http://www.planforyourhealth.com/ Latest Healthy Living News from Aetna en http://www.planforyourhealth.com/ http://www.planforyourhealth.com/ Latest Healthy Living News from Aetna TYPO3 - get.content.right http://blogs.law.harvard.edu/tech/rss Mon, 20 May 2013 17:55:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/processed-restaurant-foods-still-high-sodium/ The high sodium level of processed and restaurant foods is not getting much better, two new... What Is the Doctor's Reaction? Eat less sodium. Eat less sodium. Eat less sodium. The message is loud and clear. You do need some sodium for your body to work properly. But Americans, on average, eat about 3,400 milligrams (mg) of sodium per day. That's more than double the recommended amounts for some adults. For most adults, the recommended daily sodium intake is less than 2,300 mg per day (about 1 teaspoon of salt). The U.S. government recommends less than 1,500 mg per day for adults over age 50 or those with certain medical problems. The problems include high blood pressure and diabetes. Why does sodium matter? There is a clear link between too much sodium intake and high blood pressure. And high blood pressure greatly increases the risk of heart disease and stroke. Nearly 75 million Americans have high blood pressure. Many more are at risk of developing it. People develop high blood pressure for many reasons. But eating too much sodium is a major contributor. Some of that sodium comes from the salt we add to our foods. But by far the greater problem is the amount of sodium already in the processed foods we commonly eat. We do have control over the foods we choose to eat. However, we do not have control over the amount of sodium in processed foods. Companies and restaurants have been urged to reduce the sodium in their foods. But how good a job have they done? It appears that not much has changed. A pair of research studies, out this week, remind us just how much sodium is in processed foods and restaurant meals. One study showed that the average single meal at a sit-down restaurant contains 2,269 mg of sodium. That's almost as much as the recommended sodium limit for an entire day for an average adult. A second study looked at whether there have been any changes in how much sodium is in processed foods we buy or in the restaurant foods we order. The study looked at 402 processed foods and 78 fast-food restaurant items. Some foods had lower sodium content. But overall there had been no significant change when comparing average sodium content in foods in 2005 to foods in 2011. What Changes Can I Make Now? The first step is to try to limit how much sodium you are eating. You have the power to choose what you eat. Here are some tips:

1. Pay attention to how much sodium is in the food you buy. Check the labels. Make note of how many servings are in the package. Most labels indicate how much sodium is in one serving. If you eat the whole package, you need to multiply the amount of sodium by the number of servings you have. It's much harder to know how much sodium is in a restaurant meal. But many chain restaurants are now making the nutrition information for their foods available. Take a look. You might be shocked at what you find.


2. Cook your own food. Much of the sodium in our diets comes from processed and pre-prepared foods. If you make your food yourself, from fresh ingredients, you will automatically cut down your sodium intake. Of course, this is hard, especially in our fast-paced lives, but it's well worth the effort.


3. Don't be fooled by "low fat" or "low cholesterol" on the labels. Some packages say "low fat," some say "low cholesterol" and some say "low salt." But most foods don't have all of these in one. Remember that a food that's good for you in one way may not be good for you in another. Even those foods that are labeled as "low salt" may still have more sodium than you need. Read the labels carefully.

What Can I Expect Looking to the Future? There is no debate that Americans have too much sodium in their diets. It is well-recognized that higher levels of dietary sodium intake are linked to higher rates of heart disease and stroke. Yes, people do need to take responsibility for the foods they eat. But the food industry also needs to take responsibility by reducing the sodium in processed foods. It seems that allowing food manufacturers and restaurants to voluntarily reduce sodium has not been successful. In the future, the government may require companies and restaurants to lower sodium levels in foods. In the meantime, there is much we can do to reduce the sodium we consume. We can pay attention to labels, focus on eating fresh fruits and vegetables, and cook our own food. Otherwise, we will see the consequences of our high-sodium diets in the next decades with an increase in the rates of high blood pressure, heart disease and stroke.]]> Wed, 15 May 2013 14:09:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/doctors-urged-to-screen-for-alcohol-problems/ An influential group of experts is recommending that primary care doctors screen all adults for... What Is the Doctor's Reaction? There's so much to accomplish during a routine visit to your primary care doctor. So having a simple screening tool to determine if a person is misusing alcohol is terrific. The one question: "How many times in the past year have you had X or more drinks in a day?" X is 5 for men and 4 for women and all adults older than 65. If the answer is at least once, then the doctor should do further questioning. The person may be misusing alcohol. The U.S. Preventive Services Task Force identifies the following levels of misuse:

• Risky alcohol use: For men, more than 14 drinks per week or more than 4 drinks in one day. For women, more than 7 drinks per week or more than 3 drinks in one day. Risky means you are more likely to develop social or medical problems related to alcohol.
• Harmful alcohol use: Alcohol misuse has already impacted your physical or mental health or harmed your social relationships.
• Alcohol abuse includes one or more of the following:
  
  • Multiple times you have not met your responsibilities at home, work or school
  • Excessive alcohol use, followed by droving a vehicle, operating machinery or doing something else that put you or others in harm's way
  • Legal problems related to alcohol use
• Alcohol dependence: Physical craving for alcohol and/or symptoms of alcohol withdrawal if you try to stop drinking

Similar to all screening tests, this one-question test is not perfect. It can identify about 85% of adults who misuse alcohol. So it is a sensitive test. But about 30% of people who say that they have had more than 4 or 5 drinks at least once in the last year do not have a problem with alcohol. What Changes Can I Make Now? The U.S. Preventive Services Task Force wants primary care doctors to screen patients for alcohol misuse. Here's why:

• The question appears to do no harm. It might make someone feel uncomfortable, but not much else.
• Screening might identify a much more serious problem than the doctor has recognized or the patient has mentioned.
• Early, simple interventions may prevent risky alcohol use from becoming harmful use or abuse.

A little advice and encouragement may help you figure out if your drinking follows a risky pattern and what to do about it. The source of advice could be your primary care doctor. Or the doctor might refer you to an alcoholism counselor. Often a non-professional person who is knowledgeable about alcohol or had an alcohol problem can be very effective. This is not long-term therapy. It's perhaps two or three discussions. The helper can ask you how much you are drinking and let you know how it compares with the norm. He or she might:

• Talk briefly about the consequences of more serious alcohol use
• Provide a self-help manual or workbook
• Suggest that you keep records of your drinking and choose a goal of cutting back or stopping completely

What Can I Expect Looking to the Future? You may see increased publicity about risky alcohol use. This has been shown to be effective. In one study, people misusing alcohol were helped by little more than responding to a public appeal. The advertisement was placed in newspapers, on television, on radio and in leaflets and posters distributed in Toronto, Canada. The ad contained a telephone number, along with the following message: "Thinking of a change in your drinking? Do you know that 75% of people change their drinking on their own? Call us for materials that can be completed at home."]]> Tue, 14 May 2013 14:10:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/survey-many-teens-text-while-driving/ Almost half of older U.S. teens text while driving, a new survey shows. And those who text while... What Is the Doctor's Reaction? OMG! LOL! G2G! TTYL! Look familiar? If you have a teenage son or daughter, you've probably seen this texting shorthand before. Sometimes it seems as if teens have their very own texting language. Texting can be a fun way for teens to keep in touch with their friends. But they should never be texting while driving! Car crashes are the No. 1 killer of teenagers in the United States. About 3,000 young lives are lost every year because of car accidents. Most of these crashes are caused by driver inexperience. When you add in distractions (such as texting), the result can be especially deadly. A new study published in the journal Pediatrics looked at the rates of texting and driving among teens aged 16 years and older. The researchers used results from the Youth Risk Behavior Survey. High school students across the country take this survey. It asks them questions about their lifestyle, such as whether or not they smoke cigarettes, drink alcohol or use drugs. As part of the survey, teens were also asked whether they had sent a text or e-mail while driving during the last 30 days. In all, 8,505 students answered this question. Almost half (45%) reported texting while driving in the last month. That is a lot of distracted drivers on the road! The students who had sent texts while driving were also more likely to:

• Not always wear a seatbelt
• Ride with a driver who had been drinking alcohol
• Drink alcohol and drive

These findings suggest that a large group of teens may act in unsafe ways while driving. This is putting the teens themselves, their passengers and other drivers at risk for crash-related injuries or even death. What Changes Can I Make Now? Experts are brainstorming ways to decrease the number of teens who are texting and driving. Here are some of their proposed strategies:

• Bans on cell phone use (including texting) for new drivers. Currently, 36 states and the District of Columbia have laws making it illegal for new drivers to use their cell phones while behind the wheel. Forty-five states, and Washington, D.C., have specifically banned texting while driving for new drivers. Find out more about the laws in your state.



• New technology. Some experts have recommended installing devices that block cell phone use in teens' cars. Others have recommended devices that monitor the teen's driving behaviors (such as cell phone use). These devices provide feedback to parents.



• Parental supervision. Setting rules against cell phone use for your child is critically important. Make sure they are following these rules, too. This may be the best way to decrease texting and driving.

Teen car crashes can be prevented. Proven strategies can improve the safety of young drivers on the road. Here are more things you can do to keep your teen driver safe:

• Practice driving with your teen as much as you can. The more experience he has behind the wheel, the safer he'll drive.



• Set rules for the road. Make sure that your new driver (and her passengers) always wear seat belts. Limit the hours when she is allowed to drive. Don't allow driving at night or with teen passengers. Crashes are more likely to occur in these situations.



• Limit distractions. Sending texts, making phone calls, using a GPS or MP3 player all take a driver's focus off the road. Instead, suggest other options to these bad habits. For example, encourage your teen to pull into a parking lot to answer or make phone calls.



• Write a parent-teen driving agreement. Work with your teen to write the agreement. Have him or her sign it!
  
  • Discuss your rules of the road with your teen.
  • Talk about why the rules must be followed.
  • Explain what the consequences are for breaking them.


• Lead by example. Be a role model of good driving behaviors. Always do this, even when your children are too young to drive. Young children can pick up on your dangerous behaviors. If you talk on the phone, text, speed or drive without your seat belt, teens will do what they see you do.

The government's "Parents are the Key" campaign offers parents tools and proven steps for reducing teen driving injuries and deaths. What Can I Expect Looking to the Future? You can expect serious efforts to keep young drivers safe on the road. Laws against cell phone use and texting will be strictly enforced. States that do not have such laws may begin to pass them. You also can expect your child's pediatrician to stress the importance of practicing safe driving behaviors. The doctor is very likely to encourage you to set road safety rules for your teen. This should include no cell phone use at all while driving.]]> Mon, 13 May 2013 13:07:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/study-finds-no-benefit-from-fish-oil-pills/ Fish oil pills don't reduce the risk of heart attack and stroke in people at high risk of heart... What Is the Doctor's Reaction? Fish oil has been flying high as a health-boosting supplement. It has garnered a reputation as an easy way to protect the heart, improve brain function and lengthen life. Such claims are one reason that Americans spend more than $1 billion a year on over-the-counter fish oil. Food companies also are adding it to milk, yogurt, cereal, chocolate, cookies, juice and many other foods. Fish oil is loaded with omega-3 (or n-3) fatty acids. There are three main types:

• Eicosapentaenoic acid (EPA)
• Docosahexaenoic acid (DHA)
• Alpha-linolenic acid (ALA)

EPA and DHA are found mainly in fish. For that reason, they are sometimes called marine omega-3s. ALA is found in plant-based foods, such as flaxseed, walnuts, and canola and soybean oils. It's true that healthy people tend to have high levels of EPA and DHA in their blood. People with heart failure, stroke and heart attack often have lower levels of these omega-3 fatty acids. However, this does not necessarily mean that taking fish oil pills will prevent heart disease. In fact, there is now good evidence that you do not decrease your chance of heart attack, stroke or death by taking fish oil pills. Based on the results of a new study, even people at high risk of heart attack, stroke or premature death showed no benefit. Study results appear in today's New England Journal of Medicine. All of the people enrolled in the study had known blood vessel disease or had multiple factors that put them at high risk. They had at least four of the following risk factors, or they had diabetes and at least one of these factors:

• Age 65 or older
• Male sex
• High blood pressure
• High cholesterol
• Current smoker
• Obesity
• A family history of coronary artery disease at a younger age (father or brother younger than 55, mother or sister younger than 65)

People in the study were randomly assigned to take capsules containing either olive oil or omega-3 fatty acids. Results for the two groups were the same. The omega-3 capsules did not prevent death or hospital stays for heart attack or stroke. Side effects were also measured during the study. Minor side effects were similar in both groups. People reported no major side effects. What Changes Can I Make Now? To help prevent heart disease and lower your risk of heart attack and stroke, don't rely on omega-3 fatty acid pills. But do keep eating fish, especially fatty fish that are rich in omega-3 fatty acids. Examples of fatty fish include salmon, sardines, mackerel, char and halibut. Why the fish but not fish oil pills? Multiple well-done studies have shown that fish eaters have lower rates of heart disease and stroke. True, that doesn't prove that the fish directly causes the lower risk. But fish is one of the healthiest sources of protein. Also, stick to the proven ways to lower your chance of heart attack and stroke:

• Quit smoking.
• Exercise more.
• Eat smaller portions of food and decrease saturated fat.
• Keep your blood pressure in the normal range, with medicines if needed.
• Know your LDL cholesterol level. Lower it with a statin or other medicine if needed.
• Talk with your doctor about whether you should take a baby aspirin.

You might still decide to take fish oil pills or another type of omega-3 supplement. At low to moderate doses, this appears to be quite safe. I suggest taking no more than 1,000 milligrams (one gram) of fish-oil based omega-3s per day. For people with very high blood triglyceride levels, high-dose omega-3 pills are an effective treatment. These pills (known as Lovaza) are available by prescription. The usual dose is 4 grams per day. What Can I Expect Looking to the Future? As we have seen with other supplements, such as vitamin E, the scientific evidence supporting health benefits from fish oil does not live up to the hype. Is this the final word on omega-3s? Probably not.]]> Thu, 09 May 2013 14:12:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/diet-fitness/diet-fitness-details/newsarticle/christie-gets-surgery-to-aid-weight-loss/ New Jersey Gov. Chris Christie, who has endured both jokes and doubts about his political future... What Is the Doctor's Reaction? Weight-loss surgery has been hailed as a potential lifesaver for people who are severely overweight. It can dramatically:

• Reduce blood sugar levels
• Lower blood pressure and cholesterol
• Improve sleep apnea (a dangerous pattern of breath holding during sleep)
• Improve heart function

In general, weight-loss surgery is intended for people with a body mass index (BMI) of 40 or higher. They are considered to be very obese. People with a BMI of 35 to 39.9 also may qualify for surgery. They must also have a severe, treatment-resistant medical condition. Such conditions include diabetes, heart problems and sleep apnea. Some experts suggest that some people with type 2 diabetes and even lower BMI levels (between 30 and 34.9) be considered for surgery. Whether Governor Christie had weight loss surgery for political reasons or for concerns about his future health, he clearly fits the profile of a good candidate. We don't know his exact weight before surgery. However, the estimate is 300 pounds plus. He is just under 6 feet tall. This gives him a body mass index of at least 41. Christie also admits to multiple trials in weight-loss programs. He has lost and regained substantial amounts of weight at least a couple of times. But, like more than 95% of obese people, he has regained all the lost pounds and more. The governor has said he was otherwise in good health. Even if that was correct, his risk of developing problems directly related to obesity was high. At a BMI of greater than 40 and knowing that the surgery appeared uncomplicated for him, Christie surely chose the best and perhaps only treatment option for obesity. What Changes Can I Make Now? Today, surgeons generally suggest one of three weight-loss procedures:

• Laparoscopic adjustable gastric banding -- This is the simplest of the three procedures. It is done through small holes in the abdomen. The surgeon wraps an adjustable band around the upper stomach. This creates a small pouch with a narrow opening that empties into the rest of the stomach. The person feels full much sooner than before.
• Open Roux-en-Y gastric bypass -- The surgeon cuts into the abdomen and creates a small pouch in the stomach. This bypasses the rest of the stomach. The pouch is hooked to a loop of small intestine beyond the first section of intestine.
• Laparoscopic Roux-en-Y gastric bypass -- There's no large surgical cut. Small holes are made in the abdomen. Cameras are used to guide the instruments. The technique is otherwise similar to the open Roux-en-Y.

Governor Christie opted for the simplest procedure, the stomach banding. For most, this is same-day surgery. Christie's surgery was reported to take only 40 minutes, and he was home later the same day. Recovery moves along quickly. Christie will check in with his weight-loss surgeon regularly to see if the stomach band needs adjusting. The band can be easily tightened or loosened as needed depending on his rate of desired weight loss and how he feels. Usually weight loss should be slow and steady. He must be sure to get enough vitamins and minerals through diet, supplements or both. Roux-en-Y surgery leads to greater average weight loss than gastric banding. However, it is a more complicated operation. It also has greater short-term and long-term risks. What Can I Expect Looking to the Future? If you are considering weight-loss surgery, realize that you must commit to a lifelong change in the way you eat. Without lifestyle change, surgery will either make you miserable or not result in weight loss. And likely both. This is why people are required to go through at least one structured weight-loss program before they are eligible for surgery.]]> Wed, 08 May 2013 14:23:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/conditions/health-conditions-details/newsarticle/seeking-a-better-way-to-fight-eye-disease/ Adding components found in fish oil doesn't improve a pill that may help to slow down a blinding... What Is the Doctor's Reaction? Macular degeneration runs in my family. One of my elderly aunts was blind before she died. My grandfather struggled with his vision. It was harder for him to be unable to see well than it was for him to be terribly limited by a heart condition. He couldn't move easily, and his vision restricted him further from exploring the world through reading, watching TV or driving. Macular degeneration is an eye condition that affects our central visual area, called the macula. It's also called age-related macular degeneration or AMD. People with macular degeneration gradually lose their vision right in the middle of their eyes. They find that they cannot see well straight ahead and cannot see fine details. Severely affected people can't drive, read or do crafts. AMD is the cause of half of the blindness in the United States. It is the leading cause of blindness in the developed world. Wet and dry macular degeneration are the two types of this disease. The wet kind gets worse faster than the dry kind does. The dry kind is more common. There are some experimental treatments for wet AMD, but no good treatments for dry AMD. However, a specific combination of vitamins, discussed below, may help to slow down the disease. This latest news relates to a study called the Age Related Eye Disease Study, or AREDS. Previous research based on this study has found that certain vitamins and minerals may help prevent macular degeneration from developing or getting worse. They include vitamins C and E, beta-carotene, zinc and copper. The new study added different combinations of supplements to the original formula of proven vitamins. Researchers wanted to see if other supplements would be of further benefit. They tested four groups. All four received the original formula.

• One group also got lutein and zeaxanthin. These are plant-derived antioxidants. Lutein is found in leafy green vegetables like kale and spinach. Zeaxanthin is related to vitamin A. It is responsible for the colors of paprika, corn and saffron.
• A second group also got DHA and EPA, omega-3 fatty acids found in fish oils.
• A third group also got lutein, zeaxanthin, DHA and EPA.
• People in the fourth group got no extra supplements. They took placebo (fake) pills.

The study, unfortunately, found that none of the extra supplements further delayed or decreased vision loss. Some people received the original formula without beta-carotene, which has been linked with higher lung cancer risk in smokers. The formula appeared to be just as effective without it. Based on their analysis, the authors hope that looking further at the lutein and zeaxanthin groups will lead to a role for these supplements. In these small groups, people who received the original formula without beta-carotene did better than those whose pills included it. People who had very low levels of lutein and zeaxanthin in their diets also did better with these supplements than those who got more from their diets. What Changes Can I Make Now? Macular degeneration is more common in smokers, whites and people who have a family history of the condition. If you are over 50 and in a high-risk group, it's reasonable to see an eye doctor for an exam. At this age, it is also a good idea to be checked for other eye diseases, such as glaucoma or cataracts. If you have diabetes, you should see an eye doctor every year. Don't wait until you have trouble with your vision. At this point, we cannot restore vision, so preventing any loss is key to maintaining your eyesight. If your doctor recommends it, you might consider taking the AREDS vitamin preparation. It works best for certain groups of people, so definitely talk to a doctor before deciding to take these supplements. Also, be sure to eat your leafy green veggies. If you are already having problems with your vision, don't despair and don't delay. Your eye doctor can help you find a low-vision specialist and some visual rehabilitation. These steps can help you make the best of what you have and continue to enjoy a rich, full life. What Can I Expect Looking to the Future? This work really shows the benefit of large research studies. These studies are able to answer complicated questions and point us in good directions for future learning. Great strides have been made in macular degeneration during the last several years. I hope they will continue in both treatment and prevention.]]> Tue, 07 May 2013 00:00:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/most-parents-report-distracted-driving/ In a new survey, nearly 90% of parents admitted to being distracted by technology in the last... What Is the Doctor's Reaction? When we think of distracted drivers, we tend to think about teenagers, or those erratic drivers in front of us who don't use their turn signals because they are holding their phones. We don't necessarily think about … parents. But, it turns out, parents can be very distracted drivers. In a study just released, researchers from Michigan did a survey of more than 600 adults. All were parents and caregivers of children ages 1 through 12 who were seen in an emergency room for any reason. Researchers asked the parents how often in the last month they had performed certain distracting activities while driving with their child in the car. Here are the rough percentages that reported doing each of these activities:

• Phone calls (handheld or hands-free): 75%
• Child care (feeding, picking up a dropped toy): 70%
• Self-care (grooming, eating): 70%
• Directions (checking navigation system or map): 50%
• Entertainment (changing CD or DVD): 50%
• Texting: 15%

Almost 90% said they had engaged in at least one technology-based distraction in the last month. These activities are not all equally dangerous. Munching on a pretzel or listening to your GPS system tell you to turn right is absolutely not as dangerous as texting or leaning back to grab a dropped toy. But we know that distractions can lead to accidents. Among these parents, people who used a phone or did self-care while driving were more than twice as likely to have ever been in a motor vehicle crash. Those who did child care or got directions were just under twice as likely. Drivers who had ever been in a crash were more likely to report some sort of distracted driving than drivers never involved in a crash. Another interesting finding was that parents whose children were not restrained in the car properly (according to Michigan law) more often reported child care distractions or texting. What Changes Can I Make Now? All passengers are precious cargo, but children are especially precious. They count on parents and caregivers to keep them safe. Distractions cause accidents. We talk a lot about cell phones, but anything can do it. You could be changing a radio station, or just turning to talk to the person next to you. Anything that takes your eyes and concentration off the road can lead to a crash. It's crucial that parents and caregivers understand this. It's hard not to have any distractions. But you can limit them. Here are a few things you can do:

• It's best to pull over to make a phone call. If you have to make a call while driving, use a hands-free device.
• If snacks or toys are needed for a ride, do some planning to make sure they are within your children's reach.
• Make rules for the car. Let your kids know that you simply aren't going to fix the DVD or change the music or reach back to get something while you are driving. Then they'll be less likely to get upset and you'll be less likely to be tempted to break your rules. Don't try to explain it to them while you're in the car. Talk about it ahead of time.
• Whenever possible, have another adult (or at least an older child) with you when taking long car trips with children.
• Resist the temptation to do a drive-thru for meals. Stop and eat. Between eating yourself and reaching back to grab or give food, you are putting everyone at risk.
• Know where you are going ahead of time. This helps avoid the distraction of figuring it out on a map or your smart phone while driving. If you need to use a GPS system, use one that tells you what to do, as opposed to one that you need to look at. If you do need to look at it, mount it on the dashboard to minimize the amount of time your eyes are off the road.

What Can I Expect Looking to the Future? If we don't work to limit distractions, what we can expect is more motor vehicle accidents. I hope that this study will be a wake-up call -- and will help save lives.]]> Mon, 06 May 2013 00:00:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/fda-probes-wider-caffeine-use-in-food/ Caffeine has been showing up recently in snack foods, candy and gum. Now U.S. food regulators are... What Is the Doctor's Reaction? Hi doctor,

I'll make it short. Could you please let me know if anything in this supplement might be harmful to me? I don't use it for weight loss but just something to help me with more energy.

Thanks for your advice in this matter. I am a primary care doctor. I get questions from patients all the time about supplements, energy drinks, diet pills and herbal mixtures that have been advertised. This was a message I got last week. Many of these "energy boosters" have caffeine as their active ingredient. That was true for the supplement my patient was asking me about in this message. Each pill had the amount of caffeine that you would get from two cups of coffee. Caffeine boosters and snacks are in the news right now. This week, Wrigley started selling a caffeinated gum, calling it "the right energy, right now." Food manufacturers have also recently put caffeine into candy, chocolates, jelly beans, trail mix, chips and other snack foods. Some people are getting more caffeine through these energy snacks than they ever got from coffee. They are being marketed as a wellness product -- for more energy, better athletic performance. So are caffeinated snacks safe? In moderation, they are probably not going to do harm. However, the Food and Drug Administration (FDA) received 92 reports in 4 years about illnesses, hospital stays and deaths that came after people drank an energy drink named 5-Hour Energy. The FDA has also received reports of several deaths possibly linked to Monster Energy Drink. These reports do not prove that the caffeinated drinks actually caused the deaths. Caffeine has its effect in the body by triggering the brain to make extra adrenaline-type hormones. This can stress the heart and raise blood pressure. What Changes Can I Make Now? Caffeine is not a problem in the early part of the day, and in small amounts. But it is good for you to know the side effects of regular, heavy use of caffeine. If you want more energy, the healthiest way to get that is by exercising and by getting enough sleep, not by using caffeine:

• Caffeine may be linked to an increased heart attack risk. Researchers focused on people with slow caffeine metabolism. This means that caffeine stays in their bodies for a long time. Among this subgroup, heart attacks were more likely to occur in heavy coffee drinkers. Drinking 2 to 3 cups of coffee each day seemed to be linked with a 36% increase in heart attack risk. With 4 or more cups each day, the increase appeared to be 64%. This study was not designed in a way that would tell us for sure that there is risk from caffeine.



• Unfiltered coffee might ever-so-slightly increase your total cholesterol levels. Drinking 6 cups of unfiltered coffee (such as espresso) daily appears to increase total cholesterol by about 12 milligrams per deciliter. This small change is not much to be concerned about.



• Heavy coffee intake might change your blood level of homocysteine. This is a substance that has been linked with heart risk. In one study, people who drank 6 cups of coffee daily had a higher level of homocysteine than people who drank no coffee.



• Drinking 3 or more cups per day is linked with a higher risk of miscarriage in early pregnancy.



• Caffeine can thin your bones. It causes some calcium to filter out of the body through your kidneys.



• For some people, caffeine causes headaches. This is a common symptom of caffeine withdrawal. Other withdrawal symptoms are fatigue, foggy thinking and an irritated mood.



• Caffeine reliably causes insomnia. This is true for caffeine consumed as early in the day as noon.



• Coffee or tea with meals can make you absorb less iron from the foods you eat.



• Caffeine can cause anxiety symptoms.

But there is good news, too.

• Some cancers seem to grow less if you consume caffeine.
• Caffeine can stimulate a bowel movement. Morning coffee helps people to stay "regular."
• Sometimes, caffeine can take away a migraine headache.
• Caffeine is linked with a slightly lower diabetes risk.

What Can I Expect Looking to the Future? The Nurses' Health Study and the Physicians' Health Study each included tens of thousands of people. These studies showed no difference in diabetes or heart risk even for people drinking five cups of coffee per day. That is very reassuring about caffeine as a safe product. But now caffeine is being packaged in a way it can be just popped into your mouth. So it is possible to get a much bigger dose of caffeine at one time. The FDA is talking about restricting whether ads for caffeinated products may target children. Mostly, caffeine seems safe in moderate quantities. But we don't yet understand a "latte" about the full spectrum of risks or hazards of caffeine. ]]> Fri, 03 May 2013 00:00:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/study-no-z-pak-heart-risk-for-most-adults/ A common antibiotic does not increase the risk of heart-related death for young and middle-aged... A common antibiotic does not increase the risk of heart-related death for young and middle-aged adults without heart problems, a new study finds. Earlier research found an increased risk among people with heart disease who took azithromycin. This drug is also known by the brand names Zithromax or Z-Pak. The new study looked at 1.1 million people who took azithromycin for infections. They were compared with 1.1 million who did not take antibiotics and 7 million who took penicillin V. Patients were ages 18 through 64. People were 3 times as likely to die of heart disease or stroke while taking either antibiotic. Death rates were similar for both drugs. Researchers said the higher risk appeared to be related to the infection rather than to the treatment. The U.S. label for azithromycin and antibiotics similar to it carries a warning. It says they could increase the risk of a heart rhythm problem that can lead to death. The warning says this is more likely in people with existing heart problems. The New England Journal of Medicine published the study. HealthDay News wrote about it May 1. What Is the Doctor's Reaction? Did you ever take a "Z-Pak"? It's a common and convenient antibiotic treatment. The drug is most commonly prescribed for respiratory infections. Z-Paks contain azithromycin. The brand name is Zithromax, which is where the "Z" comes from. This is an antibiotic in the same family as erythromycin. In recent years, you may have seen news stories suggesting that taking azithromycin comes with a serious risk: sudden cardiac (heart-related) death. It's true. A study published last year found a small but real increased risk of sudden cardiac death among those taking azithromycin. They were compared with people taking a penicillin-type antibiotic. But before you swear off azithromycin forever, consider this: The study analyzed adults insured by Medicaid. That's important because this population includes people who tend to have multiple medical problems (including heart disease) and a high death rate in the first place. What about people whose hearts are healthy? Does the risk of sudden death after taking azithromycin apply to them as well? That's where a new study comes in. The New England Journal of Medicine published the new study. Researchers looked at the rate of heart- and stroke-related death among more than a million people from the general population who took azithromycin. Their ages were 18 through 64. They were compared with a similar number who took no antibiotic. Azithromycin users also were compared with more than 7 million people who took penicillin. The results were reassuring:

• The risk of heart- and stroke-related death among people taking azithromycin was similar to that among people taking penicillin.
• Compared with people taking no antibiotic, the risk of heart- and stroke-related death was nearly 3 times higher among people taking azithromycin. However, after statistical analysis, this increase appeared to be related to the infection or other health problems. It was not linked with the antibiotic.
• The number of heart- and stroke-related deaths occurring during azithromycin use in this study was quite low. The researchers estimate that, at most, 11 extra deaths might occur for every 1 million courses of treatment.

This study should provide a measure of comfort to the average person who gets a prescription for azithromycin. Of course, no medicine is completely risk-free. Allergic reactions and side effects (such as diarrhea) are relatively common with azithromycin use. People with heart problems might be better off taking a different antibiotic, if they need one. Still, this new study suggests that azithromycin seems to be safe for the heart for most people. What Changes Can I Make Now? Azithromycin can cause serious side effects. That risk is quite small, but it serves as yet another reminder that we should take antibiotics only when we truly need them. Remember that respiratory infections are often caused by viruses, not bacteria. This is especially likely for infections that cause sore throats, runny nose or cough. Antibiotics don't kill viruses. If you have heart disease, think twice before taking azithromycin. If your doctor prescribes it, ask whether you're at increased risk for heart rhythm problems. The doctor may decide to prescribe a different antibiotic. But, if you don't have heart problems, azithromycin is probably as safe as (or even safer than) other antibiotics. Perhaps the most important changes to make are those that lower your risk of respiratory infection. That means there's less chance you would even need azithromycin in the first place. For example:

• Avoid contact with people who are sick.
• Wash your hands often, especially if you're around someone with an infection. Remind infected people to wash their hands as well and to cover the nose and mouth when coughing or sneezing.
• Don't smoke.
• Get the flu shot each year. You'll be less likely to get the flu. That also means you'll reduce your chances of receiving an antibiotic. Sometimes that happens if there's concern that a bacterial infection might be causing your flu symptoms.
• Get the pneumococcus vaccination (often called "the pneumonia vaccine").

What Can I Expect Looking to the Future? In the future, we are likely to have new antibiotics. Then we won't need to rely on azithromycin as much as we do now. New antibiotics are likely to have side effects of their own. But I hope that sudden cardiac death won't be among them! More research should provide a better understanding of who is at risk of heart and blood vessel problems while taking azithromycin. Fortunately, it appears the average young or middle-aged adult is not among them. ]]> Thu, 02 May 2013 14:05:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/not-calling-911-slows-stroke-treatment/ More than one-third of people having a stroke in the United States don't call 911, a study shows.... What Is the Doctor's Reaction? Many people don't realize that stroke is the fourth largest cause of death in the United States. A stroke occurs when a part of the brain does not receive enough oxygen or nutrients. The cause is either a blocked blood vessel or a burst blood vessel in the brain. People who survive a stroke can be left with major physical and mental limitations that can be life-changing. Early treatment of stroke can be life-saving and can limit the chance of having long-term disability. Unfortunately, many people do not get to the hospital quickly. Calling an ambulance is the first step to getting the fastest treatment. A new research study reminds us that too few people having a stroke call an ambulance. Researchers studied more than 200,000 stroke patients from more than 1,500 U.S. hospitals. These hospitals were evaluating a program called "Get With The Guidelines." This is an effort by the American Heart Association and the American Stroke Association to improve stroke and heart attack care. The program promotes use of set treatment plans that are based on the latest research. Hospitals record certain measurements of care. For stroke care, they include:

• Time it takes from the start of stroke symptoms to hospital arrival and the start of treatment
• Number of people treated with clot-busting medicines
• The severity of stroke
• Number of patients who get education about stopping smoking and controlling blood pressure and cholesterol levels

These are just a few examples of the many measures that are included. The researchers in this study found that one measure in particular was worrisome. Too few people called an ambulance when they were having a stroke. In fact, one-third of those who had stroke symptoms did not call emergency medical services. Instead, they got to the hospital on their own. This was more likely in rural areas and for minorities. Here's why this matters. Clot-busting medicines can save lives and reduce disability. But they can only be given within a three-hour window from the start of symptoms. The longer it takes to get to the hospital, the less likely you are to get these life-saving medicines. Taking an ambulance gets your treatment started much faster. Why? Emergency medical teams can give you medicines you need right away in the ambulance. They also know which hospitals are set up to take care of people who are having a stroke. This means you will get to the right hospital right away. You'll also be more likely to get the most appropriate treatments. What Changes Can I Make Now? First, you have to know the symptoms of a stroke and remember to get help fast. A good way to remember these tips is the mnemonic F-A-S-T. F -- Face drooping or face numbness. If your smile is not equal on both sides, that may be a sign of a problem. A -- Arm or leg weakness. Does one arm not work as well as the other? S -- Speech problems. Are you having trouble speaking, or finding the right words, or even speaking gibberish? T -- Time is of the essence. Call 9-1-1. As mentioned above, an ambulance can get someone to hospital and to life-saving treatments fast. Other symptoms might signal a stroke as well. They include:

• Sudden confusion
• Sudden vision loss
• Sudden balance troubles

It's also important to remember the factors that increase your risk of stroke. They include:

• High blood pressure
• Atrial fibrillation (an abnormal heart rhythm)
• Diabetes
• Smoking
• High cholesterol
• Obesity
• Lack of exercise

What Can I Expect Looking to the Future? About 800,000 people have strokes each year in the United States. It is clear that the faster you get the treated for stroke, the better off you will be. I hope that better awareness about stroke symptoms of stroke and the need to get treated quickly will reduce the number of people with major limitations after having a stroke. Programs like "Get With The Guidelines" will continue to help us understand the things we do well and the things we could do better with stroke care. Picking up the phone and calling 9-1-1 with any possible stroke symptoms is one way that we could all do better.]]> Wed, 01 May 2013 14:09:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/antidepressants-and-surgical-bleeding/ People who take medicines for depression may have an increased risk of bleeding with major... What Is the Doctor's Reaction? About 10% of Americans take an antidepressant drug. For the great majority of them, that drug is an SSRI. SSRI stands for selective serotonin reuptake inhibitor. These drugs act by increasing brain levels of serotonin. Serotonin affects more than just our mood. It also plays a role in how we react to stress and anxiety. More recently, serotonin action in the brain has gained attention related to how we perceive pain. Some SSRIs are prescribed to treat chronic (long-lasting) pain. SSRIs are generally safe drugs. Like all medicines, they can produce side effects in some people. Nausea, loose stools and headaches are most common. They also can reduce sexual interest, desire, performance, satisfaction or all four. One of the more worrisome side effects of SSRIs is an increased risk of bleeding. The drugs affect serotonin levels in platelets as well as in the brain. Platelets are the sticky cell fragments that play a crucial role in blood clotting. Doctors routinely consider bleeding risk when people are scheduled for major surgery. The goal of this study was to find out if SSRI use around the time of surgery might cause more unwanted bleeding. The researchers also looked at the number of SSRI users having major surgery who died in the hospital or were admitted again within 30 days. These outcomes of surgery were worse in SSRI users. However, this type of study can only show a link between outcomes and SSRI use. It does not prove that taking an SSRI before or right after surgery was the reason for excess bleeding or directly increased risk of death. People who take an SSRI are more likely to have other medical problems than non-users. What Changes Can I Make Now? If you do need major surgery and take an SSRI, talk with your doctor about the best approach for you. Even if there is a risk of excess bleeding from an SSRI, that extra risk is extremely small. However, if you also take a drug to prevent blood clots, such as aspirin or warfarin (Coumadin), the bleeding risk could be significant. Nonsteroidal anti-inflammatory drugs (NSAIDs) on their own can cause internal bleeding. These types of drugs include ibuprofen, naproxen and many others. NSAIDs make platelets less sticky and irritate the lining of the stomach and upper intestine. So, if you combine an NSAID with an SSRI, the bleeding risk during and after surgery likely increases even more. In these circumstances, your doctor will advise you about reducing doses and/or not taking some of your medicines in the weeks before surgery. You should not stop taking an SSRI without getting advice from your doctor first. If you take it for depression, your symptoms could return. And untreated depression increases your risk of a poor outcome from surgery. Stopping an SSRI also means you might have more pain after surgery. Most importantly, suddenly stopping some SSRIs can cause "SSRI discontinuation syndrome." Symptoms include:

• Dizziness
• Nausea
• Insomnia
• Anxiety
• Irritability
• Aches and pains

This problem occurs most often when people taking high doses of a short-acting SSRI stop without slowly lowering the dose. Paroxetine (Paxil) is an example. What Can I Expect Looking to the Future? Based on this study and other evidence we have so far, no broad guidelines regarding SSRIs and major surgery will be available any time soon. As with all your medicines, you and your doctor will decide what medicines to take and how to take them based on your own situation.]]> Tue, 30 Apr 2013 14:05:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/survey-most-dont-plan-for-long-term-care/ About 2 out of 3 Americans over age 40 have done little or no planning for long-term care, a new... What Is the Doctor's Reaction? When I am an old woman, I shall wear purple. I have always loved the poem by Jenny Joseph that starts with those words. I love that the woman in this poem is unafraid to grow old, and I love her plans: I shall … go out in my slippers in the rain,
And pick the flowers in other people’s gardens,
And learn to spit. Despite being so full of plans, nowhere does she anticipate how she might pay for long-term care. A survey released this week found that two-thirds of Americans over age 40 have done "little or no planning" for how they might pay for long-term care as an older adult. As a primary care doctor, I see my patients struggle with the major impact of age-related care needs on their lives and their financial realities. Long-term care costs are huge. Really, we can't afford not to think about it. The U.S. Census Bureau estimates that $217 billion will be spent in 2015 on nursing home and residential care. This includes assisted living facilities and board and care homes. Currently, about 25% of these costs are paid out-of-pocket by older adults and their families. Almost two-thirds of the cost is paid by Medicaid and Medicare combined. Medicare pays for only a short term when illness causes disability -- 20 days in a nursing home. After that, patients must meet these costs out-of-pocket. Most older adults with chronic needs then "spend down" their funds to pay for long-term care until the money runs out. At that point, at poverty level, Medicaid support may be available. The vast majority of older adults live in their own home or apartment, or with family. This includes more than 3 out of 4 people ages 85 and older. But most people will need help, at least for a short time, as they age. They may need help with personal care, such as bathing and dressing, or more intense support in a nursing home. What Changes Can I Make Now? There is no perfect way to plan for long-term care, in the event you will need it. But you can begin to make a plan, even if it's not perfect. 1. Talk with your family. Nearly 60% of elderly people who need help with personal care rely fully on unpaid caregivers, usually their children or spouses. Sometimes this is an obvious arrangement. But your family must be flexible and committed. If a caregiver must stay at home, some family income will be lost. This is rarely a comfortable situation if everyone did not agree ahead of time. 2. Consider long-term-care insurance. Fewer than 3% of American adults have purchased a long-term care insurance policy. The average cost is high. A typical plan might cost $3,300 a year for a healthy 60-year-old husband and wife. And it might pay only a $150 a day for up to 3 years. For a person who buys this insurance at age 65, there is a 45% chance of making a claim. If you never need long-term care, the payments you made to the plan are lost. 3. An "age in place" retirement arrangement might be right for you. Some campus-like retirement communities are designed to permit an older adult to "age in place." This means you can go from a relatively independent life to a more dependent life while staying in the same community. Services often include recreation for the active elderly and 24-hour skilled nursing or rehabilitation services for the frail elderly. These organizations are called continuing care retirement communities. They are always expensive. Usually, they charge an up-front fee of $25,000 to $500,000. Then you pay a membership fee or rent each month. 4. Build up your savings. Making ends meet is a challenge. But in your working years, don't underestimate how much you need to save. "After we no longer have our mortgage, we should be able to live on that," we all think. But plan for some money to stay in your savings. If disability strikes, you will need it. 5. Write an advance directive ("living will"). Some people receive intensive medical care after they become profoundly disabled. By then, they are no longer able to let their family and doctor know what care they want. If you know that you would not want life-sustaining treatments in this condition, it is wise to record your wishes in a legal "advance directive." What Can I Expect Looking to the Future? By 2030, 20% of the U.S. population is predicted to be over the age of 65. It is not clear that Medicare and Medicaid will be able to sustain the contributions that they make now toward long-term care. This is a good reason for Americans to plan ahead. ]]> Fri, 26 Apr 2013 13:54:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/conditions/health-conditions-details/newsarticle/beta-blockers-may-trim-deaths-after-surgery/ Taking a common heart drug before surgery may reduce death rates for some patients, a new study... What Is the Doctor's Reaction? Protecting the heart has always been a big concern for anyone having major surgery. But better techniques for surgery and anesthesia have improved results. The risk of a heart attack and heart-related death has greatly decreased during the last few decades. Taking a beta-blocker before and after major surgery may be another way to help protect the heart. Examples of commonly prescribed beta-blockers include atenolol, metoprolol and carvedilol. Early studies suggested that anyone at risk of heart trouble could benefit from taking a beta-blocker before and after major surgery. These drugs slow the heart rate and decrease the heart's work load. But results of later studies were less clear for people having non-vascular surgery. Usually doctors advise a beta-blocker for patients having vascular surgery. (Vascular surgery is surgery on blood vessels. Examples include as fixing an abdominal aortic aneurysm or a bypassing blockage in a leg artery). Now doctors have a little more guidance from the results of a study published today. The study focused on six factors to find out who is most likely to benefit from taking a beta-blocker before major surgery and at least 30 days afterward. The factors were:

• High-risk surgery, such as surgery on blood vessels or an operation that typically involves a lot of bleeding
• History of stroke or narrow arteries in the neck that increase stroke risk
• Known coronary artery disease
• Heart failure
• Diabetes
• Kidney disease with decreased kidney function

For people with two or more of these risk factors, taking a beta-blocker before surgery and during the next month improved outcomes. They had a significant decrease in their risk of heart attack, cardiac arrest (heart stopping) and death during that time period. The results of the study were published in the April 24 issue of the Journal of the American Medical Association. What Changes Can I Make Now? Are you scheduled for surgery? If you have even one of the risk factors mentioned in the study, ask your doctor whether you should start a beta-blocker. Anyone over age 50 with multiple heart-disease risk factors might also benefit from treatment with a beta-blocker before surgery. It depends on how many risk factors you have and the type of surgery. As a reminder, those heart-disease risk factors include:

• Smoking or other regular tobacco use
• Family history of coronary artery disease under age 60
• High LDL cholesterol
• High blood pressure

Ideally, people who are not already taking a beta-blocker but need one should start taking it at least one week before surgery. I prefer to start it two or more weeks before surgery when possible. I start at a low dose and increase the dose gradually. Beta-blockers slow the heart rate. So this can guide the dosing. The heart-rate goal depends on the individual patient. What Can I Expect Looking to the Future? During the last few years, doctors have become less likely to prescribe beta-blockers before surgery for people not already taking them. The evidence was not conclusive. But this new study helps define which patients are likely to get the most benefit. Beta-blocker therapy for this purpose will almost surely increase.]]> Wed, 24 Apr 2013 14:32:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/some-alternatives-may-cut-blood-pressure/ Some alternative treatments may slightly lower blood pressure, a new report says. But the only... What Is the Doctor's Reaction? Sixty million Americans know they have high blood pressure (hypertension). But fewer than half have it under control. Why is that? High blood pressure alone rarely causes symptoms. And taking pills for something that doesn't make you feel bad can be hard to swallow. So many people with high blood pressure seek alternative means to help lower their blood pressure. Methods include relaxation exercises, meditation, biofeedback, yoga and acupuncture. How much can any of these lower your blood pressure readings? A large group of researchers has tried to answer that question. They did an exhaustive review of studies that looked at alternative therapies. They also included studies that looked at the impact of regular exercise on blood pressure. Many studies have looked at exercise and high blood pressure. Of the different types of exercise, the researchers found that regular aerobic exercise lowered blood pressure the most. And aerobic exercise was better than any of the alternative therapies. Interestingly, dynamic resistance training also helped lower blood pressure. You can do dynamic resistance exercises with free weights or resistance machines. Your muscles and joints are moving during these exercises. On the other hand, isometric exercises do not appear to improve blood pressure. These exercises put stress on your muscles without any movement. Using a hand grip is one example. The authors found fewer well-done studies on alternative therapies. Their analysis suggests that deep meditation, biofeedback and some relaxation techniques lowered blood pressure a little. The few studies available on yoga and acupuncture suggested no benefit. What Changes Can I Make Now? Most importantly, get your blood pressure checked. Normal blood pressure is a reading of no higher than 120/80. Readings between 120/80 and 139/89 show pre-hypertension. And high blood pressure is defined as multiple readings of 140/90 and higher. Lifestyle changes might help prevent you from needing medicines. And even if you need to take drugs to lower blood pressure, you likely will need fewer pills and lower doses. Regular aerobic exercise has been a standard recommendation to help lower blood pressure. Your goal is to work up to moderate-intensity exercise most days of the week. Ideally, strive for 45 to 60 minutes at each session. But even 20 to 30 minutes makes a difference. In addition:

• Maintain a healthy weight.
• Eat more fruits, vegetables and whole grains. Choose low-fat dairy foods.
• Eat less salt.
• Include foods rich in potassium in your diet, unless you have kidney disease.
• If you are a man who drinks alcohol, have no more than two drinks per day. Women should have no more than one drink per day.
• Don't smoke.

What Can I Expect Looking to the Future? Similar to most medical studies, this one looked at average benefits for each alternative therapy. Many people did not see lower blood pressures from one or more of these methods. But some did. So you might find that stress reduction, meditation or some other technique works for you. ]]> Tue, 23 Apr 2013 14:23:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/physical-work-may-raise-heart-stroke-risk/ Exercise is known to reduce the risk of heart disease. But a physically demanding job may... What Is the Doctor's Reaction? The advice to get regular exercise is nearly universal. And that makes sense. Study after study has shown health benefits related to exercise. The list is getting longer all the time. Exercise may reduce your risk of:

• Heart and blood vessel disease (including heart attack and stroke)
• Certain types of cancer
• Osteoporosis
• Depression
• Alzheimer's disease

So if you're physically active at your job, your risk of stroke and heart disease should be lower, right? Not so fast. Two new studies suggest that just the opposite may be true. The first study looked at people who had a heart attack, stroke or other heart-related event. They were compared with otherwise similar people who did not have these problems. The researchers found that:

• Those who had problems were more likely to work at a job that was physically demanding than those who were healthy.
• The less physically demanding the job, the lower the risk of heart disease or stroke.
• The results were confirmed even after accounting for factors known to increase the risk of heart and blood vessel disease. These factors include smoking, high blood pressure, family history, high cholesterol and diabetes.
• The results held up even after accounting for whether a person maintained a Mediterranean diet. This diet includes mostly fruits, vegetables, whole grains, legumes, fish, nuts, olive oil and wine (in moderation). It has been linked with a reduced risk of heart disease.

The second study looked at physical demands on the job and also the effect of leisure-time exercise. More than 14,000 middle-aged men who did not have heart disease filled out questionnaires about both kinds of activities. Researchers kept track of people for more than 3 years. After accounting for standard risk factors, they found that:

• As with the first study, heart and blood vessel disease was more common among men with physically demanding jobs.
• Among men with less active jobs, moderate- to high-intensity leisure-time exercise was linked with a 60% lower risk.
• Leisure-time exercise did not have this protective effect for men whose jobs were physically demanding. In fact, it appeared to increase their risk by nearly 5 times.

These results surprised me. How can regular exercise reduce your risk of heart disease while a physically demanding job increases risk? There are several possibilities:

• Physically demanding jobs may come with psychological stress that could increase risk.
• Perhaps "physical activity" at work is quite different from that during leisure-time exercise. Lifting boxes into a truck every few minutes might not provide the same benefits as sustained aerobic exercise from jogging or cycling.
• Physically demanding jobs tend to be at the lower end of the pay scale. It's possible that people with these jobs do not have access to high-quality health care. Or they may have other disadvantages that impair health.

In any case, these studies suggest that people with physically demanding jobs should pay close attention to any risk factors for heart and blood vessel disease. The harder question is whether they should scale back their exercise routines. In my view, we need more research to answer that question. What Changes Can I Make Now? Whether your job is physically demanding or not, talk to your doctor about your risk factors for heart and blood vessel disease and what to do about them. For example:

• For high blood pressure or high cholesterol, do your best to lose excess weight and improve your diet. (See DASH diet for high blood pressure and a 'heart-smart' diet for high cholesterol). Medicines may be necessary.
• If you have diabetes, losing excess weight and changing your diet are the first steps. However, medicines also may be recommended. They may include aspirin and drugs to lower blood sugar and cholesterol.
• Don't smoke. If you have not managed to quit, talk to your doctor about smoking-cessation programs.
• If you have an irregular heart rhythm called atrial fibrillation, ask your doctor whether you should take a blood thinner.

The results of these new studies question the notion that all physical activity comes with the same health benefits. Still, I think it would be a mistake to use these studies as a reason to avoid exercise! This is especially true for those whose jobs are mostly done while sitting. If your job is physically demanding, you may be getting more than enough exercise at work. Lower-intensity exercise, such as walking, may be better for you than higher-intensity activities. Talk to your doctor about your current fitness level and an exercise program that meets your needs. What Can I Expect Looking to the Future? Current advice suggests moderate-intensity exercise (such as brisk walking) for at least 45 minutes most days of the week. I think this is a good idea for most people. But we need to find out when more exercise may cause more harm than good. These two new studies are a good start. In the future, I hope we'll have more nuanced advice about exercise that takes into account the exercise people get at work.]]> Fri, 19 Apr 2013 13:36:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/western-diets-linked-with-less-healthy-aging/ A Western-style diet can undermine healthy aging, a new study finds. A Western diet includes... What Is the Doctor's Reaction? It's hardly news that changing from a Western-style diet to one that is more Mediterranean is good for you. A Western-style diet contains large amounts of sugary foods and drinks, fried foods, processed and red meats, refined grains and high-fat dairy products. A Mediterranean-style diet is loaded with vegetables, whole grains, healthy oils such as olive oil, fish and fruits. We already know that eating a Mediterranean diet helps you keep a healthier weight and decreases your risk of diabetes and heart disease. What makes this study different is the focus. The researchers took a more holistic approach rather than looking just at the risk of specific diseases related to what we eat. They wanted to see if your diet in middle age affected your overall health as you get older. The researchers had access to detailed information about the diets of 5,350 adults. Their average age was 51 when the study started. Using a tool called the Alternative Healthy Eating Index, the researchers rated their diets. A high score meant that what people ate was closer to a Mediterranean-style diet than to a Western-style diet. The researchers also had information on what happened to people during an average of 16 years after the start of the study. They divided people into 5 groups based on their health outcomes as they got older:

• Ideal aging, defined as having no chronic conditions AND high performance in physical and mental abilities
• Non-fatal heart attack or stroke
• Death related to heart or blood vessel disease
• Death from any other problem
• "Normal" aging

Most people (73%) remained alive and fell into the "normal" aging category. This outcome is vague and a bit hard to accept as meaningful. But what is impressive is that many more of the people in the ideal-aging group followed the healthier diet. And more of those who had a heart attack, stroke or died stuck to a Western-style diet. What Changes Can I Make Now? Here's a guide to a very healthy eating pattern:

• Four or more servings of vegetables a day. A serving is ½ cup of raw or cooked vegetables, 1 cup of raw leafy greens or ½ cup of vegetable juice.
• Four or more servings of fruit a day. A serving is ½ cup of fresh, frozen or canned fruit; ¼ cup of dried fruit; one medium-sized piece of fruit; or ½ cup of fruit juice.
• At least 4 tablespoons of olive oil a day.
• One handful (about 1½ ounces) of nuts, 3 or more times per week.
• Three or more servings of legumes (beans, peas and lentils) per week. A serving is ½ cup.
• Six or more servings of whole grains a day. A serving is 1 cup of dry breakfast cereal; ½ cup of cooked cereal, brown rice or whole-grain pasta; or one slice of whole-grain or multi-grain bread.
• Three or more servings of fish (especially fatty fish) a week. A serving is 4 ounces.
• One serving of yogurt or cheese a day.
• If you enjoy alcohol, limit yourself to 1 (for women) or 2 (for men) drinks a day. One drink is 5 ounces of wine, 12 ounces of beer or 1½ ounces of liquor.

Specifically avoid:

• Soda and sugary drinks
• Sweets, pastries and commercial bakery goods
• Red and processed meats
• Margarines and most tub spreads

What Can I Expect Looking to the Future? The evidence for a Mediterranean-style diet over a Western-style diet as a path to a healthier life is overwhelming. Food companies have already gotten the message. We will continue to see more products on grocery shelves reflecting these changes. ]]> Thu, 18 Apr 2013 14:12:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/faster-resting-heart-risky-even-for-the-fit/ Even fit men with higher resting heart rates may have a higher risk of early death, a new study... What Is the Doctor's Reaction? Most visits to the doctor include a check of your heart rate. It's such a simple measurement. The nurse or doctor feels your pulse near the wrist, counts the beats for 15 seconds and multiplies the number by 4. That measures the number of beats per minute. Today in most doctors' offices, heart rate measurement has become even easier. It's now usually done electronically with a blood pressure machine or with a sensor clipped at the end of your finger. Your heart rate changes from minute to minute. It depends on whether you are standing up or lying down, moving around or sitting still, stressed or relaxed. When you have been at rest for a bit, the heartbeat settles down to a stable clip. This is your resting heart rate. Traditionally, doctors have been taught that a normal resting heart rate is 60 to 100 beats per minute. Ideally, before a reading in the doctor's exam room, you have had time to sit for a while and relax (as relaxed as you can be in a doctor's exam room). If your heart rate is higher than 100 or lower than 60, your doctor will take notice and may want an EKG. Anything in between doesn't get much attention. But maybe it should. During the last few years, experts have begun to recognize that faster resting heart rates are linked to the development of heart disease and shorter lives. The leading theory has been that resting heart rates in the 60 to 70 range most often reflect better fitness. And with better fitness you are less likely to develop heart problems and more likely to live longer. This study found that people with higher resting heart rates (80 beats per minute or higher) had a shorter life expectancy than those with rates around 65 beats per minute. Previous studies have had similar findings. But what's new is that in this study higher resting heart rates meant shorter life expectancy even in fit people. So what else causes a higher resting heart rate besides not being fit? Genes play a role. Aging tends to speed up the heart rate. People who smoke or drink too much alcohol generally have higher resting heart rates. Stress, medicines and medical conditions also influence the heart rate. These are all important factors that can shorten life expectancy. What Changes Can I Make Now? You don't need to go to your doctor to check your heart rate. It's easy to do at home the same way the nurse or doctor does it in the office. And your reading at home, in a relaxed atmosphere, probably gives a more accurate picture of your heart health. The best time to measure your resting heart rate is before you get out of bed. Find the pulse in your wrist or neck, count the number of beats in 15 seconds, and multiply by four. If your heart rate is greater than 100 and you have any symptoms, give your doctor a call. Such symptoms might be fatigue, lightheadedness, shortness of breath and/or chest pain. A heart rate under 60 is common and could be a sign of being very fit. For example, when the tennis star Bjorn Borg was in his prime, his resting heart rate was 35! Many medicines also lower heart rate, especially beta blockers and other heart and blood pressure drugs. But again, if you are not extremely fit and are having any symptoms plus a very low heart rate, contact your doctor. If you are otherwise healthy but have a resting heart rate of 80 beats per minute or higher, discuss this with your doctor at your next visit. You and your doctor can review any factors that may increase your risk of heart disease. It's always good to look at ways to reduce your risk of the No. 1 killer in the United States. But you don't need to wait for your doctor's appointment. You can start to lower your heart rate today. Here's what you can do:

• Exercise more. When you take a brisk walk, swim or bicycle, your heart beats faster during the activity and for a short time afterward. But exercising every day gradually slows the resting heart rate.
• Reduce stress. The relaxation response, meditation, tai chi and other stress-busting techniques can lower heart rate over time.

What Can I Expect Looking to the Future? Along with body weight and waist size, your resting heart rate is another way you can easily assess your health at home. How important to your health is lowering your heart rate? We don't know the answer to that yet. But you can expect more studies on this important question in the future. ]]> Wed, 17 Apr 2013 00:00:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/conditions/health-conditions-details/newsarticle/exercise-slows-physical-decline-of-alzheimers/ A guided home exercise program can help slow physical decline and reduce falls in people with... What Is the Doctor's Reaction? Dementia is best known for its effects on memory and thinking. But people also lose much of their muscle strength, balance and endurance. These losses make it even more difficult for them to care for themselves and greatly increase their risk of falls. Getting regular exercise helps prevent memory loss and decreases your risk of developing dementia. But what about people who already have dementia? Can they still derive some benefit? A study called the Finnish Alzheimer Disease Exercise Trial gives a "thumbs up" to working out. The study included 210 men and women with Alzheimer's disease. All of them were still living at home with a caregiver wife or husband. Researchers divided people into three groups. They received different therapies:

1. Personalized training by a physical therapist twice a week in the home for one year
2. Group exercise classes outside the home twice a week for one year
3. Usual care without specific hands-on exercise coaching

All three groups showed declines in physical function during the year. But people who got the in-home physical therapy had about half the decline of those in usual care. They also fell less often. People who went to group exercise classes improved their strength. And they had a bit less decline than people who were assigned to usual care. The researchers suggest the following reasons that home-based physical therapy patients did the best:

• The exercises were designed and modified based on each person's needs.
• People didn't need to leave home, so they were more comfortable.
• They couldn't miss any sessions, since the therapists came to them.
• One-on-one coaching leads to a more intense workout. The therapists can give breaks as needed to allow the person to finish the hour of exercise.
• The physical therapists had special skills to instruct and coach people with dementia.

Less functional decline in the home exercisers led to lower health care costs. These savings offset the expense of personalized physical therapy. What Changes Can I Make Now? Too often older people (and many who are really not that old) have the wrong impression that they are past the point where exercise can do them any good. They also might be concerned that exercise will make them worse. That is almost never true with a well-designed exercise program. Such a program is, first of all, safe. It's easy at first, and the challenge increases at a reasonable pace. For more ideas, check out my column: You're Never Too Old or Too Frail to Exercise. What Can I Expect Looking to the Future? The main focus of research on Alzheimer's disease has, of course, been the brain. But meanwhile, this study shows that regular exercise may help many people with the disease slow their functional decline. And this can mean a longer time to remain safely in their own homes. ]]> Tue, 16 Apr 2013 14:25:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/conditions/health-conditions-details/newsarticle/antibiotic-prescriptions-add-up-to-overuse/ U.S. doctors write enough prescriptions each year to provide antibiotics to 4 out of 5 Americans,... What Is the Doctor's Reaction? How many antibiotic prescriptions does a typical family practice doctor write in a day? Two or three, according to data from the National Prescription Drug Database. This count leaves out IV antibiotics that are used for severe infections. It also leaves out skin ointments and creams. Family practice doctors, pediatricians, internal medicine doctors and dentists combined hand out two-thirds of the oral antibiotic prescriptions in America. In total, doctors are prescribing enough antibiotics to give them to 4 out of 5 Americans each year. This is too much. Antibiotics are wonderful friends when we need them. But we don't always need them. The problem with prescriptions we don't need is that antibiotics can do harm. I don't think most of my patients believe this about the harm. "Doc," they ask me time and again, "do you think I should take an antibiotic -- you know, to be on the safe side?" I do my best to help my patients know when taking an antibiotic is less safe than not taking one. But truly, I don't have time to go through all of the details. Some of my patients are frustrated when I choose not to use one of these drugs. Antibiotics can harm us in three ways:

1. Drug reactions -- These include side effects, allergies or bad reactions. In unlucky patients, some antibiotics can cause:
   
   • Kidney damage
   • Permanent hearing loss
   • Very bad rashes


2. Resistant bacteria -- Widespread use of antibiotics is to blame for "super-bugs." When you take antibiotics, you kill the easy targets. A small fraction of bacteria may be protected by a special gene, and these remain. Even if you recover from the active infection, your next infection might be "resistant."



3. Lost "normal flora" -- Many kinds of bacteria live on your skin and in your mouth, gut and respiratory tract. They are your normal flora or "microbiome." Here are some problems that happen when normal flora are lost or changed by antibiotics:
   
   
   
   • Poor digestion -- Bacteria in your intestine help you to break down carbohydrates. After antibiotics, some carbohydrates stay undigested. This results in diarrhea.
   
   
   
   • Nutrition issues -- Bacteria produce vitamin K in your body.
   
   
   
   • Colitis -- It is common to have spores from the bacteria Clostridium difficile in the intestine. The death of normal flora can allow C. diff to change from spores into more active bacteria. During this change, it makes a toxin that can cause life-threatening inflammation of the colon.
   
   
   
   • Vaginitis (yeast infection) -- It is normal for women to have yeast spores in the vagina. Bacteria determine the chemistry of the mucus in the vagina. After subtle adjustments in this chemistry, yeast multiply and change shape. They make glue-like proteins that allow them to attach to the vagina surface and form clumps. Yeast in this changed form are very irritating.
   
   
   
   • Allergic asthma -- If babies get antibiotics, they are more likely to develop asthma as kids. Exposure to harmless bacteria and proteins in your early life allows your immune system to recognize them as harmless. Without this exposure, your immune system is more likely to react later against harmless proteins and create allergy symptoms.
   
   
   
   • Inflammatory bowel disease and other autoimmune problems -- Mice that are raised "germ free" have unusual immune-system activity. Similar activity is seen in autoimmune diseases such as inflammatory bowel disease. Some of these diseases are more likely to occur in people who have had many courses of antibiotics.
   
   
   
   • Upper respiratory infections -- Pills and creams used for acne have been linked to more frequent head colds. Changes in normal flora of the nose, throat and mouth apparently can make it easier for a virus to begin an infection.

What Changes Can I Make Now? The U.S. Centers for Disease Control and Prevention says that up to half of antibiotic prescriptions may not be needed. Guidelines advise doctors to avoid antibiotics for the following:

• Acute (short-term) bronchitis
• Sinusitis that has lasted for less than a week
• Ear infections without fever in children over age 2

These infections can clear themselves without antibiotics. Viruses cause about 90% of respiratory and cold symptoms, such as runny nose and sore throat. They do not require (or benefit from) treatment with antibiotics. We are learning about ways to help normal flora to come back after antibiotic treatment. "Probiotics" help only a little. The best thing you can do is to take antibiotics only when you need them. What Can I Expect Looking to the Future? Some doctors are not wary enough of antibiotics. Even when they are, doctors don't have enough appointment time to explain all the risks of unneeded antibiotics. What we need for this problem is a public information campaign. You are being asked to choose wisely in all sorts of ways as customers of the health care system. Choosing wisely is also important when you talk with your doctor about whether to start antibiotics for any illness, particularly when you have sinus and respiratory tract symptoms. ]]> Fri, 12 Apr 2013 00:00:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/study-brain-scans-can-see-pain/ Researchers say they have found a way to "see" one type of pain on a brain scan. In the... What Is the Doctor's Reaction? "Is this pain all in my head?" I hear this question a lot. It comes up because frequently no cause can be found for the pain patients describe. I also have patients who express relief when a test result (such as an X-ray or MRI) does reveal a clear cause of pain: "Well, at least we know now I'm not just imagining it." These situations reflect an assumption of doctors and patients that "real" pain should have a reason that can be proven. Yet that's frequently not the case. The physical examination and even extensive testing may be normal. Inevitably, this leads to speculation. Could the pain be somehow "imagined" or caused by psychological distress (such as anxiety or depression)? Pain whose cause can't be found affects millions of people. Examples include migraines, fibromyalgia and many cases of back pain. These diagnoses rely mainly on symptoms reported by the patient. Tests can rule out other causes. However, they cannot confirm the cause or even the existence of pain. But this may soon change. New research explores the idea that because certain parts of the brain are active when we feel pain, it may be possible to "see" pain with a brain scan. The New England Journal of Medicine published the study results today. Researchers performed a special type of brain MRI on 114 people while a warm or uncomfortably hot (116 degrees Fahrenheit) object was applied to the forearm. This functional MRI (fMRI) showed which areas of the brain were most active when people felt the painful heat. Other scans showed "social pain." People in this part of the study had recently been through a romantic breakup. Scans measured their reactions when they were shown pictures of the former partner who had rejected them. The researchers found that:

• Several areas of the brain became active in a particular pattern during heat-induced pain. The authors called this the "pain signature."
• The pattern of brain activity correctly identified more than 90% of people who had painful heat applied to their forearms.
• The absence of this pattern of brain activity correctly identified more than 90% of people who were not feeling pain.
• The pain pattern seen in the scans was similar for physical and social pain. But there were enough differences to distinguish between the two types of pain.
• When people were treated with a pain reliever, the scans showed a reduction in the pain pattern.

You may wonder, as I did, so what? If two people report severe back pain and no cause can be found, should their fMRI results help determine treatment? Or, if the fMRI does not show the "pain signature," should that patient's pain be taken less seriously? In my view, we're a long way from knowing what to do with the results reported today! And even if we did know what to do, remember that the scans were not perfect in identifying pain. On the other hand, this study is among the first to show that pain can be reflected in a particular pattern of brain activity. This could advance our understanding of how people feel pain and eventually lead to better treatments. What Changes Can I Make Now? If you have pain you can't explain, and it isn't getting better, see your doctor. Don't assume it's because you're getting older or something you just have to tolerate. If a cause can be found, there may be a specific treatment. And even if a cause cannot be found, effective treatment may still be available. Pain can be treated in several ways. They included:

• Drugs that mainly reduce pain (analgesics)
• Drugs that reduce inflammation
• Medicines for nerve pain
• Antidepressants
• Muscle relaxants
• Physical or occupational therapy
• Exercise
• Electrical stimulation
• Meditation or biofeedback
• Acupuncture
• Massage
• Surgery

If you aren't getting better, ask your doctor whether you should be referred to a specialist in pain management. These are doctors trained in the treatment of pain, regardless of its cause. If your doctor talks with you about psychological sources of pain, that doesn't mean he or she doubts that you have pain. In fact, there is currently no reliable way to distinguish between psychological and physical causes of pain. In my experience, it's rarely helpful to question whether a person is actually feeling pain. An editorial published with this new research made a similar point: "We may ultimately have to acknowledge that 'pain is pain' and can be reported only by the patient." What Can I Expect Looking to the Future? More study will be needed to determine how the findings of this study may lead to better assessment of pain or its treatment. You can expect researchers to confirm and extend the findings of this new study. For example, the current study analyzed heat-induced pain. What about other types of pain? Can these scans be used to assess pain in people who cannot communicate well? Only time will tell. ]]> Thu, 11 Apr 2013 14:12:00 -0400