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4 Reasons to Think Twice About Back Surgery


As you may have read in the news, Tiger Woods is recovering from a recent back surgery – his fourth back operation in the past few years (this one being a fusion). Once the greatest golfer in the world, Tiger had his first surgery in 2014, but since then, even after two more surgeries, he has not been able to successfully return to the pro tour. No doubt he is hoping that this recent operation will eventually get him to a place where he can compete at the highest level and without debilitating pain.

Tiger is among many pro athletes who, eager to get back to the game quickly, opt for surgery instead of just waiting for things to heal. Unfortunately, as many of them find, quicker may not equate to better.

Steve Kerr, a former NBA player and current NBA coach, continues to struggle with the complications of his low back surgery and issues a strong warning: “…if you have a back problem, stay away from surgery. I can say that from the bottom of my heart. Rehab, rehab, rehab. Don’t let anyone get in there.” Is this sage advice or just the sentiments of an unfortunate individual with a rare bad outcome?

And, more importantly, where does spine surgery fit in for the rest of us who are not professional athletes? What do you do if you are a construction worker, nurse, or landscape gardener with a bad back who is trying to get back to work but can’t tolerate the bending and heavy lifting? Even office jobs can be impacted by back pain if prolonged sitting causes too much aggravation. Or maybe you just want to get back to golf with your friends, playing ball with the kids, and doing chores around the house.

How do you navigate dealing with the pain, concerns about pain-killer addiction, and deciding on whether surgery is the right choice or not?

In almost every case, the advice I give my own patients is to try to address the problem without surgery. Here are some reasons why I usually steer my patients down a non-surgical path:

1. The body is a pretty good healer. Whether a back injury involves the muscles, joints, ligaments, or discs, the body has its own healing mechanisms. For example, studies have found that herniated discs shrink over time and 76% resolve after a year – and the pain from a herniated disc usually resolves within 3 months. Other symptoms including weakness, sciatica, and numbness either resolve or improve after a year, as well. Our immune system seems to help clean-up herniated or extruded disc material, but this takes time, patience, and some faith.

2. Slow and steady wins the race. Yes, surgery can relieve pain symptoms more quickly than waiting it out, and that can be tempting when you are stressed about getting back to work or just trying to get off the couch. But how well does a surgically-fixed back hold up over a lifespan compared to one that relies on the body’s own built-in healing mechanisms (along with plenty of rehabilitation)? Potential problems that can happen down the road include advanced degenerative disc disease, either in the surgical area or above or below an area that has been fused with hardware, along with the risk of needing additional spine surgeries in the future. Interestingly, the well-regarded Spine Patient Outcome Research Trial (SPORT) did find spine surgery to offer positive outcomes for problems like lumbar disc herniations and spinal stenosis for the first 4 years after surgery, but the benefit seemed to wear off after that with longer follow up.

3. There are many layers to the onion. A big problem with how we view pain, including spine problems, is that we look at it purely from a physical perspective. In other words, we think the reason we hurt the way we do must be due to a structural issue, so if we operate, then the problem will get cured. Not so fast! Not only is the spine a complex conglomeration of nerves, joints, discs, muscles and soft tissues, but other factors influence how we feel, including stress, depression, anxiety, insomnia, and relationship issues. These problems, commonly associated with low back pain, won’t magically get better after an operation. And if you are worried about being dependent on pain-killers, there is no evidence to suggest your dependence will disappear on its own after spine surgery, either. You can’t expect an operation to cure all that may be ailing you.

4. You won’t see many physicians having spine surgery. Doctors develop back problems, just like the rest of the population, but how often does a physician opt for surgery to treat their own aching backs? In my experience, hardly ever. Why? Because we see the trials and tribulations of our patients with low back pain who don’t improve after laboring through their own spine surgeries, so we usually choose a different path. If a spine surgeon with a similar problem to yours doesn’t want anyone operating on his or her back, then why should you?

No matter what treatment you choose, try to weigh the balance between the need for immediate relief with the importance of having a long-term plan in place to keep your spine the very healthiest it can be so that you can stay at the top of your game.

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Can Acupuncture Solve Your Pain Problem?


Don’t be surprised if the next time you see your pain doctor they suggest you go to an acupuncturist. The Food and Drug Administration (FDA) recently released a recommendation that doctors get up to speed on complementary alternative therapies for treating pain including acupuncture and chiropractic treatment.

If you’re like many of the patients that I treat, you are probably open to trying alternative therapies, but are still feeling a bit skeptical as to whether or not acupuncture is a legitimate treatment to pursue. To the FDA’s point, I think this is where the physician’s input is key. Patients want to gauge if their physician really believes in the recommendation based on their knowledge and experience with other patients or whether they’re just throwing it out there so they can move on to the next patient and avoid prescribing more painkillers. There is a big difference between a doctor saying, “Let’s try acupuncture, it has helped a lot of my other patients,” as opposed to “Why don’t you try acupuncture since I don’t know what else to recommend at this point.”

We brought acupuncture into our own center several years ago and found it helpful in treating pain, mood disorders, head injuries, and even withdrawal symptoms, and I think our patients appreciate the fact that we thought highly enough about it to offer the service in-house. To top it all off, I started receiving acupuncture treatment myself a few years ago to treat some pretty intense sciatica I got from an extruded disc in my lower back. That means I can now look my patients in the eye and say, “I recommend trying acupuncture…I use it myself and I think it really helps.” It stands to reason that the more closely a doctor can relate to a particular clinical situation, the better equipped they’ll be at guiding their patient through a similar process.

What makes all of this so interesting is that in our era of amazing technology and innovation, we are talking about a treatment that goes back approximately 3,000 years (and first started by using rocks and stones) to help with our nation’s biggest public health problem – chronic pain and opioid dependence. In a nutshell, the theory behind acupuncture has to do with the concept of qi (pronounced “chi”), or “life energy,” that is believed to flow through the body through channels often referred to as meridians. Poor health and disease is believed to be directly related to interruptions in the flow of this life energy through the body. The insertion of acupuncture needles into key points in the body opens up this blockage and allows the qi to flow through the body, thereby restoring good health. And who wouldn’t want better qi?

Over the years, science has struggled to figure out how this ancient philosophy of treating illness fits in with what we know about modern medicine. Some studies suggest acupuncture modifies the endocrine system and can decrease levels of stress hormones, while others suspect it boosts the body’s immune system and blood flow to diseased areas. Other studies have found that acupuncture increases levels of endorphins, our brains’ natural pain reliever. Interestingly, animal studies show that naloxone, an opiate receptor-blocking compound, can inhibit the pain-relieving effects of acupuncture.

I think the most fascinating science behind how acupuncture can treat pain has to do with all the different ways it can change what happens in the brain. Neuroplasticity refers to the brain’s ability to change, adapt, and reorganize itself, and we know that the experience of chronic pain can lead to widespread neuroplastic changes. Studies using special brain imaging techniques like functional magnetic resonance imaging (fMRI) now show that acupuncture can lead to beneficial changes in brain activity in a number of different parts of the brain, including changes in pain networks. In other words, we can start to see how acupuncture actually relieves pain inside the brain.

If you are interested in trying acupuncture, there are a few basic techniques to be aware of. Basic needling is the traditional method of inserting tiny acupuncture needles in the various meridians in the body. Some acupuncturists may also employ other variations to this including electroacupuncture where an electric current is applied to the needle, moxibustionwhich uses heat, and acupressure where added pressure is applied to the acupuncture points. And of course, there is cupping which got the nation’s attention when cameras caught purple circles all over the body of swimmer Michael Phelps at the Olympic games in Rio.

Whatever technique you choose, you may need more than a few treatments to get positive results. I usually recommend trialing a course of 3-6 sessions, once or twice a week to start. Certainly, not all acupuncturists are the same, and it is worth doing some research and asking around for recommendations to find a practitioner that is right for you.

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Should You Be Using a Skin Mask?


Skin masks, though trendy, are really nothing new. Women have been putting hope in them since ancient times. Egyptian and Greek women made theirs with clay. Roman women were convinced that sheep oils were beneficial – but the smell was horrible. Other interesting Roman mask ingredients were urine, bile, swan’s fat, and excrement (yum!).

Though women have been using masks for thousands of years, that doesn’t necessarily mean that they’re essential to beautiful skin. Remember – back then, women didn’t really have many choices in skin care!

So, are masks really necessary? Let’s examine some of the myths about their power.

Myth #1: Masks are purifying. False. What exactly would a mask be purifying anyway? When you think about it, skin doesn’t really need purifying. Sure, our pores can get clogged sometimes, but that’s a different issue. Your face doesn’t sweat much, so that’s not a problem. Environmental pollutants? They can sit on top of the skin, but they can’t penetrate it because the molecules are too big. Drugs, alcohol, and other chemical contaminants are ingested and eliminated through the kidneys and liver primarily – not the skin. Bottom line: Skin purification is a marketing concept.

Myth #2: Masks can unclog pores. True. If you exfoliate first and then use an alpha hydroxy acid mask (or some clay masks) it can soften the dead cell plugs and make them easier to remove. Also, the “sticky” masks that dry and then peel off, like the Biore strips for the nose, can take some of the plugs and dead skin cells with them as you peel them off.

Myth # 3: Masks can hydrate. True. Skin hydration happens from both the inside and the outside. Yes, you absolutely need to drink water to keep your skin hydrated. But anyone who lives in the desert, flies a lot, or works in air conditioning can tell you that the humidity in the environment makes a difference. So, if you use a moisturizing mask and leave it on for at least 15-20 minutes, you can help hydrate your skin temporarily.

Myth #4: Masks can feed and nourish the skin. True and false.True in that skin can absorb minerals, lipids, hydration, vitamins, etc. from external sources, like masks and other cosmetics. These products can give our skin a boost when used regularly.

But false in that the best, most stable, consistent nourishment and hydration for any organ comes from our circulation, our bloodstream – not from the outside.

Now that we’ve talked what masks really can – and can’t – do, which kind of mask should you use?

The Clay Mask. Natural clay can have up to 75 different minerals in it, but it also has a lot of unwanted bacteria and other microorganisms. Clay sold in masks has to be processed to get rid of the bacteria which may alter the mineral content. Still, clay masks tend to be oil absorbing and nice for acne-prone and oily skin.

The Peel-off Mask. Charcoal-based or other sticky masks cling to the skin when they dry. When you peel them off, they pull dead skin, bacteria, hairs, and debris off the face. Peeling off the mask may be painful, so it should be done slowly. They are not the best option for people with sensitive or dry skin. Charcoal masks are recommended for those with oily, acne-prone skin, as they reduce excess oil and can help remove blackheads and whiteheads (comedones).

The Alpha-Hydroxy Acid Mask. Due to the acidity of these masks, they are not great for those with sensitive skin. They provide “chemical” rather than peel-off exfoliation. These masks are good for unplugging pores and getting the skin cells a little more active to get back that “glow.” Stronger ones are best done by a good aesthetician or in your doctor’s office.

The Sheet Mask. Not advised unless from an established company. These are made of a fabric soaked in a serum that is placed over the face and left to sit. The sheet traps in the serum and allows absorption into the skin. An article in Racked, a media journal focusing on pop culture and fashion, reports unsanitary packaging processes that raise concern for the safety of sheet masks. According to the article, several Korean brands use at-home packaging, rather than packaging in a sanitary factory or facility, making the safety of these products questionable.

The Moisturizing Mask. These come in many forms, including varieties that are more organic and natural. Great for dry skin, a pre-event pick up, sensitive skin, relaxation, etc. It’s hard to go wrong with these unless you have acne and oily skin.

In short, the right mask for the right skin type can be a good supplement to a great skin care regimen.

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Where Salt Is Hiding (and Why You Need to Find It)


Have you been told you need to cut back on sodium? This advice is frequently given by doctors, especially to those with high blood pressure – but it’s easier said than done. In reality, cutting back on sodium can be very hard to do.

When people think about reducing sodium in their diets, they assume that means eliminating the salt shaker at the table – one of the most common things I hear from my patients is that they “never add salt to their food.” Unfortunately, that by no means ensures they are eating a low sodium diet.

In fact, only 5% of dietary sodium is added during home cooking and only 6% is added at the table. More than 75% of the sodium Americans eat comes from restaurant, prepackaged, and processed foods. The remaining 12% of dietary sodium occurs naturally in foods. In other words, your food is loaded with sodium even before you pick up the salt shaker!

The 2015-2020 Dietary Guidelines for Americans recommend that people consume under 2300 mg of sodium per day, which is the amount of sodium found in one teaspoon of salt. But remember, 2300 mg is the upper limit of recommended sodium intake – aiming for under 1500 mg is better. Even people who are very active and lose sodium through sweating don’t need more than 1500 mg/day. The average American takes in twice that much: 3400 mg/day.

Where are we getting all of this sodium? More than 40% of the sodium we are eating every day comes from only a handful of foods:

Top Sources of Sodium

Breads and rolls
Cold cuts and cured meats
Pasta dishes (not including mac and cheese)
Meat dishes
Let’s take a look at a typical sandwich that most people would assume is a healthy choice. This graphic from the CDC shows that, in reality, that “healthy” sandwich is actually a salt bomb.

Sodium is sneaky. It hides in plain sight. The items we think are good for us because they’re “lean” or “high in protein” or “whole grain” might be loaded with sodium – and not even taste salty.  To really get a sense of how much sodium you are ingesting, you have to start being a detective and reading nutrition panels (I bet you’ll be shocked). And don’t forget to look at your beverages – Gatorade has 110 mg per cup.

It’s worth all the detective work, though – an overload of sodium sets the stage for increased heart attack and stroke risk. Extra sodium in our blood stream causes more water to be retained inside our blood vessels, increasing blood volume and causing blood pressure to rise. Higher blood pressures mean more wear and tear on your arteries, accelerating plaque buildup and predisposing you to blood vessel rupture. And that translates into an increased risk for heart attack and stroke.

Increased water retention inside blood vessels can also lead to edema – the accumulation of fluid within tissues, like those in your feet and around your ankles. If you get ankle swelling, one of the most important things you can do is reduce the amount of sodium in your diet.

And, if your heart function is compromised for any reason, increasing blood volume can put an extra strain on your heart leading to shortness of breath and even fluid accumulation in the lungs. Patients diagnosed with congestive heart failure have to be especially careful about reducing sodium in their diet.

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Masturbation: Myths and Facts


The most private aspect of sex is what we do with ourselves when we’re alone. Many people feel vaguely ashamed of the act of masturbation — perhaps they received criticism in childhood from their parents for exploring their bodies, sending the message that they should never masturbate, or at the very least, should feel discomfort about doing so.

In reality, though, masturbation is normal, at all stages of life. Children use masturbation for pleasure and to self-soothe with little connotation about sexuality. In puberty, masturbation fantasies start to revolve about mutual sexual give and take, motivating adolescents to weather the fears, risks and necessary losses about leaving home so they can find their own satisfying relationship. In adulthood, masturbation can become a more complicated issue in our families and relationships. How should we respond if we discover our children doing it? Should it be something we give up when we are fully sexually active? Here are some common facts and myths about it:

“Children who do it are at risk for being sexualized early” -  MYTH

All children self-stimulate. They explore their bodies through sensation. Touching some places brings delight and other places hurt. Children need to be taught that masturbation is a private act, is best when used alone in their own bedrooms, and that their bodies are supposed to feel good. Research shows that age-appropriate education from an informed parent about the body and its sexual function actually results in less sexual promiscuity or risk-taking in adolescence. Excessive masturbation in young children might need consideration to see if the child is anxious, neglected, or stressed.

“If you have an adult relationship, you shouldn’t need masturbation” - MYTH

Most people masturbate throughout their lives. We have sonograms of babies doing it in the womb and reports of people doing it into old age. Once we are mature or have gone through puberty, we understand the power of sharing our sexual feelings with another. But there are reasons and times a person may want a private moment of sensation – not necessarily a sexual exchange. Maybe they need a little stress relief. Occasionally, people use it to manage differences with their partner in sexual drive. Sometimes, they do it simply because it feels good.

“If you masturbate it means your marriage isn’t satisfying” – MYTH

Katie had just discovered that her husband Brian masturbating in the shower.  He told her he did it most mornings, and she was shocked. Mostly she worried that he might be doing it because he didn’t think she was sexy enough or sexual enough. He reassured her that it was not about her – he did it because it felt good, because it was quick, because he liked to start his day that way:  “Nope, I’m not disappointed in you, and I actually see this as a completely separate act than our shared love-making.”

“It teaches you about your body” – FACT

Most boys masturbate and begin to climax once they hit puberty, after their first wet dreams.  About 75% of little girls learn to have orgasms through masturbation. For women who have trouble reaching orgasm during intercourse, sex therapists might recommend self-discovery as a route to orgasm without the pressure of pleasing a partner (unless the client has a moral objection to masturbation).

“It’s the fastest way to orgasm” – FACT

Women tell me repeatedly that they can climax in two minutes by themselves but take 45 with their partners. Masturbation is usually prompted by a desire for sexual sensation. Coupled sex might be initiated by the other partner, and though a person might begin a sexual encounter willing to have sex, they may not necessarily want sexual release. Also, a partner may not touch a specific spot accurately, apply pressure correctly, or find the rhythm that will prompt an orgasm.

“You will prefer it to partnered sex” – FACT and MYTH

Mostly, people say that while masturbation is genitally satisfying, it doesn’t give them the deep sense of completion and connection that coupled sex brings. Sometimes, though, partnered sex is disappointing, and people retreat back into a solitary sex life often using pornography as stimulation. If sexual differences cause distress or separate partners, sex therapy or couples counseling is a helpful route to bring happiness and connection back.

Masturbation usually begins in childhood and is often a part of an adult’s life even if they have a good and satisfying sexual relationship with a partner. While it may feel shameful to admit, everybody does it at some point in their lives and it is a natural part of being a sexual being.

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Seniors Don't Need Calcium, Vitamin D Supplements


Seniors are wasting their time and money taking calcium and vitamin D supplements to ward off the brittle bones of old age, a new review concludes.

It turns out there's little evidence supplements protect against hip fracturesand other broken bones in older folks, according to data gathered from dozens of clinical trials.

"The routine use of these supplements is unnecessary in community-dwelling older people," said lead researcher Dr. Jia-Guo Zhao, an orthopedic surgeon with Tianjin Hospital in China. "I think that it is time to stop taking calcium and vitamin D supplements."

Not all experts agreed with this conclusion, however. Orthopedic surgeon Dr. Daniel Smith says the study makes a "bold leap" by arguing that these supplements do no good at all.

"The big picture, which seems to be lost in this study, is that the personal health cost of a hip fracture can be catastrophic," said Smith, an assistant professor of orthopedics at the Icahn School of Medicine at Mount Sinai in New York City.

"The potential benefit of calcium and vitamin D supplementation in preventing even a small number of hip fractures far outweighs the otherwise minimum risks associated with routine calcium and vitamin D supplementation in at-risk populations," Smith added.

It's been longstanding medical advice that aging people focus on getting enough calcium and vitamin D to preserve their bone health as they age.

About 99 percent of the calcium in the human body is stored in the bones and teeth, and the body cannot produce the mineral on its own, according to the U.S. National Institutes of Health. Too little calcium can lead to osteoporosis. The body also requires vitamin D to absorb calcium.

The National Osteoporosis Foundation recommends that women aged 50 or younger and men 70 or younger should get 1,000 milligrams (mg) of calcium per day. Men and women older than that should get 1,200 mg daily.

For their analysis, Zhao and his colleagues combed through medical literature to find clinical trials that previously tested the usefulness of calcium and Vitamin D supplements. They wound up with data from 33 different clinical trials involving more than 51,000 participants, all of whom were older than 50 and living independently.

Most of the clinical trials took place in the United States, the United Kingdom, New Zealand and Australia, Zhao said. The dosage of the supplements varied between the clinical trials, as did the frequency at which they were taken.

The pooled data revealed no significant association between calcium or vitamin D supplements and a person's risk of hip fracture or other broken bones, compared with people who received placebos or no treatment at all.

Calcium and vitamin D are still essential to bone health, but these results indicate you should get them through your diet and lifestyle rather than from supplements, Zhao explained.

"Dietary calcium is irreplaceable for skeletal health," Zhao said. "Milk, vegetable, fruit and bean products are the most important food sources of calcium."

"Vitamin D is synthesized in the skin in response to ultraviolet-B radiation in sunlight, and dietary sources of vitamin D are limited," Zhao continued. Exercising out in the sunshine should provide a person with all the vitamin D they need.

Potential dietary sources of these nutrients prove one of the weaknesses of the evidence review, Smith argued.

"While this study addresses concerns regarding calcium and vitamin D supplementation, it fails to address or even consider whether the patients in question are obtaining either adequate calcium and vitamin D intake in their diets or sunlight exposure, obviating the need for supplementation," Smith said.

The evidence review also included a large amount of data from the Women's Health Initiative, a federally funded study of aging U.S. women, said Andrea Wong, vice president of scientific and regulatory affairs with the Council for Responsible Nutrition, a trade association representing dietary supplement manufacturers.

"Unfortunately, the WHI data has been widely acknowledged as having limitations of its own having to do with subjects not taking the supplements as directed by the protocol, as well as those who took calcium and vitamin D supplements on their own, outside the protocol, before and during the study," Wong said.

Inclusion of the WHI might have skewed the overall results of the review, Wong argued.

In addition, later reviews of the WHI data indicated that people who started taking calcium and vitamin D supplements had a reduced risk of hip fractures and other broken bones, Wong said.

"CRN recommends that people discuss their individual needs for calcium and vitamin D with their health care practitioners," she said.

"If there is the possibility of reducing the risk of a devastating fracture by supplementing with calcium and vitamin D, as some research has found, people should not be dissuaded from supplementation by a meta-analysis that is meant as a general recommendation and may not apply to each individual," Wong added.

The new analysis was published Dec. 26 in the Journal of the American Medical Association.


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Do Girls Think Boys Are Smarter?


As a pediatrician, I enjoy talking with my patients about school. Recently, I saw a 9-year-old girl and asked about her favorite subject. She smiled and told me art, and then proceeded to say she didn’t like math. When asked why, she responded that she wasn’t very good at it.

Girls of all ages have internal biases about their abilities and can have low self-esteem more frequently than boys their own age. Now, recently published research seems to suggest girls think boys are smarter than they are, starting at about age 6.

In a study published in Journal of Science, researchers assigned various tasks to a group of 5-7 year old children. In one task, they told the children a story about a “really, really smart person” (a child-level description of brilliant). When asked whether it was the picture of a professionally dressed man or woman, girls 6 and above were more likely to point to the picture of a man. In a related task, girls were more likely to shy away from games that were supposedly for “children who are really really smart.” Younger girls, below age 6, did not seem to have these biases, researchers said.

I reached out to two experts to get their thoughts on these findings.

Heather Pressley, VP of Programming for Girls on The Run (GOTR), oversees program development for the organization, a physical activity-based positive youth development program for girls in grades 3-8. She’s also a former teacher and has a PhD in urban education.

Pressley felt the findings of this study were not surprising. “It may be because at age 6, most girls enter school and have the influence of others that may be subconsciously biased. Schools, teachers, parents and other students may unintentionally propagate these feelings in girls.”

Pressley suggested that teachers and administrators recognize their own possible subconscious bias and give both genders the same exposure to different subjects. This would promote the same confidence and competence in all areas. Additionally, they should put girls in extracurricular programs which have a “mastery climate” and a “growth mindset” – showing that talents and strengths can be developed, as opposed to believing you’re good at something or you aren’t — to help them consider subjects such as science or mathematics, she says.

Kristin Carruthers, a clinical psychologist who practices at Child Mind Institute and specializes in ADHD and behavorial disorders, felt similarly.

Carruthers said we could potentially change this by praising girls regularly about their “smartness.” Talk about their accomplishments – like helping calculate the cost of an item in a store or doing well on a math test — to help increase self-esteem and confidence. Long-term, low self-esteem could influence college choices and careers. Because they think they are not smart, some girls are less likely to take on what they perceive as challenges.

Women are inclined to pick majors that are not in science, math or technology, traditionally viewed as “challenging” subjects. In the National Student Clearinghouse Research Center report, less than 30% of women graduated with degrees in science and engineering in 2014, and interestingly this has changed by just 1% over the last decade.

Low self-esteem also can be a risk factor for other issues such as anxiety, depression, weight gain, and eating disorders, and it can affect other facets of life and can play out as difficulty in relationships.

Here are some actions I recommend for parents:

1. Let your daughter know, at every opportunity, that she can do whatever she wants as long as she puts her mind to it.

2. Treat your sons and daughters the same way. If you ask your daughter to help with the dishes, ask your son just as often.

3. Be vigilant about media in the home, on the internet and on tablets and phones. If you see a commercial or a video portraying a woman in a stereotypical role, talk to your kids about it. Use it as a teaching moment.

4. If you see a good role model who is a woman, point her out and talk about it with your children. This could be a tennis star or a CEO of a company, or just the high school kid next door who is an A+ student.

Most important, be a good role model yourself. Kids are more likely to do what we do, not what we preach. If a girl sees her mother being critical of herself, especially of how she looks or how intelligent she is, she’s encouraged to do the same.

Remember, moms need to celebrate themselves and their accomplishments. If we do that, it will help teach our daughters to do that too, and hopefully to take on challenges because they think they are worthy of them.

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Could a Pill Put the Brakes on Aging?


The No. 1 risk factor for all the big diseases -- cancer, heart disease, Alzheimer’s -- is aging.

But instead of treating the diseases, could a drug treat the aging process itself?

That’s the idea behind a growing area of research drawing extensive support from both government and private donors, including millions from Silicon Valley executives like Microsoft co-founder Paul Allen and venture capitalist Peter Thiel. While federal science agency budgets have struggled in the past decade, funding at the National Institute on Aging has risen more than 50% since 2007.

Researchers are seeking a drug to push back the most serious consequences of aging -- and keep people healthy, active, and alert years longer, a notion they call “health span.”

“I’m not interested in creating a population that lives to be 200, because that would be a problem for the world we live in,” says Corinna Ross, PhD, a biologist at Texas A&M University in San Antonio. “But if we can keep people out of nursing home care and reduce the number of Alzheimer’s and Parkinson’s patients, that would be ideal.”

What scientists know about aging has advanced sharply in the past 2 decades as they learn more about what drives the aging process within cells. With the race on to find an anti-aging pill, two of the most promising ones are drugs that already exist: metformin and rapamycin.


Doctors have prescribed metformin, the most common drug to treat type 2 diabetes, for about 60 years. But it’s received new attention as a possible anti-aging drug after researchers in Britain found that people with diabetes who took it outlived some of their peers who did not have the disease by 15%.

“They compared them to a whole bunch of people who were matched for weight and smoking and [other factors] but who didn’t have diabetes,” says Steven Austad, PhD, chairman of the biology department at the University of Alabama at Birmingham. “It turned out the diabetics on metformin were living longer than the non-diabetics who were not on metformin. ... It was very, very intriguing.”

Austad is a bio-gerontologist and scientific director of the American Federation for Aging Research. The organization is trying to raise about $65 million in federal and private funding for what Austad says would be the first human trial of an anti-aging drug. Researchers would give the drug to people ages 65 to 80 with no chronic conditions, then wait to see how long it takes until their next major health problem shows up, Austad says.

Scientists believe the drug works in the mitochondria, the powerhouses in the body’s cells that convert sugars like glucose into energy. Austad says metformin makes those powerhouses run more efficiently, reducing the release of substances known as free radicals. Free radicals can damage cells, hurting their ability to reproduce and causing defects.

Metformin may also activate an enzyme that controls the body’s demand for energy. Austad says that activation mimics the effect of a low-calorie diet, something researchers say can extend life span in laboratory animals.



Biologist Ross is one of several scientists who have looked into the potential life-extending effects of rapamycin. This potent drug, also known as sirolimus and the brand name Rapamune, is most often used in chemotherapy and to keep the bodies of transplant patients from rejecting a new organ. Studies show that the drug can extend life span in mice, roundworms, and monkeys known as marmosets.

Like metformin, rapamycin works on a cell’s mitochondria, where it may change how cells burn glucose, Ross says. Researchers suspect rapamycin can keep the mitochondria running smoothly longer.

“The image I teach to my students is the idea of a factory running out of control, and it’s just spewing stuff out the windows, and you’ve got a negative cascade effect,” Ross says. Preventing mitochondria running wild and burning out can head off effects like inflammation -- a common contributor to age-related diseases.

Rapamycin “works in everything from yeast to mice. It works in multiple mouse strains and backgrounds. It works in both sexes,” says biologist Brian Kennedy, PhD former president of the Buck Institute for Research on Aging in Novato, CA. “I think it’s really exciting.”

For example, the drug has extended life span in mice by 30% to 50%, Austad says. And multiple animal studies show its promise for protecting against cancer and heart disease, as well as degenerative brain disorders like Alzheimer’s.

But it has some powerful side effects.

Rapamycin can cause mouth sores, cataracts, and diabetes. It can also raise the risks of infection, bleeding, and some types of cancers, such as skin cancer. It can cause high blood pressure, fever, and anemia.

Kennedy says much of the rapamycin research under way is aimed at figuring out how to reduce its side effects. What researchers know about the drug’s side effects comes from people who already have serious health problems and who usually take it in combination with other drugs. But they don’t know whether those same issues would happen in healthier people taking the drug on its own.

So while rapamycin appears to produce more dramatic results, metformin is likely to get a clinical trial in humans first, Kennedy says.

“Metformin has been in millions of people. It’s pretty safe as drugs go,” he says. And as doctors and scientists delve deeper into anti-aging research, “The last thing we want is a drug that’s going to cause toxicity and have something like that happen, because that’s going to set the whole deal back.”

Ross’s marmoset study, published in 2015, was the first to look at rapamycin’s side effects in healthy primates. Like humans, marmosets have a higher risk of heart problems and metabolic illnesses when they’re obese. The study found no notable metabolic problems in a group of the monkeys who received rapamycin in human-equivalent doses for a year, and they lost significant amounts of body fat in the early months.

Beyond metformin and rapamycin, other research has looked at the potential anti-aging role of various drugs, hormones, and food compounds, with mixed or uncertain results:

  • Resveratrol, a compound found in grapes and nuts, may reduce stress that leads to cell aging. Research shows it can extend life span in yeast, worms, and fish, but these effects haven’t been demonstrated in humans yet.
  • Acarbose, a diabetes drug that can block the body’s absorption of carbohydrates, showed promise in male mice, but did little for females, Kennedy says.
  • A hormone called 17-alpha-estradiol, a type of the female hormone estrogen, has shown “great promise” in extending longevity in mice, Austad says. But its side effects haven’t been investigated enough to know what risks they may pose.

Kennedy says being able to prevent some of the most debilitating age-related illnesses holds out the hope of a better life.

“We’re better at keeping people alive with various diseases of aging, but we rarely bring them back to full health,” he says. “I think it’s going to be much better for the quality of life of the individual, and much better economically, if we can just keep them from getting sick in the first place.”

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MRIs Safe With Older Pacemakers, Study Finds


Powerful magnetic fields created during an MRI scan were thought to play havoc with some pacemakers, but a new study says these scans are safe for people with the heart devices.

Researchers tested the safety of MRIs on more than 1,500 people who had older pacemakers or implantable defibrillators -- called legacy devices -- that the U.S. Food and Drug Administration does not consider safe for MRIs. The result: No long-term adverse effects were found.

"Many patients have implanted pacemakers or defibrillators that were not designed to be used with MRI scans," said senior study author Dr. Henry Halperin. He's a professor of medicine and co-director of the Johns Hopkins Imaging Institute of Excellence in Baltimore.

A majority of people who have these devices will need an MRI at some point, he noted. The study results show that "it's really safe to do MRIs in these patients," he added.
When MRIs were first introduced, problems with scanning those patients with implanted devices did exist, according to Halperin.

"There were some real issues, like the devices would stop working, and there were 13 to 15 deaths reported," he said. Based on those reports, the FDA said that people with these devices should not have MRIs.

Since 2000, devices have been modified to make them safe during an MRI. But many people still have legacy devices that the FDA does not consider MRI-safe.

MRIs are also safe for people who have wires that connect the devices to the heart -- called leads -- left in place after new leads were implanted, Halperin added.

According to Dr. Byron Lee, a professor of medicine and director of electrophysiology laboratories and clinics at the University of California, San Francisco, "This is important research that affects patient care immediately." Lee was not involved with the new study but was familiar with the findings.

"Contrary to the official word from the device manufacturers and many doctors, almost all patients with pacemakers and defibrillators, and even those with older-generation devices, can get MRIs," Lee said.

To do the scan safely, however, special equipment and extra personnel are required, he explained.

"Currently, many facilities cannot or choose not to provide this service," Lee said. "Therefore, patients sometimes need to advocate for themselves and push for referral to capable centers."

For the study, Halperin and his colleagues tested the safety of MRIs in just over 1,500 people who needed an MRI to diagnose various conditions. However, they had either a pacemaker or an implantable defibrillator not considered to be safe for MRIs.

Before the scans, the investigators changed the pace setting on pacemakers or the defibrillating mode on implanted defibrillators so they would not react to the electromagnetic field created by the MRI.

Halperin's team found no long-term significant problems when the devices were reset after the scan.

In one patient, the battery in the pacemaker was near its expiration date and could not be reset. This patient had a new pacemaker implanted, the study authors noted.

Although some patients experienced changes in the pacemakers' function, these changes were not life-threatening or significant and did not require the device to be reset, the researchers said.

Dr. Saman Nazarian, the study's first author, said, "Given the results of our study and others, it is hard to understand the position of the Centers for Medicare and Medicaid Services to restrict access to MRIs in patients with implanted pacemakers and defibrillator systems."

Limiting people with legacy pacemakers and defibrillators from access to the potentially lifesaving diagnostic data attainable from an MRI is outdated, said Nazarian, who is associate professor of medicine at the University of Pennsylvania Perelman School of Medicine.

"If you are one of the millions of patients with a pacemaker or defibrillator system in place and have been told you need an MRI, contact a center with the expertise to enable the imaging," he said.

The study was published in the Dec. 28 issue of the New England Journal of Medicine.

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Will These 2 Home Remedies Help Your Sore Throat?


Down go another two worthless home remedies for strep throat.

Neither sugarless gum nor probiotics help to treat the symptoms or speed up recovery from a sore throat caused by bacterial infection, a new clinical trial reports.

Doctors had thought that gum sweetened by xylitol, a sugar substitute, might coat the throat and prevent the spread of strep bugs, said lead researcher Michael Moore of the University of Southampton in England.

And some doctors thought probiotics could stimulate the immune system and crowd out harmful strep bacteria, he added.

Probiotics, some suggested, might even help fend off viral infections that cause sore throat, said Moore, a professor of primary health care research.

But his team found no significant benefit from either in a four-year clinical trial involving almost 700 people suffering from sore throat.

Folks with strep should stick with proven remedies to ease their pain, Moore concluded.

"Simple painkillers taken by mouth or medicated lozenges that are anesthetic and antiseptic can provide some short-term symptom relief," Moore said.

Most sore throats are caused by viruses. But about 20 percent are caused by bacteria, most often streptococcus, Moore said.

Only a laboratory test can confirm strep throat, according to the U.S. Centers for Disease Control and Prevention.

But antibiotics are frequently overused to treat sore throat. About 70 percent of sore throat patients receive antibiotics, even though these drugs do nothing to treat a viral infection and aren't effective in soothing strep soreness, according to the Infectious Diseases Society of America.

Concerns about increasing antibiotic resistance led Moore and his team to test these two home remedies.

Clinical trial participants were divided into two groups, one testing the usefulness of gum and the other testing probiotics. Probiotics are good bacteria thought to have health benefits.

Gum chewers were given sticks sweetened with either xylitol (a birch sugar) or sorbitol, or told not to chew gum.

Xylitol has been shown to inhibit bacterial growth and coat the throat wall; the sweetener sorbitol has no such effect, but was included to test whether simply generating more saliva would help soothe the throat.

The probiotic group was provided capsules that contained either actual probiotics or a placebo.

The upshot: Neither xylitol gum nor probiotics provided effective treatment of sore throat symptoms.

"There's no shortage of remedies put forward for sore throats," said Dr. Jack Ende, president of the American College of Physicians. "It's the old axiom that if there are a lot of treatments suggested, no single one actually works."

People with a simple sore throat should try gargling with salt water, downing a spoonful of honey or taking aspirin, ibuprofen or acetaminophen to help them feel better, Ende advised.

Also, look for typical cold symptoms. If you're sneezing or coughing, you probably don't have strep throat, he said.

"Wait it out, and do not go to your doctor's office," Ende said. "He or she has nothing to offer, and all you'll do is potentially infect others in the waiting room."

People with more serious symptoms -- a high fever or swollen glands -- are more likely to have strep and should go to the doctor, Ende said.

Your doctor might prescribe antibiotics for your strep throat, but don't be surprised if you aren't provided any, Ende and Moore said.

"It gets better on its own. It really does," Ende said. "Antibiotics shorten the course by a day or two, but that's all."

However, the CDC says antibiotics are prescribed for strep to prevent rheumatic fever.

The study was published Dec. 18 in the journal CMAJ.

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Booze May Help or Harm the Heart, But Money Counts


 Alcohol's effect on heart health, good or ill, may rely in part on the drinker's income, new research suggests.

For example, the study of more than 200,000 Norwegian adults found that having a few drinks per week was linked to a lowered odds of dying from heart disease over the 30 years of the study.

But that trend was most pronounced in wealthier people.

On the other hand, drinking more than that -- four to seven drinks per week -- was linked to higher rates of heart-linked death, but only for people in the "lowest socioeconomic position," according to a team led by Eirik Degerud, of the Norwegian Institute of Public Health in Oslo.

The findings couldn't prove cause-and-effect. However, the researchers believe that any health recommendation that centers on alcohol should keep income levels in mind, since the effects of drinking seem to change depending on a person's paycheck.


One type of consumption -- regular binge drinking -- appeared to be bad news regardless of financial background, however.

Folks who routinely get drunk on a weekly basis saw their odds for fatal heart events rise regardless of their financial status, the study found.

The findings are based on an analysis of health and wealth data concerning nearly 208,000 Norwegian adults. All had been born in 1960 or earlier, and all had participated in three decades worth of compulsory censuses that had been conducted in Norway between 1960 and 1990.

Two cardiologists agreed that drinking's effects on heart may not be a "one size fits all" proposition.

As regards the potential benefits of two to three drinks per week, Dr. Michael Goyfman said that the rich may appear to benefit more, but the reasons behind that trend remain unclear.

Perhaps it may simply be that the poor are damaged more by even a little drinking, said Goyfman, who directs clinical cardiology at Northwell Health's Long Island Jewish Forest Hills, in Queens, N.Y.

Or wealthier people who have a few drinks per week might also be more apt to engage in heathier eating and exercise, explaining the supposed benefit.

Whatever the reasons, Goyfman believes that the study, "should not be interpreted as an endorsement by researchers to encourage alcohol consumption, since alcohol can have an adverse effect in those with different medical conditions."

Dr. Rachel Bond helps direct Women's Heart Health at Lenox Hill Hospital in New York City. She agreed that, "in my practice, I advise my patients to drink in moderation. The detrimental effects from other organ systems outweigh any potential cardiac benefit."

"While my patients certainly do not have to abstain from alcohol, I educate them about the risks of excessive alcohol intake," she added, "both from a cardiovascular standpoint and for their overall health and well-being, regardless of socioeconomic status."

The Norwegian findings were published Jan. 2 in the journal PLOS Medicine.

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What Tiny Telomeres May Tell Us About Aging


Do tiny pieces of DNA hold the secret to aging?

Called telomeres, these tips on the ends of our chromosomes are generating heated debate as scientists try to better understand their role in aging.

A book released earlier this year titled The Telomere Effect: A Revolutionary Approach to Living Younger, Healthier, Longer says our lifestyle choices affect our telomeres and how we age.

Nobel Prize winner Elizabeth Blackburn, PhD, and University of California San Francisco health psychologist Elissa Epel, PhD, wrote the book, which made the New York Times best-seller list.

“The foods you eat, your response to emotional challenges, the amount of exercise you get, whether you were exposed to childhood stress, and even the level of trust and safety in your neighborhood -- all of these factors and more appear to influence your telomeres and can prevent premature aging at the cellular level,” the authors write.

But some doctors and scientists argue the book is oversimplifying the science. And it comes at a time when researchers are questioning what role telomeres play in the aging process.

“There is no question that telomeres are part of the story,” says S. Jay Olshansky, PhD, of the University of Illinois, Chicago. “Are they the magic bullet that will allow us to live much longer? That’s the missing part of the equation that nobody can provide.”

So what exactly are telomeres?

Much like plastic ends on shoelaces, telomeres protect the ends of our chromosomes that carry our DNA, or genetic material.

Telomeres wear down and get shorter over your lifetime, harming their ability to protect chromosomes. When this happens, new cells don’t replace old ones. Researchers have been studying whether this cellular aging is a root cause for diseases and other problems that happen as we get older.

In 2009, Blackburn was part of a team that won the Nobel Prize in Physiology for discovering that an enzyme called telomerase can help lengthen your telomeres.

Blackburn’s book delves further into the research around telomeres and what may affect them. In it, the co-authors make the case that while telomeres are just one pathway of aging, certain lifestyle changes might stabilize telomeres or increase telomerase and help prevent aging. The book says many studies show those lifestyle behaviors include dietexercisesleep, and actions related to chronic stressand mental well-being.

Among them:

  • A small study found 45 minutes of moderate exercise, three times a week for six months “increased telomerase activity twofold.”
  • A 2012 study found that sleeping fewer hours was associated with shorter telomere length in healthy men.
  • Other studies show a Mediterranean diet is associated with longer telomeres.

“Small things we do each day add up in their effect over years and years,” Epel says. “If we are on a path for a long health span, we are not wearing our cells out, but rather getting the right nutrition and antioxidants, some activity, some joy and satisfaction, and enough restorative sleep each night, so the telomeres are maintained over years and years.”

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8 Small Changes for a Slimmer You in 2020


It's that time of year again. People are rushing to buy gym memberships and cleaning out kitchen cabinets, swearing that this year will be the year they follow through on their resolution to lose weight.
But reaching that goal doesn't require a complete lifestyle overhaul. Small steps can make a big difference in your body and health.

Here are eight ways to get started:

           Break it down. No matter how much you have to lose, changing your lifestyle to lose weight can seem overwhelming. So, don't look at it all at once, advises nutritionist Samantha Heller,  from NYU Langone Medical Center in New York City.
"Look at it one plate at a time, or even one choice at a time, but start right now, and by this time next month, you'll see good changes," she said. Instead of thinking about how you need to lose 40 pounds, figure out what 5 percent of your body weight is. For a 180-pound person, it's 9 pounds.

"If you lose 5 percent of your body weight, you can significantly decrease your risk of many diseases, like prediabetes, type 2 diabetes, certain cancers, heart disease. You lower your blood pressure, cholesterol and A1C [a long-term measurement of blood sugar levels], and it's so much less overwhelming to think about," Heller noted.

           Strive for a negative calorie balance. For years, you've probably heard that to lose a pound, you need to eat 3,500 fewer calories (the number of calories in a pound), but research has shown that it's not necessarily that simple.
Nutritionist Maudene Nelson, from Columbia University Health in New York City, said, "It works mathematically, but it doesn't work physiologically. The body defends its weight," she explained.  But you do need a negative calorie balance to lose weight -- that means you need to take in fewer calories than you use in activity and exercise to lose weight.

Both Nelson and Heller said very low-calorie diets don't work in the long term because the body goes into starvation mode. "You don't want to lose weight too quickly, because it scares the body into thinking there's no food available," Heller said.

           Plate it.Nelson loves the simplicity of the plate method. Half of your plate should be vegetables, one quarter is protein and one quarter is starch. If you finish your plate, and you're still hungry, she said be sure to refill your plate in the same way. "Don't just refill on the mac n' cheese," she advised. In the morning, you can substitute fruit for the veggies.
           Identify trouble times. Nelson asks her clients to think about the time of day they have the most trouble with food. Is it the time just before dinner when the kids are clamoring for food and you're starving and so tired you don't feel like cooking, so you stop at the fast-food drive-thru. Or is it at night when the house has quieted down and you can finally sit down, maybe with a glass of wine and late-night snack?
"In these times of day, it's hard to think about how many calories you're eating. These are times you don't want to stop and think about self-denial. So plan for these times. Have healthy snacks ready. Make sure you have ingredients for a quick meal in the fridge so you don't have to rely on fast-food," Nelson suggested.

           Add protein to every meal. Protein helps keep your blood sugar levels from spiking and then crashing. Without at least a little protein in your meal, you'll be hungry soon after eating because of a fast rise and fall in your blood sugar.
And, Heller said, be sure to have protein at breakfast, too. "Having protein in the morning can really set the stage for a better day -- whether it's eggs or yogurt, nut butter on whole grain toast or apple slices, or even leftovers from the night before," she explained.

           Track it. Both Heller and Nelson said one of the most important things you can do for losing weight is keeping track of the food you eat.
"It's not a sexy or exciting thing to do, but it can be informative and helpful," Heller said, adding that many people are surprised when they write down every bite they take at how much they actually do eat in a day. A food diary can be done with paper and pencil, or you can put technology to work because there are lots of apps for the phone. Examples include myfitnesspal, fitday and seehowyoueat (an app that lets you use pictures to keep your diary).

"You can use your food tracker to see what happened when you did well, or on days you didn't. If you over-eat one night, you can look back and see that maybe you skipped lunch and were starving. You can use it as a learning tool for the next time," Heller said.

  • Plate it.Nelson loves the simplicity of the plate method. Half of your plate should be vegetables, one quarter is protein and one quarter is starch. If you finish your plate, and you're still hungry, she said be sure to refill your plate in the same way. "Don't just refill on the mac n' cheese," she advised. In the morning, you can substitute fruit for the veggies.
  •            Identify trouble times. Nelson asks her clients to think about the time of day they have the most trouble with food. Is it the time just before dinner when the kids are clamoring for food and you're starving and so tired you don't feel like cooking, so you stop at the fast-food drive-thru. Or is it at night when the house has quieted down and you can finally sit down, maybe with a glass of wine and late-night snack?

    "In these times of day, it's hard to think about how many calories you're eating. These are times you don't want to stop and think about self-denial. So plan for these times. Have healthy snacks ready. Make sure you have ingredients for a quick meal in the fridge so you don't have to rely on fast-food," Nelson suggested.

  •            Add protein to every meal. Protein helps keep your blood sugar levels from spiking and then crashing. Without at least a little protein in your meal, you'll be hungry soon after eating because of a fast rise and fall in your blood sugar.

    And, Heller said, be sure to have protein at breakfast, too. "Having protein in the morning can really set the stage for a better day -- whether it's eggs or yogurt, nut butter on whole grain toast or apple slices, or even leftovers from the night before," she explained.

  •            Track it. Both Heller and Nelson said one of the most important things you can do for losing weight is keeping track of the food you eat.

    "It's not a sexy or exciting thing to do, but it can be informative and helpful," Heller said, adding that many people are surprised when they write down every bite they take at how much they actually do eat in a day. A food diary can be done with paper and pencil, or you can put technology to work because there are lots of apps for the phone. Examples include myfitnesspal, fitday and seehowyoueat (an app that lets you use pictures to keep your diary).

    "You can use your food tracker to see what happened when you did well, or on days you didn't. If you over-eat one night, you can look back and see that maybe you skipped lunch and were starving. You can use it as a learning tool for the next time," Heller said.

  •            Don't drink your calories.            

    Both experts said people often get empty calories from soda and juice. "It's just not worth it to drink your calories," Nelson said. What about adult beverages, such as wine and beer? Nelson said those can be considered part of the plate method. Each drink replaces a starch from your plate.

  •            Rewards.            

    Nelson said to set yourself up for success by planning rewards. Whether it's for walking a mile, or for tracking your meals for a week, give yourself more than a pat on the back. It doesn't have to be a big treat -- maybe you could buy that magazine you enjoy but usually don't purchase, or a special body lotion because it's pricier than what you normally spend.

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How to Get Your Skin Ready for Winter


A famous skin doctor in Estee Lauder’s generation, Erno Laszlo, used to say that “you want your skin to be just this side of dry.” So, not oily, but not dry – just that *perfect* level of moisture that’s so hard to attain.

Winter weather can make getting to that perfect moisture level especially challenging – and not just in cold, dry climates. Even in rainy Seattle where I live, skin is generally drier in the winter because most of us are indoors more with central heating on.

As we head into the season, here are some things you can do to keep dryness down:

  • Change to a super gentle cleanser, if you haven’t already.
  • Use a humidifier to keep central heating from drying out your skin.
  • Add an extra layer of moisturizer, or two, under your daily sunscreen.
  • When using two layers of moisturizers, pick products with different, but complementary, approaches to hydrating your skin. For example, layer a hydrating non-alcohol gel, like the SkinCeuticals Vitamin B5 hyaluronic, under your traditional moisturizer.
  • Look for moisturizers with a higher oil content, which will help to hold water in your skin and keep it better hydrated.
  • Facial oils may work well for very dry skin, but avoid them if you have acne. And if you do decide to try them, be aware: you usually won’t see the effect of a facial oil on your acne for 4-8 weeks after you start using it, so watch carefully for changes.
  • Exfoliate less frequently – it reduces the barrier layer of skin, and losing this layer allows more evaporation from your skin.
  • Rinse the salt off your skin after you work out and apply moisturizer or sunscreen.
  • Put an extra layer of moisturizer on your face midday at work. It’s quite amazing how much this helps!
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How Sugar Really Affects Your Cholesterol?


If you’re like most people, you probably think it’s high-cholesterol foods like eggs or shrimp that are the worst for your cholesterol levels. But that’s not really the case.

Because it’s not actually the cholesterol in food that’s the problem. Most of the cholesterol that circulates inside our bodies is made inside our bodies, and not absorbed from the diet. So, it’s not about avoiding foods that naturally contain cholesterol, it’s about avoiding foods that prompt our bodies to create cholesterol.

The most powerful driver of cholesterol production?

Believe it or not, it’s sugar!

When I say sugar, I mean added sugars and simple carbohydrates that can be rapidly turned into sugar within our bodies. Think not only sweets (like cakes and cookies, candies and other desserts), but other foods containing or made from refined grains – like white rice, breads, bagels and pasta.

All carbohydrates are absorbed as sugar. And when blood sugar levels go up (like after eating a bagel), the body responds by releasing insulin. Insulin is a vital hormone that makes sure sugar is stored in our bodies for use between meals. But it doesn’t just cause sugar to be stored. It shifts our bodies into storage mode in general.

And what’s the storage form of cholesterol? LDL, bad cholesterol. If insulin levels go up, LDL goes up. What’s the non-storage form of cholesterol? HDL, good cholesterol. If insulin levels go up, HDL goes down. And what if you’ve stored all the sugar you can and there’s still excess circulating in your blood stream? Insulin helps turn that sugar into fat. The result? Triglyceride levels go up.

Some of the worst cholesterol profiles I’ve seen have been in people who eat a low-fat, low-cholesterol diet but don’t pay attention to the amount, or source, of sugar they’re consuming. Instead of eating fruits and vegetables and whole grains, they’re eating fat free popcorn, and low cholesterol bread, pasta, and low fat cookies.

But to be clear – sugar that occurs naturally, like in fruits – has a very different effect on our biochemistries. Sugar that comes in the form of a whole food (like an apple) is absorbed slowly because it takes more time to digest an apple, and this helps insulin levels to stay steadier. Note that I’m talking about a whole apple – not apple sauce or apple juice (which is digested more quickly, losing some of the positive effect on your biochemistry). So, when eating carbohydrates, stick as close as you can to the original form (whole foods and grains). It’ll help you keep your insulin levels – and your cholesterol – in check.

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Statins Aren't the Only Way to Lower Cholesterol


About 3 years ago, the American Heart Association and American College of Cardiology came out with a treatment guideline recommending that statins be used as the primary method of controlling high cholesterol. Diet changes and other cholesterol-reducing medications were relegated to second class status because the authors concluded, based upon the selected data they reviewed, that using those approaches did not appear to lower overall cardiovascular risk as much as statin drugs.

And after all, the argument was, we’re not just treating people to make their numbers look good; we’re treating people to help them live better, longer – right?

Many physicians felt that this argument was taken to the extreme, especially since, in many circumstances, the guidelines advocate prescribing statin medications regardless of a patient’s initial cholesterol levels and, often, at highest tolerable doses. What’s more, the recommendations place little importance on follow-up testing of cholesterol levels.
So, the recommendations were, and remain, controversial.

Last week, a new analysis performed by leading experts in the field, looking at a wide spectrum of published data, concluded that it doesn’t matter how you get there – cardiovascular risk is reduced proportionately as cholesterol levels decline. Period.

As this new review of evidence shows, statins aren’t the only way to reduce risk – and for some, may not be the best way. And checking cholesterol levels so you know what sort of response you’ve had to treatment might actually be important so you know where you are with your risk.

Most importantly, these findings reveal that reducing your LDL, or “bad” cholesterol, by changing your diet is just as good as reducing it by taking pills, as long as you are monitoring the effects of your nutrition change and getting to your particular treatment goal.

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Is It Heart Pain or Just Heartburn?


The signals our body sends us can be confusing. And if the signal is coming from your chest, the stakes are high – is it my heart or is it just heartburn?

First and foremost, here’s a good rule to follow: If in doubt, check it out. It’s always better to be safe than sorry.

That said, there are some clues that can help discriminate between heart pain and simple heartburn:

1. Heart pain tends to be brought on by exertion or stress and is relieved with rest. Heartburn has no relationship to physical activity. Instead, it tends to be related to ingestion of food.

2. Heart pain tends to occur in the context of risk factors for heart disease, including older age, family history of heart disease, history of high blood pressure, diabetes, high cholesterol, and/or history of tobacco use. Heartburn has no relationship to heart disease risk factors.

3. Heart pain tends to be progressive over time –it will take less and less activity or stress to prompt the pain. Heartburn tends to remain more random.

4. Heart pain is unlikely to occur spontaneously in the middle of the night. Heartburn classically wakes people up at 2 to 3 in the morning.

5. Heart pain may be accompanied by shortness of breath, sweating, and a sense of doom. Heartburn tends to be an isolated symptom.

6. Heart pain does not respond to antacids. Heartburn often gets better with over-the-counter medication like Maalox or TUMS.

7. Heart pain is unlikely to be felt below the rib cage. Heartburn can be felt in the abdomen.

But none of these are absolute, which is why it’s important to listen to your body – and your intuition. If you’re experiencing a new symptom in your chest, and especially if you have risk factors for heart disease, don’t ignore it. Contact your care provider and make an appointment to be checked out. And if you are experiencing chest pain or chest burning that is not going away – especially if it’s lasting more than 30 minutes – or if you have a sense that you need immediate care, head to the emergency room.

NOTE: if you have regularly occurring heartburn, see your healthcare provider.

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How to Lower Your Blood Pressure Without Meds


If you have high blood pressure (readings persistently over 140/90 mmHg), the most important thing you can do is eliminate the factors in your lifestyle that are driving your BP northward. Eliminate those and you might avoid the need for medications, or at least reduce the amounts required to control your readings. Here’s how lifestyle changes can impact your blood pressure:

Losing weight — 5-20 mmHg decrease per 20 lbs weight lost

Eating a healthy diet — 8-14 mmHg decrease

Reducing sodium — 2-8 mmHg decrease

Regular physical activity — 4-9 mmHg decrease

Reducing alcohol consumption — 2-4 mmHg decrease

Put all these together and you can realize anywhere from a 20 to 55 mmHg drop on your own. That’s the same kind of result you’d get from being on a bunch of medications!

Eating right should be a cornerstone of your efforts, since diet affects so many of the other factors that impact your blood pressure readings. And because sodium is so hard to avoid, you’ll need to be especially diligent in this area. One easy way to reduce sodium intake: Eat an apple or other piece of fruit or some raw vegetables before you dig into anything else you might have for lunch or dinner. You might then just have a few fewer bites of your pizza or higher sodium entrée. No, it’s not a perfect plan, but it’s simple – and over time, can represent a significant sodium reduction (while improving overall dietary quality and helping you lose weight).

And even if your blood pressure readings are only “borderline” or “mildly abnormal” right now, it’s still very important to make these lifestyle changes. Taking steps to lower your readings now can keep your blood pressure problem from progressing into something more dangerous.

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Should You Stay Friends With Your Ex?


Breakups can be confusing. You know you can no longer be a couple, but does that mean you have to give up being friends, too? After all, you continue to care about each other even though your romantic relationship didn’t work out. So, what should you do?

To help you decide, read through the following questions.  As you do, consider how they apply to you in the present, as well as how they might apply in the future.

What do you really want? It is important to be honest with yourself about what you are trulythinking and feeling toward your ex. Maybe you feel that the romance has gone out of your relationship, but your friendship is still strong. Some people, though, pretend that they want to be friends when what they really want is an opportunity to win back their former partner’s love. This can leave them quietly pining or feeling tortured. If the last scenario describes you, it may be time to let go of your ex altogether. This would give you the chance to accept the losses, grieve them, and move forward in your life.

How well do you interact? Couples who have an amicable break up may be able to make a relatively smooth transition to friendship. But if fighting or high drama describe you and your ex, you both may be better with more distance between you. You can still wish each other well while choosing to go your own separate ways.

How do your interactions leave you feeling about yourself? If you and your ex continue to care for each other and communicate this in ways that leave you feeling good about yourself, then chances are that you have a solid friendship. On the other hand, if exposure to your ex leaves you doubting or critical of yourself, then you might want to rethink the wisdom of trying to maintain a friendship.

If the questions above leave you feeling that you need distance from your ex, follow up by asking yourself the next two questions.

How long do you think you need to distance yourself? It may be that you simply need time to recover from the breakup and can reconnect when you are feeling stronger. In considering when to re-approach your ex, it’s best not to give yourself a time limit. Instead, monitor yourself and consider what will work well for you each step along the way.

How much distance do you need? The answer to this can, yet again, be found in how you feel in relationship to your ex. If even casually seeing your ex in person causes you great upset, then it may be best to do what you can to limit such contact.

If seeing your ex on social media is also triggering, you might want to limit your contact here, too. This might mean not going on social media at all for a while; or just reducing how often you go on it. Or, you might decide not to be “friends” on social media. Of course, this can be complicated when you see your ex through the social media of mutual friends. In this circumstance, you need to figure out how much you need to limit this contact, too. Keep in mind that your choices do not need to be a forever ones.

Deciding whether to stay friends is very personal. So be careful when you hear people say what you should or should not do. Instead, decide for yourself the best way to handle your relationship with your ex.  In the end, you have to live with yourself, so it’s important to consider what will make you happy in the long-term.

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How to Avoid Pain Flares During the Holidays: 5 Tips From a Doctor


The holiday season can be a challenging time for pain management. For many, the transition to colder and more blustery weather means extra aches and pains. Beyond just the winter weather, the holidays can also be a time of added stress, excessive travel, poor eating (and drinking) habits, and too little sleep. All of this can lead to inopportune pain flare-ups that put a big “bah humbug” into your season’s festivities.

Here are some easy strategies to help you get through the holidays with less pain and more joy:

1. Have a Communication Strategy: Holiday get-togethers with friends and family, or even meeting new people at parties, can sometimes lead to stressful social interactions. Whether it be awkward conversations about your health or heated arguments about politics, holiday chatter has the potential to escalate your anxiety and anger and tense up those already sore body parts. When you hear somebody start to press your buttons, try not to fire back; instead, take some slow deep breaths and transition the conversation topic or smile and move on to a different group. If you know you are going into a stressful situation, have a partner with you, where the two of you agree ahead of time to work together to unwind from toxic conversations. Keep in mind that you can’t control what others say or do, but you can control how you react to it!

2. Eat Plants First: It’s no secret that many Americans put on a few pounds around the holidays. All of the yummy baked goods, along with social gatherings that involve eating, can take its toll. First, foods with added sugar or a lot of carbohydrates (cookies, cakes, etc.) create blood glucose spikes which promotes inflammation at a cellular level. Processed foods are likely high in salt and artificial ingredients which further increases swelling and bloating. And gaining just a few extra pounds can put added stress on painful joints and spines.  To avoid missing out on all of the goodies, start off by eating the healthy choices first, including vegetables, fruits, nuts, whole grains, and lean protein. Then when you move on to more decadent choices, you will be less likely to over-indulge.

3. Pace Yourself: Try not to schedule too many activities in one day and avoid putting yourself in situations that are too physically taxing. Set aside some time in your day to relax, meditate, exercise, or just go for a nice walk to avoid burnout. If you are traveling, check your bags at the curb and avoid the stress of lugging them on the plane or train and hoisting them into the overhead bin. Make a point to avoid prolonged sitting or driving if that bothers your back, and set a timer to take breaks when doing physical tasks like shoveling snow or hanging lights.

4. Watch Your Mood: For a variety of reasons, I see a lot of my patients struggle with extra levels of depression, anxiety, and stress this time of year. If you can relate, then consider doing some preventive work to avoid excessive mood swings. Spend a few minutes each day engaging in activities that calm your nervous system. That could mean pulling out an adult coloring book, listening to relaxing music, or trying some therapeutic breathing exercises. Avoid the winter blues by making a point of getting outdoors in the middle of the day, or try some phototherapy with a light box for 20 minutes. Be sure to unplug from your smartphone and social media, and try boosting your mood with 30 minutes of an activity you enjoy. Don’t hesitate to seek help from a counselor or trusted resource as opposed to fighting it alone.

5. Stay on Top of Your Sleep: Poor sleep directly correlates with more pain, so burning the candle at both ends won’t do you any favors. Engage in healthy sleep hygiene habits during the holidays as much as possible and try to stick to your normal sleep cycle whenever possible. So, avoid shopping online at all hours of the night and don’t be the last one to leave a party. Alcohol consumption can interfere with high-quality REM sleep, so look for healthy alternatives like sparkling water. Poor sleep or too much alcohol can also set you up for a bad headache the next day.

For the next few weeks, try to slow down and be in the moment. “Enjoy the little things in life, for one day you’ll look back and realize they were the big things.” – Robert Brault

Wishing you a happy and healthy holiday season and a glorious New Year!

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