VOL. 24, NO. 7 JULY 2004 How to talk with your doctor S ometimes the doctor-patient communication process needs a little help. Here are some suggestions for handling common doctor-visit scenarios: In this scenario... You could... Doctor is about to run out of the room before your questions are all answered. Ask when you can phone or e-mail to discuss your questions. If you have a list, hand it to him and arrange a time to talk. Doctor pressures you to take a medication you’ve researched and aren’t sure you want. State your specific concerns. One effective response: “I appreciate your recommendation. Let me think it over.” Doctor says about a medication, “Don’t worry about the side effects. They’re minor.” Reply: “That’s great, but can you tell me what the most common ones are?” Doctor is talking about your child in front of her in a way that could be scary. Reply: “May we step outside so we can discuss this?” Doctor seems intimidating or illness may be serious. Bring a clear-headed friend or family member with you to appointments for support and for asking questions. Or ask the doctor, “Would you mind if I audiotape our appointment so I can share it with my family?” Source: Walter F. Baile, chief of psychiatry, University of Texas M.D. Anderson Cancer Center DID YOU KNOW… WMI TPA’s parent company, Western Mutual Insurance Company, offers fully insured health, dental and vision plans to members of the Montana Retail Association (“MRA”) and to members of the Western Petroleum Marketers Association (“WPMA”) in Idaho, Montana, Nevada, New Mexico and Utah. To learn more about Western Mutual Insurance Company, visit www.westernmutualinsurance.com. WHAT’S INSIDE… • Fabulous fiber • Recipe Page 2 • Are you getting enough protein? Page 3 • Research news you can use! Page 4 • Myths and facts about eyes • Go ahead — cry Page 6 • Over-the-counter drugs • Lifting weights Page 7 • This ’n’ that • Secondhand smoke • Quotes Page 8 When you see this mouse, visit www.HopeHealth.com/hhl for more information! © HHI eating well Fabulous fiber A high-fiber diet can reduce the risk of health problems like heart disease, diabetes, and some types of cancer. HOW MUCH FIBER DO WE NEED? At least 25 to 35 grams per day. Most people, however, get only about 11 grams a day. WAYS TO BOOST FIBER 1. Use the food pyramid as your guide. If you follow the Pyramid’s recommendations to eat (daily) 2 to 4 servings of fruit, 3 to 5 servings of vegetables, and 6 to 11 servings of grains and cereals (most should be wholegrain), you should get all the fiber you need. 2. Read food labels. If a product states that it is “a good source” of fiber, it contains no less than 2.5 grams of fiber per serving. “High in,” “rich in,” or “excellent source of” fiber means the product contains at least 5 grams of fiber per serving. 3. Eat fewer processed foods. The more unprocessed a food is, the more fiber it is likely to contain. This means choosing fruits, vegetables, or nuts over a white flour- and sugar-laden snack. It means eating more beans. Add them to salads, soups, or stew. Make bean burritos the entrée at lunch or dinner. And it means eating fruits, vegetables, and nuts with their skins on when possible. Source: U.S. Department of Agriculture EATING-WELL RECIPE Berry crisp oats 3 • ⁄4 cup rolled at flour 1 -whe • ⁄3 cup whole gar su 1 • ⁄2 cup brown d • 2 Tbsp. melte butter la • 3 Tbsp. cano oil berries n of (any combinatio berries, ue bl s, rie er kb blac s) ie rr and/or raspbe 1 ed • 3 ⁄2 cups mix arch st 1 • 1 ⁄2 Tbsp. corn 2 , and oil. sugar, butter r, ou fl , ts oa e Combin aside. Mix well. Set d combine to berries an ch ar st rn co Add x 9" glass gently. 8" x 8" or 9" enly over an to in s ie rr Pour be mixture ev Spread crisp baking dish. the top. minutes. F for about 30 Bake at 350° 3 calories, er serving: 16 SERVES 8. P te, 4 g fat, 2 g protein, ra 32 g carbohyd35 mg sodium. 3 g fiber, and ttle e, Sea Heart Institut Source: Hope A few high-fiber foods All these foods contain about 5 grams of fiber per serving. • Apples, pears, and plums • Beans, peas, and other legumes, including chickpeas and lentils • Blackberries, blueberries, and raspberries • Broccoli • Cherries • Corn • Dried apricots, dates, and figs • Greens, including collards, kale, spinach, and Swiss chard • Nuts, especially almonds, Brazil nuts, and walnuts • Whole grains and foods made with them (e.g., bran cereals, whole-wheat bread, and pasta) When you see this mouse, visit www.HopeHealth.com/hhl for more information! © HHI eating well PROTEIN How much is enough? P rotein is a workhorse. Among other things, it aids in immune cell formation, boosts bone building, maintains body tissues (including muscle, hair, nails, and skin), helps keep blood sugar levels stable, helps keep us alert, and helps us feel full longer. But do most of us get enough protein for optimal health? Maybe not. The government’s RDA says that a 180-lb. adult should get at least 65 grams of protein daily. But other experts say that could be too low and that 90 to 100 grams may be better. HOW MU PROTEINCH YOUR WE FOR IGHT? E xperts esti adult nee mate that an ds anywh from 0.36 ere to protein per 0.7 grams of p o und of bod weight. y If you weig example, y h 135 pounds, for o 95 grams o u’d need from 49 to f depending protein every day, on the exp ert you talk to. Body-build ers may ne more. ed even OUTDATED RESEARCH Researchers used to think that excess protein contributed to osteoporosis. On the contrary, they’ve since learned that you need protein to keep bones strong. Likewise, you also need protein to minimize muscle loss as you get older. DON’T GO OVERBOARD That said, extreme protein intake — exceeding 150 grams a day — could cause problems for your liver and kidneys. And high-protein diets can be a problem for people with declining kidney function. People prone to kidney stones should also avoid excessive protein. BALANCE Scientists still don’t know the precise amount of protein needed each day for optimal health. Striking the right balance between too much and not enough is key. To ensure that you are getting enough, eat two to three servings a day of low-fat dairy foods, soy foods, nuts, or dried beans, plus a daily serving (3 oz.) of fish, poultry, or lean meat. © HHI Where you’ll find protein FOOD PROTEIN (grams) Fish, poultry, lean meat (3 oz., cooked) . . . . . . . . 20 – 30 Tofu, firm (1⁄2 cup) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Cottage cheese, low-fat (1⁄2 cup) . . . . . . . . . . . . . . . . . 15 Soybeans, cooked (1⁄2 cup) . . . . . . . . . . . . . . . . . . . . . . 14 Clif protein bar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12* Yogurt, low-fat (6 – 8 oz.) . . . . . . . . . . . . . . . . . . . . . . 11 Lentils, cooked (1⁄2 cup) . . . . . . . . . . . . . . . . . . . . . . . . . 9 Kashi GoLean cereal (3⁄4 cup) . . . . . . . . . . . . . . . . . . . . 8 Milk, 1% or skim (8 oz.) . . . . . . . . . . . . . . . . . . . . . . . . . 8 Peanut butter (2 Tbsp.) . . . . . . . . . . . . . . . . . . . . . . . . 8 Pudding, instant (1 cup) . . . . . . . . . . . . . . . . . . . . . . . . 8 Cheese (1 oz.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Peanuts (1 oz. or 28) . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Egg (1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Baked potato (1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Pasta, cooked (1 cup) . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Sunflower seeds (2 Tbsp.) . . . . . . . . . . . . . . . . . . . . . . 5 Hummus (1⁄4 cup) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Vegetables, cooked (1⁄2 cup) . . . . . . . . . . . . . . . . . . . . . . 2 *Protein bars vary widely in protein content — from 4 to 23 grams per bar. Sources: Environmental Nutrition, Vol. 26, No. 10; The Vegetarian Resource Group; U.S. Department of Agriculture When you see this mouse, visit www.HopeHealth.com/hhl for more information! 3 colon cancer These lifestyle changes can drastically reduce most people’s risk of ever getting colon cancer. Though the latest research looked only at men, it’s likely that the findings apply to women as well. IN ORDER OF IMPORTANCE: • Eat more high-fiber cereal and other whole grains (at least 8 grams of this type of fiber a day). • Get enough calcium and vitamin D by eating nonfat dairy foods and/or taking supplements. • If you smoke, stop. • Drink alcohol only in moderation (no more than two drinks a day for men and no more than one a day for women — even less if you’re a senior). • Take a daily multivitamin. • Exercise regularly. Source: Journal of the American Medical Association, Vol. 290, Pg. 2959 out of shape Anyone who is out of shape in their 20s runs a high risk of developing high blood pressure, diabetes, and other heart disease risk factors by the time they’re in their 30s and 40s. “People can’t wait until middle age to try and protect themselves,” said researcher Mercedes Carnethon of Northwestern University in Chicago. Source: Journal of the American Medical Association, Vol. 290, Pg. 3092 4 diet & birth defects Pregnant women who eat foods with a high glycemic index (e.g., cornflakes, potatoes, white rice, white bread, sweet beverages) are twice as likely to have a baby with birth defects. And among obese women, that risk quadruples. High-glycemic foods are foods that raise blood sugar levels relatively high and fast, either because they are high in natural or added sugars and/or are low in fiber. Researchers caution that this is only one study, however, and that more research is needed to confirm these findings. Source: American Journal of Clinical Nutrition, Vol. 78, Pg. 972 air pollution & the heart The tiny particles found in air pollution may be an even greater risk to the heart (i.e., arrhythmias, heart attacks, cardiac arrest) than they are to the lungs, say researchers. That said, air pollution still is not nearly as harmful to the cardiovascular system as smoking. These tiny particles, called particulate matter, are emitted by vehicles, coal-burning plants, and other industrial sources. Source: Circulation, December 15, 2003, on-line version The information in this publication is meant to complement the advice of your health-care providers, not to replace it. Before making any major changes in your medications, diet, or exercise, talk to your doctor. Articles written by outside contributors have not been reviewed by the Hope Health Medical Advisory Board. Research news ipecac syrup In 1997, the American Academy of Clinical Toxicology concluded that syrup of ipecac should not be given routinely to induce vomiting in people who’ve swallowed a poison. Since that time, use of ipecac syrup has declined. Now, the FDA is considering changing ipecac’s over-thecounter status to that of prescription-only. Experts say that ipecac syrup probably doesn’t help because the stomach contents move into the small intestine much more quickly than once thought. If you suspect someone has been poisoned, call poison control’s national toll-free number for first-aid advice: 1-800-222-1222. Source: U.S. Food and Drug Administration report walk to longer life Walking — even as little as two hours a week — can help people with type 2 diabetes lower their risk of dying too soon. One particular study looked at 58- and 59-yearolds who, on average, had been living with diabetes for 11 years. Those who walked at least two hours per week had a 39% lower risk of dying prematurely than those who got little or no exercise. For walking to be beneficial, it must be brisk. In other words, you need to feel your heart and breathing rates increase. obesity & cataracts Obese men and women are more likely to be diagnosed with cataracts than people of normal weight. Insulin resistance, which is more common in very overweight people, may be the reason. Insulin resistance leads to higher blood sugar levels, which could, in turn, cause damage to the eye. Source: International Journal of Obesity, Vol. 26, Pg. 1588 smoking & strokes Not only are smokers at risk for suffering an ischemic stroke (a blocked blood vessel in the brain), but new research shows they are also at risk for having bleeding, or hemorrhagic, strokes. Smokers who go through more than a pack a day have twice the risk of a bleeding stroke. Source: Stroke, March 27, 2003 (e-pub) Source: U.S. Centers for Disease Control and Prevention When you see this mouse, visit www.HopeHealth.com/hhl for more information! © HHI …you can use! monitoring blood pressure overweight Home blood pressure monitors can be a good idea for those who need to keep a close eye on their blood pressures. But you need to do three things to make sure it’s giving you accurate readings: 1. Take the blood pressure monitor to your doctor’s office. 2. Ask them to calibrate your monitor to theirs. 3. Ask them to measure your arm to make sure the cuff fits properly. Cuffs that are too small will overestimate blood pressure, while too large a cuff will underestimate it. Source: Research presented at the 2003 meeting of the American Society of Hypertension People run the risk of dying earlier simply because they are overweight — even if they don’t smoke and are otherwise healthy during middle age. Researchers found a gradually increasing risk of death beginning with a BMI of 25, which is 150 pounds for a 5'5" woman, and 174 pounds for a 5'10" man. To calculate your BMI: Multiply your weight in pounds by 703. Divide that result by your height in inches squared. Roughly 55% of American adults fit the official definition of overweight (a BMI of 25 to 29). A BMI of 30 or more is considered obese. Source: New England Journal of Medicine, Vol. 341, Pg. 1097 Before diabetes... U nder new, stricter guidelines, you could have a condition called pre-diabetes if your fasting blood glucose levels are between 100 and 126 mg/dl. Levels of 126 mg/dl or higher mean you have diabetes. If your blood sugar levels are between 100 and 126 mg/dl, your body is showing signs that it isn’t processing sugar normally. And this could mean the heart and blood vessels are beginning to suffer damage. Left untreated, pre-diabetes could progress to full-blown diabetes — and even more damage. For most people, diet improvements, exercise, and weight-loss will bring blood sugar down to healthy levels (i.e., below 100). tanning beds People who use tanning beds one or more times a month increase their risk of getting melanoma by 55%. Melanoma is the deadliest of skin cancers. The risk is even higher for women who start tanning in their 20s. For them, the risk of melanoma increases 150%. Source: Journal of the National Cancer Institute, Vol. 95, Pg. 1530 more arthritis The number of older Americans with arthritis or chronic joint problems is expected to nearly double to about 41 million by 2030. The reasons: More people are living longer, there are more people entering the “senior” category than ever before, and chronic diseases like arthritis are more likely to be diagnosed and treated. Today, about 60% of U.S. adults 65 years of age or older have arthritis. HELP FOR PAINFUL JOINTS • Get daily low-impact exercise to keep joints limber (swimming, water aerobics, walking). • Lose weight if you need to (less stress on your joints). • Consider trying the supplements glucosamine and chondroitin sulfate to lessen pain and slow down joint deterioration. Source: Morbidity and Mortality Weekly Report, Vol. 52, Pg. 489 Heat stress vs. heat stroke T o help prevent heat-related illness, know the warning signs of both heat exhaustion and heat stroke. • Heat exhaustion — You might feel dizzy and lightheaded, as if you’re going to faint. You may also have a headache. Lie down in a shady area, drink water, and rest. • Heat stroke — This is a more serious condition. People can die from heat stroke. The body’s temperature soars as well as the person’s pulse. Cool down by removing clothes and immersing in cold water, if possible. Get medical help immediately. Source: Family Safety & Health, Vol. 62, No. 2 Source: American Diabetes Association © HHI When you see this mouse, visit www.HopeHealth.com/hhl for more information! 5 health yourself EYE LORE... Myths & facts FACTS MYTHS #1: Eating carrots gives you 20/20 vision. Carrots — and all foods rich in carotenoids — help keep your retinas healthy, but they won’t give you 20/20 vision if you don’t already have it. #2: Reading in the dark is bad for your eyes. Not necessarily. It doesn’t cause permanent damage, although some people develop headaches from straining to see in dim light. #3: Watching TV too close to the set is dangerous. The first TVs emitted a lot of radiation, which may have caused problems. While this isn’t the case today, there’s really no need to sit right in front of the screen. #4: If you cross your eyes, they might get stuck that way. Although it makes you look goofy, it doesn’t cause any harm. #1: Reading a lot may contribute to nearsightedness (where it’s hard to see far-away objects). More research is needed, but some studies show that focusing on close-up objects for extended periods of time can decrease your far-away vision. But, says ophthalmologist James McDonnell, “I would be more concerned that a lack of reading causes ignorance.” #2: Staring directly at the sun can damage your eyes. This can burn your retinas and decrease your vision. Even indirect sunlight can damage your eyes over time, so always wear UV-blocking sunglasses outside on sunny days. Source: James McDonnell, MD, Director of Pediatric Ophthalmology, Loyola University Stritch School of Medicine stress less Go ahead — CRY T ears could improve your health. Tears not only cleanse your eyes, but they also cleanse your mind and soul of stresses, strains, and frustrations, according to researchers. Tears are as potent as laughter when it comes to physical and psychological relief. Crying provides an emotional release that can lower blood pressure and reduce emotional and muscle tension. Note: Frequent crying with no obvious trigger could signal depression. Source: Family Safety and Health, Vol. 54, No. 1 UPSET? How we calm down KEY: Men Women Talk it through with someone 26% 38% Try to think it through 33% 29% Get some exercise 14% 13% Have sex 6% 2% Have a drink 6% 2% Have something to eat 2% 5% Source: Men’s Health poll 6 When you see this mouse, visit www.HopeHealth.com/hhl for more information! © HHI self-care exercise WHAT TO DO ABOUT OVER-THE-COUNTER DRUGS... Maybe not as safe as you think Chafing O ver-the-counter (OTC) drugs have a good safety record. But there are circumstances in which they cause more health problems than they help. A few OTC pitfalls to watch out for: • Misdiagnosis. Because there are OTC medicines for so many ailments, we are often quick to self-treat with one. But if your self-diagnosis is wrong, you might be covering up symptoms of a more serious ailment. The best advice is not to treat yourself unless you have a familiar symptom or your doctor has already diagnosed the same problem. • Inadequate treatment. Because it’s so easy to buy a drug over-the-counter, some people delay getting needed medical treatment. • Reading labels. The problem comes when people don’t read the labels — or when they don’t take label warnings seriously. Drug companies don’t like to say anything negative about their products, so if there’s a warning, take it seriously. • Side effects. Though not as common, OTC drugs can have side effects. For example, aspirin and ibuprofen can cause gastrointestinal problems if you take them often for conditions like arthritis. • Overdosing. Some people think that if a little is good, a lot is better. But you can overdose on OTC medicines. Some people inadvertently overdose on a particular drug by taking several © HHI multi-ingredient medicines that all contain, for example, acetaminophen (e.g., Tylenol). Taking more than three times the maximum recommended dose of Tylenol can damage the liver. For this reason it’s usually better to stick to singleingredient OTC medicines. • Overuse. Taking some OTC medicines — including drugs for headache, insomnia, and stuffy nose — can lead to dependency. After the drug wears off, you get “rebound” symptoms even worse than the original ones. • Drug interactions. Mixing drugs, certain foods, herbs, and supplements can sometimes create problems. Make sure your pharmacist and doctor know everything you are taking. • Sensitivity. Some people can experience side effects — sometimes severe — from OTC drugs because of allergies, kidney and liver problems, and even advanced age. All can exaggerate the adverse effects of many OTC drugs. Source: Consumer Reports on Health, Vol. 13, No. 8 W hen you combine exercise, sweat, and skin that’s rubbing against skin (thighs and armpits), or clothing that’s rubbing, you have a formula for sore, chafed skin. PREVENTION • Rub on a thin layer of petroleum jelly or non-talc powder to keep friction at a minimum. • Wear tight-fitting bike-style shorts to protect thighs, and tight-fitting tops that won’t rub against the skin when you move. For chafed nipples, one runner suggests “corn cushions.” Source: American Academy of Dermatology LIFTING WEIGHTS... Is slower better? W hen you lift weights, slower can be better than faster, say experts. Raising and lowering weights slowly is more effective because it requires more muscle work and less reliance on momentum, says Wayne Westcott, PhD. Slower can also be safer, since movements are more controlled. Dr. Westcott recommends lifting for five seconds, lowering for five seconds, and doing only about five repetitions (rather than the usual 10 to 15). SLOW DOWN The trail is the thing, ❝ not the end of the trail. Travel too fast and you miss all you are traveling for. ❞ — Louis L’Amour When you see this mouse, visit www.HopeHealth.com/hhl for more information! 7 your health matters body, mind, & soul this ’n’ that DON’T WAIT ❝ A ship in harbor is safe, ❝ but that is not what ships are A man would do nothing if he waited until he could do it so well that no one could find fault. built for.” ❞ — John A. Shedd — John Henry Cardinal Newman DON’T OVERLOOK THESE Aside from a healthy diet, the three best things you can do to boost your immunity: 1. Meditate — or find some other way to de-stress and relax each day. 2. Exercise — at least 30 minutes most days of the week. 3. Get enough quality sleep — at least seven to eight hours a night. Source: Natural Health, Vol. 33, No. 6 Medical Editor: Vicki Rackner, MD Medical Advisory Board: Victor J. Barry, DDS Renee Belfor, RD Kenneth Holtyn, MS Robert H. Knopp, MD Lester R. Sauvage, MD Nicholas J. Stamato, MD, FACC Andy Stergachis, RPh, PhD Wallace Wilkins, PhD Secondhand smoke B reathing secondhand smoke can increase the risk of lung and heart disease. It’s perhaps no wonder when you consider there are over 40 known cancer-causing chemicals packaged in secondhand smoke. Among them: • Acetone — the solvent found in nail polish remover. • Ammonia — a floor and toilet cleaner. • Arsenic — a potent poison. • Benzene — an industrial solvent associated with leukemia. • Cadmium — found in battery acid. • Carbon monoxide — an odorless, invisible poison gas. • DDT — an insecticide. • Formaldehyde — a preservative for dead bodies, wood, and fabrics. Source: New York City Department of Health and Mental Hygiene (www.nyc.gov/html/doh/html/smoke/ smoke.html) 158363 Procrastination is ❝ the art of keeping up with yesterday.” — Don Marquis We grow neither better ❝ nor worse as we get old, but more like ourselves.” — May Lamberton Becker Each day comes bearing ❝ its own gifts. Untie the ribbons.” — Ruth Ann Schabacker You may have the loftiest ❝ goals, the highest ideals, the noblest dreams, but remember this, nothing works unless you do.” — Nido Qubein Recall it as often as you ❝ wish. A happy memory never wears out.” — Libbie Fudim © HHI © by the Hope Heart Institute, Seattle, WA • Editor: Linda Plumb; Medical Editor: Vicki Rackner, MD; Illustrator: James McFarlane; Institute Founder: Lester R. Sauvage, MD; President & CEO: Phil Nudelman • Material may not be used without permission. • For individual and group subscription information, or reprint permission, contact: Hope Health, 350 East Michigan Avenue, Suite 301, Kalamazoo, MI 49007-3851 U.S.A. Phone: (269) 343-0770 • Fax: (269) 343-6260 • www.hopehealth.com • Printed with soybean ink. Please recycle. THE HOPE HEART INSTITUTE Marketing and Distribution: Hope Health 350 East Michigan Avenue, Suite 301 Kalamazoo, MI 49007-3851 (269) 343-0770 PRSRT STD US POSTAGE PAID GRAND RAPIDS MI PERMIT NO. 1
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