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
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© 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)
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© 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
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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
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…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
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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
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© 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
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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
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