28/04/2019

Fluids, cool air key to avoiding heat stroke

The answer is more friend than foe, if the fish oil comes from food sources rather than supplements.
Omega-3s in balance

What’s so special about fish oil? It’s loaded with omega-3 fatty acids. These must come from food, since our bodies can’t make them.

The two key omega-3 fatty acids are docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Fatty fish like salmon, mackerel, and sardines are rich in these omega-3s. Some plants are rich in another type of omega-3 fatty acid, alpha-linolenic acid, which the body can convert to DHA and EPA. Good sources of these are flaxseeds, chia seeds, walnuts, pumpkin seeds, and canola oil.

Omega-3 fatty acids play important roles in brain function, normal growth and development, and inflammation. Deficiencies have been linked to a variety of health problems, including cardiovascular disease, some cancers, mood disorders, arthritis, and more. But that doesn’t mean taking high doses translates to better health and disease prevention.

Fish oil supplements have been promoted as easy way to protect the heart, ease inflammation, improve mental health, and lengthen life. Such claims are one reason why Americans spend more than $1 billion a year on over-the-counter fish oil. And food companies are adding it to milk, yogurt, cereal, chocolate, cookies, juice, and hundreds of other foods.

But the evidence for improving heart health is mixed. In November 2018, a study reported in the New England Journal of Medicine found that omega-3 fatty acid supplements did nothing to reduce heart attacks, strokes, or deaths from heart disease in middle-age men and women without any known risk factors for heart disease. Earlier research reported in the same journal in 2013 also reported no benefit in people with risk factors for heart disease.

However, when researchers looked at subgroups of people who don’t eat any fish, the results suggested they may reduce their cardiovascular risk by taking a fish oil supplement.

Evidence linking fish oil and cancer has been all over the map. Most research, including the 2018 study cited above, has not shown any decreased risk of cancer. However, some earlier research suggested diets high in fatty fish or fish oil supplements might reduce the risk of certain cancers.
Take home message

How food, and its component molecules, affect the body is largely a mystery. That makes the use of supplements for anything other than treating a deficiency questionable.

Despite this one study, you should still consider eating fish and other seafood as a healthy strategy. If we could absolutely, positively say that the benefits of eating seafood comes entirely from omega-3 fats, then downing fish oil pills would be an alternative to eating fish. But it’s more than likely that you need the entire orchestra of fish fats, vitamins, minerals, and supporting molecules, rather than the lone notes of EPA and DHA.

The same holds true of other foods. Taking even a handful of supplements is no substitute for wealth of nutrients you get from eating fruits, vegetables, and whole grains.

What should you do if you currently take fish oil? If your doctor prescribed them—they are an approved and effective treatment for people with high blood triglyceride levels—follow his or her instructions until you can have a conversation about fish oil.

If you are taking them on your own because you believe they are good for you, it’s time to rethink that strategy. If you don’t eat fish or other seafood, you might benefit from a fish oil supplement. Also you can get omega-3s from ground flaxseed or flaxseed oil, chia seeds, walnuts, canola oil, and soy oil. One to two servings per day can help you avoid a deficiency of omega-3s.

Following food author Michael Pollan’s simple advice about choosing a diet may be the best way forward: “Eat food. Not too much. Mainly plants.” Over the years, I’ve written and edited many articles for medical journals. I have to say I’m now finding it a bit odd to be on the flip side as the subject of such an article (along with 285 other people). A couple years ago, I volunteered to take part in a clinical trial testing whether an old, aspirin-like drug called salsalate could help control blood sugar in people with type 2 diabetes. The results of that trial, called TINSAL-T2D, are reported in the current issue of Annals of Internal Medicine.

All 286 volunteers were given blue pills to take every day for nearly a year. Half of us got pills containing salsalate; the others got placebo pills. Over the course of the trial, those in the salsalate group had lower blood sugar levels, and some were even able to reduce dosages of other diabetes medications they were taking.

“We were very pleased with the findings of the TINSAL-T2D study,” said lead author Dr. Allison B. Goldfine, associate professor of medicine at Harvard-affiliated Joslin Diabetes Center. “They indicate that salsalate, a drug that has been marketed for over 40 years for the treatment of arthritis, could be an inexpensive additional therapeutic option to treat patients with diabetes.”
Inflammation and diabetes

Salsalate is an old drug that’s closely related to aspirin. Use of these drugs and their natural precursor use can be traced back at least 3,500 years. Today, salsalate is used to treat arthritis pain. One advantage it has over aspirin and other nonsteroidal anti-inflammatory drugs is that it doesn’t irritate the digestive tract.

No one knows exactly how salsalate helps control blood sugar. But its effectiveness supports the idea that inflammation plays a role in type 2 diabetes. In addition to improving blood sugar control, salsalate lowered counts of white blood cells involved in inflammation. It also boosted levels of adiponectin, a potentially heart-protecting protein made by fat cells.
Not ready for prime time

The TINSAL-T2D results are promising. Salsalate helps lower blood sugar. It has a good safety profile. It has been used for years for other purposes. And it is relatively inexpensive. But it won’t be prescribed any time soon for people with type 2 diabetes.

Three safety blips appeared during the trial. 1) Those taking salsalate gained an average of two pounds during the trial while those taking the placebo lost about a pound. Over time, extra weight can lead to poorer blood sugar control. 2) Harmful LDL cholesterol rose about 10 points in the salsalate group, compared to no change in the placebo group. 3) The amount of a protein called albumin excreted in the urine was higher in the salsalate group. That could be a sign of potentially worrisome changes in the kidneys.

What we really need to know about a new or repurposed drug is how its long-term benefits and risks stack up against each other. The relatively short length of the TINSAL-T2D trial and the relatively small number of volunteers don’t provide enough information on that. According to the researchers, more work is needed before salsalate can be recommended for widespread use by people with type 2 diabetes.

Some of that work is already underway. The TINSAL-CVD study is testing salsalate’s effects on cholesterol-filled plaque in the arteries that nourish the heart. (Heart disease is the leading cause of death among people with type 2 diabetes.) If that study shows that salsalate slows the growth or spread of plaque, “a larger and longer outcome study would be needed before the FDA would provide a new indication for the use of salsalate beyond its current indication for pain management in patients with arthritis,” said Dr. Goldfine.
A personal note

I never found out whether I was taking salsalate or a placebo. It never really mattered. But I got a lot out of taking part in TINSAL-T2D. I received excellent diabetes care from an engaged diabetes specialist (Dr. Goldfine) and trial coordinator (Kathy Foster). I experienced first-hand some tests I’ve often written about. I learned that I had a late-onset type 1 diabetes called latent autoimmune diabetes of the adult, rather than type 2 diabetes. And it felt good to take part in medical research, not just write about it.

Thousands of clinical trials are in need of volunteers. If you are interested in participating in one, take a look at ClinicalTrials.gov, put together by the National Institutes of Health. It lists the nearly 70,000 clinical trials now underway in the United States. The sudden hospitalization yesterday of Teresa Heinz Kerry, wife of U.S. Secretary of State John Kerry, while vacationing on Nantucket Island is an unfortunate reminder that illness can happen at any time—even during a vacation.

Heinz Kerry was taken by ambulance on Sunday afternoon to Nantucket Cottage Hospital. She was accompanied by her husband. After being stabilized, she and the Secretary of State were flown to Massachusetts General Hospital in Boston. As of Monday morning, neither the hospital nor Heinz Kerry’s family has commented on the nature of her illness. News reports say she is in critical but stable condition.

Heinz Kerry’s situation highlights the value of electronic medical records, and the hazards of not having, or being able to access, medical information when you are travelling or on vacation.

The Patient Protection and Affordable Care Act, signed into law by President Barack Obama in 2010, mandates the development of secure, comprehensive electronic medical records by next year. Some hospitals and physicians already have electronic medical records for their patients. These records make it possible to share information with doctors across town, or across the globe. Most people don’t yet have their medical information in an easily shareable format.

In fact, it’s a safe bet to assume that if you are away from home and need emergency medical care, doctors won’t have access to your medical records. So it’s a good idea to carry at least a list of your (and your family members) medical problems, medications and doses, recent treatments, allergies, and other important health information. Keep it safe and secure, but make sure someone else knows where to find that list if you aren’t able to access it.

A potentially life-threatening event can happen at any time—even if you are in good health. Vacations are no exception. In addition to your list, it’s also a good idea to have completed, signed, and have witnessed an advance directive and health care proxy.

If you haven’t prepared an advance directive and you can’t communicate your preferences for treatment, medical choices will be left to worried relatives or to a doctor or guardian appointed by a judge, none of whom may have a clear understanding of your values, beliefs, and preferences. An advance directive lets you decide the kind of care you want to receive. A health care proxy lets you designate the person who can speak for you when you are unable to communicate. Summer’s heat is as predictable as winter’s chill. Heat-related illnesses—and even deaths—are also predictable. But they aren’t inevitable. In fact, most are preventable. Staying hydrated is the key.

No matter what the season, your body functions like a furnace. It burns food to generate chemical energy and heat. Some of the heat is used to keep your body temperature in the high 90s. The rest you have to get rid of. The body has two main ways of getting rid of excess heat:

Radiation. When the air around you is cooler than your body, you radiate heat to the air. But this heat transfer stops when the air temperature approaches body temperature.

Evaporation. Every molecule of sweat that evaporates from your skin whisks away heat. But as the humidity creeps above 75% or so, there’s so much water vapor in the air that evaporation becomes increasingly difficult.

Most healthy people tolerate the heat without missing a beat. It’s not so easy for people with damaged or weakened hearts, or for older people whose bodies don’t respond as readily to stress as they once did. Damage from a heart attack can keep the heart from pumping enough blood to get rid of heat. A number of medications can limit the body’s ability to get rid of excess heat. These include beta blockers, which slow the heartbeat; diuretics (water pills), which can make dehydration worse by increasing urine output; and some antidepressants and antihistamines, which can block sweating. A stroke, Parkinson’s disease, Alzheimer’s disease, diabetes, and other conditions can dull the brain’s response to dehydration.
Heat-related illnesses

There are three different levels of heart-related illness:

Heat cramps. These painful muscle spasms are usually triggered by heavy exercise in a hot environment. Inadequate fluid intake is usually the culprit. The remedy: slow down, tank up with water, stretch and gently massage the tight muscle, and get out of the heat.

Heat exhaustion. When body temperature begins to climb, physical symptoms such as weakness, headache, nausea, muscle cramps, profuse sweating, and flushed, clammy skin may appear. Heat exhaustion also affects mental clarity and judgment, which may appear as confusion or lethargy. Drinking water is essential. A cool shower or bath, ice packs to the skin, or other strategies to lower body temperature are also important.

Heat stroke. There are two distinct forms of heat stroke. Classic heat stroke tends to affect people who can’t escape the heat, or can’t physically cope with it. Exertional heat stroke strikes individuals who do vigorous physical activity in the heat—youthful football players at a summer training camp, firefighters battling a summer blaze, Marine recruits, and weekend warriors. Heat stroke is a medical emergency. It starts out looking like heat exhaustion, but its symptoms are more severe, and they progress more quickly, as lethargy, weakness, and confusion evolve into delirium, stupor, coma, and seizures. Body temperature rises drastically, often exceeding 105° or 106°. Heat stroke is a killer because it damages the heart, liver, kidneys, brain, and blood clotting system. Survival depends on prompt transfer to a hospital for aggressive treatment.
Warning signs of heat illness

Heat-related trouble ranges from irritating problems such as muscle cramps to heat exhaustion and the potentially deadly heat stroke. It can be hard to tell where heat exhaustion ends and heat stroke begins. Both can be mistaken for a summer “flu,” at least at first. Be on the lookout for:

    nausea or vomiting
    fatigue
    headache
    disorientation or confusion
    muscle twitches

If you think you are having heat-related problems, or if you see signs of them in someone else, getting to an air-conditioned space and drinking cool water are the most important things to do. If these don’t help or the symptoms persist, call your doctor or go to a hospital with an emergency department.
Beat the heat

Even during the nastiest heat wave, the numbers are in your favor—relatively few people have heat strokes, and fewer die. Some simple choices can help you weather the weather. An ounce of prevention will go a long way, but for heat-related illnesses, a quart is even better.

Drink to your health. The lower your coolant level, the greater your chances of overheating. Unfortunately, staying hydrated isn’t always easy. Stomach or bowel problems, diuretics, a faulty thirst signal, or low fluid intake can all interfere. On dangerously hot and humid days, try downing a glass of water every hour. Go easy on sugary soda and juice, since they slow the passage of water from the digestive system to the bloodstream. And don’t rely on caffeinated beverages or alcohol for fluid because they can cause or amplify dehydration.

Take it easy. Turn procrastination from a vice to a virtue by putting off exercise or other physical activity until things cool down. Evening and early morning are the best times to get out. If you do exercise, drink more than you usually do.

Cool is cool. Chilled air is the best way to beat the heat. Fans work, but only to a point—when the air is as warm as you are, sitting in front of a fan is about as helpful as sitting in front of a blow dryer. If you don’t have an air conditioner, spending an hour or two in an air-conditioned movie theater or store, or with an air-conditioned neighbor, can help. So can a cool shower or bath, or putting a cold, wet cloth or ice pack under your arm or at your groin. Do-it-yourselfers, take heart. Here’s something else to do at home that can have a substantial benefit on your health: measure your blood pressure. It’s easy, inexpensive, and helps control blood pressure better than visits to the doctor.

The latest evidence for the benefits of home blood pressure monitoring comes from researchers in Minnesota. They studied 450 people with hypertension, more commonly known as high blood pressure. All had blood pressures higher than deemed healthy—above 140/90, or above 130/80mmHg if they had diabetes or kidney disease.

About half of the volunteers were given home blood pressure monitors capable of electronically sending readings to a secure website. After being shown how to use their monitors, the volunteers were asked to send six readings each week. That information was assessed by pharmacists, who could adjust medications if needed and offer advice on lifestyle changes that could improve blood pressure. The other volunteers received usual care from their primary care providers.

At every step of the way, people in the home monitoring group had more success getting their blood pressure under control than people who had received only usual care. At the end of the trial, 72% of those doing home monitoring had their blood pressure under control, compared to 57% of the usual care group. The benefits persisted six months after the program had ended.

The results, published today in JAMA, are similar to the findings of previous studies on home blood pressure monitoring. But, according to the researchers, this is the first time people with both uncontrolled blood pressure and other conditions (such as diabetes) have been studied in such a program, and the first time results were measured after the formal monitoring program had ended.

“More frequent blood pressure monitoring allows more opportunities to detect blood pressure that is higher than the desired range. That may trigger more intensive treatment of elevated blood pressure,” says cardiologist Dr. Deepak Bhatt, a professor at Harvard Medical School. In other words, if you stay on top of it, you’ll do a better job of treating it.

An editorial accompanying the report said that the study “demonstrates how to improve blood pressure control by making hypertension management more like modern banking: accessible, easy, and convenient.”
The need for home monitoring

The Centers for Disease Control and Prevention reports that 1 in 3 adults in the United States has high blood pressure, and half of them don’t have it under control. High blood pressure increases the risk for heart disease and stroke, the leading causes of death in the United States.

Even though the American Heart Association and other organizations have called for greater use of home blood pressure monitoring, it isn’t yet widespread. One reason is that insurance coverage for such programs still lags. Another is that full-fledged efforts like the one in Minnesota could cost $1,350 per person.
Monitoring at home

Discover the secrets to lowering your blood pressure and reducing your risk of heart attack, stroke, and dementia!

But you don’t need a special program. You can buy a good home blood pressure monitor at a pharmacy or online merchant for anywhere from $50 to $100. (Ask if your insurance company will cover the cost.) A few things to look for:

    an automatic monitor that doesn’t require a stethoscope (it’s easier to use)
    a monitor that takes the blood pressure reading using a cuff that fits around the upper arm;
    a read-out large enough for you to see the numbers;
    a seal from an organization such as the British Hypertension Society, International Protocol for the Validation of Automated BP Measuring Devices, or Association for the Advancement of Medical Instrumentation (AAMI).

Ask your doctor, nurse, or pharmacist for help calibrating your monitor and learning how to use it.

How often should you check? At first, take your blood pressure twice a day for a week. The best times are early in the morning (before you have taken any blood pressure medications) and again in the evening. After you’ve done this for a week, once or twice a month—or whatever your doctor recommends—is fine.

“It can be a very effective way to see if blood pressure medications are doing the trick. It can also be useful to monitor for the side effect of blood pressure that is too low. Just remember that home monitoring should not be used as a substitute for regular physician check-ups, especially for patients with poorly controlled blood pressure,” says Dr. Bhatt.
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27/04/2019

Heavy drinking in middle age linked to memory loss in men

Cigarettes, cigars, and the like are the most deadly product that consumers can legally buy. Why they are sold in pharmacies, which are meant to dispense medications and other things designed to heal or promote health, has always been a mystery to me. I’m not alone. The American Pharmacists Association, the American Medical Association, and other groups have urged pharmacies to stop selling cigarettes.

Several major pharmacy chains have been mulling over whether they should take this advice. Today, one of them has acted. The CVS chain has decided to stop selling tobacco products, and will phase out their sales over the next year. The news came in a press release from CVS and an opinion piece published today in JAMA, the journal of the American Medical Association.

The authors of the article are Dr. Troyen Brennan, executive vice president and chief medical officer of CVS Caremark, and Dr. Steven A. Schroeder, director of the Smoking Cessation Leadership Center at the University of California San Francisco. (Full disclosure: both have been close colleagues of mine for many years.)
A shrinking circle

Fifty years ago, when the Surgeon General issued his famous document summarizing the health risks of smoking, more than 40% of American adults smoked. It was okay to smoke anywhere and everywhere—in restaurants, grocery stores, airplanes, and even in hospitals. It wasn’t until the mid-1980s that Brigham and Women’s Hospital, where I work, became one of the first hospitals to ban smoking inside its buildings.

Efforts to limit where people can smoke and buy cigarettes and other tobacco products has helped reduce the number of smokers to about 18% of adults in the United States. Increasing the cost through taxes has also put a dent in the number of smokers.

But we need to do more. There’s abundant evidence that making tobacco products hard to get reduces their rate of use. So I applaud CVS’s decision to stop selling tobacco products in its stores. With this public announcement from its chief medical officer, CVS is claiming the high ground. The company estimates that it takes in $1.5 billion a year from selling tobacco products, but “the financial gain is outweighed by the paradox in promoting health while contributing to tobacco-related deaths.”

Pharmacists will likely cheer the decision. According to Brennan and Schroeder, one survey of pharmacists showed that only 2% of them favor the sale of tobacco products in their stores.

It also makes sense as large chains begin to make themselves over as health care outlets, with in-store retail clinics. It has always been sadly ironic to see someone come to a drug store to get his or her medicines for high blood pressure, high cholesterol, diabetes, or pain from metastatic cancer—and then stop at checkout and get a pack of the substance that caused and continues to perpetuate those illnesses. Mass marketing of testosterone therapy may have men eager to try this seemingly simple fix. But the latest science should have them scratching their heads and putting away the credit card—at least for now.

A new study published in the online journal PLOS One shows an increase in the risk of having a heart attack in the months after starting testosterone therapy. The potential for danger was highest in older men. A report in the November 6, 2013, issue of JAMA showed that men who used testosterone therapy didn’t fare as well after artery-opening angioplasty as men who didn’t take testosterone.

A word of warning about these reports: neither was the type of study that can prove cause and effect. They can only show associations, or links. That means there’s no smoking gun here that testosterone therapy is harmful. But the studies do suggest caution.

On Friday, the FDA announced it would look into possible links between testosterone therapy and heart attack, stroke, or death in men taking FDA-approved testosterone products. In an announcement, it urged health care professionals to “consider whether the benefits of FDA-approved testosterone treatment is likely to exceed the potential risks of treatment.”
Potential risks as well as benefits

Millions of American men use a gel, patch, or injection to boost their testosterone levels. Getting extra testosterone can help those with truly low testosterone that is causing problems such as loss of bone and muscle or a low sex drive. What it can do for men with borderline low testosterone, or those without symptoms, is up in the air. As the February 2014 Harvard Men’s Health Watch reports, “The ongoing pharmaceutical marketing blitz promises that treating ‘low T’ this way can make men feel more alert, energetic, mentally sharp, and sexually functional.” What it doesn’t point out are the possible risks, according to Daniel Pendick, the newsletter’s executive editor.

Testosterone doesn’t immediately agree with a small number of men. They quickly develop acne, enlarged or tender breasts, or swelling in the ankles. In some men, testosterone causes an overproduction of red blood cells, which can increase the risk of developing blood clots inside arteries or veins.

The long-term risks aren’t really known. As the articles described above suggest, taking extra testosterone could pose problems for the heart. There are also worries that testosterone therapy could stimulate the growth of prostate cancer. But the evidence is mixed. Some studies, in fact, have shown that men taking testosterone have fewer heart problems. The link between testosterone therapy and prostate cancer is also murky.

What’s needed is a randomized, placebo-controlled trial, in which some men get testosterone and others get an inert substitute. In such a trial no one except some record keepers know who is getting what—not the volunteers or their doctors. If such a trial is done and it is large enough and lasts long enough, we should get clear answers on the benefits and risks of testosterone therapy. This wouldn’t come fast, or cheap. The Women’s Health Initiative, which tested in this way the benefits and risks of hormone therapy for women, took years and cost millions of dollars.
What to do today

Until such a trial is done, what’s a man to do in the face of such uncertainty? Take a cautious approach, advises the Harvard Men’s Health Watch:

    Take stock of your health first. There may be other reasons than your testosterone level for fatigue, a low sex drive, erectile dysfunction, and other symptoms attributable to low testosterone.
    Get an accurate assessment. If you or your doctor think you might have low testosterone, have it measured between 7 am and 10 am, when testosterone is at its daily peak. Then confirm the result with a second test on a different day.
    Be mindful of unknown risks. Ask your doctor to explain the various side effects for the different formulations of testosterone, such as gels, patches, and injections. Know what to look for if something goes wrong. And approach testosterone therapy with caution if you are at high risk for prostate cancer; have severe urinary symptoms from prostate enlargement; or have diagnosed heart disease, a previous heart attack, or multiple risk factors for heart problems.

Finally, “testosterone therapy is not a fountain of youth,” cautions the Men’s Health Watch. Don’t try it in hopes of channeling your more youthful physical or sexual self, of living longer or healthier, or of improving your memory or mental sharpness. Exercising more would be a safer—and probably more effective—approach for achieving those goals. You’ve heard it a thousand times: The key to a healthy heart and brain is a healthy diet. For a growing number of people, a Mediterranean-style diet has been the stand-in for “healthy diet.” A landmark clinical trial done in Spain, known by the acronym PREDIMED, has been putting the Mediterranean eating plan on a more solid scientific foundation.

Last year, PREDIMED researchers reported that Mediterranean-style eating—rich in fruits, vegetables, and healthy plant oils—prevents heart attacks, strokes, and death from heart disease. This week in The Journal of the American Medical Association, they report that a healthy Mediterranean-style diet can also help prevent peripheral artery disease (PAD), a form of “hardening of the arteries.” PAD happens when fatty deposits obstruct the arteries that supply blood to parts of the body beyond the heart and brain, like the legs, arms, and abdomen.

“To our knowledge, this is the first randomized primary prevention trial to suggest an association between a dietary intervention and [reduced risk of] PAD,” the study authors wrote.

It’s an important finding. As many as 12 million Americans, most of them older, have PAD. It can cause leg pain when walking that goes away with rest (called intermittent claudication); a weakening of the aorta, the main pipeline that delivers blood to the body; pain after eating; erectile dysfunction; and other problems.

Though the findings were solid, keep in mind that they are preliminary. For one thing, PREDIMED was not designed to detect an effect of diet on the risk of developing PAD—although it’s not hard to imagine it being able to do so, given the diet’s effect on heart and artery health. To be scrupulously scientific, such incidental findings need to be confirmed with a study specifically targeted at PAD.
Better evidence

But taken as a whole, the PREDIMED trial has gone a long way to place healthy eating on par with medication as a way to prevent heart disease and stroke. Many previous studies observed that people who ate the Mediterranean way seemed to be healthier than others, but only a randomized clinical trial can pinpoint cause and effect.

“PREDIMED is a randomized trial and, as such, it provides higher quality evidence in comparison to evidence from observational studies on the health benefits of the Mediterranean diet,” says Dr. Dimitrios Trichopoulos, an epidemiologist with the Harvard School of Public Health who has conducted some of those studies.

In Spanish, PREDIMED stands for Prevención con Dieta Mediterránea, or “prevention with Mediterranean diet.” The Mediterranean diet is not a specific eating prescription, but rather a general style of eating that emphasizes certain healthy foods and minimizes other not-so-healthy ones. The basic mix is a variety of fruits, vegetables, nuts, and seeds, along with moderate consumption of fish, poultry, dairy, eggs, and olive oil, and minimal red and processed meat. Some cultures that favor Mediterranean-style diets may include a glass of red wine with their meals, but it isn’t required.

In PREDIMED, nearly 7,500 men and women were randomly assigned to adopt one of three diets: a reduced-fat diet or a Mediterranean diet supplemented with generous amounts of either nuts or extra virgin olive oil. Participants were 55 to 80 years old and at high risk of cardiovascular disease, but were still healthy at the time they entered the study.

As reported earlier in The New England Journal of Medicine, the trial found that a Mediterranean diet reduced the risk of cardiovascular problems by around 30%. In a more recent report from PREDIMED, the olive oil-supplemented version of the Mediterranean diet reduced the risk of developing diabetes by 40%.
How to go Mediterranean

It’s not hard to get started on a Mediterranean style of eating. Here are some general cooking and meal-planning tips from the Harvard Health Letter to help you make the transition:

    Sauté food in olive oil, not butter. Make your own salad dressings with extra-virgin olive oil, which is pressed mechanically from ripe olives and processed without high heat or chemical solvents. This protects healthy substances in the oil.
    Eat more vegetables by having them as a snack, or adding them to other recipes. Include a portion of fruit with breakfast and desserts.
    Choose whole grains instead of refined breads and pastas.
    Incorporate kidney beans, lentils, and other legumes in salads and side dishes.
    Substitute fish for red meat at least twice per week. If you don’t like fish, use beans or poultry to get your protein.
    Limit high-fat dairy by switching to skim or 1% milk from 2% or whole milk.
    Add a modest portion of nuts to cooked grain and side dishes, and sprinkle nuts and seeds on salads.
For some people, like those with an addiction, any amount of alcohol is too much. For others, drinking alcohol is something of a balancing act — a little may be healthful, while more than a little may be harmful.

In people who can physically, mentally, and emotionally tolerate alcohol, moderate drinking has been linked to lower risks of heart disease and type 2 diabetes. Moderate drinking means no more than two drinks a day for men; no more than one a day for women. Heavier drinking increases the risk of developing some cancers, heart disease, high blood pressure, cirrhosis, and alcohol dependence.

A new report in the journal Neurology highlights the dual effects of alcohol in men. As part of the Whitehall II study in Britain, researchers assessed the drinking habits of middle-aged men and women three times over a 10-year period. The study participants also took a mental skills test three times over the next 10 years. Compared with men who didn’t drink or who drank moderately, mental decline began to appear one to six years earlier in men who averaged more than 2.5 drinks a day. (There weren’t enough heavy drinkers among women to show any clear differences.)

What’s “a drink”?
Researchers and public health experts define a drink like this:
12 ounces of beer that is 5% alcohol
5 ounces of wine that is about 12% alcohol
1.5 ounces (a standard shot glass) of 80-proof spirits (about 40% alcohol).

You can see more definitions at Rethinking Drinking, a website from the , or try one of its cocktail calculators.
Aiming for healthy drinking

There seems to be a fine line between the amount of alcohol consumed and health benefits or harms. For example, even light to moderate alcohol use is associated with a higher risk of some cancers, such as breast cancer in women. According to the Neurology study, a similar pattern may be emerging between drinking and thinking skills.

How do you know if you are drinking too much? Several simple tests have been developed to help people gauge their drinking habits. One is the 4-question CAGE test, so called because of the first letters of the key word in each question. Another is the 10-question Alcohol Use Disorders Identification Test (AUDIT), developed by the World Health Organization. You can see both of these tests at www.health.harvard.edu/173.
If you’re concerned

A little advice and encouragement may help you figure out if your drinking follows a risky pattern and what to do about it. The source of advice could be your primary care doctor. Or the doctor might refer you to an alcoholism counselor.

This is not long-term therapy. It’s perhaps two or three discussions. The helper can ask you how much you are drinking and let you know how it compares with the norm. He or she might.
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New guidelines aim to help women prevent stroke

When the SELECT trial started in 2001, there were high hopes it would prove that taking vitamin E or selenium could help prevent prostate cancer. The newest results from the trial show just the opposite—that taking selenium or vitamin E can actually increase the odds of developing prostate cancer.

Bottom line: men shouldn’t take selenium or vitamin E as a way to prevent prostate cancer, or anything else for that matter.

“I counsel all of my patients to absolutely avoid any dietary supplements that contain selenium or vitamin E—including multivitamins,” says prostate cancer expert Dr. Marc Garnick, a clinical professor of medicine at Harvard Medical School, an oncologist at Beth Israel Deaconess Medical Center, and editor in chief of Harvard’s Annual Report on Prostate Diseases.
The case against selenium and vitamin E

Studies done in the 1980s and 1990s suggested that vitamin E and selenium each somehow provided protection against prostate cancer. The Selenium and Vitamin E Cancer Prevention Trial (SELECT) was started in 2001 to see if that was true. The 36,000 healthy, middle-aged volunteers were divided into four groups. Each man took two pills a day: 400 international units (IU) of vitamin E plus 200 micrograms of selenium; vitamin E plus a placebo; selenium plus a placebo; or two placebos. Neither the men nor their doctors knew who was taking what.

Although SELECT was supposed to last until 2011, it was stopped three years early because neither vitamin E nor selenium were showing any benefit—and there were hazy warning signs they might be doing some harm.

A new report in the Journal of the National Cancer Institute clarifies the picture. A team of researchers from across the U.S. looked specifically at almost 5,000 of the SELECT volunteers who sent in toenail clippings when they joined the trial. Toenail clippings are a great way to measure how much selenium is in a man’s (or woman’s) body. The new study showed that:

    Taking vitamin E alone boosted the risk of developing high-grade prostate cancer, but only in men who started the study with low selenium levels.
    Taking selenium, either alone or in combination with vitamin E, increased the risk of high-grade prostate cancer in men who started the study with high selenium levels, but not in those with low selenium levels.
    Among men who didn’t take either vitamin E or selenium, those who started the study with high selenium levels were no more likely to have developed prostate cancer than men who started it with low selenium levels. (This means the culprit is added selenium from supplements, not selenium from food.)

“The new data are very troubling, and emphasize that supplements can cause real and tangible harm,” says Dr. Garnick. “Any claims of benefits from dietary supplements must be ignored unless large, controlled, and well-conducted investigations confirm such benefits—which I believe will be a very rare occurrence.”
Shortly after my grandfather died, I stood next to my grandmother at his grave. Her loss was palpable, and painful to watch. I vividly remember her leaning down toward his gravestone and crying out, “I’ll be with you soon, Irv.” My grandmother spoke these words out of grief, but they were prophetic. Her own health soon began to fail, and months later she joined her beloved husband.

The grief of losing a spouse or partner affects not just emotional and mental health, but physical health as well. Numerous studies show that the surviving spouse or partner is likely to develop health problems in the weeks and months that follow.

A study published this week in JAMA Internal Medicine found that individuals who had lost a spouse or partner were more likely to have a heart attack or stroke within the next 30 days. “Emotional stress will clearly wreak havoc with the sympathetic nervous system, and that can lead to problems as the authors described,” says Dr. Peter Stone, professor of medicine at Harvard Medical School and senior physician in the Cardiovascular Division at Brigham and Women’s Hospital. The sympathetic nervous system is responsible for revving up the body’s fight-or-flight response.

Keep in mind that while the association between bereavement and cardiovascular events is real, it is also very small. Although the risk of having a cardiovascular event was doubled—from 8 of every 10,000 individuals whose partners were still alive to 16 of every 10,000 among those whose spouse or partner had died—the absolute increase is small, Dr. Stone points out.

It’s also worth noting that the people in the study were ages 60 to 89. “Often the individual who has a spouse or loved one die is older and part of a group that’s more prone to coronary disease,” Dr. Stone adds.
Grief and the heart

The researchers offered several possible reasons for the cardiovascular decline. These include stress-induced changes in blood pressure, heart rate, and blood clotting.

There is also a tendency after such a profound loss for the surviving spouse or partner to disregard his or her own health and become resigned to dying, as my grandmother did. “There’s a kind of giving up or self-neglect that can set in, and some people just really don’t want to go on,” says Dr. Michael Craig Miller, senior editor of Mental Health Publishing at Harvard Health Publishing.
Focus on You

Losing your spouse or partner—especially after many years of being together—can shake up your entire world. “If the main person in your life is suddenly not there, that in itself is extremely stressful. There’s also the stress of restructuring your life, which has been one way for decades and now has changed,” says Dr. Miller.

Mourning for a loved one is important. At the same time, don’t forget about your own needs during this difficult period. Here are a few things you can do to take care of yourself:

Don’t forget the basics. Eat a healthy diet, walk or get another type of exercise every day, and take your medicine. Attending to your health will make you feel better physically, and take your mind off your loss.

Get out. When friends or family call and invite you out to dinner or to the movies, say yes even though you might be tempted to stay home alone. Maintaining social connections is an important part of the healing process.

Join a grief support group. No one knows what you’re feeling better than other people who’ve been through a similar experience. Your local hospital, senior center, religious organization, or community center can point you to a support group in your area.
Give it time

It can take several months to a year to work through grief and grieving. Allow yourself enough time to let go. However, if a year has passed and you’re still grieving, or if you’ve lost interest in activities you once loved, your grief may have transitioned to something more serious—like depression. Then it’s time to talk to your doctor or mental health professional to help you work through the pain and move forward with your life. The first-ever guidelines for preventing stroke in women don’t fool around. They offer ways to prevent this disabling and potentially deadly event from adolescence to old age.

A stroke strikes when something stops blood flow to part of the brain. That something can be a blood clot or a burst blood vessel. Without a steady supply of blood-borne oxygen and nutrients, brain cells quickly begin to die. Depending on the location of the blockage or bleed, a stroke can cause trouble speaking, swallowing, walking, and more.

More than half of the 800,000 Americans who have strokes each year are women. Nearly 4 million American women are living with the aftermath of a stroke. And because women live longer than men, their lifetime risk of having a stroke is higher.

Those numbers are why stroke prevention is especially important for women.
A high-pressure situation

High blood pressure is a leading cause of stroke. That’s why the guidelines, published yesterday in the journal Stroke, focus heavily on blood pressure, along with other risk factors—and not just among older women, as is the case with other stroke guidelines.

Take young women who are thinking about going on the birth control pill. Oral contraceptives boost the risk of having a stroke, even among women under age 45. Smoking further increases the chances of having a stroke. The new guidelines recommend that a woman have her blood pressure checked before taking oral contraceptives, and that women work to reduce other risk factors while taking these medications.

Pregnancy is another life stage that gets special attention in the guidelines. About 1 in 12 women develop preeclampsia or other blood pressure problems during pregnancy. Preeclampsia is a gradual rise in blood pressure combined with increasing amounts of protein in the urine. It can be harmful to mother and baby. Although preeclampsia disappears after delivery, women who develop it are more likely to develop high blood pressure later in life.

That’s why the task force from the American Heart Association and American Stroke Association recommends that women who have had preeclampsia, or those who are at risk for developing it, take low-dose aspirin from the 12th week of pregnancy until delivery. Some women may also need to take extra calcium. The guidelines also say that certain women who have high blood pressure during pregnancy may need to take medicine to lower their blood pressure.

Taking estrogen and other hormones after menopause was once seen as a way to prevent heart disease, stroke, and other chronic conditions. No longer, not since the Women’s Health Initiative showed long-term use of hormone therapy could actually increase heart disease and stroke risk. The new stroke prevention guidelines agree, and state that hormone therapy should not be taken to prevent stroke.

The guidelines also speak to women who have migraines with aura (sensory changes such as seeing blinking lights or smelling a strange odor). Such headaches have been linked to stroke. Women with this condition are urged to work hard to stop smoking, since the combination elevates stroke risk. Taking medications to prevent migraine attacks may also be in order.

Atrial fibrillation, a fast and irregular beat in the heart’s upper chambers, is a leading cause of stroke, more so in women than in men. Anyone with this condition should take a “blood thinner” to help prevent stroke.

The guidelines also recommend that women between the ages of 65 and 79 think about taking a daily baby aspirin (81 milligrams). Aspirin helps prevent the formation of blood clots, which are often at the root of a stroke.
The basics

The guidelines don’t ignore the fundamentals of stroke prevention, which are essentially the same for women and men:

    control high blood pressure
    don’t smoke
    aim for a healthy weight
    stay physically active
    limit sugary drinks and foods
    strive for a Mediterranean-style diet.

The release of new guidelines rarely gets much attention in the media. The attention that these new stroke guidelines are getting is well deserved. Let’s hope they succeed in what they were designed to do. Let’s face it, ladies: Sex is a topic you usually discuss behind closed doors with your partner or during lunch with your closest friends (glass of wine optional). But I’ve noticed as I’ve gotten older that sex isn’t the hot lunch topic it used to be. That’s no surprise, considering how the activity that once consumed us now has to fit into the patchwork of our lives that also includes work, kids, aging parents, and, oh yes, glorious sleep. But it does make me wonder about the future. Is there a time when sex will no longer be on the agenda? And can we—should we—change that?

The answer, it turns out, is that it’s likely up to each of us. A research letter in JAMA Internal Medicine reports that women between the ages of 40 and 65 who place greater importance on sex are more likely to stay sexually active as they age. In other words, if it’s important to you, you’ll keep on doing it. “Having taken a lot of sexual histories from midlife women, it’s probably true!” says Dr. Jan Leslie Shifren, associate professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School, and co-author of the Harvard special report Sexuality in Midlife and Beyond.

Dr. Shifren points out that the research letter did not find that sex was more satisfying for women who stated it was important to them, just that they were more likely to remain sexually active. It’s also not clear how often they had sex.

There are many reasons why sex may slow down for women when they get older, not least of which is menopause. When the ovaries stop making estrogen, the vaginal lining becomes thinner, there’s less vaginal elasticity, muscle tone, and lubrication, and arousal takes longer. As a result, women may experience

    decreased libido (a lack of interest in sex)
    difficulty with lubrication
    pain with penetration
    difficulty or inability to climax.

Some women may have sexual dysfunction that’s related to social or psychological issues, such as stress, anxiety, body image problems, relationship problems, or the lack of a partner.

Poor health can also get in the way of having sex. Heart disease can reduce the amount of blood that reaches sex organs, making it difficult to fill the blood vessels around the vagina that are crucial for adequate lubrication and arousal. High blood pressure, diabetes, depression, and incontinence can all nudge sex aside. Medications for a variety of conditions can have anti-sex side effects. For example, some drugs used to treat depression or high blood pressure can blunt interest in sex or cause difficulty reaching orgasm.

So what’s a woman to do? Seek treatment. That may not be as complicated as you think. Many sexual problems can be reversed with appropriate therapy, especially if they’re relatively new. Dr. Shifren says treatment is often successful.

Some therapies are simple, such as using a lubricant or low-dose vaginal estrogen for dryness and pain, or swapping one medication with negative side effects for another. Sometimes the treatment may be more involved, such as hormone therapy for decreased libido or sex therapy for inability to climax.

But clinical therapy is just part of the prescription. These lifestyle changes can also make a difference:

Exercise—it can improve your sexual function by improving blood flow and strengthening your heart.

Quit smoking—it will improve blood flow to the sexual organs and may also stave off menopause for a few years.

Drink alcohol in moderation, since large amounts of alcohol can dampen sexual reflexes, trigger hot flashes, and disrupt sleep.

Control your weight to give you the body image you want.

Eat a healthy diet, which helps prevent heart disease and diabetes, and helps you maintain a healthy weight.

Dr. Shifren also offers this advice: “Bring some novelty to your life. Take vacations. Go on date nights.”

Why bother with all this? Sex is important to women’s health. It revs up metabolism and may boost the immune system. Frequent sexual intercourse is associated with reduced heart attack risk. It can help the vagina stay lubricated, elastic, and healthy. And it’s fun.

If it’s important to you, you should be able to enjoy sex well into your older years. And that’s something worth talking about.
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Big arm-to-arm difference in blood pressure linked to higher heart attack risk

The next time you have your blood pressure checked, ask your health care to check it in both arms, rather than just in one. Why? A big difference between the two readings can give you an early warning about increased risk of cardiovascular disease, a new study suggests.

Researchers at Harvard-affiliated Massachusetts General Hospital and colleagues measured blood pressure—in both arms—in nearly 3,400 men and women age 40 or older with no signs of heart disease. The average arm-to-arm difference was about 5 points in systolic blood pressure (the first number in a blood pressure reading). About 10% of the study participants had differences of 10 or more points. Over the next 13 years or so, people with arm-to-arm differences of 10 points or more were 38% more likely to have had a heart attack, stroke, or a related problem than those with arm-to arm differences less than 10 points. The findings, which appear in the March 2014 American Journal of Medicine, uphold earlier work on arm-to-arm differences in blood pressure.

Small differences in blood pressure readings between the right and left arm are normal. But large ones suggest the presence of artery-clogging plaque in the vessel that supplies blood to the arm with higher blood pressure. Such plaque is a signal of peripheral artery disease (cholesterol-clogged arteries anywhere in the body other than the heart). When peripheral artery disease is present, there’s a good chance the arteries in the heart and brain are also clogged, boosting the odds of having a heart attack or stroke.

While most cardiologists routinely measure blood pressure in both arms as part of an initial evaluation, most primary care doctors don’t. “Our study suggests that a baseline blood pressure measurement in both arms by primary care clinicians may provide additional information about cardiovascular risk prediction,” says study co-author Dr. Christopher O’Donnell, a cardiologist at Massachusetts General Hospital and associate professor of medicine at Harvard Medical School.

Here’s another reason to check blood pressure in both arms: if the pressure in one arm is higher, that arm should be the one upon which to base any treatments and to check your blood pressure in the future. (The current guidelines for managing high blood pressure are discussed here).

This study didn’t look at whether more aggressive treatment in people with high arm-to-arm blood pressure differences would help protect them from heart attack or stroke. Still, it’s worth finding out if you face a high risk of heart disease. That might inspire you to redouble your efforts to improve your cardiovascular health. To that end, the top six steps are:

    Don’t smoke. Tobacco smoke is as bad for the heart and arteries as it is for the lungs. If you smoke, quitting is the biggest gift of health you can give yourself. Secondhand smoke is also harmful, so avoid it whenever possible.
    Be active. Exercise and physical activity are about the closest things we have to magic bullets against heart disease and other chronic conditions. Any amount of activity is better than none; at least 30 minutes a day is best.
    Aim for a healthy weight. Carrying extra pounds, especially around the belly, strains the heart and tips you toward diabetes. If you are overweight, losing just 5% to 10% of your starting weight can make a big difference in your blood pressure and blood sugar.
    Enliven your diet. Add fruits and vegetables, whole grains, unsaturated fat, good protein (from beans, nuts, fish, and poultry), and herbs and spices. Subtract processed foods, salt, rapidly digested carbohydrates (from white bread, white rice, potatoes, and the like), red meat, and soda or other sugar-sweetened beverages.
    Drink alcohol in moderation (if at all). If you drink alcohol, limit your intake — one to two drinks a day for men, no more than one a day for women.
    Ease stress. Finding ways to ease stress, such as exercise, meditation, mindfulness, and other techniques, can take a load off the heart and arteries.
History is repeating itself in my family. My mother has Parkinson’s disease, and my father is her caregiver. Forty years ago, my mom was the caregiver for her own mother, who had advanced Parkinson’s disease and dementia.

I didn’t know my grandmother before she became frail and sick, but I knew that her children adored her. They couldn’t bear to place her in a nursing home, so they took six-month turns caring for her in their own homes. Every day, my mother would bathe my grandmother, dress her, feed her, and make sure she took her medications. She had no additional help, and no support from my grandmother’s doctors. It was exhausting for my mother, and I felt her anguish.

That was in the mid-1970s, when being a caregiver wasn’t a defined role. Now it’s so commonplace that researchers study caregiving. They estimate that 43.5 million people in our country provide in-home, long-term care for older adult family members with a chronic illness. There’s even an entire industry of services tailored to aging in place.

But despite the awareness of these roles, and the support services now available, the attention paid to caregivers isn’t much different than when I was a kid. In fact, a report published today in JAMA finds that many physicians overlook caregiver burden.

“Most physicians haven’t been trained to ask patients about it, and it’s a new clinical habit that you have to consciously adopt and work on,” says geriatrician Dr. Anne Fabiny, medical editor of Caregiver’s Handbook, a Special Health Report from Harvard Medical School.

The authors of the JAMA study found that caregivers are typically women who spend about 20 to 40 hours a week providing care. They also found that most caregivers feel abandoned and unrecognized by the health care system. Spousal caregivers face greater challenges than caregivers helping a parent for a variety of reasons, one of which is that they tend to be older.

Of these caregivers, 32% have a high caregiver burden. There is no medical classification for “caregiver burden.” But it’s generally known as the toll that caregiving takes on a person. It can manifest in many ways, including physical ailments, mental illness, social isolation, and financial problems. “Caregivers get depressed. Then they neglect their own health or they miss doctor appointments because they can’t extract themselves from their caregiving role. They just don’t have support, so things like exercising, getting enough sleep, or engaging in a social life all fall away,” says Dr. Fabiny.

The JAMA study cites cases of elderly caregivers who are so distraught that they try to commit suicide just to get out of the situation. The authors of the JAMA report and others are urging physicians to help prevent or reduce mounting desperation among caregivers by playing a part in assessing the caregiver’s health during regular clinic visits for the person who is chronically ill.

Physicians can evaluate the caregiver by asking:

    How are you coping with these responsibilities?
    How would you describe your quality of life these days?
    How often do you get out?
    Do you have your own physician?

The answers can help physicians direct caregivers to various services and support systems. These include:

    respite for the caregiver, in the form of a home companion or an adult daycare program for the patient
    help with non-medical services such as housekeeping and cooking
    counseling about caregiver stress and its consequences, from either a therapist or support group
    training so the caregiver learns how to care for her or his loved one without injury, such as learning how to lift the person without suffering back strain.

It’s the type of support that would have eased my mother’s burden when I was a kid. And it’s especially important to me now that my parents are in a spousal-caregiver relationship. I might worry about my father, a prince who never complains, except that the situation is a little different this time around. First, my mother is not as ill as my grandmother was. Second, my parents have me, a bossy health reporter, who is aware of support options and quick to arrange them. Not everyone has that kind of inside scoop.

So I’m grateful that the medical community is stepping up to the plate and shining the spotlight on caregiver wellness.

“The person you’re caring for is only as good as you are, and if you don’t take care of yourself, you can’t take care of the person you love and are responsible for,” advises Dr. Fabiny.

The Caregiver’s Handbook includes a detailed questionnaire to help caregivers identify problems and solutions for their caregiving situations. It also offers suggestions for legal and financial planning and tips for taking care of yourself as the caregiver, with emphasis on your own health and remembering to exercise, eat right, and see friends and family. How bad can a little high blood pressure be? It turns out that it might be worse than we thought.

Fifty years ago, the rule of thumb for a healthy systolic blood pressure (the top number of a blood pressure reading [see “Blood pressure basics”]) was 100 plus your age. Today, a healthy blood pressure is below 120/80. High blood pressure (what doctors call hypertension) is any pressure above 140/90. In the spring of 2003, an expert panel appointed by the National Institutes of Health created a new category—prehypertension. It covers the 25% of Americans in the gray zone between normal blood pressure and hypertension, who have systolic blood pressures between 121 and 139 and/or diastolic pressures between 81 and 89.

Some doctors and pundits scoffed that this new definition was “disease mongering.” A study to be published in the April issue of the journal Neurology indicates that we should take prehypertension seriously.

Blood pressure basics
When the heart contracts, the pressure in the arteries rises—that’s your systolic pressure, usually written as the first number of a blood pressure reading. When the heart relaxes between beats, the pressure falls—that’s your diastolic pressure. The ideal blood pressure is 120/80.

Researchers from Southern Medical University in Guangzhou, China, examined the results of 19 high-quality studies looking at links between prehypertension and stroke. The studies included more than three-quarters of a million people, whose health and wellbeing was followed for 36 years. The researchers broke down the participants into two groups:

    Low-range prehypertension: Blood pressure between 120/80 and 129/84
    High-range prehypertension: Blood pressure between 130/85 and 139/89

People with high-range prehypertension had a 95% higher stroke risk compared to people with blood pressures less than 120/80. Those in the low-range had a 44% higher stroke risk.
Lifestyle changes lower health risks

The size of the study and the length of the followup make the results believable. They don’t mean that we should elevate prehypertension to a disease. But they do signal that we need to take it seriously.

How seriously? So far, there’s no solid evidence that people with prehypertension benefit from taking medications. Blood pressure drugs lower blood pressure, but they can also cause harmful side effects. In the prehypertension range, benefits and risks seem to cancel each other out.

Instead, lifestyle changes are the way to go for prehypertension. Here are several changes that can lower blood pressure:

    If you smoke, quit
    Strive to maintain a healthy weight.
    Stay physically active as much as you can all day.Get at least 30 minutes of moderate intensity exercise most days of the week.
    Make vegetables and fruits half of every meal. Potatoes don’t count as a vegetable.
    For the other half, aim for healthy protein and whole grain carbohydrates.
    Cut back on the amount of salt and sodium you take in. Much of the salt and sodium we consume comes from packaged foods, so check labels.
    Drink water instead of sugary beverages.
    If you drink alcohol, keep it moderate. That’s no more than one alcoholic drink a day for women, no more than two a day for men.

These changes will help beat prehypertension. Even better, they will almost surely lower your risk of having a stroke or heart attack, or developing heart failure, diabetes, kidney disease and some cancers.
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19/04/2019

Mindfulness meditation helps fight insomnia, improves sleep

How long do hot flashes last? It used to be said that menopause-related hot flashes fade away after six to 24 months. But for many women, hot flashes and night sweats often last seven years and may go on for 11 years or more.

The hormonal roller coaster that comes with the end of a woman’s childbearing years can trigger a range of hot flash symptoms. Up to 80% of women going through menopause experience hot flashes. Hot flashes, also known as vasomotor symptoms, are often described as a sudden sensation of heat in the chest, face, and head followed by flushing, perspiration, and sometimes chills. When a hot flash occurs during sleep, it can be accompanied by a drenching sweat. Such night sweats make it difficult to get a good night’s rest.The estimates of the duration of these symptoms come from the Study of Women’s Health Across the Nation (SWAN), a long-term study of women of different races and ethnicities who are in the menopausal transition. They were published in JAMA Internal Medicine.

“The data from this study confirm what many women already know firsthand. Hot flashes can go on for years and take a toll on a woman’s health and well-being,” says Dr. JoAnn Manson, professor of women’s health at Harvard Medical School and professor of epidemiology at Harvard School of Public Health.
The SWAN researchers found that some women are more likely to deal with long-term hot flashes than others. Women who had their first hot flashes before their menstrual periods ended had hot flashes for an average of nine to 10 years. When hot flashes didn’t start until after the last menstrual period, the average duration was only about three and a half years. But even on the short end of the spectrum, that’s a long time to deal with hot flashes and night sweats.
Women in the SWAN study who experienced hot flashes for a longer time tended to be current or former smokers, overweight, stressed, depressed, or anxious. Ethnicity also played a role. African American women reported the longest duration of hot flashes (averaging more than 11 years), while Japanese and Chinese women had hot flashes for about half that time.
The “reality check” the SWAN study provides on hot flashes should encourage women to seek solutions. If hot flashes and night sweats are really bothering you, don’t put up with them. Talk with your doctor about treatment options.

The most effective hot flashes treatment is estrogen-based hormone therapy, though it comes with several downsides. “While hormone therapy is very effective at relieving hot flashes, longer-term treatment carries an increased risk for breast cancer, and women at older ages have higher risks of stroke, blood clots, and other health problems. So it’s important that women explore a full range of treatment options — especially women likely to have persistent hot flashes,” advises Dr. Manson.

Several non-hormonal medications can also provide r hot flashes treatment and relief from night sweats. These include some types of antidepressants, some drugs commonly prescribed for nerve pain, and some high blood pressure medications. As with any medication, it’s best to opt for the lowest dose that effectively relieves your symptoms, and to take it for the shortest amount of time possible.

For some women, self-help measures can help ease hot flashes. These include deep-breathing exercises when a hot flash starts; dressing in layers; lowering the thermostat; staying away from caffeine, alcohol, hot beverages, and spicy foods; stress reduction techniques like meditation and mindfulness; and doing your best to stay cool in general.

A free mobile app called MenoPro, developed by Dr. Manson and her colleagues at the North American Menopause Society, helps women understand their treatment options and work with their healthcare providers to find the best approach for them. The app is currently available for iPhones and iPads. More information is available at the North American Menopause Society website. If you knew that a vaccine could prevent your daughter or son from developing a relatively common and potentially deadly cancer later in life, would you have her or him get it? Such a vaccine is available, and it’s about to get even better than it is now — but fewer than half of all teens have gotten it.

I am talking about a vaccine against the human papilloma virus (HPV). It is responsible for cervical cancer, which strikes 12,000 women each year in the United States and kills 4,000. Only 15% of women diagnosed with advanced cervical cancer survive for five years or more — a grim statistic. HPV also causes cancer of the vulva, vagina, penis, anus, mouth, and throat.

A key barrier against more widespread use of this vaccine is an issue that stops many conversations about teen health: sex.
A new HPV vaccine

Human papilloma virus isn’t a single virus. It’s a family of 150 or so related viruses. The first HPV vaccine, approved for girls in 2006 and for boys in 2009, attack four types of HPV that cause the majority of cervical cancers. The new vaccine covers nine HPV types, making it even more effective.

A report in today’s New England Journal of Medicine shows that the new vaccine was effective against 97% of cancerous or precancerous changes in the cervix, vulva, and vagina related to five HPV types not covered by the first vaccine. That means it is expected to be able to prevent most cases of cervical cancer — a very important advance in cancer prevention.
Low coverage

About half (57%) of American girls between the ages of 13 and 17 get the first dose of the HPV vaccine, while only one-third (32%) get all three necessary doses. Coverage for boys is even lower.

The recommended age for getting the vaccine is 11 to 12. One reason is that the body mounts a more powerful antibody response at that age than it does a few years later. Furthermore, children ages 11 and 12 are already scheduled to get vaccines for tetanus, diphtheria, pertussis, and meningitis, so adding the HPV vaccine would be convenient. Finally, HPV is spread mostly by sexual contact. Getting the vaccine by age 12 ensures that children will be protected before they enter their early teens, an age when a growing number of American youths begin sexual activity.

Some parents refuse HPV vaccination because they think it will encourage their children to become sexually active or sexually promiscuous. Several solid studies have refuted this.

As does a new one published last week in JAMA Internal Medicine. It took a novel approach to this issue. Dr. Anupam Jena, assistant professor of health policy at Harvard Medical School, and colleagues looked at rates of sexually transmitted infections among more than 200,000 young women before and after HPV vaccination. There were no differences in these rates, suggesting that being vaccinated does not promote risky sexual behavior.
Improving coverage

HPV isn’t a problem for women only. Boys develop HPV-related cancer, too, as highlighted by actor Michael Douglas’s revelation that his throat cancer was likely caused by HPV transmitted during oral sex. Vaccinating boys as well as girls would also help stem the spread of HPV.

In an editorial in JAMA Internal Medicine that accompanied the report by Dr. Jena’s team, Dr. Robert A. Bednarczyk of Emory University wrote, “just as we do not wait until we have been in the sun for 2 hours to apply sunscreen, we should not wait until after an individual is sexually active to attempt to prevent HPV infection.”

I believe that HPV vaccination makes good sense for both girls and boys. The benefits of cancer prevention clearly outweigh any small risks, and the benefits will be further extended by the broader spectrum of the new vaccine. I urge parents to protect their children with this important preventive measure. If you’ve ever crawled under the covers worrying about a problem or a long to-do list, you know those racing thoughts may rob you of a good night’s sleep. Sleep disturbances, like having a hard time falling asleep or staying asleep, affect millions of Americans.

The daytime sleepiness that follows can leave you feeling lousy and sap your productivity, and it may even harm your health. Now, a small study suggests that mindfulness meditation — a mind-calming practice that focuses on breathing and awareness of the present moment — can help.

A study published a few years ago in JAMA Internal Medicine  included 49 middle-aged and older adults who had trouble sleeping. Half completed a mindfulness awareness program that taught them meditation and other exercises designed to help them focus on “moment-by-moment experiences, thoughts, and emotions.” The other half completed a sleep education class that taught them ways to improve their sleep habits.

Both groups met six times, once a week for two hours. Compared with the people in the sleep education group, those in the mindfulness group had less insomnia, fatigue, and depression at the end of the six sessions.

The findings come as no surprise to Dr. Herbert Benson, director emeritus of the Harvard-affiliated Benson-Henry Institute for Mind Body Medicine. “Mindfulness meditation is just one of a smorgasbord of techniques that evoke the relaxation response,” says Dr. Benson.

The relaxation response, a term he coined in the 1970s, is a deep physiological shift in the body that’s the opposite of the stress response. The relaxation response can help ease many stress-related ailments, including depression, pain, and high blood pressure. For many people, sleep disorders are closely tied to stress, says Dr. Benson.

Mindfulness meditation involves focusing on your breathing and then bringing your mind’s attention to the present without drifting into concerns about the past or future. It helps you break the train of your everyday thoughts to evoke the relaxation response, using whatever technique feels right to you.

Dr. Benson recommends practicing mindfulness during the day, ideally for 20 minutes, the same amount suggested in the new study. “The idea is to create a reflex to more easily bring forth a sense of relaxation,” he says. That way, it’s easier to evoke the relaxation response at night when you can’t sleep. In fact, the relaxation response is so, well, relaxing that your daytime practice should be done sitting up or moving (as in yoga or tai chi) so as to avoid nodding off.

Step 1: Choose a calming focus. Good examples are your breath, a sound (“Om”), a short prayer, a positive word (such as “relax” or “peace”), or a phrase (“breathing in calm, breathing out tension”; “I am relaxed”). If you choose a sound, repeat it aloud or silently as you inhale or exhale.

Step 2: Let go and relax. Don’t worry about how you’re doing. When you notice your mind has wandered, simply take a deep breath or say to yourself “thinking, thinking” and gently return your attention to your chosen focus.
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Menopause-related hot flashes and night sweats can last for years

After shoveling for days, breaking up ice dams, and now shivering in this week’s frigid temperatures, I wouldn’t mind sitting in a sauna for a bit. A new report in JAMA Internal Medicine makes this pastime even more appealing: regularly spending time in a sauna may help keep the heart healthy and extend life.

Researchers from the University of Eastern Finland tracked 2,300 middle-aged men for an average of 20 years. They categorized the men into three groups according to how often they used a sauna each week. The men spent an average of 14 minutes per visit baking in 175° F heat. Over the course of the study, 49% of men who went to a sauna once a week died, compared with 38% of those who went two to three times a week and just 31% of those who went four to seven times a week. Frequent visits to a sauna were also associated with lower death rates from cardiovascular disease and stroke.

The results don’t surprise Dr. Thomas H. Lee, a cardiologist at Harvard-affiliated Brigham and Women’s Hospital and founding editor of the Harvard Heart Letter. “The cardiovascular effects of sauna have been well documented in the past. It lowers blood pressure, and there is every reason to believe that its effects are good for blood vessels,” says Dr. Lee.

Earlier studies have shown that regular sauna bathing may benefit people with risk factors for heart disease, such as high cholesterol, high blood pressure, and diabetes. It’s generally safe and likely beneficial for people with mild heart failure, but may not be so hot for those with unstable angina or a recent heart attack.

The researchers were quick to state that because of the unique properties of Finnish saunas, their results aren’t applicable to steam baths and hot tubs. Finnish saunas are wood-lined rooms, usually heated by a stove topped with stones. The air inside the sauna is very hot and dry, although sauna bathers periodically add water to the stones to produce a vapor known as “loyly.”
The sauna’s place in Finnish life

Sauna use is deeply embedded in Finnish culture. A nation of 5.5 million people, Finland has as many saunas as television sets — around 3.3 million. Most of the saunas are in people’s homes, although they’re also standard amenities in offices and factories. Saunas are accessible to Finns of every walk of life, so it’s unlikely that the study participants who used saunas often were already at lower risk of dying early because they were better off socioeconomically.

The researchers also emphasize that the very nature of the Finnish sauna is designed to reduce stress. The sauna has been a gathering place for family and friends for centuries. And sauna etiquette, which frowns upon swearing or discussing controversial topics while bathing, is instilled in Finns during childhood.

In fact, Finns may spend even more time in the sauna than they do exercising. While most Finns visit a sauna at least once a week, only about half of Finnish men and a third of Finnish women between 18 and 65 meet the World Health Organization exercise guidelines, which recommend the equivalent of 30 minutes of moderate-intensity physical activity five days a week. The Finnish researchers suggest that saunas may provide some cardiovascular conditioning because the high temperatures can drive heart rates to levels often achieved by moderate-intensity physical exercise.

So is sitting in a sauna the equivalent of exercising? “I don’t know that I would substitute a sauna for exercise. But exercising and then taking a sauna seems like a very healthy routine,” Dr. Lee says.
If you want to try a sauna

Although saunas haven’t become a cultural institution in the United States, many gyms, Y’s, Jewish Community Centers, and health clubs have them. If you’re intrigued about the prospect of ending your workout in a sauna and want to learn more about sauna etiquette or get instructions for building your own sauna, visit the North American Sauna Society website. The No Nuts Moms Group website lists some of the young people who have died from food allergies — many from peanut allergy — going back to 1986. The lengthy list is a sad reminder that a peanut allergy can cause a severe and sometimes deadly allergic reaction. Parents who have a child who is allergic to peanuts do many things to keep him or her out of harm’s way.

A study published online today in The New England Journal of Medicine offers some hope for parents of infants who may be headed toward a peanut allergy. That hope is peanuts.

For the study, an international team of researchers recruited infants who had an egg allergy or eczema, an allergic disorder that affects the skin. Both are indicators that a child is prone to a peanut allergy. The children were randomly divided into two groups. The parents in one group were asked to make sure their children didn’t eat any peanuts, peanut butter, or other peanut-based products until age five. Parents in the other group were asked to give their children a peanut-based snack called Bamba or peanut butter three times a week until age five.

The results were surprising and dramatic. A peanut allergy developed in 1.9% of children who ate Bamba or peanut butter, compared with 13.7% of those who didn’t eat peanuts. One explanation for this difference is that the children who ate peanuts early developed what is called immune tolerance to them. Their young immune systems adapted to the proteins in peanuts so that they did not react to them.

The researchers got the idea for this trial from a previous study of theirs. They knew that Israeli children are typically fed peanuts much earlier in life than British children. So they compared peanut allergies in Jewish children living in Israel with those in Jewish children living in London. Peanut allergies were 10 times higher in the British children than in the Israeli children.

In an unrelated study, a team from the Jaffe Food Allergy Institute at Kravis Children’s Hospital at Mount Sinai in New York City presented similar findings on Sunday at the annual meeting of the American Academy of Allergy Asthma and Immunology in Houston. They showed that a wearable patch that gradually exposes the body to small amounts of peanut protein may be effective in easing the allergy. After wearing the patch for a year, people with peanut allergies could tolerate the equivalent of four peanuts at a time. The patch, called Viaskin, is made by DBV Technologies, which funded the study.

What does this new work mean for parents? If an infant is allergy-prone, it may be a good idea to ask his or her pediatrician about skin-prick testing for peanut allergy. If adding peanuts to the child’s diet early is feasible, the New England Journal of Medicine study suggests that such a strategy may prevent a peanut allergy down the line. And while the Viaskin results are still preliminary, if further research bears out these results, this approach could be a lifesaver. How long do hot flashes last? It used to be said that menopause-related hot flashes fade away after six to 24 months. But for many women, hot flashes and night sweats often last seven years and may go on for 11 years or more.

The hormonal roller coaster that comes with the end of a woman’s childbearing years can trigger a range of hot flash symptoms. Up to 80% of women going through menopause experience hot flashes. Hot flashes, also known as vasomotor symptoms, are often described as a sudden sensation of heat in the chest, face, and head followed by flushing, perspiration, and sometimes chills. When a hot flash occurs during sleep, it can be accompanied by a drenching sweat. Such night sweats make it difficult to get a good night’s rest.The estimates of the duration of these symptoms come from the Study of Women’s Health Across the Nation (SWAN), a long-term study of women of different races and ethnicities who are in the menopausal transition. They were published in JAMA Internal Medicine.

“The data from this study confirm what many women already know firsthand. Hot flashes can go on for years and take a toll on a woman’s health and well-being,” says Dr. JoAnn Manson, professor of women’s health at Harvard Medical School and professor of epidemiology at Harvard School of Public Health.
The SWAN researchers found that some women are more likely to deal with long-term hot flashes than others. Women who had their first hot flashes before their menstrual periods ended had hot flashes for an average of nine to 10 years. When hot flashes didn’t start until after the last menstrual period, the average duration was only about three and a half years. But even on the short end of the spectrum, that’s a long time to deal with hot flashes and night sweats.
Women in the SWAN study who experienced hot flashes for a longer time tended to be current or former smokers, overweight, stressed, depressed, or anxious. Ethnicity also played a role. African American women reported the longest duration of hot flashes (averaging more than 11 years), while Japanese and Chinese women had hot flashes for about half that time.
The “reality check” the SWAN study provides on hot flashes should encourage women to seek solutions. If hot flashes and night sweats are really bothering you, don’t put up with them. Talk with your doctor about treatment options.

The most effective hot flashes treatment is estrogen-based hormone therapy, though it comes with several downsides. “While hormone therapy is very effective at relieving hot flashes, longer-term treatment carries an increased risk for breast cancer, and women at older ages have higher risks of stroke, blood clots, and other health problems. So it’s important that women explore a full range of treatment options — especially women likely to have persistent hot flashes,” advises Dr. Manson.

Several non-hormonal medications can also provide r hot flashes treatment and relief from night sweats. These include some types of antidepressants, some drugs commonly prescribed for nerve pain, and some high blood pressure medications. As with any medication, it’s best to opt for the lowest dose that effectively relieves your symptoms, and to take it for the shortest amount of time possible.

For some women, self-help measures can help ease hot flashes. These include deep-breathing exercises when a hot flash starts; dressing in layers; lowering the thermostat; staying away from caffeine, alcohol, hot beverages, and spicy foods; stress reduction techniques like meditation and mindfulness; and doing your best to stay cool in general.

A free mobile app called MenoPro, developed by Dr. Manson and her colleagues at the North American Menopause Society, helps women understand their treatment options and work with their healthcare providers to find the best approach for them. The app is currently available for iPhones and iPads. More information is available at the North American Menopause Society website.
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16/04/2019

These Best 10 Dress Forms will Surprise You

This Walk, Outline My Ensemble is making purchasing dress structures dreadfully simple. Here we have 10 of the best dress shape surveys, including our pick, best dress frame on a financial plan, learners, and propelled decisions and in addition the best movable dress conform to. Is it true that you are simply setting out into the universe of plan, or are a prepared genius needing something new?


Despite your experience, you'll require a dress shape for sticking every one of those extraordinary and awesome plans. Individuals have a tendency to stray or get exhausted, or eat an excessive number of potato chips and change shape. Your dress frame won't do anything other than be the perfect shape to hang your tasks on. It won't gripe in the event that you stick sticks in it either! In spite of the fact that you've to know how to utilize your dress shape like a star.

In any case, which dress shape to purchase? The universe of dress shape can be befuddling, so unwind, get some espresso and finish us this best dress frame survey. Outline My Outfit will enable you to have the best dress frame you require in a matter of moments!

"What do they think about dress structures?" I hear you say. All things considered, in the four years we've spent announcing and refreshing this site, we've attempted and tried pretty much every dress shape you could envision. This rundown itself is the result of 55 long periods of concentrated research, and trust me, no one burns through 55 hours taking a gander at models of limbless middles except if they are extremely energetic about what they do. I see dress structures when I close my eyes. This truly is the best dress frame audit around. The lengths we go to for our perusers!

We found the best dress structures for you, we spent seven days attempting the majority of them for you when we could, and the surveys we've gathered here will ideally spare you a great deal of time, dissatisfaction, and cash. We're not promoting any single item, that is not how we roll.

We're here to enable you to settle on the correct decision in your best dress shape audit.

So because of this, we've singled out the best dress structures available. Each future purchaser, from the architects of Paris to a destitute understudy sticking their first endeavors to their first dress shape, should discover the surveys they require ideal here.

A SHORT HISTORY OF DRESS Structures

You may be pardoned for intuition the dress shape is a cutting edge creation, maybe developed in an expert tailors' shop or in a retail chain, yet then you recollect that individuals have been wearing garments for quite a while. In 1922, Howard Carter, the celebrated around the world English voyager and prehistorian, started unearthing the tomb of Tutankhamen, the fourteenth century BC Egyptian pharaoh. When he broke through the mass of the tomb, he found a strong gold sarcophagus, nourishment, superbly protected nectar, melodic instruments and, among the Pharaoh's garments, a limbless wooden middle that was unmistakably for use by the Pharaoh's tailors. Most students of history trust this to be the principal dress frame known.

More present day cases of regal dress structures incorporate Medieval English rulers and pre-upheaval French Rulers (celebrated internationally for their excess and riches). Truth be told, wherever you look in European history, where you discover riches, you discover dress structures. These were held only for the affluent; all things considered, who else could manage the cost of a tailor? It was amid the Mechanical Insurgency of the eighteenth and nineteenth hundreds of years that the dress shape wound up accessible to regular people when institutionalization and large scale manufacturing brought what used to be extravagances into the homes of the new working class.

This white collar class had cash to spend, and shops opened with mannequins in the windows and dress structures for the making of bespoke dresses and regalia for the new callings jumping up. They were frequently made of wood or strong wax, at that point later papier-mâché.

The dress shape has again gotten away from its inceptions and would now be able to be found in the homes of the numerous at-home sewers who deliver for present day markets. Dress structures are found in the craftsmanship world; an accumulation by originator Martin Margiela from 1997 highlighted a piece built to resemble a dress frame. The dress shape has been on a long excursion, from elite sovereignty to the studios of specialists and home sewers, and has left its engraving on sewing society around the world en route.

Sorts OF DRESS Structures

Dress structures are utilized for bunches of various things and as needs be, we have many writes to browse. Try not to be threatened, it's basic when it's separated. To start with, ask yourself what the dress shape will be utilized for. Will you require legs? Do you have to modify the stature, or fall it down for transporting? Lightweight or more durable? Enormous bust or little? At that point it's a smart thought to know the amount you will spend on your sewing. In any case, don't stress in case you don't know, we'll control you sewers through what you require.

Show Dress Frame:

This is for you in case you're anticipating showing your manifestations. Show dress structures are completely pinnable (shrouded in a thick layer of froth so you can stick at any edge) and ought to be fabric secured. These are for show, so they're normally brightening, with various hued texture or examples. They are frequently flexible however for a show frame, some simply pick their optimal shape and tallness.

A show dress shape can be rock solid for more changeless show, or lightweight for transporting around appears, customer's organizations or homes. More affordable than different dress structures, these aren't suited to fitting or hanging.

Proficient Dress Shape:

A greater speculation than a show dress frame however justified regardless of each penny. You can do everything on an expert dress frame. Broadly accessible in a wide range of shapes and sizes, they're by and large more practical in extents than a show dress frame. For fitting, hanging and sticking anything while you're sewing, this is your ticket for cutting edge sewers. They can be brightening.

Wheels make them important in your bustling work environment, you'll have the capacity to move them without contacting the garments, or simply get them out the way! Highlights like collapsible shoulders, confine bottoms, and customizable statures will be unendingly valuable and let you get on with your work.

Bifurcated Dress Frame:

Dress structures with legs! You can expel them in the event that you require, yet while experimenting with another plan the legs can give a superior thought of how everything looks together with jeans or shorts. Arms are a choice worth considering, particularly in case you're doing heaps of hanging or example work.

Bifurcated dress structures are the following stage from an expert dress shape and can cost as needs be. They could be brightening in the event that you require, however measure the additional usefulness against the cash you may spend. You can spend anyplace amongst $200 and $1000, with better body shapes and customization the more costly you get. It was the attractive arms that sold them for me.

Flexible Dress Shape:

Does precisely what it says on the tin: modifies. Turn the dial and the areas move far from each other. Evaluated at the lower end of the market, a great customizable dress shape can be purchased for $200-300. This lower cost is reflected in their poorer development materials and less practical body shapes. Highlights like collapsible shoulders and being completely pinnable for the most part aren't accessible on flexible dress structures, which can confine their utilizations and improving potential outcomes.

They are valuable, be that as it may, by giving the creator bunches of various body sizes and extents on one dress frame. In case you're new to sewing, they can be the best approach to get involvement While not for showing, fitting or hanging, a customizable dress shape will discover numerous utilizations in your studio!

DRESS Frame Versus MANNEQUINS

To the regular person, they may appear like a similar thing yet that would be unadulterated numbness! A dress shape is normally the portrayal of a middle and developed with a hard inside and froth or texture outside. This is on the grounds that a creator should have the capacity to stick sticks in it.

A mannequin can't do this current, it's a strong shell in the state of an entire human, utilized as a part of retail for beautiful purposes and showing garments. The film Mannequin would have been altogether different surely on the off chance that she'd quite recently been a middle. Be that as it may, we should disregard mannequins, you came here for dress structures!

WHAT TO Search FOR IN A Decent DRESS Shape?

Try not to get sold a little guy, or leave the store with the wrong dress frame under your arm! There are a couple of essential things to search for in your look for the ideal dress shape.

To start with is write. What does it have to do? Check our rundown above for more direction.

Next is estimate. Dressing for kids, ladies, huge men or dwarves? Each size has it's own optimal extents so comprehend what you need before settling on any decisions.

Customizability – do you need it to change shape? Collapsible shoulders or an enclosure sew? Extremely imperative contemplations.

Pinnability is essential. The shallow froth will just permit sticking from a point, so is less adaptable, while thick froth will enable your pins to be stuck straight in. This is the more valuable alternative.

Cushioning – the state of your dress frame is basic, so how it's cushioned and where can have a tremendous effect. High or low shoulders and hips, the measure of the bust and back, everything checks.

Ease of use will make an assignment an errand or an enjoyment, ensure you can do all that you require with your dress shape.

Assemble quality – A well-influenced dress shape to will keep going for a considerable length of time (I acquired one of mine) though a less expensive model will lose froth and frame rapidly. Search for something tough and strong.

WHO ARE DRESS Structures FOR?

Regardless of whether you're making, sewing, altering or repairing garments, you will require a dress type of some kind. Indeed, even the most experienced sewers or creators would battle to make excellent garments that really fit anybody without a dress frame.

There are distinctive approaches to utilize a dress shape. Beginners require a considerable measure of training to develop the impulses and "the eye" for good piece of clothing making. They will make loads of excursions to their dress frame as they roll out improvements and modifications. This is all piece of the procedure, we as a whole began in a similar place, so a decent quality dress shape will help them in their movement.

Proficient dressmakers, sewers, tailors, and clothiers all need dress structures day by day in their work, regardless of whether to show their most recent manifestations or to experiment with new thoughts. Clients expect a solid match and cut, they won't get one without an all around prepared tailor and sewer.

Voyaging tailors and dressmakers require lightweight forms as they can be stacked and emptied effortlessly. In the event that you were venturing out to an article of clothing manufacturing plant to have your outlines made genuine, you could take your dress frame and show precisely what you're searching for.

HOW WE PICKED AND Tried

We started our choice with information created by our flawless volunteers. They scoured the net for the best arrangements and returned to us with their best dress shape list. In the 4 years, we've been refreshing this guide, we've tried many dress structures and, while none of them were immaculate, these surveys are the best of what we've found.

For near two months, we've been utilizing and testing these items in the network, testing them thoroughly and gathering the outcomes. We took a gander at, among others, appearance, estimate, weight, make, convenience, movability and one of a kind highlights.

These were factors reliable over all the dress structures we checked on and we feel they give an exhaustive photo of the items' qualities and shortcomings.

We just need the best item for you, that works for us (you'll return) and works for (you have what you need). By gathering your decisions down to these ten, we trust we've given you the opportunity to pick and enough alternatives not to feel constrained, while slashing ceaselessly a considerable measure of the most noticeably awful decisions so you don't need to squander your chance.

After a comprehensive correlation and counsel process, we've thought of a rundown that we're sure will be by and large the best dress frame you could get available. It's exceptionally aggressive out there and it's anything but difficult to get impeded in decisions and alternatives, yet don't stress, we've done the maths so you don't need to.

OUR Main TEN Items

Tune in up sewers! For every item, we broke down 30 of the most imperative highlights of dress structures. You can check our examination report, it's open and intended to enable you to pick the correct item for you or your business. If it's not too much trouble like any of our internet based life pages so you can see the report.

Artist DF251 Flexible Dress Shape

This dress shape is a fantastic item with its customizable size, lightweight development, 360-degree removable sew direct, and simple to-collect element.

Why this Item is Best Customizable Dress Shape?

Our exploration report demonstrated this shape as the most flexible of all our evaluated dress structures.

This thing has a sum of thirteen (!) changes in accordance with give a unimaginably exact fit.

Out of all the dress structures we tried, this was by a long shot the best as far as fit.

Twelve dials make the changing of the dress shape's measurements extremely simple, it even had settings at the neck for smooth collars and ties!

It's tender loving care like that that influenced it to emerge for us.

Being completely flexible, we can make design modifications before cutting, improving for fittings and changes.

This liberates us up to be more imaginative with textures and perceive how they wrap and hold tight the body while you're sewing. We can truly drive the vessel out on what we believe is conceivable with this dress shape.

Check client surveys on Amazon

Nitty gritty Audit

best dress frame: Searching for a movable dress shape? Settle on your decision with it!

We jump at the chance to do our exploration here and we preferred what we found when we took a gander at the Vocalist DF251. It was loaded with keen highlights and extraordinary development.

A committed stick pad and key holder at the neck of the dress frame was one such component, it was simply so flawless!

Similarly cool was the removable trim guide, which could turn 360 degrees to give us even fixes and changes. This was a flawless smaller than usual touch.

The froth is shallow, as on most customizable dress structures, so no immediate sticking here, yet regardless, the froth is high caliber and held every one of the pins we stuck in it flawlessly well.

We instantly saw the shape was extremely lightweight when we took it out the container yet it felt tough and well constructed. It fell over until the point that we put the remain on appropriately, at that point it was as strong as a stone. Senseless us.

Those with a fear of DIY will be satisfied to discover the development is smaller than expected screwdriver free!

It went together easily and we were cheerful to locate that one key is utilized to adjust every one of the twelve dials. It just accompanied one, which could be an issue in case you're in the propensity for putting whatever is in your grasp in your pocket and going home, similar to a few of us here are.

Generally speaking, it's a superb item. We cherished it and appreciated utilizing it and subtly need one of our all own. This ought to be the best dress frame for home sewers.

Stars:

Awesome look and shading

Each one of those dials! Customizability to the maximum!

That pincushion, we adore that pincushion

Best attack of all our audited dress structures

Lightweight

360-degree removable sew manage

No little screwdrivers!

Excellent froth

Huge scope of sizes

Tough and well manufactured

Great deal cost

CONS:

Shallow froth can be a deterrent

Lightweight additionally implies simple to thump over

Fell over until the point when we understood we'd gathered it off-base. Read the manual!

Check Cost on Amazon!

White Female Dress Frame By Just Mannequinsâ®

This dress frame is a choice quality item that joins shape and highlights with its awesome shape and extent, strong development and brilliant material.

We have investigated the 30 most imperative highlights for every one of the item we have chosen, and keeping in mind that this item has a few deficiencies, the one of a kind blend of successful and alluring highlights has made it our no.1 pick.

The middle stature is 27″ from shoulder to bear with a width of 14″, Bust 33″, Midriff: 24″. Hips 34″. The shape and size of this best dress frame have made it the ideal normal female size. The tallness is likewise movable from roughly 4.5 to 6 feet. The froth covering is a thin layer of astounding stuff, reasonable for side sticking. The frame can likewise be removed the tripod and set where you like, incredible for utilizing as an inside.

Regardless of having such a large number of positives, this item falls in an exceptionally moderate value extend: you can get this item for under $70.

Out 1 pick additionally has a second gap under the frame, this is utilized for showing jeans or shorts. It is made of a completely recyclable material, so this dress shape is eco-accommodating. All these emerge highlights have solidified this shape as our no.1 pick.

Check client surveys on Amazon

Nitty gritty Audit

best dress frame: Essentially the best alternative for you!

Things being what they are, what did we think? We pondered this dress shape. Of the considerable number of items we looked into, it had the most elevated normal in the 30 singular criteria we set.

The dress frame had an extremely tough development made of excellent, well-made materials, so it should keep going quite a while. The cover material is removable and launderable, which means you can keep it looking fresh out of the plastic new for quite a while, or supplant it as the time comes.

The size was phenomenal, it's an extremely supportive normal to work from, and we enjoyed the extents of the frame. They looked ideal to the eye and a variety of styles of garments can fit it.

Having the capacity to expel it from its tripod was exceptionally useful for transporting or showing the item, and in addition storing it. This shape would be reasonable for a kid who is learning.

The froth was on the thin end, so side sticking was fundamental, however this wasn't an obstacle. We stuck some jeans on effectively utilizing the second opening under the shape, the shaft was included and evacuated with no issue, to a great degree convenient!

Additional pluses for us that it was made of eco-accommodating, recyclable materials. We think about nature and the article of clothing industry doesn't have the best notoriety, so by utilizing this item we're utilizing capable materials as well as empowering their utilization.

And after that there's the cost! We couldn't trust it when we perceived the amount we'd paid for it: under $70 doesn't appear to be workable for such a top notch item, however there it is.

All in all, this is an extraordinary item. Wherever we looked we discovered quality and esteem. How they do it, we don't have the foggiest idea, however we wouldn't fret that they do! They'll get our deal.

Masters:

Amazing deal cost

Well made

Incredible size

Satisfying extents

Removable cover

Eco-accommodating materials

Recyclable

Second gap for pants

CONS:

Shallow froth so no immediate sticking

Erm, that is it!

OUR Spending PICK: NEW WHITE FEMALE DRESS AND SLACKS Shape

Moderate Pick

item

New White Female Dress and Slacks Shape by Just Mannequinsâ®

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Value for the Money Dress Frame

New White Female Dress and Slacks Frame by Just Mannequinsâ®

Extraordinary shape made of utilitarian and quality material. Its customizable wooden tripod stand, ordinary weight, and movable stature are incredible highlights at such a reasonable cost.

Why this item is Our Spending Pick?

This is a standout amongst other ladies' dress structures we attempted and at such a low value, it was unmistakably the decision for our Best Spending Pick. Not the most minimal value dress shape available, it is the least expensive with such an abundance of incredible highlights. Nothing in the value go contrasted with this smaller than expected jewel.

The shape and size of this best dress frame for those with a tight spending plan is nearly the ideal normal ladies measure, exactly what somebody on a spending needs. A decent normal makes for flexibility.

The stature of the middle is 27″, from shoulder to bear the width measures 14″, the bust is 34″, the abdomen 26″, and the hips are 35″. The tallness is flexible, from 4.5 feet to 6 feet tall, and a thin froth layer that permits sticking into the material around the frame.

A youngster could manage the cost of this for Christmas or a Birthday.

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Definite Survey

best dress shape: Short on money? Try not to stress, pick this one

We were distrustful about this frame, for the most part anything at that cost can have some genuine shortcomings, yet we needn't have stressed as this was an extraordinary item. We enjoyed the tough development and extensive base, it was extremely steady amid our tests.

The froth was as a matter of fact very thin, making direct sticking troublesome, yet we could hang all our test pieces of clothing on it without an issue. The materials were great quality, not garish but rather useful and attractive. Completed in white, it looked great among its more costly cousins in our studio, it looks high caliber and feels great to contact.

For a learner or a dressmaker on a financial plan, it is difficult to turn out badly with this dress frame. It works splendidly as a shape for hanging, hanging or fitting most pieces of clothing (with heavier canvas it may battle with the shallow froth).

When it begins to get filthy from utilize, you can simply take the cover off and wash it, or supplant it on the off chance that it is getting exhausted.

It had a typical weight, not very overwhelming, not sufficiently light that a wheeze would thump it over. For such a little measure of cash, this dress shape is a certain wagered. This could be your passageway into the garments world!

We wish we'd had something of this quality as modest when we were beginning. A decent dress shape will have a significant effect to a learner or somebody taking a shot at a tight spending plan, so in case you're searching for something in that range, this is dress frame.

Stars:

Has a Wood Movable Tripod Stand.

Highlights a thin froth layer

Movable Stature of 4.5 to 6 ft.

Alluring shading and look.

Costs less among such comparative items.

Has a reasonable shoulder to bear width of 14″

Permits sticking into the material around the froth.

CONS:

The topper tumbles off on occasion.

Scents somewhat odd.

GIANTEX Female Mannequine Middle Dress Frame

This simple to gather dress shape consummately suits the tenderfoot's financial plan, is anything but difficult to collect and lightweight, and accompanies 6 designed covers to boot.

Why this Item is Best for Learners?

From our comprehensive research process, we observed this to be the least demanding of the majority of the dress structures to collect. There is a helpful handle on the remain for changing stature, taking the tallness in the vicinity of 51.2'' and 66.2'', an extensive territory for a dress shape in this class. Our scientists revealed this was a sturdily assembled dress shape but on the other hand was lightweight and effectively moveable.

The manual was useful and simple to peruse, we had the thing gathered in the blink of an eye. A kid could gather it, and ideally, some will.

All parts are numbered and particular advances are appeared in clear outlines that were effectively comprehended. The surface material was smooth and of good quality and tidied up pleasantly. This dress frame was exceptionally reasonable.

Check client surveys on Amazon

Itemized Survey

best dress frame: New to the universe of dress structures? Indeed, you realize what to pick!

There were various things we thought made this a perfect dress shape for learners, the best being the cost. An emerge in its range, we attempted to discover anything that went after a similar cash.

Other awesome focuses about this best dress shape for apprentices were that the froth held sticks well, the variable material spreads were all decent (there were 6 distinct examples accessible) and could be changed effectively to suit various diverse pieces of clothing.

This is an overall dress frame that should consider every contingency for any genuine or novice amateur.

The wooden development felt like it would withstand a ton of utilization and was sufficiently light for movement or simple moving around the studio.

The frame was attractive yet not all that much, bunches of various apparel styles fitted and looked great on it.

Outstanding amongst other parts for our group was the simplicity with which it went together. We took it out the crate, took after the plain clear directions and voila! There it was, prepared to utilize. Everything you need from your first dress shape.

Novices shouldn't need to battle with inconvenient or substantial dress structures or discover their pins dropping out constantly. When we think back on what we began with here, if something like this had been near, we'd have snapped it up. For what you'll pay for it, you won't locate any better.

Aces:

Extremely moderate deal cost

Lightweight

Variable materials

6 designed spreads accessible

Exceptionally customizable

Eye-getting

Astounding directions

Simple gathering

Great froth covering

Ideal for an apprentice or smaller than usual business

CONS:

Lightweight means it will fall over more effortlessly

Wooden base wasn't as wide as a few

Vocalist 12-Dial Customizable Dress Frame

This dress shape from Vocalist brags of best quality with its lightweight yet solid development, movability, smooth dials, and is basically worked to last.

Why this item is Our Propelled Pick?

This is for the genuine players. Amid our examination, we found this was appraised most astounding for the quantity of cutting edge highlights accessible. As it were, this does everything.

It's expensive, however not irrationally so. For something as flexible and high caliber as this, you can hope to pay some great cash. Not for a kid, except if they're an extremely uncommon tyke!

It has 12 change dials for getting precisely what you require out of the frame.

The neck, middle, hip, abdomen, bust, and tallness all change over an expansive range. It accompanies an exceptionally helpful trim check and seasoning connection. Being lightweight and rustproof, this dress shape was intended for the whole deal. Except if the hefty size dress structures are made accessible, getting this one wouldn't be an awful decision by any stretch of the imagination.

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Itemized Survey

best dress frame: If flexibility and quality is the thing that you require, go for this one

We had high trusts in the Artist 12-dial and they were satisfied. This dress frame meets the quality guidelines we've generally expected from Artist. The scope of the bust was 39" to 45", the abdomen 30″ to 36-1/2", the hip 40-1/2" to 46", and the neck 13-1/2" to 18".

This was all that anyone could need for anything we could think to put on there. It balanced easily with no squeaking or adhering and felt great to work. We set up it together with almost no exertion and were promptly awed with the quality feel of the shape.

The covering material was a lavish red and high caliber. The froth underneath was sufficiently thick for our sticking applications and held exceptionally well.

This is a dress shape that seems as though it should last, it's exceptionally well made. The stand is solid and can take a reasonable beating, and also being sufficiently wide to stop the lightweight body toppling over. The dials all held set up without slipping and were sufficiently delicate to make little alterations, ideal for the fussbudget in each one of us.

As a fashioners instrument, we couldn't be more satisfied with this dress frame. It will cover such a significant number of various sizes and extents we needn't stress over in the case of something will fit. The vast majority wouldn't utilize a customizable dress frame to show however after all other options have been exhausted, this would carry out the activity superbly. It views quality that is difficult to beat.

This dress shape will set you back in excess of a great deal of others, however it must be viewed as a decent speculation. It'll keep you dressmaking, outlining, changing and repairing for a long time, though a more second rate item may must be supplanted in that time.

Experts:

High form quality

Lightweight

Exceptionally customizable

Smooth dials

Cool shading

Incredible materials

Quality froth

Rust proof

CONS:

Costly deal cost

Could be excessively change for a few

Dritz Sew You Dress Frame

This dress frame from Dritz brags of a high scope of flexibility with smooth dial activity, great quality form and lightweight shape, and is consummately suited for the master sewer.

For under $100, this a reasonable decision. Regardless of whether it is a shoddy sewing machine, a weaving machine or a dress frame, cost isn't generally equal to the quality you get. It has 9 changing wheels at the hips, midriff and bust and two auto-setting dials at the bust and midsection. So it's an adaptable dress frame. A pleasant touch is a pincushion in the customizable neck, this is constantly helpful and stops us losing our pins very to such an extent. Where do they all go at any rate?

The stick steerage marker worked pleasantly, so did the stature agent. We didn't know about the opal shading on the cover however it's removable and replaceable so this shouldn't be an issue.

The measurements are: 33-40 inches bust, 26-33 inches abdomen, 36-42 inches hips, 15-17 creeps back length, and14-17 inches neck. So it will change in accordance with generally measurements one might need.
This dress shape felt strong and well made, the base was sufficiently wide that we didn't thump it over. Every one of the dials turned easily and could be balanced with exactness. They didn't slip or stick, dependably an or more.

The cover material was high caliber and appears as though it could withstand some utilization. We generally like a lightweight dress frame yet this one didn't appear as though it could take a substantial outfit. When we were sticking we could just stick sideways, yet that will be normal on a flexible frame. We felt this was suited to more experienced piece of clothing laborers, novices should look somewhere else.

Experts

High scope of customizability

Great quality form

Lightweight

Smooth dial activity

Pincushion in the neck

Reasonable deal cost

Tough

CONS

Thin froth

Could be excessively costly for a few

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NO 7: NEW FEMALE JERSEY DRESS Frame WITH BASE AND NECKTOP Audit

Sweet Pick

item

New Female Jersey Dress Frame by Just Mannequinsâ®

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Eye-getting base on fiberglass body

New Female Jersey Dress Shape by Just Mannequinsâ®

This New Female Jersey dress shape is a chic frame with its normal wood flexible stand. Simple to gather and lightweight, it accompanies a decent cost for those on a financial plan.

The base on this dress shape is super awesome, and for a lower valued item it looked and could rest easy. These are the measurements: bust: 34″, midriff: 26″, hips: 35″, width: 17 inches shoulder to bear. The tallness of the middle is 27.5 Inches. Consolidated tallness: 4'4″-5'10".

So it's a decent, normal size and a genuinely nonpartisan female body shape, not very well endowed. It drew the eye pleasantly and could hold an assortment of garments styles well.

We collected this dress shape without any issues at all, the manual was great and we called the client benefit, just to perceive what they resembled. They were benevolent and accommodating, dependably a decent sign.

This dress frame is made of fiberglass with a thin froth covering and fabric for the covering. More profound froth would have been useful for coordinate sticking, and as this isn't a flexible frame (aside from tallness), it should have further froth.

It is lightweight, in any case, making stacking in and out or moving it around simple. The base was a decent help, it looks breathtaking as well.

Marginally too little to stop it toppling in the event that you give it a decent thump, however it did the activity alright. It's a decent value, it'll improve the situation those on a financial plan.

The cover wasn't removable, to the extent we could tell, and with a white shading, it could before long look messy. The complete on the wood was impeccably worthy. We preferred this item, however it didn't motivate us.

Experts

Low cost

Pleasant shape

Simple gathering

Lightweight

Cool looking base

CONS

Thin froth makes coordinate sticking outlandish

Can topple over effortlessly

Cover not removable

Shape won't not be for a few people's taste

White Female Mannequin Dress Frame by Just Mannequinsâ®

This dress frame emerges for its tasteful shape and lightweight development, and is anything but difficult to amass. It accompanies a second post for pants, as well.

With estimations of 28 Creeps for the middle, a shoulder width of 14.5 inches,

bust: 35 inches, midriff: 24 inches and hips of 33 inches, this is a thin lady's dress frame with a major bust and enough midsection to hang jeans or slacks.

The base is 4.5 feet wide and is movable to 6 feet, so it won't topple so effectively. There is a second shaft to include an abdomen for hanging jeans or slacks.

The wooden development on the base gives it a tasteful look, as does the hued band around the midriff.

Fiberglass development makes it exceptionally lightweight, and the froth was appropriate for whatever sticking we attempted. Fabric covers the frame and feels smooth and quality.

We preferred its straightforwardness, it functioned admirably and collected effectively out of the container.

The changes worked easily, however they had a feeling that they weren't as high caliber as some we've investigated. It looks great so can be utilized for show and in addition repairs, changes, hanging, and hanging.

We found that overwhelming outfits could make it topple, yet that is a direct result of its lightweight development.

A noteworthy in addition to is the value, it's a super, cool-looking dress shape for the cash. The adornments looks particularly great against this frame.

Stars

Awesome esteem

Great, tasteful look

Decent fabric

Lightweight

Amassed effortlessly

Second post for pants

CONS

Shallow froth

Second post didn't feel as great quality

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White Female Mannequin Dress and Slacks Shape

This dress shape is lightweight and simple to amass, with a decent white frame and wooden neck end and base that looks tasteful at its cost.

The shape on this dress frame was somewhat all over, it didn't have a predictable subject to the extents. In any case, that is our feeling, you may like it.

It had a stature with its base of 49 inches (4 foot 1 inch to 65 inches, or 5 foot 5 inches tall). The middle estimated 29.6″, from mid shoulder to mid shoulder it was 14.2″, the bust estimated 35″, over the abdomen was 26″, the hips came to 34″ and the extent of the base estimated 17.6″ by 14.6″.

That is a tremendous failure to midsection proportion. Be that as it may, it may carry out the activity.

The froth was thin, so no immediate sticking here, and the body was a lightweight fiberglass so can topple over.

Then again, it can be transported effectively and the white texture cover looks great against the wooden edge and neck-end.

The tallness balanced without any issues, however it felt somewhat broken-down. The second post included considers slacks and jeans to be fitted alongside your tops, which is exceptionally useful for perceiving how an entire arrangement of garments can look.

This dress frame came shoddy, we like that.The manual functioned admirably, no issues there.

The post was removable, so we took the frame off and it glanced great around our studio. It adjusted alright without anyone else. The base was made of tough wood and can take a kicking, however it could be too little for some cumbersome or oblivious people.

It did fine in our studio.

We enjoyed that the cover fell off, an absolute necessity with white dress structures. Fingers leave buildups that show up effectively against the white.

Stars

Shabby

White and wood looks tasteful

Removable second post for jeans and slacks

Removable and launderable cover

Customizable stature

Lightweight

CONS

Unstable on its feet some of the time

Thin froth anticipates coordinate sticking

Odd shape

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NO 10: WHITE FEMALE DRESS Shape ON Dark TRIPOD STAND Measure 2-4 Survey

Useful Pick

White Female Dress Shape on Dark tripod

Another very much estimated dress shape that is anything but difficult to gather, lightweight, with enormous bust and removable spreads. The white frame and dark wooden base makes a stunning mix.

Another low estimated yet attractive dress frame, this has a short body (middle tallness: 27″. shoulder to bear width: 14″ bust: 35″ midriff: 24″. hips 33″).

Lamentably, it has a thin layer of froth, so where coordinate sticking would have been valuable for heavier articles of clothing, just side sticking was conceivable.

Straight out of the crate it collected effectively and the manual offered a decent arrangement of guidelines. The gold belt may be a bit bling for a few however is effortlessly expelled.

The neck cover falls off, as does the primary body covering, making swapping them out or washing them truly bother free.

A portion of the sinks the base weren't threading legitimately however they held alright. The dark wooden base looked exceptionally cool with the white body.

Made of fiberglass, it is a dress frame that could be lifted by a tyke and pushed over by a grown-up. It's an exchange off between simplicity of transport and strength, and this dress shape compromises with genuinely well.

It looks great to us, the body is a customarily alluring female shape that will suit a ton of dressings or hangings.

This dress frame had an odd scent however it left. It was presumably the bundling, the shape itself noticed fine following multi day or two.

The cost was great, it is anything but a noteworthy speculation yet it was well made generally speaking and useful. Actually, it won't be a terrible decision regardless of whether you're simply beginning your own weaving business.

Stars

Very much valued

Huge bust

Simple get together

Great directions

Removable spreads

Cool white body

Dark wooden stand looks extraordinary

Lightweight

CONS

Thin froth, won't stick and also thicker froth

Screws weren't fitted legitimately on the base
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