My Health - Fat is more than calorie storage

A group of researchers based at the Joslin Diabetes Center and Harvard Medical School just published a paper in the journal Nature Metabolism that tells us something new and amazing, as well as confirms something we all know already.

They studied a protein that is secreted by mouse and human fat cells in response to cardiovascular exercise. The protein, called transforming growth factor-beta 2, or TGFB2, is an adipocytokine (which literally means “fat cell movement”) that seems to lower blood sugars in mice. Previous research has shown that transplanting fat cells from mice of normal weight who exercised on a wheel into mice who were overweight and sedentary resulted in improved blood sugars.

These researchers administered this “fat cell movement” protein to mice with diet-induced obesity for nine days, and found significantly improved blood sugar response to a sugar load as well as increased sensitivity to insulin, both markers of improved metabolism and lower risk for diabetes.

They found that human fat cells also secrete TGFB2 in response to cardiovascular exercise. They hypothesize that TGFB2 could be used as a treatment for the metabolic problems often linked to obesity, such as glucose intolerance, insulin resistance (both of which increase risk for developing diabetes), and diabetes.

But they also state the obvious conclusion: exercise training improves metabolism.

Why take a pill when you can take a walk?

From my perspective, the next step is not to discuss how we can make this protein into a profitable pill, but rather to discuss how we can become more active in our day-to-day lives.

We know that activity — any activity — has multiple health benefits beyond those on blood sugar. This blog has reviewed research showing that exercise lowers cardiovascular risk, relieves stress, improves memory and cognition and mood, prevents dementia, increases longevity, helps treat cancer, and on and on.

Right now, the recommended weekly amount of physical activity for adults is at least 150 minutes of moderate activity (think walking or easy biking) or 75 minutes of vigorous activity (think running or stair climbing). Children and teens should be getting 60 minutes per day of moderate to vigorous activity. These evidence-based recommendations were released by the US Department of Health and Human Services and are supported by many organizations, including the American Heart Association. (Check out our post on the new activity guidelines.)

According to a 2018 CDC study based on survey data from over 150,000 Americans from all 50 states, only 23% of adults meet those activity levels.

How can we make that happen?

On an individual level, we can realize that all activity counts, and it doesn’t have to be at the gym.

On a family level, we can make playtime more active by encouraging more outdoor play (basketball, biking, jumping rope) and discouraging indoor sitting time (video games, television). We can make family time more active by taking walks, hiking, or doing sports together.

On a community level, we can work to make walking or biking to school safer for kids, and organize or get involved with activities like town soccer leagues.

There’s more, of course, a lot more, and all of it is better (and safer) than taking another pill.

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My Health - Can vaping help you quit smoking?

It’s hard to overstate the dangers of smoking. Nearly 500,000 people die of tobacco-related disease each year in the US. Over the next decade, estimates are that around eight million people will die prematurely worldwide each year due to tobacco use. The list of tobacco-related diseases and conditions is long and growing. It includes:

• cardiovascular disease, including heart attack and stroke
• emphysema, bronchitis, and asthma
• lung and other types of cancer
• tooth decay
• weathering of the skin
• having a low-birthweight baby
• diabetes
• eye damage (including cataracts and macular degeneration).

And there are others. The point is, if you smoke, you should try hard to quit. And if you don’t smoke, don’t start!

While the dangers of smoking are clear, the best way to quit is not. In fact, there is no single best way. And most people who quit for good have to try more than once before they succeed.

What about e-cigarettes?

Users of electronic cigarettes (e-cigarettes) inhale an aerosol created by heating nicotine, flavorings, and other substances. There seems to be general agreement that vaping(the term often used to describe use of e-cigarettes) is safer than smoking cigarettes. That said, vaping can cause mouth or throat irritation, nausea, and coughing, and the long-term effects are not yet known.

E-cigarettes have been in the news a lot lately because of concerns that they are being marketed to kids, with flavor options such as cotton candy, cupcake, and tutti-fruiti. One survey found that about 80% of middle school students had seen ads for e-cigarettes. Since we know that nicotine is highly addictive and the long-term risks to kids of vaping are not known, the rising popularity of vaping among young people might create a host of unforeseen health problems in the future.

And that’s not an idle concern. Animal studies and limited human research have shown that vaping can lead to changes in the airways that are similar to those caused by smoking. And some of the same chemicals detected in the flavorings have been removed from food products because they’ve been linked with health problems. There are also concerns that teenagers who become addicted to nicotine by vaping may be more likely to smoke cigarettes as adults or try other addictive drugs such as opiates. Finally, “dual use” of tobacco products — vaping and smoking cigarettes — is not rare. A 2015 survey cited by The Truth Initiative (an anti-tobacco organization) found that nearly 60% of e-cigarette users also smoked cigarettes.

What about vaping to help you quit smoking?

Advocates of vaping have promoted it as a way to help cigarette smokers to quit. Although giving up nicotine products altogether might be the ultimate goal, there may be health benefits to a smoker who becomes a long-term vaper instead, though this remains unproven.

A new study compares vaping with other common nicotine replacement approaches as a way to help smokers quit. The findings support the idea that vaping may help some smokers.

Researchers recruited nearly 900 people who wanted to quit smoking, and randomly assigned half to receive e-cigarettes and the other half to receive other nicotine replacement products (such as nicotine patches and gum). All of the study participants received weekly individual counseling for four weeks. After one year, smoking cessation was confirmed by measures of exhaled carbon monoxide (which should be low if you’ve quit but high if you’re still smoking).

Here’s what they found:

• Among those assigned to vaping, 18% had stopped smoking, while about 10% of those using nicotine replacement therapy had quit.
• Among successful quitters, 80% of those in the e-cigarette group were still vaping; only 9% of those in the nicotine-replacement group were still using those products.
• Reports of cough and phlegm production dropped more in the e-cigarette group.

So, while e-cigarette use was associated with nearly twice the rate of smoking cessation, more than 80% of smokers entering this study continued to smoke a year later. One other caveat to note: the e-cigarettes used in this study contained much lower levels of nicotine than found in some common brands used in the US (such as Juul). The importance of this difference is unclear, but a higher nicotine level could contribute a higher rate of addiction to the e-cigarette.

Recommended ways to quit smoking

If you’re trying to kick the habit, you’ll get lots of advice. Many people try to quit cold turkey, but success rates are quite low. Hypnosis and acupuncture seem to work for some people, but these remain unproven. The best studied smoking cessation strategies include:

• behavioral therapy, such as individual counseling
• nicotine replacement therapy, such as a long-acting nicotine patch and short-acting nicotine gum
• medications to reduce the urge to smoke, such as varenicline (Chantix) or bupropion (Zyban).

In studies of these approaches, quit rates were around 20% to 25% over six to 12 months. While these may seem low, they’re significantly higher than observed among people trying to quit on their own.

What’s next?

While I think concerns about vaping are appropriate (especially regarding use among youth), this study demonstrates that it could help people quit smoking. So, vaping could soon get approval from the FDA as a smoking cessation aid, but even if that happens, it should not be the first choice given how much is still unknown. It’s possible we’ll see regulations and legislation on vaping in this country, including a higher age limit on its use, a ban on its marketing to young people, a limit to nicotine concentrations, and even a ban on flavored e-cigarettes altogether.

Ultimately, we’ll need good studies to assess the long-term safety of vaping, to confirm that when used to aid smoking cessation we aren’t just replacing one bad habit with another.

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My Health - Do you really have a penicillin allergy?

Chances are, you or someone you know is one of the 10% of Americans with a documented penicillin allergy. But just because you were told you had a penicillin allergy, or had one in the past, does not mean you have one now. People with a penicillin allergy history have their allergy disproved with allergy testing more than 90% of the time.

Penicillin: a primer

Penicillin is part of a larger drug class called beta-lactam antibiotics, which include the common penicillins and cephalosporins.

Common penicillins include ampicillin, amoxicillin, and Augmentin. Among other uses, penicillins are often used to treat ear infections, strep throat, sinus infections, and to prevent dental infection. Cephalosporins are used for similar reasons. Certain intravenous (IV) cephalosporins are important for hospitalized patients.

What is a true penicillin allergy?

True allergies can result from any medication. Symptoms can range from mild, like itching, to severe, like anaphylaxis, which can involve low blood pressure and difficulty breathing. If a reaction to penicillin included skin redness, itching, rash, or swelling, there may have been a penicillin allergy, but these symptoms can also occur for other reasons. Shortness of breath, wheezing, fainting, and chest tightness are all reactions that may indicate anaphylaxis. These reactions can be safely evaluated by a trained medical professional. Even patients with severe penicillin allergy histories are often able to take penicillins safely again, because penicillin allergy often does not persist for life.

Rarely, people have reactions to drugs, such as peeling or blistering skin, or liver or kidney injury, that are so troubling that we recommend avoiding the medication in the future.

Side effects like fatigue, nausea, and vomiting are not allergies, but because side effects are recorded in the “allergy” section of health records, their documentation contributes to confusion surrounding what is a true penicillin allergy.

Why does it matter if I have a true penicillin allergy or not?

People with a penicillin allergy on their medical record are not given penicillins, and may not be given any beta-lactam antibiotics because of concern that the allergy is shared across the antibiotic class. Instead, the antibiotics prescribed may be broader-spectrum. Broad-spectrum antibiotics may be as effective, but they often have more side effects and toxicities, such as increased risk of developing infections like C. diff (Clostridioides difficile, formerly called Clostridium difficile) or methicillin-resistant Staphylococcus aureus (MRSA). Confirming or ruling out a penicillin allergy through allergy testing could justify the risk, or potentially avert it by allowing your doctor to prescribe beta-lactams.

In other cases, your doctor may have to prescribe less-effective drugs than penicillins and cephalosporins because of a documented penicillin allergy.

What does penicillin allergy testing entail?

An allergist can assist in the diagnosis of a penicillin allergy using a skin test. This test involves pricking the skin, usually on the back or on the inside of the forearm, and placing a small amount of allergen on the punctured skin. The allergist will compare how your skin reacts to penicillin versus a positive control (histamine) and a negative control (saline). Anyone with a positive skin test to penicillin — there’s usually itching, redness, and swelling at the site of the skin prick — is allergic and should avoid penicillin.

People who have no reaction to the skin test can safely undergo the amoxicillin challenge. In this test, the allergist gives the person amoxicillin and observes signs and symptoms for at least one hour. This is done under medical supervision.

Although these tests are very useful for diagnosing penicillin allergies that are immediate, there are other types of allergies that may still occur. The most common is a minor drug rash that happens days into the course of antibiotic treatment.

When should I get tested?

I am often asked to evaluate penicillin allergies when a patient needs penicillin or another beta-lactam, and the documented allergy is obstructing the best treatment. However, the best time to have a penicillin allergy evaluated is when you’re healthy.

You can discuss allergies as part of routine health maintenance with a primary care doctor or pediatrician. Clarifying medication allergies is also a good idea before an operation; a penicillin allergy can impact infection risk, and allergies to latex and pain medications can get in the way of a smooth operation and post-operative period. Finally, women of childbearing age who are thinking of conceiving might want to evaluate an allergy to penicillin. Penicillins are used for infections in pregnancy and during deliveries for a variety of reasons. Pregnant patients can also be evaluated safely for a penicillin allergy in their third trimester.

Follow me on Twitter @KimberlyBlumen1

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My Health - Diet and exercise limit heart disease risk in men undergoing hormonal treatments for advanced prostate cancer

Men with advanced prostate cancer are typically treated with drugs that prevent the body from making or using testosterone. A hormone (or an androgen, as it’s known), testosterone drives prostate cancer cells to grow faster, so shutting it down is essential to keeping the illness in check. About 600,000 men with advanced prostate cancer in the United States today are undergoing this type of anti-hormonal treatment, which is called androgen deprivation therapy (ADT). But even as ADT helps men live longer, it exerts a toll on the body. Men can lose muscle and bone mass, gain weight, and they face higher risks for heart disease and type 2 diabetes.

The good news is that a few helpful strategies can lessen these metabolic side effects. Engaging in aerobic exercise and resistance training, for instance, has been shown to drop levels of inflammation in the body that might otherwise lead to heart disease. Quitting smoking is similarly beneficial, since tobacco smoke’s toxic effects on the heart are more pronounced in the absence of testosterone.

In a new study, researchers have shown that taking daily walks and eating a low-carbohydrate diet can also lessen ADT’s harms. During the investigation, 42 men who were just starting on ADT were split into two groups: Half the men took daily walks lasting at least half an hour five days a week, and were instructed to limit their carbohydrate intake to no more than 20 grams per day. The other half of the men (the control group) maintained their usual diet and exercise patterns.

After six months, typical weight loss among men in the walking/low-carbohydrate group was about 20 pounds, compared to a nearly 3-pound weight gain among men who stuck to their usual dietary and exercise routines. Men in the walking/low-carbohydrate group also had significantly higher blood levels of high-density lipoprotein (HDL), which removes cholesterol and lessens risks of atherosclerosis and heart disease. And they also had significant improvements in insulin resistance (a pre-diabetic condition), but only at three months and not when the levels were checked again three months later.

The study’s lead author, Dr. Stephen Freedland from Cedars-Sinai Medical Center in Los Angeles, California, says exercise combined with low-carbohydrate diets appears to be a promising strategy in men undergoing ADT that should be studied further. 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, pointing out that weight gain can be a real problem for men that endures even after ADT is discontinued. “The weight loss in the experimental group is encouraging and should be validated in larger studies,” he said. “In the meantime, combining exercise with low-carbohydrate diets is a common-sense strategy that clinicians should recommend to their patients.”

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My Health - Infertility: Maintaining privacy, avoiding secrecy

When Michelle Obama’s memoir, Becoming, was released in October 2018, several reviewers noted that her book reveals that the Obamas struggled with infertility. When I was lucky enough to receive a copy as a gift, I learned that Michelle and Barack didn’t simply have a ‘touch of infertility’: they went through IVF in order to have both Malia and Sasha.

Why, some reviewers seemed to wonder, was the public learning this significant piece of the Obamas history now? And, to be bipartisan about it, we learned in Laura Bush’s 2010 memoir, Spoken From the Heart, that she and her husband had endured a long struggle with infertility and were planning to adopt when they found they were expecting twins Jenna and Barbara.

My response is this: The Obamas and the Bushes, so different in so many ways, share the perspective of countless other infertile couples and individuals: infertility is not a secret, but it is private.

One might also say that the Obamas and Bushes acknowledge their infertility because it is in the past. For both couples, it brought them two cherished daughters. I have seen that when people are in the trenches of infertility, questions about what to say, when, and how swirl around in their heads.

Secrets, truth, and privacy

Most people recognize the danger of secrets. Secrets lead to feelings of shame. They distance family and friends and promote misunderstandings. Couples determined to tell no one about their infertility may find others assume they don’t want children, are selfish, or are clueless in thinking they can wait as long as they want. Hence, most people coping with infertility decide to tell others something — the challenge for them is avoiding the pitfalls of too much information.

When counseling infertility patients, I often suggest that they tell a simple truth. Not the whole truth. Not nothing but the truth. Less is more when it comes to talking about infertility.

Couples can think through what they want others to know. In most instances, it is simply that they want children, are having trouble making that happen, and are receiving good medical care. They want others to respect their privacy and to simply stay tuned, knowing that when there is good news to be shared, they will joyfully share it. Specifics of diagnosis, types, and timing of treatments are usually too much information.

Maintaining privacy while avoiding secrecy also arises when individuals and couples are exploring or pursuing other paths to parenthood, such as adoption, egg or sperm donation, or surrogacy. Again, I advise people to share only what others really need to know. Adoption is never a secret these days. But how much do others really need to know while people are waiting for a match with a birth mother or counting down the hours until she signs surrender papers? Often, it adds to the stress of the situation.

Is there an obligation to tell?

Similarly, when people choose egg or sperm donation, do they have an obligation to tell all to others? Years ago, I thought that those who did not acknowledge donor conception were being secretive. Then I realized that fertile heterosexual couples do not tell others how they conceived. Why should it be different for those who participate in third-party reproduction?

On NPR one day, I heard a wonderful interview with an author who had a baby at 50. The interviewer said, “I understand that you had a baby at an older age.”

“Yes, we are so fortunate that there are all sorts of ways to become pregnant these days,” the author responded. She spoke a simple truth and felt no need, it seemed, to tell the whole truth and nothing but the truth.

Privacy and dignity

The word that I have come to pair with privacy is dignity. Perhaps it is my response to living in a time of oversharing. I believe a certain dignity comes with maintaining privacy, especially when it comes to one’s family. Years ago I realized this when a couple I was counseling adopted their son. I was overjoyed for them and filled with questions. They answered some of my questions: where he was born, how long they had to remain out of state. They chose not to answer questions regarding his birth family.

“We feel that’s our son’s story to tell or not tell,” they said. “Until he is old enough to make these decisions for himself, we want to respect his privacy.”

Infertility so often feels like an out of control experience. By actively making decisions about privacy and secrecy, it’s possible for people to take back some of their lost control and gain pride in their ability to tend to and preserve their unfolding family story.

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My Health - Sweeteners: Time to rethink your choices?

When it comes to low-calorie sweeteners, you have a lot of choices. There’s the blue one, the pink one, the yellow one, or the green one. Whichever one you choose, know that scientists have probably studied it extensively. What they’ve found may surprise you.

Artificial and other non-caloric sweeteners: The major players

The marketers for artificial sweeteners have color-coded their products, but they differ in some important ways beyond their packaging. In the US, the most popular FDA-approved non-sugar sweeteners (NSSs) and their most common packaging color are:

• aspartame (blue): examples include Nutrasweet and Equal
• saccharin (pink), as in Sweet’N Low
• stevia-derived (green), including Truvia
• sucralose (yellow), as in Splenda.

How are they different? Stevia is considered a “natural non-caloric sweetener.” Saccharin and sucralose are considered “non-nutritive sweeteners” (few or no calories). Aspartame is a “nutritive sweetener” (adds some calories but far less than sugar).

Aspartame comes with a warning to be used cautiously (or not at all) by people with a rare genetic disease (called phenylketonuria, or PKU) because they have trouble metabolizing it; that’s not true for the other sweeteners. And all four vary on their level of sweetness and aftertaste, which is likely why people often prefer one over another.

Researchers take on artificial sweeteners

The reason these sweeteners exist is that people want to eat or drink sweet foods and drinks without the calories of sugar. We assume that over time, fewer calories will translate to less weight gain, more loss of excess weight, and lower risk of weight-related problems such as diabetes and high blood pressure. Although unproven, such assumptions seem reasonable: a 12-ounce can of Coca-Cola contains nearly 10 teaspoons of sugar totaling 140 calories. Over time, such empty calories can add up to many pounds of weight gain. As a result, non-caloric sweeteners long been a mainstay of dieters or anyone trying to limit caloric or sugar intake.

Are there downsides to non-sugar sweeteners?

Despite the rationale above, the effectiveness of using NSSs to lose weight, avoid weight gain, or achieve other health benefits is unproven. In fact, some studies (such as this one) found that people who often drank diet soda actually became obese more often than those who drank less diet soda or none. Another study found higher rates of metabolic syndrome and type 2 diabetes among the highest consumers of diet soda. How can this be? Researchers speculate that using NSSs may cause cravings for sweet foods, alter taste perception, or change how nutrients are absorbed. And of course, it’s possible that people simply justify eating more high-calorie (and potentially less nutritious) foods because they’ve chosen diet sodas.

In addition, research has raised questions regarding safety over the years. For example, cyclamate (which was often combined with saccharin) was banned from all US food and drink products due to concerns regarding cancer risk. Saccharin’s possible link to cancer led to a warning label; as additional research suggested no increased cancer risk in humans, this warning was dropped in 2000.

There have been reports of headaches, learning difficulties, changes in the balance of bacteria in the intestinal tract, and other problems associated with NSS consumption.

Can a new study lay safety concerns to rest?

Given all of these concerns, researchers in Europe took on the task of trying to assess the risks and benefits of various NSSs with an analysis of the best research available, including 56 previously published studies. They sought to determine the effect of various NSSs on the health of adults and kids, including those who were overweight, obese, or at a healthy weight. The effects they studied included:

• body weight
• oral health
• blood sugar
• eating behavior
• cancer risk
• cardiovascular disease risk
• kidney disease risk
• mood and brain function.

Spoiler alert: More research is needed

After an exhaustive examination of the most relevant studies, researchers concluded that:

• There were no clear differences in health outcomes between people who used NSSs often or not at all.
• No clear health benefits were observed with NSS use, but “potential harms could not be excluded.”
• The quality of the research to date wasn’t very good, and no definitive conclusions could be made regarding NSS use and these important health effects.

Disappointed? I am. Then again, at least no dramatic or severe harms were detected. And I was glad they didn’t find that my favorite (stevia) was the worst of the bunch. Until we know more, it seems reasonable to suggest the usual: “all things in moderation.” Read nutrition labels and try not to consume more than a few servings per day of any NSS.

Or, do the unthinkable: do without them.

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My Health - Should I be eating more fiber?

You probably know the basics about fiber: it’s the part of plant foods that your body cannot digest, and there are two types — soluble fiber and insoluble fiber. Both types of fiber are good for us.

Soluble fiber dissolves in water, forming a gel. It is the form of fiber that helps lower cholesterol levels, reduce the risk of heart disease, and regulate blood sugar levels. Soluble fiber is found in black beans, lima beans, Brussels sprouts, avocado, sweet potato, broccoli, turnips, and pears.

Insoluble fiber passes through the digestive system relatively intact, adding bulk to stools. It is the form of fiber that prevents constipation and regulates bowel movements, removing waste from the body in a timely manner. Insoluble fibers are found in whole wheat flour, wheat bran, cauliflower, green beans, and potatoes.

Despite these health benefits, most Americans get less than half the suggested amounts of daily fiber. The popularity of very-low-carbohydrate diets like the ketogenic or “keto” diet, the Atkins diet, and the Whole 30 diet, which may unintentionally decrease fiber consumption, hasn’t helped matters.

It may be time to give fiber another look.

New evidence confirms protective effect of fiber

A new analysis of almost 250 studies confirmed on a large scale that eating lots of fiber from vegetables, fruits, and whole grains can decrease your risk of dying from heart disease and cancer. Those who ate the most fiber reduced their risk of dying from cardiac disease, stroke, type 2 diabetes, and/or colon cancer by 16% to 24%, compared to people who ate very little fiber. The study also concluded that more fiber is better. For every additional 8 grams of dietary fiber a person consumed, the risk for each of the diseases fell by another 5% to 27%. Risk reductions were greatest when daily intake of dietary fiber was between 25 and 29 grams.

Two observational studies showed that dietary fiber intake is also associated with a decreased risk of death from any cause. Those eating the highest amount of fiber reduced their risk of dying by 23% compared to those eating the least amount of fiber. In these studies, the associations were more evident for fiber from cereals and vegetables than from fruit.

Weight control is another benefit of high-fiber diets. By helping you feel full longer after a meal or snack, high-fiber whole grains can help you eat less. In one large study, adults who ate several servings of whole grains a day were less likely to have gained weight, or gained less weight, than those who rarely ate whole grains.

Fiber: how much is enough?

On average, American adults eat 10 to 15 grams of total fiber per day, while the USDA’s recommended daily amount for adults up to age 50 is 25 grams for women and 38 grams for men. Women and men older than 50 should have 21 and 30 daily grams, respectively.

In general, it’s better to get your fiber from whole foods than from fiber supplements. Fiber supplements such as Metamucil, Citrucel, and Benefiber don’t provide the different types of fiber, vitamins, minerals, and other beneficial nutrients that whole foods do.

When reading a food label, choose foods that contain more fiber. As a rule of thumb, choose cereals with 6 or more grams of fiber per serving, breads and crackers with 3 or more grams per serving, and pasta with 4 or more grams per serving. Another strategy is to make sure that a whole-grain food has at least 1 gram of fiber for every 10 grams of carbohydrate. If you look for a 1:5 ratio, that is even better.

Ignore the marketing on front of the package labels. Just because a bread is labeled “multigrain” or “12 grain” does not mean it is a whole grain. The grains could be refined and the bread may be low in fiber. When you look at the ingredient list, make sure “whole” is the first ingredient.

Easy ways to get more fiber in your diet

Here are some strategies to increase fiber in your diet:

• Start your day with a bowl of high-fiber cereal.
• Add vegetables, dried beans, and peas to soups.
• Add nuts, seeds, and fruit to plain yogurt.
• Make a vegetarian chili filled with different types of beans and vegetables.
• Add berries, nuts, and seeds to salads.
• Try snacking on vegetables such as cauliflower, broccoli, carrots, and green beans. Serve them with a healthy dip such as hummus or a fresh salsa.
• Eat more whole, natural foods and fewer processed foods.

A few important tips as you increase your fiber:

• Do so gradually to give your gastrointestinal tract time to adapt.
• Increase your water intake as you increase fiber.
• If you have any digestive problems, such as constipation, check with your physician before dramatically increasing your fiber consumption.

Take a positive approach to eating more high-fiber foods. Beyond reducing risk of chronic disease, eating a variety of whole foods that contain good sources of fiber can be an easy and enjoyable way to keep you fuller longer and help control your weight. Fiber can expand your horizons with different tastes and textures, and can be a bonus to your health.

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My Health - Can facial exercises reverse signs of aging?

Patients often come into my office asking, “How can I look younger?” While I always recommend healthy living — a balanced diet and regular exercise — in order to look and feel younger, I have never thought of facial exercises as part of that regimen. That is, until a recent study, published in JAMA Dermatology, showed promising results that routine facial exercise may slow the unrelenting tide of time.

Facial exercises: A fountain of youth for your face?

The rationale behind the study stems from the fact that a major part of facial aging is due to the loss of fat and soft tissue, which leads to sagging and exaggeration of wrinkles. If we can lift weights at the gym and enlarge our biceps, why couldn’t the same be done for muscles in our faces, thereby filling out those contours to create a more youthful countenance?

The concept of facial exercise is not a new one. A simple Internet search will produce a litany of blog posts and books on the subject, touting a variety of programs that promise to be the next fountain of youth. What the JAMA Dermatology researchers did in their study, which was the first of its kind, was to examine this question from a more rigorous scientific perspective. They enrolled 27 women between the ages of 40 and 65 to perform daily, 30-minute exercises for eight weeks, and then continue every other day for a total of 20 weeks.

Dermatologists who did not know the participants were asked to rate their photographs before and after the exercise regimen. The dermatologists found an improvement in cheek fullness and estimated the age of the participants at 51 years of age at the start of the program and 48 at the end of the 20-week study. Furthermore, all the participants felt improvement in their own facial appearance at the end of the study.

While these results seem exciting, the study has some obvious limitations. Of the 27 patients enrolled, 11 dropped out before completing the study. One reason may be that the program was too time-consuming, clocking in at 30 minutes a day. The overall small size of the study also limits its generalizability to the larger population. In addition, there was also no control group, meaning a group of participants who did no facial exercises, which would have helped minimize the possibility that this improvement occurred by chance.

It’s also hard to draw conclusions about the longevity of these results. Presumably the exercises must be continued to maintain their effects. But for how long? And how frequently? Which exercises are most fruitful? More studies are needed to address these questions.

Facial exercises may help, but sunscreen is tried and true

For those who are still skeptical but wish to try something more evidence-based to maintain youthfulness, I have one simple suggestion: use sunscreen. You may roll your eyes at the suggestion of sunscreen from a dermatologist, but there is an enormous body of research that demonstrates the sun’s role in prematurely aging our skin. You can protect your skin from these damaging effects by using broad-spectrum, SPF 30 or higher sunscreen daily, especially on the face. An analogy I often make is to think of a rug of in front of a window in your house. How does it look after five or 10 years? If the sun can fade an inanimate object to such a degree, think of what it can do to your skin.

As for facial exercises, the jury is still out. But unlike youth-preserving cosmetic procedures that require money and time for recovery, facial exercises are free and almost certainly not harmful. So why not try facial exercises if you have the time? If they don’t make you look younger, these goofy moves will, at the very least, make you smile.

Follow me on Twitter @KristinaLiuMD

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My Health - The rise of push-ups: A classic exercise that can help you get stronger

This post was updated on February 18, 2019

The morning of my 50^th birthday in May I did something I had not tried in a long time. I dropped to the floor and did 50 push-ups, one for each year. I had to break it up into sets and the last few where shaky, but I did it.

And it felt great.

As a new member to the 50-plus club I realized this bread-and-butter exercise still works wonders as a snapshot of your fitness.  In addition, it might predict your risk for cardiovascular problems.  In a study of male firefighters published in the February 2019 issue of JAMA Network Open, men who could complete at least 40 push-ups over 30 seconds had a significantly lower risk of heart attack, heart failure or other cardiovascular problems over the next 10 years compared with men who were able to complete less than 10.

“How many you can do at one time offers a real-time measurement of your strength and muscular endurance and is an easy tool to help you improve,” says Dr. Edward Phillips assistant professor of Physical Medicine and Rehabilitation at Harvard Medical School. “You can do them anywhere and at any time. All you need is your body weight and a few minutes.”

The perfect exercise

The push-up engages your body from top to bottom. It works several muscle groups at once: the arms, chest, abdomen (core), hips, and legs. Push-ups also can be modified as needed. “By adjusting the speed you perform a push-up, the angle of your body, and even hand placement, you can add more or less intensity, or focus on specific muscles,” says Dr. Phillips.

A study published in the February 2016 issue of the Journal of Physical Therapy Science found that the chest muscle activity was greater when push-ups were performed with the hands placed halfway inward from their normal position. Hands placed outward work the triceps more.

The perfect form

To maximize what push-ups can offer you should perform them correctly.

• Begin in a full plank position with your arms extended, palms flat and just below shoulder level, feet together or about 12 inches of apart, resting on the balls of your feet.
• Keep your back straight and your weight evenly distributed.
• Look down and lower your body until your elbows are at 90 degrees (or go to the floor to rest, if needed) and then push back up to complete one rep. Try to take two seconds to go down and one second to go up.

If this is too difficult, perform from a hands and knees position. You can also do inclined push-ups where you place your hands on a counter or wall and lean forward at a 45-degree angle. “You can still engage the core and work your arms and chest, while you place less weight on the wrists and shoulders,” says Dr. Phillips.

With a regular push-up, you lift about 50% to 75% of your body weight. (The actual percentage varies depending on the person’s body shape and weight.) Modifications like knee and inclined push-ups use about 36% to 45% of your body weight.

Establish a foundation

To find your starting point, perform as many push-ups as you can while keeping good form. It could be 10, five, or even two. Focus on hitting this number at first with a rest day between sessions. As your strength improves, add more reps, or move up to a full push-up position (if you’ve been bending at the knees or doing push-ups against a wall) or build up to doing two to three sets.

Because they provide instant feedback, push-ups can be a great motivator. Push-up challenges are trendy. Can you do a certain number in a week, or in 30 days? Can you perform 15 to 20 nonstop?

“Challenges are a fun way to set up mini, short-term goals, which many men need to stay focused,” says. Dr. Phillips. Create your own push-up challenge and see if you can reach it. Begin small and once you achieve it, set the bar higher.

My challenge is to do 50 push-ups every day for the entire year. So far, so good. I knock them out before I brush my teeth in the morning, and can now do 30 nonstop. Push-ups have taught me that when it comes to improving my fitness, I can still rise to the occasion.

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My Health - Should you try kettlebells?

Kettlebells. There they were in the fitness aisle of my local big box store: cute little candy-colored cannonballs with handles on them. I was drawn to them immediately—adorable pink weights that conjured images of me as an exercise goddess in a sunny meadow, smiling and doing arm workouts with ease (in slow motion of course). Then I lifted one of the weights from the shelf and discovered—record scratch—they’re no creampuffs, they’re heavy workout tools! But apparently they’re all the rage.

How do kettlebells improve fitness?

Kettlebells have been used for centuries, most famously by 19th-century strongmen. Today the weights (which range from 8 to 105 pounds) are featured in exercise classes, gyms, and fitness equipment stores, and for good reason: they work several muscle groups at a time. Holding a lot of weight by a handle engages your arm, leg, shoulder, back, and abdominal muscles. The pull on your muscles helps to strengthen them. The pull on your bones helps stimulate new bone cell growth.

Using kettlebells can also improve your posture. “With the weight in front of you, your back muscles have to straighten up more to counteract the force of the kettlebell pulling you forward,” explains Nancy Capparelli, a senior physical therapist at Harvard-affiliated Beth Israel Deaconess Medical Center.

Swinging a kettlebell also challenges your balance and helps to improve it.

Kettlebell risks

Along with benefits, kettlebells have some risks. One is obvious: dropping the weight on your foot (nothing a goddess would do, but I might by accident). Other pitfalls: lifting too much too soon or lifting a kettlebell the wrong way can lead to muscle strains, rotator cuff tears, and falls.

If you have the bone-thinning disease osteoporosis or its precursor state osteopenia, lifting a heavy kettlebell may increase your risk for fractures, caution some experts. If you’re at risk for falling, using a kettlebell can add to your risk.

Should you try kettlebells?

Using kettlebells should be safe for healthy people as long as they:

• Use the appropriate weight. “It depends on the person. Someone who’s five feet tall and 90 pounds will typically use a lighter kettlebell than someone who’s six feet tall and 200 pounds,” Capparelli says.
• Learn the proper form from an expert first. “You need to know exactly what to do with the kettlebell and which exercises are appropriate. Otherwise you’ll increase your risk for injury, even with a lighter kettlebell,” Capparelli warns.

It helps to use a kettlebell with a handle wide enough to grip with two hands. Another tip: wear weight-lifting gloves, since the kettlebell handle can get slippery.

Starter exercises

Typical beginner kettlebell exercises include:

The farmer’s walk.Pick up one kettlebell on each side, pinch your shoulders down and back, and walk a distance of 20 feet (across a gym) four times.

The suitcase carry.Pick up a kettlebell with one hand (like you’re carrying a suitcase) and walk a distance of 20 feet (across a gym) four times. Don’t lean to the side. Repeat the exercise while carrying the kettlebell on the other side.

The goblet carry.“Pick up the kettlebell with two hands and hold it in front of you as if you’re taking a sip from it,” Capparelli says. “Then walk 20 feet back and forth a few times. That works your arm muscles, shoulders, biceps, and upper back muscles.”

The kettlebell swing.Hold a kettlebell with both hands, arms extended down in front of you so the kettlebell hangs between your legs. Lean forward, shift your weight onto your heels, and swing the kettlebell back between your legs. Then stand up as you swing the kettlebell forward to chest height. Repeat 10 times.

Getting started

If kettlebells inspire your own images of weightlifting success (meadow optional), try just picking one up in a store or at the gym first to see if you’re interested. Even after my reality check, I am definitely intrigued. But I’ll get some guidance first to avoid accidents and injury.

There are lots of kettlebell classes at local gyms and YMCAs. There are even kettlebell videos online. You can also check out the Kettlebell Workout in the Harvard Special Health Report Strength and Power Training for All Ages.

For me, adding kettlebells to a workout makes sense: anything that draws me to exercise is a winner. And getting a multi-muscle workout with one small (and pretty) tool is a dream come true.

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My Health - Got pain? Get better sleep

The cell phone blares out reveille. Your eyes open reluctantly and you realize it’s morning, having only gone to bed four hours earlier because of a late-night party. You creak out of bed to ready yourself for work, arthritic joints hurting much more than usual. A painful day lies ahead even after taking ibuprofen. Does this sound familiar? If it does, you are not alone. Nearly 70% of Americans report getting insufficient sleep on a regular basis, and approximately 20% of Americans suffer from chronic pain. Recently, the intersection between these two conditions has become more apparent.

The association between sleep deficiency or poor quality sleep and increased perception of pain from various medical conditions is well known; poor sleep quality predicts greater intensity of pain from conditions such as back strain, arthritis, and fibromyalgia. In many cases, the relationship is bi-directional. For example, my colleagues and I have documented that heartburn is worse after a poor night’s sleep, and conversely heartburn can result in disrupted sleep.

Recent studies now provide a greater understanding of why pain worsens after poor sleep. In brain imaging studies using magnetic resonance imaging (MRI), there is greater activation of brain regions controlling perception of pain after a poor night’s sleep. In addition, the activity of other brain regions responsible for dampening the sensation of increased pain is reduced. The net effect is that the perception of pain is accentuated after a poor or inadequate amount of sleep. Importantly, this observation is not just a phenomenon confined to the laboratory. In surveys of individuals with chronic pain, a night of poor sleep predicts worse pain.

The relationship between poor quality sleep and worsening pain has important implications for individuals experiencing both acute and chronic pain. More or better sleep may lessen the pain that they are experiencing.

There also is a potential public health message that cannot be ignored. The opioid epidemic is rampant in the United States, related in part to overprescription of opioids for chronic pain. Unfortunately, addiction and inadvertent overdoses are increasingly frequent. How many opioid-related deaths can be avoided if an intervention to improve sleep is implemented? The answer is not known. However, better sleep is inexpensive and generally does not require a physician’s prescription. In addition to other initiatives to address the opioid epidemic, messaging about the benefits of sleep on reducing the perception of pain could be a cost-effective public health investment.

References:

Sleep disturbances and severe stress as glial activators: key targets for treating central sensitization in chronic pain patients? Expert Opinion on Therapeutic Targets, August 2017.

Sleep and pain sensitivity in adults. Pain, August 2015.

Relationships between sleep quality and pH monitoring findings in persons with gastroesophageal reflux disease. Journal of Clinical Sleep Medicine, August 2007.

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My Health - What’s in your supplements?

If you’re taking an over-the-counter supplement that wasn’t recommended by your doctor, you’re not alone — about half of the US adult population takes one or more supplements regularly. We spend more than $35 billion on these products each year.

While it’s important that your doctor knows what you’re taking, there are many supplements out there, and it’s likely your doctor won’t know what advice to give you about a lot of them. There are a number of reasons for this but the two biggest are:

• Most supplements are not rigorously tested as a prevention or treatment for conditions for which they are promoted.
• The supplement industry is not regulated the way prescription drugs are. The ingredients on the label may not accurately reflect what’s actually in the supplement.

As a result, the major concerns of your doctor — is it safe? is it effective? — may be impossible to address.

Does the supplement label matter?

Of course it does! At the very least, you’d like to know that what’s on the label is what you’re actually taking. However, past studies have found that supplement labels may

• inaccurately describe the dose of the supplement, so you could be getting more or less than the label says.
• list the correct drug ingredients but fail to mention that it could interact with other drugs or worsen a condition you have. For example, chondroitin (often taken for symptoms of arthritis) may cause bleeding if you have a condition that makes you prone to bleed, or if you take a blood thinner, such as warfarin (Coumadin).
• contain contaminants — often the hidden ingredient is added in order to enhance the effect of the supplement. For example, banned stimulants have been found in many weight loss supplements.

While these problems have been known about for many years, there is little oversight to confirm the purity of the ingredients or the accuracy of the label.

Studies find tainted supplements or misleading labels are common

In the past, research on a variety of supplements has found concerning discrepancies between what’s on the label and what’s in the bottle. One recent report looked at three memory supplements: two of them contained none of the active ingredient, and one of those contained unidentifiable chemicals that raise serious questions about its safety.

Another, much larger study finds that the problem of tainted supplements — and lack of oversight — is widespread. Researchers analyzed warnings issued by the US Food and Drug Administration (FDA) between 2007 and 2016. These included 776 dietary supplements that contained contaminants, including

• a prescription drug, sildenafil (Viagra), in supplements sold for sexual enhancement.
• sibutramine (Meridia), found in weight loss supplements. This drug was approved in 1997 for weight loss but was taken off the market in 2010 when studies linked it to heart attacks and stroke.
• steroids or drugs with steroid effects in supplements marketed as muscle builders.

About 20% of the contaminated supplements contained more than one unapproved ingredient. In more recent analyses, more than one-third of the contaminated supplements were found by sampling products ordered online, and another third arrived by international mail delivery.

Unfortunately, the FDA announced voluntary recalls for less than half of these tainted supplements.

What’s a supplement user to do?

One option to consider is to simply stop taking the supplement. If you don’t have a condition requiring treatment with a dietary supplement and if it’s not recommended by your doctor, it might be best to rethink your use of them. Alternatively, there are organizations that certify supplements and can provide a measure of confidence in their ingredients. These include the NSF International Dietary Supplement Certification and the US Pharmacopeia (USP) Dietary Supplement Verification Program. If your doctor has recommended supplement use, check with him or her before making any changes.

Bottom line

The problem of adulterated dietary supplements is unlikely to go away anytime soon. But I am hopeful that the FDA will take a more active role on this issue and help protect consumers from dietary supplements that may contain hidden ingredients.

In the meantime, if you can’t be sure what’s in a supplement, you may be risking your health even as you’re trying to improve it. The safest thing may be to stick with the tried and true (and tested). Ask your doctor and pharmacist if you have questions. But don’t be surprised if they say little more than “buyer beware.”

Follow me on Twitter @RobShmerling

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My Health - A positive mindset can help your heart

Can being positive protect against heart disease? Yes! There is a lot of evidence suggesting that having a positive outlook — like being optimistic, cheerful, having gratitude and purpose in life — can be heart-protective. Researchers in the UK looked at psychological characteristics of over 8,000 people, and found that those who scored high on optimism and a sense of well-being enjoyed a 30% lower risk of developing heart disease. Other studies report similar findings: in a study of over 70,000 women followed for over 10 years, those who scored highest on an optimism questionnaire had a significantly lower risk of death from heart attacks (38%) and strokes (39%).

A positive outlook may even be benefit people who already have cardiovascular disease, which is significant, because they are at very high risk of having heart attacks and strokes. In the US Health and Retirement study, in participants with known stable heart disease, positive psychological traits were associated with significantly lower risks of having a heart attack, and these traits included optimism (38% lower risk), positive outlook (32%), and having a purpose in life (27%). In three separate studies involving hundreds of patients with severe disease requiring either coronary bypass graft surgery or stenting, a higher level of optimism was significantly associated with a lower risk of post-procedure hospitalizations.

How does thinking positively affect your heart?

Many studies show that people prone to negative emotions have a higher risk of heart disease. Negative emotions are associated with the release of stress hormones and a physical stress response, resulting in a higher heart rate and blood pressure. Scientists hypothesize that positive people who have a “glass half-full” approach to life are less likely to experience this stress response. Basically, those who tend to look for the bright side of negative situations can avoid the damage that stress inflicts on the cardiovascular system. Another hypothesis is that people with a positive outlook are more likely to use healthy coping strategies like problem-solving to overcome obstacles and manage stressors, whereas people with a negative outlook tend toward unhealthy coping strategies like self-medicating with food and other substances.

Keeping a gratitude journal can help

Researchers have also studied gratitude in patients with heart failure. Those who kept a daily gratitude journal, where they listed three or four things for which they were thankful every day for two months, had lower levels of inflammatory hormones and a lower heart rate during a stressful exercise. This suggests that the simple daily habit of expressing gratitude can have big long-term health effects.

 Are you an optimistic person?

Some people are naturally more inclined to have a positive outlook and look for the silver lining, while others tend to view things in a more negative light. But optimism is as much as skill as a personality trait. You can train your brain to recognize and counteract negative thinking—your heart and health will be better for it.

References

A prospective study of positive psychological well-being and coronary heart disease. Health Psychology, May 2011.

Optimism and Cause-Specific Mortality: A Prospective Cohort Study. American Journal of Epidemiology, January 2017.

Positive Psychological Well-Being and Cardiovascular Disease. Journal of the American College of Cardiology, September 2018.

Purpose in life and reduced risk of myocardial infarction among older U.S. adults with coronary heart disease: A two-year follow-up. Journal of Behavioral Medicine, April 2013.

The Protective Role of Positive Well-Being in Cardiovascular Disease: Review of Current Evidence, Mechanisms, and Clinical Implications. Current Cardiology Reports, November 2016.

Positive psychological attributes and health outcomes in patients with cardiovascular disease: Associations, mechanisms, and interventions. Psychosomatics, July-August 2012.

Relationship between positive psychological constructs and cardiovascular outcomes: A systematic review. International Journal of Cardiology, September 2015.

Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, February 2003.

Pilot Randomized Study of a Gratitude Journaling Intervention on Heart Rate Variability and Inflammatory Biomarkers in Patients With Stage B Heart Failure. Psychosomatic Medicine, July 2016.

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My Health - Parents don’t always realize that their teen is suicidal

Parents like to think that they know what is going on with their children — and that they would know if their teen was suicidal. However, research shows that this is not always the case.

In a study published in the journal Pediatrics, researchers interviewed more than 5,000 adolescents ages 11 to 17. In those interviews, they asked them if they had ever thought about killing themselves — or if they had ever thought a lot about death or dying. The parents were asked if they believed that their teens had ever thought about killing themselves or had thought a lot about death or dying.

There wasn’t a whole lot of match-up. Half of the parents of the adolescents who thought of killing themselves were unaware — as were three-quarters of the parents of adolescents who thought often about death.

If you think about it, this isn’t all that surprising, for lots of reasons. Teens may not always realize how bad they are feeling, and may not want to tell their parents when they do — both for fear of worrying them, and also because of uncertainty about how their parents might react. Parents may miss signs of depression in their teens, or quite genuinely misinterpret them or attribute them to something innocent; after all, it’s natural to want to believe that your child is fine, rather than thinking that they might be suicidal. And given how much drama can be intrinsic to the life of a teen, it’s understandable that parents could misinterpret statements about death or dying as, well, just teen drama.

The authors of the study encourage pediatricians to rely on other informants besides parents when it comes to figuring out whether a teen might be suicidal. But there are things that parents can do, too:

• Be aware of signs of depression in teens, and never ignore them. Acting sad is one of them, but there are many others:
  • dropping grades
  • being irritable or angry often
  • acting bored all the time, and/or dropping out of activities
  • difficulty with relationships, including changing peer groups or becoming more isolated
  • dangerous or risky behavior
  • persistent physical complaints such as headaches or stomachaches
  • fatigue
• Listen to your teen, and never assume that statements like “nobody cares if I live or die” are just drama. Instead of saying, “You don’t mean that,” ask them if they do mean it. Often parents worry that asking about suicide might “give them ideas,” but asking may be the only way to know — and the best way to show your teen that you are taking them seriously.
• Get help. Call your doctor, call a mental health professional, call a suicide hotline, or take your child to a local emergency room. This is crucial. If counseling is recommended, be sure to get it, and make sure your teen sticks with it.
• If you suspect your teen may be depressed or suicidal, take precautions. If you have a gun in your house, make sure it is locked up with the ammunition locked separately. Take stock of prescription medications and alcohol in your house that could be used for self-harm, and either get rid of them or be sure they are stored safely.

Sometimes it is just drama — or some short-term blues after a breakup or another one of life’s inevitable disappointments. And in the study, half of the teens whose parents thought they were suicidal, and two-thirds of those whose parents thought they thought about death, said they were fine. But when it come to suicide, it’s always better to be safe than sorry. So ask the questions — and ask for help.

Follow me on Twitter @drClaire

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My Health - Planet-friendly, plant-based home cooking

With all the news about the health and environmental advantages of eating less meat, many people are trying to eat more plant-based meals. But where do you begin?

Instead of trying to cook an entire vegetarian meal from scratch, start with one small step and build from there, says Dr. Rani Polak, founding director of the Culinary Healthcare Education Fundamentals (CHEF) coaching program at Harvard’s Institute of Lifestyle Medicine. “For example, buy some canned beans. You can then make a simple bean salad with a little olive oil and lemon juice. Or if you have a favorite recipe for beef stew, try swapping in beans for some of the meat,” he says.

A trained chef, Dr. Polak is committed to encouraging people to cook at home rather than relying on restaurant or processed food. “With home-cooked meals, people tend to eat smaller portions, fewer calories, and less fat, salt, and sugar,” he says. And people who eat more home-cooked meals tend to weigh less and have healthier cholesterol and blood sugar values compared with people who eat out frequently. Following are Dr. Polak’s suggestions for buying and preparing the building blocks of a plant-based diet: legumes, whole grains, and vegetables.

Legumes

Botanically speaking, legumes are the edible seeds from pods you can split in half. Familiar examples include the wide array of beans — black, fava, garbanzo, kidney, and pinto, to name just a few. Lentils, peas, and peanuts are also legumes.

Nutrition-wise, legumes are hard to beat. They’re a good source of protein, starch, fiber, and other nutrients, including iron, zinc, and folate. They don’t contain any unhealthy saturated fat. Plus, they’re inexpensive and widely available, they can be stored for long periods, and they are easy to prepare.

If you use canned beans, choose salt-free versions when possible, or rinse them before using, which can remove about a third of the added sodium. Cooking dried beans is simple. Just soak several cups of beans in cold water overnight. The next day, drain, cover with water, and boil until tender. Do this once or twice a week to have a convenient source of plant-based protein around which you can build a meal. “If you come home at 6 p.m., tired from a busy day, it’s good to have a ready-to-use source of protein such as beans available,” says Dr. Polak.

Whole grains

Whole grains are seeds or kernels that contain key nutrients such as protein, B vitamins, antioxidants, minerals, and unsaturated fats. All whole grains — such as barley, rye, and wheat — are also excellent sources of fiber, which helps lower cholesterol and control blood sugar. Some popular examples you’re likely to find in supermarkets include cracked wheat (bulgur), brown rice, and steel-cut oats or oatmeal. Some stores also sell more exotic whole grains, such as amaranth, farro, and millet.

As with legumes, whole grains are easy to cook, especially bulgur, another of Dr. Polak’s favorites. Just add equal parts boiling water and medium-coarse bulgur to a bowl, stir, and cover with a plate for five minutes. For brown rice and other grains that take longer to cook, use the batch cooking method.

Vegetables

Few Americans eat the recommended 2 to 2 1/2 cups of vegetables per day. The reasons for that shortfall likely vary, but shopping-related issues are often to blame. Even if you pick up plenty of produce at the store, sometimes it spoils before you get around to using it. Try these tips:

• If you shop weekly, use tender produce such as salad greens and spinach early in the week; save harder vegetables such as broccoli and carrots for later.
• Buy frozen vegetables, which are just as nutritious as fresh.
• Choose pre-cut vegetables, such as butternut squash, to save time and effort.

Putting it all together

Dr. Polak’s simple formula for a filling, nutrient-packed main dish is to combine a legume, a cooked whole grain, and chopped vegetables, which can be raw, steamed, sautéed, or roasted. There are endless variations, including warm or cold versions, to which you can also add dried or fresh fruit, spices, and fresh herbs. For recipe ideas, see the American College of Preventive Medicine’s recipes and instructional videos.

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My Health - Integrative approaches to reduce IBS symptoms

Irritable bowel syndrome (IBS), a gastrointestinal condition that involves abdominal pain and altered bowel habits (constipation, diarrhea, or both), affects over 10% of Americans. Though some find the condition merely a nuisance, for many individuals it can be quite bothersome and disruptive. While medications can sometimes offer relief, some individuals do not respond to medications or find the side effects intolerable. Fortunately, there are several well-studied, nondrug, integrative approaches that can help to reduce IBS-related symptoms and restore a sense of control over one’s life.

Stress reduction

IBS is well known to be aggravated by stress. Moreover, the symptoms and the disruption they cause can themselves become a source of stress, creating a vicious cycle of stress and discomfort. How does stress affect the gastrointestinal system? It turns out that the largest concentration of neurons outside of the brain and spinal cord is in the gastrointestinal tract, making it particularly susceptible to stress and creating a strong brain-gut connection. Stress hormones can alter movement through the gastrointestinal tract (speeding it up or slowing it down) and cause the muscles in the intestines to spasm and cause pain. Thus, for people who experience a lot of stress in their lives, learning stress-reduction techniques can be instrumental in reducing the frequency and severity of IBS-related symptoms.

Several clinical trials have demonstrated that two stress-reduction techniques — meditation and mindfulness-based interventions — can significantly reduce abdominal pain and improve bowel habits. To be most effective, these tools should be practiced daily, as over time they retrain the nervous system and reduce the amount of time that it operates in the stress (fight-or-flight) response. It’s important to remember that meditation and similar techniques are learned skills that take time and practice to build, so you are unlikely to notice an immediate improvement in IBS-related symptoms after the first or second try. There are many meditation apps, internet tutorials, and even evidence-based courses offered through major hospitals that offer opportunities to learn these invaluable skills.

Other stress-reducing approaches have also shown benefit for IBS-related symptoms. These include gut-directed hypnotherapy (a popular protocol in Europe), cognitive behavioral therapy, and possibly yoga.

Special diets

Studies have shown that foods high in FODMAPs (dietary sugars known as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) can exacerbate IBS-related symptoms by providing fuel for certain bacteria in the gastrointestinal system. The byproducts from these bacteria can cause pain and bloating. On the other hand, low-FODMAP diets can reduce the abdominal pain, bloating, diarrhea, and constipation associated with IBS. Although safe to follow for short-term use, there are no long-term studies of this diet, and sustaining this eating pattern can be challenging.

For some patients with diarrhea-predominant IBS, reducing intake of gluten, a protein found in wheat, rye, and barley, can help. This may be the case even if you do not have celiac disease, as gluten can modify the barrier function of the gut lining.

Supplements

For individuals with constipation-predominant IBS, a soluble fiber supplement (Metamucil or others containing psyllium) can be helpful. Large amounts of fiber can hinder the absorption of medications, so take your medications one to two hours before the fiber supplement. Soluble fiber is also found in foods such as beans, avocados, oats, and dried prunes. Be sure to consume plenty of water with fiber to avoid worsening the constipation.

A recent analysis of nearly 1,800 patients from multiple studies demonstrated that probiotics reduce pain and symptom severity in IBS compared to placebo. Probiotics are “good” bacteria touted to help maintain digestive health. However, given the variety of different probiotics that have been studied, it is difficult to know exactly which ones are most useful or how much to take.

Finally, peppermint oil is well known for its ability to relax the smooth muscles of the gastrointestinal system, and can help reduce the abdominal pain associated with IBS. To reduce the potential for heartburn, enteric-coated capsules (typically containing 0.2 milliliters or 181 milligrams of peppermint oil) are recommended. The dose for adults is one to two capsules up to three times per day.

Mind-body tools, a low-FODMAP diet, and some supplements can help relieve IBS-related symptoms and are generally safe for most people. They can also be used in combination with most IBS medications. If you have IBS, talk with your healthcare professional, as he or she may be able to provide you with resources to help you implement these tools in your life.

Follow me on Twitter @DrCalm123

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My Health - Tackling parent-teacher conferences: The early years

Coming into December, my wife Jenny and I had been through two parent-teacher conferences and were batting .500. The first, during my oldest son’s last year of preschool, opened with a list of stuff that didn’t shock us but his teachers weren’t too thrilled with: knocking over blocks, interrupting, not sitting still for circle time.

Milo was 4.

Unfortunately, there was no eventual, “Enough of that. He’s 4. Here’s why he’s great.” We left feeling they didn’t like him. Milo was doomed and we had failed. We decided that they were full of it, or at least that was our hope.

A year later came parent-teacher conference No. 2. His kindergarten teacher, a 30-year veteran, told us most of the class was in the middle of a bell curve, and everyone was still getting to know each other. She apologized for starting with academics. We asked how much of a concern an earlier note home was. “None,” she said.

It was a good and needed counterbalance.

A learning curve for the parent-teacher conference

I wasn’t worried going into our first-grade conference in early December. Milo’s teacher is open and quick to respond by email. I could see his progress with homework, and I have the chance to help out in class. Of course, there was more to know. But every school conference presents a numbers challenge. We had 20 minutes. Milo’s teacher had 20-plus conferences to do. I needed advice, so I asked two experts.

Dr. J. Stuart Ablon is associate professor of adolescent psychiatry at Harvard Medical School and director of Think: Kids at Massachusetts General Hospital. Julia G. Thompson is a former 40-year public school teacher and author of The First Year Teacher’s Survival Guide. They agreed on this:

You need a plan. No one has time to waste. Academics shouldn’t dominate, although they often do, so you have to ask a few pointed questions to find out about skills like collaborating, multitasking, and flexibility. But before you tackle any of that, shut up for the opening 10 minutes. “You want to see how the teacher gets your kid,” Ablon says.

Expect holes in the picture. It was only December. Not everything can be known by then. Fill in the blank spots by talking about your child’s strengths. Teachers use them to overcome weaknesses, and now you’ve clued them in, Thompson says.

Focus on a few key questions. With whatever time remains, try asking:

• How does my child handle frustration? This touches on willingness to ask for help and problem-solve, Ablon says.
• How does my child fit in? This gets at how children are interacting, whether they’re leaders or followers, what they’re excited about, and how they spend their free time. A good follow-up is so obvious, it’s rarely considered: Does my child look happy? “If they are, school is stress-free, and they’re engaging and appropriately challenged,” Thompson says.
• How well does my child settle down for work? This is about tuning out distractions, being tolerant, but also meeting expectations. Along with the teacher understanding your kid, you want to understand what the teacher wants, Ablon says.

Here’s how our parent-teacher conference played out

I quickly re-learned that 20 minutes isn’t long. Side conversations constantly present themselves, offering the chance to eat up even more time. It’s also not a scripted event. Milo’s teacher started by asking what questions we had. A tempting offer, but we threw it back to her. Whenever she asked something, I answered just the question, then stopped talking. When I shared, it was to add to her understanding. I was always conscious of the clock and constantly fighting my natural tendency to chat. But it paid off. We got her take and got in our questions.

The conference isn’t meant to be exhaustive or solve every issue –– save that for a follow-up meeting. It’s about learning, and hopefully leaving with a sense of comfort.

“You should feel that the teacher is knowledgeable and in control of themselves, which means they’re in control of the class,” Thompson says. “[Also] that they care about and value your child, and that they want to work with you.”

We know each year can change. We’ll take this victory and our .667 batting average.

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My Health - Managing pain after surgery

Surgery and pain pills used to go hand in hand. After all, you need a strong prescription pain medication to ensure you aren’t in pain after a procedure, right?

Turns out not only is prescription pain medication not always needed, but often not advisable after surgery, because it can raise the risk of opioid addiction. As a result, surgeons today are rethinking post-surgical pain management strategies. And if you’re going under the knife, you should too.

In the 1990s, the number of opioid prescriptions written for people undergoing surgery or experiencing pain conditions grew — and so did related problems. As a result, “We are in a current opioid epidemic, with 91 substance-related deaths each day, according to the CDC,” says Dr. Elizabeth Matzkin, an orthopedic surgeon and assistant professor at Harvard Medical School.

This is not just a young person’s problem. The Substance Abuse and Mental Health Services Administration estimates that the proportion of older adults who misuse opioids is set to double between 2004 and 2020, from 1.2% to 2.4%. In 2016, more than 500,000 Medicare Part D beneficiaries were given an opioid prescription by their doctor — and the average dose was well above recommended amounts.

Rethinking pain management

“Orthopedic surgeons are the third highest prescriber of opioid analgesics in the United States, and we are therefore in a pivotal position to change the current overprescribing patterns for postoperative pain management,” says Dr. Matzkin. Today, surgeons like her are increasingly turning toward non-opioid medications and other options to manage pain. And they’ve also started having more conversations with patients before surgery to come up with safer treatment plans ahead of time.

If you’re scheduled for a surgical procedure, having a plan to control pain after the surgery may help you avoid unnecessary use of opioids.

4 tips for effective and safer ways to manage your pain

Avoid opioid pain pills whenever possible. In many cases, non-opioid pain relievers, such as ibuprofen (Advil) and acetaminophen (Tylenol), will control postsurgical pain if taken as recommended. “We just completed a study of 163 knee arthroscopy patients who were sent home with non-opioid pain management,” says Dr. Matzkin. Based on the findings of this study, 82% of patients who undergo arthroscopic partial meniscectomy (a common knee surgery) or chondroplasty (a procedure to repair cartilage in the knee) can achieve satisfactory pain control with non-opioid pain management.

Limit opioid medication use. If it is necessary to use an opioid, limit the amount of time you take it, says Dr. Christopher Chiodo, an instructor in orthopedic surgery at Harvard Medical School. Ideally, you should take it for less than a week — and only when other options won’t work, he says. One way to reduce the amount of opioid medication you are taking is to alternate it with non-opioid treatments, such as ibuprofen or acetaminophen, if your doctor approves.

Adjust your expectations. “Orthopedic surgeons are also setting expectations for patients preoperatively. “When people are having surgery, they should expect to have some pain or discomfort,” says Dr. Matzkin. While no one should have to endure excruciating pain, having some pain is okay. “Letting people know that it’s okay to have some pain can actually reduce the amount of pain medications required,” says Dr. Chiodo. Sometimes when people aren’t told to expect some discomfort or pain, they get nervous when they experience it, which leads to more medication use. Think of surgery like you would exercise: you’ll be sore afterward, but you wouldn’t (and shouldn’t) take an opioid pain reliever to address the problem.

Use nonmedication strategies to manage pain. The key to effective pain management is to use a combination of methods. “If you are having surgery on a lower extremity, elevate it after the procedure. This can help substantially with pain relief, swelling, and wound healing,” says Dr. Chiodo. Icing the area can also help in the first 24 to 48 hours after surgery. But be certain to follow your doctor’s instructions carefully when using ice. It can cause tissue damage if used for too long — particularly in people who have reduced sensation in the area while the anesthetic used during surgery is wearing off.

Have a pain management plan in place before your procedure

Don’t wait until after surgery to decide what type of pain management you will use. Discuss pain control with your surgeon before your operation, and agree on a course of action ahead of time.

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My Health - In defense of French fries

I thought it must be a slow news day. The New York Times ran a story about French fries with a conclusion that shocked no one: French fries aren’t a particularly healthy food choice. But is this anything new? And just how bad are they?

Could French fries actually kill you?

Maybe. At least, that’s the implication of the study that triggered the latest news coverage. Researchers found that regular consumers of French fries don’t live as long as those who eat them less often.

Of course, I immediately wondered: is it really the French fries? What else do big-time consumers of French fries do that might affect their longevity? Are they couch potatoes (or should I say couch fries)? Do they drink too much? I’m guessing their other food choices might not be the best. Maybe it’s the Big Macs, cheesecake, and smoking that’s responsible more than the fries? So, let’s take a closer look at the study.

More French fries, more death

In June 2017, researchers publishing in the American Journal of Clinical Nutrition described a study of 4,400 older adults monitored over an eight-year period that found:

• Higher potato consumption (including fried and non-fried potatoes) was not associated with a higher risk of death.
• Eating French fries more than twice a week was associated with a more than doubled risk of death.
• The findings held up even after accounting for obesity, physical activity, smoking, and alcohol consumption (as reported by study subjects during study enrollment).

The authors had some theories on why French fries might raise the risk of death, including:

• French fries have a lot of fat and salt that could raise the risk of cardiovascular disease. During the years of this study, trans fat (a particularly unhealthy type of fat) had not yet been banned from the US market.
• High consumption of French fries could increase the risk of future high blood pressure, diabetes, or obesity (which are known risk factors for cardiovascular disease and other health problems),
• High consumers of French fries might also be high consumers of other high-fat or high-salt foods, sweetened beverages, and red meat. So, as suspected, this study does not prove that the higher rates of death among higher consumers of French fries were actually due to the fries.

But are French Fries really a “death food”?

This brings us to the real question raised by this new research: must you swear off French fries forever? I say no. Here’s why:

• The higher risk of death was noted among those who ate French fries more than twice a week. Eating them once a week or less would likely have a negligible effect on your health.
• Portion size matters. This study didn’t provide details of how many fries study subjects ate at one sitting, but an “official” serving is just 10 to 15 individual fries (130–150 calories). Most fast food establishments serve three to four times that amount! Stick with one serving, or share a restaurant serving with a couple of meal mates.
• Homemade “baked fries” using minimal olive or canola oil aren’t French fries, but they’re close… and much healthier.

The coverage of this new research (“A weapon of dietary destruction!”) made it sound as though having fries with your meal is a death sentence. But let’s not overstate the “danger” of French fries. And let’s also face this irrefutable fact: they’re too good to give up.

But, if we think of them as an occasional indulgence and understand what a single portion of French fries looks like, there’s no reason to eliminate them from your diet. And they go great with a salad.

Follow me on Twitter @RobShmerling

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My Health - 4 things everyone needs to know about measles

We are in the midst of a measles outbreak here in the US, with cases being reported in New York City, New York state, and Washington state. In 2018, preliminary numbers indicate that there were 372 cases of measles — more than triple the 120 cases in all of 2017 — and already 79 cases in the first month of 2019 alone. Here are four things that everyone needs to know about measles.

Measles is highly contagious

This is a point that can’t be stressed enough. A full 90% of unvaccinated people exposed to the virus will catch it. And if you think that just staying away from sick people will do the trick, think again. Not only are people with measles infectious for four days before they break out with the rash, the virus can live in the air for up to two hours after an infectious person coughs or sneezes. Just imagine: if an infectious person sneezes in an elevator, everyone riding that elevator for the next two hours could be exposed.

It’s hard to know that a person has measles when they first get sick

The first symptoms of measles are a high fever, cough, runny nose, and red, watery eyes (conjunctivitis), which could be confused with any number of other viruses, especially during cold and flu season. After two or three days people develop spots in the mouth called Koplik spots, but we don’t always go looking in our family members’ mouths. The characteristic rash develops three to five days after the symptoms begin, as flat red spots that start on the face at the hairline and spread downward all over the body. At that point you might realize that it isn’t a garden-variety virus — and at that point, the person would have been spreading germs for four days.

Measles can be dangerous

Most of the time, as with other childhood viruses, people weather it fine, but there can be complications. Children less than 5 years old and adults older than 20 are at highest risk of complications. Common and milder complications include diarrhea and ear infections (although the ear infections can lead to hearing loss), and one out of four will need to be hospitalized, but there also can be serious complications:

• Five percent of people with measles get pneumonia. This is the most common cause of death from the illness.
• One out of 1,000 get encephalitis, an inflammation of the brain, that can lead to seizures, deafness, or even brain damage.
• One to two out of 1,000 will die.
• There is another possible complication that can occur seven to 10 years after infection, more commonly when people get the infection as infants. It’s called subacute sclerosing panencephalitis or SSPE. While it is rare (four to 11 out of 100,000 infections), it is fatal.

Vaccination prevents measles

The measles vaccine, usually given as part of the MMR (measles-mumps-rubella) vaccine, can make all the difference. One dose is 93% effective in preventing illness, and two doses gets that number up to 97%. In general the first dose is usually given at 12 to 15 months and the second dose at 4 to 6 years, but it can be given as early as 6 months if there is a risk of exposure (as an extra dose — it doesn’t count as the first of two doses and has to be given after 12 months), and the second dose can be given as soon as 28 days after the first.

The MMR is overall a very safe vaccine. Most side effects are mild, and it does not cause autism. Most children in the US are vaccinated, with 91% of 19-to-35 month-olds having at least one dose and about 94% of those entering kindergarten having two doses. To create “herd immunity” that helps protect those who can’t get the vaccine (such as young infants or those with weak immune systems), you need about 95% vaccination, so the 94% isn’t perfect — and in some states and communities, that number is even lower. Most of the outbreaks we have seen over the years have started in areas where there are high numbers of unvaccinated children.

If you have questions about measles or the measles vaccine, talk to your doctor. The most important thing is that we keep every child, every family, and every community safe.

Follow me on Twitter @drClaire

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