Why Supplements Are Bad for Your Brain

Multivitamins are supposed to do a body good. In one little capsule, they contain every nutrient your body needs to function—a "complete" pill you need to take just "Once a Day"!

But that old adage "if it sounds too good to be true, it probably is" holds particularly true with these miracles of modern nutrition. Supplement manufacturers overload their pills with trace minerals, including harmful levels of metals that are linked to a wide variety of cognitive problems later in life, says Neal D. Barnard, MD, president of the Physicians Committee for Responsible Medicine and adjunct associate professor of medicine at George Washington School of Medicine. "These supplement manufacturers are focusing more on marketing than they are on health," he says. After all, it makes companies look good if they can advertise an entire day's nutrition in a single pill. 

Dr. Barnard recently authored a report sounding the alarm on copper and iron in dietary supplements. His group analyzed levels of those metals in multivitamins from One a Day, Nature Made, and Centrum and found that the majority contained double the recommended amounts of copper and iron, much more than most people need. While both metals do provide health benefits—copper helps your body metabolize iron, boosts your immune system, and keeps your nerves and blood vessels healthy; iron carries oxygen to red blood cells and to muscles—too much can prove fatal to your brain health, says Dr. Barnard.

How? For one, the metals are increasingly being flagged as Alzheimer's disease triggers. In fact, the authors of an August 2013 study published in the Proceedings of the National Academy of Sciences concluded that copper appears to be one of the main environmental factors behind Alzheimer's disease. The researchers exposed mice then human brain cells to low levels of copper commonly seen in the average diet, and found that the metal interferes with the way the brain rids itself of the plaques that cause Alzheimer's disease. They also found that in mice already plagued with Alzheimer's, copper can pass the blood-brain barrier and accelerate the formation of plaques.

Prior studies have come to similarly disturbing conclusions. In a 2010 review of the science on copper toxicity, published in Chemical Research in Toxicology, George Brewer, MD, professor emeritus of internal medicine and human genetics at the University of Michigan Medical School, wrote that research has linked both excess copper and iron to Alzheimer's disease, heart disease, diabetes, Parkinson's disease, and a few other neurological disorders.

He refers to one study in which researchers analyzed copper levels in the blood of a large sample of healthy adults over a six-year period, and those with the highest levels of copper lost cognition three times faster than adults with normal copper levels. Iron is suspected of causing similar damage, he writes, because both metals can introduce too much oxygen into the brain, causing "oxidative stress" that damages neurons. That same study noted that the people with the highest levels of copper and iron in their systems took multivitamins. A separate study, published in the 2008 Journal of Nutrition Health and Aging, found that in a group of 1,450 people, those who performed highest on cognition tests also had the lowest levels of copper and iron in their bloodstreams.

"Alzheimer's disease is an epidemic that is growing rapidly," says Dr. Barnard. "But up until now, most people had no idea they could do anything about it." People who take multivitamins are most likely overdosing on copper and iron, he adds. But certain processed foods are also beginning to play a role. Cereals and other goods fortified with copper and iron have disturbingly high levels, too, he says, and he's even written to the multivitamin manufacturers and some food companies asking them to remove the metals. "Not a single one has expressed any interest," he says.

How can you protect your brain against an onslaught of metals? Here's what Dr. Barnard recommends:

• Eat vegetables, not supplements. All meats and vegetables contain copper, Dr. Barnard says, but red meat contains forms of both copper and iron that are easily absorbed by your body, making it easy for the metals to accumulate over time and cause brain damage. Copper and iron in vegetables, on the other hand, are available in forms that are more easily regulated by your body—if you need more of either metal, your body takes what it needs from these plant sources and excretes the rest. Plus, eating less red meat will benefit your health—and the environment—in other ways. (For more foods that are good for your long-term brain health, read The Happiness Diet).

• Rethink all your supplements. Dr. Barnard says that most people who follow a diet of whole foods—lots of fruits, vegetables, and whole grains—don't need multivitamins, anyway. The only vitamins you might consider taking, he says, are vitamins B12 and D, which are both uncommon in foods. If your doctor does tell you to take a multivitamin, he adds, read labels to make sure you're taking on that's free of copper and iron.

• Buy a water filter. Eighty percent of homes in the U.S. have copper water pipes, and copper could be leaching from them. According to the National Sanitation Foundation, carbon filters, reverse osmosis systems, and distillers will remove copper from your water, so be sure to buy a filter that's NSF-certified to do just that.

Source: http://www.rodale.com/

The Hidden Threats in Your Herbal Supplements

From Echinacea to ginkgo biloba, herbal supplements are a $60-billion business in the U.S., but most of the products you’ll find at your local drug store or supermarket are mislabeled, contaminated or—in many cases—wholly without the herb you thought you were buying, shows a new study published in in the journal BMC Medicine.

Researchers from Canada and India tested more than 90 different herbal capsules, powders, and teas from 12 of the industry’s largest herbal-supplement manufacturers; they even had some shipped from retailers in the U.S. More than 30 percent of the supplements tested contained a substitution plant instead of the herb listed on the label, meaning the product contained none of the herb you thought you were buying. One-third contained “fillers,” usually grasses like rice or wheat, or contaminants not listed among the labeled contents. Just 16 percent of the supplements tested contained the right herbs without any contaminants, fillers, or substitutions. The researchers analyzed multiple samples of each product to ensure their results were accurate.

Obviously, this is a problem—and not just because you’re being ripped off. Some of the fillers and contaminants discovered are toxic or known to react with the listed ingredients in dangerous ways. Here are a few examples of herbs they found masquerading as other things:

• One of the products tested, labeled St. John’s Wort, actually contained an herb called Senna Alexandrina, an herb that's a Food and Drug Administration (FDA)-approved non-prescription laxative. It's also known to cause diarrhea, liver damage, and abdominal pain if ingested regularly, the researchers explain.

• Some Echinacea pills and dandelion supplements (used to calm an upset stomach) were contaminated with feverfew, an herb that can react with blood pressure medications and is a known allergen, particularly for those with ragweed allergies. It's also recommended that pregnant women avoid any products with feverfew, as it can cause premature contractions.

• Gingko products were found to be contaminated with black walnut leaves. Those contain a compound called juglone, regular exposure to which is suspected of causing tumors of the lung, skin and thorax.

The problem is that there’s very little regulation of vitamins and supplements at the FDA. Despite the fact that the agency has found everything from lead to cancer-causing preservatives in cheap supplements, they don't test or authenticate supplements regularly.

The takeaway: Pay attention to quality. The researchers aren’t releasing the names of the specific brands tested. So rely on third-party verifiers. Look for ConsumerLabs.com–certified herbal supplements, or those bearing either the U.S. Pharmacopoeia’s USP Verified Dietary Supplement or NSF Certified Dietary Supplement seals. These verify that vitamins and supplements, herbal or otherwise, have been tested for, and found free of, contaminants, and that they deliver what their labels claim.

Source: http://www.rodale.com/

Dangerously Sweet: The True Impacts of Sugar on Your Health

by integrative medicine expert Isaac Eliaz, MD founder of the Amitabha Clinic & Healing Center in Sebastopol, California

We know much more about nutrition than we did 20 or 30 years ago. We've learned to cut back on processed foods, scrutinize labels, and emphasize organic produce. But then there's sugar. And as we've come to learn, added sugar and health don't mix.

We've known for a long time that sugar is not our friend, but for many people it's as hard to quit as an addictive drug. This is no coincidence. Refined sugar does cause addiction in the brain, making it seem impossible to control our cravings.

The statistics are alarming. The average American eats 22 teaspoons of sugar a day. Children eat 32. This massive addiction is growing, too. In fact, sugar and sugar substitutes are found in many more foods today than even 10 years ago. Around 1990, the average person ate about 70 pounds of sugar each year. In 1999, U.S. Department of Agriculture estimated that number to be over 150 pounds, much of that from high-fructose corn syrup. Sugar has gone from being a special treat to a daily part of our diet. And the massive rise in diseases related to unhealthy blood sugar levels, from obesity and metabolic syndrome to diabetes and Alzheimer's, among others, certainly seems to mirror that increase. Is this a coincidence? Hardly.

Sugar and Insulin
Naturally occurring sugars found in fruits and vegetables are not a real concern. These foods have fiber, vitamins, minerals—the complete package that allows your body to process the sugars in a healthy way. Refined sugar, on the other hand, is basically a chemical extract, separated from all the healthy aspects of the original food, be it sugar cane or sugar beets, from which it was derived.

Refined sugar has zero nutritional value, but it can sure wreak havoc on our bodies. First off, it spikes glucose (blood sugar) levels. Insulin, the hormone that tells cells to take in glucose, spikes as well. Increased insulin levels tell the body to form fat and release more cortisol, a stress hormone that damages immunity and increases inflammation. These increases can also lead to insulin resistance in cells, causing excess circulating glucose. And this triggers a cascade of harmful effects, fueling chronic inflammation and wreaking havoc through the body. Left unchecked, this process can directly lead to metabolic syndrome and, later on, to type 2 diabetes.

Glucose spikes are one of the reasons sugar is so hard to quit. The increased production of insulin, cortisol, and even adrenaline they cause has an addictive quality. The brief high is followed by a rapid drop. We want more sugar to sustain our energy after the glucose crash.

Sugar's Multiple Dangers
If the only worriesome effect of sugar were that it disrupts our glucose metabolism, that would be enough to warrant reducing our consumption, but it goes far beyond that.

Refined sugar also has a bad relationship with cardiovascular health. For example, one study showed that people with high sugar intakes had much lower levels of HDL good cholesterol, as well as high triglycerides. In addition, the chronic inflammation caused by increased cortisol has been linked to cancer, heart disease, and other conditions.

Sugar consumption also has a suppressive effect on the immune system that lasts for hours after ingestion. So if you have some sugar with each meal, you are effectively suppressing your immune system all day long.

Your Brain on Sugar
One of the scariest aspects of sugar toxicity is its relationship to cognitive health. One study, conducted by the Mayo Clinic, found that people over age 70 who ate lots of sugar dramatically increased their risk for cognitive impairment.

This is not an isolated finding. A UCLA study found that fructose damaged memory and learning. Research published in the New England Journal of Medicine showed that higher glucose levels are linked to dementia. Other studies have made similar findings. In fact, some researchers are even calling Alzheimer's disease type 3 diabetes.

As if that weren't enough, sugar can help unbalance the levels of good to bad bacteria in our guts, leading to chronic infections. Undesirable organisms like yeast and other fungi enjoy feeding on the sugar we've eaten and flourish when there's plenty to go around. These imbalances are also linked to allergies, ADD, skin conditions, hypertension, and manic depression.

Real-World Solutions
If you were to ask me how much refined sugar is allowable, I would say none. However, that's not a realistic goal for most people. The idea is to cut back on sugar and, when we do indulge, to maximize our body's ability to process it.

Try not to eat sweets by themselves. Instead, combine them with foods that are high in protein, healthy oils, or fiber. These help the body metabolize the sugar, and that can reduce glucose spikes. It's definitely better to have a piece of cake after a healthy meal than as a snack on its own.

Probiotics are also important because they digest sugars for their own fuel, so they can minimize glucose spikes after a sugary meal. By adding friendly probiotic bacteria to our diets in the form of fermented foods like sauerkraut and yogurt as well as supplements, we also improve nutrient absorption, glucose metabolism, and overall digestive health.

Natural Glucose Control
There are a number of botanicals that have been shown to help control glucose spikes and improve digestion. Lipoic acid raises insulin sensitivity and can also help lower blood pressure, and alginates, which are derived from brown kelp, slow down sugar absorption. Medicinal mushrooms have also been shown to control blood sugar. In fact, a couple of recent papers have indicated they might be useful in managing type 2 diabetes. The herb fenugreek has received attention from the research community for its ability to regulate blood sugar. American ginseng and holy basil leaf can be helpful, as well.

Look for a metabolic support supplement that includes these and other ingredients to balance glucose and insulin levels. Getting those levels in balance moderates cravings because reducing glucose spikes helps prevent the inevitable crashes that make us reach for more sweets. A balanced metabolic support formula is an excellent way to reduce the impacts of sugar and help lessen cravings.

While sugar can be classified as an addictive substance, there is a relative upside to this equation: The less sugar we consume, the less we want. This is a great advantage as we try to cut down. We eat less, crave less, and feel much better. Now, that's pretty sweet!

Source: http://www.rodale.com/

The Cutting-Edge, Natural Way to Deal with Serious Gut Problems

Fecal transplant is making news as a viable treatment as our understanding of how gut health is related to general health grows.

Your fecal transplant news of the day: Three more studies suggest that implanting poop from a healthy person into the gastrointestinal tract of someone suffering with certain gut diseases or infection could help them recover.

The latest trio of studies was presented recently at the 78th Annual Scientific Meeting of the American College of Gastroenterology. In the first study, fecal matter was transplanted from one person into a patient with a weak immune system who was suffering from a Clostridium difficile, or C. diff., infection, a hard-to-treat infection often caught in hospital settings. Of the 66 C. diff. patients in the study, 78 percent were cured after a single transplant!

The idea is that the beneficial bacteria in the transplanted poop can help recolonize patients' guts with the healthy bacteria they need to fight disease. Another new study found similar results in using fecal transplants to knock down C. diff., while a third found they helped alleviate irritable bowel syndrome (IBS) symptoms. That small study looked at 13 patients with IBS who had not responded to previous treatment. After a fecal transplant, symptoms improved in 70 percent of the IBS patients, with nearly half reporting an improved quality of life.

Fecal transplants aren't common across the country yet, but an increasing number of hospitals are turning to this more natural method to help combat tough infections. More research is needed, especially to analyze the procedure's role in helping to quell the symptoms related to IBS and Crohn's disease, many researchers say.

Source: http://www.rodale.com/

5 Things You Need to Know About Breast Cancer

The statistics are startling.

Approximately one  in eight American women will be diagnosed with breast cancer over her lifetime. This year alone, that’s 232,340 women who will learn they have invasive breast cancer. The disease is the second-leading cause of cancer deaths among American women, right after lung cancer.

So here are five important things to keep in mind about breast cancer.

#1: Not all breast cancer is created equal

There’s no question that hearing the “c” word can be very frightening. But the reality is that there are a range of differences in types of breast cancer. DCIS, for example, which stands for ductal carcinoma in situ, tends to be a less aggressive form of breast cancer. Conversely, inflammatory breast cancer tends to be more aggressive.

#2: Exercise lowers your risk

We know that exercise is good for us. It’s good for your mind, it’s good for your waistline, and it can even improve your sex life. But women who exercise and have an active lifestyle also reduce their risk of developing breast cancer. It may have something to do with levels of estrogen in the body and body fat percentages. Even walking can be beneficial. One recent study found that women who were active and exercised regularly lowered their risk by as much as 30 percent as compared to sedentary women.

#3: Breastfeeding lowers your risk

Breastfeeding is great for babies. But it’s also good for moms. One study found that women who breastfed their babies were up to 25 percent less likely to develop pre-menopausal breast cancer compared with women who never breastfeed.

#4: Drinking alcohol increases your risk

So here’s the bad news. It really does appear that women who drink alcohol on a regular basis, even moderately, have an increased risk of breast cancer. That’s especially the case for younger women. One study found that women between their first period and their first pregnancy who consumed just on average seven alcoholic drinks per week had an 11 percent increased risk of developing breast cancer. So go easy on those drinks.

#5: Talking with your doctor can save your life

Talking about your breast health with your doctor is an important step in learning about your breast cancer risk, and catching and treating it early if it develops. He or she will be able to provide clinical breast exams, the best advice as to when you should be getting a mammogram and how often, as well as whether you require additional tests. For example, while you’ve probably heard  about ultrasounds and sonograms in connection with pregnancy, they’re also very commonly used in younger women with dense breasts. Combined with a mammogram, an ultrasound can sometimes distinguish between a cyst and a suspicious, possibly cancerous, lesion in these women.

Source: http://abcnews.go.com/blogs/health/

Lifestyle Changes to Treat High Blood Pressure

A critical step in preventing and treating high blood pressure is a healthy lifestyle. You can lower your blood pressure with the following lifestyle changes:

• Losing weight if you are overweight or obese.
• Quitting smoking.
• Eating a healthy diet, including the DASH diet (eating more fruits, vegetables, and low fat dairy products, less saturated and total fat).
• Reducing the amount of sodium in your diet to less than 1,500 milligrams a day if you have high blood pressure. Healthy adults need to limit their sodium intake to no more 2,300 milligrams a day (about 1 teaspoon of salt).
• Getting regular aerobic exercise (such as brisk walking at least 30 minutes a day, several days a week).
• Limiting alcohol to two drinks a day for men, one drink a day for women.

In addition to lowering blood pressure, these measures enhance the effectiveness of high blood pressure drugs.

Drugs to Treat High Blood Pressure

There are several types of drugs used to treat high blood pressure, including:

• Angiotensin-converting enzyme (ACE) inhibitors

• Angiotensin II receptor blockers (ARBs)

• Diuretics
• Beta-blockers
• Calcium channel blockers
• Alpha-blockers
• Alpha-agonists
• Renin inhibitors
• Combination medications

Diuretics are often recommended as the first line of therapy for most people who have high blood pressure. 

However, your doctor may start a medicine other than a diuretic as the first line of therapy if you have certain medical problems. For example, ACE inhibitors are often a choice for a people with diabetes. If one drug doesn't work or is disagreeable, other types of drugs are available.

If your blood pressure is more than 20/10 points higher than it should be, your doctor may consider starting you on two drugs or placing you on a combination drug.

High Blood Pressure Treatment Follow-Up

After starting high blood pressure drug therapy, you should see your doctor at least once a month until the blood pressure goal is reached. Once or twice a year, your doctor will check the level of potassium in your blood (diuretics can lower this, and ACE inhibitors and ARBs may increase this) and other electrolytes and BUN/creatinine levels (to check the health of the kidneys).

After the blood pressure goal is reached, you should continue to see your doctor every three to six months, depending on whether you have other diseases such as heart failure.

Source: http://www.webmd.com/

An Overview of High Blood Pressure Treatment

Hypertension, or high blood pressure, is dangerous because it can lead to strokes, heart attacks, heart failure, or kidney disease. The goal of hypertension treatment is to lower high blood pressure and protect important organs, like the brain, heart, and kidneys from damage. Treatment for hypertension has been associated with reductions in stroke (reduced an average of 35%-40%), heart attack (20%-25%), and heart failure (more than 50%), according to research.

High blood pressure is classified as:

• Normal blood pressure: less than 120/80
• Prehypertension: 120-139/80-89
• Hypertension: greater than 140/90
• Stage 1 Hypertension:140-159/90-99
• Stage 2 Hypertension: 160 or greater/100 or greater

All patients with blood pressure readings greater than 120/80 should be encouraged to make lifestyle modifications, such as eating a healthier diet, quitting smoking, and getting more exercise. Treatment with medication is recommended to lower blood pressure to less than 140/90. For patients who have diabetes or chronic kidney disease the recommended blood pressure is less than 130/80.

Treating high blood pressure involves lifestyle changes and possibly drug therapy.

Source: http://www.webmd.com/

Pharmacist-Guided Home Blood Pressure Monitoring

Using home blood pressure monitoring and partnering with a pharmacist for lifestyle advice and medication changes led to better control of hypertension, a new study shows.

After six months of the intervention, nearly 72 percent of the study volunteers had their high blood pressure under control compared to 45 percent in the group that received usual care. Also, the effects of the intervention persisted even after the intervention ended. Six months later, about 72 percent of the intervention group had their high blood pressure under control compared to 57 percent in the usual care group.

"The reason that only about half of people with [high] blood pressure have it under control is that usual care isn't working. We combined two interventions that we thought would be very powerful together -- home monitoring and pharmacist managements -- and this is one system that we've shown works very well for blood pressure control," said senior investigator Dr. Karen Margolis, from the HealthPartners Institute for Education and Research in Minneapolis.

The findings appear in the July 3 issue of the Journal of the American Medical Association.

High blood pressure affects about 30 percent of U.S. adults, according to background information in the study. Treating and controlling high blood pressure can help prevent cardiovascular events, such as heart attacks. However, only about half of the adults in the United States with high blood pressure have it under control.

Home blood pressure monitoring has shown some success in helping people lower their blood pressure, so the researchers took that a step further and used telemonitoring devices that could send blood pressure readings to a pharmacist who could then adjust that person's blood pressure medication accordingly.

The study included 450 people receiving care at one of eight different clinics. All of the people recruited for the study had high blood pressure that wasn't well controlled.

The patients were randomized to receive either usual care (222 people) or the study intervention, which included blood pressure telemonitoring with pharmacist management.

In the study intervention group, each person received a home blood pressure monitor capable of sending readings to a secure website that a pharmacist monitored. At the start of the study, patients met with the pharmacist for an hour and were taught how to use the machines. They were also given lifestyle advice on lowering their blood pressure.

People in the study intervention group were asked to send at least six blood pressure readings from different times of the day to the pharmacist each week. During the first six months of the study, patients and pharmacists talked by phone every two weeks, until blood pressure was under control for at least six weeks, and then they talked monthly. During months seven to 12 of the study, the calls were reduced to every two months. During the calls, pharmacists reviewed lifestyle changes and emphasized adherence to medications.

In between the phone calls, pharmacists were able to make changes to a patient's medication following an algorithm based on national guidelines, according to Margolis. In addition, these changes were reported to the patient's doctor.

Among the 380 people who attended both the six- and 12-month clinic visits, just over 57 percent of those in the intervention group had controlled blood pressure at both visits compared to just 30 percent in the usual care group.

Systolic blood pressure (the top number) dropped by an average of almost 11 mm Hg more for those in the study intervention compared to the usual care group at six months, and by almost 10 mm Hg more at 12 months. Even six months after the study ended, those who had been in the intervention group had systolic blood pressure readings an average of 6.6 mm Hg lower than the usual care group.

Margolis said that the people in the intervention group also felt more confident in managing their high blood pressure, and that they reported more satisfaction than the usual care group.

"Partnering with someone really makes a difference," Margolis said.

She said the cost of the program was about $1,200 to $1,300 per person. It's not clear yet whether or not the program will be able to prevent enough cardiovascular events to make it more cost-effective than usual care, but Margolis said that there may be ways to tailor the program to make it less expensive.

Margolis noted that doctors involved in the program did not express any concerns about having pharmacists making changes to the medication. "They feel that these are the moves they would be doing themselves because they're in keeping with the same treatment patterns that doctors use," she said.

Dr. Joyce Samuel, an assistant professor of pediatrics in the division of nephrology and hypertension at The University of Texas Health Science Center at Houston Medical School, said she has some concerns about using such a system on patients who have more complicated medical conditions, but a well set-up system would likely be fine with routine high blood pressure.

"You'd have to decide up front, who is routine and who's not, and you would need to build in safeguards about when to involve a physician in the decision, but given that so many people have high blood pressure, physicians might welcome such a system," said Samuel.

For patients, Samuel said an intervention like this is more convenient and helps provide them a better way of managing their blood pressure.

"When you bring care into the home, it puts more responsibility on the patient. It creates a psychological shift when they're taking charge, and by being accountable to the pharmacist, it may lead to better adherence," Samuel said. "When you feel fine, it's hard to get yourself to take your medications, but home blood pressure monitoring gives them something tangible to look at. They can see that the medication or the lifestyle changes work."

Source: Health Day News

Following BP-Drug Schedule May Be Critical to Survival

Failure to take blood pressure-lowering medicines as directed greatly increases the risk of stroke and death in patients with high blood pressure, a new study finds.

"These results emphasize the importance of hypertensive [high blood pressure] patients taking their antihypertensive medications correctly in order to minimize their risk of serious complications such as fatal and non-fatal strokes," said study first author Dr. Kimmo Herttua, a senior fellow in the Population Research Unit at the University of Helsinki in Finland.

"Non-adherent patients have a greater risk even 10 years before they suffer a stroke. We have also found that there is a dose-response relationship, and the worse someone is at taking their antihypertensive therapy, the greater their risk," Herttua said.

For the study, published online July 17 in the European Heart Journal, researchers followed more than 73,000 hypertensive Finnish patients, aged 30 and up, from 1995 through 2007. They looked at how often prescriptions were filled for these patients each year to determine if they followed their medication regimens. During this time, more than 2,100 died from stroke and more than 24,500 were hospitalized with a stroke.

Compared to those who followed their medication schedule, patients who did not adhere to the schedule had nearly four times the risk of dying from a stroke in the second year after being prescribed their medicines and three times the risk in the 10th year.

In the actual year that non-adherent patients died from stroke, they had a 5.7-fold higher risk than adherent patients, the study found.

Patients who didn't take their blood pressure-lowering medications correctly had a 2.7-fold higher risk of hospitalization in the second year after being prescribed the drugs, and a nearly 1.7-fold higher risk in the tenth year, the study also found.

In the actual year that non-adherent patients were hospitalized with stroke, they had nearly twice the risk compared to adherent patients.

"As far as we know, this study is unique as it is the first study to follow patients over a long period of time, repeatedly checking how correctly they are taking their medications, and linking the trajectory of adherence with the risk of fatal and non-fatal stroke," Herttua said in a journal news release.

Blood pressure refers to the force of blood pushing against your artery walls. Over time, elevated blood pressure can cause serious problems.

The study had some limitations. The researchers couldn't be sure that patients were actually taking their drugs even though they had picked them up, and the registries did not offer information on body mass index (a calculation of body fat), smoking, alcohol consumption and resting blood pressure.

Source: Health Day News

Self-Monitoring BP Appears to Improve Results

Tracking your own blood pressure at home can help you control hypertension, a new research review finds.

And if you have a clinician's help in monitoring your blood pressure, you'll likely do even better, at least in the short term, according to the study, which was published Aug. 6 in the journal Annals of Internal Medicine.

"For adults with hypertension who are willing and able to monitor their blood pressure at home in conjunction with their health care center, self-monitored blood pressure can be a useful tool to lower blood pressure, and possibly lower the risk of cardiovascular events, at least for the short term," said lead researcher Dr. Ethan Balk, from the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center in Boston.

Whether the benefits extend beyond one year needs further research, said Balk, whose team looked at more than 50 studies on the effectiveness of home blood pressure monitoring.

Self-monitoring includes keeping a record of the readings so a physician can determine if your blood pressure medicine is working effectively or needs tweaking. Left uncontrolled, high blood pressure can lead to stroke, eye and kidney damage, heart disease and disability.

Exactly how home monitoring keeps blood pressure levels low isn't clear, Balk said. "Likely reasons are improved monitoring and tailored treatment of blood pressure by both the clinician or nursing staff and the patient, and increased incentives to control one's diet and increase physical activity," he said. "But these explanations are purely conjectural."

Also, it isn't clear to what degree additional support enhances the benefits or which methods of additional support are best, Balk said.

"An important caveat is that the evidence refers to self-monitored blood pressure used in conjunction with clinicians and/or nurses who are using and monitoring the information," he said.

The results don't apply to people who decide on their own to measure their blood pressure at home without consulting medical professionals, he said.

The findings support current health care guidelines, said Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, and a spokesman for the American Heart Association.

"National and international guidelines, including those from the American Heart Association, recommend that patients with hypertension measure and monitor their blood pressure in the home setting, and a number of studies have shown this can result in better blood pressure control," he said.

"These findings ... highlight the importance of actively engaging patients in the measuring, monitoring, goal achievement and goal maintenance of their blood pressure," he said.

Blood-pressure-monitoring devices available in drugstores and other shops range in price from $30 to more than $100.

When choosing a device, the American Heart Association recommends an automatic, cuff-style, upper-arm monitor. Wrist and finger monitors are not recommended because they yield less reliable readings. Monitors for the elderly or pregnant women should be validated specifically for those purposes.

For the current report, Balk's team reviewed 52 published studies in which patients monitored their blood pressure with and without assistance. Such help ranged from educational materials to contact with a nurse or pharmacist or counseling over the telephone.

They found some evidence that monitoring blood pressure at home improved control at six months, but not at 12 months.

When patients got help, either through educational material or direct contact with medical professionals, home monitoring improved blood pressure control at both six and 12 months.

From this data, Balk's group concluded that home blood pressure monitoring is effective in the short term.

Source: Health Day News

Program Boosts Blood-Pressure Control for Patients

The rate of blood-pressure control among adults with hypertension who took part in an intensive program offered by their health maintenance organization nearly doubled in nine years, according to a new study.

One key part of the program is treating patients with a single combination blood-pressure pill, which is easier than taking multiple pills for the same condition.

"This study suggests that if you have high blood pressure, there is hope," said study researcher Dr. Marc Jaffe, an endocrinologist and clinical leader of the cardiovascular risk reduction program for Kaiser Permanente Northern California.

From 2001 through 2009, the blood-pressure control rate of those participating in the program increased from about 43 percent to more than 80 percent, Jaffe said. "I would say it's a phenomenal increase," he said. By 2011, the control rate was even higher, at 87 percent.

Jaffe's team compared that control rate to a national database that found that blood-pressure control increased much less among the general population during the same time period, from 55 percent to 64 percent.

For the study, control was defined as a pressure less than 140/90 millimeters of mercury (mmHg) while on medication. Ideally, pressure should be below 120/80 in the general population.

The study is published in the Aug. 21 issue of the Journal of the American Medical Association.

Hypertension, which increases the risk of heart attacks and strokes, affects about 29 percent of adult Americans, or 65 million people, the researchers said.

The program had five key points, Jaffe said. It established a comprehensive hypertension registry to identify patients with high blood pressure. Between 2001 and 2009, the registry increased from about 350,000 adults to about 652,000 among Kaiser's Northern California facilities. The average age of patients was 63.

It also promoted the prescription of a single combination blood-pressure pill, known from other research to work well. It included lisinopril (brand names include Prinivil and Zestril) and hydrochlorothiazide (Microzide, Esidrix). "We know a single pill is easier to remember," Jaffe said. It may also be more affordable, with one drug co-pay instead of two or more, he said.

The program also traded information about successful strategies among clinics. Kaiser clinics that achieved high rates of control shared their practices with other clinics, which then initiated them. The program also used evidence-based practice guidelines in guiding treatment.

Medical assistants were used for follow-up visits to monitor blood pressure. The medical assistants were not registered nurses or licensed vocational nurses, but were specially trained personnel who monitored blood pressure and other vital signs, Jaffe said.

"I think a lot of these components would be applicable to other centers," he said. Although the study did not examine whether blood-pressure control results in cost savings due to fewer hospitalizations and other fees, Jaffe said he believes it would.

Source: Health Day News

Hardening of Arteries & Alzheimer's Plaques Linked

Elderly people with hardening of the arteries are more likely to have brain plaques associated with Alzheimer's disease, a new study says.

The study included 91 people, average age 87, who did not have dementia and underwent scans to assess any beta-amyloid plaques in their brains. The degree of stiffness of their arteries was checked about two years later.

Half of the participants had brain plaques and these people were more likely to have high systolic blood pressure (the top number that shows the amount of pressure on blood vessels when the heart beats), higher average blood pressure and greater arterial stiffness.

For every unit increase in arterial stiffness, people were twice as likely to have beta-amyloid plaques in the brain. Arterial stiffness was highest in people who had both amyloid plaques and lesions in their brain's white matter, according to the study published online Oct. 16 in the journal Neurology.

"This is more evidence that cardiovascular health leads to a healthy brain," study author Timothy Hughes, of the University of Pittsburgh, said in a journal news release.

He noted that the link between arterial stiffness and brain plaques did not change when regular resting blood pressure was taken into account.

"This study adds to growing evidence that hardening of the arteries is associated with cerebrovascular disease that does not show symptoms. Now we can add Alzheimer's-type lesions to the list," Hughes said.

Although the study found an association between hardening of the arteries and levels of Alzheimer's-related brain plaque in older adults, it did not establish cause and effect.

Source: Health Day News

Meds That Prevent HIV Infection & Risky Behavior

HIV-negative heterosexuals who take drugs that protect them from contracting the AIDS virus from their HIV-positive partners don't engage in more risky sexual behaviors, according to a new study.

Researchers from the University of Washington in Seattle found that knowing they are protected against HIV transmission doesn't change how these people behave sexually or lead them to have sex without a condom more often.

The study is published in the Oct. 16 issue of the journal The Lancet Infectious Diseases.

"Evidence for the effectiveness of new HIV-prevention strategies, including pre-exposure prophylaxis, has spurred optimism that the global HIV epidemic might be reversed," Dr. Jared Baeten said in a journal news release. "However, an important question is whether HIV-negative partners who know they're protected by prophylaxis will compensate for this by increasing their sexual risk-taking, such as through increasing their levels of unprotected sex."

In conducting the study, an international team of researchers led by Baeten examined findings from the 2011 Partners PrEP study, which revealed that a preventive drug regimen could protect HIV-negative men and women from contracting the virus from their HIV-positive partner.

The researchers examined information on more than 3,000 people for up to one year before and after taking drugs to prevent the transmission of HIV, the virus that causes AIDS. The participants were counseled on pregnancy testing and how to reduce their risk for sexually transmitted infections, such as gonorrhea, chlamydia, and trichomoniasis.

Even before the participants learned the results of the research, which established the protective effects of the drugs, they were engaging in unprotected sex less often, the study authors found. The researchers concluded that the risk counseling the participants had received may have been effective.

After the participants knew the drugs they were taking were shown to provide protection against HIV transmission, the investigators found no significant difference in the level of unprotected sex taking place between partners.

There was, however, a slight increase in the frequency of unprotected sex outside the relationship. The researchers said there was no increase in rates of sexually transmitted infections or pregnancy.

"The results provide encouraging evidence that behavioral changes as a result of pre-exposure prophylaxis might not undermine its strong HIV prevention and public-health benefits," Baeten said.

Source: Health Day News

Study: Vitamin D Supplements May Not Raise Risk for Kidney Stones

If fear of kidney stones is preventing you from using vitamin D supplements, a new study could ease your mind.

Taking vitamin D does not increase the risk for kidney stones, the study found. People's age, gender and weight, however, may play a role in developing the condition.

Previous research suggested that adequate levels of vitamin D might help protect against a number of diseases, including certain forms of cancer.

"Our results may lessen concerns by individuals about taking vitamin D supplements, as no link was shown between such supplementation and an increased risk for kidney stones," study leader Cedric Garland, of the University of California, San Diego School of Medicine, said in a university news release.

The new study used data on more than 2,000 adults of all ages. After following the participants for 19 months, researchers found that only 13 people reported being diagnosed with a kidney stone during that time.

The study, which appears Oct. 17 in the American Journal of Public Health, did show that being older or having a higher body-mass index (BMI) were both risk factors for this condition. BMI is a measurement of body fat based on height and weight.

Men also are at greater risk for kidney stones than women, the study found. But vitamin D users are not, it suggested.

"Mounting evidence indicates that a vitamin D serum level in the therapeutic range of 40 to 50 [nanograms per milliliter] is needed for substantial reduction in risk of many diseases, including breast and colorectal cancer," said Garland, an adjunct professor with the division of epidemiology in the department of family and preventive medicine.

Garland added that supplements typically are needed to achieve this blood level of vitamin D. People with a higher BMI need more vitamin D to gain its health benefits, he said. 

Source: Health Day News

Nosebleeds Common But Seldom Serious, Study Finds

Fewer than one in 10 people hospitalized for an unexplained nosebleed requires invasive treatment to stop the bleeding, a review of nationwide data has found.

About 38 percent of people with nosebleeds so bad they are admitted to the hospital wind up having their nosebleed resolved with little or no treatment, according to the study published online Oct. 17 in the journal JAMA Otolaryngology -- Head & Neck Surgery.

Clinicians successfully treated another 53 percent of nosebleed patients either by stuffing the nose with cotton or by cauterizing a broken blood vessel using heat, electricity or chemicals.

Only about 8 percent of hospitalized nosebleed patients needed treatment through surgery or by embolization, a process in which doctors seal off the bleeding vessel from within, the researchers found.

The small minority of patients who needed invasive treatment faced increased risk and expense, the data showed. For example, the odds of patients suffering a stroke following embolization were significantly higher than in patients who were treated by packing their nose with cotton.

Study co-author Dr. Jennifer Villwock said the results show why doctors like to proceed slowly when treating a bad nosebleed, giving the more conservative options a chance before opting for more invasive treatments.

"Sometimes it seems like we are putting patients through a lot, but we are doing it with their best interests in mind because the more invasive treatments are not without risk," said Villwock, an otolaryngologist with the State University of New York-Upstate Medical University, in Syracuse. "If we can get it stopped at the bedside, that's going to be best for all involved, but that can seem frustrating when your nose has been bleeding for hours."

Three of every five people will suffer a nosebleed -- also known by the medical term epistaxis -- in their lifetime, Villwock said.

The nose contains many small blood vessels, and these can be ruptured easily, she said. Just the act of breathing can dry out and irritate the lining of the nose, particularly in low humidity or if a person is suffering from a cold or allergies.

Seasonal changes can also have an impact, an expert explained.

"This is the beginning of nosebleed season, as the weather gets cold and the heated air is on in most people's houses," said Dr. Lisa Liberatore, an ear, nose and throat specialist at the New York Head & Neck Institute at Lenox Hill Hospital in New York City. "We're going to see several patients a day, and I'm sure the emergency room is going to get their fair share of nosebleeds."

People also can suffer nosebleeds if they have taken a blow to the nose, are on a blood-thinning medication or have a cancerous lesion in their nose.

Almost everyone is able to treat their nosebleed themselves, or receive successful outpatient treatment at their doctor's office, an urgent-care clinic or an emergency room, the researchers said. Only 0.2 percent of nosebleeds require hospitalization, they said.

This study used nationwide data provided by hospitals to review the care provided to those hospitalized for a nosebleed. Researchers looked at more than 57,000 patients who were hospitalized for nosebleeds between 2008 and 2010. In all cases reviewed, the nosebleed had occurred spontaneously and for no apparent reason, Villwock said.

About 4.7 percent of patients underwent arterial ligation, a surgical procedure that ties off a blood vessel. Another 3.4 percent underwent embolization, in which a catheter delivers a sealant that closes off the bad blood vessel.

These treatments are both riskier and pricier, the researchers said. Embolization carries a five times greater risk of stroke than nasal packing, with 1.5 percent of people who underwent that procedure suffering a stroke. About 1.3 percent of people died while undergoing arterial ligation, a mortality rate nearly twice as high as that of nasal packing.

At the same time, people receiving embolization paid an average nearly $66,000 for their hospital stay, more than three times the amount charged to people treated with nasal packing. Despite this, embolization patients had average hospital stays about as long as people receiving other types of treatment for nosebleeds.

Although the study found an association between embolization treatment for nosebleed and an increased risk of stroke compared to other treatments, it did not establish a cause-and-effect relationship.

Dr. Richard Rosenfeld, chairman of otolaryngology with the SUNY Downstate Medical Center in New York City, praised the study. "This is the best sort of rocket fuel for evidence-based decisions and shared decision-making for treating [nosebleeds]. If I were a patient going into the hospital, I'd want to know these numbers. It could tip a little bit the way people make treatment decisions."

Of the hospitalized patients in the study, "these people are sick, sick pups. They have a lot of [other existing health conditions]," Rosenfeld said, including high blood pressure, alcoholism, kidney failure and lymphoma. "These data might not apply to the average healthy patient who comes in with a really bad nosebleed."

Rosenfeld said invasive treatments, although more risky, still were incredibly safe.

"Even for the most invasive treatments, most people did very well," he said. "Very few of them had poor outcomes."

Most people can handle their own nosebleeds by keeping their head parallel to the ground and applying a little ice and pressure, Villwock said.

"The rule is, if it hasn't stopped within 20 minutes, it's time to come in," she said.

Source: Health Day News

U.S. Teens More Vulnerable to Genital Herpes: Study

Today's teens may be at higher risk than ever of contracting genital herpes because they don't have enough immune system antibodies to shield them against the sexually transmitted virus, a new study suggests.

This increase in risk may be the result of fewer teens being exposed in childhood to the herpes simplex virus type 1 (HSV-1), a common cause of cold sores, researchers reported Oct. 17 in the online edition of the Journal of Infectious Diseases.

"HSV-1 now is the predominant herpes strain causing genital infection," explained Dr. David Kimberlin, chair of infectious diseases at the University of Alabama at Birmingham School of Medicine, and the author of a journal editorial.

According to Kimberlin, the new findings suggest that almost one in 10 adolescents who a decade ago would have already acquired HSV-1 and built up some immunity may now encounter HSV-1 when they first become sexually active. That could leave them more susceptible to genital herpes than young people were in the past.

"This [also] has potentially significant consequences on neonatal herpes transmission," which occurs when a baby contracts the herpes virus from a genitally infected mother, Kimberlin said. "We must continue to monitor these changes and watch for shifts in neonatal herpes infection that possibly could result."

Of the eight types of herpes, the two that are most important in terms of disease transmission are HSV-1 and herpes simplex virus type 2 (HSV-2), both of which cause lifelong infections with no known cure. These viruses can have dormant periods after an initial outbreak. HSV-1 is usually contracted in childhood, by skin-to-skin contact with an infected adult, whereas HSV-2 is most often sexually transmitted.

However, recent research indicates that HSV-1 is becoming a major cause of genital herpes in industrialized countries. One study found nearly 60 percent of genital herpes infections were caused by HSV-1, the researchers noted.

A shift by young people toward participation in oral sex might help explain the trend, experts said, since the herpes virus can easily be transmitted in this way from the mouth to the genitals.

"I tell patients herpes is like your credit history -- whatever you did you can never get rid of," said one expert not connected to the study, Dr. Marcelo Laufer, a pediatric infectious disease specialist at Miami Children's Hospital.

"Every year the proportion of patients who get infected with HSV-1 through oral sex is increasing," he said. "Adolescents who reach that age without being exposed to HSV-1 might, through oral sex, be more susceptible to the infection."

The virus is usually passed through saliva, but in more recent years better hygiene may have kept the virus from spreading to young children, Laufer theorized. That means that fewer children are now exposed and are producing antibodies against HSV.

HSV-1 and HSV-2 can also cause significant problems for newborn infants, who don't yet have mature immune systems capable of fighting the viruses. As many as 30 percent of infected babies die from this infection if they have the most severe form of the disease, Kimberlin noted.

In the new study, a team of researchers led by Heather Bradley of the U.S. Centers for Disease Control and Prevention used data from federal government surveys to track the prevalence of herpes among 14- to 49-year-olds in the United States.

Overall, they found that 54 percent of Americans in this age range were infected with HSV-1.

Among 14- to 19-year-olds, however, the prevalence of protective HSV-1 antibodies fell by nearly 23 percent from 1999 to 2010, the research team found.

Among those aged 20 to 29, HSV-1 prevalence dropped more than 9 percent. HSV-1 prevalence remained stable among those in their 30s and 40s.

These data suggest that more teens lack HSV-1 antibodies at their first sexual encounter now than in decades past, and so are more susceptible to genital herpes.

"In combination with increased oral sex behaviors among young people, this means that adolescents may be more likely than those in previous time periods to genitally acquire HSV-1," the researchers concluded.

Source: Health Day News

Surgical Tools Too Often Left Behind in Patients

You go in for surgery, and only find out later that one of the surgeon's tools -- a sponge, a needle, a surgical implement -- has been left behind in your body.

A rare occurrence? Not really, according to the watchdog group The Joint Commission, which is urging hospitals across America to find better ways to avoid the problem of "retained surgical items."

"Leaving a foreign object after surgery is a well-known problem, but one that can be prevented," Dr. Ana McKee, the commission's executive vice president and chief medical officer, said during an early afternoon press briefing Thursday.

Her group believes that this is an all-too-common problem -- one that can even prove fatal or leave severe damage to patients, both physically and emotionally.

According to the commission, there have been more than 770 reports of retained foreign objects in surgical patients over the last seven years. These cases resulted in 16 deaths and in almost 95 percent of the cases patients had to have their hospital stay extended. The objects most often left inside patients include sponges and towels, broken parts of instruments, and stapler parts and needles or other sharp pieces.

"It is critical for organizations to develop and comply with policies and procedures to make sure all surgical items are identified and accounted for as well as to ensure there is open communication by all members of the surgical team about any concern," McKee said.

Certain patients or procedures seem more prone to having implements unaccounted for after surgery. According to McKee, these include overweight patients, more rushed or urgent procedures, having more than one surgical procedure and multiple surgical teams, or having staff turnovers during the procedure.

McKee noted that the 770 cases reported is probably only the tip of the iceberg and the actual number of these incidents may be closer to 1,500 to 2,000 each year. These mistakes can also lead to financial outlay: According to the commission, leaving objects inside patients cost as much as $200,000 in medical liability payments for each case.

But there are ways to reduce the problem. Among the commission's recommendations:

• Create a reliable, standardized operating room counting system to ensure all surgical items are accounted for.
• Develop effective, standardized policies and procedures to prevent the problem that includes counting procedures, wound opening and closing procedures, and directions on when X-rays should be done during the operation to help spot stray items.
• Team briefings and debriefings would also help, with team members feeling free to express any concerns about the safety of the patient.

Too often, "problems with hierarchy and intimidation in the surgical team, failure in communication with physicians, failure of staff to communicate relevant patient information and inadequate or incomplete staff education," are a part of the problem, the commission said.

If any discrepancy is found between the objects counted and those remaining after the surgery, action must be taken and placed into the record, the commission said.

According to the commission, the problem occurs nine times more often during emergency operations than in planned ones and was four times more likely to happen if the procedure was unexpectedly changed.

The Joint Commission is an independent, not-for-profit organization, the nation's oldest and largest standards-setting and accrediting body in health care.

Source:  Health Day News

8 Mistakes Parents Make With Preschoolers

Sometimes, it may seem like your preschooler has the innate ability to push you to the outer edge of your patience. And that's on a good day.

Fear not, moms and dads. You're not alone. Preschoolers want to own their newfound independence. But they also want the close attention and love of their caregivers.

Michele Borba, EdD, author of The Big Book of Parenting Solutions, says, "These ages (3-5) are among the most active and frustrating in terms of parenting.

Here are eight common mistakes parents of preschoolers make and some smart fixes to help avoid or resolve problems.

1. Straying Too Much From Routines

Consistency is key for preschoolers, says pediatrician Tanya Remer Altmann, author of Mommy Calls: Dr. Tanya Answers Parents' Top 101 Questions about Babies and Toddlers.

When you're not being consistent with your routine, preschoolers get confused and may act out more or throw more temper tantrums. Altmann says, "If sometimes you let them do something and sometimes you don't, they don't understand."

Continue reading below...

Your child probably wants to know why last time Mommy let her play on the playground for 10 minutes when school got out but this time wants her to get in the car right away. Or why did Mommy laid down with her for 10 minutes last night while she fell asleep but now says she can't.

Fix it: Be consistent across the board -- whether it's with discipline, sleep habits, or mealtime routines. 

Altmann says if your routine is consistent 90% of the time and your child is doing well, then so are you, and a minor exception may be OK.

2. Focusing on the Negative

It's easy to hone in on your child's negative actions -- like yelling and screaming -- and ignore the good ones.

Altmann says parents tend to focus on what they don't want their preschoolers to do. "They'll say, 'Don't hit. Don't throw. Don't say 'poopy pants,'" she says.

Fix it: Notice when your child is doing something positive, and reward the good behavior.

The reward for positive actions can be your praise, or it can be giving your child a big hug or kiss. "Those types of things really go a long way with preschoolers," Altmann says.

Tell your child, "I like the way you sat quietly and listened," or "That was good when you were so friendly to the child on the playground."

3. Missing the Warning Signs

Parents often try to reason with children when they're in the throes of a temper tantrum, repeating, "Calm down, calm down." But that's like trying to reason with a goldfish, Borba says. "You've got power immediately beforehand when you can still distract or anticipate. But once the tantrum is in full force, you've lost it. The kid is not hearing you."

Fix it: Figure out and anticipate what your kid's natural warning signs are, Borba says. The usual ones are hunger, fatigue, and boredom.

So don't take your child to the supermarket unless she's napped or you've stashed a healthy snack in your purse.

4. Encouraging Whining

Does your child's whining drive you crazy? For instance, does it drive you up the wall when, right before dinnertime while getting ready to preparing food, your child starts crying, "I wanna go to the park," or "I wanna go play with Riley."

Borba says parents often give in to these whines, but this only reinforces the attention-getting behavior. Your child will figure out which buttons to push and then push them over and over again.

"This is the age when your children come out of their shells," she says. "Watch out, because they figure out what works."

Fix it: Ignore it.

For behavior that isn't aggressive, like a whine or sulk, you're better off if you don't respond to it at all. If you're consistent, Borba says, your child will think, "Well, that didn't work."

5. Overscheduling Your Child

Parents often line up a slew of activities, like dance or music classes. Then they wonder why their child isn't getting in bed and falling asleep right away after so many activities that must have made her tired.

The problem, Altmann says, is that they're still wound up and need time to calm down. Every child needs down time, especially preschoolers, she says. Whether your child is at preschool for two hours or there all day, it can be very exhausting.

Fix it: Don't overschedule your child or shuttle him from one activity to the next. Give your child time to unwind with free play when he gets home from school.

6. Underestimating the Importance of Play

Many parents feel they should sign their children up for enrichment programs to give them an edge. But that's not really the case.

What's most enriching at this age, says psychologist Lawrence J. Cohen, author of Playful Parenting, is free play. That includes dramatic play (make believe), rough housing, and goofing around.

"Free play is how children's brains develop best," he says. "In play, children will naturally give themselves the right amount of challenge -- not too easy or too hard."

Fix it: Allow your child time and space for free play. Remember that preschoolers define play as "what you do when you get to choose what to do."

Free choice -- the voluntary aspect of play -- is important, Cohen says. "Preschoolers love to vacuum or do housework, but it's play. It's not on their chore list. They've chosen to do it and they're just doing it for fun," he says.

7. Getting Distracted By the Daily Grind

Your child may play well independently, but that doesn't mean he or she doesn't crave your attention. "There's something children miss out on if parents don't get on the floor and play with them," Cohen says.

Not only do parents not get down and play, many parents are too easily distracted by their cell phone, email, or other multitasking. "Kids aren't dumb," Cohen says. "They know whether we're really paying attention or not."

Fix it: Set a timer, be enthusiastic, and stay involved for your designated play period with your child.

"A half an hour of concentrated play where you give your undivided attention and you're not worried about dinner or work," Cohen says, "is better than all day when you're only half paying attention."

8. Overreacting to Lies

Cohen says lying really freaks parents out. He urges parents to see the behavior as experimenting rather than as "a moral thing."

"When children start to lie, it's a big cognitive advance," he says. "It's kind of exciting and a little bit scary. It has an emotional charge. But then parents freak out and have visions of their child in prison, so they get very tense and anxious about it."

Fix it: Don't overreact. Know that telling a fib or two is a normal part of your child's development.

And don't get hung up on the lie itself, Cohen says. For instance, if your little Pinocchio is denying he had anything to do with a spill, you can say matter-of-factly, "You feel bad about that and I understand."

Effective parenting takes time, patience, and love. It also takes remembering that changes may not happen overnight. But as the old maxim goes, "If at first you don't succeed, try, try again." And again.

Source: http://www.webmd.com/