with the sympathetic nervous system, and bring about a counter action of the small blood vessel of the skin and digestion of the organs.

That the adrenals are of vital importance to life is shown by the fact that death rapidly follows their extirpation. These adrenals have been called the glands of Combat, for, to their secretion is attributed the power to summon to battle, the forces of the body in times of stress and strain. These glands exert a powerful tuning influence on the nervous system. The desire to action, the keenness of perception and unfailing courage are expressed by these glands. When they function properly, they intensify the flow of blood stream in to the body.
  The pancreas is a lobular gland made up of millions of small tubes lined with cells producing digestive fluids. These tubes pour the pancreatic juice into the common duct which carries to the duodenum. Pancreatic juice contains four enzymes; Trypsin, which acts on Peptones. Amylase, which acts on starch. Lipase, which acts on fat and Milk curdling enzyme which is akin to renin. The Pancreatic juice is strongly alkaline and easily capable of neutralizing gastric acid. 

The pancreas is an endocrine gland but in addition to the digestive juice which it pours into the duodenum, it delivers into the blood stream, a hormone called Insulin, which prevents diabetes. The pancreas is thus an Endocrine as well as digestive gland. Embedded in its substance is small group of cells which differ from the rest, which produce insulin a hormone, having the task of converting glucose into a form in which the body cell can use it. 

When the cells cease to function the patient develops diabetes. The pancreas exercises its influences over the solar plexus that is a network of Sympathetic nerves and ganglion situated behind the stomach and its importance has been brought into bold relief by describing it as the lower brain.

The Thymus gland which is the largest in infancy, becomes completely atrophied by the time adult age is reached. In the infant the thymus gland lies in the lower part of the neck and extends down into the thorax behind the breast bone or sternum. It is made up of a cortex composed of cells resembling lymphocytes, which comprises and an inner portion in which round cluster of flattened cells are found. In any case at puberty the thymus begins to get smaller and by about maturity, has disappeared altogether during the first 14 years of life.

This gland prevents a premature mineralization and hardening of the body so that growth and development can take place undisturbed. When the adolescent stage is reached, the thymus has to shrink as otherwise the adjustment between man and the earthly life will be retarded, may even cause death. It governs the law of adjustment.
  The Endocrine gland whose function was first recognised was the thyroid. It lies in the neck and consists of two lobes connected by a bridge under the microcosm, the thyroid is found to consist of cavities filled with gelatinous material and lined with approximately square cells. The gelatinous material contains the thyroid hormone thyroxin which is not only necessary to normal growth, the development but essential to physical and mental health. It contains iodine in relatively large quantities and so indistructs when the soil is different in iodine, disease of the thyroid is common. 

The thyroid may be so large as to hang down upon the chest, in such cases the gland is often inactive and the patient may show signs of cretinism.
  Four small glands lie in the neck close behind the thyroid. These are the parathyroids. If these glands are removed from an animal, the nervous system and the muscles become highly excitable and nervous twitching occurs which may finally take the form of fits. This state of nervous irritability is known as tatany. The animal cannot long survive without the parathyroid hormone and eventually will die of convulsion.

The thyroid is responsible for the inner activity in our system preventing the retention of water, sluggishness of the tissues, the densification of bones. The degree of the thyroid activity makes a person either alert or dull, quick or slow, animated or depressed, keen or apathetic. The proper development and the functions of the sex organs also depend upon a normal and healthy thyroid. The parathyroid glands influence the stability within our body.

The maintenance of its metabolic equilibrium by controlling the distribution and activity of calcium and phosphorus in our system. These represent a certain polarity, phosphorus being connected with the central nervous system, calcium with the skeleton. Thus we have a dynamic factor on one side and a static one on the other. The parathyroid maintains a balance between them. Poise and tranquillity are the results of the normal function of these glands.

The pituitary is remarkable gland. It lies at the base of the brain, attached to it by a stalk and enclosed in a tiny box. It is made up of two lobes which have different origin and different function. The anterior lobe develops from the embryonic mouth cavity and grows upwards to join the post lobe which grows downwards from the brain to meet it. It is no bigger than pea and yet it produces more hormones than any other endocrine glands. 

The pituitary manufactures a growth hormone and also a number of these hormones, two of these act on the thyroid and suprarenal cortex, and have been named respectively, the thyrotropic and Adrenotrophic hormones. It affects the sex glands by two gonadotropic hormones. It produces a hormone called prolactin which causes the mammary glands to secrete milk and there is evidence that the parathyroids are controlled by a parathyrotropic hormone. Finally the hormone is present which rises the sugar content of the blood, thus controlling the action of insulin which may be called the diabetogenic hormone.

The pituitary gland gives the tune to all other glands which are dependent upon it. Thus the way of orchestra is dependent on violin, it controls the inner mobility and the agility of the system promoting the proper growth of our body. It maintains the efficiency of the various structures and prevents the excessive accumulation of fat. A relaxed, harmonious and happy person without any complexes and frustration is sure to possess a normal healthy and active pituitary gland.

There are four ventricles in the brain of which the third is the most important. It is the narrow slit lying near the base of the cerebral hemispheres and separating the two thalamic from each other. At the posterior end of this slit a small nodule of grey matter projects backwards and overhangs the corporacordigemina of the mid brain. This is the pineal gland. It represents all that remains of third eye which used to adorn the foreheads of some of our lizard ancestors in far off times. One of the features of this lizard is that it has a quite well developed third eye behind and between the usual two. This is known as pineal eye and in man it is represented by the pineal gland.

The pineal gland is a tiny cone shaped body in the middle of the head behind and just above the pituitary. It contains pigment similar to that found in the eyes and is connected by two nerve cords. With the optic thalamic, it is said to control the action of light upon the body and for this reason scientists have suggested that it is the remnant of the third eye. Yoga science has pronounced it to be the seat of Intuition or cosmic consciousness. 

When the pituitary and the pineal have become fully developed and stimulated, their vibrations fuse and stirred into the life the third eye of man. When the eye of soul opens man will have personal access to higher knowledge. These seven major glands supplement and depend upon each other. Disorder in the working of these glands gives rise to defection of character or of alternation of behaviour which is the outward and visible expression of the working of the mind. 

An overactive thyroid produces emotional disturbance, an under active one slowness of thought, the expression and suspicion. A women with an overdeveloped pituitary may develop masculine outlook upon life. The extent of the part played by these glands in the formation of character and personality has been proved by experiments. It is certain that the normal physical health and mental development depend largely upon their balanced functioning; their hormones are responsible for difference between a dwarf and giant, between a happy and cheerful man characterised by mobility, radiance and vitalization of the life processes.

In the words of Dr. Hoskins the potency of the glands is almost unbelievable, their influence is pervasive in all that we do and in all that we are. They co-operate in determining the forms of our bodies and working of our minds. Hence Dr. Hoskins is right in saying that the glands are the "Tides of Life".

from the book "Unto the First", by H.H. Shri Kumarswamiji.

\4 anti-ageing pills

Doctors at a forum want the health authorities to tighten control on such over-the-counter purchases  By Braema Mathi Straits Times 4/18/01 COMMUNITY CORRESPONDENT  TOO many people are buying pills over the counter to try to delay the ageing process, and some doctors want more controls imposed on such purchases.

A PROGRAMME tailored for individuals to slow down ageing and help them live disease-free and active lives is underway in America. Named after the Greek God of Time, the Kronos programme has drawn 400 people to enrol since it began in 1998 at the University of Phoenix in Arizona. Funded by the university's 80-year-old founder and chairman, Professor John Sperling, it aims to arrest biological dysfunctions in people's bodies before they develop into diseases or serious medical conditions. Said Kronos' vice-president of research and development, Dr Christopher Heward: 'This is preventive medicine.

Timing is the essence here - to work with people before their medical condition worsens.' Dr Heward said that often, the participants' medical conditions did not fall into the clinical definitions followed by hospitals or insurance companies. Hence, a person with a mild form of diabetes could be denied treatment. This diabetes could develop into a serious form with other medical complications setting in. The 400 participants have undergone exhaustive psychological and biological testing. Using these medical snapshots, doctors prescribe diets, exercise routines, medication, herbal treatments, hormonal intakes and work routines.
                        More news:       Dr Eugene Hong, a consulting medical practitioner specialising in ageing at Gleneagles Hospital, said: 'The public is pumping quite a bit of money into these pills. It is actually quite frightening. 'Even vitamins need to be taken in the right dosage and patients are unaware how it can upset the body's balance. 'Stricter controls are needed and checks made on claims of drugs.'

He estimates that half his consultation time with elderly patients is spent reducating them about the supplements they take. Professor Peter Lim, head of Changi General Hospital's urology department, said pharmacists compounded the problem of self-medication when they give medical advice.'A pharmacist does not know the patient's overall condition, or what other medication he is on. 'He is not a doctor who can give prescriptions,' he said. He cited a case of his patient who was told to take three tablets a day, when he had prescribed only two.

The patient had a heart problem, and three pills were too much. Fortunately, the patient rang Prof Lim to check and reduced his dosage. Both doctors wanted stricter controls by the health authorities over drug purchases. For example, drugs should be labelled properly. They also wanted better education for patients and less liberal prescriptions by pharmacists.

They made this point in response to questions from reporters at the Third Singapore National Congress On The Ageing Male held yesterday at Sheraton Towers in Scotts Road. The public forum was organised by the Society for the Study of the Ageing Male. A speaker from America, Dr Christopher Heward, a biochemist, cited an American example of a check carried out on 22 samples of melatonin bought over the counter. Melatonin is a hormone-replacement drug that also helps patients with sleeping and jet-lag problems. But it can cause depression. Two samples tested had none of the drug, while only a couple of samples were 100% pure in the hormone. 

A PROGRAMME tailored for individuals to slow down ageing and help them live disease-free and active lives is underway in America.

Named after the Greek God of Time, the Kronos programme has drawn 400 people to enrol since it began in 1998 at the University of Phoenix in Arizona. Funded by the university's 80-year-old founder and chairman, Professor John Sperling, it aims to arrest biological dysfunctions in people's bodies before they develop into diseases or serious medical conditions.

Said Kronos' vice-president of research and development, Dr Christopher Heward: 'This is preventive medicine. Timing is the essence here - to work with people before their medical condition worsens.'

Dr Heward said that often, the participants' medical conditions did not fall into the clinical definitions followed by hospitals or insurance companies. Hence, a person with a mild form of diabetes could be denied treatment. This diabetes could develop into a serious form with other medical complications setting in.

The 400 participants have undergone exhaustive psychological and biological testing. Using these medical snapshots, doctors prescribe diets, exercise routines, medication, herbal treatments, hormonal intakes and work routines

\5 eyes (AMD)

Age-related macular degeneration (AMD) is the leading cause of blindness in people older than 65 in Europe and the USA. It is also as common a cause of severe visual loss in younger people as diabetes and glaucoma. But little is known about what causes AMD and there are no effective therapies for the disorder. AMD is a progressive degenerative disorder of the retina, retinal pigment epithelium, and the choriocapillaries. Drusen, a yellowish deposit consisting of cytoplasmic material released by the retinal pigment epithelium, accumulates in Bruch's membrane, which lies between the retinal pigment epithelium and the choroid. Drusen accumulation can result in "dry" AMD, in which atrophy of the retinal pigment epithelium and photoreceptor cells causes slow visual deterioration, or "wet" AMD, in which the inward growth of new choroidal vessels or detachment of the pigment epithelium leads to rapid and severe loss of central vision. Risk factors for AMD are not clearly defined, so little can be done to prevent it, explains Alan Bird (Moorfields Eye Hospital, London, UK). "There is good evidence that smoking increases the risk of developing AMD but the relevance of other factors such as a lack of carotenoids in the diet is speculative", he says. The Age Related Eye Disease Study, which has enrolled more than 5000 people, is testing the protective effects of several food supplements including b-carotene, although, says Bird, "this may not be the most appropriate carotenoid". There is no treatment for dry AMD but studies are underway to find out whether the use of laser therapy to target drusen is beneficial in wet AMD. This approach was first proposed in the early 1970s but Joan Miller (Massachusetts Eye and Ear Hospital, Boston, MA, USA) has reservations about it. "There is little evidence of a causal relation between drusen and wet AMD. Both may simply be manifestations of the same pathological process", she explains. Most potential therapies for wet AMD aim to reduce neovascularisation. Laser photocoagulation of new blood vessels delays visual loss by up to 2 years, but "can only be used in patients with clearly demarcated areas of blood-vessel growth away from the centre of the retina, or for very small central lesions -- that's about 15% of patients with wet AMD", says Miller. Even after successful treatment, neovascularisation usually recurs within months and repeated treatments destroy additional retinal tissue. Surgery may be one way to avoid retinal damage, but only small trials have been done, warns David Guyer (Manhattan Eye, Ear and Throat Hospital, NY, USA). "This very invasive procedure has many problems, and probably the only patients who might benefit from it are those in which there has been excessive bleeding behind the retina." Another option is external beam ionising radiation which has had a weak effect in some studies. But after analysing data from 500 patients treated with radiation at eight centres, Usha Chakravarthy (Queen's University, Belfast, UK) says "there is no evidence to suggest that radiation treatment is better than watching and waiting". Eight randomised trials are underway and Chakravarthy hopes that their improved design will settle the question once and for all. continued

\6 arteriosclerosis

What are the relationships between aging, arteriosclerosis and its clinical manifestations, namely coronary heart disease (CHD) and cerebrovascular disease? CHD and cerebrovascular disease are responsible for about half the deaths that occur each yr. In persons over 65 yrs of age, they are responsible for 70-80% of the deaths. Knowledge about the process of arteriosclerosis would go a long way in helping develop ways to prevent this disease.

While aging may be one of the factors precipitating the arterosclerosis process, it is also well known that there are multiple factors that can cause the disease. The major risk factors for arterosclerosis are serum lipid concentrations, smoking, and hypertension. Another factor appears to be gender. Men are approx twice as likely to develop atherosclerosis as equivalent aged women. Yet when all these factors are taken into account only about half of the variability of incidence of arteriosclerosis and coronary heart disease can be accounted for. Genetics may be a factor but conditions related to aging may also play a not so subtle role in developing the disease.

Start with the fact that as people age, there are changes in blood dynamics that can adversely affect vascular functioning and speed up the process of cardiovascular disease. It would appear that as an individual ages, his/her systolic blood pressure as well as pulse pressure rises. At the same time, elevated blood pressure coexists with other cond that may increase cardiovascular disease such as obesity, diabetes mellitus and increased LDL cholesterol. The Joint Nat Comm on Detection, Eval and Treatment of High Blood Pressure in its 5th rept (Archives of Int Med 1993) indicated that effective control of hypertension decreases both stroke and coronary heart disease in the elderly.

Not only does blood pressure increase with age, but also plasma cholesterol and LDL-cholesterol, as well as triglycerides. Interestingly, plasma cholesterol and triglycerides show a pattern of increasing in men for the first 50-60 yrs of life, then plateau and finally begin to decline. For women, the same pattern exists, but appears to occur 10 yrs later than men. HDL cholesterol do not show the same pattern, but women tend to have higher HDL cholesterol concentrations at least in the premenopausal years which may account for lower incidence of CHD in premenopausal women.

It has been doc that arteriosclerosis begins in early childhood in the form of fatty streaks. Fatty streaks are slightly raised areas of fat-filled cells (called foam cells) found within the inner wall of blood vessels and appears to arise from macrophages and contain a lot of cholesterol esters. One study showed that about 65% of the children have substantial accumulations of these cells. As individuals age, the fatty streaks increase into the second and third decades of life and then decrease, being replaced by lesions called atheromas at about the fourth decade. These lesions replace the normal cellular architecture and also fibrous plaques develop. The fibrous plaques cause complication in the lesions as well as ulceration, thrombosis, hemorrhage and mineral- ization with resultant myocardial infarctions and strokes due to occlusion of an artery.

If this is a normal process of aging, how come whole pop do not get CHD? Here researchers have suggested that a process called remodeling occur in the individuals who do not develop CHD. This involves a compensatory enlargement of the coronary arteries as part of the structural and functional changes occurring in all levels of arteries. This enlargement of the diameter of the artery is also accompanied by thickening of the artery wall and plaque formation. 

The story doesn't stop there. Other changes associated with aging including a progressive decline in glucose tolerance and the compensatory development of hyperin- sulinemia to deal with the intolerance. The latter is a major risk factor for the development of CHD. The high plasma insulin levels affect foam cells which then have a cascading effect on the capacity of blood to circulate (atherosclerosis) resulting in CHD. Insular resistance involves peripheral tissue resistance to insulin action. Thus, it may be that hyperinsulinemia secondary to an acquired or genetic insular resistance enhances the arteriosclerotic process. This leads to the theory that if you reduce the insulin levels, you may reduce  risk of arteriosclerosis and its clinical manifestation, CHD. 

This leads to another level of this complicated and not understood process. With aging, there is an increase in the total body fat usually seen as an elevated waist to hip ratio. Insulin resistance may play a role in this increased body fat and may be associated with abdominal obesity accompanying aging, rather than the aging process per se. Waist circumference involves two types of fat, depending on location: subcutaneous fat, below skin level and visceral fat, within the abdominal cavity. It would appear that visceral fat accumulation is more closely associated with insulin resistance. One study showed that visceral fat was present in almost 90% of obese patients with ischemic heart disease, and in 40% of non-obese subjects with cardiovascular disease. 

Thus if visceral fat accumulation could be controlled, society may have another way to reduce med expenses and enhance wellness of aging individuals. Determinants of this fat have been suggested to be physical inactivity, excessive sucrose (refined sugar) intake, sex hormone concentrations and aging. In this series of articles on aging, we wrote of the research in reducing caloric intake as a way of dealing with disease conditions of aging as well as moderate exercise and dietary changes as necessary concomitants of healthy living. While science tries to figure out the processes of aging and disease, the individual is empowered to increase the odds of living a full and complete life via adopting a personal life style in tune with physiological changes going on as we all age. The strategy is to implement dietary changes to control disease risk while one is healthy. It is never too early to prevent disease. Harold Rubin, MS, ABD, CRC, Guest Lecturer therubins.com

\7 aspirin benefits

Outcomes: Another Possible Aspirin Benefit for Men by JOHN O'NEIL NYT March 19, 2002
  Men over 60 who took aspirin or another anti-inflammatory drug daily were half as likely as those who didn't to be diagnosed with prostate cancer during a six-year Mayo Clinic study. The gap was even larger among men over 70, according to an article published last week in The Mayo Clinic Proceedings.

Drugs like ibuprofen and naproxen, known as nonsteroidal anti-inflammatories, have been linked to lower levels of colon and breast cancer, said the study's lead researcher, Dr. Rosebud O. Roberts.

Dr. Roberts said many of the men in the study appeared to be taking low doses of aspirin as part of a common regimen for preventing heart disease. She said she suspected that the oldest men showed the greatest benefit either because they were more likely to be taking a lot of anti-inflammatory drugs for conditions like arthritis, or because the drugs have a cumulative effect over decades.

Dr. Roberts said she considered the study's results too preliminary to be a basis of treatment recommendations. And because aspirin and the other drugs all can have significant side effects, she recommended that men considering a daily dose talk with their doctors first.

Long-Term Aspirin Benefits Seen By AP/NYT. CHI, Sep 13 00 People who take aspirin regularly to reduce their short-term heart attack risk may also be substantially extending their lives, new research suggests. The study of 6,174 adults suspected of having heart disease found that regular aspirin users faced a 33 percent lower risk of dying during a follow-up period averaging three years than patients who did not take aspirin.

The findings extend the known benefits for heart patients of taking aspirin at least every other day, which previous studies have shown can reduce the risk of heart attack and the short-term risk of death in heart attack sufferers, said the authors, who were led by Dr. Patricia Gum of the Cleveland Clinic.

"Up until now it really had not been very well established" that aspirin had long-term survival benefits for heart patients, said a co-author, Dr. Michael Lauer, clinical research director in the clinic's cardiovascular medicine department.

The study appeared Wednesday in The Journal of the American Medical Association. Dr. Lynn Smaha, a cardiologist at Guthrie Clinic in Sayre, Pa., said patients often asked him if they should regularly take aspirin, which improves blood flow through the arteries by making it less sticky and less likely to clot.

For those who have had heart attacks, "it's pretty clear that that's an appropriate recommendation," said Dr. Smaha, past president of the American Heart Association. The new study "lends credence to the possibility that long-term aspirin therapy may be of significant benefit" even for patients who have not had a heart attack, Dr. Smaha said. Dr. Lauer emphasized that patients should consult with their doctors about whether to start taking aspirin regularly.

Participants in the study were men and women who underwent ultrasound examinations, or echocardiograms, and stress tests to evaluate suspected heart problems. Researchers looked at 2,310 people who were taking about one aspirin daily or every other day at test time and 3,864 who were not taking aspirin.

There were 276 deaths in about three years of follow-up. While there were about equal numbers of deaths in both groups, the aspirin users were older when they were tested, with an average age of 62 compared with 56 for the nonusers, and had more diagnosed heart disease. Adjusting for those factors, the authors found that aspirin users were 33 percent less likely to die than those who were not taking aspirin.

The greatest benefits were found in patients who were physically unfit, over age 50 or known to have heart disease. Dr. Lauer said most of the deaths were likely to be heart related, though exact causes were not available.

\8 ASSISTED LIVING OR NURSING HOME?  USA Today, Jan 1998

As one of the fastest growing segments of the health care industry, assisted living providers are maintaining an occupancy rate of 92%  or more throughout a record-setting development phase, according to  a survey conducted for the Assisted Living F ederation of America  (ALFA), Fairfax, Va. The results indicate that assisted living  facilities are enjoying a constant stream of business, particularly  in specialized areas such as Alzheimer's units, where the stabilized  occupancy rate is as high as 98% in some areas of the country.  "This study gives us a very clear picture of the success of the  assisted living industry," explains ALFA's executive director, Karen  Wayne. "As the survey clearly confirms, assisted living is becoming  an alternative to traditional nursing home care. The findings  illustrate that residents are requiring higher levels of care, including assistance with incontinence, medication management, and  dementia." Moreover: o At a time when a Federal study shows a decline in nursing home  admissions, assisted living residents tend to have a higher level of  acuity and are staying longer than before. For example, the  percentage of residents suffering from incontinence dou bled from  15% in 1993 to 30.2% in 1996, while the average length of stay has  risen from 26 to 28.5 months. o The average age increased by one year (to 83) in 1996, and the  percentage of assisted living residents who have moved on to nursing  homes dropped from 46% in 1993 to 36% in 1996. o The variation and flexibility of assisted living facilities are  designed to meet the needs of residents, maintain their dignity, and  respect their privacy. The average amount of units within the  facilities surveyed was 58, with more than half provi ding  private/studio units, although that figure jumped to almost 75% in  the Midwest. The number offering semi-private units was highest in  the Southeast (22%) and lowest in the Midwest (4.6%). o While assisted living remains primarily private pay, about 26% of  the providers reported having some residents who receive state  assistance. Though assisted living is the lowest-price long-term  care option available, 53% of providers report some re sidents still  must rely on financial assistance from family and friends. The over-all demand for filling the important niche in seniors  housing is expected to increase as the U.S. Census projects the  85-years-of-age and older population will swell 39.3% in this decade  and 33.2% between 2000 and 2010.

\9 Balance is Essential - Dizzy Spells Are Common and Treatable at 60-Plus -- But Not to Be Ignored By Mary-Ellen Phelps Deily Wash Post Oct 16, 2001

In Dec 97, Richard L. Moyer's world started spinning. The 72-year-old was on the golf course "just standing talking to somebody," he said. Then, "all of a sudden, I started to sway." Moyer, who had spent 20 years in the Navy and never experienced even a twinge of motion sickness, feared a heart attack – until, seconds later, the harrowing sensation passed.

But his problems had just begun. Over the following three years, Moyer experienced dizzy spells that grew in intensity and duration. Some lasted for hours. "I really couldn't do anything I wanted to do," he recalled. "I never knew when [the dizziness] was going to hit. . . . You can't believe how miserable that is." Today, the Shermans Dale, Pa., resident is feeling fine, and he credits his recovery to treatment at Johns Hopkins Hospital for Meniere's disease, an inner-ear condition that can trigger severe dizziness. "I plan to do things now," Moyer said. "I don't have to fear getting dizzy."

Harry Weiss, an 86-year-old who lives in a Bethesda retirement community, has suffered brief, less severe bouts of dizziness. He is "occasionally and distressingly" dizzy, and he has no idea why. "I think I've been stopped by dizziness for many, many years now," Weiss said. "The doctors never seem to know how to deal with it. Their eyes seem to glaze over when you say you're dizzy."

Weiss and Moyer are among the many seniors who suffer from dizziness and balance problems. While these conditions can strike at any age, they fall disproportionately on older people. According to an analysis by the National Institute on Deafness and Other Communication Disorders (NIDCD), about 6.2 million Americans report chronic dizziness or balance problems, about half of them seniors. Nationally, around 9 percent of the 65-and-over population report suffering from balance problems.

And it's not just prevalence that makes balance an important issue for seniors. Older people are more likely to hurt themselves seriously if they fall – and to suffer greater disability afterward. "Usually a fall in an older person is going to impair their functioning," said Sandra Sewell, a registered nurse and clinical specialist in geriatrics who serves as the program manager for community care management at Suburban Hospital in Bethesda. Particularly for frail elderly individuals with other health issues, she said, falls can be devastating.

Brain Tumor or Allergy? Unfortunately, the symptom of dizziness can be a sign of a bewildering range of underlying conditions, from the relatively benign to the potentially fatal: low blood pressure, brain tumors, vision problems, stroke, allergies, head trauma, nutritional deficiencies and many more. Still, doctors and patients agree that seeking out medical attention early is crucial, and not only to rule out or treat serious conditions. Balance problems of more benign origin can often be treated easily – but if they are not, older people with problems that should be only mild and correctable may suffer reduced quality of life unnecessarily.

"When the nurse says you have a 75-year-old patient with dizziness, you don't know which of 20 different ways you're going to be going," said Robert Dobie, director of NIDCD's Division of Extramural Research. NIDCD, part of the National Institutes of Health, studies hearing, balance, smell, taste, voice, speech and language. Dobie's first priority is understanding what the patient is experiencing. He begins by barring the word "dizzy" from all discussions. "We banish it from our conversation because it's too vague," he said.

Dobie gets patients to describe their symptoms in more specific terms and then usually can assign the case to one of four categories, all relatively common among older people. "Getting it narrowed down" is crucial, Dobie said. "The majority of patients . . . have symptoms that can be improved." If they feel as if things around them are moving or that they're moving when they're not, that's vertigo, a condition typically related to the inner ear. Vertigo can be caused by ear infection, ear trauma or the loosening of calcium crystals within the ear due to aging.

If they feel as if they're going to fall down, disequilibrium. This type of dizziness can be associated with inner-ear problems, medication side effects, arthritis or neurological problems, to name a few possibilities. The drugs most likely to cause disequilibrium are ones that affect the brain, including sedatives, painkillers, anti-seizure medications and antidepressants. Drinking alcohol while on medication can also trigger the sensation.

If they feel as if they're going to faint, that's presyncope, which may indicate a heart, medication or blood vessel problem. Often, blood pressure medicines are the culprit. In some cases, they'll lower a patient's blood pressure too much and bring on the fainting feeling. Unfortunately, many cases fall into a fourth, unspecified category. Dobie refers to patients in this group as having "lightheadedness" or "nonspecific dizziness." Although the lack of a clear diagnosis can be troubling to the patient, generally the people in this category don't have anything seriously wrong, Dobie said.

At the Extremes. Probably the most common cause of vertigo is something called benign paroxysmal positional vertigo, or BPPV. People with BPPV experience vertigo – or nausea or lightheadedness – when they turn their heads or just roll over in bed. To understand how BPPV affects people, imagine feeling as if you've just stepped off a very fast merry-go-round – when you haven't. The attacks are brought on by loose calcium crystals or debris in a person's ear. In the case of younger people, a head injury can be the cause. With older people, degeneration of the ear's vestibular system may be to blame.

Unsettling as the condition is, it's often quite curable. In fact, doctors can perform a series of gentle maneuvers that rotate a patient's head and body in such a way that the crystals within the inner ear float back into place. In some cases, doctors have the patient turn their heads themselves. In others, patients are strapped to a table that rotates as they lie still. Either way, the process is noninvasive, takes as little as 10 minutes and is performed in doctor's offices rather than a hospital setting. With the crystals back in place, the vertigo should stop. If crystals come loose again, the treatment can be repeated.

Then there is dizziness that indicates something really serious. For example, dizziness can indicate stroke when it is paired with a number of neurological symptoms, such as a loss of consciousness, difficulty talking, the inability to move an arm or leg, or vision changes such as the appearance of blind spots. Anyone with these symptoms should seek immediate medical attention, Dobie said.

Examining Past and Present - Of course, not every diagnosis will be as straightforward as BPPV or stroke. So in many cases physicians need to probe deeper. The patient's medical history is essential, said John P. Carey, assistant professor of otolaryngology/head and neck surgery at Johns Hopkins University in Baltimore. Carey generally administers a range of hearing and balance tests. But he also wants to know about medical problems patients have faced in the past. Even those with no apparent connection to balance could make a difference, he said.

For instance, Carey believes migraines can lead to balance problems long after the painful headaches have stopped. Often, migraine-related dizziness can be treated by adjusting a patient's diet, cutting out such things as caffeine, chocolate and red wine. Regular aerobic exercise and a sleep schedule help as well, Carie advised. If those treatments fail, medication may be needed. Equally important is what's going on in a patient's life beyond the dizziness. Carey, who treats Moyer and others with balance problems, recommends that patients provide their doctors with a complete list of the medications they're taking. The patient should indicate if they've just started or stopped taking a particular drug.

Finally, Carey advised that patients keep a dizziness diary where they jot down when and how spells hit them. Documenting that attacks come when you're standing up or reaching for something, for example, can make the doctor's job a lot easier. "It's very important for patients to be very observant," he said. As for treatments, they can vary as much as diagnoses. For some, the cure may be as simple as the elimination of a particular drug or a change in dosage. For others, a special diet designed to cut salt intake and thereby reduce water retention in the inner ear may help. Less frequently, doctors may recommend medication. Very occasionally, surgery on the ear's balance mechanism may be required.

Fear of Falling - It's not just the physical aspect of dizziness that creates problems. Particularly among the elderly, dizziness can pack a powerful psychological wallop. "For someone who's 83, a fall is really frightening," said Sewell of Suburban Hospital. "It can make them lose their confidence."

The hospital's community care management program provides a variety of health and outreach services to the elderly, and complaints of dizziness among its clientele are not uncommon. Sewell said her organization takes a holistic approach to fall prevention generally and to its causes, including dizziness. That entails asking questions about a person's lifestyle and how dizziness has affected it, and perhaps making a plan for how to cope with dizzy spells.

Sewell's staff is interested in such mundane things as whether a person takes hot showers. If the water's too hot, it could touch off a blood pressure problem that brings on a feeling of dizziness or lightheadedness. Another common irritant starts with the very common act of reaching over one's head to get something. Sewell said she knows of many cases in which women, in particular, have craned their necks back as they reached for something, pinching off the blood supply in their neck momentarily and touching off a woozy feeling.

What's important is helping patients persevere and keeping their fears from getting the better of them. "As we get older, we see the consequences of things," Sewell said. "Just think about it when you were 16 or in your early twenties, all the things you did without thinking."

Sewell also advises her clients to take it easy. Moving too fast can touch off a moment of low blood pressure, when blood doesn't pump quite quickly enough to keep up with the burst of activity, resulting in lightheadedness or dizziness. Her advice: "You get up fast when somebody's at the end of the hall handing you a $100 bill. [Otherwise,] you get there when you get there."

Richard Moyer knows what it's like to have your life almost stolen away by dizziness. Although Meniere's disease – the cause of his dizziness – frequently starts in middle age, it didn't catch up with Moyer till he was in his late sixties. But when it did get him, it hit him hard. His troubles were so severe that he feared driving and mostly kept close to home. He even missed a reunion with Navy buddies that he'd been planning to attend. Dizziness put "a clamp on everything," he said.

That's why he was so relieved when his doctor got him an appointment at Johns Hopkins. The physicians there determined that he was a good candidate for a treatment involving injection of the antibiotic gentamicin into the inner ear. Gentamicin essentially deadens the faulty balance mechanism in an ear affected by Meniere's disease. The body compensates for the drug's effect by relying on a person's one good ear for balance.

After the injection, Moyer underwent physical therapy to improve his balance and learned exercises to train his eyes to help steady him. For him, it's been a miracle cure. "The help is great," he said. "I am just so pleased." Today, Moyer, who runs his own business making golf clubs, is an outspoken advocate for seeking medical help as soon as dizziness strikes. "Don't let it go," he advised. "Get help as soon as you can."


\10 Blueberries May Reduce Effects of Aging

An antidote to aging may be as close as a nearby farm or the supermarket shelves: blueberries. Elderly rats fed the human equivalent of at least half a cup of blueberries a day improved in balance, coordination and short-term memory, according to a study published this month in The Journal of Neuroscience. A cup of blueberries is a normal serving. Like other fruits and vegetables, blueberries contain chemicals that act as antioxidants. Scientists think antioxidants protect the body against "oxidative stress," one of several biological processes that cause aging. 

 After berry snacks, rats improve their balance and memory.

Barbara Shukitt-Hale, a co-author of the study at the Agriculture Department's Human Nutrition Research Center on Aging at Tufts University in Boston, says people "are told that once you're old, there's nothing you can do." But, she said, "That might not be true." Blueberries, strawberries and spinach all test high in their ability to subdue molecules called oxygen free radicals, which are created when cells convert oxygen into energy. In normal amounts, free radicals help rid the body of toxins, but they can also harm cell membranes and DNA, which results in cell deaths. The Tufts study said strawberry and spinach extract produced some improvement in memory, but only blueberry extract had a significant impact on balance and coordination. (Other fruits and vegetables high in antioxidants include alfalfa sprouts, beets, broccoli, brussels sprouts, garlic, grapes and kale.) Other studies have suggested that antioxidants in fruits and vegetables could prevent cancer and heart disease. Previous research by the Tufts scientists indicated that antioxidants slowed the aging process in rats that started taking the dietary supplement at 6 months of age. Their latest study was the first to show that antioxidants could actually reverse age-related declines, they said. The researchers do not know why blueberries were more effective than strawberries and spinach or exactly how the chemicals work in the laboratory animals. "Fruits and vegetables in general are very good for you; that's without question," said Marcelle Morrison-Bogorad, who directs the neuroscience and neuropsychology program at the National Institute of Aging. "It's another thing to know why." Clinical trials are needed to see whether humans could benefit, she said. The institute, which helped finance the Tufts research, is already sponsoring studies to test the effects of vitamin E, another antioxidant, as well as aspirin and B vitamins, on the mental processes of older women. The rats used in the Tufts study were 19 months old, the equivalent of 65 to 70 years in humans. They begin losing motor skills at 12 months. By 19 months, the time it takes a rat to walk a narrow rod before losing its balance drops from 13 seconds to 5 seconds. After eating daily doses of blueberry extract for eight weeks, the rats could stay on the rod for an average of 11 seconds. They also performed better in negotiating mazes, which signals improved short-term memory. The rats fed strawberry and spinach extracts did well on those tests, too, but they were no better at staying on the rod than rats who got no fruit extract. The scientists think that antioxidants improve cell membranes so important nutrients and chemicals can flow through more easily. James Joseph, one of the Tufts scientists, starts his day by mixing a handful of berries in a protein drink. "Motor behavior is one of the first things to go as you age," he said.

\11 Oiling the Gears for the Body's Clock

Older people may find it hard to miss that they are the targets of yet another aggressive advertising campaign, this one for products containing melatonin. The hormone, produced by the pineal gland, has shown signs of helping with a number of problems. A possible sleep inducer that seems able to reset the biological clock, it has been used to combat jet lag and some forms of insomnia. 

Recently, many companies have begun urging older people to begin taking melatonin regularly to compensate for the supposed decline of the hormone as people age. The prod- ucts are widely available at health food stores, and, since they are considered a nutritional supplement (because they can naturally occur in some foods), are not regulated by the Food and Drug Admin. 
It is unclear whether melatonin really does decline with aging, and a new study sponsored by the National Inst of Health concludes that melatonin levels remain fairly stable in healthy older adults. "If you're going to be replacing something, you ought to find out that it's missing first," said Dr. Charles A. Czeisler, the Harvard researcher who led the study. He has criticized the FDA for the absence of regs governing melatonin sales.
 Although melatonin levels are often lower in older people, Czeisler said, the cause it not aging itself, but many of the ailments that can accompany it. When researchers examined healthy people ages 65-81, they found little difference between their nighttime melatonin levels and those of people ages 18-30. Experts say regular use of melatonin can have wide, if still not understood, effects on the body, and may prove HARMFUL. 

BEHAVIOR: For Youth, Silence in a Cloud of Smoke researchers at Mass Gen Hosp in Boston were dismayed to learn in a new study that few American doctors counsel young patients about the dangers of smoking. In fact, the study found, the number of doctors who do so actually seems to be on the decline, even though most people who start smoking do so when they're teenagers. 

The researchers, who presented their findings in The Journal of the American Cancer Inst, based their conclu- sions on data from National Ambulatory Care Surveys of more than 5,000 doctors across the country from 91-96. 

The doctors said that 72% of the time they asked patients ages 11 to 21 whether they smoked. But at only 1.7% of the visits did they counsel their patients about smoking, less often than they counsel adult patients. "We were surprised at how low it is," said Dr Anne N. Thorndike, the internist who led the study. "We thought it was going to be low, but not that low." Thorndike theorized that one reason doctors did not counsel young patients against smoking was a lack of time over all. "Counseling is not reimbursed," she said. "You can't bill for conseling about smoking." 

IN THE LAB: A Case for Some Well-Toned Tissue. Working to develop engineered tissue that may one day be used to repair or replace damaged human body parts or organs, researchers at the Univ of Mich came face to face with a problem: the tissue from the lab was not as strong as that made by the body. Then they hit on the same idea that gets millions of flabby people to drag themselves to the gym several times a week: exercise. Scientists found that if they repeate- dly applied stress to the tissue as it was developing, it grew stronger, not unlike the muscles-building process in someone who lifts weights. 

The work was described in a recent issue of the journal Nature Biotechnology. Dr. David Mooney said the idea was not that novel. The real trick, he said, was developing the synthetic polymer framework to which the tissue cells were attached as they were strengthened. To date, engin- eered tissue is used on humans only in procedures invol- ving skin. Mooney, an associate professor of dentistry and engineering, said he bllieved such tissue would be used for structural repairs, like replacing ligaments, within 5 or 10 years. 

SYMPTOMS: When Fire Consumes a Sense of Smell everal years ago, doctors at the Smell and Taste Treatment and Research Foundation noticed something odd: within a two-month period, six firefighters came in for treatment and were found to have lost the sense of smell. 

The foundation, concerned that there could be a much larger problem, conducted a study of 102 Chicago fire- fighters and found that almost half had lost most or all of their ability to smell, despite their use of breathing masks during fires. The researchers, who are presenting their findings to the American Public Health Assoc's annual meeting this week, say they wonder if there could be a hidden medical problem of serious dimensions among America's estimated one million firefighters. 

How could a problem potentially this widespread go over- looked for so long? One reason, said Dr. Alan R. Hirsch, the foundation's director of neurology, is that the loss of the sense of smell seemed to come gradually, and so was simply not noticed by many of the firefighters. 87% of those found to have serious losses said they consi- dered their sense of smell normal - despite their inability to distinguish between odors like natural gas and perfume, or smoke and bubble gum. 

Apart from the hazards that loss of smell pose to fire- fighters on the job, where they need to help detect potentially dangerous situations, the deficiency has also been linked to other health problems. Researchers do not know if the firefighters are being hurt by the heat or by certain types of fires. They speculate that the sensors in the nose may be damaged after fires are contained and many firefighters take off their masks, even though char- red materials may still be sending dangerous chemicals into the air. 

REMEDIES: Of Spouses, Sex, Sleep and Snoring. If there were ever any doubts that there are a lot of snorers out there, and an equal number of long-suffering spouses, a new study puts them to rest. 

OK, so it was not really a study. Nor, for that matter, was it peer-reviewed in a prestigious med journal or conducted at a top univ with double-blind controls. It was really just a reaction to a study, but telling, nonetheless. Some weeks back, news went out about a Mayo Clinic study that looked at how much sleep was lost by people whose partners - usually men - had the severe snoring caused by obstructive sleep apnea, a serious health condition. Researchers put the loss at about an hour a night. 

The study also found that the snoring could be greatly eased when patients used an oxygen-masklike device providing what is called continuous positive airway pressure. Dr. John W. Shepard Jr., who conducted the study, said he was contacted by people around the world. 

It seems safe to predict that a new study from the National Naval Med Ctr is hardly likely to dampen interest. The new study found that when snorers used a mask, they and their spouses reported better sex lives. 

People's questions boiled down to this: Where can I get one of those masks? But people with serious snoring problems need to consult their doctors, who can refer them to sleep disorder specialists, pulmonologists or others who can provide the machines, which can cost as much as $1,200, but are covered by most insurance plans for a sleep apnea diagnosis. 

The machines are not new, and although they have a good track record, not everyone loves them. They can be encumbering, and one woman wrote that the one her husband used helped his snoring, but kept her awake with its hissing (a sign that it was not working properly, Dr. Shepard said). "I have now resigned myself to a life of sleep deprivation,"she wrote, although she thinks she has hit on a solution: building herself a room over the garage. 

Scientists Say Aging May Result From Brain's Hormonal Signals By NICHOLAS WADE
 Could it be that aging, like puberty and menopause, is a programmed life-cycle event set off by hormonal signals from the brain? A new study suggests that in the lab roundworm, and maybe people too, youthfulness is maintained by hormonal signals from the brain. When the neurons that transmit the signal suffer damage from the wear and tear of normal metabolism, the youthfulness signal fails, and the body's tissues all lapse into senescence at about the same time.

The theory that aging is a programmed, hormonal event has been proposed before, but the new study, by Dr Gary Ruvkun and colleagues at Harvard Med School, seems to present the most detailed support of it so far. They focused on a gene that is well known for the curious fact that roundworms seem to be a lot better off without it, at least in the protected conditions of the lab. When biologists disable the gene, worms live up to three times as long as usual, the equivalent of a person's living to age 240.

The gene's role is to specify a kind of protein known as a receptor; embedded in the membrane of cells, the receptor waits to be activated by the worm's equivalent of insulin and then transmits the hormone's message to the cell's metabolic machinery. The worms live longer when the receptor is dysfunctional because when cells are deaf to insulin signaling they burn less glucose and make fewer free radicals, a cell-damaging byproduct of glucose metabolism.

Confirming the link between free radicals and life span, a research team at the University of Manchester in England and elsewhere reported last month that they could make worms live more than 40% longer by dosing them with a drug that mops up free radicals. The drug mimics and enhances the action of natural enzymes that dispose of free radicals.

Though worms and people differ, they share many funda- mental processes, and the link between glucose metabo- lism, free radicals and aging may be one of them. Caloric restriction — a healthy and normal diet but with 30% fewer calories than usual — is the one intervention that reliably extends the life span of lab rats and mice.

Presumably burning fewer calories reduces free radicals and extends life span. It is not yet known if caloric restriction would increase people's life span but preliminary trials with monkeys look promising. But by what perverse calculus has evolution arranged for worms, mice and maybe people to die sooner if they metabolize energy faster?

In fact, the logic of the situation is probably the other way around: evolution has created a mechanism for stret- ching out life span if the prospects for reproduction are bleak. Across a wide range of organisms, natural selec- tion has probably favored genes that allow an animal to ride out periods of famine and to postpone reproduction until times get better.

The question adrsed by Dr Ruvkun was whether some types of cell might be more important than others in mediating the evident link between the insulin receptor gene and life span. With his colleagues Dr Catherine A. Wolkow, Dr Koutarou Kimura and Dr Ming-Sum Lee he took a long-lived strain of worms with a defective receptor gene and restored the gene's function in diff tissues one by one.

This clever genetic trick was done by inserting functi- onal copies of the receptor gene into all a worm's cells. The gene was linked to another piece of DNA, one that serves as an on- switch for the gene. Since different tissues have different on-switches, the working copy of the receptor gene was in each experiment active only in tissues for which it had the matching on-switch.

Because strains of worm with the defective receptor gene live far longer than usual, the effect of correcting the gene is to restore a normal, briefer life span. Dr Ruvkun found that only when the gene was activated in the nerve cells of the worm's brain did life span revert to normal.

"If aging were just a matter of skin and muscles wearing out, why would dogs age seven times faster than us?" Dr. Ruvkun said. "It's more likely that this is a programmed event." Dr. Ruvkun says he believes that rather than the body's just falling apart from wear and tear, as some theories of aging assume, there must be some central trigger of senescence, and that the activation of the trigger explains why everything in the body seems to age at about the same time.

He believes that his worm experiment has pinpointed the site of the central trigger, he said. The worm's nerve cells must produce some youth-promoting factor while the worm is young, but when the nerve cells become damaged by their own metabolism and free radicals, production of the youth factor wanes and the body begins to decay.

When the receptor gene's function was restored in other tissues, like nerve or muscle, the cells' metabolic response to insulin was restored but there was no change in their life spans, confirming that the gene's effect on life span is mediated via the brain cells. Dr. Ruvkun's findings are reported in last week's issue of Science.

Dr. Leonard Guarente, a biologist who studies aging at the Mass Inst of Tech, described Dr. Ruvkun's work as "an elegant demonstration that really nails down in a convincing way the primary importance of neurons in regulating life span."

Working on a different aspect of the metabolism and aging knot, Dr Guarente recently showed how metabolism was directly linked to the cell's machinery for keeping its genes under control. Dr. Caleb Finch, an authority on aging at the Univ of California, said he had argued for 30 years that the brain contained pacemakers for aging and that Dr. Ruvkun's finding provided "an exciting and profound working hypothesis."

Understanding the link between metabolism and aging would be significant but would not complete the story. "Most evolutionary and molecular biologists are uncomfortable with the thought that just 1 or 2 genes control aging," said Dr. Judith Campisi, who studies aging at the Lawr- ence Berkeley Lab. The worms given longer life by their inactivated receptor genes "still age and die," she said.

"We haven't abrogated aging," she added. All we have done is postpone it." In what passes for its brain, the little roundworm has 302 nerve cells of 118 different types. Dr. Ruvkun has assembled several of the different on-switches used by these types and intends to find exactly which nerve cell holds the trigger for determining the worm's life span.


\12 Boning Up on Calcium-Supplement

The list of foods naturally high in calcium is a familiar one by now: dairy products (especially nonfat), most dark green, leafy vegetables, and a few you might not think of such as figs, canned sardines and molasses.  But many people just do not get enough calcium from the food they eat. 

In fact, the average American consumes less than 800 milligrams of calcium per day. This is approximately the same as the recommended daily intake for a child age 4 to 8.  From about age 9 to young adulthood, a person's intake should be about 1,200 to 1,300 milligrams per day to account for growing bones. Adults need to be consuming at least 1,000 milligrams per day and older adults up to about 1,500 milligrams per day.  This calcium gap has left the door open to the manufacturers of calcium supplements, media hype and a lot of questions from consumers. 

There's not much we can do about the media hype, but maybe answering a few of the questions we have received about supplements will make it easier to ignore.  Question: How do I know which supplement is best?  Answer: Calcium supplements are available in a dizzying array of products. Every manufacturer tries to get your attention by making their product sound like the most complete and the best. 

Some of the claims made on the labels (like "all natural," "yeast free," "high potency") are just meaningless and tend to drive up the price. Remember the old adage--keep it simple.  Calcium as an element is not found uncombined, but as a compound. So the supplements always contain something else: carbonate, citrate, lactate, phosphate or gluconate. 

The dosage on the label is per pill, but the actual amt of calcium in each pill varies considerably, depending on the type of calcium in the product. For example, calcium carbonate and calcium phosphate have the largest concen- tration of elemental calcium, about 40%. By contrast, calcium citrate has 21% calcium, calcium lactate has about 13% and calcium gluconate, only about 9%. 

This means that if you are taking a 500-milligram tablet of calcium carbonate you will be getting about 200 milligrams of actual calcium. In a 500-milligram calcium gluconate pill, you would only get 65 milligrams of calcium. To get the same 200 milligrams of calcium in the calcium carbonate pill, you'd have to take three tablets of the calcium gluconate. It's important to read the labels carefully. 

There is very little evidence that any one form of calcium supplement is significantly more effective than another in preventing osteoporosis. Calcium carbonate is probably the cheapest, especially in the form of antacids, but oddly enough, at the doses needed to provide calcium supplementation, it may cause more gastrointestinal upset than the others. Calcium citrate, on the other hand, may be better absorbed. 

Look for the "USP" marking on your calcium supplements. It means the product meets the U.S. Pharmacopeia's standard for dissolving and for dosage. The marking is most likely to be found on generic products that will cost significantly less than well-advertised brands.  

Q: When is the best time to take calcium supplements?  A: In order to absorb calcium from supplements, it has to be dissolved into your bloodstream. Most of the time, only 20% to 30% of the calcium you consume is actually absorbed. Absorption rates differ depending on how much vitamin D is present and how old you are. After puberty, the rate goes down.  One way to increase the absorption of calcium is to take supplements with food and in doses of no more than 500 milligrams at each meal. If you are taking more than 500 milligrams of supplementation, spread it around with breakfast, lunch and/or dinner. 

One of nature's dirty tricks is that many foods that are high in calcium also contain oxalic or phytic acid (spinach, rhubarb and wheat bran are examples) which inhibit calcium absorption.  Q: How much calcium is too much?  A: It appears that up to 2,500 milligrams a day is safe (at least from what we know so far). But the upper limit usually advised is 1,500. Whatever the body does not absorb is excreted. The most frequently reported side effects are constipation, intestinal bloating and excess gas. If you have any of these problems, you might want to switch the type of calcium you take or increase your fluid intake.  

One cautionary note: People who are prone to forming calcium-containing stones in the urinary tract should probably not take supplements, but consuming too little calcium can also put some people at risk for stones. Calcium may also interfere with the absorption of other minerals and some drugs, so it's always a good idea to run the idea of supplementation past your health-care provider.  

Q: What about calcium-fortified foods?  A: Be sure to read the labels of any foods fortified with calcium. The particular form of calcium (calcium malate) used to fortify some prepared foods may be slightly better absorbed, and it is important to add this source of calcium to the equation before you start supplementing with pills.

* Eating Smart appears the second and fourth Mondays of the month. Dr Sheldon Margen Is a Prof of Public Health at UC Berkeley; Dale A. Ogar Is Managing Editor of the Uc Berkeley Wellness Letter. Send Questions to Dale Ogar, School of Public Health, UC Berkeley, E-mail Daogar@uclink4.berkeley.edu Search the archives of the LAX Times for similar stories about: Diet, Nutrition. You will not be charged to look for stories, only to retrieve one.

\13 constipation

Many people believe that a daily regimen of waste elimination is a sign of good health. Wrong. And failing to meet this standard, they self-medicate. Wrong again. "Fixing" your plumbing when it's not broken is asking for trouble. (Before we go on, we should note that writing about certain topics, especially those rarely discussed in public or in tasteful company, can present challenges for writers and readers alike. And be advised that some of the details that follow may not make for suitable dinner conversation -- but might well provoke amazed or alarmed discussion elsewhere. So: You've been warned. Back to the action.)

Before reaching for a laxative, find out if you really have constipation, which is defined as having bowel movements that are uncomfortable or infrequent. "People are very focused on defecating every day and end up with rigid ideas of what is normal," says Henry C. Lin, director of the GI Motility Program at Cedars-Sinai Medical Center in Los Angeles. In fact, "normal" can be three times a day or three times a week, depending on the person. And "normal" can change significantly over time, based on age and other factors.

Some simple questions can help determine if you are actually constipated: Do you feel bloated? Are your stools harder or bulkier than normal? When you feel the urge, is it difficult or painful to use the toilet? If not, your rate of elimination is probably just fine.

But if you are constipated, it's important to find out why. Inadequate dietary fiber and insufficient exercise are common causes of constipation, and they can often be corrected with modest lifestyle changes. But a sudden change in bowel habits may indicate a serious condition, such as colon cancer. Also, certain drugs -- including antihistamines, anti-hypertensives and pain medications -- can cause temporary bouts of constipation. 

Most commonly treated with stool softeners, laxatives and nutritional changes, constipation can also be addressed with biofeedback, behavior modification and increased exercise. Before resorting to prescription laxatives, some progressive mainstream doctors explore home remedies and natural supplements. Alternative practitioners generally view constipation as an intestinal imbalance and use a combination of diet, herbs, homeopathy and sometimes acupuncture.

In and Around the Mainstream - Walk down any drugstore's laxative aisle and you'll find a broad variety of potential solutions: natural fiber of all descriptions; stool softeners; "new, improved, more gentle" laxatives; enema kits. The choices can be confounding, but effective treatment may be as simple as spending 25 cents for the newspaper and reading it while sitting on the toilet. 

That's what Lin prescribes. "When somebody tells me they are constipated, I ask, 'How long do you sit there?' " he says. The way he explains it, elimination is a staged process. Initially we receive a cue that tells us nature is calling. If we choose to respond to the cue, we must consciously bear down to pass the first stool. This may sound like a no-brainer, but Lin says many patients believe they are constipated if they merely have to help things along. The process is fairly automatic once it has begun, but it can take a while. As a behavior modification technique, Lin advises sitting on the toilet for 15 minutes at a regular time each day.

The chronically bound-up might have anal sphincter sensory problems -- feeling like they always have to go, or never feeling the cue. In other cases, people inadvertently prevent voiding by squeezing the anus instead of pushing to clear the colon. Such problems can be treated with biofeedback sessions, in which the patient is able to see, on a computer monitor linked to sensors attached to the body, the effect of muscular contractions. The monitor can reveal, for example, if the patient is squeezing instead of pushing. When the patient begins to push, the change becomes evident on the computer screen.

In addition to products available in stores, home remedies are an option. Craig Rubin, a professor of internal medicine and chief of the geriatric section at University of TexasSouthwestern Medical Center in Dallas, offers this one: Mix and then refrigerate a half-cup of unprocessed bran and a half-cup of applesauce with a third of a cup of prune juice. Take two tablespoons after dinner followed by a glass of water; increase to three to four tablespoons if needed.

Speaking of water, Rubin says there's no scientific evidence that drinking more keeps bowels regular, though a diet of fresh vegetables, fruit and fiber is important. Starting a high-fiber diet should be gradual, Rubin advises, to give the body time to adjust. He suggests the herb epazote if an increased diet of beans, grains and other high-fiber foods creates an excess of gas. And a word of caution on fiber: If you are bedridden or not mobile, additional fiber can make constipation worse.

Over-the-counter stool softeners like Colace and prescription formulas like MiraLax can help because they add water to the stool, which allows it to move through the colon more easily. There is nothing wrong with occasionally taking a stimulant laxative, which prompts the colon to contract. But daily use is not advised, because over time the colon can become numb and unable to do its job. This can leave a person reliant on laxatives for routine bowel movements.

As for enemas? They're available, traditional and affordable. But they're rarely used and better choices abound.

Alternatives Include Herbs - To practitioners of alternative medicine, constipation is often a sign that the bowel is imbalanced; long-term resolution requires lifestyle and dietary changes, along with herbs to tone bowel function and other supplements to restore normal flora to the intestinal tract. Multiple studies in Europe, Asia and the United States have shown probiotic bacteria such as acidophilus to to be effective in restoring or maintaining healthy intestinal flora.

The elimination of refined foods and sugar, a decrease in animal fats and an increase in essential fatty acids (abundantly found in nuts, seeds and cold-water fish), fresh vegetables, fruit and grains is a good start, these practitioners say. Getting more exercise, sitting while eating, drinking a cup of warm lemon water before meals and eating a few stewed prunes each day can improve digestive hygiene.

Herbs such as licorice root, yellow dock, fennel seed, flaxseed, aloe latex and psyllium are believed to help constipation. Many of these have been studied, especially in Europe, and have been shown to be effective for constipation. But again, a few words of caution: Aloe latex is powerful and can cause uterine cramping; pregnant and nursing women should not take it. It may also aggravate ulcers, hemorrhoids or irritable bowel syndrome. Chronic use may lead to potassium deficiency. Flaxseed may slow down absorption of oral medications. Psyllium should always be taken with a full glass of water and shouldn't be taken within an hour of other medications because it can interfere with their effectiveness.

Before suggesting remedies, issues like the color, shape and size of stools and the amount of gas are important to assess, says Lynn Shumake, a pharmacist who specializes in natural medicine at the Riverhill Wellness Center in Clarksville. "Constipation can lead to inflammatory conditions of the bowel," says Shumake. "And we often find an imbalance of bacteria within the gut."

Shumake's remedies may include taking bitters before meals, which is thought to improve digestive efficiency. He says these herbs reduce gas and discourage the growth of yeast in the intestine, which can lead to imbalances in the colon. To restore healthy flora, probiotics like acidophilus and natural digestive enzymes are helpful. Megadoses of vitamin C (3 to 5 grams) for a few days can moisturize the digestive system, and herbal teas, such as Smooth Move, can also help. Both alternative and mainstream practitioners advise against self-medication, saying proper treatment of constipation takes individual attention by an informed professional.

Resources • National Institute on Aging: 800-222-2225; aoa.dhhs.gov/aoa/pages/agepages/constapn.html 

• National Digestive Disease Info Clearinghouse: 301-654-3810; niddk.nih.gov/health/digest/pubs/whyconst/ whyconst.htm 

Treatment of Choice is an educational column and is not a substitute for medical advice from your physician. To ask questions or suggest topics for coverage, email to health@washpost.com  Kath F. Phalen Wash Post Jan 23 01 

\14 depression

Depression in Seniors - Pt One by Emily Carton, MA LISW In his book Identity and the Life Cycle, Erik Erikson points to human development as a sequence of stages and milestones. Each stage of development from infancy through old age is described as a journey of discovering who we are in relation to ourselves, our peers, and the larger world. For example, Erikson identifies the first issue of life as that of trust versus mistrust. If an infant has a consistent and trustworthy caregiver, a sense of trust and hope is established. Without this consistent bond, the infant will have difficulty learning to trust that his needs can be met. Rather than seeing development as a straight progression up a flight of stairs, Erikson saw that each step may need to be revisited and reassessed throughout our lives. For adults in their later years Erikson viewed this as a period in which to come to terms with who we are, of recognizing and accepting our accomplishments, and of integrating all that we have learned. He defined the opposing forces as that of integrity versus despair. He believed that to come to terms and to accept our lives will lead not to hopeless or despair but to a sense of integrity. Integrity is to know and to stand on the solid ground of our lives and to live our remaining years with a sense of completeness. Opposing issues in later life: The later years bring many joys and poss. It may be the enjoyment of one's family, the participation in new activities, or the deepening pursuit of a life long interest. It can offer a period of reflection and contemplation. Yet, these years also carry a multitude of changes, and such great change at any age tips life toward increased stress. For some retirement might be a dream come true, but for others it is a time of dread. Many will be living in a body that no longer performs as it once did; some may find that they can not participate in activities they used to. There are inevitable losses of family and friends. Then too, is the knowledge that we are much closer to the end of our lives than the beginning. Defining Depression as Opposed to Sadness: From time to time everyone feels blue or melancholy. These feelings occur in response to specific events in one's life, or a cold, dark, winter day can bring a sense of lethargy. Sadness and grief over one's losses, feeling "low," on a lonely day, are normal responses to real events. These feelings vary in intensity and duration. The feelings of sadness, grief and despair that we feel when we lose something or someone that we love is part of the dance of life. Yet, in between these moments of sadness the pain lessens and the joy of living returns. One can still move forward, retreat back into sadness, and return once more to joy. When one is depressed, these feelings continue for a prolonged period of time and obliterate all other responses to life. The dance of life becomes the dance of hopelessness. The sadness is like a veil placed over the world. One can no longer really see the beauty of the first flowers of spring or dream of things ahead. The opening buds of a dogwood tree, the sounds of the first young birds of spring, go unnoticed. The obstacles in one's life seem insurmountable and life does not seem worth living. Defining Depression. The Amer Psychiatric Assoc defines depression as having at least five of the symptoms listed below that last for a prolong length of time: There can be many causes of depression: Physical Illness: Researchers have found a clear link between brain chemistry and depression. There are medical illnesses that can cause such changes and increase the likelihood of Depression. Known causes can be Parkinson's Disease, Thyroid Changes, Strokes, Diabetes, and certain forms of Cancer. Hormonal Changes in the body can also change brain chemistry and produce the onset of depression. Medications: It is also known that certain medications that are used in treating many of the disorders that increase with age can have a depressing effect. Certain blood pressure medications are known to increase the risk of depression. Interactions of medication can also cause unwanted side effects. Lack of physical and emotional reserve: The changes that occur and issues that present themselves in later life would be overwhelming for anyone at any age. Increased depression in later life might be the result of decreased physical reserves and outlets that we once had to alleviate stress. Anyone who has suffered from a major depression in life is more likely to suffer with a another episode during his or her lifetime. With the added stress that aging can bring the possibility of a recurrence increases. Facing Depression: Don't accept that depression is a normal part of growing older. Don't accept age as an explanation for what you are feeling. Ask yourself honestly, Are your satisfied with your life? Are you happy when you get up in the morning? Are there things you are looking forward to? If the answer is no, then consider that depression may be a cause. Talk to your physician. Ask about possible side effects of your medications. Share how you are feeling and inquire about a referral to a mental health professional who understands the physical and emotional changes that accompany growing older. Prolonged depression can and should be treated. Whether we have a day, a decade or a lifetime ahead of us, we have the opportunity to seize life with all it's pain and pleasure. Without the veil of despair and hopelessness consuming our energy we all can continue to live full lives in our later years. --------------- The Neurobiology of Depression The search for biological underpinnings of depression is intensifying. Emerging findings promise to yield better therapies for a disorder that too often proves fatal by Charles B. Nemeroff  
 William Styron--author of The Confessions of Nat Turner and Sophie's  Choice--chillingly describes his state of mind during a period of depression: He [a psychiatrist] asked me if I was suicidal, and I reluctantly told him yes. I did not particularize--since there seemed no need to--did not   tell him that in truth many of the artifacts of my house had become   potential devices for my own destruction: the attic rafters (and an outside maple or two) a means to hang myself, the garage a place to inhale carbon monoxide, the bathtub a vessel to receive the flow from my opened arteries. 

The kitchen knives in their drawers had but one purpose 
 for me. Death by heart attack seemed particularly inviting, absolving me as it would of active responsibility, and I had toyed with the idea of  self-induced pneumonia--a long frigid, shirt-sleeved hike through the rainy woods. Nor had I overlooked an ostensible accident, á la Randall Jarrell, by walking in front of a truck on the highway nearby.... Such hideous fantasies, which cause well people to shudder, are to the deeply  depressed mind what lascivious daydreams are to persons of robust  sexuality. As this passage demonstrates, clinical depression is quite different from the blues everyone feels at one time or another and even from the grief of  bereavement. It is more debilitating and dangerous, and the overwhelming  sadness combines with a number of other symptoms. In addition to becoming  preoccupied with suicide, many people are plagued by guilt and a sense of worthlessness. They often have difficulty thinking clearly, remembering, or taking pleasure in anything. They may feel anxious and sapped of energy and have trouble eating and sleeping or may, instead, want to eat and  sleep excessively.

Psychologists and neurobiologists sometimes debate whether ego-damaging  experiences and self-deprecating thoughts or biological processes cause 
 depression. The mind, however, does not exist without the brain.

Considerable evidence indicates that regardless of the initial triggers, the final common pathways to depression involve biochemical changes in the brain. It is these changes that ultimately give rise to deep sadness and  the other salient characteristics of depression. The full extent of those  alterations is still being explored, but in the past few decades--and especially in the past several years--efforts to identify them have progressed rapidly.

At the moment, those of us teasing out the neurobiology of depression  somewhat resemble blind searchers feeling different parts of a large,  mysterious creature and trying to figure out how their deductions fit  together. In fact, it may turn out that not all of our findings will  intersect: biochemical abnormalities that are prominent in some  depressives may differ from those predominant in others. Still, the  extraordinary accumulation of discoveries is fueling optimism that the major biological determinants of depression can be understood in detail  and that those insights will open the way to improved methods of  diagnosing, treating and preventing the condition.

Pressing Goals One subgoal is to distinguish features that vary among depressed  individuals. For instance, perhaps decreased activity of a specific neurotransmitter (a molecule that carries a signal between nerve cells) is
 central in some people, but in others, overactivity of a hormonal system is more influential (hormones circulate in the blood and can act far from the site of their secretion). A related goal is to identify simple  biological markers able to indicate which profile fits a given patient;  those markers could consist of, say, elevated or reduced levels of selected molecules in the blood or changes in some easily visualizable  areas of the brain. After testing a depressed patient for these markers, a psychiatrist could, in theory, prescribe a medication tailored to that individual's specific  biological anomaly, much as a general practitioner can run a quick strep  test for a patient complaining of a sore throat and then prescribe an appropriate antibiotic if the test is positive. Today psychiatrists have to choose antidepressant medications by intuition and trial and error, a  situation that can put suicidal patients in jeopardy for weeks or months  until the right compound is selected. (Often psychotherapy is needed as well, but it usually is not sufficient by itself, especially if the  depression is fairly severe.)

Improving treatment is critically important. Although today's  antidepressants have fewer side effects than those of old and can be  extremely helpful in many cases, depression continues to exact a huge toll  in suffering, lost lives and reduced productivity.

 The prevalence is surprisingly great. It is estimated, for example, that 5-12% of men and 10 to 20 percent of women in the U.S. will suffer
 from a major depressive episode at some time in their life. Roughly half  of these individuals will become depressed more than once, and up to 10% (about 1.0 to 1.5 percent of Americans) will experience manic phases in addition to depressive ones, a condition known as  manic-depressive illness or bipolar disorder. Mania is marked by a  decreased need for sleep, rapid speech, delusions of grandeur,  hyperactivity and a propensity to engage in such potentially  self-destructive activities as promiscuous sex, spending sprees or  reckless driving.

Beyond the pain and disability depression brings, it is a potential  killer. As many as 15 percent of those who suffer from depression or
 bipolar disorder commit suicide each year. In 1996 the Centers for Disease  Control and Prevention listed suicide as the ninth leading cause of death in the U.S. (slightly behind infection with the AIDS virus), taking the lives of 30,862 people. Most investigators, however, believe this number
 is a gross underestimate. Many people who kill themselves do so in a way  that allows another diagnosis to be listed on the death certificate, so  that families can receive insurance benefits or avoid embarrassment.  Further, some fraction of automobile accidents unquestionably are  concealed suicides.

 The financial drain is enormous as well. In 1992 the estimated costs of depression totaled $43 billion, mostly from reduced or lost worker  productivity.

 Accumulating findings indicate that severe depression also heightens the  risk of dying after a heart attack or stroke. And it often reduces the  quality of life for cancer patients and might reduce survival time.

Genetic Findings Geneticists have provided some of the oldest proof of a biological  component to depression in many people. Depression and manic-depression  frequently run in families. Thus, close blood relatives (children, 
 siblings and parents) of patients with severe depressive or bipolar disorder are much more likely to suffer from those or related conditions than are members of the general population. Studies of identical twins (who are genetically indistinguishable) and fraternal twins (whose genes  generally are no more alike than those of other pairs of siblings) also  support an inherited component. The finding of illness in both members of  a pair is much higher for manic-depression in identical twins than in fraternal ones and is somewhat elevated for depression alone.

In the past 20 years, genetic researchers have expended great effort  trying to identify the genes at fault. So far, though, those genes have evaded discovery, perhaps because a predisposition to depression involves  several genes, each of which makes only a small, hard-to-detect  contribution. Preliminary reports from a study of an Amish pop with an extensive  history of manic-depression once raised the possibility that chromosome 11  held one or more genes producing vulnerability to bipolar disorder, but  
 the finding did not hold up. A gene somewhere on the X chromosome could  play a role in some cases of that condition, but the connection is not  evident in most people who have been studied. Most recently, various regions of chromosome 18 and a site on chromosome 21 have been suggested  to participate in vulnerability to bipolar illness, but these findings await replication.

As geneticists continue their searches, other investigators are concentrating on neurochemical aspects. Much of that work focuses on
 neurotransmitters. In particular, many cases of depression apparently stem
 at least in part from disturbances in brain circuits that convey signals through certain neurotransmitters of the monoamine class. These biochemicals, all derivatives of amino acids, include serotonin, norepinephrine and dopamine; of these, only evidence relating to norepinephrine and serotonin is abundant.

 AREAS OF THE BRAIN
 Monoamines first drew the attention of depression researchers in the
 1950s. Early in that decade, physicians discovered that severe depression arose in about 15 percent of patients who were treated for hypertension
 with the drug reserpine. This agent turned out to deplete monoamines. At about the same time doctors found that an agent prescribed against tuberculosis elevated mood in some users who were depressed. Follow-up
 investigations revealed that the drug inhibited the neuronal breakdown of monoamines by an enzyme (monoamine oxidase); presumably the agent eased depression by allowing monoamines to avoid degradation and to remain
 active in brain circuits. Together these findings implied that abnormally
 low levels of monoamines in the brain could cause depression. This insight
 led to the development of monoamine oxidase inhibitors as the first class of antidepressants.

The Norepinephrine Link But which monoamines were most important in depression? In the 1960s Joseph J. Schildkraut of Harvard University cast his vote with norepinephrine in the now classic "catecholamine" hypothesis of mood disorders. He proposed that depression stems from a deficiency of norepinephrine (which is also classified as a catecholamine) in certain brain circuits and that mania arises from an overabundance of the  substance. The theory has since been refined, acknowledging, for instance, that decreases or elevations in norepinephrine do not alter moods in  everyone. Nevertheless, the proposed link between norepinephrine depletion  and depression has gained much experimental support. These circuits originate in the brain stem, primarily in the pigmented locus coeruleus,  and project to many areas of the brain, including to the limbic system--a  group of cortical and subcortical areas that play a significant part in  regulating emotions.

To understand the recent evidence relating to norepinephrine and other monoamines, it helps to know how those neurotransmitters work. The points  of contact between two neurons, or nerve cells, are termed synapses. Monoamines, like all neurotransmitters, travel from one neuron (the  presynaptic cell) across a small gap (the synaptic cleft) and attach to receptor molecules on the surface of the second neuron (the postsynaptic  cell). Such binding elicits intracellular changes that stimulate or  inhibit firing of the postsynaptic cell. The effect of the  neurotransmitter depends greatly on the nature and concentration of its  receptors on the postsynaptic cells. Serotonin receptors, for instance,  come in 13 or more subtypes that can vary in their sensitivity to serotonin and in the effects they produce.

The strength of signaling can also be influenced by the amount of  neurotransmitter released and by how long it remains in the synaptic  cleft--properties influenced by at least two kinds of molecules on the  surface of the releasing cell: autoreceptors and transporters. When an  autoreceptor becomes bound by neurotransmitter molecules in the synapse,  the receptors signal the cell to reduce its firing rate and thus its  release of the transmitter. The transporters physically pump  neurotransmitter molecules from the synaptic cleft back into presynaptic 
 cells, a process termed reuptake. Monoamine oxidase inside cells can affect synaptic neurotransmitter levels as well, by degrading monoamines  and so reducing the amounts of those molecules available for release.

 Among the findings linking impoverished synaptic norepinephrine levels to  depression is the discovery in many studies that indirect markers of  norepinephrine levels in the brain--levels of its metabolites, or  by-products, in more accessible material (urine and cerebrospinal  fluid)--are often low in depressed individuals. In addition, postmortem   studies have revealed increased densities of certain norepinephrine  receptors in the cortex of depressed suicide victims. Observers unfamiliar with receptor display might assume that elevated  numbers of receptors were a sign of more contact between norepinephrine  and its receptors and more signal transmission. But this pattern of receptor "up-regulation" is actually one that scientists would expect if  norepinephrine concentrations in synapses were abnormally low. When  transmitter molecules become unusually scarce in synapses, postsynaptic cells often expand receptor numbers in a compensatory attempt to pick up  whatever signals are available.

 SERATONIN IN ACTION A recent discovery supporting the norepinephrine hypothesis is that new drugs selectively able to block norepinephrine reuptake, and so increase norepinephrine in synapses, are effective antidepressants in many people.  One compound, reboxetine, is available as an antidepressant outside the  U.S. and is awaiting approval here.

Serotonin Connections The data connecting norepinephrine to depression are solid and still growing. Yet research into serotonin has taken center stage in the 1990s,  thanks to the therapeutic success of Prozac and related antidepressants  that manipulate serotonin levels. Serious investigations into serotonin's role in mood disorders, however, have been going on for almost 30 years, ever since Arthur J. Prange, Jr., of the Univ of NC at Chapel Hill, Alec Coppen of the Medical Research Council in England and  their co-workers put forward the so-called permissive hypothesis. This  view held that synaptic depletion of serotonin was another cause of depression, one that worked by promoting, or "permitting," a fall in  norepinephrine levels.

 Defects in serotonin-using circuits could certainly dampen norepinephrine  signaling. Serotonin-producing neurons project from the raphe nuclei in  the brain stem to neurons in diverse regions of the central nervous  system, including those that secrete or control the release of  norepinephrine. Serotonin depletion might contribute to depression by  affecting other kinds of neurons as well; serotonin-producing cells extend  into many brain regions thought to participate in depressive  symptoms--including the amygdala (an area involved in emotions), the hypothalamus (involved in appetite, libido and sleep) and cortical areas  that participate in cognition and other higher processes.

 Among the findings supporting a link between low synaptic serotonin levels  and depression is that cerebrospinal fluid in depressed, and especially in  suicidal, patients contains reduced amounts of a major serotonin  by-product (signifying reduced levels of serotonin in the brain itself).

In addition, levels of a surface molecule unique to serotonin-releasing  cells in the brain are lower in depressed patients than in healthy  subjects, implying that the numbers of serotonergic cells are reduced.  Moreover, the density of at least one form of serotonin receptor--type  2--is greater in postmortem brain tissue of depressed patients; as was   true in studies of norepinephrine receptors, this up-regulation is  suggestive of a compensatory response to too little serotonin in the  synaptic cleft. Further evidence comes from the remarkable therapeutic effectiveness of drugs that block presynaptic reuptake transporters from drawing serotonin  out of the synaptic cleft. Tricyclic antidepressants (so-named because  they contain three rings of chemical groups) joined monoamine oxidase  inhibitors on pharmacy shelves in the late 1950s, although their mechanism  of action was not known at the time. Eventually, though, they were found  to produce many effects in the brain, including a decrease in serotonin 
 reuptake and a consequent rise in serotonin levels in synapses.

Investigators suspected that this last effect accounted for their  antidepressant action, but confirmation awaited the introduction in the late 1980s of Prozac and then other drugs (Paxil, Zoloft and Luvox) able  to block serotonin reuptake transporters without affecting other brain monoamines. These selective serotonin reuptake inhibitors (SSRIs) have now  revolutionized the treatment of depression, because they are highly effective and produce much milder side effects than older drugs do. Today  even newer antidepressants, such as Effexor, block reuptake of both serotonin and norepinephrine. Studies of serotonin have also offered new clues to why depressed  individuals are more susceptible to heart attack and stroke. Activation and clumping of blood platelets (cell-like structures in blood) contribute  to the formation of thrombi that can clog blood vessels and shut off blood  flow to the heart and brain, thus damaging those organs. Work in my lab and elsewhere has shown that platelets of depressed people are  particularly sensitive to activation signals, including, it seems, to those issued by serotonin, which amplifies platelet reactivity to other,  stronger chemical stimuli. Further, the platelets of depressed patients bear reduced numbers of serotonin reuptake transporters. In other words,  compared with the platelets of healthy people, those in depressed  individuals probably are less able to soak up serotonin from their  environment and thus to reduce their exposure to platelet-activation signals.

Disturbed functioning of serotonin or norepinephrine circuits, or both,
 contributes to depression in many people, but compelling work can equally
 claim that depression often involves dysregulation of brain circuits that
 control the activities of certain hormones. Indeed, hormonal alterations in depressed patients have long been evident.

Hormonal Abnormalities
 The hypothalamus of the brain lies at the top of the hierarchy regulating
 hormone secretion. It manufactures and releases peptides (small chains of amino acids) that act on the pituitary, at the base of the brain,
 stimulating or inhibiting the pituitary's release of various hormones into
 the blood. These hormones--among them growth hormone, thyroid-stimulating hormone and adrenocorticotropic hormone (ACTH)--control the release of
 other hormones from target glands. In addition to functioning outside the nervous system, the hormones released in response to pituitary hormones
 feed back to the pituitary and hypothalamus. There they deliver inhibitory signals that keep hormone manufacture from becoming excessive.

Depressed patients have repeatedly been demonstrated to show a blunted
 response to a number of substances that normally stimulate the release of
 growth hormone. They also display aberrant responses to the hypothalamic
 substance that normally induces secretion of thyroid-stimulating hormone from the pituitary. In addition, a common cause of nonresponse to antidepressants is the presence of previously undiagnosed thyroid insufficiency.

HORMONAL SYSTEM All these findings are intriguing, but so far the strongest case has been  made for dysregulation of the hypothalamic-pituitary-adrenal (HPA)
 axis--the system that manages the body's response to stress. When a threat to physical or psychological well-being is detected, the hypothalamus amplifies production of corticotropin-releasing factor (CRF), which induces the pituitary to secrete ACTH. ACTH then instructs the adrenal gland atop each kidney to release cortisol. Together all the changes prepare the body to fight or flee and cause it to shut down activities
 that would distract from self-protection. For instance, cortisol enhances the delivery of fuel to muscles. At the same time, CRF depresses the
 appetite for food and sex and heightens alertness. Chronic activation of
 the HPA axis, however, may lay the ground for illness and, it appears, for depression.

As long ago as the late 1960s and early 1970s, several research groups reported increased activity in the HPA axis in unmedicated depressed patients, as evinced by raised levels of cortisol in urine, blood and
 cerebrospinal fluid, as well as by other measures. Hundreds, perhaps even
 thousands, of subsequent studies have confirmed that substantial numbers
 of depressed patients--particularly those most severely affected--display
 HPA-axis hyperactivity. Indeed, the finding is surely the most replicated one in all of biological psychiatry.

Deeper investigation of the phenomenon has now revealed alterations at
 each level of the HPA axis in depressed patients. For instance, both the adrenal gland and the pituitary are enlarged, and the adrenal gland
 hypersecretes cortisol. But many researchers, including my colleagues and me at Emory University, have become persuaded that aberrations in
 CRF-producing neurons of the hypothalamus and elsewhere bear most of the
 responsibility for HPA-axis hyperactivity and the emergence of depressive symptoms.

 Notably, study after study has shown CRF concentrations in cerebrospinal
 fluid to be elevated in depressed patients, compared with control subjects
 or individuals with other psychiatric disorders. This magnification of CRF levels is reduced by treatment with antidepressants and by effective
 electroconvulsive therapy. Further, postmortem brain tissue studies have
 revealed a marked exaggeration both in the number of CRF-producing neurons in the hypothalamus and in the expression of the CRF gene (resulting in elevated CRF synthesis) in depressed patients as compared with controls.  Moreover, delivery of CRF to the brains of laboratory animals produces behavioral effects that are cardinal features of depression in humans, namely, insomnia, decreased appetite, decreased libido and anxiety. Neurobiologists do not yet know exactly how the genetic, monoamine and hormonal findings piece together, if indeed they always do. The discoveries nonetheless suggest a partial scenario for how people who endure traumatic childhoods become depressed later in life. I call this
 hypothesis the stress-diathesis model of mood disorders, in recognition of the interaction between experience (stress) and inborn predisposition (diathesis).

The observation that depression runs in families means that certain genetic traits in the affected families somehow lower the threshold for depression. Conceivably, the genetic features directly or indirectly diminish monoamine levels in synapses or increase reactivity of the HPA axis to stress. The genetically determined threshold is not necessarily low enough to induce depression in the absence of serious stress but may then be pushed still lower by early, adverse life experiences.

 My colleagues and I propose that early abuse or neglect not only activates the stress response but induces persistently increased activity in
 CRF-containing neurons, which are known to be stress responsive and to be overactive in depressed people. If the hyperactivity in the neurons of children persisted through adulthood, these supersensitive cells would react vigorously even to mild stressors. This effect in people already innately predisposed to depression could then produce both the neuroendocrine and behavioral responses characteristic of the disorder.

Support for a Model To test the stress-diathesis hypothesis, we have conducted a series of experiments in which neonatal rats were neglected. We removed them from their mothers for brief periods on about 10 of their first 21 days of life, before allowing them to grow up (after weaning) in a standard rat colony. As adults, these maternally deprived rats showed clear signs of changes in CRF-containing neurons, all in the direction observed in depressed patients--such as rises in stress-induced ACTH secretion and elevations of CRF concentrations in several areas of the brain. Levels of corticosterone (the rat's cortisol) also rose. These findings suggested that a permanent increase in CRF gene expression and thus in CRF production occurred in the maternally deprived rats, an effect now confirmed by Paul M. Plotsky, one of my co-workers at Emory.

We have also found an increase in CRF-receptor density in certain brain regions of maternally deprived rats..

\13 Osteoperosis

Is the progressive loss of bone density. It is often called the "silent killer" because the cond can often go undetected until it is severe and fractures begin to occur. Sadly, if undetected, the degree of bone loss can leave a person disabled and in a great deal of pain. 

It is a bone disease in which bone tissue is normally mineralized, but the amount of bone is decreased and the structural integrity of trabecular bone is impaired. Cortical bone becomes more porous and thinner. This makes the bone weaker and more likely to fracture. 

A committee of the WHO has defined osteoporosis based on the bone density. Using standardized bone density meas- urements of the total hip, "normal" bone is greater than 833 mg/cm2. "Osteopenia" is between 833 and 648mg/cm2. Osteoporosis is lower than 648mg/cm2, and "Severe (established) osteoporosis" is when there has been a fragility fracture. Details are explained in the bone density section. 

Bone density is not a subject that many people think about on a daily basis, and so this "silent thief" can steal much of the calcium and mineral strength from your bones. Most commonly a loss in bone density is associated with changes women experience during menopause as the decreased hormonal levels affect the calcium balance in the blood and bone mass is lost as a result (Marchigiano, Sep/Oct 99).

Do I have osteoporosis? Only your physician can diagnose your condition to determine whether you have experienced bone loss or changes in bone density. Often osteoporosis patients don't know that they're at risk, or they're suffering silently. Screening tests, similar to low radiation x-rays, are commonly used to scan the heel, the wrists, the spine, or even the whole body to find weakened points or potential hairline fractures.

Kidney injuries or malfunction, vitamin deficiencies and steroid use are also known causes for the decrease in bone density. Hormone replacement therapy is used to treat both menopausal symptoms and the osteoporotic changes and associated bone loss. This can happen too if other endocrine disorders are present in either male or female patients, since the endocrine system controls the levels of the hormone calcitonin which, in turn, affects the level of calcium in the body.
  Osteoporosis Risk Factors inadequate calcium and vitamin D intake  family history  never having given birth  smoking  alcohol intake of more than 2 drinks per day  early or surgical menopause without hormone replacement therapy  small or thin frame  caucasian  sedentary lifestyle  history of treatment with steroids, antacids with aluminum,  anticonvulsant, or thyroid hormone replacement medications.

If you suspect that you're at risk for osteoporosis by the list shown here, talk to your doctor about your risk factors and consider a bone densitometry procedure to evaluate your bone density. Increasing your calcium intake and ensuring a sufficient intake of critical vitamins and minerals each day can help to decrease your risk.

\14 tumors

None of us like getting older - however, it still beats the alternative! But by being around for a longer period of time means that we become more prone to certain disorders and conditions. Our skin is no different, and tumours of various types begin to appear as we get older.

Now the very word “Tumours” strikes fear in the hearts of many, but this is purely a term we use to describe growths on the skin, which may or may not be “malignant”. In fact, most skin tumours are not malignant (called “benign”), and even with the malignant ones, the majority are not going to bring you to meet your maker before your use-by date. Having said that, it does not mean that you should ignore skin growths. Most will not kill you, but they can make the last few years very unpleasant if left untreated.

Looking first at the benign tumours, probably the most common are Seborrhoeic Keratoses. These are the dry slightly raised “warty” lesions that look as if they have been stuck on to the skin. In fact, many people “flake” them off with a well applied finger nail. They come in all colours, and a very simple way to remove them is with liquid nitrogen freezing. This leaves you with a smooth white spot where you had a rough coloured one before. (Ask to see mine!)

Another interesting lesion is the Acrochordon. These are little skin tags that hang off the skin and are often considered to be unsightly by the owner, and can be removed with one suture and one snip.

Another benign lesion is the Keratoacanthoma. These grow fairly rapidly and have a smooth outline. We usually cut them out, because they are actually quite difficult to differentiate from SCC’s (Squamous Cell Carcinomas).

Now we are into the malignant lesions and the three main types are the SCC, the BCC (Basal Cell Carcinomas) and the Melanoma. These develop over a period of time and exposure to the sun’s UV light is the main culprit. Hence our call to all parents to make sure their children are well protected by a Factor 15+ sunscreen. In 60 years time your children will appreciate you, but you’ll probably be dead by then. It’s always the case, isn’t it!

SCC’s are nearly always on sun damaged skin, and fair skinned people are the most prone. There is often a reddened area around a central scaly patch, and with long-standing ones the centre can ulcerate. Again, it is surgical excision or nitrogen freezing.

The BCC’s on the other hand are much more aggressive than the SCC’s. They have a scaly surface and a raised “pearly” edge. Known as “Rodent Ulcers” because they gnaw away at healthy tissues, they can invade and erode cartilage and even bone. Surgical excision is still the mainstay of treatment.

Finally, the Melanomas. These are dark pigmented skin lesions with irregular borders and invade the deeper tissues and can spring up as secondary lesions as well. These tumours can kill you. Wide and deep surgical excision is the treatment of choice.

Skin tumours should not be ignored. If you have some, take them to your doctor for diagnosis today!