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In the February issue of the Harvard Health Letter, Editor in Chief Dr. Anthony L. Komaroff answers a question that’s on a lot of people’s minds these days: is atorvastatin, the generic version of the cholesterol-lowering drug Lipitor, as good as the brand-name drug?

Generic atorvastatin became available for the first time in November 2011 after Lipitor lost its patent protection.

In his answer, Dr. Komaroff notes that the FDA is legally required to determine that generics are “bioequivalent” to brand-name drugs, which means they produce similar blood concentrations of the same chemicals.

“Many independent researchers have also compared generics with brand-name drugs, and the vast majority of them have concluded that generics are just as safe and effective,” Dr. Komaroff says in the Health Letter, citing research by his Harvard colleague Dr. Aaron Kesselheim and others.  

Generics are produced in other countries, and overseas manufacturers do make mistakes, Dr. Komaroff notes.  “But that’s also true of U.S.-based manufacturers,” he continues. “The FDA does regulate the manufacture of all drugs sold in the United States, which is reassuring, but I also believe the FDA hasn’t been given the budget it needs to adequately carry out its responsibilities. So I can’t give you an absolute guarantee that generic atorvastatin will be equal to brand-name Lipitor.

“But I can tell you this: I take Lipitor, and I’ll be switching to generic atorvastatin, so I will be following my own advice (something my wife has suggested that I should do more often).”

Read the full-length article: "Ask the doctor: Are generics as good as brand-name drugs?"

People with heart disease and other chronic conditions are usually prescribed one or more medications. But most take them only about half the time. Each year, this high rate of “nonadherence” leads to an estimated 125,000 deaths in the United States and costs the health care system between $100 billion and $300 billion.

The February 2012 issue of the Harvard Heart Letter looks at this huge problem and offers practical tips to help people take the medications they need.

Cost is one barrier, of course, but so are complicated dosing regimens, hassles getting prescriptions filled, and side effects. The February Heart Letter offers some ideas for getting beyond the barriers:

Cost. When you get a new prescription, check with your health plan to make sure it’s the lowest-cost option available. If not, talk with your doctor. Also, take advantage of free medication programs sponsored by pharmaceutical companies and the discount plans at large retailers and pharmacies.

Complexity. If you take several medications with different dosing schedules, talk with your doctor about how to streamline your medication regimen. Also, recent studies have shown that using mail-order pharmacies can improve medication adherence, presumably through convenience and cost advantages.

Side effects. Heart medications come with non-life-threatening but bothersome side effects, including fatigue, nausea, coughing, and muscle pain. Both doctors and pharmacists can offer effective strategies to ease side effects, but only if you talk with them about it.

The February Heart Letter feature on medication adherence also includes useful tips for establishing personalized memory aids for tracking which medications to take and when.

Read the full-length article: "Medications help the heart — if you take them"

Getting enough restful sleep restores the mind and body, preparing both for the challenges that lie ahead. Without it, mood, concentration, and mental performance suffer. And according to research reported in the February 2012 Harvard Men’s Health Watch, sleep may actually improve cognitive function. These findings suggest that even a brief nap may help boost learning, memory, and creative problem solving.

Sleep is divided into two major phases, rapid-eye-movement (REM) and non–rapid-eye-movement (NREM). Sleep begins with the NREM state, which lasts about 60 to 90 minutes, before REM sleep kicks in. Dreaming is most common during REM sleep, but it may also occur during the early stages of NREM sleep.

A 2010 Harvard study found that dreaming may reactivate and reorganize recently learned material, improving memory and boosting performance. Ninety-nine healthy college students with normal sleep patterns were studied. Each agreed to avoid alcohol, caffeine, and drugs for at least 24 hours prior to the experiment.

Each of the subjects spent an hour learning how to navigate through a complex three-dimensional maze-like puzzle. After the training period, half of the students were allowed to nap for 90 minutes, while the others read or relaxed. Following a lunch break, all the volunteers tackled the virtual maze again.

The only students whose performance substantially improved were the few who dreamed about the maze during their naps. Although the dreams didn’t actually depict solutions to the puzzle, the researchers believe the results show that the dreaming brain can reorganize and consolidate memories, resulting in better performance on learned tasks. And these maze-related dreams occurred early in NREM sleep.

In addition to this Harvard study, the February issue of Harvard Men’s Health Watch also presents three other studies which suggest that naps may boost intellectual performance, at least in the short term. The research shows that NREM sleep can improve memory and that REM sleep can enhance creative problem solving. It’s a two-step approach that can help keep minds sharper.

Read the full-length article: "Learning while you sleep: Dream or reality?"

Stress, the hormones it unleashes, and the effects of high-fat, sugary “comfort foods” can lead people to gain weight. The February 2012 issue of the Harvard Mental Health Letter explains the truth behind “stress eating” — how stress increases appetite — and what people can do about it.

In the short term, stress triggers the brain to produce corticotropin-releasing hormone, which suppresses appetite. But if stress persists, the adrenal glands (located atop the kidneys) release the “stress” hormone cortisol, which increases appetite. Once a stressful episode is over, cortisol levels should fall, but if the stress doesn’t go away — or if a person’s stress response gets stuck in the “on” position — cortisol may stay elevated.

“Fortunately there are steps people can take to reduce their stress levels,” notes Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter. Here are some suggestions:

Meditation. Meditation reduces stress and may also help people become more mindful of food choices. With practice, a person may be able to pay better curb the impulse to grab a fat- and sugar-loaded comfort food.

Exercise. Intense exercise increases cortisol levels temporarily, but low-intensity exercise seems to reduce them. And some activities, such as yoga and tai chi, have elements of both exercise and meditation.

Social support. Friends, family, and other sources of social support seem to have a buffering effect on the stress that people experience.

Read the full-length article: "Stress and overeating: Why people crave comfort food"

Eating disorders are usually associated with teenage girls and young women, but more and more women in the baby boomer generation are suffering from them as well. Clinicians who treat eating disorders report an upswing in requests for help from these women, and surveys show a steady increase in the percentage of older people who engage in disordered eating behaviors such as strict fasting, purging, and bingeing, reports Harvard Women’s Health Watch.

Many things can cause disordered eating at midlife and beyond, including grief over the loss of loved ones, marital difficulties or divorce, and heightened awareness of an aging body, which can be particularly acute in women who must work beyond retirement age, especially in fields where looks are important.

Two of the most common eating disorders in women are bulimia nervosa, characterized by eating large quantities of food in a short period of time followed by forced vomiting, and anorexia nervosa, which is an obsessive fear of gaining weight that leads to severe food restriction and the use of laxatives and diet pills. Treatment focuses on restoring a healthy eating pattern and weight and addressing emotional issues. This usually means getting help from one or more physicians, a mental health professional, and a nutritional counselor. Approaches include:

Psychotherapy. This is the cornerstone of treatment for eating disorders. It comes in several forms, including cognitive behavioral therapy, which can help people think more realistically about food and their weight and appearance, and psychodynamic therapy, which helps people gain insight into personal issues that may underlie disordered eating.

Nutritional rehabilitation. A nutritional counselor helps people recovering from eating disorders to plan a healthy diet and learn how to eat in a way that keeps the digestive system working well while avoiding problems that can arise when normal eating begins again after a period of semi-starvation.

Medication. The antidepressant fluoxetine (Prozac), combined with psychotherapy, can help reduce bingeing and vomiting. The main “medication” for anorexia nervosa is food, as no drug works well until some weight is regained. Medications may be prescribed for the depression or anxiety that may accompany an eating disorder.

Read the full-length article here: "Disordered eating at midlife and beyond"

If healthier eating is on your list of resolutions for 2012, look no further. The January issue of the Harvard Women’s Health Watch offers 12 ways to break old dietary habits and build new ones.

According to the article “12 for 2012: Twelve tips for healthier eating,” nutrition research has shifted focus in recent years from the risks and benefits of single nutrients to the health effects that come from the many interactions within and among nutrients in the foods we eat. The result is a better understanding of what makes up a healthy eating plan. Here are five of the 12 ways to improve the way you eat:

1. Pile on the vegetables and fruits — Their high fiber, mineral, and vitamin content make fruits and vegetables a critical component of any healthy diet. They’re also the source of beneficial plant chemicals not found in other foods or supplements.
2. Go for the good fats — It’s the type of fat that counts. Replacing saturated fats with polyunsaturated fat, including vegetable oils and omega-3 fatty acids (found in fish, seeds, nuts, and canola oil), as well as monounsaturated fat (avocados, olive oil, and canola oil), can help lower “bad” LDL cholesterol.
3. Rethink supplements — It’s best to get the vitamins and minerals you need from food rather than supplements. That can be difficult, especially when you are watching your calories. But it’s not impossible. The key is choosing nutrient-rich foods, like leafy green vegetables, low-fat yogurt, dried beans, whole grains, and salmon.
4. Dine mindfully — Taking time to savor your food not only helps you enjoy it more, it also helps control your appetite. If you eat too quickly, the brain may not receive signals that the stomach is full. Put down your fork between bites and chew more slowly.
5. Eat breakfast — The daily morning rush sometimes means you skip breakfast. Don’t. A healthy morning meal makes for smaller rises in blood sugar and insulin throughout the day, which can lower the risk of overeating and impulse snacking.

Read the full-length article: "12 for 2012: Twelve tips for healthier eating"