Many times in life we get the idea that if a little bit of something is good then more is better. That however, is not usually the case. Let’s look at a couple of examples:

Vitamins

Vitamins make many of us feel better. They can be good for us. However, there are certain vitamins that are stored in the liver. These include vitamins A, D, E and K. Many people take vitamin A because it can be good for the skin. However, you should be taking no more than 5000 IU’s a day. The reason is that it can be toxic to the liver and cause serious health problems.

Vitamin D is essential. It helps with bone density but it also boosts the immune system, aids in balance and heart health to name just a few. It is generally safe in a dose of 1000 IU’s daily. High doses can be toxic to the liver and cause dizziness and all sorts of problems. It is important to have your doctor follow levels if you are on a high dose.

Vitamin E can cause excessive bleeding if taken in high doses. Vitamin K in large doses does not generally cause problems in adults. However, it will interfere with those on Coumadin, a common blood thinner.

Lab and X-ray studies

Now that we have sophisticated scanners many people have chosen to have their whole body scanned. It sounds like it might be a good thing to do. However, more often than not what we find are abnormalities that people have from birth that will not cause problems but cause more tests to be done and anxiety that is not warranted. Then we end up chasing technology with technology.

Before you ask for a scan or test it is important to think it through. As an example, if you have back pain and you do not want to have surgery then do not ask for the MRI. It will likely be abnormal. MRI studies were performed on 98 people without back pain. Only 36% had a normal MRI. Half had a bulging disk, 27% had a protrusion and 38% had abnormalities of more than one disk. The chance of finding something was greater in those who were older.

Radiation exposure is cumulative

Every headache does not require evaluation with a CT scan. If you decide you want to have a heart scan to check for calcium in your coronary arteries consider that the radiation exposure is relatively high. If you decide to have a virtual colonoscopy (which is a detailed CT scan) you will again be exposed to a high dose of radiation. The radiation exposure over a lifetime adds up. That is why you need to once again think the procedures through and find out how necessary they are for your health and healing.

When it comes to your children, the same advice applies before they have multiple radiologic procedures. A recent study has found that children who underwent multiple CT scans have an increased risk of developing leukemia and brain cancer when compared to children who had not been scanned.

Procedures

Colonoscopy is a procedure that most of us will be getting every ten years. There are many people who worry when they have a little diarrhea or transient lower abdominal pain. They will often insist on having a colonoscopy before it is due to be repeated. It may not be necessary. Every procedure comes with risks. During colonoscopy the colon can be perforated and there may be a problem with the anesthesia. If a procedure is not warranted think about the complications before you push for it.

When it comes to your health, it is important to think about the consequences of taking supplements, and having procedures and tests. Moderation in all things is probably the best rule to live by.

A recent study conducted in over 800 adults has found that the major culprits in weight change (up or down) are liquid calories. Liquid calories include sodas, sweetened fruit and high calorie drinks.

When adults in this study reduced their sugar sweetened drink intake by one a day,they lost an average of 1 pound at 6 months and 1.5 pounds at 18 months.The results of this study point out the importance of liquid calories contributing to weight gain in many people. Conversely, cutting out liquid calories can make it much easier to lose weight.

You may not realize that fancy coffee drinks can contain as may as 700 calories.Soda has no nutritional value, only calories. Sweetened fruit drinks don’t usually contain much fruit. It is better to eat the actual fruit rather than have sweetened juice.

If you are someone who is hooked on soda or high calorie drinks, you might want to think about switching to the old-fashioned drink……water. It has no calories and is endorsed by your doctor!

I would estimate that one out of every 4 women I see complains of having too much gas. Over the last 5 years I have had 2 men bring up gas issues, and they only did it because their wives told them it was a problem. I find this an amusing phenomenon. Most women are embarrassed by flatulence or farting, where men are proud of the gas they pass.

I have some family members (you know who you are!) who deny that they have ever farted. Of course, that is a physiologic impossibility. If we did not pass gas we would ultimately explode. Which brings me to the question, why do we pass gas?

Two thirds of the gas in our gut comes from swallowed air. Every time we swallow we also ingest 2-3 cc’s of air. When we eat an apple we gulp down 20 cc’s of air. Drinking 10 cc’s of water adds 17cc’s of air to the belly.

The rest of the gas comes from bacteria that swallow cells that are dying and being replaced in the large intestine. They also help digest starches and fiber that makes its way to the colon. These substances are broken down into chemicals that smell and can help protect us from cancer and provide energy to the colon cells for metabolism. These bacteria make up most of the solid part of our stool.

The particular odor and volume of gas depends on what we eat and how much air we swallow. The major smell makers are sulphur containing compounds and methane. The average numbers of farts range from 7-17 a day. If we eat a lot of fiber it could be as high as 30 a day. Gum chewing, sugar substitutes, fruit juices, carbonated beverages, and ill fitting dentures can all increase the amount of gas we pass.

There has been research (believe it or not) on a small number of subjects that looked at men and women to see who had the higher volume and worse smelling flatulence. It looks like women have stinkier gas but a smaller volume. Men had a higher volume so, that in the end (pardon the pun) it was a wash. If you want to decrease the amount of gas in your system this is what you can do:
• If you smoke, quit or cut down.
• If you wear dentures, see your dentist and make sure your dentures fit correctly.
• Don’t chew gum or suck on hard candies.
• Avoid carbonated drinks, such as soda and beer.
• Drink less fruit juice, especially apple juice and pear juice.
• Avoid or eat less of the foods that cause you to have gas.
• Eat more slowly
• Beano and GasX may also be helpful
If you are one of those women who are having problems with gas, you might want to see your doctor to make sure you do not have an underlying problem. If you have a healthy gut then you might want to man up and embrace your bodily functions. You do not need to light them on fire (like some men do), butt realize this, you are not alone because everybody farts!

n honor of this, let me tell you some things you may not know about two popular fruits. They taste great and may even help you to lose weight. Let’s start with my favorite, grapefruit. Then we will move on to raspberries.

Grapefruit has many of the vitamins of the other citrus fruits but is has a lower glycemic Index. That means that sugar is released slowly in the body rather than in one quick rush.

The results of a 12-week study linking grapefruit to weight loss done at the Scripps Clinic in 2004 put 100 men and women on a diet that included half a grapefruit or grapefruit juice three times a day with a meal. The average weight loss was 3.6 pounds for those who ate their grapefruit, 3.3 pounds for those who drank it. However, many reportedly lost more than 10 pounds. Grapefruit has chemicals that may lower insulin levels and expedite weight loss. The only problem with it is that it can interact with certain medications. It is important to check with your doctor or pharmacist to find out if you are on any of these medications. If so, you need to avoid it. (Sorry about that)

Raspberries are rich in antioxidants. Eating three or more servings per week have been found to lower the risk for age related macular degeneration. The anthocyanins (important antioxidants) in raspberries have been found to delay the effect of aging. Although raspberries contain sugar it does not seem to affect blood sugar in a significant way. Red raspberry ketones are currently being used in Japan as a weight loss supplement. Red raspberry seed oil has attracted the interest of the cosmetic and pharmaceutical industries because it is rich in Vitamin E, omega-3 fatty acid and has a sun protection factor (SPF) of 24-50.

Celebrate this month by eating your favorite fruit or vegetable and enjoy!

If you have children who are graduating from high school and going off to college, it is time to give them “the talk”. It is not the talk that we baby boomers heard when we went off to school. This one is a bit more complicated. I suggest you start off with the easy topic first, eating. Then you can move on to drinking, drugs and sex. You will definitely get their attention, read on.

EATING

You have all heard of the freshman fifteen. When I went to college, I gained the freshman 15×2. That’s right. I gained 30 pounds. You don’t want your kids to do that. I had carefully watched my diet when I was in high school. It was easy because my mother was a health nut and we only had healthy food at home.

When I went to college there suddenly were so many choices. There was a salad bar, dessert bar, potatoes, bread, pizza and beer. The drinking age was 18 when I went to school, so in addition to eating a lot, I drank a lot (more on that next). I did not know how fattening beer was at the time. It is amazing how fast I put the weight on and how hard it was to take it off.

To avoid weight gain advise your children to stick with whole foods such as fruits, vegetables, and lean proteins and stay away from processed foods like chips and cheetos. Even though they are going to get caught up in school, suggest that they find ways to exercise. It will help keep their weight down and will help them to focus.

DRINKING

Binge drinking on college campuses has become epidemic. It is defined for guys as having more than 5 drinks in one sitting and for girls having 4 drinks or more in one sitting. A recent Harvard study has found that 51% of boys at college and 40% of girls binge drink and 44% of college students had done it within two weeks of the study. One in four students reported binging at least three times a week.

It may seem like a “cool”, fun activity to teens, but it is very dangerous and can cause a world of hurt. Here are some startling statistics. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), in a given year looking at college students between the ages of 18 and 24, binge drinking resulted in 1825 deaths, 599,000 injuries, 690,000 assaults, 97,000 cases of sexual abuse, 400,000 cases of unprotected sex with 100,000 reporting they were too drunk to know if they consented, 150,000 alcohol related health problems and 2.8 million people driving drunk. One quarter of these students suffered academically and had health issues such as insomnia. One percent reported being raped by an out of control intoxicated peer.

The bottom line is that binge drinking increases the likelihood that your children will suffer a sexual assault and get in one heap of trouble.

DRUGS

There are a wide variety of drugs out there that will be accessible. These include marijuana, psychedelics, ecstasy, and prescription painkillers and adderall. I am sure your kids have been warned about all of these. These drugs change their brain chemistry and some of these changes can be permanent.

I (along with you as parents) advise against them. Also caution your children to be careful if they go to a club or party that they always go with a friend and never leave their drink. It is very easy to slip a date rape drug into one. With a buddy and smart thinking, they can avoid becoming a victim.

SEX

When I went to college, the major worry was how to avoid pregnancy. Now in addition to not getting pregnant, there are so many things to worry about. One out of every four college students is infected with a sexually transmitted infection (STI). The most common is human papilloma virus or HPV. It causes genital warts and is the most common cause of cervical cancer. It can also cause oral and anal cancer. It has no symptoms so it is easily spread. Infection can occur with sexual and skin-to-skin contact.

Chlamydia is the second most common STI, which can cause pelvic inflammatory disease and can result in infertility. If diagnosed it can be treated with antibiotics. Many women are symptomatic but often men have no symptoms.

The third most common infection is genital herpes. One in five college students are infected. There is no cure but there are medicines to reduce the length of outbreaks.

Condoms can protect against the latter two. The Gardasil vaccine can protect against HPV. If your teens are on drugs or drunk they are less likely to use protection. This opens them up to these infections as well as HIV, hepatitis B (for the unvaccinated), gonorrhea and syphilis. These infections are less frequent among college students but they are out there and they can cause serious illness and even death.

College can be the best time of their life. By avoiding the pitfalls of overeating, drinking, drugs and unsafe sex, they can have a healthy, exciting and wonderful experience. Please talk to them about how to be smart. Knowledge is power. Urge them to use it!

I would like to express appreciation for my older patients (those over 80). The longer I practice, the more I have come to enjoy them. They have a lot to say.

Years ago there was an article in one of the journals written by an academic attending physician who displayed to her students how very fascinating people can be. When she arrived to go on hospital rounds with her team that consisted of medical students, interns and residents she asked which patient they would like to present to her. They replied that there was no one worth presenting on their service. She responded by telling them that everyone was presentation worthy. She asked them to pick out any patient on their team and she would find something interesting about them. They chose a woman in her 80’s who was awaiting nursing home placement.

As the attending started taking a history, it was revealed that this patient had been a passenger on the Titanic and had quite a story to tell. She held the group spellbound. The students learned quite a lesson that day.

I am lucky to have some of the most wonderful octogenarians and nonagenarians in my practice. One was a model in New York in the 1940’s, another worked on the atom bomb, and yet another was a genuine beatnik. I have a couple of patients who lived through the holocaust. They have many life lessons to teach and wonderful stories to tell.

So many times in life, we pass by an elderly person or just seem to tolerate our older relatives. If we could stop for a moment and talk to them we might learn about their life and perspective. They can become important teachers and resources.

They have taught me about what it looks like to age gracefully. They have shown me what life is like as we get closer to the end and further from the beginning and what ultimately is important. Not one has looked back on their life and wondered if they could have stayed in their office an hour longer or filed more reports.

Many have expressed regret that they did not have more time with their family members or were unable to mend torn friendships. I think they would all agree that their health, relationships, love and kindness are what matter most in life. Find out what is important to the elders in your life. You might be surprised and delighted with what they have to say.

One of the things I have learned, as I have gotten older is how to spot a truly beautiful person. Have you ever met someone and thought they were OK or average looking, but once you got to know them you realized that he or she was really beautiful? If you think about it, you will notice that after you get to know people you do not see what you did originally, rather you see what they are from the inside out.

There is such an emphasis in our culture on external beauty. Having the most beautiful hair, skin, and smile is touted as important in almost every other commercial on television. I do not believe that the secret to true beauty is found on the outside. Here is my advice for being beautiful:

Be healthy. Exercise, protecting your skin from sun exposure and healthy eating will give you the healthy glow you are looking for. This simple (yet difficult to follow) advice will improve the look of your skin, hair and your overall appearance.

Nourish your spirit. Yoga, meditation and tai chi, (as examples) are all things that can help grow your spiritual side. Finding your passion and what makes you happy is one of the best ways to nourish your soul and bring out your inner beauty.

Practice random acts of kindness. I have an example. When I was in high school, every Valentine’s Day the girl’s club would sell carnations to raise money. The boys and girls were encouraged to buy flowers for each other. I was one of those girls who never got a flower. But, my senior year I finally received one. It felt wonderful to have a flower and to be able to speculate who sent it. This year the flower mystery was finally solved.

At my high school reunion, one of my friends told me that it was her mother who bought all the girls flowers that year. She did not want anyone to feel left out. It was a small act of kindness that made a big difference in a geeky teenager’s life.

You do not need to spend money to provide kindness. Try a smile, a hug, or a word of encouragement. It will help others to feel good and you to feel great. Every time you do something nice for others it is like placing a smile in your heart. The more smiles, the better you feel; the better you feel the more beauty you will project.

Get out there. Be healthy, find your spirit, be bold, be kind and be beautiful!

Each year in the US over 700,000 people suffer a stroke and over 143,000 people die as a result.Three-quarters of those who suffer a stroke are over 65 years old.It is important to know who is at risk and how to recognize the symptoms.A stroke occurs when there is lack of blood flow to the brain.

The risk factors for a stroke are similar to those for a heart attack.These include: smoking, high blood pressure, high cholesterol, diabetes, and a sedentary lifestyle. A family history of stroke, a history of a previous stroke or transient ischemic attack (TIA), increasing age and alcohol abuse can also increase the risk of stroke.

The long term consequences of a stroke can be devastating.That is why it is important to prevent them.You can do this by reducing your risk and modifying your risk factors.Quit smoking, keep your blood pressure and cholesterol down. Eat healthy and exercise.Take folic acid as part of your vitamin regimen.

What are the symptoms and warning signs of a stroke,they include:

* Sudden numbness or weakness of face, arm or leg, especially on one side of the body
* Sudden confusion, trouble speaking or understanding
* Sudden trouble seeing in one or both eyes
* Sudden trouble walking, dizziness, loss of balance or coordination
* Sudden severe headache with no known cause

Other danger signs that may occur include double vision, drowsiness, and nausea or vomiting. Sometimes the warning signs may last only a few moments and then disappear. These brief episodes, known as transient ischemic attacks or TIAs, are sometimes called “mini-strokes.” Since they may clear quickly, many people ignore them but that is a mistake. Many people with a TIA have a stoke within 48 hours.

If you think you are having a stroke call 911. Time is of the essence. It is possible in some cases to reverse the damage of a stroke if you are treated within hours of having symptoms.

Find out more about stroke in our book, “The Smart Woman’s Guide to Midlife and Beyond”.

We know that laughing is healthy, but what about crying? It turns out that it can indeed be therapeutic as long as it is now and then and not all the time. After looking into it, I have discovered why a nice, old-fashioned cry can feel so good.

Crying is a natural response to sorrow, frustration and grief and helps relieve emotional stress. It lowers the risk for heart disease by lowering blood pressure and pulse rate and removes toxins from the body. William Frey II, a biochemist at the St Paul Ramsey Medical Center in Minnesota, has been studying tears for over 15 years.

He found that tears from stress or sadness contain different chemicals than tears that are produced by an irritant. He has done experiments analyzing tears after subjects watched a sad movie vs. when they cut onions. The sad tears contained 24% more albumin than the onion-induced tears.

They contained an endorphin called leucine-enkaphalin (which helps control pain) and prolactin a hormone, which regulates milk production. Sad tears also contain 30 times more manganese as compared to serum levels. Excess manganese is associated with anxiety, stress and serious mood problems.

Not surprisingly, women cry more than men. On average women cry 47 times a year and men cry 7 times a year. The average cry lasts 6 minutes. Eighty-five percent of women and 73% of men felt better after a good cry.

Removing stress hormones through tears is healthy. Suppressing them is not and can lead to stress related disease. Tears have a cultural purpose as well. They evoke a quick empathetic response from others.

I know in the past I have recommended a funny movie to make you feel better. Maybe once in awhile it would be good to throw in a sad one so that you can have a good therapeutic cry. Of course, if you are Kurt Vonnegut you might want to stick with the funny ones!

“Laughter and tears are both responses to frustration and exhaustion. I myself prefer to laugh, since there is less cleaning up to do afterward.” ~Kurt Vonnegut

Last spring I was at a medical conference where I heard a talk about nutrition for surgery patients presented by a prominent surgery professor. Although the information was good, I have to confess that I only remember a small amount of what I heard. What I do remember was that at the end of his very serious lecture, the professor spoke about the importance of laughter for health.

Then, he started stomping around the room laughing. It was hilarious and inspiring to see this senior surgeon in a three-piece suit convulsing in laughter. The audience spontaneously got up and started following suit (pardon the pun). Before I knew it I was laughing uncontrollably. I felt fantastic. During his talk I was having post-lunch fatigue and was fighting to stay awake. After his talk I felt alive, happy and refreshed.

I have always loved to laugh. Recently, I have realized that not only does it feel good, but also there may be health benefits. In 2000, Dr Michael Miller (not a relative) at the University of Maryland did a study, which found that patients with heart disease were less likely to find amusing daily life situations funny when compared to those without heart disease. The question raised was which came first, the lack of humor or the heart disease.

Five years later he conducted a study that may give a hint at the answer. Using healthy volunteers to see the effect of hearty laughter on blood vessels, he found that it dilated and opened blood vessels improving blood flow to the body. Sad or stressful movies had the opposite effect causing constriction and narrowing of blood vessels. The body reacts to laughter in a way that is similar to aerobic exercise.

The take home lesson from this is that in addition to aerobic exercise for wellness you can add a healthy dose of laughter. This is especially useful if you are in a place where you cannot exercise. When you are on an airplane watch a funny movie. If you are stuck at a desk at work, entertain your colleagues with some good jokes, because laughter is good medicine for all. The main side effect is that you may annoy others around you. Engaging them in whatever “funny” business is going on can solve that problem and help them at the same time.

“If taking vitamins doesn’t keep you healthy enough, try more laughter: The most wasted of all days is that on which one has not laughed. “ – Nicolas-Sebastien Chamfort