Keeping your Strength Training Routine Fresh

The evidence supporting strength training (and exercise in general) is so compelling that the U.S. Department of Health and Human Services recommends that adults do muscle-strengthening exercises for all major muscle groups at least twice a week. Ideally, this should be combined with at least 150 minutes of moderate (or 75 minutes of vigorous) aerobic activity per week, as well as balance and flexibility exercises. Strength and Power Training: A guide for adults of all ages, a newly updated Special Health Report from Harvard Medical School, offers the following tips—and more—for varying your routine, cranking up the challenge, and making strength training a lifelong endeavor.

Try new equipment. Substitute one type of equipment for another. For example, work out with machines instead of free weights one day a week, or switch from one brand of machine to another. Or try exercises using a medicine ball, resistance bands, or resistance tubing.

Change your pace. Vary your intensity—do one hard, one medium, and one lighter workout in cycles of seven to 10 days. This is a form of periodization, an exercise strategy that can enhance strength gains, help sidestep plateaus, and avoid overtraining while allowing more time for the body to heal after being thoroughly taxed. Because it can be difficult to put together a good periodization strategy, it’s essential to work with an exercise professional to come up with an effective plan that’s tailored to your needs.

Work out with a friend when you can. If your friend is careful about good form, too, this can be a way to help reinforce good habits. Some gyms have a buddy board to help members find workout partners.

Work with a trainer. Pay for a session or two with a certified personal trainer who can help you develop a well-rounded new routine

Cold Weather and Your Health
 

Is cold weather good or bad for your health? It depends. Cold weather can be hard on your health in some ways, but it also be good for it, reports the January 2010 issue of the Harvard Health Letter.

Most of us spend the winter trying to stay warm, but a little bit of exposure to cold may not be such a bad thing. There are two types of fat in the human body: white fat and brown fat. Brown fat is the heat-producing, calorie-burning fat that babies need to regulate their body temperatures. Most of it disappears with age, but adults retain some brown fat. Dutch researchers reported findings last year that showed that moderately cool temperatures of 61° F activated brown fat in 23 of 24 study volunteers. This is a good thing because brown fat burns calories more efficiently than white fat, and so may help control weight. When we get chilled this winter, we may take some consolation that at least we’re firing up those brown fat cells.

In some countries, the use of cold temperatures for medical purposes is taken quite seriously. Several years ago, Finnish researchers reported the results of a study of 10 women who, for three months, took cold-water plunges (20 seconds in water just above freezing) and submitted to whole-body cryotherapy sessions. Blood tests showed a two- to threefold jump in norepinephrine levels minutes after cold exposure. Norepinephrine is a chemical in the nervous system that wears many hats, including a possible role in pain suppression.

Before heading north in search of a colder climate, it's important to think about the toll that cold and winter can take, cautions the Harvard Health Letter. Last year, French researchers found that the increase in systolic blood pressure that occurs during the winter was especially pronounced in people ages 80 and older. Cold weather and respiratory disease, including flu, also go hand in hand.

Being "D-ficient" Bad for the Heart, Bones, and Rest of the Body

New research suggests that having too little vitamin D, the so-called sunshine vitamin, can contribute to heart disease, falls and broken bones, breast cancer, prostate cancer, depression, and memory loss, reports the December 2009 issue of the Harvard Heart Letter. Vitamin D is best known for building and maintaining healthy bones by helping the digestive system absorb calcium and phosphorus. But it does much, much more.

Coronary artery disease. Calcium deposits that stiffen the arteries are more likely to develop in people with low levels of vitamin D. In one study, men low in vitamin D were twice as likely to develop heart disease.

High blood pressure. Vitamin D decreases the kidneys’ production of renin, a hormone that boosts blood pressure. Several studies suggest that low vitamin D contributes to high blood pressure, and that getting more of the vitamin can help control blood pressure.

Statin-related muscle pain. Some people who take a cholesterol-lowering statin stop because of muscle pain. In a study of 128 men and women with statin-related muscle pain, two-thirds of them had low vitamin D levels. Among those who took a vitamin D supplement, muscle pain disappeared in 90%.

Infection. Preliminary trials suggest that too little vitamin D can leave the body prone to infection, and having enough in circulation can help the body fight off the flu, tuberculosis, and infections of the upper respiratory tract.

The Harvard Heart Letter notes that supplements are the simplest, safest way to get vitamin D. Getting 800 to 1,000 IU daily from supplements is a good goal. Ask your doctor to test your vitamin D level, and take a supplement if it is low.

Music is Good for the Heart

According to Harvard Health, music can make you laugh or cry, rile you up or calm you down. Some say it’s good for the soul. It just might be good for the heart, too.

Make no mistake—daily doses of Mozart won’t clean out your arteries or fix a faulty heart valve. But music can help ease your recovery from a cardiac procedure, get you back to normal after a heart attack or stroke, relieve stress, and maybe even lower your blood pressure a tad.

As researchers have turned their attention to the effects of music on the cardiovascular system, they have found that listening to music can lower blood pressure, slow the heart rate, and lessen anxiety in people hospitalized for heart ailments. It can ease pain and distress after cardiac surgery. In otherwise healthy people, music can lower blood pressure and ease stress.

Today, music therapy is most commonly used for people undergoing a cardiac procedure and for those recovering from a heart attack or learning to cope with heart failure or another cardiovascular condition, like angina or heart failure. For them, music therapy can alleviate stress, provide a pleasant coping strategy, and impart a feeling of control.

The Harvard Heart Letter notes that there are several ways to let music into your heart. One is to work with a music therapist. If you can’t find one through your cardiologist or medical center, try the American Music Therapy Association. Do-it-yourself music therapy is another option. Find some music that makes you feel good. Then sit and listen to it for 20 minutes or so.

Foods That Lower Cholesterol

It’s easy to eat your way to a high cholesterol level. But the reverse is true, too—changing what you eat can lower your cholesterol and improve the fats floating through your bloodstream, reports the October 2009 issue of the Harvard Heart Letter.
Different foods lower cholesterol in various ways. Some deliver soluble fiber, which binds to cholesterol in the digestive system and drags it out of the body. Some give you polyunsaturated fats, which lower LDL, the "bad" cholesterol. And some contain plant sterols and stanols, which block cholesterol absorption. Here are some of the best choices:
Oats, barley, other whole grains, beans, eggplant, and okra. These can lower the risk of heart disease, mainly via the soluble fiber they deliver.
Nuts. Studies show that daily consumption of 2 ounces of nuts—like almonds, walnuts, and peanuts—lowers LDL around 5%.
Vegetable oils. Using liquid vegetable oils such as canola, sunflower, safflower, and others in place of butter, lard, or shortening helps lower LDL.
Apples, grapes, strawberries, and citrus fruits. These fruits are rich in pectin, a type of soluble fiber.
Food fortified with sterols and stanols. Sterols and stanols gum up the body’s ability to absorb cholesterol from food. Companies are adding them to foods ranging from margarine to orange juice and chocolate.
Soy. Eating soybeans and foods made from them can lower LDL.
Fatty fish. Eating fish two or three times a week can lower LDL by delivering omega-3 fats.
Fiber supplements. Supplements offer a way to get soluble fiber.
The Harvard Heart Letter notes that adding several foods that fight high cholesterol in different ways should work better than focusing on one or two.

Getting All Your Nutrients from Food—Even If You’re Dieting

 
The best way to get the nutrients you need is from food. But some people doubt they can get everything they need from the foods they eat, especially if their daily calorie intake is at the low end of the spectrum, reports the July 2009 issue of Harvard Women’s Health Watch. Many women take a multivitamin for insurance. But do they need to? With the help of a registered dietitian, Harvard Women’s Health Watch explores how you can meet your vitamin and mineral needs through diet alone, even at 1,500 calories or fewer a day.
A balanced diet—one containing plenty of fruits, vegetables, and whole grains—offers a mix of vitamins, minerals, and other nutrients that collectively meet the body’s needs. It’s not an issue of food quantity but rather food quality. Even a low-calorie diet can deliver all the vitamins and minerals you need with one exception—vitamin D. So plan to take a vitamin D supplement. Getting the rest of your nutrients through diet requires some planning and some knowledge about food. The focus should be on nutrient-dense foods such as legumes, Brussels sprouts, kale, eggs, seeds, almonds, and fish, which are packed with vitamins and minerals and have relatively few calories.
Harvard Women’s Health Watch notes that one way to set up a plan that meets your personal nutritional needs is to work with a registered dietitian. If you’re going to do the work yourself, here are some of the questions you’ll need to ask: How much of each vitamin and mineral do I need? How many calories do I need? What do I eat? How do I know if my diet provides what I need? Harvard Women’s Health Watch lists Web sites where you can find the answers.

When Does a Headache Need Extra Attention?

A minor headache is little more than a nuisance that can be relieved by an over-the-counter pain reliever, some food or coffee, or a short rest. Severe or unusual headaches raise the specter of stroke, a tumor, or a blood clot. Although these are rare causes of headache, it's important to know when a headache needs extra attention, reports the June 2009 issue of Harvard Men’s Health Watch.

Here are some warning signs of headaches that signal the need for prompt medical care:
· headaches that first develop after age 50
· a major change in the pattern of your headaches
· an unusually severe “worst headache ever”
· pain that increases with coughing or movement
· headaches that steadily get worse
· changes in personality or mental function
· headaches that are accompanied by fever, stiff neck, confusion, or neurological symptoms
· headaches after a blow to the head
· headaches that prevent normal daily activities
· headaches that come on abruptly.

For most people, an occasional headache is nothing more than a temporary speed bump in the course of a busy day, notes Harvard Men’s Health Watch. Most headaches you can take care of by yourself with simple lifestyle measures and nonprescription medications. Relaxation techniques, acupuncture, and yoga may also help. For more persistent or painful headaches, talk with your doctor about medications and other strategies. And learn to recognize the warning signs that call for prompt medical care.

Mayo Clinic Proceedings: The Evolution of Migraine from Episodic Headache to Chronic Disorder

Patients living with migraine have strong reason for new optimism concerning a positive future. Two review articles and an accompanying editorial, "The Future of Migraine: Beyond Just Another Pill," in the current issue of Mayo Clinic Proceedings, are the basis for an ironic premise.

"Migraine is a potentially chronic, progressive disease that substantially affects patients, families, workplaces, and society," according to the editorial written by Roger Cady, M.D., of the Headache Care Center in Springfield, Mo. "Ironically, this is the springboard for renewed optimism of a more positive future for patients living with migraine."

Traditionally, Dr. Cady explains, migraine has been considered a pain disorder involving separate or even sporadic episodes. Now, the condition is defined as an all-encompassing and progressive disease that negatively affects all aspects of an individual's life. Migraine can erode quality of life during what should be a person's most productive years, according to Dr. Cady. Because migraine patients' quality of life has not improved at a pace with medical advances, research is addressing the overall severity and potential progressive nature of migraine, especially migraine episodes as a forerunner of chronic migraine.

According to the three articles, these new insights and understandings are requiring professionals to explore well beyond traditional migraine management. "Understanding migraine as a potentially chronic disease mandates a collaborative health care model with patients and health care professionals working in a partnership toward common therapeutic goals," writes Dr. Cady, specifically intervention and prevention. Physicians and patients must be encouraged to be partners, he says, and evaluation must go far beyond the physician just asking, "How are your migraines?" The models must include an invitation to comprehend and address all migraine-related health issues facing patients, Dr. Cady writes. In addition, understanding the evolutionary "stages" of migraine from sporadic to persistent offers an opportunity to develop new therapies that individualize and personalize care.

In the future, successful management of migraine will ideally be measured not by stopping an attack but by overall disease management and prevention, according to the researchers.

This new understanding of migraine as a chronic disease offers many challenges and rewards, according to Dr. Cady. "Today, the focus of care is rapidly changing from the event of the migraine to the patient with migraine," he notes. These changes present great promise for patients and health care professionals alike, representing assurances of a better future for patients with migraine, concludes Dr. Cady.

A peer-reviewed journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally. Articles are available online at www.mayoclinicproceedings.com.

Jury still out on foods, additives, and ADHD

Diet alone probably isn’t the driving force behind the behavioral and cognitive symptoms that plague children with attention deficit hyperactivity disorder (ADHD). But recent studies have renewed interest in whether certain foods and additives might affect particular symptoms in a subset of children with ADHD, in the June issue of the Harvard Mental Health Letter.

A recent analysis of 15 studies that examined the impact of artificial food colorings on ADHD suggested that removing these agents from the diets of children with ADHD would be about one-third to one-half as effective as treatment with methylphenidate (Ritalin). But the authors of the analysis cautioned that only a minority of children are particularly vulnerable to the effects of artificial additives. They also pointed out that it is difficult to determine which children are susceptible.

Other nutritional factors that have been linked to ADHD symptoms include a deficiency of omega-3 fats, which improve brain cell communication, and deficiencies of vitamins or minerals such as zinc, iron, magnesium, and vitamin B6. So far, though, the research has not shown that giving nutritional supplements to children with ADHD alleviates their symptoms.

Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter, recommends that parents of children with ADHD take a sensible approach to nutrition: eat a diet that emphasizes fruits and vegetables, whole grains, healthful unsaturated fats, and good sources of protein; go easy on unhealthy fats and rapidly digested carbohydrates; and balance healthy eating with physical activity. A healthful diet may reduce symptoms of ADHD by reducing exposure to artificial colors and additives and improving intake of omega-3 fats and micronutrients. But it certainly will improve overall health and nutrition, and set the stage for a lifetime of good health.

Avoiding Damaging and Deadly Blood Clots
 

Deep-vein thrombosis (DVT) is a dangerous blood clot that forms deep in a leg or arm vein. Pulmonary embolism (PE) is its most serious—and often deadly—complication. Each year 100,000 people die from DVT and PE, more than die from breast, prostate, and colon cancer combined. You may have heard of these conditions as “economy class syndrome.” But that's misleading. Air travel accounts for a tiny minority of DVT or PE cases. Injury, immobilization, and clotting disorders are the big culprits, reports the May 2009 issue of the Harvard Heart Letter.

You can take simple steps to prevent DVT and PE. Moving your legs is the best medicine:

If you have to sit for several hours—on a plane, in a train or car, or at work—try to get up and move around as often as you can.
While sitting, help your muscles push blood back to the heart by raising and lowering your heels, raising and lowering your toes while keeping your heels on the floor, and by tightening and releasing your leg muscles.
Avoid wearing stockings that bind your calf muscle.
Drink plenty of water.

If you’ve had a DVT or PE, talk with your doctor about whether taking a blood-thinning medication like warfarin is right for you. Wearing compression stockings that massage the legs when traveling or sitting for long periods might also be a good idea. And try to keep up with the exercises listed above.

Although most cases of DVT or PE occur in hospitals or nursing homes, doctors often fail to identify and treat individuals at high risk for developing these potentially damaging conditions, the Harvard Heart Letter notes.
 

Treatments for allergic rhinitis, from Harvard Men’s Health Watch

It’s easy to dismiss hay fever as a minor nuisance. But call it by its proper name, allergic rhinitis, and you’ll be on the way to recognizing it as a legitimate medical problem. Fortunately, it’s a problem that responds very well to treatment, reports the May 2009 issue of Harvard Men’s Health Watch.

Allergic rhinitis can be a pain. Its symptoms may include a stuffy, runny nose, sneezing and coughing, an itchy or sore throat, and itchy, burning, watery eyes. Seasonal allergic rhinitis comes and goes as various plants come into bloom. If your symptoms occur in the spring, you are probably allergic to tree pollen; in the summer, grass and weed pollens; in the late summer and fall, ragweed. Year-round symptoms usually indicate an allergy to dust mites, mold, animal dander, or other indoor allergens.

There are three strategies for keeping allergic rhinitis in check: avoiding triggers; easing symptoms with medications such as antihistamine tablets or nasal sprays, nasal steroid sprays, leukotriene blockers, and decongestants; and getting immunotherapy (allergy shots).

Harvard Men’s Health Watch notes some steps to take to help seasonal rhinitis:

• Limit your outdoor activities when pollen counts are high. If you have to do yard work, wear an N95 face mask. Shower, wash your hair, and change your clothes afterwards.
• Keep your windows and doors closed as much as possible.
• Use air conditioners instead of fans.

For year-round allergic rhinitis:

• Put pillows, box springs, and mattresses in sealed plastic covers to keep out dust mites. Wash bedding in hot water.
• Use a dehumidifier.
• If you have a dog or cat, bathe it weekly and keep it off the furniture.

Economy Got You Down? Use the Principles of Positive Psychology

Tough economic times are the perfect setting to practice the principles of positive psychology, says a new report from Harvard Medical School . Positive Psychology: Harnessing the power of happiness, personal strength, and mindfulness describes many of the concepts that have made positive psychology the most popular class at Harvard University and teaches how to put positive emotions to work in your life.

Numerous scientific studies have linked positive emotions with better health, longer life, and greater well-being. At the other end of the spectrum, chronic anger, worry, and hostility increase the risk of developing heart disease by boosting blood pressure and stiffening blood vessels. A 2005 Harvard School of Public Health study found that people who were generally hopeful were less likely to develop hypertension, diabetes, or respiratory tract infection than those who were less hopeful.

Included in Positive Psychology are vital techniques for enhancing well-being and savoring the positive aspects of your life. They include:

Single task. Multitasking is the enemy of savoring. If you’re walking the dog on a beautiful path but checking your phone for messages, you’re missing the moment. Don’t pile on so much stimulation that you dilute your ability to enjoy it.

Celebrate. Don’t keep the good moments of life to yourself. Let yourself be happy when you complete a project or when something goes well. Savor your accomplishments.

Slow down. Time affluence—having the time to enjoy your life and participate in the activities you want—predicts happiness better than monetary affluence. Try to eliminate some of the less enjoyable ways you spend your time, so you can enjoy the pleasurable experiences in your day without rushing.

Simplify. Too many options can actually diminish your pleasure.

Share the moment. Inviting someone else to share an activity can enhance the pleasure. Together you can relish the sunset, symphony, or ski run.

How to Measure Body Fat

Most of us have our private ways of assessing how fat we are. We feel our pants getting snug-or loose, if we're lucky. But there are more objective ways to answer the question. Harvard Health Letter provides a guide to three measures of fatness.

Body mass index, or BMI, is computed by taking your weight in kilograms and dividing it by the square of your height in meters. The BMI is easy to calculate, and in most people, it correlates reasonably well with overall body fat. It's also a good measure of health risk: as a rule, when BMIs go up, so do deaths, particularly from cardiovascular disease. But BMI doesn't distinguish whether the pounds are from fat or from fat-free tissue like muscle and bone. BMI also doesn't tell us about the type of fat we're carrying-a significant shortcoming, as the type of fat that builds up in the abdomen is believed to be particularly unhealthful.

Waist measurement puts a different spin on obesity: it's no longer about weight or total body fat, but about the metabolically active fat that collects around the organs in our abdomens. Waist circumference is a better predictor of diabetes than BMI and a good indicator of heart disease risk. Measuring it identifies the sizable group of people who pass muster when it comes to BMI but whose large waists put them at higher risk. Still, waist measurement hasn't become part of routine medical practice for several reasons. For one thing, there's some uncertainty about exactly where the waist should be measured, although navel-level is widely accepted. Moreover, the definition of too large a waist may need revision: some studies show that health risks start well before the current cutoffs of 40 inches for men and 35 inches for women. Finally, given all the other information that's collected on patients-blood pressure, cholesterol levels, BMI-it's not certain that adding a waist measurement to the mix would affect treatment decisions.

The waist-to-hip ratio (WHR) is a simple calculation: waist circumference divided by hip circumference. A small waist combined with big hips yields a smaller number than a big waist with small hips-and smaller is better when it comes to WHR. For women, the risk for heart disease, stroke, and other health problems starts to climb at a ratio of about 0.85, so that is often set as the cutoff for a "good" ratio. For men, the cutoff seems to be about 0.90. Waist circumference has eclipsed WHR, but the WHR may be ready for a comeback. Research shows that WHR is more strongly associated with heart disease than waist circumference alone. By taking hip circumference into account, the ratio is more sensitive to the difference between dangerous abdominal fat and the less harmful layer of fat we carry under the skin throughout the body.

7 Tips for Keeping Your Sinuses Clear

More than 20 million Americans will have at least one bout of sinusitis this year. Blockage of the channels that drain the sinuses is the main cause of this painful condition. Keeping these channels open can reduce your chances of developing the problem, while restoring drainage if they become blocked is the key to treatment, reports the recent issue of Harvard Men's Health Watch.
Many people with sinusitis recover quickly and completely without taking antibiotics simply by promoting drainage. Harvard Men's Health Watch offers the following tips:

-Drink lots of water. Good hydration helps keep mucus loose.

-Inhale steam three or four times a day. Boil water in a pan. Turn off the heat and bend over the pan with a towel over your head to catch the steam.

-Breathe deeply through your nose.

-Sleep with your head elevated.

-Use decongestants. Tablets containing pseudoephedrine or phenylephrine are helpful, but beware that they may raise your blood pressure, speed your pulse, or make you jittery.

-Avoid antihistamines. They're fine for allergies or a watery nose, but they make mucus thick and hard to drain-the last thing you want for sinusitis.

-Use a saline (salt water) nasal spray to loosen mucus and rinse your sinuses.

-A warm compress on your face may soothe sinus pain. Over-the-counter pain relievers such as aspirin or acetaminophen will help reduce pain and fever.

Antibiotics aren't the first step in treatment. Good as they are, they have potential disadvantages. They can trigger allergic reactions or cause side effects. Most people recover fully without antibiotics, but if your sinusitis is very severe or does not improve with two to four days of drainage therapy, ask your doctor if you should take an antibiotic.

Abdominal Obesity and Your Health

“How much should I weigh?” It’s a common question, and an important one. Surprisingly, though, it’s actually the wrong question. For health, the issue is not just how much you weigh, but how much of your fat is located in your abdomen, reports the latest issue of Harvard Men’s Health Watch.

Abdominal fat comes in two different forms. Some of it is located in the fatty tissue just beneath the skin. This subcutaneous fat behaves like the fat elsewhere in the body; it’s no friend to health, but it’s no special threat either. Fat inside the abdomen is another story. This visceral fat, which is located around the internal organs, can damage your health.

Scientists originally thought visceral fat was dangerous because it was linked to elevated stress hormones, which raise blood pressure, blood sugar levels, and cardiac risk. A newer explanation relies on the concept of lipotoxicity. Unlike subcutaneous fat, visceral fat cells release their metabolic products directly into the blood, so free fatty acids from visceral fat accumulate in the liver and other organs. This impairs the body’s regulation of insulin, blood sugar, and cholesterol and leads to heart problems. A third hypothesis starts with the complex role of fat cells. In addition to hoarding excess energy, fat cells produce a large number of proteins that contribute to metabolic abnormalities, inflammation, and heart disease. These three explanations are not mutually exclusive; all may help account for the hazards of visceral fat.

One way to evaluate body fat is to measure height and weight, then calculate body mass index (BMI). This is now the standard way to diagnose obesity. Another simple method uses the ratio of the waist and hip measurements. But many experts are turning to an even simpler technique: waist circumference. Because it involves one measurement instead of two, it’s more accurate and reproducible. And new research suggests that this simple measurement is the best way to tell who is at risk for the serious consequences of obesity.

So, what do you do about abdominal obesity? Harvard Men’s Health Watch suggests that you remember the basics. The only way to reduce visceral fat is to lose weight_and the only way to lose weight is to burn up more calories with exercise than you take in from food.

Leave your Earwax Alone

Earwax, a bodily emanation that many of us would rather do without, is actually pretty useful stuff-in small amounts. It serves as a natural cleanser as it moves out of the ear, and tests have shown it has antibacterial and antifungal properties. But for many people, earwax is too much of a good thing. An ear canal plugged up with earwax can cause earaches, infections, and other problems. New guidelines from the American Academy of Otolaryngology stress a let-it-be attitude and warn against removal unless the earwax is causing a problem.

You can get medical help to remove an earwax blockage. Or you can take a do-it-yourself approach. Don't try to remove the wax with a cotton swab, which tends to push the earwax back into the ear. Instead, soak a cotton ball and drip a few drops of plain water, a simple saline solution, or hydrogen peroxide into the ear with your head tilted so the opening of the ear is pointing up. Keep it in that position for a minute to allow gravity to pull the fluid down through the wax. Then tilt the head the other way and let the fluid and wax drain out. You can also use a bulb syringe to swish out the ear.

The Harvard Health Letter notes that you can also buy over-the-counter eardrops that break up earwax. Sometimes the eardrops will work on their own. Other times, a few squirts of water with a bulb syringe are needed. A clinician tackles an earwax problem in pretty much the same way as a do-it-yourselfer, but with more expertise, a better view, and better tools.
 

Making a Nap Work for You

For many of us, taking an afternoon nap is a great way to refresh when we're feeling sleepy. Harvard Men's Health Watch discusses napping, its risks, its benefits, and tips to make it work for you.
People who are sleep deprived feel groggy during the day and may fall asleep when they least want to, perhaps at their desks or, worse, behind the steering wheel. Poor sleep at night may be caused by simply not devoting enough time to sleep or by medical problems that disrupt sleep, such as restless legs syndrome and obstructive sleep apnea. And in some cases, daytime sleepiness can result directly from medical problems such as depression or an underactive thyroid.
Voluntary napping, on the other hand, is not a sign of sleep deprivation, illness, or aging. In fact, a "power nap" can be helpful as well as enjoyable. Many studies of shift workers and other volunteers have reported that a nap as brief as 20 minutes can improve alertness, psychomotor performance, and mood.
Naps, however, aren't trouble-free. One problem is sleep inertia, or grogginess and disorientation that may accompany awakening from deep sleep. The second problem is nighttime wakefulness.
To get the benefit of a quick snooze without being caught napping, Harvard Men's Health Watch suggests the following tips:
* Plan to take your nap at a good time in your daily sleep-wake cycle; for many people, sometime between noon and 4 p.m. is best.
* Don't sleep too long; a 20- to 40-minute nap may refresh your day without keeping you up at night.
* Give yourself 10 to 15 minutes to wake up fully before you resume a demanding task.

"Stealth" Tips for Adding Exercise to Your Day

Regular exercise can lower your risk for heart disease, diabetes, and even some forms of cancer. Yet many people still aren't making physical activity a priority. In its first-ever single-topic special issue, the September 2008 Harvard Health Letter offers 27 tips to get your heart rate up without going to the gym. Its recommendations include these:
1. Take the faraway spot. Walking from the farthest corner of the parking lot will burn a few calories. If it's a parking garage, head for the roof and use the stairs.
2. Get into the swing of it. Swinging your arms when you walk will help you reach the brisk pace of 3 to 4 miles per hour that is the most healthful.
3. Be part of the fun. Adults shouldn't miss a chance to jump into the fray if kids are playing on a playground or splashing around in the water. Playing along will strengthen muscles and bones and set a good example.
4. Clean house. Even if you have a cleaning service, you can take responsibility for vacuuming a couple of rooms yourself. Fifteen minutes burns around 80 calories.
5. Adopt someone as your walking, jogging, or biking buddy... Adding a social element to exercise helps many people stick with it.
6. ... even a buddy with four legs. Several studies have shown that dog owners get more exercise than the canineless.
7. Be a stair master. Taking the stairs is good for your legs, knees, and cardiovascular system. Don't overdo; take one flight at a time.

Watch How to Check Your Blood Pressure at Home

Your blood pressure changes from hour to hour, sometimes minute to minute. Standing up from a chair, watching an exciting show, eating a meal, or being stressed-perhaps because of a visit to the doctor-all influence your blood pressure. Blood pressure readings jump around so much that you are more likely to get an accurate reading if you check it at home rather than in the doctor's office, reports the September 2008 issue of the Harvard Heart Letter.
The idea underlies a new recommendation from the American Heart Association urging individuals with high blood pressure or at high risk for developing it to become do-it-yourselfers, for a number of reasons:
Find your real blood pressure: In some individuals, the doctor's office snapshot tells the whole story and is an excellent approximation of their usual pressure. In others, it isn't.
Track your progress: Checking your blood pressure at home lets you know whether your lifestyle changes and medications are having their desired effects.
Save time and medications: Home measurement may mean fewer trips to the
doctor's office. If you have "white-coat" hypertension-a rise in blood pressure when you go to the doctor-it may also mean taking fewer medications.
Watch the Video

If you choose to measure your blood pressure at home, technique matters. A free instructional video from Harvard Health Publications, online at www.health.harvard.edu/128, shows Harvard Heart Letter editor Patrick J. Skerrett demonstrating the right way to take a blood pressure reading at home. This web page also offers tips for choosing a home blood pressure monitor.
 

Joint Inflammation and Heart Disease Linked

People coping with rheumatoid arthritis or lupus already have a lot to deal with. Even so, paying attention to heart health may be especially important for this group. The August 2008 issue of the Harvard Heart Letter reports that rheumatoid arthritis doubles a person's risk of heart attack or cardiac arrest. Heart disease risk is even higher with lupus, and a new study suggests that gout, another common kind of arthritis, is also linked to cardiovascular disease.
Rheumatoid arthritis, lupus, and related autoimmune disorders are caused
by a misguided immune system. Certain white blood cells, which ordinarily protect the body from infection, attack its tissues instead. Although no one knows exactly how these conditions are connected to cardiovascular disease, it is possible they all spring from the same source-inflammation.
Inflammation is an essential part of the body's defenses. In people with rheumatoid arthritis and lupus, though, inflammation turns against the body and damages joints and other tissues. In heart disease, inflammation kicks off artery-clogging atherosclerosis, keeps it smoldering, and influences the formation of clots, the ultimate cause of heart attacks and many strokes.
Controlling rheumatoid arthritis or lupus with medications that calm inflammation may be a good start toward reducing the excess risk of heart disease. Some studies show that using medications like Remicade and Humira reduces the likelihood of having heart attacks. Statins and baby aspirin may also help.
For now, the Harvard Heart Letter suggests that the best way to control heart risk is by paying attention to diet, weight, exercise, blood pressure, and cholesterol.

Managing Seven Common Conditions Without Medication

We’ve gotten used to taking pills for everything that ails us, but medications have side effects and cost money. The April 2008 issue of the Harvard Health Letter takes a look at how to manage seven common conditions without taking medication. It takes some discipline, but in many cases, the nonpharmacological approach can do as much as pills.
Here’s a brief look at the conditions and treatments:
Arthritis: There’s a good chance that losing weight will make arthritis less painful. Combine weight loss with exercise and you may have less pain and more mobility. Even for those who don’t need to lose weight, exercise that doesn’t put “load” on the joints reduces pain.
Cholesterol: Your LDL level may drop by 5% or so if you keep foods high in saturated fat off the menu. Additional soluble fiber may reduce LDL levels as well. So can margarines fortified with sterols.
Cognitive decline: Memory training and other “brain exercises” seem to help healthy older people stay sharp. But physical exercise may benefit the brain more than mental gymnastics.
Depression: Studies have shown that regular physical activity can have a potent antidepressant effect.
Diabetes: Regular physical activity is a powerful brake on blood sugar levels as well, because exercised muscle becomes more receptive to the insulin that helps it pull sugar in from the bloodstream. Eating fewer sweets and easy-to-digest carbohydrates also helps control blood sugar levels.
High blood pressure: Losing weight, getting more exercise, and eating less sodium all lower blood pressure.
Osteoporosis: Weight-bearing exercise puts stress on bones, and bone tissue reacts by getting stronger and denser, fending off osteoporotic processes. Extra vitamin D and calcium top the list of dietary recommendations.

Seven Steps to be a Star in Heart Health, from Harvard Heart Letter

Want to be an American Ideal? You can star in this reality production (also known as daily life) by following the seven steps the American Heart Association (AHA) uses to define “ideal heart health.” Making all seven part of your life can help you protect yourself from heart disease or stroke. But even following just one or two of the steps significantly reduces the chances of having heart disease, reports the April 2010 issue of the Harvard Heart Letter.

You qualify as someone with ideal heart health if you have not been diagnosed with cardiovascular disease and

1.have never smoked or quit more than a year ago
2.maintain a healthy body weight (a body mass index under 25)
3.spend at least 150 minutes a week doing moderate physical activity or 75 minutes a week doing vigorous activity
4.eat a healthy diet
5.keep your total cholesterol under 200 mg/dL
6.keep your blood pressure under 120/80
7.keep your fasting blood sugar under 100 mg/dL.

The Simple 7 are part of the AHA’s strategy to meet its 2020 goal: “to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%.” The beauty of this approach is that its benefits extend far beyond the heart and arteries. It also works to fight other diseases that are largely caused by poor lifestyle choices—type 2 diabetes, osteoporosis, and some types of cancer, to name just a few.

The Harvard Heart Letter points readers to the AHA’s online heart health resource, called My Life Check (www.heart.org/MyLifeCheck). It includes a questionnaire that lets you know where you are on the spectrum for each of the seven goals and tools to help you develop a plan to improve your health and track your progress.

Women and Heart Disease

Heart disease isn't a gender-neutral condition. Although many of the risk factors are the same in women and men—including high cholesterol, inactivity, obesity, high blood pressure, and smoking—heart disease can develop differently in women than men, cause different symptoms, and have a different impact on long-term health. The January 2010 issue of Harvard Women’s Health Watch outlines 10 things women should know about heart risks and how to manage them. Here’s a sample:

Cholesterol. A low level of “good” HDL cholesterol—below 50 milligrams per deciliter (mg/dL)—is a bigger problem for women than elevated “bad” LDL cholesterol. In fact, the total cholesterol level is less important than the ratio of total cholesterol to HDL cholesterol. For women, the optimal ratio is less than 3.2. High triglycerides (over 150 mg/dL) also pose a bigger heart risk for women than men.

Inflammation. Evidence that inflammation plays a role in the formation of artery blockages has put a spotlight on C-reactive protein (CRP), a substance the body produces in response to inflammation. Now there’s a test for blood vessel inflammation called high-sensitivity CRP, or hsCRP. The Women’s Health Study found that women with high hsCRP results were about twice as likely as those with high LDL cholesterol to die from a heart attack or stroke. As a result of such findings, the hsCRP test is now often used to estimate the likelihood of a heart attack.

Blood pressure. Up to age 55 or so, women are less likely to have high blood pressure than men. After that, their blood pressure typically rises more sharply than men’s, and by age 70, about 80% of women have hypertension. An optimal level is less than 120/80 millimeters of mercury (mm Hg).

Exercise. The more physically active you are, the lower your risk of heart disease. Exercise can raise HDL levels, lower triglycerides, and ease inflammation, changes that are especially important for women. It also helps relieve mental stress—a risk factor for high blood pressure and thus heart problems.

Symptoms. Women are more likely than men to report less dramatic symptoms of heart disease and heart attack, including general discomfort, exhaustion, or shortness of breath under stress or during daily routines. Women are also more likely to complain of fatigue, nausea, back pain, dizziness, and palpitations.

Risk assessment. For many years, experts have relied on a risk-assessment tool based on data from the Framingham Heart Study. It estimates the risk of having a heart attack in the next 10 years by taking into account age, gender, smoking, cholesterol levels, and blood pressure. A new measure known as the Reynolds risk score adds hsCRP testing and family history to the risk calculation and has improved predictive ability, especially for heart attacks in women.

Men—The Medically Weaker Sex

Men rule on the playing field: they can generally run faster, lift more, and throw things farther than women can. In medical terms, though, men are the weaker sex, reports the January 2010 issue of Harvard Men’s Health Watch. Why? It depends on a complex mix of biological, social, and behavioral factors.

Biological factors include the fact that, compared with men, women have substantially higher levels of HDL (good) cholesterol, which protects against heart disease. In addition, excess weight—although common in both sexes—is more of a problem for males. Women tend to carry excess weight on their hips and thighs, while men add it to their waistlines. This abdominal obesity is more damaging to health than lower-body obesity, sharply increasing the risk of heart attack and stroke.

Among the important social factors are a set of traits that tend to be more common in men than in women. Type A behavior, stress, hostility, and anger have all been implicated as heart disease risk factors. Conversely, women generally have larger and more reliable social networks than men. Strong interpersonal relationships and support networks reduce the risk of many maladies.

As for behavioral factors, smoking, drinking, and drug abuse are traditionally male problems. Although the gap has narrowed to some degree, males still dominate in these self-destructive habits. Women also reap the health benefits of better diets. Meat-and-potatoes guys don’t eat veggies—but they should.

Harvard Men’s Health Watch offers 10 ways for men to achieve long and healthy lives. Among them are these:

Do You Need to Cut Back on Sodium?

It makes sense for people with high blood pressure to cut back on the amount of sodium they consume, since blood pressure is directly related to sodium in the diet. But what about the rest of us? The November 2009 issue of Harvard Women’s Health Watch addresses this question and discusses ways to lower sodium intake.

Most of the sodium in our diet comes from salt, or sodium chloride. The body needs some sodium to transmit nerve impulses, contract and relax muscle fibers, and maintain proper fluid balance. The recommended daily sodium intake for healthy adults is no more than 1,500 to 2,300 milligrams (mg)—about the amount in two-thirds of a teaspoon to one teaspoon of table salt. But the average American gets 3,400 mg a day.

Some people are especially sensitive to sodium—their blood pressure rises and falls in response to sodium intake, putting them at increased risk for cardiovascular disease even if they don’t have high blood pressure. Those most prone to salt sensitivity include the elderly, African Americans, and people with hypertension, diabetes, or chronic kidney disease. Others, though, aren't so sensitive to the effects of sodium.

Still, just about everyone should be concerned about sodium intake, notes Harvard Women’s Health Watch. A 2009 report from the Centers for Disease Control and Prevention concluded that 70% of American adults—including everyone over age 40, all African Americans, and people with hypertension—should aim for a sodium intake of no more than 1,500 mg per day. Reaching that goal won't be easy without substantially cutting the amount of salt in processed and prepared foods—the main sources of dietary sodium.

Tips to Control Pet Allergies

If you have both a pet and pet allergies, you don’t have to give up your pet. Pet lovers can take steps to reduce allergy-induced misery, according to What to do About Allergies, a newly revised Special Health Report from Harvard Medical School .

Pet allergies are caused by tiny proteins in pet dander and saliva that are notoriously "sticky" and difficult to eliminate, making pet allergies among the toughest to prevent. These proteins stick to bedding, clothing, and upholstered furniture. This explains why a person with pet allergies can start sneezing from just brushing against a pet owner. It also means that curbing your allergic response requires extra diligence.

If you can’t bear to give up your pet, here are some suggestions for controlling allergens in your environment and preventing symptoms:

Tanning Beds As Harmful as Tanning in the Sun

Whether you get it from the sun or from artificial sources such as sun lamps and tanning beds, ultraviolet radiation is linked to skin cancers and to other sorts of skin damage, particularly premature skin aging, reports the September 2009 issue of Harvard Women’s Health Watch.

Ultraviolet radiation is one part of the spectrum of light that reaches the earth from the sun. The longer ultraviolet rays (UVA), which penetrate deep into the skin, are responsible for tanning. Shorter rays (UVB) damage superficial skin cell layers, causing sunburn. Tanning beds use fluorescent bulbs that emit mostly UVA, with smaller doses of UVB. The amount of UVA radiation you get in a tanning bed is up to three times more intense than the UVA in natural sunlight, and the UVB intensity in tanning beds approaches that of bright sunlight.

There's mounting evidence of a link between tanning bed use and all skin cancers. In 2002, a study found that use of an indoor tanning device was associated with a 50% increase in the risk of basal cell carcinoma and a more than 100% increase in the risk of squamous cell carcinoma. In 2007, an international cancer research organization found that people who started indoor tanning before age 35 had a 75% greater risk of developing melanoma, a serious and sometimes life-threatening cancer.

Harvard Women’s Health Watch notes that despite the clear evidence that it’s unsafe, the use of tanning beds is on the rise. The tanning industry claims that tanning is a good way to stimulate the skin’s production of vitamin D, which is essential to bone health and has also been linked to a reduced risk for some cancers. But you can get all the vitamin D you need in a supplement, without any of the risks to your skin.

Is Peanut Butter Healthy? Yes, says the Harvard Heart Letter
 

Peanut butter contains saturated fat and sodium, so how can it be considered a healthy food? That’s what a reader recently asked the Harvard Heart Letter. It's a good question that gets to the heart of choosing foods that are good for health. Dr. Walter C. Willett, a nationally known nutrition expert and a member of the Heart Letter's editorial board, tackled that question as part of the newsletter's popular Ask the Doctor feature.
The presence of saturated fat doesn’t automatically kick a food, such as peanut butter, into the “unhealthy” camp. Olive oil, wheat germ, and even tofu—all considered to be “healthy” foods—have some saturated fat. It’s the whole package of nutrients, not just one or two, that determines how good a particular food is for health, Dr. Willett says in the July 2009 issue of the Harvard Heart Letter.
A typical 2-tablespoon serving of peanut butter has 3.3 grams of saturated fat and 12.3 grams of unsaturated fat. That puts it up there with olive oil in terms of the ratio of unsaturated to saturated fat. Dr. Willett notes that saturated fat isn’t the deadly toxin it is sometimes made out to be. The body’s response to saturated fat in food is to increase the amounts of both harmful LDL and protective HDL in circulation. In moderation, some saturated fat is okay. Eating a lot of it, though, promotes artery-clogging atherosclerosis, the process that underlies most cardiovascular disease.
Peanut butter also gives you some fiber, some vitamins and minerals (including potassium), and other nutrients. Unsalted peanut butter has a terrific potassium-to-sodium ratio, which counters the harmful cardiovascular effects of sodium surplus. And even salted peanut butter still has about twice as much potassium as sodium.
Numerous studies have shown that people who regularly include nuts or peanut butter in their diets are less likely to develop heart disease or type 2 diabetes than those who rarely eat nuts. Although it is possible that nut eaters are somehow different from, and healthier than, non-nut eaters, it is more likely that nuts themselves have a lot to do with these benefits.

New Guidelines for Aspirin Use

Aspirin was once used mainly to relieve pain and ease fever. Today it’s best known for its ability to protect hearts. Updated recommendations from the U.S. Preventive Services Task Force fill in two big gaps—about aspirin for women and about the safest dose to take. But the new recommendations don’t provide a cookie-cutter approach. Instead, they emphasize weighing the benefits of aspirin therapy against the risks, reports the June 2009 issue of the Harvard Heart Letter.

In general, you should consider taking aspirin if its benefits outweigh its risks. It makes the most sense if your chance of having a heart attack or stroke (calculated online or with your doctor) is greater than the odds of aspirin causing a problem. For men, the main benefit is preventing a heart attack. For women, it’s preventing ischemic stroke, the most common kind of stroke. For both, the risks are gastrointestinal bleeding and hemorrhagic stroke. The task force sets several tipping points based on age and sex. Although these numbers are helpful, they’re impersonal. Your doctor can help you work through the recommendations with your health considerations in mind.

Trials evaluating the heart benefits of aspirin have tested doses ranging from 500 milligrams (mg) a day to 100 mg every other day. The task force says there still isn’t enough evidence to say which one is best. But it concludes that a dose of 81 mg a day, the amount in a baby aspirin, seems to work just as well as higher doses, with fewer bleeding problems.

The Harvard Heart Letter notes that aspirin isn’t a miracle worker. If you’re really serious, there’s a lot more you can do: quit smoking, maintain a healthy weight, exercise daily, choose a healthful diet, and drink alcohol in moderation.

Green Tea Extract Shows Promise in Leukemia Trials

Mayo Clinic researchers are reporting positive results in early leukemia clinical trials using the chemical epigallocatechin gallate (EGCG), an active ingredient in green tea. The trial determined that patients with chronic lymphocytic leukemia (CLL) can tolerate the chemical fairly well when high doses are administered in capsule form and that lymphocyte count was reduced in one-third of participants. The findings appear  online in the May 2009 issue of the Journal of Clinical Oncology.

We found not only that patients tolerated the green tea extract at very high doses, but that many of them saw regression to some degree of their chronic lymphocytic leukemia," says Tait Shanafelt, M.D., Mayo Clinic hematologist and lead author of the study. "The majority of individuals who entered the study with enlarged lymph nodes saw a 50 percent or greater decline in their lymph node size."

CLL is the most common subtype of leukemia in the United States. Currently it has no cure. Blood tests have enabled early diagnosis in many instances; however, treatment consists of watchful waiting until the disease progresses. Statistics show that about half of patients with early stage diseases have an aggressive form of CLL that leads to early death. Researchers hope that EGCG can stabilize CLL for early stage patients or perhaps improve the effectiveness of treatment when combined with other therapies.

The research has moved to the second phase of clinical testing in a follow-up trial — already fully enrolled — involving roughly the same number of patients. All will receive the highest dose administered from the previous trial.

These clinical studies are the latest steps in a multiyear bench-to-bedside project that began with tests of the green tea extract on cancer cells in the laboratory of Mayo hematologist Neil Kay, M.D., a co-author on this article. After laboratory research showed dramatic effectiveness in killing leukemia cells, the findings were applied to studies on animal tissues and then on human cells in the lab. (See "Green Tea and Leukemia" in Discovery's Edge magazine.)

In the first clinical trial, 33 patients received variations of eight different oral doses of Polyphenon E, a proprietary compound whose primary active ingredient is EGCG. Doses ranged from 400 milligrams (mg) to 2,000 mg administered twice a day. Researchers determined that they had not reached a maximum tolerated dose, even at 2,000 mg twice per day.

The study was sponsored by Mayo Clinic, the CLL Global Research Foundation, CLL Topics (including contributions by individual CLL patients) and the Commonwealth Foundation for Cancer Research. Medication for the study was provided by Polyphenon E International. Others on the research team were Timothy Call, M.D.; Clive Zent, M.D.; Betsy LaPlant; Deborah Bowen; Michelle Roos; Charla Secreto; Asish Ghosh, Ph.D.; Brian Kabat; Diane Jelinek, Ph.D.; and Charles Erlichman, M.D., all of Mayo Clinic; and Mao-Jung Lee, Ph.D., and Chung Yang, Ph.D., both of Rutgers University.

The Ten Commandments of Cancer Prevention

About one of every three Americans will face some form of cancer during his or her lifetime. You can help beat these grim statistics by taking steps to protect yourself right now. In fact, up to 75% of cancer deaths in the United States can be prevented, reports the April 2009 issue of Harvard Men’s Health Watch. Here are 10 ways to get started.

1. Avoid tobacco in all its forms, including exposure to secondhand smoke.

2. Eat right. Reduce your consumption of saturated fat and red meat. Limit your intake of charbroiled foods, and avoid deep-fried foods. Eat more fruits, vegetables, and whole grains. And don’t forget to eat fish two to three times a week.

3. Exercise regularly. Physical activity has been linked to a reduced risk of colon, prostate, breast, and reproductive cancers.

4. Stay lean. Obesity increases the risk of many forms of cancer. Calories count—if you need to slim down, take in fewer calories and burn more with exercise.

5. Limit alcohol consumption. Excess alcohol increases the risk of cancers of the mouth, larynx, esophagus, liver, and colon; it also increases a woman’s risk of breast cancer. If you choose to drink alcohol, the limit should be one to two drinks a day for men, no more than one a day for women.

6. Avoid unnecessary exposure to radiation. Wear sunscreen to protect yourself from ultraviolet radiation. Get medical imaging studies only when you need them. Check your home for radon.

7. Avoid exposure to industrial and environmental toxins such as asbestos, benzene, aromatic amines, and polychlorinated biphenyls (PCBs).

8. Avoid infections that contribute to cancer, including hepatitis, HIV, and the human papillomavirus (HPV).

9. Consider taking low-dose aspirin. Men who take aspirin or other nonsteroidal anti-inflammatory drugs may have a lower risk of colon and prostate cancers.

10. Get enough vitamin D. Taking 800 to 1,000 international units (IU) daily may help reduce the risk of prostate and colon cancers.

9 Mediterranean Eating Tips

If you're thinking about New Year's resolutions, consider making 2009 the year you try eating the Mediterranean way. It's not only delicious but also appears to protect against heart disease and many other chronic conditions. The January 2009 issue of Harvard Women's Health Watch suggests some ways to get started eating Mediterranean-style.

1. Pile on the vegetables: The key is variety, so eat many different―and different-colored―ones (especially bright yellow, orange, deep green, and red). Vary your cooking method. Make your salad a main course by adding nuts, diced chicken, and cheese. Pressed for time? Buy pre-packaged salads and pre-cut vegetables.

2. Eat lots of whole fruit: Again, variety is the key. Add pear or apple slices to garden salads. For breakfast, have whole-grain cereals with fruit and yogurt―or top toasted whole-grain bread with peanut butter and sliced banana. Whirl frozen fruit into a smoothie made with low-fat yogurt and half a banana.

3. Go a little nuts: Nuts contain many antioxidants and other nutrients. Unlike snacks made from refined grains or sugar, nuts have a low glycemic index, which has a steadying effect on blood sugar. But they're calorie-dense, so restrict yourself to small amounts. Sprinkle chopped nuts on salads, fruit, or yogurt. Top cooked vegetables with almonds.

4. Go for the grain, the whole grain: Whole grains contain more vitamins, minerals, and protein than refined grains, and they have a stabilizing influence on blood sugar levels. Try pasta and breads (including wraps) made with whole-grain flours instead of refined white flour. Have brown rice instead of white rice, or try amaranth, farro, or quinoa.

5. Eat good fats: Thirty to forty percent of calories in the traditional Mediterranean diet come from fat, half or more of it from olive oil. This healthy monounsaturated fat lowers both total and LDL cholesterol when it's used to replace unhealthy saturated fats. Canola oil and nuts are also rich in monounsaturated fat. Another source of good fat is fish rich in heart-healthy omega-3 fatty acids.

6. Spice it up: Mediterranean cuisines benefit from a climate ideal for growing spices and herbs, which impart flavor, add nutrients, and can substitute for salt. So spice up your meals, especially if it encourages you to enjoy a greater variety of good foods.

7. Love those legumes: Legumes are an excellent low-fat source of protein, vitamins, minerals, and fiber, and are a good substitute for meat. Add legumes to soups and salads. Use beans instead of meat in stews or casseroles.

8. Toast to your good health: Wine (particularly red wine) with meals is a feature of the Mediterranean diet. Alcohol of any kind increases HDL (good) cholesterol, improves insulin sensitivity, and reduces inflammation. Wine in particular contains small amounts of plant substances called flavonoids that have demonstrated anti-inflammatory and anticancer activity in lab experiments.

9. Slow down: Diet plays a primary role in the health benefits of the Mediterranean lifestyle, but the leisurely pace of life also matters. Eating on the run and under stress can cause heartburn and less efficient absorption of nutrients. Eating fast also makes it more difficult to achieve and maintain a healthy weight.
 

Silence the Sleep Apnea "Snorechestra"

The snorts, whistles, and gasps you make while sleeping may do more than rob you of a good night's sleep. This "snorechestra" may be a sign of sleep apnea, which can lead to heart trouble and shorten life.

According to the Harvard Heart Letter, people afflicted with sleep apnea temporarily stop breathing many times a night. In those with the most common kind, obstructive sleep apnea, the soft tissue of the palate or pharynx completely closes off the airway. The brain, sensing a drop in oxygen, sends an emergency "Breathe now!" signal that briefly wakens the sleeper and makes him or her gasp for air. This signal fires up the same stress hormones that go into overdrive when you are angry or frightened. They make the heart beat faster and boost blood pressure. They stoke inflammation, a key player in heart disease. They can damage blood vessels and increase the blood's tendency to clot, a root cause of heart attack and stroke.

The Harvard Heart Letter notes that you don't have to take sleep apnea lying down. Steps ranging from lifestyle changes to surgery can fight obstructive sleep apnea. Losing weight can make a big difference. Sleeping on your side and forgoing alcoholic drinks before sleeping may also help. For moderate or severe sleep apnea, most doctors recommend using a radio-sized machine that keeps the airway open by blowing pressurized air into the nose. Another option is a mouth guard that thrusts the jaw forward. Surgery may be an option, but usually isn't done unless other approaches don't work or aren't appropriate.

Tai Chi Eases Several Medical Conditions

Tai chi is often described as “meditation in motion,” but it might as well be called “medication in motion.” This mind-body practice can help treat or prevent many age-related health problems, reports the May 2009 issue of Harvard Women’s Health Watch. And it may be the perfect activity for the rest of your life.

You can get started with tai chi even if you aren’t in top shape. This gentle form of exercise is slow and doesn’t leave you breathless, yet it addresses the key components of fitness—muscle strength, flexibility, balance, and, to a lesser degree, aerobic conditioning. Harvard Women’s Health Watch reports the findings of various studies showing that tai chi combined with standard medical treatment can be helpful for several medical conditions:

Arthritis. An hour of tai chi twice a week for 12 weeks reduced pain and improved mood and physical functioning more than standard stretching exercises in people with severe knee osteoarthritis.

Low bone density. Tai chi appears to be a safe and effective way to maintain bone density in postmenopausal women.

Breast cancer. In women suffering from breast cancer or the side effects of treatment, tai chi may help improve quality of life and functional capacity.

Heart disease. In one study, tai chi significantly boosted exercise capacity, lowered blood pressure, and improved levels of cholesterol, triglycerides, insulin, and C-reactive protein in people at high risk for heart disease.

Parkinson’s disease. A group of study participants with mild to moderately severe Parkinson’s disease showed improved balance, walking ability, and overall well-being after 20 tai chi sessions.

Exercise Can Help the Heart and Mind

Mind and body are really two halves of the same whole. Each profoundly influences the other. Depression and heart disease are a good example of this duality. People who are depressed are more likely to develop heart disease than people who aren’t depressed, and those who have heart disease are more likely to fall into depression. But it is possible to exploit this two-way street and simultaneously heal the mind and the heart, according to a report in the Harvard Heart Letter.
Depression isn’t just in the mind. It causes a host of physical changes that can lead to heart trouble. It increases inflammation, which is involved in artery-clogging atherosclerosis and the rupture of plaque. It boosts the production of stress hormones, which dull the response of the heart and arteries. It activates blood platelets, making them more likely to form clots in the bloodstream.
Behavioral changes wrought by depression may be even more important. People who are depressed find it hard to exercise, to pay attention to what they are eating, and to take medicines needed to protect the heart.
Depression isn’t a passing phase. Trying to “get through” depression by slogging onward is like trying to “get over” diabetes. Fortunately, a variety of treatments—especially exercise—can fight depression. The Harvard Heart Letter notes that a regular exercise program can improve mood even as it strengthens the heart by releasing mood-altering chemicals in the brain, improving the supply of energy and oxygen to the brain, spurring the growth of new nerve cells in the brain, and reinforcing connections between existing nerves.

Vitamin D has Potential to Ward Off Disease

As we move into winter, and the days get shorter, we are exposed to less sunshine. Our skin uses the sun's rays to make vitamin D. Without it, the body can't absorb dietary calcium, so it steals calcium from bones, increasing the risk of osteoporosis and fractures. But missing out on the "sunshine vitamin" has consequences for more than just bone health, reports the Harvard Women's Health Watch.
Vitamin D would be essential if it just protected bone health. But researchers have discovered that it's active in many other tissues and cells and controls many genes, including some associated with cancer, autoimmune disease, and infection. Hardly a month goes by without news
about the risks of too little vitamin D or about a potential role for the vitamin in warding off diseases, including breast cancer, multiple sclerosis, and even schizophrenia. More trials are needed to confirm vitamin D's benefits and risks. In the meantime, the evidence is so compelling that some experts already recommend at least 800 to 1,000 IU of vitamin D per day for adults.
Harvard Women's Health Watch notes that unless you live in the South and
spend a fair amount of time outdoors, or you eat lots of vitamin D-fortified foods, supplements are the best way to get 800 to 1,000 IU of vitamin D a day. Most multivitamins contain only 400 IU, but don't just take two-getting double doses of other vitamins and minerals can be unsafe. Instead, you can take a vitamin D pill to round out your daily needs. Until we know more, make sure your vitamin D intake from supplements does not exceed 2,000 IU per day.
 

Tips for Keeping Food Portions Under Control

Each of us is responsible for how much we eat, but research suggests that cultural and social norms can make it hard to choose appropriate portion sizes. Harvard Health looks into how misperceptions about portions can affect calorie intake.
In most cases, we tend to treat portions as equivalent to nutritional servings. A serving is a specific quantity of food designated on the basis of nutritional need. However, a portion—the amount you actually get on your plate, in the package, or at the counter—is often much bigger. We don’t always read the Nutrition Facts label, and may end up eating two or three servings’ worth. Studies suggest that we might be satisfied with smaller portions if bigger ones weren’t so easily available. Other research has shown that the more plentiful the food, the more we eat.
Here are some more tips for keeping portions in proportion:
Train your eye: Measure out servings (not portions) of the food you commonly eat so you know what a single serving looks like.
Change your tableware: Use a smaller bowl or a mug for cereal and a smaller plate at dinner.
Control portions at home: To discourage second helpings, serve food in the kitchen and take it to the table on plates.
Eat at regular intervals throughout the day: If you wait until you’re hungry, you’re more likely to overindulge at the next meal.
Control portions while eating out: Avoid buffets and salad bars. Instead of a dinner, order a low-fat appetizer and a large salad with dressing on the side.

Tips to Keep Children Safe Online

The chances of being harassed or sexually solicited online increases when young people interact with others via instant messaging and chat rooms. These forums may encourage impulsive and risk-taking behavior. The July 2008 issue of the Harvard Mental Health Letter describes several risky electronic arenas and offers tips to help keep kids safe.
Instant Messaging: This technology enables people to send text messages back and forth instantaneously while using computers, cell phones, and other electronic devices. It appears to put young people at risk for both bullying and sexual solicitation.
Chat rooms: These online forums enable people to exchange text messages, engage in virtual conversations, and post images. Researchers think that chat rooms pose risks for sexual solicitation and victimization not only because these venues enable participants to communicate directly and privately, but also because some sites encourage the use of obscene language and sexual talk.
Social networking sites: Sites such as Facebook or MySpace allow people to create personal profiles and communicate online. Researchers have found these sites are not as risky as other online interactions such as instant messaging and chat rooms.
Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter, suggests that to protect young people online you need to focus on the children's online behavior rather than the technology:
Be aware of what children are doing online and to whom they are talking.
Keep the computer in a family area.
Stay engaged as children get older.
Help teenagers learn how to keep themselves safe.
To prevent sexual victimization, educate young people about the dangers of online interactions. You can say that it is all right to have sexual feelings, but not to broadcast them online.
 

Distinguishing a Bad Mood from Depression in Teenagers

The teenage years are a time of emotional highs and lows. So how do you distinguish normal teenage mood swings and rebellion from actual depression? The September 2008 issue of the Harvard Mental Health Letter highlights some ways to tell.
Although depression can occur at any age, it affects teens more than younger children. Depressive symptoms may start appearing around age 13, and often peaks between 16 and 24. Yet depression can be difficult to diagnose in young people, because symptoms seldom involve mood alone. One study concluded that fewer than half of teen patients suffered mainly from depressive symptoms. More often, they developed a mix of mood and behavioral problems, for example, agitation, anxiety, attention difficulties, or defiant behaviors.
Many schools have implemented screening programs to identify teens at risk as well as programs to prevent depression. These programs generally educate staff and students about depression and suicide, provide advice and practice in challenging negative thinking, and seek to build resilience and problem-solving skills. The most effective programs are those that are implemented consistently and on an ongoing basis.
Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter, says experts have identified the following ways to distinguish mood swings from depression in adolescents:

* Severity: The more pronounced the symptoms (changes in mood, behaviors, feelings, thoughts), the more likely that the problem is depression and not a passing mood.
* Duration: Any deterioration in behavior or mood that lasts two weeks or longer, without a break, may indicate depression.
* Domains: Problems noticed in several areas of a teen's functioning-at home, in school, and in interactions with friends-may indicate depression.
 

Four Tips for Understanding Medical News

Medicine is a science. That means research should provide clear answers that stand the test of time and scrutiny from additional investigations. That’s the theory behind evidence-based, data-driven scientific medicine. But in our imperfect world, things don’t always turn out as they should. The April 2008 issue of Harvard Men’s Health Watch explains how to handle medical advice that changes from day to day and study to study.
Here are four tips:
1. Understand the different types of research you are likely to hear about. Randomized controlled clinical trials are the gold standard for medical research, and really the only way to prove whether an intervention is beneficial or harmful. Meta-analyses are also important—they combine the results of many different studies and use sophisticated statistical techniques to analyze the pooled data. Observational studies can provide information on links between two factors, but they cannot prove that one factor caused another. Results from animal and laboratory studies should be considered preliminary.
2. Read behind the headlines. Beware of summaries that transform research findings into simplistic formulas for health, and focus on results that have been published in peer-reviewed medical journals.
3. Even high-visibility medical studies published in major journals are often contradicted or modified by subsequent research. This may be frustrating, but new information should always be welcome, even if it casts doubt on established beliefs.
4. When you read about medical research, see how the new information fits into your personal health puzzle before you decide to change your ways. Keep the big picture in mind, and remember to factor in your personal preferences and priorities. If you have lingering questions, discuss them with your doctor.

Folic Acid Reduces Birth Defects, But May Cause Extra Cancers

For 20 years, the United States has been fortifying some foods with folic acid (the synthetic form of folate, a B vitamin) as part of a public health effort to prevent neural tube defects in newborns. The effort is paying off: the rate of neural tube defects is down by 30%. But there’s also evidence that the added folic acid is contributing to colorectal cancers, reports the March 2008 issue of Harvard Women’s Health Watch.
In the early years after folic acid fortification was mandated, the average level of folate in the blood of Americans nearly doubled. During that same period, a 15-year decline in colorectal cancers suddenly reversed. Although this link is not proof of cause and effect, there are biological reasons why extra folic acid may be to blame.
Only long-term monitoring can reveal whether fortifying foods with folic acid is safe—and clarify who is more (or less) likely to benefit. For now, unless you’re pregnant, lactating, or have a recognized folate deficiency, the daily recommended intake of folic acid is 400 mcg—the amount found in a multivitamin. The maximum safe amount from fortified foods and supplements is 1,000 mcg per day. With all the folic acid in fortified foods, you may exceed that limit, especially if you are taking a multivitamin. So it’s a good idea to check nutrition labels and make sure your daily folic acid intake is within bounds.
Harvard Women’s Health Watch notes there’s no known health risk from foods naturally high in folate, so try to get much of your daily requirement from a diet rich in fruits and vegetables.

HELPFUL LINKS:

Harvard Health          https://www.health.harvard.edu/

Health Canada          http://www.hc-sc.gc.ca/index-eng.php

Mayo Clinic                 http://www.mayoclinic.com/