Natural Health Treatments

Mood Shifters

2006-08-28T23:25:00.000-05:00

Most people are aware that music evokes all sorts of emotions. Good, bad, happy, sad. The question that struck me recently while in a melancholy mood and listening to melancholy music was this: Even though my mood drew me to listen to soulful music to give myself a kind of emotional hug, would I be better served listening instead to more upbeat music? Can we use the power of music to actually change our mood? Could it be a form of medication? If I changed my tune on that melancholy day and put on happy, inspiring music instead, would my mood follow suit? "You can absolutely use music to affect someone's mood," says Elizabeth J. Miles, an ethnomusicologist who has been working with music and mood for a decade and has written extensively about the power of music to actually change states in our body and mind. "Psychologists have been using music as a therapeutic technique for more than 100 years." I asked her to explain what actually makes music "sound" happy in the first place.
HAPPY MUSIC
"Music sounds happy and uplifting when there's a lively tempo and major key harmonies," she told me. "Upward leaps in the melody can help too, as in the 'power ballad.' Words help a lot as well. The music is thought to engage a place in your brain called the hypothalamus, which regulates hormones and is part of the limbic system, which is the brain's center of emotions. All sound, including music, is processed there and in the thalamus before it is processed by the cortex, the part of your brain that actually thinks." So that's the reason I get all mushy when I hear the song that reminds me of my high school prom? "Yes," Miles explained. "Reading, for example, goes directly to the cortex. But music comes through the ear and must pass through the 'feeling center' first on its way to being processed. That's why music can evoke such emotion."
USING MOOD TO ALTER YOUR MOOD
Miles suggested some ways music could be used to attempt to change one's mood. The first is a mood treatment called vectoring -- also known as the iso principle. "Vectoring -- the iso principle -- starts with where you are now," Miles explained. "For example, if you're feeling really down and someone puts on a high-intensity 'up' anthem, it might turn you off. So instead, you start with music that's closer to the mood you're in right now, or maybe one that's just a tad 'happier.' For example: Jack Johnson's song "Upside Down" from Curious George. Then, with each successive song you put on, you notch it up one rung on the emotional ladder. Just keep turning it up -- making the music a little happier, a little faster, a little more upbeat." This technique is an application of a behavior modification technique called chaining.
Miles suggested the following as a sample of an "iso" or "vector" sequence to "ramp up gradually when you're feeling down"...
1) Jewel, "Hands" or Jack Johnson, "Upside Down" 2) The Staple Singers, "I'll Take You There" 3) U2, "Beautiful Day"
What happens when you don't have time for all that music? Let's say you're in the office, and feeling just a tad sad about something or maybe you're short on energy, and need to get up to "workplace speed" quickly. Miles' suggestions for a quick mood elevator -- Beethoven's "Symphony No. 9" (Finale: "Ode to Joy") or Otis Redding's "Try a Little Tenderness." "You can also try show tunes, or any song that takes you back to a good place," she said. Miles suggested anything from the CD "Absolutely the Best of the 70's." "But don't just listen -- sing along! Or better yet, dance, assuming you have some privacy." If you don't have privacy, just tapping your toes can get your body changing. Any favorite psych-up song will do. "If you're not really down but just a little blasé and maybe have the 'afternoon slumps,' just take your happy song with you. One listen to Gloria Gaynor's song "I Will Survive" can turn a whole afternoon around."
FEELING THE BLUES
But what about when you feel kind of sad and melancholy and actually want to stay there or need to stay there to work through some emotional pain? "Perfectly normal," said Miles. "Sure it's a kind of wallowing. But it can be very cathartic -- you're expelling negative feelings out of your body." She explained that "cleansing music" can fall into two categories -- one is the kind of "sad" melancholy music I tend to listen to when feeling sorry for myself and the other is loud, angry, music with lots of buzzing and distortions. "Teenagers listen to a lot of that kind of music," Miles explained, "because their hormones are raging and they've got a bunch of feelings they have to get out." Miles suggested that this kind of "cleansing" or cathartic music might be a great option for women who tend to feel pain and hurt in a different way than men. When feeling hurt, women could react well to a quick break of cleansing music. Her choices?
1) Anything by Metallica or Megadeth (the heavy metal bands) or Public Enemy (rap) or 2) "Mars" from "The Planets" by Gustav Holst
Note: Since I know many readers are not familiar with Metallica or Megadeth, I asked Miles about other options. Alternative: Classical music by the late Sergei Rachmaninoff, a Russian composer, pianist and conductor. "If you're cleansing with that kind of music, you should limit it to just one or two songs," Miles told me. "Then 'reset' yourself afterward by listening to something relaxing. It's like taking a warm bath after a hard run on the treadmill." She also suggested that for maximum results you get physically involved in the music by drumming along on the table. And if you don't want to "cleanse" but prefer to wallow? "Make a deal with yourself," she suggested. "You get two sad songs -- you get to cry it out -- and then you start the vectoring technique to return to happiness." "Remember," she told me, "one of the absolute best things about music as a mood manager is that you can do it anywhere."

Health Food Or Sweet Dessert?

2006-08-27T22:46:00.000-05:00

Theoretically, yogurt is a health food. The key word: theoretically.Many people first heard about yogurt when stories of robust, rugged centenarians living high up in the mountains of Bulgaria attributed their longevity to their yogurt-heavy diet. Yogurt started showing up in grocery stores in the US and soon became a dietary staple of the health-conscious crowd. The problem is that most commercially available yogurts today contain more sugar than live bacterial cultures. And there's the dairy debate. Is this the same food that the rugged mountaineers were eating?
BACTERIA IS THE KEY
To get to the bottom of the yogurt debate, I talked to naturopathic physician Sonja Pettersen. She explained that the health effects of yogurt are completely dependent on the presence of live bacteria. "Why did those people in Bulgaria have such great longevity?" she asked rhetorically. "Why didn't they have degenerative diseases? It turns out that the yogurt they were eating was very rich in a particular bacteria called Lactobacillus bulgaricus. And L. bulgaricus has antiviral, antibacterial and antifungal properties as well as many other health benefits." Bulgaricus is a species of the genus of bacteria called Lactobacillus, which in turn is part of a larger group known as probiotics. "Your gut is populated by a huge number of microbes," Dr. Pettersen explained, "some of them are "good" -- such as Lactobacillus acidophilus, L. bulgaricus, L. bifodobacteria -- and some of them not so good -- such as Staphylococcus aureus. We all have both good and bad bacteria in our gut, but it's a turf issue. You need to keep the good ones in the majority and the bad ones at a minimum. The live cultures in real yogurt help do that and provide many health benefits." Dr. Pettersen believes everyone should supplement with probiotics -- the good bacteria that live in the gut -- unless they're eating plenty of "real" yogurt with live cultures. "By maintaining good gut flora, you'll prevent all kinds of different diseases," she told me. "Especially chronic degenerative diseases." Why? Because the end result of a more balanced gut flora is decreased inflammation, which is a central feature of so many degenerative diseases including heart disease. Probiotics -- like the bulgaris found in the yogurt in Bulgaria -- help increase natural killer cells (a powerful immune system weapon). They increase antibodies when we have infections and have actual antibiotic properties of their own. They improve digestion. They have anticancer properties. And if this weren't enough, they can increase good cholesterol while decreasing the bad kind. Probiotics also may have a positive effect on blood sugar. An article in the August 2005 Journal of the American College of Nutrition reported that daily ingestion of tablets containing powdered -- in other words, yogurt -- fermented milk (yogurt) with Lactobacillus reduced elevated blood pressure in mildly hypertensive patients without any adverse side effects.
LOOK FOR "LIVE AND ACTIVE CULTURES"
Originally, yogurt was milk that was left out to sour. Real yogurt is a fermented food, allowed to develop its own bacteria just like sauerkraut or any other fermented food. The National Yogurt Association (NYA) has developed a "Live and Active Cultures" (LAC) seal for the yogurt label to identify yogurt that contains significant levels of live and active cultures. Don't be fooled by the words "made with active cultures." All yogurts are made with live cultures, but no live cultures survive heattreatment. "The product has to actually contain live cultures at the time of consumption," Dr. Pettersen said. Some yogurt products may have live cultures but not carry the LAC seal. To determine whether the yogurt you buy contains living bacteria check the labels for the words "contains active yogurt cultures," or "living yogurt cultures". Three brands that contain live cultures are Stonyfield Farm, Dannon (plain) and Nancy's (http://www.nancysyogurt.com/).
The NYA has been urging the FDA not to allow products that do not contain live and active cultures to be called "yogurt". The LAC label assures consumers that the healthful properties of the organisms are present at the time they eat the yogurt, not just at the time of manufacturing. PLAIN IS BEST
The best nutritional deal is plain yogurt, which has only two ingredients -- live cultures and milk (whole milk, low-fat or skim). In some highly sweetened containers of yogurt, you're getting more calories in the sweetener than you are in the yogurt. Be sure to read the protein and sugar values on the nutrition panel. The higher the protein and the lower the sugar content, the more nutritional value you will get from it.
A NOTE FOR DAIRY AVOIDERS
For people who avoid cow's milk, there are also goat's milk yogurt and soy yogurt options. Goat's milk yogurt tends to be less allergenic than cow's milk yogurt. You still need to check for the live cultures in the product ,however. Soy and goat's milk yogurt are generally available at health-food and whole foods markets. What about the commercial kind of yogurt we see commonly on supermarket shelves? The kind with the fruit on the bottom that tastes so delicious? "A sweet treat masquerading as something healthy," Dr. Pettersen told me. As for frozen yogurt, "It's delicious, but it has absolutely no relation to yogurt's health benefits."

Living Donors Help Diabetics

2006-08-25T22:33:00.000-05:00

If at first you don't succeed, try, try again. Such is the lesson learned from a recent experimental surgery in Japan in which doctors implanted pancreatic cells from a living donor into a woman with severe diabetes. Results so far are encouraging -- the woman with diabetes is no longer insulin-dependent. According to David Sutherland, MD, PhD, head, transplant division, and director, Diabetes Institute for Immunology and Transplantation at the University of Minnesota Medical Center, a similar surgery was tried in the 1970s at the University of Minnesota Medical Center, though with unsuccessful results. The recent attempt by Japanese doctors is very encouraging for the possibility of using living donor pancreas tissue donations to aid cases of severe diabetes. To date, most pancreas replacement surgery has involved taking the pancreas from a cadaver, but results have been poor. With live tissue donation, there is a greater chance of not being rejected and of the tissue proliferating.
ABOUT PANCREAS TRANSPLANTS
The pancreas uses groups of pancreatic cells called islets of Langerhans in combination with digestive enzymes to produce insulin. Dr. Sutherland describes the islets as being like BBs scattered throughout the pancreas. However, because the pancreas is made up of two separate parts, each with its own blood supply, it is possible to transplant tissue from a living donor, much as doctors now do routinely with kidneys. Pancreas transplants from living donors sounds like the future, and perhaps it will be, says Dr. Sutherland. People can survive with half a pancreas (or for that matter, no pancreas at all -- though they become instantly diabetic and must take digestive enzymes as well as insulin for life). However, even with the less-invasive islet surgery, the donor requires careful and extensive immunosuppressive medications.
ABOUT THE JAPANESE SUCCESS
The Japanese team removed half the pancreas of a woman, harvested the islet cells and transplanted them to the woman's 27-year-old daughter, who was suffering severe attacks of hypoglycemia. (Most diabetics are able to anticipate and prevent such extreme blood sugar drops, but some are not and they often pass out as a consequence.) The newsworthy aspect is that now, almost a year later, the donor is doing well and her diabetic daughter remains insulin-independent. Part of this latest success may be the fact that the closer the donor and recipient are genetically, the greater the chances of success. Dr. Sutherland says he salutes this effort for its success. Even so, most transplant patients who received their pancreas from a cadaver eventually reject it five or more years later. Transplant surgery is not useful for pancreatic cancer because the cancer is virtually never detected until it has already metastasized. However, for people with diabetes or whose pancreas has been removed because of severe pancreatitis, Dr. Sutherland says doctors hope that someday beta cell islet transplantation from living donors will be routine. In this country, the procedure is still considered investigational and needs approval from the Institutional Review Board and the FDA before doctors can move forward with it. We'll keep watching.

New, Safer prostate Treatment

2006-08-21T01:42:00.000-05:00

Men with a diagnosis of prostate cancer are often frustrated by an array of unsatisfactory treatment options that may leave them either impotent or incontinent. Now, a less-known treatment is offering many men with prostate cancer an alternative therapy that destroys the tumor but not the prostate -- and so for many patients this means a future free of impotence or incontinence. The technique is called cryoablation, a sort of male lumpectomy that removes the tumor, leaving the prostate gland and its normal functioning in place.
DETAILS ON CRYOBATION
The pioneer of this technique is radiologist Gary Onik, MD, director of the Florida Hospital/Celebration Health's prostate cancer research program. He performed his first prostate cancer cryoablation surgery about 15 years ago, but it has been only in the last year or so that the technique has been receiving national attention, through journal articles and meeting presentations. The technique uses an exceedingly cold gas to freeze a portion of the prostate and some surrounding tissue, including one of the prostate nerves, to destroy the targeted tissue. In an ongoing study of 60 cryoablation patients, one year later 95% had stable prostate specific antigen tests and no evidence of cancer... 78% remained potent... and none reported incontinence. I spoke with Dr. Onik about this surgery and what it offers prostate cancer patients.
IS CRYOABLATION FOR YOU?
According to Dr. Onik, 75% of all patients are candidates for this type of surgery. The key is that the cancer be mostly contained in one-half the gland. It is available to men with a single cancer but also those who have a "single index" cancer, a small tumor elsewhere in the prostate in addition to the primary one. If the smaller tumor eventually gains in size, Dr. Onik explains that the patient can have a later cryoablation to treat it as well. Even an advanced cancer can respond to cryosurgery, he says, so long as it has not spread beyond the prostate gland. Doctors can tailor the procedure to destroy as much or little tissue as the patient needs. Patients also can have this surgery after radiation if radiation has failed. Dr. Onik says that cryoablation surgery is now starting to be available in other areas around the country. For anyone with a diagnosis of prostate cancer, he advises getting a thorough understanding of the extent of the disease and then looking at all the options, including, of course, cryoablation surgery. If cryoablation is the right course, find a doctor/hospital that is experienced with this procedure. While use of it is expanding, you still want to go where they have the most experience.

More Coffee... Less Diabetes

2006-08-21T01:31:00.000-05:00

Good news for coffee lovers comes from researchers at the Harvard School of Public Health. They found that people who drink coffee on a regular basis experience a substantially lower risk for type 2 diabetes. These findings appeared in an issue of the Journal of the American Medical Association (JAMA).
ABOUT THE STUDY
In a retrospective review of nine studies of coffee consumption and type 2 diabetes risk, Harvard researcher Rob M. van Dam, PhD, and his colleagues looked at 193,473 regular coffee drinkers who experienced 8,394 cases of type 2 diabetes. They excluded from consideration studies that involved type 1 diabetes, animals or short-term exposure to coffee or caffeine. Next, researchers calculated the relative risk of type 2 diabetes in relation to how many daily cups of coffee the participants consumed.
It turned out that the more coffee, the better...
The incidence of diabetes was lowest -- 0.65 (or between six and seven in 10) -- for people who consumed the most coffee each day (six or more cups).
Those who drank four to six cups daily faced a slightly more than seven in 10 (0.72) incidence.
People who drank the least coffee (which was no consumption in US studies, and two or fewer daily cups for Europeans) had a relative risk of 0.94 -- or very little risk reduction.
These numbers did not differ significantly according to sex, obesity or geographic region (which in this case meant the US and Europe). However, Dr. van Dam adds that the results were rather diverse in the lowest consumption category. He would not be surprised if future studies that are able to measure coffee consumption more precisely find a lower diabetes incidence for any amount of coffee.
MORE COFFEE, LESS DIABETES
These current findings serve to underscore the results of an earlier HSPH study in 2004, in which men who drank more than six cups of coffee a day reduced their risk of type 2 diabetes by more than 50% in comparison with men who did not drink coffee... and women by 30% in comparison with women who were not coffee drinkers. This beneficial effect was observed independent of lifestyle choices such as smoking, exercise and obesity. Scientists don't know exactly how coffee cuts diabetes risk. Paradoxically, caffeine reduces insulin sensitivity and raises blood sugar -- both no-nos for diabetes. However, Dr. van Dam emphasizes that coffee is a complex beverage that contains numerous chemical compounds and minerals, which may have both helpful and harmful impacts on the body. Components other than caffeine -- such as the antioxidants chlorogenic acid and magnesium -- actually improve sensitivity to insulin and thus help lower diabetes risk. In animal studies, trigonelline and lignans improved glucose levels. Dr. van Dam adds that additional studies on effects of coffee components in humans are clearly needed.
WHAT ABOUT DECAF?
For those of us who prefer decaf, coffee still packs some protection against type 2 diabetes. Although the effect appears to be more modest, some of this discrepancy may be attributed to study limitations. Decaffeinated coffee consumption was substantially lower than caffeinated coffee consumption, and this may have affected the estimates, explains Dr. van Dam. He points out that it is easier to detect larger contrasts in consumption than smaller differences. In addition, one can expect some misclassification when you ask for the amount of coffee people consume (change over time, differences in strength and cup size, etc.). Dr. van Dam notes that in a recently published study on coffee consumption and C-peptide concentrations (a marker for insulin resistance), the association was actually similar for decaffeinated and caffeinated coffee consumption (June 2005, Diabetes Care). He adds that it is currently unclear whether caffeine has detrimental effects on insulin sensitivity over the long term, because only short-term studies have been conducted. Nor is it clear if non-coffee sources of caffeine would have similar effects.
THE JOLT OF JAVA
Other trials have already lined up in coffee's favor, demonstrating that it can lower the risk of liver problems, gallstones, colon cancer and Parkinson's disease. Of course, there's also a downside to coffee (which pregnant women, children and people with colitis, hepatitis and other dietary challenges should not drink), such as jitteriness, insomnia and a rapid heartbeat. (Coffee stimulates liver function, which in healthy people is fine in moderation, but those with active liver disease may have symptoms worsen when they consume coffee.) Promising as it seems, Dr. van Dam and his colleagues do not go so far as to recommend drinking coffee to prevent type 2 diabetes. They emphasize that while coffee consumption may provide greater control over diabetes and possibly reduce the need for pharmaceuticals, it cannot replace the myriad health benefits of diet, exercise and weight management. Many people stop drinking coffee because they think this is good for their health. Now coffee drinkers can take comfort in knowing that their daily jolt of java not only gets them up and moving, it also provides a definite health benefit.

Silent Sight Stealer

2006-08-20T01:33:00.000-05:00

At this moment, experts estimate that several million Americans are on the road to blindness and don't know it. The disease that wreaks this visual havoc is glaucoma and it has no symptoms -- at first. Eventually, patients begin to lose peripheral vision, but by this time, damage is already considerable and permanent. Everyone over age 40 needs to be aware of the disease to prevent suffering needless loss of sight. How can you reduce your risk? Ophthalmologist Gregory K. Harmon, MD, is director of glaucoma services at the New York Presbyterian Hospital-Weill Cornell Medical Center and coauthor of What Your Doctor May Not Tell You about Glaucoma -- The Essential Treatments and Advances That Could Save Your Sight (Warner Books). I spoke with him about the latest findings regarding glaucoma. Dr. Harmon told us that the condition isn't a single disease, but rather several different ones that have a common denominator -- they damage the optic nerve (a bundle of fibers in the back of the eye). By far the most common type of glaucoma in the western world -- and the focus of our discussion -- is one called open-angle glaucoma with its slow, early asymptomatic progression. (The other principal type is narrow-angle glaucoma -- which is most likely to affect Asians and has an acute, dramatic onset.) African Americans are much more prone to glaucoma than are whites -- their risk of it is four to six times higher, says Dr. Harmon. And, it appears that Hispanics probably have the same vulnerability as African Americans.
EYES UNDER PRESSURE
Until recently, doctors believed that the common factor for all conditions leading to glaucoma was pressure from a build-up of fluid in the eyeball. They have now discovered that people with a normal pressure reading can still have the disease -- a condition called "normal-tension glaucoma." This makes the old-fashioned eye pressure test, routinely administered to patients after age 40, insufficient for diagnosis. Rather, the best way to diagnose glaucoma is to have an optometrist measure eye pressure (tonometry) and examine the optic nerve to see if there is nerve damage.
RISK FACTORS
The most important risk factor for glaucoma is pressure in the eye, says Dr. Harmon. However, you can have elevated eye pressure and not have glaucoma (a condition called ocular hypertension.) Other risks include...
Being 45 or older (although even babies can have the disease).
Having a family history of the disease.
Being substantially nearsighted -- farsighted folks are more vulnerable to narrow-angle glaucoma.
Having high or low blood pressure.
Having experienced trauma to the eye.
Use of corticosteroids, such as prednisone, whether taken internally, inhaled or used topically in the eyes.
A note about steroid use: The degree of risk concerning steroid use has to do with the strength of the medication and duration of use. Dr. Harmon says that, generally, if steroids were going to increase eye pressure, it would show up right away. Contributing editor Andrew L. Rubman, ND, reminds people that long-term use of steroids can also sometimes increase risk of glaucoma.
Doctors also evaluate the thickness of the cornea in glaucoma exams because people with thin central corneas are at much greater risk than others.
TREATMENT STRATEGIES
The goal of treatment is to reduce eye pressure, including in those patients with normal pressure glaucoma. Even in people with normal pressure, reducing it further prevents disease progression just as it does for patients with elevated pressure. Eye drops -- either to reduce the fluid in the eyeball or improve the efficiency of its drainage -- are the first line of treatment. The side effects of the most commonly used drops are few -- lashes get longer and thicker and blue-green eyes may turn brown -- and patients generally use drops for life. However, drops are not effective enough for everyone, in which case the next step is laser surgery. There is a new laser, Dr. Harmon explains, that creates a small amount of inflammation within the eye's drainage system. This, in turn, causes macrophages to come into the eye's drain and chomp up the debris inside the drain, a sort of Liquid Plumber effect, and leave it flowing more smoothly. There doesn't appear to be a downside to this surgery, and it can be performed multiple times without any known harm as of now. Patients generally continue using drops after laser, and the surgery allows much better success for the drops. When all else fails, the last measure is to have traditional surgery that creates a new drain. Whatever the treatment, all patients require regular monitoring to be sure the glaucoma doesn't begin to progress once again. Should that happen, more aggressive treatment is called for (or in the case of post-surgery patients, a return to drops).
NO PREVENTION -- RISK REDUCTION
Traditional medicine can not prevent glaucoma, says Dr. Harmon, but there are definitely ways to lower your risk of vision loss. He says that the healthier you are, the better your chances of avoiding it. In particular, he recommends regular aerobic exercise -- studies have shown it lowers eye pressure -- and eating foods that contain lots of antioxidants, such as green leafy vegetables and brightly colored fruits. It is critical to be checked annually. Glaucoma screening can be done by either an optometrist or an ophthalmologist. Should an optometrist find a problem, the patient is referred to the ophthalmologist for medical treatment.

New Drug-Free Depression Treatments

2006-08-18T00:34:00.000-05:00

More than 14 million adult Americans experience a depressive disorder every year. This doesn't describe just feeling "down" -- the problem affects many aspects of a person's life, including sleep and eating patterns, and manifests itself in feelings of worthlessness and despair and an inability to focus or believe life will get better. However, most people go on to recover within 10 months, says psychiatrist John O'Reardon, MD, assistant professor of psychiatry at the University of Pennsylvania School of Medicine in Philadelphia. There is a substantial subgroup of depressed people, more than 25% of patients, according to Dr. O'Reardon, who are "treatment resistant." For this group, standard treatment of talk therapy and/or medication, sometimes even after many years, proves to be of no help or of short-term help only. Now the FDA has approved a new device that may turn at least some of these people around, helping them to become depression-free at last. The device is called the vagus nerve stimulator (VNS), which Dr. O'Reardon told me is a sort of pacemaker for the brain. The VNS was originally developed for epilepsy patients some 15 years ago, but when doctors observed the improved moods of these patients, they began to investigate its applicability to severe depression.
HOW VNS WORKS
Doctors surgically implant the one-ounce programmable device into the left chest wall, positioned to deliver electrical signals to the left vagus nerve, which is located in the neck along the side of the esophagus. A psychiatrist programs the device for appropriate pulse-generated stimulation of the nerve. It is actually on only about 10% of the time, but the VNS has been of significant benefit for many treatment-resistant patients. Albeit potentially skewed, data from the manufacturer (Cyberonics, Inc.) showed that 18% of VNS patients became depression free... 35% had reduced symptoms... and 57% had some benefit. Although the results sound good, they are not an overnight fix. Results can take as long as one year to be fully realized. On the upside: Side effects are generally minimal, with hoarseness or scratchy throat being the most common.
OTHER TOOLS ON THE HORIZON
Dr. O'Reardon reports that he and others are currently conducting clinical trials on yet another mechanical device for depression that is already in use in Canada. Called the transcranial magnetic stimulator (TMS), this is basically a magnet that a doctor puts on the patient's scalp to stimulate appropriate areas of the brain. Depression mainly affects two parts of the brain -- the prefrontal cortex, which is involved in concentration and drive, and the limbic system, which regulates mood and emotion. Depression causes the prefrontal cortex to shut down and the limbic system, which controls anxiety and hypersensitivity to stress, to become overactive. TMS allows doctors to activate the prefrontal cortex and slow down the limbic system, thereby creating balance that had been lost. In 20-minute sessions, TMS sends out pulses for 10 seconds every minute. Patients need 15 to 20 sessions over three to four weeks to start getting results, and there are virtually no side effects. Patients may need several sessions per month as maintenance, although there are no studies yet to establish this. Dr. O'Reardon reports that TMS may get approval for use in this country in another year. Dr. O'Reardon explains that the idea behind all treatment, including psychotherapy and medication, is to reactivate and balance these neurological systems. For patients whose depression is deeply entrenched, however, a mechanical device such as the VNS or TMS may be the answer because they directly affect the brain and are generally quite low in side effects.

Anesthesia Alert

2006-08-16T23:45:00.000-05:00

Every day, patients hear physicians speak the following words -- "It's a simple procedure that we can do right here in the office." The number of office-based surgical procedures has increased by an estimated 93% since 1996. Approximately 25% of all surgeries occur in doctors' offices, and that number is expected to rise to 35% within the next few years. At first glance, that doesn't really seem like a bad thing since, for most patients, an in-office procedure is convenient, less threatening and, in general, faster than the same procedure done at a surgical center or hospital... but it's also riskier. A study published in Archives of Surgery compared surgeries conducted at ambulatory surgical centers in Florida with those done in doctors' offices, and found a tenfold increased risk for adverse incidents and death in the office setting. According to Frederick Ernst, MD, coauthor of Now They Lay Me Down to Sleep... What You Don't Know About Anesthesia and Surgery May Harm You, many of the complications and deaths are tied to the anesthesia used in office settings. "The complications occur primarily because the people who give sedation are not trained and certified in anesthesia delivery," he says. "We've had reports that office managers and secretaries are administering intravenous (IV) sedation while the surgeon does the procedure and tries to monitor the patient at the same time. That is absolutely ludicrous."
RISKY DECISIONS
These days, most in-office IV sedation involves the use of the drug propofol (Diprivan) because it acts quickly and patients can recover from it quickly. But it can be unpredictable -- in some cases, propofol-anesthetized patients even stop breathing. Because of that unpredictability, the US Food and Drug Administration (FDA) says that propofol should be "administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure." Unfortunately, that doesn't always happen, either because the surgeon feels that an anesthesiologist isn't warranted or because he/she plans to use the anesthesia at a lower dose for conscious sedation -- meaning that the patient retains his/her swallowing reflex and can respond to verbal commands. (Many states do not require that an anesthesiologist be present for conscious sedation.) The problem, according to Dr. Ernst, is that there is essentially no such thing as conscious sedation using propofol. "A lot of these guys will tell you, 'Oh, we're just going to give you a little bit,'" Ernst says. "But that's a crock. It is unconscious sedation, period." Among other potential complications, such as respiratory and cardiac arrest, when unconscious sedation is used with any drug there is a loss of the protective swallowing reflex, so anything that comes up from the stomach can cause an airway obstruction or make its way into the lungs, causing aspiration pneumonia. So what's driving the decisions? The answer is simple: cost. "Insurance companies love office-based procedures because the facility fee for office surgery is less than that for a surgery center, which still is less than that for a hospital," says Dr. Ernst. "Surgeons love it because, if they do the surgery in their offices, they get the professional fee, the facility fee and a fee for the anesthesia, so they're making money on three fronts instead of one."
KNOW YOUR QUESTIONS
The good news is that it's easy to protect yourself from unnecessary risks when it comes to anesthesia -- you just need to ask the right questions before you agree to a procedure and be prepared to take action if you don't get the answers you want. According to Dr. Ernst, there are four basic areas to cover before you agree to an in-office procedure that requires any type of sedation, including diagnostic procedures such as colonoscopy and endoscopy.
Ask about privileges. Your doctor should be approved to perform the procedure at a nearby hospital. Ask your doctor point-blank: "At what nearby hospital do you have privileges to do this procedure?" If he doesn't have an answer, don't do the procedure in his office.
Check for certification. Make sure that your surgeon is board certified, which means that he has passed a medical specialty examination. Also ask if the office is accredited, which means that a state or national agency regularly inspects the office to see that minimum standards of patient care are met.
Get an anesthesiologist. If there is going to be any kind of IV sedation, general anesthesia or major work such as an epidural, insist that a board-certified anesthesiologist or nurse anesthetist administers and monitors sedation.
Prepare for trouble. If the answers to all your other questions have been satisfactory, there's one more hurdle to cross. What happens if something goes wrong? "Make sure that there is a transfer agreement in place in that doctor's office," says Dr. Ernst, "so that if you get into any kind of trouble, there can be immediate admission to a nearby hospital -- and that hospital should be within 10 miles." That said, safer yet is to insist that a procedure that requires anesthesia of any kind be done in a hospital unless absolutely necessary.
KNOW YOUR RIGHTS
Remember, no insurance company can force you to have surgery in a doctor's office instead of a hospital or surgical center. If you ask for an anesthesiologist, and the doctor says one isn't available -- push to have the surgery done at another location. Or push for another doctor. Don't stop pushing until you get what you want. "You may have to be really aggressive," explains Dr. Ernst. "And that goes for dealing with the insurance company, as well. Right now, an insurance company cannot force you to have surgery in a doctor's office. Be strong, stick to your guns. The insurance company will know that you know what you're talking about. After all, your life is on the line."

Oh Your Aching Feet

2006-08-15T23:32:00.000-05:00

A while back, I wrote here about treatments for common foot ailments from a podiatrist's point of view. Given that it's summer and "barefoot season," and I already broke a toe from being barefoot, I decided to touch base with a naturopathic physician to get her take on foot issues. According to Carolyn Fuller, ND, at the Bastyr Center for Natural Health in Seattle, foot problems are really about more than your feet. After all, the foot bone's connected to the leg bone, the leg bone's connected to the hip bone, etc. When you don't take good care of your feet, there can be consequences for the rest of your body. For example, if you routinely encase your feet in stylish, pointy high heels, Dr. Fuller notes that you are apt to develop not only corns on your toes... the stress and strain of the unnatural position of your body puts pressure on the back, hips and neck as well. It's always a good idea to take good care of your feet and address little problems before they become big ones.
CORNS
These thick deposits of compacted, dead skin cells most frequently develop due to the repeated pressure and friction of skin rubbing against ill-fitting shoes or toe irregularities (such as bunions on the big toes). Here's what you can do about them...
Wear well-fitting shoes. This gold standard holds for all foot ailments, to which improperly fitting shoes are likely to be a major contributing factor. Shoes should not be too large or too small, and must be the correct length and width. To distribute wear and tear equally over the foot, wear a different pair of shoes each day. As for high heels, think of them in the same category as chocolate -- fine for special occasions, but not for every day.
Invest in a pumice stone. To prevent corns from developing in the first place, use a pumice stone -- a natural rock formed from cooled lava -- or a pumice foot scrub to exfoliate dead skin cells and get rid of hard, dry skin. Your best bet is to "pumice" feet after soaking them in a tub or footbath.
Do not self-treat corns. Any lesion on the foot can easily become infected, cautions Dr. Fuller, so you should not attempt to treat corns yourself. The exception: If a corn is a once-in-a-while occurrence -- say you went backpacking last weekend and developed one -- it's fine to relieve the pain with over-the-counter moleskin or padding.
What to expect at the ND's office: After a patient soaks his/her feet to soften tissue for easier removal, Dr. Fuller uses a foot emery board to slough off the thickened skin, rather than cutting it. In addition to treating the corn itself, the ND acts as a kind of health detective to get to the bottom of why corns develop in the first place. For example, often the root cause is a bone spur. According to Dr. Fuller, these bony overgrowths develop when the body tries to compensate for abnormal structure or movement elsewhere. To discover if this is the case, she examines each patient's stance and gait -- that is, how a person stands and walks. If the underlying problem turns out to be a bone spur or flat feet, then it is recommended that the patient get individualized orthotic devices to place in shoes to correct biomechanical problems.
A note about adjusting to an orthotic device: You must build your way up to using orthotics, cautions Dr. Fuller. Do not wear them all day at first, but rather for a few hours at a time. Keep in mind that you are readjusting your muscles back into a normal position, and it will take a few days to get used to this. If you try to make the transition all at once, it's likely to be painful and you may become discouraged.
FUNGAL NAILS
These thickened yellow or brownish toenails are a sandal wearer's nightmare. Tinea unguium -- a fungal infection -- may affect one or more nails and one or both feet. Dr. Fuller told me that conventional antifungal pharmaceuticals have many adverse side effects. Instead, she recommends more natural approaches to dealing with fungal nails...
Practice good foot hygiene. Make sure your feet are clean and dry before putting on shoes, advises Dr. Fuller. When you work out, she suggests that you wear non-cotton, synthetic socks that wick sweat away from skin. Another good idea: Shoes that breathe. Following a run or workout, promptly remove sweaty socks and shoes. Make sure shoes air out and dry completely before you put them on again. If you exercise everyday or go for walks in the moist morning, you might consider investing in a second pair of shoes so that you can alternate and always have a dry pair to wear. In the gym, protect yourself from germs -- wear flip-flops or sandals in the locker room and shower. And to avoid spreading infection, clean your toenail clippers with rubbing alcohol after each use.
Consider herbal fungus fighters. As with corns, Dr. Fuller cautions against self-treatment, stressing that fungal nails require the attention of a health-care professional. In her practice, she prescribes oral pau d'arco and topical tea tree oil for her fungal nail patients. A good antifungal soak consists of three to five drops of tea tree oil in a bowl of hot water. Soak for five to 10 minutes once a day, preferably after a shower or bath.
A note about athlete's foot: Since athlete's foot is a form of fungal infection, the soaks and fungal fighters above can be effective for this very common ailment.
INGROWN TOENAILS
When a toenail cuts into the soft skin surrounding it, expect pain, redness, inflammation and possibly an infection. The quicker you take care of an ingrown toenail, the less troublesome it is likely to be...
Ban sharp, pointy shoes from your life. Tight shoes with pointy toes are often the cause of ingrown toenails.
Practice good nail care. Forget about making dainty angles to show off your tanned feet this summer. Cutting nails in the corners or sides makes you more susceptible to ingrown toenails. Instead, keep nails trimmed straight across, slightly longer than the end of the toe. To make nail trimming a cinch, soften nails first with a soak in the tub or a footbath. (Note: People with diabetes should have their toenails trimmed by a health-care professional, because people with diabetes are extremely vulnerable to foot ailments and complications.)
Consider natural remedies. Calendula cream or ointment, available at the health-food store, helps heal inflamed tissue. You can also soak your feet in a hot footbath containing several drops of calendula tincture. Another option: Ask your naturopathic physician about homeopathic remedies such as Thuja occidentalis or Magnetis polus australis, which should help make the feet less vulnerable to inflammation.
If an ingrown toenail is very painful or infected, see a physician. Sometimes the only answer lies in draining any infection and removing the top portion of the nail.
PLANTAR FASCIITIS
Inflammation of the plantar fascia ligament (which runs along the bottom of the foot) can cause severe pain, especially when you first get up in the morning or after you've been stationary for a while. Here's what you can do about it...
Wear well-fitting shoes, and consider over-the-counter inserts or prescription orthotic devices. Shoes that provide good arch support are a must, especially when flat feet or high arches are part of the problem. Also a good idea: Insoles that support the arch and reduce tension on the ligament. Another option is a heel pad, cushion or lift to relieve pressure on the plantar fascia.
Stretching is essential. Plantar fasciitis is at its worst when muscles tighten up after periods of inactivity. Maintain optimal flexibility by regularly stretching the foot, heel and calf muscles. A beneficial exercise: While you're sitting at your desk, roll your foot back and forth over a tennis ball.
Ask your ND about therapeutic ultrasound treatments. In her practice, Dr. Fuller uses therapeutic ultrasound to reduce inflammation.
Ask your physician about magnesium supplements. It can help relax contracted or stiff muscles. Magnesium citrate is the form of magnesium the body absorbs best. Consult your ND about exact dosages.
Treat aching feet to a soothing soak. To ease inflammation and discomfort, dip your feet into a 104° F footbath made with three to five drops of an essential oil (such as peppermint, lavender, rosemary, cypress or tea tree) and one tablespoon of Epsom salts. Soak for five to 15 minutes.
Massage your pain away. An ice massage can help reduce inflammation and tension in the ligament.
BROKEN TOES
As for that broken or bruised toe of mine? If you insist on being foolish like me and going barefoot, then you will put yourself at risk. Should you bang that toe, then contributing editor Andrew L. Rubman, ND, recommends soaking your foot in hot water (104° F) with Epsom salts and comfrey root powder after the initial swelling has stabilized. This will speed healing. You may, however, still need to have the foot X-rayed and discuss other strategies to manage the break with your doctor or ND.
STAY IN TIP-TOP SHAPE HEAD TO TOE
Your feet can have an impact on the rest of your body. Whatever the foot ailment, take good care of them and wear shoes that fit properly.

Good News In The Fight Against Ovarian Cancer

2006-08-15T23:18:00.000-05:00

Although ovarian cancer is relatively rare -- striking one woman out of 108 -- it is fatal for more than half of the women who do develop it because detection in early stages is so difficult. Anything that might help a woman stack the deck against this cancer is clearly important information, but there has been little of it to date. Now a Swedish study suggests that something as simple as having a cup or two of tea each day might lower risk. The study, from the Institute of Environmental Medicine at the Karolinska Institute in Stockholm, enrolled 61,057 women, ages 40 to 76, who responded to a food-frequency questionnaire and who were then followed for an average of 15.1 years. During that time 301 women were diagnosed with ovarian cancer. When the researchers evaluated data concerning food and drink consumption, they discovered that the women who drank two or more cups of tea per day had a 46% lower risk of ovarian cancer than the women who drank no tea. Women who drank one cup per day had a 24% lowered risk and women who drank considerably less, from three cups a month to five or six per week, lowered risk by 18%. While previous laboratory research has associated tea drinking with reduced cancer risk, this was one of the few studies that investigated tea consumption and ovarian cancer risk in a population of women. A logical question, however, is if tea drinkers in particular have other healthful habits that might factor into the decreased cancer risk. I put that question to Susanna Larsson, MSc, who was a chief researcher on the study. She says that they controlled for such variables, including the amount of fruits and vegetables the women ate and their alcohol consumption. The study did not cover exercise or smoking habits, she says, because neither of these has been associated with ovarian cancer. Larsson is quick to add that more research is in order to confirm their findings, but she points out that tea is a rich source of polylphenols, and these may reduce cancer risk because of their strong antioxidant properties. The majority of women in the study -- 68% --- were in fact tea drinkers, Larsson says, and most of them drank black, not green tea. This study gives afternoon tea time a whole new meaning.

Top Disease-Preventing Foods

2006-08-15T23:04:00.000-05:00

Almost every major medical condition is either caused or affected by what you eat. Yet very few medical doctors are knowledgeable about nutrition. As a result, they rarely give nutritional advice -- even when specific foods can help curb symptoms or correct underlying problems as well as or better than prescription medications.
Best food treatments for five common diseases...
ASTHMA
This respiratory ailment affects up to 20 million Americans and is becoming increasingly common, presumably because of worsening air pollution.
Best foods: Chili peppers... fish... and coffee.
People who regularly consume hot sauces or chili peppers may have less frequent -- and less severe -- asthma attacks. Capsaicin, the chemical that makes peppers hot, may stimulate nerve endings to help keep airways open. The fatty acids in cold-water fish, such as salmon, tuna and sardines, lower levels of prostaglandins and leukotrienes, chemicals that increase airway swelling.
Helpful: Three or more two- to three-ounce servings of fish each week can reduce the frequency of asthma attacks.
Doctors traditionally have advised people to drink one cup of strong coffee at the onset of asthma attacks if none of their usual medications are available. One of the active ingredients, methylxanthine, relaxes airway muscles. Adult asthmatics who drink several cups of caffeinated coffee daily have 30% fewer asthma attacks than noncoffee drinkers. I recommend three to four cups a day, provided you don't have active ulcers or cardiac arrhythmias.
CATARACTS
A cataract is a clouding (opacity) of the lens of the eye, which results in impaired vision. Much of the damage is caused by free radicals, harmful oxygen molecules that are produced as a by-product of metabolism.
Best foods: Brightly colored fruits and vegetables -- especially squash, spinach, broccoli, oranges, carrots and sweet potatoes. They're rich in vitamins C and A as well as beta-carotene, all of which reduce eye damage.
Helpful: Eat five or more servings daily.
CONGESTIVE HEART FAILURE
It occurs when an underlying condition -- such as a viral infection, hypertension, a narrowed heart valve, etc. -- inhibits the heart's ability to pump blood.
Best foods: Brown rice, spinach, oatmeal, legumes (such as beans and peas), potatoes and bananas. They're rich in magnesium and potassium, both of which improve cardiac function.
Warning: These minerals often are depleted by the use of diuretics -- standard drugs for the treatment of heart failure.
Helpful: Eat two daily servings of magnesium- and potassium-rich foods.
Also: Eat four to six small daily meals instead of three big ones. Blood flow to the stomach following big meals increases energy demands on the heart.
Limit total daily sodium intake to less than 2,000 mg daily (a little less than one teaspoon). Excessive salt increases fluid retention and reduces the heart's pumping ability.
GALLSTONES
About half of the 20 million American adults who have gallstones don't have symptoms. In the remaining sufferers, these collections of solid crystals in the gallbladder or bile ducts may cause severe pain under the breastbone or in the upper right side of the abdomen, especially after meals. The presence of such crystals can irritate the gallbladder and promote infection. Even a single, large stone developing in the gallbladder predisposes that organ to cancer.
Best foods: Fruits...legumes ...and vegetables -- anything that's low in fat. Fatty foods stimulate gallbladder contractions that can precipitate attacks.
Bonus: The fiber in plant-based foods interacts with bile in the gallbladder and reduces stone formation. A high-fiber diet may dissolve existing stones and also helps with weight loss.
Warning: People who are just 10% overweight are twice as likely to get gallstones as those who maintain a healthful weight.
Helpful: Get 35 g to 45 g of fiber daily. Eat at least five daily servings of fruits and vegetables, along with whole-grain pasta and breads, legumes and other high-fiber foods.
Good choices: One cup of baked beans (13 g of fiber)...one medium baked potato (4 g)...one large apple (5 g)...or one-half cup All-Bran (10 g).
IRRITABLE BOWEL SYNDROME (IBS)
It's associated with excessively strong and frequent contractions of intestinal muscles. Symptoms include gas, bloating, diarrhea and abdominal cramps.
Best foods: Legumes, whole-grain breads and cereals. They're high in soluble fiber, which reduces diarrhea without adding too much "bulk" to the intestine. Coarse miller's bran, available in health-food stores, is very high in insoluble fiber.
Helpful: Slowly work up to two tablespoons of miller's bran, twice daily. To reduce constipation when eating high-fiber foods, drink several extra glasses of water a day.
Avoid milk and other dairy foods for a few weeks to see if symptoms subside. Many people with IBS are unable to digest the lactose in dairy foods. If you are among them, take a supplement, such as Lactaid, with meals.

Hidden Meaning On The Grocery Shelf

2006-08-13T01:30:00.000-05:00

When buying orange juice recently, I had to pause and scratch my head for a moment. I just wanted juice, yet I was confronted with an array of choices. Did I want Tropicana Immunity-Defense Orange Juice or Tropicana Healthy Heart? Then again, there was a calcium-added variety and a low-carb version. If I chose one of these, would my health suffer in the other areas? Which was more important -- my immune system, my heart or my bones? Having spent some time in my early career in the packaged-foods industry, I am familiar with the food-labeling strategies used to maximize consumer purchase -- great promotional copy sells. Nonetheless, there I was, feeling the pressure to pick just the right orange juice -- and the guilt if I chose wrong. If I, somewhat of an industry insider, was confused, what about the rest of the world?
TAKING CARE OF BUSINESS
"It's a huge marketing gimmick," says Marion Nestle, PhD, a professor of nutrition at New York University in New York City. She told me that plain, old orange juice is a fine food as it is, and if people need supplements, they can take them. The fact is that food manufacturers are in business to make a profit, and they're going to put everything they legally can on their labels to rope you into purchasing their products. If promoting immunity or heart health or bone strengthening is going to sell more orange juice, then that's what they're going to do.
DON'T GET FOOLED AGAIN
Fortunately, concerned consumer advocacy groups are leaning on food manufacturers to 'fess up and tell the truth. Even the Federal Trade Commission (FTC) has gotten into the act, administering a recent slap on Tropicana's corporate hand over dubious claims for its "Healthy Heart" juice. To give you some perspective on the problem, here are a few recent labeling issues in the news...
The problem: Just what does "low-carb" mean? No one knows for sure because the FDA has yet to come up with a definition.
The solution: With the Atkins folks filing for bankruptcy protection, the low-carb marketing hype will ease, though consumers still will be looking for low-carb options. While waiting for the FDA to figure out a definition of "low-carb," read the labels carefully.
Of course, low carb isn't the only label catch phrase to watch out for. Also beware of...
Cholesterol-free. This may be true, but what about the saturated fat content? Saturated fat can be even worse for your heart than dietary cholesterol.
90% fat-free. That's the label on the lower-fat ground beef at my supermarket, but 10% still is a lot of fat.
Fat-free. Remember those notorious fat-free cookies we used to scarf down with abandon? How many inches did we add to our hips with that "guiltless pleasure"? They might have been fat-free, but oh, the calories!
The problem: Tropicana claimed that drinking two to three cups of OJ a day for four weeks would lower systolic blood pressure by an average of 10 points as well as improve cholesterol and homocysteine levels.
The solution: Noting that Tropicana's claims were unsubstantiated, the FTC prohibited the firm from making them any longer. But since we live in an imperfect world, they're still allowed to label their juice "Healthy Heart."
READ BETWEEN THE LINES
What all this means is that you as a consumer must educate yourself. Understand that it is marketing hype and that, for the most part, one food or nutrient will not make that much difference to health, advises Dr. Nestle. And even though food manufacturers do not make labels easy for you to read, make it a habit to read the "Nutrition Facts" on product labels. Learn how to decode them and read between the lines. Here are a few helpful tips to start out with...
Check the ingredients. Ingredients are listed according to their amount in food, with the first three or four making up most of a given product. If sugar or fat are listed here, chances are it is not a healthy choice.
Watch out for jargon. Labels are rarely so straightforward as to state simply fat or sugar. This is why you need to keep an eye on other names for fat (such as hydrogenated vegetable oil, coconut or palm or other oil, lard, shortening, lecithin and cream solids) and sugar (also know as corn sweetener, dextrose, fructose, fruit juice concentrate, high-fructose corn syrup, malt, maltose, molasses, etc.).
Pay attention to serving sizes. This is one of food manufacturers' biggest tricks. A small bag of chips or cookies represents one serving, right? Wrong! There may be as many as four servings in that bag. Check the label, and do the math.
PROMISES, PROMISES
Don't squander your hard-earned dollars on foods that promise to make you thinner or healthier or happier. Packaged, processed foods with alluring labels are not the answer. If the claim is low-fat, they're often packed with sugar and calories. Low-carb? Check the fat content. In the long run, you can't make up for an unhealthy lifestyle by purchasing foods that make "healthy" or "low-fat" or "low-carb" promises on the label. Packaged prepared foods have gone through significant processing to be shelf stable and look as good as they do. It is far healthier to stick with the real deal -- fresh, whole foods. It doesn't take long to steam fresh veggies or to cut fresh fruit. And even marinating chicken to bake is easy if you plan just a little bit ahead. According to Dr. Nestle, there are just no shortcuts to good health.

Five Keeps You Alive

2006-08-12T03:01:00.000-05:00

I spoke recently with nutrition expert Susan M. Kleiner about how good fruit is for you. The good Dr. Kleiner was kind enough to share her favorite fruit choices, based on everything from antioxidant content to taste, accessibility and portability. Dr. Kleiner generally recommends that her nutrition clients eat three pieces of fruit a day, including some type of berry (for the anthocyanins and vitamin C) and an orange-flesh fruit such as a peach, nectarine, cantaloupe, papaya or mango (for beta-carotene). Add frozen fruit to smoothies when fresh isn't available. You may be comforted to know that frozen is almost as good as fresh as long as it is completely ripe when frozen -- which is generally the case.
See if any of Dr. Kleiner's top five fruits makes your list...
1. Dried plums (also known as prunes). Rich in fiber, especially pectin, a soluble fiber that may help decrease cholesterol. Packed with phenols that neutralize free radicals in the body and a good source of potassium and iron, too. "And because they're so portable, dried plums are on top of my list," says Dr. Kleiner.
2. Blueberries. These are full of super nutrients, including anthocyanins, pterostilbene and ellagic acid. They protect you from an assortment of health problems, including cancer, cardiovascular disease, vision loss and cognitive decline. And don't neglect strawberries, blackberries or raspberries, says Dr. Kleiner, which are also rich in fiber and other health-protective nutrients.
3. Mangoes. Mangoes are exotic, sweet and rich in vitamin A, vitamin C and beta-carotene, plus potassium and fiber. These and the mango's other nutrients promote cardiovascular health and protect against colon cancer. Choose other beta-carotene-rich fruits, too, such as cantaloupes, peaches, nectarines and papaya.
4. Apples. Apples are antioxidant-rich and full of phytonutrients that may reduce your risk of cancer, heart disease, asthma and type 2 diabetes. Make sure you also eat the peel, which is rich in soluble and insoluble fiber (pectin) -- great for gut health -- plus quercetin and proanthocyanidins.
5. Bananas. Bananas are high in potassium, which may protect against high blood pressure, heart disease, stomach ulcers and bone loss. They are surprisingly full of antioxidants, and fit the on-the-go lifestyle.
So should you eat brain-protective blueberries every day if dementia is in your family history? Dr. Kleiner thinks that's a miscalculation. Better: Enjoy the wonderful fresh fruits of the season, which will give you a variety of delicious nutrients that help your body in assorted ways. You'll feel better and enjoy your food more.

The Green Way To Beat The Blues

2006-08-12T02:49:00.000-05:00

True depression -- what the medical profession calls clinical depression -- is a serious, debilitating and sometimes life-threatening disease. Fortunately, depression doesn't become this extreme for most people, but for the many millions of people who suffer a bout of mild depression each year, it can be a great intrusion on their professional and personal lives. While antidepressants were the fifth-largest category of pharmaceutical sales in 2004, there are natural treatments that can help. To find out about them, I called Mark Stengler, ND, author of The Natural Physician's Healing Therapies and Prescription for Natural Cures (Wiley).
DIET AND DEPRESSION
It's not high-tech, but Dr. Stengler's first line of defense for mild depression links diet with depression. In an effort to ease their unhappiness, people who are depressed often indulge in goodies -- chocolate, ice cream, cookies and the like. But that, says Dr. Stengler, is definitely a mistake. Although sugar might make you feel better in the short run, it can worsen depression. Other things to limit or avoid: Caffeine, alcohol (which the body responds to as a depressant in spite of alcohol's immediate boost) and wheat -- again because in some people, it intensifies depression. Yet another reason to say no to processed baked goods, loaded with sugar and wheat as they are, is that many contain trans fatty acids (also labeled hydrogenated or partially hydrogenated oils). Trans fatty acids drive down levels of healthful omega-3 fatty acids -- and omega-3s are important for combating depression. Dr. Stengler says to eat foods high in omega-3s several times a week, including cold-water fish such as salmon, mackerel, sardines and cod, as well as ground flaxseeds, walnuts and flax oil.
ALLERGIC REACTION
Depressed people frequently suffer unknowingly from food allergies or sensitivities, says Dr. Stengler, which often can provoke depression. He advises going to a naturopathic physician for a diagnosis and treatment plan. Avoiding problem foods will result in your feeling better emotionally as well as physically. It is also important when depressed to keep your blood sugar at a steady level because blood sugar drops can intensify depression and irritability. Dr. Stengler suggests eating five smaller meals rather than three full meals. Two caveats about this, however: Be wary about potentially increasing your caloric intake -- gaining weight will just make you feel worse... and if you suffer from acid reflux or stomach problems such as gastritis, contributing editor Andrew L. Rubman, ND, advises sticking to three meals a day plus two low-glycemic index carb snacks such as nuts, unsugared nut butters, seeds, sweet potatoes, yams and single servings of legume dishes. This will maximize the effectiveness of your stomach acids, and thus, your digestion. You also can take chromium to keep blood sugar levels even -- when they are normalized, mood is better. Dose: 200 micrograms daily.
VITAMIN SUPPORT
Dr. Stengler also has a vitamin protocol to ease depression. The B vitamins, especially B-6, B-12 and folic acid, are intricately involved in metabolizing neurotransmitters in the brain. He advises taking a 50-mg B-complex supplement twice a day. Add to your omega-3s by taking a fish oil supplement that contains 500 mg to 1,000 mg of EPA/DHA (the key omega-3 acids) each day. These will help improve neurotransmitter function and provide an antidepressant effect, he says. Ginkgo biloba, which many people take for memory enhancement, improves the blood flow to the brain and neurotransmitter activity as well. Take 60 mg to 120 mg twice a day of a product containing at least 24% flavoglycosides and 6% terpene lactones. Be sure to take a high-potency multivitamin, which, he says, provides the base of nutrients you need that are involved with brain function. Other helpful supplements may include SAM-e, 5-HTP, St. John's wort (buds and leaves), and L-tryptophan. Seek medical advice regarding appropriateness and dosage levels. Dr. Stengler suggests looking into homeopathic remedies as well as yoga and acupuncture. Many of his patients have found these quite useful in fighting depression.
SPECIAL FOR WOMEN
Women who are prone to premenstrual syndrome, which is a type of cyclical depression, need additional help. Dr. Stengler often prescribes chasteberry (vitex), a hormone balancer, to his patients who may require a daily dose of as much as 40 drops of the tincture or 180 mg to 240 mg in capsule form (containing at least 0.5% agnuside or 0.6% aucubine) every day of the month for four or five cycles as a therapeutic trial. He also often prescribes 500 mg of calcium and 250 mg of magnesium twice daily -- every day -- in order to increase the conversion of L-tryptophan into serotonin. Women also might want to try a natural progesterone cream applied to the inner wrist for 15 days to 27 days of the cycle. It's best to talk to a trained professional and not self-medicate for depression. While there is limited risk in making dietary changes, getting the right combination of supplements or proper levels of progesterone cream are best done under supervision. And, of course, don't forget regular exercise. As I have written many times before, research continuously supports that exercise -- 30 minutes to 60 minutes, three to five times a week -- is an effective antidepressant, almost a guarantee your spirits will be lifted for hours afterward.

The Healing Chair

2006-08-09T22:34:00.000-05:00

Good vibrations. It's far more than the classic lyric from the Beach Boys. It also describes a surprising technology for delivering relaxation and pain relief through specially designed furniture. Developed simultaneously in Scandinavia and the US some 30 years ago, vibroacoustics feature speakers in recliners, mats, mattresses and other types of soft furniture that transmit music and vibrations directly to the body. Unlike massage chairs, which are one-vibration recliners, vibroacoustic equipment features numerous simultaneous vibrations that surround the individual with the soothing effects of the music. Target benefit: Pain and medication reduction.
IN SYNC
The underlying principle of vibroacoustics is that the body has many of its own pulsing vibrations that maintain key functions -- the heart pumping blood, the gastrointestinal (GI) tract pushing food through the digestive process, the kidneys sending urine on its way -- and that the resonance of vibrations and sound merge with these biological rhythms to promote good health. Vibroacoustic research is still limited, but what does exist is promising. A number of studies, including one by the National Institutes of Health (NIH), whose Clinical Medical Center has used vibroacoustic equipment for more than 10 years, have found that the equipment sharply reduced patients' symptoms of stress and pain. Smaller studies have shown that it calmed Alzheimer's disease patients and autistic children, reduced tension, pain and symptoms associated with chemotherapy treatment, reduced the amount of time patients were in surgery and the number of postoperative medications they needed, and it lessened the pain of arthritis.
WHY IT WORKS
There are several theories as to why vibroacoustics works. The most widely accepted is that it brings about the "relaxation response," so named by Harvard professor Herbert Benson to describe a mental, physical and emotional state of lowered blood pressure and decreased heart, breathing and metabolic rates. A second theory is that it stimulates certain receptors under the skin and in connective tissue around organs and joints that prompt the brain to inhibit the sensation of pain. And there are researchers who postulate that vibroacoustics might trigger a sort of internal massage that facilitates a cleansing effect on brain cells, although this is still highly speculative, according to music and imagery specialist Chris Brewer, MA, who works with vibroacoustics in institutions around the country. She says that the equipment is becoming increasingly popular for in-home use, especially by people who have chronic back pain. A company called Somatron distributes vibroacoustic equipment and now offers a wide range of items for sale to consumers and institutions. These include bean bag chairs, wedge pillows, mats (which Brewer says are popular with physical therapists because they relax patients and thereby facilitate range of motion and treatment), a recliner cushion and chair, mattresses, pillows and other items. Brewer says that the most popular item is the recliner chair. The design places the body in the same position as astronauts are in for blast-off because the particular position puts the least amount of pressure on the body. This equipment is relatively expensive (e.g., nearly $3,000 for the recliner chair, $1,195 for the body pillow and $195 for the headrest), but... it's far cheaper in the long run than pain medication or other medical treatments.
PICK YOUR PLAYLIST?
Somatrom offers music designed specifically to maximize the quality of vibrations and in turn the experience of relaxation, but Brewer says that you can use any type of music you prefer. (Music is provided through your own sound equipment hooked up by a cable to the speakers in the furniture.) She recalls a group of teens who chose their favorite rock music for use in the mat as they lay on it, and they were delighted with the effect. The amount of time people generally spend in a vibroacoustic session is from 10 to 40 minutes, though 30 minutes is about average. To maximize the benefits of a vibroacoustic session, Brewer advises creating a peaceful setting -- low lights, an area with privacy and few or no competing sounds. As to how long the benefits will stay with you after a session, the answer is that thus far no one really knows. Brewer reminds me, though, that the chair can help people cut down on the amount of painkillers they use and that people using the equipment learn to put themselves in a relaxation mode quickly even when they are in other environments, far from home and their vibroacoustic recliner.
For more information on the Somatron Company and its equipment, go to www.somatron.com.

Brighten Up Your Meals And Health With Turmeric

2006-08-09T00:06:00.000-05:00

One of my favorite childhood dishes is still served at special family occasions -- something we fondly call "yellow rice." It is baked rice seasoned with turmeric, which gives it a wonderfully bright yellow color with a mellow herbed taste. It is turmeric that gives the distinctive flavor and yellowish hue to Indian dishes such as curries. Little did my mother know when she discovered the recipe that in addition to creating a fun family side dish, she was protecting us with turmeric's powerful anti-inflammatory compounds and antioxidants. For the details on this versatile healing botanical, I spoke with registered herbalist David Winston, founding member of the American Herbalists Guild.
Multiple Healing Benefits
Winston told me that turmeric has a wide variety of healing abilities...
Powerful anti-inflammatory components safely reduce the pain and swelling of arthritis, carpal tunnel syndrome and joint inflammation in general.
Anti-inflammatory benefits also extend to gastrointestinal (GI) challenges such as indigestion, stomach upset, ulcers and irritable bowel syndrome.
Disease-fighting antioxidants help wipe out unstable oxygen molecules that can otherwise run amok, damaging cells and opening the door to dangerous diseases such as cancer.
Turmeric helps curb excessive immune responses that characterize diseases such as allergies, asthma and multiple sclerosis.
Studies suggest a still wider range of healing benefits, such as lowering cholesterol and fighting atherosclerosis.
Turmeric or Curcumin?
Don't mix up turmeric with its most well-known active ingredient, curcumin. Turmeric is a member of the ginger family with a long history of use in healing. It contains a variety of inflammation-fighting compounds known as curcuminoids -- the most widely known and extensively studied of which is curcumin. While curcumin alone can be irritating, turmuric contains a number of active ingredients that combine to have a gastroprotective effect.
At the health-food store, you can purchase either turmeric (commonly in capsule or tincture form) or a standardized curcumin product. Winston personally prefers turmeric, as it contains all of the herb's anti-inflammatory, antimicrobial and antioxidant components working together.
As a culinary herb, Winston considers turmeric to be a very safe remedy. Because it stimulates bile secretion, however, you should not use turmeric if you have a bile duct blockage. A standard dose of turmeric is 2 milliliters (ml) to 3 ml of the tincture three or four times a day, or two capsules of the powdered herb three times daily. An average dose of curcumin consists of 400 mg (containing 95% curcumin) in capsule form up to three times daily. Note: Turmeric should be used with caution in individuals prone to bleeding or on blood thinners.
Spice Up Your Life
An easy way to incorporate more turmeric into your diet is to go out for Indian food instead of pizza this week, or add a little curry powder to dishes at home. While you can't eat enough to have a real therapeutic effect -- that is, to cure what ails you -- Winston notes that eating turmeric can help prevent inflammatory problems such as ulcers, GI tract cancers and atherosclerosis. So add a little spice to your life and give your health a boost at the same time... not a bad combination.

Secrets Of Feeling Younger

2006-08-08T23:47:00.000-05:00

You've heard people say it: Today's 50 is yesterday's 40... 60 is now more like 50. Yes, some of that's because life expectancy is rising. But that's not all. It's also because the social revolution of the 1960s and 1970s opened a path to timelessness. The baby boomers have taught the world a lesson with regard to defying aging through a youth-focused mind-set and health-conscious lifestyle. Anyone of any generation can choose to live youthfully -- it's not just for baby boomers.
CHOOSE YOUR AGE
One example of youth-focused living is the group of seniors who tour in their own rock show (no, I don't mean the current tour of the Rolling Stones), belting out witty takes on aging like "Stairway to Heaven," "Every Breath You Take" and "Forever Young." These seniors and many like them choose to live not by the calendar or number of candles on their birthday cake but from their heart -- and to enjoy all their time on earth. To learn more about how to "age gracefully," I spoke to Edward L. Schneider, MD, dean emeritus and professor of medicine and gerontology at the University of Southern California (USC) and author of AgeLess: Take Control of Your Age and Stay Youthful for Life (St. Martin's).
Dr. Schneider told me that there are two secrets to taking control of your aging...
Keep living. If you drop out of life and just watch TV all day, you're going to feel your age (and more). Staying active and engaged is the real key to aging gracefully.
Stay healthy. Even if your spirit says, "I'm young," your body won't keep up if you don't take good care of it.
To maintain youthful zeal, Dr. Schneider recommends a number of basic elements to good health. They sound simple -- no high-tech treatments or high-priced medications. That's the beauty of it.
GET MOVING
Physical activity is the single most important thing you can do. This doesn't have to mean intense workouts at the gym, stresses Dr. Schneider. Just get off the couch.
Dr. Schneider recommends: Put on your walking shoes, and join a few friends for a daily morning trek through the park. It's never too late to start moving, and exercise will make you feel better all around, mind and body. According to one study, walking 30 minutes five or more times a week at a rate of two to three miles an hour reduces your risk for cardiovascular disease by a big big 30%.
WEIGHT TRAINING, TOO
Important as it is to get moving, that's not enough -- you also need to pay attention to weight training. Falling down and breaking a hip is just about the worst thing that can happen to an older person.
Dr. Schneider recommends: Invest $10 in a set of hand weights, and use them every day. Weight training keeps bones strong and intact as you age.
GET YOUR SLEEP
Older people often find it difficult to get to sleep at all, let alone get a good night's sleep. But getting sufficient sleep is essential to remaining active, cheerful and alert.
Dr. Schneider recommends: Alternate hot and cold. Soak in a hot bath or shower, and then slip in between cool sheets in a cool, dark room.
WATCH WHAT YOU EAT
Good nutrition is the secret to preventing the degenerative diseases of old age, yet for one reason or another -- social isolation, dental problems, reduced taste or smell or physical or mental health issues -- many older people fail to eat properly.
Dr. Schneider recommends: Sprinkle antioxidant-packed berries on whole-grain cereal for breakfast... have a salad garnished with a few chicken strips or shrimp for lunch... or opt for the salmon instead of the prime rib the next time you go out for dinner. Try to eat omega-3-rich coldwater fish (such as salmon, tuna or sea bass) at least twice a week, and aim to meet the USDA recommendation of nine daily servings of fruits and veggies. If you live alone, make an effort to get together with friends for at least a few meals each week.
TAKE SUPPLEMENTS
According to contributing editor Andrew L. Rubman, ND, even a good daily multivitamin cannot provide all the nutrients you need, so talk to a trained physician -- preferably a naturopathic one -- about supplementation. (Caution: Many older people have chronic health concerns for which they take multiple medications. This makes consulting an expert an absolute must before taking supplements.) Dr. Schneider recommends...
Calcium. If you're age 50 or older, take 1,500 mg daily. For maximum calcium absorption, be sure your supplement includes magnesium.
Fish oil. Take 1,000 mg to 3,000 mg daily. This is one of the best things you can do for your heart, notes Dr. Schneider. Note: Do not take fish oil if you have a bleeding disorder or if you are taking blood-thinners, such as warfarin (Coumadin) or aspirin.
Folic acid. Take 800 mcg daily. Folic acid is a B vitamin that lowers levels of homocysteine, an amino acid in the blood that damages blood vessel walls and contributes to cardiovascular disease.
LEARN TO LIVE WITH STRESS
Stress is not going to go away, so the best thing you can do is learn how to cope with it.
Dr. Schneider recommends: Develop your own coping mechanisms, such as exercise, meditation or talking things over with a friend. Try to keep a perspective on what's really important, and don't sweat the small stuff.
THE POWER OF PREVENTION
Of course, there's lots more you can do to stay healthy as you age -- get regular check-ups, control chronic conditions such as high blood pressure or diabetes, stay sharp by reading books and doing crossword puzzles, keep up with your friends and community connections and steer clear of unhealthy habits such as drinking too much alcohol or smoking.

Easy Yoga Secrets For All

2006-08-08T02:28:00.000-05:00

A breath of fresh air always feels great. So it is not a surprise that breathing is a critical element of one of the most energizing and relaxing techniques in the world: Yoga. Anyone can use its techniques to calm and focus during stressful times, or to provide a quick pick-me-up during a midday lag period. I asked Jeff Migdow, MD, director of prana yoga teacher training at the New York Open Center in New York City and author of Breathe In, Breathe Out (Time-Life) for his favorite exercises.
To Relax: Alternate Nostril Breathing
When you're nervous and anxious, one of the best things you can do is to stop and take a deep breath -- literally. For relaxation, Dr. Migdow recommends alternate nostril breathing, or nadi shodhana ("channel purification"). This calming, balancing breath helps to integrate the right (creative) and left (active) sides of the brain.
How to do it...
Sit comfortably in a cross-legged position or in a chair.
Raise the thumb and fourth finger of your right hand to your face. Keep the two first fingers folded into your palm.
Bring your thumb to the right side of your nose. Rest it gently against your right nostril, and inhale fully left.
Release your thumb, block off your left nostril with your ring finger, and slowly exhale right.
Then fully inhale right.
Release your ring finger, block off your right nostril with your thumb and slowly exhale left.
Repeat this sequence five to 10 times.
Dr. Migdow's special tips: Try to exhale twice as long as you inhale, because this is the relaxing phase. When you inhale, press your abdomen out so the diaphragm can drop down. Draw the abdomen in as you exhale to squeeze all the air out.
To Energize: Kapalabhati
Kapalabhati is the Sanskrit name for this energizing and uplifting breathing exercise, which is essentially a series of forced exhalations through the nose, in between which air flows in passively. According to Dr. Migdow, kapalabhati renders your perceptions more clear and accurate, and it is an excellent pick-me-up when you're feeling tired or sluggish. It clears the sinuses, stimulates the digestion and generates heat.
How to do it...
Sit comfortably in a cross-legged position or in a chair.
Inhale a medium-sized breath, and then exhale sharply through the nose. As you do so, draw your navel back toward your spine.
Release the belly and let the air flow back into the lungs through your nose.
Exhale sharply.
Start with five breaths at a time. As you grow more skilled in the technique, exhale more quickly. Work your way up to 30 breaths or more at a comfortable pace.
Dr. Migdow's special tips: Wait at least three hours after you eat to practice kapalabhati. Due to increased pressure in the abdomen, this breathing exercise is not for you if you have high blood pressure, congestion, fever, headache, an inflammatory disease such as colitis or if you are pregnant.
If you're interested in learning more about the breathing exercises of pranayama yoga -- or about any other type of yoga for that matter -- visit the Web site of the Yoga Journal at www.yogajournal.com. There you can find step-by-step instructions on a variety of yoga exercises or locate a class in your area. Although you can practice yoga on a daily basis on your own, it's best to learn the techniques first from an experienced teacher. That way you'll be sure you are doing them the right way, so you can derive the greatest possible health benefits from practicing yoga.

Shooting Pain

2006-08-08T02:17:00.000-05:00

We all have aches and pains in our backs -- but few are quite as distracting as the nerve pain of sciatica. I learned this the hard way when a friend recently suffered from a bout of sciatica that had her limping around for weeks. After several sleepless nights, she visited an orthopedist who prescribed a round of steroids to cut the inflammation (as readers know, I am not a fan of steroids because of their multiple adverse side effects) and extensive physical therapy. While the treatment seems to have worked -- for now -- I still wanted to find out how she could avoid use of steroids in the future. The good news: There are options for this all-too-common "pain in the butt."
Battle of the bulge
The problem stems from the sciatic nerve, the largest nerve in the body, which runs down each side of the lower spine, through the buttocks, down the back of each leg and into the feet. Surprisingly, sciatica doesn't necessarily involve pain in the back -- the pain often radiates from other points along this nerve. Sciatica is merely a symptom -- the actual problem is caused by compression of the nerve itself. Finding the cause of that pressure isn't always easy.
In many cases, a bulging spinal disk (aka a slipped disk, ruptured disk, herniated disk, etc.) puts pressure on the nerve as it exits the spine. But the two aren't always related (and this is where diagnosis and treatment of sciatica gets a bit murky). A study published in The New England Journal of Medicine found instances of bulged and protruding disks in people with no symptoms of back or leg pain. "It can be misleading," says Douglas R. Johnson, MD, medical director of the Inpatient Rehabilitation Unit at Charlton Memorial Hospital in Fall River, Massachusetts, and coauthor of Back Sense: A Revolutionary Approach to Halting the Cycle of Chronic Back Pain (Broadway). "Lots of people with terrible back and leg pain have no disk problems at all, and lots of people with no back or leg pain can have ruptured disks. It's tricky. The disk problem is really only a piece of the puzzle."
Painful complications
So if the problem isn't a bulging disk, what is it? According to Dr. Johnson, another common (but less well-known) cause of sciatica-like pain is based in our muscles. "Many cases are actually from muscle tightness, the spasms of which can cause a radiating pain down the leg," he explains. "Most people think of muscle pain as an aching pain, but muscles also can suffer a much deeper and severe form of pain called myofascial pain." Myofascial pain can mimic the burning, stabbing pain associated with sciatica caused by a bulging disc. On top of that, there's piriformis syndrome, where the piriformis muscle, which is found deep in the buttocks, irritates the sciatic nerve due to muscle tightness. In a study published recently in the Journal of Neurosurgery: Spine, researchers used relatively new nerve-imaging technology called magnetic resonance neurography to get detailed images of the sciatic nerve in 239 patients whose sciatica had not improved after being treated for a damaged disk. They found that 69% of the patients had piriformis syndrome.
How can you know?
This is no time for self-diagnosis. "You need to see your regular doctor in order to know [what's causing the problem]," says Dr. Johnson. There are tests that your doctor can do to differentiate between nerve pain and muscle-type pain -- as well as rule out other serious health problems such as a tumor, narrowing of the spinal canal or degenerative disk disease -- which can help direct a course of action. (A thorough exam will include reflex tests in the affected leg and a straight-leg raising maneuver, among others.) Once you've established the root of the pain you're experiencing, you can move on to treatment.
Your next moves
According to Dr. Johnson, because sciatica results from so many different factors, the best intervention is one that's tailored to each individual. Depending on the cause and severity of your sciatica, here are some remedies to consider...
Wait it out. Disk-related sciatica usually goes away on its own in six weeks or so. If your pain isn't severe, mild exercise, such as walking and stretching, can help your recovery.
Be aggressive. If your sciatica is more severe or the pain is muscular, talk to your physician about aggressive physical therapy. "Unless they're in excruciating pain, we treat most people with physical therapy," says Dr. Johnson. That's because most people suffering from back and leg pain tend to avoid working the afflicted areas -- the exact opposite of what you need.
Try chiropractic care. Often when the source of the sciatica has been established, manipulative therapy can aid in easing the pain.
Seek multiple opinions. If your doctor recommends surgery to alleviate your sciatica, keep this in mind: Surgeons tend to be "overly optimistic" about the results of back surgery -- in one survey, nearly 40% of patients had no measurable reduction in back pain postsurgery, even though their doctors had assured them of the results. Before you go under the knife, get a second (and third) opinion. "Talk to as many people as possible," says Dr. Johnson. "Get some surgical opinions as well as some nonsurgical opinions. I generally recommend a physiatrist's opinion, as well. There are a number of studies that show that people who go to physiatrists for the treatment of back pain get very good outcomes."
Get back to normal. Once you have a bad back, you always have a bad back, right? Wrong. "The idea that you need to be very careful or you can never get back to normal activities doesn't turn out to be true," explains Dr. Johnson. In fact, if you keep your muscles stretched and strong, it's possible to put your back problems behind you -- for good.
Note: If your back pain or sciatica is accompanied by bowel or bladder incontinence and/or progressive weakness in your legs, seek immediate medical attention. Unless treated quickly, these symptoms signal a severe problem that can lead to permanent damage.

New Ways To Put Fires Out

2006-08-07T02:47:00.000-05:00

Stomach acid has been getting a bad rap for years. Witness all the ads for antacids that block its production to ease your pain. Besides easing the symptoms of indigestion, use of antacids was supported by studies that associated a chronic condition of "too much stomach acid" with stomach cancer. Nonetheless, longtime readers have seen us write repeatedly about the importance of healthy complete digestion and how an adequate level of stomach acid is critical to that process. So it didn't surprise me too much when researchers at the University of Michigan Medical School discovered that too little stomach acid also can lead to stomach cancer. The study author was Juanita L. Merchant, MD, PhD, professor of internal medicine and of molecular and integrative physiology. When I discussed the findings with her, she explained that stomach inflammation -- whatever its cause -- can lead to the development of stomach cancer, and this study revealed that chronic inflammation can result from too little acid. Her study was performed on a group of mice that had been genetically engineered so that they no longer had the gene that is responsible for gastrin, the hormone that stimulates the production of hydrochloric acid (which is stomach acid). Without gastrin, of course, the mice ended up with almost no gastric acid. As a result, they developed chronic gastritis (inflammation of the stomach). Their condition progressed to atrophy of the stomach lining, which eventually led to gastric cancer.

THE CYCLE OF STOMACH ACID
The role of acid in the stomach, says Dr. Merchant, is actually more of a security guard, helping protect the stomach from invading microorganisms, than it is a tool for breaking down food for digestion (though some fats, salts and nutrients do enter the body directly from the stomach). Food coming into the stomach is far from sterile. Acid protects the stomach lining from microorganisms that are ingested with the food, while starting the process of sterilizing food so that by the time it gets into the small intestine, it is relatively clean. With too little acid, bacteria enters the stomach, causing the immune system to respond by sending in inflammation to kill the "invaders."

IMPACT OF INFLAMMATION
Researchers are now discovering that the inflammatory response also attacks certain stomach cells, one of which makes the hydrochloric acid or possibly gastrin. When inflammation becomes a chronic condition, the acid-producing cells may be lost to the stomach, which then leaves it vulnerable to abnormal cell formation and tumor growth.

THE ROOT OF STOMACH CANCER
There is no way to know when stomach cancer starts to develop in a person, says Dr. Merchant, but it takes from 20 years to 40 years to do so. (Most people are between the ages of 50 and 70 when diagnosed.) It appears that many people who develop stomach cancer ingested something at some point in the past that carried destructive bacteria, most often the Helicobacter pylori bug that is responsible for up to 90% of stomach ulcers. Once H. pylori and possibly other bugs settle in, the immune system sends antibodies into the bloodstream, but it can't destroy H. pylori because the bug stays in the stomach lining. The immune system doesn't give up, however, and the consequence is chronic inflammation. Why H. pylori creates this situation in some people and not in others is something that just isn't known at this point.

WHAT THIS MEANS TO YOU
This research has several implications for humans, says Dr. Merchant. She notes that antacids have their place in the easing of acid reflux as well as to aid in healing ulcers and addressing its symptoms, and they are safe for very short-term, intermittent use. However, ongoing use of antacids leaves the stomach vulnerable to irritation from these outside invaders. Doctors are particularly concerned about the obese pediatric population, where many cases of acid reflux have already developed. The children treat the condition with higher-powered antacids called proton-pump inhibitors (PPI) -- esomeprazole (Nexium), lansoprazole (Prevacid) and omeprazole (Prilosec) -- that can make them vulnerable to inflammation. Doctors are concerned about the long-term risk of taking the PPIs. Looking to the future, Dr. Merchant points out the need for a diagnostic tool that will reveal abnormal changes early while there is still time to intervene and correct the problem. By identifying pre-cancerous conditions, doctors could investigate tissue samples and if necessary treat the cancer before it takes hold. She adds that achieving this goal is still far away, but this study has made important steps toward that end. In the meanwhile, go easy on the antacids.

Medications Are Not One Size Fits All

2006-08-07T02:44:00.000-05:00

If you are carrying excess pounds, finding clothes that fit may be the least of your problems. Besides the well-publicized increased risks of developing cardiovascular disease, diabetes and certain types of cancer, researchers now report that obese people may require different medication doses and are not necessarily getting them. This is leading to life-or-death consequences for some. According to a study published in the Archives of Internal Medicine, some overweight or obese women receiving chemotherapy for breast cancer aren't getting doses of chemo that are appropriate for their size. That's because some doctors fear that using full doses (based on body size) of powerful chemo drugs could cause toxic side effects in these patients. The researchers analyzed data from 9,672 breast cancer patients around the country who were treated with chemo after surgery. The heavier the woman, the greater the likelihood of receiving reduced chemotherapy doses, the researchers found. And the women who received inadequate doses of chemo were more likely to experience poor outcomes.

Dosing chemo
Jennifer Griggs, MD, MPH, lead author of the study and an associate professor at the University of Rochester School of Medicine and Dentistry, explained to me that doctors currently base chemo doses on body surface area, which is calculated using a person's height and weight. But some physicians reduce that amount when treating heavier patients. Other doctors may reduce the dose during chemo and then add one or two more cycles. In the heavier patients, the total chemo doses may be the same, but these women don't receive the intensity of full doses. This practice is not supported by oncology specialty societies, hospitals, pharmaceutical manufacturers or, most importantly, by the studies used to prove efficacy. If doctors underdose or alter recommended frequency of administration, they are providing substandard, actionable care. Part of the problem is that current medical literature includes no information on dosing heavy patients, says Dr. Griggs, who is a breast cancer specialist at the University's James P. Wilmot Cancer Center. Since doctors are trained to "do no harm," many err on the side of caution. However, in reality, underdosing may actually cause more harm than good. Full doses of chemo are safe, Dr. Grigg's study found. The severely obese women in her study who received a full chemo dose appropriate to their size were no more likely than leaner women to be hospitalized with side effects. "Sixty-three percent of the women studied got the right doses, so a lot of doctors are confident that it's safe to give full doses. But 37% did not," says Dr. Griggs. Women who are overweight would be smart to lose weight for a variety of health reasons. However, if you are overweight and you are beginning chemotherapy, Dr. Griggs advises you to be forthright and ask your doctor how he/she doses for heavy people, This issue applies to men with assorted cancers, as well.
Cancer treatment is traumatic enough. Be sure it is effective as well.

New Early Heart Disease Detector

2006-07-30T22:58:00.000-05:00

Heart attacks can happen out of the blue. Almost everyone knows someone who has, without warning, experienced a heart attack -- sometimes fatal -- as the first sign of cardiovascular disease. One minute you're feeling fine... then, wham!

According to George T. Kondos, MD, associate professor of medicine at the University of Illinois College of Medicine (UIC) in Chicago, this makes it all the more important to come up with new and better ways to predict risk. Dr. Kondos told me about one of the most promising new diagnostic tests for heart disease -- the heart scan, also known as a coronary calcium scan, which he began utilizing in 1983. This painless, noninvasive imaging procedure, similar but more advanced than a computed tomography (CT) scan, can quickly detect the presence of artery-clogging calcium in coronary arteries even before there is any outward sign of a problem. In combination with other health information, this can help better assess risk.

A Reliable Predictor
Dr. Kondos and his colleagues at UIC have scanned more than 90,000 people and found the test to be reliably predictive in people who otherwise have few risk factors or symptoms. For example, from January 1993 to December 1995, Dr. Kondos and his colleagues tested 5,635 self-referred men and women with no symptoms of heart disease. In the three and a half years following the scans, 224 participants required angioplasty or bypass surgery, had a heart attack or died. According to Dr. Kondos, the CT scan detected high amounts of calcium deposits in 95% of those who experienced cardiovascular events, in comparison with low amounts of calcium in 67% of those who did not. He notes that while treadmill-based stress tests -- a more common measure of cardiovascular risk -- detect more significant blockages, heart scans can pick up smaller potential blockages at an earlier stage. This means that you may be able to take more timely action to address small problems before they develop into big ones -- just the wake-up call you need to start paying more attention to your diet, maintaining a healthy weight and getting regular aerobic exercise to help reduce underlying inflammation. Of course, this is not to say that everyone should march right out and get a heart scan. Although scans are often aggressively marketed at many walk-in health facilities, Dr. Kondos emphasizes that these tests are intended for those at intermediate risk -- people who have a 10% to 20% risk of having a cardiac event in the next 10 years. If you're young and healthy and at low risk, you don't need one. Likewise, if you're at high risk, a heart scan is not going to be particularly useful since the treatment protocols for high-risk patients go beyond identification of early calcification. (Note: Your doctor will determine your risk profile based on a medical examination and your personal and family health history.)

For Those at Intermediate Risk
The bottom line? If you're at intermediate risk for cardiovascular disease -- a category that Dr. Kondos estimates fits 35% to 40% of the American public -- consider having a heart scan. In particular, he recommends this test for men over age 45 and women over age 50 who have one or more risk factors, including age, family history of heart disease, high blood pressure, high cholesterol, diabetes or smoking. If that's you, talk to your doctor about getting scanned. It's fast, easy and painless.

Alergic To Fast Food

2006-07-26T00:04:00.000-05:00

It is well-known that peanut allergies can be severe -- even lethal. What most people don't know, though, is that sesame -- both its seeds and oil -- despite its many healthful properties, also can cause allergies with equally severe reactions. The incidence of sesame allergy is rising (in 1996, one in 2,000 people suffered from it and one in 90 people suffered from peanut allergy) though it is not a surprise given the rising popularity of sesame in our food supply -- in particular, feeding it to babies whose immune systems are still developing. Fast-food restaurants use sesame seeds on their buns... the seeds are ubiquitous in breads, crackers and the like... and the oil and paste are turning up in salad dressings and soups. Middle-Eastern restaurant chefs use sesame with a heavy hand, and manufacturers are using it in a multitude of cosmetics and ointments -- even as a part of the material in gel capsules for medications.

BEYOND PEANUTS: What you need to know about sesame allergies
To heighten awareness of sesame allergies, Michigan State University food scientist Venugopal Gangur, DVM, PhD, and colleagues searched the medical literature for reports concerning sesame allergy. The first published case in the US he found was from 1950, and reports since then have led to more than a dozen articles in the 1990s reporting on nearly 1,000 patients. In Europe and Canada, health authorities have put sesame on the lists of major food allergens, and Canada and the UK have mandated that products carrying it must be so labeled. The FDA in this country, however, has been slow to follow suit, which researchers find perplexing, given the danger. I called Dr. Gangur to talk about the problem of sesame allergy. He says that the reason sesame (as well as peanut) allergies are on the rise is likely due to a combination of better diagnosing and reporting and the fact that so many more products now contain sesame in some form. Allergic people react to sesame in foods or in products used topically. Topical products can cause atopic dermatitis as well as internal reactions just as ingesting sesame can cause skin eruptions -- runny nose, asthma attacks and, most severely, anaphylaxis, the potentially fatal reaction that involves breathing difficulty. Dr. Gangur explains that people must increase their vigilance about a potential sesame allergy, in particular those who have peanut or other nut allergies, because there is evidence that these allergies overlap. Anyone who has a suspicious reaction to sesame should see an allergist to be tested. Unfortunately, people do not outgrow this allergy -- it might actually become more severe. Avoiding sesame is the only treatment, although there are ongoing efforts to develop vaccines against these allergies, says Dr. Gangur. In the meantime, allergic people should keep inhalers and other medicines and devices at hand to control reactions. Severely allergic people should keep epeniphrine at hand, as it is the only life-saving drug for acute reactions.

Breath Of Life

2006-07-26T00:00:00.000-05:00

I'm convinced that my yoga teacher's true mantra (not the private one she isn't allowed to share with us) is "Breathe!" In various permutations, she repeats this order dozens of times each class as we move from pose to pose -- remember to breathe, watch your breath as it moves in and out of your body, focus, breathe in, breathe out. Although you may think that breathing is a normal, automatic function and no one needs to remind you to do it, the fact is that many of us inadvertently hold our breath when we tense up or exercise. Deep breathing is one of the best ways to make your way through a stressful situation, and awareness of your breath helps you get the most out of any physical activity. Actor Paul Sorvino wrote a book a number of years ago about how he cured his asthma with breathing techniques. If you had to choose just one thing to do to improve your health, it would be to pay more attention to your breath, observes Andrew L. Rubman, ND, hatha yoga master and contributing editor. Breathing techniques can help you relax, give you more energy and improve your overall well-being.

For Stress Relief
We all want to be productive, but most of us push too hard and put too much pressure on ourselves, warns Dr. Rubman. By burning the candle at both ends, instead of achieving our lofty goals, we end up succumbing to stress. His recommendation? Take a deep breath. Clear out the stale air, and replace it with a fresh stock of new, revitalizing oxygen. Dr. Rubman told me that by manipulating the frequency and depth of your breathing, you can bring about profound psychological changes in your body. Deep breathing quiets you so you can find the calm at your center. In particular, Dr. Rubman advises mastering the basic breathing practices of pranayama yoga and practicing them on a regular basis. The more you practice, the more automatic your breathing responses will become as you move through your daily life, notes Dr. Rubman. Soon you will find yourself taking stressful experiences in better stride, greeting them with deep, balancing breaths instead of shallow, panicky gulps. To get in the habit of conscious breathing, Dr. Rubman suggests placing notes to yourself around the places you spend the most time, reminding you to breathe. Post them on frequently visited strategic locations, such as the computer, the kitchen cabinet, the bathroom mirror or the clock in the car. When you glance to see how long you've spent sitting in a traffic jam, for example, the note will remind you to center yourself and calm your jangling nerves by taking a slow, deep, intentional breath.

For Physical Well-Being
Of course, stress is not just harmful psychologically -- it also has a direct negative impact on your physical health. Anxiety and tension are contributing factors to cardiovascular disease, gastrointestinal disorders and a variety of other ills. Chronically elevated levels of the notorious stress hormone cortisol raise blood pressure and heart rate and contribute to the accumulation of belly fat that places you at a higher risk for heart disease and diabetes. According to Jeff Migdow, MD, director of prana yoga teacher training at The Open Center in New York City and author of Breathe In, Breathe Out (Time-Life), controlling your breath helps you gain more control over yourself in body as well as in mind. Mindful breathing protects against stress as well as stress-related diseases.

THE PROPER WAY TO BREATHE
While we all breathe all day everyday, most breathing is not done right. According to Dr. Rubman, if you don't breathe correctly, you may hyperventilate and become lightheaded. Dr. Migdow notes that most people routinely breathe shallowly instead of deeply, utilizing only a tiny portion of their lung capacity and building up carbon dioxide. To relax the center of the brain, Dr. Migdow recommends that you begin by taking a deep breath. Always inhale through your nose, not your mouth. Breathe in slowly and fully, and be aware of your breath as it gradually expands your abdomen, then rib cage, and finally the upper portion of your lungs. Exhale through the mouth, trying to exhale for twice as long as you inhale, for this is the relaxing element. Dr. Rubman uses the following imagery to describe full breathing: Allow the breath to descend to the base of the chest like sand beginning to fill a bag. Feel the base of the lungs fill and uniformly press down on the abdomen. As the sand rises in the bag, the ribs move from the base of the chest to the shoulders like bucket handles swinging up on the buckets laid on their sides. As the lungs near capacity, the shoulders rise and swing slightly back at the peak of inhalation. Exhalation is simply the reverse process -- as if someone made a video of the inhalation and rolled it backward at half speed. For every second counted as you breathe in, aim for double the count as you breathe out. It's impossible to breathe deeply and still feel stress, says Dr. Migdow. The more that you breathe consciously, the greater the benefit. Start by devoting two minutes each hour to deep breathing, and you'll be more relaxed and productive the whole day.

Power Puff

2006-07-20T23:59:00.000-05:00

There are more than 20 million Americans suffering from asthma, and according to the American Academy of Allergy, Asthma, and Immunology, there are more than 5,000 asthma-related deaths each year. That's why I was alarmed by a study published last fall in Chest, the medical journal published by the American College of Chest Physicians, which showed that many asthmatics could be unknowingly misusing their inhalers -- meaning they won't get potentially life-saving medicine when they need it most. The problem stems from not understanding exactly how the canister of an asthma inhaler works. "Metered-dose inhalers all use a propellant of some sort," says Martha V. White, MD, director of research at the Institute for Asthma & Allergy, "and the actual medicine runs out before the propellant does." So even if you hear your canister working when you give it a squeeze, you might only be inhaling the propellant, and not the medicine. And that's a big problem.

DOING IT RIGHT
Even if you've been using an inhaler for years and think you're doing it right -- please, read this article anyway. You never know what you might learn. Here's how to do it right, according to Dr. White...
Count. All new metered-dose inhalers come with an automatic dose counter -- they need one in order to be approved by the FDA. If your inhaler doesn't have a counter, ask your doctor for a new prescription to get one with a counter. In the meantime, you'll need to count for yourself. Divide the number of times each day you use your inhaler by the number of doses in the canister -- that's how many days the canister will last. Mark it on the canister, and on a calendar.
Don't waste it. "Remember, every time you spray, it counts as a use," says Dr. White. "Even the first couple of sprays when you're priming the canister." And, according to Dr. White, you only need to prime your inhaler when you first put in a cartridge. If you're priming before each use, you're using medicine. Be sure to include this usage in your calculations.
Count some more. Most physicians recommend that the puff is inhaled and held for 10 seconds, or as long as is comfortable, to deliver the full dose.
Carry a spare. Bronchodilators -- asthma medications that quickly relax the lungs during an attack -- can be harder to track because they aren't used on a daily basis. That's why Dr. White recommends always carrying a spare canister. "If your asthma medication suddenly stops working, you can trash the canister and go to a new one," she says.
Consider a nebulizer. Those who have difficulty taking a deep breath and holding it -- a must for any asthma medication -- should consider using a nebulizer, a machine-and-mask system that delivers medicine over a five-minute period. This is especially useful for infants, the elderly and people who have bad asthma attacks.
Know when to get help. If you feel as though your asthma symptoms have changed or you've had to go to the emergency room (or if your asthmatic child is suddenly very lethargic) talk to your health-care provider about what you're experiencing. Perhaps it's time to review your medications as well as diet, nutrition and exercise programs. A simple change could have you back up and running. Literally.

Déjà Vu Research

2006-07-20T23:54:00.000-05:00

Yet another study has come out purporting to expose the ineffectiveness of echinacea, the very popular botanical medicine for the common cold. "I told you so," say those who defend their cocktails of decongestants, antihistamines and analgesics. But before you throw your echinacea bottle in the trash and rush to the pharmacy, let's take a closer look at exactly what researchers did and did not discover this time around. To sort out the results, I spoke with two of the top herbal experts in the country -- Francis Brinker, ND, author of Complex Herbs, Complete Medicines (Eclectic), and Mark Blumenthal, founder and executive director of the American Botanical Council. They were in agreement that this was by no means the definitive trial on echinacea, though Blumenthal did point out that while he doesn't question the accuracy of this specific study, the results apply only to a particular type of echinacea used at a particular dosage in a particular population. Both he and Dr. Brinker advise consumers to see the results for what they are in this narrow context, rather than leaping to sweeping, simplistic conclusions -- as many mainstream media critics of natural medicine have already done -- that "echinacea doesn't work."

About the Research
In the double-blind, randomized, placebo-controlled trial, 437 student volunteers at the University of Virginia were given about one-third the dose of echinacea considered effective by US experts or a placebo. Next they were deliberately exposed to a particular type of rhinovirus that causes colds, and sequestered in hotel rooms for two weeks. Researchers found that those who were given echinacea did not experience fewer colds, fewer symptoms or a reduction in the duration of symptoms, compared with those who were given a placebo. The results of this federally funded study were published in the July 28, 2005, edition of The New England Journal of Medicine.

A Limited Study
Although the trial was accurate insofar as it went, our experts told me that there were significant limitations...
Type of echinacea. The study utilized extracts of the root of a species of echinacea known as Echinacea angustifolia. However, Blumenthal points out that there are many different species of echinacea available (Echinacea angustifolia, Echinacea purpurea, etc.)... different parts of the plant (aboveground versus roots)... different preparations (juice, alcoholic extract, pills, etc.)... and different dosages -- and they are not biochemically equivalent. This study narrowly examined low doses of one that was made in a university lab, rather than a commercial remedy that you might go out and buy in a local health-food store -- yet universal results are being assumed from the study. In fact, while Echinacea angustifolia root has been quite popular, recently there has been a trend away from its use due to ecological concerns about the conservation and sustainability of wild medicinal plants. Because Echinacea angustifolia is more difficult to cultivate commercially, products you find in stores today are apt to contain Echinacea purpurea, which was not tested.
Daily dosage. The dosage of echinacea used in the trial was 1.5 milliliters (ml) three times a day, which represents 300 mg per dose (900 mg daily). Dr. Brinker notes that this dosage is on the low side, particularly following the onset of symptoms. He told me that while you might use a low dose like this for general prevention, once you felt like you were getting sick you would take more. In fact, the dosage used in the study was a fraction of the one recommended by the World Health Organization (WHO), which is a total daily dose of 3 g.
Frequency of administration. The trial should have optimally tested echinacea at more frequent as well as higher doses, notes Blumenthal. He explains that more frequent dosing is recommended when you feel as if you're coming down with a cold or flu. A more typical dose is six times daily -- or even more -- rather than the three times daily used in the study.
Participants in the trial. Researchers studied echinacea in young, healthy college students. Yet this is not the population most likely to benefit from its use, notes Dr. Brinker, since they already enjoy robust health and competent immune systems. It would have made more sense to study echinacea's ability to enhance immunity in people who were older and more susceptible to colds to see the impact echinacea would have on those who are more vulnerable to illness.

One Piece of the Puzzle
Used intelligently and appropriately, echinacea continues to be one of Dr. Brinker's favorite botanical medicines. He told me that it works particularly well in combination with other immune-enhancing herbs, such as goldenseal. And don't overlook the fact that echinacea can function as a valuable alternative to antibiotics, which in recent years have been so overprescribed and overused that doctors fear they will no longer be effective when we really need them. When you have a cold is a good occasion to take echinacea, because antibiotics are often wrongly prescribed for colds and do nothing for them. Even when you have a bacterial infection following a cold (for example, sinusitis), when antibiotics are useful, echinacea can complement their use by pumping up your immune system.

Echinacea Rx
For the best results, buy Echinacea angustifolia root and/or Echinacea purpurea herb extract. Several quality product sources are: Eclectic Institute, HerbPharm, and Herron. "Take for to six doses daily with water or herb tea for three days, then one dose three times a day," advises Dr. Brinker. One dose is 1,000 mg of dried root in capsules or tablets or 1 teaspoon (5 ml) of echinacea alchoholic extract. Fresh freeze-dried root in capsules provides the most complete reliable source. Though there's no proven benefit to popping a daily dose of echinacea for prevention, you can use it for extended periods without worry. There are very few side effects, aside from stomach upset in some people. Some critics have cautioned against taking echinacea if you have ragweed allergies. When all is said and done, Dr. Brinker believes that the government-funded study fills in one piece of the puzzle about echinacea -- using small doses of a whole plant extract on an infrequent basis probably won't help otherwise healthy people when exposed to a virus. However, he emphatically believes that taking this limited and narrow information and making a blanket statement from it that "echinacea doesn't work" makes no sense at all.

At Risk For Heart Disease?

2006-07-19T01:24:00.000-05:00

It has long been known that declining kidney function is a precursor of cardiovascular disease. In fact, the state of your kidney function can be an indication of a potential problem throughout the body. What doctors didn't know was that the standard kidney function test -- serum creatinine -- was not an especially effective measure of kidney function, especially in older people. Now they do. More importantly, researchers at San Francisco VA Medical Center have proof of a far more effective test -- one that measures cystatin C.
WHAT'S WRONG WITH CREATININE TESTING?
Creatinine is a protein waste product of muscle mass, which healthy kidneys clear from the blood. Elevated creatinine in the blood shows that the kidneys aren't functioning properly. But there's a catch -- people who lose muscle mass with age don't produce much creatinine, which means that a blood test will indicate the kidneys are working fine even when they are not. Detecting kidney problems is crucial not only for the possibility of kidney disease but also because declining kidney function is a proven precursor of cardiovascular disease.
WHAT'S RIGHT WITH CYSTATIN C TESTING
Researchers at the San Francisco VA Medical Center recently did a study on a different blood protein waste called cystatin C that the kidneys also clear. Unlike serum creatinine, cystatin C has nothing to do with muscle and so the question was, would measuring the amount of circulating cystatin C be a more sensitive test for kidney function in people over 65 and so of cardiovascular disease risk? The answer was a resounding yes. The study measured creatinine and cystatin C in blood samples gathered in 1992 and 1993 from 4,637 participants aged 65 or older in the Cardiovascular Health Study, a long-term study conducted in four areas of the country. Creatinine measurements showed that only the top 10% of the entire group studied had a significant risk of death from all causes and no independent association of risk of death from cardiovascular reasons. In contrast, the cystatin C test identified low, medium or high risk of death from all causes as well as death from cardiovascular causes. It showed that people with the highest level of cystatin C had a 700% greater risk of death from cardiovascular causes than those with the lowest level. Furthermore, the study established that 60% of the entire group studied had some form of kidney function decline.
INSIGHT FROM THE RESEARCHER
I talked with the study's lead author, Michael Shlipak, MD, MPH, associate professor of medicine, University of California, San Francisco. Now that we know that kidney function often declines with age, it is important to identify kidney dysfunction early and to treat it with appropriate lifestyle changes and, if necessary, medicine. This would no doubt decrease cardiovascular risk and death among the elderly. Yet another value of the cystatin C test, Dr. Shlipak says, is that because it is sensitive to any kidney function decline, it helps determine patient risk for many medical procedures and even surgeries. The reason: Kidney function is directly related to patient risk, and having a realistic evaluation of it will give doctors and patients a more reliable guide in making treatment decisions. The test is FDA-approved for diagnostic purposes now, and although more expensive than the serum creatinine test, Dr. Shlipak says it isn't costly. Unfortunately, only one company makes the test at this time, limiting its availability. Ask your doctor for it anyway. The results will be worth the effort.

Injury Prone

2006-07-19T01:08:00.000-05:00

I have previously written about the problems women have with injury to the anterior cruciate ligament (ACL), a crucial part of the knee. Unfortunately, due to fluctuating hormones, women are actually prone to injury in all soft tissues (muscles, tendons and ligaments). Andrew L. Rubman, ND, explains that depending on what life stage a woman is in, she either lacks enough hormones to protect soft tissue... or has too many hormones, making her vulnerable to injury.
MENOPAUSAL AND POST MENOPAUSAL
Specifically, irregular and often insufficient progesterone levels make menopausal and postmenopausal women more likely to bruise. The reason: Cortisone, which is necessary to control inflammation, including bruising, is partially produced from progesterone. Too little progesterone equals less bruise protection. A second hormonal complication takes place when estrogen levels drop at menopause or in response to stress or other factors. The drop in estrogen can make it more difficult for injured capillaries to stop bleeding. Why? Because clotting requires calcium and calcium needs estrogen to facilitate its entry into soft tissue and the capillaries. Too little estrogen equals too little calcium, which equals problems with clotting and bleeding. To address both of these hormonal drops, Dr. Rubman recommends that women talk to their doctors about getting a prescription for bioidentical trivalent estrogen cream that contains three active forms of estrogen -- estriol, estradiol and estrone.
YOUNGER WOMEN AND OVULATION
Younger women aren't off the hook, either. For the most part, their higher levels of female hormones offer protection, but these women are vulnerable to soft-tissue injury in the three days of the month surrounding ovulation. During that time, the body releases a hormone called relaxin that softens the capsule of the ovaries to allow the release of the egg. However, relaxin "relaxes" other connective tissues as well, making them more vulnerable to injury during this period. A sure sign of ovulation is that the texture of vaginal discharge changes, taking on a "spindling" effect. Dr. Rubman advises women who are physically active to slow down if possible during those three days each month, or at the least, be particularly careful.
TREATING THE INJURY
If you do get a soft tissue injury -- a sprain of the ligament (the connective bands holding bones together), or a strain of the tendons (the ends of muscles that connect them to bones) or muscles -- Dr. Rubman suggests the following for optimum healing...
Sprained ligaments: In the acute phase -- when even light pressure elicits discomfort -- of a sprained ligament, ice the injury. Best: Five or so minutes on, five or so minutes off -- as often as possible. When it no longer hurts to apply gentle pressure to the injury, switch to contrasting heat and ice. (Heat increases the rate of nutrients going in and waste coming out of the ligaments.) Place the injured area in an Epsom salts bath at 100° F to 104° F (check with a thermometer) for five minutes... follow by icing for two minutes and then nothing for three minutes. Repeat this 10-minute cycle three or four times in a row and perform two or three times a day until you can move normally. Pain should decrease and perhaps be gone. Note: Individuals with medical conditions that may alter the perception of or response to heat should seek professional oversight for treatment.

Tendon injuries: Tendons often require treatment by a physician. However, Dr. Rubman says you also can aid healing with icing and heat therapy (outlined above) and with aloe vera -- but from the inside out. Mix one-quarter cup each of aloe juice concentrate and water, and drink it. Stop when stools are soft. Aloe vera helps heal soft tissue injuries by converting uric acid -- a waste product of the injury -- to urea, a metabolic waste product converted by the body from ammonia, which the body can more easily rid.

Muscle bruises: For bruised muscles, make a comfrey root powder pack. Boil dried comfrey root powder with water until you have what Dr. Rubman describes as a "thick goop." Put this into a compress and place directly on the bruise. Keep it on all day, even throughout the night, he says, and watch the bruise disappear.

Surgery Results Are No Sure Thing

2006-07-19T00:59:00.000-05:00

If you're one of the millions of Americans contemplating surgery to remedy low-back pain, wait a minute and think about this...
A study released last June in Spine, an international journal for the study of the spine, found that most surgeons are "overly optimistic" when they're talking to patients about the benefits of back surgery -- nearly 40% of those surveyed had no measurable reduction in back pain post-surgery, even though their doctors had assured them of the results. How can that happen? It's the result of a complicated mix of doctors who are too quick to recommend surgery... patients who are desperate for quick relief and pushing for surgery... and surgeons who rarely hear feedback on the long-term results of back surgery because they are often out of the loop once the surgery is over. "Often the surgeon is not aware of what happens to his/her patients one year later and may simply assume that no news is good news, " says John-Paul Vader, MD, MPH, associate professor at the University of Lausanne Medical Centre in Switzerland and one of the study's co-authors. "What we need are high-quality clinical databases that systematically follow up on patients undergoing procedures (and those who forego the procedures) to help us acquire information about prognosis and outcomes."
NOW WHAT SHOULD YOU DO?
Here are some things to try before you opt for the knife...

Wait it out. As excruciating as it sounds, many types of back pain -- including those associated with sciatica -- go away on their own within six to eight weeks.

Look for connections. According to Dr. Vader, the best candidates for surgery are those who have an acute case of sciatica (not back pain alone), with a protruding disc that can be viewed with radiological imaging, and a clear connection between the pain they're experiencing (including disappearance of a tendon reflex or massive loss of strength in the thigh or leg) and the nerve root affected by the protruding disc. If all of these factors aren't present, surgery likely won't be your best option.
Seek multiple opinions. Get advice from both surgical and nonsurgical specialists before you decide on the right course of action for your problem. For therapy advice, get a referral to a physiatrist, a physician who specializes in physical medicine and rehabilitation.
Get back to life. Don't baby your back for long -- it will only get weaker. "It is generally recognized now that, with the exception of perhaps a very short period of rest during the initial one to three days after an injury, the best results occur with those patients who have continued their normal daily activities," says Dr. Vader.
In the end, you may still decide that surgery is your best treatment option. But by studying all the alternatives available to you, you'll know what lies ahead should you choose surgery -- and you'll be more realistic about the possible outcomes.

Soy For You

2006-07-19T00:53:00.000-05:00

A few years ago, if you had asked me what the best "health food" in the world was, I probably would have said "soy." Now I'm not so sure. For years, we've been hearing that soy is a good source of protein, lowers cholesterol and reduces the risk for heart disease. There was also talk of soy protein having a protective effect against cancer. The reputation of soy still seems solid with mainstream doctors and dietitians. Lately, however, there have been rumblings of dissent in the nutritional community -- and some of these rumblings are very loud. Have we been oversold on soy? To find out, I spoke with Kaayla Daniel, PhD, CCN, nutritionist and author of The Whole Soy Story: The Dark Side of America's Favorite Health Food (New Trends), who wrote three well-documented protests filed with the FDA regarding the proposed soy protein/cancer health claim. What I learned was disturbing.
MARKETING Versus SCIENCE
"Soy is not a health food, soy is not a panacea and soy has not even been proven safe," Dr. Daniel told me. "It's a triumph of marketing over real science." According to Dr. Daniel, the soy we are being sold in today's US market is a far cry from the soy eaten in Asian diets. "The type of food Asians eat is very different from what's appearing on the American table," she said. "While Asians do indeed eat small amounts of old-fashioned whole soy, they do not consume processed products made with soy protein isolate, texturized vegetable protein and soy oil. They rarely if ever consume soy shakes, energy bars, soy milk, soy burgers and other newly invented foods that use processed soy rather than 'the real deal'."
THE PROBLEMS WITH SOY
According to Dr. Daniel -- and to the growing number of soy detractors -- there are several other problems with soy...
First, it's not a particularly good source of protein. "Soy is very low in an essential amino acid called methionine, without which it can't be fully digested and utilized by the system," said Dr. Daniel. "It consistently scores low on almost all protein ratings except one, the protein digestibility corrected amino acid score (PDCAAS), which was set up as almost an 'affirmative action' rating system to make soy look better than it is."
Second, soy contains phytates. Phytates are compounds found in beans, grains and seeds that bind toxic metals such as cadmium (a good thing), but also bind with minerals such as iron, zinc, calcium and magnesium, preventing their absorption (a bad thing). Phytates can cause iron deficiencies, leading to fatigue, lethargy, poor athletic performance and a weakened immune system. Iron deficiencies also can affect the thyroid, which in turn leads to weight gain. Soy also contains protease inhibitors, compounds that inhibit important enzymes, such as trypsin, which are needed to digest protein. Protease inhibitors are the reason that soy protein, in all forms, is notoriously hard to digest and can badly stress the pancreas. "The commonly held notion that low levels of these protease inhibitors pose no threat to human health is simply untrue," said Dr. Daniel. Protease inhibitors have been linked to malnutrition and pancreatic disease. "While it's widely believed that cooking destroys them, it does not eliminate them completely."
Finally, there's the issue of phytoestrogens, which are plant estrogens found in soybeans. Phytoestrogens exert estrogenic effects directly and indirectly throughout the body. When eaten in sufficiently large quantities, "they can interfere with the production of thyroid hormones, disrupt menstrual cycles, contribute to infertility, even interfere with testosterone production in men, reducing their sex drive," Dr. Daniel told me. She concedes that soy sometimes reduces hot flashes but warns that the possible benefit is outweighed by proven risks to the thyroid, already a vulnerable gland for menopausal women, most often causing weight gain, fatigue and brain fog. Due to dangerous risks to ovarian hormone production, these phytoestrogen products derived from soy should not be used over the long run to treat PMS or symptoms of menopause.
SOY AND CANCER
As for the claim that soy prevents cancer, soy estrogens are listed as carcinogens in some chemistry textbooks. Dr. Daniel believes that compounds in soy may indeed have valid pharmaceutical uses in cancer treatment, but that's not the same as saying we should eat a lot of soy foods. According to Dr. Daniel, numerous studies actually show that soy can contribute to, cause and accelerate the growth of cancer. "Most alarmingly," she told me, "parents who feed their infants soy formula are unwittingly giving them the hormonal equivalent of three to five birth control pills a day, potentially interfering with brain and reproductive system development." The British Dietetic Association, Swiss Federal Health Service and other health authorities have warned parents and pediatricians against the use of soy formula, but in America, 25% of the bottle-fed market uses soy formula... and this number is growing. Although most researchers are more moderate, believing that one or two portions of a good soy protein a day are probably fine, more and more nutritionists share Dr. Daniel's thinking. "There's no problem eating traditionally fermented products like miso in moderation, and even a little tofu once in a while," she told me, "but for people who want protein shakes, whey is a much better choice. The problem isn't the moderate consumption of soy -- it is the enthusiastic view of it as a perfect protein option for those looking to reduce their consumption of red meat and dairy products."
The answer? Moderation. Almonds anyone?

The Daily Dose

2005-06-28T22:31:00.000-05:00

Next time you're trying to decide if you should exercise or not because you just "don't feel like it," consider this: In a study at University of Missouri-Columbia, researchers found that mice deprived of exercise for only two days had a 30% reduction in insulin effectiveness as measured by the amount of glucose content in their muscles. The implication? Regular exercise is required to keep your body's engine running smoothly and efficiently. Researchers had mice run on exercise wheels for three weeks and then deprived them of their activity -- enforced lethargy, if you will -- for up to two days. Amazingly, in just that short time, the mice's sensitivity to insulin dropped. Insulin works by removing glucose (blood sugar) from the bloodstream, transporting it into the muscles and other tissues where it then binds to receptors on the muscle wall that make it possible for the muscle to turn glucose into energy. Among active people, this system is highly efficient, but in non-exercisers, that's not the case -- they have fewer receptors in the muscles for binding insulin, and this makes the process of transferring glucose to muscles for energy production sluggish. Sluggish energy production translates into lack of energy, weight gain and increased blood sugar levels. As I said above, the results were striking -- in the newly lethargic mice, the amount of glucose their insulin took to the muscles decreased by one-third. I talked with the study's author, Frank Booth, PhD, professor of biomedical sciences and director of the MU Health Activity Center. Dr. Booth says that although this was a mouse study, a similar study on humans also has shown rapid changes in insulin insensitivity with inactivity. He adds that even among people with a high genetic risk for diabetes, studies have shown that regular exercise can reduce their risk of developing the disease by 40%. This clearly shows that the rule of exercise is to do it nearly every day. But the question remains, "How much?" Dr. Booth says that getting Americans to exercise presents a challenge that requires changing the culture of a car society. Unfortunately, in our mechanized, computerized, remote-controlled society, people don't need to be physical to accomplish their tasks. Dr. Booth suggests that it's not necessary to "work out" each day -- it's necessary to be physical each day. Walk, climb stairs, do yard work, sweep the garage, vacuum the rugs -- these are all physical activities that make the body move. Start there... and then you can work your way up to a more structured exercise regimen. Just don't do nothing.

Specific Solution

2005-06-28T22:24:00.000-05:00

Seven years ago, a friend who suffers from Crohn's disease wanted to get pregnant (which normally isn't problematic for Crohn's sufferers), but she was dealing with a particularly bad flare-up of the disease. Her doctor gave her two options. She could go on the drug 6-MP, which brought with it risks that include allergy, leukopenia (a serious reduction in white blood cells), pancreatitis and nausea and that takes up to six months to take effect, and even longer to taper off. Or she could have surgery to remove the diseased portion of her intestine. Neither option appealed to her, so she started digging. Eventually, she found the book that made the difference: Breaking the Vicious Cycle: Intestinal Health Through Diet, by Elaine Gottschall, BA, MSc. Testimonials about the book and the diet it outlines -- known as the Specific Carbohydrate Diet (SCD) -- gushed about how well it worked, so she tried it, faithfully following its rigid guidelines. Six months later, the disease was in remission, and she was pregnant. Now, years later, she has slacked off on the diet and her symptoms have reemerged, so she is contemplating using the diet again. While the SCD requires commitment, for those who suffer the pain of chronic intestinal illness and/or the misery of side effects from damaging drugs such as 6-MP or prednisone, it is definitely an option worth considering. Generally speaking, the SCD is a strict grain-free, lactose-free, sucrose-free regimen intended to treat a broad range of inflammatory bowel diseases -- ulcerative colitis, celiac disease, diverticulitis, Crohn's, etc. The idea behind it -- our bodies had millions of years to adapt to a diet consisting mainly of meat, fish, eggs, vegetables, nuts and low-sugar fruits, but we're not as equipped to digest more recent introductions to our diet, such as starches, grains, pasta and legumes, not to mention the refined sugars and chemical additives so common today. The remnants of the undigested nutrients overfeed opportunistic intestinal microbes, and the resulting by-products lead to inflammation. The book specifically outlines which foods are allowed and which ones aren't -- and those guidelines need to be followed exactly. There are two major challenges to the diet. First and foremost, I won't kid you -- it's a lot of work. Because many processed foods contain emulsifiers and additives that use the wrong type of carbohydrates, dieters are forced to prepare their own ingredients. (Eating out is not a good idea, because you won't know exactly what's in your food.) This goes beyond simply shopping at a natural-food store. Need flour? Grind some almonds into a fine powder. Ketchup? Mayonnaise? You need to make your own. It's time consuming and tedious, though Gottschall is quick to point out that if a parent has a child suffering from a bowel disease, the inconvenience is worth the outcome. "Why not hire a retired grandmother to come in once a week and cook for you?" she says. Anecdotal evidence, such as that found on Gottschall's Web site, (www.breakingtheviciouscycle.info), and reviews of the book at Amazon.com and elsewhere support Gottschall's claim that thousands of people suffering from inflammatory bowel disease (IBD) have been helped by the diet. For medical science, though, that's not enough. "The diet is a neat idea, but we actually have no real proof that it's beneficial," says Edward Loftus, Jr., MD, associate professor of medicine in the division of gastroenterology and hepatology at the Mayo Clinic College of Medicine in Rochester, Minnesota. "The best kind of evidence is from randomized control trials, where there are two groups of patients and neither the patients nor their physicians know if they're getting the actual intervention or a placebo. Then you see which group improves. Unfortunately, it's incredibly difficult to design a randomized trial of diet." "I try to be open-minded about these things," Dr. Loftus continues, "but these diets haven't been subjected to the level of scrutiny needed for us to recommend them. Studies are needed to prove that this diet works." Though Dr. Loftus is willing to talk to his patients about diets such as the SCD, he feels that many gastroenterologists likely wouldn't be. "Doctors want to help their patients," he says, "but they're naturally skeptical about therapies unless the therapies are proven." Contributing editor Andrew L. Rubman, ND, feels that, in many cases, the problem is more than mere skepticism, and is instead a reaction to the litigious nature of our society. "If gastroenterologists do mention a connection to diet, it means they need to be experts in that diet in order to give you care," he says. "If they aren't experts and give advice on the diet, they're being negligent and that opens them up to litigation." Also, according to Dr. Rubman, designing a study to "scientifically" evaluate the many components of this diet is virtually impossible. Diets are difficult to test scientifically because there are so many ways that food can affect the body. Whatever the reason, Gottschall has been hearing skepticism from the medical community for the past 40 years. "To this day, if you have a child with chronic diarrhea, and you ask a gastroenterologist what to feed that child, he will say food has nothing to do with it," she claims. "This is lunacy." All the skepticism does is strengthen the 84-year-old author's resolve to promote the diet, even if it only reaches one person at a time. When it comes to an individual's health, Ms. Gottschall, Dr. Loftus and Dr. Rubman all agree on this: The better informed a patient is about his or her situation, the better his decisions will work for him. "If the doctor and the patient can work with each other and understand each other," said Dr. Loftus, "then that's going to be a much more beneficial relationship going forward." If you suffer from one of the IBDs and are considering trying the SCD, here's how to start...
*Find the right doctor. If you're interested in trying the SCD as part of your treatment, read Gottschall's book and talk to your doctor about it. He/she should be open to the idea and willing to help. If not, find another doctor. Or, consult a naturopathic physician who specializes in gastroenterology. He is more likely to be open to treatment protocols such as this. To find a naturopathic physician in your area, visit the American Association of Naturopathic Physicians' Web site at www.naturopathic.org.
*Get diagnosed. If your symptoms aren't the result of an IBD, the diet won't help. "I won't talk to anybody unless they've been diagnosed," states Gottschall. "What if it's a tumor causing the problem?"
*Get tested. People who suffer from IBD often have nutritional deficiencies -- low levels of folic acid, vitamin B-12, calcium and iron are common. Get a blood or urine test to check your levels. You may need to take supplements to make up the difference. Don't just buy what you think you need from a health-food store or on-line. Have your health-care practitioner prescribe the exact dose of what you need.
Note: Because of the relationship between intestinal health, hormone regulation and blood glucose management, people with diabetes, those undergoing hormone therapy and people taking selective serotonin reuptake inhibitors (SSRIs) should seek additional input from their physicians before trying the diet.
Stay informed. In the end, you're responsible for the decisions regarding your own health. Read as much about the pros and cons of any diet before moving forward with it, and don't be afraid to ask for several medical opinions before you decide what's right for you. After first seeing friends and family suffer, live on dangerous medications or have surgery -- and then seeing the improvement this diet can make -- you would certainly want to consider it as an option.

Not So Confidential

2005-06-28T22:14:00.000-05:00

We talk a lot about threats to your medical privacy. But one of the most recent incidents was something straight out of the "Believe It or Not" file. Back in April, a box of hospital statements fell off the back of a delivery truck in Cleveland, scattering 3,000 confidential patient records over the downtown streets and sidewalks of the city. The documents contained patient names, home addresses, insurers and policy numbers, the names of treating physicians, admission and discharge dates, and detailed billing information. Obviously, there's nothing those poor folks could have done to prevent their private records from becoming tumbleweed in downtown Cleveland: Sometimes circumstances are just plain out of your control. But it is important to take every measure you CAN to safeguard your medical privacy. One way to do that is to fill out a "Declaration of Medical Privacy Intent" form. This form was created by the Citizens' Council on Health Care (CCHC) -- a non-profit organization that promotes the right of each individual to control his health care decisions. You can print one out from their web site (www.cchconline.org), fill in the appropriate information, and then instruct your doctor, psychologist, pharmacist, and insurance companies to include the form with your permanent records. Unfortunately, a "Declaration of Medical Privacy Intent" can't guarantee your privacy, but it is a good way to make your position known to every person who opens your file.

It's All Fenugreek to Me

2005-06-28T22:11:00.000-05:00

Q: I have been taking fenugreek to help my hormones and to increase energy. Now I read that it also lowers blood pressure and cholesterol. How much do I need to take to gain these benefits? And is there anything else fenugreek is good for? A: Fenugreek is a plant that is native to southeast Europe and west Asia. Its small seeds, which have a bitter taste, are often used in Middle Eastern or North African cooking. But generations of Egyptians, Greeks, and Romans have also used fenugreek for its many medicinal properties. As you have learned, the spice can improve cholesterol levels. In a 24-week study where subjects were given 25 g a day, "good" HDL cholesterol rose by 10 percent, while "bad" LDL cholesterol steadily decreased. Studies have also shown that fenugreek can help stabilize blood sugar in diabetics. It works so well that sometimes it can cause the blood sugar to dip too low, so be sure to talk to your doctor before trying it for this condition. Fenugreek can also aid digestion. Occasionally it can cause diarrhea, though. Decreasing your dose should alleviate this side effect. In addition to seeds and capsules, fenugreek also comes in powder and gum forms.

What is...cholesterol? Most cholesterol is produced by the liver from saturated fats. Cholesterol is an important component to many cells of the body. It is involved in the formation of hormones and bile salts and it helps transport fats to tissues.

Race to the Finish

2005-06-24T22:31:00.000-05:00

Is work dangerous to your health? A large Swedish study indicates that if you operate under high-pressure deadlines, it may well be. In the 3,500 person study, the Stockholm Heart Epidemiology Programme (SHEEP), investigators discovered that men are six times more likely and women three times more likely to have a heart attack if they take on increased responsibilities at work, especially ones they don't like. Even more startling is that having a high-pressure deadline increased heart attack risk within the next 24 hours by a factor of six -- meaning that such people are six times more likely to have a heart attack than unaffected people. Given that so many of us operate under high-stress deadlines -- both at work and in our personal lives -- I called stress expert Joan Borysenko, PhD, to discuss it. Dr. Borysenko, author of 11 books on the mind-body connection and a frequent lecturer, explains that when people deal with extended high-stress situations, they tend to forget their own needs in order to focus on the project at hand. (If you doubt that, think back to college finals.) That not only makes you vulnerable to health risks, it also diminishes the quality of your work, she says. Nearly 100 years ago, Harvard researchers came up with the Yerkes-Dodson law, which shows that people who are under pressure work more efficiently to a certain point and then productivity drops, as she says, like a stone. That makes taking time to care for yourself a win-win for everyone. Dr. Borysenko says there are three rules to follow to care for yourself and keep you focused...
*Exercise daily. Simply walking for 20 minutes early in the day will bring you a huge dividend of improved mood and ability to focus.
*Eat three nutritionally sound meals a day. Include lean protein at each meal -- the body uses it quickly under stress -- along with fruits, vegetables and whole grains.
*Take at least 30 minutes every day for an activity that centers you. Listening to classical music, for example, not as background noise but by putting your feet up and paying attention, has been shown to be as relaxing as 10 mg of Valium. Meditation, of course, also works. Studies show that women can reduce stress by tending or befriending, which is why, as trite as it might sound, calling a friend or neatening up the house can be particularly relaxing in stressful periods for women.
And, no matter how busy you are, do not forget to make every effort to get a full night's sleep. Contributing editor Andrew L. Rubman, ND, adds that during times of stress, certain vitamin and mineral stores also can get depleted, leaving your body running on empty. A good calcium/magnesium supplement coupled with orally absorbable B-12, such as hydroxycobalamin or methylcobalamin, and a twice-daily multi-B will help you better handle stress from the inside out. Taking care of yourself requires about 50 minutes of your day, says Dr. Borysenko. But you'll find that you gain a great deal in the end -- increased productivity, relaxation and continued enjoyment of life, even under deadline pressure.

Make New Friends and Keep the Old

2005-06-24T22:25:00.000-05:00

It's the age-old debate: Women complain that men talk too little. Men complain that women talk too much. Interestingly, recent research shows that women's tendency to use communication to relieve stress actually may be saving their lives. Their secret: Having a network of friends to help release the stresses of life. "Women's friendships are vital to mental health," says Shelley E. Taylor, PhD, distinguished professor of psychology at the University of California, Los Angeles (UCLA), whose 2000 landmark study on women's friendships identified physical measures associated with stress management. We all know about stress and how damaging it can be to our health. Until this study, it was generally believed that the universal response to stress was either "fight or flight." That is, either confront the enemy or run away from it -- whether it is a sabre-toothed tiger, a cranky boss or someone who cuts in front of you in line. Now, however, Dr. Taylor and Laura Cousin Klein, PhD, assistant professor of biobehavioral health at Penn State University, have discovered something quite significant in their research about stress and gender differences. Until now, most studies about stress have focused on the male response -- but the female response to stress is different. Dr. Klein realized that when things were stressful in her lab (at UCLA), the women came in, cleaned, had coffee and talked. The men, however, holed up alone somewhere away from everyone else. Drs. Taylor and Klein hypothesized that while "fight or flight" might be the initial physiological response in both men and women, the behavioral response in women is actually "tend and befriend." Tending involves nurturing to protect oneself and one's offspring, thus reducing stress. Befriending involves creating and maintaining social networks to aid the process of tending. The reason for this behavior is a hormone called oxytocin. The behavior can not be written off as solely cultural, but rather, as physiological. Oxytocin is part of a complex "biobehavioral signaling system" and seems to be one key to explaining why women form support groups of all kinds. It is best known as a hormone that prompts labor and milk production and is partially responsible for signaling a woman to nurture her children as well as to seek out other women for help and protection. It has a calming effect and is released during periods of stress. Oxytocin's release during stressful moments means that a woman's first response may be to call a friend or relative to help her resolve whatever problems are besetting her. However, oxytocin doesn't discriminate by gender. When a man is under stress, he too produces the hormone, but most of its beneficial effects are suppressed by androgens (male hormones such as testosterone). The result is that when stuck in traffic, for example, a woman might call her mother, sister or best friend... while most men want to start cursing or clenching their fists. We already know that stress is a killer. In a Harvard Medical School Health Study, it was found that the more friends women had, the less likely they were to develop physical ailments as they aged, and the more likely they were to be leading a joyful life. The researchers concluded that not having close friends or confidantes was as detrimental to one's health as smoking and extra weight. The next time your spouse tells you that you spend too much time with your friends or you talk too much, simply smile and say, "Thanks for noticing."

A Gut Reaction

2005-06-24T11:58:00.000-05:00

Q: What is a "leaky gut," and what are the symptoms?
A: Leaky gut is a common problem, but it often goes unrecognized. It is a condition in which inflammation or damage to the intestinal wall causes large spaces to develop between the cells of the wall. When this happens, foreign elements such as bacteria, toxins, and food have the potential to "seep through" the intestinal wall and to invade the circulatory system, leading to a number of health problems. Basically, the thing to keep in mind is that if your intestines are not healthy, neither are you. The gut is the body's point of entry for nutrients and fuel. The symptoms of a leaky gut mimic irritable bowel syndrome: gas, bloating, abdominal pain, indigestion, alternating constipation and diarrhea. This can lead to confusion over the diagnosis. If you have these symptoms, it may benefit you to bring up the possibility of leaky gut with your physician.

Sugarcoating the Truth

2005-06-24T11:56:00.000-05:00

Snap, crackle, thud: That could be the jingle for cereal manufacturers who have tried low-sugar versions of some popular sugar-sweetened cereals. Reduced-sugar versions of Fruity Pebbles, Cocoa Puffs, Trix, and Frosted Flakes have recently appeared on supermarket shelves, and most consumers who purchase them think they're buying a healthier alternative to the super-sweet originals. But scientists have found that the cereals contain virtually the same amounts of calories, carbohydrates, fat, fiber, and nutrients as the original versions. Nutritionists at five universities were recently asked by the Associated Press their opinion of these new cereals. They suggested that eating low-sugar cereals held no nutritional advantage. The scientists found that the removed sugar had been replaced with other carbohydrates to preserve the cereal's crunch. Since the body treats all refined carbohydrates the same, whether they are grains or sugars, these low-sugar cereals don't even benefit people with diabetes. Bottom line: The cereals are just a marketing ploy. They were introduced last year after the media began focusing attention on the nation's obesity problem, particularly among children and adolescents. Food lobbying groups have frequently cited sugary cereals as part of the problem, stating that the cereals encourage children to consume empty calories rather than nutritional whole foods. All the negative publicity forced food companies to come up with new ways to sell their products to a public obsessed with weight-watching and health. What is the cereal manufacturers' view on all this? Well, they claim they never said the low-sugar cereals were more nutritious, just lower in sugar. They say they simply are providing a variety of options to buyers who are concerned about the amount of sugar in their diets. They can sugarcoat it all they want, but the truth is, if you're concerned about your sugar intake, your best bet is to avoid these cereals altogether.

Peel Me a Grape

2005-06-23T22:06:00.000-05:00

Some people take grape seed extract (GSE), a supplement with many antioxidant properties, because it's said to improve vascular disorders, diabetes, leg cramps, skin problems and even impotence. Now researchers have found that when they put GSE into mammalian tissue, it produces molecular changes that suggest the supplement could protect normal brains against dementia. The study was conducted at the University of Alabama-Birmingham for the Purdue-UAB Botanicals Center for Dietary Supplements Research, and initiated in part by the National Institutes of Health Office of Dietary Supplements. I talked with Eric Yarnell, ND, president of the Botanical Medicine Academy and author of many books on complementary and alternative medicines, about the study. Dr. Yarnell is a firm supporter of the use of GSE. He says that its antioxidants do in fact make it a powerful tool for all the reasons listed above. But, surprisingly, he isn't particularly impressed with this study. Although the study bills itself as the first direct evidence that GSE affects specific proteins in normal brains protecting them against future dementia, Dr. Yarnell says that it has been known for some time that grape and grape compounds help protect the brain. The findings are not new, he says. The only distinctive feature of this test-tube study is that it demonstrates one particular mechanism of action that now provides an explanation for results science had previously found. Still, the study does serve to underscore the effectiveness of GSE. Dr. Yarnell explains that it is the proanthocyanidins, a class of nutrients belonging to the flavonoid family, also called procyanidolic oligomers (PCOs), that make GSE so valuable for health. In addition to their antioxidant properties, PCOs are believed to strengthen blood vessels and assist blood circulation, hence their relationship to vascular health. You don't need to take GSE, though, to add PCOs to your diet, says Dr. Yarnell. And you also don't have to eat grapes if you don't like them. Most berries, such as cranberries and blueberries, have the same benefits. In fact, he says all fruits and vegetables that are purple or red are good, as is hawthorn, a berry found in supplement form. With summer berry season just around the corner, the benefits of PCOs give another reason to enjoy the bounty of the season.

Going Up

2005-06-23T21:59:00.000-05:00

It's not surprising that pharmaceutical firms number among the Fortune 500's wealthiest and most powerful companies. American consumers -- and overwhelmingly, seniors -- are footing the bill for their fat profits. Need proof? This April, the American Association of Retired Persons (AARP) reported that 195 brand-name prescription drugs rose in price by an average of 7.1% in 2004 -- compared with a general inflation rate of only 2.7%. Unfortunately, steep price hikes are nothing new with Big Pharma. This is the fifth year in a row that manufacturers' wholesale list prices for brand-name prescription drugs have outstripped inflation. Since 1999, the average wholesale price of more than 150 popular drugs rose by 35.1%, nearly three times the 13.5% inflation rate over the same period. According to the AARP, of the 195 brand-name drug prices tracked in 2004...
*143 rose by more than 5%.
*46 rose by 7.6% to 10%.
*35 increased by 10% to 15%.
*Eight rose by more than 15%.
*Only one drug price -- Prilosec 20 mg -- did not change.
Generic Drugs: Still a Relative Bargain
The AARP also monitored the prices of 75 generic drugs. The good news is that these rose by an average of only 0.5%, with only nine outpacing inflation. This means that generics still represent a relatively good deal for consumers. What is driving the dramatic leap in brand-name prices? One constant factor is that when drug patents expire after 18 years, pharmaceutical manufacturers face stiffer competition from lower-priced generic drugs. This means that for the period when patents still are in place, companies work hard to make as much money as possible, raising prices as high as the market will bear. But with the new Medicare benefit for seniors about to kick in in January 2006, drug companies have a strong additional motivation. According to Marshel D. Davis, an assistant professor in the health sciences department at the University of Arkansas in Little Rock, it is obvious that pharmaceutical manufacturers are upping their prices in anticipation of the drug discount cards slated to be distributed soon to all older Americans. While Medicare claims that the new cards will give senior citizens discounts of 11.5% to 17% off average retail drug prices, he says that by January 2006, brand-name prescription drug prices are apt to have risen so much that they will cancel out any real benefit. Not only will seniors continue to pay a lot for their drugs -- all taxpayers will watch their hard-earned money wasted through this pricing abuse. It is frustrating that we can't directly challenge the Pharma companies on their policies. But there are steps you can take to undercut their efforts...
*Whenever possible, ask your physician to prescribe less expensive generic drugs. A list of all FDA-approved drugs and their generic equivalents can be found at www.fda.gov/cder/obdefault.htm.
*All things being equal, ask your physician to prescribe older, less expensive drugs. (An added benefit here is that older drugs generally have a longer track record for safety.)
*Ask your doctor to prescribe higher-strength tablets and use a pill splitter (not a regular kitchen knife) to split them in half. NOTE: Not all prescriptions are candidates for pill splitting. Do not do this with capsules, enteric-coated pills or timed-release preparations.
*Ask your physician to write 90-day rather than 30-day prescriptions. You may want to check with your insurance company first, but often the co-pay is the same for a 30- or 90-day supply.
*Shop around. Compare prescription drug prices among different pharmacies in your area. Also investigate on-line alternatives, which can be as much as 20% to 50% less expensive because of their lower overhead. Reliable on-line pharmacies include Medco (www.medco.com) and Express Scripts (www.expressscripts.com).
*Look into pharmaceutical companies' lower-cost drug programs. For example, 10 drug manufacturers have banded together to offer discounted savings on more than 275 brand-name drugs in the Together Rx Access Card Program. For details, visit www.TogetherRxAccess.com or call 800-444-4106.
*For a list of state pharmacy assistance programs, visit the Web site of the National Conference of State Legislatures at www.ncsl.org/programs/health/drugaid.htm. Programs vary state by state, but often there are special discount programs for low-income seniors, the disabled and/or low-income people without insurance who are not eligible for Medicaid.
*Look for "special discounts" that may apply to groups of people who fall into the new "pre-disease" category/market. In order to encourage broader prescription and utilization of drugs, new studies are looking into prescribing medications for conditions that show indications of developing. Under the label of wellness medicine, we now see pre-hypertension, pre-diabetes, pre-high cholesterol and pre-obesity, which the pharma companies are "treating" with drugs. Often, before insurers reimburse for the "pre-condition" perscription, samples are made available to test the efficacy of the pharmaceutical. While premedicating for a condition has its supporters and detractors, you may be able to qualify for free samples nonetheless.
To learn more about the upcoming changes, visit www.medicare.gov or call 800-MEDICARE (1-800-633-4227).
Above all else, look at your lifestyle. Are there things you can do to make yourself healthier through proper nutrition, exercise, good sleep and the elimination of cigarettes and excess alcohol? By creating a healthier environment for your body, you may reduce your need for one or more drugs or at least lower your need for them, as a diabetic friend of mine recently learned. She cut her use of Glucovance from three times per day to one time per day simply by eating a healthier diet and exercising regularly. What can you do?

A Message In A Bottle

2005-06-23T21:54:00.000-05:00

Q: Is there anything that can be done to restore hair color? A: There are some natural options to try to combat graying hair. Studies have reported that the combination of 100 mg of pantothenic acid (vitamin B5), 200 mg of PABA, and 50 g. of brewer's yeast have proven effective in restoring hair color. Keep in mind that you won't see drastic overnight results using these supplements; any results will be seen gradually over the course of a few months. And it should also be noted that if you stop taking these supplements, you will lose any benefit you gained and the gray will return. If you'd prefer to get rid of the gray entirely (and sooner), with a more herbal-based, non-chemical product, try henna, which can change your hair color without endangering your health. Studies have shown that women who used chemical-based dyes for long periods have a much higher incidence of non-Hodgkin's lymphoma and other cancers. The good news is, there seem to be more and more non-chemical products to choose from. If the above doesn't work, you can always remain philosophical about it: with age comes wisdom. Why cover that up?

More Harm Than Good

2005-06-19T12:27:00.000-05:00

If you're not convinced yet that synthetic, mainstream hormone replacement therapy (HRT) is more trouble than it's worth, then here's yet another reason: Researchers have found that hormone pills seem to worsen urinary incontinence, especially the leakage brought on by sneezing, laughing, coughing, or walking. Women on HRT have more than double the risk of developing this particular type of incontinence, the study concluded, and the risk was especially acute for those taking pills containing estrogen alone as opposed to the combination pill of estrogen and progestin. Those taking estrogen-only pills had a 53 percent greater chance of developing any type of incontinence by the end of one year than women who were given a placebo. Women given pills containing both hormones experienced a 39 percent increase in risk. For those who were already experiencing problems with urinary incontinence, hormones were found to make it worse. Those taking estrogen faced a nearly 60 percent higher risk of worsening symptoms over the course of a year; women given a combination pill saw their risk climb 20 percent higher than those taking a placebo. The findings come from the same government study that over the past few years have linked the supplements to a higher risk of heart attacks, strokes, breast cancer, and dementia in women taking them to relieve symptoms of menopause. The study followed 27,347 women, ages 50 to 79, as part of the Women's Health Initiative. This latest finding is particularly startling because it completely contradicted what all of the "experts" thought was true: that estrogen and progestin actually lessened or prevented incontinence in menopausal women. This is just one more reason to opt for bio-identical HRT instead of the synthetic, problem-laden variety. If you'd like to look into this option, you might want to refer to Dr. Wright's book "Natural Hormone Replacement for Women over 45" (available in most bookstores and from amazon.com).

What is....urinary incontinence? Urinary incontinence is a disorder that affects primarily older people, particularly women. It occurs when the the efficiency of the muscles surrounding the urethra declines. There are many different forms of the disorder: stress incontinence, brought on by laughing, sneezing or heavy lifting; urge incontinence which is frequently triggered by a sudden change in position; total incontinence, which is a complete lack of bladder control; and overflow incontinence, a condition where the person is unable to empty the bladder normally, often because of an obstruction.

Little Things Can Mean a Lot

2005-06-18T14:22:00.000-05:00

Managing diabetes can be a tedious ordeal. Constant vigilance is required to watch all that you eat while constantly monitoring blood sugar levels. In the midst of all the "big stuff," Judith H. McQuown, diabetic and author of 1,001 Tips for Living Well with Diabetes: Firsthand Advice That Really Works, said she has found some little things that have made a big difference for her in coping with diabetes. Some of her favorite strategies include...
*Double-check unusual test results. Don't immediately take a glucose tablet or adjust medications when you get a blood glucose reading that's unusually high or low. Repeat the test -- and then repeat it a third time if the first two tests are off by more than a few points. Unusual readings when you don't feel any differently could be due to contamination from trace amounts of food or other substances on the fingertips.
*Buy sugar-free medicines. The sugar in cough syrups, some antacids and other medications makes it harder to control blood glucose. Some over-the-counter drugs can change blood glucose readings by up to 50 points. Buy drugs with the words "sugar-free" prominently displayed on the label.
*Use the smallest-gauge needles for injecting insulin. Smaller needles -- say, a 31-gauge needle instead of a 28 -- do the same job with less pain and tissue damage. Ask your doctor to prescribe the smallest gauge needle available.
*Take a daily multivitamin/mineral supplement. A recent study found that only 17% of people with type 2 diabetes who took a multi got an infectious illness, compared with 93% of those taking a placebo.
*Experiment with lancing devices. They're not all the same. Some penetrate too deeply or are hard to use. Try different ones to see what's best for you. Consider a pressure-adjustable model, which allows you to dial in different pressures for different fingers.
Give your fingertips a rest. It's fine to check blood sugar by lancing other parts of your body -- your forearm, calf, thigh, etc. Caution: You must use fingertip blood when testing for hypoglycemia.

Someday -- One Day

2005-06-18T14:18:00.000-05:00

People with visible or measurable medical conditions, such as diabetes or high blood pressure, are easy to treat. They know they have a problem that needs to be treated -- now. But "someday" illnesses, such as osteoporosis, are a much different story. An average woman will lose 1% to 2% a year of bone mass after the age of 30 if she doesn't do something about it. If you keep losing bone mass, osteopenia (early bone loss) becomes osteoporosis (potentially irreversible bone loss). Once you have osteoporosis, it is almost too late to rebuild bone strength and density... and drugs used to slow loss are not without their risk. A far better choice is a healthy diet and lifestyle that prevents the development of this life-limiting condition. The good news is that it doesn't take a lot of effort to ensure that you're still swinging a golf club for years to come. According to Liz Neporent, MA, CSCS, author of Weight Training for Dummies, the key to osteoporosis treatment is quite simple: "You have to lift weights," said Neporent. "You can throw calcium at the problem all day long, but unless you train your bones to hold onto that calcium, it's not going to do much good. Weight training teaches bones to hold on to calcium and stay strong. The act of weight-bearing exercise sends a signal to the bones that they need to be strong to endure the exercise." "The one thing most people don't realize," pointed out Neporent, "is that osteoporosis is site specific. What that means is that you might not get it in your legs, but you easily could get it in your upper body if you don't use your arms. That's why a weight-training program has to address all the major muscle groups of the body." "Walking is a great way to hold on to bone strength," said Neporent. "Running is great as well, if you do it in moderation." She defined moderation as whatever doesn't cause you to have joint pain. "Both running and walking are terrific for stimulating bone growth in the legs," she said. "They load the bones with weight -- your own -- and help you to keep calcium in the bones where it belongs. Water aerobics, on the other hand, won't stimulate bone growth because there's no impact or weight-bearing on the bones and joints." But what about the rest of the body? Weight training -- using enough weight to create increased resistance and strength, such as wearing a backpack loaded with some additional weight or using hand and ankle weights. Neporent designed a basic exercise program aimed at maintaining bone health that can be done in only 20 minutes. You can do it at home or at a gym. "You need to do one good exercise for each of your major body areas," said Neporent.
Choosing the right weight is critical to the success of the program -- you have to present the bones with enough of a challenge to stimulate growth. "Choose a weight that you can do eight to 15 repetitions with," Neporent explained. "If you feel like you can easily go on after the 15 repetitions, it's time to increase the weight." "Do one set of each exercise, and perform the entire routine twice a week," Neporent told me. This is also the protocol that the prestigious American College of Sports Medicine (ACSM) advocates for the maintenance of strong muscles and healthy bones. Here's the routine...
*Squat. Stand with feet hip-width apart. Bend your knees till your thighs are parallel to the floor. As you bend down, don't go too far forward with the upper body. Keep your abs tight and don't let your knees shoot out over your toes. (Pretend you have a chair behind you and you're aiming your butt for the chair. Then stand back up.) Add hand weights when you're comfortable. You can hold the weight at your sides or at shoulder level. You even can hold shopping bags filled with cans at your sides. "After all," said Neporent, "weight is weight."
*Calf raise. Stand on a step, hold onto something for balance and hang your heels off the edge of the step. Then lift up onto your toes and lower your heels down below the edge of the step. Repeat. When you can do it easily, hold a weight in your free hand.
*Leg curl. Kneel on your elbows and knees, extend and lift your right leg straight back, parallel to the floor. Bend the knee and bring the heel towards the ceiling. Lower back down to parallel position and repeat. Then do the left leg. When these become easy, you can add ankle weights. *Crunch. Lay on your back with your knees bent and feet hip-width apart. Bend you arms, and touch your fingers to your neck, right behind your ears. Don't lace your fingers together. Your elbows should be slightly rounded inward. There should be enough space for a grapefruit between your chin and your chest. Slowly curl your upper body up and forward off the floor, tightening up the abs. Go until your shoulder blades clear the floor. It's not necessary to go much higher to get benefit.
*Nonmilitary push-up. Get on your hands and knees and do push-ups to the floor with your upper body. This works the entire upper body, especially the chest and shoulders.
*Pullover. Stack a couple of big pillows on the floor and sit with them behind you. Lean back against them so that you are at an incline. Take a weight in both hands and hold it directly in front of your chest so you're laying back at an incline with your arms extended directly in front of your chest. Lower your arms over and behind your head, keeping your arms extended, then bring them back to the starting position in front of your chest. Repeat.
*Shoulder press. Hold a weight in each hand at shoulder level while sitting or standing. Raise the weights straight up to the ceiling and return to starting position at the shoulders.
*Bicep curl. Stand with weights in your hands, palms facing out and feet shoulder-width apart. Keep your upper arms at your sides and bring the weights up toward your shoulders by bending the elbows. Then lower them back down.
*Tricep dips. Sit on the edge of a bench or step with your hands on the edge of the bench, fingers facing forward, and feet on the ground in front of you. Lift your butt off the bench and lower it to the floor by bending your arms at the elbows. Stay perpendicular to the ground, with your back straight. Lift up by straightening your arms.
That's all there is to it. With a little practice, you can complete the entire workout in about 20 minutes. Note: Check with your doctor before starting this or any other exercise regimen. Neporent reminded me not to neglect nutrition. "It's not enough to just take calcium," she said. "We need some sunlight for vitamin D. Go for a 10-minute walk in the morning sun to get your vitamin D. Magnesium, manganese, boron and vitamin K are all important to bone health as well. Make sure your supplement includes them to help with the absorption of calcium." Check with your health-care provider for the best supplements for you, since there are vast differences in how different forms of calcium and magnesium are absorbed. While the above workout won't get you into a smaller size of clothing, it will help ensure that you are walking tall for years to come.

Tears of Joy

2005-06-17T22:39:00.000-05:00

Sure, onions can add flavor to your favorite dishes. But did you know that they can help in preventing osteoporosis, too? Scientists at the University of Bern, Switzerland, have discovered that a chemical compound found in onions appears to retard bone loss. Researchers analyzed the active chemical components of white onions and ascertained that a peptide called GPCS was most likely responsible for this benefit. This information adds to other studies, which have also found benefits in eating onions. Last month I told you about a study conducted at Cornell University that found that onions with the strongest flavor, such as New York bold onions, western onions, and yellow shallots, seem to inhibit the growth of liver and colon cancer cells. In the Swiss study, the researchers obtained a group of isolated bone cells from newborn rats and exposed the cells to parathyroid hormone to stimulate bone loss. They then exposed the treated cells to the peptide compound GPCS. They found that exposure to the compound helped to significantly inhibit the loss of bone minerals, including calcium. This is great (if not surprising) news; onions contain the antioxidant polyphenol, specifically the flavonoid quercetin. It is widely believed that polyphenols play a role in preventing the onset of all sorts of serious health conditions -- from certain cancers to cardiovascular disease. Now it looks like we can add osteoporosis to that list as well.

Diet and Potassium

2005-06-17T22:34:00.000-05:00

Q: I know that bananas, raisins, prunes, and potatoes are all good sources of potassium. But those foods are a concern for those of us who suffer from Type 1 diabetes and must maintain strict control over our blood sugar levels. Can you tell me some low glycemic sources of potassium that I might add to my diet? A: You are right to be concerned. A food's glycemic index rates the speed at which your body metabolizes carbohydrates and the food's ability to increase blood sugar. Avoiding foods that create too much of an insulin reaction in your body is the key to controlling diabetes. Unfortunately, as you have found, many foods that are rich in potassium also rate high on the glycemic index. There are other foods that are known to be rich in potassium, but please check with your doctor to make sure they are right to include in your diet, and to get details about how much or how often they should be added. Sun-dried tomatoes are an excellent source of potassium. So are sweet potatoes, which are on the lower end of the glycemic index. Beet greens, celery, carrots, radishes, tomatoes, Swiss chard, squash, and spinach are other good sources and can be added as your diet permits. White beans or soy beans, seeds, and nuts, (which are also a good source of protein), are high in potassium, too. Taking a potassium supplement may be your best bet if you can't get enough potassium through diet alone. If you are following a low-carbohydrate diet and are not eating at least five to six servings of vegetables every day, make sure you take at least 400 to 500 milligrams of potassium daily.

What is ...the glycemic index? The glycemic index rates the speed at which various carbohydrates are metabolized and ranks their ability to raise blood sugar. Glucose is used as the reference point for the index, with a rating of 100 on the scale. Table sugar has a rating of 65; a bagel 72; sweet potatoes earn a 54; an apple ranks a 36, while watermelon comes in at 72. Basically, the higher the rating on the glycemic index, the bigger impact the food will have on your blood sugar level.

They Do

2005-06-17T22:29:00.000-05:00

Guess what? This is Men's Health Week (June 13-19). So, I thought I'd let you know the key to men's good health: Be married. According to a recent report from National Center for Health Statistics, married men are healthier than single men, except for slightly increased obesity rates. The report, based on interviews with 127,545 adults age 18 and over, explains that married men are less apt to be in fair or poor health than single, divorced or widowed men... that fewer married men smoke or drink heavily... and they are more physically active.
While this report is new, it isn't really news -- studies have consistently shown that marriage is good for men's health. But the information continues to be intriguing. Why is marriage so good for men, and is there a lesson in it for the rest of us? To find out, I called Michael Hirt, MD, who has an active family practice as medical director of the Center for Integrative Medicine at Encino-Tarzana Regional Medical Center. Dr. Hirt is also associate clinical professor at the UCLA School of Medicine. Dr. Hirt says that men are notorious for refusing to see doctors and for failing to take good care of themselves. But this attitude changes among married men, partly he says, because they start to invest in their good health as a way of caring for their family. But, he adds, the changed attitude also reflects having a woman in their lives. Women, he says, are much more aware of health and are more comfortable involving themselves in the health-care system than are men. Women nudge and, when necessary, push their men to have regular checkups, to seek treatment for possible problems and to follow the doctor's orders. Women are also instrumental in getting men to live more healthfully in general. Dr. Hirt does worry, though, about the higher overweight rate among married men. The report found that 70.6% of husbands were overweight versus 65.1% of all men. He says that, at the very least, men should take it upon themselves to lose even just 10 pounds. Although not a lot, he says that 10 pounds can reduce the risk for chronic disease and contribute significantly to good health.

Looking Through the Keyhole

2005-06-17T22:22:00.000-05:00

Colon cancer is the third most common cancer afflicting men and women alike. It's a challenging disease to live with and treat, but now its sufferers have a new alternative to standard open surgery. In a Mayo Clinic study reported in the New England Journal of Medicine last year, researchers demonstrated that "keyhole" laparoscopic surgery was as safe and effective as more invasive, or "open," operations for most people with colon cancer. The National Cancer Institute (NCI) funded this comparison study as a top priority clinical research project. Colon cancer surgery involves removing the diseased part of the colon and reattaching the healthy segments. With laparoscopic surgery, instead of doing this through a major incision, surgeons make several small "keyhole" incisions through which they insert a tiny camera and miniature surgical instruments, such as scissors and graspers. They manipulate the instruments based on images passed from the camera to a monitor in the operating room. According to Heidi Nelson, MD, a colorectal surgeon at the Mayo Clinic and chief author of the study, survival rates, tumor recurrence and complications are virtually identical with open and laparoscopic surgery. However, the laparoscopic procedure offers more quality-of-life advantages to patients. As with all laparoscopic procedures, for people with colon cancer, less invasive surgery translates to a less traumatic experience overall -- less postoperative pain, less pain medication, a faster recovery and the chance to go home a day or two earlier. After healing, instead of a six- to eight-inch vertical scar, a person is left with several smaller, less noticeable horizontal scars. Laparoscopic surgery for colon cancer was introduced in 1991, after being used in gallbladder and appendix operations in the 1980s. In 1994, performances of the procedure ground to a virtual halt due to widespread concerns: Surgeons could not remove all the cancer with this procedure... tumors cells would be disturbed... and there would be higher rates of recurrence. The seven-year international study put these concerns to rest, says Dr. Nelson. She and her colleagues at 48 hospitals in the US and Canada randomly assigned 872 people with colon cancer to undergo either standard or laparoscopic surgery. The study excluded patients with late-stage or metastatic cancer that had spread to other organs... extensive scarring from previous surgery... or rectal cancers or tumors in the mid-portion of the colon. Laparoscopic surgery is not for everyone. Very large tumors cannot be removed through a keyhole. Open procedures remain a better alternative when cancer spreads, to make sure the surgeon removes it all... and it is not possible to use laparoscopic surgery with hard-to-reach cancers. Dr. Nelson summarized the findings. Researchers found...
*A virtually identical survival rate -- 86% of laparoscopic patients were alive three years after surgery, as compared with 85% who underwent standard surgery.
*Almost exactly the same rate of colon cancer recurrence in both groups. Cancer recurred in 872 patients, 76 who underwent laparoscopic surgery and 84 who had the standard operation.
*Similar rates of complications during surgery and for 30 days afterward.
*A longer operation with the laparoscopic procedure (150 minutes compared with 95 minutes for the open operation), involving two or three quarter- to half-inch incisions and one two-inch incision, as opposed to one incision of six to eight inches or longer.
*A shorter hospital stay for laparoscopic patients (an average of four to five days instead of five to eight).
*Less pain following laparoscopic surgery, so less pain medication (three days versus four days of intravenous medication, and one day versus two of oral pain relievers).
*A quicker recovery overall with laparoscopic surgery -- one month rather than the usual six to eight weeks.
Laparoscopic surgery is more technically challenging than the standard open procedure, and it demands considerably more skill and experience. Dr. Nelson rates it as nine out of 10 on a scale of difficulty and complexity. Surgeons who participated in the study were required to have performed at least 20 laparoscopic colon surgeries. They also had to remain on their toes: In one out of five laparoscopic procedures, circumstances such as an unexpectedly large tumor compelled surgeons to change plans and perform open surgery. If you are considering this option, it is a good idea to interview potential surgeons first. Ask how familiar they are with the procedure, how many laparoscopic colon procedures they perform each year and where their training took place. If you are uncomfortable with any of the answers, move on to another surgeon. For more information, visit the Web site of the American Society of Colon and Rectal Surgeons at www.fascrs.org. Dr. Nelson anticipates that as a result of the national study, more surgeons will gain skill and experience in this procedure, and laparoscopic surgery for colon cancer will become more widely available. At present, laparoscopic procedures comprise only 10% of all colon cancer surgeries, but projections are that in time they will rise to 60%. At Mayo Clinic, the percentage already stands between 35% and 40%. This follows a trend that already has occurred with gallbladder operations, 90% of which are now performed laparoscopically. Minimally invasive surgical approaches are now a focus in medical schools -- and that is good news for all of us who might face surgery one day.

5 Natural Anxiety-Busters

2005-06-17T22:16:00.000-05:00

Q: What natural relaxers can I take to cope with stress better? A: First, you may want to look at your diet to see if it is too high in refined sugar and carbohydrates. Eliminating refined sugar, white flour, and other highly processed foods from the diet can help the body regulate insulin. This is important because when the body's blood sugar falls, adrenaline is released to compensate, which in turn, can induce the symptoms of anxiety. Eating smaller, more frequent meals containing a variety of protein and vegetables is a wiser choice, as is staying away from caffeine. Some natural supplements that are known to have a calming effect are niacinimide and injectable vitamin B12. Both need to be used under a doctor's supervision in order to have dosages and responsiveness closely monitored. The herbs kava and St. John's wort can also help alleviate stress and anxiety.

Keeping Your Eggs In The Basket

2005-06-17T22:12:00.000-05:00

Most women wouldn't choose to have their ovaries removed if their doctor didn't deem it necessary. But now it seems there's even more reason to think twice about this major procedure. New research done at the Mayo Clinic College of Medicine shows that the removal of ovaries could increase the risk of Parkinson's disease. In fact, the risk is double if both ovaries are removed. This discovery was made after examining the medical records of 5,000 women in one Minnesota county over a 37-year period. These new findings, presented at the annual meeting of the American Academy of Neurology, cast doubt on whether the elective removal of ovaries in women already undergoing a hysterectomy is the wisest choice, especially for patients with a family history of Parkinson's disease. What is the connection between the ovaries and Parkinson's disease? It has to do with the protective qualities of estrogen, which is produced by the ovaries. Estrogen has been shown to make certain nerve cells less susceptible to toxins, perhaps by triggering genes that make protective proteins. The particular nerve cells that estrogen helps include those in an area of the brain that controls voluntary movement. In Parkinson's patients, that is the region of the brain that shows deterioration, causing the illness' characteristic symptoms of shaking and unsteady gait. In the past, the relationship between estrogen and Parkinson's disease has been investigated only in animals. This latest study is seen as a step forward, as it is based on women and their care. In the Mayo clinic investigation, researchers found that of the 2,485 women who had undergone the surgical removal of one or both ovaries, 43 developed Parkinson's symptoms and 25 developed the full-blown disease. Removal of both ovaries seemed to place patients at an even greater risk than those who had just one ovary removed. Experts strongly caution that this information shouldn't be taken in isolation. For many women, surgical removal of the ovaries is necessary to combat ovarian cancer. But for those patients for whom removal of the ovaries is an elective procedure -- that is, when it is performed along with a hysterectomy to eliminate the future risk of ovarian cancer -- it may be a good idea to discuss this latest information with your surgeon to judge what is in your best interest.

Sound Asleep

2005-06-14T21:50:00.000-05:00

Q: A friend of mine has terrible insomnia. Is there anything besides sleeping pills that can help her get more than 4 1/2 hours of sleep a night? A: There are lots of practical ways to ensure a restful night. Try to go to bed and get up at the same time each day; avoid caffeine, nicotine, and alcohol, especially at night; and don't eat or drink too close to bedtime. Creating a restful environment helps, too. Reduce light and noise from your bedroom; make sure your bed, bedding and room temperature are comfortable, and try to keep work and television out of the bedroom. Make it a place for sleep and intimacy only. If you can't fall asleep within 15 to 20 minutes, don't toss and turn. Get up and try a warm bath, reading, or listening to soothing music. Try again after you are sleepy enough. If worrying keeps you awake, keep a journal nearby to write down your concerns in order to release them. I would avoid over the counter and prescription sleep aids, since they can be habit-forming and leave you with a groggy, "hung over" feeling the next day. Natural herbs such as kava and valerian work better; they can induce sleep without any daytime drowsiness. They're especially effective when used together. Some other natural supplements to try are passion flower, California poppy and Corydalis cava (in a 4:1 combination), and the Chinese herb Suanzaorentang. And while I don't suggest prescription drugs very often, there is one, called Xyrem, that I've found to be a highly effective and very safe sleep aid. It also helps relieve anxiety and depression. But Xyrem is expensive (about $200 a month) and somewhat hard to get. Your doctor cannot simply write a prescription for it and have it filled at a local drug store. Instead, you (or your doctor) have to fax the prescription to a "central pharmacy." And you will be required to watch a video warning you about sharing or misusing your prescription by giving it to someone else. It wasn't always this way. Years ago, Xyrem was available in health food stores under its chemical name, gamma-hydroxybutyric acid, or GHB. You may have heard media reports of GHB. It has been branded the "date-rape drug," as it is a sexual disinhibitor, like alcohol. Because of its misuse, the government now puts strict controls on its distribution. Given these hurdles, your physician may be resistant to prescribing it. But if he or she takes the time to research it, he will find that it is much safer than other sleep pills and more effective, too.

Beyond Bran

2005-06-14T21:44:00.000-05:00

When you think fiber, images of bran flakes and jars of Metamucil probably come to mind. But there are other, more appealing sources out there to help you get your dose of health-promoting fiber. Oatmeal, beans, carrots, grapefruit, oranges, apples, and pears all contain fiber. But recent research shows that there's another fiber source that can offer some distinct heart-healthy benefits. This study followed 25 people (18 women and 7 men) with mildly elevated cholesterol counts for 19 weeks. At the beginning of the study, researchers put the subjects on a diet that was moderately low in fat and cholesterol. Then their meals were supplemented with barley products containing low, medium, and high amounts of a fiber known as beta-glucan. Those on the highest-fiber diet saw their LDL (bad) cholesterol drop by an amazing 17 percent. The most significant drop occurred after the fourth week, leading researchers to believe that it may take several weeks of supplementing with barley or other fiber-soluble foods to see a significant benefit. Barley contains soluble fiber. This type of fiber does not break down in the stomach or intestines, but when mixed with water in the body it forms a gel, which not only helps keep your digestive system "moving," but also helps lower cholesterol levels. The addition of barley or other fiber-rich foods to your diet may prove to be an easy and effective way to lower your bad cholesterol. But the recommended daily requirement for fiber is 25 grams -- and it would take a lot of barley to reach that dose. But incorporating some of the other sources I mentioned above, and even adding a fiber supplement to your diet can help you get there without too much effort.

What is...fiber? Fiber is an indigestible carbohydrate found in fruits and vegetables. It comes in two forms: soluble and insoluble fiber. Neither form can be digested and are not absorbed into the bloodstream. Instead of being used for energy, fiber is excreted from our bodies. Soluble fiber forms a gel when mixed with liquid, while insoluble fiber does not. Insoluble fiber passes through our intestines largely intact.

Cease and De-cyst

2005-06-14T21:33:00.000-05:00

Q: I read with great interest your tip about using SSKI for fibroids. Does this therapy work for ovarian cysts, too? And if so, where can I get it? A: Yes, it does, and for the same reason. SSKI helps the body metabolize estrogen, which is also the culprit in ovarian cysts. In minor to moderate cases I generally recommend six to eight drops taken daily in a few ounces of water. It takes about two to three months of this to see results. But many people who have used this therapy have had a great deal of success. For the record, the same dose will also work for fibrocystic breast disease, and should work in about three to six months. Just don't forget to contact a nutritionally knowledgeable physician who can monitor your thyroid function during treatment. You shouldn't need a prescription to obtain SSKI -- although if you are working with a physician you can get it that way. You can also obtain it from a compounding pharmacist and some natural food stores. Please contact the International Academy of Compounding Pharmacists (www.iacprx.org) to locate a compounding pharmacist in your area if you don't know one already.

What is...an ovarian cyst? Ovarian cysts are fluid-filled sacs that form on the ovaries. With cancer rates climbing, and cancer deaths the second leading cause of death in this country, the word "cyst" can be scary. However, most ovarian cysts are benign in women who are past puberty and pre-menopausal. (Ovarian cysts in pre-pubescent and post-menopausal women have a greater risk of being cancerous, however.) Usually they are not painful and they resolve without treatment, although sometimes they can cause infertility, menstrual problems, and pelvic pain. The best way to guard against ovarian cysts is to keep your estrogen and progesterone levels balanced. The best way to get rid of them naturally when they become a problem is with Dr. Wright's suggested SSKI therapy (above).

McMedicine

2005-06-14T21:29:00.000-05:00

The latest medical innovation has reached a neighborhood near me -- and it will probably reach you, too, if it hasn't already. People are busy. Doctors are overworked. Three and four hours of waiting at the emergency room or urgent care facility for a 10-minute diagnosis and prescription is frustrating to everyone. One entrepreneur -- and frustrated father -- decided to do something about it. He started a fast-growing chain called MinuteClinic. Perhaps the name says it all, but let me expand. This chain, and other facilities like it, are staffed by nurse practitioners, and they limit their practice to diagnosing and treating just a handful of common ailments and procedures, such as strep throat, earaches, bronchitis, poison ivy, bladder infections, and some vaccinations. Here in Maryland, they're located within Target stores. Certainly the "shorter-wait-time, no-appointment-necessary, medical-care-while-you-shop" convenience of MinuteClinics is appealing. So I hate to be a spoil sport. But I think it's a problem. Or rather, it's an attempt at slapping a quick-fix band-aid on a much bigger problem. First of all, there is no continuity of care provided, or even implied. The assumption is that people have a primary doctor, and that they are keeping their doctor informed of the clinic visits. Which may or may not be the case. Second, the danger of missing a more serious problem is elevated. Chronic colds, strep throat, or other infections can be a signal of immune system deficiencies and underlying disease. Quick-visit clinics are an invitation to symptom management rather than practicing preventive care or case management. (Of course, that's not exactly happening at the emergency room or urgent care centers, either.) The MinuteClinic concept is merely a symptom of much bigger problems we're facing in health care today. I don't know that we can stem this tide. The business model is too strong, and the demand for lower cost, faster health care is too high. MinuteClinic alone has plans for 200 more locations in the next four years. Like McDonald's, they will be everywhere -- but whether you go or not will be up to you. More than ever, the responsibility to practice preventive and natural health will fall to the consumer. The better option here is to safeguard your health naturally, keep track of your medical records and visits, and establish a relationship with a nutritionally savvy physician who will work with you to find natural remedies for your health challenges. Don't give in to drive-thru health care.

Trail Markers

2005-06-10T11:59:00.000-05:00

Many people take their teeth and dental health for granted. However, there are an increasing number of studies in medical journals and in the media about the wide-ranging and potentially fatal consequences of gum disease, also known as periodontal disease. You think your dentist is just nagging about flossing, right? The truth is that gum disease has been repeatedly linked to risks of heart disease, stroke, the development of type 2 diabetes and even elevated cholesterol. What is it about gum disease that makes it so dangerous in so many ways? To find out, I called Michael P. Bonner, DDS, coauthor of The Oral Health Bible. Dr. Bonner's explanation was simple. "Let's connect the dots," he said.
Dot One. Gum disease is, of course, an infection, said Dr. Bonner, and infections produce inflammation. Inflammation elevates a molecule produced in the liver called C-reactive protein, or CRP.
Dot Two. Elevated CRP is a known cause of heart attack and stroke and is implicated in type 2 diabetes.
Dot Three. When gum disease is left untreated, the infection it produces spreads throughout the body.
Dot Four. Treatment for gum disease can lower CRP, and thus lower risk for other, potentially fatal conditions, such as heart attack and stroke.
To put all this together, Dr. Bonner said, think of it this way -- any condition ending in "itis," such as gingivitis, gastritis, sinusitis, pancreatitis, is nothing more than a chemical cascade caused by inflammation and processed by the liver, which in turn creates CRP. Often, this cascade begins in the mouth, with periodontal disease. Dr. Bonner disagrees with the notion that more studies are necessary to prove the links between gum disease and heart health and stroke. For him, there already is enough existing evidence. When he discovers a patient with periodontal disease, Dr. Bonner likes to test him/her -- via a blood test -- for CRP or for glycated hemoglobin (HbA1C) or both. HbA1C is another molecule in the body that may be elevated by inflammation. "That gives me a baseline to work with," he said. "Then, after a course of treatment, I retest. You can see the risk levels of CRP and HbA1C actually drop after treatment." In 1910, the Mayo brothers said that a clean mouth will help a person live 10 years longer. With all that we now know, Dr. Bonner recommends that we take their good advice.

Word of Mouth

2005-06-10T11:36:00.000-05:00

While it remains controversial, chelation therapy has been used for more than 60 years to clear the body of heavy metals, such as lead, in order to cleanse the body of their toxins. However, doctors and patients noticed almost immediately that it seemed to improve cardiovascular health as well. Today, it has become popular for that purpose. After that article appeared, many readers wrote in asking for information about oral chelation. Proponents advocate its use for cardiovascular health in particular, and it is theoretically a more convenient form of chelation therapy. With intravenous (IV) chelation therapy, patients must go once a week for an IV drip that lasts about three hours. The average number of IV treatments runs from 20 to 40. With oral chelation therapy, however, people take between three and 20 capsules every day, which contain some EDTA (the amino acid delivered intravenously in standard chelation therapy) but also a number of other ingredients, such as garlic, niacin and vitamin B-6. Patients continue taking the capsules throughout their life for enhanced health. Although on the surface it seems that taking pills would be far easier and cheaper than extended IV treatments, the real question is, is it effective? For answers on oral chelation, I first talked with my original source, Allan Magaziner, DO, coauthor of four books on natural cures for cardiac problems and current president of American College for the Advancement in Medicine (ACAM). He responded that it would be a mistake to compare the effects of oral chelation with IV chelation for cardiovascular benefits. The body absorbs only 5% of the EDTA that is in oral therapy, which he says is too small an amount to be effective. He adds that the capsules may have some good antioxidants and that the EDTA may remove some heavy metals from the bloodstream, but there is no scientific evidence that the therapy has any cardiovascular benefit. Dr. Magaziner also said that a few doctors feel oral chelation is helpful for clearing heavy metal poisoning, but most doctors feel its effects are too mild to be useful. I then called Elmer M. Cranton, MD, former president of ACAM as well as of the American Holistic Medicine Association and a longtime proponent of chelation therapy. He also is most assuredly not in favor of oral chelation. Indeed, he has serious concerns about its efficacy and safety. Not only does the body not absorb oral EDTA well, he says, but even if it did, the amount of it in oral preparations is so small that it couldn't possibly do its job. Although oral chelation might rid some metal from the blood, that is not how chelation assists cardiovascular health, said Dr. Cranton. EDTA pulls a variety of toxins out of the cells, but there must be a high concentration of EDTA to achieve this -- much higher than what is in oral chelation pills. Many of Dr. Cranton's concerns about oral chelation have to do with the way in which oral chelation works versus IV chelation. Chelating means "to bind" -- for instance, when you see on supplement labels that a mineral is chelated, this means it has been bound to amino acids to improve absorption. If the body can absorb only 5% of the EDTA taken by mouth, this leaves 95% of it roaming the digestive tract. Dr. Cranton's concern is that this free EDTA then chelates, or binds, to vital nutrients, such as zinc and manganese, making them unavailable for the body to use. In traditional IV chelation, EDTA is in the body for short bursts once a week and then clears. This takes place generally about 30 times. In oral chelation, however, the patient takes many capsules a day, every day for a lifetime. He worries that this will leave people chronically depleted of many nutrients. Oral chelation proponents claim that this is not a problem because EDTA is FDA-approved for use in foods as a preservative. Dr. Cranton rebuts this with the fact that only tiny amounts -- much less than what a person gets from the capsule therapy -- are used in foods. Dr. Cranton said that he cannot prove that the EDTA in oral chelation binds nutrients and makes them unavailable, but it is reasonable to think that it does. His concern about this issue and oral chelation overall is that there is no scientific evidence to show that it is safe or to establish that it is effective. He has spent years gathering scientific evidence on the positive effects of IV chelation on cardiovascular health, and he is delighted that the National Institutes of Health (NIH) is conducting a study on this issue. After fighting for decades to show that IV chelation is an effective tool for treating cardiovascular problems, he is concerned that oral chelation, which has no scientific proof supporting it, will give critics a bandwagon to jump on for negating the real cardiovascular benefits of IV chelation. Should you want to pursue IV chelation, be certain to seek the care of an ACAM-trained chelation expert, and have your general practitioner monitor the results for both benefits and risks. Keep in mind that it can take months to notice the benefits of chelation therapy. As for my reader friends who asked about oral chelation... it may be easier, but it also may be risky and ineffective.

Rare Find

2005-06-09T22:53:00.000-05:00

Doctors have always labeled celiac disease as a rare food allergy that, while a serious condition for those afflicted, is generally not something the rest of us need to worry about. Well, it seems that the underlying problem that causes celiac disease -- an autoimmune condition caused by gluten intolerance -- isn't so much rare as it is undiagnosed. Some researchers postulate that individuals often have symptoms for as many as 11 years before they are diagnosed correctly. Worse, they believe that only 2.5 percent of those who have some form of gluten intolerance ever get diagnosed at all. This is sad, considering how serious the health consequences can be -- and that the condition can often be completely rectified through diet. Untreated, gluten sensitivity can result in a long list of disorders, including many cancers, autoimmune disorders, neurological diseases, chronic pain syndromes, and even psychiatric and other brain disorders. The classic symptoms of celiac disease include diarrhea, weight loss, and malnutrition. However, digestive symptoms are not the only symptoms celiac can cause. Neurological disorders associated with the disease include sporadic and progressive cerebellar ataxia, cerebral atrophy and dementia, cerebral vasculitis, myopathy, peripheral neuropathy, and epilepsy. If you suspect that you or anyone in your family might have celiac disease, or a gluten-sensitivity, you can ask your doctor to perform a tTG or tissue transgluminase test. Keep in mind that if you have already eliminated wheat or gluten products from your diet, this test will come up negative, even if you have the sensitivity. But if you have consumed any wheat products and have the sensitivity, this test will do a better job of picking it up than previous tests. If you do have celiac disease or gluten-intolerance, eliminating grains and grain products (like rice, pasta, bread, etc.) from your diet can go a long way in helping you feel better --sometimes even better than you can imagine. Many people who have this disease report that they were so accustomed to their low level of health, they almost didn't know they had a problem -- until they went gluten-free. Suddenly, they transform into healthy people, full of energy. Co-author of the book Dangerous Grains, Ron Hoggan, reports that he didn't realize until he eliminated gluten grains from his diet how uncomfortable and chronically ill he had been for much of his life. To learn more about gluten sensitivity, check your local library or bookstore for a copy of Dangerous Grains by James Braly and Ron Hoggan. Being aware of this condition and knowing what signs to look for may just keep you or someone you know from becoming one of those "undiagnosed" statistics.

What is...hypochlorhydria?

2005-06-09T22:50:00.000-05:00

Hypochlorhydria is the official term for having too little stomach acid -- and it is a common condition found in people with celiac disease. Stomach acid is a necessary ingredient for proper digestion and a key factor in determining how much of the vitamins and minerals in the food you ingest actually make their way into your system. This condition is much more common than people realize. As we age, our stomach acid levels naturally decline. Unfortunately, many people believe that heartburn and indigestion is a result of having too much stomach acid. So they pop purple pills and antacids to decrease their production of stomach acid, which only adds to the problem. Ultimately, hypochlorhydria can result in serious health problems including depression, macular degeneration, early aging, osteoporosis, sexual dysfunction, skin disorders, rheumatoid arthritis, even an increased risk of certain types of cancer. Fortunately, it can be resolved easily and naturally once it is detected and properly diagnosed. Dr. Wright has written an entire book on this subject called "Why Stomach Acid Is Good For You" that gives the entire scoop on this common -- and commonly missed -- health problem. This book is available in most bookstores as well as through amazon.com.

Your way or the highway

2005-06-09T22:45:00.000-05:00

Q: My doctor has had me on HRT for a while now. But after all the reading I've been doing on the dangers associated with it, I really want to pursue treatment with bio-identical hormones further. The problem is, my doctor isn't interested in working with me on making the switch. Do you have any tips for finding a doctor in my area who will be willing to work with me? A:I wish your problem was less common, but, unfortunately, the growing number of people searching for alternatives to pharmaceuticals are often thwarted in their efforts by their healthcare provider. However, there are a couple of resources that may be able to help. First, the American College for Advancement in Medicine (ACAM) -- (800)532-3688, (949)583-7666, www.acam.org -- can provide a list of doctors near you who are skilled in natural medicine. ACAM is a not-for-profit association of physicians in various fields who believe in using natural alternatives in their practice. Their website listing will also indicate if the doctor has a specialty -- and some do specialize in bio-identical hormone replacement. Another resource is the American Association of Naturopathic Physicians (AANP). Check the AANP website at www.naturopathic.org for a listing of qualified naturopathic doctors (N.D.s) in your area. N.D.s take a holistic approach to health, looking at the entire person, not just a subset of symptoms. Of course, in choosing any doctor, make sure you find someone who will listen to you and who will spend the time it takes to resolve your health concerns and challenges in a safe and effective way.

HERE WE GO AGAIN

2005-06-09T22:33:00.000-05:00

Here we go again. The US Food and Drug Administration (FDA) says that Crestor is safe, yet new research from Tufts-New England Medical Center shows that it has more than twice the number of adverse incidents, including kidney damage, than other leading statins. Sounds like deja vu in the aftermath of the recent NSAID problems. With sales of Crestor topping $1 billion in the 12 months ending March 31, 2005, and sales of all statins estimated to be around $20 billion in 2004, this may be just the tip of the iceberg with regard to the tough decisions millions of Americans must face in managing their cholesterol. I spoke with Jay Cohen, MD, author of What You Must Know About Statin Drugs & Their Natural Alternatives, about the implications of this latest research. One of the core issues for Dr. Cohen is the overprescribing of excessively powerful medications. Crestor is far more potent than its competitors, and far more potent than necessary for most people with elevated cholesterol. The milder statins are strong enough to lower cholesterol to recommended levels in the vast majority of people -- few need as powerful a drug as Crestor, with its increased risk of side effects. It was obvious from the day Crestor went on to the market that this drug had problems, says Dr. Cohen. He has been consistently questioning its safety on his Web site, www.medicationsense.com, and observes that this is yet another example of how poor the system is at recognizing a dangerous drug before it causes harm. In the Tufts study, published in the May edition of the American Heart Association's journal Circulation, researchers compared statistics of adverse reactions reported by doctors to the FDA specific to Crestor as well as for three other statins -- Lipitor (atorvastatin), Pravachol (pravastatin) and Zocor (simvastatin). Based on the analysis, researchers found...
*The rate of adverse events per million prescriptions was 28 for Crestor, 13 for Zocor, 4.3 for Lipitor and 3.5 for Pravachol. Adverse events that researchers specifically examined in the study were muscle and kidney damage.
*There were six deaths per million people taking Crestor, as compared with three per million with Zocor, two per million with Lipitor and one per million with Pravachol.
Frighteningly, the Tufts study comes on the heels of an FDA statement reaffirming Crestor's approval, following repeated questions about its safety profile. In November 2004, FDA researcher David Graham, MD, MPH, sounded the alarm about Crestor, complaining to a congressional committee that it was unsafe. Soon after, contending that its risks of potentially life-threatening side effects were too high, the consumer watchdog group Public Citizen's Health Research Group petitioned the FDA to withdraw Crestor from the market.
Yet in March, the FDA concluded that the risks of serious side effects from Crestor were no greater than those of rival statins Lipitor, Pravachol and Zocor, and refused Public Citizen's request. Given the FDA's poor track record over the past year -- from antidepressants in teens to COX-2 inhibitors to NSAIDs -- it's not surprising that the organization is dragging its heels on Crestor... but Public Citizen predicts that Crestor will ultimately be banned. While Crestor is being aggressively promoted as the most powerful statin, Dr. Cohen says the key is to use the least potent drug at the lowest possible dose that controls your cholesterol. Keep in mind, too, that not everyone needs a statin -- there are natural alternatives. Many people can control cholesterol with regular exercise and a healthy diet (eating more fruits, vegetables, soy and fish and consuming less saturated fat), observes Dr. Cohen. In an upcoming article, I will outline Dr. Cohen's recommendations for natural, safer cholesterol-lowering alternatives, including garlic, guggulipid, niacin, omega-3 fatty acids, plant sterols, policosanol, red yeast rice and soy. If it turns out that you do need a statin to get your cholesterol down, Dr. Cohen says to work with your doctor to determine the lowest dose of the least potent -- and therefore least side-effect-prone -- medicine to lower it to recommended ranges. Statin drugs that are less powerful than Crestor -- including Mevacor (lovastatin), Lescol (fluvastatin) and Pravachol -- are strong enough for most people and cause fewer side effects. If these prove insufficient, Lipitor or Zocor usually does the trick. All these drugs have far better track records for safety than Crestor, emphasizes Dr. Cohen. All statins work the same way and potentially have the same side effects. This means that while lower doses of milder statins are less likely to cause side effects, you must always be on the lookout and sensitive to changes in your body. Do you suddenly have muscle aches or difficulty concentrating? Don't automatically chalk these up to exercise or aging -- they could be caused by statin use. Report all possible side effects to your doctor and talk about adjusting medications and/or dosages to eliminate them. If your doctor won't discuss side effects or dosages with you or tries to send you off with a free sample of Crestor, find yourself a new doctor. The fact is, our bodies need a certain amount of cholesterol, and many experts remain unconvinced that cholesterol plays such a significant role in cardiovascular disease after all. According to Daily Health News contributing editor Andrew L. Rubman, ND, "The latest information on heart disease shows limited causation between cholesterol and coronary vascular disease. It is difficult for me to understand why these drugs are used to the degree that they are but for a medical system that focuses on symptom-suppressing drugs. The solution to the cholesterol problem usually lies in helping the gastrointestinal tract and liver to function better, which allows the body to better self-regulate." Both the statin story and the FDA fiascoes seem far from over. Only time will tell what happens as pressure mounts on Crestor's embattled manufacturer, AstraZeneca. With the publication of this new study, Public Citizen has already renewed its call for Crestor's ban. Stay tuned as I continue to bring you the latest news on statins and natural alternatives.

No Straggler Here

2005-06-08T23:12:00.000-05:00

I was one of those people who used to get colds a lot. In fact, I know that taking vitamins and nutrients makes a difference. Ever since I began my regimen of vitamins, I've had a lot fewer colds, and when I do get one, I'm under the weather for a much shorter time. One of my secret weapons has been the Chinese herb astragalus. Everyone seems to know about echinacea, but astragalus, although lesser known, is in many ways an even more powerful immune system booster and general tonic. Astragalus is what herbalists call an "adaptogen." That means it helps the body maintain balance -- if your immune function is too high, it brings it down, for example in autoimmune disease, and if your immune function is too low and you keep getting colds, it brings it up. Numerous scientific studies have confirmed the medical value of astragalus: It increases energy, stimulates antibodies and increases resistance to viruses. (One Chinese study showed an 11% to 45% increase in natural killer cells -- key components of the immune system -- after taking astragalus, plus a significant increase in the production of the body's own antiviral arsenal, interferon.) And wait, there's more! This little herbal remedy also contains amino acids and 14 trace minerals. It's a great source of selenium, which has an antioxidant content 500 times greater than that of vitamin E. Medical herbalist Chanchal Cabrera in Ashland, Oregon, recommends it for chronic immune disorders, including allergies, HIV, autoimmune disease and cancer. Astragalus is also perfectly safe. It has no known side effects, and even children can use it -- just be aware that the dose is for a 150-pound adult, so proportion a child's dose accordingly (e.g., a 50-pound child gets one-third of the dose). In fact, just about the only "contraindication" is using it with the immune-suppressing drug cyclophosphamide, used to prevent transplant rejection and as a chemotherapy agent. The immune-enhancing effects of astragalus could theoretically work against the suppressing effects of that drug, so if you're on cyclophosphamide, says Cabrera, check with your doctor or herbalist. Astragalus is available in many forms -- root, powder, extract or tea (use 3 g to 6 g of the dried root in 12 oz of boiling water). The most common form -- and the one herbalists use most -- is the tincture. At the first sign of feeling under the weather, Cabrera suggests 3 ml to 5 ml three times a day, taken in hot water or tea. Try this and you may understand why the Chinese often keep it in their water container to get the tonic effects all day long.

The Real Culprit in Cardiovascular Disease

2005-06-08T23:04:00.000-05:00

We've been drilled so long and so loudly about watching cholesterol levels that many people whose levels are low assume that they are automatically out of the woods and will avoid cardiovascular disease. Wrong! Only about half of people who have heart attacks have abnormal cholesterol (blood lipid) levels. The latest research shows that the real culprit is inflammation. Scientists have long suspected that cholesterol is not the holy grail of heart disease that it has been made out to be, and now studies at two major medical institutions confirm that elevated C-reactive protein (CRP), a marker of inflammation, also is a key risk factor. Inflammation plays a major role in the development and progression of artery-clogging atherosclerosis, the chief underlying cause of heart attack and stroke.
The bottom line: Independent of other risk factors, the higher your CRP level, the higher your risk for cardiovascular catastrophe. The good news is that adding CRP screening to lipid screening in those at risk can identify inflammatory problems sooner, so you can take aggressive steps to control them. In the January 6, 2005 issue of the New England Journal of Medicine, two different research groups came to similar conclusions about CRP. At Brigham and Women's Hospital in Boston, a team examined the cases of 3,745 coronary disease patients to compare the impact of two cholesterol-lowering drugs -- atorvastatin (Lipitor) and pravastatin (Pravachol). They found that the choice of medicine was not as significant as getting LDL ("bad") cholesterol numbers below 70 in high-risk patients... and lowering CRP to below 2 mg per liter of blood. In those who reached the LDL target, the risk for recurrent heart attacks or dying from a heart attack or stroke was reduced by another 50% when the CRP level was lowered to 2 mg. A Cleveland Clinic Foundation study involved 502 heart disease patients who took statins for 18 months. Ultrasounds of their arteries confirmed that lower cholesterol levels led to slower progression of arterial blockage. Significantly, the tests also indicated that "the decrease in CRP levels was independently and significantly correlated with rate of progression." According to cardiologist Steven Nissen, MD, author of the Cleveland Clinic study, these two trials strongly suggest that we should focus statin therapy on reducing CRP, not just cholesterol. He adds that we must now begin to think of CRP as an accelerator of disease activity, not just a marker associated with high risk. Although a simple, inexpensive blood test is all that is required to measure CRP, most doctors do not monitor CRP as closely as cholesterol. American Heart Association (AHA) guidelines recommend that physicians consider CRP testing for people at intermediate risk for cardiovascular disease (defined as having a 10% to 20% risk for a heart attack in the next 10 years based on current health status and history). If you are in this category, your doctor will inform you. Risk factors that can place you in this category include cholesterol numbers, high blood pressure and diabetes.
Still another reason to watch CRP: Other research suggests that elevated CRP may be an early indication of type 2 diabetes. Dr. Nissen emphasizes that it is essential to get both cholesterol and CRP under control. Fortunately, many of the same general lifestyle recommendations that enhance cardiovascular wellness overall also can help reduce CRP levels...
*Maintain an appropriate weight. CRP increases as weight increases, and Dr. Nissen points out that reducing intra-abdominal fat can drop CRP by 40% to 50%.
*Engage in regular exercise. One more reason to get off the couch is to lower your CRP, advises Dr. Nissen.
*Follow a healthful diet. While diet is not directly linked with CRP, a well-balanced diet is necessary to get your weight under control.
If CRP remains elevated even after lifestyle adjustments, your doctor will consider medication. At present, statins (the same drugs prescribed to lower cholesterol) are the only drugs known to reduce CRP. Another drug awaiting FDA approval -- the anti-obesity, anti-smoking rimonabant (Acomplia) -- shows promise in lowering CRP, and chances are that current research will spark greater interest in developing more new medications. Contributing editor Andrew L. Rubman, ND, adds that there are also a number of nonprescription options for reducing CRP, including antioxidant, omega-3 and vitamin B-12 therapies, to name but a few. He suggests trying and exhausting all natural options before resorting to problem-prone statins. As we came to the close of our conversation, I asked Dr. Nissen if we are closer to an answer to cardiovascular disease. Will lowering cholesterol and CRP keep us from having a heart attack or stroke? He told me that although this offers some of the best protection we have available today, scientists still have a lot to learn about cardiovascular disease, and there are many risk factors out there that we have yet to uncover. In the meantime, take advantage of all that we do know -- this also means controlling blood pressure and diabetes, managing stress efficiently and staying away from cigarettes. Once again -- take good care of your body, and it will take good care of you.

Stop Popping

2005-06-03T11:51:00.000-05:00

Think it's okay to pop over-the-counter (OTC) painkillers on a regular basis? Think again. A study at Baylor College of Medicine in Houston, Texas, reports that chronic use of ibuprofen, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can damage the small intestine. According to lead researcher David Y. Graham, MD, "We have always known that NSAIDs can cause potentially deadly stomach problems, but the extent of the impact on the small intestine was largely unknown until now." The Baylor team compared 21 arthritis patients taking a variety of NSAIDs for 90 days with 20 controls who took acetaminophen... or no drug at all. Following this period, using a new technique called video capsule endoscopy, all participants swallowed capsules that contain tiny cameras to photograph their small intestines. Researchers found that small intestine injury occurred in 71% of NSAID users, compared with only 10% of those in the control group. The injuries ranged from small erosions to severe ulcers. Alarmingly, the injuries caused no warning symptoms in any participants. Anyone who takes aspirin or other NSAIDs regularly for a year has a 1% to 4% risk for serious gastrointestinal complications, warns Dr. Graham. More disturbing numbers come from the American Gastroenterological Association (AGA)...
*Use of these medications leads to more than 100,000 hospitalizations a year.
*There are more than 16,000 NSAID-related deaths a year -- more than from AIDS and more than four times as many as from cervical cancer.
*Although potentially severe complications of NSAID use can develop within weeks, only one in five people experience any warning symptoms.
In response to these concerns, the AGA launched the REDUCE (Risk Education to Decrease Ulcer Complications and their Effects from NSAIDs) campaign to increase public awareness of the potentially harmful effects of NSAIDs. To learn more, visit www.2REDUCE.org or call 1-888-273-3823. As always, the lowest possible effective dose of any medicine is best. When it comes to NSAIDs, Dr. Graham says that the best approach is for doctors to prescribe or recommend them according to the patient's individual needs. He notes that the risk of side effects is greatest with anti-inflammatory doses (800 mg three times a day) rather than doses for pain relief (for example, 200 mg of ibuprofen). In some cases, your health-care provider also may prescribe the drug misoprostol (Cytotec), which protects the stomach lining and decreases stomach-acid secretion. However, this too does not come without risks -- misoprostol may cause miscarriages, premature labor or birth defects -- so talk to your doctor about what is safest long term. As for acetaminophen (Tylenol), it is not an NSAID and may be a safer alternative for occasional pain relief. However, Dr. Graham points out that acetaminophen does not have anti-inflammatory activity and is not without its own health risks. Long-term use can cause kidney damage and liver failure. Remember, pain is a symptom of a problem, it is not a problem in and of itself. Work with your doctor(s) to find treatment options that help address the underlying sources of your pain, rather than simply suppressing the pain with medication. For example, a recent government study confirmed that acupuncture reduced pain and improved function in people with arthritis. Clearly, living on drugs is not the answer.

Say Cheese

2005-06-03T11:44:00.000-05:00

When people ask me if it's hard living without wheat, sugar and dairy, I tell them it's not so bad. What do I miss most? Cheese. Maybe you're lactose intolerant or maybe, like me, you just feel better and have fewer health issues when you don't consume dairy, especially cow's milk. If so, you might be as excited as I was to find an array of delicious non-cow's-milk cheeses at a cheese shop recently. To find out if dairy avoiders really can indulge -- at least a little -- in some of the cow's-milk alternatives, I spoke to nutritional consultant Carolyn Katzin, MS, CNS. Katzin, a cheese lover like me, had some interesting things to say about our favorite food. According to Katzin, our genetic heritage has a lot to do with why some people do perfectly well ingesting cow's milk and some people (like me) don't. Katzin believes that people who have lived in certain regions for centuries have adapted to foods native to those regions. Asians, for example, have a very high tolerance for soy products, while Northern Europeans might find them irritating. Similarly, said Katzin, Northern Italians tolerate cow's milk very well, but Southern Italians don't -- they are far more likely to flourish on the cheese and milk from goats and sheep. Interestingly, most dairy sensitivity is not related to lactose but to the proteins and other compounds in milk unique to the species of the animal and the consumer's sensitivity. For some reason, cow proteins and other compounds are more irritating to people than proteins from sheep or goats. "In cheese, milk and meat, the most important consideration from a health point of view is what the animals have been eating," says Katzin. "Grass-fed animals always produce healthier foods with higher omega-3 fat content, and goats and sheep are far more likely to come from small farms, where they graze on pasture." This is why cheese produced in Switzerland, where grass feeding for dairy production is mandated, is generally better tolerated.
Goat Cheese
Most people know that chevre -- soft "goat cheese" (made from goat's milk) -- has both a distinctive texture and tang. There are many varieties of chevre that are widely available, most of them from France. Three of the best known are...
*Crottin de Chavignol, which originates from Sancerre in the Central Region, an area internationally renowned for its wines, castles and pastoral way of life.
*A cheese log from Chabichou du Poitou.
*Cypress Grove, which is a popular American brand. Its chevre is a delicious substitute for cream cheese. Cypress Grove also makes an amazing fromage blanc and a chevre log.
For me, chevre is okay, but it's not a creamy Gouda or tangy Cheddar. Katzin explained that because the production of hard cheese requires milk to be heated to a degree that is too high for sensitive goat's milk, sliced goat cheeses are unavailable. That said, there are several finds that are definitely worth a try...
*Tomme de Chevre.
*Cypress Grove Humboldt Fog.
*Cypress Grove fromage a trois, which combines organic pesto, dried tomato and pine nuts, and slices beautifully.
*Holland Goat Gouda, which I found at Whole Foods Market, has a chocolate-like texture and melts in your mouth.
Sheep's-Milk Cheese
The taste of fresh sheep's-milk cheese is akin to that of yogurt and is terrific with fresh preserves or maple syrup... white mold cheese is quite mild, like a new Camembert... and sheep's-milk feta is extraordinary. Probably the best-known example of a sheep's-milk cheese is Roquefort, named after a town in the south of France, where it originates.
Some of my finds include a sheep's-milk Manchego... and a delicious sheep's-milk hard ricotta by Sini Fulvi. Like cow's-milk cheeses, some of the goat's- and sheep's-milk cheeses are made from raw milk and some from pasteurized milk. Katzin explained that the positive side of raw-milk cheese is that it has a broader spectrum of microorganisms that contribute to the natural flora of a healthy digestive system. Additionally, cheese from raw-milk products is not subject to the allergenic issues that pasteurization causes. "If you buy raw-milk cheese of any variety, it's important that these cheeses come from reputable sources," Katzin said, as the downside of raw milk and raw-milk cheeses can be contamination. The goat's- and sheep's-milk cheeses in this article have never had known problems associated with them, even those made from raw milk, so you should be fine with any one of them. However, if you have any concerns, talk to your doctor first. In a few weeks, I will be writing about totally dairy-free alternatives. But although goat's-milk and sheep's-milk cheeses don't give me a "free pass" for dairy, they are but a few of the cheeses I have recently discovered that I can treat myself to. As the numbers of nondairy users rise, alternatives are growing. Check out your local cheese shop or Whole Foods store if you have one nearby. Half the fun is the adventure of searching and tasting.

Combine and conquer

2005-06-03T11:34:00.000-05:00

We all know that certain foods can be categorized as bona fide cancer preventers. But what do you get when those foods are combined? There are currently 40 studies underway that examine specific food combinations and their preventative health benefits. Early results show that combining foods can offer even greater cancer prevention and overall healthier combinations of nutrients than any one food can offer individually. How about a filet of salmon on a bed of watercress surrounded by a ring of broccoli florets, and crushed walnuts dusted across the top -- sound like an incredible dinner plate at a fancy restaurant? It's also a cancer killer extraordinaire. You see, each of these foods has a cancer-fighting ingredient. But something magical happens when they are combined into one dish. Together, they are particularly high in two nutrients -- sulphoraphane and selenium. The combination of these two nutrients is 13 times more effective than either one alone. The sulphoraphane found in broccoli also has a synergistic relationship with lycopene and with another flavonoid, apigenin, which is found in apples, endive, beans, broccoli, celery, cherries, cloves, grapes, leeks, onions, barley, parsley and tomatoes. Eating meals that combine foods of different colors may also impart improved health benefits over eating any one color of food alone. It's like the new Rubik's cube of food -- the combinations and the beneficial effects could be endless. This may not seem groundbreaking. After all, even though science has always studied one food at a time, we've never eaten that way. But in the next few years you'll be able to combine foods based on more than just how they taste together. You'll be able to design menus for your family based on evidence of their health-protecting value. Entire cookbooks will be designed around the ultimate diets for preventing cancer, heart disease, autoimmune disease, and the many other health challenges that are prominent today. Suddenly the future looks very good -- and healthy.

Skipping stones

2005-06-03T11:29:00.000-05:00

Q: I just spent my weekend in agony at the emergency room passing a kidney stone. It was my first one, and I'm determined to make it my last. Can you give me any dietary or nutritional advice that will help me avoid taking drugs, while also avoiding getting another kidney stone? A: There are plenty of effective strategies to prevent further stones. Although you didn't specify in your message, I suspect you had the most common form of kidney stone -- calcium oxalate. If so, consider taking magnesium and vitamin B6 supplements. Vitamin B6 will cut down on the production of oxalate, and magnesium will make it more soluble. I generally recommend 200 milligrams of each, twice daily. While toxicity from these supplements is unlikely, you should watch out for diarrhea from the magnesium, or any tingling of the feet and hands from the B6 -- these are signs that the dose is too high and should be cut back. There are also some diet and lifestyle changes you may want to make. Drink plenty of water, since dehydration can contribute to stone formation. Cut back on sugar, salt, and animal protein, all of which are stone causers. Also, be mindful of the oxalate content of the foods you eat. Beans, coca, parsley, rhubarb, spinach, and black tea are all high in oxalates and should probably be on your restricted list. Finally, you might want to find a nutritionally oriented doctor who can monitor and follow up with your progress. If you need a list of such physicians in your area, you can contact the American College for Advancement in Medicine (949-583-7666; www.acam.org).

The Smell of Success

2005-06-01T23:27:00.000-05:00

In recent issues, I've talked about the effects that different scents have on sexuality, family relations and weight loss. With the power of smell being so important in the animal world, it was not so surprising when Alan R. Hirsch, MD, director of the Smell and Taste Treatment and Research Foundation in Chicago and author of Life's a Smelling Success told me that scent can even have a positive influence on learning. In a study conducted by Dr. Hirsch's foundation, researchers recruited 22 volunteers at a Chicago mall and asked them to take a series of tests wearing scented and unscented masks. The tests were essentially connect-the-dot, trail-making puzzles, standard memory exercises that are paradigms for real-life learning tasks, such as spatial analysis, motor control, attention shifting, alertness, concentration and number sense. Dr. Hirsch and his colleagues found that a mixed floral scent caused a significant improvement in learning. People who had a normal sense of smell and enjoyed the floral scent learned to complete the test 17% faster on average in subsequent trials when the odor was present. While researchers do not know exactly why a floral scent improves test-taking abilities, Dr. Hirsch speculates that it may reduce anxiety or induce a positive feeling that improves cognition. Interestingly, other scents did not have a similar impact on learning. According to Dr. Hirsch, this study points to the possibility that a floral scent may help improve learning in people who have suffered a stroke or head trauma or who have learning disabilities or dementia, such as Alzheimer's disease. It also might play some role in general education, although Dr. Hirsch notes that real-life classrooms are so filled with distractions and sensory stimuli that they would dim an odor's subtler impact. Further studies are necessary to determine whether any of these applications are practical. In the meantime, it can't hurt -- and it might help -- to light a floral-scented candle when you turn on your computer or open a book.

Loss of Innocence

2005-06-01T23:12:00.000-05:00

We've all read the headlines about celebrities checking into rehabilitation facilities because of substance abuse. While some of their problems may be due to lifestyle and personal choices, many are rooted in unrelated injuries that were treated with prescription painkillers. While celebrities make headlines, innocent families across the country are being torn apart every day by these highly effective -- but very powerful -- medications. The question is, are they too effective? The stories about "instant addiction" concerning OxyContin and similar powerful painkillers have frightened many people and made them wonder if living with severe pain wouldn't be better than risking drug addiction. Are there better and safer alternatives for pain treatment? For insight into this important problem, I called Sudhir Diwan, MD, director of the division of pain management in the department of anesthesiology at New York-Presbyterian Hospital Weill Cornell Medical Center in New York City. Dr. Diwan explains that these painkillers are opiates, a powerful class of drugs that includes heroin and methadone, as well as morphine, Percocet, Demerol and Vicodin, among others. When taking any of these opiate painkillers, he says, there are three by-products to consider...
*Addiction. This is not a physical response but rather a psychological reaction that is very similar to any other addiction including shopping and gambling.
*Dependence. This response is physical and relates completely to the medication. Should a person stop using the drug abruptly, physical side effects will occur.
*Tolerance. In time, users require greater amounts of the drug to address an unchanged amount of pain.
Dr. Diwan says that psychological addiction is rare among people using opiate painkillers to treat authentic pain. That said, before a doctor prescribes an opiate, he/she has a responsibility to ensure that the patient is a good candidate -- that is, he/she does not have a history of substance abuse... a personality disorder, such as borderline personality disorder, in which people are very prone to addiction... or other condition that could predispose him to addiction. (When in pain, people with personality disorders will still be treated, but with a regimen appropriate to their situations.) Physical dependency can happen to anyone who takes an opiate for more than a few weeks. This makes it critical for people who are ready to stop treatment to wean from it over time and with careful supervision. Tolerance, which also builds over three to four weeks, requires some adjustment in treatment -- either a change in the amount prescribed or in the type and balance of painkillers being used including, perhaps, adding the nonopiate COX-1 drugs -- naproxen (Aleve), aspirin, etc. A complicating side issue is a situation doctors refer to as "pseudoaddiction." This describes people who either have a source of pain that has been misdiagnosed and so the pain medications are not effective in treating the pain or who become so anxious about the possible recurrence of pain that they take more and more of the drug prophylactically. To the outside world, this appears to be addiction, but Dr. Diwan says that it is not -- doctors need to understand what is behind the behavior and address it to avoid a seemingly addictive behavior pattern. For patients who require long-term pain control, the goal is to block the pain so that the patient doesn't have to experience it at all. According to Dr. Diwan, this means that doctors must be especially sensitive to signs of abuse for long-term problems -- patients who regularly "lose" the prescription or pills or have multiple prescribing doctors. Patients must talk to their doctors about other methods of pain control, such as longer-acting sustained-release drugs. Long-acting drugs also have fewer psychological effects, Dr. Diwan says, because there are no highs involved as there are with short-acting medications. For example, there are two types of OxyContin -- one is short-acting and gives the user a rush... the other releases more slowly and so doesn't provide a rush. Opiates are not to be taken lightly. Dr. Diwan emphasizes that anyone who requires opiates should do so under the close supervision of a doctor who is highly trained in managing them. In addition to your regular doctor, work with a pain management specialist, who will be far more familiar with risks and benefits of different treatment protocols. Also, include members of your family in conversations with your doctor(s). Opiates can distort an individual's judgment and behavior, so those who are close can provide feedback on what they are witnessing. Opiates should not be taken with alcohol or any medication that can cause sedation. Dr. Diwan advises chronic pain sufferers to examine alternative methods to relieve their pain, such as acupuncture, chiropractic or deep tissue massage. See the previous article "Back It Up" for the huge impact chiropractic has had on back pain... and for its impact on reducing costs associated with controlling back pain. Mark Stengler, ND, author of Prescription for Natural Cures (Wiley) suggests that when you are ready to come off painkillers, the first step is careful and supervised weaning with your doctor, a process that can take several months. To make that process easier, he advises acupuncture, chiropractic and deep tissue massage, as well as MSM (methylsulfonylmethane), which has a natural pain relief and anti-inflammatory effect, or proteolytic enzymes. Dr. Stengler likes Repair, by Enzymedica (www.enzymedica.com), also available at health-food stores, which are good for fighting inflammation. For osteoarthritis pain, he suggests glucosamine sulphate (1,500 mg to 2,000 mg daily) or the herb boswellia (same dosage, and you can take it along with the glucosamine). That said, should you develop either an acute or chronic pain condition, talk to as many medical professionals as you can about treatment options, leaving opiates as a last resort. If you do need to take them, it is crucial to work with experts in the field to monitor how you use the drugs to be sure you do not fall into addiction.

Back It Up

2005-05-24T22:33:00.000-05:00

Back pain is one of the most common reasons why people seek medical care, accounting for more than $100 billion in annual health-care costs. It is the second-leading cause of doctor visits and hospitalizations. But, before you go under the knife or fill a prescription for painkillers, consider this: A new study shows that chiropractic care can significantly reduce the health-care costs, hospitalizations and surgery associated with back pain. The research was sponsored by American Specialty Health Plans, Inc., a health insurance company that provides coverage for complementary medicine. Results were published in the October 11, 2004, issue of Archives of Internal Medicine. In a retrospective claims-data analysis, researchers looked at the records of 700,000 members of a health plan that had chiropractic coverage and one million members of the same plan that had no chiropractic benefits. The difference in costs and treatments for those with access to chiropractic care was staggering. Versus the group without chiropractic benefits, those with chiropractic benefits were found to have...
*37% fewer imaging tests, such as X-rays and magnetic resonance imaging (MRIs).
*41% fewer hospitalizations.
*32% fewer back surgeries.
*28% overall reduction in cost of treatment.
Nearly everyone can expect to experience back pain at some point in their lives, says Jerome F. McAndrews, DC, a chiropractor in Claremore, Oklahoma, and a spokesperson for the American Chiropractic Association. Yet even though back pain is so common, conventionally trained medical doctors typically have a hard time figuring out what causes it. Frustrated by the absence of standardized physical examinations and diagnoses, physicians often end up ordering MRIs to get to the bottom of the problem. Unfortunately, this strategy can backfire, because most MRIs are "abnormal." Spinal abnormalities are actually quite common, and they usually have nothing to do with back pain... but a bulging disk on an MRI can lead to a recommendation for surgery even though the real problem may be weakness, stiffness or muscle spasms in the areas surrounding the joints. The fact is that most primary care practitioners have little training in the management of musculoskeletal conditions, says Dr. McAndrews. As a result, costs quickly add up as physicians order expensive tests and treatments. He worries that many conventional doctors are inclined to think that they can mechanically fix the problem with surgery. In contrast, chiropractors practice spinal manipulation, an approach that has been approved for low back pain by the US Department of Health and Human Services' Agency for Healthcare Research and Quality. Chiropractic's hands-on treatment utilizes leverage and exercises to adjust spinal structures back to their proper positions rather than modifying them with surgery and hoping that this will address the pain. If you have an acute injury -- say you threw out your back because you lifted a heavy box without bending your knees -- a chiropractor may be able to get you properly realigned in as little as one visit. Long-standing misalignments in the musculoskeletal system -- for example, if you have a crick in your neck or a pain in your hip and have been adjusting other body parts to favor it for months or years -- usually require multiple visits to the chiropractor. With either type of injury, surgery is generally not the answer for most people. Not only does the cost run into the tens of thousands of dollars, but other important factors to be considered are pain and discomfort, follow-up therapy, uncertain outcome, the possibility of long-term disability and last but certainly not least, the risks associated with any operation. Though not all chiropractic care is gentle (some can be dramatic and decidedly not gentle), surgery should only be used after therapies like chiropractic have been tried and exhausted. Dr. McAndrews notes that while chiropractic can certainly be helpful in emergency situations, its best use may actually be preventive maintenance -- just as it is better to take care of minor mechanical problems with your car before they develop into major ones, you should address minor aches, pains and maladjustments in your body before they deteriorate into major, debilitating conditions. To that end, Dr. McAndrews recommends yearly chiropractor visits. I always say, "Nothing is a panacea" -- not even chiropractic. However, adding chiropractic to your health-care coverage can result in a win-win situation, saving you time and pain, and saving your insurance company money. And who knows? Someday you may even see some of those savings passed back to you in the form of lower premiums. To find a licensed chiropractor in your area, go to the American Chiropractic Association's Web site at http://www.amerchiro.org/ or to the American Association of Naturopathic Physicians' Web site at http://www.naturopathic.org/.
A study in the journal Neurology warned of an association between neck cracking and stroke. If you are considering spinal manipulation, ask your chiropractor about the risk for stroke.

Give Yourself a Boost

2005-05-18T13:07:00.000-05:00

Major depression remains difficult to treat. Despite the wide array of antidepressant medications available today, finding the right medication is very much a hit-or-miss proposition. For a variety of reasons, some people never achieve total symptom relief with single-drug treatment and end up taking two or more drugs for long periods of time. Enter the dietary supplement SAMe (S-adenosyl-L-methionine, or "Sammy," for short). Researchers at Massachusetts General Hospital in Boston recently reported that the effectiveness of antidepressive medications are often enhanced with the addition of SAMe. In a recent uncontrolled study of 30 people who struggled with depressive symptoms even while on antidepressants, half reported significant symptom improvement when they were given SAMe with their regular medication. Of these, 43% reported no depressive symptoms at all after six weeks of taking SAMe along with their prescribed antidepressant. Jonathan E. Alpert, MD, PhD, lead researcher of the study, says that symptom improvement was determined by looking at composite scores of three measures: The Hamilton Depression Rating Scale... the Montgomery Asberg Depression Rating Scale... and Clinical Global Impressions. Although no qualitative symptom-by-symptom analysis was performed, Dr. Alpert's own clinical impression was that the greatest improvements were in patient motivation, interest and energy level. The 30 patients in the trial were knowingly given 800 mg to 1,600 mg of SAMe daily along with their current antidepressant medication. Study participants were taking either venlafaxine (Effexor) or one of the class of drugs known as selective serotonin reuptake inhibitors (SSRIs), including Prozac, Zoloft and Lexapro. SAMe is not an herb or a hormone. It is a molecule that the human body manufactures from methionine, an amino acid found in protein-rich foods. How does SAMe improve mood? It is not known for sure, but researchers believe that SAMe enhances the action of various "mood-boosters" in the brain, such as serotonin and dopamine. Future research is required to learn more about the specific how's and why's of SAMe's impact. Dr. Alpert is currently conducting two more trials involving SAMe. One is a placebo-controlled study with 80 participants. Subjects will not know if they are receiving SAMe or a placebo with their antidepressant. The larger number of participants and the creation of a control group will allow a better examination of symptom-by-symptom results with both the antidepressant and the antidepressant-plus-SAMe groups, he said. The second trial will examine SAMe as a single-agent treatment compared directly with an SSRI antidepressant and with a placebo. This trial elevates SAMe from adjunct status to a possible equal alternative to antidepressants. Both ongoing SAMe studies are sponsored by the National Institutes of Health. Can you try using SAMe today? There appear to be no risks associated with using SAMe in conjunction with antidepressants. People who take blood thinners should not take SAMe. Talk to your doctor about whether or not it might be helpful for you... and take it only under his/her supervision. SAMe has been reported effective with restoring arthritic joints and with chronic liver disease as well. However, the FDA has not extensively evaluated SAMe or, of course, approved it.

True Blue

2005-05-18T12:49:00.000-05:00

It may sound strange, but sometimes just shedding a little light on a health matter -- in this case, blue light -- can make a big difference. FDA-approved blue light therapy for the treatment of acne and precancerous lesions known as actinic keratoses (AKs) can be a better choice than conventional treatments, such as oral antibiotics for acne, or freezing or scraping AKs. To learn more about this intriguing alternative, I spoke with Barney Kenet, MD, a dermatologist at New York Hospital-Cornell Medical Center in New York City and the coauthor of Saving Your Skin.
Blue Light for Acne
Many factors contribute to the development of acne. One of these is the presence of Propionibacterium acnes (P. acnes) on the skin. Hundreds of tiny sebaceous glands normally excrete an oily substance called sebum to keep the skin healthy. When the tiny pathways through which sebum passes become clogged, P. acnes enter them and grow, then swelling ensues and a pimple forms. Blue light therapy works by destroying the P. acnes bacteria. Why blue light? Because these bacteria produce pigments called porphyrins that, when activated by blue light, result in a photodynamic effect that kills the bacteria. Treatment consists of sitting in front of a blue light in your dermatologist's office for 15 minutes twice a week. The light is not hot or painful -- however, it is critical that the patient wear special protective goggles to guard his/her eyes (a standard practice with all light treatments), since low-frequency light has been linked to macular degeneration over time. Four to five weeks of treatment are normally required, and the resulting remissions last as long as eight months. Although blue light is not a cure-all, Dr. Kenet notes that it significantly reduces pimple formation and provides a simple, risk-free alternative to treatments such as oral antibiotics. Given the health dangers of excessive antibiotic use as well as its reduced effectiveness on many bacteria, non-antibiotic options are always worth considering. Blue light therapy works best for mild to moderate acne, says Dr. Kenet. It is not as effective against the deep cystic variety. The cost of blue light therapy is in the hundreds of dollars. Insurance does not always cover it -- check first. Blue light therapy, approved by the FDA in 2003, is available at most major medical centers.
Blue Light for Actinic Keratoses - Precancerous Skin Cells
Another application for blue light therapy is in the treatment of AKs. These dry, rough, scaly, discolored patches are caused by excessive sun exposure that most often appear on the face and scalp of fair-skinned people over age 40. Prompt action must be taken to rid the skin of AKs, which may otherwise develop into skin cancer. Treatment of AKs takes place in a two-part process known as photodynamic therapy. A photosensitizing agent called aminolevulinic acid (ALA) is first applied to the designated skin area at the doctor's office. You go home, and then return to the doctor's office the next day, when the skin is exposed to blue light. The acid is selectively absorbed by sun-damaged spots -- the blue light seeks out the acid and burns off the damaged cells. This results in the focused destruction of precancerous cells while leaving healthy skin cells intact, explains Dr. Kenet. Blue light treatment for AKs lasts about 20 minutes, and there is usually less discomfort than with older treatments, such as freezing, scraping or burning off lesions. However, you still may experience some tingling, stinging, prickling and burning. These sensations subside forf the most part when the procedure ends, although they may still be felt to some degree for the next 24 hours. Following treatment, there is typically mild reddening and swelling of the treated area and surrounding skin, which peaks 24 hours later. This improves significantly after a week and disappears completely within four weeks. Other short-term side effects may include scaling, itching and changes in skin color. In most cases, one treatment is enough to destroy AKs. If necessary, a second treatment can take place eight weeks later. Side effects such as reddening are usually minimal, and many people enjoy getting treatment over with once and for all rather than having to apply cream on a daily basis for weeks on end. Exercise Caution
While blue light therapy is very effective, there are a few things you must keep in mind when undergoing treatment... Skin is exquisitely sensitive to light after photodynamic therapy, warns Dr. Kenet. Exercise extreme caution: You must avoid all exposure to sunlight and other sources of bright light for 40 hours. If you find that some exposure is inevitable -- cover up completely with clothing and a broad-brimmed hat. Sunscreen will not help because it does not protect treated skin.
Certain medications increase your sensitivity to light. Before undergoing photodynamic therapy, inform your physician if you are using any of the following...
*Sulfonylureas (for diabetes).
*Phenothiazines (for serious mental and emotional disorders, such as schizophrenia).
*Tetracyclines, fluoroquinolones, griseofulvin and sulfonamides (to treat infections).
*Thiazides (for high blood pressure). While taking these drugs does not preclude having blue light therapy, much greater precautions are needed. Although it is the new kid on the block, blue light therapy shows promise as a treatment that may be a little kinder and gentler on the skin and cause fewer side effects than some of its conventional alternatives. Unfortunately, because of its newness, it is not always covered by insurance -- but it's worth asking your doctor and insurance company about.

Pointed Solution

2005-05-18T12:43:00.000-05:00

With all the bad news about the side effects of arthritis drugs, results of a study showing the effectiveness of acupuncture at easing pain and improving function in people with osteoarthritis of the knee comes as very good news. The results of the University of Maryland landmark study, funded by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health (NIH), were published in the December 21, 2004 issue of the Annals of Internal Medicine. This was the longest and largest randomized, controlled clinical trial of acupuncture ever conducted. To learn more, I contacted lead researcher Brian M. Berman, MD, founder and director of the Center for Integrative Medicine (CFIM) and professor of family medicine at the University of Maryland School of Medicine. He told me that the study involved 570 participants, age 50 or older, who had osteoarthritis of the knee. All had significant knee pain, had never experienced acupuncture, had not had knee surgery in the six previous months and had not used steroid or similar injections. They were randomly assigned to one of three groups...
*Acupuncture. Participants in this group received 23 true acupuncture sessions over 26 weeks.
*Sham acupuncture. Participants in this placebo group received the same number of sham acupuncture sessions over 26 weeks.
*Educational guidance. Participants in this control group followed the Arthritis Foundation's standard self-help course for managing their condition.
The participants' progress was assessed at four, eight, 14 and 26 weeks. During this period, they continued to receive standard medical care, including anti-inflammatory and pain medications. Researchers found that...
*By week eight, those receiving acupuncture experienced a significant increase in function.
*By week 14, they also had a significant decrease in pain, compared with the sham and educational guidance groups.
*At week 26, acupuncture patients had a 40% decrease in pain, and nearly a 40% improvement in knee function.
According to Dr. Berman, true acupuncture was 44% more effective than sham acupuncture for reducing pain and 30% more effective for improving physical function. Both true and sham acupuncture were far more effective than educational guidance. Dr. Berman and his colleagues concluded that acupuncture is a useful accompaniment to conventional therapies. It is also sometimes used as a stand-alone treatment, although that was not the case in this study. Dr. Berman adds that acupuncture appears to be quite safe, and participants in the study experienced no side effects. Dr. Berman says that while acupuncture is sometimes used alone, their goal was to test it as an adjunct treatment with standard therapies. If you decide to try acupuncture, choose the practitioner with care. To find a licensed acupuncturist in your area, visit the American Academy of Medical Acupuncture's Web site at www.medicalacupuncture.org. In addition, many insurance companies now cover acupuncture, but check first. Preauthorization may be required.

Creeping Up

2005-05-18T12:29:00.000-05:00

Somehow, as I've gotten older, the weight seems to go on more quickly and come off more slowly -- no matter how much I exercise. I know many women whose once-lean bodies turned matronly as they reached menopause. The good news, though, is that several recent studies prove that weight gain at menopause is not inevitable. The National Institutes of Health sponsored the Study of Women's Health Across the Nation (SWAN) in which researchers tracked 3,064 ethnically diverse women ages 42 to 52 over a three-year period. None had yet gone through menopause at the time the study began. At the end of the three years, the women had gained an average of 4.5 pounds, or 3% of their body weight, and increased waist circumference by about one inch. However -- and this is what's really intriguing -- whether or not the women had gone through menopause made no difference in their weight gain. Furthermore, the study found that women who were highly active or who became active during the course of the study did not gain weight. In fact, with activity, some lost both weight and inches from their waistlines. In the second study, Harvard's famous ongoing Nurses' Health Study, researchers measured 116,686 young and middle-aged women several times during an eight-year period. They discovered that women who drank no more than one sugar-sweetened soft drink per week did not gain weight, but women who drank more put on weight. So, is it simply the age-old issue of "too much in results in too much on"? To discuss how to control weight in middle age, I called Jana Klauer, MD, research fellow at the New York Obesity Research Center at St. Luke's-Roosevelt Hospital in New York City and physician in private practice teaching weight control. Dr. Klauer says that menopause does not dictate weight gain and it is crucial to avoid gaining weight at this time because postmenopausal women's cardiovascular risks go up -- extra weight is an additional risk. She acknowledges that weight can be harder to control in middle age -- not because of hormones, but because metabolism slows by about 10% in these years. If unchecked, this can result in a gain of 10 or so pounds. You can indeed stop and even easily reverse that slowdown. Tests for metabolism are largely based on the body's resting rate (when the body is not in motion), she says, and the determiner of that is mostly the amount of muscle mass a person has. The more muscle you have, the higher your metabolic rate will be. The way to obtain more muscle mass is through exercise, especially strength training. Working with weights several times a week isn't nearly enough when it comes to exercise, says Dr. Klauer. She emphasizes that exercise after age 40 is no longer an option -- to stay healthy, it is a daily imperative. She recommends an hour each day of a weight-bearing exercise such as walking, jogging, cycling, dancing and the like -- whatever takes you beyond the level you experience walking around your house or office. Although this may seem like a lot, if you can manage 15-minute spurts of activity throughout your day, it adds up. Be sure the activity you choose helps you build strength in your legs. Dr. Klauer points out that if the legs aren't strong, people begin to slow in their movements and balance problems set in. After women pass age 40, their food choices also begin to play an ever-bigger role, says Dr. Klauer. Diet should be one that is heart-healthy and nutrient-rich. In fact, she points out that if you are eating all the nutrients you need, there won't be room in your diet for what she considers junk foods -- processed foods, simple carbs, including high-sugar foods, and anything more than one drink of alcohol a day. She reminds people that large quantities of fruits and vegetables are a wonderful way to keep weight under control because they are filling and provide much-needed fiber. She also advises eating about 60 g a day of high-quality protein. (Example: 3.5 ounces of fish has about 21 g of protein... a similar amount of chicken has 25 g... and a pint of milk has 19 g.) To get started on a healthy diet that will help you reduce or maintain a proper weight, Dr. Klauer says to record everything you eat until your new way of eating is firmly entrenched. She finds that most people are shocked to see how many little extras have crept into their daily diet, small splurges that add up to big numbers on the scale. Keeping a record will make you aware of what extra treats you are eating and help protect you from falling back into those bad habits. No doubt, following the high level of exercise and healthy diet that Dr. Klauer describes is the surest way to control weight in and past middle age. It is also the best guarantee of a long and healthy life. And that's not a bad trade-off, not bad at all.

Optical Illusions

2005-05-18T12:26:00.000-05:00

A popular dieting strategy is to eat less off small plates, a sort of visual trick. Many people scoff at that, but several new studies back it up. They prove that most times it's our eyes -- not our stomachs -- that decide how much we eat. This is crucial to keep in mind these days, when restaurant portions are designed to fill oversized people. The author of these and numerous other studies on how and why we eat is Brian Wansink, PhD, a professor in both the marketing and nutrition departments at University of Illinois, Champaign. In one recent experiment, he asked 76 adults to estimate how much tomato soup they planned to eat from 24-ounce bowls set before them. The majority responded visually: 55% said they would eat until their bowl was empty... another 26% said they would eat until the soup was half gone... only 19% said they would quit when they were no longer hungry. The researchers then divided subjects into two groups and removed the visual cue -- the size of the bowl -- for one group. By secretly refilling their bowls slowly and persistently through tubes in the bottom, the researchers in effect took away the size of the bowl as a way of helping the subject decide how much to eat. After 20 minutes everyone quit eating, at which time the group with refilling bowls had consumed twice the amount that the other group had. However, when asked to rate how full they were, their answers were the same as those in the other group. In other words, the subjects could have consumed half the amount they did and still have experienced the same satisfaction. Dr. Wansink tells me that visual cues influence virtually all of us in determining how much we eat. Many people deny it, but studies repeatedly show that people eat what's in front of them, using an empty plate -- not a full stomach -- to signal them when to stop. Furthermore, people have visual biases based on the tableware itself. We perceive tall, slim glassware as bigger than same-sized short, squat glasses. For one study, a group of teens poured juice into both types of glasses, but assuming the short glasses were smaller, the kids poured -- and drank -- 70% more from them than they did from the tall glasses. Dr. Wansink's advice for smart diners is this: Control portions by deciding before you start how much food you want to consume, and dish up that amount, no more. Use visual biases to your advantage -- drink from tall slim glasses and eat from salad plates to fool your eyes into thinking you're eating more.

Statistically Significant

2005-05-18T12:16:00.000-05:00

As one of our regular readers , you know that I explore and discuss complementary and alternative medicine right along with what is coming down the mainstream medical pipeline, since achieving optimum health sometimes - indeed often - requires traveling several paths. Although modern medicine thankfully offers us a great deal in both acute and chronic care, the practitioners of naturopathy and other alternative therapies also have many ways to treat and teach. Their drugs are born not in pharmaceutical houses, but through research of nature's effective tonics and medicines over the course of many centuries. The big question I hear frequently from readers is about the validity of the naturopathic practitioners' claims and advice. They want to know: Where's the evidence? There aren't any big studies on this "stuff." Before I address this question, here is a brief reminder about the safety of prescription medications: As we all know, pharmaceutical manufacturers put their drugs to the test through the gold standard of drug testing -- lengthy controlled clinical trials. In spite of these measures, how many headlines have we seen in just the last six or eight months that reversed the drug safety these trials had supposedly established? Vioxx anyone? How about Celebrex? In late February, the manufacturer of the just-released drug Tysabri (natalizumab), intended to reduce multiple sclerosis relapses, withdrew it from the marketplace. The reason? Several patients taking it developed a rare neurological disease -- one patient with fatal results. My purpose is not to say that prescription drugs are bad -- far from it. Rather, it is to point out that even rigorous testing of the most promising drugs can't and doesn't prove absolute safety over the long term. And what gets reported to the public is not necessarily the entire truth, which is why the FDA is now revising regulations on full disclosure of research results. Which brings me to natural products and the level of safety and efficacy consumers can assume for them. To help me out on this, I called Michael Traub, ND, past president of the American Association of Naturopathic Physicians (AANP), chair of the AANP's Scientific Affairs Committee as well as director of the Lokahi Health Center of integrated care. When I explained the readers' concern, Dr. Traub responded that he applauds questioning of medications in general, whether prescription or natural. He feels it is always good to have heightened awareness about any medication you might take. For example, a few years ago, in spite of years of successful use of the kava herb, some people in Europe developed liver problems while using it. Dr. Traub and other practitioners used their concern to energize further investigation. In time they discovered that these patients had preexisting conditions or were taking additional medications that challenged the liver, so the additional work of processing the kava "overloaded" it. Furthermore, the research showed that the patients were ingesting parts of the kava plant not traditionally used. Dr. Traub's and others' suspicions about the plant paid off by seeing to it that kava was used as originally -- and safely -- intended. Dr. Traub says that there are two important points to be made about drug testing. The first concerns prescription drugs and the dangerous side effects that don't necessarily show up in clinical trials. The reason, he says, is that even though testing involves large numbers of people, certain side effects will not show up until many more people -- even millions -- are taking the drug in question. With the number of users having expanded exponentially, any potentially dangerous side effects a drug may have are bound to eventually surface. The second point concerns complementary, or traditional, medications. Dr. Traub says that when people assume there isn't much scientific evidence backing these medications, they are flat-out wrong. The problem is that most doctors -- and people in the media who report on medical studies -- generally read the high-profile medical journals, such as New England Journal of Medicine (NEJM) and Journal of the American Medical Association (JAMA). Doctors often also read one or two journals that are specific to their own specialty. However, most studies of natural medications do not appear in these well-read publications. Rather, they appear in lesser-known specialty medical journals targeted to the naturopathic specialists, rendering the studies virtually unknown to the general public and mainstream doctors. This holds true even though they are peer reviewed in the same way as the more visible studies... and despite the reams and reams of well-designed and well-conducted research. Although most studies on natural materials do not have the huge sample size paid for by the pharmaceutical companies, many are indeed similar in size to a lot of mainstream studies. Remember, too, that these studies are in addition to the large quantity of anecdotal and observed evidence of natural medications that has accumulated over many, many years of product use. Where, then, does this leave you as a concerned health-care consumer? Dr. Traub's reminder is to be both wary and careful. He points out that no medication is harmless -- even over-the-counter products of all types can have serious side effects when used improperly. Most importantly, Dr. Traub recommends that you always choose health-care practitioners who have sophisticated understanding of your specific medical condition(s) and needs and how the medication in question works. Be confident of your right to question the information available to you... as well as your right to seek out and create a team of knowledgeable professionals in both mainstream and traditional medicines who can work together to find out what is right for you.

Making MelaTonin

2005-05-18T12:07:00.000-05:00

Since melatonin is the brain-produced hormone that regulates our sleep cycles, many people have thought that taking melatonin supplements at night would aid with sleep disorders. But researchers at the University of Alberta Evidence-Based Practice Center in Canada recently reviewed 130 studies of melatonin use in sleep disorders and concluded that there is no evidence that melatonin supplements help insomnia -- at least in most cases. There was one exception: Researchers found that in two studies of persons with Delayed Sleep Phase Syndrome (DSPS) melatonin seemed helpful. People with DSPS have difficulty falling asleep before the early morning hours and then have trouble waking in the morning, which seems to suggest abnormalities in their melatonin production cycles. Theoretically, it seems that melatonin should work across the board with sleep disorders. Why didn't it? Researcher Nina Buscemi, PhD, says that if a person already is producing normal levels of melatonin, giving him or her additional melatonin won't help. In many of the studies looked at, Dr. Buscemi said, melatonin was given just before bedtime, when natural internal levels would have been high, anyway -- at least in those people who were producing normal levels. When levels are low, such as in those with DSPS, supplemental melatonin is more likely to have an effect. I asked Mark Stengler, ND, a naturopathic physician in La Jolla, California, for his reaction to the Alberta study. He said that he has seen a number of other studies showing positive results with melatonin. But he agrees that melatonin is not a panacea in sleep disorders. However, there are some do-it-yourself methods to maximize your melatonin output. Try these before considering supplements...
*Make sure your bedroom is completely dark. Darkness stimulates melatonin release.
*Consume foods containing tryptophan in the evening. Tryptophan is an amino acid that is a precursor in making melatonin. Tryptophan-rich foods include turkey and milk, hence the familiar adage to drink milk before bedtime. You also can consider having your doctor write a prescription for tryptophan, but take it only under his/her supervision.
*Avoid alcohol, aspirin and caffeine -- they can depress melatonin production.

De-Bugging your Spring

2005-05-18T11:54:00.000-05:00

Ah, spring! The flowers are blooming, the birds are chirping, and the bugs start biting! Before the welts started swelling, I called contributing editor Andrew L. Rubman, ND, for his advice on bug bite prevention and treatment. Good insect bite prevention begins from the inside out, says Dr. Rubman. Make sure to take your B-vitamins consistently, he advises. Most insects are repelled by the presence of vitamin B-1 in human sweat. Effective vitamin therapy varies according to age and general health, but a multiple vitamin B suppement twice a day should be adequate as follows (adjust the dose down by age and weight for children)...
*For most adults and teenagers: a B-50 multivitamin that contains 50 mg of B-6 and other B vitamins
*For children ages seven to 12: a B-25 multivitamin that contains 25 mg of B-6 and other B vitamins.
*Talk to you doctor about doses for children under the age of six.
To make sure you are taking enough vitamin B to repel insects, check your urine, says Dr. Rubman. You'll know you are taking enough to keep bugs away if your urine turns yellow. While it is unusual to overdose on B-vitamins, check with your medical provider if you have any significant chronic diseases or are taking other medications. If you like gadgets, Dr. Rubman told me about an interesting one. The FC-50 electronic flea and tick repeller, manufactured by Innotek, repels insects within a few meters via ultrasound. Although it is designed to be clipped to a dog's collar, soldiers in Iraq have successfully used the FC-50 to repel sand flies. In addition, Innotek has received anecdotal reports that the FC-50 has been effective in repelling ticks as well -- a good thing to keep in mind if you live in areas where deer ticks create concerns about Lyme disease. The FC-50 is the size of a cigarette lighter, can be clipped to clothing and runs on a watch battery. (www.innotek.net or 800-826-5527. Cost: $25.) DEET is an extremely effective deer tick repellent and can be purchased just about anywhere. Dr. Rubman admits that DEET is synthetic and a poison, but it is absorbed quickly into the body and completely eliminated through the urine without harm to most and can be used safely by people in general good health. If you do get a bite, Dr. Rubman suggests:
*After Bite, available in most health-food stores. It is extremely effective in soothing the intense itching caused by mosquito bites. Itch control is vitally important, says Dr. Rubman, because scratching open wounds can create potentially problematic secondary infections. Just be sure to store After Bite in a safe place away from kids, because its main ingredient is lye (sodium hydroxide). Dr. Rubman says there is no danger if After Bite is applied properly. If applying to children, watch them for five minutes or so to be sure they don't touch their eyes or ingest it. By that time the solution should be absorbed.
Alternatively, Dr. Rubman recommends a combination one-two punch with the following herbs:
*Goldenseal, an antimicrobial herb, helps control secondary infection and purifies tissue. Apply topically to the bite. Make a paste of the root powder and cover with a hot, moist compress.
*Comfrey, another herb, helps to remove the puffy, stiff swelling of a bite. Apply topically using the same technique as with goldenseal.
For maximum effectiveness, apply goldenseal first, then comfrey. If inconvenient, the two may be combined into a single paste.
*Aloe vera has long been a staple in bug-bite treatment. But don't buy your aloe vera in the health-food store or supermarket. Dr. Rubman says use only fresh aloe vera directly from the plant, since much of aloe vera's power is lost one hour after it is extracted from the leaf. You can buy aloe vera plants at your local nursery. Break off a leaf and squeeze out the gel onto the bite.
*For relieving the itch and pain of multiple bites over a broad area of the body, use witch hazel. Or, take a bar of Aveeno (oatmeal) soap, put it in your hand with a little water and make a stiff foam, then "paint" this over the bite area. It will dry to a dust. Aveeno draws out the poisons and toxins from the skin. Or, take a warm bath in two cups of Aveeno oatmeal bath powder and two cups of Epsom salts. (Note: Dr. Rubman says Aveeno is great for poison ivy as well.) Emergency care required: Dr. Rubman warns that if you have had hypersensitive reactions to insect bites in the past and/or if you experience a systemic reaction, such as difficulty breathing, an itchy or scratchy throat, mucous buildup in the back of the nose, or if you feel dizzy or confused, you should get immediate care from a physician or go to the emergency room of the nearest hospital.

Scarred for Life

2005-05-11T22:48:00.000-05:00

Last month my brother smacked his head on the gate of his minivan, and what did he do? He called his little sister for advice. To minimize scarring from the stitches across his forehead, I told him to use vitamin E. Just puncture the liquid capsule with a sterile needle and squeeze the contents over the wound as it heals. (This is great, too, for minor burns. Just wait until the scab forms to apply.) Of course there are many natural remedies that help heal skin. For additional information about healing skin and scars, I spoke with holistic practitioner Diane Spindler, ND, PhD, of Indian Hills, Colorado. Take good care of the wound initially. For minor cuts and scrapes, rinse the affected area under cool water, clean with an antiseptic solution such as hydrogen peroxide, allow to dry and, if required, cover with a sterile bandage. You can also apply a small amount of antibiotic ointment such as bacitracin or Polysporin. For wounds such as deep cuts and punctures, large area scrapes and second- or third-degree burns, seek immediate medical care and closely follow your doctor's instructions. To speed healing, stimulate skin regeneration and prevent infection, Spindler recommends the topical application of herbal remedies. However, do not apply any botanical if the wound is open. You can find ready-made products containing these herbs at quality health-food stores, or fashion your own remedies...
*Comfrey contains a compound called allantoin, which helps heal bruises, sprains and strains. Buy powdered comfrey root. Make a paste by placing powder in simmering water and saturating a bandage. Cover the area with the bandage. Apply warm water to the bandage every two or three hours.
*Calendula stimulates the growth of new skin and blood vessels. Make a hot compress, soak a sterile towel in tea made from dried calendula flowers and apply it to the wound after scabbing. Allow to cool a bit before applying so that you don't burn yourself.
*Aloe vera helps speed the healing of superficial minor scratches or bruises. It is best to use fresh aloe vera directly from the plant, since much of aloe vera's power is lost one hour after it is extracted from the leaf. You can buy aloe vera plants at your local nursery. Break off a leaf and squeeze out the juice onto the scratch or bruise.
*Tea tree oil is a powerful antiseptic. According to contributing editor Andrew L. Rubman, ND, it aids wound healing by suppressing yeast, mold and fungi. Apply it directly to minor wounds after scabbing. Avoid pure tea tree oil, which may be too strong.
Important: Avoid exposing the affected area to the sun for six months. Cover up with clothing or sunblock. A sunburn can impede healing and worsen a scar.
When you can't completely avoid scarring, there are treatments today that can significantly reduce the appearance of scars or even make them disappear altogether. Procedures such as laser therapy and dermabrasion are routinely carried out under local anesthesia at dermatologists' offices, and pressure bandages or massage can flatten raised scars.
One note of caution: If you or your child experiences a facial wound that is likely to require stitches, try to avoid going to the local emergency room, where you might encounter an inexperienced resident. To avoid scarring, your best bet is to ask your primary care provider to refer you to an experienced plastic surgeon to repair the wound.

The Right Fit

2005-05-11T10:55:00.000-05:00

Hip-replacement surgery has dramatically altered the future for thousands of people crippled by arthritic hip joints. I know one man who reveled in adventures such as jumping from helicopters and skiing down virgin slopes -- until arthritis in his right hip made even walking difficult for him. Today, thanks to hip replacement, although he no longer leaps from helicopters, he is once again skiing advanced slopes. The problem has been, though, that artificial hips could not survive long-term wear and tear, and often had to be replaced. Consequently, doctors usually recommended that patients wait as long as possible for surgery to maximize the possibility that the hip joint would outlive the person. Now, English researchers are evaluating another approach to material for replacement parts -- a ceramic socket with a metal head for the thighbone (the femur). The team is taking the ceramic-on-metal model into clinical trials shortly. If tests prove successful, the researchers say the new model will likely be available for use within five years. To discuss this potential advancement in the hip-joint-replacement world, I called orthopedic surgeon Thomas P. Schmalzried, MD, associate medical director of the Joint Replacement Institute at Orthopaedic Hospital in Los Angeles. Dr. Schmalzried told me that metal-on-metal was actually used as far back as the 1960s, but design problems flawed the original prostheses. The next improvement was the evolution of using metal for the femur head and a cup made of polyethylene (a type of plastic) for the socket. However, this conventional polyethylene turned out to be a major problem in the so-called "wearing out" of the prosthesis -- the process in which normal use of the joint causes small particles of the prosthesis material to break off. Eventually, so many particles can accumulate around the joint that they cause inflammation and bone loss, thereby necessitating a new prosthesis and another surgery to position it. With conventional polyethylene, the particles were bigger and sooner created the need for another replacement. When metal-on-metal bearings became available in the last decade, they created considerably less debris around the joint, says Dr. Schmalzried. They also have had remarkable success in providing patients with greater mobility, allowing them to partake in virtually all activities. These prostheses have not been in use long enough for doctors to have data on their durability, but Dr. Schmalzried says they have found that the metal-on-metal models from 30 years ago -- even with their design flaws -- have proved to be durable in patients all these years later. Not everyone can tolerate metal-on-metal prosthesis, though. Although Dr. Schmalzried emphasizes that it is extremely rare, some people are sensitive to the nickel alloy used in the metal and cannot tolerate the ions released by the rubbing of the bearings. When released, these ions can cause inflammation around the joint, and in turn pain and degeneration. He says this is the primary problem with the metal-on-metal, and he doesn't see that the ceramic-on-metal model would improve the situation in any meaningful way. Consequently, he remains satisfied with the number of choices now available to patients. These include the improved polyethylene material (called cross-linked) for the joint socket that can be used with a metal or ceramic head, ceramic on ceramic and metal on metal, including titanium alloys that do not contain nickel. Dr. Schmalzried advises potential hip-replacement patients to discuss their goals, lifestyle and expectations with the surgeon, and work together to determine which choice of material is appropriate. He says the salient criteria for a patient's decision should not be age, but rather the person's level of activity. polyethylene may be fine for older or less active people, whereas those who are more active want to consider the more durable metal-based options. One other piece of good news: Surgery now requires only three days in the hospital and surprisingly little follow-up therapy. Unlike knee replacement with its grueling regimen of physical therapy, hip-replacement patients recover rapidly -- with a few weeks of rehabilitation -- and need to perform only simple exercises, including stationary bike riding, walking and some gentle stretching, says Dr. Schmalzried.

They've Got To Be Kidding!

2005-05-10T09:31:00.000-05:00

The US Dietary Guidelines don't seem to do a lot for Americans. Twenty-five years ago, the government began issuing these guiding principles to keep us healthy and fit, yet today we are flabbier than ever. This past January, the government took another crack at whipping us into shape, and, for the first time, emphasized weight control as well as healthy eating. The new guidelines recommend that we eat lots more fruits and vegetables, whole grains and low-fat milk... lay off the sugar, salt and trans fats... and exercise for as much as an hour-and-a-half a day. Nothing too new here, other than the exercise advice... and since I'm one of the most dedicated exercisers I know and find it hard to squeeze in just one half-hour daily -- my reaction to the recommendation was, "They've got to be kidding." To get some expert advice on the new guidelines, I spoke with Loren Cordain, PhD, a professor of health and exercise science at Colorado State University in Fort Collins, and Wayne Westcott, PhD, exercise physiologist at the South Shore YMCA in Quincy, Massachusetts.
What to Eat and Do...
FRUITS AND VEGETABLES
What the new guidelines say: Five a day is not enough. The new guidelines stress the need for nine daily servings of fresh fruits and vegetables. Examples of one serving...
One medium-sized fruit, 1/2 cup raw, cooked, frozen or canned fruits (in 100% juice) or vegetables
3/4 cup (6 ounces) 100% fruit or vegetable juice
1/2 cup cooked, canned or frozen legumes (beans and peas)
1/4 cup dried fruit
1 cup raw, leafy vegetables.
Our experts respond: Excellent advice. Although this may seem like a lot of fruits and veggies to pack into one day, it's easy to do if you make fresh produce a part of every meal. Sprinkle berries or sliced bananas on your whole-grain breakfast cereal... for lunch, enjoy a hearty salad... snack on baby carrots or red pepper strips... whip up a smoothie using a frozen banana instead of ice... and at dinner, sneak more fresh vegetables into a pasta or stir fry.
WHOLE GRAINS
What the new guidelines say: Consume three or more 1-ounce servings of whole grains daily. Generally speaking, at least half the grains you eat each day should be whole grains.
Our experts respond: Whole-grain products are clearly a healthier choice than products made from refined white flour. This means opting for brown rice instead of white rice, whole-grain instead of white bread, oatmeal or ready-to-eat cereal that lists a whole grain as its first ingredient rather than processed breakfast cereals. That said, Dr. Cordain believes that we generally place too great an emphasis on grains in the American diet and should focus more on eating fresh fruits and vegetables, lean meat and seafood. Choose "alternative carbs" from beans, seeds, nuts and legumes.
MILK
What the new guidelines say: Consume three cups a day of fat-free or low-fat milk, or an equivalent amount of yogurt or cheese.
Our experts respond: According to Dr. Cordain, there is way too much lobbying power behind the famous milk mustache, and dairy products are both overtouted and overrated. He notes that milk is less nutrient-dense than fresh fruits and vegetables (a better dietary choice all around) and difficult for many people to digest. Thus, calcium and magnesium are not easily absorbed and there is virtually no nutritional benefit. In a recent study at Colorado State University, healthy young people who drank a glass of milk experienced an insulin surge identical to that from eating a slice of white bread. (Read more about this research in an upcoming article.)
EXERCISE
What the new guidelines say: Exercise at a moderate to intense level for at least 30 minutes most days of the week. To prevent weight gain or sustain weight loss, the new guidelines up the ante even further to 60 minutes to 90 minutes daily.
Our experts respond: How many people realistically have the time or inclination to fit in that much exercise? Dr. Westcott has a better solution. Noting that intensity and effort count as much as the duration of exercise, he points out that the harder you work, the more calories you burn. For example, 90 minutes of walking and 30 minutes of running burn the same number of calories (about 600). Do not overlook the importance of strength training in your workouts. Thirty minutes on the Nautilus circuit burns more calories (about 240) than walking for 30 minutes (about 200). Dr. Westcott recommends that you fit in three 30-minute sessions of strength training weekly as well as at least 30 minutes of aerobic exercise daily. Keep in mind that other activities -- using the stairs instead of the elevator, walking instead of driving, cleaning the house and mowing the lawn -- all add up.
One other consideration with regard to the new exercise recommendations for those who need to lose weight: Losing weight is a simple equation. If you eat more calories than you burn each day, you gain weight. Eat fewer and lose weight. So, it stands to reason that the 60/90 minutes of exercise recommended for weight loss can be softened by watching your caloric intake as well. WHAT TO AVOID
SUGAR
What the new guidelines say: Choose and prepare foods and beverages with little added sugars.
Our experts respond: There's not a lot of muscle here, and our experts are not alone in seeing the fine hand of the sugar industry behind this relatively toothless recommendation. On the other hand, the final recommendation is actually stronger than the one in the preliminary advisory committee report, which said only to choose carbohydrates wisely. Soft drinks are among the worst sugar culprits, and you are best off replacing them whenever possible with a tall glass of good old-fashioned water.
FATS
What the new guidelines say: Limit your intake of saturated and trans fats, and keep your total fat intake to 20% to 35% of calories. Most fats should come from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts and vegetable oils.
Our experts respond: Dr. Cordain believes that the guidelines could have been much clearer about outlining the differences between good fats and bad fats. In particular, most nutritionists go much further and recommend the complete elimination of trans fats -- those artery-clogging partially hydrogenated oils that are nearly ubiquitous in foods from chicken nuggets and french fries to cookies and crackers. Dr. Cordain also would have liked to see more emphasis placed on the importance of healthy fats in the diet -- for example, a recommendation that we eat omega-3-rich deepwater fish, such as salmon and mackerel, at least twice a week.
SODIUM
What the new guidelines say: Consume less than one teaspoon of sodium a day. Choose and prepare foods with less salt.
Our experts respond: If you're at risk of high blood pressure and are salt sensitive, it's a good idea to limit salt. Check the sodium content of any processed foods you eat -- you'd be surprised at how much salt sneaks into your body by that route. But remember, consuming too little salt can be lethal. Don't assume that less is better.
In short, Americans have a long way to go to get back into shape. Flawed though they may be, the new guidelines are a step in the right direction.

Hot On The Trail

2005-05-10T09:22:00.000-05:00

A reader named Barbara wrote in that she developed acid reflux shortly after her doctor prescribed salmeterol (Serevent) for her asthma. Instead of linking her new problem with the new medicine she was taking and prescribing a lower dose or recommending a different drug, her physician simply gave her antacids to treat the reflux. Fortunately, before it came time to take a medication to cope with the side effects of the antacids, Barbara realized that the reflux started soon after she began taking Serevent. So, she got off the merry-go-round and stopped taking Serevent. The reflux disappeared. According to Jay S. Cohen, MD, author of Over Dose: The Case Against the Drug Companies (Tarcher/Putnam), there is a "side effect epidemic" in this country. My father-in-law was a victim of it this past fall, when he developed pneumonia thanks to a cough brought on by high blood pressure medication. This is not a minor or occasional concern, warns Dr. Cohen. It is a systemic problem involving scores of medications -- high blood pressure drugs, cholesterol-lowering medicines, antidepressants and more -- and millions of people. Take cholesterol-lowering statins, for example. These drugs are among the most widely used, best-selling medicines on the market today, yet their side effects have been grossly understated by drug manufacturers. At high doses, statins may cause debilitating joint and muscle pain and weakness, for which a physician is likely to prescribe anti-inflammatory drugs. In turn, anti-inflammatory drugs can cause diarrhea, abdominal pain, heartburn, ulcers and gastrointestinal bleeding, for which he/she might prescribe an antacid or antispasmodic drug, and both of those have their own corresponding side effects. So the dangerous merry-go-round keeps on turning. Dr. Cohen cautions that all drugs have side effects, and prescribing new drugs to overcome the side effects of old drugs is clearly not the answer. It simply complicates health issues even further... and can bury clues to the original underlying problem. Even worse: The problem gets exaggerated by the drug manufacturers' one-size-fits-all dosage recommendations. When the same dosage is recommended for a 300-pound football player and your 100-pound grandmother, there's a problem. The point of this story? Side effects happen. Work with your doctor to monitor and control your drug intake, and always take the lowest possible effective dose of any medication. When you start taking a new drug, or change your dosage of an old one, always be on the lookout for seemingly unrelated side effects. It's not enough to pay attention only to whether or not your original symptoms go away. You also must keep an eye on what's happening throughout your body. If something changes -- even if it seems totally unrelated -- speak up. Always remember, you know your body best and are the best advocate for your own health.

Animal Magnetism

2005-05-05T22:26:00.000-05:00

A while back, I had a conversation with my naturopath about whether magnets really can help alleviate pain. "Bah," he said. However, much to the surprise of nonbelievers everywhere, more and more studies are indicating that magnets can indeed relieve pain. This is especially good news given the dangers of many pain relievers. A research team at Peninsula Medical School (Plymouth, England) conducted a study that was recently published in the BMJ (formerly named the British Medical Journal) on the use of magnets to relieve osteoarthritis pain. The study included 194 people with osteoarthritis in the hip or knee. They were separated into three groups -- one group wore a standard strength magnetic band... a second group wore one with weaker strength... and the third group wore a placebo band. After 12 weeks of wearing the devices, the group wearing the standard strength magnets reported significant reduction in pain versus those wearing the weak one or the placebo. To get a better understanding of what magnet therapy is about, I spoke with neurologist Michael I. Weintraub, MD, clinical professor of both neurology and internal medicine at New York Medical College in Valhalla and adjunct clinical professor of neurology at Mt. Sinai Medical School in New York City. Dr. Weintraub has been studying magnet use for a number of years, in particular for his patients suffering from the pain of diabetic neuropathy (nerve disorders that can cause numbness, tingling and burning pain in people with diabetes). One problem in evaluating magnets, says Dr. Weintraub, has been that past studies were poorly designed, combining different types and strengths of magnets with different ailments into a single study. Although initially a skeptic, Dr. Weintraub designed and conducted carefully controlled studies with a placebo group on magnet use, including one with 375 people suffering from diabetic neuropathy. The results were enlightening -- wearing magnets relieved sensations of burning and tingling as well as exercise-associated pain. Dr. Weintraub says that even though doctors don't know why magnets work, he is now convinced that magnets often can be more effective in providing pain relief than even drugs. Okay -- so magnets have worked in the lab. How can you make use of them at home? Here's a primer on using magnets...
Magnet strength: Magnet strength is measured in gauss -- a refrigerator magnet is 10 gauss, while magnets used to treat pain go as high as 10,000 gauss or more. Dr. Weintraub explains that the quality and strength of the magnet is critical to its success -- it must be strong enough to penetrate the affected tissue, which might be quite deep or at a distance from the site of the magnet. A basic magnet, one with about 300 gauss to 500 gauss, can penetrate an inch or so, but Dr. Weintraub says that if, for instance, you are wearing a magnet to relieve deep back pain from a disc problem, you are going to need a stronger one. In that case, start with one that is well over 1,000 gauss and go higher if you find that isn't strong enough to ease pain. For pain in the finger joints, he suggests a wristband (not a bracelet that doesn't stay flush to the skin) that is at least 350 gauss.
How long to wear it: The amount of time you need to wear your magnet is another question. Wearing these isn't like taking an aspirin -- you should plan to have a magnet on for some time. Dr. Weintraub had his study subjects wear magnets 24 hours a day for four months. He says this was an arbitrary decision, but the effectiveness indicates that frequent wearing over a long period of time is likely advisable. The good news is that magnets don't wear out -- the material supporting the magnet may (such as in the shoe inserts), but Dr. Weintraub says the magnet itself will keep going and going. Dr. Weintraub reports that some patients find that to achieve ongoing pain control, they need to wear the magnets on a steady basis. However, it is unclear if this is true for all conditions that magnets are used for.
Best brands: Magnets are popular items and come in a wide range of prices. Dr. Weintraub says Bioflex (800-619-2717, www.bioflexmagnets.com) is a manufacturer of reliable products, but you may find other brands as well. He cautions that price does not necessarily guarantee a high-quality product.
One caveat about using magnets: Anyone with a medical device such as a pacemaker -- or whose partner has such a device -- should not wear magnets. They can disrupt the work of the device. Pregnant women also are advised not to wear them for the duration of their pregnancy.

Spicing Things Up

2005-05-03T22:54:00.000-05:00

After going out for spicy Mexican or Thai food, you may notice that your sinuses suddenly are clearer. The reason: Hot peppers, the fruits of the Capsicum plant, contain an active ingredient known as capsaicin that actually reduces sinus headache pain and nasal congestion. The good news: Sinusitis sufferers no longer need to eat out to breathe easier and subdue sinus discomfort. Relief is as close as the capsaicin creams at your local health-food store. The chemistry of that spicy meal is quite fascinating. Capsaicin dilates the capillaries in the mucous membranes and skin, which is why your nose runs when you eat spicy food, explains Eric Yarnell, ND, RH (AHG), adjunct professor at Bastyr University in Kenmore, Washington. The dilation of the capillaries by capsaicin permits more efficient circulation of nutrients into tissue and waste material out. This helps remove not only any superficial irritants to the nasal pathway, but also anything deeper in the tissue produced in reaction to the chronic inflammation that has been causing the sinusitis and headaches. Capsaicin also causes the nerves to shoot out large amounts of substance P (a pain-causing chemical), which is what makes capsaicin trigger burning and itching sensations upon application. Eventually the nerves can't make any more substance P, and the pain ceases. People usually experience some immediate relief from sinus pain and congestion with the topical form of capsaicin. However, it may take several days for the pain to fully disappear (both the initial sinus pain and the discomfort of the capsaicin itself). According to Dr. Yarnell, the longer you use it, the less intense the sensations you will feel. If you use capsaicin long enough, the sinus pain will go away completely. What brand or type of capsaicin is best? Dr. Yarnell usually tells his patients to buy capsaicin in cream form at their local health-food store. You apply the cream to the area of concern, carefully following the application instructions on the label. For example, if you have arthritis in your knee, you apply it to the knee. For sinus pain, wearing disposable gloves, apply a small amount to the nasal mucosa. Dr. Yarnell notes that some people cannot tolerate the burning sensation of capsaicin, especially on the sensitive mucosa. Depending on the severity of symptoms, he recommends using it two or three times a day. It is best to start with the mildest formula possible, since if it is too strong or used in too high a frequency, it is extremely irritating. Dr. Yarnell also emphasizes that it is essential to wash your hands with hot water and lots of soap after application to avoid getting the pepper on other vulnerable body parts, especially the eyes and genitals. Better yet, apply the cream with disposable gloves. If you do get some in your eyes, flush them out with lots of water. Capsaicin is very strong and will get the nose running again, says Dr. Yarnell. However, it is not a cure in and of itself. Dr. Yarnell believes that capsaicin is best viewed as part of an overall treatment plan for chronic sinus challenges that should also include other medicines and lifestyle changes to address underlying allergies or infection. A naturopathic physician can help you lay out a plan of action.

Extreme Makeovers

2005-05-03T22:40:00.000-05:00

Among the most popular reality TV shows these days are graphic ones featuring extreme makeovers. Personally, I can't bear to watch them... and I believe that many people would never go under the knife just to improve their appearance. But now along comes what is theoretically a kinder, gentler solution to the traditional face-lift: Thermage. Last year, the US Food and Drug Administration (FDA) approved this "non-invasive plastic surgery" for the face. Instead of making incisions, Thermage uses deep heat to tighten and contour the skin and its underlying tissues. It reminds me a little of those commercials for "vacuum" machines that tighten your tummy. Is Thermage for real? Is it safe? To get the facts about Thermage, I spoke with Barney Kenet, MD, a dermatologist at New York-Presbyterian Hospital Cornell Medical Center in New York City and coauthor of Saving Your Skin (Four Walls, Eight Windows). He told me that Thermage is a safe and effective way to obtain tighter, younger-looking skin without resorting to surgery. The results are more subtle and natural than those of a conventional face-lift... recovery time is nil... and in experienced hands, the procedure poses little risk. Thermage works by using radio frequency (RF) technology to apply deep, uniform and powerful heating to the inner layer of skin, or dermis, while the outer layer (the epidermis) is protected with a cooling spray. This promotes the contraction of collagen, which is the building block in the skin that gives it structure and firmness. Some contraction is immediate, but even more takes place over time. Although improvement usually can be seen after just one treatment, there is even more improvement over time, because the skin continues to tighten for three to six months while the technology stimulates the production of new collagen fibers. It lasts for at least 12 months and may last 24 months or longer. Thermage usually requires only one or two treatment sessions (with at least six months between the two). During the procedure, the dermatologist lightly touches the desired areas of the face and neck with a small device called a ThermaTip, which delivers a controlled amount of RF energy to the skin. Treatment continues for approximately one to one-and-a half hours, as the dermatologist slowly conducts five to 10 passes over the skin at a low heat setting. As far as discomfort goes, Dr. Kenet says that the experience is comparable to a visit to the dentist. There is some pain -- a pinching and sensation of heat. Oral or injected medications can take the edge off this discomfort. In contrast, surgery requires four to six weeks of recuperation. Best of all, there is no cutting, bleeding or bruising, and no recovery time with Thermage. Afterward, you simply can head back to the office or go out to dinner. Dr. Kenet also notes that when performed correctly by an experienced practitioner at a low heat setting, the risk of side effects is very modest. In 1% to 2% of cases, Thermage does not work on someone's skin. This is most likely to happen in heavy smokers or people who have received excessive sun exposure, whose skin has lost much of its elasticity. There are no special maintenance strategies after treatment. Just follow your regular skin-care routine. Research is under way to determine if this technique can be used on other skin areas that could benefit from tissue tightening and contouring. Dr. Kenet says that many doctors already use it to tauten loose skin on saggy underarms and tummies. Thermage will never replace a surgical face-lift. It is a subtle technique geared toward those with mild aging issues who require minor -- not major -- facial intervention. Thermage -- at about half the price of plastic surgery -- is an excellent alternative for people who don't have the time, money or interest in plastic surgery, and want a safer and less-invasive alternative, explains Dr. Kenet. While it's not going to do the trick for those who want major changes, he says Thermage can benefit virtually anyone who wants to obtain a delicate lift to droopy cheeks and sagging jaw lines. Moreover, it does not leave patients with the mask-like, expressionless faces of aging divas who have indulged in one cosmetic surgery too many. Dr. Kenet stresses that for the best results and the highest degree of safety, you must see an experienced, knowledgeable practitioner who is prepared to do multiple passes over the skin at a low heat setting. This yields the safest, most effective and consistent results. Before undergoing the procedure, make certain that this is your dermatologist's approach. If it is not, go elsewhere. An inexperienced practitioner who uses a high heat setting and rushes through just one or two passes is less likely to significantly improve the skin, and a high heat setting can cause complications such as burning or scarring. To learn if Thermage is available in your area, click on the "Locate a Doctor" feature at the Web site of Thermage, Inc., www.thermage.com. Keep in mind that this is a cosmetic procedure that insurance will not cover. The cost varies dramatically, but in general ranges from $3,000 to $5,000.

A Relaxing Detox

2005-05-03T22:27:00.000-05:00

Here's a tricky question that almost no one gets right the first time they hear it:
Q: What is the body's largest organ?
A: The skin.
It weighs roughly six pounds, and if taken off your body and laid flat it would cover more than 20 square feet. More importantly, skin is instrumental in stabilizing the body's internal environment. And just as the interior of the body benefits from detox, so does the skin. In a previous alert, panelist Ann Louise Gittleman, Ph.D., C.N.S., shared information about special cleansing baths developed by Dr. Hazel Parcells, who Dr. Gittleman calls a pioneer of inner and outer cleansing. According to Dr. Parcells, radiation (from cosmic rays and naturally occurring radioactive materials in our environment) is a hidden killer that assaults our immune systems, via the skin, on a daily basis. For skin detox, Dr. Parcells recommends this salt and soda soak, which is highly alkaline and helps neutralize the effects of radiation: Place 2 pounds of salt with 2 pounds of baking soda in a hot bath and soak for 20 minutes, until the water cools. That's all there is to it. In addition to the typical radiation we're exposed to daily, each airline flight increases our exposure to gamma-ray radiation, which may put some frequent fliers at greater risk of cancer. Dr. Parcells suggests that a salt and soda soak following every flight, as well as every dental or medical x-ray, will go a long way toward providing your skin the detoxification it needs in order to help keep the rest of your body healthy.

Prepping the System

2005-05-03T22:08:00.000-05:00

"Surgery is one of the biggest stresses the body can endure." The mental stress that goes hand in hand with surgery is a given. The stress that panelist Allan Spreen, M.D., refers to in the above quote concerns the demands that surgery puts on the immune system. In the alert "Answering the Call" Dr. Spreen shared his insights on five immunonutrients that have been shown to improve immune system function after surgery. But if you regularly take a host of dietary supplements, there are some important adjustments you'll need to make prior to any surgical procedure that requires anesthesia. As Dr. Spreen told us in a previous alert , high levels of vitamin C can complicate the anesthesia process. Here's how Dr. Spreen explains the interaction: "The specifics of vitamin C apply to the mega-vitamin takers. Very high doses of C over time cause the body to 'awaken' dormant enzyme systems that more fully utilize high doses of the nutrient. If you take low doses, the body shuts these pathways down for your benefit. If it didn't it would too rapidly empty the body's 'C pipeline' and you'd be constantly deficient. "For those people I tell them to TAPER the C over time, reaching nearly zero just before surgery (not weeks before). This is because such high doses are good enough detoxifiers that more anesthetic drugs may be necessary for the anesthesiologist to keep you under. BUT, the absolute INSTANT you tolerate oral intake, you jack the C back up to heroic levels." In one of the commentaries I found on the immunonutrients report that appeared in the British Medical Journal, osteopathic physician Dr. Joseph Mercola stated his opinion that herbal supplements should be discontinued prior to surgery, noting that some of these supplements are powerful enough to function like drugs. I asked Dr. Spreen about the herbal issue, and he agreed with Dr. Mercola...to a point. "Yes, herbs are like drugs. The simple reason is that no drug companies design their drugs using mere brilliance. Pharmaceutical developers get their ideas from herbal effects, then try to alter the molecule enough to patent the thing (and cause all sorts of toxic side effects), hoping it'll still do what the herb did, without killing you first. "The developers are good, however, at picking good herbs. Proscar is an excellent example. It is a derivative of the herb Serenoa repens (saw palmetto), which does work against benign enlargement of the prostate (better than Proscar), and with no side effects. Of course, the drug company will admit neither detail. "As to when, and whether, to quit an herb, the situation is much the same as with prescription drugs. You should seek advice from someone educated in the agent's effects to know whether to stop it and when (or whether to increase it and how much!). I'd certainly never stop my saw palmetto weeks before surgery (or the day before, or ever)." Returning to the subject of non-herbal supplements, Dr. Spreen had this final note: "Surgery is a major stress, and for that you want the maximum dose of nutrients for the body to choose from for the repair function. Vitamin C, and probably NAC should be discontinued (my sister-in-law required half-again as much medication to put her under as she was pumping the vitamin C heavily as 'insurance'...the anesthesiologist even commented on it). "However, the instant I could hold something down I'd be right back at them (and tons of other supplements) full force - C, A, E, B-complex, NAC, alpha lipoic acid, milk thistle extract, zinc, essential fatty acids, and others." In addition to dietary supplements, any over-the-counter medications need to be scrutinized before surgery as well - especially aspirin. Most patients are advised that aspirin therapy for heart health should be discontinued well before surgery to minimize bleeding. And even though it might be a good idea to stop aspirin therapy altogether (see the alert "Wonder Goes Under"), evidence shows that coronary bypass surgery patients may want to talk with their doctors about aspirin use after surgery. In a 2002 New England Journal of Medicine study that examined more than 5,000 coronary bypass patients, the use of aspirin immediately after surgery was associated with a 48 percent reduction in ischemic complications and a 50 percent reduction in the incidence of stroke. The current rule of thumb is to avoid aspirin for the first 24 hours after bypass surgery because aspirin increases the risk of bleeding. However, in an editorial accompanying the study, Dr. Eric J. Topol of the Cleveland Clinic Foundation called the findings "powerful." Based on the study, Dr. Topol believes aspirin should be given within the first six hours after surgery.

Going Nuts

2005-05-01T12:01:00.000-05:00

Years ago, it seemed that almost every home I visited had a dish of whole walnuts at hand. It was never clear if anyone actually shelled and ate the walnuts, but if they didn't, they should have. Research is piling up that walnuts are a powerhouse for your health. The latest study, conducted in Australia and published in the journal Diabetes Care, involved 58 people with type 2 diabetes who were assigned to one of three groups. All followed a low-fat diet that included fish, fruits and vegetables, but one group also ate 30g of walnuts (approximately six whole nuts) each day. At the end of six months, while all groups showed some improvement in healthy HDL cholesterol, the researchers termed improvement for members of the walnut-eating group as "significant." In addition, the walnut-eating group had a 10% drop in artery-clogging LDL cholesterol. I tend to think of walnuts as something added to salads and cookies, not as part of a daily diet, but botanical expert Eric Yarnell, ND, RH (AHG), is so enthusiastic about walnuts in the diet that he advises eating 10 to 20 whole walnuts each day! The reasons are many, but they come down primarily to walnuts' high content of omega-3 fatty acids and copper, both nutrients that are extremely deficient in the American diet. Not only that, the omega-3 fatty acids in highest quantity in walnuts -- alpha-linolenic acid (ALA) versus docosahexaenoic acid (DHA) and eicosapentaenoic (EPA) -- also can be very satisfying. As a result, many walnut-eaters find they have fewer cravings for simple carbohydrates. Walnuts are an excellent source of fiber, which Dr. Yarnell describes as ridiculously insufficient in the typical diet, as well as magnesium, zinc and some vitamin B-6. The body needs a balance of zinc and copper to help maintain proper cholesterol levels. Most people tend to consume too much zinc (he advocates not more than 20 mg a day) and not enough copper. Walnuts deliver both in balance. Dr. Yarnell says that baking with walnuts does not hurt their nutrient content, but be sure to avoid cooking with walnut oil. Heat breaks down the oil so fast that it quickly becomes toxic. (The omega-6 content of some vegetable oils -- such as canola, sunflower, sesame and safflower -- makes them highly resistant to heat, he says, and okay to use.) Store all nuts -- including walnuts -- in the freezer, preferably in an airtight container, and take out just what you plan to eat each week. This will keep the oils fresh and preserve the antioxidant properties.