March 7, 2008
NIH Podcast Episode #0053
Balintfy: Welcome to the 53rd episode of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health-the nation's medical research agency. I'm your host Joe Balintfy. Coming up in this episode: the first of a two part series where we talk in-depth about the risks of drinking; also we’ll have reports focusing on children: one about developing language skills, the other about children with autism. But first, a report on new research showing how to lower chances for heart disease. That's next on NIH Research Radio.
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Balintfy: Diuretics are a type of medication that help the body release sodium and water. A recent study shows that Diuretics appear to be as good as, or better than, other blood pressure drugs for treating some patients. Wally Akinso reports:
Akinso: New results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial show that diuretics treatment are the most effective blood pressure medication for people with metabolic syndrome. Metabolic syndrome is a group of risk factors frequently linked to overweight and obesity that increase the chance for heart disease and related health problems. Diuretics offer greater protection against cardiovascular disease, including heart failure, and stroke and are at least as effective for lowering blood pressure as newer, more expensive medications. Dr. Paula Einhorn, program director for the National Heart Lung and Blood Institute’s Division of Prevention and Population Sciences, says these findings are important for patients with metabolic syndrome.
Einhorn: It showed that for both men and women the diuretic based treatment was more protective against heart failure and overall cardiovascular disease than the ACE-inhibitors and the alpha-blocker base treatment. The diuretic base treatment was also more protective against heart failure than the calcium-channel blocker base treatment.
Akinso: In addition the results provide important new evidence supporting the use of diuretics for initial blood pressure-lowering therapy in black patients with metabolic syndrome.
Einhorn: These results provide particularly important evidence for black patience with metabolic syndrome. When compared with those taking diuretics, those receiving ACE-inhibitors had poorer blood pressure control and a 24 percent greater risk of overall cardiovascular disease. This included a 37 percent greater risk of stroke and a 49 percent greater risk of heart failure. They also had a 70 percent risk of kidney failure.
Akinso: Dr. Einhorn says medications to treat hypertension should always be combined with lifestyle approaches to lowering blood pressure. She adds that patients should discuss these study results and their treatment with their doctors before making any changes. ALLHAT was sponsored by the NHLBI. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
How Much is Too Much?
Balintfy: It’s the time of year for spring breaks. Young adults and even adolescents – particularly college-aged students – may be planning celebrations that involve drinking.
Willinbring: We really would like to see fewer people getting hurt due to their drinking during spring break.
Balintfy: We’re talking with Dr. Mark Willenbring. He’s the Director of the Treatment and Recovery Research Division in the National Institute on Alcohol Abuse and Alcoholism.
Willenbring: Most heavy drinking occurs in young people. And in fact, the portion of the population that has alcohol dependence at any point in time is greatest between the ages of 18 and 25. That's not something most people think of. Most people think of an alcoholic as somebody who's 40 or 50 years old, that has been ill for 20 or 30 years. And that does occur in a more chronic relapsing form, but the most common form of alcohol dependence occurs earlier in life. And a lot of people today who are within a few years that they may suffer a lot of consequences in the meantime.
So, I'm thinking here of spring break, for example. There's an increasing number of young adults and adolescents who are dying of alcohol poisoning. And some of the most dangerous things are things like drinking games. And so, what I would really encourage people to do is really think carefully before getting involved, before going out for a night, decide how much you're going to drink in advance. Decide how you want to drink. Don't drink too much too fast. That's really the dangerous thing, drinking too much too fast.
Balintfy: NIAAA’s Dr. Willenbring explains that too much too fast is binge drinking.
Willenbring: How much his too much too fast? How do we define a binge? A binge is about five drinks in a two-hour period. Five drinks in a two-hour period bring you to, the average adult, up to the level of being legally drunk. So that's too much too fast, five drinks in two hours. And if you think how much can be in martini or in margarita or other mixed drink or cocktail particularly, it could have three or four drinks. I've seen bars, for example, advertise 12-ounce martinis. Now, if a drink is an ounce and a half, and even at a bar, you know, it's going to be at least half pure booze and maybe more. I mean, you can figure it out. That's probably, that's at least four drinks or five drinks right there. So -- and that stuff can go down pretty easily and I think that's what I'm saying, is just trying to raise people's awareness that a drink is, not a drink is a drink, I mean, in the sense of how it comes to you.
And so if people want to protect themselves, they’ll do things like space their drinks. They'll drink, you know, some water or plain tonic or ginger ale or diet coke or something like that, you know between drinks. They'll pace them so they're not drinking more than one or two drinks an hour, for example. They'll, and they'll make sure that they don't drink these highly concentrated drinks rapidly. That's how people really get into trouble. And, of course, drinking games where you're actually drinking shots, that's really, that's really dangerous because you can black out and get into a real problem without intending to and that's really what we're trying to prevent.
Balintfy: Dr. Willenbring emphasizes the definitions of one drink are as follows: 12-ounces of beer, 8 or 9 ounces of malt liquor, five ounces of table wine, or one and a half ounces of hard liquor – these all have about the same amount of pure alcohol. Dr. Willingbring recommends checking the NIAAA website for more information, including limits on alcohol intake.
Willenbring: The Institute recommends that a daily maximum be no more than three drinks for women and no more than four drinks for men in any one day, and no more than seven drinks a week for women and no more than 14 drinks a week for men.
Now it's not like if you go to eight or 15 drinks in a week something terrible will happen. What it is, is that it increases your risk of something bad happening. And the more you drink in a day and the more often you have a heavy drinking day, the more the daily risk is that something bad will happen. Well what kind of things could happen? Well, you could fall and hurt yourself. People also get aggressive. They get into fights or suffer from assaults. So they become vulnerable. And they may be vulnerable to sexual assault, for example, because they're intoxicated.
We all know about drinking and driving. That's one of the major killers of young people in this country. And it's down from where it was, but it's still a really big problem. And people should also be aware that they shouldn't get in the car with a driver who's been drinking because a lot of times the victim of a drinking driver are other people in the car with that driver, or people in the other car.
Balintfy: If these kind of bad things go on long enough, Dr. Willenbring warns that people can develop symptoms of alcohol dependence, which is also known as alcoholism. But Dr. Willenbring explains, there’s a progression of problems associated with drinking. For example, alcohol abuse.
Willenbring: Alcohol abuse refers to having repeated problems associated with drinking, particularly social problems or trauma, or drink-driving, hazardous use. That's the most common cause of a diagnosis of alcohol abuse is drinking and driving. But it also may be things like having trouble getting up in the morning and going to work, trouble with your partner or spouse, or parents, or children, trouble with your activities as a student, keeping up with your studies, for example, or skipping class, these kinds of things. And so if someone repeatedly has those kinds of adverse consequences and then keeps on drinking and has them repeatedly, then that's what we call alcohol abuse.
Balintfy: How do you know if you’re abusing alcohol?
Willenbring: A lot of time with abuse, it's other people who let you know, like a police officer pulls you over and gives you a DWI. That's a signal, right? Or friends or family members who say, “Hey look, I'm really concerned about your drinking,” or, “You really made a fool of yourself last night,” or things like that. Or bad things start to happen. You hurt yourself and then you have a blackout and you have sex with somebody that you really didn't intend to. Actually, that was just shown in the movie "Knocked Up." That's how she got knocked up, was because they were both drinking and she didn't even remember having sex that night. That's the kind of thing that can happen.
So people are aware of these external things. I think, more commonly, though, is the sense of drinking more than you intend or for longer periods of time than you intend. Those are really the early symptoms.
Balintfy: We’ll have more from NIAAA’s Dr. Willenbring in our next episode. To learn more about alcohol and alcoholism, visit vwww.niaaa.nih.gov.
Balintfy: Up next, reports on how research looks into helping children. Stay tuned.
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Balintfy: In the first of two more reports from Wally Akinso, we learn about the effectiveness of programs designed to help children learn language skills.
Akinso: For children who struggle to learn language, the choice between the numerous interventions may matter less than the intensity and format of the intervention according to a study by the National Institute on Deafness and Other Communication Disorders. The aim of the study was to assess whether kids who used a commercially available language software program, had greater improvement in language skills than kids using other methods. Dr. Judith Cooper, the NIDCD Deputy Director, discusses the intensive process that the children went through.
Cooper: The purpose of this study was to compare some of the various treatments that are available on a very large scale. This was in fact probably the biggest study that’s been done. There were over two hundred children involved in this study and they were randomly assigned to four different treatments. And we had about 54 children in each of the 4 treatment types. The setup was in this study was the children came to somewhat of a summer school kind of program and the language intervention that they received lasted an hour and forty minutes five days a week for six weeks. And when they weren’t in intervention they had an opportunity to play with other children in the classroom. And the study tested the children in their language abilities before they receive treatment then immediately after they received treatment and then to look at the long-term effects of treatment they tested 3 months after treatment was over and then six months after treatment was over.”
Akinso: The study included an individual language intervention with a speech-language pathologist, two computer-assisted language interventions, and a nonlanguage academic enrichment intervention that focused only on math, science and geography. Dr. Cooper says language impairment can improve with hard work.
Cooper: The take home message to me is really exciting and that is first off it’s clear that children specific language impairment can improve and can improve dramatically. However that seems to have to be paired with some rather intensive and focused intervention. It seems that it’s not so much for clinicians and parents to have to choose well which intervention does my child need, it’s rather the intensity of the intervention and the format of the intervention that’s really important. All of these interventions require that the child listen intently and carefully, pay close attention, and respond quickly. And all of this was also paired with a chance to interact with other children, in a situation where they can share language abilities.”
Akinso: Of the children who worked with a speech-language pathologist, 80 percent made large gains. About 74 percent of those in the group using the Fast ForWord-Language computer-assisted language program, which is specially designed to improve auditory processing deficits which may underlie some language impairments, made big improvements. Of the children in the general academic enrichment group, almost 69 percent made large gains. And 63 percent of children in the other computer-assisted language intervention group made large improvements on language measures. Dr. Cooper said these gains are much larger than the improvements that have been reported in long-term studies of children who have received language therapy in public school settings. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Balintfy: In this next report, we learn that diary-free diets and unusual food preference could put boys with autism and autism spectrum disorder at higher risk than normal for thin bones. This is according to a study funded by the newly renamed Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Akinso: Researchers believe that boys with autism and autism spectrum disorder are at risk for poor bone development for a number of reasons. Theses factors are lack of exercise, a reluctance to eat a varied diet, lack of vitamin D, digestive problems, and diets that exclude casein, a protein found in milk and milk products, which provide a significant source of calcium and vitamin D. Dr. Mary Hediger, a biological anthropologist in NICHD’s Division of Epidemiology Statistics and Prevention Research, explains that a deficiency of these important nutrients in the boys’ diets could result from a variety of causes.
Hediger: They tend to have poor nutrition. Boys with autism or autism spectrum disorder have repetitive eating habits. And they have fairly restricted food choices. Sometimes it has to do with texture preferences, all sorts of various things. That may mean they have an unbalanced diet. They tend to have decreased or limited physical activity. A lot of times parents will want to put their child on something called gluten or casein-free diet, because of a belief that these kinds of diets will help ameliorate the symptoms of autism. There’s no real good evidence of this, but it is so common to see on the internet and sort of word of mouth parents that this works that a lot of parents who have children with autism will try anything and this is one of the things they’ll try.”
Akinso: According to Dr. Hediger researchers recommended that larger studies be conducted to confirm their results. She added that parents of children with autism or autism spectrum disorder should speak with a dietitian during their children’s routine medical care to make sure that their diets are balanced. This is Wally Akinso at the National Institutes of Health Bethesda Maryland.
Balintfy: And that’s it for this episode of NIH Research Radio. Please join us again on Friday, March 21st when our next edition will be available for download. I'm your host, Joe Balintfy. Thanks for listening.
NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.