6 Easy and Amazing Oatmeal Recipes to Try This Week

Ask anyone what their favorite breakfast is, and you’ll likely get answers ranging from veggie omelets to sugary cinnamon buns. But how many people can say their favorite morning meal is oatmeal? Well, that’s all about to change. Not only is oatmeal super healthy (it’s packed with belly-filling fiber), but it’s also incredibly versatile. Whether you prefer the grains sweet or savory — or packed with protein or healthy fats — we have the right recipe for you. And remember that no matter which flavor combination you choose, one thing is guaranteed: You’ll never look at oatmeal the same way again.

Tomato Basil Oatmeal
Sweet oatmeal recipes are easy enough to find, but savory ones? Those are a little harder to pull off. With its tomato puree, pine nuts, fresh herbs, and Parmesan cheese, Oatgasm’s tomato and basil oatmeal reminds us of a lower-carb bowl of pasta — one that you’ll want to eat for breakfast, lunch, and dinner. Mangia!

Slow Cooker Overnight Oatmeal
Don’t have time to cook breakfast in the morning? No problem. Just toss 2 cups of oats into a slow cooker, top with some dried berries, and add water. Wait 90 minutes, and voila! With just 193 calories, this slow cooker overnight oatmeal will be your new favorite breakfast.

Blueberry Muffin Overnight Oats
Our love of overnight oats continues with this mouthwatering blueberry version from Eat Yourself Skinny. (Seriously, how gorgeous is this?) The Greek yogurt and chia seeds add an extra shot of protein (13.4 grams in one jar!) and a chewy, flavorful texture. And did we mention it only takes a few minutes to make?

Date-Sweetened Apple Pie Oatmeal
This gluten-free apple pie oatmeal from the Minimalist Baker is sweetened with dates, apple slices, and a dash of honey. It’s part crispy, part thick and creamy, and all parts totally delicious. Plus, it’s easy to mix and match this base recipe with other toppings — think: toasted nuts and flaxseed.

5-Minute Oatmeal Power Bowl
Who says comfort food can’t be healthy, too? This oatmeal power bowl from Oh She Glows is not only delicious, but it also lives up to its belly-filling promise: laden with chia seeds, almonds, and cinnamon, it’s an instant, energizing way to start your day.

Raspberry-Almond Overnight Oatmeal
Breakfast doesn’t get much easier than this raspberry almond oatmeal. Simply combine oats, milk, yogurt, almonds, chia seeds, and a dash of almond extract in a pint-sized mason jar, then shake, stir, and refrigerate. It’s packed with healthy ingredients, and served up in a perfect portion size, too!

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.

6 Detoxifying Vegetable Soup Recipes for the New Year

Bone broth was the hipster darling of 2015 food trends, but if healthy eating is one of your resolutions, just sipping on broth isn’t going to cut it. It’s a new year, and 2016 is all about doubling down on fruits and veggies in the most delicious way possible. Sure, salads pack in a lot of produce, but broth-based soups may be the most satisfying — and warming! — route to healthy eating this winter. If you’ve been mainlining gingerbread and peppermint bark for the past two weeks, a detoxifying veggie soup is the perfect way to usher in a healthier new year, one satisfying slurp at a time. Here are five recipes that’ll give your resolutions staying power all month long:

Many-Veggie Vegetable Soup

Many-Veggie Vegetable Soup 

We like to think of this dish from Love & Lemons as the “everything but the kitchen sink” of all soup recipes. Here at Everyday Health, we have a strict “no produce left behind” policy, and this is the perfect way to use up all of those death-row veggies in the fridge. Satiating sweet potatoes and carrots pair with lighter veggies like zucchini, tomatoes, and kale to create a hearty, stew-like dish that makes a delicious winter lunch or light supper.

Spiralized Vegan Ramen Soup With Zucchini Noodles

Spiralized Vegan Ramen Soup With Zucchini Noodles

Happiness is when two of your food obsessions (ramen and spiralizing) come together to create a healthy, guilt-free dish. Our friend Ali over at Inspiralized created the ultimate healthy substitute for when you’re jonesing for ramen. This recipe, which swaps noodles for zucchini ribbons, clocks in at 117 calories per serving, which makes it the perfect starter. Or you can make a vegan-friendly meal by adding protein-rich tofu or quinoa — or vegetarian (and a little more authentic!) by serving it with a perfect soft-boiled egg.

 

Spinach Soup With Rosemary Crouton

Spinach Soup With Rosemary Croutons

Here’s another “easy button” recipe that requires just a few essential ingredients that can be swapped in and out depending on what you have in the fridge. Here, cooked spinach, onion, and potatoes are blended with rosemary to create a vegetable-rich savory slurp, but you could use any green you have on hand (think: kale, arugula, mustard greens) and a variety of herbs (thyme, basil, and tarragon would all do the trick!). Eschewing bread this month? Just skip the croutons.

Carrot Apple Ginger Soup

Carrot Apple Ginger Soup

If you haven’t hit the supermarket for your annual “New Year, New You” shopping spree, check the crisper for these holiday holdovers: carrots, onions, apples, and ginger. This bright, sweet, and spicy soup from Joy the Baker keeps in the fridge for up to four days and freezes like a dream. Your first week of January lunch problem? Solved!

Amazon Bean Soup

Amazon Bean Soup With Winter Squash and Greens

If you’re looking for a vegetarian soup that even the most persnickety carnivore will love, look no further. The United Nations has declared 2016 the “International Year of Pulses” (pulses being beans and legumes to me and you), and for good reason: Beans are cheap, healthy, and environmentally-friendly sources of protein that are packed with fiber and nutrients. We love this wintry mix of beans, carrots, squash, and greens, finished with a squirt of lime. You can easily make this a vegan dish by swapping the butter for heart-healthy olive oil and the chicken stock for a veggie version.

No-Bone Broth

No-Bone Broth

Now that you’ve got five delicious soup ideas, you’ll need some broth. Matt Weingarten, culinary director for Dig Inn, created this No-Bone Broth recipe from kitchen scraps, like apple cores, vegetable peels, and the tops and tails of celery, to create a nutrient-rich, vegan stock that’s a perfect base for any soup recipe.

The Link Between Diet and Eye Disease

Eye disease is one of the most common causes of permanent disability in the United States. More than 20 million Americans age 40 and older have cataracts, and 10 million Americans age 60 and over have age-related macular degeneration (AMD). These eye diseases occur as we grow older, and proper nutrition may have some affect on both of them.

Cataracts develop on the lens of the eye when the proteins in the lens are damaged. These proteins are responsible for keeping the lens clear. When they become damaged, the lens becomes cloudy or opaque, and your vision may become blurry. You may also have poor night vision or double vision with cataracts. Cataract surgery is often necessary to remove and replace the damaged lens with an artificial lens.

AMD occurs when cells in the macula of the eye die. The macula is located in the center of the retina in the back of the eye, and is responsible for your sharp, central vision, which you need for reading and other tasks that require good eyesight. Once the macula is damaged, your vision is no longer clear, and you cannot make out fine details of objects. There is no cure for AMD, but proper nutrition may help prevent it from worsening.

Diet and Eye Disease: What Is a “Healthy Eyes” Diet?

According to Nelson, the nutrients associated with eye health are vitamins C and E; carotenoids, beta carotene, lutein, and zeaxanthin; omega-3 fatty acids; zinc; and vitamins B6, B9 (folic acid or folate), and B12.

“Antioxidants, especially lutein, help deter build-up of waste products in the retina, which in turn helps reduce your risk for AMD,” says Jennifer K. Nelson, MS, RD, director of clinical dietetics and associate professor of nutrition at the Mayo School of Health Sciences in Rochester, Minn. “Folate and vitamin B6 decrease the presence of the blood chemical homocysteine, which lowers your risk for AMD. Antioxidants also help prevent the cross linking of proteins in the lens which can cause cataracts.”


Here's a list of foods containing eye-healthy nutrients:

  • Fruits and vegetables (good sources of vitamins C and E)
  • Dark green vegetables such as kale and spinach (lutein, vitamin E)
  • Yellow and orange fruits and vegetables (beta carotene and zeaxanthin)
  • Anchovies, herring, mackerel, salmon, sardines, trout, tuna, and white fish (omega-3 fatty acids)
  • Beef, eggs, lamb, milk, peanuts, pork, and whole grains (zinc)
  • Bananas, chicken, dried beans, fish, liver, pork, and potatoes (vitamin B6)
  • Citrus fruits, fortified cereals, dried beans, green leafy vegetables, liver, mushrooms, nuts, and peas (folic acid)
  • Dairy products, eggs, meat, poultry, and shellfish (vitamin B12)

A diet high in refined carbohydrates, such as white rice, white bread, and pasta, may actually increase your risk of developing AMD. These foods have a high glycemic index, which means they are broken down rapidly into blood glucose or sugar. Choose breads and pasta made from whole grains and brown rice for your complex carbohydrates.

Diet and Eye Disease: Nutrition Supplements for Eye Health

 

In 2001, the National Eye Institute’s Age-Related Eye Disease Study (AREDS) found that taking a specific supplement of high doses of vitamin E, beta carotene, zinc, and copper may prevent intermediate AMD from progressing to the advanced stage. AREDS found no evidence that the supplement benefited anyone who showed no signs of AMD or those with early stage AMD. The AREDS-2 clinical trials are currently being conducted to look at the addition of lutein, zeaxanthin, and omega-3 fatty acids to the original AREDS formula.

For those with intermediate AMD who want to try the supplement formula, a discussion with your doctor is a must. “Because the AREDS-recommended supplement contains relatively high doses of antioxidants and zinc, you and your health care provider need to determine if the AREDS supplement is right for you,” cautions Nelson. “It is important that you do not self-medicate any supplements higher than the daily recommended intakes."

“We also need to look at the long-term effects of taking the AREDS supplement,” says Nelson. “For example, the AREDS formula has a very high level of beta carotene, which may increase the risk for lung cancer in smokers.” Nelson adds that eating a diet with plenty of green leafy vegetables, fish, and fortified cereals should make taking supplements for eye health unnecessary for most people.

“We’re only just beginning to look at nutrition and eye health, and it’s an exciting time because we have found such a link,” says Nelson. “A healthy diet is the foundation for healthy eyes.”

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.

 

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.

 

18 Ways to Make This Your Healthiest Summer Ever

I don’t know about you, but I’m tired of summer always being linked to the dread of bathing suit season when there are so many healthy aspects to celebrate this time of year. Fresh produce is abundant, beautiful, and more affordable. The weather (at least in most parts of the country) is perfect for outdoor walking, biking, hiking, and swimming, and the days are longer so you have more time to fit in physical activity. Vacations allow you time to relax, de-stress, and get active with friends and family, and your schedule may be more flexible, allowing you more time to focus on healthy habits.

With summer upon us, it’s the perfect time to set some health goals and embrace new opportunities to eat smart and get fit. Here are 18 ideas to motivate and inspire you throughout the sunny months ahead:

Head to the Farmer’s Market

Loading up on summer’s best and freshest produce, including leafy greens, tomatoes, corn, zucchini, green beans, berries, and stone fruits will make it easier to gobble up more vegetable and fruit servings.

Make salad your main course a few times a week. Take advantage of farm-fresh lettuce and the bounty of seasonal produce to concoct creative salad bowls. For a quintessential summer meal, top your greens with sweet corn, diced tomato, avocado, and crumbled feta.
Swap sugary desserts for delicious seasonal fruits. Instead of reaching for cookies, pastries, or chocolate after dinner, dig into a bowl of naturally sweet, ripe fruit. Best bets include berries, watermelon, cantaloupe, apricots, peaches, and plums.
Lay out a healthy, no-cook summer spread. If it’s too hot to cook, throw together a picnic-style meal of sliced raw veggies (carrots, cherry tomatoes, zucchini, cucumber, etc.) with hummus, sliced whole-grain bread or crackers, cheeses, olives, fruit, nuts, hard-boiled eggs, and other tasty nibbles.
Get grilling. It’s a terrific way to infuse flavor into lean proteins like skinless chicken breasts and thighs, turkey burgers, fish, shrimp, and pork tenderloin, especially if you start with a tasty spice rub or marinade. If you cook extra, you’ll have ready-to-eat proteins to add to leafy green or grain-based salads for simple meals later in the week.
And don’t forget the grilled veggies. Whenever you fire up the grill, toss on some sliced zucchini, summer squash, eggplant, bell peppers, and/or mushrooms. Chop them up and toss with pasta or cooked whole grains like brown rice, farro, and quinoa for a simple meal. Or, layer grilled vegetables on whole-grain bread spread with goat cheese or hummus for a tasty vegetarian sandwich.
Cool down with fruit smoothies. Blend your favorite summer fruits — and veggies like carrots, spinach, and beets — with yogurt and your milk of a choice for a hydrating breakfast or snack. The fruit will add plenty of sweetness, so you can skip added sugars like maple syrup and honey. Make extra and pour into ice pop molds or small paper cups with popsicle sticks for a fun frozen dessert.
Start your day with a hearty, refreshing breakfast. Overnight oats are a great choice this time of year (they’re the more seasonally appropriate counterpart to a hearty bowl of hot oatmeal). Or, top fresh fruit with a dollop of protein-rich yogurt or part-skim ricotta cheese and optional chopped nuts. I can’t wait to dig into my first bowl of fresh cherries, peaches, or nectarines with ricotta!
Go skinny-dipping. Whip up a tasty new dip each week to enjoy with all of the deliciously dunkable summer produce. Try Greek yogurt with mixed fresh herbs, artichoke pesto (you have to try this recipe!), or any number of unique hummus variations, including roasted red pepper, beet, edamame, and carrot-based blends.
Start spiralizing. I don’t endorse a lot of single-use kitchen gadgets, but I’m pretty fond of the vegetable spiral slicers that are all the rage right now. The price is right at about $15 to $25 per machine, and you can use it to make low-cal veggie pastas and salads out of all of the inexpensive summer bumper crops like zucchini, summer squash, cucumbers, carrots, and even beets. Check out this recipe for zesty Carrot Noodle Stir Fry from the blog Inspiralized.
Sip on iced tea. To help you stay hydrated in the hot weather, I suggest keeping a pitcher or two of unsweetened iced tea in the fridge at all times. Switching up the flavor from week to week will prevent you from getting bored in the beverage department. Mint green tea is a classic summertime brew, but I also love fruity combos like pomegranate and raspberry.
Plant something … anything! Never grown anything edible before? Don’t let that stop you; starting a simple garden in pots or other containers is actually really easy. Go to the nearest hardware store and pick up a large planter, a bag of potting soil, and a small potted plant, like any fresh herb or one of the vegetables listed here. Consider starting with basil or a cherry tomato varietal; they’re both easy to grow and versatile in the kitchen.
Go on a pick-your-own adventure! Don’t wait for apple picking in the fall. Make a date with family or friends to harvest summer produce at a local orchard or farm (visit pickyourown.org to find a site near you). If you’re willing to put in the labor, you can buy buckets of berries, stone fruit, and other seasonal items at a great price.
Sit down and enjoy meals outdoors. So many people I know own lovely patio sets but rarely use them. Make a plan to sit down to a family meal in your backyard once a week. You’ll likely eat more slowly and mindfully when you’re dining al fresco. If you don’t have access to an outdoor eating space, plan a fun picnic at a local park.
Master a few healthy recipes for summer cookouts. Finding lighter fare at barbecues can be a challenge, but if you volunteer to bring a healthy dish, you know you’ll have at least one good option to pile onto your plate and dilute some of the heavier entrees and sides. To keep things simple, bring a big bowl of fruit salad or pick up a crudite platter from the grocery store. If you don’t mind doing a bit more prep, I recommend throwing together a pasta salad with lots of veggies, like this colorful soba noodle salad with edamame, red pepper, and purple cabbage.
Go for a daily walk. Now that the days are longer, it’s easier to squeeze in a short walk at the start or end of your day. Aim for at least 30 minutes most days of the week (but if you can only commit to 15 or 20, that’s still well worth the effort). When things start to heat up, schedule an early morning or late evening walk when temps are cooler.
Hit the trail. For a change of scenery, seek out some local walking and hiking trails in your area using sites like alltrails.com and traillink.com. Pack a healthy lunch or snacks and make a day of it!
Take a hiatus from TV. With all the network hit shows on summer break, it’s the perfect time to reduce your screen time. Cut down on evening television viewing and spend that time outdoors walking, biking, doing yardwork, or playing with the kids or grandkids.

9 Diet Hacks Nutritionists Use Every Day

1 / 10   Think Like a Nutritionist With These Simple Tips

Whenever we have a diet or nutrition question, we call on a dietitian or nutritionist to lead us in the right direction. Although you may picture them noshing on raw veggies and sipping water all day, they aren’t always perfect — they enjoy dining out, battle the munchies, and love dessert just like the rest of us! The difference is they know the insider tips to shave calories off comfort food favorites, satisfy cravings the healthy way, and pack more nutrition into each meal. Make their tricks second nature and soon you’ll be an expert at keeping the flavor you crave, while slimming down your meals and your waistline

8 Healthy Game Day Snacks for Football Season

1 / 9   Skip the Takeout and Whip Up These 8 Winning Snacks

Even if you're not a football fanatic, game day is always an excuse to watch a good matchup, spend time with family and friends, and especially to eat your favorite foods. Nachos, chili, cheese dips — your upcoming game-day gathering will probably boast some of the best non-holiday spreads of the year. Game on! This year, it’s not about what foods you should avoid; instead, we scoured our favorite blogs for healthier game day dishes that score major points for flavor, originality, and nutrition. One look at these winning recipes and you won’t want to order out.

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!

Tomato Basil Oatmeal

Sweet oatmeal recipes are easy enough to find, but savory ones? Those are a little harder to pull off. With its tomato puree, pine nuts, fresh herbs, and Parmesan cheese, Oatgasm’s tomato and basil oatmeal reminds us of a lower-carb bowl of pasta — one that you’ll want to eat for breakfast, lunch, and dinner. Mangia!

5 Cooking Tips to Spice Up Your Heart-Healthy Diet

Add Flavor, Texture, and Zest with Heart-Healthy Ingredients

If you have high cholesterol and blood pressure, your doctor has probably advised you to start following a healthy diet as part of your treatment plan. The good news is that delighting your taste buds while sticking to a heart-healthy meal plan is easy — and many of the foods you enjoy most likely aren’t off limits. Healthy herbs and spices lend robust and savory flavor, hearty nuts add texture and a buttery taste, and teas infuse a bright flavor and antioxidants. Michael Fenster, MD (also known as Dr. Mike), a board-certified interventional cardiologist and gourmet chef, shares his cooking tips for preparing delicious meals that will boost your heart health. These choices are part of a healthy lifestyle that may reduce your risk for heart conditions like high blood pressure, heart attack, or stroke down the road.

5 Cooking Tips to Spice Up Your Heart-Healthy Diet

Add Flavor, Texture, and Zest with Heart-Healthy Ingredients

If you have high cholesterol and blood pressure, your doctor has probably advised you to start following a healthy diet as part of your treatment plan. The good news is that delighting your taste buds while sticking to a heart-healthy meal plan is easy — and many of the foods you enjoy most likely aren’t off limits. Healthy herbs and spices lend robust and savory flavor, hearty nuts add texture and a buttery taste, and teas infuse a bright flavor and antioxidants. Michael Fenster, MD (also known as Dr. Mike), a board-certified interventional cardiologist and gourmet chef, shares his cooking tips for preparing delicious meals that will boost your heart health. These choices are part of a healthy lifestyle that may reduce your risk for heart conditions like high blood pressure, heart attack, or stroke down the road.

Vitamin D

 

 

All Diet and Nutrition Articles

All Diet and Nutrition Articles

 

For Pain, It Matters Which Doctor You See

As a physician anesthesiologist, I know how challenging it can be to treat patients who are in pain. For most people, pain is temporary. But for more than 100 million Americans, there is no end to pain.

Chronic pain can be broad or focused, dull or sharp, distracting or excruciating, and in many cases, debilitating.

Your likelihood of experiencing chronic pain increases with age. Gender can also influence how much pain you have. In general, women report having more pain than men.

The Serious Effects of Pain

Living with chronic pain can affect your life in many ways:

Mental health changes. According to a 2006 survey from the American Academy of Pain Medicine, almost two-thirds of people living with chronic pain have reported a decrease in overall happiness and 77 percent reported feeling depressed.
Increased fatigue. Pain can affect your daily functioning, resulting in decreased concentration, diminished energy levels, and difficulty falling or staying asleep.
Decreased job performance. Chronic pain costs the U.S. more than cancer, heart disease, and diabetes. Health economists estimate that the cost of chronic pain may be as high as $635 billion a year, according to a report published in the Journal of Pain. We can only guess how many people have been limited in their professional advancement because of pain.
Which Doctor Is Best at Treating Pain?

If you  are experiencing pain, your first stop should be to visit your primary care physician. A 2010 analysis of a national medical database found that 13 percent of all doctors visits were to discuss pain. Of these visits, 45 percent were at a primary care physician's office. Less than 1 percent of those surveyed sought help from a specialized pain physician.

Specialized pain physicians are underused by patients, probably because the specialty is relatively new and people don't know about it. These physicians are trained to treat difficult pain conditions using the most advanced treatments.

I like to compare pain physicians to football players. The goal of all of these doctors is the same — to relieve pain — but the role they play varies:

Anesthesiologists spend four years of their training managing anesthesia and pain control in surgical patients. Most pain specialists are anesthesiologists, and they can offer a full array of pain treatments.
Neurologists focus on targeting the neural, or nerve, aspects of pain. Treatments include medications and procedures to treat nerve-related pain.
Physical medicine and rehabilitation physicians focus on relieving pain and improving their patients' day-to-day functioning via physical therapy and physical reconditioning.
The Future of Pain Treatment

Recently, the American Society of Anesthesiologists analyzed dozens of peer-reviewed medical journals from the past year to create its first Women’s Pain Update. Highlights from the report include:

Success with alternative pain-relief methods such as music, yoga, and rose oil.
Breast cancer research that found the type of anesthesia used during breast cancer surgery can affect how quickly and comfortably you recover.
New research has also led to the development of medications that can decrease nerve irritation and depression caused by pain. Similarly, there are several new procedures that can treat pain.

For example, pain specialists can use X-ray or ultrasound imaging guidance to provide relief through steroid injections that target specific nerves and areas of the spinal cord. The procedure is fairly low risk when administered by a physician specifically trained in interventional pain treatments. All three major pain societies, the American Pain Society, the American Society of Interventional Pain Physicians, and the American Academy of Neurology, state that epidural steroid injections are best suited for those with a pinched or inflamed nerve root (also called radiculopathy).

However, we still have a lot to learn about steroid procedures. Studies have shown that any type of epidural injection — including saline — can relieve pain. In fact, such injections provide twice the pain relief of intramuscular steroid injections, without the associated risks.

Don't resign yourself to a life  in pain. If you are one of the millions of people lacking an effective remedy for your pain, a trained pain medicine physician may be able to help you achieve your pain management goals.

This Row Will Kick Your Core Into Overdrive

He single-arm  is a classic exercise, but it's not always done correctly. You'll often see people rocking their entire upper bodies on the move, putting their lower back at risk for injury and not getting the most out of the row.

That's where this TRX row comes in, because it forces you to keep near-perfect form. It's an exercise that will keep you honest on all your single-arm rows, and combined with a at the end that's also on the , it makes a perfect finishing move to a pull-day workout.

When’s The Best Time to Exercise?

Ask the Fitness Expert,  Jennifer Bayliss

Q: What’s the best time of day to exercise?

A: The best time of day to exercise is the time that works best for you. Studies go back and forth on this topic and there are benefits in exercising in the morning and later in the day. Ultimately, it comes down to personal preference and lifestyle. Choose a time that helps you make exercise a regular and consistent part of your routine. Here’s why:

It’s all about finding your rhythm.
Ever wonder why some of us are morning people while others are not? This has quite a bit to do with your body’s internal clock, or your circadian rhythms. Circadian rhythms are a daily cycle of sleep and wake cycles. It’s this cycle that regulates physical, mental, and behavioral changes within a 24-hour period. Body temperature, blood pressure, and metabolism are some of the physiological processes that can be affected by your body’s internal clock. These rhythms respond to changes in the environment and can be set and reset. The changes in the environment that can have an effect on circadian rhythms include lightness and darkness, temperatures within the environment, artificial light, the use of an alarm clock to wake, timing of meals, and time of day you exercise. Your personal clock can affect what time of day you prefer to exercise. So, are you a morning person or a night owl?

If you’re a morning person…
It’s a no brainer: You should workout in the AM. Research suggests that those who exercise in the morning tend to be more consistent with their exercise routine. The idea is you’ll get your workout in before any other events or distractions of the day interfere, thus setting yourself up for success. People who exercise earlier in the day generally find they can manage their time better and they feel more energized throughout the day. If you do exercise in the morning, make sure to give yourself a little extra warm-up time to get your body temperature elevated and your muscles warm. Some people have trouble exercising in the morning because of dizziness, fatigue, or lightheadedness experienced when working out on an empty stomach. If that happens to you, try having a small snack, such as a banana or a serving of low-fat yogurt, prior to exercise.

If you’re a night owl…
Afternoon or evening exercise can be the perfect way to unwind. Some people find that afternoon or evening workouts are more productive and help relieve some of the stresses of the day. For others, exercise in the morning doesn’t feel good because, when you wake up, your muscles may feel tight and your blood sugars may be low. Afternoon or evening workouts may just seem that much better because you are more alert, your body temperature is naturally elevated, and your muscles are warm and flexible. You also have the added benefit of having had the opportunity to get some food in your system which can help you feel more energized during your workout.

Whether you exercise for weight loss, stress relief, or one of the many other health benefits, it is important to be consistent. Schedule that time for exercise based on what works best for you — morning, noon, or afternoon. Your body’s internal clock will reset itself and your sleep habits and changes to meal times will either fall into place or can be adjusted based on when you decide to work up a sweat!

Do you have a fitness question for us? Leave a comment below!

Jennifer Bayliss is a fitness expert and coach at Everyday Health. She is a certified strength and conditioning specialist through the National Strength and Conditioning Association, a AFAAcertified personal trainer, and holds both an undergraduate and a graduate degree in exercise science.

Teens and E-cigarettes

In Figure 2 Teen e-cig users are more likely to start smoking.
30.7 percent of e-cig users started smoking within 6 months while 8.1 percent of non users started smoking. Smoking includes combustible tobacco products (cigarettes, cigars, and hookahs).

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10 Winter Foods for Depression

1 / 11   Boost Your Mood With Seasonal Bounty
It’s winter, and depending on where you live, it could be very cold and gray, with sunshine in short supply. The winter doldrums plus holiday high anxiety make this season especially stressful and depressing for many people. But you might be able to eat your way to a better mood. Load your plate with these winter foods for depression to lift your spirits.

DIY Beauty Treatments for Every Skin Problem

  • 1 / 7   DIY Beauty Solutions

    Strawberries, lemons, blueberries, and onions – sounds like your average grocery list, right? Just as they are nutritious and important for a well-balanced diet, these ingredients can give your skin and hair a major boost, too.

    Read on to learn these six expert-recommended at-home treatments that can help combat your biggest beauty woes.

  • 2 / 7   Problem: Hyperpigmentation and dark spots

    Solution: Fresh lemon juice and a red onion


    Lemon juice and red onions are naturally acidic, and when combined together, they create a gentle-yet-effective at-home alternative to dark spot and hyperpigmentation treatments that are often formulated with harsh chemicals.

    For best results, Michael Lin, MD, a board-certified dermatologist in Beverly Hills, California, suggests blending ¼ of a red onion with freshly squeezed lemon  juice before applying it to the desired area with a Q-tip. After 10 to15 minutes, wash off the homemade treatment with a mild cleanser.

  • 3 / 7   Problem: Dry, calloused hands and feet

    Solution: Almond milk and coffee grounds


    For a smoothing hand and foot scrub, Lin suggests combining almond milk with leftover coffee grounds from your morning roast. Almond milk is rich in antioxidants and vitamin E, which helps protect skin from free radicals that can damage cells and break down collagen. Coffee grounds, on the other hand, offer exfoliating benefits that help reveal radiant skin. “Using a caffeine scrub helps to stimulate cells and elastin, and temporarily firm the skin,” says Lin. 

    Combine 2 cups of almond milk and the coffee grounds in a bowl, then scrub the formula in circular motions on your hands and feet.

  • 4 / 7   Problem: Dull skin

    Solution: Peppermint tea


    Using topical treatments isn’t the only way to achieve gorgeous, glowing skin. In fact, radiant skin can be attained from the inside out by drinking a generous cup of peppermint tea. Dallas-based celebrity aesthetician Renee Rouleau advises her celebrity clients to drink a cup of the minty stuff before red carpet events.  

    “Peppermint tea is known to boost blood circulation, giving skin a vibrant glow,” says Rouleau, adding that peppermint can also help decrease stress. 

  • 5 / 7   Problem: Uneven skin tone and UV damage

    Solution: Strawberries and honey


    Strawberries in particular are jam-packed with vitamin C and are a natural source of salicylic acid, which is often found in anti-acne treatments to help clear skin and keep flare-ups at bay. When paired with honey, which has anti-bacterial benefits, they create a powerful at-home alternative to a store-bought mask. 

    Mash together three strawberries and 1 Tbsp. honey and apply the mixture. Wash off the mask with warm water after 15 minutes.

  • 6 / 7   Problem: Dry, frizzy hair

    Solution: Coconut oil


    As the weather gets warmer, your hair can become dry, frizzy, and completely unmanageable. Because of its moisturizing benefits, coconut oil is highly effective when it comes to nourishing hair and battling frizz. 

    For a hydrating hair treatment, New York City stylist Nunzio Saviano, owner of Nunzio Saviano Salon in New York City, recommends working a tablespoon of liquefied coconut oil through your hair post-shampoo. Leave the oil in for five to 10 minutes and rinse it out with chilly water, which will also help close the hair cuticle and seal in moisture, fighting frizz.

  • 7 / 7   Problem: Product buildup

    Solution: Apple cider vinegar

    Product buildup (sometimes confused for dandruff) is residue left behind on your hair and scalp by shampoo, mousse, hairspray, and other styling products. Additionally, dirt, natural oils, and hard water mineral deposits can build up on your hair shaft, leaving locks dull and weighed down. For a quick at-home fix, celebrity colorist Kyle White recommends a five-minute apple cider vinegar treatment.

    “Apple cider vinegar is an effective clarifying

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Diabetis

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.

Overly Controlling Moms Lose Out, Study Says

Helicopter parents, take note: A mother has a better relationship with her child if she respects the youngster's need for independence at a young age, a new study suggests.

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Mothers who allowed children more freedom at age 2 were viewed more positively by their children later in childhood, according to the University of Missouri study.

The study included more than 2,000 mothers and their children. The researchers observed how much the mothers controlled the children's play at age 2 and then interviewed the children at fifth grade to assess how they felt about their mothers.

"When mothers are highly controlling of small children's play, those children are less likely to want to engage with them," Jean Ispa, co-chair of the department of human development and family studies, said in a university news release.

 

 

Respect for independence is important both for children's growth and for creating positive parent-child relationships, she said. "We found that mothers who supported their children's autonomy were regarded more positively by their children than mothers who were highly directive," she said.

RELATED: Being a Good Parent Without Judging Other Parents

"Mothers who are very directive when their children are toddlers often tend to still be controlling when their children enter adolescence," Ispa noted.

Mothers with small children mostly use physical controls, she said, but when children are older these directives become more verbal and psychological -- not allowing kids to speak their mind, for instance. "It's not surprising that their children begin to view them in a negative light," Ispa said.

The findings, published online recently in the journal Social Development, don't mean that parents should not establish and enforce rules or offer advice, Ispa said. She noted that behavioral rules -- such as teaching children to check for cars before crossing the street -- did not have a negative impact on mother-child relationships.

It was psychological control -- such as inducing guilt or telling children what to think and feel, or to play in certain ways -- that damaged mother-child relationships, the study found.

 

 

"Many times, parents think that employing these controlling behaviors is the 'right way' to raise children, but our research shows that really does not work," Ispa said.

"Allowing children age-appropriate levels of autonomy to make safe decisions is very good for kids, and they usually will make wise decisions when they have been taught about safe choices as well as consequences," she added.

"A good place for parents to start would be to have open discussions and allow their children to express their own points of view," she suggested. "When giving children instructions, explain reasons for decisions rather than simply saying, 'Because I said so.' "

How Trauma Can Lead to Depression

You don't have to have been personally involved in a traumatic experience to suffer the effects.

Over the last few years, a long string of traumatic events have occurred and been widely covered in the news, including movie theater, school, and workplace shootings, as well as natural disasters such as typhoons and earthquakes. These events can be devastating for those personally involved, yet their impact may also be felt by others not directly involved at all.

Many people can go through or hear about such traumatic events and be fine after some time without additional interventions, says Anthony Ng, MD, chief medical officer at Acadia Hospital and chief of the psychiatry service at Eastern Maine Medical Center in Bangor.

But some people who experience such traumatic events — whether personally or just by hearing about them — can become depressed, according to the Depression and Bipolar Support Alliance. Traumatic life events were found to be the biggest single cause of anxiety and depression in a study by researchers at the University of Liverpool published in 2013 in PLoS One. 

RELATED: The Healing Power of Horse Therapy for PTSD

For some, traumatic events such as the Boston Marathon bombing and Sandy Hook Elementary School shooting challenge their basic assumptions about how life works, says Irina Firstein, a licensed therapist who has lived and practiced in New York City for more than 25 years. They can become so scared that they develop a generalized anxiety or panic disorder, which can lead to depression, she says.

Depression and PTSD: What's the Connection?

People who continue to experience extreme symptoms of stress long after a traumatic event may have post-traumatic stress disorder (PTSD), which can also lead to depression — a continued feeling of intense sadness that interferes with a person's ability to function normally.

Depression and PTSD often coexist, and their symptoms may overlap. A study on Vietnam veterans counducted 40 years after the war, published in 2015 JAMA Psychiatry, found that about a third of those who suffered from PTSD also had major depressive symptoms.

Symptoms of depression include sadness, feelings of loss, disillusionment, loss of appetite, and difficulty sleeping, Firstein says.

Symptoms of PTSD include:

Reliving traumatic events through flashbacks or nightmares
Avoiding experiences that remind you of the trauma
Panic attacks
Physical symptoms such as rapid heartbeat, trembling, shortness of breath, or headaches
Symptoms of PTSD and depression that commonly occur together include:

Trouble concentrating
Avoidance of social contacts
Irritability
Abuse of drugs or alcohol
How to Cope With the Effects of Traumatic Events

"Some of these symptoms are normal after such an event," Firstein notes. "However, if they persist, one should try to get professional help.”

Dr. Ng. says red flags that you're not managing well on your own include:

Missing a significant number of days of work or school
Withdrawing from family members or people around you
Experiencing mood swings, such as being irritable and angry to the point that it’s causing problems at home
Not being able to eat and losing weight
Not being able to sleep at night. “As a result, you feel exhausted and can’t function in the daytime,” Ng says.
Having thoughts of hurting yourself or others
Mental health professionals can help. “Psychotherapy; eye movement desensitization and reprocessing, or EMDR therapy (trauma reprocessing using eye movements); and medication are very effective," Firstein says.

In addition to getting professional help, ways to cope with PTSD and depression include:

Spending more time with friends and family
Learning as much as you can about PTSD and depression
Taking part in activities you enjoy
Getting regular exercise
Learning relaxation techniques
Joining a support group
Avoiding drugs and alcohol
The following resources can help you find ways to cope with trauma and depression, as well as help you find therapists in your area: 

Your family doctor. “Tell your doctor, ‘I’ve experienced these symptoms. What can I do?’ Your doctor might treat you or refer you to a psychiatrist or counselor or therapist,” Ng says.
The National Alliance on Mental Illness HelpLine. This organization's staff and volunteers can help you find treatment. Call 800-950-NAMI (6264) or email info@nami.org.
The National Suicide Prevention Lifeline. If you are having suicidal thoughts, call 800-273-TALK (8255). Counselors are available 24/7, and the service is free and confidential.
The American Psychological Association’s psychologist locator.
The PTSD Alliance.
The National Center for PTSD, part of the U.S. Department of Veterans Affairs.  
The Anxiety and Depression Association of America.
Don’t Ignore Symptoms That Persist

Unexplained and unexpected trauma has always been part of the human experience, and depression and PTSD are common results of these events. The best way to deal with them is to know the symptoms and ask for help.

Additional reporting by Beth W. Orenstein.

News From AAN: Correction on Tysabri/PML Blog (last of paper)

Last week we posted a blog about the risks of PML for patients taking Tysabri, based on news from the American Academy of Neurology (AAN) meetings which took place earlier this month. In the comments section, Chris asked that we check our facts and report back.

Well, once again, your commitment to the Life With MS Blog community has paid off.

I jotted off a quick e-mail to the Public Affairs department for Biogen/Idec and waited… and waited… and got nothing. Because, however, of the active participation of our community the conversation was noted and I got an e-mail asking if we needed any assistance directly from the senior manager for international public affairs.

I am not happy that I was wrong, but I am happy to know that we can get the correct information out to you today.

I had reported that Alfred Sandrock, MD, PhD, of Biogen/Idec, presented findings from the company’s study on progressive multifocal leukoencephalopathy (PML) in patients using Biogen/Idec’s MS drug, Tysabri. I was mistaken in my assessment of “immunosuppressive” (IS) therapy in the list of risk factors for PML.

Risk factors for PML include:

More than two years on Tysabri
Prior immunosuppressant therapy
Positive serology for JC virus infection
According to Biogen, immunosuppessants, in the context used by Dr Sandrock are limited as:

“A prior IS would be considered mitoxantrone, azathioprine, methotrexate, cyclophosphamide, mycophenolate, cladribine, rituximab, and chemotherapy (not otherwise specified).”

Not included, as you can see, are any of the other MS disease modifying therapies (DMT) or even corticosteroids like Solu-Medral or Prednisone — which is normally considered an IS drug, but not for the case of the PML warning.

The original press release that I received on the topic was incomplete and I apologize for the misunderstanding.

As a side note, I took advantage of the conversation to request more information on the companies rational in keeping the patent on the JC Virus assay test that I also mentioned in that same blog post. I’ll update you on that conversation as soon as it happens.

Once again, your voice was heard by the people who have the answers and I think we’ve cleared up the misunderstanding. Thank you all for your continued involvement in our community. It makes a big difference in the lives of so many!

Wishing you and your family the best of health

 

Plastics Chemical Tied to Changes in Boys' Reproductive Development

When expectant mothers are exposed to plastics chemicals called phthalatesduring the first trimester, their male offspring may have a greater risk of infertility later in life, a new study suggests.

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Boys exposed to the chemical diethylhexyl phthalate (DEHP) may be born with a significantly shorter anogenital distance than those not exposed to these chemicals. Anogenital distance is the distance between the anus and the genitals. A shorter anogenital distance has been linked to infertility and low sperm count, the researchers explained.

"We saw these changes even though moms' exposure to DEHP has dropped 50 percent in the past 10 years," said lead researcher Shanna Swan, a professor of preventive medicine and obstetrics, gynecology and reproductive medicine at the Icahn School of Medicine at Mount Sinai in New York City.

"Therefore, we have not found a safe level of phthalate exposure for pregnant women," she contended.

Swan said that this study cannot prove that these boys will have fertility problems as adults or that DEHP causes these problems. However, animal studies have implicated the chemical in male reproductive problems. Based on the data from this study, Swan believes there is a strong association between exposure to DEHP and fertility in human males.

DEHP is used to soften plastics. Most exposure results from eating foods that pick up the chemical during processing, Swan said.

RELATED: 10 Toxic Household Items You Should Throw Away Now

 

 

"Since food is the largest source of DEHP for consumers, it is difficult for pregnant women to minimize exposure," she said. "Eating unprocessed food will likely help. However, eliminating DEHP from food really has to be done by food producers."

The chemical is also found in medical tubing and in a variety of products, including flooring, wallpaper, lacquers and personal care products, Swan said.

The report was published Feb. 19 in the journal Human Reproduction.

For the study, Swan's team collected data on almost 800 pregnant women and their infants.

Specifically, the researchers found that exposure in the womb to three types of DEHP was associated with a significantly shorter anogenital distance in boys, but not in girls.

A group representing the chemical industry took issue with the study, however.

In a statement, the American Chemistry Council (ACC) stressed that the study only examined one type of phthalate, not all versions of the chemical. And it said that phthalates are "one of the most widely studied family of chemicals in use today."

The ACC added that DEHP "is known to break down into its metabolites within minutes after it enters the body. Information collected by the Centers for Disease Control and Prevention over the last 10 years indicates that, despite the fact that phthalates are used in many products, exposure from all sources combined is extremely low -- much lower than the levels established as safe by scientists at regulatory agencies."

 

 

But another expert says phthalate exposure may not be benign. Dr. Kenneth Spaeth, director of the Occupational and Environmental Medicine Center at North Shore University Hospital in Manhasset, N.Y., said, "virtually everyone in the U.S. experiences continual exposure to phthalates."

And, a number of studies have tied the chemicals with changes in developing fetuses. "Phthalates, in particular, have been shown in both human and animal studies to interfere with normal fetal development," he said.

This study supports what has been demonstrated before, that phthalate exposure in the first trimester is linked to male reproductive development, Spaeth said. "This study is an important step forward in establishing this effect because the study included a much larger number of individuals than prior studies and helps identify one particular agent, DEHP, as an important contributor to this effect," he said.

Additionally, this study shows the importance of exposure in the first trimester as a critical window for the effect of phthalates on the male reproductive system. "On the whole, given these features, the authors have contributed important information about the public health risk posed by phthalates," Spaeth suggested.

Light Box Might Help Nonseasonal Depression, Too

Light therapy, a treatment for a kind of depression known as seasonal affective disorder (SAD), may also benefit nonseasonal depression, a new study indicates.

"The combination of light and an antidepressant seems to work very well for treating nonseasonal depression," said study leader Dr. Raymond Lam, a professor and head of the Mood and Anxiety Disorders Program at the University of British Columbia in Canada.

Depression, a leading cause of disability worldwide, affects one in 20 people, according to background information with the study. Current treatments include psychotherapy and antidepressant medication, but recurrent episodes are common.

Since bright light treatment is used for people whose seasonal depression occurs in the darker months, the researchers hypothesized it might also lift depression that isn't brought on by light deprivation.

Lam and his team randomly assigned 122 adults with major depression not related to seasonal affective disorder to one of four groups. One group got 30 minutes of bright light treatment a day and took a placebo pill, while another used a device that was not light therapy and took the antidepressant fluoxetine (Prozac). A third group took a placebo pill and used a placebo device, while a fourth took Prozac and got light therapy.

The researchers followed the men and women for eight weeks, looking to see how many went into remission -- defined as having normal scores on a widely used depression scale.

"About 60 percent of the patients who got the combination [Prozac plus light] treatment went into remission with their symptoms compared to about 40 percent on light therapy alone," Lam said.

RESEARCH: 12 Ways to Treat Seasonal Depression

The antidepressant alone was not superior to placebo medication. Only about 30 percent of those on placebo medication and sham light treatment had remission, as did just 20 percent of those on Prozac with sham light treatment.

Light therapy alone was better than placebo, but not from a statistically significant point of view, Lam said.

Experts can't say for sure why light therapy works, but for seasonal affective disorder they think it may help correct disturbances in the body's circadian rhythms, or internal clock.

The same may be true for nonseasonal depression, Lam said. "Another theory is that light affects neurotransmitters in the brain such as serotonin [which affects mood]," he said. Or both could play a role, he added.

One limitation of the study, published online Nov. 18 in JAMA Psychiatry, is that patients' natural light exposure was not measured, the researchers said.

Simon Rego is director of psychology training at Montefiore Medical Center and an associate professor at Albert Einstein College of Medicine in New York City. He said the study is the first well-designed comparison of light therapy and the combination of light therapy and antidepressant medications in adults with nonseasonal major depressive disorder.

"In this case, the authors found that the light treatment, whether delivered alone or particularly when delivered in combination with an antidepressant medication, was efficacious in the treatment of nonseasonal [depression] and, just as important, the treatments were well-tolerated by the subjects," Rego said.

"It appears that light therapy, which is already seen as an effective treatment for seasonal affective disorder, may also be appropriate for nonseasonal [depression]," he added.

However, questions remain, Lam said, such as how long the combination treatment should continue.

Light boxes are sold at drugstores and other locations, Lam said, for less than $100 to $300. Some insurance plans cover them, he said.

Recommended treatment involves sitting in front of the fluorescent light box for a half hour daily as soon as possible after waking up. Lam said this can be done while eating breakfast or working on the computer.

The Canadian Institutes of Health Research funded the study. Lam reports serving as a consultant to or receiving honoraria for speaking from various pharmaceutical companies, including Eli Lilly and Co., which makes Prozac.

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Why Some Seniors Lose Their Hearing

Do you have difficulty hearing conversations held in a noisy room? Do you have a harder time picking up women’s voices than men’s? Do you constantly ask others to repeat what they just said? If you answered ‘yes’ to these questions, you may be experiencing hearing loss — especially if you are 65 or older.

About 8.5 percent of adults between the ages of 55 and 64 suffer from hearing loss, according to the National Institute on Deafness and Other Communication Disorders. That number jumps to 25 percent for those 65 to 74, and it doubles to 50 percent for ages 75 and older. After high blood pressure and arthritis, hearing loss is the most common chronic condition affecting senior health.

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What Causes Hearing Loss?

As you age, you are at risk for two types of hearing loss. The most common type of hearing loss in seniors is presbycusis, or age-related hearing loss. A gradual loss of hearing that affects both ears, presbycusis occurs when tiny hairs in the ear, which are necessary for converting sound waves to sound, become damaged or die. Hearing loss from presbycusis is permanent because once these hairs are damaged or die, they are not replaced with new growth.

Related: 11 Early Signs of Dementia

The other type of hearing loss that seniors experience is tinnitus, or ringing in the ears. Tinnitus can be either permanent or temporary.

Risk Factors Related to Hearing Loss

A lifetime of exposure to loud noises such as music, motorcycles, or firecrackers can cause hearing loss in seniors. Noise-related hearing loss often results in tinnitus. Other causes of and risk factors for hearing loss experienced by seniors include:

  • Smoking
  • Allergies, high blood pressure, tumors, or stroke
  • Medications
  • A punctured eardrum
  • Viruses or bacteria
  • Earwax buildup

Your genes may also play a role in presbycusis, as it tends to run in families. Environmental factors like loud music and smoking make it difficult to determine the effect of genetics on age-related hearing loss; however, according to American Family Physician, an estimated 50 percent of age-related hearing loss is inherited.

Men are also more likely than women to develop hearing loss, and they’re more likely to develop it at an earlier age, says American Family Physician.

The Consequences of Hearing Loss

Losing hearing can have a significant effect on other aspects of your wellbeing. Researchers in a 2014 survey of 18,300 adults found that about 12 percent of participants with hearing loss had moderate to severe depression compared with about 5 percent of those with excellent hearing. The survey, which was published in JAMA Otolaryngology Head and Neck Surgery, also noted that women were particularly susceptible to depression related to hearing loss.

Hearing loss also appears to worsen cognitive functioning, according to a study published in the February 2013 issue of JAMA Internal Medicine. Among the nearly 2,000 seniors studied, hearing loss lowered cognitive functioning on some assessments as much as 41 percent more than it did among those without hearing loss.

Hearing Aids and Other Treatment Options

Though you can’t always fully prevent hearing loss, you can take steps to minimize or overcome it. Age-related hearing loss may be prevented or at least lessened by avoiding loud noises.

Because there is no known cure for age-related hearing loss, treatment is generally focused on improving your ability to function day to day. Your doctor may treat you or refer you to a hearing specialist such an otolaryngologist (or ENT, a medical doctor who specializes in the ear, nose, and throat) or an audiologist (a licensed professional who diagnoses and helps manage hearing problems). The cause and extent of your hearing loss will determine the course of treatment.

hearing aid may be one recommendation from your doctor or audiologist. Hearing aids can be beneficial for many, but according to the National Institute on Deafness and Other Communication Disorders, fewer than 30 percent of adults older than 70 who could benefit from a hearing aid have one. Hearing aids have come a long way over the years and are available in a variety of styles. A hearing aid and its battery will either fit behind the ear, on the ear, just inside the ear, or in the ear canal.

Types of hearing aids include:

  • Analog hearing aids that increase the volume of some sounds while lowering the volume of others
  • Digital hearing aids that allow you to determine which sounds to make louder or lower

Using assistive listening devices also can help compensate for hearing loss. These products either amplify sound, such as sound from telephones, televisions, and radio listening systems, or alert the user visually, such as with smoke detectors or alarm clocks.

 

 

Surgery may be another consideration. Cochlear implants are electronic devices with one part surgically implanted in the skin and the other part worn behind or in the ear. Used only for severe hearing loss, implants will not restore normal hearing, but they can make sounds louder. Because of the nature of the implants, they are not without risks — they pose the potential for infection, damage to the facial nerve, and tinnitus.

Speech or lip reading and sign language may be an answer for some seniors with hearing loss. Both of these techniques require training and practice and are generally recommended for those with severe hearing loss.

See your doctor as soon as you think you have a hearing problem. The loss of hearing could be a symptom of another medical condition. Seniors with untreated hearing loss are also more likely to suffer emotionally and socially when they areunable to interact with friends and family members. Left untreated, hearing loss could lead to deafness, and seniors who do not address their hearing loss put their lives at risk if they are unable to hear emergency warnings such as car horns or smoke alarms.

Statins May Boost Survival Odds After Cardiac Arrest

The odds of surviving cardiac arrest seem higher for patients who've been taking cholesterol-lowering statins, a new study shows.

Researchers in Taiwan studied the medical records of nearly 138,000 cardiac arrest patients. Those already using statins such as Lipitor (atorvastatin) or Crestor (rosuvastatin) were about 19 percent more likely to survive to hospital admission and 47 percent more likely to be discharged. Also, they were 50 percent more likely to be alive a year later, the study found.

"When considering statin use for patients with high cholesterol, the benefit of surviving sudden cardiac arrest should also be considered, as statin use before cardiac arrest might improve outcomes of those patients," said study author Dr. Ping-Hsun Yu.

Yu is a researcher from the National Taiwan University Hospital and College of Medicine in New Taipei City.

The greatest survival benefit from statins was seen in patients with type 2 diabetes, Yu's team said.

Cardiac arrest is the abrupt loss of heart function. Death often occurs instantly or shortly after symptoms appear, according to the American Heart Association.

"We know that a large proportion of cardiac arrests occur due to coronary plaque rupture," said Dr. Puneet Gandotra, director of the cardiac catheterization laboratories at Northwell Health Southside Hospital in Bay Shore, N.Y.

RELATED: Bystander CPR Doubles Cardiac Arrest Survival Rates

"This rupture leads to a snowball effect in arteries and can cause arteries to get blocked, resulting in a heart attack or cardiac arrest," he explained.

So how might statins help?

"I feel that due to statin therapy, there is significant plaque stability and the effects of rupture are not as significant. Thus, an improvement in survival is noticed with patients on statin therapy who have cardiac arrests," Gandotra said.

Statins are often prescribed for patients after a heart attack or stroke as a way to prevent a second cardiovascular event. However, "this does not mean that everyone should be on statin therapy," Gandotra said.

These drugs can have side effects, such as muscle pain and weakness and higher blood sugar levels. In addition, the value of statins for preventing a first cardiac arrest or stroke is not clear, the researchers added.

Dr. Suzanne Steinbaum, director of Women's Heart Health at Lenox Hill Hospital in New York City, said, "What we learn from studies like this is that [statins] have other benefits.

"A study like this gives me a reason to say, 'There are more reasons for you to take a statin than just to lower your cholesterol,' " Steinbaum said.

For the study, Yu and colleagues divided the medical records of almost 138,000 patients according to whether they had used statins for 90 days within the year before their cardiac arrest. The researchers also accounted for gender, age, other medical problems, number of hospitalizations, post-resuscitation and other variables.

Because more than 95 percent of the patients in the study were Asian, these results might not apply to other groups or ethnic populations, Yu said.

The findings were to be presented on Sunday at the American Heart Association annual meeting, in New Orleans. Data and conclusions presented at medical meetings are usually considered preliminary until published in a peer-reviewed medical journal.

New Cholesterol Drugs Vastly Overpriced, Study Contends

The list price of these newer drugs is upwards of $14,000 a year per patient.Getty Images
Are new medicines for people with out-of-control cholesterol wildly overpriced? It's a question that's sparking debate among consumers and providers of care.

Now, researchers at the University of California, San Francisco (UCSF) report that the price of these drugs -- called PCSK9 inhibitors -- would have to be slashed by a whopping 71 percent to be deemed cost-effective.

PCSK9 inhibitors are a relatively new class of medicines for treating patients whose LDL (bad) cholesterol isn't well-controlled on statins or who cannot tolerate statins. Lipitor (atorvastatin) and Crestor (rosuvastatin) are examples of first-line statins doctors typically prescribe to patients with high cholesterol.

The UCSF team didn't question whether these new medicines are effective in reducing heart attacks and strokes.

"These are super awesome drugs, they really work," said study co-author Dr. Kirsten Bibbins-Domingo.

But the price is "far in excess" of what would be considered a reasonable cost for the clinical benefit they provide, added Bibbins-Domingo, a UCSF professor of medicine, epidemiology and biostatistics.

The list price of these newer PCSK9 drugs is upwards of $14,000 a year per patient.

Dr. Kim Allan Williams, who was not involved in the study, is past president of the American College of Cardiology. He said some doctors have a difficult time with such studies because they compare patients' lives and "events" — such as heart attack and stroke — versus dollars spent on these medicines.

The new study doesn't change his view of the value of the PCSK9 inhibitor class.

"No one's giving those drugs unless the patient is incapable of getting to the target [level of LDL cholesterol]," said Williams, who is chief of cardiology at Rush University Medical Center in Chicago. "You're only going to use it for a situation where you have no choice."

RELATED: 8 Foods That Can Cause High Cholesterol

Because the study is based on list prices, not what patients actually pay, it's also "difficult to analyze the cost-effectiveness when [you] don't know exactly what the cost is," Williams added.

He said he's had patients with copays of $380 a month and others who had zero copays because the cost was completely covered by insurance. He worries, though, that poor patients may not be offered the same access to these medicines.

The CSF researchers designed the study to find out how much bang for the buck these drugs actually provide.

Their study updates a prior cost-effectiveness analysis using current list prices as well as results of a recent clinical trial. That trial demonstrated the clinical effectiveness of Repatha (evolocumab), one of two PCSK9 inhibitors approved by the U.S. Food and Drug Administration, in reducing the risk of heart attack and stroke.

Based on a simulation involving 8.9 million adults who would meet trial criteria, adding PCSK9 inhibitors to statins would prevent 2.9 million more heart attacks and strokes compared with adding Zetia (ezetimibe), another type of medication that blocks the production of cholesterol by the liver.

But the PCSK9 inhibitor class is not cost-effective based on a threshold of $100,000 for each life year gained, the study authors contend. They found that you would have to spend $450,000 per year to get one extra year of life per year.

"The price would have to be between $4,000 and $5,000 [per year] for it to be cost-effective," said Bibbins-Domingo. "If you look in other countries, in Europe, for example, that is in fact where this drug is priced."

Dr. Josh Ofman, senior vice president of global value, access and policy at Amgen Inc., the maker of Repatha, took issue with the findings. "We think that their model is deeply flawed," he said.

The study was based a 3 percent per-year rate of heart attacks and strokes, while other studies use much higher rates — more than three times higher — based on "real-world" data, Ofman said. The study is modeling a population that's not having many heart attacks and strokes, he said.

Ofman also questioned the threshold for determining cost-effectiveness that the UCSF researchers used. He said other organizations use a minimum of $150,000 per quality-adjusted life-year saved.

As for the price differential between the United States and Europe, Ofman cited many factors, from government price controls to how those countries price these drugs.

Amgen isn't alone in its criticism of how these medicines are valued. Earlier this month, several national provider and payer groups raised concerns about how the PCSK9 inhibitors are valued in a letter to the nonprofit Institute for Clinical and Economic Review, which assesses the value of new medicines.

More than a dozen organizations, including the National Forum for Heart Disease & Stroke Prevention, the American Pharmacists Association Foundation and the American Society for Preventive Cardiology, signed the letter citing concerns ranging from the types of patients that could benefit from these drugs to the importance of preventing heart attacks and strokes — not just deaths.

"The big controversy about all these types of analyses is what we're willing to value a patient's year of life at," Ofman said.

The new study was published in the Aug. 22/29 issue of the Journal of the American Medical Association.

Regis Philbin Takes on High Cholesterol

The legendary talk-show host is helping raise awareness about heart health and the importance of staying on drug treatment.

Regis Philbin has been entertaining us for more than 50 years — from his legendary morning show with Kathie Lee Gifford and Kelly Ripa to . With his carefree personality and love of the sharp, off-the-cuff one-liner, at age 86 he remains one of America’s favorite television personalities. Seemingly forever young, he got a wake-up call in 1992, when he faced a major health scare that spurred him to lead a more .

Philbin was away from the TV studio and on a trip in Florida when he started to experience sharp chest pains.

“My heart was driving me crazy, I couldn’t believe it, I had these chest pains,” Philbin says. “We did an down there in Florida and my doctor told me my cholesterol levels were at 300. Are you kidding me? Three hundred!”

High blood cholesterol is one of the major markers of heart disease. According to the , a healthy total cholesterol level is less than 200 milligrams per deciliter (mg/dL). Any levels at 240 mg/dL or above — like the levels Philbin had — would be considered significantly high.

Once Philbin was back in New York, his doctor put him on his first , and Philbin, with his wife, Joy, by his side, decided that he would make significant to fight off the progression of his heart disease.

“I think things changed in a hurry,” Philbin says about his approach to his health.

“It shook us both up, it was a wake-up call,” Joy recalls of her husband’s health scare. “Quite frankly, I didn’t give cholesterol a thought myself. I mean, Regis didn’t have the best diet, but I never thought it was that bad. It kind of set him on a new regimen. You really start to feel your mortality. He was only 61 when he had his first event.”

This wouldn’t be his only heart health scare. Philbin had triple bypass surgery in 2007 because of a buildup of .

The ‘Take the Cholesterol to Heart’ Campaign

Right now, the Philbins are raising awareness about heart health through the “” campaign, which they launched in October 2017 in cooperation with Kowa Pharmaceuticals and the American Academy of Family Physicians Foundation. The campaign aims to encourage people to remain on a heart-healthy routine while also seeking out better information and asking questions before considering stopping their . Philbin, who has shared almost everything about his life over decades of being on air, has always been very open about his experiences with and was approached by the campaign to be its public face.

Joy says that what was most stunning to her about being part of the campaign was learning that 50 percent of people who are on statins stop taking the drugs after one year of use. She adds this shocked her because of how helpful the drugs were for her husband’s health.

Statins are drugs that lower blood cholesterol levels by blocking an enzyme that produces cholesterol in the liver. Getting people to maintain their drug regimen is one of the big challenges of treating high cholesterol, says , the president of the Utah Lipid Center and a fellow at the American Heart Association and the National Lipid Association.

“The big question is, why do these people stop taking their statins? One issue is you don’t necessarily feel better or worse when you take a statin; you have to go through testing to know your cholesterol is lower, so you don’t necessarily have a daily reminder every morning telling you you’re getting better,” Brinton says. “Another thing is that some patients will experience , like muscle pain or weakness. They might have stomach pain or a skin rash.

"There’s also a lot of negative and sometimes factually inaccurate information on the web. However, reputable medical sites cite evidence that highlight the positive health benefits of statins and show that these side effects do not occur in anywhere near the high numbers some of these other sites might lead you to believe.”

Reasons to Stay on Your Statins

A looked into the effectiveness of both statin and non-statin therapies for lowering cholesterol. The study reviewed 49 trials from 1966 to 2016 that involved 312,175 people in total. The report’s authors assert that statins should remain at the front of the line in treating cholesterol, but alternative therapies could be just as helpful if a person can’t tolerate statins or is looking for a different source of treatment. These could involve bile acid sequestrants or even a simple .

“I’ll say this up front, . They prevent heart attack and can prevent stroke. But a statin can’t work if you don’t take it,” Brinton stresses.

Brinton says there are a few things people should keep in mind when looking to lower their cholesterol with statin treatment:

Stay informed. To help counter some potentially inaccurate information out there, Brinton says the first person to turn to is your doctor. Beyond that, he says there’s useful information at places like the , the American Heart Association, and the National Lipid Association website, .

Know your options. Brinton says that people who are discouraged by one drug should know that there are multiple statin drugs out there. “A lot of people who stop their statin for whatever reason didn’t talk to or consult their doctor, who then doesn’t have a chance of helping them decide what to do,” he adds. “There are several statins out there, and people need to realize that there are other options if what they try first doesn’t work out.”

Be vigilant. If you’re having a bad experience, your statin medication could be reacting with other medications you are taking. Brinton says it is important that people tell their doctor about other medications or supplements they're on. They could then be prescribed a different statin.

How Regis Stays Healthy in Retirement

This all rings true for the Philbins. After his scare in the early '90s, Philbin started seeing a cardiologist, , and became even more of a “fitness freak,” Joy says.

“When you’re in your thirties, for example, you aren’t running to a doctor. But when you hit your sixties, you become a little more proactive about your health,” Joy says. “If your diet is wrong, you start looking into it. You become more aware.”

Echoing Brinton, Joy says that communication between you and your doctor is key in maintaining the best possible heart health.

“Some people avoid going to the doctor; they’re afraid of bad news,” she adds. “It’s important to maintain that [relationship]. You get closer to your doctor as you age, it’s one of the things you do. That’s crucial. It was so important for Regis.”

For his part, Philbin is doing everything he can to stay healthy in retirement. The talk-show host with the gift of gab is more than happy to share his heart health journey.

“I’ve been dealing with this for 25 years. It’s been a long time,” Philbin says. “I'm always more than happy to talk about this. For me, it’s everything.”

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.

Recognizing an Addiction Relapse

Treatment and recovery from an addiction to drugs or alcohol are steps in a lifelong journey. Unfortunately, 40 to 60 percent of drug addicts and almost half of all alcoholics will eventually go through a substance abuse relapse.

If someone dear to you has been in addiction treatment, it is important for you to be able to recognize if that person is relapsing as early as possible. This way, the problem can be addressed before it spirals out of control. Just because your loved one relapses does not mean that their addiction treatment has failed, however; it just means that the current treatment regimen probably needs to be reevaluated.

Addiction Relapse: Obvious Signs

"Most of the time the signs are so obvious," says Thomas Kosten, MD, Jay H. Waggoner chair and founder of the division of substance abuse at Baylor College of Medicine in Houston.

According to Dr. Kosten, the following are common indicators of a drug or alcohol addiction relapse:

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  • Alcohol is missing from the house.
  • Bottles of alcohol are found around the home.
  • Your loved one comes home obviously intoxicated.
  • Money is missing from bank accounts or stolen from friends or family member.
  • Medicine is missing from the house.

 

 

Addiction Relapse: Early Indicators

 

 

There are also signals from the addict that a relapse is just around the corner, when steps can be taken to prevent the relapse or at least address it in its earliest stages. Your loved one may exhibit the following emotions and behaviors:

  • Anxiety
  • Anger
  • Impatience
  • Extreme sensitivity
  • Moodiness
  • Not wanting to be around people
  • Refusing help
  • Not complying with treatment recommendations
  • Problems with sleeping
  • Appetite changes
  • Reminiscing about the past
  • Lying
  • Seeing friends that they've used drugs or alcohol with in the past
  • Talking about relapse

Addiction Relapse: Stepping in

When you suspect that your loved one has relapsed, Kosten says the best thing to do is tackle the issue head-on. He suggests that you start the conversation in the following way:

  • First, say to your loved one, “I think you’re using.”
  • If the person admits he is using again, then say, “We need to do something about this."
  • Kosten suggests that at this point you start setting limits by saying something such as, "Unless you get help, you will have to leave the house."

If your loved one is showing signs of an impending relapse but hasn’t yet relapsed, Kosten says that it is important to confront him first. Otherwise it is very unlikely that you are going to be able to convince him to get back into addiction treatment. Then you should encourage him to continue with treatment, talk to an addiction counselor or sponsor, and practice good self-care — that is, get enough sleep, eat well, and take steps to relieve stress.

If the addict refuses to talk with a professional or you feel that you need anaddiction expert to help you learn how to confront him, contact your local Council for Alcoholism and Drug Abuse. Or if you have access to the person’s doctor, addiction counselor, or sponsor, speak to that person about how you might deal with the situation.

An Expert's Guide to Sneezin' Season

Allergy sufferers should prepare for a particularly 'nasty' spring, New York sinus specialist says.

This could be a bad spring allergy season and people with allergies need to be prepared, an expert warns.

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"With the crazy up and down weather, some parts of the country could see worse allergy-provoking conditions. There is likely to be a pollen superburst this season, so sufferers should get ready," Dr. Jordan Josephson, a sinus specialist at Lenox Hill Hospital in New York City, said in a hospital news release.

"It promises to be a nasty spring," he added.

It's crucial to deal with allergy symptoms immediately, according to Josephson.

"Allergies left untreated can cause sinus swelling leading to chronic sinusitis. Allergies can also affect your digestive tract. Gastroesophageal reflux disease (GERD) can be a direct response of the allergic response. So allergies can seriously affect your quality of life. Just ask any allergy or sinus sufferer," he said.

 

 

Dr. Punita Ponda is assistant chief in the division of allergy and immunology at Northwell Health in Great Neck, N.Y. She suggested that if you know you have spring allergies, start taking allergy medication at least one to two weeks before the start of allergy season. Then continue taking it throughout the season, she noted in the news release.

RELATED: 9 Seasonal Allergy Signs You May Be Overlooking

 

 

Josephson outlined a number of other ways to keep your allergy symptoms under control, including: staying indoors as much as possible between 10 a.m. and 4 p.m., when pollen counts are highest; using your air conditioner, which cleans and dries the air; keeping doors and windows closed; and using an air purifier.

After being outdoors, remove your clothes and wash them immediately. Keep pollen-exposed clothes separate from clean clothes. You should also take a shower after being outside in order to remove pollen from your skin and hair, he suggested.

In addition, irrigate your sinuses daily to flush out pollen. And take antihistamines, but try to avoid decongestants.

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.

8 Things You Can Start Doing Now to Look Younger

2 / 9   Use the Right Skin Care Products

When shopping for skin care products, there are three powerful ingredients you should look for to maintain youthful-looking skin, says Robinson. One, check the label for a serum containing antioxidants like vitamin C (Robinson likes Elizabeth Arden Prevage Anti-Aging Daily Serum), which will help brighten your skin; two, add retinoids, which increase cell turnover and stimulate collagen renewal, to your routine; and three, start using an alpha hydroxy acid exfoliator to remove the top layer of dead skin cells (Robinson is a fan of Peter Thomas Roth Un-Wrinkle Peel Pads, which are gentle enough to be used daily). 

7 Quick Fixes to Look More Attractive

One look at the billion dollar anti-aging industry and it's no surprise we find youth beautiful above all else. But skin isn't the only indicator of it — the size of your eyes is, too. "Women with baby-like features such as large, widely-spaced eyes are typically judged to be most attractive," says Viren Swami, PhD, author of The Psychology of Physical Attraction,who cites cross-cultural study data from African-American, Asian, Hispanic, and Taiwanese participants.

The quickest and easiest way to maximize your eyes is to sketch a line on the top lash line using a smoky shade, and then smudge the shadow with a brush or your fingertip to soften and blend, says Tina Turnbow, a celebrity makeup aritst.

Surprising Physical Signs of Heart Disease

Many people associate heart disease with obvious symptoms, like chest pain. But there are some not-so-obvious connections, like swollen feet or bleeding gums, that should also merit a heart check from your doctor.

The classic red flags for a heart attack are familiar to anyone who has watched medical dramas on television. The patient, usually an older man, starts wheezing and gasping for breath. Then he clutches his chest, staggers, and eventually falls over. In real life, the signs and symptoms of heart disease are much more varied and subtle.

Signs Versus Symptoms of Heart Disease
First, some definitions. Heart disease symptoms are indications that you feel or experience, while a sign of heart disease is something your doctor can see or find. Obvious heart disease symptoms include shortness of breath and chest pain. But your doctor will also look for common heart disease signs during an examination or in a patient interview.

Knowing the signs of heart disease is important because you may have them before you have any of the common heart disease symptoms. Letting your doctor know about these warning signs could help you get early treatment for heart disease.

"Signs like ankle swelling or weight gain do not necessarily mean you have heart disease, but taken together with other symptoms of heart disease, laboratory studies, and family history, they are an important part of making a diagnosis of heart disease or heart failure," says Carl E. Orringer, MD, associate professor of medicine and director of the Preventive Cardiovascular Medicine and LDL Apheresis Programs at the University of Miami Miller School of Medicine.

Swelling of the Feet and Lower Legs
Retention of fluid in the feet and legs is known as peripheral edema. Edema may appear as "sock marks" on your legs and ankles at the end of the day, especially if you wear tight socks or hose. Mild peripheral edema is common. Your doctor may check for this sign by pressing a finger against your ankle or shin bone to see if a depression or dent is left behind. This is called "pitting edema” and it could indicate congestive heart failure.

Edema may be a sign of heart failure because when your heart is not pumping well, fluid from inside your blood vessels tends to leak out into surrounding tissues. The legs and ankles are common areas for edema because of the effects of gravity.

"Peripheral edema may be caused by a host of issues,” says Dr. Orringer. “The bottom line is that most people with peripheral edema do not have heart disease, but it could be an important sign if there are other signs and symptoms of heart failure."

Male Pattern Baldness
"If you watched any of the royal wedding, you might have noticed that Prince William is balding on the top of his head. This type of balding of the crown of the head in young men may be a sign of an increased risk for heart disease," says Orringer.

Several large studies have confirmed the link between baldness and heart disease. Compared with men with a full head of hair, men with crown loss have an increased risk of heart disease of about 23 percent. Men with complete loss of hair on the top of their head have an increased risk of 36 percent.

The combination of hair loss, high blood pressure, and high cholesterol pushes the risk even higher. This link may be due to too much of the male hormone testosterone, which interferes with hair growth on the head and causes hardening of the arteries. That doesn't mean you are doomed to heart disease if you are bald, but it does suggest you should be screened more carefully for other signs and symptoms of heart disease.

Yellow Bumps on the Skin
Xanthomas are deposits of fat that build up under the skin. They may appear as small yellow bumps or as flat, wide plaques on your elbows, knees, hands, feet, or buttocks. A type of xanthoma called xanthelasma palpebrarum appears on the eyelids. These yellow, fat deposits can potentially be signs of heart disease because they may indicate high levels of fats in the blood.

"Xanthomas may be a sign of a rare, inherited type of blood disorder in which high levels of triglycerides accumulate in the blood. Xanthomas may also be a sign of increased cholesterol, and they may disappear once cholesterol levels are under control," says Orringer.

Gum Disease
Swollen, sore, or bleeding gums are usually a sign of poor oral hygiene, but may also be an important sign of heart disease. "The association between gum disease and heart disease is the real deal," says Orringer. "There is plenty of research available now that backs up this connection."

Gum disease and heart disease may be linked because they are both signs of poor circulation, or there could be common bacteria that are involved in both gum disease and plaque buildup inside coronary arteries. The link may also have something to do with the body's response to prolonged inflammation. In any case, taking better care of your teeth and gums may be a good way to cut down your risk for heart disease.

Emotional Stress
Weakening of the heart muscle accompanied by extreme emotional stress, grief, or loss, especially in women, is called takotsubo cardiomyopathy, or broken heart syndrome. When this occurs, surging stress hormones, especially adrenaline, trigger cardiac pain that feels a lot like a heart attack, often with heart palpitations, shortness of breath, and flushing. But unlike during a real heart attack, the arteries are not blocked. This potentially serious and often overlooked condition is more common in women than in men; in fact, men make up for only 10 percent of diagnosed cases.

Signs of Heart Failure
Heart failure means the heart is not functioning as well as it should. It doesn't mean the heart has failed. Another term for heart failure is congestive heart failure, or CHF. Heart failure gradually gets worse over time. Some early warning signs may include:

Weight Gain If your heart starts to fail and fluid starts to build up in your tissue, causing edema, you might see a sudden weight gain.

Frequent Urination Heart failure may cause decreased blood flow to the kidneys, which causes you to retain more fluid. One of the signs of this fluid may be frequent urination.

Cataracts Although the exact cause of the relationship between cataracts and heart disease is not known, studies show that people who have cataracts are at higher risk for heart disease, high blood pressure, and high cholesterol. "This link is probably more of an association than a sign of heart disease," says Orringer.

Nighttime Cough "One of the signs of heart failure may be the buildup of fluid in the chest and heart when lying flat at night. This increased fluid can cause a nighttime cough," explains Orringer.

Remember that all these heart disease signs may have many different causes. They do not mean you have or will get heart disease. But combined with other heart disease signs and symptoms, your blood tests, and your family history, they give your doctor the best chance to find heart disease early and keep you in good health.

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.

 

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.