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Good Friends Are Good for You

2009-05-03T19:22:00.002+08:00

Good Friends Are Good for You

They might get on your nerves at times, but good friends have bigger benefits than you may realize.
By Tom Valeo

WebMD FeatureReviewed by Brunilda Nazario, MD"You got to have friends to make that day last long," sings Bette Midler. But good friends may help your life last longer, too, according to an Australian study. Conducted by the Centre for Ageing Studies at Flinders University, the study followed nearly 1,500 older people for 10 years. It found that those who had a large network of friends outlived those with the fewest friends by 22%.

Why is this so? The authors suspect that good friends discourage unhealthy behaviors such as smoking and heavy drinking. And the companionship provided by friends may ward off depression, boost self-esteem, and provide support. Also, as people age, they may become more selective in their choice of friends, so they spend more time with people they like.

Close relationships with children and relatives, in contrast, had almost no effect on longevity. Lynne C. Giles, one of the four researchers who conducted the study, emphasized that family ties are important; they just seem to have little effect on survival.

The Health Benefits of Good Friends
Lots of research has shown the health benefits of social support.

One such study, reported in the journal Cancer, followed 61 women with advanced ovarian cancer. Those with ample social support had much lower levels of a protein linked to more aggressive types of cancer. Lower levels of the protein, known as interleukin 6, or IL-6, also boosted the effectiveness of chemotherapy. Women with weak social support had levels of IL-6 that were 70% higher in general, and two-and-a-half times higher in the area around the tumor.

In 1989, David Spiegel, MD, a professor of psychiatry at Stanford University, published a landmark paper in Lancet. Itshowed that women with breast cancer who participated in a support group lived twice as long as those who didn't. They also had much less pain.

Sheldon Cohen, PhD, a psychology professor at Carnegie Mellon University, in Pittsburgh, has shown that strong social support helps people cope with stress.

"Friends help you face adverse events," Cohen tells WebMD. "They provide material aid, emotional support, and information that helps you deal with the stressors. There may be broader effects as well. Friends encourage you to take better care of yourself. And people with wider social networks are higher in self-esteem, and they feel they have more control over their lives."

Other studies have shown that people with fewer friends tend to die sooner after having a heart attack than people with a strong social network. Having lots of friends may even reduce your chances of catching a cold. That's true even though you're probably exposed to more viruses if you spend a lot of time with others.

"People with social support have fewer cardiovascular problems and immune problems, and lower levels of cortisol -- a stress hormone," says Tasha R. Howe, PhD, associate professor of psychology at Humboldt State University. "Why? The evolutionary argument maintains that humans are social animals, and we have evolved to be in groups. We have always needed others for our survival. It's in our genes. Therefore, people with social connections feel more relaxed and at peace, which is related to better health."
Friends Can Be Stressful
Friends can be a source of stress, though. In fact, friends can cause more stress than others precisely because we care so much about them.

Julianne Holt-Lunstad, PhD, an assistant professor of psychology at Brigham Young University, has found that dealing with people who arouse conflicted feelings in us can raise blood pressure more than dealing with people we don't like.

"My colleagues and I were interested in relationships that contain a mix of positivity and negativity," she says. "For example, you might love your mother very much, but still find her overbearing or critical at times."

By attaching people to portable blood pressure monitors, Holt-Lunstad and her colleagues found that blood pressure was highest when people were interacting with someone they felt ambivalent about.

What she found really surprising was that these interactions caused higher blood pressure than those with people the research subjects felt completely negative about. "We suspect that people we feel positive toward can hurt us that much more when they make a snide comment or don't come through for us because they are important to us. Friends may help us cope with stress, but they also may create stress."

So would we be better off having no friends at all?

Hardly. "One thing research shows is that as one's social network gets smaller, one's risk for mortality increases," Holt-Lunstad says. "And it's a strong correlation -- almost as strong as the correlation between smoking and mortality."

The Impact of Loneliness
What about loners? Are they at greater risk of dying because they prefer to be alone?

Only if they feel lonely. One study found that drug use among young people was higher among those who said they were lonely. Older lonely people tended to have higher blood pressure and poorer sleep quality. They also were more tense and anxious.

Another study found that college freshmen who had small social networks and claimed to be lonely had weaker immune responses to flu vaccinations. They also had higher levels of stress hormones in their blood.

Unfortunately, Americans have fewer friends than they used to, according to a recent study, "Social Isolation in America," published in the American Sociological Review. The authors found that from 1985 to 2004, the number of Americans who feel they have someone with whom they can discuss important matters dropped by nearly one-third. The number of people who said they had no one they could discuss such matters with tripled to nearly 25%. The authors suspect that long work hours and the popularity of the Internet may contribute to the decline in close relationships.

The study also found that the percentage of people who talk about important matters only to family members increased from 57% to 80%. Those who depend solely on their spouse for these talks increased from 5% to 9%.
How Women's Friendships Are Different From Men's
In general, women are better at maintaining friendships than men. Women "tend and befriend," says Shelley E. Taylor, PhD, a psychology professor at UCLA. They respond to stress by protecting and nurturing others ("tending"), and by seeking support from others ("befriending"). This pattern regulates the seeking, giving, and receipt of social support, Taylor says. It produces health benefits by reducing psychological and biological stress.

And Margaret Gibbs, PhD, a professor of psychology at Fairleigh Dickinson University, found that men and women relate to others differently throughout life.

"We found that women seemed more geared to empathy, while male friendships are more geared to companionship and altruism," she tells WebMD. "Male friendships are more about helping each other -- mending the lawn mower, that sort of thing. Women's friendships tend to have a more emotional content -- listening to friends' stories and coming up with helpful solutions."

Mexico Swine Flu Epidemic Worries World

2009-04-27T19:54:00.000+08:00

Mexico Swine Flu Epidemic Worries World
Swine Flu Deaths in Healthy Young People Raise Fears of Pandemic
By Daniel J. DeNoon

WebMD Health NewsReviewed by Louise Chang, MDApril 24, 2009 -- Mexico's deadly swine flu outbreak is caused by the same virus identified in the U.S., says CDC Acting Director Richard Besser, MD.

The CDC is analyzing 14 virus samples sent from Mexico. Seven of them, the CDC learned today, are very similar to the unusual swine flu strain isolated from U.S. patients.

Swine Flu Outbreak:
Get the Facts
Get the latest swine flu information from the WebMD and the CDC, plus other facts you need to know.

Swine Flu FAQ
CDC Swine Flu updates
Swine Flu Case Count Rising
Swine Flu Sickens 2 California Kids

© 2009 WebMD, LLC. All rights reserved.

"People are concerned about this situation," Besser said at a news conference. "We are worried as well. Our concern has grown since yesterday."

Sixty people in Mexico have died of the flu -- and so far, 16 of the deaths are confirmed cases of swine flu, news sources quote Mexican officials as saying.

World Health Organization spokesman Gregory Hartl told the Canadian news agency CBC that there have been some 800 cases in Mexico City, where schools are closed due to the outbreak.

Alarmingly, the flu outbreak in Mexico is striking healthy young people -- a pattern that would be expected if a flu virus new to humans emerged.

"Because these cases are not happening in the very old or the very young, which happens with seasonal influenza, this is an unusual event and a cause for heightened concern," Hartl said in a CBC interview.

That's not the only eyebrow-raising feature of the swine flu outbreaks. Infections have occurred in Mexico, California, and Texas -- where warm weather should mean the end of the normal flu season, says William Schaffner, MD, president-elect of the National Foundation for Infectious Diseases and chair of preventive medicine and infectious diseases at Vanderbilt University.

"Will we see this flu virus transmitted in the warm months? That would give us heartburn," Schaffner tells WebMD. "And is this a harbinger of things to come during our next flu season?"

Another disconcerting feature of the outbreak is that it's probably too late to contain it to limited geographical areas.

"We are seeing cases in Texas and California with no connection between them. This makes us think there has been transmission from person to person through many cycles," Besser said. "For containment we need limitation to a confined geographical area, and we have not seen that here."

The World Health Organization is convening an expert panel to determine whether to raise its pandemic flu alert level. Because of bird flu, we're at level 3. If the panel finds evidence of "increased human-to-human transmission" it goes to level 4. If there's evidence of "significant human-to-human transmission," it goes to level 5.

A pandemic will be declared only if there is "efficient and sustained human-to-human transmission" of a new flu virus. That clearly has not happened yet.

"Whether or not this [swine flu] strain causes a widespread pandemic will depend on its transmissibility among humans. That has not yet been fully elucidated, but should be shortly," Pascal James Imperato, MD, MPH, professor and dean of public health at SUNY Downstate Medical Center, Brooklyn, N.Y., tells WebMD.

Should there be a pandemic -- something that is far from certain -- the CDC has already begun work on a vaccine. Would it be ready by next flu season?

"It would be an Olympic sprint -- a mammoth feat -- to produce a flu vaccine by October," Schaffner says.
What You Should Do Now
Infectious disease experts agree with the CDC that now is a good time to think about what you'd do if there were a widespread flu outbreak.

Here's what you can do right now: Wash your hands often and well.

The CDC has not yet warned travelers to avoid the San Diego or San Antonio areas, and it is not restricting travel to or from Mexico. However, travelers to or from those areas should be sure to use all normal precautions to avoid catching or spreading a cold or flu.

People who live in or visit those areas and who get flu-like symptoms should see a doctor to get tested for the swine flu virus.

Swine Flu FAQ

2009-04-27T19:51:00.001+08:00

Swine Flu FAQ
WebMD Provides Answers to Your Questions About Swine Flu
By Daniel J. DeNoon

WebMD Health NewsReviewed by Louise Chang, MD The swine flu virus in the U.S. is the same one causing a deadly epidemic in Mexico. What is swine flu? What can we do about it? WebMD answers your questions.

What Is Swine Flu?
Like humans, pigs get the flu. Four different type A swine flu strains commonly circulate among pigs. Most recent swine flu viruses have belonged to the H1N1 and H3N2 subtypes. Pigs typically get sick but usually don't die from swine flu.

The new swine flu virus infecting humans is very unusual. It's somehow acquired genes from swine, bird, and human flu bugs. And it's also got genes from Eurasian swine flu viruses that aren't supposed to be in North America.

Do Humans Get Swine Flu?
Normally, swine flu bugs don't infect people. Historically, there's a case every year or two in the U.S. among people who have contact with live pigs.

But from December 2005 to January 2009 there was an uptick in swine flu cases. There were 12 human swine flu infections during this time. Eleven of these people had direct or indirect contact with pigs; in the twelfth case it was not known whether there was pig contact.

It's possible this uptick was due to improved reporting systems, but the CDC says "genetic changes in swine flu viruses and other factors might also be a factor."

The new swine flu virus is different. It's not yet clear that it's here to stay. But it is infecting humans, and that has world health officials keeping a close eye on it.

What Are the Symptoms of Swine Flu?
Swine flu symptoms are similar to regular flu symptoms and include cough, sore throat, fever, chills, headache, and fatigue. Some patients have also reported nausea and diarrhea. There is no easy way to distinguish swine flu from other types of flu or other germs. It takes a lab test to tell whether it's swine flu.

Can Swine Flu Spread From Person to Person?
The U.S. residents infected with swine flu virus had no direct contact with pigs. The CDC says it's likely that the infections represent widely separated cycles of human-to-human infections.

Have There Been Previous Swine Flu Outbreaks?
If swine flu sounds familiar to you, it's probably because you remember or have read about the 1976 swine flu outbreak at Fort Dix, N.J., among military recruits. It lasted about a month and then went away as mysteriously as it appeared. As many as 240 people were infected; one died.

The swine flu that spread at Fort Dix was the H1N1 strain. That's the same flu strain that caused the disastrous flu pandemic of 1918-1919, resulting in tens of millions of deaths.

Concern that a new H1N1 pandemic might return with winter led to a crash program to create a vaccine and vaccinate all Americans against swine flu. That vaccine program ran into all kinds of problems -- not the least of which was public perception that the vaccine caused excessive rates of dangerous reactions. After more than 40 million people were vaccinated, the effort was abandoned.
As it turned out, there was no swine flu epidemic

I Got a Flu Shot. Am I Protected Against Swine Flu?
No. There is currently no swine flu vaccine.

It's possible that the seasonal flu vaccine might provide partial protection against H3N2 swine flu bugs. But the strain that appeared in California is the H1N1 swine flu strain. It is very different from the H1N1 human flu strain included in the seasonal flu vaccine.

It's not known whether previous infection with human type A H1N1 flu might provide partial protection against the type A H1N1 swine flu in the current outbreak.

However, the CDC has made a "vaccine seed" from swine flu isolated from an infected person, and has begun the process of developing a vaccine should the need arise. Whether a vaccine could be produced in quantity by next flu season is a huge question.

How Serious Is the Public Health Threat of a Swine Flu Epidemic?
Any flu epidemic is worrisome, especially when a new strain of flu bug is involved.

"Influenza A viruses new to the human population that are able to efficiently transmit from person to person and cause illness may represent a pandemic threat," the CDC warns.

It's worrisome that, unlike seasonal flu, the swine flu outbreak in Mexico is attacking healthy young people. That's a hallmark of pandemic flu bugs.

But it takes more than a new virus spreading among humans to make a pandemic. The virus has to be able to spread efficiently from one person to another, and transmission has to be sustained over time. In addition, the virus has to spread geographically.

Is There a Treatment for Swine Flu?
Yes. While the swine flu bug is resistant to older flu medicines, it remains sensitive to Tamiflu and to Relenza.

Can You Get Swine Flu by Eating Pork?
No. You can only catch swine flu from being around an infected pig -- or, if it's the new swine flu virus, from an infected person.

Swine Flu: U.S. Declares Public Health Emergency

2009-04-27T19:48:00.000+08:00

Swine Flu: U.S. Declares Public Health Emergency

CDC Has Reports of at Least 20 People in the U.S. Sickened by Swine Flu
By Miranda Hitti

WebMD Health NewsReviewed by Louise Chang, MDApril 26, 2009 -- The U.S. government today declared the swine flu outbreak a public health emergency. Swine flu has sickened at least 20 people in the U.S., by the CDC's latest count.

"We are declaring today a public health emergency," Secretary of Homeland Security Janet Napolitano said today at a White House news briefing. That declaration is "standard operating procedure," Napolitano said. "It is similar to what we do when we see a hurricane approaching a site. The hurricane might not actually hit but allows you to take a number of preparatory steps. We really don't know ultimately what the size or seriousness of this outbreak is going to be."

Swine Flu Outbreak:
Get the Facts
Get the latest swine flu information from the WebMD and the CDC, plus other facts you need to know.

Swine Flu FAQ
CDC Swine Flu updates
Swine Flu Case Count Rising
Swine Flu Sickens 2 California Kids

© 2009 WebMD, LLC. All rights reserved.

As part of the emergency, the Department of Homeland Security is releasing 25% of stockpiled antivirals -- Tamiflu and Relenza -- to the states.

Here's what officials want you to do: Stay home if you're sick, avoid close contact with people who are sick, wash your hands often, avoid touching your eyes, nose, and mouth, cover your mouth or nose with a tissue when coughing or sneezin g, and keep up with health information in your own community.

The CDC has gotten reports of lab-confirmed swine flu cases in eight people in New York City, seven people in California, two in Texas, two in Kansas, and one in Ohio.

All of those swine flu cases have been relatively mild, although one person was briefly hospitalized, according to Keiji Fukuda, MD, assistant director-general for health security and environment at the World Health Organization.

The eight swine flu cases in New York City involved students at Saint Francis Preparatory School in Queens. All have recovered fully, according to a news release from the New York City Department of Health and Mental Hygiene.

So far, U.S. cases of swine flu have been milder than those seen in Mexico, where the World Health Organization has confirmed that at least 20 people have died from swine flu; health officials are investigating dozens more deaths in Mexico.

More swine flu cases are likely in the U.S. as public health officials heighten their hunt for the new strain of swine flu virus, notes Anne Schuchat, MD, the CDC's interim deputy director for science and public health program. Her advice: Be prepared for the possibility that there may be severe cases, and even fatalities, in the U.S.

"I do fear that we will have deaths here," Schuchat said today at a news conference.

Countries around the world are watching for the virus, and scientists are scrambling to learn more about the virus and stop it before it becomes a pandemic.

Fukuda says the global health community is taking the swine flu threat "very seriously" but wants more information before deciding whether to raise the WHO's pandemic alert level from phase 3 to phase 4.

An influenza pandemic occurs when a new influenza type A virus emerges for which there is little or no immunity in the human population, begins to cause serious illness, and then spreads easily from person to person worldwide, according to background information from the U.S. Department of Health and Human Services.

The WHO has a scale ranging from phase 1 (low risk of a flu pandemic) to phase 6 (a full-blown pandemic is under way).
Swine Flu Symptoms
Symptoms of swine flu seen in U.S. patients so far have been "relatively nonspecific -- high fever, cough sore throat, muscle aches, possibly vomiting and diarrhea in some numbers," says Schuchat.

The problem is, those symptoms aren't unique to swine flu.

They "can be caused by so many different things," Schuchat says, which makes it "impossible" for a patient to tell if they have swine flu, as opposed to another flu virus or a different illness.

"This is a dilemma, a challenge, we're wrestling with," says Schuchat. She encourages patients to use their judgment about whether they're sick enough to see a doctor, and to definitely do so if they've recently been to a high-risk area, such as Mexico.

Schuchat also notes that there have been cases of the virus spreading from person to person in the U.S. The two confirmed cases in Kansas are a husband and wife, one of whom traveled to Mexico. Two days after returning home, the spouse became ill, says Schuchat.

WebMD Senior Writer Daniel J. DeNoon contributed to this report.

Build a Better Date Night

2009-04-18T10:19:00.002+08:00

Build a Better Date Night

Feature from "Good Housekeeping" MagazineBy Sarah Mahoney

Whether your trysts are regular or once in a blue moon, you can rev up your romantic routine. For more great dates, check out these 7 fun ideas.

Tell the truth: Did your date nights vanish years ago, along with sleeping in, Sunday brunches, and reading the newspaper over coffee? Or have they become as stale as, well, 15 years of the missionary position?

In either case, you're due for a refresher. Couples should give special time together a high priority, because it not only helps you stay connected, the latest research reports, but it also makes both partners happier. "Date night is one of the best ways couples have to pull back from the fray and remember there's an 'us' hidden in the swirl of their daily lives — and really focus on maintaining and celebrating their connection to each other," says Pepper Schwartz, Ph.D., a sociology professor at the University of Washington in Seattle and relationship expert from perfectmatch.com.

To help keep your marriage strong, date night should be fun — of course — but you should also make it novel in some way, or you'll grow bored with your time together and, possibly, with each other, says Arthur Aron, Ph.D., a psychology professor at the State University of New York at Stony Brook who researches couples' interactions. That doesn't mean that you have to give up your beloved French film nights or ballroom dancing sessions and start bungee jumping just for the sake of novelty. Rather, you should simply make the effort to think creatively about how to spend your time together. "My wife and I love the ballet," says Aron, "and my sister gave us a backstage tour at the local dance company, so we got a different perspective on something we already enjoy."

To discover how to spice up date nights, we found three couples who faced challenges and asked them to road-test expert fix-it advice. Read on to see what worked — and why.

The Kitchen Cure
Names: Nina and Jayme Deibler

Hometown: Pittsburgh

Married: 4 years; she's 37, he's 38

Kids: A daughter, 2

Their challenge: Making date night happen at all

"My husband and I used to have great dates," Nina says. "We both love good food, and we'd often spend five or six hours cooking and experimenting with different wines."

But since their daughter was born, finding couple time has gotten harder. "I travel frequently for my job, and Jayme often works evenings and weekends," she says. "So when we do have a few hours, we usually want to spend them with our daughter."

"Working parents worry that time spent as a couple subtracts from time spent with their kids," explains Schwartz. "But when couples feel guilty leaving a child with a sitter, I tell them, 'This isn't selfish, it's protecting both your marriage and your family.'"

Expert Makeover

"It's great that these two have such a strong common interest," says James M. Graham, Ph.D., assistant professor of psychology at Western Washington University in Bellingham. "I'd like them to indulge their passions in a project they can finish in a few hours — one with a unique twist. Experimenting together makes a date more satisfying, just as team-building exercises draw people closer."

When a couple has to overcome a new challenge, their sense of accomplishment after they succeed is magnified. "Dates that allow that kind of growth let you surprise yourself and your partner," he says, "and see each other in a new light." Just keep changes and challenges moderate. "This should be fun, not traumatic."

The Deiblers decided to try making sushi — a dish they love in restaurants but had never prepared themselves. They bought the basic equipment (including a book of instructions) at a favorite cooking store and arranged for Nina's mom to take care of their toddler for a few hours.

The verdict: A huge hit

Her take: "The expert really nailed it when he suggested a project for us — this was great. And it was a challenge: The rice had to be just the right temperature, and some of the chopping and rolling was tricky. We did need the time without our daughter, but several of my neighbors want to trade babysitting so we can all have date nights. I found this experience very inspiring — it made me feel like we were dating again. Next time, I want to try cooking Indian food."

His take: "The food turned out really well, and we had the kind of fun we haven't for ages. It reminded me how good we are at working together and how we complement each other: Nina did the organizing and the shopping, and got the rice going. Then we took turns chopping and wrapping, tasting as we went along. And because we did it all between 5 and 7:30, we are confident now that we can make something like this happen at least every other week."

5-Minute Fixes
Names: Cate and Dan Adams

Hometown: Salt Lake City

Married: 18 years; both are 49

Kids: Twin girls, 16

Their challenge: Making limited time together feel meaningful

"We've always tried to do date nights, even before we had kids," says Cate. "Then, after the girls were born, we didn't go out often. Now that they're older, we both work full-time and still don't go out much.

"After our last anniversary, we decided that we'd try to spend five minutes each day just talking and connecting. And it's helped. But we'd like to find a way to make that time more special."
Expert Makeover

The experts loved the five-minute ritual, which eases the scheduling pressure that prevents many date nights from happening at all. But Schwartz advised the Adamses to expand beyond their "How was your day?" conversations and get creative. She suggested that they develop ways to mix it up by brainstorming together and surprising each other. She emphasizes that no one, including the Adamses, should feel pressured to come up with something novel for every single date. There's nothing wrong with what the two do now: chat in the kitchen while Dan does the dishes. But sharing a glass of wine, going for a short walk, or just sitting on the deck once a week can make those few moments feel more special.

The overachieving couple decided that they would come up with something different to do every single day for an entire week. One night, they traded foot massages. The next, Cate asked Dan to show her how to fix a flat tire on her bicycle. Another evening, each drew a picture of the best thing that happened to them that day. And one night, after Dan noticed someone selling weird-looking rocks on eBay, they raced down to the creek that runs through their backyard to see who could find the most eBay-worthy stones.

The verdict: Sure, it was nice, but enough already!

Her take: "The night we brainstormed was funny, and we laughed a lot throughout the week. But the best part, honestly, was all the talking we did while we were doing these things. In almost every case, we wound up spending much longer than five minutes, and it was good to realize we could make that much time for each other."

His take: "We had some fun with this, but I missed the quietness — and the spontaneity — of just being able to sit down and talk with Cate and decompress. And having to think of something new to do every night just wouldn't be sustainable in the long run, obviously. But I can see doing something special more often than we do now."

The Active Answer
Names: Camille and Kent Boskovich

Hometown: La Grange, IL

Married: 22 years; both are 47

Kids: A son, 19, and a daughter, 17

Their challenge: Spicing up their tried-and-true routine

These two spend plenty of time together — and enjoy it. They work out at the same gym, they have dinner out once a week, and they often spend weekends driving to their daughter's hockey tournaments in other cities.

Still, "our dates are pretty boring," Camille says. And while they enjoy elaborate events — from opera to White Sox games — they're looking for date ideas that don't take much advance scheduling.

Dating can be complex for couples like this, as they anticipate an empty house — and a kid-less social calendar. Even people with common interests, like these two, need to expand their dating repertoire, says Aron. He advised them to explore more in the fitness realm. They already enjoy it, and his research shows that couples typically find shared physical activity one of the best ways to bond. Aron actually persuaded spouses to Velcro themselves together and crawl across gym mats — and found that it made them feel more in love than they had before this unusual exercise.

"It's really important that they pick something they're both new to," he says — maybe a swing-dance class or snowshoeing. But they shouldn't worry that every activity has to be a perfect fit, says Schwartz. "Think of yourself as an anthropologist doing research, and remember, if you don't like it, you don't have to try it again," she says. Plus, even a bad date can be a good bonding experience and provide a couple with a shared memory to laugh about later.

After looking at their options, Camille and Kent tried a fitness yoga class at their health club: She had taken a few classes in the past but was still a novice, and he had always been interested in giving it a go.

The verdict: Mixed reviews but headed in the right direction

Her take: "I was surprised Kent was game to try this, but it was really great. The instructor asked us to do some tough poses, and Kent kept shooting me a look like, 'Are you kidding me?' On the one hand, I worried that he wasn't enjoying it that much. On the other, it was funny — and it really felt good to do something besides going out to dinner, especially something physical and healthy. So this inspired us: We're going to do a few sessions with a trainer next."

His take: "Honestly, is this a better date than going out for dinner and sharing a bottle of wine? No way. But that said, it was OK, and I would try it again. I'm looking forward to the training sessions. I'm a treadmill guy, so it'll be good to add weights — and fun to do it with my wife."

Originally published on January 15, 2009

10 Ways to Catch a Liar

2009-04-18T10:15:00.002+08:00

10 Ways to Catch a Liar

Experts have 10 tips that can let you know if someone isn't telling you the whole truth.
By Heather Hatfield

J.J. Newberry was a trained federal agent, skilled in the art of deception detection. So when a witness to a shooting sat in front of him and tried to tell him that when she heard gunshots she didn't look, she just ran -- he knew she was lying.

How did Newberry reach this conclusion? The answer is by recognizing telltale signs that a person isn't being honest, like inconsistencies in a story, behavior that's different from a person's norm, or too much detail in an explanation.

While using these signs to catch a liar takes extensive training and practice, it's no longer only for authorities like Newberry. Now, the average person can become adept at identifying dishonesty, and it's not as hard as you might think. Experts tell WebMD the top 10 ways to let the truth be known.

Tip No. 1: Inconsistencies
"When you want to know if someone is lying, look for inconsistencies in what they are saying," says Newberry, who was a federal agent for 30 years and a police officer for five.

When the woman he was questioning said she ran and hid after hearing gunshots -- without looking -- Newberry saw the inconsistency immediately.

"There was something that just didn't fit," says Newberry. "She heard gunshots but she didn't look? I knew that was inconsistent with how a person would respond to a situation like that."

So when she wasn't paying attention, he banged on the table. She looked right at him.

"When a person hears a noise, it's a natural reaction to look toward it," Newberry tells WebMD. "I knew she heard those gunshots, looked in the direction from which they came, saw the shooter, and then ran."

Sure enough, he was right.

"Her story was just illogical," says Newberry. "And that's what you should look for when you're talking to someone who isn't being truthful. Are there inconsistencies that just don't fit?"

Tip No. 2: Ask the Unexpected
"About 4% of people are accomplished liars and they can do it well," says Newberry. "But because there are no Pinocchio responses to a lie, you have to catch them in it."

Sir Walter Scott put it best: "Oh what a tangled web we weave, when first we practice to deceive!" But how can you a catch a person in his own web of lies?

"Watch them carefully," says Newberry. "And then when they don't expect it, ask them one question that they are not prepared to answer to trip them up."

Tip No. 3: Gauge Against a Baseline
"One of the most important indicators of dishonesty is changes in behavior," says Maureen O'Sullivan, PhD, a professor of psychology at the University of San Francisco. "You want to pay attention to someone who is generally anxious, but now looks calm. Or, someone who is generally calm but now looks anxious."

The trick, explains O'Sullivan, is to gauge their behavior against a baseline. Is a person's behavior falling away from how they would normally act? If it is, that could mean that something is up.

Tip No. 4: Look for Insincere Emotions
"Most people can't fake smile," says O'Sullivan. "The timing will be wrong, it will be held too long, or it will be blended with other things. Maybe it will be a combination of an angry face with a smile; you can tell because their lips are smaller and less full than in a sincere smile."

These fake emotions are a good indicator that something has gone afoul.

Tip No. 5: Pay Attention to Gut Reactions
"People say, 'Oh, it was a gut reaction or women's intuition,' but what I think they are picking up on are the deviations of true emotions," O'Sullivan tells WebMD.

While an average person might not know what it is he's seeing when he thinks someone isn't being honest and attribute his suspicion to instinct, a scientist would be able to pinpoint it exactly -- which leads us to tip no. 6.

Tip No. 6: Watch for Microexpressions
When Joe Schmo has a gut feeling, Paul Ekman, a renowned expert in lie detection, sees microexpressions.

"A microexpression is a very brief expression, usually about a 25th of a second, that is always a concealed emotion," says Ekman, PhD, professor emeritus of psychology at the University of California Medical School in San Francisco.

So when a person is acting happy, but in actuality is really upset about something, for instance, his true emotion will be revealed in a subconscious flash of anger on his face. Whether the concealed emotion is fear, anger, happiness, or jealousy, that feeling will appear on the face in the blink of an eye. The trick is to see it.

"Almost everyone -- 99% of those we've tested in about 10,000 people -- won't see them," says Ekman. "But it can be taught."

In fact, in less than an hour, the average person can learn to see microexpressions.

Tip No. 7: Look for Contradictions
"The general rule is anything that a person does with their voice or their gesture that doesn't fit the words they are saying can indicate a lie," says Ekman. "For example, this is going to sound amazing, but it is true. Sometimes when people are lying and saying, 'Yes, she's the one that took the money,' they will without knowing it make a slight head shake 'no.' That's a gesture and it completely contradicts what they're saying in words."

These contradictions, explains Ekman, can be between the voice and the words, the gesture and the voice, the gesture and the words, or the face and the words.

"It's some aspect of demeanor that is contradicting another aspect," Ekman tells WebMD.

Tip No. 8: A Sense of Unease
"When someone isn't making eye contact and that's against how they normally act, it can mean they're not being honest," says Jenn Berman, PhD, a psychologist in private practice. "They look away, they're sweating, they look uneasy ... anything that isn't normal and indicates anxiety."

Tip No. 9: Too Much Detail
"When you say to someone, 'Oh, where were you?' and they say, 'I went to the store and I needed to get eggs and milk and sugar and I almost hit a dog so I had to go slow,' and on and on, they're giving you too much detail," says Berman.

Too much detail could mean they've put a lot of thought into how they're going to get out of a situation and they've crafted a complicated lie as a solution.

Tip No. 10: Don't Ignore the Truth
"It's more important to recognize when someone is telling the truth than telling a lie because people can look like they're lying but be telling truth," says Newberry.

While it sounds confusing, finding the truth buried under a lie can sometimes help find the answer to an important question: Why is a person lying?

These 10 truth tips, experts agree, all help detect deception. What they don't do is tell you why a person is lying and what the lie means.

"Microexpressions don't tell you the reason," says Ekman. "They just tell you what the concealed emotion is and that there is an emotion being concealed."

When you think someone is lying, you have to either know the person well enough to understand why he or she might lie, or be a people expert.

"You can see a microexpression, but you have to have more social-emotional intelligence on people to use it accurately," says O'Sullivan. "You have to be a good judge of people to understand what it means."

Extra Tip: Be Trusting
"In general we have a choice about which stance we take in life," says Ekman. "If we take a suspicious stance life is not going to be too pleasant, but we won't get misled very often. If we take a trusting stance, life is going to be a lot more pleasant but sometimes we are going to be taken in. As a parent or a friend, you're much better off being trusting rather than looking for lies all the time."

Can You Trust Your Mammogram?

2009-04-16T10:59:00.003+08:00

Can You Trust Your Mammogram?

WebMD Feature from "Good Housekeeping" MagazineBy Fran Smith

Why even smart doctors miss breast cancer - and how to make sure you're getting the best care.
No matter what you know about other diseases, breast cancer is probably the one that scares you most. It is frightening, striking nearly 182,000 women this year and plunging them into a world of complicated, arduous treatment. So it's heartening to know that more women are being diagnosed early, when the odds of beating the cancer are as high as 98 percent. Prevention and treatment are becoming personalized, thanks to genetic tests and new types of drugs. And after decades of no change, the death rate has finally begun to drop — about 2 percent annually since 1990.

Yet behind these impressive statistics lies one dumbfoundingly scary fact: Just because better tools and treatment exist is no guarantee that you'll get any of them. Your mammogram could be interpreted inaccurately, a lump could be incorrectly diagnosed, and you may not receive the best treatment for you simply because of where you live, the type of surgeon you choose — or even the doctor's sex.

That's why it's more important than ever to know the right questions to ask. Breast cancer is a complex disease (some researchers suspect it's at least five genetically distinct conditions), and no single approach works best for everybody. At every step — when you have your annual mammogram or get a suspicious lump checked out or undergo treatment — you should, at the very least, receive care that meets the scientific guidelines issued by leading cancer organizations. Here's how to make sure you do.

Screening Snafus
When you get a mammogram, it's common to have a stab of anxiety about what the radiologist will find. What should also concern you: the doctor who's doing the detecting.

The news: In a new study, researchers reviewed nearly half a million mammograms performed at 44 facilities. At the best centers, doctors identified cancer when it was present just about 100% of the time; at others, that number was closer to 70%, says study leader Stephen Taplin, M.D., M.P.H., a senior scientist at the National Cancer Institute. Facilities with a breast-imaging specialist (defined here as a doctor who spends at least half her time reading mammograms) had the best record.

Why it matters: Getting a regular mammogram is key to finding breast cancer early. Five-year survival rates drop from a high of 98.1% for early, breast-only tumors to 27.1% for advanced cancer that has spread to distant organs.

What you should do: When you call for an appointment, ask if there's a breast-imaging specialist on staff. If not, shop around, advises Diana Miglioretti, Ph.D., a researcher with the Group Health Center for Health Studies in Seattle. "I'd go to someone who has been interpreting screening mammograms for at least 10 years."

Follow-up Foul-ups
If your screening mammogram is abnormal or you have a lump, the next step is often a diagnostic X-ray, which takes magnified close-ups of the suspicious tissue.

The news: In theory, diagnostic mammograms should be easier to interpret than screening ones because the doctor knows where trouble may be lurking. Yet the largest study analyzing how well radiologists do on these critical exams found they missed 21 percent of cancers on average. The real shocker was the range: The top performer found every tumor, while the worst missed an astonishing 73 percent. Doctors affiliated with academic medical centers did best: They correctly diagnosed 88 percent of cancers.

Why it matters: Missing a tumor at this step could mean a delay in diagnosis — possibly a dangerous one, if a tumor isn't detected and treated before the cancer has spread.

What you should do: As with screening X-rays, the doctor who reads your diagnostic X-ray should be someone who specializes in mammograms, says Miglioretti, who led the study. Unless you live in a rural area, you should be able to find such a specialist no more than an hour or two away. "It's worth the drive," she says.

Surgical Biases
The biggest decision many women face when they're diagnosed with breast cancer is whether to have a mastectomy (removal of the entire breast) or a lumpectomy (only the tumor and surrounding tissue are cut out). In many cases, breast-conserving surgery, including lymph node testing and follow-up radiation, has the same lifesaving benefits as mastectomy. Yet your surgeon may not explain the options and consequences clearly or evenhandedly.

The news: Clinical guidelines developed by leading organizations favor breast-conserving surgery because it's less drastic. That's true whether you live in Augusta, ME, or Augusta, GA. Yet a review of 800,000 patient records found that while 70% in the Northeast had breast-sparing surgery, only 58% of those in the South did (the numbers for the West and Midwest were 63 percent and 61 percent, respectively). The review didn't look for a why, but study leader Jack Sariego, M.D., professor of surgery at Temple University, notes that the more rural South likely has fewer radiation facilities and fewer academic medical centers to promote surgical advances.

Beyond your zip code, the type of surgeon and hospital you choose may affect the recommendation you'll receive. Doctors who treat a lot of breast cancer or who work in cancer centers or academic medical centers suggest lumpectomy more often than general surgeons in the community. Surgeons trained after 1981 are also more likely to recommend a lumpectomy than older doctors, past research from the University of North Carolina at Chapel Hill has shown.
Why it matters: In a survey of 1,132 women who had either a lumpectomy or a mastectomy, almost half indicated they did not understand the risks and benefits of their choice.
What you should do: Ask loads of questions, starting with, "Am I a candidate for breast-conserving surgery, and if not, why not?" advises Dr. Sariego. Do your own research. And don't be shy about asking the first surgeon to recommend another for a second opinion. Better yet, look on your own: A recent study shows you're more likely to wind up with someone experienced and affiliated with a cancer program, compared with women who rely on referrals from their doctor or health plan, says Steven Katz, M.D., professor of medicine and health management and policy at the University of Michigan.

While you're asking questions, find out how your lymph nodes will be tested to see if the cancer has spread. A newer procedure, called sentinel-node biopsy, is less invasive and far less likely to cause permanent arm swelling than old-fashioned lymph node removal, but about 35 percent of patients aren't getting it, a recent multicenter study found.

Post-Surgery Neglect
Lumpectomy is just as effective as mastectomy only if it includes lymph node testing and a course of radiation treatments — generally five days a week for about six weeks. That's something your surgeon should make clear before you choose one procedure over the other.

The news: In 2003, only 71 percent of lumpectomy patients followed through with radiation, down from 79 percent in 1992, University of Minnesota epidemiologist Beth Virnig, Ph.D., reported last December. "A lot of women with serious breast cancer are not getting comprehensive treatment," she says.

Why it matters: If you don't undergo a full course of radiation, your chances of local recurrence within 10 years are as high as 30 percent, says Dr. Katz. (If you do, they drop to about 8 to 10 percent.)

What you should do: Talk with a radiation oncologist before surgery. Ask how long your treatment will last and what the side effects might be. For that matter, talk with all the specialists who may be involved in your postsurgical care. Women often feel panicked and pressured to start treatment immediately, but it's usually safe to wait two to three weeks.

Reticence on Reconstruction
If a lumpectomy isn't right for you, a mastectomy followed by reconstruction is an alternative — but you may have to bring up the subject.

The news: Only about one-quarter of surgeons regularly send patients for a plastic surgery consultation before they make their lumpectomy or mastectomy decision, researchers from the University of Michigan found in a 2007 study. Who's most likely to make that referral? Women surgeons — as well as those who treat a lot of breast cancer. Reconstruction can be done during the same surgery as the mastectomy, but it requires the general and plastic surgeons to share turf and mesh schedules, which may be inconvenient for them — even if it's good for you.

Why it matters: Both procedures will alter your appearance, but in different ways. This may seem like a minor worry when you're newly diagnosed and terrified, but it's likely to become important when you're well.

What you should do: "Ask your surgeon how your breast will look, how your clothing will fit," says Amy Alderman, M.D., M.P.H., an assistant professor of surgery at the University of Michigan. Even if you're sure you want breast-conserving surgery, you may want to consult with a plastic surgeon. Lumpectomy sometimes changes the breast more than women expect; a specialist can help you assess what might happen in your case. This is not vanity: Women who end up with extremely uneven breasts are more likely to be depressed and to worry that their cancer will return, a brand-new University of Michigan study found. Or you may want to seek out a breast surgeon who's experienced in oncoplastic techniques, which can improve the look of the breast.

Thankfully, the days of "Doctor knows best" are behind us. But that means breast cancer patients have to work with their physicians to make tough choices. To do that, women must share their fears and desires. "The doctor only knows what's on your X-ray and pathology report," says Karen Sepucha, Ph.D., a senior scientist with the Health Decision Research Unit at Massachusetts General Hospital: "What you care about needs to get on the table."

And you have to be the one who makes sure it does.

More Ways to Get the Answers You Need
Going for a Third Opinion
Kim Friedrich, 37
Mastic, NY

Kim Friedrich was in shock. In February 2007, her left breast had a tumor one-and-a-half times the size of a golf ball; because it was so big and aggressive, the surgeon told her she needed to have that breast removed, as well as the other as a precaution. A second doctor agreed. "I kept seeing myself on my deathbed," Friedrich says. She'd look at her two daughters and seize up with grief — would they grow up without her? While she would have done anything to live, she wasn't convinced she had to lose her breasts. Neither doctor had taken much time with her, she realized. Friedrich began to do research and talked to everyone she could. When an acquaintance raved about her breast specialist, at a cancer center a three-hour drive away, Friedrich pressed for an appointment. The mastectomy recommendations did not surprise the doctor. "That's old thinking," he told her. His advice: a course of chemotherapy (which shrank the tumor down to the size of a pea), followed by a lumpectomy and radiation. It was very tough, but Friedrich has no doubt she chose the right treatment — and doctor: "I got two quick assessments, and felt like they were thinking, 'Let's just do what's fastest and move on to the next patient.'"

When It's Not "Nothing"
Amalia Rigoni, 50
Olympia Fields, IL

Although she'd had a normal mammogram just a few months earlier, in March 2000, Amalia Rigoni was uneasy about a lump she felt in her lower right breast. Both her gynecologist and internist said she was fine. A diagnostic mammogram detected nothing. Still, she insisted on seeing a surgeon. That doctor, a general surgeon, told her to come back in six months. So Rigoni tried another tack: "If your mother had breast cancer, where would you send her?" The surgeon recommended a breast specialist who'd been his professor. The specialist checked her by closing his eyes and palpating the breast. "I don't like the feel of that lump," he said. "It was surreal," Rigoni recalls. "But I said, 'Thank God. At least I know what's going on.'" Almost nine years later — after a mastectomy, reconstruction, radiation, and three years of the drug tamoxifen followed by five on Femara — she's fine. Now Rigoni's a hotline coordinator for Breast Cancer Network of Strength, counseling women who may be facing the same struggle to get answers. "I tell them that doctors may know medicine, but you know your body. If something doesn't feel right, get it checked out." And, she adds, "go to a specialist."

Filling the Info Gap
Evelyn White, 48
San Francisco, CA

Support groups can provide invaluable information that patients may not get from their doctors. Evelyn White, for example, says her medical care was "great." She was diagnosed with breast cancer in February 2006, and underwent a mastectomy. But the chemo that followed left her unable to move — and she was suffering terrible crying jags. A friend thought it might be the medicine that White was taking for nausea — Ativan, a powerful sedative. She asked her doctor about stopping the drug and then, at a meeting of a cancer survivors' organization, heard about an alternative. There was a newer drug, Emend, developed specifically to prevent the nausea of chemotherapy — without causing depression. Once her physician switched the meds, "I felt a thousand percent better, physically and emotionally," says White. Later, the group helped in another key way. White had assumed her cancer was genetic (her sister was a survivor as well), and she was worried that her daughter, 24, might be at increased risk. Armed with information she got from a meeting, she underwent testing and, last year, was thrilled to be able to strike that worry off her list.

7 Relationship Problems and How to Solve Them

2009-04-10T20:42:00.003+08:00

7 Relationship Problems and How to Solve Them

Here's how to resolve the most common relationship problems and get your love life back on track.
By Carol Sorgen

FeatureReviewed by Louise Chang, MDIt's the rare couple that doesn't, sooner or later, run into a few bumps in the road. If you recognize ahead of time what those relationship problems can be, you'll have a much better chance of weathering the storm, experts say.

Ideally, a couple should discuss certain basic issues -- such as money, sex, and kids -- before they decide to start their life together. Of course, even when you do discuss these issues beforehand, marriage (or a long-term, live-in relationship) is nothing like you think it's going to be.

In spite of the fact that every marriage experiences relationship problems, couples who are successful have learned how to manage them and keep their love life going, says marriage and family therapist Mitch Temple, MS, author of The Marriage Turnaround. They gain success in marriage by hanging in there, tackling problems, and learning how to maneuver through the complex issues of everyday married life. Many do this by reading self-help books, attending seminars, browsing articles on the Web, going to counseling, observing other successful couples, or simply by trial and error.

Here are some common issues and ways to resolve them:

Relationship Problem: Communication

All relationship problems stem from poor communication skills, says Elaine Fantle Shimberg, author of Blending Families. "You can't communicate while you're checking your BlackBerry, watching TV, or flipping through the sports section," she says.

Problem-solving strategies:

Make time ... yes, an actual appointment with each other, Shimberg says. If you live together, put the cell phones on vibrate, put the kids to bed, and let the answering machine pick up your calls.
If you can't "communicate" without raising your voices, go to a public spot like the library, park, or restaurant, where you'd be embarrassed if anyone saw you screaming.
Set up some rules ... like not interrupting until the other is through, banning phrases such as "You always ..." or "You never ..."
Remember that a large part of communication is listening, so be sure your body language reflects that. That means, don't doodle, look at your watch, pick at your nails, etc. Nod so the other person knows you're getting the message and rephrase if necessary, such as, "What I hear you saying is that you feel as though you have more chores at home, even though we're both working." If you're right, the other can confirm, and if what the other person really meant was, hey, you're a slob and you create more work for me by having to pick up after you, perhaps they'll say so but in a nicer way.

Relationship Problem: Sex

Even partners who love each other can be incompatible sexually. Compounding these problems, says Mary Jo Fay, is the fact that men and women alike are sorely lacking in sex education and sexual self-awareness. Yet, having sex is one of the last things we should be giving up, says Fay, who addresses the topic in her new book, Please Dear, Not Tonight. "Sex brings us closer together, releases hormones that help our bodies both physically and mentally, and keeps the chemistry of a healthy couple healthy," she says.

Problem-solving strategies:

Plan, plan, plan, Fay says. Make an appointment -- not necessarily at night when everyone is tired. Maybe during the baby's Saturday afternoon nap. Or perhaps a "before-work quickie," Fay suggests. Or ask Grandma and Grandpa to take the kids every other Friday night for a sleepover. "When sex is on the calendar, it increases your anticipation," Fay says, adding that mixing things up a bit can increase your sexual enjoyment as well. Why not sex in the kitchen? Sex by the fire? Sex standing up in the hallway?
California psychotherapist Allison Cohen, MA, MFT, also suggests learning what truly turns your partner on by asking him or her to come up with a personal "Sexy List." And, of course, you do the same. What do each of you truly find sexy? "The answers may surprise you." Swap the lists and use them to create more scenarios that turn you both on.
If your sexual relationship problems can't be resolved on your own, Fay recommends consulting a qualified sex therapist, who can help you both address and resolve your issues.

Relationship Problem: Money

Money problems can start even before the wedding vows are said, from the expenses of courtship to the high cost of weddings. The National Foundation for Credit Counseling (NFCC) recommends that couples who have money woes take a deep breath and have a serious conversation about finances.

Problem-solving strategies: The NFCC offers the following advice for having that much-needed financial conversation:

Be honest about your current financial situation. If things have gone south, continuing the same lifestyle that was possible before the loss of income is simply unrealistic.
Don't approach the subject in the heat of battle. Instead, set aside a time that is convenient and non-threatening for both parties.
Acknowledge that one partner may be a saver and one a spender, understanding that there are benefits to both, and agreeing to learn from each other's tendencies.
Don't hide income or debt. Bring financial documents, including a recent credit report, pay stubs, bank statements, insurance policies, debts, and investments to the table.
Don't blame.
Construct a joint budget that includes savings.
Decide which person will be responsible for paying the monthly bills.
Allow each person to have independence by setting aside money to be spent at his or her discretion.
Decide upon short-term and long-term goals. It's OK to have individual goals, but you should have family goals, too.
Talk about caring for your parents as they age, and how to appropriately plan for their financial needs, if necessary.

Relationship Problem: Struggles Over Home Chores

Nowadays, most partners work outside the home -- and in today's economy -- often at more than one job, so it's important to equitably divide the labor at home, says Paulette Kouffman Sherman, PhD. She is the author of Dating from the Inside Out: How to Use the Law of Attraction in Matters of the Heart.

Problem-solving strategies:

Be organized and clear about your respective jobs in the home, Sherman says. "Write all the jobs down and agree on who does what." Be fair: Make sure each partner's tasks are equitable so no resentment builds.
Be open to other solutions, Sherman adds: If you both hate housework, maybe you can spring for a cleaning service. If one of you likes housework, the other partner can do the laundry and the yard. As long as it feels fair to both people, you can be creative and take preferences into account.

Relationship Problem: Not Prioritizing Your Relationship

If you want to keep your love life going, making your relationship a focal point does not end when you say "I do." "Relationships lose their luster," says Karen Sherman, PhD, author of Marriage Magic! Find It, Keep It, and Make It Last. "So make yours a priority."

Problem-solving strategies:

Do the things you used to do when you were first dating: Make gestures of appreciation, compliment each other, contact each other through the day, and show interest in each other.
Plan date nights. Schedule time together on the calendar just as you would any other important event in your life.
Respect one another. Say "thank you," and "I appreciate ... ." It lets your partner know that he/she matters.

Relationship Problem: Conflict

Occasional conflict is an inevitable part of life, says New York-based psychologist Susan Silverman, PhD, but if you and your partner feel like you are starring in your own nightmare version of the movie Groundhog Day, it's time to break free of this toxic routine. Recognizing these simple truths will lessen anger and enable you to take a calm look at the underlying issue.

Problem-solving strategies:

Conflict resolution skills can help you and your partner learn to argue in a more constructive manner, says Silverman, who offers this advice:

You are not a victim. It is your choice whether to react and how to react.
Be honest with yourself. When you're in the midst of an argument, are your comments directed toward resolution, or are you looking for payback? If your comments are blaming and hurtful, it's best to take a deep breath and change your strategy.
Change it up. If you continue to respond in the same way that has brought you pain and unhappiness in the past, you can't expect a different result this time. Just one little shift can make a big difference. If you usually jump right in to defend yourself before your partner is finished speaking, hold off for a few moments. You'll be surprised at how such a small shift in tempo can change the whole tone of an argument.
Give a little; get a lot. Apologize when you're wrong. Sure it's tough, but just try it and watch something wonderful happen.
"You can't control anyone else's behavior," Silverman says. "The only one in your charge is you."

Relationship Problem: Trust

Trust is an essential part of a relationship. Are there certain behaviors that are causing you to not trust your partner, or do you have unresolved issues that are hindering you from trusting others?

Problem-solving strategies: You and your partner can develop trust in each other by following these tips, suggested by Fay.

>Be consistent.
>Be on time.
>Do what you say you will do.
>Don't lie -- not even little white lies, to your partner or to others.
>Be fair, even in an argument.
>Be sensitive to the other's feelings. You can still disagree but don't discount how your partner is feeling.
>Call when you say you will.
>Call to say you'll be home late.
>Carry your fair share of the workload.
>Don't overreact when things go wrong.
>Never say things you can't take back.
>Don't dig up old wounds.
>Respect your partner's boundaries.
>Don’t be jealous.
>Be a good listener.

Although relationships have their ups and downs, there are things you can both do that may well minimize marriage problems, if not help avoid them altogether, says psychologist Karen Sherman. Be realistic. Thinking your mate will meet all your needs -- and will be able to figure them out without your asking -- is a Hollywood fantasy. "Ask for what you need directly," Karen Sherman says.

Use humor -- learn to let things go and enjoy one another more. And be willing to work on your relationship and to truly look at what needs to be done. Don't think that it will be better with someone else; the same problems you have in this relationship because of lack of skills will still exist

Master Stress in Only 10 Minutes a Day

2009-03-29T16:32:00.005+08:00

Master Stress in Only 10 Minutes a Day
by Dharma Singh Khalsa

As I write this article, the stock market continues its wild gyrations and the economic and other rampant stress of our times is beginning to take its toll on our health.
This is not just my opinion, it’s also been shown in a recent poll published by the American Psychological Association (APA).1 Money and the economy topped the list of stressors for at least 80% of those surveyed. Finances now overshadow the more usual daily stressors of work and relationships, with 46% of people reporting that their stress is due to worries about providing for their family’s basic needs.

My own research clarifies that when you feel you have less control over your stress, it definitely causes you more concern. It raises your internal mind, body, and emotional threat level.2
Women Worse Off

Unfortunately, the brunt of this economic stress is falling upon women more than men. According to the APA’s poll, compared with men, more women say they are stressed about money, the economy, job stability, housing costs, and health problems affecting their families.
Ladies of the boomer generation (ages 44-62) and Matures (aged 63+) are most likely to report the economy as a significant stressor, while women in general rank financial worries above personal health. Female Boomers report increases in stress associated with their job stability and health problems affecting their families.

Moreover, mature women are reporting dramatic increases in stress associated with family health concerns (87%), the economy (92%), and money (77%).
Beyond that, Generation Xers (ages 30-43) and Millennials (ages 18-29) are not immune from financial worries either. Generation Xers are the women most concerned about money (89% report money as a source of stress) and Millennials are most concerned about housing costs as a source of stress (75%).

The current work from the APA clearly reveals that our economic stress is causing more than half of Americans to report irritability, anger, fatigue, headaches, and sleeplessness. What’s worse, these stress sufferers say they self-medicate by over-eating unhealthy foods, over drinking, and generally straying from healthy habits.1

In addition to the above-mentioned symptoms, the rise in stress-related issues can:
1. Weaken your immune system
2. Raise your blood pressure
3. Disturb your sleep
4. Lead to depression
5. Cause memory loss

So What Can You Do?
As seen in the picture below, in 1949, a Swiss physiologist named Dr. Walter Hess, won the Nobel Prize in Physiology and Medicine by revealing that two separate and distinct centers exist in your brain. The one on the left is the stress center, while the other one is an anti-stress center.3

An x-ray of the brain’s stress (left) and relaxation centers (right).
When you are able to activate the anti-stress spot by following the directions below, many wonderful health-promoting events occur. Your blood pressure goes down, your pulse decreases, your unhealthy stress chemicals plummet, and, perhaps most importantly, the amount of oxygen your body needs goes down.
This puts you into a true anti-aging zone, because, when you use less oxygen, you create fewer free radicals, which are a hallmark of the aging process.4
Additionally, as emerging medical research shows, the relaxation response changes your genetic expression for the better. The reason is because unbalanced stress shortens the tip of your gene called the telomere, and relaxation lengthens your telomere because it stops the harmful effects of stress on your genes. This new search shows that relaxation techniques such as meditation, actually “turn off” the disease-promoting process stress causes.5
Over the years, there have been hundreds, if not thousands of research studies revealing many health and healing benefits of regular relaxation techniques such as meditation, prayer, visualization, and so on, including the picture of a much younger brain. Regions involved in memory and attention were thicker in people who meditated regularly. While these areas tend to shrink with age, older meditators were able to ward off some of this shrinkage.6-7
Meditation has many other positive benefits as well. As seen in the illustration below, in many research studies over three decades, meditation has been shown to help your heart, reduce anxiety, soften chronic pain, and increase longevity.6

Regular meditation improves health and reduces disease.

A compilation of studies modeled after an article published by the Transcendental Meditation people many years ago. I wrote about it in Meditation as Medicine.
Here are the four steps needed to enter into the stress-mastering relaxation zone:

1. Comfort: You don’t have to sit like a pretzel to meditate. You can enter the zone in a soft chair. One caveat is that you don’t want to be so comfortable that you fall asleep.
Quiet: Your relaxation time is a special time, not to be interrupted by checking e-mail, blackberries, cell phones, or pets. Your time to meditate is sacred. If your spouse or significant other doesn’t meditate, they shouldn’t be in the room with you. The same holds true for children.

2. A Tool: In the basic form of relaxation, your tool can be any thought, sound, short prayer, or phrase upon that you wish to focus. It can literally be anything. Even paying attention to your breath works well. Ideally your word should be something easy. Examples are peace, love, heal, or the word one, which has a long history of being used in the research on basic relaxation and meditation.

3. An Attitude: Once you begin the process, you’ll be surprised to discover that your mind reacts like a four-year-old child. If you ask a four-year-old to sit still, they will probably end up running all around the room. It’s the same with your mind. At a time when you expect your mind to calm down, it actually speeds up. Why is this so? Well, all the pressure you have stored inside your mind is pent up in there. So, when we begin to elicit the response, it’s as if a trap door opens and “boom,” all these thoughts come flying out:

“Why didn’t I go to the bathroom before I started?
“I have to balance my checkbook.”
“I sure hope we get that mortgage.”
“Where’s my brother? He was supposed to be here an hour ago.”
“Whatever happened to Joan from the first grade?”

When you practice this technique, your mind will be bombarded by thoughts.

I’ve been doing it for three decades and it still happens to me every day. Not to worry. This is simply the normal stress-releasing process and is expected. It’s what you do with the thoughts that really count.

And what you do is — just let them go and return to your word.

As one of my patients from England once said in a great Beatles accent, “Oh, Dr. Dharma. You mean you just start all over again?” That’s right. When other thoughts enter your mind, you just start all over again. The way you do that is by going back to your focus word. For example, let’s say your word is one. When other thoughts enter into your mind, you simply say to yourself: “Oh, well, [your name], “relax, one.” That’s all there is to it.

To end the technique, simply inhale, hold your breath for a moment, and exhale. Then inhale again, slowly stretch your arms up, exhale, and relax. Slowly open your eyes and hold your gaze on whatever you see, for about one minute. Then inhale, exhale, and take your time getting up.
Believe it or not, you only have to do this for 10 minutes at least once every day, preferably before breakfast, to get the full effect. If you can do it a second time in the afternoon, all the better.

You can use a digital clock or even open your eyes and look at your wristwatch. Just don’t use an alarm, because it’s too startling. What you’ll find, with time, is that your mind will automatically know when the time is up.
It’s easy.

Best of Blessings,
Dr. Dharma

References
Stress In America; American Psychological Association Report, October 7, 2008.
Khalsa, D. 1998. Alternative therapies in Health and Medicine. 4(6): 38-43.
Hess WR. Dtsch Med Wochenschr. 1961; 86 3-8.
Beary, J,F, & Benson, H. (1974). Psychosomatic Medicine. 36, 115-120.
Dusek, J, et al. PLoS One 3(7): e2576, Published online July 2, 2008.
Khalsa, D. Meditation as Medicine. Atria Books 2001.
Lazar, S et al. 2005. Neuroreport. 16 17): 1893-1897.

Inspiration: The Power that Drives Your Creativity

2009-03-29T16:23:00.004+08:00

Inspiration: The Power that Drives Your Creativity
by Dr. Matthew Anderson

When was the last time you felt truly inspired?
Can you remember the physical sensations that went with it?
How about the intense emotions that accompanied it?
Did your mind join in with ideas, plans and
possibilities for creative action?
Did this experience lead to something amazing
and wonderful in your life?
Is it something you would like to experience more often?

To be inspired implies an infusion of spirit — to be filled with a spirit of energy that can often feel powerful, exciting, stimulating, creative and even divine. Inspiration has been at the core of almost every great accomplishment known to human beings. But, for most people it seems to come and go at will, essentially uncontrollable. What if that was not the case? What if you could increase the frequency and intensity of inspiration with the proper use of certain techniques? Would you want to know more?

The experience of inspiration can become a regular part of your life if you are willing to follow the guidelines I have outlined below. They work for me and they will work for you.

Guidelines for Inviting Inspiration

Since we cannot control inspiration (trying to control it usually kills it), we need to learn how to invite it into our inner being. It is something that comes to us (or wells up within us) when we have created a receptive container. Here is how to do that.

1. Be willing to honor inspiration when it arrives. Be respectful.

2. Value imagination. Staying in your head (being rational and pragmatic) is the antithesis of creativity. Imagination is central and essential to the development of your inspiration.

3. Allow positive emotions to be part of the process. Feelings like wonder, excitement, joy, and enthusiasm nurture and encourage inspiration.

4. Practice stillness. Inspiration most often appears during times of quiet reflection. Excessive busyness will completely block the flow.

5. Pray for it. I often pray this simple prayer: “God open my heart and mind to receive your creativity and inspiration.”

6. Act on it. Action indicates that you are a trustworthy recipient of the gift. Once you have passed this “test” you will experience an increased flow of inspiration.

Let Providence Work It’s Magic

Finally, remember and trust in the following statement made by the great poet and philosopher, Johann Wolfgang von Goethe (1749-1832). I have posted it on the wall in my office. You might do the same.

“Concerning all acts of initiative (and creation) there is one elementary truth, the ignorance of which kills countless ideas and splendid plans: that the moment one commits oneself, then Providence moves too…

"Whatever you can do,Or dream you can, begin it,Boldness has genius,Power and magic in it.”

The 7 Steps to Happily Ever After

2009-03-22T11:26:00.003+08:00

The 7 Steps to Happily Ever After
Feature from "Redbook" Magazine

By Marjorie Ingall

What makes love last a lifetime? Affection? Yep. Respect? Sure. But a great marriage is not just about what you have. It's about what you do to make a relationship stronger, safer, more caring and committed. Here's how to make your "forever" fantastic.

Marriage is a home, a refuge against the outside storms. And like any house, it requires a strong, lasting foundation. To build one, every couple needs to take certain steps — seven, to be precise — that turn the two of you into not just you and me but we. You may not move through all the steps in order, and you may circle back to complete certain steps again (and again and again). But if you make it through them all, you'll be well on your way toward creating a marriage that will be your shelter as long as you both shall live.

Step 1: Find a shared dream for your life together.

It's easy to get caught up in the small stuff of married life: What's for dinner tonight? Whose turn is it to clean the litter box? Did you pay the electric bill? But the best partners never lose sight of the fact that they're working together to achieve the same big dreams. "Successful couples quickly develop a mindfulness of 'us,' of being coupled," says REDBOOK Love Network expert Jane Greer, Ph.D., a marriage and family therapist in New York City. "They have a shared vision, saying things like, 'We want to plan to buy a house, we want to take a vacation to such-and-such a place, we like to do X, we think we want to start a family at Y time.'"

This kind of dream-sharing starts early. "Couples love to tell the story of how they met," points out Julie Holland, M.D., a psychiatrist in private practice in New York City and a clinical assistant professor of psychiatry at the New York University School of Medicine. "It's like telling a fairy tale. But happy couples will go on creating folklore and history, with the meet-cute forming the bedrock of the narrative." As you write and rewrite your love story ("our hardest challenge was X, our dream for retirement is Y"), you continually remind yourselves and each other that you're a team with shared values and goals. And P.S.: When you share a dream, you're a heck of a lot more likely to make that dream come true.

Step 2: Ignite (and reignite) a sexual connection.

In any good relationship, sex is way more than just a physical act. It's crucial for the health of your emotional connection, too: It's something only the two of you share; it makes you both feel warm and loved; it draws you back together when you're drifting apart. And did I mention that it's a whole lot of fun?

Striking up those sparks when you first meet is easy. Nurturing a strong, steady flame? That's the hard part. When you've got a mortgage, a potbelly, and a decade or two of togetherness under your belts, it can be hard to muster up the fire you felt when you first got together. That's when it's even more important to protect your sex life and make it a priority. "You have to keep working to create allure and seduction for each other or your sex life will become lackluster," Greer points out. "Who wants the same turkey sandwich over and over? You want it on whole wheat! On toast! As turkey salad! On a roll!" (And now I will imagine my husband covered with Russian dressing. Thanks, Dr. Greer.)

As the years go by, you'll keep revisiting and realigning and reimagining the passion you have for each other. And if you keep at it, you'll have a sex life that transcends your marriage's lack of newness, the stresses of family and work, the physical changes that come with aging. Now that's something worth holding on to.

Step 3: Choose each other as your first family.

For years, you were primarily a member of one family: the one in which you grew up. Then you got married, and suddenly you became the foundation of a new family, one in which husband and wife are the A-team. It can be tough to shift your identity like this, but it's also an important part of building your self-image as a duo (and maybe, eventually, as three or four or...).

For me, making this transition meant stopping the incessant bitching to my mom when I was mad at my husband — my behavior was disloyal, and I had to learn to talk to Jonathan, not about him. My friend Lynn tells the story of her mother's reaction to a trip to the Middle East she and her then-boyfriend (now husband) had planned. Her mother hit the roof, calling incessantly to urge Lynn not to go. Eventually, Lynn's boyfriend got on the phone with Mom and explained why they were excited to share this experience. "It was clear then that we were the team," Lynn says now. "Not teaming up against my mother, but teaming up together to deal with her issues."

Whatever your challenges — an overprotective mom? an overly critical father-in-law? — you have to outline together the boundaries between you and all of the families connected to you. Not only will you feel stronger as a united front but when you stick to your shared rules, all that family baggage will weigh on you a lot less.

Step 4: Learn how to fight right.

I'm embarrassed to think of how I coped with conflict early in my relationship with Jonathan. I stormed out — a lot. I once threw an apple at his head. Hard. (Don't worry, I missed — on purpose.) I had a terrible habit of threatening divorce at the slightest provocation. But eventually I figured that this was pretty moronic. I didn't want out, and I knew that pelting someone with fruit was not a long-term marital strategy.

"Fighting is the big problem every couple has to deal with," says Daniel B. Wile, Ph.D., a psychologist and couples therapist in Oakland, CA, and author of After the Fight. That's because fights will always come up, so every couple needs to learn how to fight without tearing each other apart.

Fighting right doesn't just mean not throwing produce; it means staying focused on the issue at hand and respecting each other's perspective. Couples that fight right also find ways to defuse the tension, says Wile — often with humor. "Whenever one of us wants the other to listen up, we mime hitting the TV remote, a thumb pressing down on an invisible mute button," says Nancy, 52, an event producer in San Francisco. "It cracks us up, in part because it must look insane to others." Even if you fight a lot, when you can find a way to turn fights toward the positive — with a smile, a quick apology, an expression of appreciation for the other person — the storm blows away fast, and that's what matters.

Step 5: Find a balance between time for two and time for you.

Jonathan and I both work at home. This frequently leads to murderous impulses. Though I'm typing away in the bedroom and he's talking to his consulting clients in our small home office, most days it really feels like too much intimacy for me.

But that's my bias. When it comes to togetherness, every couple has its own unique sweet spot. "There are couples that are never apart and there are couples that see each other only on weekends," Greer says. With the right balance, neither partner feels slighted or smothered. You have enough non-shared experiences to fire you up and help you maintain a sense of yourself outside the relationship — not to mention give you something to talk about at the dinner table. But you also have enough time together to feel your connection as a strong tie rather than as a loose thread.

Your togetherness needs will also change over time, so you'll have to shift your balance accordingly. "My husband and I spend a lot of time together, but it's almost all family time," says Katie, 40, a mom of two in San Leandro, CA. "We realized a few months ago that we hadn't had a conversation that didn't involve the kids or our to-do lists in ages, so we committed to a weekly date. We were so happy just to go to the movies and hold hands, something we hadn't done in ages. It felt like we were dating again!"

Step 6: Build a best friendship.

Think about the things that make your closest friendships irreplaceable: the trust that comes with true intimacy, the willingness to be vulnerable, the confidence that the friendship can withstand some conflict. Don't those sound like good things to have in your marriage, too?

"Happy couples are each other's haven," says Holland. "They can count on the other person to listen and try to meet their needs." Greer adds, "When you're true friends, you acknowledge and respect what the other person is; you don't try to control or change them. This creates a sense of safety and security when you're together — you know you're valued for who you are and you see the value in your partner."

Then there's the way, when you've been with someone a while, that you become almost a mind reader. You have a shared history and inside jokes. Your guy knows what you'll find funny, you forward him links to articles you know he'll enjoy, and best of all, you two can make eye contact at a given moment and say volumes without opening your mouths. And is there anything more pleasurable than sharing the newspaper with someone? Sitting in companionable silence, absorbed in your respective reading, sipping coffee, occasionally reading something out loud, but mostly just lazing happily together, communing without needing to speak? Ahh....

Step 7: Face down a major challenge together.

You're sailing along through life, and suddenly you hit a huge bump. A serious illness. Unemployment. The loss of a home. A death in the family. How do you cope?

The truth is, you never know how strong your relationship is until it's tested. All too often, the stress of a crisis can pull a couple apart. But the good news is, when you do make it through in one piece, you might just find yourselves tighter than ever.

"What didn't happen to us?" says Daryl, 28, a preschool teacher in Harrisburg, PA. "My husband lost his job and took a minimum-wage job he was way overqualified for just to make ends meet. He was offered a better job in a mountain town outside San Diego, so we moved. Then during the California wildfires several years ago, our house burned down and we lost everything. We were living in a one-room converted garage with no running water and a newborn. But we found that this chaos somehow brought us even closer together. We took turns losing it. We really kept each other sane."

Hey, marriage is no roll in the hay. It's tough, real work. But the reward, the edifice you build together that will shelter you through years of tough times, is more than worth the effort. The small, friendly cottage you build — decorated with your shared history and stories, filled with color and laughter — will be the warmest and safest retreat you can imagine.

Your 12 Most Embarrassing Beauty Questions -- Answered

2009-03-20T15:33:00.004+08:00

Your 12 Most Embarrassing Beauty Questions -- Answered

By Amy M. Keller.

When the normal bacteria on your feet interact with moisture trapped in your socks and shoes, they emit stinky sulfurous byproducts, says Doris J. Day, M.D., an assistant professor of dermatology at New York University.

1. What causes foot odor?

The fix: Since dry feet equals odor-free feet, wear absorbent cotton socks with shoes made from breathable materials, like canvas and leather, and sprinkle Zeasorb - an over-the-counter drying powder - into your shoes every morning. Three nights a week, pour a pot of tea made with several regular (not herbal) tea bags into a basin, then soak your feet for five to 10 minutes. The tannic acid in tea temporarily inhibits sweat production. See your doctor if your feet are also red, swollen or scaly to make sure a bacterial or fungal infection isn't causing the smell.

2. Why does my breath smell despite constant brushing?

Although brushing will help prevent cavities (so don't stop scrubbing), it can only mask bad breath, since the problem really lies within your throat and tongue, not your teeth. When the bacteria in your mouth lose access to oxygen (which can happen when you use alcohol-based mouthwashes, take certain prescription medications for depression or high blood pressure or simply sit with your mouth shut for a long time), they emit smelly sulfur compounds, says Harold Katz, D.D.S., founder of The California Breath Clinic in Los Angeles; this is the same principle at work with foot odor. Eating garlic and onion also makes your breath stink because they contain - surprise - those same sulfur compounds.

The fix: Contrary to popular belief, a tongue scraper won't banish bad breath - sulfur compounds cannot be removed manually. Instead, keep your mouth oxygenated by drinking water throughout the day and using an over-the-counter oral rinse with chlorine dioxide in both the A.M. and the P.M. to neutralize sulfur compounds. (Try TheraBreath Oral Rinse.) Chewing on oxygen-rich vegetables, like parsley and celery, can also diminish odors. If these tricks don't work, see your dentist.

3. I've started to sweat through my blouses. Should I be worried?

Most likely there's nothing to fear, says Joseph L. Jorizzo, M.D., chairperson of dermatology at Wake Forest University School of Medicine in Winston-Salem, NC. You probably just have a benign, hereditary tendency toward excessive sweating that can crop up at any age. But see your doctor to rule out an overactive thyroid, a low blood-sugar level and a number of other problems that can cause continual heavy sweating.

The fix: Before bed, towel-dry your armpits and apply the prescription antiperspirant solution Drysol (it contains a higher percentage of aluminum chloride - a drying agent - than regular deodorants do). Wash the solution off in the A.M. and don't reapply any deodorant. Repeat nightly. Still not satisfied? Ask your doctor about Botox injections - one treatment ($800 to $1,500) can paralyze sweat glands for six months to a year.

4. Every time I shave, I get a bumpy rash along my bikini line -- what's causing it?

A too-close shave or waxing can make hairs split and loop around just under the surface of the skin. As these off-kilter hairs grow, they push up against your skin, causing inflammation and redness, says Lawrence Moy, M.D., chief of dermatology at Harbor-UCLA Medical Center.

The fix: Put down your loofah; dermatologists now agree that rubbing the bumps to free trapped hairs will only make the problem worse. Instead, apply an OTC acetylsalicylic acid (a.k.a. aspirin) solution twice a day for two to seven days to gently exfoliate the top layer of your skin. (Try Soft Cell.) Once you shed this layer, the looped hairs will be able to poke through. A cortisone injection, administered by your dermatologist, will decrease inflammation in bigger bumps. If ingrown hairs are a persistent problem, you may want to consider laser treatment, which damages the hair follicles and prevents hair growth. You'll need about three treatments (each around $350) followed by a touch-up every six months to a year.

5. I've heard that spider veins are hereditary. My mom doesn't have them, so why do I?

Genetics isn't the only cause of these unsightly blue veins. Pregnancy and trauma to the leg (like bumping into something) can bring them on, says Esta Kronberg, M.D., a Houston, TX, dermatologist.

The fix: Though vitamin K cream has been touted by some as the next big thing in spider-vein treatment (possibly because of its ability to constrict blood vessels, which supposedly makes veins less visible), there's no way the molecules in the cream can penetrate the skin on your legs and be absorbed into your veins, says Jorizzo. The best option - with 95 percent of patients seeing improvement after one to three treatments (up to $300 per treatment, per leg) -- is still sclerotherapy, tiny injections of saline solution, which irritates veins and causes them to swell shut.

6. Are the bumps on my butt and on the backs of my arms pimples?

No. They're actually called keratosis pilaris - the cause is unknown, but some claim that it's a hereditary condition.

The fix: You can soften and help slough off bumps by rubbing them with a mixture of equal parts petroleum jelly and either water or cold cream. If that doesn't work, prescription Retin-A probably will, but it can irritate the surrounding skin. A better alternative: prescription LactiCare-HC Lotion 2 1/2%, which contains lactic acid to dissolve dead skin cells and hydrocortisone to soothe any acid-induced irritation. Rub lotion onto bumps twice a day until they clear up.

7. What's causing my toenail fungus?

Toenail fungus is actually athlete's foot (often picked up from shared showers or borrowed shoes) that has spread into your toenails.

The fix: The most effective treatment is a prescription antifungal pill like Lamisil or Sporanox, but be warned: These treatments are only 70 to 80 percent effective at best, and even when they work it takes nearly a year and a half for the toenail to fully grow out, says Day. Prevent a recurrence by wearing shower slippers every time you rinse off at the gym and by not borrowing shoes.

8. Why do my teeth look so dingy?

Smoking and excessive consumption of dark beverages (like coffee, tea, soda and red wine) are the main causes of stained teeth, says Lana Rozenberg, D.D.S., founder of the Rozenberg Dental Day Spa in New York City.

The fix: As with clothing stains, the longer discolorations remain on your teeth, the harder they are to remove - so keep up those twice-a-year dental visits. You can lighten your teeth several shades with a whitening toothpaste that contains carbamide peroxide, but use it only once a day to avoid drying out gum tissue. (Try Rembrandt Plus with Peroxide toothpaste.) Floss treated with the whitening agent silica has also been proven to polish away stains, which often form between teeth. (Try Johnson & Johnson Reach Whitening Floss.) For more dramatic results, your dentist can bleach your teeth up to eight shades brighter with a highly concentrated peroxide gel administered via laser ($800 to $1,500) or in a custom-fitted mouthpiece ($600 to $1,000) that you wear an hour a day for about 10 days, says Rozenberg. (Though drugstore bleaching kits are much less expensive, they aren't quite as effective -- the gel isn't as strong, and since the mouthpieces aren't created specifically for you, the gel can drip out of them and inflame your gums.)

9. Why do I have stretch marks?

You may suspect that the marks on your tummy, thighs or hips were caused by pregnancy or significant weight fluctuations. What you may not know, though, is that hormonal changes that occur during normal growth spurts can also cause your skin to stretch and scar, says Lawrence Moy, M.D. Red marks appear when your skin stretches and thins so much that you can see your blood flowing through the skin's thinned outer layers, says Joseph L. Jorizzo, M.D., When your skin stretches minimally or the stretched skin is thick, white marks result.

The fix: No treatment is guaranteed to remove stretch marks, but you can make them less noticeable. Try twice-daily applications of OTC Striae Stretch Mark Creme - several studies have confirmed that it can reduce red or white marks in about four weeks. Or ask your doctor about laser therapy ($450 to $700 per treatment), which can tone down the brightness of recently acquired red marks, or microdermabrasion ($50 to $150 per session), which can diminish the appearance of white marks.

10. Could there be a serious underlying cause for excess facial hair?

If you fight your follicles on a daily basis or sprout lots of hairs on your chin, see your doctor. Polycystic ovarian syndrome (a disorder characterized by high levels of male hormones) or an adrenal gland problem could be to blame. If you're moderately hairy (you tidy up your brows or upper-lip area once a month), you've probably just got your genes to thank.

The fix: Vaniqa - a new, odorless prescription cream- has recently been approved by the FDA to decrease light to heavy hair growth anywhere on the face ($50 for a two-month supply). Though it doesn't yield immediate results (you'll need to keep using your regular hair-removal methods at first), the cream blocks one of the enzymes responsible for hair growth, gradually slowing it down as long as you continue to use it, says Ken Washenik, M.D., director of dermatopharmacology at New York University School of Medicine. For those who don't respond to Vaniqa, six laser hair treatments ($150 each) can significantly decrease hair growth for months. A monthly electrolysis session for up to a year ($60 to $100 each) can remove hair permanently.

11. Why is my face so shiny?

If you are also losing hair and have stopped getting your period, a hormonal imbalance could be the culprit, and you should see your doctor. If not, your skin is just oversensitive to your male hormones (we all have them) - and this is triggering the production of excess oil. Another possibility: a too-harsh cleansing routine (some of you have written to us saying you use rubbing alcohol to nix shine!). Many derms believe that alcohol-based toners and gritty scrubs can overdry and irritate your skin and make it produce extra oil to compensate, says Doris J. Day, M.D.

The fix: Your best bet is to regulate oil without overdrying your skin. So in the morning, wash your face with an oil-free lotion cleanser, then rub on an alcohol-free toner. (Try Cetaphil Daily Facial Cleanser for Normal to Oily Skin and Bath & Body Works Bio Face Oil-Control Facial Toner.) Top with the OTC oil-absorbing gel Clinac OC. Sop up shiny spots throughout the day with blotting papers. (Try Hard Candy Shiny Sheets.) Repeat your A.M. routine - minus the gel - before bed. If you continue to shine, ask your dermatologist about Retin-A Micro. Less irritating than regular Retin-A, this prescription cream was created to treat acne but has also been proven effective against oiliness.

12. What causes hand warts?

The human papilloma virus is responsible for warts - but to get them you have to be both genetically predisposed and in close contact with an infected person, says Doris J. Day, M.D.

The fix: With a clean nail file, gently slough off the top layers of your warts daily to remove dead skin, says Day. (Do not use this nail file for anything but wart removal.) Then rub on over-the-counter Occlusal HP - its highly concentrated salicylic acid dissolves warts. If warts remain after several months, consult your dermatologist about other remedies, including laser therapy and liquid nitrogen treatments. Despite treatment, however, warts can come back. A warning: Be careful when engaging in sexual activity - though it's unlikely, hand warts can spread to your (or your partner's) genitals.

2009-03-20T15:30:00.001+08:00

Secrets of Restaurant Nutrition
What you need to know about nutrition and food safety in your favorite restaurants.
By Elizabeth Lee
Reviewed by Louise Chang, MD

Restaurant secrets often start with nutrition. And until now, those restaurant nutrition facts have been available on a hit-or-miss basis.

That's starting to change, as Congress considers two bills that would require chain restaurants to provide information similar to that on a nutrition facts label on packaged foods in supermarkets.

Beyond restaurant nutrition, there are other tips and tricks of the trade that many diners don't know. Want to find out more restaurant secrets about food safety, portion sizes, and which foods offer the most nutrition -- and value -- for the buck? Keep reading.
Calorie Counts

One of the biggest restaurant secrets is nutritional information. Think about it: How many diners would chow down on one of Outback Steakhouse's Bloomin' Onions if they knew it contained an estimated 2,130 calories?

But that may be changing. Of the two bills going through Congress, one would require restaurants with 20 or more outlets to provide nutrition information however they choose, such as on brochures or web sites; another would require restaurant nutrition information on menus or menu boards.

"If it isn't on the menu then it isn't worth doing, because nobody sees it," says Margo Wootan, director of nutrition policy for the consumer advocacy group Center for Science in the Public Interest.

In New York City, where restaurants with at least 15 outlets were recently required to begin displaying calories on menus or menu boards, diners have taken notice. Some 90% of restaurant patrons said calorie counts were higher than expected, according to a survey by Technomic, a Chicago-based market research firm.

That information is changing what 82% of diners order, according to the Technomic study. Sixty percent of those surveyed said it also affects what restaurants they visit.

Want more restaurant nutrition information now on what you're eating? Check web sites. Most fast-food chains already provide this information online, as do a handful of dinner-house chains. Yum Brands, which owns Kentucky Fried Chicken, Taco Bell, Pizza Hut, and other brands, is starting to place calorie counts on menu boards at all company-owned restaurants nationwide and will finish the work by 2011.
Off-Site Food Preparation

To cut down on labor costs, speed up service, and reduce the risk of food-borne illness, many chain restaurants and some independent restaurants serve food that is partially or fully cooked elsewhere, often in a central kitchen or food-processing facility. The practice helps restaurants solve training issues caused by the industry's high employee turnover rate.

"There are big labor savings," says Barbara Fields Brown, director of operations for Global Concessions, which owns 12 restaurants at Atlanta's Hartsfield-Jackson International Airport. "And we do not have to be worried about a lot of cross-contamination, because the food has already been cooked."

For diners, the benefits are less clear. They'll find consistently prepared food at chain outlets across the country. But if they'd like their steak prepared without seasoning or less salt in the chicken fajitas, they're out of luck.
How Clean Is the Restaurant?

Restaurants accounted for 41% of food-borne disease outbreaks between 1990 and 2006, according to a report compiled by the Center for Science in the Public Interest. Private homes accounted for 22%.

Checking out a restaurant's health inspection report offers just a snapshot of its cleanliness on one day. If you live in a state or region where inspection reports must be posted in a restaurant or grades placed on entry doors, take the time to check out the information. Some inspection forms show previous grades, giving a more complete picture of a restaurant's attention to sanitation.

Many states and regions are moving to put restaurant health scores online, too. Find out who inspects restaurants in your area, then go online and look for scores. Hint: Many are listed under the "environmental health" section of local health department web sites.

Many restaurants have stringent food safety policies and training programs. Check out their web sites or ask a manager for information. Find out if the restaurant offers sick leave to employees. Many don't, which means sick employees are likely to show up for work and potentially spread illness.
Economy's Impact on Restaurant Food

As restaurants adjust to having fewer patrons, they may be adjusting what's on the plate to keep prices low. That can mean reducing the portion size of more expensive foods, or substituting less costly items, all of which can affect restaurant nutrition.

Some restaurants are shrinking portions of meat and adding more vegetables and starches. More steamed broccoli is a good thing, but watch out for plates heaped with starches heavy in calories and saturated fat, such as buttery mashed potatoes and noodles in a cream sauce.

Other restaurants are leaving portion sizes alone but switching from more expensive, leaner cuts of meat, like tenderloin and pork chops, to fattier meats such as pork shoulder (Boston butt), spare ribs, beef short ribs, and chuck roast.

Here's another restaurant secret: For the best bargains and the most nutrients, stick to the center of the menu. Entrees usually have lower markups and more nutritional balance than other parts of a menu, like desserts, beverages and appetizers. A non-chocolate dessert may cost more than four times as much as the ingredients it contains. Lobster, on the other hand, is priced much closer to what it actually costs the restaurant, says Kevin Gillespie, executive chef at Woodfire Grill in Atlanta.

Small plates that are scaled-down versions of entrees can be a good deal. But watch how many you order, to keep calories and costs under control. Restaurants that have switched to small plates report higher check averages, because customers typically order more food.
Special Diets

On a special diet? Check a restaurant's web site before you go. Many restaurants, especially chain restaurants, include restaurant nutrition information about allergens, gluten-free foods, and diabetic exchanges online even if they don't disclose calories and other nutritional data.

Ask for a customized plate if you're on a restricted diet, but understand that not all restaurants can fulfill your request. While some chefs enjoy the creative challenge of preparing a low-sodium or low-fat meal, a special meal may be tougher at high-volume restaurants that may rely on meats or entrees prepared off-site.
Watch the Seafood

Be picky about seafood. Chef and author Anthony Bourdain clued foodies in to an unwritten restaurant secret -- never eat seafood on Mondays -- in Kitchen Confidential. That's because many restaurants, except a select group that specialize in fresh seafood, don't get deliveries over the weekend. And seafood deteriorates much more rapidly than meat and poultry.

Carvel Grant Gould, executive chef at Atlanta's Canoe, adds another warning. "I reject stuff all day long, and then they sell it to somebody else," she says. "You ought to eat your seafood in a place that's very reputable."

You can't check out a cooked piece of fish as you would a raw filet in the supermarket, but you can still evaluate it for freshness. When the plate comes to your table, smell the seafood. If it smells fishy, or of ammonia, it's not fresh.
Foods High in Sodium

Foods prepared in restaurants as well as packaged foods are often high in sodium, even those that seem healthier. A McDonald's Premium Southwest Salad With Grilled Chicken and Newman's Own Creamy Southwest Dressing has more sodium (1,300 milligrams) than a Big Mac (1,040 milligrams).

Sodium counts can be higher at dinner-house chains, where the portions are often large. An order of grilled pork chops at Romano's Macaroni Grill contains 3,540 milligrams of sodium, more than double the amount most adults should eat in a day. A child's portion of macaroni and cheese comes in at 1,980, according to the restaurant's web site.

Check nutrition information if it's available. Some restaurants provide sodium information or suggest lower-sodium options, even if they don't disclose complete nutritional data. Outback Steakhouse suggests that guests who want to cut sodium order salads without croutons or dressings, and get burgers and sandwiches without cheese, sauces, bacon, and dressings.

If you are trying to control how much sodium you consume while dining out, the American Heart Association recommends asking that your food be prepared without salt. It also advises using pepper or fresh lemon juice instead of salt to season your food. But if the food is prepared in a central facility rather than in the restaurant's kitchen, you may not be able to get a meal prepared without added sodium.

SOURCES:

Jacobson, M. and Hurley, J. Restaurant Confidential, Workman, 2002.

News release, National Restaurant Association.

News release, Technomic, Inc.

News release, Yum Brands

Margo Wootan, director of nutrition policy, Center for Science in the Public Interest.

News release, Center for Science in the Public Interest.

Center for Science in the Public Interest: "Dirty Dining."

Sarah Klein, staff attorney for food safety, Center for Science in the Public Interest.

Restaurant Hospitality: "Less is More."

Kevin Gillespie, executive chef, Woodfire Grill, Atlanta.

Carvel Grant Gould, executive chef, Canoe, Atlanta.

Arby's.

American Heart Association.

Romano's Macaroni Grill.

Outback Steakhouse.
Reviewed on February 25, 2009

High Cholesterol Treatment -- What Works?

2009-03-20T15:27:00.000+08:00

High Cholesterol Treatment -- What Works?
Safe, effective treatment for high cholesterol isn't hard -- but it can be confusing. Get the facts.
By R. Morgan Griffin
Reviewed by Brunilda Nazario, MD

If you've just been diagnosed with high cholesterol, you may be worried. After all, along with your age, genes, and other factors, high cholesterol is a major contributor to cardiovascular disease, heart attack, and stroke. But while you can't turn back the clock or yank out unhealthy genes from your DNA, you can change your cholesterol numbers. That's because high cholesterol treatment works.

"We have good, safe treatments for high cholesterol," says Adolph Hutter, MD, a cardiologist at Massachusetts General Hospital and a professor of medicine at Harvard Medical School. "They can directly lower your risks of heart attack, stroke, and death. So why not take advantage of them?"

For many people, making changes to their lifestyle -- eating better, losing weight, and exercising -- will be enough to lower cholesterol. Others may benefit from medicines. Often, a combination of these approaches is the right choice.

But where do you start? "People tend to be very confused about treating high cholesterol," says Nathan D. Wong, PhD, director of the heart disease prevention program at the University of California, Irvine.

WebMD talked to experts to help reduce the confusion -- and help you sort through your high cholesterol treatment options.

* Is it time to consider medication? Take this quiz for cholesterol-lowering tips.

Finding the Best High Cholesterol Treatment

There's a lot of variability in how high cholesterol treatments work in a given person. Treatment that did wonders for your spouse may do nothing for you. Some of it depends on your genes. You and your doctor will need to come up with a custom-tailored approach.

For most people, the first high cholesterol treatment to try is three lifestyle changes:

* Eating better
* Maintaining (or losing) weight
* Exercising more

Some people, if they already have other risk factors -- such as diabetes -- may immediately start medication as well.

While lifestyle changes can really help bring your cholesterol down, Wong says that not enough people give them a real chance.

"The problem is that both patients and their doctors like immediate results," he tells WebMD. "Lowering your cholesterol with exercise and diet is just not like that."

So try to give high cholesterol lifestyle treatments time to work. If they do, you can avoid the hassle of being on a daily medicine for the rest of your life.
Eating Right as a High Cholesterol Treatment

We've all heard that diet has an effect on cholesterol, but there's much confusion about what you should or shouldn't eat. Here's a rundown of the current evidence.

* Fat. If you have high cholesterol, you should cut down on saturated fat -- found in fatty meats and whole milk dairy products like cheese, ice cream, and butter. You also need to reduce your intake of trans fats, a man-made fat found in many processed foods, like stick margarine.

But the message isn't as simple as "fat is bad." There are a number of foods with healthy unsaturated fats that will actually improve your cholesterol. They include fatty fish like tuna and salmon, walnuts, and almonds. Since even good fats are high in calories, you should still eat them in moderation.
* Calories. According to Wong, the importance of counting your calories is often overlooked by people with high cholesterol. No matter how much or how little fat or cholesterol is in a food, its calories still add up. Eating too much of it can lead to weight gain, and that increases your risk of high cholesterol.

* High cholesterol foods. Experts have long urged people with high cholesterol to shun foods loaded with cholesterol, like egg yolks, shrimp, and organ meats. While some recent evidence suggests eggs may not be quite as harmful as once thought, experts still generally recommend you limit all high cholesterol foods. Also, don't assume that a food labeled "cholesterol-free" is necessarily good for you.

So what sort of diet works as a high cholesterol treatment? Ask your doctor for specific recommendations. Some experts recommend a Mediterranean-style diet, which cuts down on saturated and trans fats, while boosting intake of healthy unsaturated fats from fish and nuts.

If an improved diet doesn't help your cholesterol, don't feel like a failure. Because of their genes, some people just don't respond as well to this approach.

Weight Loss & Exercise as a High Cholesterol Treatment

Being overweight or obese ups your odds of having high LDL (bad cholesterol) and triglyceride levels and low HDL (good cholesterol) levels. It can also lead to other serious risks like high blood pressure, diabetes, and heart disease. So it's crucial to keep a healthy weight.

As a high cholesterol treatment, physical activity can have a modest effect. Exercise can lower your triglycerides (and bad LDL cholesterol to a lesser extent) and boost your good HDL cholesterol. So you should aim to get some physical activity -- even just a brisk walk -- for 30-60 minutes most days of the week.

But there are limits to what exercise can do. "For most people, exercise by itself wouldn't be an effective therapy to lower cholesterol," says Laurence S. Sperling, MD, director of preventive cardiology at the Emory University School of Medicine, Atlanta, Ga. But it can keep your weight down and reduce other cardiovascular risks.

Medications as High Cholesterol Treatments

If lifestyle changes haven't been enough as a high cholesterol treatment -- or if you're at high risk of cardiovascular problems -- your doctor will likely turn to medications. In most cases, the first drug you will try is a statin.

Statins like Crestor, Lescol, Lipitor, Mevacor, Pravachol, and Zocor work by blocking the effects of an enzyme that helps make cholesterol. They can lower bad LDL cholesterol by an impressive 20-55%. They have a modest effect on triglycerides and give a mild boost to your good cholesterol, too.

But don't assume that taking a statin makes you invulnerable. They won't cancel out a diet of french fries and fondue. "Statins are a complement to dietary changes," says Hutter, "not a replacement for them."
As with any drug, there are side effects. They can cause muscle aches, an increase in liver enzymes, and other issues. But the risks are low and it's important to keep them in perspective.

"On one hand, statins can reduce your risk of death, heart attack, stroke by 30-35%," says Sperling. "On the other, they pose a 1-2% risk of generally mild side effects." The benefits are often worth the small risk, Sperling says.

Although they tend to be overshadowed by statins, other medicines are also important high cholesterol treatments instead of, or in addition to, statins. They include:

* Bile acid resins like Colestid, Lo-Cholest, Prevalite, Questran, and WelChol. They stick to cholesterol in the intestines and prevent it from being absorbed. They can lower LDL cholesterol by 15-30%.
* Ezetimibe (Zetia) blocks some of the cholesterol from being absorbed by your body. It can lower LDL levels by 18-25%.
* Fibric acid like Antara, Atromid, Lopid, and Tricor. They reduce your triglycerides and may give a mild boost to your HDL.
* Niacin, available as Niacor, Niaspan, and Nicolar. Niacin modestly lowers LDL cholesterol and triglycerides and can raise HDL cholesterol at low doses. LDL levels are usually cut by 5-15%.
* A combination medicine like ezetimibe with simvastatin (Vytorin) which uses a statin to block production of cholesterol and ezetimibe to prevent cholesterol from being absorbed.

Remember that medicines aren't right for everyone. Since they're often taken for life, you and your doctor need to carefully discuss whether you should use them.

Do Alternative High Cholesterol Treatments Work?

While lifestyle changes and medicines have been shown to lower cholesterol and reduce your risk of cardiovascular disease, the same can't always be said for many alternative treatments. Some of the various supplements and herbs that have been touted as high cholesterol treatments are garlic, policosanol, and guggul.

While a few studies of garlic have found a modest benefit, a recent study of policosanol found no effect. However, none of these studies have been large enough to be definitive, experts say.

Keep in mind that, unlike medications, herbal products are not regulated by the FDA. They are not evaluated to see if they work. They could also interact with other medicines you use.

"You just don't know what you're getting when you buy these products," says Wong. So if you want to take an alternative high cholesterol treatment, be sure to talk to your doctor.
Sticking to Your High Cholesterol Treatments

Many people find that their dedication to lowering their cholesterol fades over time. When they're first diagnosed, they're gung ho. They go on a diet and train like marathon runners. But after a few months, they get complacent. Their low-cholesterol cookbooks gather dust and their gym membership card lies in a sock drawer.
Sticking to Your High Cholesterol Treatments continued...

It is very easy to forget about high cholesterol. Even though it may still be doing damage, you can't feel it.

So how can you make healthy changes stick? The experts have some advice.

* Get tested regularly. All adults need to be tested at least once every five years. People with high cholesterol or other risk factors may need to be tested once a year or more.
* Know your numbers. "People need to know what the cholesterol numbers are and what their target numbers should be," says Sperling.
* If you've been prescribed medicine, take it. It's easy to get lax about taking a daily medicine. So do what you can to remember. Use a weekly pill box or an alarm to help you remember.
* Get help in making lifestyle changes. Changing the way you eat isn't easy -- you've probably developed some bad habits over the decades. But, unfortunately, Wong says that many doctors -- because they are so busy -- just don't give good guidance on this crucial part of treatment.

"Doctors might just tell a patient, 'Exercise more and eat less,'" Wong says. "But making these changes requires a lot more than vague advice."

So ask specific questions about what to do. If you find you're having trouble making changes to your habits, check back in with your doctor. If possible, Wong suggests having a few meetings with a dietician who can help guide you.

Perhaps most importantly, you need to stay involved. Don't be a passive about your high cholesterol treatment. Partnering with your doctor will lead to better results, says Sperling.

So whether you've been just diagnosed with high cholesterol or have known for years (and never gotten around to doing anything about it) now is the time to get serious. High cholesterol treatment is safe and it works. It could even save your life.

Is There Sex After Heart Disease?

2009-03-20T15:23:00.002+08:00

Is There Sex After Heart Disease?
Doctors have good news for heart patients hoping to resume sexual activity.
By Karen Springen

Reviewed by Louise Chang, MD

Four years ago, Emmetsburg, Iowa, insurance agent Jim Wirtz, now 65, had triple bypass surgery. Just 10 days later, he was back at the office. Three weeks after that, he received a clean bill of health from his doctors, who said he could do any physical activity -- except shovel heavy snow.

Wirtz took their advice, and he and his wife resumed having intercourse. "Stay in the game, whether it's sex or work," he says. "My own philosophy is, you just better live."

Wirtz is doing what doctors say most heart disease patients can and should do: having sex after heart disease. "We encourage people to stay physically and sexually active," says Vincent Bufalino, MD, a cardiologist and spokesman for the American Heart Association and president and CEO of Midwest Heart Specialists. "They tend to be happier folks."

That's good news for the 80 million Americans with one or more forms of cardiovascular disease, including the 7.9 million who will suffer from a new or recurrent heart attack this year.

There are, of course, some caveats to resuming sex after heart disease. Here's what else people need to know:
Stress Tests

It's important to remember that sex is a workout. So doctors typically tell patients to abstain from sex after heart disease until they can withstand the cardiac workout.

"The concern is if somebody has absolutely no physical activity and then with sexual activity is more physically active than any other time," says Peter Schlegel, MD, chairman of urology at New York-Presbyterian/Weill Cornell Medical Center.

But patients who can handle the stairs or walk six minutes on the treadmill should be OK. "They shouldn't have any fear," Bufalino says. "I tell them if you can pass your stress test, you are more than comfortable to do anything you want -- have intercourse, play tennis, or go for a light jog around the block. We shouldn't have intercourse be one of the things we stay away from."
Sex After a Heart Attack or Bypass Surgery

Not surprisingly, some patients, or their partners, are afraid that sex will trigger a heart attack.

"After a heart attack or any kind of heart disease, they're frightened about whether or not they can have a sexual life," says Wei Jiang, MD, an internist and psychiatrist at Duke Health Systems at Duke University.

But the reality is that most patients can have a sexual life. Although you can't jump into sex the day after a heart attack or surgery, most people can resume sexual relations three to six weeks afterward, as long as they are free of chest pain or other complications.

Sex also gives heart disease patients a good incentive to change their lifestyles. "What's bad for the heart is bad for the penis," says Harry Fisch, MD, a urologist at Columbia University, and author of Size Matters. And what's good for the heart -- exercising, maintaining an ideal body weight, not smoking -- is good for the bedroom. "Everything that is healthy for your heart is healthy for your erection," Schlegel says.

If concerns persist, "You may want to seek out a psychologist to speak with about some of your fears," says Susan Czajkowski, PhD, program director for the NHLBI's division of prevention and population sciences. "The goal really is to get people back to as close as possible their normal set of activities and feeling good about themselves and feeling pleasure… Quality of life is important."
Erectile Dysfunction

Although heart disease is a risk factor for erectile function, erectile dysfunction can be an early warning sign of cardiovascular disease. The reason: the tiny arteries that go into the penis are about half the diameter of the ones that go into the heart, so they "clog up" first, says Craig Niederberger, MD, a urologist at the University of Illinois at Chicago. "The penis is like a red flag…You generally get about three years between symptoms of erectile dysfunction and symptoms of heart disease. Every man with ED should be considered a man with potential heart disease."

People with heart disease also likely have other risk factors for ED such as hypertension, diabetes, smoking, and obesity.
Medications

Beta-blockers, used for irregular heart beats after open heart surgery and to lower blood pressure, are the biggest culprit that can interfere with sex after heart disease. They lower blood pressure -- and the "hemodynamic fill of the penis," says Paul Turek, MD, a retired professor of urology at the University of California at San Francisco and director of the Turek Clinic in San Francisco. "Think of it as a hose. If you lower the pressure, you're effectively … turning off the hose. The inflow is lower."

Doctors also can try to adjust the drug's dosage over time, which can also help, or switch patients to a different medication.

An erectile dysfunction drug may help, but some men may not be able to take ED drugs because of other medications.
Using ED Drugs

Viagra, Levitra, and Cialis are OK -- with some exceptions. Phosphodiesterase inhibitors (Viagra, Cialis, and Levitra) do not increase heart attack or death rates and are considered safe for most men wishing to have sex after heart disease. One exception is in men taking nitrates (usually for angina, the sense of tightness in the chest), because the combination of the two drugs can cause a large and sudden decreases in blood pressure.

Another caveat: "the pill enables them to perform activities that will tax the heart the way it hasn't been before," Turek says. Many men feel timid and hesitate to ask about these types of medications, Niederberger says. He reassures them by explaining that the erection problem is related to the heart problem and that "sexual activity is a healthy thing to do." Sometimes a man will say, "my wife is afraid for me to take it," Niederberger says.

If ED drugs don't work, doctors may offer alternatives such as injections (which patients give themselves five or 10 minutes before intercourse and which last 15 to 60 minutes), vacuum-erection devices (a plastic cylinder that draws blood into the penis, and then a ring is placed at the base of the penis) or surgery (a prosthesis can be surgically implanted).
Depression and Psychological Issues

Men and women may suffer from depression after a heart attack, which can cause a lack of interest in sex, Jiang says. But some antidepressants may also affect sexual desire and function.

"We are truly in a dilemma," Jiang says. And not surprisingly, men with erectile dysfunction typically feel depressed, which decreases the desire to have sex after heart disease.

Therapy to deal with psychological issues can also help with sexual problems.
Lifestyle Changes Can Help

Men who take steps to live healthier can help their hearts and their sex lives. Sex also gives heart disease patients a good incentive to change their lifestyles.

Exercise increases blood flow everywhere, including to the penis, Fisch says. He recommends walking 10,000 steps a day, or 30 minutes of moderate exercise every day.

Losing weight helps patients lower their blood pressure and their cholesterol levels. Smoking constricts and damages the arteries, including those going into the penis. Heavy drinking can lower libido and lead to erectile dysfunction.

The bottom line on sex and heart disease? Patients need to talk to their doctors about their individual cases because someone who has bypass surgery is different from someone who has a mild heart attack. "They should have very open and honest conversations with their physicians," Czajkowski says. Ideally, she says, bring in a significant other.

Patients with any fear of having sex after heart disease might want to remember that intercourse is psychologically -- and apparently physically -- healthy and can have a "protective effect" on men's health.

Mother Nature's Natural Germ Fighters

2009-03-14T14:46:00.002+08:00

Mother Nature's Natural Germ Fighters
By Lisa Forgione,

Natural Topical Therapies

Some natural substances have amazing anti-infective properties, but are not effective or safe skin treatmentswhen taken internally. However, they work wonderfully when applied topically to the skin or mouth area. Please see Part 1 of this article for the internal therapies available.

Tea Tree Oil has been used for centuries for all types of skin infections, scabies, insect bites, burns, and acne. It effectively penetrates deep down into the skin layers. It is also useful for hard-to-treat fungal infections, such as nail fungus, dandruff, vaginitis, and ringworm. Apply topically to the gums for periodontal disease. It should not be taken internally and should be discontinued if irritation develops.

The essential oil of clove can be applied topically to mouth ulcers, sore gums and toothaches. Gargling with diluted clove oil helps relieve sort throats. It can be used topically like tea tree oil for all kinds of skin infections.

As its name implies, comfrey helps heal burns, bites, stings, bedsores, skin ulcers, dermatitis, scabies, inflamed bunions and rashes. It is available in ointments and creams.

Remember having a cold as a child and the soothing feeling of Vick's VapoRub on your chest? Eucalyptus in the Vick's is what suppressed your cough and let you sleep. Eucalyptus is a terrific decongestant, and useful for all kinds of respiratory infections -- apply topically to the chest or back, or use as a steam vapor that can be made from the leaves.

For Internal and External Use
You have probably heard of silvadine as a topical burn treatment. Colloidal silver is a powerful antibiotic for both internal and topical use. It can treat drug-resistant staph, tuberculosis and the bird flu. In Africa, it is used to treat just about everything, including AIDS, hepatitis, malaria, cholera, and pneumonia. It can be used topically to treat burns, wounds, thrush and other skin infections.

Use a 5-parts-per-million concentration, at a dose of one teaspoon three to four times per day. There have been rare instances of silver overdose resulting in skin and nail discoloration. However, this is from ingesting silver salts, not colloidal silver. Carefully research the product you are buying for is strength and purity and follow the directions for usage to the letter.

Check your spice shelf for oregano. Wild oregano and oregano oil both fight bacterial, viral and fungal infections, along with boosting your immune system. Use oregano to help fight acne, allergies, athlete's foot, insect stings, bronchitis, colds, diarrhea, gum disease, parasites, sinusitis and skin infections. Apply the oil topically as needed. Wild oregano is also available in capsules to take orally as directed.

There are many more natural products available to fight infections of all types. We have covered the more common ones here. It's astonishing how readily available these treatments are -- and they are inexpensive! You can avoid germ resistance, antibiotic side effects, and long waits at your doctor's office by allowing Mother Nature to heal you. A visit to your local health food store or an internet search will provide you with information and easy access to these exciting products.

The editors at Total Health Breakthroughs know it is impossible to avoid germs. We want you to be happy, healthy and infection free. Winter is cold, flu and pneumonia season. So, eat your garlic, oregano, cinnamon and honey, rub on your tea tree oil and breathe your eucalyptus vapor. Care for yourself naturally and safely, and live well!

Artichoke & Wild Salmon Eggs Benedict

2009-03-14T14:44:00.001+08:00

Artichoke & Wild Salmon Eggs Benedict
By Kelley Herring

Boost your body's antioxidant defenses with this Benedict breakfast! The production of eggs benedict glutathione -- your body's master antioxidant and detoxifier -- is manufactured by your liver given the right ingredients, including sulfur-containing amino acids and selenium.1 This delicious dish provides 51% of your daily requirement for selenium, plus those sulfur-containing aminos from the organic eggs.

Time To Table: 30 minutes
Serves: 4

Excellent Source of: Fiber, Iron, Magnesium, Potassium, Protein, Selenium, Zinc, Vitamin A, Vitamin B12, Vitamin C, Folate, Riboflavin
Good Source of: Calcium, Niacin
Preferences: Gluten-Free, Low Sugar

Ingredients
1 ounce organic cream cheese
8 medium organic artichoke bottoms, drained
2 ounces wild smoked salmon
6 large organic omega-3 eggs
4 large organic egg whites
4 tsp. organic extra virgin olive oil
2 Tbsp. organic plain yogurt
2 tsp. organic lemon juice
3 tsp. fresh oregano, chopped

Preparation
Preheat oven to 425°F. Toss artichoke bottoms with 2 teaspoons olive oil and 2 teaspoons oregano. Place them top-side down on half of a large baking sheet. Roast until the artichokes are just beginning to brown, about 12 to 14 minutes. Meanwhile, whisk yogurt, lemon juice and 1 teaspoon water in a small bowl until smooth. Set aside. In a large bowl, beat eggs and whites. Heat the remaining 2 teaspoons oil in a large nonstick skillet (preferably ceramic or porcelain enamel) over medium-high heat. Add the eggs and cook, folding and stirring frequently with a heatproof rubber spatula until almost set, about 2 minutes. Remove from the heat and fold in cream cheese and the remaining 1 teaspoon oregano. To serve, divide the artichoke bottoms among 4 plates. Top each artichoke with equal portions scrambled egg, smoked salmon and creamy lemon sauce. Garnish with oregano sprigs if desired.

Nutrition Information
323 calories, 15 g fat, 5 g saturated fat, 6 g monounsaturated fat, 2 g polyunsaturated fat, 0 g trans fat, 329 mg cholesterol, 537 mg sodium, 29 g carbohydrate, 1 g sugar, 14 grams fiber, 25 g protein

Reference

1. Gladyshev VN. Selenoproteins and selenoproteomes. In: Hatfield DL, Berry MJ, Gladyshev VN, eds. Selenium: Its molecular biology and role in human health. 2nd ed. New York: Springer; 2006:99-114.

5 Fat-Burning Strategies

2009-03-10T13:59:00.001+08:00

5 Fat-Burning Strategies
Here's how to work out, eat right -- and lose fat.
By Kathleen Doheny

You work out zealously and eat healthy meals -- at least most of the time -- and the pounds are starting to drop off. You're looking and feeling more toned, too, just as you'd hoped.

But with all this effort, shouldn't you lose fat? Shouldn't the flab be dissolving faster? If you're of a certain age, you know the flab we're talking about.

If you're a woman, you may still have the dreaded muffin top, that slab of fat that spills stubbornly over the top of your best jeans, spoiling the look. Or if you're a man in that same bracket, you may have the unsightly pot belly that adds years to your otherwise youthful physique.

Shouldn't fat burning be faster? Not to mention easier?

WebMD consulted an exercise physiologist and an exercise physiologist/registered dietitian to find out how best to burn fat -- once and for all!

Here are their five best fat-burning strategies:
1. How to Burn Fat: Get Realistic

Get real tip No. 1: "You can't spot reduce," says Darlene Sedlock, PhD, an associate professor of kinesiology at Purdue University, West Lafayette, Ind. "Nobody wants to hear that."

Translation: If you're hankering to get rid of the jeans spillover or the pot belly, you need to burn fat from head to toe. "Anything to reduce your overall body fat will help," she says.

Get real tip No. 2: You need to give it some time. "There's no easy fix to the flab," Sedlock says. "Over time, some of the flab will disappear," if you're diligent about the eating and exercise plans. Give it several months, she suggests. Your weight might not change, but you will notice a difference in the way your clothes fit, she says.

Get real tip No. 3: This is perhaps the cruelest. You probably can't expect to be as flab-free as when you were 20. "Skin loses elasticity as you age," Sedlock says. The sagging of the skin adds to the unsightly appearance of flab, she says.

Other factors also make flab a challenge, says Jim White, an exercise physiologist and registered dietitian in Virginia Beach, Va. who is a national spokesman for the American Dietetic Association. "As we age, muscle mass declines, and metabolism slows, so we are definitely fighting an uphill battle."

So is some flab inevitable with age? "It seems to happen, but if you make a concentrated effort to avoid it, you can," Sedlock says. Too late if you're reading this article, of course, but preventing flab is a lot easier than banishing it, she says.

Even so, it's possible to reduce your fat and flab, White and Sedlock say. Besides being realistic, here are their best tips.
2. Fat-burning Workout: Pump Up the Cardio

A good overall cardiovascular conditioning exercise program is crucial to burn fat, say Sedlock and White. "Walking is excellent," White says, but most people have to pump it up a bit from their routine pace, especially if they've been exercising for a while and the flab isn't budging.
2. Fat-burning Workout: Pump Up the Cardio continued...

"Increase the days," White suggests. "If you work out two days, go to three. Or if you're jogging for half an hour, increase it to 45 minutes or an hour."

Interval training -- that is, alternating bursts of intense activity with bursts of lighter activity -- is a good way to burn more fat, White says. "Walk for five minutes, then jog for five," he says, then repeat. That strategy will burn overall more calories and more fat. If you are already jogging, jog then sprint to mix it up, he says.

Increasing intensity for a short period within your regular workout will burn more total calories and therefore more fat, Sedlock says.
3. Fat-burning Workout: Pump Iron or Do Other Strength Training

If you're trying to banish flab, weight training three times a week for a half hour each session -- if you're a beginner -- is ideal, White says. Once your flab is under control, two weight training sessions a week usually will help you maintain tone, he says.

"Work the full body," he says, rather than focus only on, say, triceps work for flabby upper arms. A full workout works all the major muscle groups, not just the flabby ones.

If you're a beginner to weights or other kinds of strength training, such as resistance bands, get some expert instruction first by hiring a personal trainer for a session or two, experts suggest.

You can incorporate the full-body weight training exercises that focus on your flabby areas, of course, White says. "For the muffin top, focus on the [abdominal] oblique muscles by doing bicycle kicks," he says, "or do oblique twists with the cable [weight] machine."

A simpler at-home exercise to burn fat, White says, is: Get a broom, hold it straight up over your head, then lean to the right and the left. You should feel the effort in your so-called love handles.

For flabby upper arms, you can do dumbbell kickbacks with hand weights. (With upper arm parallel to the floor and bent at the elbow, lean over a weight bench or other low bench with your other arm supporting your body. Extend the lower arm holding the weight until it is straight. Repeat and switch the weight to the other hand.)

To maximize the fat burning during weight training, women should aim for 12 to 15 repetitions per exercise, White says, and focus on a higher number of reps rather than constantly boosting the weight. Men should aim for eight to 12 reps and increase the weight periodically.
4. Fat-Burning Workout: Crunch Your Flab

Although a lot of people think a thousand sit-ups or crunches a day will get rid of the flab, that's not entirely true, Sedlock says. "Sit-ups aren't going to get rid of your abdominal fat, per se," she says. "Sit-ups strengthen the abdominal musculature." So that means with enough sit-ups your tummy should have a better appearance, she says.

"If part of the muffin top is due to those muscles not being exercised for a long time, toning up those muscles may help," she adds.

Pot bellies can be toned up with crunches and reverse crunches (lie flat and raise your hips and legs to work the lower abdominals).
5. How to Lose Fat: Overhaul Your Diet

Every other week, it seems, there's some new "fat-burning" food or supplement. On the list: chili peppers, low-fat dairy, and numerous dietary supplements.

There's some truth to the fat-burning food claims. "Some studies show certain foods can speed metabolism," White says.

For instance, capsinoids -- compounds derived from chili peppers -- increased fat burning slightly, and more so in subjects who had a body mass index (BMI) over 25, the beginning of overweight, according to Japanese researchers who published the study in Bioscience, Biotechnology, and Biochemistry.

Researchers have debated the role of dairy foods in weight management. Diets with at least three daily servings of [low-fat] dairy products speed weight loss and body fat loss in obese people compared to a diet with little dairy, according to Michael Zemel, PhD, of the University of Tennessee, who has published his results of the value of dairy in the Journal of the American College of Nutrition and other journals.

But White says don't rely on the so-called fat-busting foods to banish flab while you eat whatever you want the rest of the day. Instead, White suggests, incorporate the fat-burning foods into a sound diet.

What's sound and flab-unfriendly? Whole grains, lean protein, plenty of fruits and vegetables, and eight glasses of water daily, White says.

Small frequent meals also help you lose weight, White says, although not all experts agree that many mini-meals are better than three square meals.

"I have a client who came in eating one [huge] meal a day, and he weighed 300 pounds," White says. He put the man on five small, healthy meals a day. He lost weight, White says, and was amazed. Eating often also helps keep your energy levels up, White says.

SOURCES:

Jim White, RD, exercise physiologist and registered dietitian; national spokesman for the American Dietetic Association, Virginia Beach, Va.

Darlene Sedlock, PhD, associate professor of kinesiology, Purdue University, West Lafayette, Ind.

Zemel, MB.Journal of the AmericanCollegeof Nutrition, December 2005; vol 24: pp 537S-46S.

Inoue N. Bioscience, Biotechnology, and Biochemistry, February 2007; vol. 71: pp 380-389.

St. Jeor S. Circulation, Oct. 9, 2001; vol 104: pp 1869-74.

WebMD Feature: "Experts Debate How Often We Should Eat for Weight Loss."
Reviewed on February 06, 2009

Healthy Cooking Secrets from Celebrity Chefs

2009-03-10T13:48:00.002+08:00

Healthy Cooking Secrets from Celebrity Chefs
Star chefs share cooking tips and healthy recipes.
By Kathleen M. Zelman, MPH, RD, LD

It seems the latest category of superstar in America is the celebrity chef. The popularity of food shows, restaurants, and cookbooks masterminded by our favorite celebrity chefs shows no sign of waning.

With that in mind, WebMD took this question to several star chefs: Do you have any secrets to pass on to those of us at home hoping to cook and eat more healthy foods?

The good news, experts say, is that one of the easiest ways to change your eating habits is to start cooking more at home. Healthier eating starts in the kitchen, where you control the ingredients, the preparation, and the serving size.

In fact, one celebrity chef -- Ellie Krieger, host of Food Network’s Healthy Appetite -- has made healthy and delicious cooking her life's work.

"As you become more adventurous in the kitchen, you will quickly learn that healthy food can be delicious once you master simple techniques and become more familiar with testing recipes and ingredients," she says.

Here are tips from several celebrity chefs to demystify cooking and help you become a healthier cook.

Celebrity Chef Tip No. 1: Look for Inspiration

Emeril Lagasse, famed for his restaurants, cookbooks, and cooking shows, attributes his success to his mentors.

"Throughout my career, there have been so many people who have inspired me, such as chefs Alice Waters, Charlie Trotter, and Mario Batali. But beyond chefs, restaurateur Ella Brennan taught me how to lead by talent and hard work, leaving my ego behind," he says. "If you find someone or something that inspires you, it will give you the support to be adventurous and bring your culinary skills to another level."

Your own inspiration might come from cooking shows, cookbooks, or great cooks you know personally.

Anne Quatrano, chef and co-owner of three restaurants, including the top-rated Bacchanalia in Atlanta, says she drew inspiration for her culinary skills from her grandmother and great-aunt.

Celebrity Chef Tip No. 2: Choose Great Ingredients

Great ingredients make great food. Your ingredients don't have to be expensive, just fresh and of good quality, says Lagasse.

Quatrano creates dishes that star local, organic produce because, she says, "fresh ingredients need less manipulation."

At the renowned Blackberry Farm retreat in Tennessee, chef Josh Feathers credits the award-winning cuisine to the organization's commitment to sustainable, local, and fresh foods.

"We plan our menus farm-to-table around what we can grow seasonally on the property and the end product is incredibly delicious," says Feathers.

Celebrity Chef Tip No. 3: Be Passionate About Food

"When you have passion for food, you can take it to the next level of 'wow' food," Lagasse says.

Celebrity Chef Tip No. 4: Stock Your Kitchen with Essential Ingredients and Tools

Great chefs can make a meal out of almost anything. Witness the Iron Chef TV show, in which chefs are given a group of ingredients to prepare without the help of recipes.

If you want to be creative, start by having good, basic ingredients on hand in your pantry, refrigerator, and freezer.

You also need the right tools, including a good set of pots, pans, knives, and cutting boards, say the experts.

Celebrity Chef Tip No. 5: Keep it Simple

Some of the best dishes are made up of just a few well-prepared ingredients.

"Don’t be apprehensive about trying simple preparations that let the ingredients shine, especially if you buy what is local and fresh," says Quatrano, who with her husband, Clifford Harrison, won "best new chefs" honors from Food and Wine magazine.

Krieger’s suggestion: "Select five dinner meals that look appealing, doable, and simple to get started. Once you've mastered these, add in another recipe to start to build a repertoire of recipes you love."

Celebrity Chef Tip No. 6: Make it Your Own

Individualize your recipes and meals to suit your palate. For example, there are a hundred ways to make onion soup; you can experiment with stocks, herbs, types of onions, and cooking techniques to make it your own.

Rich Tromonto, the Chicago restaurateur who is a judge on Bravo’s Top Chef show, says he takes great pride in developing new recipes, and making sure his staff can duplicate them consistently.

Remember, cooking is all about experimenting, so don’t get discouraged if your recipe is not up to par the first time around. Just step back and think how you could make it better next time, say the experts.

Celebrity Chefs’ Recipes

Ready to hit the kitchen? Lagasse and Krieger shared three easy-to-prepare recipes with gourmet results.

Baked Shrimp with Tomatoes and Feta

Ingredients:

1 tablespoon olive oil

1 medium onion, diced (about 1 1/2 cups)

2 cloves garlic, minced (about 2 teaspoons)

Two 14.5-ounce cans no-salt-added diced tomatoes, with their juices

1⁄4 cup finely minced fresh flat-leaf parsley

1 tablespoon finely minced fresh dill

11/4 pounds medium shrimp, peeled and deveined

1/4 teaspoon salt, plus more to taste

1/4 teaspoon freshly ground black pepper, plus more to taste

2/3 cup crumbled feta cheese (about 3 ounces)

Preparation:

1. Preheat the oven to 425°F.
2. Heat the oil in an ovenproof skillet over medium-high heat. Add the onion and cook, stirring, until softened, about 3 minutes, then add the garlic and cook for 1 minute. Add the tomatoes and bring to a boil.
3. Reduce the heat to medium-low and let simmer for about 5 minutes, until the tomato juices thicken.
4. Remove from the heat. Stir in the parsley, dill, and shrimp and season with salt and pepper. Sprinkle the feta over the top. Bake until the shrimp are cooked through and the cheese melts, about 12 minutes.

Yield: 4 servings

Nutrition Information: Per serving: 295 calories, 10.5 g fat, 4 g saturated fat, 34 g protein, 12 g carbs, 2 g fiber, 235 mg cholesterol, 645 m sodium.

Recipe from The Food You Crave (Taunton, 2008). Republished with permission.

Roasted Spaghetti Squash with Parmesan Curls

Ingredients:

1 spaghetti squash

2 tablespoons olive oil

2 tablespoons extra virgin olive oil

1/4 cup Parmesan cheese, shaved with vegetable peeler

Preparation:

1. Preheat oven to 400 degrees F.
2. Slice spaghetti squash in half lengthwise. Drizzle cut side with olive oil, salt and pepper.
3. Place squash, cut side down, on a parchment-lined baking sheet. Bake until squash is tender when pierced with a fork, 45 minutes to 1 hour.
4. Remove squash from oven and cool slightly, to handle. Into a bowl, shred the inside of the squash with fork to resemble spaghetti. Drizzle with extra virgin olive oil and top with curls of Parmesan cheese. Serve warm.

Yield: 2 entrée or 4 side servings

Nutrition Information: Per serving: 184 calories, 4 g protein, 8.5 g carbohydrate, 16 g fat, 3.4 g saturated fat, 7.5 mg cholesterol, 2 g fiber, 113 mg sodium.

Recipe courtesy Emeril Lagasse, Martha Stewart Living Omnimedia, Inc. Republished with permission.

Grilled Peaches with Red Wine Syrup

Ingredients:

1 750 ml Sangiovese or other dry red wine

2 sprigs fresh rosemary

1/2 vanilla bean, split lengthwise and scraped (beans reserved)

1/3 cup sugar

6 large ripe peaches, halved and pits removed

Vanilla ice cream for serving (optional)

1. Preheat a grill to medium high.
2. Place the peaches, skin-side down, onto the grill and cook until lightly charred, 5-7 minutes, depending on the grill. Turn peaches over and continue to grill for and additional 2 minutes.
3. Combine wine, rosemary, vanilla bean and seeds and sugar in a 2 quart saucepan and bring to a boil. Continue to cook for about 10 minutes, until slightly reduced and the flavors combine. Transfer the peaches to saucepan and continue to simmer for 5 minutes. Let peaches cool in wine syrup.
4. Serve in a bowl with strained syrup and ice cream if desired.

Yield: 6 servings

Nutrition information: Per serving (not including ice cream): 217 calories, 2 g protein, 31 g carbohydrate, .4 g fat, 0 g saturated fat, 0 mg cholesterol, 2.5 g fiber, 5 mg sodium.

Recipe courtesy Emeril Lagasse, Martha Stewart Living Omnimedia, Inc . Republished with permission.

SOURCES:

Rick Tromonto, chef; owner, Cenitare restaurants, Chicago.

Emeril Lagasse, chef; owner, Emeril’s restaurants; author, From Emeril's Kitchens: Favorite Recipes from Emeril's Restaurant, New Orleans.

Ellie Krieger, MS, RD, host, Food Network’s Healthy Appetite; author, Foods you Crave.

Josh Feathers, executive chef, Blackberry Farm, Walland, Tenn.

Anne Quatrano, co-chef and co-owner, Bacchanalia, Quinones, Star Provisions, and Floataway Cafe, Atlanta.

Rick Tromonto, chef; judge, Top Chef TV show; owner, Cenitare restaurants, Chicago.
Reviewed on February 02, 2009

Tips to Avoid Foot Pain From High Heels

2009-03-05T12:41:00.001+08:00

Tips to Avoid Foot Pain From High Heels
Experts discuss foot care techniques to cope with the painful consequences of wearing high heels.
By Colette Bouchez
Reviewed by Louise Chang, MD

Do the most important men in your life -- and the shoe boxes in your closet -- bear the names Manolo, Jimmy C, Enzo, and Stevie M? If so, then there's a good chance high heels are a part of your life.

But unlike Carrie Bradshaw in TV's Sex and the City -- who chased men, taxis, and sometimes a dog in the park while teetering on 4-inch stilettos -- high-heeled life in the real world can be a killer.

"Women do love their high heels, but if you wear them all the time, significant foot pain and other problems can ensue, either as a direct result of the heels or exacerbated by them," says Morris Morin, DPM, director of podiatric medicine at the Hackensack University Medical Center.

Problems range from common concerns like bunions, corns, and calluses to more complex issues like misshapen hammertoes or that excruciating pain in the ball of the foot that seems to grow worse with each passing year.

Still, many women refuse to give up their high heels: A survey conducted by the American Podiatric Medical Association showed some 42% of women admitted they'd wear a shoe they liked even if it gave them discomfort; 73% admitted already having a shoe-related foot issue.

So what's the answer? Doctors say if you must wear them at all, take a few precautions, and catch and treat problems early on. If you do, you'll not only avoid many high-heel problems, but you'll make the time you spend in spikes a happier day for your feet.

(Do you often wear high heels? Share your experiences on WebMD's Women’s Health: Friends Talking message board.)
High Heels and Foot Pain: What You Should Know

Anytime you wear shoes that are tight or constrict the natural shape of your foot, doctors say it's bound to cause foot pain.

But when you add high heels in to the equation, podiatrist Stuart Mogul, DPM, says pain can quickly escalate to damage.

"In addition to restricting the foot, you are also increasing the weight on the area that is restricted, so you're not only crushing your toes, but you're crushing them and then putting weight on them, and that's a problem," says Mogul.

Among the most common problems he sees are painful, aching bunions -- those bony protrusions that usually pop up at the base of the big toe and distort the shape of the foot.

"High heels don't cause bunions, but they sure can aggravate them. Both the heel height and the point of the shoe can play a role," says Mogul.

Moreover, he says some women who have bunions also have a displaced bone on the bottom of the big toe joint, which changes the way the foot "tracks" or acts during motion.

"If the foot is then placed in a high heel, and pitched forward, the pressure on these bones increases and bunion pain grows worse," he says.
While integrating lower heels into your wardrobe can help some, often the best solution is bunion surgery to straighten the bone.

If you're wearing high heels on a daily basis, it's likely you've already experienced two more common problems: corns and calluses. These thickened layers of dead skin usually occur on the toes or sides of the foot and are actually the body's way of defending your feet against assault. Only in this case, says Morin, your shoes are the enemy.

"When you start developing corns and callus, or even ingrown toe nails, pressure from shoes that don't quite fit is often the problem," says Morin.

Other times it can be the result of a "hammertoe" -- a condition that causes the bone of the affected toe to curl under, leaving the top to rub against the shoe. When that shoe is a high heel, says Morin, problems and pain are intensified.

While wearing a lower heel shoe can help some, the solution may require a surgical procedure that helps straighten the hammertoe.
High Heels and Midlife Crisis

It's true that nothing can lift the spirits like a sassy new pair of high heels. But if it seems those heels were a lot more comfortable in your 20s and 30s then they are in your 40s, 50s, and beyond, you're right.

Feet change with age, say experts, and some of those changes can make wearing high heels a lot less comfortable. One of the most common: a loss of fat in the bottom of the foot.

"As you age, you lose some of the fatty deposits that normally protect the ball of the foot -- and some of it also slides forward towards the toes," says Morin.

When we slip our feet into those strappy stiletto sandals and step down, he says our weight is thrown on the spot where we have less protection.

"In extreme cases you actually have the bony ends of the foot grating down into the sole of the shoe with almost no protection at all," he says.

Not only does this cause pain, but it may also increase your risk of stress fractures and osteoarthritis in the feet.

And while some doctors attempt to repad the foot using injections of silicone or wrinkle filling injections like Restalyne, both Morin and Mogul say it's not a good idea.

"These injectables are not meant to withstand the pressure of body weight; they don't last and they tend to move around from the weight," says Morin.

Moreover, the American Orthopedic Foot and Ankle Society warns women against these and other strictly cosmetic procedures for the feet. Calling the trend alarming, they warn consumers that risks -- including infection, nerve injury, and difficulty walking -- frequently outweigh benefits.
A much better idea for bottom-of-the-foot pain, says Morin, is the use of heavily padded insoles. "They act as a buffer between your foot and the ground, and that's all you really need."

And finally, if you've worn primarily high heels for most of your life, you may experience shrinkage of the Achilles tendon, the area that runs from the back of the heel to the calf. This can result in pain when wearing a low-heel shoe or even the inability to walk barefoot.

The antidote here: Stretching exercises like runners do. In rare instances, Mogul says you may need surgery to lengthen the Achilles tendon.
5 Tips to Protect Your Feet When Wearing High Heels

We know you love your high heels, so we won't even hint at the fact that you'd be better off in sneakers. At the same time, what good is that great pair of red patent-leather stilettos if all you can do is sit and admire them?

If you’re going to wear heels, WebMD combined advice from our two experts, along with suggestions from the American Podiatric Association, to protect your feet.

1. Get the best-fitting high heel possible. While this may seem like a given, stop and think: How many pairs of high heels cause your feet to slide to the front, leaving a gap big enough for a small cell phone behind your heel? Mogul says high heels that don't fit properly cause the front of the foot to fly forward, creating more pressure -- and pain -- on toes. Look for narrow heels with a snug but not tight fit to correct the problem.

2. Cushion, cushion, cushion. While a full-shoe insert can help, if you have pain in the ball of the foot -- or you'll be standing in your heels a long time -- invest in silicone metatarsal pads. They look like flattened gummy bears, but they do a super job of shock absorption, says Morin. "It's like replacing the fat padding you lost."

3. Wear a thicker heel for stability. "A thicker heel will give you better balance and may help relieve some pressure by distributing the weight on your foot more evenly, says Morin. Alternating heel heights can also help reduce problems with the Achilles tendon.

4. Pay attention to the "slope" or "pitch" of the heel. While some 4-inch heels will give you a straight drop down to the flatbed portion of the shoe, others will be a more gradual slope. This may be easier on the arch, says Morin, and might help relieve some pain in the ball of the foot.

5. Wear open-toe high heels to relieve pressure on corns and calluses. See a podiatrist to have corns and calluses professionally removed and correct the problem that’s causing them. But if that's not possible, opt for open-toe shoes to take pressure off inflamed areas.

10 Body-Smoothing Secrets from the Top Skin Experts

2009-03-05T12:37:00.002+08:00

10 Body-Smoothing Secrets from the Top Skin Experts
By Didi Gluck
Marie Claire Magazine

The difference between pretty and knockout sexy? The feel-good factor. Skin experts spill their top 10 body-smoothing secrets — for every inch of you.

1. Sexy back
Just because you can't see them — your back, your backside, the backs of your arms — doesn't mean others can't. They deserve TLC, too. Sudsing up with an antibacterial cleanser prevents breakouts on bacterial your back and bottom, while using an alpha- or beta-hydroxy lotion on the undersides of arms can nix keratosis pilaris (aka, the little bumps below your biceps). Tempting as it may be, don't overscrub, cautions dermatologist David Bank, M.D., author of Beautiful Skin, as it will only aggravate the situation.

2. Save your neck
So close, and yet so far! The sad truth is, treating your neck like your face doesn't work. "Your neck ages in its own way and so has special needs," explains Adrienne Denese, M.D., Ph.D., of the eponymous skincare line. "Neck tendons shrink through the years and become more visible, and unfortunately, the thin, easy-to-scar skin in this area doesn't respond to lasers and peels as well as your face does." Some remedies your grandmother told you about: "If your posture is excellent, your neck will age well," says Denese. Stretching your neck also helps. Denese suggests this stretch: Tilt your head back and stretch your lower lip over the upper one; hold for a few seconds. Repeat 10 times. There are several effective neck-specific products containing retinol, peptides, and glycolic acid, but if you're thinking serious measures, talk to your dermatologist about Botox (the injections — about $2000 per session — are good for about five months) or a neck-lift (from $3000 to $5000).

3. Treasured chest
"For a really nice décolleté, I believe in moisturizing constantly and dusting on a bit of shimmer," says Rebecca Apsan, owner of Manhattan lingerie shop La Petite Coquette — where beautiful busts are her business. And while each season brings an abundance of boudoir-worthy bras, there are now just as many bust gels and creams, with ingredients specifically formulated to give a temporary lift and impart a smoother texture.

4. Hand-to-hand combat
Water, paper, chemicals: all enemies of soft hands. "You have to fight back every day," says Jan Arnold, founder of Creative Nail Design, whose posh polishes are now a runway favorite. "First, exfoliate to slough off the dead cells. Then, while skin is moist, slather on a cream rich enough to compensate for how few oil glands your hands have." (Most body or face creams don't cut it here.) "Treat your hands to a paraffin-wax dip next time you're getting a salon manicure," adds Arnold. "Wax enables hydrating ingredients to penetrate deeper."

5. Vein attempts
Always hard to fight: heredity and hormones, the chief causes of dilated "spider" veins. But not impossible. "Lasers, which are so effective in other cosmetic procedures, don't work on big veins and often bring about bruising," explains Steven Victor, M.D., director of Victor Dermatology & Rejuvenation in New York City. "Injections are faster, easier, and cheaper." Some dermatologists, including Victor, prefer polidocanol injections over the more painful saline, which causes veins to collapse and disappear. Two to six rounds are usually necessary, at $375 per session.

6. Razor's edge
Nothing beats a razor for quick hair removal. Invest in a sturdy one to ensure a shave that's close but not treacherous. Let your skin soak up some water for a few minutes (this is why shower time is ideal), so that hair is literally standing at attention, which makes it easier to lop off. Prepping skin with a protective shaving gel with hydrating vitamin E is best, although your hair conditioner will work in a pinch. New to the market: razors with built-in creams and gels. Love 'em.

7. Happy feet
Celebrity podiatrist Suzanne Levine, DPM, treats the nonglam side of glamorous people: yellowed toenails, fungi, calluses, and fissures. "I can tell someone's age the moment they take off their shoes," she says. Prevent dead-skin pileup by using a pumice stone in the shower — and don’t be tempted into using a razor. "That will only cause more skin to grow back," says Levine. Pamper your feet with occasional moisturizing facial masks, and take a pedicure holiday on occasion: Let nails go lacquerless once in a while, and brighten up the natural nail by swabbing on hydrogen peroxide.

8. Get jiggly with it
Ninety percent of women — including supermodels — have cellulite. Few, after all, are immune to its underlying causes, such as hormones, fat, and heredity. Remedies run from Mesotherapy — the red-hot treatment from France that injects plant extracts and other herbal substances into your fat pockets — to the recently FDA-approved Smartlipo, a fat-melting laser that's inserted just below the skin's surface ($4000 to $5000 per area). And while some women still lie down and let the skin-kneading rollers of Endermologie do their stuff, others find a firming moisturizer will plump up the area and make cellulite less noticeable (a sensible choice, since no cellulite "fix" has been proven to be permanent).

9. Smooth moves
A new FDA-OK'd light therapy called Titan is producing respectable results in firming saggy stomachs and breasts. There's no downtime, and the cost is a plus: $750 to $2500 a session for up to three visits, compared with up to $30,000 (the price of a tummy tuck and boob job). In search of a more polished skin surface, women are also opting for skin-doc developed moisturizers rich in vitamins and hyaluronic acid, which combat signs of aging — sagging, lost luster, dryness — as effectively below the neck as they do above. Winter tip: Choose one of the new moisturizing shower gels that cleanse and leave behind a layer of hydration.

10. Glow time!
Linda Hay, the makeup wizard behind the bronzed goddesses in Victoria's Secret ads and fashion shows, knows from fabulous faux tans: "Whether you're using body makeup or a self-tanner, exfoliate first so you get an even finish," she says. Self-tanning mousses are simplest to slather on and quickest to dry; if you go the makeup route, choose a luminous lotion, which is easy to apply all over. Shimmer powders, swears Hay, slim the silhouette.

Unlocking the Secret Pleasures of Menopause

2009-03-05T12:34:00.001+08:00

Unlocking the Secret Pleasures of Menopause
Physician-author Christiane Northrup tells women that midlife can be a good thing, especially for those who boost their nitric oxide and foster their sexuality.
By Kathleen Doheny
Reviewed by Louise Chang, MD

As an obstetrician-gynecologist, Christiane Northrup, MD, of Yarmouth, Maine, has spent years caring for women when something went wrong with their bodies.

These days, she doesn't see patients anymore, devoting her time instead to speaking and writing. At midlife, she has a new plan and a new mission: teach women everything that can go right with their bodies when they reach midlife.

What she is proposing may seem nonsensical to some and like a breath of fresh air to others. She wants midlife women to discover the secret pleasures of menopause. She's convinced that menopause -- traditionally viewed as the signal a woman is washed up and over the hill -- is overdue for a brand new spin.

"The truth is that women over 50 are just hitting their stride," she writes in the introduction of her new book, The Secret Pleasures of Menopause, published this month.

The new book is meant to be "fluffy," she says, much less serious than her previous books, including The Wisdom of Menopause and Women's Bodies, Women's Wisdom.

Northrup is well aware that women going through menopause often focus on hot flashes, hormonal and mood swings, and viewing themselves as washed up.

She actually had to do a bit of talking to herself along those lines, as she admits in the book.

Slowly but surely, she came to view the transition as a good thing -- to see and appreciate the secret pleasures of menopause.

Look at the benefits of menopause, she suggests. "You become far more intuitive, you are no longer satisfied with the status quo, and you find your voice in a different way," she says.
The Nitric Oxide Connection

One of the points of Northrup's chatty new tome is getting women to say yes to pleasure.

"You can turn yourself on," she tells women approaching midlife. "You can rewire your brain and your body to feel more pleasure. The brain is the biggest sex organ in the body."

Getting to all this pleasure, she says, depends on paying attention to your nitric oxide levels, which she'll bet are probably too low.

Nitric what? Many midlife women may never have thought about -- or heard about -- nitric oxide.

Nitric oxide is a colorless, odorless gas that tells blood vessels to relax and to widen, in turn resulting in a lowering of blood pressure. Discoveries about nitric oxide that led to the development of the ED drug Viagra earned three scientists a Nobel Prize a decade ago.

Although it's the stuff by which erectile dysfunction (ED) drugs work, it's not the exclusive domain of men, Northrup says. (Indeed, one of the 1998 Nobel recipients, Ferid Murad, MD, co-wrote a book, The WellnessSolution, published in 2006, promoting a regimen of diet, exercise, vitamins, and antioxidants that works by increasing nitric oxide levels.)

Northrup says it's time midlife women discovered the benefits of boosting nitric oxide levels as their own gateway to better sexuality and sensuality at midlife and beyond.

"Most of us don't produce enough to keep us vibrantly healthy," she says.

Practicing her suggestions will boost levels, she says. Simply thinking joyous thoughts can boost it, she claims. "A joyous thought would be: 'The best times of my life are yet to come.'"

Boosting nitric oxide can also be accomplished by exercising regularly, meditating, and having sex regularly, she says.
Northrup's Rewiring Plan

Northrup gives plenty of commonsense suggestions on how to find the secret pleasures of menopause, the kind of stuff everyone has heard before -- eat a balanced diet, take supplements to get enough vitamins, find a workout you enjoy and stick with it, reduce stress.

But the new message is the importance of maintaining -- even expanding -- sexuality. Out goes the idea that a woman in her 50s and 60s and beyond can't be sexy -- or have plenty of sex. For the doubtful, she offers ideas on how to go from feeling frumpy to sensual first by changing your mind-set. Among the suggestions:

* Buy great underwear, even if you're without a partner. Quiet the voice that says, "But no one but me will see it."
* Redefine yourself. (If your grown-up kids balk or snicker, ignore them.) After she got divorced at midlife, she jazzed up her wardrobe with a bit of leopard print, which her youngest daughter initially balked at -- a reaction Northrup ignored.
* Learn to love yourself. Buy yourself flowers every week. Get a massage. Or offer to trade foot rubs or massages with your partner.
* Get to know yourself up close and personal. In a section subtitled "To Know Thy Clitoris Is to Love Thy Clitoris," Northrup talks about how to explore and find out what specific area of the clitoris is most a turn-on for you. (Hint: she says to try your 1 o'clock position, as you look down).
* Rewire negative thoughts. Instead of "Ugh, my thighs are heavy," Northrup suggests focusing on more positive facts about them, like they are soft and smooth and your partner likes to caress them.

Sex after menopause can be the best ever, Northrup insists. She offers her "7 secret keys that will open the door to wonderful sexuality and sensuality after menopause."

Among them: she advises women to explore their own pleasure, learn to turn themselves on, release negativity, and live in a way that motivates others to be at their best and their healthiest.
Second Opinions

"The advice is good," says Wulf Utian, MD, PhD, a consultant in women's health for the Cleveland Clinic in Ohio and executive director of the North American Menopause Society, who tells WebMD he is not speaking on behalf of either organization, rather offering his own opinion.

But whether nitric oxide can be given all the credit, he is not so sure. "We know nitric oxide is extremely important in bodily functions," he says. "The advice [in the book] is good, but there is nothing new about the advice. She is trying to add a scientific hook."

"If her book is successful at getting people to develop a positive attitude and improve their quality of life, than I say more power to her," he says. But he says research on nitric oxide has a ways to go before proving that it is as important to well being as Northrup contends.

For most women, feeling better about menopause may be enough, he says. How it happens is probably irrelevant.

The New Heart Tests: Which Ones Should You Have?

2009-03-05T12:29:00.001+08:00

The New Heart Tests: Which Ones Should You Have?
Experts explain the pros and cons of coronary calcium scores, carotid artery ultrasound, and CT heart scans.
By Charlene Laino
Reviewed by Louise Chang, MD

We've all heard the stories: someone seemingly healthy, with normal cholesterol levels and no obvious risk factors, drops dead of a heart attack. How can this happen?

Morteza Naghavi, MD, says it's because traditional risk factors may not tell you what you really need to know: whether your arteries are diseased.

"Why are cholesterol, smoking, family history so lousy? Because they're just risk factors," says Naghavi, chairman of the Society for Heart Attack Prevention and Eradication (SHAPE) and director of American Heart Technologies in Houston.

"They don't speak to whether the arteries are diseased. So we need to directly visualize the artery. Is there plaque and is the artery dilating properly? You can have a diseased artery regardless of how may risk factors you have."

That disconnect has led more doctors to recommend that patients undergo high-tech heart tests that offer detailed images of the blood vessels as a means of lowering heart disease risks. The three tests -- calcium coronary scores, carotid artery ultrasound, and CT heart scans (CT angiography) -- "are all good at determining early atherosclerosis, or hardening of the arteries," says American Heart Association (AHA) past president Robert Bonow, MD, head of cardiology at Northwestern University's Feinberg School of Medicine in Chicago. "They can help to identify people early on that need aggressive risk factor modification."

But as with anything, these tests have their merits and drawbacks. So how can you tell if these tests are for you? To find out, WebMD spoke with three leading heart health experts: Naghavi, Bonow, and Todd C. Villines, MD, co-director of cardiac CT at Walter Reed Army Medical Center in Washington, D.C.
1. Coronary Calcium Scores

What Are Coronary Calcium Scores?

Calcium is one component of plaque that can build up inside the coronary arteries that supply oxygen-rich blood to heart muscle. Measuring it can help determine the level of plaque buildup that leads to narrowing of the heart arteries, the hallmark of coronary artery disease.

During the test, you lie in a hollow CT scanner. X-ray beams create multiple images of the heart; a computer measures the amount and density of calcium deposits in the artery walls and provides a calcium score. The score can range from 0 to more than 400, and any score over 100 is associated with an increased risk of heart disease.

"Studies have consistently shown that the higher your calcium score, the higher your risk of heart attack or other coronary artery disease event," Villines says. One of the most recent studies, published last year in the New England Journal of Medicine, showed that the coronary calcium score predicted heart events -- heart attack, death from coronary heart disease, or chest pain (angina) -- among men and women of all races. In that study, people with a coronary calcium score of 101-300 were more than seven times as likely to experience a heart event than someone with no evidence of coronary calcium; people with higher scores were at even greater risk.
Who Should Get Coronary Calcium Scores?

People at intermediate risk of heart disease based on traditional risk factors. This includes men over 50 with at least one added risk factor and women over 60 with at least two added risk factors, such as high blood pressure or high cholesterol, according to Villines. In these individuals, the need to commence medications to control these risk factors may not be clear.

For people at intermediate risk, a high calcium score would likely lead to more aggressive lifestyle changes, such as aspirin therapy, and even high-dose statin drugs to control cholesterol, Bonow says.

On the other hand, if you're at high risk to begin with (because you have diabetes or because you have heart or vascular disease), you should already be on aggressive therapy, so measuring the calcium score wouldn't change anything, Bonow explains. And people at low risk are unlikely to have calcium buildup; even if they do, their overall risk of a cardiac event is usually still low, he says.

One exception may be low-risk women, Villines says. "Data from the Multi-Ethnic Study of Atherosclerosis trial showed that women at low risk and a high calcium score faced the same risk of heart attack or dying of heart disease as people at high risk. So even though it's not integrated into the guidelines, I would consider this test in women aged 45 to 65 with at least one risk factor -- or even with no risk factors when there is a strong family history. It might change management."

Naghavi believes that all men ages 45 to 75 and women ages 55 to 75 should undergo screening with either the coronary calcium scan or carotid artery ultrasound -- regardless of whether they have other risk factors. People may have low cholesterol levels or other low risk factors and still have heart problems, he says. "We need to go beyond traditional risk factors."

Bonow, Villines, and many other doctors disagree, saying that further study is needed to show that widespread screening will truly help. "Testing everyone would lead to a lot of costs and detection of minor abnormalities that mean nothing but can cause needless anxiety and further testing," Bonow says.

Advantages of Coronary Calcium Scores

Villines notes that the only study directly comparing coronary calcium scores to carotid artery ultrasound showed that calcium scores are better at predicting risk of future heart problems. Adds Bonow, "Of the two tests, coronary calcium is probably the better studied. Calcium in the blood vessels is clearly a marker of atherosclerosis, and it can be quantified."

"The test is painless and quick," he adds.

Disadvantages of Coronary Calcium Scores

Because calcium deposition is not the first thing that happens during plaque buildup, "a negative test doesn't mean you don't have [any] atherosclerosis," so a low or absent calcium score may make you feel safe even if you're at risk, Bonow says.
Furthermore, as we age, the chance that some plaque has deposited is significant and it is common for older individuals to display calcification in their arteries. So a positive test doesn't necessarily place you at risk: In one study, low amounts of calcium were detected in two-thirds of the participants who did not experience coronary events. The key may be your relative score -- how you compare to your peers. You may be at increased risk only if your score is significantly higher than expected based upon your age and gender.

Also, the test does involve some exposure to radiation, although "at very low doses," Bonow says. A new AHA advisory says CT scans should be used judiciously to minimize exposure to ionizing radiation, but that medically appropriate examinations should not be avoided.

How Much Do Coronary Calcium Scores Cost?

The test typically costs $200 to $500. As with most screening tests, Medicare and other insurers usually do not pick up the tab.
2. Carotid Artery Ultrasound

What Is Carotid Artery Ultrasound?

This test uses ultrasound and sophisticated software to quantify the thickening of the inner walls of the carotid arteries that supply blood to the brain, a sign of early atherosclerosis. "Studies in over 50,000 patients have shown that if you're in the 75th percentile or higher for your age group, you have a higher risk of coronary heart disease and stroke," Villines says. Being in the 75th percentile means that 75% of your peers had less artery thickening than you.

Who Should Get Carotid Artery Ultrasound?

As with coronary calcium scores, carotid artery ultrasound should be reserved for people at intermediate risk of heart disease based on traditional risk factors, according to Bonow and Villines. Naghavi says SHAPE "recommends carotid artery ultrasound or coronary calcium scores as a first line of screening for men over 45 and women over 55. However, of the two tests, I'd lean toward calcium scores."

Advantages of Carotid Artery Ultrasound

This is a painless noninvasive test that can be performed easily in the doctor's office and does not expose the patient to radiation.

Disadvantages of Carotid Artery Ultrasound

Unlike coronary calcium scores, carotid artery ultrasound "does not inform you directly about the heart," as you are looking at the arteries in the neck, Naghavi says.

Also, the accuracy of the test is very dependent on the skill and expertise of the technologist performing the study, "so you need a trained operator who knows all the current protocols. Be sure to ask if your institution follows the most current guidelines," Villines advises.

How Much Does Carotid Artery Ultrasound Cost?

The test typically costs $200 to $500. As with most screening tests, Medicare and other insurers usually do not pick up the tab.
3. CT Heart Scans

What Is a CT Heart Scan?

During CT heart scans (also know as CT angiography), patients receive a contrast dye through an IV. X-rays are passed through the body and are picked up by detectors in the scanner. Special software uses the information gathered during the scan to create 3D images of the coronary arteries on a computer screen.

CT angiography scans give doctors a detailed look at the coronary arteries, which supply blood to heart muscle, without cardiac catheterization.

Who Should Get CT Heart Scans?

While contrary calcium scores and carotid artery scans are used to evaluate people without symptoms, CT angiography is typically reserved for intermediate-risk people with symptoms such as chest pain or shortness of breath that could be due to coronary heart disease, Villines says.

CT heart scans can also be useful if a patient is at low risk for heart disease and has "mildly abnormal" results on an exercise stress test. "Right now, these patients are referred for catheterization, but the CT scan could help avoid that," he says.

Advantages of CT Heart Scans

The technique is quick, producing pictures within five to 10 seconds, compared with 30 to 45 minutes for cardiac catheterization, the "gold standard" for evaluating blood vessel obstructions. It's noninvasive, with less risk and discomfort than catheterization, which often requires sedatives and sometimes a night in the hospital.

Disadvantages of CT Heart Scans

It fails to produce good images in people with a lot of calcium deposits in their arteries, Bonow says. It should not be used in people with chronic kidney disease or severely obese patients, Villines says.

There are also concerns about cancer risks. According to a new study, CT angiography has the potential to expose patients to high doses of radiation, and methods available to reduce radiation dose are not frequently used. A recent study reported that the average radiation exposure from a CT angiogram evaluation is equivalent to 600 chest X-rays.

Villines says that over the past two years, Walter Reed doctors have been able to reduce radiation during CT angiography by 50% to 70% through the use of radiation-sparing techniques. Patients should ask if such methods will be used before having the procedure, he advises.

How much do CT Heart Scans cost?

The CT scan, including the doctors' fee, costs about $1,000. Medicare and other insurers are still evaluating whether to pay for the scans.

In summary, there are several tests which can be used to determine whether or not you have diseased arteries. The results of such tests could influence the type of preventive treatments which are recommended. However, no test is perfect and regardless of test results, optimizing lifestyle choices still remains a cornerstone of heart disease prevention.

When it comes to your heart health, there are no hard and fast rules, our experts say. Talk to your doctor if you have any concerns.

2009-03-05T12:28:00.000+08:00

22- Long Live Tricks

2009-03-05T12:22:00.002+08:00

22 Live-Long Tricks

By Nancy Rones

It only takes a few minutes a day to dramatically improve your health. And with our list of fun and easy good-for-you habits, you'll want to get started right away.

Yeah, yeah — you know that exercising and eating right should be at the top of your daily to-do list. But let's face it: Some days there's barely enough time to sprint from the car to the pizza parlor to grab a pie to go. We're in no way suggesting you abandon those bigger long-term health goals, but we would like to help you by giving you these 22 simple, science-backed steps that you can take today— and every day — to live a longer, healthier, happier life. And don't let the small nature of these lifestyle tweaks fool you: They're proven to have a major impact on your health.
Buy a bouquet.

Looking at flowers can put you in a brighter mood, research from Rutgers suggests. In three different studies, receiving flowers was shown to have both immediate and long-term positive effects on emotional outlook.
Go overboard on sunscreen.

Skin cancer is the most common form of cancer in this country, but it is largely preventable. While you definitely want to use a broad-spectrum sunscreen (which blocks both UVA and UVB rays) with an SPF of 15 or higher, slathering on enough sunscreen is actually the most important factor for determining how effectively a lotion works, according to a study published in The Lancet. If you're spending a full day on the beach, aim to go through a whole small 3- to 5-oz tube. In winter months when UV rays are weaker, applying an SPF moisturizer to your face and other exposed skin in the morning or before you head outdoors is probably enough. But know that there's no hard evidence that sunscreen protects against malignant melanoma, which is the deadliest form of skin cancer, so your best protection is to minimize direct sun exposure and wear protective clothing in addition to lubing up.
Have oatmeal for breakfast.

Why? For starters, it may help you shed unwanted pounds: In one study, participants who had oatmeal for breakfast ate 30 percent fewer calories at lunch compared to those who had cornflakes. Oats are complex carbs, so they digest slowly and keep blood sugar steady, which fends off hunger and may help control type 2 diabetes. Oatmeal also acts like a sponge during digestion by soaking up excess cholesterol for faster excretion, which can lower risk of heart disease, says Dee Sandquist, R.D., an American Dietetic Association spokesperson.
Play some head games.

Keeping your mind stimulated boosts memory and brainpower and slashes your risk of developing dementia nearly in half, according to a study conducted at the University of New South Wales in Australia. Look for fun ways to challenge your brain: Try to memorize the phone numbers programmed into your mobile phone and make calls without using speed dial; brush your teeth or try using chopsticks with your nondominant hand; mentally tally the total cost of your groceries as you put each item in the shopping cart; or start a monthly trivia game night with friends.
Turn the tube off during dinner.

You already know that watching television at mealtime can lead to mindless eating and subsequent weight gain. Now, a study in the Journal of the American Dietetic Association suggests that families glued to the TV at dinnertime eat fewer fruits and veggies during the meal. To protect your family's health— and their waistlines — move the TV out of the kitchen and put it near the treadmill instead.
Cook with herbs and spices.

Flavoring recipes with fresh herbs and spices rather than cooking with the old standbys — salt, butter, and sugar — can cut sodium, fat, and calories and improve a food's overall health benefits, says Suzanna Zick, N.D., a naturopathic physician at the University of Michigan. "Many herbs such as thyme and oregano are similar to green, leafy vegetables in that they're high in vitamins and minerals," says Zick. Seasonings such as saffron and basil are believed to contain cancer fighters, and "warming" or spicy herbs such as nutmeg and black pepper may also help lower blood pressure.
Treat yourself to dark chocolate.

For years, experts have touted chocolate's ability to help fight cancer and protect your heart. The latest good news: Enjoying about 30 calories of dark chocolate a day (one or two dark chocolate Hershey's Kisses) can help lower your blood pressure enough to reduce your risk of dying from heart disease by 5 percent and of stroke by 8 percent, according to a study in the Journal of the American Medical Association.
Switch to whole-wheat bread and brown rice.

Let go of your nostalgia for the refined white stuff you grew up on — it's basically an empty-calorie food that takes your blood sugar for a roller-coaster ride. Whole grains, on the other hand, contain slow-digesting complex carbs that help keep blood sugar levels steady, plus they're high in fiber, which has been shown to decrease your risk of heart disease, diabetes, and some cancers, says Sandquist. Swapping white for whole- wheat bread can also improve regularity and help you feel full faster, so you're less likely to overeat. Aim for three servings of whole grains a day.
Snack on blueberries.

Compared with more than 40 other fruits and vegetables, blueberries pack the greatest antioxidant punch per serving, according to USDA data. Other research also shows that the antioxidants in blueberries may protect vision and improve motor function and short-term memory. Since berries aren't in season right now, grab a bag from the freezer section — frozen berries are just as good for you as fresh ones — and toss a handful into your homemade pancake batter or blend them into smoothies.
Lift with your legs.

Women are more likely than men to suffer back pain because we tend to have weaker back muscles, says Miriam Nelson, Ph.D., author of Strong Women, Strong Backs. When you're heaving heavy items, kneel down to pick them up — don't bend over from the waist — and clench your abs as you stand up to take the strain off your lower back.
Chew, chew, chew.

Taking the time to thoroughly chew and break up your food makes it easier for your body to extract and absorb nutrients, explains Jack A. Di Palma, M.D., director of the gastroenterology division at the University of South Alabama in Mobile. Plus, keeping food in your mouth longer increases production of saliva, which helps neutralize the stomach acids that cause reflux. And because it takes about 20 minutes for the stomach to signal the brain that you're full, the more slowly you eat, the fewer calories you'll likely consume before you're ready to drop your fork.
Toast with wine.

Red or white, take your pick. The latest research suggests that drinking wine of any hue helps protect against cardio-vascular disease, tooth decay, and upper respiratory infections. But there can be too much of a good thing: Downing two or more alcoholic drinks a day has recently been linked with an up to 82 percent greater risk of developing breast cancer.
Stretch after a hot shower.

Increasing your flexibility with regular stretching can prevent muscle soreness, improve posture, and reduce your risk of injury. "It's best to stretch when muscles are warm and more elastic, whether from exercising or simply standing under hot water," says Nelson. She recommends doing the following three post-shower stretches, which target women's tightest zones (hold each stretch for 20 seconds and repeat three times):

For your lower back: Stand 2 to 3 feet away from a chair and hold on to the back. Keeping your abs tight and your back straight, bend forward at the waist as far as you can comfortably go.

For your calves: Place your hands on a wall in front of you, step your right leg back about 2 feet, and gently press your right heel down; repeat with your left leg.

For your shoulders: Stand with your fingers laced behind your head and gently pull your elbows back.
Floss.

Cleaning between your teeth helps get rid of the bacteria-laden plaque that causes gum disease and possibly a plethora of other problems, including heart disease, stroke, and premature births.
When nature calls, go!

Even if you feel too swamped to take a two-minute potty break, don't put it off. "Stagnant urine in the bladder can lead to urinary tract infections in healthy women," says Jacques Ganem, M.D., a urologist in Charlotte, NC. When you do go, don't hover over the seat, even in public restrooms. It may cause you to rush and not fully empty your bladder, plus the seat's not as dirty as you think: Out of 14 different areas in kitchens and bathrooms, the toilet seat was found to be the least contaminated in a study published in the Journal of Applied Microbiology. If you're still feeling squeamish, wipe the seat with toilet paper and line it before you sit (which, by the way, keeps it dry for the next customer so she can sit down!).
Wash your hands before going to the bathroom.

Think of all the germs you touched while pushing that grocery shopping cart or handling toys at your child's preschool, says Ganem. To avoid transferring them to your private parts, he advises washing your hands thoroughly for at least 10 seconds before peeing.
Make time for me-time.

The list of reasons why chronic high stress is bad for us seems never ending: It can lead to depression, high cholesterol, and weight gain, to name a few. "You want to keep everyday stress levels low, so that when something really nerve-racking happens, your body's stress response isn't over the top," says Pam Walker, Ph.D., a Dallas-based clinical psychologist. Find regular outlets for blowing off steam, such as yoga, journaling, or having fun with friends.
Take a daily multivitamin.

It's good health insurance for imperfect diets — which many of us have, says Michael F. Roizen, M.D., author of You: Staying Young. He recommends choosing a multi that contains the following nutrients: vitamin D (800 to 1000 IUs); calcium (600 mg twice a day — you'll need a separate supplement to meet these needs); magnesium (400 mg); and folic acid (400 mcg; 800 mcg if you're pregnant or trying to become pregnant).
Sport UV-blocking shades.

"Sun exposure can have significant long-term effects on your eyes and on the sensitive skin around them," says Elaine Hathaway, M.D., an ophthalmologist in Highland Park, NJ. Some potential risks: cataracts, macular degeneration (the leading cause of blindness in older Americans), and basal cell carcinoma, the most common form of skin cancer. To protect your peepers, look for sunglasses that promise to block 99 to 100 percent of UVA and UVB rays, and wear them year-round since the sun's rays are damaging even on cloudy and winter days.
Sip white tea.

White tea is gearing up to replace green tea as the ultimate health brew. While both beverages contain cancer-fighting antioxidants called polyphenols, the leaves and buds used to make white tea undergo less processing than green tea leaves and as a result retain more antioxidant power. Studies have also found that white tea extract may help fight some common bacterial infections, including strep and staph.
Relax the right way before bed.

Sleep deprivation doesn't just leave us groggy and grumpy — it also puts us at greater risk for obesity, heart problems, depression, and motor vehicle accidents. Unfortunately, more than half of American women get a good night's sleep only a few times a week, according to the National Sleep Foundation's 2007 Sleep In America Poll. One likely reason: Eighty-seven percent of us opt to zone out in front of the tube for an hour before bed rather than turning in early, and watching television stimulates the brain, making it harder to fall and stay asleep. To ensure sound slumber, TiVo your favorite late-night shows for later viewing, and crawl into bed.
Snuggle with your honey.

Hugging your partner is linked with higher levels of oxytocin, a hormone believed to help form sexual and social bonds, plus it lowers your blood pressure, according to research at the University of North Carolina at Chapel Hill. Need another excuse to get close? Research shows that women in strong, committed relationships lead happier, healthier lives.

6 Ways to Build a Better Body on a Budget

2009-01-28T14:22:00.001+08:00

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

2009-01-28T14:19:00.000+08:00

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

2009-01-28T14:16:00.000+08:00

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

2009-01-28T14:05:00.003+08:00

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

2009-01-28T13:59:00.002+08:00

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

2009-01-28T13:56:00.001+08:00

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

2009-01-11T15:15:00.002+08:00

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

2009-01-11T15:12:00.001+08:00

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

2009-01-11T14:42:00.003+08:00

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

2009-01-07T15:00:00.000+08:00

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

2009-01-07T14:58:00.000+08:00

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?

2009-01-07T14:55:00.001+08:00

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

A Woman's Guide to Heart Attack

2009-01-07T14:52:00.001+08:00

Her Guide to a Heart Attack: Recognizing Female Heart Attack Symptoms
By Katherine Kam
Reviewed by Michael W. Smith, MD

On a Monday morning in April, Merle Rose, a New Jersey woman, experienced what some doctors call "female heart attack symptoms;" a feeling of indigestion and extreme fatigue. Later, she had nausea, vomiting and fainting.

But she never had chest pain-a "typical" male heart attack sign. When she got to the emergency room, doctors couldn't find any sign of heart attack and Rose says, "They would have sent me home."

As Rose's experience shows, many doctors-and women themselves--still don't realize that female heart attack symptoms can look very different than those of men. In fact, according to a study of women's early heart attack signs published in Circulation, women have more unrecognized heart attacks than men and are more likely to be, "mistakenly diagnosed and discharged from emergency departments."

In the emergency room, physicians had assumed she had a gastrointestinal illness. But at the time, no one told Rose that she had suffered a heart attack.

When an outside cardiologist recommended by Rose's regular doctor ordered testing that uncovered major blockages, doctors still made no mention of heart attack, she says.

So when did she finally get word? Not until several months later, when she visited a new female cardiologist. This doctor told her in retrospect that she had suffered a textbook case of undiagnosed female heart attack.

"That's the first I ever heard," Rose says. "This doctor told me, 'They didn't connect the dots.'"
Female Heart Attack Symptoms: What are They?

These chest-related heart attack signs often appear in men, and many women get them, too:

* Pressure, fullness or a squeezing pain in the center of the chest, which may spread to the neck, shoulder or jaw;
* Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath;

But many women don't have chest pain. In the Circulation study on early female heart attack symptoms, researchers found that during a heart attack, 43% of the 515 women studied had no "acute chest pain... a 'hallmark symptom in men,'" according to study authors.

Nevertheless, the study cited evidence that many emergency room doctors still look mainly for chest pain. Only a minority check for the other types of symptoms that women tend to develop. As a result, doctors may miss heart attacks in women.

"Although women can have chest tightness as a symptom of a heart attack, it's also important for women to recognize that might not be their symptom," says Nieca Goldberg, MD, a cardiologist and chief of Women's Cardiac Care at Lenox Hill Hospital in New York City and author of "The Women's Healthy Heart Program."

"Women commonly have symptoms of shortness of breath, unexplained fatigue, or pressure in the lower chest, so they easily mistake it as a stomach ailment."

In the Circulation study, common female heart attack symptoms include:

* shortness of breath (57.9%)
* weakness (54.8%)
* unusual fatigue (42.9%)

Women also had these symptoms:

* Nausea
* Dizziness
* Lower chest discomfort
* Upper abdominal pressure or discomfort that may feel like indigestion
* Back pain
Female Heart Attack Symptoms: Warning Signs That a Heart Attack May Be Coming

In the weeks preceding an actual heart attack, some of these symptoms may even appear as early warning signs, according to the Circulation study.

Goldberg, who is familiar with the study, says, "About six weeks before the actual heart attack, women were more likely to experience shortness of breath, unexplained fatigue or stomach pain as an early warning sign that they might have a blocked artery."

Rose was a prime candidate for a heart attack: a family history of heart disease, high blood pressure, high cholesterol and type 2 diabetes. Long before her heart attack, she had struggled with extreme fatigue.

"I felt like I was being rolled over by a steam engine-couldn't make plans," she says. Doctors put her on antidepressants. She also developed shortness of breath. "I was constantly gasping for breath." But because of the depression diagnosis, "I thought this was an anxiety issue."

"I did have symptoms of heart disease," Rose says. "They just didn't connect it and I didn't connect it."

If you get early warning signs, call your doctor and talk about the possibility of heart disease.

"That's the time to come in for an evaluation," says Goldberg.

On the day of a heart attack, these symptoms can strike without any provocation; for example, shortness of breath may come without physical activity. Symptoms can appear during rest or even awaken a woman from sleep, and they're much worse, Goldberg says.

"They just come on and they're severe. I had one patient describing that she was so short of breath that she could barely talk to the 911 operator."
Female Heart Attack Symptoms: Calling 911

If you believe you're having heart attack symptoms, dial 911 right away for an ambulance to take you to the emergency room. Wait no more than 5 minutes.

"As a doctor, I know from experience that when chest pains or other symptoms occur, most women are reluctant to call 911," Goldberg says. "That's precious time that we could be saving your heart muscle."

Women often worry about being embarrassed if they're not having a heart attack after all, she says. But embarrassment will pass without causing long-term damage; a heart attack may not.

Others don't appreciate the seriousness of the situation. One of Goldberg's patients had heart attack symptoms at age 57 and insisted on straightening up her house before she let her husband call 911. "This delay could have been fatal," Goldberg says.

Calling for an ambulance is better than taking a taxi or having someone else drive you, Goldberg says. And unless you have absolutely no other option, you shouldn't drive yourself. "You don't want to pass out driving your car," she says.

A big advantage to calling 911: emergency medical personnel can start treatment, such as oxygen, heart medication, and pain relievers, as soon as they arrive, says Mohamud Daya, MD, MS, an associate professor of emergency services at Oregon Health and Science University.

One more compelling reason to go by ambulance: "When you come into the emergency room with the [cardiac] monitor hooked up, you're really taken seriously," Goldberg says. "You look the part."
Female Heart Attack Symptoms In the Emergency Room

When you reach the emergency room, describe your symptoms, but don't offer your own conclusions, Goldberg says. "I wouldn't go through this whole dissertation about how, 'Oh, I thought it was a stomachache, I thought it was this.' You should just tell the doctor how you feel. Don't interpret it for them."

If it doesn't occur to the emergency room doctor to check for heart attack, be bold. Goldberg tells women to say outright: "I think I'm having a heart attack." Because many doctors still don't recognize that women's symptoms differ, they may mistake them for arthritis, pulled muscles, indigestion, gastrointestinal problems, or even anxiety and hypochondria.

In short, female heart attack symptoms may be missed-and dismissed. When one of Goldberg's patients entered the emergency room with such symptoms, doctors gave her antacids. "She said, 'Listen, I'm diabetic and women's heart disease symptoms can be different, and unless you give me an EKG, I'm not leaving this place.' And the next day, she had a bypass."

Of course, stomach pain could prove to be nothing more than a bad case of gastrointestinal illness. "But what I tell all my patients is, 'It's best to check out your heart first because a potential heart attack is life-threatening,'" Goldberg says.

And if your fear of heart problems turns out to be unfounded, don't sweat it, she adds. Doctors would much rather diagnose you with indigestion than a heart attack.

SOURCES: Merle Rose.

Nieca Goldberg, MD, chief of Women's Cardiac Care, Lenox Hill Hospital, New York.

Mohamud Daya, MD, MS, associate professor of emergency services at Oregon Health and Science University.

Mayo Clinic.

National Heart, Lung, and Blood Institute.

American Heart Association.

McSweeney, JC et al. "Women's Early Warning Symptoms of Acute Myocardial Infarction," Circulation, 2003 Nov 25;108(21):2619-23.
Reviewed on July 24, 2008

Kawasaki Disease: What You Need To Know

2009-01-07T14:49:00.002+08:00

Kawasaki Disease: No Link to Travolta Death
Childhood Kawasaki Disease Unlikely Cause of Seizures in Travolta's Teenage Son Jett Travolta
By Daniel J. DeNoon
Reviewed by Louise Chang, MD

Jan. 5, 2009 -- Jett Travolta's childhood brush with Kawasaki disease is highly unlikely to have caused the seizures that may have led to his death, a Kawasaki expert tells WebMD.

Jett Travolta, the 16-year-old son of actors John Travolta and Kelly Preston, died on Jan. 2. The teen, known to have suffered frequent seizures, struck his head against the bathtub in the hotel where his family was staying, according to media reports.

Kawasaki disease is a mysterious and frightening illness. Might Kawasaki disease have caused Jett Travolta's seizures?

WebMD asked Kawasaki disease expert Nathan Litman, MD, chief of infectious disease and director of pediatrics at New York's Montefiore Medical Center.

"I am unaware of any association of Kawasaki disease with seizures," Litman tells WebMD.

Kawasaki disease can leave a person with an abnormally narrow coronary artery, and this can lead to a future heart attack. Early reports suggest Jett Travolta did not suffer a heart attack; an autopsy is under way.
Kawasaki Disease: Mysterious Ailment on the Rise

Nobody knows what causes Kawasaki disease, but it can be deadly. It's not common in the U.S., although incidence is increasing in Japan.

First described in Japanese medical literature by pediatrician Tomisaku Kawasaki, MD, the disease is a disease of childhood. Litman says 80% of cases occur in children under 5. Cases are very rare in anyone over the age of 10.

John Travolta has said in interviews that his son had Kawasaki disease when he was about 2 years old. In an interview with CNN's Larry King in 2001, Travolta expressed the opinion that the illness was brought on by Jett's overexposure to cleaning products, particularly carpet cleaner.

Science has yet to discover the cause, although most researchers think it's an infectious agent, probably a virus.

That would account for why it strikes early in life, why most cases occur in the winter, and why there are Kawasaki outbreaks. But an infectious agent would likely spread in families, and Litman says it's rare to see more than one child in a family come down with Kawasaki disease.

The classic symptom of Kawasaki disease -- technically known as mucocutaneous lymph node syndrome -- is a high fever lasting for five days or longer. Other symptoms include:

* Pinkeye (conjunctivitis) in both eyes, but without purulent discharge.
* Redness of the lips, tongue, and lining of the mouth. Lips are often cracked or bleeding.
* A swollen cervical lymph node larger than 1.5 millimeters in diameter.
* A red rash on the body, which may be flat or bumpy and which may have different patterns.
* Changes in the extremities: swollen hands and feet with redness of the palms and soles. In the second week of illness, there may be peeling of the skin starting around the fingernails and extending to the arms.

Kawasaki disease is diagnosed when a child has five days of high fever and any four of the five symptoms listed above.

There may be other troublesome features, Litman says: swelling of the gallbladder, diarrhea, and painful swelling of the joints. But the scariest thing about Kawasaki disease is its possible effects on the heart.
Kawasaki Disease and Heart Trouble

"The most troublesome feature of Kawasaki disease is involvement of the heart," Litman says. "What worries everyone is that in the convalescent phase, about 10 days into the illness, there may be inflammation of the coronary arteries, which can result in aneurysm formation. This can cause turbulence throughout the artery and cause [narrowing] of the artery, which could cause a heart attack."

If not treated, one in five children with Kawasaki disease would get coronary aneurysms. Fortunately, treatment cuts this risk to about one in 20.

Treatment involves a high dose of immune globulin and a high-dose aspirin until the fever goes down. Once the fever goes away, the child's aspirin dose is reduced and doctors perform an echocardiogram to check for heart abnormalities.

"This generally results in a return to a happy state," Litman says. "In kids who do develop aneurysms, some may resolve, but this may still be a forerunner of adult-type coronary artery disease. They may be left with residual stenosis [narrowing of a heart artery] that can cause a future heart attack."

So if Kawasaki disease didn't cause Jett Travolta's seizures, what did? Seizures are the result of an electrical storm in a part of the brain. Some people simply develop frequent seizures for no apparent reason. Sometimes the cause is a trauma, infection, or tumor.

Media reports have suggested that Jett Travolta may have suffered from autism. The Church of Scientology, of which his parents are members, does not believe that autism is a valid diagnosis, and the Travolta family has rejected the idea that Jett had autism.

However, among children diagnosed with autism, there is a high prevalence of seizure disorder.

SOURCES:

Nathan Litman, MD, chief of infectious disease and director of pediatrics, Montefiore Medical Center, New York.

WebMD Medical Reference from Healthwise: "Kawasaki Disease Overview."

Levisohn, P.M. Epilepsia, 2007; vol 48: pp 33-55.

Associated Press.

CNN.com

TMZ.com

Your Best Breasts

2009-01-07T14:42:00.002+08:00

Your Best Breasts
By Beth Howard

A decade-by-decade look at the latest news on cancer, the ups and downs of surgical enhancement--even how to find the perfect bra.

In the dramedy that constitutes a woman's life, the brain and heart play the starring roles--but breasts surely have a major part. They start turning heads as soon as they make their debut; they nurture babies with milk uniquely suited to an infant's needs. They provide pleasure, bolster body image, and inspire pride and satisfaction. But as you get older, all that front-and-center attention has a downside. Where they once heralded your youth, your breasts may now seem to announce your decline. They can be a source of discomfort--and as you enter the years of higher cancer risk, they probably cause you some worry now and then.

Despite this dramatic shift, you don't hear much about how best to cope with these changes. And except for frequent reminders about getting mammograms, there isn't even much info about how to keep your breasts healthy for the long haul. What's needed: an owner's manual for the over-40 breast, with a guide to cancer prevention and treatment, help with everyday problems, and a no-hype look at how to preserve perk--including surgical options and the lift you can find in a lingerie drawer (if you know what you're looking for). Got breasts? We've got answers.
INSIDE STORY: How the Breast Ages

* Your breast has more of the milk-producing glands called lobules in its upper outer quadrant. Result: That area is particularly prone to pre-period tenderness--and to the development of tumors.
* The milk ducts transport milk to the nipple. About 95% of breast cancers begin within the ducts.
* Fat fills the spaces between the lobules and ducts--more of it as you get older. That increases sag, but has a bonus: It makes mammograms easier to read.

BREAST PAIN: What's Normal, What's Not

In the run-up to menopause, your breasts can feel like a battleground--the scene of all manner of lumps, pains, and general aggravations. Thank goodness, most of these breast bothers have nothing to do with cancer. (Studies show that pain is the sole symptom of breast cancer in 2% of cases or less.) But don't just feel reassured--feel better. Here's how.

You have: Lumpiness or thickened and tender areas

It may be: Fibrocystic breast changes, a condition that affects so many women (more than 60%, estimates say) that it's considered a version of normal. Researchers don't entirely understand the cause, although they lay blame at least partly on hormones. The thickened, rubbery feeling comes from fibrous tissue--the same sort of tissue in scars. The lumps are due to fluid-filled cysts. Breasts may also feel full and achy and have a clear yellow or greenish discharge. Rest easy: Fibrocystic breast changes don't increase breast cancer risk. And though the problem typically worsens in the years before menopause, most women find relief as their hormones quiet down.

Try this: Reduce your caffeine consumption--it exacerbates soreness in up to 50% of women. NSAIDs (nonsteroidal anti-inflammatory drugs) such as aspirin and ibuprofen help some women, as do vitamin E (800 IU daily) and evening primrose oil (1,500 to 3,000 mg daily). Research on primrose oil is mixed, but it can't hurt you. If pain is severe, your doctor may prescribe a drug to block the effect of your reproductive hormones.

You have: A single, distinct lump

It may be: A cyst. In 80% of cases, a lump is not due to cancer. Cysts are usually firm and round; they can be smaller than a BB or as big as a grape, sometimes larger. They often disappear after your period but can recur with the next cycle.

Try this: Because there's always the possibility of cancer, tell your doctor about any new or dominant lump. NSAIDs may help ease pain.

You have: Thick green or black discharge

It may be: Mammary duct ectasia, which just means that one of your milk ducts has become inflamed and clogged. As many as 1 in 4 women develops the condition during or after menopause. Other signs of the problem: soreness, a lump or thickening, an inverted nipple, or the pain, swelling, and redness of mastitis (breast infection).

Try this: Warm compresses, NSAIDs, and a supportive bra often help. But you should have your doctor take a look. Antibiotics may be necessary--and you may need the duct surgically removed if the problem doesn't get better.
CANCER: The Best Detection & Care

40s Your risk of developing breast cancer in this decade: 1 in 70

You should know:

* After years of bickering, most experts now agree that mammograms save lives for women over age 40. Alas, only 64% of 40-somethings show up for regular screenings, according to the American Cancer Society (ACS).
* If cancer is found, be prepared for intensive treatment. Cancer in these years tends to be more aggressive and less likely to respond to estrogen-blocking therapies such as tamoxifen. But younger women typically can tolerate more treatment side effects, so you can get larger, more effective doses of chemo drugs, says Gabriel Hortobagyi, MD, chairman of the breast medical oncology department at the University of Texas M.?D. Anderson Cancer Center. "On average, chemo in women younger than 50 reduces recurrence rates by as much as 55%, compared with 20 to 30% in older women," Hortobagyi says.

Essential steps:

* Don't forget your mammogram. Even with the recent drop in incidence, your risk of developing cancer remains higher than for younger women--yet mammography rates in this age group have fallen 7% since 2000. Early detection pays off: Breast cancer that develops in a woman's 50s is more likely to be estrogen receptor positive, so there are more drugs available to treat it.
60s Your risk of developing breast cancer in this decade: 1 in 28

You should know:

* Though your risk is increasing, so is the power of one major weapon in your arsenal: Mammograms may be more effective now, because your breasts likely contain a greater proportion of fat than in younger days. (Fat typically appears as black on x-rays, while everything else--including cancer--appears as shades of white.) According to a new analysis from the Mayo Clinic, the breasts of women over age 60 are about half as dense as in the years before menopause.
* Cancer may be more common, but it progresses less quickly. It takes 2.1 years for tumors to double in size among women in their 60s, compared with 1.4 years for women in their 50s.

Essential steps:

* Learn about cancer preventives. (Age is a woman's biggest risk factor.) Raloxifene, already approved for preventing and treating osteoporosis, was okayed last October for postmenopausal women at high risk of breast cancer. Like tamoxifen, the first effective preventive for the disease, it also bolsters bones, says Banu Arun, MD, an associate professor in breast medical oncology at M.D. Anderson.

70s Your risk of developing breast cancer in this decade: 1 in 26

You should know:

* Although researchers say that practitioners are more likely to skip mammograms in their elderly patients, the screening can still save lives, according to data from the Albert Einstein College of Medicine. "As long as a woman is generally healthy," says breast surgeon Laura L. Morris, MD, MBA, medical director for Women's Health Services at Indiana University, "mammograms can benefit a woman in her 80s and even beyond that."

Essential steps:

* Don't settle for treatment "lite." Doctors used to be less likely to offer older breast cancer patients all the therapies recommended by the National Institutes of Health. Age increases the odds of other health conditions such as heart disease, which can make some treatments risky--but even if an elderly patient is healthy, her doctor may assume she isn't up for a punishing regimen. Fortunately, such bias is diminishing as doctors gain experience with treating older patients, says Richard J. Bleicher, MD, a breast surgeon at the Fox Chase Cancer Center in Philadelphia. If you're concerned, he suggests, ask if the treatments you're offered are the standard of care.

NIP/TUCK: The Fixes and Risks

A life well lived leaves traces on your body: laugh lines, crow's feet, and, yes, breasts that aren't as firm as they used to be. One perfectly good reaction: Shrugging at the changes--especially if the shrugging is done in the right bra (see box at right). But for some women, that gesture doesn't have the desired oomph. More than 163,000 women over age 40 got gravity-defying help from a scalpel in 2007, spurred on by improved surgical techniques and the return of the silicone implant. Here, Prevention investigates the benefits and downsides of nips, tucks, and more.
Lift

The rate of lift surgery has nearly doubled since 2000, according to the American Society of Plastic Surgeons (ASPS), with well over 53,000 procedures in 2007.

How it works: By removing excess skin and tightening the surrounding tissue, surgeons can raise and reshape the breasts. A new technique leaves a smaller scar that can be neatly camouflaged by the nipple's areola--although many factors determine whether this less conspicuous approach or the older anchor lift is right for you.

Downside: The procedure can't replace lost volume, so if breast deflation is a big issue for you in addition to sag, a lift may not be adequate.

Breast Implants

The number of women over 40 getting breast implants increased by 17% between 2005 and 2006; in 2007, more than 107,000 women in that age range got the procedure.

How it works: Adding implants during a breast lift helps with sag and loss of volume. A 1994 study from Washington University School of Medicine found that 95% of women felt better about themselves after the surgery. But it presents a tough choice: saline or silicone. Silicone implants look and feel more natural than saline, but in 1992, they were pulled off the market for use in cosmetic procedures because of concerns they might raise the risk of scleroderma or other disorders. Now, after several large National Cancer Institute studies, silicone is back. "Breast implants have been studied more extensively than any other medical device," says Donna-Bea Tillman, PhD, director of the Office of Device Evaluation at the FDA. "And our experts concluded that they're safe and effective."

Downside: About 10% of implants--saline or silicone--rupture within 5 years, and the rate goes up as time passes. To make sure ruptured implants are detected and removed, women should get an MRI 3 years after surgery and then again every 2 years (in addition to their annual mammogram). Implants can also harden--it happens with up to 80% of the silicone variety and 40% of saline ones. All told, most women need to replace or remove an implant within 15 to 20 years, says Walter L. Erhardt, MD, past president of the ASPS. Implants can also make mammograms harder to read, though technologists who perform the exam make adjustments. A study from the University of Washington found that mammograms missed 55% of breast cancers in women with implants, versus only 33% among women without them. Fortunately, there's no sign that the murky mammograms affect mortality. "Women with augmentation may be more breast aware and seek medical care more quickly," suggests study author Diana L. Miglioretti, PhD.

Reduction

More than half of reduction surgeries were in 40-plus women in 2007, according to the ASPS; more than 56,000 women over 40 got the procedure. Small wonder: By that age, the health effects of large breasts--chafed skin, back and neck pain, and grooves in the shoulders from ill-fitting bras--are mounting. In a recent study, discomfort was vanquished or greatly reduced 1 year after surgery for 88% of patients. "Women invariably say they wish they'd had it sooner," Erhardt says. Benefits go beyond comfort. Breast exams and mammograms are often easier to perform and more effective after surgery. And some research suggests it can even reduce the risk of breast cancer, especially in those over age 50.

Bonus: Because of the health problems that can result from uncomfortably large breasts, insurance often picks up the tab.

Downside: The surgery can cause a loss of nipple sensation, and in some cases, can result in asymmetry of the breasts.
6 habits That Can Save Your Life

Some risk factors for breast cancer--such as the age you started menstruating--can't be changed, but these key habits help keep cancer at bay, no matter when you start.

1. Keep moving "Exercise lowers levels of estrogen, which is linked to breast cancer," says the ACS's Debbie Saslow. It's best to get 45 to 60 minutes of heart-thumping activity most days of the week, but moderate levels (30 minutes, 5 days a week) can make a difference. You're never too old: A recent study in the British Medical Journal showed that postmenopausal women (along with those with a normal body mass index, or BMI) get more of a benefit from regular sweat sessions than other women.

2. Get--and stay--slim After menopause, obese women have double the risk of breast cancer compared with women of a healthy weight. But weight gain among previously trim women also bodes ill. "Gaining even 20 pounds of weight as an adult increases risk," says Heather Spencer Feigelson, PhD, MPH, strategic director of genetic epidemiology at the ACS.

3. Take vitamin D More and more studies demonstrate the cancer-fighting power of this vitamin. The latest piece of evidence, reported at the recent meeting of the American Society of Clinical Oncologists: Breast cancer patients who were deficient in vitamin D were 94% more likely to have their cancer spread than women with adequate D levels. "I advise women to take 800 to 1,000 IU a day," says Andrew Kaunitz, MD, a professor of obstetrics and gynecology at the University of Florida College of Medicine-Jacksonville.

4. Drink lightly, if at all New data from the National Cancer Institute shows that women who have one or two drinks daily increase the risk of the most common kind of breast cancer by 32%--and those who drink more hike their risk by 51%. Experts recommend no more than a glass a day.

5. Keep hormones temporary Long-term use of HT can increase breast cancer risk, the Women's Health Initiative demonstrated--and new research shows the heightened risk persists several years after you stop. Take hormones only if menopausal symptoms are unmanageable, and limit time on the therapy to no more than 5 years. Consider alternatives, such as SSRI antidepressants for hot flashes and vaginal creams with estrogen for dry genital tissues.

6. Forget self-exams, but be self-aware After hearing for years that you should do a monthly breast self-exam, you might be surprised to learn that it's now considered optional. Studies have found that it doesn't save lives and can increase the odds of an unnecessary biopsy. But many doctors are reluctant to completely abandon it. "About 15% of breast cancer is detected by women themselves," says Eva Singletary, MD, a professor of surgical oncology at M.D. Anderson. So doctors still want you to get to know your breasts--and alert your provider to anything outside the norm for you.

6 habits That Can Save Your Life

Some risk factors for breast cancer--such as the age you started menstruating--can't be changed, but these key habits help keep cancer at bay, no matter when you start.

1. Keep moving "Exercise lowers levels of estrogen, which is linked to breast cancer," says the ACS's Debbie Saslow. It's best to get 45 to 60 minutes of heart-thumping activity most days of the week, but moderate levels (30 minutes, 5 days a week) can make a difference. You're never too old: A recent study in the British Medical Journal showed that postmenopausal women (along with those with a normal body mass index, or BMI) get more of a benefit from regular sweat sessions than other women.

2. Get--and stay--slim After menopause, obese women have double the risk of breast cancer compared with women of a healthy weight. But weight gain among previously trim women also bodes ill. "Gaining even 20 pounds of weight as an adult increases risk," says Heather Spencer Feigelson, PhD, MPH, strategic director of genetic epidemiology at the ACS.

3. Take vitamin D More and more studies demonstrate the cancer-fighting power of this vitamin. The latest piece of evidence, reported at the recent meeting of the American Society of Clinical Oncologists: Breast cancer patients who were deficient in vitamin D were 94% more likely to have their cancer spread than women with adequate D levels. "I advise women to take 800 to 1,000 IU a day," says Andrew Kaunitz, MD, a professor of obstetrics and gynecology at the University of Florida College of Medicine-Jacksonville.

4. Drink lightly, if at all New data from the National Cancer Institute shows that women who have one or two drinks daily increase the risk of the most common kind of breast cancer by 32%--and those who drink more hike their risk by 51%. Experts recommend no more than a glass a day.

5. Keep hormones temporary Long-term use of HT can increase breast cancer risk, the Women's Health Initiative demonstrated--and new research shows the heightened risk persists several years after you stop. Take hormones only if menopausal symptoms are unmanageable, and limit time on the therapy to no more than 5 years. Consider alternatives, such as SSRI antidepressants for hot flashes and vaginal creams with estrogen for dry genital tissues.

6. Forget self-exams, but be self-aware After hearing for years that you should do a monthly breast self-exam, you might be surprised to learn that it's now considered optional. Studies have found that it doesn't save lives and can increase the odds of an unnecessary biopsy. But many doctors are reluctant to completely abandon it. "About 15% of breast cancer is detected by women themselves," says Eva Singletary, MD, a professor of surgical oncology at M.D. Anderson. So doctors still want you to get to know your breasts--and alert your provider to anything outside the norm for you.

7 Principles for Controlling Diabetes for Life

2009-01-05T13:45:00.003+08:00

7 Principles for Controlling Diabetes for Life

This article describes the 7 principles of good diabetes care. These principles, or steps, will help you manage your diabetes and live a long and active life. Every person who has diabetes has different needs. Talk to your health care team about a treatment plan that is best for you. Diabetes affects almost every part of the body and good diabetes care requires a team of health care providers. They include doctors, diabetes educators, nurses, dietitians, pharmacists, mental health workers, eye specialists, foot specialists, dentists, and social workers.

It Is Important to Control Diabetes

Taking good care of diabetes will make you feel better and can lower your chances of getting

*

heart disease
*

stroke
*

eye disease that can lead to a loss of vision or even blindness
*

nerve damage that may cause a loss of feeling or pain in the hands, feet, legs, or other parts of the body and lead to problems such as lower limb amputation or erectile dysfunction
*

kidney failure
*

gum disease and loss of teeth

Principle 1: Learn as Much as You Can About Diabetes

The more you know about diabetes, the better you can work with your health care team to manage your disease and reduce your risk for problems. You should know what type of diabetes you have. If you do not know, ask your doctor whether you have type 1 or type 2 diabetes.

*

Type 1 diabetes. People who have type 1 diabetes need to take insulin every day. This type of diabetes is less common and used to be called juvenile diabetes.
*

Type 2 diabetes. Diet and daily physical activity help to control type 2 diabetes. Most people also need to take diabetes pills or insulin. Type 2 diabetes is very common and used to be called adult onset diabetes.

Diabetes is always a serious disease. Terms that suggest that diabetes is not serious, such as “a touch of diabetes,” “mild diabetes,” and “sugar’s a little high,” are not correct and should no longer be used.

Many People Who Have Diabetes
Do Not Know It

Finding and treating diabetes early can prevent health problems later on. Many people with type 2 diabetes have no symptoms and do not know they have diabetes. Some people are at higher risk for diabetes than others. People at high risk include those who

* are older than 45

* are overweight

* have a close family member such as a parent, a brother, or a sister who has or has had diabetes

* had diabetes during pregnancy

* had a baby that weighed more than 9 pounds

* are African American, Hispanic or Latino, Asian American or Pacific Islander, or American Indian

* have high blood pressure

* have high cholesterol or other abnormal blood fats

* are inactive

Ask your doctor if you have type 1 or type 2 diabetes.

If you know someone who has any of the risk factors for diabetes, suggest they talk to their doctor about getting tested
Principle 2: Get Regular Care for Your Diabetes

If you have diabetes, it is important to

*

see your health care team regularly
*

make sure your treatment plan is working. If it is not, ask your health care team to help you change it
*

ask your family, friends, and co-workers for help and support when you need it

Work with your health care team to get the best help to control your diabetes.

Ask your health care team how often you need to see them for check-ups.

Write down the date and time for your next visit.

Ask your doctor, clinic or office staff, or pharmacist to help you find resources if you have problems paying for food, medicines, and medical supplies. You should be able to get Medicare or other insurance to help you pay for diabetes supplies.

Make a list of questions and concerns you want to talk about at your next visit to your health care team.
Principle 3: Learn How to Control Your Diabetes

Diabetes affects many parts of the body. To stay healthy, it is important to know how to eat the right foods, how to be physically active, and how to look after yourself. Using the following checklist will help you learn how to control your diabetes.

How Active Are You in Controlling Your Diabetes?

Look at the list below. Check all the boxes that describe you.

I talk to my health care team about:

*

my special needs to help control my diabetes
*

ways to improve my ABC numbers: A1C,* Blood pressure, and Cholesterol
*

aspirin therapy to prevent heart problems
*

getting regular physical activity
*

quitting smoking, if needed

I learn from my doctor, diabetes educator, podiatrist, pharmacist, or dietitian how to

*

follow a meal plan to control my diabetes
*

check my feet every day
*

take my medicines as prescribed
*

check my blood glucose levels

*A1C (pronounced A-one-C) is a measure of your average blood glucose over the last three months. You should get this test at least twice a year.

I visit my

*

doctor at least twice a year
*

eye doctor each year and report any changes in vision
*

dentist twice a year
*

specialists as my doctor advises

Go over any items you did not check with your health care team. Learning how to control your diabetes can help you stay healthy.
Principle 4: Take Care of Your Diabetes ABCs

A major goal of treatment is to control the ABCs of diabetes: A1C (blood glucose average), Blood pressure, and Cholesterol. You can do this in many ways.

*

Follow a meal plan that was made for you.
*

Be active every day.
*

Take your medicine as prescribed.
*

Before taking any non-prescription medicines, vitamins, or herbal products, ask your pharmacist how they may affect your diabetes or prescription medicines.
*

Test your blood glucose on a routine basis.

Talk to your health care team about the best ways to control your A1C, blood pressure, and cholesterol and know your target numbers.

Get involved in setting goals and making a treatment plan for your diabetes.
Principle 5: Monitor Your Diabetes ABCs

To reduce your risk for diabetes problems such as blindness, kidney disease, losing a foot or leg, and early death from heart attack or stroke, you and your health care team need to monitor the diabetes ABCs: A1C, Blood pressure, and Cholesterol. Talk to your health care team about how to reach your target numbers.

Get the A1C Test

The A1C test is usually done by your doctor. It measures how well your blood glucose has been controlled over the last three months. This test is very important because it tells how well you are taking care of your diabetes over the long term. It should be done at least twice a year.

* The target A1C for most people with diabetes is less than 7.

Ask your health care team what your A1C is and keep a dated record of the results.

Discuss your A1C target with your health care team and write it down.

Discuss what you need to do to reach your target.

Check Your Own Blood Glucose

You may need to check your own blood glucose on a regular basis to help control your diabetes. It will tell you what your blood glucose is at the time you test. Keep a record of your results and show it to your health care team. Some meters and test strips report blood glucose results as plasma glucose values which are 10 to 15 percent higher than whole blood glucose values. Ask your doctor or pharmacist whether your meter and strips provide whole blood or plasma results.

*

The target glucose range for most people using whole blood is 80 to 120 before meals and 100 to 140 at bedtime.
*

The target glucose range for most people using plasma is 90 to 130 before meals and 110 to 150 at bedtime.

Talk to your health care team about the best ways to check your own blood glucose.

Ask your health care team what your blood glucose targets are before meals, after meals, and at bedtime and write them down.
Principle 5: Monitor Your Diabetes ABCs continued...

Ask what to do if your blood glucose is often higher or lower than it should be.

Ask how to get the supplies you need to do the tests. Most insurance companies, including Medicare, now pay for diabetes supplies.

Know Your Blood Pressure

High blood pressure makes your heart work too hard. This leads to strokes and other problems such as kidney disease. Your blood pressure should be checked at every visit. You may need to check it yourself.

* The target blood pressure for most people with diabetes is less than 130/80.

Ask your health care team what your blood pressure is and keep a dated record of the results.

Discuss your blood pressure target with your health care team and write it down.

Discuss what you need to do to reach your target.

Ask if you need to test your blood pressure yourself. If so, find out how, when, and what supplies you need.

Know Your Cholesterol

LDL is the bad cholesterol that builds up in your blood vessels. It causes the vessels to narrow and harden, which can lead to a heart attack. Your doctor should check your LDL at least once a year.

* The target LDL cholesterol for most people with diabetes is less than 100.

Discuss your LDL cholesterol target with your health care team and keep a record of the results.

Discuss what you need to do to reach your target.

Keep a Record of Your Results

Keeping a record of your results helps you reach your targets. It helps you know when you and your health care team need to take extra action.

Use a record card to keep track of your ABC numbers.

Principle 6: Prevent Long-Term Diabetes Problems

People with diabetes must control their blood glucose, blood pressure, and cholesterol to prevent the problems of diabetes: heart attack, stroke, eye and kidney problems, nerve damage, impotence, foot or leg amputation, gum disease, and loss of teeth. Here are the key self-care activities to help you manage your diabetes and live a long and healthy life.

Daily

*

Follow your diabetes meal plan with the correct portion sizes. Eat a variety of foods that are high in fiber and low in fat and salt.
*

Be active every day.
*

Take medicines as prescribed. If you have questions, talk to your pharmacist or doctor about your medicines.
*

Look at your feet and wash and dry them well each day. Tell your podiatrist or health care team about any changes with your feet.
*

Check your mouth daily for gum or tooth problems. Call your dentist right away if you have problems with your teeth or gums.

As Needed

*

Test your blood glucose as prescribed by your doctor.
*

Check your blood pressure as prescribed by your doctor.
*

Reach and stay at a healthy weight.
*

Stop smoking.
*

Make sure your eyeglasses or contact lens prescription is up to date so you can see clearly. Report any changes in your vision to your health care team.

Work with your health care team to prevent diabetes problems.
Principle 7: Get Checked for Long-Term Problems and Treat Them

See your health care team regularly to check for problems that diabetes can cause. Regular check-ups help to prevent problems or find them early when they can be treated and managed well. Along with the checks of your A1C, blood pressure, and cholesterol (see Principle 5), here are some tests that you will need:

* Triglycerides (a type of blood fat)

Get yearly

* Dilated eye exam to check for eye problems

Get yearly

* Foot check

Get every visit

* Complete foot exam to check for circulation, loss of feeling, sores, or changes in shape

Get yearly

* Urine test to check for kidney problems

Get yearly

* Dental exams to prevent gum disease and loss of teeth

Get twice a year
Diabetes Care Record

A1C (blood glucose average) My target _______
Date Result

__________ __________

__________ __________

__________ __________

A1C target suggested for most people with diabetes is below 7

BLOOD PRESSURE My target _______
Date Result

__________ __________

__________ __________

__________ __________

BP target for most people with diabetes is below 130/80

CHOLESTEROL (LDL) My target _______
Date Result

__________ __________

__________ __________

__________ __________

LDL target for most people with diabetes is below 100

TRIGLYCERIDES My target _______
Date Result

__________ __________

__________ __________

__________ __________

Triglycerides target for most people with diabetes is below 150

WEIGHT My target _______
Date Result

__________ __________

__________ __________

__________ __________

SELF-MONITORED BLOOD GLUCOSE (SUGAR)
Whole blood Suggested target range My target Whole blood Suggested target range My target
Before meals: 80-120 _______ At bedtime: 100-140 _______

Plasma Suggested target range My target Plasma Suggested target range My target
Before meals: 90-130 _______ At bedtime: 110-150 ______

Talk to my health care team about my:
ABCs - A1C, Blood pressure,
Cholesterol (LDL) Medications
Meal plan Glucose self-monitoring plan
Physical activity plan Foot care

Ask about:
Aspirin therapy Stopping smoking
Pneumonia vaccine Resources to help me
Medicare or other insurance benefits

Make sure I get a: DATE DATE
Dilated eye exam - once a year ______ Kidney function test - once a year
______
Foot check - every visit ______ Dental exam - twice a year ______
Complete foot exam - once a
year ______ Flu shot - once a year ______

Take good care of your diabetes for life and be sure to follow these 7 principles:

PRINCIPLE 1
Learn as Much as You Can About Diabetes

PRINCIPLE 2
Get Regular Care for Your Diabetes

PRINCIPLE 3
Learn How to Control Your Diabetes

PRINCIPLE 4
Take Care of Your Diabetes ABCs

PRINCIPLE 5
Monitor Your Diabetes ABCs

PRINCIPLE 6
Prevent Long-Term Diabetes Problems

PRINCIPLE 7
Get Checked for Long-Term Problems and Treat Them

People with diabetes who keep their blood glucose,
cholesterol, and blood pressure under control
can expect to live a long and active life.

Resources

For more information about how to control your diabetes, contact:

American Association of Diabetes Educators
800-TEAM-UP4 (800-832-6874)
Web site: www.aadenet.org

American Diabetes Association
800-DIABETES (800-342-2383)
Web site: www.diabetes.org

American Dietetic Association
800-366-1655
Web site: www.eatright.org

American Heart Association
800-AHA-USA1 (800-242-8721)
Web site: www.americanheart.org

Centers for Disease Control and Prevention
Division of Diabetes Translation
877-232-3422
Web site: www.cdc.gov/diabetes

Juvenile Diabetes Research Foundation International
800-533-CURE (800-533-2873)
Web site: www.jdrf.org

National Diabetes Education Program
800-438-5383
Web site: www.ndep.nih.gov

National Heart, Lung, and Blood Institute
(301) 592-8573
Web site: www.nhlbi.nih.gov

National Institute of Diabetes and Digestive and Kidney Diseases
National Diabetes Information Clearinghouse
800-860-8747

Top 10 Diet and Nutrition Resolutions

2009-01-05T13:41:00.001+08:00

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.
Reviewed on November 18, 2008

Glazed Ostrich Tenderloin

2009-01-05T13:37:00.001+08:00

Glazed Ostrich Tenderloin
By Kelley Herring

Haven't tried ostrich? Don't wait any longer! This amazingly delicious, nutrient-dense food has the texture of lean beef, is ultra low in fat, and packed with protein. In fact, one serving of this easy and elegant dish provides a whopping 43 grams of muscle building, blood-sugar balancing, organic protein. Serve with my recipe for Horseradish Smashers and a fresh green salad.

Serves: 10
Time to Table: 3 hours (Active Time: 30 minutes)

Benefits
Excellent source of iron, potassium, protein, selenium, zinc, vitamin B6, vitamin B12, niacin, riboflavin
Good source of magnesium
Preferences: Gluten-Free, Low Carb, Low Sugar, High Protein

Ingredients
4 lb organic, free range ostrich tenderloin
1/4 cup organic tamari
2 tbsp. organic garlic, minced
1 tbsp. organic ginger, minced
2 tbsp. freshly ground black pepper
2 tsp. organic grapeseed oil
6 cups organic chicken broth
1/2 tsp. thyme

Preparation
First, place chicken broth, thyme and 1 Tbsp. garlic in a pot and cook over medium heat until reduced by three quarters to make a demi-glace. Marinate ostrich in tamari mixed with garlic, ginger, pepper and oil for up to 2 hours. On a hot grill with lid down, sear ostrich for 2 minutes on each side. Ostrich will be almost cooked. Remove and cool.

Slice ostrich into 1/4" medallions. Arrange half of the medallions in the pan and immediately turn them, starting with the first one placed. When all are turned, pour half the demi-glace over pan and remove ostrich to platter. Cover loosely and place in warm oven. Repeat with balance of medallions. Serve immediately.

Nutrition Information
263 Calories, 4 g Carbohydrate,143 mg Cholesterol, 8 g Total Fat, 0 g Fiber, 43 g Protein, 533 mg Sodium, 0 g Sugars, 2 g Saturated fat, 0 trans Fat,3 g Monounsaturated fats, 2 g Polyunsaturated fats

The One Supplement You Need Every Day

2009-01-05T13:34:00.000+08:00

If I Had To Pick Just One…

By Dr. Bill Stillwell

If I were asked to pick just one supplement for optimal joint health, I would have to go with fish oil.

Why fish oil? Well, fish oil contains EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), long-chain polyunsaturated fatty acids (PUFAs), commonly referred to as omega-3 fatty acids or just omega-3's. These omega-3 PUFAs have a number of beneficial effects on the body, including the joints.

In any type of arthritis, pain comes from two main sources:

Exposed and irritated nerves in the bone which are vulnerable to friction and chemical irritants when the protective cartilage layer is destroyed.
Inflammation which causes the synovial membrane of the joint to swell, grow, and produce excessive amounts of joint fluid ("water on the knee").
Omega-3 fatty acids have been shown to reduce inflammation by interfering with the production of inflammation-producing chemicals which stimulate pain nerves in the tissues.

While it is true that there are some vegetarian sources of omega-3's like walnuts, flaxseed (linseed) oil, canola oil, soybean oil, etc., all of these are short chain polyunsaturated acids which must be converted by the body into longer chain PUFAs to be useful. Since fish oil already contains long chain PUFAs, it's the best dietary source.

In fact, fish oil is so effective, that some studies have shown that it can relieve pain symptoms even in cases of rheumatoid arthritis (RA). RA is a serious autoimmune condition that can affect joints and soft tissues throughout the entire body.

One study showed that fish oil reduced morning stiffness and joint tenderness and increased the effectiveness of NSAIDs in patients with RA.1 Another study suggested that the long-term use of fish oil (over 12 weeks at 6 grams a day) may decrease the need for NSAIDs and other RA medications.2,3

Finally, a recent Australian study showed that fish oil reduced the use of NSAIDs by 75% in RA patients and reduced inflammation-causing chemicals by up to 41%.4

When you add these benefits to the others known to be associated with fish oil like lowering triglycerides, "thinning" the blood (reducing the risk of clots), and benefitting both the heart and brain (60% of the brain is fat and half of that is DHA), there is no doubt that it's the king of joint supplements.

When taking fish oil supplements, it is also a good idea to take vitamin E (3 mg for every 1 gram of fish oil) to protect against oxidation.5 A garlic supplement can also be taken to prevent increased levels of LDL cholesterol.

References

Mayo Clinic, National Standard Patient Monograph 2008.
Geusens, P et al. Arthritis & Rheumatism, 37:824-829, 1994.
Kremer, JM et al. Ann Int Med. 106:497-503, 1987.
Darlington, LG and Stone, TW, Brit J Nutr. 85:251-269, 2001.
Cleland, LG et al. J Rheum. on-line, 2006.

10 Beginner Tips for Safe Workouts

2009-01-05T13:31:00.000+08:00

10 Beginner Tips for Safe Workouts
By Craig Ballantyne

When my client Carrie first came to me, she was injured. Only three weeks earlier she had made up her mind to lose weight and starting running for 45 minutes per day. But this was not a good idea, given that she hadn't run in years and was 20 pounds overweight.

After only a few workouts, she had developed a muscle strain in her upper thigh and it required weeks of rehabilitation to heal. This made our fat burning workouts more difficult because she couldn't do interval training and some of the bodyweight exercises I use with all of my clients.

Over time, Carrie healed and she lost fat with my short burst workouts. However, no one should have to get hurt like Carrie did using a traditional weight loss program.

It bugs me that so many trainers still recommend long, slow cardio workouts for fat loss, when research shows them to be relatively ineffective — and experience shows that cardio often just lands folks in the doctor's office.

If I could have met Carrie before she started running, here are 10 tips I would have given her to lose fat fast and without getting hurt.

It is very important for all of us to train conservatively and not overdo things. If you are doing resistance training, and everyone should, don't do any exercise that you aren't sure how to do. Always get personal instruction from a certified trainer.

Don't do anything that hurts or "doesn't feel right". There are plenty of alternative exercises for any exercise in every workout program. Just ask a qualified trainer for help.

Whenever you start a new resistance training program, use lighter weights than normal and perform only one set per exercise. This will minimize the muscle soreness that accompanies any new program.

If you need extra recovery within the workout or between workouts, don't hesitate to take it.

Check your ego at the gym door and start with the easier alternative exercises if appropriate, even if you have exercised in the past. The new exercises, and new style of movements will cause muscle soreness even from workouts you think "look easy". Surprisingly, this also goes for yoga. Many beginners over-stretch and end up with injuries often associated with weight training. So no matter what you do, be conservative.

Do not do interval training or hard cardio more than four times per week. Even pro athletes don't play hard every day, so why should you?

Never skip a warm-up. Also, instead of using a treadmill to warm-up (which is pointless), do a general bodyweight circuit of easy squats, easy pushups, and ab planks to better prepare your body for resistance training.

If you have any type of injury at all, get medical attention and have a professional therapist rehabilitate your injury before starting an exercise program.

Check with your doctor before starting any new exercise or diet program. All together now, Safety first!

If you decide to use running as your form of interval training, make sure you have good running shoes, always do an extra thorough warm-up, and choose a safe running surface (grass or trails rather than pavement/concrete). If you use a treadmill, please operate it safely.
Keep these 10 safety tips in mind before you start your new fat burning workout. Train safe!

Preventing Joint Damage From Rheumatoid Arthritis

2009-01-05T13:16:00.000+08:00

Preventing Joint Damage From Rheumatoid Arthritis

When rheumatoid arthritis flares up, it makes joints feel stiff and achy. That discomfort may go away at times, but there may still be permanent damage. Eventually rheumatoid arthritis can harm joints so they don't work as well even when the disease itself is not active. How does joint damage occur, and how can it be prevented?

Doctors call the active periods of rheumatoid arthritis disease activity. During disease activity, infection-fighting cells (white blood cells) are mistakenly allowed into the joint. No one understands why this happens, but it's clear the infection fighters don't belong there.

Inside the joint, these cells produce chemicals that they usually use to kill invading microorganisms - only none are there. Instead, the chemicals damage the healthy joint tissue. During high levels of disease activity, you experience a flare - joints become swollen, stiff, and painful. You can also have low levels of disease activity that come and go without your feeling any symptoms.

There are two main ways this process can cause joint damage:

* The infection-fighting chemicals cause cartilage to slowly weaken. Cartilage is the cushion between bones in a joint. Over time, putting stress on the joint or bearing weight on it can wear down the weak cartilage more. This is called degenerative disease, and it is similar to what happens in "regular" arthritis (osteoarthritis) - only it happens faster in people with rheumatoid arthritis.
* The inflammation inside the joint stimulates the joint lining (synovium) to grow and spread where it doesn't belong. If it continues long enough, it can harm healthy cartilage or bone.

The simple rule of thumb is, the "longer" and "stronger" the disease activity, the more joint damage is probably occurring.

* A person with joint swelling and stiffness every day is more likely to have joint damage than a person with these symptoms once a month. (Longer disease activity)
* Someone with a lot of joint swelling is more likely to have damage than a person with just a little bit. (Stronger disease activity)

How can you tell if you are having disease activity? It can sometimes be difficult.

* You can be feeling a lot of pain, yet suffer no damage to your joints.
* Joint damage can also occur without feeling any pain.
* Joint swelling is a reliable sign, though. For the most part, having joint swelling is proof of having ongoing disease activity.
* The length of morning stiffness each day is also useful. Ask yourself, after getting up, "How long does it take until I'm feeling as loose as I'll feel for the day?" The longer you feel stiff, the more likely it is that your rheumatoid arthritis is active.
* Another sign you can look for is a "boggy" joint. When the joint lining begins to grow abnormally, it may give a joint a mushy texture. This boggy condition will remain even when you are not having a flare. If you notice this happening, you should see your rheumatologist.
If you are diagnosed with rheumatoid arthritis, your doctor will do a complete joint examination and get X-rays and blood tests soon after. At later visits, you will be checked for any changes to your tests, and your doctor will address possible joint damage with you.

Now that you know how rheumatoid arthritis causes joint damage, and what to look for, you should also know how to prevent it.

Because treatment for rheumatoid arthritis is improving, many experts believe people who have it today, taken as a group, will develop less joint damage than ever before. You can gain control of it and improve your chances.

* Get treated early. Much of the joint damage that eventually becomes serious starts soon after rheumatoid arthritis is discovered. The earlier you are treated, the less the chance of joint damage.
* Get treatment often. People who see their rheumatologist regularly (several times a year) have less joint damage than people who do not.
* Exercise! You can exercise without causing joint damage. In fact, just the opposite is true - regular exercise makes joints stronger. Your doctor will help you with an exercise plan that is safe, effective, and personalized for your fitness level and condition.
* Rest when you need to. Finding the balance between rest and exercise is important so you don't overdo it.
* Use a cane in the opposite hand from a painful hip or knee. This reduces wear-and-tear on the affected joint.

View Article Sources Sources

SOURCES: Harris, E., Kelley's Textbook of Rheumatology, 7th edition, W.B. Saunders, 2005. Klippel, J. Primer on the Rheumatic Diseases, 12th edition, Arthritis Foundation, 2001. van Leeuwen, M., Journal of Rheumatology, 1994; vol 21: p 3. Ward M., Archives of Internal Medicine, 1993; vol 153: p 2229. Wolfe F., Journal of Rheumatology, 1991; vol 18: p 1290.
Reviewed by Marc C. Levesque, MD on March 24, 2008

Eliminating the Foods that are Bad for You

2008-12-27T13:08:00.000+08:00

Eliminating the Foods that are Bad for You

By James LaValle, R.Ph, ND, CCN

Did it ever occur to you that the reason you can't lose weight may be due to the fact that you are eating foods that you're allergic to? This is a revelation to many people who have struggled unsuccessfully for years to get rid of unwanted pounds.

The prevalence of food allergies is on the rise in both children and adults.1-2 Allergies can be responsible for a number of health issues including irritable bowel type symptoms3 and migraines.4 Very few people are aware however, that immune responses to foods can go on to create a number of metabolic disruptions that can contribute to weight gain.

At LMI where we counsel people to lose weight using our Metabolic Code Diet (MCD) eating program, we see this all the time. We had one patient in our diet group who had tried a very low carb diet in the past, and lost no weight. The reason? She was sensitive to dairy and didn't know it. On her previous diet, she was eating a lot of cheese. On the MCD, which is a lower carb, low allergen eating plan, she cut out the cow's milk cheeses and dairy products, ate according to our meal recommendations, and the weight started coming off.

There are several ways common dietary allergens can keep weight on you. When the body is having an immune reactivity to food, it can cause increased stress hormone production. Increased cortisol in particular can contribute to insulin resistance — and that reduces your body's ability to process the glucose from foods high in carbs. And the increased insulin keeps you from being able to burn fat.

Increased cortisol can also go on to inhibit the body's ability to convert your primary thyroid hormone, T4, to the active form, T3. Without enough active T3, it is very difficult to lose weight. If you have developed an immune response (an allergy) to certain foods, it can also go on to cause autoimmune antibodies which can attack any tissue in the body, including thyroid tissue. Autoimmune attacks on the thyroid cause one of the most common forms of low thyroid, called Hashimoto's thyroiditis.

So, in a roundabout way, food sensitivities can slow metabolism and cause weight gain. By decreasing your consumption of any foods to which you might be sensitive, you may potentially improve insulin sensitivity, lower glucose, and promote better thyroid hormone production.

There are seven foods responsible for almost all food allergies — peanuts, other tree nuts like walnuts, fish/shellfish, soybeans, eggs, wheat and cow's milk. The only two foods we limit initially on the MCD eating program are wheat and cow's milk dairy. Why? Through years of clinical practice, we have found that wheat and dairy are usually the most problematic. So, we eliminate cow's milk products and wheat, and anything made from them.

This part of the MCD eating plan can be a challenge at first for many people. Western diets are so centered around wheat and dairy there is almost no red-blooded American who doesn't eat at least some wheat and dairy every day. But you would be surprised at the variety of breads, crackers, and chips that are available wheat-free. (You just need to be careful to eat them within your limited carbohydrate portions.) You can even find a wide array of goat and sheep's milk dairy products in most supermarkets and health food stores. What most people find is that they may miss a few of the eliminated foods at first, but their quality of life improves so much, that eventually they don't miss them at all.

We estimate that food allergies contribute to weight gain in at least 30% of our patients who come to us for weight loss. Of those, the vast majority doesn't have to go any further than eliminating wheat and dairy to jump start their weight loss.

The Metabolic Code Diet is a sensible eating plan that you can follow for the rest of your life and never feel deprived or hungry. But most importantly, since it addresses all the potential causes of metabolic disruption, it's an eating plan you can count on to get at the root causes of your weight gain, making it a better long-term solution for healthy weight loss and management.

References

1. http://www.newswise.com/articles/view/545808/
2. Kagan RS (February 2003). Environ. Health Perspect. 111; (2): 223–5.
3. Zar S, et al. (July 2005). Scand. J. Gastroenterol. 40 (7): 800–7.
4. Arroyave-Hernandez CM, et al. Rev Alerg Mex. 2007 Sept-Oct; 54(4):162-8.

Men: "Hormone Hell" is NOT Just for Women!

2008-12-27T13:00:00.002+08:00

Men: "Hormone Hell" is NOT Just for Women!

By Layne Lowery

Can men go through menopause? Absolutely! You might not know it, but estrogen dominance, or andropause, is a major health hazard for men over 40. This hormone imbalance occurs when your body builds up too much estrogen and xenoestrogens -- which are synthetic forms of the hormone.

You've probably never heard of estrogen dominance -- and your doctor would probably misdiagnose your symptoms. But this could be the reason you suffer from...

Memory loss and "senior moments"
Depression and mood swings
Sleepless nights
Unwanted weight gain-- especially belly fat
Muscles turning into flab
Low sex drive and erectile dysfunction (ED)
Enlarged prostate and other prostate problems-- and a frequent need to urinate
Hair loss
Male breasts or "man boobs"

There are three main reasons why these unpleasant symptoms of male menopause may be tormenting you: 1) aging, 2) environmental pollutants, and 3) your diet.

As you get older, your body doesn't make as much testosterone. The remaining testosterone gets weaker and easily converts to estrogen. Unfortunately, mid-life weight gain increases estrogen production because fat cells contain the aromatase enzyme, which changes testosterone into estrogen.

Another cause for hormone imbalances comes from xenoestrogens -- or toxins that imitate estrogen-- which are dumped into the environment by industrial, agricultural, and chemical companies. In his health newsletter, Dr. HingHau Tsang said these phony hormones are offshoots of products such as spermacides, detergent, plastics, plastic bottles, pesticides, herbicides, personal care products, and lacquers.

Dr. Tsang also said commercially raised beef, chicken and pork, as well as birth control pills and canned foods, contain xenoestrogens. He said massive amounts of hormones are regularly injected into beef and poultry, which can upset your natural estrogen levels.¹

John R. Lee, M.D., an expert in natural progesterone therapy, thinks that significant amounts of estrogen are the main cause of prostate enlargement AND prostate cancer!²

And estrogen dominance can also lead to erectile dysfunction (ED). According to Nick Delgado, Ph.D., a leading expert on anti-aging, a number of men with ED are "at greater risk for heart attacks, strokes, diabetes, or hypertension."³

So whether you call it estrogen dominance, "male menopause," or andropause -- estrogen overload is a real health hazard. And as indicated in a report titled "Manopause" by Lisa Marshall, large numbers of baby boomers are being hit with symptoms of male menopause.⁴

Therefore, Dr. John Morley, lead researcher of estrogen dominance in men and head of the geriatrics division at Saint Louis University Medical School, predicts that, "We are going to see an explosion of interest in it."⁵

What does this mean for you? Have your hormone levels checked to ensure that you don't have elevated levels of estrogen that can cause major health problems. A good naturopathic practitioner can advise you on lifestyle changes and nutritional supplements that will help keep your hormones in balance and reduce your risk of both male menopause and chronic disease.

References

HingHau Tsang, M.D., Dr. HingHau Tsang's Crusade on Nutrition: Newsletter #75--"Estrogen Dominance, Natural Progesterone and Men," Tsangenterprise.
John R. Lee, M.D., Natural Progesterone.
Nick Delgado, Ph.D., "Steps to Overcoming Estrogen Dominance and Slowing Symptoms of Aging," Ezine Articles.
Lisa Marshall, "Manopause," Natural Awakenings.
John R. Lee, M.D., Medical letter--"Prostate Disease and Hormones," March 2002.