The affliction is called celiac disease. It is a reaction to gluten, a protein most commonly found in wheat but also in rye and barley as well. It turns up in pasta and crackers as well as bread. It can surprise you in meat sauces, ice cream, medications, and cosmetics.

It is far more than a wheat allergy. In fact, it is not an allergy at all but an autoimmune disease.

Your immune system attacks the gluten and harms your small intestine when you eat wheat, rye or barley, according to the American Celiac Disease Alliance (ACDA). The result is a damaged intestine that makes it difficult for your body to absorb the nutrients you need to be healthy.

It can pop-up in your life almost any time. Sometimes, children show signs of gluten intolerances. Many times, a person is well into adulthood before it is diagnosed.

“Celiac disease is something you are born with, but it is often not diagnosed until later in life,” said Roshini Rajapaksa, MD, of the New York University School of Medicine.

“I think that older people are being diagnosed much more often,” agreed Mark DeMeo, MD, head of a Celiac Clinic at Rush University Medical Center in Chicago and a specialist in gastroenterology and nutrition. “We are basically more cognizant of it.”

The disease is found equally in men and women, the two experts agreed. However, women are more likely to be diagnosed because they are more persistent about learning why they are ill, Dr. DeMeo noted.

Millions Suffer From Celiac Disease

More than two million people in the United States have celiac disease, which is about one in 133 people, according to the National Digestive Disease Information Clearinghouse of the National Institutes of Health. In addition, the inherited potential for celiac may lurk in about one in 22 people, although they may not produce any symptoms.

Sometimes, viruses or infections can damage your immune system and cause celiac. The length of time a person was breastfed and the age a person started eating foods containing gluten might be factors as well—studies show the longer a baby is breastfed, the lower the chance of him or her developing celiac disease.

While genetics is a key factor in determining whether you have or will have celiac disease, “there needs to be another trigger,” Dr. DeMeo said. Stress or surgery can bring it on.

Georgiana Vines fits those criteria. When she learned she had celiac disease, she was 67, a widow and a cancer survivor.

How To Diagnose It

Diagnosis is done via blood tests and, if positive, biopsies of tissue from the small intestine.

Vines had been losing weight and was anemic.

“I was sent to a gastroenterologist by my oncologist because of the anemia,” the Knoxville, TN, resident said. “I also had suffered the weight loss during the illness and death of my husband, but no one seemed concerned about it because my weight was normal for my height and body size.”

Vines had a colonoscopy two years earlier, so the gastroenterologist did not believe she needed another but did do an endoscopy—a procedure in which a tube is inserted in the body for visual inspection. Indications were that she had celiac disease; blood work confirmed it.

“Others tell me they’ve had the blood work first and then confirmation from the endosocopy,” Vines said.

Symptoms of Celiac Disease

“Because celiac has so many different symptoms and can act differently in different people, it often goes undiagnosed for years,” Dr. Rajapaksa said. “So it is important to be checked for it if you are not feeling well, especially because we now know that this is a relatively common disease in the U.S.”

Following are some of the symptoms listed by the ACDA and the National Institute of Diabetes and Digestive and Kidney Diseases:

• Unexplained weight loss
• Fatigue
• Weakness
• Vomiting
• Gas, bloating, abdominal pain
• Chronic diarrhea or constipation
• Unexplained iron deficiency
• Anemia
• Bone or joint pain or arthritis
• Bone loss or osteoporosis
• Depression or anxiety
• Tingling or numbness in the hands and feet
• Seizures
• Missed menstrual periods
• Infertility or recurrent miscarriage
• Canker sores inside the mouth
• An itchy skin rash called dermatitis herpetiformis.

Symptoms may vary according to your age and the amount of damage to your small intestine. It’s possible to have the disease for ten or more years before it is diagnosed. People with celiac disease may not have any symptoms but can still develop complications of the disease over time. Long-term complications include malnutrition, which can lead to anemia, osteoporosis, liver diseases, and cancers of the intestine.

People with celiac disease tend to have other diseases in which the immune system attacks the body’s healthy cells and tissues. They include diabetes, thyroid disease, liver disease, and rheumatoid arthritis. Patients with celiac disease should also get the pneumococcal vaccine due to decreased spleen function which typically fights this infection, and they should have a repeat biopsy about 3-4 months after starting a gluten-free diet to assure improvement/resolution.

There are some patients who are diagnosed via screening and confirmed with biopsy that still remain asymptomatic. These patients, although they feel fine eating gluten, can develop nutrient deficiencies, increased risk of gastrointestinal cancers, increased chance of developing other autoimmune diseases, and mothers with celiac that do not adhere to the diet have greater risk of delivering preterm infants.

A study by Jonas F. Ludvigsson, MD, at Orebro University Hospital in Orebro, Sweden, concluded that celiac sufferers have an increased risk of bone fracture. There are indications that are particularly true for postmenopausal women above 50, according to a study by Michael Davie, MD, consultant physician and director of research at the Charles Salt Centere for Osteoporosis and Bone Disease in Shropshire, United Kingdom, and his colleagues.

No Cure, But Relief Possible

Can anything be done to cure celiac, other than sticking to a restricted diet? “No,” Dr. Rajapaska said. “Just diet. Although people are working on treatments, they are just in the research phase right now.”

There is no way to prevent celiac, Dr. DeMeo said. “It happens.”

“I was frightened,” Vines said, when her doctor told her the blood work confirmed the disease.

“I asked him what he was going to do about this. ‘Send you to a nutritionist,’ he said. ‘Is that all?’ I asked. He said ‘yes,’ and I hugged him. As a former cancer patient, it was reassuring to know that diet was the prescription.”

For most people, following a gluten-free diet will stop the symptoms, heal existing intestinal damage so the villi in the intestine can absorb nutrients into the bloodstream, and prevent further damage. Improvement begins within days of the diet change, with full healing in an adult may take several years. Watching one’s diet becomes a lifetime commitment. Family members of those with celiac disease should be screened as well since they are at an increased risk of also having the disease.

Balanced Though Limited Diet

Instead of wheat flour, use potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour. Buy gluten-free bread, pasta, and other products. An increasing number of retail grocery stores carry them. Organic food stores also are sources. Check on-line for gluten-free products.

Eating out is possible, although it can be a challenge. Ask your server or chef if they have a gluten-free menu. If not, ask about ingredients. Order your meal accordingly.

Vines is careful to ask for gluten-free foods when eating out. On a recent cruise, she found sufficient gluten-free foods, including tasty bread. Her waiter noted that the chefs baked gluten-free bread for several passengers who could not eat wheat.

“More and more restaurants are aware of this disease,” Vines said. “Some, particularly Italian restaurants, have gluten-free menus. Others are prepared to substitute dishes.”

It’s Not Just Food

Check product labels and talk with your pharmacist. Even your prescribed medications and lipsticks may contain gluten.

The Food Allergen Labeling and Consumer Protection Act (FALCPA), which took effect in 2006, requires food labels to clearly identify wheat and other common food allergens in the list of ingredients. FALCPA also requires the U.S. Food and Drug Administration to develop and finalize rules for the use of the term “gluten-free” on product labels.

            – Susan S. Stevens

Resources:

• American Celiac Disease Alliance: www.americanceliac.org
• American Dietetic Association’s Celiac Disease Nutrition Guide: www.eatright.org
• Dr. Mark DeMeo: http://rush.photobooks.com/directory/profile.asp?dbase=main&setsize=10&last=demeo&Submit=Search!&pict_id=0005890
• Dr. Jonas F. Ludvigsson: http://ki.se/ki/jsp/polopoly.jsp?d=16569&a=44710&l=en
• Dr. Michael Davie: http://www.rjah.nhs.uk/consultants.aspx?id=79
• National Digestive Disease Information Clearinghouse: www.celiac.nih.gov and
• http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/
• National Food Allergen Labeling and Consumer Protection Act:  http://www.fns.usda.gov/fdd/facts/nutrition/FoodAllergenFactSheet.pdf
• Dr. Roshini Rajapaska: http://www.med.nyu.edu/people/rajapr01.html

Widening the Use of a Cholesterol Drug May Come With Risk

AstraZeneca, makers of the popular statin Crestor, are aiming to market their drug as a preventive measure for millions of people who do not have cholesterol problems. But experts say this may not be a healthy move. Cholesterol-lowering drugs, or statins, are the most commonly prescribed drugs in the United States, but they may not be as safe a preventive medicine as previously believed for people who are at low risk of heart attacks or strokes. Recently published evidence indicates that statins could raise a person’s risk of developing Type 2 diabetes by 9%. Crestor may now be prescribed for apparently healthy people if they are older — men 50 and over and women 60 and over — and have one risk factor like smoking or high blood pressure, in addition to elevated inflammation in the body. A study found that taking Crestor resulted in a 55% reduction in heart attacks, 48% reduction in stroke, and 45% reduction in angioplasty bypass surgery. However, critics say that in real world terms this means 500 people would need to be treated with Crestor for a year to avoid one usually survivable heart attack. And at $3.50 a pill, the cost of prescribing Crestor to 500 people for a year would be $638,000 to prevent that one heart attack. Some doctors also say this will turn healthy people into patients, committing them to a lifetime of medication.

Click here to read the full New York Times article: http://www.nytimes.com/2010/03/31/business/31statins.html?pagewanted=1&tntemail1=y&emc=tnt

Alzheimer’s

Fighting Alzheimer’s With Games

A new project, the Cognitive Fitness and Innovative Therapies, or CFIT, is trying to see if the onset of Alzheimer’s can be delayed, perhaps indefinitely by keeping people at risk for the disease intellectually and physically fit with quizzes and other cognitive challenges. Participants in the program follow an exercise regimen and a meal plan based on the Mediterranean diet, and control blood pressure and cholesterol. A recent study published in JAMA showed that people who exercised more and followed the Mediterranean diet more closely had a 35% to 44% lower risk compared with those who didn’t follow these regimens. There are also social activities at the center, since one of the risk factors for cognitive decline isn’t having friends, like a Wii station where people can join in games. People are also encouraged to take on increasingly difficult brain challenges to improve cognitive function. It’s recommended that people begin efforts to prevent Alzheimer’s disease in their 50s, and even if someone is destined to get the disease, delaying its onset for even a few years could dramatically improve quality of life.

Click here to read the full Wall Street Journal article: http://online.wsj.com/article/SB10001424052748703416204575145921517534304.html

Breast Health

Bone Strengthening Drug May Reduce Spread of Breast Cancer

Results of a new study suggest that Zometa (zoledronic acid) may reduce the spread of breast cancer by preventing chemotherapy-related bone loss. Chemotherapy speeds up bone turnover, which releases bone-derived growth factors that can promote tumor growth in breast cancer patients. The study looked at 120 women undergoing chemotherapy for locally advanced breast cancer. It found that among women who had no tumor cells in their bone marrow at the start of the study, 87% of those in the zoledronic acid group were free of tumor cells at three months, compared with 60% of those who received chemotherapy alone. After one year, the rates were 40% and 33%, respectively. The study also found that zoledronic acid prevented chemotherapy-related bone loss.

Click here to read the full U.S.News & World Report article:  http://www.usnews.com/health/family-health/cancer/articles/2010/03/31/bone-strengthening-drug-guards-against-spread-of-breast-cancer.html

General Health

The Bigger the Smile, the Longer Your Life?

A new study published in the journal Psychological Science has linked the size of smiles with longevity. Researchers looked at smile ratings of baseball players and compared that with data from deaths. They found that longevity ranged from an average of 72.9 years for players with no smiles (63 players) to 75 years for players with partial smiles (64 players) to 79.9 years for players with big smiles (23 players). Positive emotion has been linked to both physical and mental well-being. And big smiles are more likely to reflect true emotion than partial smiles. Previous research has also shown that people who smile a lot are usually happier, have more stable personalities, more stable marriages, better cognitive skills and better interpersonal skills.

Click here to read the full Los Angeles Times article: http://www.latimes.com/features/health/la-he-capsule-20100329,0,4042521.story

Congress Approves Public Initiatives to Prevent Disease and Encourage Healthy Behavior

These new initiatives are an effort to counter sedentary lifestyles, smoking, and eating high-fat, high-calorie foods. Some of these include requiring chain restaurants to provide nutrition information on their menus and a new federal trust fund to pay for more bicycle paths, playgrounds, sidewalks and hiking trails. There are also some provisions to reduce the toll of preventable diseases, including allowing more access to cancer screenings, which will result in catching cancers earlier when they’re more treatable. The law will also entitle each Medicare beneficiary to an “annual wellness visit,” in which a doctor can assess the patient’s condition, check for signs of Alzheimer’s disease and draw up a “personalized prevention plan” with a screening schedule for the next 5 or 10 years. The Secretary of Health and Human Services said these initiatives have immense potential to “save lives and to save money.”

Click here to read the full New York Times article: http://www.nytimes.com/2010/04/05/health/policy/05health.html?ref=health

Chris Crowley, New York Times' Bestselling Author

Five years ago, New Yorker Chris Crowley, 70, a retired Wall Street lawyer, went for his annual check-up with a new doctor, Harry S. Lodge, MD, 47, an internist and professor at Columbia University’s College of Physician and Surgeons. The physician told Crowley he could either be “on the slow, stead curve from fifty to death, or be younger next year and for many years to come in all the ways that matter.”

“What do I have to do?” Crowley asked his new doctor. At that meeting, the two men forged a friendship and a bond, and went on to co-author two best-selling books (one for men and one for women) on how to make aging well the most important job of your life.

Their book, “Younger Next Year for Women: Live Strong, Fit, and Sexy – Until You’re 80 and Beyond,” describes ways to change how you age, with methods backed by science. Dr. Lodge provides the scientific background while Crowley lends a hilarious slant and interpretation. The book will show you how to avoid 70% of the normal problems of aging and eliminate 50% of illness and injury. The key is found in Harry’s Rules, a program of exercise, diet, and maintaining emotional connections.

Can we really hold age at bay as these authors promise? We asked Crowley, now 75, to help us understand the years after menopause when women typically experience increases in bone loss, acceleration in heart disease, cancer, arthritis, fatigue and depression. Lodge and Crowley have a practical plan to make the next third of your life – think 30+ years – some of your best. “Our body holds the remarkable ability to repair and renovate itself, provided we help it,” Crowley said.

What made you write a book for women? How is it different than the book you wrote for men? 

The publisher suggested it and said women are generally more interested in reading about health. We found that women age and resist aging exactly the same way that men do – the rules in the first book apply equally to women, but women come at aging in a very different way. Women are much more optimistic about aging, they are not as scared, and they age a bit more gracefully.

Did you come across any surprises in writing this book?

In doing research for the book and spending time with women over 50, I found a surprisingly broad surge of optimism in women in their 50s and 60s – they have spent so many years being good, looking after their kids, and taking care of ‘Old Fred,’ and at this point they say ‘Hey, what about me? This is my turn and my time to shine.’ We found that men get a little scared in their 50’s and 60’s whereas women are optimistic.

What is the typical process of aging and how can I change it?

The typical process of aging in this country is the steady downward curve from 50 to the day you die – every year, you are a little fatter, a little slower, a little less fun. But we want to show you how to flatten out that curve. If you do a few key things, you can be about the same or better than when you were 45 or 50, and these things can make life even better till you are 80 and beyond. The fundamental key is relentless, serious exercise six days a week – four days of aerobic exercise and two days of strength training.

What is the most important thing to do to become, functionally, younger next year?

Exercise is the silver bullet – we just can’t emphasize that enough. Exercise, exercise, exercise – it is a miracle! Listen to these two things: You can avoid 70% of aging until the very end just by doing serious exercise. You can completely avoid 50% of all serious illness – heart attacks, adult on-set diabetes, lots of cancers, Alzheimer’s, – by doing serious aerobic exercise, 45 minutes a day, four days a week. It is a miracle!

What do you say to someone who says, ‘I have never worked out, so is there hope for me too?’

Absolutely! When you think of those numbers I gave you, it’s just nuts not to do something in terms of exercise. We were designed in the evolutionary crucible of survival as athletes. We are all designed to move. Just start going to a gym, do classes, fast walk. Start to do something today and do it for the rest of your life.

In the book you say ‘learn to eat rationally.’ What does that mean

Quit eating crap! I am working on a new book and one of my new rules in the book is: ‘Never eat anything that comes to you through a car window.’ We just eat mountains of crap in this county. At least 50% of our diet should be plant based. I am sure you have read The Omnivore’s Dilemma by Michael Pollan, which says that we are all being hosed down with corn byproducts and fructose. There is a prevalence of corn in the American diet and it is not good for us. We are being force-fed all this junk that is so toxic.

You use yourself as an example in the books. Can you tell us about your typical day of living by the ‘Younger Next Year’ rules? Do you ever have a glass of wine with dinner? Is diet coke ever allowed?

Chris with wife Hilary in Colorado

I am an old person and we old people tend to wake up early. I am a pretty good kid about the exercise. I exercise almost every day of the week. In the Berkshires, we have a gym in an old barn in the back that I frequent.

If the weather is borderline OK, I hop on my bike and ride 19 miles in the hills. I ski a lot. My wife and I are both retired, so we are going on a six-week ski vacation in Colorado.

Does your wife Hilary follow the rules?

She is pretty good. We work out together a lot. We work at about the same pace with about the same level of interest. She does a lot of yoga, which I don’t enjoy, but otherwise we ski, bike and take classes together.

What has it been like to go from being a retired guy to becoming a best-selling author?

Wonderful – I think everybody should do it! I am doing a lot of writing now and giving speeches. First of all – who knew? We thought the first book would do well, but who knew that five years later, we could sell 8,000 copies in January, 2010. It has been an amazing journey. We get oodles of lovely letters from readers saying ‘Hey, you changed my life,’ or ‘Hey, I lost 40 pounds after reading the book.’

After I met Harry, I went from being a weekend exercise guy, to being a six- day-a -week exercise guy, and that essentially changed my life. Just last week my wife and I went to a fancy party in New York at a nice club to celebrate a 70^th birthday. I looked around and so many of these folks who were my age were taking these little, short, timid steps….there were some with canes. I thought, ‘Gee whiz, you guys are not paying attention! And these were able people too. They didn’t look like they were having any fun either. And I said, ‘The hell with that, I am going to keep moving in a big way.’ My advice to you is: make sure you are having fun, stay involved and connected, and keep moving.

Trail Mix

Yes, trail mix is full of dried fruit, nuts, and seeds which give us lots of fiber and heart-healthy fat…plus, it tastes good too.  So, what’s the problem?  Let’s break it down:

Dried fruit – like all fruit, it’s loaded with fiber, vitamins, and minerals.  But during the dehydration process, all of the moisture is taken out of the fruit leaving it smaller and much more concentrated in sugar.  Thus, a small amount packs a stronger calorie punch.  It’s still healthy and nutritious…just be aware of the serving size!

Nuts and seeds – full of fiber and heart-healthy fat, so definitely a healthy snacking choice.  But even heart-healthy fat is high in calories, so serving size is something to pay attention to here as well.

Yummy extras – rarely is trail mix devoid of a sweet extra, something like coconut, chocolate chips, or M&Ms.  These treats add flavor but also sugar and calories.

While it is nutritious, a little bit of trail mix goes a long way: ½ cup = 350 calories.  That’s more than a hot fudge sundae! 

Better Alternative: You can still eat trail mix, just watch the serving size: limit yourself to ¼ cup per serving.  Pre-portion out your serving and put the rest away to avoid over-eating.

Low-Fat Milk

Milk definitely does a body good – it’s full of calcium, vitamin D, and protein.  But what about the fat?  You probably already know that drinking whole milk is not the best move for your waistline, but you may not realize how close 2% milk is to whole milk. 

Consider this:

   Whole milk = 150 calories

   2% reduced fat milk = 120 calories

   1% reduced fat milk = 100 calories

   Fat-free skim milk = 80 calories

     (serving size: 1 cup)

Better Alternative:  Switch from reduced-fat milk to fat-free milk and save a bundle of calories while still getting all of the nutrients!

Granola

Full of whole grains, dried fruit, and nuts – so lots of fiber and nutrients are found here too.  But…there’s lots of added sugar as well.  Because granola is sold in cereal boxes, we tend to equate it with other types of cereal and we usually pour the same size serving into our bowls.  Big mistake.  A standard serving size for cereal is 1 cup.  Pour 1 cup of Cheerios into your breakfast bowl and you’ll get 103 calories.  For the same amount of granola, you’ll get closer to 400 calories! 

Better Alternative: Go ahead and eat granola, just make sure you watch the serving size.  Try adding ¼ cup to a parfait with yogurt and fresh fruit.  Or fill your cereal bowl with fruit before topping it off with granola instead of the other way around.  Other smart breakfast choices include whole-grain, low-sugar cereals and oatmeal.

100-calorie Snack Packs

They’re advertised as being a healthy snack choice, but are they actually good for you?  That’s the question you should be asking yourself.  These calorie-controlled snack packs may help to minimize over-eating, but they don’t provide much in the way of nutrients.  They usually come in the form of chips, cookies, or crackers and contain little to no fiber, vitamins, or minerals.  This means that while these snacks are only 100 calories, they’re empty calories! 

Healthier Alternative:  Try a container of yogurt, an apple with 1 tbsp of peanut butter, a small handful of nuts, or some whole-grain crackers with hummus.  For 100 calories, these snacks are all more filling and more nutritious.

Exotic Fruit Juices 

With fruits like acai, mangosteen, or pomegranate, these juices sound tasty and healthy.  Their labels tell us that they’re high in antioxidants and pack more punch than our average fruits and vegetables.  But the truth is that while these exotic fruits are very nutritious on their own, that doesn’t necessarily translate into high-quality juices.  Many of these juices are little more than sugar water with a little fruit added in.  To make an educated decision, read the ingredient list before buying and be on the lookout for ingredients such as high fructose corn syrup, agave nectar, sugar, and evaporated cane juice. 

It is also important to keep in mind that these healthy fruits are not superior to our standard fruits and vegetables that are found closer to home.  They have different nutrient profiles, not better nutrient profiles. 

Better Alternative: Save the money you’d spend on expensive fruit juices and make sure that your diet contains a wide variety of fruits and vegetables instead.  When buying juice, look for juices made with 100% fruit juice…one serving of these juices counts as one serving of fruit. 

Adult Cereals

In the grocery store, you deliberately though wistfully bypass the colorful, sugary “kid” cereals in favor of the more mature and nutritious adult varieties, but are you really doing yourself any favors?  Not necessarily.  Despite what manufacturers would have us believe, many of the cereals marketed towards adults contain as much sugar or more than the popular “kid” cereals on the market today. 

Better Alternative:  Don’t throw your hands up in the air and rush back to “kid” cereals out of frustration!  Just take the time to read the food labels and look for cereals that contain less than 10g sugar per serving and are made from whole grains such as corn, oats, or bran.  Add fresh fruit to your cereal bowl and eat with confidence.

Turkey Burgers

You think these are better for you than the typical beef variety, but the truth is that ground turkey often times contains the skin and fat of the bird, so it’s not necessarily any better for you than your typical hamburger. 

Better Alternative:  When shopping for ground turkey, opt for ground turkey breast and always inquire if the skin was removed prior to processing.  When you crave beef, reach for the leanest cuts available such as ground sirloin or 95% lean ground beef.

Don’t Let Yourself Be Fooled By Foods! 

In order to sell their product, advertisers will use words and phrases that grab your attention and appeal to your desires.  At times, these messages can be deceptive and misleading.  One of the best things you can do to avoid these types of mistakes is to read the food label and ingredient list on products before you buy.  Knowing what’s in the food that you’re buying can help you make educated decisions.

First of all, do not let your surprise or relief concerning any diagnosis stop you from asking your doctor questions. Learn everything possible about your condition. If you don’t have the presence of mind to ask the questions when you see your doctor, call with queries later.

Here are ten questions to ask that will both make your visit to the doctor go more smoothly, and help insure better health down the road.

The first six are suggested by Amy K. Anderson, MD, Chief Medical Advisor for JustANumber.com and WebEd. Dr. Anderson is board-certified in internal medicine and is a practicing physician at Northwestern Memorial Hospital in Chicago.

1. Are any changes to my current medications necessary? Can I stop taking anything, etc.? “I think it’s good to reassess a patient’s medicine list on a routine basis, but often a doctor just keeps meds going without reevaluating their necessity,” Dr. Anderson said.

2. Are there any illnesses to which I may be predisposed, either due to my lifestyle or for genetic reasons?

3. Are there any vaccines I should receive at my age? “Certain vaccines need to be given in adulthood–tetanus every ten years, pneumovax at age 65, a vaccine for shingles at 60 ,and flu vaccine yearly–and these can sometimes get overlooked at a routine physical” or other examination, Dr. Anderson noted.

4. What are the risks and benefits of (fill in the blank)? “This is useful for just about any procedure, medication, or recommendation that a doctor gives a patient,” Dr. Anderson said. “It’s extremely important that both the doctor and patient are on the same page regarding expected outcomes and possible failures of any treatment offered.”

5. May I have copies of my test/lab results? “This usually requires filling out paperwork to authorize releasing the records, but the more information a patient has about his or her medical history, the easier it will be to seek second opinions or if she needs to move, etc. and get new doctors,” Dr. Anderson explained.

6. Do you commonly treat my illness? “This is especially important for a specialist because they frequently only focus in one specific area, and if they don’t see the particular disease that a patient has on a regular basis, they may not be the ideal doctor for that patient and may refer the patient to another specialist,” according to Dr. Anderson.

Irene O’Neill, MD, of Munster, IN., trained in internal medicine and currently working in occupational medicine, suggested three more questions.

7. If I have to be admitted to the hospital, will you be the one taking care of me? “Some doctors only see their patients in the office and transfer the care of their hospitalized patients to a hospital specialist or ‘hospitalist,’” Dr. O’Neill said.

8. How necessary is that test? “Because we live in such a litigious society, doctors tend to be very thorough in working up problems,” Dr. O’Neill said. “If you don’t have insurance, or have a high deductible, your doctor needs to be aware of this. Be frank with the doctor and let her or him know your insurance and/or financial situation. The doctor usually can prioritize the tests and comfortably rule out serious problems with fewer tests.”

9. Is there a generic medicine available to treat my problem? “With some of the newer drugs costing $5-to-$10 a pill, only people with good insurance can afford them,” Dr. O’Neill said. “Generic does not mean inferior. They are strictly regulated. Because generics have been on the market for such a long time there are no surprises, unlike with some of the newer drugs that are suddenly pulled from the market because of new findings.”

Last, but not least, comes a question from Elaine Fantle Shimberg of Tampa, FL, an award-winning author of 22 books about taking care of your health.

10. If you need surgery, ask your doctor how many procedures of this type the doctor has performed and what were their outcomes?

Dr. O’Neill also advises you to check websites to get more information about your diagnosis.

“There are some preferred websites,” Dr. O’Neill said. “If you are diabetic, the American Diabetic Association is a good place to start. If you have heart disease, you should check out the American Heart Association Web site. If you are seeing a specialist, the physician may be able to steer you to the better sites for your condition. The more you know about your illness, the better choices you will make.

“Ask yourself, ‘What can I do in terms of my lifestyle choices to improve my outcome?’ The more you take charge of your health, the better the outcome. Often, a change in lifestyle is more effective than the medicine the doctor is prescribing,” Dr. O’Neill stated.

If your changes include over-the-counter supplements, do consult with your doctor, Dr. O’Neill advised.

“Not all supplements have been proven to do what they claim,” Dr. O’Neill concluded. “There usually are studies that have attempted to objectively evaluate those claims. Your doctor may be aware of which supplements have been shown to be beneficial, and which have not.”

– Susan S. Stevens

Resources:

• Amy K. Anderson, MD: www.justanumber.com/contributors/
• Elaine Fantle Shimberg:  www.elainesbooks.com
• American Heart Association: www.americanheart.org
• American Diabetes Association: www.diabetes.org

With a bit of talent and plenty of dedication, Mary Ann Presman, 69, has turned her passion of reading, writing, and story crafting into a mid-life career. In 1995, after retiring as an advertising and public relations manager and copywriter, Mary Ann of Rockford, IL attended the famed Iowa Summer Writer’s Festival where she took a workshop that launched her on the road to becoming a published author.

“Early on I heard Jane Smiley speak at an author’s reading,” Mary Ann recalled. “She gave me hope in a Q&A by saying that she did think writing can be taught. She said you had to have some talent, but that by continuing to work at it, one could improve their skills. Obviously, I bought that.”

Mary Ann (center) at a writer’s workshop in Jamaica that was led by novelist Pam Houston (front row, left).

In the past 14 years, Mary Ann has attended more than 12 workshops and embracing her independent spirit, drives solo from Illinois to workshops in Provincetown, Portland, and St. Petersburg. “I slide in my CDs of road music – Willie Nelson, Steve Goodman, the Dixie Chicks- and I am off,” she said.

In 2010, Mary Ann will have a book published and available on Amazon. The new book titled “Curse? There Ain’t No Stinking Chicago Cub Curse,” is a collection of sports-related stories of Mary Ann’s, and fellow writer James Wolfe, who has published five novels. There are eleven stories–about golf, baseball, pool, blackjack, horse racing, bocce ball, basketball, tennis, and Scrabble dating. “It’s a fun book of stories with a few surprises,” Mary Ann said.   

We asked Mary Ann to tell us about her journey to becoming a published author.

Mary Ann at the family farm in Galena, IL

When and how did you get the writing bug? How old were you?

When I was a sophomore in high school (a ga-jillion years ago!) I wrote an essay about my Grandmother’s farm kitchen that won a rosary as best in our little English class. That was very important validation.

Can you tell us which famous writers you have met?

I’ve studied with some of the best: Pam Houston, Dennis Lehane, Margot Livesey, Antonya Nelson, Jim Shepard. The workshops typically have writers who will either be keynote speakers, or teach other workshops and read/speak in the evenings. So I heard Tom Perrotta read two nights before he was nominated for an Academy Award for the film adaptation of his novel, “Little Children.” I’ve also seen/heard read Jane Smiley, Peter Carey, John Irving, Elizabeth Strout, Bonnie Jo Campbell, Richard Price, Elizabeth Berg, Jodi Picoult, Jonathon Franzen, Michael Chabon, Alexandra Fuller, E. J. Doctorow, Augusten Burroughs, Anne Lamott, David Lodge, Laura Lippman, John Updike, Anna Quindlen, Joyce Carol Oates, Ann Patchett, Jacqueline Mitchard, Annie Proulx, and Margaret Atwood, among others. They were all memorable in their own way.

Did you have an ‘aha moment’ in your writing career thus far?

Well, mostly it’s when I read somebody like Elizabeth Strout or Elizabeth Berg and see the kind of writing I aspire to create. I enjoy reading others–Dennis Lehane, for instance–but I’m never going to write like he does.

Did you ever get really discouraged and think of giving it up?  If so, what did you do to recharge yourself?

I suppose I’ve been momentarily discouraged when I’ve received a rejection notice for a story that I thought would finally be published. But by signing up for a workshop every summer, I require myself to create a new story to be critiqued and I get pumped up by the workshop experience itself.

What is the best part about writing, and the things you find the most challenging?

The most challenging part for me is to keep at it because I’m not a very disciplined person and you are your own boss as a writer. I need to give myself deadlines. The best part of writing, of course, is when you know that someone has honestly enjoyed reading your story. I am addicted to reading and I aspire to giving someone else the pleasure that other writers have given to me…the comfort in knowing that you are not the only one who has such foibles, or the joy in sharing even a fictional character’s success in overcoming life’s unexpected obstacles.

Where do you find your story ideas?

Story ideas really do pop up just about anywhere. Some are adaptations, exaggerations of true-life happenings. Often, I observe a person, or more likely–two or three people together–and I imagine what might be going on between them. Presto! A story!

What does your family think of your writing career?

Since we’re all readers, they’re very supportive and very good at critiquing first or second drafts. My brother, Gary Houy, is a great editor–and with online communication he has served as an indispensable help with the book we’re about to publish. 

What’s next?

As I’ve been working on getting my 50,000 words down for the National Novel Writing Month exercise, I’ve written a couple of chapters that definitely have possibilities either as standalone stories or as part of a new collection. I’ve learned a lot over the last few years and I’m eager to continue honing my skills and improving my craft.

Mary Pat Byrne (If you have an idea for an inspiring story, please send the details to MPB@JustANumber.com)

“Whoa there…I’ve already got enough on my plate.  I don’t have time to make more changes that don’t directly benefit me!” –says the casual reader.

I hear you.  But this is where you’ll want to listen up and take notes: Greening your diet does more than just help the environment, it helps YOU too!  By trying the following tips, you’ll create less waste, lose a few inches off of your waist, and save some of your hard-earned dollars all at the same time!  Since when did sustainable living ever sound so fun?

Limit Your Intake of Red Meat

Red meat isn’t so great for you and it isn’t so great for the environment either.  Beef can contain high amounts of saturated fat, cholesterol, and calories which, when consumed in excess, can contribute to heart disease and obesity. Dietitians recommend that red meat intake be limited to no more than twice per week.

On the environmental front, it’s been estimated that the livestock sector accounts for 18% of global greenhouse gas emissions and cattle is the biggest contributor.  The carbon footprint of 1 kg of beef is four times higher than that of pork and more than 10 times higher than a single kilogram of poultry.  The reason for this huge difference is that cattle eat a lot of food and produce a lot of methane gas (aka they pass a lot of gas!).  I know this may sound funny, but I’m being serious here…the high demand for beef in our culture has led to a huge population of cattle that are bred to satisfy our hunger and their methane gas emissions are a huge contributor to our greenhouse gas emissions.  Cutting down on your intake of beef could cut as much carbon as leaving your car at home a few days a week.

Be a Vegetarian for a Day

While the carbon footprint of cattle is highest, the carbon footprint of all animal products is higher than their vegetarian counterparts.  Animal products are excellent sources of protein, but they aren’t the only way to get protein in your diet.  Beans, nuts, seeds, tofu, and whole grains are some of the many vegetarian sources of protein.  These are also important parts of a healthy diet that is low in fat, cholesterol, and calories, and high in vitamins, minerals, and antioxidants.  There are no disadvantages to foregoing meat on a regular basis and there are tons of advantages to squeezing more fruits, veggies, and whole grains into your diet, so try passing on the animal products for at least one day a week.  You’ll be doing yourself and the environment a favor!

Try Some of the Local Cuisine

Foods with the smallest carbon footprints of all usually come from places close to where you live.  These foods haven’t had to travel very far to get from the field to your plate.  Locally grown food is usually better for you because it’s fresher too!  Consider a tomato picked from a farm in your town versus a tomato grown in Chile.  The locally grown tomato can be picked at its peak of ripeness and appear on your plate in as little as one day whereas the Chilean tomato must be picked weeks earlier and has to travel on a refrigerated plane, train, or automobile before it can get to you.  The nutrient level of a freshly picked tomato is also much higher than that of a weeks-old tomato that was picked prior to ripening.  And don’t even ask me which one tastes better!

Farmers’ markets are becoming increasingly common these days and, unless you have your own garden, they are the best option for finding locally grown food at reasonable prices.  You’re also supporting your local economy and you’re able to get to know the people who grew your food, so it’s a win-win for everyone.  If you want to take it one step further, try planting your own garden or even a few pots on the porch.  Canning and freezing the fall’s harvest can help to stretch your locally grown food into the winter months when fresh produce is out of season.

Pass on the Processed Food

The carbon footprint of processed foods is quite high because each individual ingredient must be transported to the factory where the processing takes place. Once there the product itself needs to be produced and packaged, then the final product must be transported to the store where you buy it.  This whole process is very energy driven.  In addition, processed foods are often full of sugar, sodium, fat, additives, and preservatives…not the ingredients we should be aiming to put in our bodies on a regular basis.  A better choice for you and the environment would be to opt for whole foods that have been minimally processed such as fruits, vegetables, and whole grains.  Passing on processed foods more often will do your pocketbook a favor too as they tend to be more expensive than fresh foods.

Opt for Organically Grown Goods

Organically grown foods have been grown without the use of synthetic pesticides, chemical fertilizers, or genetically engineered ingredients. This is good news for us since we don’t really want to load our bodies up with foreign chemicals that we aren’t designed to process.  The build up of these chemicals in our bodies has been associated with an increased risk of various cancers, birth defects, nerve damage, and other health problems.  While there are many experts who claim that the levels found in our foods are safe, there are others who cite scientific evidence suggesting otherwise.  There are still a lot of questions out there about the safety of synthetic pesticides and fertilizers, but there are no questions about the safety of organically grown foods.  Thus, whenever possible, I recommend opting for organic.

Another plus in the organic column is that, when tested, many organically grown foods are shown to have higher nutrient profiles than their conventionally grown counterparts.

Organic farming practices promote soil fertility, minimize soil erosion, encourage water conservation, and reduce pollution.  Not only do they produce a healthier product for you, but they help to maintain a healthier Earth too!

Eat In

This tip is guaranteed to save you money since eating in almost always costs less than buying ready-made food outside your home.  Use your kitchen and your Energy Star rated appliances to produce healthy meals that don’t require a pizza delivery man or a trip to the drive-through.  Take this one step further and pack your own lunch, make your own coffee, and bring your own water.  You’ll be cutting down on waste by using your own reusable lunch box and Tupperware containers, your own coffee mug, and your own reusable water bottle.  You’ll also have better control over your diet which is always associated with a trimmer waistline!

Waste Not, Want Not

You’ve probably heard your mother or grandmother utter this phrase before, but have you ever really thought about what it means?  As defined by The American Heritage New Dictionary: “If we don’t waste what we have, we’ll still have it in the future and will not lack it”. When considering our relationship with the environment this phrase takes on new meaning.  If we all try to waste a little less now, maybe one day we (or our future generations) won’t lack basic necessities such as good food and clean water.  By living mindfully now, we’ll treat our Earth better and ourselves healthier.  Go green, save green, and get lean!

Social Networks Are a Source of Support for the Chronically Ill

For many fighting chronic illness, the Internet becomes a lifeline. Beyond finding information on their illness, people can build relationships and get the support they need to keep going. From blogs to discussion groups, social networking allows people who are homebound with illness to continue to engage with society, and some call that lifesaving. Others use the Web to find practical tips about living with their disease or disability that doctors and family members, having not lived with it themselves, cannot provide. So, for those battling chronic illness, the Internet can not only provide invaluable information, but can open the door to whole new social life. Some of the larger patient networking sites are PatientsLikeMe, HealthCentral, Inspire, CureTogether and Alliance Health Networks.  

Click here to read the full New York Times article: http://www.nytimes.com/2010/03/25/technology/25disable.html?ref=health

Osteoporosis

Combat Bone Loss With…Tequila?

Not quite, but Mexican researchers have found that agave, a substance from the plant used to make tequila may help fight osteoporosis and other diseases. Fructans—nondigestible carbohydrates consisting of molecules of fructose—are found in abundance in agave, artichokes, garlic, onions and chicory. This study found that mice that were fed agave fructans absorbed more calcium from food, excreted less calcium in their feces, and had a 50% increase in levels of a protein associated with the build-up of new bone tissue. Results suggest that supplementing your diet with agave fructans could help prevent bone loss and improve bone formation. Tequila, however, won’t help because the fructans turn into alcohol when agave is processed into tequila.

Click here to read the full U.S.News & World Report article: http://www.usnews.com/health/family-health/bones-joints-and-muscles/articles/2010/03/23/tequila-plant-may-help-fight-bone-loss.html

Heart Health

When Is High Blood Pressure a Good Sign?

Swedish researchers report that high blood pressure is a good indicator of long-term survival for people admitted to an intensive care unit because of chest pains that indicate a major heart problem. Scientists say even dangerously high blood pressure could indicate patients with better cardiovascular reserves; that those patients who can produce a very high response may have less severe disease or a more intact neuro-hormonal system. But this is not to say the high blood pressure should be ignored. The study found that those who were treated for their high blood pressure before being released did better. This study indicates that those patients hospitalized with blood pressure below 128 need to be followed more closely.

Click here to read the full U.S.News & World Report article: http://www.usnews.com/health/family-health/heart/articles/2010/03/23/when-heart-is-in-crisis-high-blood-pressure-a-good-sign.html

Breast Health

More Exercise, Less Eating May Reduce Breast Cancer Risk

Up to a third of breast cancer cases could be avoided through exercise and diet, researchers announced at European breast cancer conference in Barcelona. The International Agency for Research on Cancer estimates that 25% to 30% of breast cancer cases could be avoided if women were thinner and exercised more. According to a 2006 British study, obese women are up to 60% more likely to develop any cancer than normal-weight women. Many breast cancers are fueled by estrogen, a hormone produced in fat tissue. Experts suspect that the more overweight a woman is, the more estrogen she’s likely to produce, which could in turn fuel breast cancer. They believe that even in slender women, exercise can help reduce the cancer risk by converting more fat into muscle. The American Cancer Society recommends 45 to 60 minutes of physical activity 5 or more days a week to reduce the risk of breast cancer.

Click here to read the full Washington Post article: http://www.washingtonpost.com/wp-dyn/content/article/2010/03/25/AR2010032500200.html?sub=AR

Exercise

An Hour a Day to Keep Pounds at Bay

New research has just been published in the Journal of the American Medical Association suggesting an hour a day of moderate exercise is necessary to prevent weight gain. The study found that less active women were much more likely to gain 5 pounds or more than the most active women. It also found that overweight and obese women tended to be less active than the healthy-weight women, and overall their physical activity was insufficient to help them control their weight. Women consistently engaging in 60 minutes a day of moderate exercise gained less than 5 pounds in 13 years. The most common activity for women in the study was walking. Researchers determined 30 minutes of more vigorous exercise like running or jogging was equal to 60 minutes of walking. And other studies have shown that physical activity can be accumulated in short bouts of at least 10 minutes each. Researchers emphasize that getting even 30 minutes a day 5 days a week is beneficial for lowering the risk of heart disease, some types of cancers and type 2 diabetes.

Click here to read the full USA Today article: http://www.usatoday.com/news/health/weightloss/2010-03-24-preventweightgain24_ST_N.htm?loc=interstitialskip

Women over 50 you can take some easy steps now to prevent osteoporosis later.

Osteoporosis means porous bone. Women make of 80% of osteoporosis sufferers, and 16% of menopausal women have the disease. Here are five of the best bone loss prevention strategies to take now, so you avoid bone loss later. Incorporating these tips into your day will also promote your long life.

1) Exercise: Maintain a weekly exercise routine that works out the entire body. Start with fast walking, which is great for strengthening your feet, ankles and knees. To strengthen hips, spine and wrists, strength and resistance exercises using free weights or dumbbells, will help prevent bone loss and fractures.

2) Eat Well: Eat a well-balanced, vegetable-rich diet rich in calcium. Dairy products like milk, yogurt and cheese are calcium-rich for strong bones. Salmon, sardines, spinach, soy beans, broccoli and peas are also high in calcium.

3) Take Your Supplements: Take vitamin and mineral supplements with calcium. Doctors recommend that women over 50 get at least 1,500 mg a day. Vitamin D and magnesium are also helpful as they aid in the bone’s absorption of calcium.

4) Minimize Unhealthy Habits: Smoking cigarettes and drinking alcohol to excess can weaken bones. By stopping or minimizing these habits you will allow your bones to absorb calcium and help the growth of cells that promote bone density. Smoker’s bones can’t absorb the calcium like non-smokers bones can.

5) Get A Bone Density Scan: Ask your doctor for a bone density scan to determine if you are at risk of osteoporosis. Once you know your bone density levels, you have a baseline and take preventative measures to ensure your bones never become brittle and break

History Is Made With Healthcare Reform

The House approved legislation Sunday night that will extend insurance coverage to 32 million uninsured Americans and improve the coverage of those with insurance. And for the first time, the American Medical Association is supporting a plan for government-orchestrated healthcare reform after having denounced earlier proposals as dangerous experiments in “socialized medicine.” Republican politicians still argue against what they call a government takeover of medicine. Using phrases like “death panels” and “pulling the plug on granny,” some see the new legislation as dependency on the federal government and the death of freedom. In any case, some notable aspects of the new bill include requiring most Americans to acquire health insurance, helping cash-strapped individuals and families purchase it through government-operated insurance marketplaces called exchanges, increasing Medicaid enrollment by almost 50%, and imposing regulations on private insurers that would prevent them from denying someone coverage based on preexisting conditions. Far from perfect, the new plan is a step toward bringing coverage to those who need it most.

Click here to read the full Medscape Today article: http://www.medscape.com/viewarticle/718911

AMA Supports New Healthcare Legislation—for the Most Part

Considering the healthcare status quo unacceptable, the American Medical Association supports the new healthcare bill, saying people live sicker and die younger if they receive all their medical care in the emergency room. The American College of Physicians and the American Academy of Pediatrics also support the new healthcare legislation, which just passed the House Sunday night. However, the AMA still finds fault with the bill. Foremost among its criticisms is its lack of a permanent repeal of Medicare’s sustainable growth rate formula, which will result in a pay cut for physicians this year. The group also voices its disagreement on penalties for physicians who do not participate in Medicare’s Physician Quality Reporting Initiative and regulations that would effectively ban physician-owned hospitals.

Click here to read the full Medscape Today article: http://www.medscape.com/viewarticle/718909

Health Screening

Are We Being Overtreated?

According to an article in the Washington Post, Americans are getting too many medical tests. A New England Journal of Medicine study suggested that too many patients are getting angiograms and the American Cancer Society cast doubt on routine PSA tests for prostate cancer. This is in addition to the recent guidelines limiting mammograms and PAP smears for women under a certain age. Some doctors, however, argue that these screenings can improve survival chances and that saving even a few lives is worth the cost of routinely testing tens of thousands of people. On the other hand, some say doctors too frequently practice defensive medicine, ordering tests or procedures to protect themselves against lawsuits. Adding to the increase in screenings are patients who they themselves demand routine tests. Patients who want avoid getting tests they really don’t need are advised to thoroughly discuss testing with their doctors, including their individual disease risks, general pros and cons of testing, and possible harms a particular test may cause.

Click here to read the full Washington Post article: http://www.washingtonpost.com/wp-dyn/content/article/2010/03/12/AR2010031201083.html

Obesity

Obesity Is a Problem, So Why Don’t Doctors Talk to Their Patients About It?

Doctors know how critical a problem obesity is, but they have a hard time talking to patients about it. A new report just released by the STOP Obesity Alliance suggests that both doctors and patients are frustrated with the conversations they’re having about weight. While most doctors know it’s their responsibility to help their patients lose weight, they often don’t know what to say because they have little or no training in weight management and nutrition. This often hurts patients, because just being told they’re overweight does little good if they don’t know how to lose it. Dr. William Bestermann Jr., medical director of Holston Medical Group in Kingsport, Tennessee, says the dialogue needs to be ongoing. For patients to be successful in weight loss, their doctor should monitor their progress, offer encouragement and coach them throughout the process.

Click here to read the full New York Times story: http://well.blogs.nytimes.com/2010/03/16/doctors-and-patients-not-talking-about-weight/

Diabetes

Eat More Brown Rice to Combat Diabetes

A new research study analyzing data from 39,765 men and 157,463 women has found that people who ate 2 or more servings of brown rice per week were 11% less likely to develop type 2 diabetes than those who ate less than one serving of brown rice per month. Researchers say that replacing 50 grams/day (about a quarter cup) intake of white rice with the same amount of brown rice was associated with a 16% lower risk of type 2 diabetes, whereas the same replacement with whole grains as a group was associated with a 36% lower diabetes risk. Brown rice is rich in fiber and vitamins, but the process that converts brown rice into white rice destroys 67% of the vitamin B3, 80% of the vitamin B1, 90% of the vitamin B6, half of the manganese, half of the phosphorus, 60% of the iron, and all of the dietary fiber and essential fatty acids. So whenever possible, enjoy the benefits of whole grains by choosing brown rice over white.

Click here to read the full U.S.News & World Report article:  http://www.usnews.com/health/diet-fitness/diabetes/articles/2010/03/03/whole-grains-take-a-bite-out-of-type-2-diabetes-risk.html

Click here to read more about the benefits of brown rice: http://www.whfoods.com/genpage.php?tname=foodspice&dbid=128