Do you eat healthy during the week, then ease off the brakes on the weekend? You’re not alone.
But such a five days on-two days off eating regimen can erode diet quality, according to a study published recently in the Journal of the Academy of Nutrition and Dietetics.
Not only did participants take in more calories on weekends than on weekdays, they were less healthy calories, to boot.
They consumed more alcohol and fat, and ate less of the good stuff, like yogurt, fruits, dark green and orange vegetables, chicken, nuts and seeds, and whole grains.
And if the calories you consume on the weekend exceed the number you take in during the week, that’s a net surplus—read: weight gain.
Besides stalling any weight-loss efforts, weekend junk-food binges can also negatively impact the healthy bacteria in your gut.
A lab study published in Molecular Nutrition & Food Research found that cycling on and off junk food was almost as detrimental to the delicate balance of the gut microbiome as eating it all the time.
In particular, a junk-food diet reduces the microbes needed to metabolize flavonoids, a category of micronutrients thought to help with weight loss and brain health.
If you look forward to letting loose on the weekends, find other ways to unwind.
For instance, try a new activity—you’ll burn more calories and boost your weight-loss (or control) efforts.
If going out for a big brunch is your downfall, schedule a trip to the gym instead.
Weekends are also perfect for doing some healthy cooking. Make enough to have for brown-bag lunches so weekday eating is more satisfying.
Researchers are concerned that chemicals used in the manufacture of mattresses could affect the health of children and infants. (Courtesy Spectrum Health Beat)
Most people consider their bed a safe haven, but new research suggests your body heat might trigger the release of potentially harmful chemicals from your mattress.
Mattresses are known to release minute amounts of gaseous chemicals called volatile organic compounds.
These compounds come mainly from the polyurethane used in the mattress, but also from other chemicals used in flame retardants and plastics, the researchers said.
Unfortunately, your body heat appears to increase compound emissions from your mattress, according to tests conducted on eight different types of polyurethane mattresses.
But don’t toss out your mattress just yet: The estimated doses of most compounds remained well below the levels that could cause health effects, researchers noted.
However, some compounds did reach levels of concern for infants and young children, if their ages were considered in exposure calculations, the researchers added.
“There is no reason to panic and yet it is important to understand that air quality in our sleeping micro-environment is important with regard to our exposure to various pollutants such as VOCs,” said senior researcher Yael Dubowski, an associate professor with the Israel Institute of Technology. “Hence, we should make an effort to improve it.”
Health effects associated with compounds range from eye, nose and throat irritation to headaches and organ damage, according to the U.S. Environmental Protection Agency.
Some compounds, including benzene, acetaldehyde and formaldehyde, have been associated with increased cancer risk.
For the study, Dubowski and her colleagues subjected eight different mattresses to simulated sleeping conditions, mimicking the elevated body heat, humidity and carbon dioxide caused by humans when they sleep for even a few hours.
The mattresses had been allowed to air out for at least six months prior to the study, noted Sarah Evans, an assistant professor of environmental medicine and public health at the Icahn School of Medicine at Mount Sinai in New York City.
“Often we think, well, if you let something air out for a little while, you can dramatically reduce the level of chemicals that are off-gassed,” said Evans, who wasn’t involved with the study. “In this case, even after six months they still saw appreciable levels of off-gassing.”
Body heat appeared to increase each mattress’s release of compounds, compared with the levels released when the mattresses were not in use, researchers found.
Estimated exposures remained below the “No Significant Risk Levels” set under strict California environmental laws, researchers noted.
However, if the exposure levels took into account a child’s age, the picture took on more concern. For example, compounds linked to cancer such as acetaldehyde, formaldehyde and benzene approached or exceeded age-adjusted levels, researchers said.
The new study was published recently in the journal Environmental Science & Technology.
Experts are generally more concerned about children’s exposure to compounds, said Dr. Kenneth Spaeth, chief of occupational and environmental medicine at Northwell Health in Great Neck, N.Y.
Babies in particular spend a lot of time in their crib, lying on foam mattresses that produce these gases, said Spaeth, who had no part in the study.
“By virtue of their age and size, they have heightened vulnerability to potential toxic effects,” he said.
Even if these chemicals don’t do immediate harm, there is concern that exposure will increase their lifelong risk of cancer, Evans and Spaeth said.
The best way to protect against compounds is to maintain good ventilation inside your home, by opening windows and using fans, they said.
“Indoor air can have as much as 10 times higher VOCs than outdoor air,” Evans said. “Getting fresh air in can really help reduce those exposures.”
Consumers also can choose mattresses made of materials other than polyurethane foam, Evans said. Mattresses containing cotton, wool and natural latex will all produce lower levels of gases.
Unfortunately, it can be very difficult for consumers to suss out what’s in a mattress and what sort of compounds those materials might produce, Spaeth said.
“Consumers are in a very difficult position,” Spaeth said. “It’s very hard to get good information about what a mattress contains, and even if you know that, unless you have a good understanding of the different materials it’s hard to know what chemicals might be emitted from those materials.
“The chemicals that are being emitted are not going to be listed in a label that indicates what the mattress is made of,” Spaeth said. “These are byproducts of the materials.”
The burning discomfort behind your breastbone that moves up toward your neck and throat. The bitter or sour taste of acid in the back of your throat.
Heartburn.
It’s caused when acid from the stomach flows backward, or refluxes, up into the esophagus, irritating the throat, vocal cords and entrance to the lungs.
For most, it’s a minor annoyance. But for some, it’s a sign of gastroesophageal reflux disease, a condition that could lead to even more serious health problems.
1. Do you frequently have one or more of the following:
An uncomfortable feeling behind the breastbone that seems to be moving upward from the stomach?
A burning sensation in the back of your throat?
A bitter acid taste in your mouth?
2. Do you often experience these problems after meals?
3. Do you experience heartburn or acid indigestion two or more times per week?
4. Do you find that antacids only provide temporary relief from your symptoms?
5. Are you taking prescription medications to treat heartburn, but still having symptoms?
If you said yes to two or more of the above, you may have GERD. To know for sure, see your doctor or a gastroenterologist. In most cases, an endoscopy should be performed to evaluate the severity of GERD and identify the possible cause.
Don’t ignore your heartburn
Up to 20 percent of Americans suffer from typical symptoms of GERD, noted Praveen Sateesh, MD, a gastroenterologist with Spectrum Health Medical Group. These symptoms include:
Frequent heartburn (two or more times a week)
Difficulty swallowing (dysphagia)
Food sticking in the esophagus
Dry cough, hoarseness or sore throat
Regurgitation of food or sour liquid (acid reflux)
Sensation of a lump in the throat
While heartburn is the classic symptom, an estimated 65 percent of people with GERD experience atypical symptoms.
“These lesser-known symptoms are important to note because patients and their doctors may not associate them with reflux disease,” Dr. Sateesh said. “They therefore don’t pursue appropriate treatments.”
Atypical symptoms of GERD include:
Chronic cough
Persistent sore throat
Hoarse voice
Persistent postnasal drip
Chronic throat clearing
Choking
Dental erosion
Chest pain
Over time, Dr. Sateesh said, inflammation caused by GERD wears away the lining of your esophagus and can cause some serious complications:
Asthma, chronic cough and ear, nose and throat problems. These are known as extra-esophageal manifestations and the connection to GERD often goes unrecognized, even by health care providers.
Peptic stricture. This is a chronic acid injury and scarring of the lower esophagus. Patients often complain of food sticking in their throat, Dr. Sateesh said.
Barrett’s esophagus. This is a precancerous condition where the lining of the esophagus changes to resemble intestinal tissue. Once this happens, patients who initially experience heartburn won’t be able to feel the burning sensation any longer and incorrectly think the problem has gone away. Barrett’s is the No. 1 risk factor for developing esophageal cancer.
Esophageal cancer. This cancer is increasing at fast rate in the U.S. and results when GERD or Barrett’s is left untreated for many years.
To learn more about acid reflux and heartburn, including treatment tips, watch Dr. Sateesh on Fox 17 Morning Mix.
Nearly nine in 10 American adults lose sleep to binge watch TV, a new survey finds.
The more than 2,000 U.S. adults who took part in the American Academy of Sleep Medicine poll in September ranked sleep as their second-highest priority, with family being first.
But despite considering sleep important, 88% said they’d stayed up late to watch multiple episodes of a TV show or streaming series.
The rate was highest (95%) among 18- to 44-year-olds. Many also delay bedtime to play video games, read and watch sports, the survey revealed.
“It’s encouraging that Americans rank sleep as one of their highest priorities, but choosing to binge on entertainment at night instead of sleeping has serious ramifications,” AASM president Dr. Kelly Carden said in an academy news release.
Younger adults (aged 18 to 34) were more likely than those 35 and older to have stayed up late to play video games (72% versus 38%), and men were more likely to do so than women (59% versus 42%).
Two-thirds of respondents said they’d lost sleep to read. Women were more likely to do so than men (71% versus 61%), the survey found.
Nearly 60% of adults lost sleep to watch sports, including 75% of men and 45% of women. Adults between 25 and 54 years of age were more likely than those in other age groups to have stayed up late for overtime or extra innings (54% versus 51%).
That lost shut-eye can have serious consequences, Carden said.
“Sleep is essential to health, well-being and safety—and chronic insufficient sleep can lead to an increased risk of health problems, mood disorders and motor vehicle accidents,” she pointed out.
Losing sleep due to streaming, reading or playing video games can also lead to negative feelings. For example, 24% of respondents admitted feeling frustrated after delaying their bedtimes.
Feeling bad was most common for those in Generation Z (born in 1997 or later), who said that staying up late caused frustration (32%), worry (23%) and guilt (19%).
Such feelings can make it harder to drift off, especially if a person tries to make up for the lost sleep, according to the AASM.
The poll has a margin of error of plus or minus 2 percentage points and a confidence level of 95%.
The rise in use of prescription medication—and illegal drug usage—has rendered middle-age adults a substantial fall risk. (Courtesy Spectrum Health Beat)
New research shows they are a significant risk among middle-aged adults.
Why? Blame multiple prescription medications, as well as alcohol and illegal drug use, a new study suggests.
Health care providers “typically think about falls in people over age 65. But these people were primarily in their 50s and falls were an important concern,” said study author Julie Womack. She’s an associate professor at Yale University’s School of Nursing.
For the new study, the researchers analyzed data from the Veterans Aging Cohort Study, which includes patients who receive care through the U.S. Veterans Health Administration.
The team identified 13,000 fall cases and compared them to patients of similar age, race, sex and HIV status, who did not suffer falls.
The use of multiple medications was a significant factor in falls among patients with and without HIV.
The researchers examined HIV status because people being treated for HIV infection take several medications, often at a younger age.
Medications associated with serious falls included those commonly used to treat anxiety and insomnia (benzodiazepines, like Xanax), as well as muscle relaxants and prescription opioids (such as OxyContin).
The findings suggest that programs designed to prevent serious falls in older adults may need to be modified to address risks for middle-aged adults, according to Womack.
“Fall risk factors are highly prevalent in the baby boomer generation more generally. The next step is to look at interventions for the middle-aged,” she said in a Yale news release.
Those interventions could target drinking and illicit drug use in addition to taking multiple medications, Womack said.
“When we’re thinking about fall prevention programs, we have to think about alcohol and substance use. We need to help individuals cut back,” she suggested.
Womack noted that it’s important to reduce falls in middle-aged and older adults because falls are associated with injuries, hospitalizations and death.
The study was published recently in the Journal of Acquired Immune Deficiency Syndrome.
People who watch less TV and are physically active live more years free of heart disease, according to a new study.
Past research has shown people who are highly physically active tend to live more years free of cardiovascular disease.
But researchers of a study published recently in the Journal of the American Heart Association wanted to look specifically at how TV viewing habits fit into the equation.
Using data from 13,534 people ages 45 to 64, investigators studied three factors—how much TV people generally watched, how often they were physically active in their leisure time and how long they lived without having a stroke, heart failure or coronary heart disease.
After an average of 27 years, people who were highly active and watched little or no TV lived about two and a half years longer free of stroke, heart failure and coronary heart disease than those who often watched TV and weren’t active.
TV watching impacted health regardless of physical activity, the study found.
Those who seldom watched or never watched TV lived about a year longer free of each type of cardiovascular disease than those who often watched TV.
“This study suggests that engaging in any physical activity and viewing less TV could help you live more years free of (cardiovascular) disease,” said Carmen Cuthbertson, the study’s lead author.
“Because there’s such a large cardiovascular disease burden in the U.S., we wanted to focus on how to extend the years you live in health,” said Cuthbertson, a postdoctoral fellow in the epidemiology department at the University of North Carolina at Chapel Hill.
The study was limited, she said, by the fact that participants were asked only about “leisure time” activity and not about household chores or physical activity during work or commuting.
She said she’d like future studies to incorporate wearable devices to track physical activity and sedentary time.
Bethany Barone Gibbs, a professor of health and physical activity at the University of Pittsburgh who was not involved in the study, applauded the research for focusing not on death, but on how people can live longer lives free of cardiovascular diseases.
While the results don’t prove frequent TV watching causes heart disease, she said, its findings help clarify how physical inactivity affects health.
“Studies have shown that people who sit for hours at a time develop various vascular dysfunctions—blood begins pooling in the legs and circulation gets worse, especially in the extremities, which we think causes vascular damage that can lead to the long-term development of heart disease,” said Gibbs, vice chair of the American Heart Association’s Physical Activity Committee.
“TV watching is just one domain of sedentary behavior, but it’s also a really modifiable behavior,” she said.
The study began in the late 1980s before smartphones and the internet impacted how long people sit in front of screens, Gibbs said. She called for new in-depth research into how cardiovascular health is affected by overall sitting time as well as binge-watching TV.
“Now, we can sit back and not even have to lift a finger to watch the next show on Netflix,” she said. “I think television-watching is becoming an even more important target when it comes to behavior change and reducing our risk of cardiovascular disease.”
Joining social groups and establishing their own support network is an essential component to a caregiver’s quality of life. (Courtesy Spectrum Health Beat)
If you’re a caregiver for a family member, you need to look after your own mental health to provide the best care for others, an expert says.
Caregivers are at increased risk for depression and anxiety.
Clinically significant symptoms of depression occur in 40%-70% of caregivers, and major depression occurs in 25%-50% of these caregivers, according to the Family Caregiver Alliance.
“Taking time to care for yourself is not selfish. In order to have the strength to care for a loved one, it is extremely important that caregivers take care of their own physical and mental health,” said Dr. Vassilios Latoussakis, a psychiatrist at Gracie Square Hospital, a psychiatric facility in New York City.
Latoussakis offered the following advice.
Pay attention to your stress levels, he said in a hospital news release. If you find yourself crying, losing your temper or having fantasies of rescue or flight, seek help.
Stress can affect your physical health, causing problems such as headaches, sleep issues, heart troubles, high blood pressure, and elevated fat and sugar levels.
If you’re feeling the effects of stress, make an appointment with your primary care provider, Latoussakis advised.
There are a number of ways to reduce stress, including regular physical activity, relaxation techniques such as breathing, yoga or mindfulness, making time to see friends and doing activities you enjoy.
It’s important to have a support network of people with whom you can talk, confide and gripe.
Another good idea is to join a support group of caregivers where you can share concerns, practical issues and problems, Latoussakis said.
More than 34 million Americans have provided unpaid care to an adult aged 50 or older in the past year, according to the National Alliance for Caregiving and AARP.
I recently heard about two patients who ended up in the hospital with gallstones just a short while after they gave birth to their babies.
They both ended up having their gallbladders removed.
Women who experience gallstones after their child is born will typically experience this within two to four months after delivery.
More than 25 million people suffer from gallstones, but women encounter this at a much greater rate than men—and that’s before pregnancy is factored in.
You are indeed more prone to gallstones when you’re pregnant.
Why? The extra estrogen in your body. Among its various effects, estrogen increases cholesterol.
Progesterone can also lead to gallstones. This hormone relaxes tissue, including within the gallbladder.
Battling blockages
About the size of a pear, the gallbladder is located below the liver.
Though you can live without it, the gallbladder does have its use.
The liver makes bile, which is stored in the gallbladder. When we eat food—especially high-fat food—bile is released from the gallbladder and sent to the intestines to aid in digestion.
In some cases, the bile crystalizes and forms gallstones. These can be as small as sand or as large as a golf ball.
Gallstones are usually composed of calcium bilirubinate, cholesterol and calcium carbonate.
It’s critical to understand that gallstones can cause a problem when they block ducts. They won’t allow the bile to leave, which can cause inflammation, or cholecystitis.
People may have gallstones and not even know it. Symptoms only tend to arise when the stones block or obstruct the body’s natural processes.
Symptoms include:
Upper abdomen pain, which can radiate to right shoulder and back
Steady pain after eating fatty meals
Abdominal pain lasting longer than five hours after eating
Fever or chills
Nausea or vomiting
Yellowing of the eyes
Dark urine
Clay-colored bowel movements
In the past we’ve looked at a condition called cholestasis of pregnancy, which entails symptoms similar to those experienced by gallstones.
Testing for gallstones can involve an ultrasound, which helps doctors visualize what is happening. A blood test can also reveal signs of infection.
Doctors can use CT and MRI imaging to further uncover problems.
Antibiotics may be used if there are signs of infection, but doctors may turn to surgery to remove the gallstones or the gallbladder.
Promoting prevention
There are some steps you can take to help reduce the chances of developing gallstones.
First and foremost: Eat healthy and keep your weight under control. Yes, if you’re pregnant you will be gaining weight—you are growing a human being inside you. But excess weight isn’t helpful.
Other useful tips:
Limit bad fats and make sure you’re getting healthy fats, which are monounsaturated fats and omega-3 fatty acids.
Even mild anemia—low levels of hemoglobin in the blood—may raise a person’s odds for Alzheimer’s disease and other types of dementia, a new study finds.
The same Dutch research also found a correlation between heightened dementia risk and high blood levels of hemoglobin.
“With around 10% of people over age 65 having anemia in the Americas and Europe and up to 45% in African and southeast Asian countries, these results could have important implications for the burden of dementia,” noted study lead author M. Arfan Ikram, of Erasmus Medical Center in Rotterdam, the Netherlands.
Hemoglobin is the protein in red blood cells that transports oxygen.
The new study included more than 12,000 people averaging 65 years of age. None of the participants had dementia at the beginning of the research.
Hemoglobin levels were measured at the start of the study and 6% of the participants were found to have anemia.
The participants’ health was then tracked for an average of 12 years. During that time, 1,520 developed dementia, including 1,194 who were diagnosed with Alzheimer’s disease, according to the report published online recently in Neurology.
The study was not designed to prove cause and effect.
However, the research showed that people with anemia were 41% more likely to develop Alzheimer’s disease and 34% more likely to develop any type of dementia than those without anemia, the team reported.
In another finding, people with high levels of hemoglobin were also more likely to develop dementia.
Those with the highest levels were 20% more likely to develop dementia than those with levels in the middle.
Those with the lowest hemoglobin levels were 29% more likely to develop dementia than those with levels in the middle, the research found.
In a journal news release, Ikram added that the findings could be significant, given that “the prevalence of dementia is expected to increase threefold over the next decades, with the largest increases predicted in the countries where the anemia rate is the highest.”
The question of how hemoglobin levels affect dementia risk is still unclear, however.
“More research is needed to determine whether hemoglobin levels play a direct role in this increased risk or whether these associations can be explained by underlying issues or other vascular or metabolic changes,” Ikram explained.
Dr. Satjit Bhusri is a cardiologist at Lenox Hill Hospital in New York City. Looking over the findings, he stressed that hemoglobin’s role as an oxygen transporter to the brain might be key.
“Any quick or slow loss of oxygen will lead to a cognitive decline and manifest as dementia,” he noted. Conversely, Bhusri said, “elevated hemoglobin is a reaction to some underlying disease. That disease is forcing the body to produce more hemoglobin. This can result in an increase in thickness of blood and poor flow to the brain.”
Another expert believes the findings should serve as a reminder to doctors to pay attention to even mild anemia when it occurs.
“I think that physicians should not write off mild anemia in any age group, because it clearly is associated with brain dysfunction over time,” said Dr. Guy Mintz. He directs cardiovascular health at Northwell Health’s Sandra Atlas Bass Heart Hospital in Manhasset, N.Y.
Mintz also noted that many of the participants in the study were still in their 60s and 70s, so “we are not looking at an elderly, frail group of patients.”
As for people with elevated levels of hemoglobin, he believes that in many instances this happened in response to the smoking habit.
So, the link between hemoglobin levels and dementia “can be another motivational tool to get these patients to stop smoking,” Mintz said.
Your dog might be your heart’s best friend, if a new study is any indication.
Researchers found that compared with people who had no pets, dog owners tended to have fewer risk factors for heart disease: They got more exercise and had healthier diets and lower blood sugar levels.
Even compared with other pet owners, they were doing better with diet and exercise.
The study of nearly 1,800 Czech adults is not the first to suggest our canine friends can do our hearts good. In fact, in 2013 the American Heart Association issued a scientific statement saying that dog ownership is likely linked to a lower risk of heart disease.
That was largely based on evidence that people with dogs are more physically active. The new findings suggest the benefit might extend to diet and blood sugar levels.
It’s easy to see how having a dog could get people moving, according to senior researcher Dr. Francisco Lopez-Jimenez.
And it’s possible that dog owners’ lower blood sugar levels were related to their exercise habits, said Lopez-Jimenez, a cardiologist at the Mayo Clinic in Rochester, Minn.
It’s less obvious, though, why dog ownership would encourage a healthier diet. One possibility is that the two are not directly related, he said.
On the other hand, past research has shown that dogs do more than demand walks and get us moving: They offer companionship and emotional support, according to Lopez-Jimenez.
“They can decrease your feelings of loneliness and give you a sense of purpose,” he said. “You have someone to look after.”
And that, he speculated, might encourage people to take better care of themselves.
Dr. Glenn Levine, a volunteer medical expert with the AHA, was lead author of its statement on pets and heart health. He said that, overall, there is “reasonably good data” that adopting a dog can increase people’s physical activity levels.
“That’s the strongest and most direct (cardiovascular) benefit,” said Levine, who is also a professor at Baylor College of Medicine in Houston.
He agreed, though, that pets might support heart health in less-direct ways, too.
“There may be other benefits as well—including reduced stress, greater companionship and happiness, and other factors that could lead people to take better care of themselves,” he said.
For the study, the researchers used data from a health survey of 1,769 Czech adults, aged 25 to 64.
Overall, more than two-thirds of dog owners (67%) met the “ideal” AHA recommendations for exercise. That means 150 minutes of moderate aerobic exercise, or 75 minutes of vigorous activity, each week—along with muscle strengthening exercises a couple of days per week.
In contrast, only 48% of people without pets met that ideal, as did 55% of other pet owners, the findings showed.
When it came to diet, few people met the AHA ideal, which includes plenty of fruits, vegetables, beans, fiber-rich grains, fish and lean meat.
But dog owners were doing better than others: Fewer than 7% scored in the “poor” range for diet, versus 16% of people without pets and 13% of other pet owners.
Dog owners did, however, fall short in one heart-health measure: Their smoking rates were highest.
It’s not clear why, according to Lopez-Jimenez—and it might not hold true in other countries, such as the United States. In general, smoking is more common in Eastern Europe.
The bottom line, according to Levine, is that people might enjoy health benefits from having a canine companion. But the AHA does not advocate adopting a dog for that purpose.
“The primary purpose of adopting or rescuing a dog should be to give the dog a loving and caring home,” Levine said. “The health benefits that may come from this are a bonus.”
The findings were published recently in Mayo Clinic Proceedings: Innovations, Quality & Outcomes.
Menopause is often referred to as a “perfect storm” where all the odd changes and symptoms women experience collide.
This collision creates insulin resistance resulting in increased belly fat.
At the Spectrum Health Medical Group Midlife and Menopause Clinic, we have an entire team to help women with menopause symptoms, including weight gain.
One of our team members, Irene Franowicz, is a registered dietician who practices what she preaches. She encourages healthy eating and cooking and she teaches others how to prepare healthy foods in her weight management program, Eating the Mediterranean Way with Low Glycemic Carbohydrates.
Even better, Irene demonstrates techniques to counteract the effects of aging and menopause.
Right before and during menopause, one of the most common complaints women experience is weight gain. Many of my patients say, “I am doing the same things with my diet and activity level, but I keep gaining weight.”
One of my patients—we’ll call her Sarah—has experiencing this. At age 49, Sarah struggled to stop gaining weight. She knew she already had a bit of a weight problem, and at age 45 she noticed it was becoming more difficult to lose weight.
Busy juggling family and work, Sarah would often eat on the run as she and her family headed out the door to soccer games, school events and other functions. She exercised when she could, but it wasn’t enough. To make matters worse, when Sarah was 48 years old, she broke her foot and couldn’t move around for five weeks.
Unfortunately, she gained 15 pounds during that time.
Sarah knew her risk of gaining even more weight was high, because she had two strikes against her: she had diabetes when she was pregnant and diabetes ran in her family.
When her periods became very sporadic and she started having hot flashes, she came to see us in the Midlife and Menopause Clinic. From this visit, Sarah learned she was in perimenopause and smack dab in the middle of a perfect storm.
Modify meals
Sarah came to the right place for answers.
We helped her understand that her low estrogen was making her metabolism worse by making her more insulin-resistant. As a result, her body was storing every calorie it could.
No wonder she continued to gain weight. She was trying very hard to make some positive changes, including getting more sleep, drinking more water and exercising more regularly. Sarah still needed more help with her diet, so we sent her to Irene’s class at Spectrum Health.
Irene centers her teaching on the Mediterranean diet because it is low glycemic, meaning it’s low in simple sugar.
Irene’s real passion is working with women in perimenopause and menopause and teaching them how to eat in a way to overcome weight gain. Her low glycemic meal plans are carbohydrate-controlled and high in antioxidants. She created the Mediterranean diet program to help the thousands of women who come to her and say, “I can’t seem to lose weight any more, even though I am eating the same.”
In her classes, Irene offers ideas for meal plans, plus recipes for breakfast, lunch, dinner and snacks. Each week, the participants sample delicious recipes and leave with a list for grocery shopping.
Irene has seen great success in women who have adopted her Mediterranean diet program and she enjoys teaching how dietary modifications can reverse the metabolism. It’s simple—even with small weight loss, sugar levels drop.
After seeing me and then talking to Irene, Sarah was thrilled to learn we’re all teaching the same concepts.
She started preparing meals in advance and making healthy, tasty snacks for her entire family. Before too long, Sarah had lost 9 pounds and her sugar level dropped while her energy level went up—she was overjoyed.
Instead of feeling like her life was on the downslide, Sarah now envisioned a much brighter future for herself. She even considered joining Irene’s strength training and yoga classes, something she never thought she could do.
Using a team approach to health care, Irene and I often refer patients to each other. When Irene sees women struggling with hormone issues, she refers them to us in the Midlife and Menopause Clinic and we also send patients to Irene’s classes. We share our skills to provide a wide net of support to as many women as possible.
The doctors at Spectrum Health Medical Group and in our OB/Gyn practice are always encouraging our patients to be physically active.
The benefits of living an active lifestyle include keeping your cholesterol, blood sugar and weight under control; preventing cancer, type 2 diabetes and heart attacks; and improving your sleep.
Even better, regular physical activity also reduces falls, joint pain and depression. It helps you feel better about yourself.
Fitness is something that can be measured and improved, and it starts with having a goal.
When I talk to my patients about fitness and goals, I am always reminded of a patient I’ll call Cathy.
Cathy aims to get ‘hot’
While rushing from one room to another in my office one day, I came around a corner too quickly. I almost ran into a woman I didn’t know, so I excused myself.
She stopped me and said, “You don’t recognize me, do you?” I confessed that I wasn’t sure who she was, and she said, “Then you probably don’t remember what you said to me last year, either?” Again, I admitted that I did not. She continued, “You asked me how I wanted to be in the next year when I turned 50, and I had to really think about it. I decided I wanted to turn 50 and feel ‘hot’. So, I decided I would do what it would take, and I just ran my first half marathon. Now I feel ‘hot’!”
We stood there in the hallway for a few minutes and talked about her transformation, and hers was such a great story of how a single goal could change an entire lifestyle.
Cathy’s story began about a year before our chance encounter in the hallway of my office. She had come in for her annual exam, and she was discouraged about her weight and overall fitness level. She left my office that day approximately 25 pounds over a healthy weight, had belly fat she didn’t like, and wore clothes two sizes larger than she wanted.
Like many women, Cathy had a very busy work life, and she barely had time for anything besides work and family. It seemed that after a long work day, her evenings were filled with preparing dinner, packing lunches and helping her kids with homework.
Cathy would try to take a walk on the weekends, but she didn’t have time to exercise regularly, and she got winded just walking up a flight of stairs. She didn’t do any strength training, wasn’t flexible and often complained of leg cramps.
And the list of bad habits went on, including:
Drinking too much coffee and not drinking enough water
Eating on the run
Eating very few fruits and vegetables other than an occasional salad for lunch
Cathy knew that she wanted to look “hot,” but she also knew she had a lot of planning and work to do if she was going to become the person she envisioned in her mind.
During her annual visit, I mentioned the Presidential Fitness Test (adultfitnesstest.org) as a way to find a general measure of how she compared to other women her same age. She looked it up, saw what she was up against, and created a goal to help her on her journey to better health.
Achieving her goal
Cathy’s goal: She wanted to be fit. More specifically, she wanted to be able to run at least three miles, be physically stronger and more flexible. She knew she would not only feel better about her appearance but also be stronger as she faced her next 50 years of life. Her goal kept her motivated when it would have been much easier to give up.
Of course, there were barriers that Cathy knew she would need to overcome—time, motivation, energy and knowledge. During her visit, we talked about starting small so she wouldn’t get discouraged and give up.
She took my advice and started taking walks whenever she had even a little free time—at lunch, after work (before making dinner), and after dinner. Cathy began doing sit-ups and push-ups in the morning before her shower, and stretching every night before bed.
As the weeks and months went on and she had increased energy, Cathy added more to her routine. Her walks turned into a walk/run combination, eventually running more than walking. She started with just 15-20 minutes of exercise at one time but gradually increased the time as she became stronger.
One thing that really helped Cathy stay positive was to measure her exercise by time instead of distance or speed. This proved to be very beneficial to Cathy and helped her keep working toward her goal.
It also helped that Cathy’s husband and kids supported her efforts to become more physically fit. Her husband would take walks with her at night after dinner, and her son rode bikes with her on the weekends. She even found herself wanting to go for a walk instead of grabbing coffee with a girlfriend.
Cathy’s hard work and persistence began to pay off. At that point, she had dropped one pant size, her belly fat started to decrease, and she no longer had leg cramps. More importantly, Cathy’s blood pressure improved, her cholesterol decreased, and her blood sugar made it to the normal range.
As Cathy’s activity level increased, her numbers continued to go down. She was encouraged to keep on her journey, and by the time I saw her, she had run a half marathon, gone down three pant sizes, and lost 35 pounds.
She said she’d never felt better in her life. Although it took almost a year, Cathy met her goal and turned 50 feeling “hot.”
A good mood is infectious among teens, but depression is not, a new study suggests.
Researchers looked at more than 2,000 American high school students to see how they influenced each others’ moods. They found that a positive mood seems to spread through groups of teens, but having depressed friends doesn’t increase a teen’s risk of depression.
In fact, having plenty of friends in a good mood can halve the chances that a teen will develop depression over six to 12 months. Having a lot of happy friends can also double the likelihood of recovering from depression over the same time period, the researchers found.
However, the study could only show an association between happy friends and a lower risk of depression or a faster recovery from depression. It cannot prove a cause-and-effect relationship between these factors.
“We know social factors, for example living alone or having experienced abuse in childhood, influences whether someone becomes depressed. We also know that social support is important for recovery from depression, for example having people to talk to,” study author Thomas House, a senior lecturer in applied mathematics at the University of Manchester in the U.K., said in a university news release.
“Our study is slightly different as it looks at the effect of being friends with people on whether you are likely to develop or recover from being depressed,” he added.
These findings suggest that promoting friendships, through such activities as social clubs, might help guard against depression, House noted.
“This was a big effect that we have seen here. It could be that having a stronger social network is an effective way to treat depression. More work needs to be done but it may that we could significantly reduce the burden of depression through cheap, low-risk social interventions,” House concluded.
Taking a moment each day to journal or plot out your thoughts could help you improve your focus, a key aspect of your well-being. (Courtesy Spectrum Health Beat)
If you’re satisfied with your life, you probably have emotional well-being.
Emotional well-being can be mastered just like any other skill, according to Richard Davidson, founder of the Center for Healthy Minds at the University of Wisconsin-Madison.
How? By developing four key traits, said Davidson, a neuroscientist.
Resilience
The first is resilience. Research at the Center for Healthy Minds found that, over time, regular mindfulness meditation can help you learn how to bounce back from adversity.
Mindfulness meditation teaches you to become aware of your thoughts and emotions, center yourself and decide how you would like to proceed with the rest of your day. Find out more at mindful.org.
Positivity
Having a positive outlook is the second key trait—both finding the positive in others and being positive in the way you approach life.
Another type of meditation called compassion meditation is said to bring measurable changes after two weeks of 30-minute-a-day sessions. The goal is to switch from being judgmental to being caring.
Focus
Next is improving your attention level. A Harvard study found most people spend nearly half of their waking hours not paying attention to what they’re doing.
Letting the mind wander typically makes people unhappy, the researchers concluded. Practice focusing on the here and now, one task or activity at a time.
Generosity
Finally, become more generous of spirit. This means feeling happy for others when they do well rather than being envious or bitter, emotions that only hurt you.
Generous behavior activates circuits in the brain that promote well-being while enhancing the lives of those around you.
Yes, it takes time and effort to change your thinking and the way you see the world, but the benefits are infinite. And the more you practice, the more natural it will feel.
Diabetes is the body’s inability to properly process sugar, causing blood sugar to rise to unhealthy, sometimes dangerous, levels.
But the opposite problem—low blood sugar—can be a concern for people with diabetes, too.
About 60 percent of people with diabetes have had episodes of low blood sugar, known as hypoglycemia, according to a national survey by the American Association of Diabetes Educators. Of those people, 19 percent went to an emergency room.
“The prevalence is huge, and patients are concerned about it,” said Evan Sisson, PharmD, MHA, and a certified diabetes educator and former American Association of Diabetes Educators board member.
But the survey also showed that many patients “don’t know how to recognize hypoglycemia, and what to do if they do have it,” Dr. Sisson added.
A surprisingly high percentage of the survey’s respondents—nearly one-fifth—didn’t know how to define low blood sugar.
The number of patients who are unaware of low blood sugar treatment, or not properly treating low blood sugar, is worrisome to medical professionals because they demonstrate high patient concern but low knowledge.
When addressed properly at the first sign of symptoms, hypoglycemia can be little more than a minor annoyance. But if ignored, the symptoms become significantly worse—sluggishness, mental confusion, loss of consciousness.
Low blood sugar symptoms—the alarm signals include feeling shaky or sweaty, hungry or nauseated, or having a pounding heart—can begin when glucose levels drop to 70 milligrams per deciliter, or lower.
“Several factors put patients at increased risk of hypoglycemia,” said Annie House, a certified diabetes educator and diabetes education program coordinator at Spectrum Health Medical Group.
These factors include: too much diabetes medicine, too little food, or unplanned activity such as extra exercise in the summer or snow shoveling during the winter—any of which can use up much of the body’s glucose supply.
“Diabetes educators know to screen patients for these things and discuss the symptoms, treatment and methods of preventing low blood sugar,” House explained.
She added that modern technology is helping with such increasingly popular devices as continuous glucose monitors, which can warn patients electronically if their blood sugar is getting too low.
Dr. Sisson emphasized the importance of people with diabetes staying alert to their body’s changes.
“We’d like people to stay tuned to what their bodies are telling them,” he said. “Being able to anticipate changes in our body’s blood sugar from various activities, or from a missed meal or snack, is an important skill that comes from discipline and vigilance. And it’s important to include a patient’s medical professional in this effort.”
House said the diabetes professionals at Spectrum Health often bring up the subject of hypoglycemia during patient assessments. People with diabetes should ask their medical team about the impact of glucose medication or activities on blood sugar levels, just as a primary care provider may want to remind patients to check blood glucose before or after any physical activity, and to have appropriate snacks readily available if glucose levels fall.
Don’t be shy about this.
“When I talk with patients, one of the things I try to highlight is that hypoglycemia is a common issue,” Dr. Sisson said. “For that matter, diabetes itself is common. They’re not the odd person out. They’re not alone.”
Including a patient’s entire medical team to help develop a disciplined approach to monitoring symptoms is strongly recommended.
“We believe the patient is part of their own team,” Dr. Sisson said. “The take-home message for us in this survey is that more education is needed all the way around.”
House noted that the subject of hypoglycemia is covered, in depth, in Spectrum Health diabetes group classes, which are covered by most insurance plans.
“Hearing other people’s experiences resonates well,” she said. “Someone else’s story can have a big impact on another patient’s personal behaviors.”
By consistently monitoring their blood sugar and working with a diabetes educator, people can manage their diabetes and minimize the incidence of low blood sugar.
Kaitlyn Jones left school early one Wednesday in January because she felt awful: headache, body ache, chills, fatigue.
It must be the flu, she thought, noting how some of her fellow cosmetology students were among the many suffering from the virus this year.
She hoped she could get a prescription to treat it. But once she got home and learned she had a 102-degree fever, the last thing she wanted to do was get back into the car and go to the doctor.
So Kaitlyn, 18, took her mom’s advice and pulled up the MedNow app on her iPad.
Within minutes, she was having a video visit with Melissa Wilson, a nurse practitioner with MedNow, Spectrum Health’s telemedicine service.
MedNow lets anyone in Michigan who has access to a smartphone, tablet or camera-equipped laptop to receive non-emergency care from a Spectrum Health provider on-screen, 24/7.
“It was kind of like FaceTime,” Kaitlyn said. “Super easy.”
No waiting room
After she signed in to the app and picked the next available appointment time—in this case, immediately—Kaitlyn connected via video chat with a MedNow medical assistant, who got her registered and verified her insurance.
Then Wilson took over the video visit, asking about Kaitlyn’s medical history and walking her through a brief physical exam. From the comfort of her family’s home in Rockford, Michigan, Kaitlyn checked her neck and ears for tenderness and tried to show Wilson the back of her throat using her iPad’s camera.
“We went through my symptoms together, and then she prescribed Tamiflu,” Kaitlyn said. “She sent it right away from there to the pharmacy, so I was able to get it that night.”
Two days later, she felt well enough to return to class.
Tamiflu, or oseltamivir, is an oral drug that can shorten the duration of seasonal influenza if you take it soon after contracting the illness. It’s not essential for all flu patients, but it was important for Kaitlyn because she has Type 1 diabetes, which puts her at higher risk for complications.
Photo by Chris Clark, Spectrum Health Beat
“I thought, we need to nip this in the bud,” said Holly Jones, Kaitlyn’s mom. “With diabetes, it’s just more complicated when they get the flu.”
Kaitlyn’s diabetes diagnosis is only a few months old, making her extra cautious about her health.
“Because I’m so new, I’m hyper aware and really scared of doing anything that would cause my blood sugars to go crazy,” she said.
The idea of sitting in a doctor’s office or urgent care center didn’t sit well with her—or her mom.
“I didn’t want her near the germy waiting room to catch whatever else was in there,” Holly said.
That’s what made the MedNow visit so ideal.
“I don’t even think you got out of your pajamas,” Holly said to her daughter.
Growing popularity
Kaitlyn’s video visit wasn’t just fast and convenient—at $45, it was also less expensive than a trip to the doctor, an urgent care center or the emergency department.
According to Amanda Reed, MedNow’s operations director, each MedNow visit saves patients and insurers more than $120, on average, compared to other sources of care. These cost savings, combined with convenience and quality of care, have propelled MedNow’s popularity.
“We reached our new high mark on January 24, with 127 patients seen in one day,” Reed said. “We had over 5,000 app downloads in the month of January alone.”
This year’s hard-hitting flu season is a catalyst for MedNow’s growth, according to Elizabeth Suing, PA, one of about 30 providers who spend at least part of their time treating MedNow patients.
“Right now, over 50 percent of the patients we are seeing in a day are flu patients,” she said.
Many of these are first-time MedNow users. But Suing predicts they’ll be back the next time they need non-emergency care—treatment for concerns like allergies, back pain, bites and stings, diarrhea, nausea and vomiting, sinus problems, sprains and strains, urinary symptoms and more.
“Patients love the telemedicine. They love the convenience of it,” Suing said. “I think it’s the way that the world is going.”
Kaitlyn’s mom, Holly, confirms Suing’s view.
“I recommend it a lot,” she said. “My friends will say, ‘Oh, but I don’t want to go to urgent care,” and I say, ‘Try MedNow. Download the app. Make an appointment.’”
That morning sudoku puzzle could be the whetstone that sharpens your mind well into your later years, according to researchers. (Courtesy Spectrum Health Beat)
Mornings spent figuring out Sudoku or finessing a crossword could spell better health for aging brains, researchers say.
In a study of over 19,000 British adults aged 50 and over who were tracked for 25 years, the habit of doing word or number puzzles seemed to help keep minds nimble over time.
“We’ve found that the more regularly people engage with puzzles such as crosswords and Sudoku, the sharper their performance is across a range of tasks assessing memory, attention and reasoning,” said research leader Dr. Anne Corbett, of the University of Exeter Medical School.
“The improvements are particularly clear in the speed and accuracy of their performance,” she added in a university news release. “In some areas, the improvement was quite dramatic—on measures of problem-solving, people who regularly do these puzzles performed equivalent to an average of eight years younger compared to those who don’t.”
Does that translate to protection against Alzheimer’s and other forms of dementia? The study “can’t say” at this point, Corbett said, “but this research supports previous findings that indicate regular use of word and number puzzles helps keep our brains working better for longer.”
The study was conducted online. Participants were assessed each year, and they were asked how often they did word and number puzzles. They were also given a series of tests measuring attention, reasoning and memory, to help assess changes in their brain function.
The result: The more often participants did word and number puzzles, the better their performance on the brain tests, Corbett’s group found.
Although the study couldn’t prove cause-and-effect, some differences were significant. Brain function for those who did word puzzles was equivalent to 10 years younger than their actual age on tests of grammatical reasoning and eight years younger than their age on tests of short-term memory.
The findings are outlined in two papers published in the International Journal of Geriatric Psychiatry, adding to results presented at the Alzheimer’s Association International Conference in 2018.
The study is now expanding into other countries, including the United States.
Brain experts in the United States weren’t surprised by the findings.
The large, decades-long study “confirmed what your grandmother told you: ‘If you don’t use it, you lose it,’” said Dr. Gayatri Devi. She’s a neurologist specializing in memory disorders at Lenox Hill Hospital in New York City.
The fact that something as simple as puzzle-solving can take years off the brain is “a comforting finding,” Devi said.
She stressed that exercising the body can do the same. “Physical exercise is one proven way to keep our brains and our body healthy,” she said.
Dr. Gisele Wolf-Klein directs geriatric education at Northwell Health in Great Neck, N.Y. She said interventions to help the brain stay healthy longer are sorely needed.
“As older patients live longer, the growing number of Alzheimer’s patients represents a major challenge for health care systems worldwide,” Wolf-Klein said. “Currently, the pharmaceutical industry has yet to propose any promising medical treatments. So, searches for lifestyle interventions that might preserve cognition (thinking) has become a priority.”
“This study further supports many (prior) studies highlighting the benefits of mind exercises,” she said. It also “reinforces the need for all of us to keep our minds as active and engaged as possible.”
Feel a dark mood coming on? Wearable technology could one day alert you in advance, aiding in management of depression or other mood disorders. (Courtesy Spectrum Health Beat)
A high-tech wristband is being developed along the same lines, potentially helping patients who struggle with mood disorders.
The smart wristband would use a person’s skin to track their emotional intensity. During a mood swing, either high or low, the wristband would change color, heat up, squeeze or vibrate to inform the wearer he might be in the throes of depression or anxiety, the researchers said.
“As the feedback is provided in real time, our devices encourage people to become more aware of their emotions, name them, potentially reflect on what causes them and even learn how to control their emotional responses in order to change the visual or tactile feedback provided by the device,” said researcher Corina Sas. She is a professor of human-computer interaction and digital health at Lancaster University in the United Kingdom.
About 10% of U.S. adults struggle with a mood disorder, such as depression, anxiety, bipolar disorder or seasonal affective disorder, according to the U.S. National Institute of Mental Health.
Part of the treatment for a mood disorder involves becoming more aware of emotions and then learning to regulate emotional response, the study authors said in background notes in their report.
Co-author Muhammad Umair, a Lancaster research associate, explained, “We wanted to create low-cost, simple prototypes to support understanding and engagement with real-time changes in arousal. The idea is to develop self-help technologies that people can use in their everyday life and be able to see what they are going through,” he said in a university news release.
To that end, the U.K. researchers are developing wristbands that use sensors to detect changes in a person’s emotional intensity by tracking the electrical conductivity of their skin.
The devices then communicate those emotional changes either through materials that change color, heat up, vibrate or squeeze the wrist, the researchers said.
“Depression has a range of emotions, but if we talk about sadness, then as this is associated with low arousal—or what we call emotional intensity—the device will most likely reflect low arousal,” Sas said. “On the other hand, anxiety tends to be associated with high-intensity arousal, so that device will most likely reflect this.”
However, Sas noted, the device does not differentiate between positive or negative emotions, but between high- and low-intensity ones.
The researchers tested six wrist-worn prototypes with 12 people who wore them over two days.
Participants said the wristbands effectively prompted them to evaluate their emotions.
One participant told the researchers: “When I see the feedback, I feel present, I start to reflect what I was doing before and try to think how I am feeling at that moment.”
Another said: “It made me more aware of my feelings and made me think what feelings I have. But if I didn’t have the device, I wouldn’t be probably as aware as I am when wearing it. It did give me a way to think of my own emotion; made me aware of my own emotions.”
But participants were also concerned that negative feedback from the device might pose a potential hazard.
One said it could “be used as a trigger and might push you down the negative path.”
That’s a concern shared by Jessy Warner-Cohen, a health psychologist with Long Island Jewish Medical Center in New Hyde Park, N.Y.
“I caution against letting a device dictate to a person their own emotions,” she said.
On the other hand, such a device is consistent with a long-established tradition of biofeedback, in which people use “physiological cues to help us actively try to regulate our minds and bodies,” Warner-Cohen said.
The device could help people recognize specific habits or tics that occur when they have a mood swing, she added.
“For example, if a person can identify that they clench their jaw when stressed then, in reverse, noticing when they clench their jaw can help a person recognize they are getting stressed and take proactive steps to alleviate such,” Warner-Cohen explained.
Dr. Victor Fornari, a psychiatrist with Zucker Hillside Hospital in Queens, N.Y., said the wristbands may be the beginning of “a new frontier” in helping to identify and regulate anxiety and depression.
“Increasing awareness about emotional reactions and improving the way individuals can self-regulate their emotions can be very helpful and important for everyone, but particularly for individuals with a mood or anxiety disorder,” Fornari said.
The technology is not yet patented, Sas said, and it is some ways off from being available to consumers.
“We need about another year to develop a more robust version of our research prototypes so that we can integrate both visual and tactile feedback, for which we will need increased computational power,” she said. “At that stage, we will look into running clinical trials to explore its value for people living with affective disorders, such as depression or anxiety.”
The researchers were scheduled to present their work at the Designing Interactive Systems conference in San Diego, Calif.
Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.
It’s a hard habit to break—sinking your teeth into a favorite fast-food breakfast sandwich.
But your drive-thru addiction could be making a big dent in daily calorie and fat limits without giving you the nutrients needed to fuel your day.
Take these steps for a healthy breakfast sandwich remix, great taste included:
Skip the sausage
When you must buy a ready-made sandwich, skip the bacon or sausage. Replace a croissant, white roll or biscuit with a whole-wheat English muffin or whole grain wrap, like a corn or whole-wheat tortilla or a pita pocket.
Go homemade
Here are other do-it-yourself steps that shouldn’t take more time than driving to a chain restaurant:
If you’re feeling adventurous, make a batch of crepes with whole-wheat pastry flour to use as the wrap. Store leftovers between sheets of wax paper in the fridge—they’ll be ready for a grab-and-go breakfast the rest of the week. If you’re short on time or you’re cutting back on calories, use a broad leafy green, like red leaf lettuce or romaine, as your wrap.
Fill your wrap of choice with 3 to 4 ounces of protein, such as eggs, a turkey sausage, your favorite smoked fish or even lean meat leftovers—nowhere is it written that you can’t have chicken for breakfast.
Now load up on the fixings. This is a great way to get in vegetables. Go beyond tomato slices with bell pepper rings, mashed avocado and even sautéed onions and mushrooms. Add crunch with arugula, spinach or kale shreds.
And for extra flavor without extra calories, top with salsa, hot sauce or fresh herbs. Then roll up your wrap and dig in.
Difficulties with daily activities such as dressing, walking and eating can be seen in rheumatoid arthritis patients a year or two before they’re diagnosed, a new study shows.
“This is a new finding, and a finding that is quite intriguing,” said lead author Dr. Elena Myasoedova, a rheumatologist at the Mayo Clinic in Rochester, Minn.
“It may reflect an accumulation of symptoms between the time of first onset and the time required for providers to actually diagnose patients,” she said in a Mayo news release.
The study also found that chronic increased levels of difficulty with daily activities (functional disability) continued even after patients were diagnosed with rheumatoid arthritis and began treatment.
That may be due to a number of factors, including increasing physical and mental pain, use of treatments such as glucocorticoids and antidepressants and anticipation of relief from symptoms, she added.
For the study, the researchers looked at 586 rheumatoid arthritis patients and 531 people without the disease in the Rochester Epidemiology Project database of medical records.
The rate of functional disability was more than two times higher among rheumatoid arthritis patients than in those without rheumatoid arthritis. In most age groups, rheumatoid arthritis patients had a 15% or higher rate of functional disability than those without the disease.
The findings show the importance of early treatment for rheumatoid arthritis patients, according to Myasoedova.
“Alerting your health care provider to difficulties in daily living can assure that patients receive the help they need,” she said.
About 1.5 million Americans have been diagnosed with rheumatoid arthritis, an autoimmune disease that most often affects the joints but can also impact other parts of the body.
Rheumatoid arthritis is one of the most common chronic conditions associated with functional disability in the United States and has a significant impact on well-being and quality of life.
Symptoms can include joint pain or swelling, but 40% of patients have symptoms that don’t involve the joints, such as fatigue, fever and loss of appetite.
The study will be published in an upcoming issue of the journal Mayo Clinic Proceedings.
Repetitive strain injury can affect anyone who uses his or her hands a lot and repeats the same movements over and over again. It can develop whether you’re working at a computer all day or spending hours of leisure time immersed in handicrafts.
At first, symptoms—like pain and tingling—may go away once you stop the motions or the activity.
But without treatment, including lifestyle changes, symptoms are likely to become so severe that you could become unable to continue with your work or hobby.
Recognizing symptoms
Pain or burning
Tingling
Numbness
Weakness
Swelling
Soreness
Don’t hesitate to see your doctor if you experience one or more of these symptoms—don’t assume that a few days off is enough to stop repetitive strain injury.
If the source of pain isn’t addressed, symptoms can become irreversible.
Part of the solution is to take regular breaks from problematic but necessary activities throughout the day. Get up and move around for at least five minutes every half-hour, and stretch your arms, wrists and fingers.
Practice good posture.
When sitting, your head and back should form a straight line from ears to hips. When at the computer, don’t let your wrists bend to one side. Keep them in line with your forearms, fingers slightly curved over your keyboard.
Don’t self-treat by wearing a splint or using a wrist rest—both can interfere with natural movement and blood circulation.
Typing tips to try
Use all fingers to type, not just one
Use keyboard shortcuts
Take advantage of voice recognition software
Also, consider investigating the Alexander Technique, an approach to movement aimed at better posture and body mechanics helpful for repetitive strain injury.
Could your personality as a teen forecast your risk for dementia a half-century later?
Very possibly, say researchers, who found that dementia risk is lower among seniors who were calm, mature and energetic high schoolers.
“Being calm and mature as teen were each associated with roughly a 10% reduction in adult dementia risk,” said study co-author Kelly Peters, principal researcher at the American Institutes for Research in Washington, D.C. “And vigor was associated with a 7% reduction.”
The finding has its origins in the 1960s, when more than 82,000 students in roughly 1,200 U.S. high schools took a personality test. More than 50 years later, their personality traits were compared to dementia diagnoses.
While Peters said there’s plenty of evidence that personality changes near the time of a dementia diagnosis, the lingering question has been whether personality or some aspects of it actually causes dementia.
“That’s the big question,” she said. “Is it only that personality can be affected by dementia? Is it just an expression of the disease?” By focusing on teens who didn’t later develop dementia, Peters said, “this study really starts to tease that out.”
At an average age of 16, the students were assessed for 10 traits: calmness, vigor, organization, self-confidence, maturity/responsibility, leadership, impulsivity, desire for social interaction, social sensitivity, and artistic and intellectual refinement.
By 2011-2013, when they were almost 70 years old, more than 2,500 had developed dementia.
Enter lead author Benjamin Chapman, an associate professor of psychiatry at the University of Rochester in New York.
After stacking 50-year-old personality profiles up against current medical records, he and his team found that the risk of dementia was notably lower among seniors who were calm, vigorous and mature as teens.
Calmness was defined as being stress-free and not neurotic, vigor as being energetic and outgoing, and maturity as being responsible, reliable and conscientious.
Peters said the findings could guide policy thinkers to develop improved social support systems “to help kids build up protective qualities.”
But she highlighted some reservations.
For one thing, the team “only looked at traits that were protective,” she said.
And money seemed to matter: Calmness, vigor and maturity did not appear to protect against adult dementia among teens who grew up in relatively poor households.
Chapman’s study also tracked dementia only around age 70. That, said his Rochester colleague Dr. Anton Porsteinsson, means “there’s a lot more work to do.”
He was not involved in the study.
“The average age of an Alzheimer’s diagnosis is around the early 80s,” said Porsteinsson, director of the university’s Alzheimer’s Disease Care, Research and Education Program. “So it would be really good to repeat this in another 10 to 15 years, to see what’s happening when dementia risk is really at its peak.”
While the findings highlight a link between dementia and personality, he said that it’s hard to draw a direct correlation.
“If you’re calm and conscientious, do you make better health choices in your life? And if so, are specific personality traits directly decisive with respect to dementia? Or does your risk for dementia indirectly reflect those better decisions?” Porsteinsson said.
Heather Snyder is vice president of medical science relations at the Alzheimer’s Association.
“There are a wide variety of social, environmental and genetic factors that may contribute to our risk for dementia, and more research is needed to determine what those are and how they interact,” said Snyder.
But she said that “there is not enough evidence at this time to suggest that an intervention strategy for personality type in high school would be effective.”
Porsteinsson warned against using the study to conclude that there’s clearly a “good” personality and a “bad one.” It could be, he said, that impulsiveness and neuroticism, while bad for dementia, “bring a different skill set to the table” that has value.
“We don’t necessarily want all kids to be calm and composed at all times. We don’t want everyone to fit into the same mold,” Porsteinsson said.
“So we have to be very careful about how we interpret these findings until we really understand a lot more about what this is all really about,” he said.
The study was published recently in JAMA Psychiatry.
Teenagers living in cohesive neighborhoods—where trusted neighbors get involved in monitoring each other’s children—experience fewer symptoms of depression and anxiety, a study suggests.
The researchers also found consistent results across different cities regardless of family composition and neighborhood income, indicating strong neighborhoods help teen mental health across various populations.
Along with common risk factors, neighborhood environments should probably be given more attention when looking for potential factors linked to teen mental health problems, said study author Louis Donnelly. He’s a postdoctoral research associate at the Bendheim-Thoman Center for Research on Child Wellbeing at Princeton University in Princeton, N.J.
“Notably, whether a child grew up in a higher- or lower-income household, the associations were similar. The findings can be generalized across different city contexts,” he added.
About 14 percent of adolescents in the United States have had depression or a mood disorder. Eight percent have been severely impaired from an anxiety disorder, the study said.
The study included information on more than 2,200 children born in large U.S. cities. The information was collected between 1998 and 2000.
The study authors wanted to see if “neighborhood collective efficacy”—a blend of social cohesion and shared expectations for social control—was linked to better teen mental health.
The teens evaluated their own mental health at age 15. Parents provided “collective efficacy” information when their children were 3, 5 and 9. Parents ranked their agreement with statements such as, “People around here are willing to help their neighbors,” or “People in this neighborhood generally don’t get along with each other.”
Another scale asked parents to express their belief in statements demonstrating that neighbors would be likely to intervene or get involved in scenarios such as, “Children were spray-painting buildings with graffiti,” or “Children were showing disrespect to an adult.”
The researchers found that the “neighborhood effect” offered a protective effect similar to depression prevention programs targeting teens.
“There are really two (measurements) that are distinct, one being social cohesion and mutual trust. This is the idea of believing that people in your neighborhood share similar values and can be relied on for support,” Donnelly explained.
“The second dimension relies on informal social control,” he added. “We measured that based on the extent to which families and other adults can be relied upon to intervene … (such as) if a fight broke out in the street or children are not attending school.”
Maurice Elias said he wasn’t at all surprised by the study findings. He’s a professor of psychology at Rutgers University in Piscataway, N.J.
“The idea that being in a supportive environment would be good for children’s mental health shouldn’t be a revolution,” said Elias, also director of the Rutgers Social-Emotional and Character Development Lab. “It’s always nice when research helps confirm common sense. I see this as one of those examples.”
Mum’s the word the next time you have your blood pressure checked.
Talking while the cuff is on can boost your blood pressure reading. So can a full bladder or crossing your legs, the American Heart Association says.
“These simple things can make a difference in whether or not a person is classified as having high blood pressure that requires treatment,” said Dr. Michael Hochman, a member of the heart association’s blood pressure task force. He’s also an associate professor of clinical medicine at the University of Southern California.
“Knowing how to measure blood pressure accurately at home, and recognizing mistakes in the physician’s office, can help you manage your pressure and avoid unnecessary medication changes,” Hochman said in a heart association news release.
Here, the heart association outlines seven common culprits that can alter your blood pressure reading.
Having a full bladder can add 10 to 15 points to a blood pressure reading. Always try to use the bathroom before getting a reading.
Poor support for your feet or back while seated can raise your blood pressure reading by 6 to 10 points. You should sit in a chair with your back supported and feet flat on the floor or a footstool.
Crossing your legs can add 2 to 8 points to your reading.
If your arm hangs by your side or you must hold it up while getting a reading, your blood pressure numbers may be 10 points higher than the actual figure. Your arm should be on a chair or counter so that the blood pressure cuff is level with your heart.
Having the cuff placed over clothing can add 5 to 50 points to your reading. The cuff should be on a bare arm.
A too-small cuff can add 2 to 10 points to a reading.
Talking can add 10 points to your reading. Remain still and silent while your blood pressure is taken.
If you struggle with anxiety, you might want to skip that second cup of coffee, new research suggests.
For some people, caffeine may help with concentration and provide an energy boost, but it can cause problems for those with general anxiety disorder, said Dr. Julie Radico, a clinical psychologist with Penn State Health.
“Caffeine is not the enemy,” she said in a university news release. “But I encourage people to know healthy limits and consume it strategically because it is activating and can mimic or exacerbate the symptoms of anxiety.”
Low doses of caffeine are in the range of 50 to 200 milligrams. Consuming more than 400 milligrams at once may lead to feeling overstimulated and anxious and bring on symptoms such as racing heart, nausea or abdominal pain.
Anxiety is a common problem, but many patients and their doctors don’t think about caffeine as a potential contributing factor, said Dr. Matthew Silvis, vice chair of clinical operations in the division of family medicine at Penn State Health.
“We want people to consider whether there may be a connection between their caffeine consumption and anxiety,” he said.
As well as being a potential problem for people with anxiety, caffeine can interact negatively with medications for seizure disorders, liver disease, chronic kidney disease, certain heart conditions or thyroid disease, Silvis noted.
“Medical disorders that a patient may already have can become more difficult to control,” he said.
In terms of amounts of caffeine, an average cup of home-brewed coffee has about 100 milligrams, compared with 250 milligrams in a tall Starbucks coffee and as much as 400 milligrams in energy drinks.
A can of Mountain Dew has 55 milligrams while a can of Coca-Cola has 35 milligrams.
Many vitamin and sports or nutritional supplements also contain caffeine, but many people don’t think to check the labels of those products, Silvis added.
A simple one-legged stand can help strengthen your lower body, ultimately improving your balance and reducing the risk of falls. (Courtesy Spectrum Health Beat)
Bad balance is a common cause of dangerous falls, especially among older adults.
Falls send more than 2 million adults to the emergency room every year and often result in lengthy rehab stays.
Preventing falls is a priority for staying healthy and preventing painful broken bones as you age. Easy strength and balance exercises that you can do anytime, anywhere, such as tai chi and yoga, can help you stay steady on your feet.
But first it’s important to know how good (or lacking) your balance is.
Grab a friend or loved one, a sturdy chair and a stopwatch to check your balance with a quick test called the single leg stance. It basically involves standing on one leg. Doctors use it to predict who might be at risk of falling.
Stand barefoot in front of the chair but don’t touch it. Cross your arms. Lift one leg up off the floor and start the timer. As you feel yourself start to sway, immediately steady yourself with the chair and stop the timer.
Here are the average times that indicate good balance when you stand on one leg based on age:
Ages 18-39: 43 seconds for men and women
Ages 40-49: 40 seconds for men and women
Ages 50-59: 36 seconds for women, 38 for men
Ages 60-69: 25 seconds for women, 28 for men
Ages 70-79: 11 seconds for women, 18 for men
Ages 80-99: 7 seconds for women, 5 seconds for men
If you become unsteady before your specific time, talk to your doctor. Illness, medication and even footwear can throw you off balance. Together, you and your doctor can find solutions.
You can improve your balance by practicing the one-leg stance, but as a training exercise, hold onto a chair and don’t let go.
Lift one leg for 15 seconds, rest and repeat three times, then switch legs.
The stronger your lower body, the steadier you’ll be on your feet.
For safety reasons, always have someone with you when trying a balance exercise for the first time. Or consider a group balance class.
Many community centers offer fun fitness programs to help adults prevent falls.
By understanding the implications of both numbers in a blood pressure reading, you may gain more understanding of your risk for heart disease and stroke. (Courtesy Spectrum Health Beat)
When it comes to blood pressure readings, the “top” number seems to grab all the attention.
But a large, new study confirms that both numbers are, in fact, critical in determining the risk of heart attack and stroke.
Blood pressure measurements are given as a “top” and “bottom” number. The first reflects systolic blood pressure, the amount of pressure in the arteries as the heart contracts. The second reflects diastolic blood pressure, the pressure in the arteries between heart muscle contractions.
For years, systolic blood pressure has been seen as the one that really matters. That’s based on studies—including the famous Framingham Heart Study—showing that high systolic blood pressure is a stronger predictor of heart disease and stroke.
At the same time, though, doctors measure both systolic and diastolic blood pressure—and treatment guidelines are based on both. So just how important is that diastolic number?
“The idea behind this new study was to address the confusion,” said lead researcher Dr. Alexander Flint, an investigator with Kaiser Permanente Northern California’s division of research.
Using medical records from 1.3 million patients, his team confirmed that, yes, high systolic blood pressure was a stronger risk factor for heart attack and stroke.
But those risks also climbed in tandem with diastolic pressure. And people with normal systolic readings were still at risk if their diastolic pressure was high.
“There’s been a common belief that systolic blood pressure is the only one that matters,” Flint said. “But diastolic definitely matters.”
He and his colleagues reported the findings in a recent issue of the New England Journal of Medicine.
The definition of high blood pressure has gotten a revamp in recent years. Guidelines issued in 2017 by the American College of Cardiology and other heart groups lowered the threshold for diagnosing the condition—from the traditional 140/90 mm Hg to 130/80.
The fact that treatment guidelines include a diastolic pressure threshold implies that it’s important.
And indeed it is, said Dr. Karol Watson, a member of the ACC’s prevention section and leadership council.
In fact, she said, doctors once thought that diastolic blood pressure was the more important one, based on research at the time. Then came the studies showing that systolic pressure was generally a better predictor of people’s risk of heart disease and stroke.
In addition, Watson said, high systolic blood pressure is more prevalent, because of natural changes in blood pressure as people age.
“As we get older, systolic blood pressure keeps marching up,” she explained. Diastolic blood pressure, on the other hand, generally peaks when people are in their 40s to 60s—and then it declines.
But it’s clear, Watson said, that while systolic and diastolic blood pressure are different they both deserve attention.
In the latest study, cardiovascular risks rose with each “unit increase” in systolic pressure above 140, by about 18% on average. Meanwhile, each increase in diastolic blood pressure above 90 was tied to a 6% increase in heart disease and stroke risk.
The researchers saw a similar pattern when they looked at blood pressure increases above the 130/80 threshold. That, Flint said, supports the 2017 guideline shift.
The findings are based on over 1.3 million patients in the Kaiser Permanente health system who had roughly 36.8 million blood pressure readings taken from 2007 through 2016. Over eight years, more than 44,000 patients had a heart attack or stroke.
According to Flint, it’s the largest study of its kind to date.
The bottom line for patients, Watson said, is that they should care about both blood pressure numbers.
In her experience, she noted, patients often point to the number that’s in the normal range and say, “But look how good this is.”
Flint agreed, saying that no one should “ignore” the diastolic number.
“It’s important not only in blood pressure treatment, but on the side of diagnosis, too,” he said.
As caregivers and clinicians navigate the various phases of cancer survivorship, it spotlights the ever-present need for resources that optimize care. (Courtesy Spectrum Health Beat)
More Americans are surviving cancer and their numbers could top 22 million in another decade, the American Cancer Society says.
Currently, thanks to better screening and treatment, more than 17 million Americans who had cancer remain alive, the society said in a report.
While this is good news, it comes with a cautionary note.
Cancer survivors often have long-term difficulties. Many must also overcome barriers to get the treatments they need, the researchers said.
“People with a history of cancer have unique medical, psychosocial and economic needs that require proactive assessment and management by health care providers,” said report co-author Robin Yabroff. She’s senior scientific director of health services research for the cancer society.
“Although there are growing numbers of tools that can assist patients, caregivers and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care,” Yabroff said in a society news release.
The report estimated that 8 million men and nearly 9 million women have a history of cancer.
Among the survivors, 68% had their cancer diagnosed five or more years ago and 18% at least 20 years ago.
Also, while nearly two-thirds of survivors are 65 or older, nearly 66,000 survivors are 14 and younger. Close to 48,000 are 15 to 19 years old.
Because of the growing and aging population, survivorship is increasing even though the number of women who develop cancer remains stable and the number of men with cancer declines, the researchers found.
The most common cancers among men are prostate, colon cancer and melanoma. Among women they are breast, uterine and colon cancer.
The report was published in the journal CA: A Cancer Journal for Clinicians.
Researchers found that women following a low-fat diet reduced their overall calories, changed their cooking methods and reduced portion sizes of meat and dairy products. (Courtesy Spectrum Health Beat)
Health experts have long touted the benefits of a low-fat diet for preventing heart disease, but now a large study suggests it might do the same against breast cancer.
Researchers found that eating low-fat foods reduced a woman’s risk of dying from breast cancer by 21%. What’s more, the women on low-fat diets also cut their risk of dying from any cause by 15%.
“This is the only study providing randomized controlled trial evidence that a dietary intervention can reduce women’s risk of death from breast cancer,” said study author Dr. Rowan Chlebowski.
He is from the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center in Torrance, Calif.
Diet has long been suspected to be a factor in cancer.
Obesity has been linked to 12 different types of cancers, including postmenopausal breast cancer, according to the American Institute for Cancer Research. And, a diet full of healthy foods, such as vegetables, fruits, whole grains and legumes is thought to help protect against cancer.
Chlebowski noted that previous studies have shown a higher cancer incidence in countries where people tend to eat more fat.
The latest study looked at the effect a low-fat diet might have on the incidence of breast cancer and death.
Nearly 49,000 postmenopausal women from 40 centers across the United States were included in the study. The women were between the ages of 50 and 79 and had no history of previous breast cancer.
Eighty percent of the women were white, which Chlebowski said matched the population when the study began.
Between 1993 and 1998, the women were randomly assigned to one of two dietary groups. One group was assigned to a normal diet. This diet had about 32% of their calories from fat. The low-fat group had a target of 20% or less of calories from fat.
Chlebowski said the low-fat diet was close in content to the Dietary Approaches to Stopping Hypertension diet, or DASH diet. This emphasizes eating vegetables, fruits, legumes and whole grains, while avoiding high-fat meats and dairy products, according to the U.S. National Heart, Lung, and Blood Institute.
The low-fat group lost a modest amount of weight. Chlebowski said there was about a 3% difference in weight between the groups. He said the researchers factored the weight difference into their calculations and that weight alone didn’t affect the risk of death.
Women in the low-fat group adhered to the diet for about 8.5 years and both groups were followed for an average of nearly 20 years.
The women in the low-fat group weren’t able to achieve the 20%-or-less target for fat, but they did manage around 25%, according to the researchers. And they did increase their intake of fruits, vegetables and grains.
“The diet was more moderate than originally planned. But we saw a diet of 25% to 27% fat is largely achievable,” Chlebowski said.
He said the researchers don’t know if any individual components of the diet were more important than others, but they hope further study will tease that out.
In the meantime, Chlebowski said he thinks the message should be one of dietary moderation rather than looking for any one particular food or food group.
He said the women in the low-fat study group reduced their overall calories, changed their cooking methods and reduced their portions of meat and dairy products.
The findings are to be presented soon at the American Society of Clinical Oncology annual meeting in Chicago. Findings presented at meetings are typically viewed as preliminary until they’ve been published in a peer-reviewed journal.
ASCO breast cancer expert Dr. Lidia Schapira, from Stanford University, noted that this study shows “what we put on the plate matters. It’s worth coaching and pushing patients to put more fruits and vegetables on their plates.”
She added that even when women didn’t reach the more stringent dietary fat goal of 20%, they still showed a health advantage from trying to reduce the fat in their diets.
Dr. Monica Bertagnolli, president of ASCO, said these findings were “really, really striking.”
She noted, “This was not an incredibly restrictive diet. People were able to adhere to it pretty well.”
And yet, the incidence of breast cancer went down by 8% in the women on low-fat diets.
“They were getting fewer breast cancers and even when they did get breast cancer, their death rate was reduced,” Bertagnolli said.
Craving something sweet? It may be tempting to gobble up old favorites like candy, chocolate, cookies and cupcakes.
But where does that get you? Lots of calories. Refined sugar. Virtually no nutritional value.
As an alternative, it may be time for you to consider one of nature’s sweet treats: dates.
Along with its caramel-like sweetness, this delectable fruit delivers a healthy dose of antioxidants, fiber, potassium, magnesium, vitamin B6, plant-based iron and an array of other vitamins and minerals.
And it’s hard to go wrong with a natural food.
“There are a multitude of naturally delicious fresh and dried fruits, such as dates, that provide sweetness with fiber, lowering the glycemic load impact,” Spectrum Health dietitian Caren Dobreff said.
Dates vary by size and weight, so the nutrient information can vary widely. Larger dates can weigh up to 24 grams—and pack about half a gram of protein and just under 1.6 grams of fiber. Smaller dates can weigh about 8 grams and provide 6 grams of carbohydrate, 5 grams of natural sugars and less than 1 gram of fiber.
Dobreff said those smaller dates may be a better fit for those needing to watch their daily total sugar intake, even if it is natural sugar.
Courtesy Spectrum Health Beat
Dates work as a sweet treat on their own, but there are many ways to incorporate them into your cooking and baking, Dobreff said.
“We take a recipe and we give it some interest and a little bit of sweetness, but not off the charts,” she said.
Eliminating refined sugars and replacing them with natural sugar, as found in dates, can help you recalibrate your taste buds to what nature intended for sweetness.
“I want people to have a real idea of what sweet is supposed to taste like,” Dobreff said. “All the added sugars, syrups and artificial sweeteners have given us an unrealistic idea of what sweet is supposed to be like.”
When using dates, Dobreff recommends using the whole date as opposed to products such as date sugar, which is made from dehydrated dates ground into a granulated sugar, or date syrup, which is made by boiling the dates and reducing the liquid to a honey-like consistency.
“The whole food is going to have higher fiber content, which is incredibly important when it comes to regulating your blood sugar level,” Dobreff said. “Added sugars and syrups have virtually no fiber, which has a stronger impact on our blood glucose level.
“And, as we all know, what goes up must come down—and then we have a sugar crash.”
Here are Dobreff’s tips for incorporating dates into your diet:
Use them in baking to replace chocolate chips or candies. If you’re making homemade protein bars or energy bites, add dates for something different.
Add dates to a leafy green salad or to a whole grain salad, such as farro or quinoa.
For a finger-food snack, cut the date open butterfly-style and put peanut butter or almond butter inside. Kids love this one.
Chop them and add them to roasted vegetables such as Brussels sprouts, tossed in balsamic vinegar. “It makes for a wonderful, healthy comfort food,” Dobreff said.
Instead of raisins, add chopped dates to your hot cereal or oatmeal. Go a step further and add apples and cinnamon.
Try these recipes from Spectrum Health’s culinary medicine classes: coconut pecan date rolls and roasted cauliflower salad with dates and golden raisins.
Courtesy Spectrum Health Beat
When shopping in the grocery store, you’ll find dates in the baking or produce section near the dried fruits and nuts. They’re usually offered as organic, too, if you desire.
Remember to remove the pits when you prepare them, Dobreff said.
Dates are a great way we can add nature’s sweetness to our cooking, all while avoiding refined sugars.
“I am hoping that people will think more about, ‘How can I make this dish taste good and use more of a whole food natural ingredient?’” Dobreff said.
School is back in session, and if your child has had his or her annual checkup, their doctor might have talked to you about the importance of kids and adults obtaining the human papillomavirus (HPV) vaccine.
The HPV vaccine can prevent genital warts and penile cancer in men; cancer of the cervix, vagina and vulva in women; and anal and throat cancer in both men and women.
The HPV vaccine keeps the body from becoming a carrier even if a person is exposed to the virus through sexual contact.
A patient of mine I’ll call Deb recently went through some fairly intense testing to rule out cervical cancer, and it was very stressful for her.
She came to see me for her annual exam and Pap smear, and she had experienced abnormal Paps in the past. She even had to have a colposcopy to make sure she didn’t have cervical cancer. Fortunately, Deb did not have cancer, but she wanted to make sure her kids wouldn’t have to endure the same procedures and worries she endured.
I recommended the HPV vaccine to give her some reassurance for her children.
The HPV vaccine is available in three different brands, each covering two, four or nine different types of the virus. The vaccine is given in three doses within a 24-week period. It can be given to both boys and girls and it has been shown to be safe and effective for females and males between the ages of 11 and 29.
The vaccine can also be given even if the person already has the HPV virus, because it can protect against other types of viruses as well. The optimal range for girls and boys to receive the first shot is between the ages of 11 and 12, because the immune response is better the earlier it is given. In addition, whether or not we like to think about it, kids often have sex before we suspect they do.
In countries where vaccines are more mandated, the HPV vaccine rate is approximately 80 percent. In the U.S. the rate is 54 percent for the first shot and only 33 percent for all three shots. The higher the rate of vaccination, the fewer the women who will develop cervical cancer.
Bottom line: Get your kids vaccinated.
So, why is our vaccination rate so low compared to other countries? In a survey, parents gave the following reasons for choosing not to get their kids vaccinated against HPV:
They think the vaccine is unnecessary.
They think the vaccine is ineffective.
They think the vaccine is unsafe.
They don’t understand the details of the HPV vaccine.
They don’t think their children would have sex that young.
Health care providers know the vaccine is safe, effective and necessary—and they know that parents need to learn more about the vaccine and appreciate the reality that some children will have sex at a young age. There is excellent information available to support the decision to vaccinate kids early.
I am happy that Deb trusted me and was willing to consider the vaccine to reduce her daughter’s chance of having abnormal Pap smears in the future.
Even if the shot has been given, it is still important to screen for HPV and abnormal cells on the cervix. Pap smears should be started at age 21 and performed every three years after that.
I follow the recommended guidelines to start co-testing of the Pap and HPV at age 30; if the results are negative, repeat the test every three years. If there are abnormal cells present, the next step is to do a colposcopy, where we look at the cervix with a telescope and take a biopsy of the cervix.
Of course, there are several other ways to prevent the HPV virus, and I told Deb to give the following advice to her children:
Do not smoke.
Use a condom every time.
Delay sex until after age 15.
Deb appreciated the information I shared with her and scheduled
appointments for her kids to get their vaccines during their checkups.
As a gynecologist who has had to perform hysterectomies on many women because of cervical cancer, I’m very happy that Deb made the choice to have her kids vaccinated.
Bad eating habits begin at a young age in American children, a new study finds.
Researchers analyzed data from more than 1,200 babies (aged 6 to 11 months) and toddlers (12 to 23 months) between 2011 and 2016.
They found that 61% of babies and 98% of toddlers consumed added sugars in their typical daily diet, mainly in flavored yogurt and fruit drinks.
Infants consumed about 1 teaspoon of added sugars daily (about 2% of their daily calorie intake) and toddlers consumed about 6 teaspoons (about 8% of their daily calories).
The main sources of added sugar for infants were yogurt, snacks and sweet bakery products. For toddlers, the top sources were fruit drinks, sweet baked products and candy.
Asian toddlers consumed the fewest added sugars (3.7 teaspoons) and blacks the most (8.2 teaspoons).
The study was published online recently in the Journal of the Academy of Nutrition and Dietetics.
“This has important public health implications since previous research has shown that eating patterns established early in life shape later eating patterns,” lead investigator Kirsten Herrick said in a journal news release. She’s a researcher with the Division of Health and Nutrition Examination Surveys at the U.S. Centers for Disease Control and Prevention.
The findings did bring some good news: The percentage of babies and toddlers whose daily diets include added sugars declined, as did the amounts they consumed.
But consumption of added sugars remains high among young children.
Herrick noted that a previous study found that 6-year-olds who had consumed any sugar-sweetened drink before their first birthday were more than twice as likely to drink such beverages every day than those who had not.
“Previous research into the diets of children over 2 years old associated sugar consumption with the development of cavities, asthma, obesity, elevated blood pressure and altered lipid profiles,” Herrick said.
Only one U.S. health organization—the American Heart Association—offers guidelines on sugar consumption for children under age 2, researchers noted.
“Our study’s findings about infant and toddler diets should raise awareness among health organizations and practitioners and inform future guidelines and recommendations,” Herrick said.
She advised parents to be cautious about added sugars in the foods they give babies when weaning them.
Parents should talk to a health care provider about which solid foods to introduce, and check the nutrition information on food labels.
Intermittent fasting—the fancy term for going up to 14 or 16 hours without eating anything—is all the rage these days.
Dietitians and their celebrity clients are touting it as the latest and greatest weight-loss tool.
And there’s been some promising evidence that the approach may even lower the risk of developing Type 2 diabetes, one of the most serious chronic illnesses in the world.
Researchers who have linked intermittent fasting to improved sensitivity to insulin also recently discovered it might lower pancreatic fat in rats. And that may reduce the odds of developing diabetes.
In a small study of humans with pre-diabetes, participants who ate from the hours of 7 a.m. to 3 p.m. saw significant improvements in their insulin sensitivity and blood pressure.
But don’t approach intermittent fasting without some measure of caution.
Kristi Veltkamp, MS, RD, outpatient dietitian at Spectrum Health Blodgett Hospital, said it makes sense to take intermittent fasting with a healthy sprinkling of skepticism, especially when it comes to its relationship to diabetes prevention.
“Some people do lose weight when they try this style of eating,” she said. “And the No. 1 way we know to prevent diabetes is by losing weight.”
Even shedding as little as 5 to 10% of your body weight can reduce the risk of diabetes by 58%.
“So this type of eating may be helpful because people are losing weight,” she said. “But that doesn’t mean intermittent fasting gets the credit. From that perspective, any weight-loss method can be said to lower diabetes risk.”
The strict timing of meals can have a significant downside for some people.
“Often, they get so hungry that they overeat during their eight-hour window, sometimes making poor food choices,” Veltkamp said.
For others, it’s just not convenient, especially if they are trying to eat meals as a family.
Most people consume the last meal of the day in the evening, not by 3 p.m.
“By all means, experiment,” she said. “For example, often people are surprised to discover that they feel better eating breakfast later in the day.”
But until more conclusive data emerges, pay close attention to the guidelines already proven to prevent diabetes.
5 proven ways to keep diabetes at bay:
1. Eat the Mediterranean way
If you haven’t already experimented with a Mediterranean diet, now’s the time. Eating meals with plenty of fish, vegetables, whole grains and olive oil has been linked to an 83% lower chance of developing diabetes.
2. Nix the nighttime snacks
Even if you never try intermittent fasting, those evening snacks—often scarfed down in front of the TV—can sabotage any healthy diet. Once you’ve left the dinner table, try to stop eating for the evening.
3. Pay attention to protein
Veltkamp recommends including some protein in every meal and snack. This includes dairy, nuts or cheese. “It keeps people full longer and helps with cravings,” she said.
4. Quit bashing carbs
While processed foods, soft drinks and white sugar cause rapid ups and downs in glucose levels, Veltkamp worries that too many people vilify all carbohydrates.
Whole grains and fruits are a healthy part of every diet, she said.
“Sugar isn’t all bad,” Veltkamp said. “I’ve yet to have to tell a patient that they’re eating too many apples.”
5. Strive for flexibility
Finally, when you’re looking for a lifetime approach to healthy eating, it’s smart to be gentle with yourself.
While all-or-nothing diets may be the craze—from the Keto plan to Whole 30—she advocates a much more forgiving approach, with an 80/20 rule.
Strive for solid, sensible meals 80% of the time, then relax with the remaining 20% of meals.
Rob Buitendorp didn’t worry much about the little lump he found on his neck, behind his right ear.
It didn’t hurt, didn’t get in the way. He had no problems swallowing or speaking.
But he had a doctor’s appointment in three weeks, so he decided to ask about it then.
He is so glad he did.
Buitendorp, a 73-year-old retired insurance adjuster, is one of the growing number of people diagnosed with HPV-related throat cancer. And thanks to his quick reaction, he benefited from early detection and treatment.
“If the cancer is detected early, then patients are more likely to have a choice of effective cancer treatments,” said Thomas O’Toole, MD, a Spectrum Health head and neck surgical oncologist.
It is the most common HPV-associated cancer in the U.S.—more common even than cervical cancer. But the lack of awareness about the disease hampers efforts to combat it.
“This is an epidemic,” Dr. O’Toole said. “It can happen to basically anybody and it’s the scariest thing. It really strikes middle-aged healthy people out of the blue.”
Photo by Chris Clark, Spectrum Health Beat
Early detection is key to surviving—or suffering fewer physical effects. But the earliest signs often go unrecognized by patients and, sometimes, even by doctors, Dr. O’Toole said.
The most common early symptom patients notice is a painless bump on the neck. A sore throat is the second most common sign. Too often, people wait months, hoping the problem will go away, before they seek medical care.
“If you have a bump on your neck and it’s been there for more than two weeks, you should go to your doctor, even if you don’t feel any other symptoms,” Dr. O’Toole said. “The quicker we get a diagnosis, the quicker you can get treatment, which is important in terms of improving patients’ survival.”
He recommends the HPV vaccine to prevent the cancer from occurring.
The Food and Drug Administration initially approved the vaccine for youths age 9 to 26 years. But in October 2018, it expanded the approved use of the vaccine to include men and women age 27 to 45 years.
“Because HPV-related cancers may develop decades after exposure to the virus, it may be a while before we see the impact of the vaccine on the incidence of oropharynx cancer,” Dr. O’Toole said.
Cancer rates on the rise
In the 1980s, the medical community began identifying problems with throat cancers related to the human papillomavirus, or HPV.
As smoking became less popular, the incidence of most head and neck cancers declined, as expected. But one form began to show up more often—cancer of the oropharynx.
If you open your mouth and look in a mirror, you see much of oropharynx at the back of your throat. It includes the tonsils, the base of the tongue, soft palate and the back wall of the swallowing passage.
Long before Buitendorp’s diagnosis, lab analysis of oropharynx cancers began to find evidence of a virus in the tumors. They identified HPV in 15 to 20 percent of tumors in the 1980s, and in 80 percent of tumors by 2004.
Photo by Chris Clark, Spectrum Health Beat
HPV viruses, which can be sexually transmitted, are common and doctors believe many people have been exposed to them.
“It’s only rare that people end up with cancer from it. It’s something we don’t fully understand—who’s going to develop cancer,” Dr. O’Toole said.
Treatments for cancer of the oropharynx include surgery, chemotherapy and radiation.
“We try to identify what we think is going to be the most effective treatment for the patient with the fewest side effects,” Dr. O’Toole said.
To reduce delays in diagnosis of throat cancer, the American Academy of Otolaryngology-Head and Neck Surgery has developed a clinical practice guideline for evaluation of adult patients with a neck mass, Dr. O’Toole said.
“They recommend that when adult patients have a neck mass for more than two weeks or of uncertain duration without signs of infection, there should be an examination of the upper aerodigestive tract, including the oropharynx and larynx,” he said. “This usually will require referral to an otolaryngologist.
“Dr. O’Toole’s office called and said this is something that should be seen immediately.”
Bob Buitendorp
When Buitendorp’s internist looked at the lump on his neck in February 2018, he recommended seeing an otolaryngologist. He gave him the phone number for Dr. O’Toole.
When he arrived home, Buitendorp discussed it with his wife, Ruth. He figured he would follow up on the advice—eventually—but he wasn’t worried. The bump was painless.
“In my family, we have a problem with procrastination,” he added.
Fifteen minutes later, a phone call surprised him.
“Dr. O’Toole’s office called and said this is something that should be seen immediately,” he said.
Photo by Chris Clark, Spectrum Health Beat
At the first appointment, Dr. O’Toole examined Buitendorp’s throat and showed pictures of a suspicious area on the right tonsil.
“He showed me a growth on the inside that was directly related to the external growth,” Buitendorp said.
Dr. O’Toole performed a fine needle aspiration biopsy in the office. Later, in an operating room, he performed a biopsy of the tonsil, which confirmed an HPV-related cancer.
Dr. O’Toole performed the operation with the use of the da Vinci robot. The minimally invasive procedure is performed through the mouth. He made only one incision a few inches long in the neck to remove lymph nodes.
The minimally invasive approach makes recovery easier, he said.
A more traditional approach could involve cutting the jaw in half and opening the face like a book. Or a surgeon might make an incision across the neck and take apart the muscles that attach the voice box to the jaw.
“All those things disrupt the muscular attachments,” he said.
He advises patients considering surgery to get an evaluation by a surgeon who can perform a minimally invasive operation.
Dr. O’Toole removed the tumor, which affected the back of the tongue, tonsil and throat. And he removed 66 lymph nodes.
Buitendorp spent five days in the hospital recovering.
“Everything went better than I ever expected,” he said. “I was talking the first day.”
After the surgery, Buitendorp didn’t eat for a week. He lost 25 pounds.
Photo by Chris Clark, Spectrum Health Beat
In the year since then, he has worked with speech therapists to regain the ability to eat a variety of foods. He takes small bites and eats slowly.
“I’m also getting my taste buds back slowly,” he said.
The post-surgery weight loss is common, Dr. O’Toole said.
“Most people can expect to lose 10 to 20 percent of their body weight,” he said.
Buitendorp knows the cancer or the treatment could have taken a far greater toll without quick treatment.
“This could have been serious if I had not said something to (my doctor),” he said. “That is the key. If you see something wrong, talk to your doctor.”
Everyone hates you. You’re a freak. You’re a loser.
Did you react viscerally to these hurtful words? Did the phrases make you cringe or recoil, maybe make your stomach uneasy or your muscles tense?
If so, you just experienced—ever so slightly—the pain, fear and hurt that victims of bullying experience on a daily basis.
Bullying happens every day, in every school building, in every neighborhood throughout the country. But changes in society and technology have brought us to a place where bullying has become especially rampant and particularly vicious.
Dr. Lowery regularly works with young people who are bullied on a daily basis. While such professionals see firsthand the harm that it causes, it doesn’t mean the rest of us should be blind to it.
The same mechanisms that allow bullying to become widespread—the Internet, social media, instant communication, smartphones—are also tools that inform us about bullying. We’ve all seen stories in the news, or on Facebook, about families and children who have left communities to escape bullying. We’ve read stories about adolescents driven to suicide because of relentless bullying online or at school.
What’s going on and how can we stop it?
Who’s at risk?
Bullies pick targets who are perceived as vulnerable and less likely to fight back or tattle, Dr. Lowery said.
A New England Journal of Medicine report found that gender issues also play a major role in identifying children most at risk of bullying. The study interviewed about 4,270 fifth-graders, following up with them in seventh and 10th grades. Across all grades, the children identifying or perceived as gay, lesbian or bisexual were 91 percent more likely to be bullied.
Many other children are also targeted every day, for different reasons.
They’re perceived as different from peers—overweight or underweight; wearing glasses or different clothing; new to school; unable to afford items other kids consider “cool.”
They’re perceived as weak or unable to defend themselves.
They’re depressed or anxious, or they have low self esteem.
They’re less popular than others and they have few friends.
They don’t get along well with others, they’re seen as annoying or provoking, or they antagonize others for attention.
Effective school programs, awareness campaigns and legislative protection can help protect children, Dr. Lowery said, but such measures can’t completely erase the harmful behaviors.
Dr. Lowery screens for bullying risk with her patients by asking questions during any exam. She noted a few trouble signs to watch for:
Depression and anxiety
Isolation
Mood changes, especially after time on social media
School avoidance
Such symptoms can be attributed to many different causes, but bullying is high on the list. It’s important for parents and teachers to intervene early and get help, she said.
The great agitator: social media
Social media and addiction to technology have without a doubt escalated the problems associated with bullying, Dr. Lowery said.
Bullying is potent in itself. Add social media and instant communication, and it takes on a vicious life of its own.
Children today feel tremendous pressure because the bullying doesn’t stop when they get home from school; there are now no limits to how far bullying can spread.
If you’re a bullied child, there is no escape.
“Because kids are so attached to their technology, it can appear as if they are even going along with it, watching their own abuse play out,” Dr. Lowery said, recalling a patient who was being bullied on Facebook. “When I suggested she simply stop looking at her phone, she said, ‘This phone is my life. Social media is all I’ve got.’”
It’s dangerously counterproductive. “It’s a Catch 22 where they don’t have social relationships or social acceptance, but they can’t look away from the social media,” Dr. Lowery said.
Parents need to help their children set proper values on things like smartphones and social media.
“I had a young lady who was suffering and miserable from bullying,” Dr. Lowery said. “I said to her, ‘No more Facebook. You don’t need social media to survive.’ You have to convince them to take steps.”
One of the key differences in children who are equipped to respond appropriately to a threat and those who aren’t: Support.
Support at home, support at school, support in their life.
Dr. Lowery said she’s seen children perform better when they’re linked to someone who can provide guidance and support: An in-school advocate, a teacher, counselor, a bus driver, or any mentor who can help that student regularly while at school.
“Bullying is not easy to stop,” Dr. Lowery said. “If a child comes to us for an assessment—particularly if they are reluctant to open up at home—we can at least become more informed and take steps before serious damage happens.”
At home, families need to encourage open communication, especially when it involves technology and social media.
“You’ve got to know what is happening on social media with your kids, regularly,” she said. “Ask about it, check in and tackle it together. Set limits. Get off the social media regularly, so that life without it feels normal, too. Brainstorm for activities to replace social media during those breaks.”
Parents need to help their children understand that social media “checkups” aren’t a form of punishment; they’re simply an added layer of protection that lets kids know “you have their backs,” Dr. Lowery said.
Proactive
When bullying happens, it comes down to helping kids know they’re connected and they have options.
“If we can help with counseling resources, assessments or even medication, sometimes we can help navigate the administrative pathways with parents and the teens,” she said.
While Dr. Lowery believes a traditional school setting has great value, it must sometimes be set aside for the health of a child. When a bullying situation has become too traumatic or has spiraled out of control, Michigan offers other alternatives, such as homeschooling or an online curriculum.
“Whether it allows a student to take a step back or becomes the permanent solution, (it) depends on the school’s resources and the family,” Dr. Lowery said. “But it’s better than letting a young life spiral out of control. Suicide is a real risk related to bullying.”
