My Health - Aerobic exercise or tai chi for fibromyalgia–which is better?

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Fibromyalgia is a common condition that causes chronic body-wide pain and affects millions of people. The cause is unknown, and medications approved to treat it often aren’t effective, cause side effects, or both. To say we need better treatments for fibromyalgia is an understatement.

Non-medication treatment of fibromyalgia — especially exercise — is an essential part of treatment. But the last thing people with this condition want to do is exercise! Their pain and fatigue, so typical of this disease, make physical activity more wishful thinking than reality for most fibromyalgia sufferers. Even so, studies suggest that as long as people start “low and slow” (exercising at low intensity and for short duration, and very gradually increasing both), physical activity can be tolerated and even enjoyed.

Is there a “best” type of exercise for fibromyalgia?

A new study compared two types of physical activity among people with fibromyalgia: aerobic exercise (such as brisk walking, as commonly recommended) and tai chi, an ancient form of martial arts often practiced for health benefits. Past studies have demonstrated that tai chi can be effective for people with fibromyalgia.

Researchers enrolled 226 adults with fibromyalgia and randomly assigned 151 to learn and practice tai chi (once or twice a week for 12 or 24 weeks), while 75 were assigned to participate in standard “moderate intensity” aerobic exercise (twice a week for six months, with an aim of raising the heart rate during exercise to an aerobic range). Study subjects were representative of “real world” patients who varied in age, had other health problems, and took a number of medications.

What did the study show?

Compared with aerobic exercise, study participants assigned to the tai chi groups:

• attended their assigned exercise classes more reliably
• reported significant improvement on a standard survey of fibromyalgia symptoms when asked six months after treatment began
• had less anxiety
• felt better able to cope and had higher self-efficacy (a belief that they were able to improve their symptoms through their own actions)
• reported more improvement after 24 weeks of tai chi (vs. 12 weeks of tai chi)

Both groups reduced their use of pain relievers to a similar extent. And no serious injuries or side effects of the treatments were reported.

Does this mean everyone with fibromyalgia should try tai chi?

As is true for most treatments, there is not a single best option in all circumstances. It may not work well for those who don’t like tai chi (or don’t give it a chance), or feel they cannot participate due to poor balance, weakness, or other health problems.

In addition, the study itself is not the last word on which activities are best for people with fibromyalgia. Not everyone will have access to high-quality tai chi instructors (though in this study, results were consistent across three instructors). Skeptics will point out that since study subjects knew which treatment they were getting, the placebo effect could account for the findings. And, of course, there are countless other exercise programs that were not included in this study.

Stand by for more on exercise and other treatments for fibromyalgia

This new research suggests that instead of current recommendations to get aerobic exercise (as with taking brisk walks), tai chi might be just as good or better for many people with fibromyalgia.

In the near future, it’s likely that we’ll have better ways to diagnose and treat fibromyalgia. In addition, a better understanding of why it develops in the first place could lead to preventive approaches. Until then, I’ll keep telling my patients what I’ve been telling them for years: when fibromyalgia gets better, it’s usually because of something the patient is doing, not because of a medication I prescribed. Being physically active does seem to be a particularly necessary part of the approach. Based on the results of this latest research, tai chi may be a good place to start.

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My Health - 4 ways to protect against skin cancer (other than sunscreen)

It’s almost May and here in the northeast, front-of-the-pharmacy aisles are filled with myriad brands and types of sunscreen. While sunscreen is essential to lowering your risk for skin cancer, there are other simple, over-the-counter options you can incorporate into your summer skin protection routine.

Nicotinamide may help prevent certain skin cancers

Nicotinamide is a form of vitamin B₃ that has been shown to reduce the number of skin cancers. In a randomized controlled trial performed in Australia (published in the New England Journal of Medicine), the risks of basal cell carcinoma and squamous cell carcinoma were significantly reduced — by 23%. Nicotinamide has protective effects against ultraviolet damage caused by sun exposure. The vitamin is safe and can be purchased over the counter. We recommended starting the vitamin (500 mg twice a day) to all our patients with a history of a basal cell carcinoma or squamous cell carcinoma, or with extensive skin damage due to sun exposure. One caveat is that the vitamin must be taken continuously, as the benefits are lost once stopped.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs, such as ibuprofen and aspirin, may have a modest effect on skin cancer prevention. A systematic review showed that the risk of squamous cell carcinoma was reduced by 15% with non-aspirin NSAIDs, and by 18% with any NSAID. Some studies of melanoma have also shown positive results; one found a 43% reduction in melanoma with continuous aspirin for five years, while other studies have failed to show any risk reduction. NSAIDs are known to inhibit an enzyme responsible for inflammation and pain, known as COX-2, which is overexpressed in squamous cell carcinomas. A limitation to many of the studies on NSAIDs in skin cancer is that the amount of NSAID taken varied. Especially at higher doses, NSAIDs are associated with other side effects, such as ulcers, and so I do not routinely recommend that my patients take these drugs to lower skin cancer risk.

Polypodium leukotomos

Polypodium leukotomos is a tropical fern found in Central and South America that has antioxidative, immunomodulatory, and anti-inflammatory effects, and is being marketed as an oral “sunscreen.” A recent small study of 22 patients showed that the fern extract altered the effects of UVB light (the more carcinogenic form of ultraviolet light) in 17 of the 22 patients to varying degrees. However, it is important to recognize that there are limitations to this study. First, it was unable to evaluate UVA light, which also causes skin cancer. Second, it is difficult to determine the most appropriate dose from the study. The participants received two doses of 240 mg of polypodium leukotomos two hours and one hour before ultraviolet exposure, but it is not clear how best to advise patients to use it. So, you may wonder whether I recommend this to my patients. The answer is, not yet. But I do plan to try the extract myself and on my husband (who has a history of skin cancer) this summer. Just keep in mind, this does not replace sunscreen and sun-protective clothing.

Watch your alcohol intake

Although alcohol is not a classic “over-the-counter” product, it has been in the spotlight in the past year, as alcohol is estimated to be responsible for 3.5% of all cancer deaths. Two meta-analyses suggested an association between skin cancer and alcohol intake. One study found that the risk of basal cell carcinoma increased by 7% and squamous cell carcinoma by 11% for every standard beer or small glass of wine each day. Another study showed a 20% increase in melanoma in drinkers, and the risk increased with the number of drinks. However, these studies didn’t take into account other factors that could affect the results, some of which cannot be measured. One example is that ultraviolet light is the main factor that increases basal cell carcinoma and squamous cell carcinoma, and alcohol consumption has been associated with behaviors that increase one’s risk of getting a sunburn. So what is the recommendation? The American Cancer Society recommends limiting alcohol consumption to one drink per day for women and two drinks per day for men.

And you still need sunscreen!

Since we have yet to find a magic pill that completely prevents sunburns and eliminates skin cancer risk, this is my plug for good old-fashioned sunscreen. Sunscreen has been shown to reduce both melanoma and squamous cell carcinoma. Randomized prospective studies in Australia showed that individuals who used daily sunscreen had a 50% reduction in melanoma and a 40% reduction in squamous cell carcinoma, compared to individuals who used sunscreen intermittently. So when the sun and warm weather beckon, remember to apply a broad-spectrum sunscreen with at least SPF 30 prior to going out in the sun, reapply every two hours, and apply liberally: 1 teaspoon to each arm, head and neck, front torso, and back; and 2 teaspoons to each leg.

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My Health - Heart attack versus cardiac arrest

If you’re confused by the terms used to describe heart attacks, you’re not alone. They’re often described as “mild” or “massive,” or even the ominous-sounding “widow maker.” But these terms are not necessarily helpful, and they may create confusion and anxiety.

The good news: most people who have a heart attack survive. The bad news? “Any heart attack can be fatal, no matter how big, how small, or where it occurs in the heart,” says Dr. James Januzzi, a cardiologist at Harvard-affiliated Massachusetts General Hospital. “Furthermore, there’s a lot of misunderstanding among the general public about what a heart attack actually is,” he says.

The connection between heart attack vs. cardiac arrest

Perhaps the most common source of confusion is the difference between a heart attack and cardiac arrest. A heart attack (what doctors call a myocardial infarction or MI) is defined as damage to part of the heart muscle caused by inadequate blood flow to that area. Most of the time, this happens due to a blockage in one of the heart’s arteries. Known as a type 1 heart attack, such blockages typically occur when cholesterol-laden plaque lining an artery ruptures. A clot forms, obstructing the vessel.

While a heart attack is a plumbing problem, a cardiac arrest is an electrical problem. Cardiac arrest happens when the heart’s electrical system malfunctions, causing it to beat rapidly and chaotically — or to stop beating altogether. Without blood circulating to the brain, lungs, and other organs, the person gasps or stops breathing and becomes unresponsive within seconds.

A heart attack is a common cause of cardiac arrest, but most heart attacks do not lead to cardiac arrest. Other possible causes of cardiac arrest include heart failure, a clot in the lungs, a serious imbalance of potassium, magnesium, or other minerals in the blood, a drug overdose, or a blow to the chest.

Does size matter?

Some heart attacks cause more harm than others. During a heart attack, blood levels of a protein released by damaged muscle (troponin) give some sense of severity. Afterwards, an ultrasound of the heart (echocardiogram) can reveal the extent of the damage. “A large heart attack will significantly reduce the squeezing strength of the heart muscle,” says Dr. Januzzi.

The term “widow maker” refers to a heart attack caused by a blockage near the top of the left anterior descending (LAD) artery, the main artery that supplies blood to the front of the heart. However, heart attacks that involve the LAD are not necessarily fatal, and those involving other arteries can be deadly, too.

What to do

Call 911 right away if you or someone near you has symptoms of a heart attack or cardiac arrest. Common heart attack symptoms include:

• uncomfortable pressure, squeezing, or pain in the chest
• pain or other uncomfortable sensations in an arm, the back, neck, jaw, or stomach
• shortness of breath
• sudden nausea or vomiting
• lightheadedness or dizziness
• unusual fatigue.

Signs of cardiac arrest are a sudden loss of responsiveness and abnormal breathing (either not breathing or only gasping). Give hands-only cardiopulmonary resuscitation (CPR) until help arrives.

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My Health - Apple cider vinegar diet: Does it really work?

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People search for information on a wide variety of health topics in Google and other search engines. That’s no surprise.

But I was surprised to learn that “apple cider vinegar weight loss diet” was among the fastest-rising health topic searches for Google in 2017. And then I found out that apple cider vinegar has been used medicinally for centuries!

Why the renewed interest? And, more importantly, does it work?

What is the apple cider vinegar diet?

Apple cider vinegar comes from apples that have been crushed, distilled, and then fermented. It can be consumed in small quantities or taken as a supplement. Its high levels of acetic acid, or perhaps other compounds, may be responsible for its supposed health benefits. Although recommendations for “dosing” vary, most are on the order of 1 to 2 teaspoons before or with meals.

What can the apple cider vinegar diet do for you?

For thousands of years, compounds containing vinegar have been used for their presumed healing properties. It was used to improve strength, for “detoxification,” as an antibiotic, and even as a treatment for scurvy. While no one is using apple cider vinegar as an antibiotic anymore (at least, no one should be), it has been touted more recently for weight loss. What’s the evidence?

Studies in obese rats and mice suggest that acetic acid can prevent fat deposition and improve their metabolism. The most widely quoted study of humans is a 2009 trial of 175 people who consumed a drink containing 0, 1, or 2 tablespoons of vinegar each day. After three months, those who consumed vinegar had modest weight loss (2 to 4 pounds) and lower triglyceride levels than those who drank no vinegar. Another small study found that vinegar consumption promoted feeling fuller after eating, but that it did so by causing nausea. Neither of these studies (and none I could find in a medical literature search) specifically studied apple cider vinegar.

In all, the scientific evidence that vinegar consumption (whether of the apple cider variety or not) is a reliable, long-term means of losing excess weight is not compelling. (On the other hand, a number of studies suggest that vinegar might prevent spikes in blood sugar in people with prediabetes and type 2 diabetes by blocking starch absorption — perhaps that’s a topic for another day.)

Is there a downside to the apple cider vinegar diet?

For many natural remedies, there seems to be little risk, so a common approach is “why not try it?” However, for diets with high vinegar content, a few warnings are in order:

• Vinegar should be diluted. Its high acidity can damage tooth enamel when sipped “straight” — consuming it as a component of vinaigrette salad dressing is a better way.
• It has been reported to cause or worsen low potassium levels. That’s particularly important for people taking medications that can lower potassium (such as common diuretics taken to treat high blood pressure).
• Vinegar can alter insulin levels. People with diabetes should be particularly cautious about a high vinegar diet.

So what?

If you are trying to lose weight, adding apple cider vinegar to your diet probably won’t do the trick. Of course, you’d never suspect that was the case by the way it’s been trending on Google health searches. But the popularity of diets frequently has little to do with actual evidence. If you read about a new diet (or other remedy) that sounds too good to be true, a healthy dose of skepticism is usually in order.

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My Health - How to talk to your doctor about medication

Pharmacology has changed the practice of medicine. Scientists are continually working on new and better drugs to manage medical conditions, from high blood pressure to autoimmune diseases to cancer. The mechanism of a drug — how it actually works on the condition it is mean to treat — is one important factor, but drug delivery, meaning how the medication arrives at the target it is meant to affect, is also key.

As a patient, it’s your right to understand everything about a medication prescribed for you. That doesn’t mean you have to become a scientist or pass an exam about pharmacology. But you can and should ask your doctor to explain to you why she has selected this medication for you, how it works, and what side effects you should expect. An article in Pharmacy World and Science explores what medications mean to patients and why it’s important to think about these concepts. Do I need this medicine? How will it impact my body? What control do I have over the effects of the drug?

Find out why this particular medication

No matter what the health condition is, there is always more than one choice of medication to treat it. Ask why the one your doctor recommends is the best choice for you. You want to know what the medicine is expected to do and how that will be monitored. Will you be expected to keep a log of your pain, symptoms, blood pressure, or blood sugars? Is this a medicine your doctor has used before and is familiar with? It’s a red flag if he says, “Well, I haven’t tried it before with a patient, but it seems like the right choice.”

Sometimes a physician will try a drug that is new to the market, but you need to know exactly what makes this medicine special for your condition. Be wary of medicines that are “brand name only.” That means they are newer to medical practice, will likely be more expensive, and that there is less experience using them. Sometimes, a newer brand name drug is a great choice, but if your doctor just heard about it and isn’t yet familiar with potential side effects and clinical response, you need to know that.

Be sure you know how to take the medication

Morning or evening? Empty stomach or after a meal? What if you miss a dose? Can you have a glass of wine while taking this medicine? Is it okay to drink grapefruit juice (which interacts with many medicines)? Will you need to “titrate up” (meaning to increase slowly until you get to the right dose)?

Your doctor should carefully review medication side effects

All drugs have potential side effects, even acetaminophen (Tylenol). Fatigue, weight gain, and headache are common, but there are lots of others. Some drugs can make your urine turn a different color — scary unless you know to expect it. Your GI system may move more quickly, resulting in diarrhea. Hair loss is an unpleasant drug side effect that can sometimes be prevented by taking supplements with the medicine. Tremor is another side effect that can limit how much of a medicine you’re able to tolerate.

Whatever you experience is real, so make sure you keep a list and let your doctor know. Anyone can be allergic to a medicine (and sometimes it’s just a simple rash that fades when you stop the drug), but a more serious and potentially life-threatening side effect is anaphylaxis. That means that you can actually stop breathing as your body goes into crisis mode. Don’t ignore any new symptoms when you start a drug.

Keep track of your experience and ask questions

It’s often useful to keep a list of questions in a notebook you take to medical appointments, or on your phone. Phone apps are great ways to track responses and side effects, so be sure to ask about options. Make sure you have all the answers about your medication, including how long you’re expected to try it before an adjustment or change.

Medicine can be life-altering. Taking medication prescribed for you can help you feel better or prevent health problems down the road (or both). But if a drug isn’t working for you or you are concerned about new symptoms or side effects, speak up. Your doctor needs to know in order to change the drug or dose, or consider other options.

New choices offer patients incredible options to improve their health. Your job is to understand your medicine and to tell your doctor if you can’t tolerate it or don’t want to take it. Medication adherence starts with you, but treatment is a partnership, so ask the questions you need to understand your treatment.

Source

Understanding the meaning of medications for patients: The medication experience, Pharmacy World and Science, January 2008.

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My Health - Overcome exercise excuses

Although most people know that regular exercise is vital to good health, many find that it’s a hard habit to maintain. Just over half of adults in the United States meet the recommended advice to do moderate-intensity exercise (such as brisk walking) at least 30 minutes a day, five days a week.

Two of the main reasons people say they don’t exercise are 1) not having enough time, and 2) having joint pain, fatigue, or a chronic health condition. Even people who aren’t working full-time can still find it hard to make time for exercise. They may be caring for an ill spouse, taking care of their grandchildren, doing volunteer work, and filling their days with other pursuits. However, for some people in their 60s and 70s, reaching retirement age comes with a revelation.

“People wake up to the idea that exercise is a worthy thing to do. They make time for it because they realize it can help them enjoy a healthy life for as long as possible,” says Dr. Edward Phillips, assistant professor of physical medicine and rehabilitation at Harvard Medical School.

Practice piggybacking to get your exercise in

He encourages people to find creative ways to “piggyback” activity onto things you’re already doing regularly. One simple trick is to stand or walk every time you’re on the phone. Get earphones or a headset, which you can also use to listen to podcasts or audiobooks during a daily walk.

When you go shopping, don’t circle in your car looking for a spot near the store entrance — make it a habit to park far away. “You’ll get in some extra steps without spending much more time,” says Dr. Phillips, who also directs the Institute of Lifestyle Medicine at Spaulding Rehabilitation Hospital. If you can, walk or ride a bike to do your errands. Or park in a central location and walk to as many places as possible. “My 80-year-old mother-in-law does this and gets in nearly a mile’s worth of steps by walking to the post office, bank, and pharmacy rather than driving from place to place,” says Dr. Phillips.

You can even use toothbrushing time to get in a little balance exercise, as Dr. Phillips does. He uses an electric toothbrush that buzzes every 30 seconds, which prompts him to switch from standing on one leg to the other leg.

Think of the exercise guidelines as a goal to reach over time. If you haven’t been very active for a while, start slowly. Not sure you can commit to walking for 10 minutes at least four days of the week? Aim lower. Start with a goal of two days a week. When that becomes easy, add another day. Then start adding two more minutes to your walk, and then five minutes. Eventually, you’ll reach the goal of walking for 30 minutes, five days a week.

Exercising with physical limitations

Physical limitations from health conditions (especially arthritis) often make people reluctant to exercise. In fact, exercise nearly always makes you feel better, not worse — provided you make the right modifications, says Dr. Phillips. Do you have joint pain in your knees, hips, or ankles? Stick to non-weight-bearing exercises, such as swimming or doing water aerobics, or low-impact exercise, such as using an exercise bike or an elliptical machine.

Strengthening the muscles that support your joints can help ease pain. A physiatrist, physical therapist, or personal trainer experienced in working with people who have arthritis can help you choose and adapt activities that will work for you.

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If you’ve never had a formal exercise program, or if you’ve allowed your exercise routine to lapse over the years because of illness, time pressures, or family obligations, check out Harvard Health Publishing’s online course Starting to Exercise. This program will help you create a safe, well-rounded exercise plan — one that fits your life and that you will be likely to stick with.

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My Health - Lowering nicotine in cigarettes

Follow me on Twitter @mallikamarshall

When I was about 10 years old, my mother had me take a puff on an unfiltered Camel cigarette in an effort to discourage me from smoking in the future. Well, needless to say, it worked. After coughing and sputtering for what seemed like hours, I have never touched another cigarette.

While I am in no way suggesting that parents follow in my mother’s footsteps (in fact I would strongly discourage it), as a pediatrician and parent myself I want to ensure that children and teens never take that first puff. But in fact, the majority of smokers in the US begin smoking in their youth.

According to the Centers for Disease Control and Prevention, cigarette smoking remains the leading cause of preventable disease and death in the United States, and tobacco kills more than 480,000 Americans every year. Cancer, heart disease, stroke, chronic lung disease, infertility, pregnancy complications, fractures, cataracts, gum disease — the list of diseases caused or complicated by tobacco use goes on and on. So why do people continue to smoke? Because they can’t quit.

The role of nicotine

Cigarettes contain nicotine, a highly addictive substance found naturally in tobacco. When inhaled, nicotine travels quickly to the brain, causing a variety of pleasurable sensations. Many report an adrenaline “kick.” Others report a feeling of relaxation and improved mood. Some say it makes them more alert and improves their ability to concentrate.

The downside is that nicotine is highly addictive, and once you start smoking it becomes increasingly hard to stop. People who do try to quit can experience profound withdrawal symptoms including cravings, anxiety, depression, irritability, and inattention.

Other than telling young people to stay away from tobacco products, how can we make them less attractive? Less addictive? That is where the US government is now stepping in.

Reducing nicotine in cigarettes

In July 2017, the FDA announced a regulatory plan to explore lowering nicotine levels in cigarettes, and just last month the agency took what FDA Commissioner Dr. Scott Gottlieb called a “historic first step.” It released an “advance notice of proposed rulemaking” which marks the beginning of the agency’s effort to reduce nicotine levels in cigarettes.

To support the effort, the agency pointed to data from an FDA-funded analysis published in the New England Journal of Medicine on March 15, 2018. The statistical model found that cutting nicotine levels to “minimally addictive levels” could slash smoking rates from 15% to as low as 1.4% and lead to a substantial reduction in tobacco-related deaths. In fact, the researchers estimate that such an initiative “could save millions of lives and tens of millions of life-years over the next several decades.”

Previous studies have found that use of cigarettes with very low nicotine levels could result in greater efforts to quit smoking and a decrease in the number of cigarettes smoked per day. This most recent analysis provides even more evidence.

Critics say that smokers will simply compensate by smoking more cigarettes, but some research suggests that’s unlikely. The levels of nicotine will be so low that smokers will no longer have the drive to smoke more.

The “nicotine notice” is just the beginning of the FDA’s effort to regulate tobacco products and protect citizens from the harmful effects of nicotine, and the planned rollout will most certainly take time. The FDA is encouraging public comment for 90 days before further steps are taken.

In the meantime, I hope parents will continue to discourage their kids from using tobacco products like my mom did with me, but perhaps with open dialogue instead of an unfiltered Camel.

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My Health - Cryotherapy: Can it stop your pain cold?

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Let’s say you’ve started working out at the gym and you’re wondering what you can do for your aching muscles. How does this sound? Put on a pair of gloves, shoes, socks, and a protective headband to cover your ears and face — but wear little else. Then step into a cold room for three to four minutes. By “cold” I mean really cold: between −100° C and −140° C (which is −148° F to −220° F)!

If that sounds good to you (really?), you may already be using whole body cryotherapy (WBC). And if it sounds terrible to you (or just strange), perhaps you haven’t heard of this increasingly popular “treatment” for sports injuries and a host of other conditions. It’s become even more popular in recent years as celebrities and professional athletes have embraced it. (I’m going to resist the temptation to namedrop here… okay, just a few: Justin Timberlake, Jennifer Aniston, and LeBron James reportedly engage in WBC. If you feel compelled, you can Google “cryotherapy celebrities” to find out about others).

The idea comes from the simple observation that applying ice or other types of cryotherapy (cold treatment) can provide pain relief for inflamed, injured, or overused muscles. Another version of cryotherapy is to soak a sore area (such as an arm or leg) or the entire body in cold water (called cold water immersion, or CWI).

The claimed benefit of whole body cryotherapy

According to websites promoting whole body cryotherapy, it may be recommended for “anyone who wants to improve their health and appearance” — which by my estimation would be just about everyone — as well as for

• recovering from a painful sports injury
• a chronically painful condition such as rheumatoid arthritis
• athletes who want to improve their performance
• weight loss
• improved mood or reduced anxiety.

And the list goes on. However, the escalating claims of benefit and rising popularity led the FDA to warn consumers recently that, “If you decide to try WBC, know that the FDA has not cleared or approved any of these devices for medical treatment of any specific medical conditions.”

Does whole body cryotherapy actually work?

Good question! One website offering WBC services recommended that customers perform their own search of the medical literature. That doesn’t exactly inspire confidence. Another provided links to dozens of studies that varied so much it was hard to know what to make of them. For example, the temperatures of the cold chambers varied, as did the duration and number of treatments across studies. Some assessed elite athletes or active adults who were generally young and fit, but still others enrolled people with chronic illnesses, such as rheumatoid arthritis and multiple sclerosis. And then there’s the question of how to define success. Each study had its own way of assessing the response to treatment.

A recent review of the evidence found that WBC

• may lower skin or muscle temperatures to a similar (or lesser) degree as other forms of cryotherapy (such as applying ice packs)
• may reduce soreness in the short term and accelerate the perception of recovery after certain activities, though this did not consistently lead to improved function or performance
• could be helpful for “adhesive capsulitis” (frozen shoulder), a condition marked by severe loss of shoulder motion that may complicate certain injuries; there are no long-term studies of WBC for this problem
• did not alter the amount of muscle damage (as reflected by blood tests) after intense exercise.

What are the downsides of whole body cryotherapy?

While whole body cryotherapy is generally considered safe and few problems have been reported with its use, some people are advised to avoid WBC because it may worsen conditions such as

• poorly controlled high blood pressure
• major heart or lung disease
• poor circulation (especially if made worse by exposure to cold)
• allergy symptoms triggered by cold
• neuropathy (nerve disease) in the legs or feet.

Local irritations, including skin burns, have been reported, although these should be avoidable with proper preparation.

Perhaps the biggest downside is cost. While first visits may be offered at a discount, a single session may run $20 to $80, and a course of treatment can cost several hundred dollars (and is not typically covered by health insurance in the US).

The bottom line on whole body cryotherapy

From the available evidence, it’s hard to know if whole body cryotherapy reliably prevents or treats any particular condition, or if it speeds recovery or improves athletic performance. And even if it did, there’s little proof that it’s more helpful than much less expensive cryotherapy options, such as simply applying ice to a sore area.

My guess is that the lack of convincing evidence that WBC works is unlikely to diminish its popularity. As long as people are convinced it’s helping (and as long as they can afford it), WBC is here to stay… at least until the next “big thing.”

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My Health - A tired child? What you should know

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Children often complain of being tired. Usually it’s for simple reasons — because it’s the end of a busy day, or because they stayed up late the night before, or because they are trying to get out of doing something they don’t want to do. When kids are sick they are usually tired, and need more rest to get better. But when a child complains all the time, and fatigue starts to get in the way of things they usually enjoy, it could be a sign of a problem.

Here are some possible reasons for chronic fatigue in children:

• Sleep problems. This makes sense, obviously, since if a child doesn’t get enough sleep, or good enough sleep, they will be tired. There are lots of ways this can happen, such as:
  • Staying up later than they should for homework or whatever reason. Children need at least 8 to 10 hours of sleep a night; if they are getting less, it catches up with them
  • Waking up frequently during the night, whether it’s because they are a light sleeper or because of a sleep disorder
  • Sleep apnea, or pauses in breathing that happen during sleep. The most common cause is enlarged tonsils or adenoids, but there are other causes as well.
• Side effects of medications. Many medications can cause sleepiness, including common allergy medications.
• Infections, such as Epstein-Barr virus. There are some infections that can make children very tired, and some of them can last for weeks or months.
• Chronic illnesses, such as asthma. When chronic illnesses are in poor control, they can cause fatigue. The reason for the fatigue depends on the illness. For example, children with poorly controlled asthma can feel frequent shortness of breath, which makes them feel tired. For some illnesses, feeling tired may be the first clue something is wrong.
• Anemia. The red cells in the blood carry oxygen to the cells in the body. When there aren’t enough of them, it causes fatigue.
• Hypothyroidism. When the thyroid gland doesn’t produce enough thyroid hormone, the metabolism of the body can slow down and make the person feel tired.
• Heart problems. This is very rare in children, but if the heart is weak, it can cause fatigue.
• Cancer or other serious diseases. These too are very rare, but feeling tired can be one of the early symptoms.
• Depression, anxiety, or other mental health problems. When life feels hard for children, for whatever reason, they may feel it and express it as fatigue. This is much more common than many of the medical reasons listed above.

Just as adults can have chronic fatigue without any clear medical reasons, children can as well. Children can feel so tired that they have trouble with normal activities such as school, sports, or playing with friends.

What to do if you have a tired child

If your child is complaining of feeling tired all the time for more than a week or two, you should make an appointment with your doctor so that the doctor can:

• Take a very careful history of the fatigue and any associated symptoms, and ask questions about everything going on in your child’s life, including sleep habits and anything that could be causing stress or anxiety
• Do a thorough physical examination, looking at your child’s weight and growth and looking for any physical abnormalities
• Do any tests that might be needed. Testing would depend on your child’s symptoms and physical examination, and could include blood tests, urine tests. or imaging such as x-rays or MRIs
• Decide if a visit with a psychologist or other mental health professional would be helpful.

Most of the time the reason for chronic fatigue in children is nothing serious — and very treatable. So instead of worrying, or spending time on Google, call your doctor’s office and make an appointment. It’s the fastest way to figure out what’s going on, and get your child back to feeling well.

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My Health - Screening mammograms: One recommendation may not fit all

To date, official recommendations on when and how often a woman should have a screening mammogram, have been based on risk factors (such as age, a family history of breast cancer, a personal history of radiation to the chest), genetic testing (the BRCA test, for example), or troubling results from a previous biopsy. Race and ethnicity have not officially factored into the equation — yet.

Does race matter when it comes to screening mammograms?

A recent study by Harvard doctors at Massachusetts General Hospital reinforces prior data suggesting that race and ethnicity can be a separate risk factor for breast cancer, and should be taken into account when advising women on when and how often to have a screening mammogram.

The authors studied almost 40 years of data in a massive, publicly available US research information bank called the Surveillance, Epidemiology, and End Results (SEER) Program, and identified over 740,000 women ages 40 to 75 with breast cancer. They wanted to know if the age and stage at diagnosis differed by race.

It did. White women’s breast cancers tend to occur in their 60s, with a peak around 65. However, black, Hispanic, and Asian women’s breast cancers tended to occur in their 40s, with a peak around 48. In addition, a significantly higher proportion of black and Hispanic women have advanced cancer at the time of diagnosis, when compared to white and Asian women.

This fits with prior studies, including a separate analysis of data from SEER as well as the Center for Disease Control’s National Program of Cancer Registries (NPCR). They found that non-Hispanic white women tend to have the least aggressive breast cancer type, while black women tend to have the most aggressive type, as well as more advanced disease at diagnosis.

Basically, there are reliable data to suggest that we take race and ethnicity into account when we counsel patients about when to start mammograms and how often to have them. While many doctors are aware of the data and are sharing this information with patients, it’s not part of “official” guidelines.

So what are the official guidelines for screening mammograms?

Well…

Breast cancer screening has become an area of some controversy, with at least six different US organizations offering varying opinions, more or less in the same ballpark (give or take 10 years, that is). For the average woman without the risk factors listed above, the recommendations range from

Every woman over age 40 should have a mammogram every year, but, it’s a shared decision-making process so talk about it first (American College of Obstetrics and Gynecology)

to

Start at age 45 and then every year until age 55, then every other year (American Cancer Society)

to

Start screening mammograms at age 50 and have them every other year (United States Preventive Services Task Force).

This variability seems confusing, but what is consistent is that all guidelines recommend a shared decision-making process. That means a woman should talk with her doctor to determine when to first have a screening mammogram, and how often she should have one.

Reasons a woman might not want to start screening mammograms at age 40

Apart from some awkwardness and discomfort, why wouldn’t a woman want to start screening mammograms at age 40? Every screening test carries some risk, including unnecessary additional imaging and biopsies. The idea is that by starting screening later, the likelihood of catching cancer early isn’t outweighed by the risks of screening. Many of my patients have gotten that dreaded callback after their mammogram: “We see something that may be cause for concern and need you to return for additional images.” This is nerve-racking and involves additional radiation exposure. If the area is still worrisome, then a biopsy may be done. Most biopsies are negative, and even when positive, we don’t know for sure that all low-grade, localized cancers are going to progress. We treat them when we find them for sure, but it’s possible that not everyone will benefit from lumpectomy and radiation or mastectomy.

What do women need to know about screening mammograms?

Doctors should counsel women accurately about their risks and benefits for cancer screening, and while guidelines are helpful, they are only guidelines. We need to know where the guidelines came from, what data was used to create them, and — most importantly — what data were not used to create them. In the case of breast cancer screening, race and ethnicity have not yet been formally included in the existing guidelines, and women need to be aware of that and what it means for them.

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My Health - Yoga for people with back pain

Whenever my lower back gets tight (which happens more often than not after being glued to my work chair for hours on end), I sit on the floor and slowly move into my favorite yoga pose: half lord of the fishes, also known as a seated spinal twist. Just a twist to the left and right never fails to restore my sore back.

Yoga is one of the more effective tools for helping soothe low back pain. The practice helps to stretch and strengthen muscles that support the back and spine, such as the paraspinal muscles that help you bend your spine, the multifidus muscles that stabilize your vertebrae, and the transverse abdominis in the abdomen, which also helps stabilize your spine.

But unfortunately, yoga is also the source of many back-related injuries, especially among older adults. A study published in the November 2016 Orthopedic Journal of Sports Medicine found that between 2001 and 2014, injury rates increased eightfold among people ages 65 and older, with the most common injuries affecting the back, such as strains and sprains. So, the question is this: how can you protect an aching back from a therapy that has the power to soothe it?

Proper form is especially important for people with back pain

The main issue with yoga-related back injuries is that people don’t follow proper form and speed, says Dr. Lauren Elson, instructor in medicine at Harvard Medical School. “They quickly ‘drop’ into a yoga pose without gradually ‘lengthening’ into it.”

This is similar to jerking your body while lifting a dumbbell and doing fast reps instead of making a slow, controlled movement, or running on a treadmill at top speed without steadily increasing the tempo. The result is a greater chance of injury.

In yoga, you should use your muscles to first create a solid foundation for movement, and then follow proper form that slowly lengthens and stretches your body. For example, when I perform my seated twist, I have to remember that the point of the pose is not to rotate as fast and far as possible. Instead, I need to activate my core muscles and feel as though my spine is lengthening. Then I can twist slowly until I feel resistance, and hold for as long as it’s comfortable and the tension melts away.

Starting yoga if you have back pain

Talk to your doctor first about whether it’s okay to begin a yoga program if you suffer from low back pain. Dr. Elson suggests staying away from yoga if you have certain back problems, such as a spinal fracture or a herniated (slipped) disc.

Once you have the green light, you can protect your back by telling your yoga instructor beforehand about specific pain and limitations. He or she can give you protective modifications for certain poses, or help guide you through a pose to ensure you do it correctly without stressing your back. Another option is to look for yoga studios or community centers that offer classes specifically designed for back pain relief.

Remember that the stretching and lengthening yoga movements are often what your low back needs to feel better, so don’t be afraid to give it a try. “By mindfully practicing yoga, people can safely improve their mobility and strength while stretching tight and aching back muscles,” says Dr. Elson.

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My Health - Digestive enzyme supplements for heartburn?

My love affair with spicy food came to a sad end a few years ago. Age — and I’m guessing too many jalapenos — have left me prone to heartburn if I eat meals with a fiery flare. My doctor says there’s no underlying condition causing the problem, and advises me to avoid the foods that seem to trigger symptoms. But that’s tricky sometimes.

So I was particularly interested when a friend suggested that an over-the-counter (OTC) digestive enzyme supplement might help. I learned pretty quickly that there are lots of ads for the pills and powders. It’s a booming business, with sales for OTC digestive enzymes of all kinds expected to reach $1.6 billion by 2025.

About the supplements touted for heartburn relief

OTC digestive enzymes claim they can help you break down food, just like digestive enzymes your own body makes (mostly in the pancreas). For example, there’s

• lipase, which breaks down fats
• amylase, which breaks down carbohydrates
• proteases and peptidases, which break down proteins.

The supplement versions of these enzymes come from plants and animals. Plant sources include bromelain, derived from pineapples; papain, derived from papayas; and lactase that’s obtained from purified yeasts or fungi. Animal sources include enzymes from the pancreases of pigs, cows, or lambs.

But there’s no way to know what’s really in supplements. The FDA does not regulate them, therefore you can’t be sure what the pills are really made of or the exact amounts of enzymes they may contain. “It’s buyer beware,” warns Dr. Kyle Staller, a gastroenterologist at Harvard-affiliated Massachusetts General Hospital.

Do supplements help heartburn?

Sometimes the body doesn’t make enough digestive enzymes. This can slow the digestion process and lead to uncomfortable symptoms.

Would a digestive enzyme supplement help treat the symptoms of occasional heartburn, caused by acid reflux, slow stomach emptying, or an unknown reason (like I have)? The answer is that we don’t know. “Unfortunately, there is little evidence that OTC digestive enzymes are helpful for heartburn,” says Dr. Staller.

But we do know that OTC digestive enzymes can help manage other conditions. For example, if you don’t make enough of the enzyme alpha-galactosidase, needed to digest the sugar in beans, you may benefit from taking an alpha-galactosidase supplement (Beano, Bean Relief).

Or if you don’t make enough of the enzyme lactase, needed to digest lactose — the sugar in milk and milk-based products — you may benefit by taking a lactase supplement (Lactaid, Lactrase). “If you don’t have lactase, the undigested lactose goes to the colon, which leads to more fluid entering the colon and more gas produced by bacteria in the colon. That creates bloating, flatulence, and diarrhea,” explains Dr. Staller. “A supplement might help.”

What about prescription enzymes?

Sometimes doctors recommend taking prescription-strength digestive enzymes. These may be necessary when digestion enzyme levels are low because of a health condition such as chronic pancreatitis or cystic fibrosis.

Taking prescription digestive enzyme medications helps bring levels back to normal. “People with known deficiencies clearly get a benefit,” says Dr. Staller.

But these medications are not appropriate treatments for heartburn.

The rest of my story

Because I am persistent, I asked if it would hurt to try an OTC digestive enzyme for occasional heartburn. Both my doctor and Dr. Staller had the same answer: “In most cases, it’s unlikely to be harmful. But don’t spend a lot of money on them,” Dr. Staller advised. In other words, it won’t hurt, but we don’t know if it will help. So don’t make a big investment in the treatment.

With that dubious green light and a lot of curiosity, I tried an OTC enzyme made from papaya. And guess what — it helped! But as a health reporter I know that this could have been the result of my own personal hope (the placebo effect) or just a happy coincidence.

I also know that ignoring my doctor’s orders to avoid spicy foods (which is my heartburn trigger, but may not be someone else’s) would be foolish, and could cause damage to my esophagus. So would using digestive enzymes as a crutch to eat anything I want.

The lesson for me is that the OTC digestive enzyme supplement is there if I need it in a pinch, and that it might or might not work.

But I won’t make a habit of using it. I’ll keep the spice factor dialed down to a lower heat, and l’ll just have to learn to love being symptom-free the way I once loved those jalapenos.

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My Health - Cholesterol: Understanding HDL vs. LDL

There are two main types of cholesterol: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). (Lipoproteins are made of fat and protein, and serve as vehicles for your cholesterol to travel through the blood.) Cardiologists are often asked about low-density lipoprotein (LDL) versus high-density lipoprotein (HDL). The difference is important to understand.

What does HDL cholesterol do?

HDL clears from the body via the liver. HDL may therefore prevent the buildup of plaque, protect your arteries, and protect you from atherosclerotic cardiovascular disease. It is considered the “good” cholesterol, and higher levels are better. A good goal to aim for is higher than 55 mg/dL for women and 45 mg/dL for men. The higher your HDL cholesterol numbers, the lower your risk is for heart disease, vascular disease, and stroke.

How to increase HDL cholesterol

Although HDL levels are driven by family genetics, you can improve HDL levels in three key ways:

• If you are a smoker, research clearly shows that quitting smoking can increase HDL.
• Adopting a heart-healthy diet low in fat and high in fiber can also modestly raise your HDL.
• Aerobic exercise can also have positive effects on HDL. Have trouble exercising? Find a buddy; research shows it helps motivate you. That exercise can be as simple as increasing the amount of walking you do (for the sake of exercise, not a stroll) each week.

Lastly, although primarily used to decrease high LDL, some statin medications may potentially increase HDL levels moderately. Any medical treatment option should be discussed with your doctor. Importantly, high HDL does not protect you from the untoward effects of high LDL.

What does LDL cholesterol do?

LDL is considered the “bad” cholesterol. It carries cholesterol to your arteries, where it may collect in the vessel walls and contribute to plaque formation, known as atherosclerosis. This can lead to decreased blood flow to the heart muscle (coronary artery disease), leg muscles (peripheral artery disease), or abrupt closure of an artery in the heart or brain, leading to a heart attack or stroke. Over a third of the US population has high LDL cholesterol. Diagnosis is made via blood testing, so if you don’t check, you won’t know.

For LDL, the lower the number the better. A good goal to keep in mind is less than 130 mg/dL if you don’t have atherosclerotic disease or diabetes. It should be no more than 100 mg/dL, or even 70mg/dL, if you have any of those conditions or high total cholesterol. It’s very important to set your own target cholesterol levels with your doctor. Obesity, a large waist circumference, a sedentary lifestyle, or a diet rich in red meat, full-fat dairy, saturated fat, trans fats, and processed foods can lead to high LDL cholesterol.

How to lower LDL cholesterol

Lifestyle and diet changes are the main ways to prevent or lower high LDL. A trial of eating a low-fat diet, regular aerobic activity, maintaining a healthy weight, and smaller waist circumference is an appropriate first step. It is best to set a timeline to achieve your goals with your doctor. In some cases, if those lifestyle changes are not enough, your physician may suggest a cholesterol lowering medication, such as a statin. If you are considering over-the-counter herbal or ayurvedic medications for cholesterol, please discuss those with your physician first as well.

Rarely, very high LDL is genetic and passed down in families. This is called familial hypercholesterolemia and is caused by a genetic mutation that decreases the liver’s ability to clear excess cholesterol. This condition can lead to very high LDL levels, and heart attack or stroke at a young age in multiple generations. Those individuals may require special medical treatment for prevention and treatment of atherosclerotic cardiovascular disease.

Remember, knowledge is the first step. If you don’t know your cholesterol levels, get tested. That will give you and your physician a starting point for lifestyle changes and medications if needed. In the meantime, adopt a heart-healthy lifestyle, and do it with friends and family no matter their ages. There’s no time like the present to prevent heart disease.

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My Health - Celebrities get shingles, too

Follow me on Twitter @RobShmerling

Perhaps you heard the news recently that Lin-Manuel Miranda has shingles. Headlines announced this in a variety of ways:

• Hamilton creator Lin-Manuel Miranda is suffering from shingles (NY DailyNews)
• Lin-Manuel Miranda has shingles; must be quarantined from his baby (today.com)
• Lin-Manuel Miranda has shingles, regrets joke about blurred vision (CBS News).

Without more information, these headlines might leave you wondering: is this a serious condition? Is it dangerous for children? Can it lead to blindness?

What is shingles?

The term “shingles” refers to a painful rash caused by infection with the varicella-zoster virus (VZV), a member of the herpes family of viruses. The typical rash usually leads to a quick diagnosis — there are groups of tiny fluid-filled “bubbles” or blisters limited to a single patch of skin. However, the rash may be preceded by burning pain over the skin, fever, fatigue, or headache. Miranda reportedly thought he was experiencing a migraine when it started.

VZV is the same virus that causes chickenpox. Anyone who has had chickenpox (usually as a child) can have the virus hidden in nerves beneath the skin. Years later it can erupt onto the skin as shingles. The name comes from the Latin cingulum, which means belt. The rash of shingles often spreads over a patch of skin in a pattern that resembles a belt.

Shingles is quite common. According to the CDC, almost one in three people will develop shingles in their lifetime. But the risk is not random. It’s more common in people over age 50 and those who have a weakened immune system. Other celebrities reported to have suffered with shingles include Roseanne Barr, Richard Nixon, and Robin Williams.

Is it contagious?

Shingles is contagious. A person who has not had chickenpox in the past and has not been fully vaccinated against chickenpox can develop chickenpox if they have close contact with someone who has shingles. The two doses of the chickenpox vaccine are recommended for children between the ages of 12 and 15 months and between the ages of 4 and 6 years old. That’s why Miranda was “quarantined” from his 8-week-old son, who has (presumably) not had chickenpox and is too young to have received the vaccination. Once the rash scabs over, usually within seven to 10 days, shingles is considered much less contagious.

Complications of shingles

Complications occur in about one in 10 people who have shingles. These include:

• continued pain (called postherpetic neuralgia) in the area of the rash, even after the rash has disappeared
• eye infection and inflammation which, although rare, can lead to vision loss
• ear inflammation and pain
• meningitis (inflammation of the lining of the brain)
• bacterial skin infection

Concern about vision loss for Miranda was real after he’d tweeted that he had blurry vision. He later clarified that it was because he’d had his pupils dilated for an eye examination, not due to the infection.

Preventing and treating shingles

Shingles can be prevented. The shingles vaccine is currently recommended for people ages 50 and older; those with weakened immune systems should not receive it. It is not 100% effective, but those who develop shingles despite the vaccine tend to have a slightly shorter duration of rash and a lower incidence of complications (especially postherpetic neuralgia).

In addition, if enough people receive the vaccination for chickenpox, the frequency of shingles may decline. Proof that this is the case may not be available for many years, since the interval between chickenpox and shingles can be several decades and the chickenpox vaccine only became widely available in the mid-1990s.

Treatment of shingles includes an antiviral medication (such as acyclovir, famciclovir, or valacyclovir) and pain medications (such as a nonsteroidal anti-inflammatory medication, tramadol, or oxycodone).

The bottom line

Shingles is a common disease that may become less frequent due to recently developed vaccinations. For most people, it’s a painful but temporary problem; when complications develop, it can be much more troublesome. Check with your doctor about vaccinations for chickenpox and shingles, any unexplained rash, or if you’re exposed to someone with shingles. Hopefully we’ll soon learn that Miranda has recovered quickly and completely.

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My Health - Giving antacids and antibiotics to babies can lead to allergies

Follow me on Twitter @drClaire

Allergies are on the rise, especially food allergies. While nobody knows for sure why this is happening, a leading theory is that we may be doing things that mess up our natural microbiome.

Our microbiome is the trillions of organisms that live on and in our bodies, such as bacteria, archaea, fungi, and viruses. We generally think of these organisms as “germs” that can cause illness — and while they can, in some situations it turns out that the right organisms in the right balance actually help keep us healthy. Our microbiome affects how we digest foods, stay at a healthy weight, fight infection, and stave off diseases like diabetes. Through its link to our immune system, our microbiome is thought to be linked to our risk of allergic reactions.

Two common types of medications, antacids and antibiotics, can mess up our microbiome. Antibiotics do it by killing not just the bacteria that make us sick, but also the bacteria that help keep us healthy. As for antacids, by making the stomach less acidic they make it more likely that bacteria from the mouth (that are normally killed by the acid in the stomach when swallowed) make it down into the intestine. Those mouth bacteria can crowd out the bacteria that our intestines need to function normally.

In a study published in JAMA Pediatrics, researchers studied almost 800,000 children from birth to about 4 years of age. They looked to see if the children got antacids or antibiotics in the first six months of life, and then tracked to see if they went on to have any allergic conditions. They found that children who got antacids were twice as likely to have food allergies as those who didn’t, and children who got antibiotics were twice as likely to have asthma as those who didn’t. Children who got either antacids or antibiotics showed an increased risk of other kinds of allergic conditions, from hay fever to severe allergic reactions.

This does not mean that infants should never get antacids or antibiotics. Antibiotics can be lifesaving for infants with bacterial infections, and there are situations when antacids can be extremely useful. But both medications are often overused. Antacids are often used in babies with reflux, or fussiness with feeding; while they can be helpful, the symptoms can be managed in other ways and usually resolve with time. Antibiotics are often used for upper respiratory infections, even though most upper respiratory infections are caused by viruses and don’t need antibiotics.

Moving forward, doctors need to be thoughtful and careful about how they prescribe antacids and antibiotics to infants, only doing it when truly necessary. Parents of infants need to be informed consumers. When given a prescription for either antacids or antibiotics, they should ask if it is truly necessary — and whether there are any alternative treatments that might be tried.

It’s about breaking old habits, and thinking about treatments in different ways based on what research is telling us. The more we learn, the more we can keep our children healthy, not just now but for the rest of their lives.

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My Health - Which diet is best for long term weight loss?

Much has been made of the recently published results of the DIETFITS (Diet Intervention Examining the Factors Interacting with Treatment Success) study. Most of the headlines emphasized the fact that the two diets involved — low-fat and low-carb — ended up having the same results across almost all end points studied, from weight loss to lowering blood sugar and cholesterol.

What’s most interesting, however, is how these two diets are similar.

The authors wanted to compare low-fat vs. low-carb diets, but they also wanted to study genetic and physical makeups that purportedly (their word) could influence how effective each type of diet will be for people. Previous studies had suggested that a difference in a particular genetic sequence could mean that certain people will do better with a low-fat diet. Other studies had suggested that insulin sensitivity may mean that certain people will do better with a low-carb diet.

What DIETFITS revealed about weight loss

The study began with 609 relatively healthy overweight and obese people, and 481 completed the whole year. For the first month, everyone did what they usually did. Then, for the next eight weeks, the low-fat group reduced their total fat intake to 20 grams per day, and the low-carb group reduced their total carbohydrate intake to 20 grams per day. These are incredibly restricted amounts, considering that there are 26 grams of carbs in the yogurt drink I’m enjoying as I write this, and 21 grams of fat in my half of the dark chocolate bar my husband and I split for dessert last night.

That kind of dietary restriction is impossible to maintain over the long term and, as this study showed, unnecessary. Participants were instructed to slowly add back fats or carbs until they reached a level they felt could be maintained for life. In addition, both groups were instructed to

• eat as many vegetables as possible
• choose high-quality, nutritious whole foods and limit anything processed
• prepare food themselves at home
• avoid trans fats, added sugars, and refined carbohydrates like flour.

People were not asked to count calories at all. Over the course of a year, both groups attended 22 classes reinforcing these very sound principles — and all participants had access to health educators who guided them in behavioral modification strategies, such as emotional awareness, setting goals, developing self-efficacy (also known as willpower), and utilizing social support networks, all to avoid falling back into unhealthy eating patterns.

Participants in both groups also were encouraged to maintain current US government physical activity recommendations, which are “150 minutes of moderate intensity aerobic physical activity (2 hours and 30 minutes) each week.”

Two different diets that are not so different after all

Get all that? Basically, the differences between groups were minimal. Yes, the low-fat group dropped their daily fat intake and the low-carb group dropped their daily carb intake. But both groups ended up taking in 500 to 600 calories less per day than they had before, and both lost the same average amount of weight (12 pounds) over the course of a year. Those genetic and physical makeups didn’t result in any differences either. The only measure that was different was that the LDL (low density lipoprotein) was significantly lower in the low-fat group, and the HDL (high density lipoprotein) was significantly higher in the low-carb group.

I love this study because it examined a realistic lifestyle change rather than just a fad diet. Both groups, after all, were labeled as healthy diets, and they were, because study investigators encouraged eating high-quality, nutritious whole foods, unlimited vegetables, and avoiding flours, sugars, bad fats, and processed foods. Everyone was encouraged to be physically active at a level most Americans are not. And — this is a big one — everyone had access to basic behavioral counseling aimed at reducing emotional eating.

When it comes to diet, everything old is new again

This whole study could just as well be called a study of sustainable healthy lifestyle change. The results jibe very much with prior research about healthy lifestyle. The end message is the same one that we usually end with:

The best diet is the one we can maintain for life and is only one piece of a healthy lifestyle. People should aim to eat high-quality, nutritious whole foods, mostly plants (fruits and veggies), and avoid flours, sugars, trans fats, and processed foods (anything in a box). Everyone should try to be physically active, aiming for about two and a half hours of vigorous activity per week. For many people, a healthy lifestyle also means better stress management, and perhaps even therapy to address emotional issues that can lead to unhealthy eating patterns.

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My Health - Can DNA markers predict aging?

It’s a bit like clockwork: Soon after an important scientific finding about health, a slew of self-help products arrive to support it. Added sugars are unhealthy? Try this diet. A sedentary lifestyle leads to disease? Do this workout.

So it’s not surprising that increasing knowledge about DNA markers for longevity called telomeres has spawned yet another round of self-help tools. The latest encourages you to measure the stuff via doctor’s office or a home kit. But should you?

Telomeres and aging

Telomeres are strings of DNA that protect the ends of chromosomes. Telomeres tend to shorten over time as they do their job, so they’re considered biological markers of aging. Unhealthy lifestyle habits — such as smoking, eating junk food, obesity, inactivity, and chronic stress — are also associated with shorter telomeres. Shorter telomeres, in turn, are associated with a lower life expectancy and higher rates of developing chronic diseases, such as cardiovascular disease.

Telomere testing to show biological aging?

According to telomere testing companies, learning your telomere length might provide insight into your “biological” age.

You’ll find the tests in several places. One is the Internet. For as little as $100, some companies will sell you a home kit that allows you to send your DNA (in a drop of blood or a cheek swab) to a lab. After a few weeks, the company mails you the test results, which tell you what your telomere length is and how that length compares to your peers.

For more money, you can talk to a company “coach,” who explains the results to you and helps you come up with a plan for healthier living.

Other (more expensive) ways to get the test include:

• going to a walk-in clinic with a doctor who’ll order the test for you and then talk you through the results
• buying and ordering a test from a company that directs you to a lab or a doctor who works in your area
• asking your own physician to order the test for you.

What the tests don’t tell you

There’s no way to know how accurate various telomere tests are. “There are a few published methods for telomere measurements. Some are better than others in terms of quality control and robustness. The most common method is called the real-time PCR method. “We run it in my lab at the Harvard Cancer Center. But it requires expertise to run the test, and there are a lot of variables,” explains Dr. Immaculata De Vivo, a Harvard Medical School professor and genetics researcher at the Dana-Farber/Harvard Cancer Center.

Having just one telomere test — even in a research lab — can’t tell you how fast your telomeres are shortening. This is because we’re not all born with the same quantity of telomeres, and because you’d need a baseline test followed over time to find out how much telomere length you’re losing.

Plus, even if your telomeres are shortening, it doesn’t mean something bad will happen. “And if your telomeres are long, it doesn’t guarantee that something bad won’t happen,” says Dr. William Hahn, a Harvard Medical School professor and chief research strategy officer at Harvard-affiliated Dana-Farber Cancer Institute.

Should you try telomere testing?

The commercial labs and clinics plugging telomere tests suggest that the results will help you make better lifestyle decisions to slow telomere shortening and increase telomere length.

Is it really possible? “There’s nothing that has been proven to prevent the shortening of your telomeres,” says Dr. Hahn.

However, since stress and unhealthy lifestyle habits have been linked to shorter telomeres, it is reasonable to suppose that stress reduction and healthy lifestyle might be beneficial. “There is mounting evidence that a healthy lifestyle buffers your telomeres,” Dr. De Vivo says.

Learning your telomeres’ status could then be a wake-up call to change behaviors associated with telomere shortening, such as eating a healthier diet, losing weight, stopping smoking, or reducing stress.

But do you really need to pay for a test to tell you that? It may be easier to adopt healthy habits associated with a longer life.

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My Health - New study once again casts doubt on PSA screening

To screen or not to screen for prostate cancer? This remains an important question. Screening relies on a highly imperfect measure, the prostate-specific antigen (PSA) blood test, which is prone to false-positive results. And with mounting evidence that survival benefits from screening pale in comparison with the harms from overtreatment — particularly incontinence and impotence — the pendulum has steadily swung away from it. Still, screening research continues, in the hopes that some lifesaving benefits may be found.

Now the latest study once again casts doubt on PSA screening as an effective public health tool.

British scientists divided more than 400,000 men between the ages of 50 and 69 into two groups: one was screened for prostate cancer with a single PSA test, and the other wasn’t tested for the disease at all. After an average of 10 years of follow-up, prostate cancer death rates in both groups were nearly identical. Cancer was detected more often in the screened group, but mostly it was low-grade, with a questionable need of treatment.

“This was the largest study of PSA screening to date, and the results don’t support it,” said Dr. Michael J. Barry, a professor of medicine at Harvard Medical School, and author of an editorial accompanying the published study.

Called the Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP), the study’s approach of giving men a single PSA test differs from the more traditional strategy of testing men repeatedly every few years. However, prior studies investigating repeated PSA tests have reached similar conclusions. One European study with 162,000 men, for instance, concluded that for every life saved by screening, 27 men would be diagnosed and treated for prostate cancer that wouldn’t have been lethal if left undetected.

During the CAP study, 189,386 men were assigned to screening and 219,439 men were assigned to a non-screening control group. After 10 years on average, 549 of the screened men had died from prostate cancer, compared to 647 men in the control group who hadn’t gotten a PSA test. The number of prostate cancer deaths among the controls was higher, but so was the number of men in that group to begin with. So the researchers adjusted for the different sample sizes with a statistical tweak: they compared death rates in terms of person-years, or the total number of years that men in either group had participated to the study. Analyzed that way, the study revealed 0.30 prostate cancer deaths per 1,000 person-years in the screened group, and 0.31 deaths from prostate cancer per 1,000 person-years in the controls, which amounts to a negligible difference.

Dr. Barry, who was recently a member of the US Preventative Services Task Force, an influential group of independent experts who publicly discourage PSA screening, emphasized that most men who opt for the test get it more than once. And with each additional PSA test, he said, the odds of being diagnosed with prostate cancer grow higher. “But is repeat screening worth the risk of a low-grade cancer diagnosis and all the treatment complications that come with it?” he asked. “It’s hard for us as clinicians to make those decisions for our patients. We need to make them with our patients to determine if they feel those risks are worth taking on.”

Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org, agreed. “This study adds to the discouraging screening literature, and again, simply does not support screening of asymptomatic individuals,” he said.

Fortunately, Garnick added, men diagnosed with prostate cancer following a PSA test may not have to be treated either in the short or long term. Depending on tumor characteristics, some can opt to have their cancer monitored with active surveillance, which relies on periodic prostate biopsies or MRI to look for new signs that treatment may be necessary. “Hopefully, current research that uses sophisticated genetic testing or biomarkers of prostate cancer may help provide more precise information about those who are likely to most benefit from screening and treatment,” Garnick said. “But we are not there yet.”

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My Health - Eat these foods daily (or at least often)

Improving your diet can seem like a lofty goal, one that people often think requires rigid self-discipline and sacrifice. Cupcakes out, pizza out, treats out, sigh.

But it doesn’t really have to be that way. Sometimes making better decisions for your body can be about adding — not taking away. This may create a more palatable option for those looking for a health boost that feels like a bonus, not a burden.

But what to add? I asked Teresa Fung, adjunct professor in the department of nutrition at the Harvard T.H. Chan School of Public Health for her advice on what foods pack the biggest nutritional punch to a daily diet. Below is her list of five well-balanced options that she says you should eat every day — or at least as often as possible.

1.  Salmon. This oily fish, known for its bright pink color, is rich not only in healthy protein but also in omega-3 fatty acids, which benefit both your heart and your brain. It also provides you with bone-building vitamin D. Still, serving up salmon every day would be a stretch for most people. Aim instead to eat it at least once a week to reap the health benefits, says Fung.

2.  Brussels sprouts. These crunchy little green balls, which look like mini-cabbages, are nutrient-dense and low in calories — only 28 in half a cup. They offer up a well-rounded group of vitamins, including vitamin A, vitamin C, vitamin K, potassium, and folate. Like other cruciferous vegetables, Brussels sprouts feature bioactive compounds, such as antioxidants, which are chemicals that help prevent cell damage inside your body. Taste-wise, Brussels sprouts may be a controversial pick, because while they’re certainly cute, some people find them bitter. If you’re firmly in the “dislike” camp, you can substitute other green vegetables for Brussels sprouts to get a similar nutritional boost. But keep an open mind. You can reduce the bitterness of Brussels sprouts by roasting them with a spritz of olive oil. Add some chopped nuts to the top for a little extra crunch and flavor (as well as extra benefits; see below).

3.  Blueberries. These dark-colored little berries are high in antioxidants, particularly vitamin C, says Fung. Weighing in at 56 calories for 100 grams, blueberries also offer up a good dose of vitamin A and fiber. While most grocery stores will stock blueberries year-round, feel free to substitute another dark-colored fruit — like pomegranates or cherries — if blueberries aren’t in season. Or for some variety, swirl up some frozen blueberries, which taste good at any time of year, with plain yogurt (see below) to make a smoothie.

4.  Nuts. Crunchy and satisfying, nuts not only are filling but also provide an infusion of healthy oils, protein, and vitamin E. Choose any type of nuts: almonds, walnuts, even peanuts (technically a legume), or grab a handful of mixed nuts. Just make sure they’re unsalted, says Fung. But keep in mind these are a high-calorie treat. Depending on the type of nut you choose, an ounce can ring in at 200 calories or more — so limit daily intake to a sprinkling to get the benefits without packing on any extra pounds.

5.  Plain yogurt. This creamy treat gives you a dose of probiotics, which are healthy bacteria that help keep your gut working properly and contribute to better overall health. Yogurt is a nutrient-rich food that fuels your body with protein, calcium, magnesium, vitamin B₁₂, and some key fatty acids that your body needs to stay healthy. And if you choose a high-protein yogurt, it can keep you feeling full, which may help you trim your waistline. While you may prefer flavored yogurts, it’s better to stick with plain. “The problem with flavored yogurt is some of the brands out there have way too much sugar,” says Fung. Sugar negates many of the health benefits of yogurt. Plain yogurt too tart? Toss in some blueberries for added sweetness, says Fung, or add nuts for some crunch. These simple additions can improve the taste, and you can check off three of the foods on this list in one easy snack.

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My Health - Interval training: More workout in less time (and you can do it)

You’ve heard it a million times — exercise benefits your body, your brain, and your quality of life. You’re sold, but the problem is it can be hard to carve the needed time out of a busy day. If your schedule is putting the squeeze on your workouts, there may be a way to get the same fitness benefits in less time: interval training.

Interval training uses short bursts of strenuous activity to ramp up your heart rate and boost your fitness. The word strenuous probably sounds a little scary if your fitness level is closer to couch potato than super athlete, but interval training can work for almost anyone.

“If done properly, it can be safe for the vast majority of people,” says Dr. Meagan Wasfy, an instructor in medicine at Harvard Medical School and a cardiologist at Massachusetts General Hospital.

The trick is to define “high intensity” based on your fitness. For an elite athlete, high intensity might mean grueling wind sprints, but if you’re not that fit, it might be as simple as incorporating a few brief periods of speed walking or slow jogging into your morning walk.

Getting started with interval training

While interval training is safe for most people, it might not be appropriate for those with heart problems, breathing disorders, or other medical conditions. So, as with any new exercise regimen, it’s always a good idea to get clearance from your doctor before you begin. Once you get the go-ahead, you can start incorporating intervals into your fitness program a little at a time.

Your goal should be to perform at least a half-hour exercise session five times a week, with the first five and last five minutes devoted to warm-up and cool-down, says Dr. Wasfy. The actual workout should last 20 minutes, alternating between high and low intensity for whatever activity you are performing. For example, you might swim or cycle more intensely for 30 seconds, and then slow back down for 30 seconds to recover before speeding up again. You can use longer recovery periods initially if you need to.

While these high-intensity intervals that get your heart rate up can be as short as 30 seconds, the goal should be to extend them over time, eventually working up to high-intensity intervals that are at least two minutes long.

Those short bursts of activity can considerably improve the benefits of your workout. Ultimately, “during a 30-minute workout, including warm-up and cool-down, between 10 and 15 minutes will be at high intensity,” says Dr. Wasfy. But it will be a more productive 30 minutes than it would have been using a traditional workout format. “If you think about exercise volume as calories burned or steps taken, you will get more done in the same period of time,” she says. “This is appealing to people who are fitting exercise into a busy schedule.”

Initially, you may not have the endurance to perform interval training during all your weekly workout sessions, but you can slowly build up on that end as well.

Taking cues from your body

In order to successfully incorporate interval training, you have to listen to your body and respond to it accordingly. “The downside of interval training is that any time you are pushing your body to high intensity, you may unmask symptoms of underlying health problems,” says Dr. Wasfy. For example, a heart blockage that might not bother you on a regular walk could produce symptoms during interval training. The same could be true of musculoskeletal problems — a budding knee problem could get worse quickly when you are doing high-intensity intervals. So, be certain to pay attention to your physical needs. If you notice a problem, talk with your doctor.

Fostering fitness gains

Studies show that interval training, performed safely and correctly, may help you achieve more rapid fitness gains. Those short, high-intensity bursts help your body get used to exercising at a higher level, which makes it easier for you to do more at that level over time. If you’re not getting into that zone on a regular basis, your functional fitness will stagnate, says Dr. Wasfy. For example, a brisk daily walk is great, but it won’t improve your fitness beyond a certain point if you’re not moving your body into that higher-intensity range. Challenge yourself to help increase capacity. You’ve got to feel a little uncomfortable to ratchet up your fitness level, she says. Interval training allows you to do this incrementally.

In addition to its other benefits, interval training can reduce blood pressure and other cardiovascular risk factors, as well as improve blood sugar control, research shows. The American Society of Sports Medicine says the practice can also help you lose weight — particularly that troublesome abdominal fat — and maintain muscle mass.

In addition to squeezing a better workout into a shorter period of time, interval training can jolt you out of an exercise slump by adding a little interest and excitement to a stale routine.

So, next time you work out, try incorporating intervals, and take your old workout to new levels.

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