6 Ways to Build a Better Body on a Budget

6 Ways to Build a Better Body on a Budget
Lean times don't mean you have to skimp on fitness. Try these suggestions for workouts and home gym equipment on the cheap.
By Colette Bouchez

FeatureReviewed by Louise Chang, MDGym memberships, personal trainers, pricey equipment for the home gym - all these expenses can make it tempting to use tough economic times as an excuse for avoiding exercise. But the truth is that you can build a better body on a budget. From simple workouts with no equipment, to getting some of the benefits of a trainer for free with the click of a mouse, there are lots of ways to stay in shape and still save money.

To help point you in the right direction, WebMD asked the experts for advice on how you can get fit for little or no money.

6 Ways to Build a Better Body on a Budget
1. Schedule Your Workouts
When you've got a membership to a high-tech gym or a standing appointment with a personal trainer, the expense means you're less likely to skip out on workout time. Experts say it's essential to approach your "no frills" workout with the same convictions.

"This means putting it on your schedule, making a specific time for when you're going to do your workout, and it means doing all you can to limit interruptions -- like turning off the phone, making sure the dog is walked before you start, and, if necessary, letting family members know that for 30 minutes or so, they are on their own," says Susie Shina, director of FitnessOneEighty.com and author of 60-Second Circuits: 1,000 Easy Exercise Combos You Can Do Anywhere.

You can also help keep your workout on track by laying out your exercise clothes the night before, says Shina. "This acts as a reminder that you don't want to skip out on your session."

What can also help: Choose a playlist of your favorite exercise songs and load them into your mp3 player, or create a workout CD. Timing the music to fit the length of your workout will help keep you on track for the whole routine.

"Motivation and music go hand in hand, so again, it's another way to ensure you stay motivated," says Shina.

2. Choose Workouts That Work at Home
When you're starting a workout program, it can be hard to figure out what exercises you should be doing -- particularly if you don't have the budget for pricey equipment or personal training advice.

But all you really need to do, says Charla McMillian, JD, CSCS, is follow a few simple guidelines.

"You have to ensure that all your major muscle groups are targeted at least once each week -- and no more than three times a week, and your program has to include 30-60 minutes of moderate to vigorous aerobic exercise three to five times a week," says McMillian, creator of FitBoot.com, a training program for fitness professionals.

And don't forget to stretch, which helps with both strength and flexibility.
2. Choose Workouts That Work at Home continued...
"Always begin every workout with a few simple stretches, and always end with at least two to three minutes of stretching," suggests Adrian Garce, a Greenwich, Conn.-based personal trainer.

McMillian and Garce suggest these basic, no-equipment exercises to get you started:

Squats. Standing upright, feet wider than shoulders apart, with arms extended forward or hands on hips for balance, squat down. Push knees outward as you descend, until thighs are parallel with the floor. Continue pushing knees outward as you stand.
Partial-body push-ups (with knees on the floor).
Modified jumping jack. Instead of moving your arms over your head, do these while pressing the palms of your hands together at chest level, with elbows out to form a straight line.
Chair crunches. Sit on a chair with hands under your behind, arms straight, and fingers facing inward toward one another. Contract your pelvis and lower abs, and, keeping your knees bent at a 90-degree angle, lift your feet off the floor and tuck your knees in toward your chest, bending the upper body slightly toward your knees. Do as many as you can until you reach fatigue.
Chair dips. Place your hands on the side of the chair and wrap your fingers around the edge. Scoot forward until your bottom is on the edge of the chair and your arms are fully extended. Keep your feet about 3 inches apart with legs extended, so knees are at approximately 150 degrees with your heels grounded. With elbows pointed back and tucked in tight alongside the body, do 15-20 dips, 3 seconds down and 1 second up. Keep your chest up and your shoulders back.
3. Turn Your Housewares Into "Gymware"
Your home may already be a home gym. Experts say if you think outside the (treadmill) box, you'd be surprised at how many household objects can be substituted for fitness equipment.

Here are few suggestions:

Use soup cans for weights. Janet Lee, deputy fitness editor of Shape magazine, says that any triceps or biceps exercise you'd do at the gym with dumbbells, you can do at home using cans of soup. To properly gauge the weight, don't go by the ounces listed on the can -- that's liquid weight. Instead, weigh the cans on your scale to figure out the poundage that's best for you.
Use jugs as weights.Fill a household bucket or jug with water (or sand, rock salt, or powdered detergent), secure the top with duct tape. Lift it up and down in front of you as you do squats.
Substitute paper plates for body sculpting equipment. The key here, says Lee, is to use the plates to help your body slide on a carpet. This allows you do body sculpting moves that would ordinarily require workout equipment. You can do the sliding lunge (put the paper plate under one foot and lunge forward). Try stimulating skating to work your butt and thighs: Just attach the plates to your feet with rubber bands and slide away. Or, get down on all fours, put the plates under your hands, and use them to work your chest by sliding your arms back and forth.
Substitute a countertop for a push-up bench. In most homes at least one countertop, in the kitchen or bath, is the right height for a push-up. Put both hands on the countertop, extend your legs behind you at an angle, lean down into the counter and then push back up.
Substitute pantyhose for resistance bands. Almost any exercise you can do with a resistance band, you can do with old pantyhose or tights. For example, sitting on the floor with legs straight, loop a pair of pantyhose around the balls of your feet and pull back with both hands as if you were using a rowing machine.
4. Use Your Computer for Motivation and Help
Do you tend to work out better when someone is setting goals for you? Then don't overlook the power of your computer - and many free applications that can provide some of the stimulation you need.

You can find exercise-tracking tools and spreadsheets on a number of websites. Use them to create and maintain a training regimen, keep track of your progress, and even to share online with friends, family members, and fellow exercisers.

For how-to instructions for specific exercises, check out WebMD's fitness slideshow, including those illustrating a 30-minute workout and abs exercises.

Further, video sites like YouTube.com are full of free videos from exercise gurus willing to share their know-how. Some other sites offer free workouts to download to your mp3 player. However, the experts warn, you shouldn't take advice from just anyone.

"Make sure the fitness instructor is qualified. There is a lot of questionable advice out there, even on DVDs you purchase, so always make sure the advice is coming from someone certified by a reputable fitness organization," says Therese Pasqualoni, an aerobics instructor and director of StrikeItHealthy.com.

5. Take a TV Exercise Break
Here's a no-excuses, no-expense workout: Instead of going to the kitchen for a snack during TV commercials, exercise instead.

"Pick a different activity for each commercial and do it till the show comes back on," suggests Shina. "During one commercial, do crunches; during another, do squats; during another, march in place. The longer you watch TV, the more exercise you'll get in, and before the night is over you've got at least 15 to 20 minutes of workout time."

6. Spend a Little, Get a Lot
If you do have a few dollars to put toward building a better body, here is the fitness equipment experts say can give you the most benefits for the least amount of money:

A dumbbell set that represents a realistic range of what you need to lift (5-30 pounds for most women, 10-50 pounds for most men)
An adjustable weight bench (one that goes from flat to incline or decline)
A mirror for the wall so you can see your technique
Kettle bells -- hand weights that can be used to tone your entire body
Resistance bands, a type of rubber tubing that creates resistance for your muscles
Instructional DVDs
Stability ball
Step bench for step aerobics

SOURCES:

Susie Shina, personal trainer; founder and director, FitnessOneEighty.com; author, 60-Second Circuits: 1,000 Easy Exercise Combos You Can Do Anywhere.

Charla McMillian, JD, CSCS , NSCA-certified strength and conditioning specialist; director and founder, FitBoot.com.

Adrian Garce, personal trainer certified by the National Academy of Sports Medicine (NASM) and International Fitness Professionals Association (IFPA) for functional training; Bosu integrated expert certified by ECA World Fitness.

Janet Lee, deputy fitness editor, Shape Magazine.

Therese Pasqualoni, fitness trainer; director, StrikeItHealthycom.

Reviewed on October 15, 2008

Bipolar Disorder: What you Need to Know

8 Myths About Bipolar Disorder
Bipolar disorder is on the rise, yet myths persist. Experts separate the facts from the fiction.
By Kathleen Doheny

FeatureReviewed by Brunilda Nazario, MDBecause of increased awareness and diagnosis, more people than ever before have a basic understanding of bipolar disorder, the condition formally known as manic depression.

Yet myths persist about this mental disorder that causes mood shifts from depression to mania and affects a person's energy and ability to function.

WebMD asked five bipolar disorder experts to help unravel what's myth and what's fact. Read on for the eight common myths about bipolar they often hear from patients and the public.

(What myths have you had to deal with while living with bipolar disorder? Talk with others on WebMD's Bipolar Disorder: Support Group board.)

Bipolar Myth No. 1: Bipolar disorder is a rare condition.
Not so, according to statistics and research. In a given year, bipolar disorder affects about 5.7 million American adults, or about 2.6% of the U.S. population 18 and older, according to the National Institute of Mental Health.

Estimates for children and teens vary widely, partly because there is debate about the criteria for diagnosis, say Thomas E. Smith, MD, a research scientist at the New York State Psychiatric Institute and an associate professor of clinical psychiatry at Columbia University College of Physicians and Surgeons in New York.

But the Child and Adolescent Bipolar Foundation estimates that at least three quarters of a million American children and teens may suffer from bipolar disorder, although many are not diagnosed. A recent study by researchers from Columbia University and elsewhere showed the diagnosis of bipolar disorder is up dramatically in children and teens and is also on the rise in adults.

When the researchers looked at the number of office visits with a bipolar disorder diagnosis in 1994-1995 and 2002-2003 in the U.S., they found that the number of office-based visits increased 40-fold for children and nearly doubled for adults from the first time period to the second.

Bipolar Myth No. 2: Bipolar disorder is just another name for mood swings.
Not so. The mood swings associated with bipolar disorder are very different than those of people without the condition, says Matthew Rudorfer, MD, associate director of treatment research in the division of services and intervention research at the National Institute of Mental Health in Bethesda, Md.

"The mood swings of bipolar [disorder] are more severe, longer lasting, and maybe most significant of all, they interfere with some important aspect of functioning, such as ability to work at one's job, or manage one's home, or be a successful student," he says.

The mood swings of a person with bipolar disorder, experts agree, are far more severe than, say, a person without bipolar disorder being bummed out because rain spoiled the weekend plans or weight loss efforts aren't showing the desired results.
Bipolar Myth No. 3: People with bipolar disorder shift back and forth from depression to mania very often.
The Jekyll-Hyde personality, the type that can turn on a dime from sad to euphoric, is a myth about bipolar, says Gary Sachs, MD, director of the Bipolar Clinic and Research Program at Massachusetts General Hospital in Boston and associate professor of psychiatry at Harvard Medical School. ''The average bipolar patient will be depressed more often [than manic]," he says.

There are people with bipolar who will shift back and forth more quickly than others, Sachs says. But that's not the typical pattern, he says. "For the most part what is typical is to have an abnormal mood state colored by a predominance of high or low.''

What's an abnormal mood state? Something intense or unexpected in relation to a situation, such as giggling instead of crying when you find out your home will be foreclosed, Sachs says.

Bipolar Myth No. 4: When they're in the manic phase, people with bipolar disorder are often very happy.
True for some, experts tell WebMD, but not for others. And a person with bipolar disorder may enter the manic phase happy but not stay that way. "The hallmark of mania is a euphoric or elevated mood," Smith says.

But, he says, "a significant number of people become edgy and irritable as the mania progresses."

"Many people are actually frightened when they go into mania," says Sue Bergeson, CEO of the Depression and Bipolar Support Alliance in Chicago, a patient-run mental health organization. "When you are moving into mania, you are losing control of your actions and thoughts," she says. Patients often complain they can't sleep, too.

A person in a manic phase may go on spending sprees, use poor judgment, abuse drugs or alcohol, and have difficulty concentrating. Sexual drive can be increased and behavior can be "off" or out of character for what is normal for them.

It's crucial, Smith says, to treat a manic phase (typically with mood-stabilizing drugs). If untreated, it can progress from an elevated mood to euphoria to extreme disorganization and other common signs of mania -- lack of sleep, increased energy, and disorganized behavior that interferes with relationships, he says.

"I don't think people look forward to manic episodes," Smith says. "When you are not manic, you can look back and see how disruptive your life became."

Smith advises bipolar disorder patients to know their early signs of a manic or depressive episode so they can get additional treatment promptly.
Bipolar Myth No. 5: There is a bipolar test.
Not true. In early 2008, an at-home bipolar test, sold over the Internet, made headlines. But the test only tells users whether their genetic makeup puts them at higher risk of having or getting bipolar disorder.

The bipolar test evaluates saliva samples for two mutations in a gene called GRK3, associated with the disorder. But it can't tell users for sure.

Today, a diagnosis of bipolar disorder depends on a doctor taking a careful patient history, asking about symptoms over time. A family history of the disorder increases a person's chances of getting it.

Bipolar Myth No. 6: Bipolar disorder can't be diagnosed until age 18.
Not true, says Sachs. But it is true that it's more difficult to diagnose it in some people than in others, because of varying patterns of the disorder.

And typical childhood behavior -- such as having a tantrum and recovering quickly to go to a birthday party -- can also make it difficult to diagnose the condition in children.

"There are clearly cases of children who have classic presentation in the early childhood years," he says. But if a child does not have a classic pattern, it's usually more difficult to make the diagnosis.

Even so, the disorder may be present but not diagnosed until later, he says. According to the National Institute of Mental Health, the median age of onset for bipolar disorder is 25 years old (half are older, half are younger).

But Sachs says many adult patients report having symptoms before age 18, whether they were officially diagnosed or not.

Bipolar Myth No. 7: People with bipolar disorder should not take antidepressants.
Not true, says Smith, who explains where the myth originated. "There's a concern, and it's valid, that some people who are depressed and bipolar, if they take antidepressants ... could flip into a mania."

The thinking, however skewed, is that the mood will be elevated too much and mania will result. Although the concern has some validity, Smith says, "that does not mean you should always avoid antidepressants." Sometimes, he says, people need the drugs, especially if the depression persists.

In a study published in The New England Journal of Medicine, Sachs and his colleagues randomly assigned 366 patients with bipolar disorder to a treatment of mood stabilizer drugs and placebo or to mood stabilizer drugs and an antidepressant, following them for up to 26 weeks.

They found no differences in adverse effects, including a shift from depression to mania, between the two groups.

Bipolar Myth No. 8: Aside from taking medication and engaging in psychotherapy or "talk therapy," a person with bipolar disorder has few options for controlling the condition.
Not true. "Medication and therapy are important," says Ken Duckworth, MD, medical director of the National Alliance on Mental Illness. But paying attention to lifestyle can help, too, he says.

"Active" strategies, such as getting regular aerobic exercise, keeping a regular bedtime, eating a healthful diet, and paying attention to personal warning signs that a shift to depression or mania is coming can all help a person manage bipolar disorder, he tells WebMD.

"If people know their warning signs, they can stave off disaster," Duckworth says. For instance: If a person with bipolar knows he starts to wake up at 4 a.m. when he is shifting to mania, he can pay attention to that pattern, Duckworth says, and promptly seek medical help.

Sources:

Ken Duckworth, MD, medical director, National Alliance on Mental Illness, Arlington, Va.

Matthew Rudorfer, MD, associate director of treatment research, division of services and intervention research, National Institute of Mental Health of the National Institutes of Health, Bethesda, Md.

Gary Sachs, MD, associate professor of psychiatry, Harvard Medical School; director of the Bipolar Clinic and Research Program, Massachusetts General Hospital, Boston.

Thomas E. Smith, MD, research scientist, New York State Psychiatric Institute; associate professor of clinical psychiatry, Columbia University College of Physicians and Surgeons, New York.

Sue Bergeson, CEO, Depression and Bipolar support Alliance, Chicago.

National Alliance on Mental Illness: "True or False? The top 10 Myths About Bipolar Disorder."

National Institute of Mental Health: "Bipolar Disorder."

WebMD Feature: "At-Home Bipolar Disorder Test: Help or Hindrance?"

Child and Adolescent Bipolar Foundation: "Pediatric Bipolar Disorder Fact Sheet."

Reviewed on August 01, 2008

The Faces of Brain Cancer

The Faces of Brain Cancer
Three survivors of brain cancer similar to that affecting Sen. Edward Kennedy tell how they're coping.
By Kathleen Doheny

When doctors announced that Sen. Edward Kennedy had a kind of brain cancer called malignant glioma, many people hearing the news had probably never heard of the cancer.

For some, however, the diagnosis was painfully familiar. WebMD talked to three survivors of brain cancer similar to that affecting the senator, including two who have survived it for more than 10 years. Their advice to Kennedy: Don't listen to statistics, and don't give up hope.

Here are their stories:

Jim Owens
Jim Owens, 46, Minneapolis, vice president of an engineering and construction firm for air conditioning and heating. Diagnosed originally with oligodendroglioma of the right parietal lobe in 1998; five recurrences since then, with diagnosis revised to a mixed or malignant glioma.

A long-time athlete, Jim says his love of sports, as well as his love for his wife and young son, now 8, keeps him fighting.

The first symptom came out of the blue. "I was training for a marathon and had a seizure at the end of a workout," he says of that day in 1998, right before the tumor was found. "I had no idea what it was. Half my body went numb."

Thankfully, friends who were with him insisted he go to the hospital immediately, despite his protests that he was fine and it was nothing. After a battery of tests, Jim was told nothing that night. "It wasn't until early the next afternoon the doctor said, 'It's bad. You have a brain tumor.'"

He was taken into surgery, but then there was more bad news: "The tumor was wrapped around the motor strip," says Jim, referring to the band running down the lobe of the brain that controls bodily movements.

So they presented the next options: radiation and chemotherapy.The tumor began shrinking, and Jim kept fighting. He got married. A year after the diagnosis, he competed in the Ely Wilderness Trek, a 15-kilometer cross-country ski race. "I finished, but it wasn't pretty," he says, laughing.

He and his wife, Barb, welcomed a son, Max, in August 1999.

Jim has had multiple recurrences, beginning in January 2003, fighting each time by seeking out multiple opinions, agreeing to join a clinical trial, and taking drugs approved for other cancers that might help his."Every time I would have a recurrence, it would take a couple days to get myself standing up straight again," he says.

He found renewed resolve each time."The cancer is not going to run my life. I am going to reclaim my life and live my life."

"I'm having the best spring I've had in years," he says. With his brother, he is training for the Ride for Roses in Austin in October, an event sponsored by the Lance Armstrong Foundation. In 2004, he rode with Armstrong, a cancer survivor, on a coast-to-coast benefit bike tour.
To help others, he blogs and posts info on his own web site, Jim's Journey.

This spring is especially sweet because of his latest MRI results, Jim says. "I've had two MRIs in a row and we have heard the word 'reduction,'" he says, meaning the tumor is shrinking again. "We haven't heard that word since 2003. I'm so thrilled and so happy."

To Kennedy, he would say: "Have hope. You are going to have a lot of statistics thrown at you. Don't listen to the worst-case scenario. Look at all your options, including new drugs. The biggest thing is to really have hope."

Maria Hartmann
Maria Hartmann, 59, Miami, Fla. Diagnosed in 1998 with malignant glioma.

"I was at my house, with my mother-in-law, and the World Series was on. My husband was at the game."

The seizure hit."I was convinced I was epileptic," Maria says. The battery of tests run on her once she was rushed to the hospital suggested otherwise. The doctor told her she had a glioblastoma.

The surgeon at the University of Miami removed what he could and inserted a thin wafer to deliver chemotherapy.

"After that came conventional chemo and radiation twice a day," Maria says. "I was 49."

"I told myself, either I live or I die. I knew I was not going to die. I had a lot of faith. I am very strong. I said, 'I am not going to let this get me.'"

Part of that strength, she says, comes from her immigrant parents. "I was born in Cuba, and I came with my parents as a political refugee. It took a lot of guts for my family to leave everything and come here. I say, for my sister and myself, that was our first lesson in courage. My parents were very strong; I never heard any complaints in our house. They gave us strength."

At the same time as she was fighting her brain cancer, her brother-in-law was fighting stomach cancer. "My sister kept saying, 'I cannot lose my sister and my husband at the same time.' My surgery was in January 1998. I went with him to all his chemo and radiation. He died in May 1998."

When Maria's 25th wedding anniversary came around, she was still in chemo. She told her husband where she wanted to go -- Lourdes, a Christian pilgrimage destination. Her son, now 30,and daughter, now 28, went along.

"It's a place of inspiration," she says. "Everyone is looking for a cure.The waters are cold. There is nothing in the water, it is just our faith. There is a big tank of water where you submerge. I couldn't go in beyond my knees. '''

"I only wanted strength -- strength to endure whatever I had to endure."She has had good news. "It's been five years or more that the MRI came back with no change."

"I would tell Sen. Kennedy not to give up. I wrote him a note, [advising him] not to listen to statistics. Because many things can happen."

"I believe my recovery is a miracle."
Sara Bennett
Sara Bennett, 60, office supply store employee, Elyria, Ohio. Diagnosed May 7 with left temporal lobe glioblastoma.

In her work for a large chain office supply store, Sara shows customers how the machines work. "I never had any problem when a customer was coming in to make a purchase. I could tell them anything about the product."

Suddenly, that changed. "I'd be explaining a printer to a customer and halfway through the conversation, I'd lose my thought, I couldn't explain it."

Beginning in March 2008, she began to notice daily headaches, not typical for her.

By early May, she took a week off and got herself a thorough physical, a CT scan, and an MRI.

Her doctor then sent her to the Cleveland Clinic, where she got the bad news.

She underwent surgery in early May, and then during a checkup in the doctor's office had seizures. Looking back, she realizes she had suffered seizures while working at the computer.

Soon, she will start radiation and chemo.

A widow who lost her husband in 1999 and has eight grown children, she is still in good spirits."I don't get down, I don't let myself get down. It's like I have an inner peace. The doctors and everyone I have talked to have been very honest. They have explained things 100 percent."

Her religious faith helps keep her calm, she says. What also helps? She is convinced that "my husband has been watching out for me. That may sound strange to some people."

But she believes it is true.

Kennedy's strength -- some of it, unfortunately, from dealing with so many family tragedies -- will keep him going, Sara says. "He seems to have a very good outlook."

Expert Q&A: A Healthy Diet for Type 2 Diabetes

Expert Q&A: A Healthy Diet for Type 2 Diabetes
An interview with Hope Warshaw, MMSc, RD.
By R. Morgan Griffin

FeatureReviewed by Louise Chang, MDHere's some good news: Healthy eating can have a dramatic impact on the symptoms and progression of type 2 diabetes and its frequent precursor, prediabetes. But the problem is that there's a lot of conflicting information out there. Just what does healthy eating with type 2 diabetes really mean? No sweets? Scheduled snacks? Low-fat, low-carb -- or neither?

To help guide you, Let's turned to Hope Warshaw, MMSc, RD, CDE. She's been a dietitian and diabetes educator for almost 30 years, and is the author of numerous books on the subject, including Diabetes Meal Planning Made Easy, published by the American Diabetes Association.

How does a healthy eating plan for someone with type 2 diabetes differ from what everyone else should be eating?
It doesn't. The nutrition recommendations from the American Diabetes Association echo the healthy eating guidelines for the general public. Everyone should be eating more whole grains, fruits, and vegetables and less saturated and trans fat. Remember that the type of fat matters to your heart and blood vessels. We've moved away from recommending a strict low-fat diet and shifted toward an eating plan that allows for a moderate amount of fat, provided you choose healthier fats, like monounsaturated and polyunsaturated fats.

If you have diabetes and are trying to lose weight, don't take the drastic diet approach, like a low-carb diet. It might help you lose weight in the short-term, but there's not good evidence that it will help you keep it off. Here's my point: You're going to have diabetes for the rest of your life. You need to be thinking about minor doable changes in your eating habits that you can really maintain. Even small steps towards healthier eating result in big rewards, like lower blood glucose and improved blood pressure and lipids.

You also don't need a special diet to tell you how to eat healthy. Most people -- especially people reading WebMD -- already know. The big challenge is actually doing it day after day, year after year.

What is the connection between diabetes and heart and blood vessel diseases?
The connection is huge. It is said that diabetes is a cardiovascular disease. But lots of people haven't realized it yet. They worry more about diabetes affecting their eyesight and kidneys. Yes, that can happen. But the fact is that people with diabetes suffer and die much more from heart and blood vessel disease. That's the real issue.

This is the key reason there's been a big change in the focus of diabetes management. It's no longer just about glucose control. It's at least -- if not more -- important for people to focus on controlling blood pressure and blood lipids, particularly LDL cholesterol. By the time someone gets diagnosed with diabetes, he or she may have already been living with serious risk factors for heart and blood vessel disease for years.
What is prediabetes and what should people do if they're diagnosed with it?
Prediabetes is an in-between stage -- blood glucose is higher than normal but not high enough to fit the diagnosis of diabetes. The diagnosis of prediabetes should be a clear message that you're currently on the road to type 2 diabetes. If you don't take action now, you have a greater than 70% chance of developing type 2.

But this doesn't need to happen. Results from several studies, including the Diabetes Prevention Program, suggest that a small amount of weight loss -- 5% to 7% of your body weight combined with 150 minutes a week of physical activity -- can help slow down the progression. If you catch it early and do something, you can really have an impact on either preventing or delaying the onset of type 2.

What is the relationship between being overweight and type 2 diabetes?
It's a pretty direct relationship. About 80% of people with type 2 diabetes are overweight. Excess weight leads to insulin resistance, and insulin resistance leads to elevated blood pressure, abnormal blood lipids and diabetes.

Do people with type 2 diabetes need to eat snacks throughout the day to control their glucose?
No, but there's a lot of confusion about this. Experts used to tell people to eat snacks because the only medications we had to treat high blood glucose levels could cause the side effect of hypoglycemia, or low blood glucose. Regular meals and scheduled snacks were a way of limiting the problem. But now there are several newer medicines that lower blood glucose without that side effect. Plus, people have blood glucose meters and can check their glucose at any time.

If snacking is your natural way of eating, there's nothing wrong with one or two snacks a day. For instance, if a healthy snack in the afternoon -- like an apple and some reduced-fat cheese -- prevents you from being so famished at dinner that you gorge yourself, go ahead.

But people with diabetes should ditch the idea that they need to eat snacks. It can be counterproductive. Some people find all the snacks really inconvenient. Other people sit down for a snack and overeat, or they make unhealthy choices because they don't have anything better around.

Can people with type 2 diabetes eat sweets?
Yes, people with diabetes can enjoy sweets. There's an old idea that sweets are verboten for those with diabetes, but that's no longer correct.

It's true that the carbohydrates in sweets can raise your glucose levels, but an equal amount of starch would have similar effect. I don't think people with diabetes need to run around looking for sugar-free candies or insist that their families bake them sugar-free deserts.

However, you have to be smart about sugary foods and sweets. Sweets pack in a lot of calories and they tend to be high in fat, particularly in unhealthy saturated fat. So anyone with diabetes needs to be careful about how many they eat.
Can people with diabetes drink alcohol?
Yes. Generally, the recommendations for people with diabetes are the same as they are for everyone else. For women it's one drink a day, for men it's two. However, the amount of alcohol you drink -- and whether you drink alcohol at all -- should be affected by how you manage your condition, what medications you're on, and your overall health.

One precaution: some diabetes medications can increase the risk of hypoglycemia when you're drinking alcohol. So if you're at higher risk of hypoglycemia, practice caution.

What impact does physical activity have on type 2 and prediabetes? How much and what types of exercise are recommended?
Physical activity is crucial for people with type 2 diabetes and prediabetes. It helps lower blood pressure and boost levels of good HDL cholesterol, which reduce your risk of heart and blood vessel disease. It lowers blood glucose and decreases insulin resistance. Studies show that while exercise doesn't help much with weight loss, it's critically important for maintaining weight loss.

As for what and how much, start with small steps -- literally! Walking is easy. Find time to walk a few times a week for 20 minutes. Work your way up to 30 minutes five times a week. You need to find physical activities that you enjoy, since you need to incorporate them into your life permanently. Using weights and resistance training can be a good idea too. The higher the percentage of muscle and the lower the percentage of fat in your body, the better your insulin sensitivity.

Do you have any other tips on successful weight loss and control for people with prediabetes and type 2 diabetes?
If you're thinking about losing weight, the first thing you need to do is assess whether you're really ready to make some big, permanent changes. If you are, start by looking at what you're doing now. What are you eating and how much physical activity do you get? Do some self-monitoring. Then once you have a sense, target specific things you want to change. Don't try to fix your whole life at once. You've got to focus on small changes to what you're doing now.

You also need some support. As a dietitian (and person who works hard to manage my weight) I know how hard it is to follow a healthy eating plan and be physically active day after day. So, it's my belief that if people are going to be successful in maintaining weight loss, they need to be connected and supported. For people who are comfortable online, I think the most cost-effective and efficient approach is joining an online program that fits your needs. Today there are a variety of them, from Weight Watchers to Vtrim to the Cardiometabolic Support Network.

In today's environment, I think we all can find it challenging to live a healthy lifestyle. How do you do it?
I'm 4-foot-10 inches and not getting any younger, but I really do put the healthy eating guidelines into practice. Portion control is my 'numero uno' strategy. In fact, my nickname at home with my food-loving husband and daughter is the Portion Control Queen. I enjoy sweets a couple of times a week, but it's either eating a half cup of really good ice cream or splitting a superb dessert from a restaurant or bakery. I don't have the calories to spare on mediocre. When it comes to burning calories, I'm out to exercise nearly every morning Monday through Friday, either for a 2-mile walk or a longer stint at the gym. What really motivates me is both feeling good today and my desire for a healthy future

SOURCE:

Hope Warshaw, MMSc, RD, CDE, dietitian; diabetes educator; author, Diabetes Meal Planning Made Easy, 3rd ed., published by the American Diabetes Association.

Top 10 Everyday Super Foods that Fight Disease

10 Everyday Super Foods

These easy-to-eat foods are packed with multiple nutrients to help you stay healthy.
By Kathleen M. Zelman, MPH

If only there were some kind of potion or pill that had everything you needed for weight loss and good health. Unfortunately, no such pill exists, but there is a solution -- something that not only promotes wellness and weight control but tastes good, too. These multitasking "super foods" provide multiple disease-fighting nutrients, fill you up so you can enjoy plenty of food without excess calories, and are easy to include in everyday meals. After all, what good is a super food that is hard to find, difficult to prepare, and the kids won't eat?

Eaten regularly, these foods will help you satisfy the recommendations of the U.S. government's 2005 Dietary Guideline, giving you nutrients that are typically missing from American diets. According to the Guidelines, Americans need to eat more fruits, vegetables, whole grains, and low-fat dairy products.

Of course, experts are quick to point out, this list of top 10 super foods by no means includes all the nutritious foods that should be part of a healthy diet.

"What is ultimately the most important to good health is a dietary pattern that includes all these foods, along with a wide variety of other nutritious foods and regular physical activity," says Tufts University researcher Alice Lichtenstein, DSc.

And don't forget that portion size matters, even when it comes to healthy foods. You can take more liberties when eating simply prepared vegetables, but you should take care to eat other super foods in sensible portions.

"Foods like nuts are nutrient rich, but if you overeat them you can pack on the pounds, and that defeats the purpose," says Elisa Zied, MS, RD, author of Feed Your Family Right!

Top 10 Multitasking Super Foods

Low fat or fat-free plain yogurt is higher in calcium than some other dairy products and contains a great package of other nutrients, including protein and potassium. It can also be enhanced with other good-for-you substances. "Yogurt is a vehicle food that can be enriched with probiotics for a healthy balance of bacteria in your gut, and beneficial, heart-healthy plant stanols," says Zied. "And lactose sensitive people may tolerate yogurt better than milk." Look for plain yogurt fortified with vitamin D, and add your own fruit to control sweetness and calories. Versatile yogurt can also be used in entree and bakery recipes, in dips for veggies, etc. Don't like yogurt? Skim milk is another super dairy food that has only 83 calories per cup and is easy to slip into coffee to help you get one of the recommended three servings of dairy each day. "Dairy foods contain practically every nutrient you need for total nutrition -- and in just the right balance," says bone health expert, Robert Heaney, MD. "No other food group in the diet is as complete or as economical."

Eggs make the list because they are nutritious, versatile, economical, and a great way to fill up on quality protein. "Studies show if you eat eggs at breakfast, you may eat fewer calories during the day and lose weight without significantly affecting cholesterol levels," says Elizabeth Ward, MS, RD, author of The Pocket Idiot's Guide to the New Food Pyramids. Eggs also contain 12 vitamins and minerals, including choline, which is good for brain development and memory. Enjoy them at any meal or hard-cooked as a portable snack.

Nuts have gotten a bad rap because of their high fat content. But their protein, heart-healthy fats, high fiber, and antioxidant content earn them a place on the top 10 list. The key to enjoying nuts, experts say, is portion control. "All nuts are healthful in small doses, and studies show they can help lower cholesterol levels and promote weight loss," says Today Show nutritionist Joy Bauer, MS, RD. "I like pistachio nuts because they also contain plant sterols and it takes longer to crack the shell and eat them, making it easier to control the portion. Whether you prefer pistachios, almonds, peanuts, walnuts, or pecans, an ounce a day of nuts help fill you up. Nuts add texture and flavor to salads, side dishes, baked goods, cereals, and entrees. They taste great alone, too. Zied recommends putting together your own "100-calorie packs" of nuts for easy and portable snacks.

Kiwis are among the most nutritionally dense fruits, full of antioxidants, says Ward. "One large kiwi supplies your daily requirement for vitamin C," says Ward. "It is also a good source of potassium, fiber, and a decent source of vitamin A and vitamin E, which is one of the missing nutrients, and kiwi is one of the only fruits that provides it." The sweet taste and colorful appearance of kiwis makes it easy to slice in half, scoop out with a spoon and enjoy alone, or slice it into desserts, salads, or side dishes. Kiwifruit can also have a mild laxative effect due to their high fiber content.

Quinoa is now readily available in many supermarkets and is one of the best whole grains you can eat, according to Zied. "It is an ancient grain, easy to make, interesting, high in protein (8 grams in 1 cup cooked), fiber (5 grams per cup) and a naturally good source of iron," she says. Quinoa (pronounced keen-wa) also has plenty of zinc, vitamin E, and selenium to help control your weight and lower your risk for heart disease and diabetes, she says. Quinoa is as easy to prepare as rice and can be eaten alone or mixed with vegetables, nuts, or lean protein for a whole-grain medley. Try to make at least half your daily grain servings whole grains. In addition to quinoa, try barley, oats, buckwheat, whole wheat, wild rice, and millet.

Beans, beans, good for your heart -- really! Beans are loaded with insoluble fiber, which helps lower cholesterol, as well as soluble fiber, which fills you up and helps rid your body of waste. They're also a good, low-fat source of protein, carbohydrates, magnesium, and potassium. Bauer favors edamame (whole soybeans) because they also contain heart-healthy omega-3 fatty acids. Beans can easily substitute for meat or poultry as the centerpiece of a meal, says Bauer, but they also work as a side dish, or tossed into soups, stews, or egg dishes. The U.S. Dietary Guidelines recommend 3 cups weekly.

Salmon is a super food because of its omega-3 fatty acid content. Studies show that omega-3 fatty acids help protect heart health. That's why the American Heart Association recommends eating fatty fish like salmon twice weekly. Salmon is low in calories (200 for 3 ounces) has lots of protein, is a good source of iron, and is very low in saturated fat. You can simply grill or bake it, top it with salsas or other low-fat sauces, or serve it on top of salad greens. If you don't like salmon, Lichtenstein recommends eating other kinds of fish, like canned tuna. And what about the mercury content? (Mercury is known to accumulate in fish.) "The benefits of eating salmon or other fatty fish twice weekly far outweigh any risks, but if you are concerned, check with your doctor," says Zied.

Broccoli is one of America's favorite vegetables because it tastes good and is available all year long. It's a rich source of vitamin A, vitamin C, and bone-building vitamin K, and has plenty of fiber to fill you up and help control your weight. "Some people think beta-carotene (vitamin A) is only found in orange and yellow vegetables, but broccoli is an excellent source," says Ward. You can eat broccoli raw, lightly steamed, stir-fried, roasted, or grilled. Eat it as a side dish, or toss into grains, egg dishes, soups, and salads.

Sweet potatoes are a delicious member of the dark orange vegetable family, which lead the pack in vitamin A content. Substitute a baked sweet potato (also loaded with vitamin C, calcium, and potassium) for a baked white potato. And before you add butter or sugar, taste the sweetness that develops when a sweet potato is cooked -- and think of all the calories you can save over that loaded baked potato. "If we eat more foods like sweet potatoes that are rich sources of potassium, and fewer high-sodium foods, we can blunt the effect of sodium on blood pressure and reduce bone loss," says Zied. Other dark orange vegetable standouts include pumpkin, carrots, butternut squash, and orange bell peppers.

Berries pack an incredible amount of nutritional goodness into a small package. They're loaded with antioxidants, phytonutrients, low in calories, and high in water and fiber to help control blood sugar and keep you full longer. And their flavors satisfy sweets cravings for a fraction of the calories in baked goods. Blueberries lead the pack because they are among the best source of antioxidants and are widely available. Cranberries are also widely available fresh, frozen, or dried. All can add flavor and nutrition to numerous dishes, from salads and cereals to baked goods and yogurt.

SOURCES: Robert P. Heaney, MD, John A. Creighton University Professor, Creighton University. Joy Bauer, MS, RD, author, Joy Bauer's Food Cures; nutritionist, the Today Show. Elizabeth Ward, MS, RD, author, The Pocket Idiot's Guide to the New Food Pyramid. Elisa Zied, MS, RD, spokeswoman, American Dietetic Association; author, Feed Your Family Right! U.S. Department of Agriculture's 2005 U.S. Dietary Guidelines. Alice Lichtenstein, DSc, Stanley N. Gershoff Professor of Nutrition Science and Policy, Friedman School of Nutrition Science, Tufts University. Asia Pacific Journal of Clinical Nutrition, June 2002; vol 11, issue 2: pp164-168.

Reviewed on December 04, 2008

Four Tricks to Cut the Salt

Low-Sodium Recipe and Cooking Tips

According to the U.S. government, Americans are supposed to eat no more than 2,300 milligrams -- about 1 teaspoon -- of salt a day. People with high blood pressure are told to limit salt even more, to just 1,500 milligrams. That's about a half teaspoon of salt daily.

Considering that salt is an ingredient in just about every type of processed food or restaurant meal, it's no wonder most Americans are getting double -- or triple -- the amount of sodium they need each day. Just 8 ounces of tomato soup can have 1,200 milligrams of sodium. Three ounces of ham can have more than 1,000 milligrams. And 1 ounce of pretzels or 2 tablespoons of salad dressing can pack upwards of 500 milligrams of sodium.

Salt may add flavor to your food, but getting too much of it can also cut years from your life. Studies have linked a high-salt diet to increased risk of high blood pressure, which increases the risk of stroke and heart disease. Research also has shown that reducing the salt in your diet may help lower those risks.

Low-Sodium Meals: How to Cut the Salt in Your Cooking
It is possible to limit the salt in your meals without sacrificing the flavor of your food. Here are three low-sodium cooking tips to help you make healthy, delicious meals that are good for your heart:

Keep it real. Processed foods are often loaded with extra salt. That's because salt acts as a preservative. Cooking your own meals from scratch is the best way to control how much sodium goes into your food. Cookbooks and the Internet are full of easy low-sodium recipes that take all of the guesswork out of cooking. Opt for fresh fruits or vegetables instead of canned. Choose fresh poultry, fish, and meat instead of processed or smoked varieties. For side dishes, make brown rice or whole baked potatoes instead of instant or flavored rice or mashed potatoes. If you have to use canned foods, such as tuna, rinse the contents beforehand to wash away some of the sodium.

Become a label reader. Scour every food label for sodium content. Look for products labeled "sodium-free" (less than 5 milligrams of sodium per serving), "very low sodium" (35 milligrams or less per serving), or "no salt added." Watch out for broths, dressings, soy sauce, bouillon cubes, meat tenderizers, seasoned salts, and condiments (mustard, ketchup, barbecue sauce), which are notoriously high in salt. Watch for additives such as monosodium glutamate (MSG), baking soda, baking powder, and sodium benzoate, which are all sodium compounds.
Don't follow directions. When a recipe calls for even a pinch of salt, replace it with another herb or spice. You can try rosemary, marjoram, thyme, tarragon, onion or garlic powder, curry powder, pepper, nutmeg, cumin, ginger, cilantro, bay leaf, oregano, dry mustard, or dill.

Spicing Up Your Low-Sodium Menu
Salt-free doesn't have to mean taste-free. You can substitute dozens of different seasonings and ingredients to spice up to your low-sodium meals. Here are just a few ideas:

Marinate chicken breasts or pork chops in lemon juice, orange juice, or red wine
Roll fish in sesame seeds before baking
Spice up beef with a mixture of onion, peppers, sage, and thyme
Toss in a few fruits and vegetables, such as dried apricots, raisins, red pepper, or yellow pepper for extra flavor
Simmer carrots in cinnamon and nutmeg
Sprinkle some dill and parsley onto potatoes before roasting
Add a dash of chili powder to corn
Toss your pasta with fresh chopped garlic
Replace salted butter with unsalted butter
When cooking with cheese, opt for fresh mozzarella or cheeses labeled "low-sodium"
Try a commercial salt-free seasoning blend (such as Mrs. Dash), or make your own mix with this recipe from the American Heart Association:
1/2 teaspoon cayenne pepper 1 teaspoon mace, ground

1 teaspoon basil, ground 1 teaspoon onion powder

1 tablespoon garlic powder 1 teaspoon black pepper, ground

1 teaspoon thyme, ground 1 teaspoon sage, ground

1 teaspoon parsley, dry flakes 1 teaspoon marjoram

1 teaspoon savory, ground

SOURCES:

USDA: "Dietary Guidelines for Americans -- 2005."

U.S. Department of Health and Human Services: "Your Guide to Lowering Your Blood Pressure with DASH."

Cook, N. BMJ, published online April 20, 2007.

Oklahoma Department of Human Services: "Tips for Managing Your Congestive Heart Failure."

National Heart, Lung, and Blood Institute: "Your Guide to Lowering High Blood Pressure."

Top 10 Diet and Nutrition Resolutions

Top 10 Diet and Nutrition Resolutions
The best ways to lose weight and eat healthfully in the new year
By Kathleen M. Zelman, MPH, RD, LD

It's resolution time again, and first on your list is to lose weight and eat more healthfully. But how exactly do you go about doing that -- and how do you keep yourself from becoming a resolution dropout once Feb. 1 rolls around?

To draw up a list of the absolute best diet and nutrition resolutions, I consulted weight loss experts around the country. Here are their suggestions for some tried-and-true -- and very doable -- behavior changes that will help you lose weight.

1. Stack the odds in your favor. We all have our own particular strengths and weaknesses. Katherine Tallmadge, MA, RD, advises playing up your strengths and making a plan to avoid getting sidetracked by your weaknesses. Don't simply wish you could do better this time -- take concrete steps to ensure that you do, says Tallmadge, author of Diet Simple. For example:

* If you reach for high-calorie foods because they're convenient, make sure you have healthy alternatives available. Go grocery shopping at least weekly to stock up on wholesome foods. Keep a list so you have enough for the week.
* If you're a social eater, plan non-food events with your friends. Take walks, go sightseeing, go to a movie or take a hike.

2. Get the rest you need. Susan Moores, MS, RD, a nutrition consultant from St. Paul, Minn., is excited about recent research on the hormonal effects that sleep deprivation can have on appetite. Hers is a resolution you don't see often -- and one most people will welcome hearing.

3. Give yourself permission to be human. Anne Fletcher, MS, RD, author of the Thin for Life books, suggests a resolution that allows you to slip up without going into a slide. People who lose weight and keep it off know how to pick themselves up after they slip. Gained some weight on vacation? No problem. Just get right back into healthy eating and exercise to lose the extra pounds.

4. List the eating and exercise habits you'd like to change, and select one to work on. Don't try to change a second habit until the first one has become a habit, says Boston-based nutrition consultant Elizabeth Ward, MS, RD. A list of habits is easier to tackle than sweeping resolutions, she says. "Resolutions imply major changes that appear doable and seem downright insurmountable by two to three weeks out, largely because most people are not ready to make a change but think they should because of the New Year," says Ward, author of Healthy Foods, Healthy Kids.

5. Choose brightly colored fruits and vegetables plus the brown of whole grains. Your diet should look like a rainbow with a complement of brown, says Connie Diekman, MEd, RD, director of university nutrition at Washington University in St. Louis and the voice of the syndicated radio show Eating Right Minute
6. Practice low-calorie evening relaxation traditions. Instead of an after-work cocktail, drink a "virgin Mary" in a wine glass after a long day, suggests Dawn Jackson, RD, a weight-loss dietitian at Northwestern Memorial Hospital Wellness Institute in Chicago. Or unwind with a hot cup of herbal or no-calorie flavored tea instead of reaching for sweets.

7. Aim for lighter forkfuls. Another suggestion from Jackson, who is also a spokeswoman for the American Dietetic Association: Putting less on each fork will help you eat more slowly. This, in turn, helps you enjoy your food more -- and, ultimately, to eat less.

8. Eat when you're eating. Try not to multitask (reading, watching television, answering emails, driving) while you eat, says Jackson. Instead, sit at a table and enjoy what you are eating.

9. Escape food cravings. When cravings strike, Christine Palumbo, MBA, RD, an Allure magazine columnist, suggests trying one of the following tricks:

* Chew intensely flavored gum.
* Brush your teeth.
* Drink a large glass of water or sugar-free soda, or a cup of tea.
* Take a brisk, 5-minute walk.
* Wait 20-30 minutes. If the craving persists, satisfy it with a small portion.

10. Stop eating before you're stuffed. The time to stop eating is when you reach "5" on a hunger scale of 1-10, where 1 is famished and 10 stuffed to the gills, suggests Ellie Krieger, MS, RD, author of the upcoming book Small Changes, Big Results. Pushing your plate away at a 5 is a natural way to control portions without measuring, and it helps you cue into your body's needs.
12 More Little Changes

To add to the experts' list, I have a list of small, sustainable resolutions that -- along with the above suggestions -- should help you reach your weight loss goals:

1. Switch from higher-fat to lower-fat products. Instead of cream, use milk in your coffee.
2. No eating after 8 p.m., except when you go out for dinner.
3. Get some kind of physical activity each day, even if it's only for 20-30 minutes. No excuses.
4. Eat at least five servings a day of fruits and vegetables.
5. Start each day with a nourishing breakfast.
6. Eat only from a plate, not the bag or container.
7. Pack healthy snacks when you are on the go.
8. Watch one hour less of television each day.
9. Get a dog for companionship and to help you get daily activity.
10. Add strength training to your fitness routine at least one day a week.
11. Journal your meals at least once a day.
12. Allow yourself occasional treats, in moderation, so deprivation does not lead to a binge.

Making Them Stick

You've heard from the pros; now it's up to you. Make your own personal best list of resolutions that will help you lose weight and improve your health. Keep the list with you, as a screensaver on your computer or posted in a highly visible spot. It will serve as a motivator to help you make healthful changes each day.

Some other ways to make sure you stay with the program:

* Reward yourself. To reinforce your success, build in a reward system. Make a commitment that, for example, you get to the gym five times a week, you will treat yourself. The best treats are not food-related. Celebrate your success with a manicure, a trip to see a hot new movie, or whatever feels special to you.

* Control your surroundings. Spend time with people who support and encourage you. Stock your house with nutritious foods and throw out the empty-calorie temptations. Avoid buffets, and choose restaurants that offer healthy options.

* Seek support. Finding an exercise pal or an online diet buddy, especially one with goals similar to yours, is one of the best ways to ensure success. It's easier to get out of bed on those cold mornings when you know someone is counting on you to exercise with them. And buddies are lifesavers when you need someone to talk you off the ledge. One suggestion: Buy your buddy a pedometer, and work together to meet 10,000 steps a day.
When You Backslide

No matter how committed you are, you will occasionally overeat. Simply accept that these things happen, and get right back on track. Remember that losing weight is more like a slow and steady marathon than a sprint. Good luck, and happy New Year!

SOURCES: Katherine Tallmadge, MA, RD, columnist, The Washington Post; author, Diet Simple; spokeswoman, American Dietetic Association. Susan Moores, MS, RD, nutrition consultant; spokeswoman, American Dietetic Association, St. Paul, Minn. Anne Fletcher, MS, RD, author, Thin for Life series. Elizabeth Ward, MS, RD, nutrition consultant, author, Healthy Foods, Healthy Kids, Boston. Connie Diekman, MEd, RD, member, board of directors, American Dietetic Association; host, Eating Right Minute; director of university nutrition, Washington University, St. Louis. Dawn Jackson, RD, spokeswoman, American Dietetic Association; weight loss dietitian, Northwestern Memorial Hospital Wellness Institute, Chicago. Christine Palumbo, MBA, RD, columnist, Allure magazine; registered dietitian, Naperville, Ill. Ellie Krieger, MS, RD, author, Small Changes, Big Results.

Blissing Out: 10 Relaxation Techniques To Reduce Stress On-the-Spot

Blissing Out: 10 Relaxation Techniques To Reduce Stress On-the-Spot
If your hectic lifestyle has got you down, experts say relaxation techniques can bring you back into balance -- some in five minutes or less.
By Jenny Stamos Kovacs
Reviewed by Louise Chang, MD

The kids need a ride to school, your husband can't find his shorts, your boss has just scheduled an online meeting, and your best friend desperately needs your help -- all at the same time.

Is it any wonder that you can't find a minute for relaxation? In fact, if you're like most women, you may have even forgotten how to relax.

And while experts say that some stress is good for you -- it can sharpen your senses and your mind -- too much stress is bad for your mental and physical health. At the same time, relaxation can do wonders to restore balance in your life -- and may even reduce some of the health risks associated with stress.

WebMD talked to the experts to learn more about relaxation -- and how to attain it. What follows are 10 on-the-spot techniques you can use -- any time and almost anywhere -- to reduce the tension in your life.

1. Meditate

If you're thinking meditation means twisting your body into an uncomfortable position and uttering "oohs" and "omms" for an hour, guess again. Any repetitive action can be a source of meditation, says Herbert Benson, MD, author of The Relaxation Response anddirector emeritus, Benson-Henry Institute for Mind Body Medicine in Chestnut Hill, Massachusetts. This includes walking, swimming, painting, knitting -- any activity that helps keep your attention calmly in the present moment.

When you catch yourself thinking about your job, your relationship or your lifelong to-do list, experts say to simply let the thought escape, and bring your mind back the repetition of the activity. Try it for just 5 to 10 minutes a day and watch stress levels drop.

2. Picture Yourself Relaxed

Is your mind too talkative to meditate? Try creating a peaceful visualization, or "dreamscape." To start, simply visualize anything that keeps your thoughts away from current tensions. It could be a favorite vacation spot, a fantasy island, that penthouse in New York City -- or something "touchable," like the feel of your favorite silk robe or cozy sweater.

The idea is to take your mind off your stress, and replace it with an image that evokes a sense of calm. The more realistic your daydream -- in terms of colors, sights, sounds; even touch and feel -- the more relaxation you'll experience.

3. Breathe Deeply

Feeling stressed evokes tense, shallow breathing, while calm is associated with relaxed breathing, says Michael Lee, author of Turn Stress into Bliss and founder of Phoenix Rising Yoga Therapy in Bristol, Vermont. So to turn tension into relaxation, he says, change the way you breathe.

Try this: Let out a big sigh, dropping your chest, and exhaling through gently pursed lips, says Joan Borysenko, PhD, director of Harvard's Mind-Body Clinical Programs. Now imagine your low belly, or center, as a deep, powerful place. Feel your breath coming and going as your mind stays focused there. Inhale, feeling your entire belly, sides and lower back expand. Exhale, sighing again as you drop your chest, and feeling your belly, back and sides contract. Repeat 10 times, relaxing more fully each time.

4. Look Around You

"Mindfulness is the here-and-now approach to living that makes daily life richer and more meaningful," says Claire Michaels Wheeler, MD, PhD, author of 10 Simple Solutions to Stress. It's approaching life like a child, without passing judgment on what occurs. Mindfulness means focusing on one activity at a time, so forget multi-tasking! Staying in the present-tense can help promote relaxation and provide a buffer against anxiety and depression.

Practice it by focusing on your immediate surroundings. If you're outdoors, enjoy the shape and colors of flowers, hear a bird's call or consider a tree. In the mall, look at the details of a dress in the window, examine a piece of jewelry and focus on how it's made, or window-shop for furniture, checking out every detail of pattern and style. As long as you can keep your mind focused on something in the present, stress will take a back seat.

5. Drink Hot Tea

If you're a coffee-guzzler, consider going green. Coffee raises levels of the notorious stress hormone, cortisol, while green tea offers health and beauty, says Nicholas Perricone, MD, author of 7 Secrets to Beauty, Health, and Longevity.

Chamomile tea is a traditional favorite for calming the mind and reducing stress. And black tea may be a stress-fighter, too, researchers from University College London report. Participants who drank regular black tea displayed lower levels of cortisol, and reported feeling calmer during six weeks of stressful situations than those who drank a placebo with the same amount of caffeine.

6. Show Some Love

Induce the relaxation response by cuddling your pet, giving an unexpected hug to a friend or family member, snuggling with your spouse, or talking to a friend about the good things in your lives, says psychologist Deborah Rozman, PhD, co-author of Transforming Stress. When you do, you'll be reducing your stress levels.

Why? Experts say social interaction helps your brain think better, encouraging you to see new solutions to situations that once seemed impossible, she says. Studies have also shown that physical contact -- like petting your dog or cat -- may actually help lower blood pressure and decrease stress hormones.

7. Try Self-Massage

When your muscles are tense and you've no time to visit a pro, try this simple self-massage technique from Darrin Zeer, author of Lover's Massage and Office Yoga. Relax, and travel straight to Zen-land.

* Place both hands on your shoulders and neck.
* Squeeze with your fingers and palms.
* Rub vigorously, keeping shoulders relaxed.
* Wrap one hand around the other forearm.
* Squeeze the muscles with thumb and fingers.
* Move up and down from your elbow to fingertips and back again.
* Repeat with other arm.

8. Take a Time-Out

Adults need time-outs, too. So when you sense your temper is about to erupt, Jeff Brantley, MD, author of Five Good Minutes In the Evening, suggests finding a quiet place to sit or lie down and put the stressful situation on hold. Take a few deep breaths and concentrate on releasing tension and calming your heartbeat. Quiet your mind and remember: Time is always on your side, so relax. The stress can wait.

9. Try a Musical Detour

Music can calm the heartbeat and soothe the soul, the experts say. So, when the going gets rough, take a musical stress detour by aligning your heartbeat with the slow tempo of a relaxing song. And you might want to make that a classical tune. Research shows that listening to 30 minutes of classical music may produce calming effects equivalent to taking 10 mg of Valium.

10. Take an Attitude Break

Thirty seconds is enough time to shift your heart's rhythm from stressed to relaxed, Rozman says. The way to do that: Engage your heart and your mind in positive thinking. Start by envisioning anything that triggers a positive feeling -- a vision of your child or spouse, the image of your pet, that great piece of jewelry you're saving up to buy, a memento from a vacation -- whatever it is, conjuring up the thought will help slow breathing, relax tense muscles and put a smile on your face. Rozman says that creating a positive emotional attitude can also calm and steady your heart rhythm, contributing to feelings of relaxation and peace.

SOURCES: Herbert Benson, MD, director emeritus, Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Chestnut Hill, MA; associate professor of medicine, Harvard Medical School; author of The Relaxation Response.Benson-Henry-Institute for Mind Body Medicine: "Elicit the Relaxation Response," "The Stress Response," "The Relaxation Response," and "Mindfulness." Michael Lee, author of Turn Stress into Bliss; founder, Phoenix Rising Yoga Therapy, Bristol, VT.Joan Borysenko, PhD, co-founder of the Mind/Body Clinical Programs at Harvard Medical School's Beth Israel Deaconess Medical Center, Boston, MA; author of Saying Yes to Change. Claire Michaels Wheeler, MD, PhD; founder, Center for Mind-Body Medicine, Portland, OR; author of 10 Simple Solutions to Stress.Alice D. Domar, PhD, executive director, Domar Center for Complementary Health Care, Waltham, MA; author of Healing Mind. Nicholas Perricone, MD, adjunct professor of medicine, Michigan State University's College of Human Medicine, East Lansing, MI. Deborah Rozman, PhD, psychologist; co-founder, Institute of HeartMath, Boulder Creek, CA. Zeer, D. Office Yoga, Chronicle Books, 2000. Jeff Brantley, MD, founder/director, Mindfulness-Based Stress Reduction Program, Duke University Center for Integrative Medicine, Durham, NC; co-author of Five Good Minutes in the Evening.Steptoe A. Psychopharmacology, Jan 2007; vol 190: pp 81-89.
Reviewed on October 27, 2008

Why You’re Not Happy

Why You’re Not Happy
Six common barriers to personal happiness and fulfillment and how to overcome them.
By Annie Stuart
Reviewed by Brunilda Nazario, MD

Happiness can be a paradox: The more you reach for it, the more it seems to slip through your fingers. “Ask yourself if you’re happy, and you cease to be so,” says Darrin McMahon, PhD, author of Happiness: A History.

How could this be true? Could it be you’re looking for happiness in all the wrong places? Do you think happiness is what you get when you get what you want? Some say happiness is a little like falling in love, that you can’t make it happen. If that’s the case, then how can you become happier?

At the 2008 Happiness & Its Causes Conference in San Francisco, a wide range of people -- from scientists, doctors, and psychologists to artists, philosophers, and Tibetan Buddhists -- offered their thoughts on the topic. Here are a few of their tips for overcoming six common barriers to happiness.
Happiness Barrier No. 1: Complexity

Solution: Simplify

Schooled in Buddhist monasteries since childhood, Thupten Jinpa, PhD, knows a thing or two about the benefits of simplicity. Why do you think monks and nuns shave their heads, he asks? For one, it simplifies their lives.

A principal English translator to the Dalai Lama, Jinpa is no longer a monk. But he still holds on to some of the lifestyle's spartan values. “My family has a one-car policy,” he says, pointing out the hassles of owning more than one -- the costs, the maintenance, and the time managing the details. Multiple credit cards? They don’t create freedom or happiness, he argues -- although, these days, he might get less of an argument about that.

Modern life has elevated individual choice to the highest level, he says, but these choices come at a big price. “We often conflate quality of life with standard of life,” Jinpa says, “but after a point, the connection [between the two] disappears.”

If you simplify your life, you create more space in your day, making it possible to reflect on your life.
Happiness Barrier No. 2: A Breakneck Pace

Solution: Take a Pause

The same culture that entangles you in a web of complexity may also have you on the constant chase, Jinpa says. “That kind of tension takes a toll on your soul and your psyche.” Whether you call it meditation, silence, or prayer, taking a “pause” just a few minutes a day can help you “recharge your batteries” and make you feel happier. A good time to do this is in the morning. Without it, your life may feel out of control.

Venerable Robina Courtin, a Buddhist nun and organizer of the Happiness & Its Causes Conference, recommends spending these minutes practicing mindful meditation. “During the day, we’re completely absorbed by our senses,” she says, “so we don’t pay attention to our minds.” Sit in a quiet place and simply anchor your mind on your breathing. When your mind wanders, bring it back to your breath. Through this process, you learn to observe what your mind is saying.
Happiness Barrier No. 3: Negativity

Solution: Let go

“Your prison is nothing in comparison with the inner prison of ordinary people: the prison of attachment, the prison of anger, the prison of depression, the prison of pride.” wrote Lama Zopa Rinpoche to a California prisoner, a student of the Liberation Prison Project, which offers Buddhist teachings to people in prison.

Some might view this statement as a bit of an exaggeration. But negative, compulsive thoughts do have a quality of stickiness to them, Jinpa says. How you see things and the way you experience the world are strongly linked, making it critical to adopt a positive outlook. “You interact with the world through your senses and mind,” he says. “If you can find a way to stand at the doorway of your senses, you can have a say in how you experience the world.”

In our culture, though, we take it as natural that people are angry, depressed, or dejected, Courtin says. “No wonder we get depressed -- it’s a depressing world view. It says you can’t do anything about it.” If you believe your abusive boss, father, or partner is the main cause of your suffering, for example, then you’ve tied your own hands and risk becoming imprisoned by toxic thoughts.

The Buddhist view, by contrast, is that happiness is what you get when you give up a neurotic state of mind, Courtin says. It’s empowering, she says, because knowing you can change it gives you the courage to look inside, pay attention, and take responsibility for your thoughts. Rather than judging negative thoughts, Courtin advises observing them with compassion. Then ask yourself, “What can I do about this?”

Techniques like mindful meditation can help with this, but may not be for everyone, especially those experiencing severe depression, says Philippe R. Goldin, PhD, research associate in the department of psychology at Stanford University.

But there are other simple steps you can take to counteract negativity and enhance your happiness. Practicing gratitude is one. People appear to have a certain set point for happiness, a range that’s influenced by genetics. But those who regularly practice gratitude can enhance this set point by as much as 25%, reports Robert Emmons, PhD in his book, Thanks!: How Practicing Gratitude Can Make You Happier. Through his research, Emmons found that people who kept gratitude journals felt better about their lives, exercised more, and were more optimistic.
Happiness Barrier No. 4: Despair

Solution: Stay hopeful

Did a parent attempt to protect you as a child by saying, “Don’t get your hopes up”? There’s no evidence that hope is hurtful, says David B. Feldman, PhD, assistant professor of counseling psychology at Santa Clara University in California. Instead, hope can greatly enhance happiness in people.
Happiness Barrier No. 4: Despair continued...

But genuine hope isn’t a yellow smiley face or the denial of death at the bedside of a loved one in hospice, says Feldman, who’s pursued research and clinical work addressing the question: “How do people maintain hope and meaning in the face of adversity?

Three components are essential for hope to thrive, Feldman says. They are having goals, as well as a plan and the motivation to achieve them. “Those who succeed don’t internalize the blame game, either internally or externally,” he says, “They ask, ‘what now?’”

In addition to reaching goals, these people perform better in sports and school, Feldman says. They have a greater tolerance for pain. They use health-promoting behaviors. They also have a lower risk for depression, anxiety, and heart disease.

Feldman advises setting personally meaningful goals and checking to see where your hope falters -- is it with the plan or the motivation? Allow yourself to daydream, he says. It’s a wonderful source of hope and, therefore, happiness.
Happiness Barrier No. 5: Suppressing sadness

Solution: Feel the real

Having a positive outlook doesn’t mean you never allow yourself to feel sadness. The parents who try to protect their children from dashed hopes -- or any kind of sadness -- may actually produce the opposite effect than is intended, says James R. Doty, MD, director of the Center for Compassion and Altruism Research and Education at Stanford University. Some suffering, he says, makes you a whole person and allows you to acclimate and move forward in your life. Doty speaks from experience. He had an alcoholic father and invalid mother. He lived on public assistance for much of his youth.

“Happiness is not the absence of sadness,” says David Spiegel, MD, medical director of the Center for Integrative Medicine at Stanford University School of Medicine. It is not a stiff upper lip or the pop psychology mantra, intoning “always stay upbeat” in the face of cancer. “Phony happiness is not good.” By suppressing sadness, you suppress other, more positive emotions, as well, he says, so people who try to suppress emotions actually become more anxious and depressed.

By finding outlets for sadness and frustration, you gain some measure of control, Spiegel says. Using others as a sounding board -- not as a toxic dumping ground -- can help convert generalized anxiety and depression into targeted feelings you can address with specific solutions.
Happiness Barrier No. 6: Navel-gazing

Solution: Connect with others

How important are social networks to your happiness? Perhaps even more important than you realized. A recent 20-year study of more than 4,000 people showed that happiness is influenced not just by your immediate friends and family. The happiness of a friend of a friend of a friend -- someone you’ve never even met -- can also influence your happiness. It turns out that happiness can spread through social networks, like a virus.
Happiness Barrier No. 6: Navel-gazing continued...

Unfortunately, many people spend so much time by themselves navel gazing, they don’t benefit from this positive “contagion.”

The more self-absorbed you are, the more your world closes in, and the less realistic you become, all of which produces a vicious circle. “You become oblivious to the needs of others, and the world shrinks still more, making you less able to see outside yourself.” If asked, ‘Why are your problems so special?” says Jinpa, you might respond, “Because they’re mine!”

“If you have such a huge ego, you’re setting yourself up as a huge target, which can easily get hit,” Jinpa says. But using a “wide-angle lens” instead helps you see connections you wouldn’t otherwise see, such as the universality of suffering. All it may take is having a loved one diagnosed with a serious disease to realize how many people are grappling with similar challenges. Feeling joined by others on this journey provides some comfort and happiness.

The straightest path to making connections like these? Compassion and caring for others.

Even primates seem to understand this, says Robert M. Sapolsky, PhD, author of Why Zebras Don’t Get Ulcers and research associate with the Institute of Primate Research at the National Museum of Kenya. Primates that groom each other after a stressful event experience a reduction in blood pressure. The clincher? Grooming others has a greater impact than getting groomed, says Sapolsky.

Compassion engages us with others, removes isolation, builds resilience, and leads to deep fulfillment, says Doty. “Without compassion, happiness is simply short-lived pleasure.”

Tenzin Gyatso, the 14th Dalai Lama, may have said it best: “If you want others to be happy, practice compassion; if you want to be happy, practice compassion.”

SOURCES:

Happiness & Its Causes, San Francisco, Nov. 24-25, 2008.

Emmons, R. Thanks!: How Practicing Gratitude Can Make You Happier, Mariner Books, 2008.

Snyder, C. Journal of Personality and Social Psychology, April 1991; vol 60: pp 570-585.

Fowler, J. BMJ Online, Dec. 4, 2008.

WebMD Medical News: “Happiness Is Contagious."

Darrin McMahon, PhD, Ben Weider Professor of History, Florida State University.

Thupten Jinpa, PhD, principal English translator to the Dalai Lama; advisory board member, Mind and Life Institute, Montreal.

Venerable Robina Courtin, executive director, Liberation Prison Project; organizer, Happiness & Its Causes San Francisco.

Philippe R. Goldin, PhD, research associate, department of Psychology, Stanford University, Palo Alto, Calif.

David B. Feldman, PhD, assistant professor of counseling psychology, Santa Clara University, Calif.

James R. Doty, MD, clinical professor, department of neurosurgery; director, Center for Compassion and Altruism Research and Education at Stanford University, Palo Alto, Calif.

David Spiegel, MD, professor, department of psychiatry and behavioral sciences; medical director, Center for Integrative Medicine, Stanford University School of Medicine, Palo Alto, Calif.

Robert M. Sapolsky, PhD, professor, department of biology, Stanford University, Palo Alto, Calif; research associate; Institute of Primate Research, National Museum of Kenya.
Reviewed on December 30, 2008

When Your Doctor Orders Cholesterol-Lowering Medications

When Your Doctor Orders Cholesterol-Lowering Medications
Do you really need statins to lower cholesterol?
By Gina Shaw
Reviewed by Brunilda Nazario, MD

You’ve just left your doctor’s office with a prescription for a statin medication to help lower your cholesterol. But you may be nervous. You’ve heard that you’ll have to take this cholesterol-lowering medication for the rest of your life. And your doctor noted that statins, like all medicine, can cause side effects.

Why should you take a statin? Can’t you just improve your cholesterol levels by eating right and exercising? The answer is yes -- and no. Healthy cholesterol and triglyceride levels look like this:

Total cholesterol: less than 200 mg/dL

HDL (“good” cholesterol): 40 mg/dL or more for men, 50 or more for women

LDL (“bad” cholesterol): less than 130 mg/dL

Triglycerides: less than 150 mg/dL

Many people can get their cholesterol and triglyceride levels into these healthy ranges through a combination of a healthy diet and an active lifestyle. But for many others, these lifestyle changes help, but are not enough.
Measuring the Benefits of Statins, Diet, and Exercise

“Lifestyle changes certainly are the cornerstone of cholesterol reduction,” says Michael Miller, MD, director of the Center for Preventive Cardiology at the University of Maryland Medical Center.

Exercising, eating a healthy diet, and losing weight can result in:

* A 5% to 10% reduction in LDL cholesterol
* A 10% to 30% reduction in triglycerides

But for those with very high LDL cholesterol or triglycerides, those lifestyle measures may be insufficient. “If your lipid levels are way out of whack, for example, reducing your LDL by 10% may not get you down to a healthy level,” Miller says.

* Statin medications act quickly and can help reduce LDL or “bad” cholesterol by up to 50% or more.
* Statins also help increase HDL or “good” cholesterol by up to 15%.

If you’re making healthy lifestyle changes at the same time, says Miller, you should see major changes in your cholesterol levels within two to four weeks after beginning lipid-lowering therapy.

“Statins are very simple: you take them once a day, and their effects are quite profound,” says Patrick McBride, MD, MPH, director of the preventive cardiology program and the cholesterol clinic at the University of Wisconsin School of Medicine and Public Health.

“Not only do statins improve your cholesterol levels, but they reduce your risk of heart attack, stroke, and cardiovascular events. They’re one of the great success stories of modern medicine,” says McBride.

Most recently, the JUPITER trial showed that statins can also slash the risk of heart attack nearly in half for people with normal cholesterol but high levels of a protein associated with inflammation.
Statin Side Effects and Other Worries

What about side effects from taking statins? It’s true that any medication comes with side effects. Side effects most commonly seen with statins are headache, GI tract upset, muscle and joint aches, or rash. Very rarely, patients may experience muscle or liver damage.
Statin Side Effects and Other Worries continued...

Overall, however, the risks of statins are low. “They’re less than the risks associated with taking two aspirin a day,” says McBride. The benefits are well established, with hundreds of thousands of people studied in clinical trials. The benefits enormously outweigh the risks for the right person.”

In fact, although there is a very small risk of liver damage from statins, McBride notes that many other people see a benefit to their liver after taking statins, because they had previously built up fat or triglycerides in the liver, which can lead to inflammation and damage.

When there is liver damage or muscle weakness because of the use of statins, those side effects all reverse themselves when the patient stops taking the statin.

What about the idea that you’ll have to take statins for the rest of your life? That’s the wrong way of looking at it, McBride says.

“I have very few patients who stay on the same medications for five years, let alone the rest of their life,” he says. “New medications and new options will come along. You’ll change. We’ll change. For the near term, you will be on statins every day, but as new things develop, we’ll adapt.”
Questions to Ask Your Doctor About Cholesterol Medication

If you’re concerned about why your doctor has prescribed statins to lower your cholesterol, here are a few questions to ask:

* Why do you think I’m a good candidate for this medication?
* What will this do for me and my body?
* What are the potential benefits versus the risks to me specifically?
* Will this have any interactions with anything else I’m taking? (Be sure to tell our doctor if you’re taking over-the-counter medications or supplements. Several supplements can interact with statins.)
* What are the long-term goals of therapy?
* Can I take a supplement instead of a statin to lower my cholesterol?
* Will supplements interfere with the effects of the statin?

Miller tells his patients to look at statins as they would a vitamin to boost health. “In many ways, that’s what it is,” he says, “and it’s the only one that we know that works so well to improve cholesterol and lower cardiovascular risk.”


SOURCES:

Michael Miller, MD, director, the Center for Preventive Cardiology, University of Maryland Medical Center, Baltimore.

Patrick McBride, MD, MPH, director, preventive cardiology program and cholesterol clinic, the University of Wisconsin School of Medicine and Public Health, Madison, Wis.

American Heart Association, Atlanta.
Reviewed on December 30, 2008

Drug Errors Common in Chemo Treatments

Drug Errors Common in Chemo Treatments
Improved Communication May Be Best Method to Prevent Mistakes
By Bill Hendrick

Reviewed by Brunilda Nazario, MD

Jan. 1, 2009 -- A new study shows that medication errors are common among children and adults taking chemotherapy drugs at home or in outpatient clinics.

Researchers reviewed records of nearly 1,300 patient visits at three adult oncology outpatient clinics and 117 patient visits at one pediatric facility between Sept. 1, 2005, and May 31, 2006.

They showed that 7% of adults and 19% of children taking chemotherapy drugs in outpatient clinics or at home were given the wrong dose or experienced other medication mistakes.

The study, published in the Journal of Clinical Oncology, calls for improved communication to cut down on errors it describes as "high" in adult and pediatric cancer patients.

Of the errors involving adults, 55 had the potential to harm the patient, and in 11 instances, harm was caused, the researchers say.

About 40% of the medication errors in children had the potential to cause harm, and four children actually were harmed by mistakes, the study shows.

In a news release, Kathleen E. Walsh, MD, assistant professor of pediatrics at the University of Massachusetts Medical School, says that as cancer care increasingly shifts to outpatient settings, the potential for errors goes up correspondingly.

More than 70% of errors in children occurred at home, says Walsh, the study's leader.

Examples of pediatric errors included giving the wrong amount of medication or giving it at the wrong frequency because of confusion about instructions.

The mistakes in adults included the administration of incorrect doses because of confusion over conflicting orders. Consequences of mistakes included patients being overhydrated prior to giving chemotherapy and abdominal pain in patients taking narcotics without treatment for constipation.

The researchers say more than 50% of errors involving adults were in clinic administration, 28% in ordering medications, and 7% in use of chemo in patients' homes.
Why Medication Mistakes Happen

"As cancer care shifts from the hospital to the outpatient setting, adults and children with cancer receive more complicated, potentially toxic medication regiments in the clinic and home," Walsh and colleagues write in the article.

According to the researchers, methods to prevent outpatient medication mistakes often fail because of a lack of recognition of errors, communication problems, and fragmentation of care.

Chemotherapy regimens outside of clinical settings are "particularly complex because of the intense monitoring required" and a plethora of potential problems made more likely when drugs are taken in a non-clinical setting, they write.
Preventing Medication Errors

"Information technology such as computer order entry, electronic medication administration records and bar-coding used to prevent errors in the inpatient setting may be particularly important in outpatient clinics where multiple oral and intravenous medications are administered, such as in an oncology clinic," the researchers contend.

One simple strategy to reduce errors: requiring that medication orders not be written until the day of administration, the researchers suggest.

Walsh says in the release that most errors involving children could be reduced "by better communication and support for parents of children who use chemotherapy medications at home."
View Article Sources Sources

SOURCES:

News release, University of Massachusetts Medical School.

Walsh, K. Journal of Clinical Oncology, published online ahead of print Dec. 29, 2008.

When should you get a bone density scan, and why?

Bone Scans and Bone Health Screenings
When should you get a bone density scan, and why?
By Matthew Hoffman, MD
Reviewed by Celia E. Dominguez, MD

A bone density scan can detect thinning bones at an early stage. If you already have osteoporosis, bone scans can also tell you how fast the disease is progressing.

But an abnormal bone scan can create as many questions as it answers. Who should get a bone density scan, and what do the results mean? If your bone density is below normal, what can you expect, and what should you do?
A Date With DEXA

Most bone scans use a technology called DEXA (for dual energy X-ray absorptiometry). In a DEXA scan, a person lies on a table while a technician aims a scanner mounted on a long arm. (Think of the machine that X-rays your teeth at the dentist; the difference is that this test uses very low energy radiation.)

"DEXA currently is the easiest, most standardized form of bone density testing, so that's what we use," says Mary Rhee, MD, MS, an endocrinologist and assistant professor of medicine at Emory University in Atlanta.

The DEXA scanner uses beams of very low-energy radiation to determine the density of the bone. The amount of radiation is tiny: about one-tenth of a chest X-ray. The test is painless, and considered completely safe. Pregnant women should not get DEXA scans because the developing baby shouldn’t be exposed to radiation, no matter how low the dose, if possible.

Measurements are usually taken at the hip, and sometimes the spine and other sites. Insurance or Medicare generally pays for the test in women considered at risk for osteoporosis, or those already diagnosed with osteoporosis or osteopenia.

Other less commonly used technologies can measure bone density. They include:

* Variations of DEXA, which measure bone density in the forearm, finger, or heel.
* Quantitative computed tomography (QCT). Essentially a CAT scan of the bones, QCT provides more detailed images than DEXA.
* Ultrasound of the bones in the heel, leg, kneecap, or other areas.

While all of these can determine bone density and osteoporosis risk, "DEXA is the most important test and is the gold standard," says Felicia Cosman, MD, clinical director for the National Osteoporosis Foundation.
Interpreting Your DEXA Bone Scan Results: T-Scores and Z-Scores

DEXA scores are reported as "T-scores" and "Z-scores."

* The T-score is a comparison of a person's bone density with that of a healthy 30-year-old of the same sex.
* The Z-score is a comparison of a person's bone density with that of an average person of the same age and sex.

Lower scores (more negative) mean lower bone density:

* A T-score of -2.5 or lower qualifies as osteoporosis.
* A T-score of -1.0 to -2.5 signifies osteopenia, meaning below-normal bone density without full osteoporosis.

Multiplying the T-score by 10% gives a rough estimate of how much bone density has been lost.

Z-scores are not used to formally diagnose osteoporosis. Low Z-scores can sometimes be a clue to look for a cause of osteoporosis.
DEXA Bone Scans: What Your T-Score Means

Being told your bones are thin is cause for concern, but not alarm. If your T-score is low, what can you expect?

First of all, unless you're a woman past menopause or a man older than 50, your risk of fracture is very low. In these groups, even with a T-score less than -2.5, bones are usually strong and treatment isn't recommended.

On the other hand, if you've been told you have osteoporosis, take it seriously. Feeling fine is no protection at all: fractures of the spine can be silent and painless. "Anyone with osteoporosis should be on some kind of treatment," according to Baker.

For those with osteopenia (T-score between -1.0 and -2.5), the picture gets confusing. It's harder to predict fracture risk in this group of people. Focusing too closely on the T-score can be a mistake. "The DEXA T-score is not a perfect predictor for bone health or fracture risk," says Rhee.

Actually, bone density (measured by T-score) is only one aspect of fracture risk. Your risk factors (see above) can be just as important. Using both the T-score and risk factors for fracture leads to better predictions.

The World Health Organization is developing a formula using risk factors in combination with the T-score to determine 10-year fracture risk. "We'll probably see this coming into use in the next few years," says Rhee.
Bone Scan T-Scores: When It's Time to Treat

The National Osteoporosis Foundation recommends treatment for:

* Postmenopausal women with T-scores less than -2.0, regardless of risk factors.
* Postmenopausal women with T-scores less than -1.5, with osteoporosis risk factors present.

In addition, anyone with a fragility fracture (a fracture from a minor injury) should be treated for osteoporosis. This is true regardless of the DEXA scan results.

Treatment generally begins with a bisphosphonate medicine (Actonel, Fosamax, or Boniva). These drugs are proven to increase bone density and reduce the risk of fracture. Other options include:

* Estrogens (hormone replacement therapy)
* Calcitonin
* Teriparatide
* Raloxifene

In addition, the National Osteoporosis Foundation recommends 1,200 milligrams of daily calcium intake -- through diet and/or supplements.
When Should You Get a Bone Density Scan?

When, and how often, you should get a bone density scan depends on your age, risk factors, and whether you’ve already been diagnosed with thinning bones.

The general rule: anyone at risk for osteoporosis should get a bone density scan. Don’t wait for a fracture or a formal diagnosis.

Postmenopausal women are at highest risk, because estrogen (which falls after menopause) preserves bone strength. But men get osteoporosis, too. "They just get it later," says Mary Zoe Baker, MD, an endocrinologist and professor of medicine at the University of Oklahoma Health Sciences Center. Usually around age 70, "men start to catch up to women" in developing osteoporosis, according to Baker.
When Should You Get a Bone Density Scan? continued...

Major expert groups make the following recommendations for osteoporosis screening and bone scans:

Women over age 65: All women over the age of 65 should get a DEXA scan, according to the National Osteoporosis Foundation and the U.S. Preventive Services Task Force.

Postmenopausal women under age 65: For women under 65, a bone scan is not universally recommended. The National Osteoporosis Foundation recommends a bone scan for women with risk factors for osteoporosis:

* History of bone fracture as an adult
* Current smoking
* History of ever taking oral steroids for more than 3 months
* Body weight under 127 pounds
* Having an immediate family member with a fragility fracture (a broken bone from a minor injury, suggesting osteoporosis).

Premenopausal women: Generally, premenopausal women should not get bone scans. Even with an abnormal DEXA scan, the risk of fracture is still very low, and treatment isn't recommended. "The No. 1 rule is, don't get the test unless you know you're going to treat" if the result is abnormal, says Baker.

Men: Experts differ in their recommendations for bone scans for men. The National Osteoporosis Foundation recommends all men over the age of 70 should get a bone scan. At that age, "many men are on their way to developing osteoporosis," says Cosman.
Bone Scans for Osteoporosis: How Often?

If you've been told you have thin bones, you'll want to know if they're improving or getting worse over time. How often should a bone scan be done?

Medicare and many insurance companies will pay for a bone scan every two years in women with osteoporosis or who are at high risk. Because the response to treatment occurs slowly, this is usually an acceptable time interval, according to Rhee.

"In cases with high bone turnover rates, like women taking high-dose steroids," checking bone density as often as every six months may be necessary, says Rhee.

For women with a normal bone scan, waiting a few years to retest is fine, adds Rhee.

Another thing to keep in mind: not all DEXA scanners are created equal. There are slight differences in the calibration of different manufacturers' machines. Ideally, you should get all your bone scans on the same DEXA scanner. Getting retested on a different manufacturer's scanner could give a false impression of bone loss (or gain).
Besides the Bone Scan: Other Tests for Osteoporosis

Are other tests needed besides a bone scan for osteoporosis? Certain medical conditions can cause thinning of the bones. These include:

* Kidney disease
* Hyperparathyroidism (overactive secretion of parathyroid hormone)
* Vitamin D deficiency
* Hyperthyroidism (overactive thyroid)
* Hyperthyroidism (overactive thyroid)
* Liver disease
* Intestinal disease

By taking your medical history and checking routine laboratory blood tests, your doctor can detect these and other causes for low bone density.

Since estrogen keeps bones strong, can getting your estrogen levels checked help? "Probably not," says Baker. Rarely, perimenopausal women with heavy periods might need hormone checks. But for the vast majority, "DEXA is the only test they need."

SOURCES:

National Osteoporosis Foundation web site: "Fast Facts."

Khan, A. CMAJ, 2002; vol 167: pp 1141-1145.

Cranney, A. Endocrine Reviews, 2002; vol 23: pp 496-507.

U.S. Preventive Services Task Force: "Osteoporosis: Prevention and Treatment."

National Osteoporosis Foundation web site: "Physician's Guide to Prevention and Treatment of Osteoporosis."

Committee statement, Journal of Clinical Densitometry, 2004; vol 7: pp 17-26.

Wainwright, S. Journal of Clinical Endocrinology and Metabolism, 2005; vol 90: pp 2787-2793.

National Osteoporosis Foundation web site: "BMD Testing: What the Numbers Mean."

Kolta, S. Osteoporosis International, 1999; vol 10: pp 14-19.

Conference of Radiation Control Program Directors' Task Force: "Technical White Paper: Bone Densitometry," October 2006.

Mary Rhee, MD, MS, endocrinologist and assistant professor of medicine, Emory University, Atlanta.

Felicia Cosman, MD, clinical director, National Osteoporosis Foundation.

Mary Zoe Baker, MD, endocrinologist and professor of medicine, University of Oklahoma Health Sciences Center.
Reviewed on July 30, 2007