Saturday, March 31, 2012

Use it or Lose it



Mind Games Help Healthy Older People Too


Cognitive training including puzzles, handicrafts and life skills are known to reduce the risk, and help slow down the progress, of dementia amongst the elderly. A new study published in BioMed Central's open access journal BMC Medicine showed that cognitive training was able to improve reasoning, memory, language and hand eye co-ordination of healthy, older adults.


It is estimated that by 2050 the number of people over 65 years old will have increased to 1.1 billion worldwide, and that 37 million of these will suffer from dementia. Research has already shown that mental activity can reduce a person’s risk of dementia but the effect of mental training on healthy people is less well understood. To address this researchers from China have investigated the use of cognitive training as a defence against mental decline for healthy older adults who live independently.


To be recruited onto the trial participants had to be between 65 and 75 years old, and have good enough eyesight, hearing, and communication skills, to be able to complete all parts of the training. The hour long training sessions occurred twice a week, for 12 weeks, and the subjects were provided with homework. Training included a multi-approach system tackling memory, reasoning, problem solving, map reading, handicrafts, health education and exercise, or focussing on reasoning only. The effect of booster training, provided six months later, was also tested.


The results of the study were positive. Profs Chunbo Li and Wenyuan Wu who led the research explained, "Compared to the control group, who received no training, both levels of cognitive training improved mental ability, although the multifaceted training had more of a long term effect. The more detailed training also improved memory, even when measured a year later and booster training had an additional improvement on mental ability scores."


This study shows that cognitive training therapy may prevent mental decline amongst healthy older people and help them to continue independent living longer in their advancing years.


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The above story is based on the March 27, 2012 news release by BioMed Central.


The research is published in: Yan Cheng, Wenyuan Wu, Wei Feng, Jiaqi Wang, You Chen, Yuan Shen, Qingwei Li, Xu Zhang, Chunbo Li. The effects of multi-domain versus single-domain cognitive training in non-demented older people: a randomized controlled trial. BMC Medicine 2012, 10:30 doi:10.1186/1741-7015-10-30

Stevia Extract


Eversweet Chocolate Malt is sweetened with an all-natural sweetener made with the best tasting part of Stevia rebaudiana plant.


Stevia rebaudiana regulates blood sugar, prevents hypertension and tooth decay. Studies have shown that it has antidiabetic, antibacterial as well as antiviral properties (1).


Journal Reference:

Kujur RS, Singh V, Ram M, Yadava HN, Singh KK, Kumari S, Roy BK. Antidiabetic activity and phytochemical screening of crude extract of Stevia rebaudiana in alloxan-induced diabetic rats. Pharmacognosy Res. 2010 Jul;2(4):258-63.


CLICK HERE for the complete report.

Chillies Warm Your Hearts

Picture credit: http://blogtokwan.blogspot.com


Chillies have been a part of the human diet in the Americas since at least 7500 BC. Following their discovery by Columbus in 1492 many cultivars of chillies spread across the world, used in both food and medicine.


Modern medicine and science is now starting to validate many of the anecdotal health properties assigned to chillies and discover a number of potential new uses as well.


Researchers at the Chinese University of Hong Kong focused their study on capsaicin and capsaicinoids, compounds that give cabai burong, cili padi, cayennes, jalapeños and other chilli peppers their fire.


Capsaicin already has an established role in medicine in rub-on-the-skin creams to treat arthritis and certain forms of pain. Past research suggested that spicing food with chilies can lower blood pressure in people with that condition, reduce blood cholesterol and ease the tendency for dangerous blood clots to form.


"Our research has reinforced and expanded knowledge about how these substances in chilies work in improving heart health," said Zhen-Yu Chen, a professor of food and nutritional science. "We now have a clearer and more detailed portrait of their innermost effects on genes and other mechanisms that influence cholesterol and the health of blood vessels. It is among the first research to provide that information."


Chen and his colleagues gave two groups of hamsters high-cholesterol diets, before giving one group food with varying amounts of capsaicinoids while the other control group had foods with no capsaicinoids.

They found that in addition to reducing total cholesterol levels in the blood, capsaicinoids reduced levels of the so-called "bad" cholesterol (which deposits into blood vessels), but did not affect levels of so-called "good" cholesterol. The team found indications that capsaicinoids may reduce the size of deposits that already have formed in blood vessels, narrowing arteries in ways that can lead to heart attacks or strokes.


Capsaicinoids also blocked the activity of a gene that produces cyclooxygenase-2, a substance that makes the muscles around blood vessels contract, restricting the flow of blood to the heart and other organs. This had the effect of relaxing muscles and allowing the blood to flow more easily.

"We concluded that capsaicinoids were beneficial in improving a range of factors related to heart and blood vessel health," said Chen.


"But we certainly do not recommend that people start consuming chilies to an excess. A good diet is a matter of balance. And remember, chilies are no substitute for the prescription medications proven to be beneficial. They may be a nice supplement, however, for people who find the hot flavor pleasant."


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The report was part of the 243rd National Meeting and Exposition of the American Chemical Society (ACS), being held in San Diego the week of March 26, 2012


The above story is based on the March 27, 2012 news release by the American Chemical Society (ACS).

Asthmatic Coughs and Wheezes


Picture credit: http://www.letusbreathe.com


How Colds Cause Coughs and Wheezes


Asthmatics often report bouts of coughing, wheezing and breathlessness when they have a cold and there is no current medicine that sufficiently treats this problem.


Researchers at Queen’s University Belfast are investigating ‘cough receptors’ that line the cells of the airway and how these are affected by rhinovirus – a virus frequently responsible for the common cold.


The team showed that rhinovirus infection caused an increase in the number of these cough receptors– making the airways more sensitive.


Dr Hani’ah Abdullah, who is working on the project, explained how these receptors, called transient receptor potential (TRP) receptors, work.


Trigger Factors


“TRP receptors respond to chemical and physical stimuli in the environment such as pollutants in the air, a change in air temperature and some of the toxic chemicals found in cigarette smoke. Once activated, these receptors cause the individual to cough and wheeze.” she said.


Professor Louise Cosby and Dr Lorcan McGarvey from the Centre for Infection and Immunity, Queen’s University Belfast, are jointly leading the research team of scientists and clinicians. Their group took airway cells from mild asthmatics and healthy individuals and infected them in the laboratory with rhinovirus, which is the most common virus to exacerbate symptoms of asthma. The results showed that rhinovirus infection caused an increase in the number of TRP receptors in the airway cells and that this effect was most pronounced in the mild asthmatics. “The increase in receptor numbers makes individuals more sensitive to environmental stimuli, making them more likely to suffer from prolonged bouts of coughing,” explained Dr Abdullah.


“It’s feasible that therapies could be developed that block either the sensitivity of cough receptors or their increase in number. This would keep symptoms under control and ultimately improve the lives of asthmatics,” said Dr Abdullah.



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The above story is based on the March 27, 2012 news release by Society for General Microbiology.


Their findings of the Queen’s University Belfast researchers were presented at the Society for General Microbiology’s Spring Conference in Dublin, 26-29 March 2012


If you have asthma, you need to know some key strategies for prevention of asthma symptoms. While there’s no asthma cure, there are steps you can take to reduce the chances of having the frightening asthma symptoms such as coughing, wheezing, and difficulty catching your breath.


CLICK HERE for prevention guide by WebMD


Lowering LDL, the Earlier the Better



Coronary atherosclerosis -- a hardening of the arteries due to a build-up of fat and cholesterol -- can lead to heart attacks and other forms of coronary heart disease (CHD).


Lowering low-density lipoprotein (LDL), or "bad" cholesterol, reduces the risk of CHD.


According to a new research, lowering LDL beginning early in life resulted in a three-fold greater reduction in the risk of CHD than treatment with a statin started later in life.


By the time most people begin treatment to lower LDL, CHD has often been quietly developing for decades. Because coronary atherosclerosis begins early in life, lowering LDL at a younger age would understandably be more effective at reducing heart attacks.


Researchers sought to test this hypothesis by using genetic data to conduct a series of "natural" randomized controlled trials* involving over one million study participants.


"Our study shows that the benefit of lowering LDL cholesterol depends on both the timing and the magnitude of LDL reduction," said Brian A. Ference, director of the cardiovascular genomic research center at Wayne State University School of Medicine and the study's principal investigator.


Start Diet & Exercise Now!


"The increased benefit of lowering LDL beginning early in life appeared to be independent of how LDL was lowered. This means that diet and exercise are probably as effective as statins or other medications at reducing the risk of CHD when started early in life."


"The results of our study demonstrate that the clinical benefit of lowering LDL can be substantially improved by initiating therapies to lower LDL cholesterol beginning early in life," Dr. Ference said.


Coronary heart disease is the most common cause of death and disability throughout the world. Treatment of CHD and its risk factors is costly and consumes a large proportion of health care expenditures. Dr. Ference believes that the results of this study suggest that focusing on prolonged and sustained reductions in LDL cholesterol beginning early in life has the potential to substantially reduce the global burden of CHD.



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The above story is based on the March 26, 2012 news release byAmerican College of Cardiology.


The research was presented at the recent American College of Cardiology's 61st Annual Scientific Session.


* The researchers used a novel study design called a Mendelian randomized controlled trial (mRCT) to study the effect of nine single-nucleotide polymorphisms (SNPs), or single-letter changes in DNA sequence, each of which is associated with lower levels of LDL cholesterol. Because each of these SNPs is allocated randomly at the time of conception, inheriting one of these SNPs is like being randomly allocated to a treatment that lowers LDL cholesterol beginning at birth. The researchers found that all nine SNPs were associated with a consistent 50-60 percent reduction in the risk of CHD for each 1 mmol/L (38.67 mg/dl) lower lifetime exposure to LDL cholesterol. Lowering LDL by 2 mmol/L (77.34 mg/dl) could reduce the risk of CHD by almost 80 percent.

Rapid Rise in Blood Pressure Before Midlife May Cause Irreversible Heart Damage

Picture credit: www.bichonhealth.org


Doctors are currently more likely to recommend blood pressure medications for older people who have a higher overall cardiovascular risk, thanks in part to their age, and few monitor patients' blood pressure frequently enough to track the rate of increase.


The current "watch-and-wait" approach to high blood pressure readings in younger people may set patients on a course for irreversible heart damage.


A new research suggests that early detection and treatment of rapidly rising blood pressure in midlife may be required to prevent long-term damage to the heart.

The study tracked cardiac health indicators 1,653 men and women over 66 years and found that a sharp rise in blood pressure in midlife, not just crossing a certain threshold, can increase a person's risk of heart disease later in life.


Medications do not fully reverse damage to the heart from high blood pressure


The results revealed people who experienced a relatively rapid increase in blood pressure during midlife typically had a larger left ventricle -- an independent risk factor for heart disease and other health problems -- than those whose blood pressure edged up more slowly or later in life. Those taking medication to manage high blood pressure had a larger left ventricle than those with the same blood pressure who had never taken medication, suggesting that treatment in later life did not reverse the consequences of a rapid rise in blood pressure in earlier years.


Based on the study findings, a borderline or pre-hypertensive blood pressure reading (a systolic pressure of 120 to 139 mm Hg or a diastolic pressure from 80 to 89 mm Hg) -- even in your 30s -- should warrant more frequent monitoring so doctors can assess the rate of change in blood pressure.


"If people have a rapid rise in blood pressure, early treatment should be considered, because we know from this study that, 30 years down the line, they're going to have more heart damage than somebody with a slower rise in blood pressure," Dr. Arjun K. Ghosh said on behalf of the study team.



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The above story is based on the March 24, 2012 news release byAmerican College of Cardiology.


The research was presented at the recent American College of Cardiology's 61st Annual Scientific Session.

Thursday, March 29, 2012

SLEEPING TOO MUCH OR TOO LITTLE CAN BE BAD FOR YOUR HEART

Picture credit: www.horizontalimage.net


Getting too little sleep – or even too much – appears to spell trouble for the heart.

New data reveal that adults who get less than six hours of sleep a night are at significantly greater risk of stroke, heart attack and congestive heart failure.

Even those who reportedly sleep more than eight hours a night have a higher prevalence of heart problems, namely chest pain (angina) and coronary artery disease, a narrowing of the blood vessels that supply blood and oxygen to the heart.

The research paper“Sleep Patterns and Prevalence of Cardiovascular Outcomes- Analysis of National Health and Nutrition Examination Survey” was presented at the American College of Cardiology’s 61st Annual Scientific Session.

Analyses of 3,019 patients over the age of 45 years who participated in the National Health and Nutrition Examination Survey (NHANES) showed that people getting too little sleep were two times more likely to have a stroke or heart attack and 1.6 times more likely to have congestive heart failure.

Those reporting more than eight hours of sleep a night were two times more likely to have angina and 1.1 times more likely to have coronary artery disease.

“We now have an indication that sleep can impact heart health, and it should be a priority,” said Rohit R. Arora, MD, FACC, chairman of cardiology and professor of medicine, the Chicago Medical School, and the study’s principal investigator. “Based on these findings, it seems getting six to eight hours of sleep everyday probably confers the least risk for cardiovascular disease over the long term.”

Insufficient sleep has previously been linked to the hyper-activation of the sympathetic nervous system, glucose intolerance, diabetes and an increase in cortisone levels, blood pressure, resting heart rate and inflammatory markers – all of which are associated with cardiovascular disease. However, researchers are still unclear as to why longer sleep duration might be linked to heart problems.

Dr. Arora speculates that the people sleeping more than eight hours, who report chest pains to their doctor, may have been given a greater clinical workup than people getting less than six hours of sleep, who are not presenting chest pains, which may explain why there are more significant cardiovascular events in this group; however, this needs to be evaluated in future long-term studies. In addition, unknown factors not yet elucidated and other co-morbid conditions like diabetes mellitus, obesity or hypertension may cause higher risk in those sleeping under six hours.

Dr. Arora says larger prospective studies are needed to confirm these findings and, if proven, to determine whether asking about sleep patterns presents a cost-effective way to further screen and identify patients who may be at high risk for heart disease.

The above story is based on the March 25, 2012 news release by American College of Cardiology.


Read our earlier report

Too Little or Too Much Sleep Harmful

Sleeping either less than 7 hours or more than 8 hours may be a risk factor for an array of common medical problems, including weight gain, diabetes and hypertension .



Go to ’Search This Blog’ on the right hand column and type ‘SLEEP’ for more thatn18 reports on the dangers of too much and too little sleep on adults as well children.



Bagaimana Cara Terbaik Membantu Mengurangkan Berat Anak Anda

Picture credit: http://sp.life123.com

Ingin Kurangkan Berat Anak Anda?

Kurangkan Berat Anda Sendiri!

Satu kajian oleh penyelidik di Universiti California, Sekolah Perubatan San Diego dan Universiti Minnesota menunjukkan bahawa perubahan berat ibu bapa merupakan penyumbang utama kepada kejayaan penurunan berat badan kanak-kanak dalam rawatan berasaskan keluarga kanak-kanak obesiti.

Para penyelidik menilai terhadap 80 kumpulan keluarga dengan kanak-kanak yang berusia 8 hingga 12 tahun yang mempunyai berat badan berlebihan atau obes, yang mengambil bahagian dalam program rawatan ibubapa sahaja atau ibu bapa + rawatan kanak-kanak selama lima bulan.

Kajian ini memberi tumpuan untuk menilai kesan 3 jenis kemahiran keibubapaan yang diajar dalam rawatan tingkah laku berasaskan keluarga untuk kanak-kanak obes, dan kesannya terhadap setiap berat badan kanak-kanak: ibubapa menjadi model menunjukkan tingkahlaku bagi menggalakkan kehilangan berat badan mereka sendiri, perubahan dalam persekitaran pemakanan di rumah dan gaya dan teknik keibubapaan (contohnya, keupayaan ibu bapa untuk membantu menghadkan tingkah laku pemakanan kanak-kanak, menggalakkan kanak-kanak mengambil bahagian dalam aktiviti yang diprogramkan).


Konsisten dengan penyelidikan yang pernah diterbitkan, perubahan BMI ibu bapa adalah jangkaan yang signifikan dalam penurunan berat badan kanak-kanak.


Para penyelidik menyimpulkan bahawa pegawai klinikal perlu memberi fokus kepada menggalakkan ibu bapa untuk menurunkan berat badan bagi membantu anak mereka dalam pengurusan berat badan yang berlebihan atau obes.


Jangkaan yang paling penting dalam penurunan berat badan kanak-kanak

"Bagaimana cara ibu bapa boleh membantu kanak-kanak obes mengurangkan berat badan? Kurangkan berat badan sendiri, "kata Kerri N. Boutelle, PhD, profesor bersekutu pediatrik dan psikiatri di San Diego UC dan Hospital Kanak-kanak Rady San Diego.


"Ibu bapa adalah yang orang yang paling ketara dalam persekitaran kanak-kanak, bertindak sebagai guru yang pertama dan paling penting," kata Boutelle "mereka memainkan peranan penting dalam mana-mana program berat badan untuk kanak-kanak, dan kajian ini mengesahkan pentingnya mereka sebagai contoh dalam membentuk tingkah laku pemakanan yang sihat dan senaman untuk anak-anak mereka. "


Artikel di atas adalah berdasarkan berita keluaran 14 Mac 2012 oleh Universiti California, San Diego.

Kajian diterbitkan dalam edisi dalam talian
Obesity, jurnal rasmi The Obesity Society: Kerri N. Boutelle, Guy Cafri and Scott Crow. Parent Predictors of Child Weight Change in Family-Based Behavioral Obesity Treatment. Obesity, 2012 DOI: 10.1038/oby.2012.48

One Day at Sharif's Primary 6 class

Picture credit: http://dearoptimists.files.wordpress.com


One day at Sharif’s St Xavier Primary School in Air Itam, Penang, a teacher trying to teach good manners asked her students the following question:


“Ali Baba (Sharif’s nickname), if you were on a dinner date with a nice young lady, how would you tell her that you have to go to the bathroom?”


Sharif said, “Just a minute I have to go pee.”


The teacher responded by saying, 'That would be rude and impolite.'


What about you, Kim Beng, how would you say it?'


Kim Beng said, “I am sorry, but I really need to go to the bathroom. I'll be right back.”


“That's better, but it's still not very nice to say the word bathroom at the dinner table,” the teacher responded.


She then turned to Johnny, the foreign exchange from Texas, “And you, little Johnny, can you show us your good manners?”


Little Johnny in his thick Yankee drawl, “I would say, ‘Darling, may I please be excused for a moment? I have to shake hands with a very dear friend of mine, to whom I hope to introduce you to after dinner’ “


The teacher fainted..... because Shariff and the rest of the prepubescent boys were screaming for Little Johnny to repeat this excellent pick-up line!


Saturday, March 24, 2012

Pain Relievers Could be Spiking Your Blood Pressure

Picture cedit: http://www.labspaces.net


Doctors and patients need to be aware of risks, TAU researcher cautions


Diseases such as kidney failure and endocrine tumors are among the suspects causing high blood pressure — but could the common pain relievers in your medicine cabinet be the culprit?


According to Prof. Ehud Grossman of Tel Aviv University's Sackler Faculty of Medicine and the Sheba Medical Center, many common over-the-counter and prescription medications are underlying causes of hypertension, which is a major risk factor for stroke, heart attack, and aneurisms. The chemical components of the drugs can raise blood pressure or interfere with anti-hypertensive medications, he explains. And while many medications can cause this drug-induced hypertension, both patients and doctors remain dangerously uninformed.


Weighing the treatment options


"In diagnosing the causes of hypertension, over-the-counter drugs like ibuprofen are often overlooked," says Prof. Grossman. Patients often assume that because a medication can be obtained without a prescription, it's relatively harmless. But that's not always the case.


Many of the medications that are linked with a rise in blood pressure are quite widely used, says Prof. Grossman, whose research provides an overview of which medications are related to high blood pressure. Examples include contraceptive pills, various anti-depressants, anti-inflammatory pills to control pain. and bacterial antibiotics.


Though high blood pressure is a known side effect of many of these medications, doctors do not always account for them in their treatment plans, and they don't inform patients of the potential risks associated with these medications. It's ultimately the doctor's responsibility to weigh treatment options and present the best course for their patient should issues of hypertension arise, Prof. Grossman says.


Doctors may be advised to decrease the dosage of the drug, or add an anti-hypertensive drug to the treatment regime, he says. In any case, awareness on the part of both doctors and patients needs to be raised. "Many physicians don't account for this, and some don't even know about it. It's their responsibility to be informed and make sure that their patients are aware that this is a possibility."


Cost and benefit


Though much of the time a course of treatment can be altered to account for the dangers of hypertension, that isn't always the case. For example, new anti-vascular endothelial growth factor drugs, which may increase blood pressure, block the formation of new blood vessels and arteries to solid tumors. Because the drugs are so effective in treating these malignancies, the benefit outweighs the cost, he believes.


But that doesn't mean that patients shouldn't be watched closely for signs of hypertension. "Once a patient has won a longer life with the use of these drugs, you don't want to expose them to problems associated with blood pressure, such as stroke," says Prof. Grossman. There are simple ways to counteract drug-induced hypertension, such as the thoughtful addition of anti-hypertensive medications to a treatment plan, he says.


The above story is reprinted from the March 20, 2012 news release by American Friends of Tel Aviv University.


Prof. Grossman’s research was published in the American Journal of Medicine:

Grossman E, Messerli FH. Drug-induced hypertension: an unappreciated cause of secondary hypertension. Am J Med. 2012 Jan;125(1):14-22.

Health Tip: Help Prevent Heel Problems


Here's what you can do

The heel is the largest of the human foot's 26 bones. And it's no stranger to strain and pain.

The American Podiatric Medical Association suggests how to help prevent heel problems:

  • Make sure your shoes fit well and offer plenty of support for the entire foot.
  • Make sure you wear the right shoes for each activity.
  • Stop using shoes that are well worn on the soles or heels.
  • Carefully warm up and stretch before exercise, and remember to pace yourself.
  • Treat your body to the right foods and plenty of rest; lose weight if you are overweight or obese.

Lack of Sleep May Increase Calorie Consumption

Picture credit : http://www.insidershealth.com


People who were sleep deprived ate more than 500 additional calories per day.


Chronic lack of sleep may contribute to obesity.


If you don’t get enough sleep, you may also eat too much — and thus be more likely to become obese.


That is the findings of researchers who presented their study at the American Heart Association’s Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2012 Scientific Sessions.


“We tested whether lack of sleep altered the levels of the hormones leptin and ghrelin, increased the amount of food people ate, and affected energy burned through activity,” said Virend Somers, M.D., Ph.D., study author and professor of medicine and cardiovascular disease at the Mayo Clinic, Rochester, Minn.. Leptin and ghrelin are associated with appetite.


The researchers studied 17 normal, healthy young men and women for eight nights, with half of the participants sleeping normally and half sleeping only two-thirds their normal time.


Participants ate as much as they wanted during the study.


Researchers found:


  • The sleep deprived group, who slept one hour and 20 minutes less than the control group each day consumed an average 549 additional calories each day.
  • The amount of energy used for activity didn’t significantly change between groups, suggesting that those who slept less didn’t burn additional calories.
  • Lack of sleep was associated with increased leptin levels and decreasing ghrelin — changes that were more likely a consequence, rather than a cause, of over-eating.


“Sleep deprivation is a growing problem, with 28 percent of adults now reporting that they get six or fewer hours of sleep per night,” said Andrew D. Calvin, M.D., M.P.H., co-investigator, cardiology fellow and assistant professor of medicine at the Mayo Clinic.


The researchers noted that while this study suggests sleep deprivation may be an important part and one preventable cause of weight gain and obesity, it was a small study conducted in a hospital’s clinical research unit.


“Larger studies of people in their home environments would help confirm our findings,” Calvin said.


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The above story is reprinted from materials in the March 14, 2012 release by the newsroom of the American Heart Association


That is the findings were presented at the American Heart Association’s Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2012 Scientific Sessions: Somers V, Carter RE, Levine JA. Lack of sleep may increase calorie consumption. MP030


Zestzfulness: Lack of Sleep Linked to Childhood Obesity

May 08, 2011

Picture credit: www.fitnesshealthgym.com. The obesity pandemic is claiming its presence even among youngest of children and is clearly on the rise. The potential interrelationships between sleep and obesity have gained ...


Zestzfulness: Early to Bed and Early to Rise: It's Keeping Kids Leaner

Oct 05, 2011

Zestzfulness: Lack of Sleep Linked to Childhood Obesity May 08, 2011 The researchers believe that lack sleep contributes to obesity by wreaking havoc on metabolism and the endocrine system -- and this is especially true ...


Zestzfulness: Sleep Disturbance Associated with Cardiovascular ...

Jan 26, 2012

People who suffer from sleep disturbances are at major risk for obesity, diabetes, and coronary artery disease, according to new research from the Perelman School of Medicine at the University of Pennsylvania. For the first ...