1. food and drink
2. food
3. grains and pasta

MAYO CLINIC HEALTH LETTER
Tools for Healthier Lives
VOLUME 30 NUMBER 4 APRIL 2012
Inside this issue
HEALTH TIPS . . . . . . . . . . . . . 3
Gout and diet choices.
NEWS AND OUR VIEWS . . . . 4
Erectile dysfunction drug approved to treat BPH symptoms.
Rare brain infection avoided with
safe sinus irrigation.
CANCER VACCINES . . . . . . . . 4
The quest heats up.
CLOSTRIDIUM
DIFFICILE . . . . . . . . . . . . . . . . 6
A super serious bug.
Adult scoliosis
Dealing with
spinal imbalance
Scoliosis is the development of asymmetrical curvature and twisting of the
spine. It’s commonly thought of as a
disease that occurs in adolescents,
and is sometimes associated with
wearing a back brace to keep the
curve from worsening.
In fact, scoliosis is more common
in older adults than in adolescents.
Some adults who had scoliosis as adolescents may see gradual worsening of
their scoliosis with age, but the majority of older adults with scoliosis didn’t
have it earlier in life.
Scoliosis in older adults is a distinctly different problem from that in
adolescents. In adults, back braces are
used sparingly, if at all. Adults often
benefit most from regular exercise. If
surgery is needed, breakthroughs have
made certain scoliosis procedures far
easier on the body and far more effective than in the recent past.
What’s happening?
Scoliosis in older adults is usually
caused by the wear and tear (degeneration) of the spine that commonly
INSIDE WHOLE GRAINS . . . . . 7
The gritty details.
SECOND OPINION . . . . . . . . 8
Coming in May
ROTATOR CUFF REPAIR
Shoulder pain solutions.
CROWNS AND IMPLANTS
Faster and more accurate.
NORDIC WALKING
Exercise with stability.
NAILS AND HEALTH
What your nails reveal.
Scoliosis in older adults is usually caused by the wear and tear (degeneration) of the spine
that commonly occurs with age.
www.HealthLetter.MayoClinic.com
Visit us on the Internet at the address listed to the left, where you’ll find more
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occurs with age. This may include
back problems such as:
■ Degenerating disks — Disks
are the pads between your vertebrae that act as cushions and allow
for spine flexibility. Disk degeneration is a natural part of aging, and
diminished disks can place more
pressure on joints of the spine.
When a disk degenerates unevenly,
eventually scoliosis can result.
■ Osteoporosis — This weakening and thinning of bone can
cause the vertebrae to fracture and
compress. Asymmetric compression can contribute to scoliosis.
■ Prior back surgery that removed spine tissues — Procedures
such as laminectomy or facetectomy that remove parts of the spine
that are pressing on nerves can
lead to spine imbalance.
■ Arthritis — Specifically, this
is the development of wear-andtear arthritis (osteoarthritis) in the
joints of your spine (facet joints).
Spine imbalance — whether
caused by pre-existing curvature
from youth, disk degeneration or
osteoporosis-related degeneration
— places uneven force on facet
joints. This can cause or worsen
arthritis in those joints, leading to
further imbalance of the spine.
en. The body responds by producing bony outgrowths that can pinch
or compress root nerves that branch
from the main spinal column. This
can lead to pain or numbness that
radiates down one leg and may
cause leg weakness. The pain may
come and go.
The body also responds by thickening spine ligaments. These can
gradually squeeze or compress your
spinal column (spinal stenosis). It
may take years, but this may cause
pain that’s centered in the buttocks,
rather than radiating down the leg.
Position changes such as sitting and
leaning forward can often provide
relief. But as ligament thickening
progresses, position changes provide less relief and leg weakness
may make it difficult to walk.
Stooped posture is another concern with scoliosis. To relieve pain,
you may tip your trunk forward
while standing or walking. This
can strain and fatigue back muscles, or even cause painful muscle
spasms. Additional concerns may
include having a rib that pinches
against the pelvis or compression
of abdominal organs, particularly
in those who are overweight. Advanced scoliosis may even make it
difficult to keep yourself upright.
■ Addressing bone health —
Work with your doctor to develop
a plan to stop or slow bone thinning that can lead to osteoporosis
and increase risk of spine fractures.
This includes getting adequate calcium and vitamin D and possibly
taking osteoporosis medications.
■ Maintaining a healthy weight
— The more weight you carry, the
more stress it puts on your back.
■ Stopping smoking — Smoking reduces blood flow to disks
and accelerates disk degeneration.
■ Using pain therapies — Acetaminophen (Tylenol, others), ibu­
profen (Advil, Motrin, others) or
naproxen (Aleve, others) can help
relieve pain. Certain antidepressants and anti-seizure drugs also
may be considered. Your doctor
may prescribe narcotic-containing
drugs for severe, persistent pain.
Pain progression
Get active
EDITORIAL BOARD
Scoliosis in older adults isn’t
necessarily considered a problem
until symptoms develop. Most older adults with considerable spinal
curves — especially those who are
fit and healthy — can be quite active with no symptoms at all.
Problems with scoliosis are often preceded by lack of fitness —
specifically the loss of strength in
the core muscles of the trunk — and
being overweight or obese. These
factors — in addition to spine degeneration and unbalanced spinal
mechanics — may at first cause low
back pain. Over time, osteoarthritis
of spine joints may develop or wors-
2
www.HealthLetter.MayoClinic.com
Usually, treatment of pain from
degenerative scoliosis is similar to
treatment for other types of chronic
back pain. Strategies include:
■ Exercising — Exercise, such
as yoga or Pilates, that strengthens
core muscles of the trunk is one of
the biggest determinants of longterm health. Avoid extremes of rotation and bending, and use good
posture. Balance training and overall fitness can help prevent falls.
Load-bearing exercise such as
walking can help combat bone degeneration. Aquatic exercise may
be a good alternative if walking is
too difficult or painful.
April 2012
MAYO CLINIC HEALTH LETTER
Managing Editor
Aleta Capelle
Medical Editor
Robert Sheeler, M.D.
Associate Editors
Carol Gunderson
Joey Keillor
Associate Medical Editor
Amindra Arora, M.D.
Medical Illustration
Michael King
Customer Service
Manager
Ann Allen
Editorial Research
Deirdre Herman
Proofreading
Miranda Attlesey
Donna Hanson
Julie Maas
Administrative Assistant
Beverly Steele
Shreyasee Amin, M.D., Rheumatology; Amindra Arora,
M.D., Gastroenterology and Hepatology; Brent Bauer,
M.D., Internal Medicine; Julie Bjoraker, M.D., Internal
Medicine; Lisa Buss Preszler, Pharm.D., Pharmacy;
Bart Clarke, M.D., Endocrinology and Metabolism;
William Cliby, M.D., Gynecologic Surgery; Clayton
Cowl, M.D., Pulmonary and Critical Care; Mark Davis,
M.D., Derma­tology; Timothy Moynihan, M.D., Oncology; Suzanne Norby, M.D., Nephrology; Daniel Roberts, M.D., Hospital Internal Medicine; Robert Sheeler,
M.D., Family Medicine; Phillip Sheridan, D.D.S.,
Perio­don­tics; Peter Southorn, M.D., Anes­thesiology;
Ronald Swee, M.D., Radiology; Farris Timimi, M.D.,
Cardiology; Matthew Tollefson, M.D., Urology; Debra
Zillmer, M.D., Orthopedics; Aleta Capelle, Health
Information. Ex officio: Carol Gunderson, Joey Keillor.
Mayo Clinic Health Letter (ISSN 0741-6245) is published
monthly by Mayo Foundation for Medical Education
and Research, a subsidiary of Mayo Foundation, 200
First St. SW, Rochester, MN 55905. Subscription price
is $29.55 a year, which includes a cumulative index
published in December. Periodicals postage paid at
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POSTMASTER: Send address changes to Mayo Clinic
Health Letter, Subscription Services, P.O. Box 9302,
Big Sandy, TX 75755-9302.
If inflammation and swelling
around nerves is a suspected component of your pain, an injection of
an inflammation-reducing corticosteroid drug may help provide pain
relief that can last for a few months.
Health tips
Gout and diet choices
Surgery that helps
Regardless of the severity of
scoliosis you have, surgery won’t
help you if you still have good balance, manageable pain and are
able to function. However, surgery
may be indicated when you have:
■ Radiating nerve root compression that’s also causing leg
weakness or significant disability
■Compression of the spinal
column that’s causing pain and
weakness, especially if the pain
doesn’t subside with an injection
of an inflammation-reducing corticosteroid or other pain therapies
Since nerve compression and
pinching are the main indications
for surgery, surgery often involves
removing tissues — such as bone
or disk material — that are pressing on a nerve and causing pain or
other symptoms. When this nerve
decompression involves removal
of facet joint tissue (facetectomy),
it may cause or worsen spine instability. Therefore, your surgeon may
couple this with additional work
to fuse spine segments together or
implant metal bracing devices to
add stability to the spine.
In the past, fusing vertebrae often involved harvesting bone from
the pelvis, requiring more incisions,
blood loss, pain and hospitalization. Even then, the fusion failed
about a third of the time and most
people ended up with ongoing pain
where bone was harvested.
Today, traditional bone fusion is
done less frequently in scoliosis surgery. Synthetic fusion options may
include the use of bone morphogenetic protein (BMP). This naturally
occurring growth factor stimulates
bone growth.
When nerve decompression involves removal of tissue, your surgeon may implant metal braces to add stability.
Surgeons soak a small collagen
sponge in a BMP-infused liquid.
The sponge is then placed within
spinal segments, where it stimulates
rapid bone growth that spreads
from natural bone and permeates
the sponge. Within months, the
sponge is replaced by bone.
Fusion with BMP may eliminate
the need to take bone from elsewhere. The rate of successful fusion is consistently greater than 90
percent, often enabling spinal fusion procedures to be done through
much smaller incisions.
At Mayo Clinic, BMP fusions
can reduce blood transfusion needs
in large scoliosis procedures by
about 80 percent. Hospital stays
can be reduced from five to seven
days to two to three.
However, it’s not an option for
people with existing tumors, as the
growth factor may accelerate tumor growth. There’s controversy as
to whether BMP increases cancer
risk in those without tumors, but
Mayo Clinic experts believe the
risk — if any — is very low. ❒
April 2012
Gout is a painful and potentially disabling form of arthritis
characterized by excess levels
of uric acid. Dietary and lifestyle factors may play a part in
reducing uric acid. For example, losing excess weight is associated with lower uric acid
levels. Other factors include:
■ Choosing the right type
and amount of proteins —
Increased gout risk has been
associated with eating large
portions of red meat, seafood
and fish. Eating poultry isn’t
associated with gout risk.
Make red meat meals infrequent and eat more meatless meals. If you do eat meat,
eat no more than 4 to 6 ounces daily. Instead focus on lowfat dairy products, which may
substantially reduce gout risk.
Plant proteins, especially nuts
and legumes, also are good
protein choices that don’t increase risk of gout.
■ Avoiding alcohol —
Evidence suggests beer and
hard liquors can raise uric
acid levels. But there doesn’t
appear to be an association
between gout and drinking
wine in moderation.
■ Limiting sugar — Put
the brakes on beverages that
contain lots of fructose. Fructose is a carbohydrate, and
it’s the only one known to increase uric acid levels.
■ Keeping hydrated —
Aim for eight to 16 cups of
fluid — mainly water — each
day. Fluids help remove uric
acid from the body. Coffee
may decrease risk of gout. ❒
www.HealthLetter.MayoClinic.com
3
News and our views
Erectile dysfunction drug approved to treat BPH symptoms
For men, two common problems of aging include difficulty achieving or sustaining an erection and urinary problems due to noncancerous enlargement of the prostate gland (benign prostatic hyperplasia,
or BPH). Now, a drug that has been used for erectile dysfunction
may have beneficial effects on BPH symptoms, as well.
The Food and Drug Administration recently approved tadalafil
(Cialis) for treating urinary symptoms of BPH. Mayo Clinic doctors
say that while tadalafil has some beneficial effects, alone it probably
isn’t enough for more-severe symptoms.
Still, for men who have erectile dysfunction and urinary symptoms of BPH, tadalafil may be worth trying. The risk of side effects
with tadalafil is relatively low, with backache and headache being the most common. Downsides to tadalafil use include cost, as
there’s no generic equivalent. In addition, tadalafil can’t be taken by
men who take nitrate medications for heart problems.
For those not choosing surgical options, traditional drug choices
for BPH symptoms — including alpha blocker drugs and 5 alpha
reductase inhibitors, or a combination of the two — remain the most
effective choice for relieving urinary symptoms. It’s not well studied
whether using tadalafil in combination with drugs from one or both
of these drug classes would prove beneficial. For now, tadalafil isn’t
recommended for use with alpha blockers, as the combination may
increase the risk of developing abnormally low blood pressure. ❒
Rare brain infection avoided with safe sinus irrigation
Recent news of two deaths caused by rinsing sinuses with contaminated tap water has drawn attention to the steps necessary to avoid potentially introducing a deadly organism to the brain through the nose.
Both deaths were caused by the organism Naegleria fowleri, a
single-celled ameba commonly found in warm fresh water, such
as lakes and rivers. Rarely, it may be present in water heaters with
temperatures lower than 117 F or in geothermal drinking water. The
ameba causes no problem if swallowed. But if it gains entry through
the nose and travels to the brain, it can cause a brain infection called
primary amebic meningoencephalitis (PAM). PAM usually results in
death within one to 12 days.
Although the risk of the infection is very low, there are steps you
should take if you rinse your sinuses with water. The Centers for
Disease Control and Prevention (CDC) recommends that the water
be distilled, sterilized or previously boiled for one minute — three
minutes at elevations above 6,500 feet — and then cooled. Filtered
water is another option, as long as your water system filter has an
absolute pore size of 1 micron or smaller. The CDC recommends
that the device used to help irrigate the sinuses — for example, a
neti pot — be rinsed with distilled, sterilized, boiled or filtered water
and then left open to air-dry before its next use. Plastic neti pots or
sinus rinse bottles should be replaced every three months. ❒
4
www.HealthLetter.MayoClinic.com April 2012
Cancer
vaccines
The quest heats up
Scientists worldwide are working
to develop vaccines to help the
immune system isolate and destroy cancer cells while sparing
healthy cells.
The key is understanding how
cancer cells disguise themselves
from the body’s disease-fighting
immune system and tricking them
into making their presence known.
Immune system primer
Your immune system protects
your body from foreign invaders
— primarily infectious germs (microbes) that cause disease. The
immune system also helps protect
against abnormal, damaged or diseased cells, including cancer cells.
Normally, your white blood
cells lead the charge. Specialized
white blood cells — called lymphocytes — act like arrows directed at certain microbe invaders or
abnormal cells.
Most standard vaccines help the
body recognize foreign substances
(antigens). Antigens stimulate a
specific immune response. For instance, the vaccine created to prevent measles contains a weakened
live measles virus. That virus acts
like an antigen, prompting your immune system to fight the virus and
create a long-lasting immunity.
Your immune system knows
not to attack your normal cells because normal cells have their own
set of self-antigens that set them
apart as nonthreatening. Cancer
cells are different — they can carry
both self-antigens and cancer-associated self-antigens, which flag the
cancer cells as being foreign.
Cancer vaccines are either preventive or treatment oriented. Pre-
ventive cancer vaccines are designed to protect against infections
that are linked to the risk of developing certain cancers. Cancer preventive vaccines include:
■ Cervical cancer vaccines —
Most cases of cervical cancer are
caused by various strains of sexually transmitted human papillomavirus (HPV). The two vaccines
approved by the Food and Drug
Administration (FDA) are Gardasil
and Cervarix. Both vaccines are
given before age 26 and can prevent precancerous lesions if given
prior to exposure to the virus. Both
can prevent most vaginal and vulvar cancer in women, and Gardasil can prevent genital warts.
■ Hepatitis B virus (HBV) vaccine — Chronic HBV infection
can lead to a type of liver cancer
called hepatocellular carcinoma.
The FDA approved the vaccine in
1981, making the HBV vaccine
(Recombivax HB, Engerix-B) the
first cancer preventive vaccine. It’s
given to most U.S. children shortly
after birth and again after age 1.
Both preventive vaccines use
antigens from part of the virus
known to prompt or contribute to
cancer development.
A different approach
Cancer-treatment vaccines work
a different way. In simplest terms,
they’re structured to harness the
power of the immune system.
The first cancer-treatment vaccine was in 2010. The vaccine —
sipuleucel-T lactated Ringers solution (Provenge) — is individually
customized for men with a certain
type of advanced prostate cancer.
The vaccine uses specific immune system cells from a man’s
blood to help increase his body’s
immune response to an antigen
found on most prostate cancer
cells. In trials, the vaccine increased
survival by about four months. Another prostate cancer vaccine still
MUC1 is a protein being studied for vaccine development. At left, MUC1 (in red)
lines a normal duct in the breast. At right,
MUC1 is produced at high levels in a lymph
node where cancer is present. Adapted by
permission from Macmillan Publishers Ltd.
Oncogene 22, 1324-32, 2003.
under study uses a particular virus
to stimulate the body’s immune response to prostate cancer cells. It’s
also being studied for use by men
with advanced prostate cancer.
Cutting edge
Decades of research have gone
into understanding what fuels cancer cells and keeps them alive. The
National Cancer Institute (NCI) has
recognized the importance of several tumor proteins for vaccine development. Among them is MUC1,
a protein found in abundance on
the surface of tumor cells, such as
those in breast, ovarian, pancreatic and colorectal cancers.
MUC1 is produced at high levels when cancer occurs and changes normal cell structure. Viewed under a microscope, tumor-associated
MUC1 proteins appear to be decorated with distinctive, shorter sets
of sugars, distinguishing them from
healthy cells.
In 2011, researchers at Mayo
Clinic and at the University of
Georgia published early findings
from laboratory studies of a cancer
vaccine that’s built around helping the immune system recognize
and kill cancer cells that exhibit
changes in their surface MUC1
proteins. It’s too soon to know if
the vaccine will make it into clinical trials. But early efforts indicate
the vaccine produces a strong immune response.
Along with others, Mayo Clinic
researchers are pursuing a possible
April 2012
vaccine treatment for melanoma,
an often deadly skin cancer. Several prior melanoma vaccine trials
have helped advance and refine
the quest. In 2012, Mayo Clinic
researchers expect to be involved
in the start of two new melanoma
vaccine clinical trials.
Mayo Clinic also has FDA approval for clinical trials of ovarian
and breast cancer vaccines designed to prevent cancer relapse.
The vaccines target proteins.
One is folate receptor alpha protein, found in abundance in breast
and ovarian cancer cells. The other protein is HER-2-neu, found on
some of the most aggressive breast
cancers. It’s hoped the vaccines
will boost the immune system in
women who’ve completed conventional treatment for ovarian or
breast cancer and have no sign of
disease. Early studies found both
vaccines worked best when there
was less disease.
Reason for hope
The efforts of cancer vaccine
researchers worldwide is fueling
optimism that eventually the immune system may be prompted to
identify and destroy cancer.
According to the NCI, active
clinical trials of cancer treatment
and cancer preventive vaccines
are underway for more than a dozen types of cancer. Clinical trials
for vaccines under study are conducted in many settings. Some of
these include cancer centers, large
medical centers, small hospitals
and doctors’ offices.
If you’re interested in learning more about possible cancer
vaccine clinical trial options, talk
with your doctor. In addition, the
National Cancer Institute keeps a
list of all cancer clinical trials. To
reach the NCI, call 800-422-6237.
National Cancer Institute information is also available on the Internet at www.cancer.gov. ❒
www.HealthLetter.MayoClinic.com
5
Clostridium
difficile
A super serious bug
Antibiotic drugs have cured illness
and saved countless lives by destroying infection-causing bacteria.
But bacteria can be adaptive organisms. Clostridium difficile (klosTRID-e-uhm dif-uh-SEEL) — also
called C. difficile or C. diff — is one
example. C. difficile is a bacterium
that may cause no symptoms, or it
can cause problems ranging from
diarrhea to life-threatening inflammation of the colon.
In recent years, C. difficile infections have become more frequent,
severe and difficult to treat. Older
adults are at particularly high risk
of developing a C. difficile infection, especially if they’re in a hospital or long term care facility. In
an ironic twist, taking antibiotics
can trigger a C. difficile infection.
High-risk situations
C. difficile bacteria can be found
throughout the environment, but
are most common in hospitals and
other health care facilities where
people are especially vulnerable to
infection. These bacteria are passed
in feces and produce hardy spores
that without effective cleaning can
persist on surfaces for months.
C. difficile spreads through contact from an environmental source
or a health care worker’s hands to
a patient and then into the mouth
and gastrointestinal tract. Touching contaminated objects such
as cart handles, bedrails, bedside
tables, toilets, telephones, remote
controls, sinks and thermometers
may allow spread of the organism.
Simply coming in contact with
the microorganism usually isn’t
enough to make you ill. Your body’s
defenses usually protect you.
6
www.HealthLetter.MayoClinic.com
However, antibiotics may disrupt the protective bacteria in your
gut, allowing C. difficile to cause
illness. That’s because your intestines contain millions of beneficial
bacteria, many of which help keep
harmful bacteria like C. difficile in
check. When you take an antibiotic
to treat an infection, the drug can
destroy some of the helpful bacteria and C. difficile can grow out of
control. The risk of infection goes
up if you take broad-spectrum antibiotics that target a range of bacteria, use multiple antibiotics or take
antibiotics for a prolonged period.
Additional risk factors include:
■ Having had abdominal surgery or a gastrointestinal procedure
■ Having had a previous C.
difficile infection
■ Taking stomach acid-suppres­
sing medications for problems such
as gastroesophageal reflux disease
Serious symptoms
C. difficile infection may be suspected in anyone with diarrhea
who is taking or has taken antibiotics within the past three months,
or in those who develop diarrhea
within a few days of hospitalization. The most common symptoms
of mild to moderate infection are:
■ Watery diarrhea three or more
times a day for two or more days
■Mild abdominal cramping
and tenderness
Many people have loose stools
during or shortly after antibiotic
therapy. Still, contact your doctor
if these milder symptoms last more
than three days.
Seek emergency care if you
have symptoms of severe C. difficile infection such as a new fever,
severe pain or cramping, blood in
your stool, or very frequent watery
bowel movements a day. Many
times, people describe their stool as
green in color and odorous.
C. difficile can cause significant inflammation and potentially
April 2012
deadly complications such as severe dehydration, shock or potential rupture of the colon.
Isolation and treatment For mild illness, the first step
may be to stop taking the antibiotic
that triggered the infection. This
may relieve symptoms. However,
many people require additional
treatment to eliminate the infection.
This includes antibiotics directed at
the bug. Treatments may include:
■ Specific antibiotics — Metronidazole (Flagyl), oral vancomycin
(Vancocin) or fidaxomicin (Dificid)
keep C. difficile from growing.
■ Intravenous fluids, nutrition
— These help avoid dehydration.
■ Surgery — Very rarely in lifethreatening cases, removal of the
colon may be lifesaving.
About a fourth of people with
C. difficile develop recurrent symptoms shortly after completing treatment. Treatment for recurrent disease usually includes:
■ A repeat course of a first line
antibiotic or a prolonged course of
vancomycin
■ Avoidance of the antibiotics
that caused the problem
A novel approach is to restore
healthy intestinal bacteria by placing healthy donor stool in the colon. The treatment works more
than 90 percent of the time when
everyting else has failed, but few
physicians provide the procedure.
Stopping the bug
If you or a loved one has an
episode of diarrhea or you’re visiting a health care facility, vigorously wash your hands with soap
and warm water for 30 seconds.
The friction of rubbing removes
the spores. Alcohol-based hand
sanitizers don’t effectively destroy
spores of C. difficile. At home, clean
the bathroom and other high-touch
surfaces daily with a 1-to-10 dilution of household bleach. ❒
Inside
whole grains
The gritty details
Have you ever wondered what
distinguishes wheat bread, wholewheat bread and 100 percent
whole-grain bread
from one another?
The answer is how
much processing —
refining — the original grain has undergone since harvest.
Americans are good at eating
grain-based foods. The problem is
that the majority of those foods are
highly processed refined grains, not
whole grains. Dietary Guidelines
for Americans recommends at least
half of your daily grain servings be
whole. Making the right choices ensures you get adequate whole-grain
nutrients and fiber.
True grit
Whole grains include the entire
grain, usually called the kernel. The
nutrient-dense kernel includes a fibrous outer coating (bran) that protects the kernel’s interior. Most of
the interior is endosperm, a starchy
substance that provides energy
for the kernel’s reproductive seed
(germ). The germ is a treasure trove
of vitamins, minerals, healthy unsaturated oils and phytochemicals.
Whole grains are products made
from kernels that are cracked,
crushed or flaked, as long as the
proportions of bran, endosperm
and germ are relatively the same
as when the grain was intact. That
relative sameness can be re­created
by adding back the same amounts
of bran, germ and endosperm removed during processing.
Although compounds are altered when whole-grain kernels are
cracked, crushed or flaked, those
Check the label
Ingredients are listed on labels according to weight.
For products such as
breads or cereals, if whole
grains are first or second after
water, and are the primary
ingredient, that product is
considered predominantly
whole grain. For foods with
multiple whole grains, look
for those to be listed at the
top of the ingredient list.
Among the whole grains
you may see listed are wholegrain corn or barely, buckwheat (kasha), millet, oats,
oatmeal, popcorn, quinoa,
brown or wild rice, and
whole rye. Whole wheat may
be listed several ways, including wheat berries, cracked
wheat and bulgur.
You can also check the
Percent Daily Value of dietary fiber listed on the Nutrition Facts label — the higher
the percentage, the better.
Look for foods that have
between 2.5 and 5 grams,
which constitutes 10 to 19
percent of the Daily Value.
Foods high in dietary fiber
contain 5 or more grams.
Commit to more grit
changes may not be as significant
as when grains are refined. Refined
grains have a finer texture. The bran
and germ are removed leaving the
endosperm, which is pulverized.
Refining strips away fiber and
vitamins. Most refined products are
enriched with added iron and B vitamins — thiamin, riboflavin, niacin and folic acid. Often, the term
“enriched” appears on the package.
Whole grains are associated
with protection from cardiovascular
disease. They may also help lower
weight and reduce incidence of diabetes, although evidence is limited.
Dietary guidelines generally
recommend that most older women get five to six 1-ounce grain
servings a day, and most older men
get seven to 10 1-ounce servings.
Examples of a 1-ounce serving
are a slice of bread, a cup of readyto-eat cereal, or one-half cup of
cooked cereal, rice or pasta.
Some simple ways to eat more
whole grains include:
■ Choosing whole-grain cereals
— Try steel-cut oats, a home-made
porridge of cracked wheat berries
or mixtures of whole grains such as
oats and brown rice. These are typically cooked with milk or water.
■ Choosing whole-grain breads
— Have a hearty toast with your
yogurt and fruit. Enrich your sandwich with whole-grain bread.
■ Trying new dishes — Cook
brown rice, wild rice, quinoa or
barley. Or try groats. These are
minimally processed whole-grain
kernels of oats or barley with the
outer husk or hull removed. Groats
are usually soaked and then slowly
simmered until soft.
■ Substituting whole grain —
Instead of regular pasta, use wholegrain pasta. Substitute brown rice
for white rice or potatoes in soups
and other dishes. ❒
April 2012
www.HealthLetter.MayoClinic.com
7
Second opinion
Q: I have more eye floaters than
in the past. Should I be worried?
A: Eye floaters are the gray or transparent specks, strings or webs that
you may see drift about when you
move your eyes. A noticeable increase in eye floaters over time
probably warrants a visit with an
eye doctor, as an increase in floaters can be a sign of an underlying
eye problem.
More importantly, if you experience a sudden increase in the
number of floaters — especially if
accompanied by flashes of light or
a loss of peripheral vision — seek
immediate eye evaluation. These
painless symptoms could be caused
by a retinal tear or retinal detachment. Without prompt treatment, a
retinal tear or detachment can lead
to permanent vision impairment or
even blindness in the affected eye.
A sudden increase in floaters
can also be caused by a hemorrhage or an inflammation in the
eye. Any sudden increase in floaters is deserving of an evaluation by
an eye specialist.
Still, eye floaters are usually
harmless and most people have a
few floaters drifting around inside
their eyes. Eye floaters are often
caused by age-related changes that
occur as the jelly-like substance
(vitreous humor) inside your eyeballs becomes more liquid. In rare
instances, eye floaters can become
so numerous that they significantly
interfere with your vision.
If that happens, your doctor may
suggest a surgical procedure (vitrectomy) that uses a hollow needle to
withdraw vitreous humor from your
eye. The vitreous humor is replaced
with a saltwater solution. However,
this procedure can cause retinal detachment and cataracts, and it may
not remove all floaters. Laser procedures carry the same serious risks
and are rarely recommended. ❒
Q:
When my husband drops a
piece of food on the floor, he
quickly picks it up and eats it,
claiming that if it’s not on the floor
for more than five seconds, it’s just
fine. I think he’s asking for trouble.
What do you think?
A: He may be asking for trouble.
One study tested how long it took
for salmonella bacteria to transfer from tile, wood or carpet to a
slice of bologna that was dropped
on the surface. The bologna in the
different tests was picked up after
five, 30 and 60 seconds.
It turns out that the transfer of
virtually all of the bacteria that
would end up on the bologna oc-
curred almost immediately. Leaving the bologna on the floor for
five seconds resulted in virtually
the same amount of salmonella
bacteria contamination as it did
when the bologna was left for a
minute.
The Centers for Disease Control
and Prevention estimates that each
year, one in six Americans gets sick
from foodborne illness — and about
3,000 Americans die of foodborne
diseases. Eating dropped food isn’t
a common means of acquiring food
poisoning, but the risk of contamination does exist. You have no way
of knowing what types of bacteria
are on your floor, and research has
found that bacteria can persist for
hours, days or weeks — although
the amount does decline over time.
Food that’s been dropped on the
floor is almost immediately contaminated with any organisms it comes
in contact with, so it potentially
could cause illness if eaten. ❒
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