Nocturnal Eating Disorder More Than Just Hunger
You’re really not sure why you’re gaining weight, are inexplicably tired in the morning, and the kitchen, which was clean when you went to bed, is now a mess. If this sounds familiar, you may have a sleep-eating disorder that is more serious than the midnight munchies.
It is estimated that about 4 million Americans, mostly women, have a condition known as nocturnal sleep-related eating disorder, or NSRED, in which they consume large amounts of food during the night when they may be only half-awake. If they do remember, they may be too ashamed to admit it, says Lea Montgomery, a clinical instructor at the Harris School of Nursing at Texas Christian University in Fort Worth. Pasta and sweets are favorites, but on rare occasions people have been known to snack on cat food, cigarettes or cleaning products during their nighttime kitchen excursions.
Other sleep problems such as sleep apnea and restless-leg syndrome may prompt a bingeing episode. The condition also has been linked to low melatonin levels and high levels of the stress hormone cortisol. In an article alerting nurses to the unusual sleep disorder, Montgomery points out that identifying the problem is critical so treatment can begin, and the person can take steps to avoid accidental poisoning, burning or cutting herself while preparing food in a sleepy state. (RN 2002: 65 (4):41-43.)
Controversial Herb Promoted Weight Loss in Healthy Adults
The herbal product ephedra has been in the news the past year because it was an ingredient in dietary supplements linked to the deaths of some college and professional athletes. There is scientific evidence that ephedra may contribute to heart attacks and strokes. Now some surprising news: Ephedra safely promoted weight loss in a large group of healthy men and women participating in a six-month study.
Lead author Carol N. Boozer, director of the Energy Metabolism Core Laboratory at the New York Obesity Research Center at St. Luke’s-Roosevelt Hospital and Columbia University, says she and her colleagues were asked by a consortium of supplement manufacturers to do a rigorous trial testing the safety and effectiveness of the common diet combo of ma huang (ephedrine alkaloids) and kola nut (caffeine). The researchers agreed to undertake the study on the condition that the results would be published even if they found the supplements were unsafe or didn’t work.
After thorough checkups, involving 24-hour blood pressure and heart rate monitoring and electrocardiograms, the 167 volunteers were divided into two groups: One took two tablets of the supplement three times a day, which Boozer says is the upper limit of the usually recommended dose; the other group took a placebo.
At the end of six months, the average weight loss of those taking the supplements was 15.4 pounds; those taking the placebo lost 6.8 pounds. Side effects ranged from heart palpitations and irregular heartbeat to insomnia and dry mouth, causing 80 people to drop out. However, the side effects occurred with nearly equal frequency in both groups. For instance, of the five people who dropped out because their blood pressure went up, three were taking the placebo.
In an editorial accompanying the study, Dr. Richard L. Atkinson, editor of the International Journal of Obesity, advised consumers to use ephedra-caffeine supplements with “great caution” and only with guidance from a physician. (International Journal of Obesity [2002] 26, 593-604.)
Metamizole ‘Aspirin’ Banned but Still Found in Ethnic Markets
Pain relievers containing metamizole have been banned in the U.S. for years, but researchers at the University of Utah say such products, sometimes known as Mexican aspirin, are being sold at markets that cater to Latino immigrants. Doctors are concerned because metamizole, or dipyrone, can cause a severe drop in white blood cells with potentially fatal consequences.
“The side effect is rare, but there is no way to predict who is susceptible,” says Dr. Carrie L. Byington, a pediatrician at the University of Utah School of Medicine. Physicians who aren’t aware of the cause of a patient’s fever and low white blood cell count may misdiagnose the condition, which resembles leukemia.
Byington became aware of the problem when treating a 4-year-old with these signs. The child’s mother reported giving him metamizole. The mother, too, had been seriously ill and hospitalized five months earlier after she had taken the drug, which is often sold under the brand name Neo-melubrina. Neither she, nor her doctors, had linked the drug to her illness.
Subsequently, Byington and her colleagues surveyed Spanish- and Portuguese-speaking parents of children treated in a clinic and learned that 35% had used metamizole. Byington said many of the people had purchased the drug in the U.S and given it to their children.
“If we’re seeing this in Salt Lake City, I’m sure it’s available everywhere,” Byington said. She cites another survey done last year that found widespread use of Neo-melubrina in two San Diego clinics. These surveys may be underestimating the prevalence of the drug because researchers questioned mainly Latino patients. Byington reports that there are more than 240 metamizole preparations manufactured in 18 countries.
“Physicians treating children with fevers need to find out if they’ve been treated with dipyrone, and if they have, we need to get the family to stop using that agent,” said Dr. Brian Johnston of White Memorial Medical Center in East Los Angeles. (Pediatrics 109 (6): E98.)
Exercises Soon After Delivery May Help Moms Avoid Incontinence
New mothers may not talk about incontinence among their friends, but it is estimated that as many as one in three have trouble with bladder control. For many it becomes a chronic problem. When pelvic floor exercises are started soon after delivery, a recent Australian study shows, it may be possible to avoid this troubling complication. Previous research suggests the exercises are helpful in treating urinary incontinence, but this is the first study to show they may be useful before symptoms occur.
The researchers recruited more than 700 women in three hospitals who had given birth to large babies within the last 48 hours or who had medically assisted vaginal deliveries, such as with forceps. One group received exercise instructions from the therapist, whom they also visited again eight weeks later. The second group had the usual care--a brochure describing the exercises and an invitation to attend a postnatal class. The one-on-one instruction appeared to improve the women’s discipline: 89% of them did the exercises three times a week or more, compared with 57.6% of those in the second group who received no personalized instruction. About 38% of those in the exercise program had symptoms of incontinence, compared with 31% in the usual care group. (British Medical Journal 2202; 324:1241.)
Viagra Letdown? Doctors Say Read Instructions and Try, Try Again
Viagra failure may say more about whether a man reads directions or remembers what his doctor told him than his physical ability to have an erection. Understanding how Viagra works, how to take it and a willingness to keep trying can make all the difference in a successful response, according to research presented in May at the American Urological Assn.’s scientific meeting in Orlando.
At the beginning of this study, more than 200 men for whom Viagra hadn’t worked had a medical evaluation and watched a video about erectile function. They were given printed instructions, including directions to take the pill one hour before sexual stimulation and on an empty stomach or after a low-fat meal. Men were also advised to avoid alcohol, to try the medication several times and to show the instructions to their partners.
The program direction helped about 40% of the men. Typically, they needed to try Viagra six to eight times before experiencing the drug’s maximum effect. This may be due, in part, to anxiety among men who had been sexually inactive for several years “reentering the sexual arena,” says Dr. Geoffrey N. Sklar, a urologist at the University of Maryland School of Medicine.
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Dianne Lange can be reached by e-mail at DianneLange@cs.com.
