11 Struggles Every New Runner Understands

I've never been one of those people. You know the kind, the ones who wake up in the morning or lace up in the evening and "go for a run."

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I've always been envious of my roommates, who can sneak in a jog with ease and carry on with their day, as if they had done something casually simple like taking the trash out. So, I made a vow to give running another chance. After all, the exercise has been shown to make you happier, reduce your risk for disease and even increase longevity.

While group classes and long walks will probably always be more my speed, I did find that I was enjoying running more than I ever did in the past. However, that doesn't come without a few hiccups. Below are a handful of struggles all new runners can probably relate to.

Getting winded in the first few minutes.

Probably one of the most discouraging elements of getting into a running routine is realizing that you're not as in shape as you thought you were. I continuously find myself doing more walking or jogging than actual running. But just because you need those intermittent breaks doesn't mean you aren't a runner. In fact, research shows that walking intervals during your run can help you maintain your overall pace.

Two words: Sore. Muscles.

The second-day pain is real. If you're experiencing those achy muscles, try one of these post-run remedies. Just make sure you're checking in with your body as you establish your routine. A little soreness is OK, but if the pain is more intense you may have sustained a running-related injury.

 

 

Feeling overwhelmed by the copious amount of races.

Color runs, beer runs, zombie runs, princess half marathons... the list is seriously endless. However, there are some perks to picking a race. Signing up for one helps you set a goal as you get into a routine, plus there's an opportunity to turn it into a social event by participating with your friends.

If your goal is to become a marathon runner (and props to you!), there are also some benefits there: Research shows consistent long-distance running can improve cardiovascular health and lower the risk for other organ disorders, the Wall Street Journal reported.

The jolting agony of waking up at 6 a.m.

My sleepy brain is constantly telling me my bed feels better than running (and often, the bed wins). If you need a little extra motivation, try one of these hacks to help you jumpstart your morning workout.

The boredom.

Part of the reason I never got into a routine in the first place was because the exercise itself seemed extremely dull to me (the treadmill is my arch-nemesis). Once I discovered more running-path options, I started to have more fun. However, that's not to say that I don't get a little bored sometimes — and that's OK.

Note: If you still just can't get excited by the process most of the time, you may want to try a more entertaining workout option instead. Exercise should be engaging, not mind-numbing.

Trying to find your perfect route.

Finding your favorite place to run is like finding a good apartment: It feels elusive until one day you hit the lottery. Whether you're into lush scenery or a skyline, it's important to find the routes that work for you in order to make the exercise entertaining.

The joy of picking out new workout clothes.

Sleek tanks! Compression pants! Neon shoes!

Running toward (multiple) "finish lines."

If you've ever uttered to yourself just one more pole, you're not alone. In fact, picking out an arbitrary finish line on your run can improve your performance. Research shows those who stare at a target in the distance go faster and feel less exertion than those who don't concentrate on anything, The Atlantic reported.

 

 

Bargaining with yourself on your run.

If you run five more blocks, you can binge-watch Scandal when you get home, I tell myself. Chances are I'd probably do it anyway — but at least it encourages me in the moment.

Creating a playlist that will consistently keep you motivated.

No, a simple music-streaming app won't do when your lungs are on fire and your legs feel weak. You need that one specific song that will inspire you to keep going (shout out to all my Shake It Off comrades). If you're looking for a playlist to spice up your run, check out some of these.

Eating Well As You Age

Looking in the mirror for changes as you age? A healthy diet helps to ensure that you'll like the reflection you see. Good nutrition is linked to healthy aging on many levels: It can keep you energized and active as well as fight against slowing metabolism and digestion and the gradual loss of muscle mass and healthy bone as you age.

Making healthy diet choices can help you prevent or better manage chronic conditions such as high blood pressure, high cholesterol, and diabetes. It's never too late to adopt healthier eating habits.

Strategies for Healthy Eating as You Age

Replace old eating habits with these healthy approaches:

  • Eat every three or four hours. “This keeps energy levels high and keeps appetite hormones in check to avoid overeating,” says Kim Larson, RD, of Total Health in Seattle and a spokesperson for the Academy of Nutrition and Dietetics.
  • Eat protein at each meal. Aim for 20 to 30 grams to help maintain muscle mass. Choose fish at least twice a week as a source of high quality protein. Other good sources of protein include lean meat and poultry, eggs, beans, nuts, and seeds.
  • Choose whole grains. Replace refined flour products with whole grains for more nutrients and fiber.
  • Choose low-fat dairy. Cutting out the saturated fat may help lower your risk for heart disease.
  • Learn about portion sizes. You may need to scale back on the serving sizes of foods to control your weight.
  • Choose nutrient-rich whole foods over empty calories. Whole foods are those closest to their natural state. Empty calories are typically processed foods with added salt, sugar, and fat. For example, snack on whole fruit instead of cookies.
  • Eat a “rainbow” of foods. “Eat five to seven servings of fruits and veggies each day to keep antioxidants like vitamins A, C, and E high,” Larson says. Choosing fruits and vegetables of different colors provides your body with a wide range of nutrients. According to research published in the May 2012 issue of the Journal of the American Geriatric Societyexercise coupled with higher fruit and vegetable intake led to longer lives. Fruits and veggies also fill you up with fiber, which cuts down on snacking and helps control weight, Larson says.
  • Choose healthy cooking techniques. Try steaming, baking, roasting, or sautéing food rather than frying it to cut back on fat.
  • Cut down on salt. If you’re over 51, national recommendations are to eat less than 1,500 milligrams of salt per day. Look for low-sodium foods and season your meals with herbs and spices rather than salt.
  • Stay hydrated. “Dehydration can cause irritability, fatigue, confusion, and urinary tract infections,” Larson says. Be sure to drink plenty of water and other non-caffeinated liquids throughout the day.
  • Ask about supplements. You may have changing nutrient needs as you get older and might benefit from vitamins B12 and D, calcium, and omega-3 fatty acid supplements, Larson says. Ask your doctor or a dietitian for guidance.

Overcoming Challenges to Healthy Eating

Eating a healthy diet can be complicated by changes you may face as you age, such as difficulty eating or a limited budget. There are strategies you can try to solve these common challenges:

  • If you've lost your appetite or sense of taste: Try new recipes and flavors — adding spices, herbs, and lemon juice can make foods more appealing. If you take medication, ask your doctor if appetite or taste changes are side effects and if switching to another drug might help.
  • If you have a hard time swallowing or chewing: Choose foods that are moist and easy to eat, such as nutritious soups made with beans and vegetables, Larson says.
  • If affording groceries is difficult: Shop from a list — careful planning can help you make the healthiest and most cost-effective food choices. Use coupons or shop on days when discounts are offered. Buying fruits and veggies when they’re in season and frozen produce in bulk can also help control expenses.
  • If you have trouble preparing meals: Consider buying healthy prepared or semi-prepared meals or at least pre-cut ingredients to cut down on energy-draining prep time.

Larson believes in the importance of enjoying your food. Make healthy-diet changes step by step and have fun experimenting to find new tastes and cooking styles. Eat slowly and pay attention to the experience. “Create a pleasant eatingenvironment," she says. "Sit by a window and enjoy every bite.”

What You Need to Know About Hyperpigmentation

Even small skin traumas like a pimple or bug bite can leave you with complexion-busting dark spots. “This is one of the most common ailments that patients come to see me about,” explains Jeanine Downie, MD, director of Image Dermatology in Montclair, New Jersey. “It’s an annoying condition that affects all skin types, but the good news is that it’s fairly easy to treat.”

Find out how Dr. Downie helps patients treat and avoid marks on their complexions.

Everyday Health: What causes hyperpigmentation?

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Jeanine Downie: Any trauma or inflammation to the skin — either from acne, pimples, bug bites, or simply a bump, cut, or scratch — disrupts the surface layers where you have melanin, responsible for skin’s color. As the skin heals, it leaves behind residual pigmentation and dark spots.

 

 

 

EH: Is there anything you can do to prevent it?

JD: Unfortunately, if you’re prone to these dark spots, it’s tough to prevent them. Still, picking or scratching at an irritation will further traumatize the area, so hands off! You’ll also want to be vigilant about wearing sunscreen. As your skin gets darker, so will those hyperpigmented areas — it’s not like a tan is going to even out the color. Obviously, daily sunscreen wear is a must anyway, but this is just one more reason to protect your skin from UV rays.

EH: What steps can you take to treat it?

JD: The sooner you start taking care of your wound, the better it’ll look once healed. I recommend keeping the wound covered, especially if the skin is broken, and applying a topical healing ointment.

 

 

For large cysts or cuts, you may even want to see your dermatologist for a treatment plan. Once the pimple or cut has healed, apply 2% hydroquinone cream, which is available over-the-counter, or 4% hydroquinone, available by prescription from your doctor.

If the topical creams don’t quite do the trick, talk to your dermatologist about chemical peels or laser treatments to completely eliminate more stubborn discoloration.

EH: Is hyperpigmentation more common in people with darker complexions?

JD: No matter your skin color, everyone is susceptible to hyperpigmentation. Still, those with darker complexions seem to hold on to those spots for much longer because they have more melanin in their skin. It also means those hyperpigmented areas are going to be darker and more visible as well. Pregnancy and certain medications can increase your body’s production of melanin, and lead to hyperpigmentation as well.

6 Ways to Prep Your Skin for Summer

Scheduling vacation plans and buying a new swimsuit will mentally prepare you for summer, but your skin may need some help getting ready, too. For gorgeous, smooth skin you'll feel ready to bare, you need to take a few simple steps. Try this head-to-toe refresher to take your skin out of hibernation.

1. Reveal Glowing Skin

Regular exfoliation can be a part of a healthy skin regimen no matter the season; as long as your skin is not sensitive, exfoliation can help you achieve smooth, healthy-looking skin that makes you look more glowing and youthful. “But it must be done with care,” says Doris Day, MD, a dermatologist in New York City. “The goal is to lift off the outer layer of skin cells that are ready to be sloughed off without stripping the skin.”

 

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Brushes, polishing cloths, and scrubs offer easy ways to smooth away rough spots. Rotating cleansing brushes work by physically buffing off the dead skin cells. Exfoliating cloths, microdermabrasion kits, and scrubs with granular ingredients also operate the same way. “For the body, look for a scrub that contains coarse particles that dissolve over time, like sugar, so you don’t irritate the skin,” says Dr. Day.

Products that chemically exfoliate the skin contain ingredients such as glycolic, salicylic, or polyhydroxy acids that cause the skin to shed its outer layer and reveal the newer layer.

2. Remove Hair Without Irritation

If your summer forecast calls for sunny days at the beach or poolside, you may be putting some effort into removing unwanted hair. But once you rip off the wax strip, it’s also important to care for the skin that’s newly exposed to the elements.

Give your skin some time to recover before rolling out your beach towel or getting active outdoors. “I advise clients to stay out of the sun or heat for at least 48 hours after any hair-removal process,” says Cindy Barshop, owner of Completely Bare spas. “Follicles are vulnerable to irritation, and skin may be sensitive due to any heat or friction from lasers, waxing, or shaving.”

Since most of us don’t plan our hair removal that far in advance, buffer your tender skin with an oil-free sunscreen, wait for it to dry (about 5 minutes), and dust on some talc-free baby powder, says Barshop. To prevent ingrown hairs, it’s helpful to wear loose-fitting clothing and use an after-waxing product that contains glycolic and salicylic acids, which team up to prevent dead skin cells from causing bothersome bumps.

 

 

3. Fight UV Rays With Food

All the work you put into making your skin look good won’t be worth it unless you guard it from the sun’s damaging rays, which are strongest during the summer. Surprisingly, you can protect yourself from the inside, too. “In addition to usingsunscreen, eat cooked tomatoes every day if you know you’re going to be in the sun,” says Jessica Wu, MD, assistant clinical professor of dermatology at USC Medical School. According to research, cooked tomatoes are rich in lycopene, an antioxidant that helps fight the effects of UV rays such as redness, swelling, and blistering from sunburn. If you plan to spend a lot of time outdoors, you may benefit from consuming tomato sauce, grilled tomatoes, or even Bloody Marys. “This doesn’t replace sunscreen, but the habit could give you additional protection if you can’t reach your back and miss a spot,” Dr. Wu adds.

4. Clear Up Body Breakouts

It’s no better to have acne on your body than on the face, especially in the heat, when hiding and covering up isn’t an option. The approach to treating acne on the back, chest, and elsewhere on the body is the same as treating facial acne: “Exfoliate regularly, don’t pick, and treat with effective ingredients,” says Day.

Washing with products that contain salicylic acid helps slough off the dead skin cells; a treatment product with micronized benzoyl peroxide can also help by penetrating the skin and killing off the bacteria that cause acne.

If your skin is sensitive, investing in an acne-treating blue light tool may be worth the cost. “You simply wave the light wand over skin for five minutes daily and it helps kill bacteria,” says Leslie Baumann, MD, a dermatologist in Miami. If you have severe body acne, see a dermatologist.

5. Erase Cellulite

First, the good news: Some products may be able to smooth out the undesirable dimples and unevenness of cellulite. The bad news: They won’t get rid of cellulite forever. The smoothing and toning effect, like many good things in life, is fleeting. Still, it may be worth slathering on a toning body lotion to make your skin look and feel tighter for a day at the beach or a special event.

“Products that contain caffeine and theophylline temporarily dehydrate fat cells,” says Dr. Baumann. “However, it’s the massage and the application of the cream that does the work.” The best course of action long-term is to exercise regularly, coupled with targeted massage, suggests Baumann.

Another way to hide cellulite is to apply a fake tan. Take advantage of the newest self-tanners, which have come a long way from the strong-smelling streaky creams or sprays of yesteryear. “There has been so much progress in the formulations — the colors are natural, there’s no streaking, and the scent is so much better,” says Day.

6. Treat Your Feet

If you’ve stuffed your feet inside boots all winter, they probably could use a little TLC for sandal weather. Jump-start your program with a salon pedicure, or if you’re short on time, you can heed Day’s DIY tip, which will help soften feet while you sleep. First, remove thicker skin with a foot file. Apply a rich emollient cream or ointment, then cover the feet in plastic wrap and cotton socks. Leave on overnight. Repeat every day until you achieve smooth skin, then once a week to maintain soft skin.

7 Healthy Habits of the 2016 Presidential Candidates

The New Hampshire primary's in full swing, and if there’s one thing all the presidential hopefuls can agree on, it’s that running for office is the ultimate endurance challenge. They’re canvassing across the country with little time to exercise or sleep, and it doesn’t help that at every stop they’re tempted by unhealthy foods like pizza, pork chops, and pies. So how do the presidential candidates stay healthy and keep their energy levels up during the grueling primary season? Read on to find out!

What Is Guillain-Barré Syndrome?

Guillain-Barré syndrome (GBS) is an illness that can result in muscle weakness or loss of muscle function in parts of the body.

In people with Guillain-Barré syndrome (pronounced GHEE-yan ba-RAY), the body's own immune system attacks the peripheral nervous system.

The peripheral nervous system includes the nerves that connect the brain and spinal cord to the limbs. These nerves help control muscle movement.

GBS Prevalence

Guillain-Barré syndrome is a rare disease.

The Centers for Disease Control and Prevention (CDC) estimates that about 1 or 2 out of every 100,000 people develop GBS each year in the United States.

Anyone can get GBS, but the condition is more common in adults than in children, and more men than women are diagnosed with GBS each year.

Causes and Risk Factors

Doctors don't know what causes Guillain-Barré syndrome.

Many people with GBS report a bacterial or viral infection (such as the flu) days or weeks before GBS symptoms start.

Less common triggers for GBS may include:

  • Immunizations
  • Surgery
  • Trauma

Guillain-Barré syndrome is not contagious — it cannot spread from one person to another.

Types of GBS

There are several types of Guillain-Barré syndrome, which are characterized by what part of the nerve cell is damaged.

The most common type of GBS is called acute inflammatory demyelinating polyradiculoneuropathy (AIDP).

In AIDP, the immune system mistakenly attacks the protective nerve covering that helps transmit nerve signals from the brain to other parts of the body.

Guillain-Barré Syndrome Symptoms

The first symptoms of Guillain-Barré syndrome often include feelings of tingling or weakness in the feet and legs. These feelings may spread to the arms and face.

The chest muscles can also be affected. Up to a quarter of people with GBS experience problems breathing.

In very severe cases, people with GBS may lose all muscle function and movement, becoming temporarily paralyzed.

Signs and symptoms of Guillain-Barré syndrome may include:

  • Pricking or tingling "pins and needles" sensations in the fingers, toes, ankles, or wrists
  • Muscle weakness that starts in the legs and spreads to the upper body
  • Unsteady walking
  • Difficulty with eye or facial movements (blinking, chewing, speaking)
  • Difficulty controlling the bowels or bladder
  • Rapid heart rate
  • Difficulty breathing

What Is Binge Eating Disorder?

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It's unclear what causes binge eating disorder.

Like other eating disorders, BED is probably caused by a combination of genetic, psychological, and social factors.

Some risk factors for binge eating disorder include:

  • A history of anxiety or depression
  • A history of dieting (especially in unhealthy ways, such as skipping meals or not eating enough food each day)
  • Painful childhood experiences, such as family problems

Symptoms of Binge Eating Disorder

People with binge eating disorder have frequent bingeing episodes, typically at least once a week over the course of three months or more.

Binge eating episodes are associated with three or more of the following:

  • Eating much more rapidly than normal
  • Eating until feeling uncomfortably full
  • Eating large amounts of food when you're not feeling hungry
  • Eating alone, because you feel embarrassed about how much you're eating
  • Feeling extremely disgusted, depressed, or guilty after eating

Some people also display behavioral, emotional, or physical characteristics, such as:

  • Secretive food behaviors, including hoarding, hiding, or stealing food
  • Feelings of anger, anxiety, worthlessness, or shame preceding a binge
  • Feeling disgusted with your body size
  • A strong need to be in control, or perfectionist tendencies

Binge Eating Disorder Treatment

If you have binge eating disorder, you should seek help from a specialist in eating disorders, such as a psychiatrist or psychologist.

There are several treatments available for BED. Treatment options may include:

 

10 Varicose Veins Myths

If you have ropy, blue blood vessels in your legs, you may think that they’re unsightly but don't cause any overt symptoms. Yet for some people, varicose veins can cause skin damage and, even worse, lead to dangerous blood clots.

They’re incredibly common: Varicose veins affect about one in four U.S. adults, or about 22 million women and 11 million men between ages 40 and 80.

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Your leg veins face an uphill battle as they carry blood from your toes to your heart. Small flaps, or valves, within these vessels prevent blood from getting backed up on this journey, and the pumping action of your leg muscles helps push the blood along. 

But if these valves weaken, blood can pool — primarily in the veins of your legs — increasing pressure in the veins. As a result of this increased pressure, your body tries to widen the veins to compensate, causing them to bulge and thicken, and leading to the characteristic twisted appearance of varicose veins.

 

 

To help you learn the facts about these enlarged veins, we've set the record straight on 10 sometimes confusing pieces of information, including who gets varicose veins and why, health problems they can cause, and treatment options.

Myth 1: Varicose Veins Are Only a Cosmetic Issue

“A lot of people are told by primary care doctors or others that varicose veins are a cosmetic issue only, when oftentimes they can be much more than that,” saysKathleen D. Gibson, MD, a vascular surgeon practicing in Bellevue, Washington.

“A significant percentage of patients with varicose veins will eventually develop symptoms,” says Pablo Sung Yup Kim, MD, assistant professor of surgery at Mount Sinai's Icahn School of Medicine in New York City. “The most common include dull achiness, heaviness, throbbing, cramping, and swelling of the legs.” Other symptoms include severe dryness and itchiness of the skin near varicose veins. People with varicose veins are also at an increased risk for a dangerous type of blood clot known as deep vein thrombosis.

Other not-so-common signs and symptoms, found in less than 10 percent of patients, include bleeding, skin discoloration, skin thickening, and ulcer formation — all due to varicose veins, says Kim. Unfortunately, once you have skin damage, it’s usually permanent.

“It’s very important to seek medical advice if you have varicose veins and experience symptoms — before changes in the skin are irreversible,” he says.

Myth 2: Varicose Veins Are an Inevitable Sign of Aging

Aging definitely worsens varicose veins, though not everyone gets them. “It's a degenerative process that gets worse and more prominent as we age,” says Dr. Gibson. But young people can get varicose veins, too. While the average age of patients treated in Gibson’s practice is 52, she and her colleagues have treated patients as young as 13.

If you've got varicose veins, it may run in your family. “The cause of varicose veins is primarily genetic,” Gibson explains.

Changes in hormone levels also come into play as a risk factor for varicose veins. “Your risk can be made worse, especially by pregnancy,” she adds.

Myth 3: Varicose Veins Are Strictly a Women’s Issue

While varicose veins are more common in women, men get them, too. About one-quarter of adult women have some visible varicose veins, compared to 10 to 15 percent of men.

Steve Hahn, 51, of Kirkland, Washington, first noticed in his twenties that he had varicose veins in his left leg after he sprained his ankle playing basketball. When he injured his knee about 10 years ago, he noticed that the varicose veins had become more extensive.

“After about five years of thinking about it, I finally had them treated,” he says. “Both of my legs felt very heavy all of the time at this point, as opposed to just after walking a golf course or playing tennis or basketball.”

After treatment, Hahn says, “I feel like I have new legs.” The heaviness is gone, as is the ankle swelling, which he didn't know was related to the varicose veins. And as a side benefit, he adds, he looks better in shorts.

Myth 4: Running Can Cause Varicose Veins

Exercise — including running — is usually a good thing for your veins. “Exercise is always good for the circulation,” Kim says. “Walking or running can lead to more calf-muscle pumping and more blood returning to the heart.”

“Being a runner doesn’t cause varicose veins,” adds Gibson, though there's controversy about whether exercise makes them worse or not.” Compression stockings can help prevent blood from pooling in your lower legs during exercise. “For patients who haven't had their varicose veins treated and are running, I recommend compression. When you’re done running and are cooling off, elevate your legs,” she says.

Myth 5: Varicose Veins Are Always Visible

While the varicose veins you notice are right at the surface of the skin, they occur deeper in the body, too, where you can't see them. “It really depends on the makeup of the leg,” Gibson says. “If you've got a lot of fatty tissue between the muscle and the skin, you may not see them. Sometimes surface veins are the tip of the iceberg and there's a lot going on underneath.”

Myth 6: Standing on the Job Causes Varicose Veins

If you have a job that requires you to be on your feet a lot — as a teacher or flight attendant, for example — you may be more bothered by varicose veins. But the jury's still out on whether prolonged standing actually causes varicose veins. “People tend to notice their varicose vein symptoms more when they’re standing or sitting,” Gibson explains.

RELATED: Steer Clear of These 9 Artery and Vein Diseases

Myth 7: Making Lifestyle Changes Won't Help

Your lifestyle does matter, because obesity can worsen varicose veins, and getting down to a healthy weight can help ease symptoms. Becoming more physically active is also helpful. “Wearing compression stockings, doing calf-strengthening exercises, and elevating your legs can all improve or prevent varicose veins,” saysAndrew F. Alexis, MD, MPH, chairman of the dermatology department at Mount Sinai St. Luke's and Mount Sinai Roosevelt in New York City.

Myth 8: Surgery Is Your Only Treatment Option

The only treatment available for varicose veins used to be a type of surgery called stripping, in which the vein is surgically removed from the body. That’s no longer the case. While this procedure is still the most commonly used varicose vein treatment worldwide, according to Gibson, minimally invasive procedures that don't leave scars have become much more popular in the United States.

Endothermal ablation, for example, involves using a needle to deliver heat to your vein, causing it to close and no longer function. While the procedure doesn't leave a scar, it can be painful, and you may have to undergo sedation before being treated. “You have to have a series of injections along the vein to numb it up; otherwise, you wouldn't be able to tolerate the heat,” Gibson explains. You may need to take a day off from work to recover, as well as a few days off from the gym.

Some medications, called sclerosing agents, close a vein by causing irritation. Others are adhesives that seal a vein shut and don’t require the area to be numbed. Gibson and her colleagues have helped develop some of the new technologies and products used in treating varicose veins, including adhesives.

Milder varicose veins can be treated by dermatologists with non-invasive approaches, such as laser therapy and sclerotherapy, says Dr. Alexis. “For more severe cases where symptoms may be involved, seeing a vascular surgeon for surgical treatment options is advised.”

Although treatment for varicose veins means losing some veins, you have plenty of others in your body that can take up the slack, explains Gibson. “The majority of the blood flow in veins in the leg is not on the surface at all; it's in the deep veins within the muscle,” she says. “Those deep veins … are easily able to take over for any veins that we remove on the surface.”

Myth 9: Recovery After Varicose Vein Treatments Is Difficult

 

 

Newer treatments have quicker recovery times. “These procedures can be performed in an office within 20 to 30 minutes with no recovery time. Patients can usually return to work or daily activities on the same day,” Kim says.

Myth 10: Varicose Veins Can Be Cured

Treatments are effective, but they aren't a cure, Gibson says. Sometimes, varicose veins can make a repeat appearance after treatment. “What I tell my patients is it's kind of like weeding a garden,” she says. “We clear them all out, but that doesn't mean there's never going to be another dandelion popping out.”

10 Essential Facts About Ovarian Cancer

Statistically speaking, ovarian cancer is relatively rare: It represents just 1.3 percent of all new cancer cases in the United States each year, according to the National Cancer Institute (NCI). But although its numbers are small, the fear factor for many women may be disproportionately large.

We spoke to two leading ovarian cancer experts: Robert J. Morgan, Jr., MD, professor, and Mihaela C. Cristea, MD, associate clinical professor, of the medical oncology and therapeutics research department at City of Hope, an NCI-Designated Comprehensive Cancer Center in Duarte, California.

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Here are 10 essential facts about ovarian cancer that you should know:

1. About 20,000 women in the United States are diagnosed with ovarian cancer each year. As a comparison, nearly 250,000 women will be diagnosed with breast cancer this year, according to the American Cancer Society. Of the women diagnosed with ovarian cancer, 90 percent will be older than 40; most ovarian cancers occur in women 60 or older, according to the CDC.

2. You should see your doctor if you experience any of these ovarian cancer symptoms:

  • Vaginal bleeding (especially if you’re past menopause)
  • Abnormal vaginal discharge
  • Pain or pressure in the area below your stomach and between your hip bones
  • Back pain
  • A change in bathroom habits, such as urgently needing to urinate, urinating frequently, or having constipation or diarrhea

It’s important to pay attention to your body and know what’s normal for you. If you have abnormal vaginal bleeding or have any of the other symptoms for two weeks or longer, see your doctor right away.

 

 

These symptoms can be caused by many different problems, but it’s best to have them evaluated, suggests the University of Texas MD Anderson Cancer Center.

3. It’s tricky to pinpoint early, milder symptoms of ovarian cancer. However, the findings of a study published in Cancer in 2007 point to a cluster of vague symptoms that may suggest the need for ovarian cancer testing, says Dr. Morgan. In the study, researchers linked these symptoms to the possibility of ovarian cancer:

  • Pelvic or abdominal pain
  • Strong urge to urinate or frequent urination
  • Bloating or increased abdominal size
  • Difficulty eating or feeling full early

If a woman experiences these symptoms on more than 12 days a month for less than one year, she should insist that her doctor perform a thorough ovarian evaluation, says Morgan. This might include the CA-125 blood test or atransvaginal ultrasound exam.

4. Early detection can mean a better prognosis. When detected early enough, ovarian cancer can be cured. “Stage 1 and stage 2 ovarian cancer is curable about 75 to 95 percent of the time, depending on the tumor grade and cell type,” says Morgan. But because this cancer occurs deep inside the body’s pelvic region, it is often diagnosed in later stages, he says. The cure rate for stage 3 ovarian cancer is about 25 to 30 percent, and for stage 4 it's less than 5 percent, he adds.

RELATED: Overcoming Ovarian Cancer, Twice

5. Ovarian cancer has several key risk factorsThese include:

  • Women with a family history of ovarian cancer may be at higher risk.
  • Women who have never been pregnant and women who have uninterrupted ovulation due to infertility treatments seem to be at higher risk.
  • Early onset of your period, or having a late menopause, seems to increase risk.
  • Using talcum powder in the genital area may increase risk.
  • Smoking is a risk factor for a type of ovarian cancer known as mucinous ovarian cancer. Quitting smoking seems to reverse the risk back to normal, says Morgan.

6. Ovarian cancer is not a single disease. In reality, it’s a diverse group of cancers that respond to different treatments based on their molecular characteristics, says Dr. Cristea. Treatment will also depend on other health conditions, such as diabetes or heart problems, that a woman might have.

7. Ovarian cancer treatments are evolving and improving all the time.Immunotherapy is emerging as a new treatment option for many malignancies, including ovarian cancer,” says Cristea. In another recent development, the firstPARP inhibitor, a DNA-repair drug, has been approved for women with BRCA-mutated ovarian cancer when chemotherapy hasn’t worked. “Women should also ask their doctors about clinical trials that are evaluating immunotherapy as well as other new treatments,” she adds.

 

 

8. Surgery may prevent ovarian cancer in women at very high risk. For women who carry the BRCA or other genes that predispose them to ovarian cancer, doctors often recommend surgery to remove the ovaries and fallopian tubes.Angelina Jolie, the actor and human rights activist, decided to have this surgery in March 2015. “Removing the ovaries can decrease the risk of developing the disease by 98 percent, and can substantially decrease the risk of developing breast cancer,” notes Morgan. Women in this very high-risk group should opt for this surgery after they’ve completed childbearing at around age 35, he notes.

9. Even after remission, ovarian cancer can still respond to treatment. “About 80 to 90 percent of ovarian cancer patients will achieve remission after chemotherapy treatment,” says Morgan. However, many of those women will later experience a recurrence of the cancer. The longer the remission, notes Morgan, the better the chances are for achieving a second remission.

10. It’s best to see an ovarian cancer specialist. When you’ve been diagnosed with ovarian cancer, getting a referral to an ovarian cancer specialist is a wise move, says Cristea. If you’re having surgery, it’s best to have a gynecologic oncologist perform the operation instead of a gynecologist, she adds. And to make sure you’re getting state-of-the-art treatment, consider seeking a second opinion at a NCI-Designated Cancer Center.

How to Prevent Hearing Loss

Do you have trouble following a conversation in a noisy room? Do other people complain that you have the television turned up too loud? If the answer to either of those questions is yes, you may already have some degree of hearing loss.

Hearing loss can start at any age. According to the National Academy on Aging and Society, the number of affected Americans between the ages of 45 and 64 has increased significantly since 1971. But it’s much more common in seniors: Some 40 percent of the 20 million Americans who have hearing loss are 65 or older.

Contrary to popular belief, however, hearing loss is not an inevitable part of aging. Some causes of hearing loss can be prevented, and most types of hearing loss can be helped.

Types and Causes of Hearing Loss

There are three basic types of hearing loss:

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  • Sensorineural hearing loss is caused by damage to the inner ear nerves or the nerves that carry sound to the hearing area of the brain. Once you have this type of nerve damage, the only treatment is a hearing aid. Causes of sensorineural hearing loss include injuries, tumors, infection, certain medications, and excessive noise exposure.
  • Conductive hearing loss is caused by a condition that blocks sound waves from being transferred to the nerves involved in the hearing process. Whereas sensorineural hearing loss usually affects both ears, conductive hearing loss may only affect one ear. Common causes include ear infections, ear wax, ear trauma such as a punctured eardrum, and other diseases that affect the ear canal, the eardrum, or the tiny bones in the middle ear. Unlike sensorineural hearing loss, this type of hearing loss can often be corrected and restored.
  • Mixed hearing loss occurs when someone who has nerve type hearing loss from aging or noise trauma then gets an ear infection or develops a wax impaction, causing their hearing to suddenly get much worse. It’s a combination of sensorineural hearing loss and conductive hearing loss.

Hearing Loss Evaluation

If you are having trouble hearing or develop sudden deafness, you need to get your hearing checked as soon as possible. Sudden deafness is a serious symptom and should be treated as a medical emergency. For many people, though, hearing loss may be gradual and not obvious. Here are seven warning signs to watch out for:

  • You have trouble hearing while on the telephone.
  • You can’t seem to follow a conversation if there is background noise.
  • You struggle to understand women’s or children's voices.
  • People complain that you turn up the TV volume too high.
  • You constantly ask people to repeat themselves.
  • You have a long history of working around loud noises.
  • You notice a ringing, hissing, or roaring sound in your ears.

 

 

If you think you have any kind of hearing loss, the place to start is with your doctor. Whether your hearing loss is gradual or sudden, your doctor may refer you to an audiologist (a medical specialist in hearing loss) or an otolaryngologist (a medical doctor specializing in disorders of the ear).

 

 

Depending on the cause and type of your hearing loss, treatment may be as simple as removing ear wax or as complicated as reconstructive ear surgery. Sensorineural hearing loss can't be corrected or reversed, but hearing aids and assistive devices can enhance most people’s hearing. For those with profound hearing loss approaching deafness, an electronic hearing device, called a cochlear implant, can even be implanted in the ear.

Tips for Hearing Loss Prevention

One type of hearing loss is 100 percent preventable: that due to noise exposure. Noise is measured in units called decibels: Normal conversation is about 45 decibels, heavy traffic may be about 85 decibels, and a firecracker may be about 120 decibels. Loud noise — anything at or above 85 decibels — can cause damage to the cells in the inner ear that convert sound into signals to the brain. Here are some tips for avoiding noise-induced hearing loss:

  • Minimize your exposure to loud noises that are persistent.
  • Never listen to music through headphones or ear buds with the volume all the way up.
  • Wear ear plugs or protective earmuffs during any activity that exposes you to noise at or above 85 decibels.
  • See your doctor about a baseline hearing test, called an audiogram, to find out if you already have some early hearing loss.

You should also see your doctor if you have any symptoms of ear pain, fullness, or ringing, or if you experience any sudden change in your hearing. These symptoms could be early warnings of preventable hearing loss.

Hearing loss or deafness can have a serious effect on social well-being. It can cut you off from the world around you. Know the causes of hearing loss, and practice hearing loss prevention to preserve the hearing you still have.

CBT Beats Light Therapy for Seasonal Depression

Cognitive therapy was aimed at 'getting people out of hibernation mode.'

Individuals with seasonal affective disorder (SAD) who participated in 6 weeks of daily cognitive-behavioral therapy (CBT) saw more improvement than those who used light therapy, with the advantage for CBT becoming apparent two winters post-intervention, researchers reported in AJP In Advance.

Two winters after receiving either CBT or light therapy, researchers found that those who received CBT experienced a smaller proportion of recurrence as measured the SIGH-SAD, a primary measure of SAD symptoms, as compared with those who received the light therapy (27.3 percent versus 45.6 percent, respectively), and larger proportion of remissions from SAD as defined by a score of  less then 8 on the Beck Depression Inventory-II (68.3 percent  versus 44.5 percent, respectively), according to Kelly Rohan, PhD, and colleagues from the University of Vermont.

For the study, Rohan and colleagues randomized 177 patients to receive either light therapy on a daily basis for 30 minutes upon waking or to receive CBT-SAD, a type of intervention that delivered psychoeducation, behavioral activation, and cognitive restructuring specifically targeting winter depression symptoms in group therapy sessions twice per week for 6 weeks.

Rohan told MedPage Today that CBT-SAD therapy involved "getting people out of hibernation mode so they approach rather than avoid winter... the activities do not necessarily need to be outdoors or involve communing with snow. They involve anything the person finds enjoyable that can be done in the winter to experience pleasure, rather than withdrawing and socially isolating oneself, which breeds depression." This could involve staying active in one's routines, such as going to the gym, maintaining hobbies, or developing new hobbies to take the place of summer-specific hobbies, or seeing people socially, for instance.

The following winter, researchers contacted study participants in both groups, asking them to resume the treatment they received during the previous winter under their own volition.

Those who received light therapy the previous winter received a letter asking them to resume the daily light therapy upon the onset of the first depressive symptom and those who received CBT-SAD were encouraged to use the skills taught to them the previous winter. Researchers instructed participants in both groups that if recommended strategies were insufficient to relieve symptoms of depression, they should pursue formal treatment, and included contact information for local mental health centers.

RELATED: How to Survive Daylight Saving Time and Shorter Days

Researchers conducted in-person visits in January or February of the first winter following the initial intervention as well as the second winter.

Responses to CBT the first winter after the intervention strongly predicted its effectiveness the following winter. Those who were depression-free the first winter following the intervention were markedly more likely to be depression-free during the second winter compared with those had still shown depression symptoms during the first winter.

In contrast, those who received light therapy who remained depression-free the winter following the intervention were only twice as likely to avoid recurrence during the second winter compared with those without a substantial initial response.

Light therapy has long been used as a treatment for SAD, but one major obstacle to success in treatment includes lack of compliance. In the study, only about a third of subjects reported continuing light therapy at each follow-up, which may have been in part due to study design, according to the authors.

Said Rohan, "In practice, these data indicate that there are options for treating SAD. If someone is willing not only to use light therapy to alleviate current symptoms, but also to keep using daily light therapy until spring and resume using it each fall/winter season, that is a viable option -- however, if someone is willing to work on their thoughts and behaviors in CBT-SAD over 12 sessions in a winter, that is also an option. Better yet, CBT-SAD is a treatment that might have longer-lasting benefits than light therapy in terms of lower risk for SAD recurrence and less severe symptoms two winters later."

Rohan said she hopes to get rates of depression recurrence even lower following SAD treatment in her next study. "This may involve early fall booster sessions to reinforce use of CBT-SAD skills as the seasons change," she noted, or for those who receive light therapy, a conversation regarding increasing compliance with the daily regimen to offset depression recurrence.

7 Dietitian-Approved Pumpkin Spice Foods You'll Love

1 / 8   Healthy Treats to Celebrate the Season

Fall means beautiful foliage, back-to-school time, and, you guessed it, pumpkin spice everything. From lattes to hummus (yes, you read that right), there’s no shortage of pumpkin spice-flavored products on the market. The problem is that many of these foods are laden with fat and sugar. A grande pumpkin spice latte with whipped cream at Starbucks, for example, contains a whopping 50 grams (g) of sugar and 380 calories — enough for a whole meal! Then there’s the pumpkin muffin from Dunkin’ Donuts, which weighs in at 550 calories and 24 g of fat.

The good news is you don’t have to steer clear of foods with pumpkin: They contain even more potassium than bananas, which means they can help lower blood pressure and decrease the risk of stroke and heart disease. Plus, a study published in February 2014 in the International Journal of Clinical Oncology found that consuming foods rich in beta-carotene — like pumpkins — is associated with a decreased risk of colon cancer, and a study published in 2004 showed that it may also reduce risk of prostate cancer.

To help you get into the spirit of the season — without widening your waistline — try these dietitian-approved pumpkin spice treats!

Prescription Drugs That Cause Depression

Some prescription drugs can cause or contribute to the development of depression and other mood disorders.

What do certain asthma, acne, malaria, and smoking-cessation prescription drugs have in common? Answer: Their possible side effects include depression or other mood disorders.

Depression as a side effect of prescription drugs is widespread and increasingly gaining attention. The medications that contribute to drug-induced depression might surprise you. For example, an asthma medication, Singulair (montelukast), is prescribed to help people breathe more easily, but its side effects may include depression, anxiety, and suicidal thinking, according to a research review published in Pharmacology in 2014.

“In 2009, Merck added psychiatric side effects as possible outcomes with Singulair, including tremor, depression, suicidality — suicidal thinking and behavior — and anxiousness,” says J. Douglas Bremner, MD, researcher and professor of psychiatry and radiology at Emory University School of Medicine in Atlanta.

Drugs With Depression as a Side Effect

Dr. Bremner has published studies on the possible relationship between the use of retinoic acid acne treatments and the development of depression. One of the drugs within this category is Accutane (isotretinoin), the oral treatment for severe acne that has been associated with psychiatric problems, including depression.

“The original brand-name version of isotretinoin, Accutane, was taken off the market in 2009, although it continues to be marketed as Roaccutane in the U.K., Australia, and other countries," Bremner notes. "In the U.S. there are three generic versions available that have also been associated with reports of depression and suicide, Sotret, Claravis, and Amnesteem."

RELATED: Are You Getting Hooked on Anxiety Medications?

The full list of drugs that could cause depression is a long one. British researchers found 110 different medications between 1998 and 2011 that were associated with increased depression risk, according to a report published in BMC Pharmacology and Toxicology in September 2014.

Besides isotretinoin and montelukast, drugs that can cause or contribute to the development of depression or other mood symptoms include:

Lariam (mefloquine), used to treat malaria. Depression, anxiety, and psychosis are among the side effects of this medication, according to an article in Medical Science Monitor in 2013 that explored the chemical cascade behind mood changes.
Chantix (varenicline), used to stop smoking. The Food and Drug Administration (FDA) lists hostility, anxiety, depression, and suicidal thoughts as possible side effects of this medication.
Inderal (propranolol hydrochloride) and other drugs in the beta-blocker class, used to treat high blood pressure. Research on beta-blockers and depression suggests that some, but not all, of the medications in this class can contribute to depression, according to a report in the February 2011 issue of the Journal of Clinical Psychopharmacology.
Contraceptives. Contraceptives including those delivered by vaginal ring or patch could lead to depression in some people, according to research published in the Cochrane Database of Systematic Reviews in 2010.
Corticosteroids. Some people who take corticosteroids experience side effects such as depression, anxiety, and panic attacks, among other symptoms, according to a review of research published in Rheumatology International in 2013.
Interferon-alpha. As many as 40 percent of people using this immunologic medication may experience depression, according to a 2009 report in Dialogues in Clinical Neuroscience.
Interferon-beta. The link between this immunologic medication and depression is debated, but researchers reporting in Therapeutic Advances in Neurologic Disorders in 2011 note that depression is a concern for those who take it, in part because of their underlying conditions.
Nonnucleoside reverse transcriptase inhibitors. These HIV medications may increase the risk for depression, according to research published in the September 2014 issue of HIV Medicine. Arimidex (anastrozole) and aromasin (exemestane). Both of these long-term breast cancer therapies may contribute to depression, according to the FDA.
Vigabatrin. This anticonvulsant may cause depression, irritability, and psychosis, notes a review of studies in Acta Neurologica Scandinavica in 2011.
The FDA investigates drugs that have many reports of depression symptoms as a side effect. It requires what are called black-box warnings to be clearly printed on medications, like isotretinoin, that have been linked to depression and suicidal behavior, among other serious health threats. Make sure you read the information pamphlets that come with your prescription medications (and ask your pharmacist if you don’t understand what they say). You can stay on top of any news about their side effects by setting up a news alert on Google.

You can get the latest drug safety information on the FDA website.

Also, pay attention to how you feel. Though you may be taking medications that seem unrelated to mood, let your doctor know if you have symptoms such as sadness, difficulty sleeping, hopelessness, sleep changes, or thoughts of suicide.

“If you suspect your medication may be causing depression or similar problems, talk with your doctor and, if necessary, consult with a psychiatrist,” Bremner advises. The good news is that drug-induced depression usually clears up once you stop taking the medication.

Are Your Drugs Causing Depression?

It can be challenging to figure out whether your depression is related to taking a prescription drug, but here are some indicators:

Timeline. Drug-induced depression is defined as depression that appears within a month of starting or stopping a medication, according to the American Society of Health-System Pharmacists (ASHP). The society also advises that other conditions that might cause depression have to be considered in figuring out whether medication is the contributing factor. Bremner found in his research that the timeline varies from weeks to a month or two.
Dose-response relationship. With some drugs, depression symptoms may get better as the dose is reduced or worse as it is increased. This is usually a clear indicator of a relationship.
If you are uncertain about whether your changes in mood or energy are drug symptoms, talk with your doctor. Screening tools and questionnaires can reliably identify depression. You can also send information about your experiences to the FDA.

Prescription Drug-Induced Depression Treatment

In severe cases, people taking prescription drugs have developed depression leading to suicidal behavior. Because of this risk, don’t ignore or try to wait out feelings of depression, even if you believe they are only a prescription drug side effect. Talk with your doctor about these options to correct the situation:

Switching to an alternative treatment. If an equally effective medication that does not have depression as a side effect exists, the easiest option is to switch prescription drugs.
Getting a psychiatric evaluation. This may be recommended in any case to make sure you do not have an underlying psychiatric condition that has gone undiagnosed. People with a history of depression may have a worse response to some medications. An antidepressant might be prescribed in order to help manage depression symptoms.
Talk therapy will not work in this case, says Bremner, because the problem is chemically based. You will need prescription medication to address the depression if you cannot stop taking the drugs that are causing it.

If you think your depression symptoms are linked to a prescription drug you’re taking, talk with your doctor right away, get screened for depression, and find a better way to manage both your health issues and your mood.

Breast Cancer Awareness Month 2017

October is Breast Cancer Awareness Month, an annual campaign to raise awareness of breast cancer risks, the value of screening and early detection, and treatment options available to women and men who are diagnosed with one of the many forms of breast cancer. More than 249,000 people in the United States are diagnosed with invasive breast cancer every year, and nearly 41,000 die from the disease.

Over the years, a loop of pink ribbon has come to symbolize breast cancer awareness, and today the image of a pink ribbon can be found emblazoned on thousands of products, from apparel to dishware to office supplies. But there's more to awareness than just wearing pink.

A Diet for Better Energy

Complex carbs are key for sustained energy throughout the day, while too many sugary snacks can lead to energy crashes. Find out which foods you need for round-the-clock energy.

 

Juggling the responsibilities of work, life, and family can cause too little sleep, too much stress, and too little time.

Yet even when you're at your busiest, you should never cut corners when it comes to maintaining a healthy diet. Your body needs food to function at its best and to fight the daily stress and fatigue of life.

Energy and Diet: How The Body Turns Food Into Fuel

Our energy comes from the foods we eat and the liquids we drink. The three main nutrients used for energy are carbohydrates, protein, and fats, with carbohydrates being the most important source.

Your body can also use protein and fats for energy when carbs have been depleted. When you eat, your body breaks down nutrients into smaller components and absorbs them to use as fuel. This process is known as metabolism.

Carbohydrates come in two types, simple and complex, and both are converted to sugar (glucose). “The body breaks the sugar down in the blood and the blood cells use the glucose to provide energy,” says Melissa Rifkin, RD, a registered dietitian at the Montefiore Medical Center in the Bronx, N.Y.

Energy and Diet: Best Foods for Sustained Energy

Complex carbohydrates such as high-fiber cereals, whole-grain breads and pastas, dried beans, and starchy vegetables are the best type of foods for prolonged energy because they are digested at a slow, consistent rate. “Complex carbohydrates contain fiber, which takes a longer time to digest in the body as it is absorbed slowly," says Rifkin. Complex carbs also stabilize your body’s sugar level, which in turn causes the pancreas to produce less insulin. This gives you a feeling of satiety and you are less hungry.”

Also important in a healthy, energy-producing diet is protein (preferably chicken, turkey, pork tenderloin, and fish), legumes (lentils and beans), and a moderate amount of healthy monounsaturated and polyunsaturated fats (avocados, seeds, nuts, and certain oils).

“Adequate fluids are also essential for sustaining energy,” says Suzanne Lugerner, RN, director of clinical nutrition at the Washington Hospital Center in Washington, D.C. “Water is necessary for digestion, absorption, and the transport of nutrients for energy. Dehydration can cause a lack of energy. The average person needs to drink six to eight 8-ounce glasses of water each day.”

Energy and Diet: Foods to Avoid

 

Simple carbohydrates, on the other hand, should be limited. Ranging from candy and cookies to sugary beverages and juices, simple carbs are broken down and absorbed quickly by the body. They provide an initial burst of energy for 30 to 60 minutes, but are digested so quickly they can result in a slump afterward.

You should also avoid alcohol and caffeine. Alcohol is a depressant and can reduce your energy levels, while caffeine usually provides an initial two-hour energy burst, followed by a crash.

Energy and Diet: Scheduling Meals for Sustained Energy

 

“I always recommend three meals and three snacks a day and to never go over three to four hours without eating something,” says Tara Harwood, RD, a registered dietitian at the Cleveland Clinic in Ohio. “If you become too hungry, this can cause you to overeat.”

Also, try to include something from each food group at every meal, remembering that foods high in fiber, protein, and fat take a longer time to digest.

Even if life is hectic, it’s important to make wise food choices that provide energy throughout the day. Your body will thank you.

 

7 Healthy Habits of the 2016 Presidential Candidates

The New Hampshire primary's in full swing, and if there’s one thing all the presidential hopefuls can agree on, it’s that running for office is the ultimate endurance challenge. They’re canvassing across the country with little time to exercise or sleep, and it doesn’t help that at every stop they’re tempted by unhealthy foods like pizza, pork chops, and pies. So how do the presidential candidates stay healthy and keep their energy levels up during the grueling primary season? Read on to find out!

8 Reasons You Have No Energy

You’d be hard-pressed to find someone who doesn’t hit snooze or experience the midafternoon slump every once in a while, but if you constantly feel like you’re dragging it may be time to take a closer look at your routine. If you don’t have a related health condition and are getting enough shuteye each night, you may be to blame for the constant fatigue. Here are 8 energy-zapping habits that you can change today.  

1. You’re eating too much sugar. While the candy jar is an obvious culprit, refined carbohydrates like white bread and rice, chips, and cereal are a major source of sugar,too. This type of simple sugar is digested quickly by the body, leading to a dip in blood sugar levels that leaves you feeling fatigued. Be sure to replace refined carbs with whole grain varieties for a lasting energy boost.

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2. You aren’t exercising enough. It may seem counterintuitive that exerting energy will actually increase it, but adding a workout to your daily routine will give you a short-term energy boost. Plus, regular exercise improves sleep quality, which will ultimately leave you feeling more well rested.

3.  You’re skipping breakfast. "Skipping breakfast can definitely contribute to low energy in the morning," says Johannah Sakimura, MS and Everyday Health blogger. "It's important to give your body good fuel to start the day after an extended period of fasting." Without this fuel, your body is running on empty – leaving you famished by lunchtime and more likely to make unhealthy choices that will cause that midafternoon dip in blood sugar. "Try to combine healthy carbohydrates, like fruit, veggies, and whole grains, with a protein source, such as eggs, nuts, or dairy. The carbs give you an initial boost, and the protein helps sustain you until your next meal," says Sakimura.

4. You’re sitting too much. Not only is sitting for prolonged periods of time harmful to your health (just one hour of sitting affects your heart!), but it’s a major energy zapper as well. Standing up and moving for even a few minutes helps get your blood circulating through your body and increases the oxygen in your blood, ultimately sending more oxygen to your brain which increases alertness. If you work a desk job, try this move more plan to keep your blood pumping.

5. You’re drinking too much caffeine. Whether it’s a can of soda or constant refills of your coffee mug, many of the beverages we reach for when we feel tired are packed with caffeine – a stimulant that will give you a quick jolt, but can also leave you crashing soon after if you ingest too much. Plus, if you’re drinking caffeinated beverages into the afternoon, they may start to have an effect on your sleep quality. If you’re a coffee drinker, switch to water late-morning and replace soda with seltzer for a bubbly afternoon pick-me-up without the crash.

6. You’re dehydrated. We all know the importance of drinking enough water – and even mild dehydration can have adverse effects on your energy level, mood, and concentration. Aim for at least one glass of water per hour while sitting at your desk, and be sure to fill your bottle up even more if you’re doing strenuous activity or are outdoors in high temperatures. 

7. You have poor posture. A study found that slouched walking decreased energy levels while exacerbating symptoms of depression. The good news: Simply altering body posture to a more upright position instantly boosted mood and energy, while enabling participants to more easily come up with positive thoughts. So sit up straight! Set reminders on your phone or calendar throughout the day to remind yourself to check in with your posture and straighten up. 

8. You’re not snacking smart. If you’re running to the vending machine for a quick afternoon snack, your selection – most likely high in simple carbs and sugar – will take your energy levels in the wrong direction. Instead choose a snack that has a combo of protein and complex carbs for an energy boost that will last throughout the afternoon. Think trail mix, veggies and hummus, or peanut butter on whole wheat toast.

12 Ways to Ease Seasonal Depression

1 / 13   Seasonal Depression: Common But Treatable
If shorter days and shifts in weather zap your energy and make you feel blue, you’ve got classic symptoms of a seasonal mood disorder. Seasonal affective disorder (SAD) is a form of seasonal depression triggered by the change in seasons that occurs primarily in winter. Why do some people get SAD? Experts aren’t certain, but some think that seasonal changes disrupt the circadian rhythm: the 24-hour clock that regulates how we function during sleeping and waking hours, causing us to feel energized and alert sometimes and drowsy at other times.

Another theory is that the changing seasons disrupt hormones such as serotonin and melatonin, which regulate sleep, mood, and feelings of well-being. About 4 to 6 percent of U.S. residents suffer from SAD, according to the American Academy of Family Physicians, and as many as 20 percent may have a mild form of it that starts when days get shorter and colder. Women and young people are more likely to experience SAD, as are those who live farther away from the equator. People with a family history or diagnosis of depression or bipolar disorder may be particularly susceptible.

"It is important to treat SAD, because all forms of depression limit people's ability to live their lives to the fullest, to enjoy their families, and to function well at work," says Deborah Pierce, MD, MPH, clinical associate professor of family medicine at the University of Rochester School of Medicine and Dentistry in Rochester, New York. Here are a few SAD treatment options you might want to consider.

How to Find the Right Therapist for Your Depression

The right therapist can make all the difference in getting the best treatment for depression, but do some homework before you choose one.


If you're depressed, a therapist can teach you how to deal with your feelings, change the way you think, and change the way you behave to help ease your symptoms.

Finding a therapist you are comfortable with is essential. You will need to talk openly and honestly with your therapist about your thoughts and feelings, so it's important to find the right specialist for you, says Ryan Howes, PhD, a clinical psychologist and a clinical professor at the Fuller School of Psychology in Pasadena, California.

The first step is to look at yourself and determine what it is you need, Dr. Howes says. “Ask yourself, Am I the sort of person who benefits from someone who tells me what to do? Or do I need someone with a good ability to listen and who will talk through things with me?" he advises. Your answer will tell you whether you need someone who will provide directive or non-directive therapy.

Also consider whom you might feel most comfortable with: a man or a woman; someone about your age, or someone younger or older; someone with lots of experience, or someone who is relatively new with fresh ideas. “Once you narrow it down, you can start looking for people who meet your criteria,” Howes says.

Different Types of Therapists and Their Credentials

Several types of mental health professionals can serve as a therapist for people with depression. Being aware of the training differences might help you narrow your search.

Psychiatrists are medical doctors (MD or DO degree) who have completed specialized training in mental and emotional disorders. They can diagnose, treat, and prescribe medications for depression. Psychiatrists may also provide individual or group therapy. Philip R. Muskin, MD, professor of psychiatry and chief of consultation-liaison psychiatry at the Columbia University Medical Center in New York City, advises starting with a physician if you’re severely depressed.

Psychologists have a doctoral degree (PhD or PsyD) in psychology. They are skilled in the diagnosis of emotional disorders and spend most of their time providing individual or group psychotherapy, but do not prescribe medication.

Social workers usually have a master’s degree in social work (MSW) and have training in providing individual or group therapy.

Licensed professional counselors have a master’s degree in psychology (or a related area) and are trained to diagnose and counsel individuals or groups.

Psychiatric nurses are registered nurses (RNs) with training in psychiatric nursing.

Sources of Referrals

How do you go about finding the right therapist for you?

You might want to start by talking with your family doctor. If your doctor feels you need a mental health specialist, he or she should be able to give you referrals, Dr. Muskin says. Or you might be the one to tell your regular doctor, "I need to see a psychiatrist, and this is why,” he adds.

RELATED: 5 Things Psychologists Wish Their Patients Would Do

You could also ask around to see if your friends or family members know of a good therapist who has experience in treating depression. “Personal references can be very good, particularly if they come from someone who knows you well and what you like,” Muskin says.

Here are other resources to help you find a therapist for depression treatment: 

The National Alliance on Mental Illness (NAMI) runs a helpline that can help you locate support. Call 800-950-NAMI or email info@NAMI.org.
The American Psychological Association has a therapist locator on its website.
The Anxiety and Depression Association of America can also help you locate a therapist near where you live. 
Your health insurance company likely has a dropdown menu item, such as “find a provider,” for names of professionals in its network.
Schools and universities often have counseling services that can offer referrals if they can’t help you directly. You may have access if you’re an alum or faculty.
The clergy Faith leaders often know of mental health professionals who can help. And if they know you, they can recommend someone who fits your personality and needs. 
Employee Assistance Programs If offered by your employer, they’re part of your benefits package.  
How to Interview Potential Therapists

Once you have a list of at least two or three potential therapists, it's time to figure out which one is best for you. Call each therapist to get some key information before making an appointment.

Questions to ask include:

Are you taking new patients?
What experience do you have treating patients who have depression?
Where do the therapy sessions take place? Some psychiatrists have more than one office where they see patients, Muskin says. Their location and when they hold appointments can matter to you, he adds.
How much does the therapy cost? Do you take my insurance?
Can I meet with you before committing to a therapy session?
RELATED: 6 Questions Everyone Should Ask Their Therapist

If you're able to make a consultation appointment before a therapy session, ask the therapist more specific preliminary questions, such as:

What type of therapy would you recommend for my depression symptoms?
What will this type of therapy involve?
What are the benefits and the primary goals of my depression treatment?
Are you willing to work with other members of my medical team to coordinate my depression treatment? This is especially important if you have a non-MD therapist who will rely on your primary care doctor to prescribe medications.
How often would I need therapy sessions?
After meeting with a potential therapist, take some time to decide whether you are comfortable with them. If you aren’t, keep looking until you find one you like and trust.

Some people will improve with psychotherapy alone; others may need both psychotherapy and a prescription antidepressant. Once you start therapy for your depression, be patient. Psychotherapy (sometimes referred to as talk therapy) for depression can sometimes be painful, and you may find yourself doing most of the talking during the first few sessions. Your therapist will partner with you to ease your depression symptoms and improve your life.

Carbohydrates: Your Diet's Fuel

Before you feast on chicken and boycott carbs, take a closer look at the U.S. Food Pyramid.

Carbohydrates are highlighted as an important part of ahealthy diet, and not banned by any means. Your body needs a wide variety of foods to function and stay healthy.

"Carbohydrate is one of the macronutrients that we need, primarily for energy," says Sandra Meyerowitz, MPH, RD, a nutritionist, online nutrition coach, and owner of Nutrition Works in Louisville, Ky.

While fats and protein are also necessary for energy, they're more of a long-term fuel source, while carbohydrates fulfill the body's most immediate energy needs. "It's your body's first source of energy — that's what it likes to use," adds Meyerowitz.

Maria Sharapova’s 5 Best Tips for Glowing Skin and Killer Confidence

Maria Sharapova isn’t just a talented athlete. With supermodel looks, it’s no surprise that the Russian-born blonde has endorsement deals with a slew of beauty and fashion brands and has been photographed for the “Sports Illustrated” Swimsuit Issue. (She even edged out rival Serena Williams to be named the highest paid female athlete in 2014 by “Forbes” magazine.) 

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The five-time Grand Slam winner, who is currently gearing up for this year’s US Open, took time out of her busy schedule to chat with Everyday Health at a recent Supergoop! press event. She reveals her healthy skin habits, how she stays energized during a tough match, and more. 

 

 

1. The most important step in her beauty routine: As one of the best tennis players in the world, Sharapova spends plenty of time out in the sun practicing and playing grueling matches. To ensure her fair skin stays protected, she reaches for SPF almost as soon as she wakes up. And in fact, she says she’s been an avid sunscreen user since her teenage years. 

“It’s important for me to think about sunscreen early in the day, because as you go about your day, you’re thinking about the challenges ahead and the activities you’re doing and [sunscreen] is almost not on your mind anymore,” she says. “I have a bottle of sunscreen next to my shower, so I wake up, take a shower, towel off, and apply.” When she’s playing tennis, Sharapova relies on Supergoop! Everyday Sunscreen Broad Spectrum SPF 50, which she says has a lightweight texture and doesn’t sting her eyes as she sweats. 

RELATED: 10 Best SPFs for Every Skin Concern

2. Her glow-boosting secret: In addition to slathering on SPF in the morning, Sharapova starts her day with a whole lot of water to stay hydrated and keep her skin fresh. “I usually wake up and drink more than a half liter of water, just to get my mind ready and aware that I need to drink [water],” she explains. 

 

 

3. How she relaxes before a big match: For Sharapova, getting enough sleep is one of the keys to her success. “I love to sleep. I love taking naps,” she says. “That’s been part of my regimen since I was a young girl. I used to have a morning and afternoon practice, and I’d come home and have lunch and then take a 45 minute nap. To this day, I enjoy doing that if I have the opportunity.” 

4. Her favorite pre-game meal: When it comes to food, Sharapova keeps it simple. “I’ve learned a lot over the years about how I react to foods and how much energy I have,” she says. “Usually, I eat a little bit of chicken and a lot of green vegetables [before a match].” Sharapova also likes to whip up her own green juices, visiting local stores to pick up veggies and adding lemon and kiwi for sweetness. 

5. How she stays confident: One of the easiest ways Sharapova gives herself a boost is by spritzing on her favorite perfume before walking out the door. And before she steps onto the court, she reminds herself of how lucky she is to be following her dream. 

“I’ve played this sport for a long time and put in a lot of work and effort,” she says. “And that moment when you’re about to go on the court — that’s what you work for, that’s the goal — it’s a privilege. No matter if you win or lose, the opportunity to go out there is pretty special. It’s very powerful.”

Parent's Depression May Harm Child's Grades, Study Finds

A child's grades in school might suffer if a parent is suffering from depression, according to a new study.

Researchers found that Swedish teens received lower grades during their final year in school if either of their parents had previously been diagnosed with depression.

The difference in grades was noticeable but not huge, said senior author Brian Lee, an associate professor of epidemiology and biostatistics at Drexel University's Dornsife School of Public Health in Philadelphia.

"It's not an entire letter grade drop, but at the same time it might be the difference between a student passing or failing," Lee said.

Parents' depression could affect the children's home lives, causing stress that impacts their academic performance, Lee said.

"Depression is a social disease," he said. "It doesn't just affect you. It affects your relationships as well. If there's strain there, it may affect the child's academic performance."

Since depression can be handed down, it also could be that the children are not doing as well in school because they suffer from undiagnosed mood disorders, he added.

Infants also might receive poorer care during early development if their mothers are depressed -- less breast-feeding or nurturing, for example -- which could have long-term impacts on children's ability to learn and problem-solve, he said.

"There are many different mechanisms to explain what we've found, and those are just a few possibilities," Lee said.

The study, published online Feb. 3 in JAMA Psychiatry, only found an association between parental depression and worse grades, however, not a direct cause-and-effect relationship.

In the study, Lee and his colleagues examined data on more than 1.1 million children born in Sweden between 1984 and 1994.

Compulsory education ends at age 16 in Sweden, and kids leaving school are assigned a final school grade based on how well they did in their last year. The researchers compared the final grades of teens whose mothers and fathers had been diagnosed with depression against those of teens whose parents do not have a mood disorder.

RELATED: Should You Have Kids If You’re Depressed?

They found that maternal and paternal depression affected a teen's performance during that final year in school, even if the depression occurred years earlier.

In general, both maternal and paternal depression in any period of a child's life were associated with worse school performance. Maternal depression was associated with a larger negative effect on school performance for girls compared with boys, according to the results.

The impact of depression is as large as similar effects on grades caused by differences in family income and the level of mom's education, the researchers reported.

Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center in New Hyde Park, N.Y., said, "This study provides strong evidence to suggest that children who have a depressed parent are at increased risk for lower academic performance."

Adesman, who was not involved with the research, found it "striking" that parental depression affects learning "regardless of whether the parental depression occurred early in a child's life or later and regardless of whether it is the mother who is depressed or the father."

The findings show that parents suffering from depression need to get help if they want to protect their kids, said Myrna Weissman, chief of epidemiology at the New York State Psychiatric Institute and a professor at Columbia University in New York City.

"We must make sure there's good available treatment for the parent so they stay asymptomatic. That would help a great deal," said Weissman, who wrote an editorial accompanying the study. "We have great data now showing if you treat the parent, the children function better."

Friends of a parent with depression should urge them to seek help, Weissman said.

Schools can offer programs to help children of depressed parents, but Weissman thinks it would be better to get treatment for the adult.

"Depression is highly treatable," she said. "I would certainly begin there."

More Evidence That Depression Shortens Lives

People with depression tend to die earlier than expected -- a pattern that has grown stronger among women in recent years, new research finds.

The study followed thousands of Canadian adults between 1952 and 2011. Overall, it found people with depression had a higher death rate versus those without the mood disorder.

The link only emerged among women starting in the 1990s. Yet by the end of the study, depression was affecting men's and women's longevity equally.

The findings do not prove that depression itself shaves years off people's lives, said lead researcher Stephen Gilman.

The study could not account for the effects of physical health conditions, for example.

"So one explanation could be that people with depression were more likely to have a chronic condition," said Gilman, of the U.S. National Institute of Child Health and Human Development.

RELATED: Can 'Magic Mushrooms' Kick-Start Depression Treatment?

But even if that were true, he added, it would not mean that depression bears no blame -- because depression can take a toll on physical health.

"Many studies have found that people with depression have higher risks of heart disease and stroke, for example," Gilman said.

The findings are based on 3,410 Canadian adults who were followed for up to several decades. The first wave of participants was interviewed in 1952, the next in 1970, and the final in 1992.

At each wave, roughly 6 percent of adults had depression, based on a standard evaluation.

And on average, those people had a shorter life span. For example, a 25-year-old man who was depressed in 1952 could expect to live another 39 years, on average. That compared with 51 years for a man without depression.

Men with depression at any point had a higher risk of dying over the coming years, versus those free of the disorder.

The picture was different for women, though. The connection between depression and mortality only surfaced in the 1990s.

Women with depression at that point were 51 percent more likely to die by 2011, compared with other women. That brought their risk on par with depressed men.

The reasons are unclear. "Why would depression be less toxic to women at one time point than another?" Gilman said.

He speculated that societal shifts have some role. Women in recent decades have been much more likely to juggle work and home life, or be single mothers, for example.

Another possibility, Gilman said, is that women tend to suffer more severe depression these days.

There was some evidence that the impact of depression lessened over time. Men with depression in 1952 no longer showed a higher death risk after 1968, for example -- unless they also had depression at the later interviews, too.

As for causes of death, there was no evidence that suicides explained the risks among people with depression.

"There were actually few suicides," Gilman said. "People with depression died of the same causes that other people did -- like cardiovascular disease and cancer."

Dr. Aaron Pinkhasov is chairman of behavioral health at NYU Winthrop Hospital in Mineola, N.Y.

He said depression can indirectly shorten life span in a number of ways. Depressed people are less able to maintain a healthy lifestyle, and are more vulnerable to smoking and drinking. They may also be less equipped to manage any physical health conditions.

"Once depression sets in, you may not have the motivation or energy," said Pinkhasov, who was not involved with the research.

Gilman said his study can't say whether treating depression erases the higher death risk associated with it.

But, Pinkhasov said, there is evidence that depression treatment can help people better control high blood pressure and diabetes, for example.

He stressed that there are various effective treatments -- from "talk therapy" to medication.

"Don't blame yourself for being 'weak,' or tell yourself you should just snap out of it," Pinkhasov said.

John Hamilton, a counselor at Mountainside Treatment Center in Canaan, Conn., agreed.

He said that women, in particular, can have a "sense of shame" over mental health symptoms in part because they feel they need to be the rock of the family. "They might even have people around them saying, 'Snap out of it, you have kids,'" said Hamilton, who also had no role in the study.

"But depression is no different from any other chronic disease," he said. "We need to have a compassionate, nonjudgmental approach to it."

The results were published Oct. 23 in the journal CMAJ.

What Is Guillain-Barré Syndrome?

Guillain-Barré syndrome (GBS) is an illness that can result in muscle weakness or loss of muscle function in parts of the body.

In people with Guillain-Barré syndrome (pronounced GHEE-yan ba-RAY), the body's own immune system attacks the peripheral nervous system.

The peripheral nervous system includes the nerves that connect the brain and spinal cord to the limbs. These nerves help control muscle movement.

GBS Prevalence

Guillain-Barré syndrome is a rare disease.

The Centers for Disease Control and Prevention (CDC) estimates that about 1 or 2 out of every 100,000 people develop GBS each year in the United States.

Anyone can get GBS, but the condition is more common in adults than in children, and more men than women are diagnosed with GBS each year.

Causes and Risk Factors

Doctors don't know what causes Guillain-Barré syndrome.

Many people with GBS report a bacterial or viral infection (such as the flu) days or weeks before GBS symptoms start.

Less common triggers for GBS may include:

  • Immunizations
  • Surgery
  • Trauma

Guillain-Barré syndrome is not contagious — it cannot spread from one person to another.

Types of GBS

There are several types of Guillain-Barré syndrome, which are characterized by what part of the nerve cell is damaged.

The most common type of GBS is called acute inflammatory demyelinating polyradiculoneuropathy (AIDP).

In AIDP, the immune system mistakenly attacks the protective nerve covering that helps transmit nerve signals from the brain to other parts of the body.

Guillain-Barré Syndrome Symptoms

The first symptoms of Guillain-Barré syndrome often include feelings of tingling or weakness in the feet and legs. These feelings may spread to the arms and face.

The chest muscles can also be affected. Up to a quarter of people with GBS experience problems breathing.

In very severe cases, people with GBS may lose all muscle function and movement, becoming temporarily paralyzed.

Signs and symptoms of Guillain-Barré syndrome may include:

  • Pricking or tingling "pins and needles" sensations in the fingers, toes, ankles, or wrists
  • Muscle weakness that starts in the legs and spreads to the upper body
  • Unsteady walking
  • Difficulty with eye or facial movements (blinking, chewing, speaking)
  • Difficulty controlling the bowels or bladder
  • Rapid heart rate
  • Difficulty breathing

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Depression Screening Should Include All Pregnant, Postpartum Women

All U.S. adults, including pregnant and postpartum women, should be screened for depression by their family doctor, the nation's leading preventive medicine panel recommends.

Further, doctors need to follow through and get treatment for anyone who tests positive for depression, the U.S. Preventive Services Task Force concluded in an update of its depression screening guidelines.

This is the first time the panel has specifically advocated depression screening in pregnancy and shortly after giving birth. It cited a U.S. study that found that 9 percent of pregnant women and more than 10 percent of postpartum women exhibited signs of major depression.

The American College of Obstetricians and Gynecologists (ACOG) applauded the recommendation.

"Because fewer than 20 percent of women in whom perinatal depression is diagnosed self-report their symptoms, routine screening by physicians is important for ensuring appropriate follow-up and treatment," said ACOG president Dr. Mark DeFrancesco in a statement.

Depression can harm both the child and mother, interfering with their interactions and affecting social relationships and school performance, the panel noted. Risk factors during pregnancy and after delivery include poor self-esteem, child-care stress, prenatal anxiety and decreased social support, the report said.

The new report -- published Jan. 26 in the Journal of the American Medical Association -- updates a similar recommendation the panel issued in 2009 that called for routine screening of adults.

In general, primary care physicians should be able to treat most cases of uncomplicated depression, and refer more complex cases to a psychiatrist, said Dr. Michael Pignone, a member of the task force and director of the University of North Carolina's Institute for Healthcare Quality Improvement.

"That's part of our job," Pignone said.

Options for treatment include therapy with a psychologist or licensed clinical social worker or antidepressant medications.

The task force is an independent, volunteer panel of national experts in preventive medicine. It issues recommendations, and revisits them on a regular basis to make sure that medical evidence still supports the guidelines.

RELATED: 9 Depression Types to Know

Depression is among the leading causes of disability in persons 15 years and older, the panel noted.

Millions of adults suffer from depression and don't know it, said Dr. Michael Thase, a professor of psychiatry at the University of Pennsylvania Perelman School of Medicine.

At any given time, between 5 percent and 10 percent of U.S. adults suffer from a depressive disorder, but half receive no treatment for their depression, Thase said.

The task force's depression guidelines are aimed at detecting and helping those adults who unknowingly have depression, Pignone said.

"This is about screening, not about diagnosing people who come to a doctor's office saying, 'I feel depressed.' The potential value of screening is in those people who would not be found as part of regular clinical care," he said.

Some people may not want to acknowledge they are depressed because there is a stigma around mental illness, Pignone said. Others might just think they are feeling blue, and will get over it.

"In some people, their symptoms may seem more physical to them," he added. For example, depression might cause stomach pain, headaches or sleeping problems.

The task force did not recommend any particular questionnaire for depression screening, because "there are many good tools and there's no single tool that should be recommended above others," Pignone said.

The most common screening tool, the Patient Health Questionnaire, consists of 10 simple questions that can be answered in minutes, according to the U.S. Department of Health and Human Services.

The task force also could not recommend how regularly people should be screened, because not enough research has been done in that area, Pignone said.

"The task force recommendation is that people should be screened at least once," he said. "For the meantime, clinicians should use their judgment about the risk of depression in their patients, in deciding how often to screen."

However, the task force did emphasize the need to follow up a positive screening with treatment.

Dr. Michelle Riba, a former president of the American Psychiatric Association, agreed that primary care doctors should be able to treat most patients with depression.

However, Riba added that doctors should develop a relationship with a psychiatrist they can consult on cases of depression. The psychiatrist could talk with the practitioner on the phone, review patient charts, and help decide the best course of action.

Doctors also should be open to other forms of treatment for depression, such as cognitive-behavioral therapy or light therapy, said Elizabeth Saenger, a psychologist in private practice in New York City.

Light therapy affects the body's production of the hormone serotonin, and studies have shown it can help alleviate depression symptoms, Saenger said.

It makes sense for primary care doctors to lead the way on depression screening because they see patients most often, said Dr. Alan Manevitz, a psychiatrist with Lenox Hill Hospital in New York City.

Treating depression can help patients face other health problems with which they are struggling. "As depression gets worse, so many other chronic illnesses also get worse," Manevitz said. "People don't take care of their health as well when they are depressed."

Many Under 40 May Not Need Regular Cholesterol Checks: Study

Many adults under 40 may not need to have routine cholesterol screenings, a new study suggests.

To come to this conclusion, the researchers looked at the real world implications of two conflicting sets of guidelines on cholesterol testing.

One, from the American College of Cardiology/American Heart Association (ACC/AHA), says that all adults older than 20 should have a cholesterol screening. They also suggest a repeat test every four to six years.

The other guidelines come from the U.S. Preventive Services Task Force, a government-funded, independent panel of medical experts. They say many adults can go longer before their first cholesterol test -- until age 35 for men, and age 45 for women.

The exception would be people with a major risk factor for heart problems -- such as high blood pressure, smoking or a family history of early heart disease.

Those patients can start cholesterol testing at age 20, the task force adds.

The new findings support the "more targeted" approach the task force uses, according to lead researcher Dr. Krishna Patel, of Saint Luke's Health System in Kansas City, Mo.

Why? The study, Patel explained, tried to estimate the impact of the two different guidelines in the "real world."

To do that, the researchers used data on 9,600 U.S. adults aged 30 to 49 who were part of a government health study.

The study team found that among nonsmokers with normal blood pressure, very few were at heightened risk of suffering a heart attack in the next 10 years. That means very few would be considered candidates for a cholesterol-lowering statin -- even with elevated LDL (so-called "bad" cholesterol) levels.

"So, screening cholesterol early doesn't bring much actionable information," Patel said. "If we're not going to treat, there's no point in doing it."

The study was published May 15 in the Annals of Internal Medicine.

Others disagreed with Patel's point.

The point of screening younger adults is not so doctors can put them all on statins, said Dr. Neil Stone, one of the authors of the ACC/AHA guidelines.

Instead, there are two central reasons, Stone explained.

One is to spot younger adults who may be heading down a path toward heart disease later in life.

Once they know their LDL is high, they and their doctors can have an "all-important discussion" about diet and lifestyle changes, said Stone, who is also professor of medicine at Northwestern University's Feinberg School of Medicine in Chicago.

READ MORE: 9 Things Dietitians Wish You Knew About High Cholesterol

The other reason is to catch cases of familial hypercholesterolemia, a genetic condition that causes very high LDL levels (above 190 mg/dL), he said.

People with the condition have a much higher-than-average risk of heart disease, and often develop it at a young age.

Because of that, the condition should be treated with statins, according to the ACC/AHA.

There is "strong and compelling evidence," Stone said, that catching the condition in younger adults makes a difference.

Dr. Paul Ridker, who wrote an editorial accompanying the study, had a similar view.

"Familial hypercholesterolemia is a common disorder, and it's easy to detect," said Ridker, of Brigham and Women's Hospital in Boston. "Why delay something as simple and inexpensive as a cholesterol test?"

Plus, he said, catching even "run-of-the-mill" high LDL is important.

"Knowing about it early in life can be a good motivator to make lifestyle changes," Ridker said.

What if a young adult has healthy LDL levels? Ridker said he'd be "fine" with that patient forgoing further tests until later in life.

For her part, Patel agreed that a one-time check, to catch familial hypercholesterolemia, is a wise move for young adults. But she questioned the value of repeat testing.

According to Stone, the ACC/AHA guidelines say it's "reasonable" to repeat cholesterol testing every four to six years. "It's not mandatory," he noted.

But people's lives, and heart disease risk factors, change as they move through adulthood, Stone said. So, a periodic cholesterol check can be useful when it's done as part of a "global risk assessment" where doctors look at blood pressure, smoking habits and other major risk factors for heart disease.

Motivating younger adults to get those risk factors under control is critical, according to Stone. "We know it's a big deal if you can have optimal risk factor [control] by age 45 or 50," he said.

In the study, very few people were at elevated risk of heart attack -- as long as they didn't smoke or have high blood pressure. ("Elevated" meant a greater than 5 percent chance of having a heart attack in the next 10 years.)

In the absence of those two risk factors, only 0.09 percent of men younger than 40 were at elevated risk of heart attack. And only 0.04 percent of women younger than 50 were.

But smoking, in particular, changed everything: Among male smokers in their 40s, one-half to three-quarters were at elevated risk of a heart attack.

"Smoking had a huge effect," Patel said. Smokers, she stressed, should "definitely" have their cholesterol tested -- and, more importantly, quit the habit.

Side Effects of Multiple Sclerosis Medications

Twelve disease-modifying medications are FDA-approved to treat relapsing forms of multiple sclerosis (MS). Specifically, these drugs help prevent relapses and slow progression of the disease.

The newest disease-modifying medications are called “immunomodulators” because they affect the functioning of your immune system. 

“All these therapies highlight the increased choices and options for patients living with MS, and the ability of physicians to select a therapy based on individual characteristics,” says Ari Green, MD, assistant clinical director of the UCSF Multiple Sclerosis Center and director of the UCSF Neurodiagnostics Center in San Francisco.

But all drugs can have adverse side effects, and those associated with MS medications range from mild (such as flu-like symptoms or irritation at an injection site) to serious (such as progressive multifocal leukoencephalopathy [PML], a viral disease in the brain).

One of the challenges of MS treatment is balancing risk and benefit, says Dr. Green. Stronger medications might be more effective at slowing progression of the disease, but they may also be associated with more risks.

Discussing Medication Side Effects With Your Doctor

"A doctor has to have a frank and open discussion to find out what is tolerable for patients," says Green. "Some side effects go away as the body gets used to MS medications, but others, such as irritation where the injection takes place, do not."

Because people experience side effects differently, each individual has to decide which side effects he or she can live with, he adds.

In some cases, what are thought to be drug side effects may actually be MS symptoms. Fatigue and headache, for example, may be either.

Keeping a detailed log of your symptoms can help your doctor determine whether you are experiencing a symptom of multiple sclerosis or a medication side effect.

Make a note of when your symptom began, how long it lasted, what might have triggered it, and whether anything you did eased the symptom.

“The more patients are engaged in keeping track of things, the more they can be positively and appropriately engaged in directing their own care,” says Green. This information can also help your provider select appropriate therapies in the future.

Managing MS Medication Side Effects

Some simple steps can often help you manage the most common side effects of MS medications:

Infection risk Some of the immunomodulatory medications increase your risk of common infections, so it’s important to practice prevention strategies such as washing your hands frequently and limiting your contact with people who are ill.

Flu-like symptoms Fever, chills, achiness, and feeling generally under the weather are not uncommon following interferon beta injections, leading some users to stop the medication. Interferon beta medications include Betaseron, Extavia, Avonex, Rebif, and Plegridy.

According to nurses with expertise in MS care, the following steps can help to manage these side effects:

Staying hydrated
Eating healthfully
Taking medications before sleep
Warming injectable medicines up to body temperature before injecting
You can also take a small dose of Advil, Motrin, or Nuprin (ibuprofen) an hour before and an hour after your injection. Tylenol (acetaminophen), Aleve (naproxen), or Benadryl (diphenhydramine) may also help ease these side effects, Green says.

RELATED: 7 Side Effects of MS Steroid Treatment

Injection-site irritation Applying ice to your injection sites before injections, and a warm compress afterward, can help ease any irritation.

Some people may also benefit from some retraining on the finer points of giving themselves injections, notes Green. This is especially true because most people learn how to give self-injections right after their diagnosis — a period when they’re undoubtedly absorbing lots of information about the disease.

If you’re having trouble injecting your MS medication, speak to your healthcare provider about working with an MS nurse for training in self-injections.

Heart health The medication Gilenya (fingolimod) is known to slow some users’ heart rate within the first six hours after the first dose. Because of this, your doctor may advise you to have your first dose in a clinical setting, where your pulse and blood pressure can be monitored.

Distinguishing Side Effects From Symptoms

The immediate side effects of MS medications may be more apparent once you experience them. Immediate side effects, such as flu-like symptoms and chills, are easy to discern, says Green. Even the muscle aches and pains that can occur immediately after taking disease-modifying MS medications differ from the pain associated with multiple sclerosis.

The one rare medication side effect that might be hard to distinguish from an MS symptom is PML, which has been related to use of the drug Tysabri (natalizumab). PML, however, will progress much more quickly than multiple sclerosis — a good reason to stay on top of your medical checkups.


Ongoing Medication Monitoring

Most of the medications prescribed for MS require regular blood tests to keep track of the treatment’s effect on your body, including your liver.

The drug Lemtrada (alemtuzumab) requires blood and urine monitoring before, during, and for four years after treatment is given to watch for serious autoimmune conditions associated with the drug.

In addition to monitoring for side effects, you and your doctor should monitor for positive effects of drugs as well. Green says that a change in therapy is needed if you are having more than one MS relapse a year, if multiple new brain lesions are seen on your MRI, or if your symptoms are progressing despite treatment. Switching medications is a decision you and your doctor should make together.

Eating Carbs and Fats Before a Workout? Read This

The New York Times published an article “Should Athletes Eat Fat or Carbs?” last week which was based on a study that shows a diet comprised of 85 percent fat can help improve overall performance for ultra-endurance athletes more than the traditional high-carbohydrate diet considered best for athletes. And by fat, they mean good fats that come from foods like nuts, avocados, and extra-virgin olive oil — not your cheeseburgers and French fries. But before you throw all your healthy eating rules out the window, it’s important to note that this recommendation is not for most of us — these recommendations for real athletes. We’re talking about people who exercise for a living — think NBA players, Olympic swimmers, or professional marathoners.

Let’s be honest: Most of us don’t run more than two marathons a week or work out at all hours of the day, so this way of eating is not recommended, even for high school and college players and people who exercise regularly. However, this information certainly brings into question traditional thinking and, as so often with these studies, leaves us wondering if this type of eating could benefit other types of athletes or moderately active people. We’ll need to continue to watch the research for more answers.

It’s important to remember that carbohydrates are an essential part of a healthy, well-balanced diet and provide fuel for your workouts in the form of glycogen, which is stored in the liver and muscles. Fat, however, must be broken down into fatty acids before it can be used as fuel, and only endurance athletes who vigorously exercise throughout the day are able to use up all their glycogen stores before their bodies start using fat. A ketogenic diet, like the ones the article reviews with 85 percent of the diet from fat, forces your body to use fat more readily as an energy source. This is referred to as a ‘ketoadaption’ and takes several weeks to achieve.

Still, it’s not a good idea to overdo it on carbohydrates or fat for all your meals. Fats should only comprise 20 to 30 percent of your total daily calorie intake per meal (think two slices of avocado). Carbohydrates should make up 40 to 50 percent of your meal, and sources of good carbohydrates include vegetables, fruits, legumes, and whole grains. Government experts have offered suggestions for the 2015 Dietary Guidelines, (due to be published in the fall) which encourage Americans to cut down on meat, added sugars, and starchy, high-carb foods and include more fruits, vegetables, whole grains, and healthy fats into their diets.

“The move toward reducing the amount of carbohydrates recommended for the general public is because most of us are not active. We sit too much! When we don’t move, or if we move for only an hour a day, we’re not utilizing all the carbohydrates we are eating, and therefore we continue to gain weight and increase our risk for chronic diseases. For the most part, we are moving too little and eating too much and especially carbohydrates because they are easy, available, and taste good,” says Maureen Namkoong, MS, RD nutrition and fitness director at Everyday Health.

There’s a place for good carbohydrates and fats in a balanced diet. Good carbohydrates and fats give you energy, may help you lose weight, and promote cardiovascular health. But too much of a good thing can be bad — and this is true for fats and carbs, too.