The motivation is more important than the reversal of obesity Information

September 7, 2012 by Dr. Val Jones health, advice, opinion

Recently, I found my way to a podcast of interesting NPR via a link to Dr. Ranit Mishori (@ ranitmd) on Twitter. The host of the show interviewed a physician (Dr. Mishori), an obesity researcher (Sara Bleich), and is a family nurse practitioner (Eileen O'Grady) on health care providers how to try (or not) to help patients to manage their weight. Several of the patients and called practitioners participate.

First of all, I found this fascinating that research has shown that the BMI of the attending physician has a significant impact on the question of whether if he or she is willing to counsel a patient on weight loss. Physicians weight normal (those with a BMI of less than 25 years) were more likely to address the subject (and follow with weight loss and exercise of planning with their patients) than doctors who were overweight or obese. Sara Bleich believes that this is because an overweight and obese doctors is recognize the problem to other people who have similar body types or personal shame on their weight makes them feel that they do not have the right to give advice because they do not practice what they preach. While 60% of Americans are overweight or obese, 50% of doctors are also in these categories.

Although it is not entirely surprising that sensation of physicians overweight or obese as they, it made me wonder what could influence other personal conditions based on evidence of the care for patients. Is a doctor with hypertension less able to encourage accession salt restriction or drugs? What is depression, smoking cessation tobacco or erectile dysfunction? Is there some personal diseases or conditions which threaten the good care and treatment in others?

Several calls told negative experiences with physicians, where they have been "read the Riot Act" on their weight. Said overweight woman she handled this by avoiding simply go to the doctor at all, and another said obese man her doctor made her cry. However, the man continued to lose 175 pounds thanks to changes in diet and exercise and said that the "magic" is just what he needed to galvanize action.

Dr. Mishori found that the "Riot Act" approach was rarely useful and usually insane patients. She advocates a more nuanced and more sensitive approach that takes into account the social and financial patient situation. She explained that there is no use advocates personal training of a person on food stamps. Doctors must be more sensitive to the conditions of life of the patients and physical capabilities.

In the end, I felt that the nurse practitioner Eileen O'Grady contributed to some useful observations - it was argued that the factor limiting the speed in reversing obesity is not information, but the motivation. Most patients know what they "do" but just do not have the motivation to start and keep at it until they reach a healthy weight. Ms. O'Grady has dedicated his practice of coaching by phone weight loss, and believes that the phones have a large advantage over in-person visits: patients are more likely to be honest when there is no direct visual contact with their provider. His secret of success, beyond a non-moralistic therapeutic environment, highlights small achievable goals. She said that if she does not believe that the patient has at least 70% chance of success, they should not set this particular goal.

Objectives can be as simple that "find a training outfit suited." As the patient grows in confidence with their success, bigger, wider goals can be set. Intensive group therapy and weight loss training can be more motivating strategy that we must help the Americans to shed unwanted pounds. Apparently, universal service providers working group accepts, as they recommend "intensive behavioral interventions, multi-component" for those who screen positive for obesity in their cabinets.

I think it is unfortunate that most physicians believe that "simply don't have time to advise patients on obesity." Diet and exercise are two medical the most powerful tools we have to fight against many chronic diseases. What else is so important that it is further our time focusing on the "elephant in the room?".  Pills are not the way forward in the treatment of obesity - and we should have the courage to admit it and to better address the problem head-on in our offices and our own lives also.

Tags: BMI, Coaching, advice, education, Information, Motivation, NPR, obesity, BMI, Podcast, nizatidine doctor Mishori, USPSTF recommendations, weight loss

Ultraviolet radiation damage can have long-term consequences for your eyes

July 23, 2012 by Dr. Val Jones in Audio, health

If you have been invited to be part of a nuclear radiation cleaning crew, I'll bet that you do not want to wear protective clothing. Not only the costume of white rabbit of hazardous materials, but gloves, goggles, mask and slippers, right?  But when it comes to exposure to ultraviolet radiation, we often put on "half a costume" as on. We cover our skin with sunscreen (maybe), but we regularly protect our eyes. I don't know why forget us this step, but it is time for serious protection of the eyes.

In a recent interview with Dr. Jeanine Downey, dermatologist and optometrist, Dr. Stephen Cohen, we discussed the long-term damage that UV rays can cause skin and eyes. I hope that you can listen to the full conversation here:

Sun damage of the skin have a familiar appearance - brown spots, wrinkles, thinning and enlarged pores.  UV radiation causes visible damage to the eyes - yellowish horny (the "white" of the eye), scars (called pterygia) and crow feet. Over time, the skin of the eyelid may become cancer from exposure to the Sun, while the eyeballs develop cataracts and macular degeneration (which can lead to blindness). The risk of these diseases and conditions can be greatly reduced with Sun protection measures. And it is not that difficult to do...

Tips for protecting your eyes:

1 Wear a hat to wide to protect your face and your eyes from the Sun.

2 Wear enveloping sunglasses that absorb at least 99 a100% of UVA and UVB rays for maximum eye protection.

3. If you wear contact lenses, ask your doctor to look at if your lenses are UV protection. Contact lenses ACUVUE ® OASYS ® brand offers the highest level of available UV blocking, blocking at least 90% of the UV - A radiation and 99% of the UV - B radiation. While blocking UV contact lenses offer significant additional protection for the carriers, they did not completely cover the eyes and surrounding area and should not be considered as a substitute for the UV blocking sunglasses. For maximum protection, blocking UV contact lenses must be worn in conjunction with quality, wrap, UV blocking sunglasses and a hat to wide.

4 Remember that UV rays are more intense when reflected off the water surface and snowy owl. Just because it is winter time does not mean that you do not need to wear your sunglasses.

So the next time you reach for your sunscreen, don't forget to take your hat and sunglasses with you too! Fortunately, costume rabbit and booties are still optional for protection against UV radiation.

Disclosure: Dr. Val Jones is a consultant paid for VISTAKON ® Division of Johnson & Johnson Vision Care, Inc..

Labels: ACUVUE, Cancer, cataracts, contact lens, eye, macular degeneration, sunglasses, Sun Protection UV, UV radiation, broad-brimmed

Women are more motivated by a Fitness Chubby trainer?

July 26, 2012 by Dr. Val Jones in health, opinion, true stories

I am taken aback by a recent conversation with the owner of a gym. She is interested in encouraging the women to come to the gym for the beginner fitness classes and is considering a strategy meeting for its staff and key clients. I asked if I could join and she said that I was specifically a-invited. A little upset, I asked why it was - after all, I am a rehabilitation physician, who devoted my career to move people.

"You are too advanced." She said. "Beginners concern the way in which you are working, we are really more focused on the creation of a less intimidating environment for women.

"You mean, like planet Fitness ads." Those where the athletes are not welcome? "Confused, I asked.

"I do not like these ads, but the idea is the same." Beginners feel deflated by with people who are in much better shape. They not even want their instructor look too good. »

"You're kidding me." Women really would prefer to work with a chubby trainer? »

"Yes." In fact, I have had some women come to the gym room and request not to be matched with some of our personal trainers, precisely because only they look too fit. "They are afraid that they will be invited to work too hard, beyond their comfort zone."

"Then why they come to the gym in the first place?" I asked. "What is motivating their if they do not want hard work or change their body in the direction of the sport for trainers?

"They are just interested in staying the way they have always been." Maybe they started to put on weight after they hit their 40's and 50's and want to just go back to where they were in their Beardmore. They are not interested in running marathons or lift heavier weights in the gym room. They do not want to be pushed too much, and they prefer the trainers who appear healthy but not extreme. »

Medically speaking, there is an extreme effort to be in good health. Many studies have shown that the regular market is sufficient to prevent certain diseases, and loss success stories of weight (described in the National Registry of weight for example) generally result from adherence to a system of restraint caloric and his commitment in moderate exercise.

In a sense, these women who "want that hard work" are - they do not have to perform extreme feats to be in good health. However, I am always fascinated by the preference for the "medium of research" trainers and apparent bias against athletics. This must be a fairly common bias, although because the national channels (such as planet Fitness) gym took on it and is the cornerstone of their marketing strategy. "Any judgment" - unless you have buns of steel, I suppose.

When I choose a trainer that I'm looking for someone who embodies the best of what the exercise can provide. An athlete who has been their trade through years of sweat and effort... because it is my star in the North. Of course, I can never reach the North Star myself, but I would like to achieve. And that is what motivates me.

But for others, having a professional athlete for a trainer can be a bad state of mind. If your aspiration is to be in good health but not sports, then it is logical to find inspiration in those who embody this attitude and style of life. The important thing is that we all meet the minimum requirements for exercise for optimal health. According to the CDC, this means that:

** 2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (i.e., walking) every week

and

** muscle - strengthening activities on 2 days or a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms).

How you get there, and with which you arrive, belong you. Chubby or steely - with regard to health and fitness is the best mantra, "what works."

Tags: Athletes, fat body, CDC, Chubby trainers, guidelines of the exercise, Fitness, physical trainer, NWCR, Personal Trainers, Planet Fitness, weight loss, what is good

The Ten Worst Hospital Design Features: A Family Member’s Perspective

July 21st, 2012 by Dr. Val Jones in Health Tips, Humor, True Stories

An ICU Bed False Exit Alarm

I just spent the last 8 days in the hospital, at the bedside of a loved one. Although I squirmed the whole way through a tenuous ICU course and brief stop-over in a step-down unit, it was good for me to be reminded of what it feels like to be a patient – or at least the family member of one – in the hospital. The good news is that the staff were (by and large) excellent, and no major medical errors occurred. The bad news is that the experience was fairly horrific, mostly because of preventable design and process flaws. Having worked in a number of hospitals over the years, I recognized that these flaws were commonplace. So I’ve decided to tilt at this great hospital design “windmill” on my blog – with the hope that someone somewhere will make their hospital a friendlier place because of it.

Most of these design and process flaws have one thing in common: they prevent the patient from sleeping. In some circles, sleep deprivation is an organized form of torture reserved only for the most dangerous of terrorists. In other circles, it is hospital policy. And so, without further ado, here is my top 10 list of annoying hospital design flaws:

#1: False Alarms. Every piece of hospital equipment seems to be designed to beep for a complex list of reasons, many of which are either irrelevant or unhelpful. I snapped a photo of a particularly amusing (to me anyway) alarm (see above). This was a bed alert, signaling the “patient exit” of an intubated and sedated gentleman in the ICU. Not only was the location of the alert sign curious (if you could get close enough to the alert screen to read the text, you would surely already have noticed that the patient was AWOL) but it was triggered by mattress pressure changes that occurred when the patient was repositioned every 2 hours (as per ICU pressure ulcer prevention protocol).

The I.V. drip machines are probably one of the worst noise pollution offenders, beeping aggressively when an I.V. *might* need to be changed or when the patient coughs (this triggers the backflow pressure alarm, leading it to believe that a tube is blocked). Of course, I also thoroughly enjoyed the vitals monitor that beeped every time my loved one registered atrial fibrillation on the EKG strip – a rhythm he has been in and out of for years of his life.

#2: Intercom Systems. Apparently, some hospital intercom systems are wired into every patient room and permanently set at “full volume.” This way, every resting patient can enjoy the bleating cries for housekeeping, tray pickup, incoming nurse phone calls,physician pages, and transport requests for the entire floor full of individuals undergoing the sleep deprivation protocol.

#3: The Same Questions Ad Nauseum. Over-specialization is never more apparent than in the inpatient setting. There is a different team of doctors, nurses, PAs, and techs for every organ system – and sometimes one organ can have four teams of specialists. Take the heart for example – its electrical system has the cardiac electrophysiology team, the plumbing has the cardiothoracic surgery team, the cardiologists are the “minimally invasive” plumbers, and the intensivists take care of the heart in the ICU. Not only is a patient assigned all these individual micro-managing teams, but they work in groups – where they rotate vacations and on-call coverage with one another. This virtually insures that the sleep-deprived patient will be asked the same questions relentlessly by people who are seeing him for the very first time at 20 minute intervals throughout the day.

#4: Inopportune Intrusions. There are certain bodily functions that benefit from privacy. I was beginning to suspect that the plastic urinal was attached to the staff call bell after the fifth time that someone summarily entered my loved one’s room mid-stream. Enough said.

#5: Poorly Designed Tubing. Oxygen-carrying nasal cannulas seem to be designed to maintain a slight diagonal force on the face at all times. This results in the slow slide of the prongs from the nostrils towards the eye. Since the human eye is less efficient at absorbing oxygen than the lungs, one can guess what might happen to oxygen saturation levels to the average, sleep-deprived patient, and the resulting flurry of nursing disturbance that occurs at regular intervals throughout the night (and day). My loved one particularly enjoyed the flow of air pointed directly into his left eye as he attempted to rest.

#6: The Upside Down Call Bell. In an age of wireless technology, where almost every American has a cell phone and/or a flat screen television, it is odd that the light, TV, and nurse call bell control system must be tethered to a short  cord positioned just outside of the patient’s reach. The controller is also designed so that the cord comes out of the box’s farthest point, causing it to remain upside down in the hands of anyone lucky enough to reach it from a chair or bed.

#7: Excessive Hospital Bands. In addition to multiple rotating IV access points, my loved one’s wrists and ankles were tagged with not one but four hospital band identifiers, including one neon yellow band sporting the ominous warning: “Fall risk.” If that little band is the only way that a staff member can ascertain a patient’s risk for falling down unassisted, then one is left to wonder about their powers of perception. In a moment of rare good humor, my loved one looked down at his assorted IV tubes and three plastic wrist bands and concluded, “I’m one stripe away from Admiral.”

#8: The Blank White Board. Sleep-deprivation-induced delirium can be rather disorienting. To help patients keep track of their core care team names, most hospital rooms have been outfitted with white boards. Ideally they are to be filled out each shift change so that the patient knows which activities are scheduled and the names of the staff that will be performing them. Filling out these boards is tiresome for staff members (not to mention that the dry erase markers are usually missing) and so they remain blank most of the time. This has an anxiety producing effect on patients, as the boards boldly proclaim that no nurse is taking care of them, and no activities are scheduled.  I also noted that the size of the board lettering was a fraction smaller than a person with 20/20 vision could make out from the distance of the bed.

#9: The Slightly-Too-Tight Pulse Oximeter. Because being tethered to a bed with IV tubing, telemetry cords, and a nasal cannula is not quite irritating enough, hospital staff have devised a way to keep one unhappy finger in a constant, mild vice grip. This device monitors oxygenation status and helps to trigger alarms when nasal cannulas achieve their usual peri-ocular destination every 30 minutes or so.

#10: The Ticking And Creaking IV Drip. During the few rare moments of quiet, we did not enjoy any sort of blissful silence, but rather the incessant ticking of the I.V. drip machine. My loved one remarked that he felt as if he were trapped in an endless recording loop of the first 5 seconds of the TV show “Sixty Minutes.” And so if the alarms, tethering, interruptions, PA announcements, tubing, or white boards didn’t drive you mad, the auditory reinforcement of a ticking time bomb next to your head could bring you close to tears.

And so, because of all these nuisances (not to mention the ill-fitting hospital gowns, inedible food, and floors covered with various forms of “seepage” that penetrated patient socks on hallway ambulation attempts) we had one of the most unpleasant experiences in recent memory. All this, and no dissatisfaction with the surgical team or the primary procedure performed during the hospital stay. In the end, it’s the little things that can drive you crazy – or make you well.

Tags: Acute Care, Annoying Things About The Hospital, Bells, Caregivers, False Alarms, Flaws, Hospital Design, ICU, IV Drips, Noise, sleep deprivation

Patients have access to the results of prior laboratory tests their doctor examines their?

July 25, 2012 by Dr. Val Jones in health, opinion, true stories

Six weeks ago, that I had a lesion of the skin removed by a surgeon. Approximately 7 days after the biopsy, I received a letter from the pathology laboratory where the sample was analyzed under a microscope. With bated breath, I opened the letter, assuming that this criterion it contained the results, but was disappointed to find a Bill instead. As a physician, it felt strange to be in a position of having to wait as a colleague to give me the results that I have been trained to understand for me. However, I knew that in this case, I was wearing my "patient hat", and that I should trust that I would receive a call if there were an anomaly. I have not yet received a call, and I assume that no news is good news. But what happens if no news is an oversight? Perhaps there was a breakdown of communication between the path lab and the surgeon (or colleagues) and someone forgot to tell me about melanoma? Unlikely but not impossible, right?

Patients feel a similar anxiety with regard to the testing laboratory on a constant basis. In a perfect world, they would receive results along with their physicians, as well as an explanation full of what mean tests. But most of the time there a long time - a delicate period where patients must wait for a call or make a nuisance of themselves to the staff of the Office. Should not be a better way?

The New York Times looks at the issue of "the anguish of waiting for the results of tests", with some tips for patients in limbo:

As patients must wait for the results of the tests, anxiety increases as the slips of time in slow motion. But experts say that patients can regain a sense of control.

Start before the test itself.Because fear can cloud memory during interviews with doctors, take notes. If you can, bring a friend for the capture of the details that you may be missing.

A few questions first:

What precisely is this test reveal? What are its limitations?How long should take results and why? The doctor calls the results, or should I contact the Office?If it is my responsibility to call, what is the best time, and who should I ask?What is advice of the physician to obtain results online?

I think that patients should have access to their results without consideration of their doctor? While my first instinct is to say "Yes", I wonder if more anxiety may be caused by the results without an interpreter. There are so many results that may seem scary at first (for example, a mammogram with a "find" - the term "find", may mean that the entire breast was visualized in the image, or that there was a shadow caused by a layer of fat or - less frequently - it can also indicate that a suspicious lesion was observed). I do not argue that patients do not include the results of tests on their own, but the medicine has its own brand of jargon and nuances which require the experience to interpret.

Consider slight deviations from the average of a series of blood tests. They can be quite normal in the personal context of the patient, but can simply be listed by the laboratory as high or low. This can cause unnecessary anxiety for the patient. And what of smear results are listed as "ASCUS" - of atypical squamous cells of undetermined significance? These can occur if the patient had simply sexual recent and are not necessarily signs of cancer.

""And what about the ambulance"chasing lawyers" there? Will be it additional frivolous right costumes created by the results of laboratory tests reported directly to the consumer as abnormal in some way (when they are really not, taking into account the clinical situation full) and the patients, assuming that their doctor has been neglect reporting does not the anomaly for them earlier? This could happen.

Ultimately, I think that physicians need to all make a concerted effort in the before laboratory (with an explanation if necessary) test results for patients as quickly as possible. But because doctors are those who command the tests in the first place, they do not have the right to see their (before the patient where appropriate)- and the obligation to transmit the information timely and fully explained. This is the value of having a doctor to order a test - expertise in the interpretation of the results are part of the package (and cost). When patients controlling their own tests (and in some cases they can) then we must all first to receive the results.

For my part, I will have to resort to Office staff nuisance to get my results confirmed... like any other regular patient. Oh well.

Tags: DTC, EMR, Laboratory Tests, NYT, pathology, Patient Empowerment, results, expected to Get Patients their Laboratory Test results until their doctor?

In Defense Of Doctors: Why We Act Like Jerks, And How To Handle Us When We Do

July 5th, 2012 by Dr. Val Jones in Health Tips, Humor, Opinion

A Typical Jerk, M.D.

Editor’s Note: This post is meant to be tongue-in-cheek. We sincerely hope that our colleagues are not offended by the use of the term “jerk” to describe physician behavior. If you are a jerk, please feel free to leave a nasty complaint in the comment section of this post. Thank you!

Physicians have a reputation for being, to put it bluntly, jerks. It took me a long time to accept the fact that we are (on average) a disagreeable bunch, and my years of denying that there is a problem has finally given way to acceptance and even some degree of tolerance of “assholitry.” Few of us doctors think that we’re the one with the attitude problem, but I’m afraid that even the sweetest pediatrician can show some mighty claws when backed into a corner.

I didn’t think that I was a jerk until a few days ago when a surgeon made a medical error in the care of my loved one. I won’t go into details here, but let’s just say that evisceration was on the menu. My family member overheard one of the conversations and commented timidly, “I think you’ve probably just successfully alienated yourself from the entire medical community at Hospital X.” Yes, I was a total fire-breathing monster.

But this got me thinking – maybe if I explained all the reasons why doctors have bad attitudes, there would be a little more grace shown to us? Maybe our patients would be less offended and more understanding of our dispositions? I suspect that most people feel that there is “no excuse for rudeness” but I’ll offer a few nonetheless and see if I can’t change your mind. Here are the primary reasons that doctors are jerks:

1. We are afraid.

Being responsible for sick peoples’ lives is a scary thing. There are so many variables outside our control, and yet we believe that we must control the outcomes at all costs. It’s as if doctors somehow absorb the false belief that we can cheat death, and so when our patients don’t experience the optimal outcome from our every action and decision, we engage in some serious self-flagellation or (for those who possess a higher jerk index) we kick the proverbial dog (i.e. you).

Fear of inadvertent medical errors is a real butt-clencher for many doctors, and as science provides us with more insight into disease management we must be ready to do things differently, and to relearn everything we were taught. Keeping abreast of all these changes is very hard work, as there are over 6000 new research studies published world-wide each day. Our fear of failing to know everything we “should” causes many of us to hide behind a veil of toughness. Arrogance is often just a cover for vulnerability, and with so much information that we’re expected to digest, we are at risk for making a bad decision if we aren’t up to date. And when a doctor makes an error, he or she can pay a high penalty, including public humiliation by her peers, loss of her medical license, livelihood, the pain and suffering of legal action, and even confiscation of personal assets and savings.

And then there’s the daily fear of “fire-breathing monsters” like me. At any turn, irate family members, colleagues, hospital administrators, and staff can swoop in and criticize your best efforts.

2. We are hen-pecked.

A Physician With Three Hospital Administrators

The constant juxtaposition of trivial and critical can make doctors seem dismissive and arrogant. This is a subtle point, but one that is really important to understand a physician’s mental state. Imagine that you’re tending to a dying man with a gunshot wound to the chest, and a hospital administrator taps you on the shoulder to ask if you could fill out a form about insurance coding. You would view that request as particularly annoying given the context in which it occurred, right?

This may be an extreme example, but similar scenarios play out in our work days constantly. We are frequently interrupted (in the midst of very grave conversations, for example) with requests for approval of Tylenol orders, coding clarifications for duplicate insurance documents, or updates of no apparent consequence (such as, “Dr. Jones, I just wanted you to know that Mrs. Smith did receive your Tylenol order.”)

The very act of doctoring can make us feel as if we’re undergoing harassment by the hopelessly inane, punctuated by terrifying bouts of near-death scenarios accompanied by the usual fire-breathing monsters. If that job doesn’t turn you into a jerk, then… you probably are a robot.

3. We are exhausted.

Sleep deprivation is a well-known form of torture used by interrogators to extract information from “evil-doers.” It is also used by residency programs to keep whining residents from having the energy to complain effectively or to organize their efforts against their torturers. Then once these doctors-in-training accept chronic sleep deprivation as the new-normal, they carry an expectation of it throughout the rest of their careers. Of course, sleep-deprived people are more likely to be irritable, short-tempered, impulsive, grandiose, and hostile – aka jerks.

4. We were probably jerks to begin with.

Getting into medical school is extremely competitive. Only the very top students make it, and they are generally ranked according to science test scores (not compassion scores or charming personality scores). Successful pre-meds are generally type A personalities with a fierce competitive nature. And what kind of person would sign up for a career where they are harassed, blamed, required to do endless paperwork of indeterminate usefulness, denied regular sleep, and endure hostility from staff, coworkers, family members, and error-prone colleagues? A person with a pretty thick skin and a high tolerance for sadism and/or masochism… also known as a jerk. So, for the few doctors who don’t enter medical school as fully formed jerks already (let’s say they didn’t realize what they were getting into), the work they do will thicken their skin eventually, creating jerk-like personality traits in the end.

A High Jerk Index Surgeon

Is there a jerk scale in medicine? Who are the biggest jerks? Yes, all doctors exist somewhere on the jerk continuum, and you can roughly guess where they’ll be depending upon how likely that an encounter with them will end in your demise. Trauma surgeons, cardio-thoracic surgeons, and neurosurgeons have the strongest jerk traits, while pediatricians, physiatrists, and family physicians are probably on the other end of that scale. There are some exceptions, of course, but actually not many.

What can you do to make the best of having to work with a jerk? At some point, you or a loved one will need medical care (no one gets out of this life alive) so you will probably have to deal with some serious jerks along the way. Knowing that this is in your future, you should probably start planning how you will handle this now. I offer you my do’s and don’ts of jerk management, or how best to ally with your physician:

Don’t:

1. Bring your doctor more trivia. Jerks have a low tolerance for irrelevant details, largely because they are tortured by it daily (such as pages of EMR-generated duplicates of physical exam findings from interns). Think about what you really want to talk about with your doctor and don’t get side tracked with your own personal “hot flash tracker” data or other tangential story that is unrelated to your current problem.

2. Threaten your doctor with legal action or allusions to your “friend the lawyer.” The jerk you’re talking to is already frightened enough about frivolous law suits. If you tap into that fear he or she will just go into self-protection mode and probably harm you with excessive and unnecessary tests, consults, and referrals. Or even worse, maybe they’ll hide information from you.

3. Attack your doctor’s judgment directly. This is a tricky one because your doctor won’t always make the best clinical decision in your case, and you have the right to point that out. The best strategy for getting your way (assuming that you’ve found a true error) is to be friendly about it. Use the Socratic method if you can so that they’ll think they discovered the mistake themselves.

4. Fight fire with fire. You would think that you could get some respect from a jerk by being just as nasty to them as they are to you – and that strategy may work with playground bullies – but unfortunately that rarely helps in medical culture. More likely the physician will become quiet and simply resolve to stonewall you and be extra unhelpful in processing your care needs. You don’t need that.

Do:

1. Be prepared for your visit. Bring a list of your medications, relevant medical history and test results. Write down your questions in advance. Anticipate the questions that your doctor will ask you (if you can) and be ready with focused answers. You will look like a super-star and your doctor will be indebted to you.

2. Be understanding of our lateness. I know it drives you crazy and you feel disrespected by your doctor. But know that lateness can be caused by many things, including ill-prepared patients, really sick people, emergency surgery and golf games. If your doctor is a major jerk and the cause of his/her lateness is golf-related, then at least YOU will feel better if you presume he/she was delayed by a real emergency.

3. Be a “compliant” patient. Once you and your doctor decide upon a care or treatment plan that is right for you, try to stick with it. It’s in your best interest to do so and your doctor will love you for it. Sure, if he’s a big jerk he’ll only love you because your good outcomes make his performance measures (and payment structure) increase, but if he has a conscience he’ll also be genuinely pleased that you’re well.

4. Find another doctor if you need to. Although this isn’t always an option for folks in rural areas, if your doctor is impossible to work with, then you should find someone else to take care of you. Be very polite, get copies of all your medical records, and then take them elsewhere. Don’t be stoic and stick with a total jerk if your care is being compromised by his or her attitude and behavior.

So there you have it. When you have your next unsatisfactory encounter with me or one of my colleagues, please consider that there are some good reasons for our irritability. But being a jerk isn’t always a bad thing, because if your loved one needs a medical champion, then a fire-breathing monster is probably an excellent advocate. You can harness a monster for your purposes if you follow the do’s and don’ts of physician relationship management. I wish you luck with your future encounters with us!

Tags: Arrogant Doctor, Bad Attitudes, Doctor Patient Relationship, ePatient, Jerk, Physician, Surgeons, What To Do, When Your Doctor Is A Jerk

Your Nagging Fitness Questions Answered With Scientific Evidence

July 9th, 2012 by Dr. Val Jones in Book Reviews, Health Tips

I just finished reading a great little book called, “Which Comes First, Cardio Or Weights? Fitness Myths, Training Truths, And Other Surprising Discoveries From The Science Of Exercise” by Alex Hutchinson, Ph.D. I’m very grateful to Alex for patiently sifting through over 400 research studies in a quest to answer (with evidence, not subjective opinion) some of our most nagging exercise questions.

Alex is the perfect guy to do this exercise myth-busting as he is a competitive runner, professional journalist, and has a Ph.D. in physics. His writing is crisp, uncluttered, and bears the understated humor of a Canadian. To be honest, I enjoyed his book so much that I was contemplating blogging about most of his conclusions. However, I don’t want to teeter on the edge of copyright infringement, so I’ll just provide you with some highlights from my favorite sections of the book:

1. Do compression garments help you exercise? I’ve wondered this many times as I jiggled my way down the road on a long run. I’ve always liked the theory behind tight outer-garments, that they reduce unnecessary movement during running, thus making one’s movement more efficient and reducing the bounce and drag on muscles and skin. They may also help with blood return to the heart and reduction in peripheral edema, speeding recovery from exercise. Believing the plausibility of the argument, I have indeed sprung for some rather expensive running tights.

So what does the scientific literature have to say about compression garments’ role in exercise? Apparently there is nothing conclusive yet. Small studies have shown no clear improvement in exercise economy, athletic power or endurance, or recovery from exercise. The only measurable benefits appear to have occurred in those who believed that the compression garments would help their performance. A nice reminder of the importance of the “mind-body” connection in athletic pursuits. Bottom line: if you like how you feel in compression garments, by all means wear them. But don’t expect any dramatic improvements in anything more than your jiggle factor.

2. Will sitting too long at work counteract all my fitness gains? The short answer to this question is: possibly. I was surprised to note that at least one large study found that sitting for more than six hours per day increased one’s risk of death by 18-37% regardless of how much exercise one performed in the other eighteen hours of the day. Long periods of sitting appear to be quite bad for your health, so getting up and moving around every hour or more is important if you have a sedentary job or lifestyle.

3. Does listening to music or watching TV help or hurt my workout? Listening to faster-tempo music can result in increased exercise effort (in many cases completely unconsciously), while TV-watching usually results in a reduced exercise effort. This is because watching videos requires visual attention and subtle changes in balance and movement occur to accomplish it.

4. Will stretching help me avoid injuries? As a person with limited flexibility, I found this section of the book to be quite comforting. As I have blogged previously, stretching has not been shown to reduce the risk of injury or post-exercise soreness. In fact, it can decrease power and speed for certain athletes, though it is important for those who intend to perform great feats of flexibility (such as gymnastics).

5. Should I take pain killers for post-workout soreness? Interestingly, non-steroidal anti-inflammatory drugs (NSAIDs) are not particularly effective in reducing post-exercise pain and can even interfere with muscle repair. NSAIDs block prostaglandins, which are important in collagen synthesis. While NSAIDs are useful in reducing inflammation and swelling in acute injuries (such as an ankle sprain), general muscle soreness isn’t a good reason to pop some ibuprofen.

6. Will drinking coffee help or hinder my performance? I’m one of the few people I know who doesn’t drink coffee, so I was surprised to discover that I may have been missing out on an important exercise enhancer. According to decades of research, caffeine is likely to improve your exercise performance. Studies have shown that pure caffeine (not necessarily in its coffee form) enhances sprint performance as well as endurance activities up to two hours. In 2004 the World Anti-Doping Agency removed caffeine from its list of restricted substances, so expect to see some caffeinated athletes in this summer’s Olympics.

7. What’s the best way to breathe during exercise? If you’ve ever marveled at your own panting, you’ve also probably wondered if there is a more efficient way to breathe – or at least a less embarrassing way. The answer is no. Studies have shown that people who consciously work to make their breathing less labored expend more energy and get less oxygen in the process. So, keep on breathing the way your body wants to… you’re naturally more efficient at it than you think.

I hope that these little tidbits have whet your appetite for more of Alex’s excellent insights. I have fully equipped myself with fast-paced music and a little caffeine, as I move my inflexible, jiggly, panting self down the road on another long run.

Tags: Alex Hutchinson, Book Review, Breathing, Caffeine, Cardio Or Weights, Exercise, Fitness, Myth-Busters, Mythbusters, Myths, Olympics, Running, Stretching, Tips, Which Comes First

How to have an old age in good health: food for thought on the labour day

September 3, 2012 by Dr. Val Jones in the health, real stories

I spent the last two weeks make visits home "at risk" the elderly in rural areas of South Carolina. At the rate of approximately 7 House calls a day, I was able to make a few observations based on a respectable sample. I was surprised and intrigued by the conditions of life that I met, and I am pleased to announce that I did today my first physical examination in a careful review of a team of the cat, cock and hen (photo left). On another house call I I was offered a goat Pygmy as a thank-you for my efforts, and countless good-natured folk I was offered-the Ice House and these edible delectables such as fish and fishing honey cakes.

But what has me the most is that some elderly people were in much better health than others of their age, and the healthier who all had one thing in common: strict daily exercise regimens. I realize that this is not revolutionary News (which is good for us), but the contrast between those who exercised and those who could not have been more clear to me.

A particularly charming 85-year-old man gave me a tour of his vegetable garden and explains that he has bicycle in the city, six days a week to give friends and folk of the city churches of okra (and other vegetables). Growing vegetables and giving away them was the work of his current life, and although he lived in extremely modest circumstances, what he had was clean and tidy. He was happy, bright and had the physique of an athlete.

Contrast this man another patient in his 80's engaged in all and is smoking cigarettes inside most of the day. He was blind in one eye, almost deaf, difficult to breathe, had wounds on his skin. He was depressed, machines and bloated heart failure. I was sad to see his State and the relative squalor in which he lives. Smell of urine and smoke permeated the House, and I wondered how much more he would survive.

When I arrived at the House of a eighties, I noted that the garage was filled with watermelons of different sizes. After investigation, the man said that he has hand-picked the watermelons of a plot of land that it has 2 miles of his home.  He brought them home with a wheel barrow... and made many trips back and forth over the past week. There no medication and a normal physical examination.

And then my days - back to back tours with the elderly who either were involved in active, or have been weakening, plunged inside with progress of dementia and chronic disease. I realized that no medical treatment has the power to overcome damage implacable than inactivity, smoking and cause of deconditioning. The secret to old age in good health lies in the choice of life, not bottles of pills.

As we enjoy the last weekend of the summer day, consider the importance of this work is actually in our mental and physical well be. You are never too old to carry watermelons on the road, culture of okra to your neighbors or simply commit cessation and daily walks. If you do this regularly, your health will improve surely - and your quality of life will be immeasurably improved. Ultimately, adding life to years is what medicine is all about.

Tags: Exercise, health, home visits, life choices, SC, Secret of good health, the elderly, smoking cessation

Normal Blood Sugar Levels May Harm the Brain

Study Suggests Need to Reconsider What's Healthy

Sept. 4, 2012 -- Blood sugar levels at the high end of what is considered normal may put the brain at risk, according to a new Australian study.

Researchers in Canberra report a link between the shrinkage of two brain regions, the hippocampus and the amygdala, and normal blood sugar levels.

The hippocampus and amygdala are involved in memory, among other things, and researcher Nicolas Cherbuin, PhD, says shrinkage in these areas could worsen memory.

"It has been generally assumed that blood glucose in the normal range is not a risk factor for brain health in non-diabetics," Cherbuin says. "If the present results are replicated in other studies the definition of normal fasting blood glucose levels and of diabetes may need to be re-evaluated."

For the study, Cherbuin, a neuroscientist at Australian National University in Canberra, and his colleagues studied 249 people in their early 60s. Each of them had blood sugar levels in the normal range. At the beginning of the study, and again four years later, the researchers scanned their brains.

Comparing the before and after images, they found significant brain shrinkage among those whose blood sugar levels were high but still below the World Health Organization's threshold for pre-diabetes. The researchers report that those high levels may account for a 6% to 10% decrease in the volume of the hippocampus and amygdala.

Cherbuin and his team then excluded people who were overweight or obese, and substituted the American Diabetes Association's stricter normal range for that endorsed by the WHO. The results were virtually the same.

Cherbuin says they did not take their conclusion "lightly," but the association between these higher blood sugar levels and brain shrinkage was "robust."

Next, he plans to study the impact that such brain changes may have.

Cherbuin's results suggest a need to reassess what's considered a healthy blood sugar level, but more research must be done before any changes to recommendations are made, says neurologist Marc Gordon, MD.

"The research is too preliminary, and the association shown here does not establish a cause or mechanism," says Gordon, chief of neurology at Zucker Hillside Hospital in Glen Oaks, N.Y., who describes the study as thoughtful and carefully considered. "To speak as a clinician and tell patients that they better cut out all candy because it will shrink their brain is a leap of faith."

Cherbuin says that we still do not fully understand all the factors involved in regulating blood sugar levels. We do know enough to say that poor diet, lack of exercise, and constant stress likely play a leading role in maintaining unhealthily high levels, he says.

"It is this chronic exposure to high glucose levels that is more likely to lead to poorer brain health," he says.

For Gordon, who says that there is good evidence that such factors all likely play some role in thinking and memory decline, the message is a simple one.

"It's just what all of our mothers told us: Eat well and exercise," says Gordon. "That's a principle we would all do well to live by."

Can Childhood Obesity Hinder the Brain?

Reading, Math Worse in Kids With Many Obesity-Related Risk Factors

Sept. 4, 2012 -- A new study shows that children who are overweight or obese may face problems with brain development, especially if they have risk factors for metabolic syndrome.

Metabolic syndrome is a cluster of problems that set the stage for diabetes and heart disease.

 The risks for metabolic syndrome include:

Belly fatHigh levels of blood fats called triglyceridesInsulin resistance or prediabetesHigh blood pressureLow level of "good" HDL cholesterol

Researcher Antonio Convit, MD, says the bottom line is, "We are seeing brain changes in kids with metabolic syndrome and we don't know if this is reversible."

Children with metabolic syndrome scored 10% lower on mental tasks that are important for learning, he says. The findings appear in Pediatrics.

In the new study, obese or overweight teens with metabolic syndrome could not read as well, scored worse on math tests, and took longer to complete tasks than children who did not have metabolic syndrome. What's more, their brains also had physical differences.

The new study included 49 teens with metabolic syndrome and 62 without it. The more metabolic syndrome risks that participants had, the more pronounced the brain changes were, the study shows.

Convit calls for testing for insulin resistance among at-risk children, particularly those who are very overweight and those who have a family history of diabetes or heart disease.

Other solutions include having physical education programs in school. "We should invest more in physical education so kids are fitter and less likely to have insulin resistance, which is the main driver of these brain changes."

Insulin is a hormone that helps the body turn sugar into energy. Insulin resistance occurs when the body does not use insulin properly.

Michele Mietus-Snyder, MD, says the new findings should serve as a wake-up call.

"Every cell in every organ system requires energy to live and insulin is the gatekeeper," she says. "Insulin resistance has reached beyond the traditional organ systems to the brain."

"We need to be very vigilant when children start to gain belly fat because we don't want children to fall behind the metabolic eight ball." If that occurs, it becomes a catch-22. "How can you expect someone to make healthy choices when they are [mentally] impaired?"

Scott Kahan, MD, MPH, is the director of the National Center for Weight and Wellness in Washington, D.C. "Metabolic syndrome was unheard of in kids until recently," he says. "It is striking that a significant number of kids have metabolic syndrome, but the fact that we can show further consequences in the brain is even more striking."

Prostate Cancer: Start-and-Stop Hormone Therapy Works

Sept. 5, 2012 -- "Start and stop" hormone therapy is as effective as continuous therapy in the treatment of some prostate cancer patients, a study shows.

Hormone therapy is also known as androgen deprivation. It is often used to treat prostate cancer if surgery or radiation fails.

The treatment works by blocking the production of the male hormones called androgens, which fuel prostate cancer growth. But there are serious side effects:

FatigueHot flashesMood swingsLoss of libidoErectile dysfunctionBone loss

In a new study from Canada, researchers compared men who went on and off hormone therapy with men who had continuous treatment. The researchers found the on-and-off treatment can be as effective as continuous treatment with fewer of these troubling side effects.

The study is published in The New England Journal of Medicine.

The study included about 1,400 prostate cancer patients whose cancer had not responded as hoped to radiation therapy. The researchers used a blood test called PSA to measure the cancer’s response to treatment. Rising PSA levels after treatment can mean the cancer did not respond well to treatment or has recurred.

Roughly half the men in the study were treated with continuous hormone therapy. The other half received the treatment for eight months, followed by observation. These men went back on treatment when PSA levels rose.

Over nearly seven years of follow-up, the average survival time in both groups was around nine years.

A total of 524 men died during this time, but most died from causes other than cancer. Just 18% of deaths in men receiving intermittent hormone therapy and 15% of deaths in the continuous-treatment group were due to the cancer.

Men who went on and off the hormone treatment reported fewer hot flashes, less loss of libido and erectile dysfunction, and fewer urinary issues. But the researchers say the difference in quality of life was not as profound as might be expected.

There was also no evidence that the start-and-stop treatment schedule prolonged the time in which hormone therapy worked, as the researchers had hoped.

Nevertheless, study researcher Juanita M. Crook, MD, calls the study "practice changing" for prostate cancer patients with rising PSA levels who need more treatment.

She says since many of these men remain on hormone therapy for the rest of their lives, a treatment strategy that can improve quality of life should be embraced.

"Intermittent therapy has been increasingly used over the past few decades, but we never knew if we were risking years of life to achieve a better quality of life," she says. "Now we know that this is not the case."

American Cancer Society Director of Prostate and Colorectal Cancers Durado Brooks, MD, says the findings confirm that on-and-off treatment is as effective as continuous treatment.

But Oliver Sartor, MD, who is medical director of the Tulane Cancer Center in New Orleans, says the study did not address an important unanswered question: "Do men with rising PSAs but no symptoms even need the hormone treatment?"

"The big debate in the field is whether to even treat patients with rising PSAs before there is evidence of [cancer spreading]," he says. "The answer is not clear."

Emma Roberts: Life On and Off the Set

The actress talks about her new film, "Celeste and Jesse Forever," young adulthood, and her charitable work with kids and teens.By Melanie D. G. Kaplan
WebMD the Magazine - Feature

When Emma Roberts won the role of a bratty pop star in Celeste and Jesse Forever (opening in August), she was thrilled. Of course she was delighted to be playing opposite Rashida Jones, known for her roles in NBC's Parks and Recreation and The Office. But Roberts was also pretty excited about playing dress-up.

"This character is the combination of every pop star we could think of, so my makeup, hair, and wardrobe were so much fun," Roberts says. "I wore a rainbow faux fur vest and super-long blonde extensions. That's why I wanted the part so bad. Because I knew I'd never be able to be like this in real life!"

In real life, the 21-year-old actor habitually hits snooze on her alarm clock, oversleeps, and rushes out of her Los Angeles apartment in the least time-consuming outfit possible. Today she's wearing polka-dot jeans, a T-shirt, and flip-flops (she's about to get a pedicure). But when she's on the red carpet, she's all girl. "I try to wear dresses," she says. "I feel like it's such a fairy tale."

It may seem that Roberts' life has been one big fairy tale. Her very first audition yielded the role of Johnny Depp and Penelope Cruz's daughter in Blow, she became a tween star as Addie Singer in Nickelodeon's Unfabulous, and she has polished her acting skills in a number of films, both independent (Lymelife) and blockbuster (Hotel for Dogs). This summer, she's been shooting Dito Montiel's heist drama, Empire State. Last but not least, she is the niece of actor Julia Roberts and daughter of actor Eric Roberts.

Growing up, Roberts visited Aunt Julia on shoots and, she says, was so dazzled by the behind-the-scenes magic that her parents had to drag her away at night. Even now, she says, she cherishes every moment on the set, where she is endlessly inspired by experienced actors and directors. After working with Jones, who not only starred as Celeste but also wrote the script for the new film, Roberts started thinking about writing and producing. 

Earlier this year while shooting the comedy Adult World, in which she co-stars with John Cusack, she got to know director Scott Coffey really well and is now eager to do more comedy -- maybe something of Bridesmaids'  ilk, she says. And her onetime dream of starting a girl band was reignited when she got to sing in her Celeste and Jesse Forever pop star role. "The acting part is fun," she says, "but there's so much more to explore."

Meanwhile, Roberts is exploring her own adult world -- maintaining an apartment, keeping her room clean without being asked, and staying fit with yoga and SoulCycle, an intense indoor cycling workout. Although she decided to take a break from school after attending Sarah Lawrence College last fall, she says she constantly reads on the set to help pass time.

Dirty Secret: Trying on Makeup

There aren't germs in that communal makeup at the cosmetics counter -– or are there?By Shelley Levitt
WebMD the Magazine - Feature

Q: I love trying on makeup, but I don't use those tiny plastic swabs at beauty counters. Am I going to bring home something besides a great new shade of gloss?

A: It's quite possible. To a dermatologist, that's like strolling through a public restroom. Those tubes and jars resemble petri dishes, teeming with microbes and bacteria. The viruses that cause herpes and pink eye thrive on moist, inanimate objects -- making a pot of lip gloss, foundation, or eye shadow a perfect breeding ground.

Even if the salespeople are careful about wiping off testers after customers use them, they may not be aware of all the passing shoppers who dipped a finger into a product or swept it onto their lips, cheeks, or hands.

So, a disposable tester is a good defense against contamination. Just make sure that lipstick tube or blush brush is wiped with alcohol and dried before you try.

--Joshua Zeichner, MD, director of cosmetic and clinical research, Department of Dermatology, Mount Sinai Hospital, N.Y.

Find more articles, browse back issues, and read the current issue of "WebMD the Magazine." 

NFL Players at Higher Risk of Brain Diseases

Sept. 5, 2012 -- Former National Football League (NFL) players may have a higher risk of dying from diseases that damage brain cells.

Research has raised red flags about the health risks associated with cumulative blows to the head. Now a new study finds that pro football players are four times more likely to die with Alzheimer's or Lou Gehrig's disease (amyotrophic lateral sclerosis or ALS), compared to the general population.

The study looked at nearly 3,500 football players with five or more years in the NFL, playing from 1959-1988. There were a total of 334 deaths, including seven with Alzheimer’s and seven with ALS listed on their death certificates.

The new findings appear in the journal Neurology.

At greatest risk were NFL players who held “speed” positions, such as quarterback, running back, halfback, fullback, and tight end. These players were three times more likely to die from a brain-related disease than their teammates who played non-speed positions, such as defensive and offensive lineman.

Still, there's a lot of information the study can’t provide. For example, researchers did not have information on head injuries or concussions sustained by the players or knowledge about any other risks for these diseases.

The study also did not look at why football players may be at higher risk for dying from these brain diseases. The theory is that repeated blows to the head may start a process that results in one or more brain-damaging disorders in some people.

Past research has linked concussions to chronic traumatic encephalopathy (CTE), a disorder that has symptoms similar to those of ALS, Alzheimer’s, or Parkinson’s disease. But it is not yet known if CTE develops independently or is the beginning signs of these diseases.

“There are probably other factors involved, such as other environmental exposures or genetic factors, but we are in the very early stages of knowing how those may be involved,” says researcher Everett Lehman, of the CDC’s National Institute for Occupational Safety and Health in Cincinnati.

More Adults Report Getting Cholesterol Tested

More Adults Report Getting Cholesterol Tested

Sept. 6, 2012 -- The number of adults who say they have had high cholesterol at some point in their lives has gone up, and that may not be a bad thing, according to the CDC.

A new survey of adults nationwide suggests that they are learning the importance of checking their cholesterol. This awareness, not new cases, is likely the reason the numbers have gone up, the report's authors write.

This may well be true. In a CDC report published earlier this year, researchers found that the overall level of high cholesterol among adults over 20 had dropped from 18% to 13% between 2000 and 2010.

High cholesterol is a major risk factor for heart attack and stroke.

The report drew on data from the Behavior Risk Factor Surveillance System (BRFSS), a telephone survey conducted by the CDC. More than 350,000 American adults take the survey each year. Questions about cholesterol are asked every two years.

In 2005, 72.7% of U.S. adults over 18 said they had had their cholesterol checked at least once in the previous five years. By 2009, that percentage had risen to 76%.

Among those who had been tested in 2005, a third of them reported being told they had high cholesterol at some point in their lives. Four years later, in 2009, 35% said their cholesterol was high or had been so in the past.

84.5% of Washington, D.C., adults said they had been tested for high cholesterol, compared to 67.7% of Idaho adults.Most states showed a big rise in testing between 2005 and 2009. Eastern states had generally higher rates of testing than Western states.94.7% of adults 65 and older said they had been tested, compared to 63.2% of adults ages 18 to 44.54.4% of adults 65 and older said they currently had or had had high cholesterol, compared to 23.7% of adults ages 18 to 44.More men reported high cholesterol than women: 37.5% vs. 32.6%.More Hispanics and Asian/Pacific Islanders reported high cholesterol than other groups (36.3% and 37.5%, respectively) -- 33.1% of African-Americans said they had or had had high cholesterol.New Mexico, at 30.5%, had the lowest percentage of adults reporting high cholesterol. Texas, at 38.8%, had the highest. About a third of all states showed an increasing number of adults who reported high cholesterol.

Finding high blood cholesterol early through testing is the first important step to treatment and lowering the risk for heart attack and stroke, the report’s authors write.

Public health experts, medical experts, and health educators should emphasize cholesterol testing, especially for young adults, men, Hispanics, and those with lower levels of education, they write.

Take 5: Diabetes

Our diabetes expert answers five questions about lifestyle and blood sugar control.By Christina Boufis
WebMD the Magazine - Feature

If you're one of the nearly 24 million Americans living with type 2 diabetes, you know your body has difficulty using or producing insulin. What can you do to manage the disease? We asked Jill Crandall, MD, professor of clinical medicine and director of the diabetes clinical trials unit at Albert Einstein College of Medicine in New York City, to debunk some myths and help you learn to live well.

Not really. It's a misconception that people with diabetes can never have a dish of ice cream. The diet we recommend for people with diabetes really isn't very different from the diet we recommend for everybody.

For most people, eating balanced meals of protein, carbohydrates, and modest amounts of unsaturated fat is the best approach. Large carb meals (pasta, bread, potatoes, rice) and concentrated sweets (fruit, fruit juice, cake) raise blood sugar, so it's best to eat those foods in moderation.

The plate method is often helpful: Think of dividing your dinner plate into three sections. Half the plate should be vegetables or salad, a fourth should be protein (for instance, meat or fish), and a fourth should be starch (such as rice or pasta, preferably whole grain).

We all know junk food like candy and donuts is not good for anybody. Junk food is especially problematic for people with diabetes because it tends to be high in carbohydrates and excess calories. But we try to stay away from saying there are certain things you can never have, because sometimes the idea of deprivation just makes foods all the more appealing.

If you know you want to have that piece of cake at the end of dinner, then don't eat any bread with dinner, or have a very small portion of rice.

Some people find frequent, small meals work for them -- they don't get too hungry, and their bodies can handle smaller amounts of carbs better. But others find they end up gaining weight this way -- the frequent meals may not be that small. However, skipping meals is probably not a good idea because people get hungry, then can't control their next meal very well.

Keeping a food diary, along with testing blood sugar before and after meals, is a good way to see the effect of particular foods on blood sugar level. The immediate feedback can be helpful.

And pay attention to portion sizes. Food labels are useful (they provide information about carbohydrate content as well as total calories), but the portion sizes they list are often unrealistically small (how many people eat half a muffin?). Although weighing food servings can be annoying, it might help train your eyes as to what a "6-ounce serving" of something really looks like.

Most US kindergartners get vaccines, risks remain

AppId is over the quota
AppId is over the quota
by David Beasley, Last updated August 24, 2012

ATLANTA (Reuters) - Most U.S. kindergartners received the recommended vaccines for measles and other preventable diseases during the 2011-12 school year, but local clusters of unvaccinated children still pose a health risk, federal health officials said on Thursday.

More than 95 percent of kindergartners were vaccinated for diphtheria, tetanus, acellular pertussis, polio and hepatitis B, meeting federal guidelines, the Centers for Disease Control and Prevention said in a new report.

The study found 94.8 percent of kindergartners had received the measles, mumps, and rubella vaccine, and 93.2 percent got the recommended two doses of vaccine for chickenpox, slightly below the federal government's target levels of 95 percent or higher vaccination rates.

The study by the U.S. public health and safety agency, which included data from 47 states and the District of Columbia, found pockets where children had not been vaccinated or there was a low rate of coverage. The report did not specify where these clusters were located.

"Although statewide levels of vaccination coverage are at or very near target levels, locally low vaccination coverage for extremely transmissible diseases such as measles remains a threat to public health," the CDC said.

Last year, there were 17 outbreaks of measles and 222 measles cases in the United States, the highest since 1996, the CDC said.

Most of the cases involved unvaccinated patients who contracted measles in other countries, highlighting the importance of high vaccination rates among U.S. school children, said Dr. Melinda Wharton, deputy director of the CDC's National Center for Immunization and Respiratory Diseases.

"It is of concern when we have these communities in the United States where there's enough people who have made this decision [not to vaccinate] that if the measles virus is imported from overseas, that it could actually spread and cause an outbreak," Wharton said.

All 50 states offer medical exemptions to vaccines, and some states provide religious and philosophical exemptions as well, Wharton said.

Exemptions increased slightly in 2011 from 2009, though exemption levels were low overall, the CDC said. Alaska had the highest exemption rate in 2011 at 7 percent, and Mississippi had the lowest at 0.1 percent.

Some parents who skip or delay vaccines for their children cite safety concerns, such as the belief of a link between vaccines and autism. The CDC says research has not uncovered a link between the two.

"Based on all the science that has been done to date, and there's been a lot of it, there's no evidence that vaccines are a causal factor," Wharton said.

SOURCE: http://1.usa.gov/R46Hco MMWR, August 23, 2012.

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The Truth About Prenatal Nutrition and Fitness

Eat for two when you're pregnant? Skip your workout? Our expert tells you what you need to know to stay healthy.By Christina Boufis
WebMD the Magazine - Feature

You've heard all kinds of things about what you should and shouldn't do to stay healthy and fit when you're pregnant. To separate fact from fiction, we asked our experts for their fitness and nutrition tips. As always, check with your doctor about which guidelines are right for you.

Eat for one. You need to add only about 300 calories a day to your diet, starting in the second trimester, according to the American College of Obstetricians and Gynecologists (ACOG). "It's really not that much," says Anna Maria Siega-Riz, PhD, RD, professor of epidemiology and nutrition at the University of North Carolina's Gillings School of Global Public Health.

Take your vitamins. When you're pregnant, you need increased amounts of certain vitamins and minerals, such as folic acid and iron, says Siega-Riz. Prenatal supplements ensure you're getting the 400 to 800 micrograms of folic acid needed to help prevent neural tube birth defects like spina bifida, as well as extra iron for your increased blood volume.

Start exercising. "It's a myth that it's too late to begin exercising during pregnancy," says Marjorie Greenfield, MD, division director of General Obstetrics and Gynecology at University Hospitals Case Medical Center in Cleveland and author of The Working Woman's Pregnancy Book. And while it's probably not a good time to learn how to inline skate or play soccer, brisk walking is fine, she says.

ACOG recommends at least 30 minutes of exercise on most days of the week, which can help with everything from improving sleep to protecting against gestational diabetes. But whatever you do, "don't work out so hard you can't talk. Don't bang your tummy," Greenfield says. "As long as you follow the rules, do whatever [exercise] feels right to you," whether that's running, brisk walking, or swimming.

"But we don't recommend hot yoga," she adds. "Getting overheated is not good for you." No matter what exercise you're doing, "if you start feeling really hot, you have to stop."

Stay hydrated. While you don't need to down lots of extra water during pregnancy -- six to eight glasses a day is fine -- you do need to stay hydrated. Make sure you don't get dehydrated when exercising, says Greenfield.

And skip the sweetened drinks. "A lot of women don't realize that sweetened beverages -- juices, sweet teas, and Frappuccino-type coffee drinks -- have a lot of calories and added sugar," Siega-Riz says. "So it's really easy to gain weight."

Keep your balance. As you progress in your pregnancy, "you have to be cautious about things that involve balancing because your center of gravity is different and you may not adjust so quickly," Greenfield says. While you don't have to forgo bike riding, for example, you may have to go slower or adjust your workout.

Reader Tip

"My doctor told me the best medicine for swollen feet and ankles is a swimming pool. I have been going to the pool nearly every day." -- Beckie_33, WebMD community member

Find more articles, browse back issues, and read the current issue of "WebMD the Magazine."

How I Got My Husband to Love Rhubarb

Making rhubarb savory instead of sweet is what converted this author's husband. Try her recipe!By Monica Kass Rogers
WebMD the Magazine - Feature

Kim Ode's husband, John, isn't big on desserts. So this 57-year-old, Minneapolis-based reporter always assumed that's why he declined all the rhubarb pies and tortes she liked to make. But when she came home with the news that she'd be writing a book about rhubarb, "the truth came out," Ode laughs. "John just winced at the thought of all that rhubarb!"

His dislike for rhubarb was partly textural: Cooked rhubarb can be slightly viscous, stringy, and loose. But he also objected to the overly sweetened taste of rhubarb in desserts. On its own, rhubarb is extremely tart, Ode says, so rhubarb recipes usually pile on the sugar to compensate.

As Ode started testing recipes, she found that while it still took a little sweetness to tame rhubarb's pucker, the resulting pickles, sauces, and compotes were solidly in the savory camp, winning John over. His favorite? Shrimp in Kimonos, a seafood version of pigs-in-a-blanket in which shrimp is paired with a rhubarb-rosemary-ginger-onion compote in crisp-fried wonton bundles. "Even after a year full of every rhubarb recipe test imaginable, John tells me I can make that recipe for him any time," Ode says

Rhubarb Nutrition

Rhubarb's ruby red, pink, and green striped coloring makes it one of the prettiest garden sights from spring to fall. Nutritionally, rhubarb has a lot going for it, especially when it's not over-sugared in recipes. It's low in calories (a half cup raw has 15) and is a source of vitamin C as well as fiber -- one cup of cooked rhubarb has 2.2 grams, about the same as a slice of whole wheat bread. It also provides calcium, a respectable 105 milligrams per cup of raw rhubarb.

Studies show that eating rhubarb can help lower LDL or "bad"cholesterol because of its mix of soluble (8%) and insoluble (66%) fiber. One big caveat: Don't eat the leaves cooked or raw. They contain a toxic chemical you don't want in your rhubarb dishes.

Cool Rhubarb Fact

Although rhubarb is botanically classified as a vegetable, in 1947 the U.S. Customs Court in Buffalo, N.Y., ruled rhubarb was a fruit since that's how it was mainly used.

Rhubarb Recipe: A Side Dish to Grilled Meat

Rhubarb is good stewed into sauces, compotes, ketchups, and even "rhubarbecue" sauce. As a side for grilled meat, oven-crisp 2 slices nitrate-free bacon and blot with paper towels. Cook 1 medium chopped onion in a skillet with 1 tbsp bacon drippings until soft. Add 1 cup chopped rhubarb, 3 tbsp maple syrup, 1½ tbsp red wine vinegar, and a pinch of allspice and thyme. Simmer 5 minutes until soft. Mix with crumbled bacon and serve.

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Salmonella Outbreak Traced to Mexican Mangoes

Daniella Brand Mangoes Recalled in U.S.; 105 Sickened in 16 States

Aug. 31, 2012 -- An ongoing salmonella outbreak traced to mangoes has sickened at least 105 people in 16 states across the U.S.

There have been 25 hospitalizations but no deaths. People who fell ill after Aug. 6 may not have been reported. In Canada, where health authorities first identified the outbreak, there have also been several cases.

Splendid Products has recalled the mangoes, sold under the Daniella brand name. The recall applies only to mangoes with stickers bearing PLU numbers 3114, 4051, 4311, 4584, or 4959. These mangoes, and mangoes without stickers, should be thrown out.

The company says the recalled mangoes were sold at retail locations including Costco, Save Mart Supermarkets, Food 4 Less, Ralph’s, Topco stores, El Super, Kroger, Giant-Eagle, Stop & Shop, Aldi, and some Whole Foods stores. Other stores may have also carried the recalled product. The recalled mangoes were sold in the U.S. between July 12 and Aug. 29.

States reporting cases are California (80 cases), Delaware (1), Hawaii (3), Idaho (1), Illinois (1), Louisiana (1), Maine (1), Michigan (1), Montana (1), Nebraska (1), New Jersey (1), New York (3), Oregon (1), Texas (2), Washington (6), and Wisconsin (1).

The salmonella strain responsible for the outbreak, Salmonella Braenderup, usually causes two or three cases a month in the U.S.

The salmonella outbreak traced to mangoes is not linked to the ongoing salmonella outbreak traced to cantaloupe.

The cantaloupe outbreak, caused by a different salmonella strain (Salmonella Typhimurium), has now sickened at least 204 people in 22 states, with two known deaths. This week, 12 states reported 26 new cases.

CDC and FDA investigators have traced the outbreak to cantaloupe grown by Chamberlain Farms Produce Inc. of Owensville, Ind. The company recalled all of its cantaloupe and will not ship any new melons for the rest of this growing season.

Salmonella cases linked to cantaloupe occurred in Alabama (13 cases), Arkansas (5), California (2), Florida (1), Georgia (4), Illinois (24), Indiana (22), Iowa (8), Kentucky (63), Massachusetts (2), Michigan (6), Minnesota (5), Mississippi (5), Missouri (13), New Jersey (2), North Carolina (5), Ohio (5), Pennsylvania (2), South Carolina (3), Tennessee (8), Texas (2), and Wisconsin (4).

Within 12 to 72 hours of eating salmonella-contaminated food, most people get:

These symptoms usually last four days to a week. Most people recover without treatment, although the diarrhea may be so severe that a person needs hospital care.

Sometimes salmonella bacteria escape the gut and get into the bloodstream. From there, different parts of the body are infected. These infections can be fatal. Immediate treatment with antibiotics is needed.

Teens who smoke pot can damage memory, intelligence

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LONDON (Reuters) - Teenagers who become hooked on cannabis before they reach 18 may be causing lasting damage to their intelligence, memory and attention, according to the results of a large, long-term study published on Monday.

Researchers from Britain and the United States found that persistent and dependent use of cannabis before the age of 18 may have a so-called neurotoxic effect, but heavy pot use after 18 appears to be less damaging to the brain.

Terrie Moffitt, a psychology and neuroscience professor at King's College London's Institute of Psychiatry, said the scope and length of the study, which involved more than 1,000 people followed over 40 years, gave its findings added weight.

"It's such a special study that I'm fairly confident cannabis is safe for over-18 brains, but risky for under-18 brains," she said.

Before the age of 18, the brain is still being organized and remodeled to become more efficient and may be more vulnerable to damage from drugs, she added.

Moffitt worked with Madeleine Meier, a post-doctoral researcher at Duke University in the United States, to analyze data on 1,037 New Zealanders who took part in the study. About 96 percent of the original participants stuck with the study from 1972 to today, she said.

At age 38, all participants were given a battery of psychological tests to assess their memory, processing speed, reasoning and visual processing.

Those who had used pot persistently as teens scored significantly worse in most of the tests. Friends and relatives regularly interviewed as part of the study were more likely to report that the heavy cannabis users had attention and memory problems such as losing focus and forgetting to do tasks.

The researchers also found that people who started using cannabis in adolescence and continued for years afterwards showed an average decline in Intelligence Quotient (IQ) test scores of eight points between the ages of 13 and 38.

"Study subjects who didn't take up pot until they were adults with fully-formed brains did not show similar mental declines," Moffitt said.

"MARIJUANA IS NOT HARMLESS"

She said the decline in IQ could not be explained by alcohol or other drug use or by having less education, and Meier said the key variable was the age people began to use pot.

Meier said the study's message was clear: "Marijuana is not harmless, particularly for adolescents."

While eight IQ points may not sound like a lot on a scale where 100 is the mean, Meier said an IQ drop from 100 to 92 would mean dropping from being in the 50th percentile to being in the 29th.

Higher IQs also correlate with higher levels of education and income, better health and longer lives, she said. "Somebody who loses eight IQ points as an adolescent may be disadvantaged ... for years to come," she added.

Robin Murray, a professor of psychiatric research at King's Institute of Psychiatry, who was not involved in this work, said the study was impressive and the findings should be taken "very seriously".

"It is of course part of folk-lore among young people that some heavy users of cannabis seem to gradually lose their abilities and end up achieving much less than one would have anticipated," he said in a statement. "This study provides one explanation as to why this might be the case."

Previous research on cannabis use has also pointed to potential long-term psychiatric effects.

A study published in March last year found that people who use it a lot in their youth dramatically increase their risk of psychotic symptoms, and that continued use of the drug can increase the risk of developing a psychotic disorder.

Meier pointed out that it was not possible to say from this latest study what a safer age for persistent pot use might be, or what kind of dosage level causes damage.

According to the 2011 United Nations Office for Drugs and Crime (UNODC) global drugs report, which used data from 2009, between 2.8 and 4.5 percent of the world's population aged 15 to 64 - or between 125 and 203 million people - had used cannabis at least once in the previous 12 months.

SOURCE: http://bit.ly/NS97zV Proceedings of the National Academy of Sciences, online August 27, 2012.

Organic Foods Not Necessarily Better

Study Questions Health Benefits of Eating Organic

Sept. 4, 2012 -- Will eating pricey organic foods make you healthier? Maybe not, a new research review shows.

The review sums up evidence from hundreds of studies of organic foods. It's published in the Annals of Internal Medicine.

Some of the studies compared organic milk, meats, eggs, and produce to non-organic foods. Those studies measured nutrients in the foods as well as contaminants like pesticides and bacteria. A few studies tried to find health differences between people who ate only organic or only non-organic foods.

After weighing all the evidence, the researchers conclude that organic foods don't appear to have more vitamins or nutrients than non-organic foods.

Non-organic fruits and vegetables were 30% more likely to have pesticides than organic fruits and vegetables. But because it's rare for any produce to exceed pesticide safety limits set by the FDA, researchers say it's not known whether reducing an already small exposure makes a difference.

The review also shows that organic meats are less likely to harbor "superbug" bacteria that are resistant to treatment with antibiotics. But researchers say most antibiotic-resistant infections in people come from misuse of antibiotics, not from eating contaminated foods.

In the end, researchers say there's no evidence that people who stick to organic diets are healthier than people who eat non-organic foods.

Not everyone agrees.

"There are many different reasons why people choose organic. They may be concerned about animal welfare or the environment. They may do it for taste," says researcher Crystal Smith-Spangler, MD, of Stanford University in California. "I didn't find that nutrition is a major reason to choose organic foods."

Nutrition experts praised the research since it helps to dispel some myths that might make people afraid to eat fresh fruits and vegetables.

"When we're talking about organic, it's really the process, not the product. The process of organic farming is different than conventional farming, but that doesn't mean that the food is bad or unsafe," says Melissa Joy Dobbins, RD, MS, a spokeswoman for the Academy of Nutrition and Dietetics.

Dobbins points out that organic foods can cost twice as much as non-organic foods.

"I don't want that mom who's at the grocery store to feel guilty if she can't afford organic. That mom shouldn't feel like she's making a lesser choice," Dobbins says.

Other experts, however, called the new review misleading.

"The message the general public is going to get is that there are no health benefits from organic foods so why seek it out? Why pay a slightly higher price? I do think the science and facts support some very significant and important long-term benefits," says Charles Benbrook, PhD, a professor of agriculture at Washington State University in Pullman, Wash.

Benbrook points to a similar review published last year that reached the opposite conclusion. That study, by British researchers, found that organic fruits and vegetables contain about 12% more disease-fighting nutrients than non-organic foods. Sticking with organic produce, researchers concluded, would be the equivalent of eating 12% more regular fruits and veggies.

Other experts say the study's conclusions shouldn't change the major reasons that people choose organic foods.

"Nutrition is a lesser concern. It's not the main reason people are buying organic. If you eat organic food, you still need to eat a varied diet, it's not going to solve every health woe. It's marketed to be pesticide-free and antibiotic-free, and that was strongly supported by the study," says Sonya Lunder, MPH, a senior analyst with the nonprofit Environmental Working Group.

New book of cuisine exalts the power of plants

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Ginkgo Biloba Doesn't Protect From Alzheimer's

Second Major Study Shows No Benefit to Supplement

Sept. 5, 2012 -- A second large study failed to show that the supplement ginkgo biloba can prevent Alzheimer's disease.

The study included close to 3,000 elderly people in France with memory problems. Some of them took ginkgo biloba and some did not.

Over five years of follow-up, about the same number of people in the two groups got Alzheimer's disease.

The study is published in the journal Lancet Neurology.

An earlier study followed people in the U.S. for an average of six years. It also found no evidence that ginkgo biloba prevents Alzheimer's disease or delays mental problems.

Ginkgo biloba is widely used and marketed as a memory-boosting drug. Alzheimer's researcher Lon Schneider, MD, says it shouldn't be.

He says close to 10,000 people have participated in studies examining ginkgo biloba's impact on memory and the brain.

"This supplement has been studied as extensively as any drug, with no evidence that it improves memory" or delays problems with thinking, Schneider says. He says if ginkgo biloba were being developed as a drug, it would have been abandoned long ago.

"The drug company response would probably be, 'We're not wasting another dime on this dog,'" he says.

The French study included people in their 70s and older. They had complained to their doctors of having problems with memory.

Half of the people took ginkgo biloba twice a day. The other half took identical-looking placebo pills.

Over the next five years, 4% of the ginkgo biloba group and 5% of the placebo group were diagnosed with Alzheimer's disease.

In a written statement, study researcher Bruno Vellas of Toulouse, France's Hopital Casselardit called for more studies on whether taking ginkgo biloba over the long term affects age-related memory decline.

"The fact that prevalence of [Alzheimer's disease] is expected to quadruple by 2050 suggests that research into preventative therapies for this disease needs to receive urgent attention," he says in the statement.

But Schneider says investigators would be better off looking elsewhere for effective treatments.

"If there were truly nothing else that might delay the onset of dementia I could understand why users might want to stick with ginkgo biloba," he says. "But we are learning about more and more health behaviors that appear to impact risk."

Studies suggest that getting regular exercise, eating less fat, and treating high blood pressure, high cholesterol, and other heart risk factors all protect against age-related memory decline, he says.

Vitamin d supplements may not improve heart health

by Genevra Pittman, updated 4 September 2012

NEW YORK (Reuters Health) - despite numerous studies linking higher levels of blood vitamin d heart attacks and deaths, a new trial found giving daily older women of d supplementation did not cut heart risk.

Women's cholesterol, blood pressure and blood glucose was not lower after one year to take one of the two doses of vitamin D than those who took placebo free of vitamin pills.

What is called observational studies, which measure vitamin d in the blood of the people and then follow them over time - tend to find a link between heart health and vitamin levels.

"There is a tremendous amount of epidemiological data showing a relationship between low levels of vitamin d and an increased risk of cardiovascular events," said Dr. Michel Chonchol, who studied this association at the University of Colorado Denver, but was not involved in the new research.

But these types of testing can prove the cause-effect because it is impossible to take into account all possible food and lifestyle differences between people with lower and higher vitamin D levels.

Randomised controlled trials, regarded as the "gold standard" studies of medicine, were designed to circumvent this obstacle. By dividing a group of people at random and give some but not for others a special treatment, researchers can better hone in on its specific effects.

For new trial, Adrian Wood of the University of Aberdeen in Britain and colleagues divided 305 sixties women into three groups. Every morning for a year, the women took either 400 units International (UI) or 1000 IU of vitamin d or a placebo.

Participants were returned to the laboratory every two months for a panel of heart tests.

In the study, women in each group were similar on most measures of health. Women in the placebo group, for example, had 152 pounds in weight, blood pressure and total cholesterol of 128/78 of 238.

The next year, cholesterol levels and blood pressure vary according to the season - but not based on knowledge if the women were taking additional vitamin d.

Ultimately, no there was no clear difference between the three groups of changes in cardiac markers, the wood team reported in the Journal of the clinical endocrinology & metabolism.

The study did not look far enough or have enough women, to determine if vitamin d could affect heart attack or death.

Food sources of vitamin d are cod liver oil and other fish and fortified juices and dairy products.

The Institute of Medicine recommends that most adults is 600 IU of vitamin d per day. In a report of 2010, he found there is strong evidence linking vitamin d and calcium for a better bone health but that the other benefits offered, including blood pressure and cardiovascular disease are provided.

However, some researchers believe taking additional vitamin D - especially for people who have very low levels first - can help prevent inflammation of the body and to play a role in the regulation of blood sugar.

SOURCE: http://bit.ly/ODc3xc Journal of Clinical Endocrinology & metabolism, August 3, 2012 online.

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Beyond Statistics: 2 Faces of West Nile Virus

Thousands Now Live With West Nile Virus Infection. Here, 2 Share Their Stories

Aug. 31, 2012 -- This year, more than 1,500 people in the U.S. have been diagnosed with West Nile virus infection and several have died.

Transmitted by the bite of a mosquito, the infection isn't equal opportunity.

© 2012 WebMD, LLC. All rights reserved.

Some infected people don't notice any symptoms. Others have a milder form of the disease, known as West Nile fever. About 1 in 150 people infected develop severe complications, including infections of the brain (encephalitis) or spinal cord and connecting nerves (meningitis) or paralysis.

Rob Wagner Jr., 52, is a construction worker in Riverside County, Calif., near Los Angeles. He learned he had West Nile virus earlier this month.

Don R. Read, MD, is a Dallas surgeon who became infected in 2005 at age 63. He says he is still coming back from the complications, including paralysis.

Rob Wagner Jr., is a big guy who has worked construction most of his life. Most recently, he has been working as a glass glazer in Southern California.

In early August, he was hanging out at a friend's house in the city of Riverside, spending a lot of time in the backyard.

A lifelong mosquito magnet, he remembers being bitten but not thinking much about it. "I was getting bitten every night," he says.

One morning soon after, he woke up with a burning fever. "I was sweating like crazy," he says. The day before, he remembers feeling like he was coming down with something.

He was lagging at work. "I have to deal with measurements, stuff like that," Wagner says. "I was really slow, feeling incompetent in my measurements."

He had an excruciating headache. He says he's had those before, and they were linked with his high blood pressure. "It was like flu symptoms," he says.

"I had a friend take me to the emergency room." They told him the fever was 105 degrees.

"They started doing tests, taking blood. They did CT scans and MRI." He had two painful spinal taps, a typical test to check for meningitis, which doctors suspected.

Doctors admitted him to the hospital. They decided the diagnosis was bacterial meningitis and started him on antibiotics.

The pain was so bad the doctors put him on morphine.

The week he spent in the hospital was a nightmare, his sister, Pamela Vest, says. "A whole week, we couldn't even talk to him because he was so out of it."

"One morning he woke up crying," she says, "saying, 'What is wrong with me?' 'What is it?'"

When he improved some, he was released.

Then came the call from the Riverside County Department of Health. "It wasn't bacterial meningitis, it was West Nile virus," he says.

"I didn't know that much about it," he says. "I was still kind of out of it."

Non-Alcoholic Red Wine May Boost Heart Health

Sept. 6, 2012 -- Much research has touted the health benefits that come from drinking moderate amounts of red wine.

Now, a new study may extend some of these benefits to teetotalers. Non-alcoholic red wine may be even more effective at lowering blood pressure in men who are high risk for heart attack. The study findings appear in Circulation Research.

The study included 67 men who had diabetes or three or more heart disease risk factors. When the men drank red wine with alcohol, their blood pressure went down a little, and there was no change in blood pressure levels when they drank gin.

When the men drank non-alcoholic red wine, their blood pressure went down enough to lower their risk of heart disease by 14% and stroke by as much as 20%.

The real health benefits in red wine may be found in powerful antioxidants called polyphenols, not the alcohol. In fact, the alcohol in red wine may dampen its blood pressure-lowering potential. In the study, the red wine with alcohol and non-alcoholic wine contained equal amounts of polyphenols.

The researchers were able to link polyphenol levels to a boost in men’s levels of nitric oxide, which helps lower blood pressure. Nitric oxide helps blood vessels relax and allows more blood to reach your heart and organs.

During the study, the men ate similar diets and drank either 10 ounces of red wine, 10 ounces of non-alcoholic red wine, or 3 ounces of gin. All of the men tried each diet/beverage combination for four weeks.

“The non-alcoholic part of the wine -- namely polyphenols -- exert a protective effect on the cardiovascular system,” says researcher Ramon Estruch, MD, PhD of the University of Barcelona in Barcelona, Spain. “Polyphenols also have anti-inflammatory and antioxidant properties that may be useful to prevent other disease such as diabetes."

He predicts that more people will turn to non-alcoholic wine in the future. 

This is welcome news for people who can’t or don’t want to drink alcohol, says Suzanne Steinbaum, DO, at Lenox Hill Hospital in New York City. Although some alcohol is thought to be good for you, too much alcohol can increase blood pressure levels.  

“Certain people don’t want to drink alcohol, so here we have an alternative way for them to get the heart health benefits,” she says. “It’s not so much the alcohol as it is the polyphenols in red wine.”

Other alcoholic drinks have also been shown to have health benefits, but they may do so differently than red wine, Steinbaum says.