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Parenting Tips You Need To Know The Top 10 Mistakes Even Smart Moms Make

Whether you’re a new mom or the leader of a pint-sized brigade, it’s hard keeping up with all the do’s and don’ts of motherhood. Here are the 10 biggest mistakes parents make and how to avoid them… We like to think of ourselves as the best moms – ever. But even when we think we’re doing everything right, we’re not. Here are 10 of the biggest mistakes made by savvy moms and first-time moms alike: 1. Sharing a bed with baby. Bonding, breast-feeding, or 2 a.m. bottles and diaper changes are much easier when Junior is next to you at night. But you may be putting your child at risk. Bed-sharing is becoming more common in the U.S.: The number of babies who cuddle with their parents at night more than doubled (from 5.5% in 1993 to 12.8% in 2000), according to the National Infant Sleep Position Study. Infants who sleep in their parents’ beds, however, are 40 times more likely to suffocate than those who don’t, according to a 2003 St. Louis University study. Why? Babies may be smothered by the bedding, a parent rolling on top of them, or getting trapped between the mattress and the wall, headboard and/or footboard. One way to co-sleep safely (especially during baby’s first year) and be a better parent is to park the crib or bassinet next to your bed. Make sure it has a firm mattress with a fitted sheet but no other bedding. No pillows or stuffed animals – they’re potential hazards. Don’t allow loose blankets either, because they can easily cover the baby’s face. Instead, use warm sleep sacks, with holes for head and arms. And of course, always put infants to sleep on their backs to reduce the risk of Sudden Infant Death Syndrome (SIDS). 2. Putting your child to bed with milk or juice. This is the perfect setup — for cavities, says Michael Ignelzi, a Greensboro, N.C., dentist and orthodontist and spokesman for the American Academy of Pediatric Dentistry. When kids sip milk or juice all day long or even just at night, cavity-causing bacteria in the mouth convert the beverages’ sugars into tooth-decaying acid. How serious can it be? Recently, Ignelzi put four crowns into a 23-month-old boy’s mouth. The toddler had been drinking milk every night for his entire life, he says. “The milk sugars had rotted his top front baby teeth down to the nubs.” So limit milk and juice to meal or snack times because then “you have a lot of salivary flow, which neutralizes the acid,” Ignelzi explains. Between meals and at night, there’s not a lot of saliva, and “the acid attacks for hours.” 3. Buying second-hand toys or baby furniture. In a down economy, who could blame a mom for trying to save a few bucks by picking up gently used items at a garage sale or on Craigslist? But before you snap up that bargain, check Recalls.gov. This government-based clearinghouse for product recalls can tell you if the toy you’re eyeing is hazardous. Manufacturers get a dismal return on many recalled children’s products. “Most recalled products are still out there, and people are unaware that the product their child is using is potentially lethal,” says Gary Smith, M.D., director of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio. 4. Showing your child “smart baby” DVDs. Do you feel less guilty and maybe even think you're being a better parent by letting your tot watch Brainy Baby and Baby Einstein DVDs? It’s OK, you rationalize, because the programs give kids a leg up on education. That’s not what research shows. Instead of boosting Susie’s language skills, the programs seem to hinder them. For every hour babies spent watching such educational DVDs, they knew 6-8 fewer words than babies who didn’t view them, according to a 2007 University of Washington study. Another 2009 UW study found that when the TV is on, even in the background, parents interact less with their children, which also holds back language development. In fact, for every hour the TV is on, babies hear about 7% fewer words. So forget the DVDs and turn the boob tube off. Invest in old-fashioned building blocks instead. Another 2007 UW study found that toddlers who play with blocks have 15% bigger vocabularies than kids who don’t. 5. Putting kids in the basket of a shopping cart. Supermarket shopping carts don’t look dangerous. But each year about 20,000 kids end up in emergency rooms because they tip over or fall out. “The basket is absolutely the worst place” for a child to ride, Smith says. “A kid’s center of gravity is up around the chest and when they reach for something on a shelf as you’re passing by, they just go over the top.” A safer way to shop with your youngster? Choose a bulky, tough-to-steer cart, preferably one with a seating space low to the ground. They’re less likely to topple and a child is closer to the floor in a fall. 6. Sharing utensils with your child. There isn’t a mom who hasn’t dipped a spoon into hot oatmeal to test the temperature, then used that same spoon to feed her tot. Or who hasn’t scooped up a dropped pacifier, given it a quick lick to “clean” it and then popped it back in Janie’s mouth? Not so fast. These are perfect ways to pass the cavity-causing bacteria (and other germs) in your mouth to your baby, says dentist Ignelzi. A cleaner idea: Taste with one spoon and feed with another. And wash off or use a wipe to clean pacifiers. 7. Delaying or avoiding vaccines. Some parents — like celebrity Jenny McCarthy — refuse to give their children vaccines for measles, mumps and rubella (MMR) because they believe they cause autism. Another trend is ignoring the vaccine schedule recommended by the Centers for Disease Control and Prevention and using an “alternative” spaced-out timetable instead. The claim? It’s safer. Actually, it’s a life-threatening mistake. Delaying vaccines leaves your child open to “serious, preventable diseases at the most vulnerable time in their lives, in infancy,” warns Christopher Tolcher, M.D., an assistant clinical professor of pediatrics at UCLA and a spokesman for the American Academy of Pediatrics. For starters, skipping the MMR won’t prevent autism, says Paul Offit, M.D., chief of infectious diseases at Children’s Hospital of Philadelphia and author of Autism’s False Prophets: Bad Science, Risky Medicine and the Search for a Cure (Columbia University Press). Studies of thousands of children have shown that they can develop autism whether or not they’re vaccinated. Second, refusing the MMR vaccination increases the odds that a child will get measles — still a leading killer of kids worldwide — by up to 35 times. In 2008, when the U.S. experienced its largest measles outbreak in a decade, nearly half the 131 sickened kids were unvaccinated. Do you worry that giving too many vaccines at once taxes a baby’s still-developing immune system? That fear isn't supported by science, Tolcher says. “What babies get in the vaccines pales in comparison to the amount of microorganisms and environmental contaminants that go into their mouths every hour of the day.” 8. Leaving your child alone in the car “just for a minute.” Your toddler just fell asleep in the car and you have to pick up milk before you go home. You’ll be fast, you think. What’s the harm? It’s more dangerous than you think. About 36 young children die each year because they were left alone in a hot car. In about 18% of cases, the child was intentionally left behind while the parent ran an errand. “People don’t realize how quickly a car heats up,” Smith says. Even on a mild day, the temperature inside a parked car can jump 19 degrees above the outside air is — in just 10 minutes. “Within 20 minutes, it’s like an oven,” he says. Because their bodies heat up about three to five times faster than adults’, it doesn’t take long for an infant or toddler to get heatstroke. And that can be fatal. 9. Skipping helmets on tricycles rides. A fall from three to four feet can cause serious injury, even if the child isn’t pedaling. “Children on wheels above a hard surface need to wear a helmet,” Smith says. “It doesn’t matter if it’s four wheels, three wheels or two wheels.” Need another reason to insist on the helmet? It can be habit-forming. Kids who wear helmets when they’re pedaling a trike are more likely to wear them when they’re older and riding bikes or doing tricks on a skateboard or scooter. “It’s like wearing a seatbelt in the car,” Smith says. “You start early and consistently enforce the behavior.” 10. Leaving your child alone in the bath or shower. About 100 children under 5 years old drown each year in the bathtub, usually because a parent or babysitter steps away for a few minutes. “Young children need to have constant supervision in and around water. Period,” Smith says. “You should be able to reach out and touch them.” Another hazard: slips and falls. Research from Smith’s center shows that more than 43,000 kids get hurt in bathtubs and showers each year. Are You A Good Mom? Being a good mom means more than baking cookies and joining the PTA. But sometimes a busy schedule and not enough "me" time gets in the way of being the best mother you can be.

How to Beat the Blues: A Doctor's Tips Recommendations for Recognizing and Dealing with Depression

If you were clinically depressed, would you know it? Depression is easy to confuse with PMS – and thus ignore. We talked to depression expert and psychologist Carol Landau, Ph.D., to find out the symptoms of true depression and how to beat the blues… Feeling down? You’re not alone. Women are twice as likely as men to suffer from depression. In fact, 20%-25% of American women will fall into a depression in their lifetimes, says Carol Landau, Ph.D., a clinical psychologist and professor of psychiatry and medicine at Alpert Medical School, Brown University. Landau ought to know. She’s one of the leading experts in the country on women and depression. Co-founder of Women’s Health Associates medical practice at Brown University, she has written about the disorder and menopause in medical journals and books. She’s now working on a new book, Midlife Mood Matters: An Exploration of Depression in Women. We sat down for a one-on-one with Landau to find out how depression can affect you. Plus, get her expert tips on dealing with depression. How do you know if you’re just sad or seriously depressed? Sadness is normal and happens to everybody. Depression is a specific clinical condition [that affects your body, mood and thoughts]. To be diagnosed with depression, you have to feel extremely sad or have lost interest in life, and you must experience 4 out of the 7 following symptoms nearly every day and for at least two weeks. Increase or decrease in weight or appetite without conscious dieting Insomnia or excessive sleepiness Agitation or lethargy and difficulty getting out of bed Loss of energy and fatigue nearly every day Feelings of worthlessness or inappropriate guilt Difficulties concentrating, thinking or making decisions Recurrent thoughts of suicide Why is depression more common in women? A lot of women are sensitive to shifts in hormones, so they might suffer from a mood disorder postpartum [after giving birth] and perimenopause [the time just before menopause]. But women are also more sensitive to stress, which is a big factor in depression, especially if they’re living in difficult situations. Why does stress affect women more? Women and men deal with stress differently. Men will engage in an activity. They distract themselves. Of course, they’re not really doing something about the stressor – they just do something else. Women, on the other hand, start brooding: What did I do wrong? How should I have handled it differently? We want to talk about things and will replay interactions in our minds. We’re the ones up worrying at night and that makes them vulnerable to depression. Are other female traits linked to depression? Many women I see in therapy have “selfless syndrome,” a cluster of traits and a sense of self based on meeting others’ needs. Women who fall into unhealthy care-giving situations often suffer from selfless syndrome. They believe their problems result from a failure to relate with enough sensitivity to other people. They often need a lot of supportive and marital therapy to overcome excessive selflessness. As sex roles have evolved, I’ve also seen men who are overly selfless. They, too, tend to be prone to depression. We need to realize that all of us have needs and require reciprocal relationships. What role do hormones play in depression? Many women suffer from premenstrual dysphoric disorder (PMDD), which is similar to premenstrual syndrome (PMS) but more severe. In the 10 days or so before their periods, women are moody, angry and sad. They have low energy and disturbed sleep. Unlike PMS, PMDD symptoms are so bad that they interfere with daily functioning. Women with PMDD are at risk for postpartum and major depression. Do hormones affect our moods during menopause? Actually, women are more likely to have depression during perimenopause, the 2-3 years before their periods end. They’re even more vulnerable if they suffer from hot flashes and night sweats for an extended time. Many believe the resulting sleep disturbance and hormonal disruption trigger depression. So basically, untreated prolonged hot flashes can be as much a risk for depression as severe stress. The American Congress of Obstetrics and Gynecology (ACOG) is very concerned about postpartum depression (PPD). Why? Every year, up to 15% of new moms develop PPD, which is similar to major depression except it usually happens in the months after delivery. PPD is so hazardous because it can affect the bonding relationship [and, ultimately, the baby’s health]. But many PPD cases are confused with the exhaustion that comes from having a new baby. It’s also tough to diagnose PPD because more than half of new moms suffer from “baby blues,” which occurs only in the two weeks after you have a baby. PPD, on the other hand, can occur within the year after giving birth – though it’s usually in the first six weeks after delivery – and can affect your ability to function. Can medications cause depression? Absolutely. Many medications, such as hormones and those used to control or treat high blood pressure, Parkinson’s disease, mononucleosis and stroke – to name a few – can cause depression. That’s a big reason why you should see your primary-care doctor if you’re depressed. Your doctor can clarify if your depressed mood is medically related. How is depression treated in women? Moderately or severely depressed women are usually prescribed a combination of antidepressant medications called selective serotonin reuptake inhibitor, or SSRI, and psychotherapy. But we’re also using SNRIs - serotonin-norepinephrine reuptake inhibitors, such as duloxetine (Cymbalta) and venlafaxine (Effexor) - which are less likely to reduce libido than SSRIs. Are they effective? Recent media reports have suggested antidepressants don’t work and it’s simply a placebo response. But I’ve seen too many people benefit from them to believe that. Women who don’t respond to one antidepressant therapy may receive another medication to enhance the effect of the antidepressant, including buspirone (Buspar), lamotrigine (Lamictal), lithium or anti-seizure medications. What are the latest treatments? We’re also seeing a return of electroconvulsive therapy [also known as electric-shock therapy]. It isn’t as traumatic as what we saw in the movie “One Flew Over the Cuckoo’s Nest” and it seems to be effective for treatment-resistant depression. But I’m concerned about its impact on memory. More promising for resistant mood disorders is vagus nerve stimulation, which delivers an electrical impulse to the left vagus nerve in your neck and, in turn, affects mood centers in your brain. How does therapy fit in? Therapy is critical. Most people with depression might try psychotherapy for eight weeks before taking an antidepressant – as long as they’re not suicidal or very severely depressed. One of the best is cognitive behavioral therapy (CBT) because it lasts longer than the effects of medication – you’re actually changing the way someone thinks. Another effective treatment is interpersonal therapy, in which the therapist challenges the patient’s irrational ideas and gives homework assignments on ways to correct thoughts. It involves bringing in family members and improving social relationships with new conflict resolution strategies and changing social roles. It hasn’t been evaluated as thoroughly as CBT. If you’re battling depression, consider joining a support group too. And don’t just do it online. A lot of support groups provide good information and you need that face-to-face interaction, which can help improve mood. Why don’t more women get treatment? Many lack access to medical care. Even women with insurance have poor access. Many are underinsured with a $5,000 deductible. So if you break your ankle, you’re more likely to get care. If you’re depressed, you’re more likely to feel you should just pull yourself together. How can women avoid depression? Start by getting a handle on stress, which is often easier said than done. Exercise regularly. Physical activity won’t treat major depression, but it can [reduce stress] and definitely help you feel better. Avoid drinking alcohol in excess and taking prescription tranquilizers such as clonazepam (Klonopin) or lorazepam (Ativan), which can make sadness and anxiety worse. Make time for friends. A study of inner-city women in the 1970s found that women who had just one confidante were less likely to have depression. And talk to your primary-care physician if you don’t feel right – he or she can rule out medical causes. Learn more about Landau’s work on depression and women’s health on her website, www.carollandau.com.

9 Top Rosacea Triggers and How to Tame Them Red, Ruddy or Dry Skin? Get Solutions to Rosacea's Symptoms

Just when your rosacea is under control, those red bumps and rosy glow appear out of nowhere. What caused this sudden outbreak? That hot bubble bath or can of soda could be to blame. Here’s how to tame the top 9 rosacea triggers... You really want to order that glass of wine. Or just spend a hot day outside in the sun. But if you’re one of 14 million Americans with rosacea, you know what will happen if you do: Your face reddens with bumps and pus-filled pimples. Eyes tear and eyelids swell; then the itching starts. These are classic symptoms of the chronic inflammatory skin condition. At first you may just blush easily. But if left untreated, blood vessels can show up like lines of red ink. Remember old-time actor W.C. Fields? His ruddy skin, bulbous nose and spidery veins were partly due to an extreme case of rosacea. Fields' skin problem affects men 25 times more than women, says dermatologist Charles E. Crutchfield III, M.D., medical director of Crutchfield Dermatology in Eagan, Minn. Experts don't know what causes the disorder. It’s common in people with fair skin – especially people from Scotland, Ireland and England – and typically affects men and women older than 30. And if your parents had it, there’s a greater chance you’ll get it too. It’s important to get “rosacea under control and keep skin clear so you don’t have those secondary side effects,” says Bruce Katz, M.D., director of the Juva Skin & Laser Clinic in New York City. “It’s not a dangerous condition and not a hard one to control.” But it's a challenge, because many factors set off a red skin response and they vary from one person to the next. “Rarely is everyone [set off] by everything on the list,” Crutchfield says. Stress can set off an outbreak in some; others by favorite indulgences, like a hot bath, big mug of coffee or a long run. “The key is to find out which triggers are yours, so you can avoid them,” Crutchfield says. Here are 9 common rosacea triggers and natural tips to combat them: 1. Spicy foods Hot peppers topped the list of trigger foods, according to a 2003 survey of 502 women with rosacea by the National Rosacea Society. Mexican-style foods, such as hot salsas, ranked second, followed by chili, hot sausage and Cajun foods. Even horseradish and vinegar can bring on scarlet in some. Rosacea tip: Don’t worry, you’re not doomed to bland meals. “Try spices, like Mrs. Dash [salt-free seasoning blend], that add flavor but not extreme spiciness,” Crutchfield says. In recipes that call for red pepper or chili powder, substitute 2 parts cumin and 1 part oregano. Other flavor boosters: Swap out a spicy salsa for a refreshing fruit salsa with peaches, raspberries, orange juice, chopped mint, a pinch of cinnamon and a splash of balsamic vinegar (skip the last ingredient if it causes inflammation). 2. Hot beverages That grande latte will give you more than an energy boost. “Having a hot cup of tea or coffee causes your blood vessels to dilate, so you get flushing,” Katz says. Rosacea tip: Let steamy drinks cool down to room temperature before sipping – or order them iced. 3. Stress According to a 2001 survey by the National Rosacea Society involving 700 people with the disorder, 91% said that emotional strain was a rosacea trigger. Although the link between rosacea and anxiety isn’t clear, experts, including Katz, often point to the “target organ” theory: Some people hold stress in their stomachs or get migraines. Others get rosacea’s red glare. Rosacea tip: In the survey, 83% of those who used stress management techniques reported fewer outbreaks. When you feel stressed, the National Rosacea Society suggests you take a deep breath to the count of 10, then breathe out slowly, also counting to 10. Repeat until you feel calmer. Or practice visualization: Close your eyes and picture a scene you love – a beach, picnic spot, your patio – and sit quietly for several minutes as you do. 4. Hot baths Soaking in the tub feels wonderful on a chilly day, but not if you have rosacea. Hot baths set off outbreaks in 53% of those surveyed in a 2010 National Rosacea Society survey of 424 patients. Why? The hot water makes blood vessels dilate, triggering red skin, says Doris Day, M.D., a New York City dermatologist and author of Forget the Facelift (Avery). Rosacea tip: Keep your bath water about body temperature or cooler. But don’t go cold: Your skin doesn’t like temperature extremes. “The water should be as cool as you can stand,” Day says. “You shouldn’t have to acclimate to it.” And skip the heavy scrubbing – it can further irritate your skin. Use a soft cloth and a gentle hand. 5. Strenuous exercise Don’t stop exercising – just be mindful of how you do it. Rosacea tip: To avoid a flare-up, follow these doctor-recommended tips to keep your temperature under control when exercising: Warm up for 5 minutes by stretching and lifting light weights before you pick up the pace. Exercise in the early morning or evening when weather is coolest. “Or exercise in an air-conditioned room,” Day advises. That means you can still go for that long run on hot days, as long as you do it on a treadmill at the gym. Work out more often but for shorter periods. Stay cool by drinking cold water while you exercise. 6. Alcohol There’s no truth to the myth that too much booze causes rosacea, but alcoholic drinks, particularly wine, make blood vessels open and skin flush, says Crutchfield. Plus, drinks are dehydrating, which shrinks pores, making it easier for them to clog. (Clogged pores are the first step toward rosacea blemishes and infection.) Alcohol is also a triple threat because it leads to poor sleep, which increases stress, and that can trigger rosacea. Rosacea tip: It’s best to avoid alcoholic drinks if you want to avoid ruddy skin. But having rosacea doesn’t mean you have to be a complete teetotaler – if you’re willing to accept the consequences. “I have several patients who say that on New Year’s Eve or on their birthday, they’re going to have a glass of champagne,” Crutchfield says. “It’s a risk that at times they’re willing to accept.” And sip water to keep from getting dehydrated, further subduing this rosacea trigger. 7. Extreme hot and cold weather Just like steamy beverages, a hot, sunny day can dilate blood vessels, leaving you rosy-cheeked. Actually, the sun is a double whammy, because sunlight irritates the skin of as many as 61% of rosacea sufferers, according to the non-profit International Rosacea Foundation. Cold weather is not much better because pores can clog more easily. Rosacea tip: Stay as close to 70˚-80˚temperatures as much as possible. “When you go out in cold or windy weather, put on a jacket and scarf to avoid getting too cold,” Day says. If you’re sensitive to sunlight, wear sunscreen, sunglasses and a hat year-round – and stay in the shade as much as possible, she adds. 8. Dehydration We’re made up of at least 50%-60% water, Day points out. “One important function of skin is temperature and water balance,” she says. Drinking water helps wash out toxins that otherwise clog your skin. Rosacea tip: Stay hydrated. Choose icy water to cool your system and keep blood vessels from dilating, the reason behind your red skin. 9. Stimulants Rosacea’s ruddiness is another good reason to cut down on caffeinated drinks, cigarettes and excessive sugar: All expand blood vessels and bring on that ruddy skin. They also make you sweat more, which clogs pores, and increases stress by revving up your nervous system. Even artificial sweeteners like aspartame can activate a flare-up. Rosacea tip: Reducing stress can help cut cravings for guilty pleasures. “People tend to have more stimulants when they’re stressed – and stress is itself a stimulant,” Day says. If soda is the culprit, switch to caffeine-free to see if it’s sugar or caffeine that’s aggravating your condition. “Caffeine may not be a trigger for everyone with rosacea,” Day says. “But if you notice that it makes you red or flushed, [cut back].” Health writer Dorothy Foltz-Gray is a frequent contributor to Lifescript. For more information, visit our Skin Heath Center. Are You Skin-care Savvy? The skin is a living, breathing organ, and what you don't know about taking care of it could keep your complexion from looking fantastic. If your skin-care knowledge could barely fill a pillbox, you need a refresher course.

How Diabetics Can Reduce Cholesterol Tips From Dietitians to Lower Fat and Improve Health

Love to snack and eat out? Hey, who doesn't? But those habits pack on pounds – and add up to elevated cholesterol, a particular problem if you have diabetes and a high risk of heart disease. We asked the nation's top dietitians how changes in diet and lifestyle may help tame high cholesterol. Read on for their easy tips... If you have diabetes, your daily routine is filled with numbers. Besides taking blood sugar measurements several times a day, you have to count calories and carbohydrates. Add in one more figure to monitor closely: your cholesterol levels. That's because people with diabetes often have low levels of (good) high-density lipoproteins (HDL) and higher levels of (bad) low-density lipoproteins (LDL). This raises your risk of heart disease and makes you more likely to die from coronary disorders, like heart attack, stroke or atherosclerosis. "Research clearly shows that cholesterol leads to formation of plaque, the substance that blocks arteries," says Prediman K. Shah, M.D., director of the cardiology division at Cedars-Sinai Heart Institute and Medical Center in Los Angeles. People with diabetes should maintain an LDL of less than 100 mg/dl [or milligrams per deciliter] and an HDL of higher than 40 mg/dl for men and 50 mg/dl for women, advises the American Diabetes Association. Chronic elevated cholesterol levels can lead to a condition called diabetic hyperlipidemia. Taking statins, lipid-lowering drugs that are widely prescribed, is one easy way to control cholesterol. But you can also tackle the problem by watching how much fat you eat. For example, "limit eating out and look at labels and calories," says Elizabeth Caetano, R.D. "More than likely, if you look at calories, you’ll lower your fat intake." Also, cut back on the amount of fat you use as an added ingredient or in cooking, says Kristine Clark, R.D. and Director of Sports Nutrition at Pennsylvania State University. For more fat-trimming tips, we spoke to Clark and some of the nation's top dietitians at the American Dietetic Association's (ADA) Food and Nutrition Conference in San Diego. Read on for their advice on how to cut fat if you have diabetes or just want to eat healthier. Reduce Cholesterol Tip #1: Ditch fried foods. Fried foods are "the most potent source of fat in people’s diets," warns Pamela Nisevich Bede, R.D., Dayton, Ohio. "Frying means you submerge a food in hot fat," Clark says. So avoid most deep-fried fast foods and sides like onion rings, French fries and crackers, which are high in fat and calories. Reduce Cholesterol Tip #2: Eat lean protein. The easiest way to decrease fat is not to eliminate but limit the fatty meats you eat, says Brierley Wright R.D., Burlington, Vt. Read labels on meat packages, advises Amy Galena R.D., of Weight Management and Eating Disorders, Baptist Medical Center, Jacksonville Beach, Fla. When buying meat, "look at the meat for the marbling – the white lines in the red meat," she says. "Look for cuts that have less marbling" because they have less fat. And choose cuts like beef rounds or ends. "The top rounds are going to be the leanest," Galena says. Other tips to lower cholesterol: Choose white meat pork over red meat pork. Trim fat off the meat. When you cook it, drain the fat. Have low-fat poultry and beef and eat more fish, "which has healthy fats," says Collette Roney, R.D., Washington, D.C. "Bake, broil, roast or grill meat and even vegetables," Clark says. "You’re going to save a lot of fat calories." Reduce Cholesterol Tip #3: Choose low-fat dairy. “Choose low-fat or fat-free dairy products, including cheese and milk,” advises Clark. For example, eat 2% fat, skim or non-fat milk with cereal. That includes your morning latte. "If you love flavored coffee drinks, ask for nonfat milk and hold off the syrups," she says. "A tablespoon of chocolate syrup is 50 calories," and some coffee drinks with chocolate contain as much as 1/4 cup (200 calories), she says. Reduce Cholesterol Tip #4: Replace butter with plant-based or fruit spreads. “Just put honey, jelly or apple butter on bread,” Clark says. “You’re getting moisture and enhancing the taste of the toast, but avoiding fat completely.” She also recommends olive oil-based spreads. "You can use those as butter or margarine replacement, and they actually have plant esters in them that can lower cholesterol," she says. Reduce Cholesterol Tip #5: Eat more fruits and vegetables. "They’re naturally low in fat," Wright says. "If you fill up on those, you’re less likely to want desserts." Reduce Cholesterol Tip #6: Watch out when dining out. Restaurants are potential minefields when you're trying to cut back on fat and calories, nutritionists warn. That's because "you just don't know what you're getting in restaurants," says Manuel Villacorta, R.D., spokesperson for ADA, San Francisco, Calif. Even healthy entrees may be fattening, he says. So ask your server about how the food is prepared and "find out the definition of healthy." Watch out for supersized portions too. For example, "you’re not going to see [meats] the size of a deck of cards on a plate" in a restaurant, Galena warns. "You’re going to see a piece a lot bigger." Extras also can spell diet trouble. When eating out, follow the “restaurant rule of two” and “eat only two additional items” besides your entrée, advises Brian Wansink, Ph.D., author of several books on eating habits and diets, including Mindless Eating: Why We Eat More Than We Think (Bantam). “It can be the bread and dessert or it can be an appetizer and a glass of wine, but not two pieces of bread and coffee and dessert." Other tips to lower cholesterol: If you don't take the time to pack lunch in the mornings, you could be unknowingly boosting fat and calorie intake. "Stop eating processed takeout food," says Maria Pari-Keener, R.D., New York City, N.Y. "Salads can be the worst meal," Villacorta says. "Look at the ingredients. If you have cheese, avocado, nuts, cranberries, sautéed onions, bread crumbs, seeds – all that adds up. Start making choices like, Maybe I should cut out the cheese but leave the walnuts." Reduce Cholesterol Tip #7: Watch portions. Dietitians liked the visual MyPlate portion guidelines revised by the U.S. Department of Agriculture in 2011. "If you eat that way, having fresh fruits and vegetables, you're probably going to hit your mark," says Stephanie Bess, R.D., Springfield, Ill. For foods like steaks or lean beef, stick to 3 ounces. "An extra 2-3 ounces of meat a day is a lot of extra fat," says Jim White, R.D., ADA spokesman, Virginia Beach, Va. Reduce Cholesterol Tip #8: Be smart about desserts. You don't have to give up all desserts. In fact, there's room for indulgences. "Have the full-fat item but don't have it often," says Pari-Keener. "If you want to enjoy cheesecake, you can have it now and then. "But be wary of mini desserts, says Galena. They're small but deceptive. "Even though it’s a shot size or says 'mini dessert,' they pack a punch," she says. "Two mini desserts could add up to 500 calories." Another sweet diet derailer: high-fat pastries. "Go with the lower-fat versions," White says. Another tip to lower cholesterol: “Have fruit for dessert or low-fat frozen yogurt,” says Galena. Reduce Cholesterol Tip #9: Don't give up fats entirely. Don’t fear fat. "Fat tastes good," Galena says. "Don’t deprive yourself; you’ll be depressed by the end of the month." Besides, "fat can really help you when you're trying to diet," she says. "If you eat enough, it satisfies you and keeps you full longer." About 30% of your calories should come from fat," says Lea Russell, R.D., St. Petersburg, Fla. But make sure it’s healthy fat. For example, "nuts are high in calories but they're an important fat," she says. Also watch how much you nosh on nuts. Just 6-9 of them is a serving size. "People like to eat nuts but they consume them by handfuls as many as two, three and four times a day," Villacorta says. "That's a high fat intake." Reduce Cholesterol Tip #10: Heart-healthy fats are better, but don't overdo them. Fish and plant-based foods provide important omega-3 or heart-healthy fats. You can find them in salmon, mackerel, sardines, herring, anchovies, caviar and white albacore tuna canned in water or canola oil, flaxseed oil, walnuts and dark green, leafy vegetables. Eat monounsaturated fats found in most nuts, avocados and olive oil. But don't go bananas over your fats. “Heart-healthy fats don't mean 'all you can eat,’” Villacorta advises. "You still need to watch your portions. A teaspoon of oil is a serving size. One-eighth slice of an avocado is a serving size." Other tips to lower cholesterol: If you know you’re not going to eat for a long time, make a peanut butter and jelly sandwich. It’s the last thing to get digested in your stomach, Galena says. For a filling breakfast, have an egg, peanut butter, cheese and nuts. You can even use light cream cheese on a bagel. For more information and expert advice, visit our Diabetes Type 2 Health Center. How Well Do You Understand Cholesterol? Cholesterol is much maligned, yet many people don’t understand this essential substance and how it works in our bodies. Do you know your HDL from your LDL?

Happily Married? It’s Good for Your Health

Happily coupled people stress less, have lower disease rates and enjoy other health perks. Find out why a loving union makes for a longer, fitter life... Along with china, kitchen gadgets and tax breaks, saying “I do” can also bring big health advantages. “Across every major category of illness and mortality, married people fare better than the unmarried – not just in the U.S., but internationally,” says Joseph Hullett, M.D., of OptumHealth Behavioral Solutions in San Juan Capistrano, Calif. Besides a possible boost in your standard of living, a joint household can mean less financial stress and greater odds of having health insurance. Money aside, marriage comes with a priceless gift: better health, according to a wide variety of studies. But just having the license isn’t enough; it’s the quality of the relationship that’s key. Women in troubled marriages suffer greater health problems than singles do. Here's how tying knot delivers more than monogrammed towels. You live a healthier lifestyle When women find mates, they spend less time at the late-night bar scene with a martini and cigarette. Compared to singles, married people are less likely to smoke, drink heavily or use illegal drugs, according to studies compiled by the Centers for Disease Control and Prevention (CDC). Plus, monogamy reduces the risk of sexually transmitted infections, since you won’t be going home with a guy you just met. You’re also less likely to participate in risky activities. “Married people tend to think twice before going bungee-jumping or sky-diving,” says Jay Kent-Ferraro, Ph.D., a psychologist in Tulsa, Okla. Mate-less people are more unstructured: “They don’t eat as well or go to bed at the same time [each day],” says Jennifer Freed, Ph.D., a marriage and family therapist in Santa Barbara, Calif. “All those have been proven to be calming to the [body].” But there’s a downside to marriage’s stability: weight gain. Happily attached people are three times as likely to be obese as dating couples, according to a 2009 University of North Carolina study. It’s because they’re spending more time watching TV and less working out, according to a 2010 Greek study that followed 17,000 couples. Still, committed partnership gives you a diet advantage. When you make a pact with your husband to slim down together, “you’ll be more successful than if you try to do it alone,” Freed notes. Someone has your back Having a spouse means there’s someone to remind you to take vitamins or get a mammogram. He’s also an extra set of eyes to notice your health changes. “Your partner sees things you may not see,” Freed says. “I knew a woman who had been having mysterious chest pains, and her husband said, ‘Let’s go check this out.’ ” Sure enough, one of her heart valves needed repair. Wedded people also spend less time in hospitals. “If a married patient has a complicated medicine regime, the partner can help handle it,” says psychiatrist Scott Haltzman, M.D., author of The Secrets of Happily Married Women (Jossey-Bass). Your partner may even help you recover from a life-threatening illness, he says. “Your ability to recover is tied to the idea that you’ve got a meaningful connection to another human being.” Indeed, a nine-year Japanese study of more than 94,000 people, published in 2007, found that a married woman’s risk of dying from any cause is half that of a single. Marriage even lowers crime risk. Coupled or married women are 3-4 times less likely to be crime victims than single, separated or divorced females, according to the National Archive of Criminal Justice Data’s Crime Victimization Survey. Having a partner shields them from dangerous experiences and situations, Haltzman says. You have less stress Chronic stress can lead to or exacerbate just about every kind of health problem, including heart disease, stroke and cancer. Stress raises blood pressure, disrupts sleep, impairs immune function and raises the risk of obesity. Plus, stressed people often fall back on bad coping mechanisms such as smoking, drinking, overeating and using drugs, which further erode health, notes Elizabeth Lombardo, Ph.D., a psychologist and public speaker on stress control. “We’re also less likely to exercise when we feel down or distressed,” she says. Having a partner to talk and laugh with – and lean on – eases burdens. In a 2007 study of 400 nurses, British researchers found that those in long-term relationships were far less affected by job stresses than singles. A woman needs to be listened to, Freed says. “In a healthy marriage, you have a regular listening partner who knows you well enough to understand your concerns,” he says. “Having somebody to check in with and talk through stressful issues has been proven to be very helpful.” A study from the University of the West of Scotland also revealed that people who had sex at least once in two weeks were better able to manage stressful situations. But there’s a catch... Marriage only buffers stress if your union is fairly happy. Unhappy relationships with a lot of conflict and hostility hurt health. That’s especially true for women, because the physical effects of tension – elevated stress-related hormones, higher blood pressure, faster heart rate and depressed immune function – linger longer in females than in men. The effects aren’t minor. In a 2009 University of Manitoba (Canada) study, depression rates were nearly three times higher among unhappily married women as those who were blissfully wed. Marital discord has a physical toll too. A 2000 University of Texas study found that people at risk for diabetes were twice as likely to develop the chronic disease in stressful marriages. And several Ohio State University studies showed that couples who don’t fight fairly – for example, they’re disrespectful, mean-spirited or call each other names – have lower immune function, slower recuperations from surgery and delayed wound healing, making them more vulnerable to illness. Every couple fights, but when there’s respect – and less negativity, rudeness and condescension during an argument – “you have better immune function,” Lombardo says. A stressful marriage also increases risk for cardiovascular diseases. In a 2010 Brigham Young University study, unhappily married couples had higher blood pressure than the unwed. Couples in marital bliss had lower readings than singles. When researchers at San Diego State and University of California, San Diego, examined 400 participants in a long-term women's health study, they found that unhappily married women developed more arterial plaque than happily married females, and more heart-disease factors than singles: lower levels of HDL (“good”) cholesterol and higher LDL (“bad”) cholesterol, as well as higher blood pressure, glucose and insulin levels. One reason is the chronic stress in their lives. Even more broken-heart evidence: Unhappily coupled women who had had one heart attack had three times the risk for another within five years, according to a 2000 Swedish study. But divorce isn’t the path to better health. In a 2009 University of Chicago study, people who’d lost their spouse to death or divorce had more chronic health problems on average than married or single people. So although marriage can be very healthy for women, choose your partner carefully and put a lot of effort into making it work.

THOUGHT FOR THE DAY...

Love is the ultimate meaning of everything around us. Love is not a mere sentiment. Love is the ultimate truth at the heart of creation.

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Manage Daily Chores with Osteoarthritis Symptoms How to Get Things Done Despite Joint Pain and Stiffness

Cooking, cleaning, gardening, putting away groceries. These daily tasks aren’t always so simple if you suffer from osteoarthritis pain and stiffness. But by taking precautions, you can minimize the discomfort created by common household duties. Read on for expert advice and devices to help you take care of your home and your joints... With severe osteoarthritis symptoms, you can’t take everyday activities for granted. The degenerative condition – in which damaged cartilage leads to joint pain and stiffness – can turn even simple household chores into an uncomfortable ordeal. So how do you handle jobs that others do without even thinking? By using body-friendly movements and labor-saving devices, and pacing yourself, experts say. “You’ll save yourself a lot of pain by performing a task properly,” says David Borenstein, M.D., president of the American College of Rheumatology in Washington, D.C., and author of Heal Your Back (M. Evans & Co.). Osteoarthritis symptoms affect joints from your neck to toes. Before starting a chore, determine if it will involve joints that give you the most trouble, he says. If you’re prone to osteoarthritis knee pain, for example, it may flare during tasks that require walking or kneeling. Shoulder pain is more likely to kick in when reaching for items, for example, while cooking, sweeping or mopping. But osteoarthritis pain shouldn’t mean shirking chores entirely. Staying physically active – not just with traditional exercise but also by doing household tasks and gardening – helps your body handle everyday movements more easily, according to a January 2011 study published in Arthritis & Rheumatism. Read on for tips to getting household tasks done effectively and efficiently, without worsening osteoarthritis symptoms. 1. Prevent arthritis pain when bending. Common chores: Unloading and loading the dishwasher, washer and dryer; washing dishes; picking up items from the floor; making beds; ironing; cleaning under furniture; cleaning low objects such as a sink. When doing repetitive tasks, like loading or unloading the dishwasher, it’s tempting to bend forward at your waist. But that puts pressure on the discs in your lower back, known as “shear forces,” which can contribute to back pain and stiffness. Bend properly: Avoid bending at the waist, Borenstein advises. “Use your hips and knees to lower yourself instead,” he says. Also, don’t bend over repeatedly, says Katrina M. Vlachos, M.D., an orthopedic health and rehabilitation specialist for DISC Spine and Sports Center in Marina del Rey, Calif. “Empty a few dishes at a time and then take a break,” she suggests. “Then take out the silverware basket and empty it while sitting or standing.” Lift things right: “Back muscles are relatively weak compared with leg muscles,” Borenstein says. That’s why you should bend your knees and lift objects with your legs. When lifting a package – for example, a bag of groceries or basket of laundry – hold it close to your body. That brings the weight closer to your center of gravity, resulting in less stress on the back. Also, make sure you know the weight of whatever you’re lifting. “If you think a box is empty and it’s actually very heavy, you can injure your back trying to lift it, resulting in tissue damage,” Borenstein adds. You can also hurt your back if it’s too light. If you think you’re lifting something heavy but the box is empty, you’ll recruit all your muscles to lift it – and all that energy is transferred to your spine, which can also cause a strain, Borenstein says. Keep your body straight while reaching down: When picking up small items off the floor, use what physical therapists call a “golfer’s lift.” Keep both legs straight. As you bend forward, raise the leg opposite your outstretched arm behind you. (Your upper body and outstretched leg will be parallel to the floor, forming a “T” shape with your other leg.) Give it a rest: When cleaning objects low to the floor, limit yourself to 15-20 minutes at a time. Then get up and walk around to keep your muscles from tightening, says Vlachos. 2. Prevent arthritis pain when kneeling. Common chores: Washing floors, cleaning low cabinets, scrubbing tubs and showers. Osteoarthritis symptoms in your knees can make kneeling painful, but several approaches may help. Keep your knees cushioned: “Use soft knee pads,” Vlachos suggests. They’re available in sports, gardening and some hardware stores. Kneel on one knee: Bring the other foot out in front in a modified lunge; switch knees often to minimize pressure. “And use your ‘good leg’ – the one that hurts the least – to lift yourself up when you’re ready to stand,” Borenstein says. Take frequent breaks: Get up and walk around a couple of times each hour to prevent stiffness in your legs, suggests Vlachos. Use ice: If your knees are sore after kneeling, apply an ice pack or bag of frozen peas for 20 minutes to reduce inflammation, Vlachos recommends. Sit when possible: Crouch on a low stool instead of kneeling while gardening, for example, says Borenstein. When gardening, leave enough room between rows of plants for the stool. This also helps you avoid twisting and hurting your back while trying to maneuver between them, Borenstein says. 3. Prevent arthritis pain when reaching. Common chores: Putting on clothes, fixing your hair, reaching for objects while cooking, grabbing items out of kitchen cabinets and shelves. If you’ve noticed osteoarthritis symptoms in your shoulders, reaching overhead to do your hair or take things out of a cabinet can cause more pain and stiffness, says rheumatologist Joseph Markenson, M.D., professor of clinical medicine at Weill Cornell Medical College in New York. “If you have osteoarthritis of the spine and neck with pain that radiates down to your hands, avoid lifting anything overhead,” he advises. That kind of osteoarthritis pain could indicate you’re putting pressure on the nerves. To get things done without lifting or reaching: Make objects easily accessible: Place items you regularly need in a mid-height cupboard or on a counter. Use a step stool: By putting your head at the same height as the object, “a stool improves your mechanical advantage when you’re reaching for something or have to lift it,” Vlachos says. Just make sure the stool is steady and you have something to hold on to. A fall could worsen osteoarthritis symptoms. Use grabbing or reaching tools: These handy gadgets – the PikStik Pro is one example – are often available in housewares stores or online. 4. Prevent arthritis pain when walking or pushing. Common chores: Vacuuming, mopping, sweeping, pushing a lawnmower. Make vacuuming easier: Choose a lightweight vacuum cleaner that requires less dexterity and strength, says Borenstein. And make sure it has an on/off switch you can operate with your foot to avoid bending over. Find a vacuuming technique that doesn’t aggravate your pain points, Borenstein advises. “You may find it’s easier to put [the vacuum] in front of you instead of using it off to the side, where you’re relying more on your arms,” he says. “However, if you have osteoarthritis pain in your shoulders, using it on the side may be a better choice.” Vacuum only a few rooms at a time or per day and take breaks. “Take your time, take small steps and keep the vacuum cleaner close to your body,” Vlachos says. Align your body: Keep your head up and spine straight, with arms in a relaxed position. Switch arm movements often to vary the stress – for example, alternate a side-by-side motion with figure-8s. Use a push broom if you have back pain: This will keep you from twisting your back, which you might do with a flat broom. 5. Prevent arthritis pain when standing for long periods. Common chores: Cooking, folding clothes, waiting in line. Standing in one place for long periods can worsen pain and stiffness, says Vlachos. “It may seem counterintuitive, but movement is actually helpful for easing osteoarthritis pain.” That’s because muscles are contracted when you’re standing, leading to a decrease in blood flow and oxygen (which help reduce inflammation), Borenstein says. You’re also putting constant stress on lower-body joints. To keep your osteoarthritis symptoms in check: Limit standing time: Set a timer to go off every 15-20 minutes. If you’re standing in line, have a friend hold your place. “Walk around for about 5 minutes before going back to it,” Vlachos says. Take a load off: Alternate activities that involve standing with ones that involve sitting to minimize the stress on joints. For example, while preparing food, “alternate chopping while sitting and stirring while standing,” Borenstein says. Keep a stool handy: Stand with one foot on the stool, and alternate feet frequently, says Borenstein. This more relaxed stance will help reduce back pain, he says. Stand softly: Wear shoes with well-cushioned soles and stand on gel or anti-fatigue mats to reduce joint stress, suggests Vlachos. 6. Prevent arthritis pain by giving yourself a break. Don’t take everything on yourself – delegate tasks among family members or ask for help from friends when needed. If you can afford it, hire a professional cleaner to take on difficult jobs. And never do more than your body can handle, Vlachos says. “Even if you’re having a good day, don’t clean your whole house or walk a mile to the store just because you feel you can,” she says. “It’s a surefire recipe for pain.” For more expert advice and information, visit our Osteoarthritis Health Center. Linda Melone, a Certified Strength and Conditioning Specialist (CSCS), writes frequently about fitness for Lifescript. How Much Do You Know About the Types of Arthritis? About 46 million American adults – nearly one in five – suffer from some type of arthritis. It’s estimated that number will rise to 67 million by 2030. Do you or someone close to you have arthritis?

13 Ways to Relieve Chronic Pain What to Do When It Hurts All Over

Need pain relief? Here are 13 prescription and natural remedies you can get at the pharmacy and grocery store. Move over aspirin. When the PMS, migraine or lower back pain gets so bad you don’t want to leave your bed, it’s time to reach for the strong stuff. But which pain med is right for your aching body? Read on for a list of top (sometimes surprising) remedies that can help women get relief. Prescription Drugs Depending on how bad it hurts, the doctor might recommend an anti-inflammatory drug – or deep-acting narcotic to kill the pain and soothe your brain. Here are 8 commonly prescribed remedies and how they work: 1. Celebrex This popular drug reduces inflammation that causes pain. Who’s it for? Widely prescribed for arthritis, back pain, joint pain and chronic disorders, Celebrex usually works within a few days. Watch out: Many people remember Celebrex’s infamous sibling, Vioxx, which was yanked off the market in 2004 because of increased risk of heart attack, stroke and death. Despite its close relation, the Food and Drug Administration (FDA) insists Celebrex is safe. But I advise steering clear of Celebrex if you have high blood pressure or heart disease. Voltaren, Mobic, Motrin and Naprosyn are brands of other anti-inflammatories that have fewer side effects. They seem to be easier on the circulatory system and heart, but cause more stomach upset and ulcers. 2. Ultram Ultram (tramadol) may help if over-the-counter pain relievers don’t work. It blocks receptors in the brain so you no longer feel the pain. Who’s it for? Ultram makes you feel good from head to toe. It works on post-operative and low back pain, osteoarthritis, fibromyalgia and headaches. And it might even make you happy because it boosts a brain chemical called serotonin, which is often suppressed in people who have depression. Watch out: The biggest problem? It may trigger seizures in susceptible people. It’s also habit-forming and shouldn’t be prescribed for people with a history of alcoholism or addiction. Other side effects include drowsiness, dizziness, headache, itching, sweating and agitation. Don’t drink grapefruit juice, which can spike levels of this painkiller. 3. Vicodin or Lortab These narcotics change the way your body senses pain. Stronger versions include Percocet and Percodan. Who’s it for? They relieve moderate aches and pains, and are terrific for headaches, back pain, joint pain and nerve pain. Watch out: Vicodin and Lortab are addictive. They also might make you dizzy, sleepy, nauseated and constipated. You’ll be warned not to drive or operate machinery while taking them. 4. Oxycontin With a super-cool delivery system that uses a tiny mesh inside the tablet, Oxycontin slowly releases medication over 12 to 24 hours. Who’s it for? Oxycontin is one of the big guns in the pharmacy. It’s for people who don’t respond to the regular arsenal of pain drugs, for example, those with very strong cancer pain or severe injuries such as fractures, neck pain and back pain. Watch out: Oxycontin must be swallowed whole. It should never be crushed or chewed – as drug addicts and kids looking for a buzz do. People who do – even by accident – usually don’t live to tell about it. Tampering with the pill releases the entire dose into the body at once. 5. Lidoderm A convenient skin patch, it delivers lidocaine, an anesthetic that numbs the skin. Who’s it for? A Lidoderm patch can be used before a minor medical procedure or before getting a shot. It may also ease back pain, and the burning and stinging caused by shingles. Watch out: Too much lidocaine can stop the heart. Seriously. 6. Lyrica Lyrica belongs to a class of drugs used to control seizures, but it works well to treat pain. Who’s it for? It relieves nerve pain caused by diabetes, shingles, trigeminal neuralgia, as well as other burning and stinging that shoot into your arms, legs, fingers, toes and face. Watch out: Lyrica can make some people confused and sleepy, short of breath and weak. You have to work your way up to the most effective dose and work your way off it. Don’t suddenly stop taking Lyrica. 7. Duragesic This patch delivers powerful pain medication through your skin and into your bloodstream, bypassing the gastrointestinal tract. Unlike Lidoderm, which only numbs the area, Duragesic relieves pain. Who’s it for? It’s reserved for the most chronic, disabling pain – for example, that's experienced by a terminally ill cancer patient. One patch works for three days. Watch out: Side effects include drowsiness, as well as slowed breathing and heart rate. Don’t cut the patches! People have died when the entire dose was released at once. It’s supposed to be delivered slowly. Also, absolutely no alcohol with this one! 7. Botox Yep, I’m talking about Botulinum toxin, the same pretty poison used to smooth out wrinkles. This type, called Myobloc, is injected into the skin where you have pain. Who’s it for? Botox can help relieve migraines, back pain, neck pain and other painful conditions. One series of shots can offer several months of relief. As a bonus, various forms of Botox can treat sweaty palms and armpits. How beautiful is that? Watch out: The most common side effects include pain, tenderness and bruising at the injection site. 8. Steroids Steroids aren’t just for body builders. Prescribed steroids, such as prednisone, methylprednisolone and dexamethasone, control inflammation and pain in the body. But don’t expect to build any muscles; the drugs I’m talking about are strictly medicinal. Who’s it for? Taken orally, these drugs ease arthritis and severe body pain. If your sinus cavities or breathing tubes are inflamed, steroids can be inhaled or squirted up the nose. Watch out: The list of side effects is long and depends on the type of steroid. You may have insomnia, crankiness, constipation, stomach cramps, infections and sometimes psychosis. Natural Remedies You won’t find the following remedies at the pharmacy, but these natural alternatives may offer relief from aches and pains. 1. Pineapples This fruit contains a powerful extract called bromelain, which acts like Pac-Man chomping down dangerous clots and plaques that cause pain and inflammation. Who’s it for? Pineapples or the supplement bromelain can help women who have arthritis or post-surgical inflammation. 2. Crabs and Lobsters Shellfish are rich in glucosamine, which helps build up the squishy cartilage between your joints. Studies have compared natural glucosamine to medicine and guess what? Glucosamine worked better in the long run! Who’s it for? Crabs and lobsters are perfect fare for women with osteoarthritis. 3. Fish Go for the fish that swim in freezing water like salmon, cod and mackerel. Fish or supplements with pure omega 3 fish oils can reduce the amount of nasty prostaglandins, which cause pain and inflammation. Who’s it for? Women with several health problems benefit from a diet rich in fish. Omega 3s not only ease pain, but also relieve constipation and clean up clogged arteries. It’s ideal for people who have pain and heart disease or high cholesterol. You can take it with almost all medications and other supplements. Plus, it has a slight beneficial blood-thinning effect. Fish oils also increase your skin’s suppleness − a cool bonus from these slimy critters. Look for better brands that meet or exceed pharmaceutical standards. 4. Worms More specifically silkworms, but you don’t have to eat them! You’re looking for a supplement with the pain-busting extract serrapeptase, derived from worms. When the silkworm emerges from hibernation as a moth, it produces an enzyme that breaks up the cocoon and works as an anti-inflammatory. Who’s it for? Serrapeptase supplements help women suffering from fibromyalgia, arthritis, bursitis, tendonitis, plantar fasciitis – pretty much any kind of “itis.” The brand Vitalzym X works well because it combines serrapeptase with other natural anti-inflammatories. Vitalzym may also shrink fibroid cysts. 5. Green-Lipped Mussels (Perna Canaliculus) You can eat the little guys if you want, but the pain-relieving quality comes from their extract. Green-lipped mussels are popular in New Zealand, which explains why so few Kiwis have arthritis. The magic in the mussel lies in two primary ingredients: a natural antihistamine and omega 3 fatty acids, which calm inflammation. There’s also a little glucosamine present. Who it can help: Women with asthma, multiple sclerosis and skin problems can benefit. Those with shellfish allergies will want to pass on them. For other ways to relieve pain, look beyond your comfort zone: Consider hands-on healing: hypnosis, transcendental meditation, yoga, massage, chiropractic care and acupuncture. These are all non-drug alternatives that reduce pain chemicals and stress in the body. Want more? Get your own copy of The 24-Hour Pharmacist or Drug Muggers: How to Keep Your Medicine from Stealing the Life Out of You! Learn more about Suzy Cohen at DearPharmacist.com. Plus, meet Suzy Cohen. How Bad Is Your Back Pain? So your back hurts? You may need to see a doctor, or your pain be more normal than you suspect.

How to Avoid an Allergy Attack Don’t Let the High Pollen Count Bring On Seasonal Symptoms

The weather’s warming, blooms are bursting – and you couldn’t be more miserable. Find out how to stop an allergy attack this season… It starts with a runny nose, watery eyes and a tickle in the back of your throat. At its worst, you may feel as if you’ll never stop sneezing. If this happens every year, you have seasonal allergic rhinitis – otherwise known as hay fever. It strikes when plants release pollen, usually in spring. When you breathe it in, your immune system thinks it’s being attacked, so it releases chemicals called histamines to fight the invaders. Instead, you wind up sneezy, watery and itchy. More than 50 million Americans have some type of allergy, according to the American Academy of Allergy, Asthma and Immunology (AAAAI). If you’re one of them, here’s how to stay healthy when pollen count is high: Allergy Attack Risk Factors The severity of allergy symptoms depends on season, weather and even your menstrual cycle. Being aware of these factors can help avoid attacks, experts say. Consider: Time of year: Generally, pollen season lasts from February or March through October. The farther south you live, the earlier pollen – and allergy – season hits, according to the AAAAI. In warmer places, it can be year-round. Ragweed, the plant that causes the strongest seasonal symptoms, is most active at the end of summer – so that’s the worst time for nature hikes. The weather: Shifts in climate can trigger allergies, says Gary Rachelefsky, M.D., professor of allergy and immunology at the Geffen School of Medicine at the University of California – Los Angeles (UCLA). “Changes in barometric pressure – a drop in humidity and hot air – can worsen symptoms,” he says. “Even moving in and out of air-conditioned rooms can aggravate someone who is sensitive.” Windy days can be the worst, says Vincent Tubiolo, M.D., an allergy specialist in Santa Barbara, Calif. Breezes carry pollen through the air that you breathe. Rain washes away some pollen, and may improve things temporarily, he adds. But don’t be complacent; shortly after a rain shower, pollen count rises even higher than before. Your time of the month: Believe it or not, allergy symptoms can be linked to your monthly cycle. “Rising and falling hormone levels can affect allergies,” Rachelefsky says. Over-the-counter allergy medications can help when symptoms arise, he adds. Write down when this happens, so you can predict when to avoid outside activity in the future. Pregnant or trying to conceive? Many over-the-counter allergy relief medications are safe to take – but consult your doctor first, Rachelefsky cautions. Other substances: If environmental allergens such as dust mites, pet dander and mold bother you, they could also worsen your seasonal pollen symptoms, says allergist Anne K. Ellis, M.D., director of the Environmental Exposure Unit at Kingston General Hospital in Ontario, Canada. This phenomenon is called “priming.” Your body’s defenses are already lowered, so it’s harder to fight off new seasonal allergies. Eliminating or minimizing exposure to these substances helps reduce the risk of an allergy attack. If you’re allergic to pet dander, for example, don’t let “Mr. Tinkles” sleep with you. If dust mites are a problem, clean frequently and use allergy-proof bedding. Avoiding Allergens Here are 10 more things you can do to minimize your pollen exposure and reduce symptoms, according to allergist Tubiolo and UCLA’s Rachelefsky. 1. Don’t track in allergens. They can attach to your shoes. Cut down on indoor particles by parking shoes outside your door. 2. Change often. After spending time outdoors, change your clothes and put the dirty ones in the hamper. 3. Don’t wait till morning to shower. Showering when you get home erases any allergens you brought with you. This also helps keeps pollen out of your bedroom – a prime spot for allergens of all kinds. 4. Clear the air. To remove even tiny particles from the air, use air purifiers with HEPA (high-efficiency particulate air) filters. Keep them running continuously, and change filters according to manufacturer’s instructions. You should also use high-quality filters in your vacuum cleaner, air conditioner and furnace to keep the air in your home as allergy free as possible. 5. Shut your doors and windows. A HEPA purifier can’t keep up if you’re constantly letting in allergen-filled outdoor air. If you need fresh air, open windows in the evening when pollen counts are lower. 6. Wait to go outside. Schedule outdoor time when the pollen count is lower – cool afternoons and evenings are your best bet. Be careful on hot, windy days and after a rain, when the air may be full of allergens. And find someone else to mow your lawn or rake leaves, both of which can stir up pollen. 7. Keep track of pollen levels. The AAAAI’s National Allergy Bureau reports on pollen and mold levels around the country. Check it (or sign up for email alerts) to learn about high-allergen days when it’s better to stay indoors. 8. Change your workout schedule. Don’t avoid exercise just because you fear an allergy attack, Tubiolo advises. But be smart about it: Schedule hikes and other outside exercise late in the day, and check the pollen count first. During peak season, take allergy medication before any outdoor activity, Tubiolo says. Or find activities you can do indoors, such as swimming, basketball, weightlifting or yoga. 9. Protect your lungs. Pollution, fireplace smoke, dust and tobacco smoke have an adverse effect on your respiratory tract. These irritants will likely increase your susceptibility to seasonal allergies, Rachelefsky says, so avoid them as much as possible. 10. Travel wisely. Don’t let allergies sideline your vacation. Use a pollen tracker to find destinations with the lowest counts. For example, heading to the beach or taking an ocean cruise probably won’t result in allergy attacks. If you take a road trip, keep the windows and vents closed and the air conditioning on so that you breathe clean, dry air. (Worried about fuel consumption? Air conditioning gobbles gas, but so does driving with the windows down. And at highway speeds, there isn’t much difference, according to the Stanford University School of Earth Sciences.) Take Your Medicine It’s virtually impossible to avoid all allergens – which means you need medications in your allergy arsenal, Rachelefsky says. “The best, first line of defense for an allergy attack is over-the-counter antihistamines, or an antihistamine/decongestant combination,” he says. Antihistamines work by blocking your immune-system’s itchy and sneezy reactions, while decongestants reduce swollen tissue in the nose and elsewhere. “Non-sedating antihistamines, such as Claritin (loratadine) and Zyrtec (cetirizine), offer relief from three of the four major symptoms of allergic rhinitis: sneezing, itching, watery eyes and runny nose,” Rachelefsky says. Some sufferers also swear by natural remedies, such as saline nasal rinses that wash away allergens. (Learn more helpful ways to outsmart those allergies.) After an allergy specialist determines exactly what your triggers are, you get a series of injections with a vaccine containing extracts of those allergens. Eighty to 90% of patients experience dramatic improvements in their symptoms, Ellis says.

Unexplained Pain: Could Those Aches and Fatigue Be an Autoimmune Disease? Learn the Symptoms and Treatments of 6 Common Autoimmune Diseases

Are you exhausted and depressed? Do your joints ache? These are telltale symptoms of more than 80 of the autoimmune diseases that exist. Find out the 6 most common, what happens when your body turns against itself and how to diagnose and treat symptoms... When our immune systems work right, our body is able to fend off attacks from invading bacteria and viruses. But with an autoimmune disease, it fights against us. Instead of protecting, it attacks, sending armies of your body’s disease-fighters to battle your own healthy tissue, cells and organs. Up to 22 million Americans have autoimmune disorders, according to the National Institutes of Health (NIH). Nearly 80% of them are women — many in their childbearing years, according to the Centers for Disease Control and Prevention (CDC). And the numbers are growing. “Autoimmune diseases are much more prevalent now than they were 20 years ago,” says Virginia Ladd, president of the American Autoimmune Related Diseases Association. “Each disease is relatively rare, but looking at them collectively, that’s another story.” Why the increase? Unfortunately, that’s a medical mystery. Researchers suspect genetics, infection and the environment are triggers. Just as the causes are puzzle, so are the symptoms. If they appear together, three major red flags signal an autoimmune disease: joint pain, fatigue and depression, says health educator Rita Baron-Faust, M.P.H., co-author of The Autoimmune Connection: Essential Information for Women on Diagnosis, Treatment, and Getting on With Your Life (McGraw-Hill). But many other different signs also can point to an autoimmune disease. The tipoff for type 1 diabetes, for example, is excessive thirst and frequent peeing. Hair loss is a symptom of lupus. The Big 6: What You Can Do More than 80 autoimmune diseases exist, according to the NIH. Here’s a look at the 6 most common: 1. Rheumatoid Arthritis (RA) About 1.3 million Americans — adults and children — have this incurable chronic disorder, and 75% of them are women, the NIH reports. With RA, the immune system’s white blood cells attack the joint lining, causing inflammation, redness, warmth and pain. Joint damage usually appears in the first two years. Over time, the cartilage and bone destruction can cripple sufferers. Symptoms include: Pain in the wrists and fingers of both hands Tender, warm joints in both knees and elbows Morning discomfort Fatigue/loss of energy Fever How to diagnose it: Because there’s no definitive lab test and symptoms are often slow to appear, RA is difficult to diagnose. Symptoms may seem vague. A woman simply might feel under the weather and have pain in her hands or feet. Ultimately, you’ll need a combination of lab and physical exams to pinpoint RA. Blood tests can detect the presence of rheumatoid factor (RF) antibodies, but not all affected people test positive. X-rays also can track joint damage over months or years. How to treat it: Over-the-counter anti-inflammatory drugs such as ibuprofen (Advil or Motrin) may ease mild symptoms, Baron-Faust says. If joint damage, aches or pain get worse, you may need disease-modifying anti-rheumatic drugs (DMRADs), such as Methotrexate. In the short-term, corticosteroids may reduce pain and inflammation, but they have serious side effects, such as infection. Newer biologic response modifiers (Humira, Enbrel, Remicade) may help those who don’t respond to other treatments, but these also increase the risk for infections and lymphoma. Though it can be hard to manage, mild to moderate exercise is also recommended because it can strengthen muscles, increase mobility and reduce depression. To find classes, contact the Arthritis Foundation (800-283-7800) or the YMCA (800-872-9622). Research also shows that some supplements, such as omega-3 fatty acid, may help improve symptoms. But consult your doctor before turning to alternative methods. 2. Type 1 Diabetes Surprised that type 1 diabetes is an autoimmune disease? It's often lumped together with type 2 diabetes, but type 2 isn’t an autoimmune disease. With type 1, autoantibodies target the insulin-secreting beta cells of the pancreas. Insulin regulates blood sugar levels and the 3 million Americans with type 1 lack the hormone to begin with, says Walter Gaman, M.D., of Executive Medicine of Texas, a practice in Southlake. People with type 2 diabetes are resistant to insulin, but produce it. When too much sugar accumulates in the blood, the kidneys go into over-drive to get rid of it. This is why the most common early symptoms both types of diabetes are excessive thirst and frequent urination. Others include: Fatigue Vision problems Unexplained weight loss Chronic vaginal yeast infections How to treat it: Unlike other autoimmune diseases, type 1 is easily diagnosed by a urinalysis and a fasting blood glucose test. People with type 1 diabetes must monitor blood sugar levels daily and control them with insulin (administered by injection or pump). A healthy diet and exercise also work to regulate blood sugar. Uncontrolled, the disease can lead to lead to kidney damage, heart disease, blindness and stroke. 3. Lupus The Lupus Foundation estimates that 1.5 million Americans have the disease, which hits women about 10 times more often than men. Lupus attacks tissue and organs and may damage joints, kidneys, blood cells, skin, the heart, lungs — even your brain. Like snowflakes, no two cases of this chronic inflammatory disease are alike. It’s difficult to diagnose because “there’s a spectrum of different manifestations, complaints, signs and symptoms,” says Susan Manzi, M.D., M.P.H., director of the Lupus Center of Excellence at the University of Pittsburgh Medical Center. On average, a patient may see four doctors before receiving an accurate diagnosis, she says. The doctor to see? A rheumatologist. The first sign may be a butterfly-shaped rash across the cheeks and nose. But women often experience extreme discomfort and puzzling symptoms, which sometimes fade and reappear in episodes known as “flares.” Other common symptoms: Achy and swollen joints Aches and fatigue Fever Anemia Hair loss Mouth and nose ulcers Raynaud’s phenomenon (fingers and toes turn white or blue in the cold) Easy bruising Anxiety or depression Shortness of breath or chest pain Skin sores from sun exposure How to treat it: Medications that “quiet down the immune system” may keep symptoms manageable and prevent flare-ups, Manzi says. For patients with mild symptoms, the anti-malarial drug Plaquenil can ease inflammation. For moderate symptoms, the steroid prednisone — a powerful anti-inflammatory and immune system suppressor — is often prescribed, though it may increase the risk for infections, osteoporosis and other disfiguring side effects. Chemotherapy and transplant anti-rejection drugs may help patients with complications such as kidney disease or brain disorders, including memory loss and seizures. But new lupus treatments are in clinical trials. One experimental drug, Benlysta, shows promise in reducing symptoms and the need for steroids. Lupus patients have a much higher risk of heart disease, so exercise, a healthy diet and weight and stress management are important. Also avoid the sun, because ultraviolet light can trigger flares. 4. Inflammatory Bowel Disease (IBD) IBD includes Crohn’s disease and ulcerative colitis (UC), both painful, chronic conditions that attack the digestive system. UC causes inflammation in the large intestine; Crohn’s causes sores and ulcerations anywhere in the gastrointestinal tract, from the mouth down, says Ann Silverman, M.D., director of the Henry Ford Center for Inflammatory Bowel Disease in Detroit, Mich. With IBD, the immune system mistakes normal bacteria in the intestines as foreign bodies. It responds by flooding the intestines with too many white blood cells, which causes the inflammation. With chronic inflammation, the digestive tract can be damaged or infected with ulcerations, fistulas and abscesses, which result in rectal bleeding, abdominal pain and diarrhea. UC patients almost always have rectal bleeding, but that’s not always the case for those with Crohn’s; it depends on what area of the GI tract is affected. In severe cases, life-threatening perforations of the intestines and hemorrhages may need emergency surgery and blood transfusions. Inflammatory bowel disease “can look completely different in different patients,” Silverman says. It isn’t easy to diagnose because symptoms often are confused with irritable bowel syndrome (IBS), which is also characterized by diarrhea and/or constipation. IBS isn’t an autoimmune disease. So how can you tell? Waking up at night for a bowel movement, blood in the stool and anemia indicate that the problem is more severe than IBS, Silverman says. Crohn’s disease and UC are believed to be caused by a genetic predisposition and outside triggers, such as a salmonella infection. “If a patient has been someplace like Mexico, you check for amobas or a toxin,” Silverman says. “Some people start out with an infection, get better and relapse.” The infection disappears, but inflammation of the colon remains, she says. Symptoms of Crohn’s and UC include: Abdominal pain Frequent diarrhea Nausea and vomiting Fever Anemia Weight loss Night sweats Joint pain Ulcerations throughout the digestive tract Blood in the stool How to treat it: You’ll need to see a gastroenterologist. Besides taking a thorough medical history and doing a physical exam to determine if the abdomen is inflamed or tender, the specialist also should examine the anorectal area for hemorrhoids, fissures, abscesses or fistulas. A blood chemistry profile can turn up anemia from intestinal bleeding and the presence of white blood cells, indicating infection or inflammation. Among the diagnostic tests you may have: Flexible sigmoidoscopy, in which a lighted, bendable tube is inserted into the anus and colon. A small camera transmits images to a computer screen, allowing the doctor to see inflamed tissue and other abnormalities. Barium X-ray, in which a patient swallows the metallic chemical barium sulfate and has X-rays taken of the GI tract. Colonoscopy, in which a long, lighted scope is guided into the colon. Depending on the disease’s severity, anti-inflammatory drugs, corticosteroids, antibiotics and immune system suppressors, may be prescribed. Surgery is an option for chronic blockages or bleeding. Because IBD can hinder the absorption of some essential nutrients, you may need vitamins D, A, K or B12 supplements. There’s no concrete evidence that diet makes a difference with inflammatory bowel disease, but many sufferers find some relief by avoiding: Dairy products Raw fruits and vegetables Gassy foods like beans and broccoli Spicy foods Alcohol Caffeine 5. Sjogren’s Syndrome With Sjogren’s Syndrome, immune cells attack and destroy the glands that produce tears and saliva, according to the National Institute of Neurological Disorders and Stroke. About 4 million Americans have Sjogren’s — women are nine times more likely than men to be affected. At its worst, the disorder damages the kidneys, lungs, liver, pancreas and brain. It frequently causes arthritis and fatigue, and less commonly, nervous system disorders, inflammation of the blood vessels and airways, and lung disease, says Aryeh Fischer, M.D., co-director of the Autoimmune Lung Center of the Division of Rheumatology and ILD Program at National Jewish Health in Denver, Colo. Lymph nodes may swell and those with Sjogren’s have a higher risk of lymphoma. “We don’t know why people develop Sjogren’s,” Fischer says. “It’s probably a combination of genetic and environmental interactions.” Nearly everyone with Sjogren’s has dry eyes and mouth. “It’s important to distinguish it from dry eyes alone, because that symptom is so common in the general population,” Fischer says. The disorder sometimes accompanies other autoimmune diseases, most commonly rheumatoid arthritis and lupus. Other symptoms: Fatigue Joint pain Dry cough Vaginal dryness Dry skin and rashes Changed sense of taste Enlarged salivary glands Dental cavities Difficulty swallowing How to treat it: Women often discover they have Sjogren’s at the dentist or eye doctor, because mucous membranes and glands in the eyes and mouth show early symptoms. Optical tests can evaluate tear production and determine if chronic dry eye has damaged the cornea. A urinalysis can detect kidney problems and blood tests can confirm inflammation. But to be classified as Sjogren’s, a doctor must confirm autoimmunity – either by the presence of antibodies or by a salivary gland biopsy, Fischer says. Unfortunately, there’s no quick fix for dysfunctional glands. Special eyedrops, drinking more liquids, moisturizers and vaginal lubricants can help ease dryness. Prescription medications can increase saliva flow to keep the mouth moist and reduce cavities. Your doctor may recommend over-the-counter or prescription non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen) for joint pain, as well as the anti-malarial Plaquenil. Immunosuppressants, such as Methotrexate, can treat complications in the lungs, blood vessel or central nervous system. Drugs used to treat rheumatoid arthritis also can help. 6. Multiple Sclerosis (MS) The NIH estimates that up to 350,000 Americans have MS — most of them 20-40 years old. Women are more than twice as likely as men to get this central nervous system disorder. With MS, the immune system attacks the brain, spinal cord and optic nerves, says Barbara Giesser, M.D., a Los Angeles neurologist and one of the authors of Multiple Sclerosis for Dummies. It destroys myelin, the protective sheath that covers nerves. That interferes with signals between the brain and the rest of the body and causes the numbness, tremors and pain that are hallmarks of the disease. But the progression of MS is different in everyone, Giesser says, and most people with MS have a normal life expectancy. MS isn’t fatal “and it’s not contagious,” she adds. Because symptoms can be mild, intermittent and overlap other diseases, some patients go years before being diagnosed. MS can look like everything from lupus to Lyme disease to infections and metabolic and inflammatory diseases, Giesser says. “A common symptom is numbness and tingling, but there are a billion things that can cause that.” Symptoms include: Depression Numbness or weakness in legs or arms Vision problems and eye pain Tingling or pain throughout the body Tremors Balance problems Dizziness How to treat it: MS is treatable, Giesser says, “but we don’t have a cure for it.” If a doctor suspects MS, he’ll first do blood tests to rule out other ailments with neurological symptoms, such as Lyme disease. The next step is a neurologist’s evaluation. Magnetic resonance imaging (MRI) of the brain can show lesions, indicating myelin damage. Corticosteroids can reduce inflammation and other medications called interferons can slow the disease's progression over time, but may damage the liver. Physical therapy may help with mobility problems. Integrative medical specialist Andrew Weil, M.D., recommends light aerobic exercise and some natural supplements, such as ginger and turmeric, among others. Consult your doctor before considering alternative methods. And most MS patients must avoid exposure to any hot environment, because their symptoms get worse. In fact, before the use of MRIs, the disease often was diagnosed by putting patients in a hot bath. What’s Your Inflammation IQ? Research indicates that inflammation is behind more than 80% of the conditions we suffer from – everything from arthritis to heart disease. Fighting it can get you on track to a healthier, happier life.

Expert Advice on Osteoarthritis Relief Patience White, M.D., Explains Causes and Help for Joint Pain

Could you be at risk for osteoarthritis, the most common type of arthritis? To find out, you’ll want to check your parents’ medical histories and consider your weight. Patience White, M.D., explains the latest symptoms and treatments, including alternative therapies, for this chronic condition... You don’t have to be old to be affected by osteoarthritis symptoms. The disease can show up even in your early 20s. So how can you stay active and pain-free? Is there new osteoarthritis treatment on the horizon? In an edited conversation with Patience White, M.D., vice president of public health for the Arthritis Foundation and a rheumatologist at the George Washington University School of Medicine, in Washington, D.C., we get answers to these and other questions. What is osteoarthritis — and how is it different from rheumatoid arthritis? Osteoarthritis is the most common type of arthritis, affecting approximately 27 million Americans. It occurs when joint cartilage loses its elasticity and breaks down, causing the connecting bones to rub against each other. The joints most affected include the hips, knees, hands, lower back and neck. The number of diagnosed cases of osteoarthritis is estimated to reach 67 million by 2030. Statistics show that about half of all adults develop knee osteoarthritis at some point in their lives. The condition is common because the joint carries our weight, is put under stress as it moves with every step and is prone to injury in sports and other activities. Rheumatoid arthritis, in contrast, is an autoimmune disease in which a person’s immune system attacks the body’s own tissues. This causes fluid build-up, inflammation and pain in the joints. It’s a systemic disease, meaning the pain can occur anywhere. What causes osteoarthritis? There are many risk factors for osteoarthritis, but genetics may play the largest role. Inherited knee and hip osteoarthritis can originate from either side of your family, but osteoarthritis of the hand generally comes from the mother’s side. Since many people with osteoarthritis are undiagnosed, you may need to delve into your parents’ history. Knee or hip problems could mean knee or hip osteoarthritis. Does Mom have knobby fingers? It’s probably due to osteoarthritis of the hands. What are the other major risk factors? Injuries also cause osteoarthritis, especially if they are severe enough to require surgery. The next most common risk factor is weight. About 66% of adults diagnosed with arthritis are obese, according to the Centers for Disease Control and Prevention (CDC) in Atlanta. Is there anything you can do to reduce the risk of osteoarthritis? Absolutely. Most important: lose weight. More than 65% of people in the U.S. are overweight, according to the CDC, and at great risk for knee osteoarthritis. Every pound you gain puts four pounds more pressure across your knees. Losing 10 pounds takes 40 pounds of pressure off your knees. There is evidence that obese people have greater levels of inflammatory hormones, which can irritate joints and make them more vulnerable to injury. Stay active. It improves the strength and balance of the muscles and ligaments that help the knee work. Moderate activity three times a week can reduce the risk of disability from knee osteoarthritis by 47%, according to the CDC. Can medications control osteoarthritic pain? Yes, but none will work as well as losing weight. In 2004, researchers at Johns Hopkins Medical Institutions in Baltimore found that a 15-pound weight loss reduced osteoarthritis pain by 40%, improved function by 50% and reduced stiffness by 50%. In contrast, medication caused only a 28% improvement in these factors. Taking any pain medication over time leads to a [higher] risk of side effects. Long-time use of non-steroidal anti-inflammatory drugs (NSAIDs) can cause bleeding in the stomach, and acetaminophen can cause liver damage. Anti-inflammatory creams and lotions can be effective, but even these can be absorbed through the skin and cause side effects or interact with other medications. Taking medication initially will reduce pain levels so you can be more active. More physical activity and weight loss will decrease pain and require less medication. That will slow the progression of the disease and prevent you from becoming disabled. What’s the best way to lose weight? Can a certain diet or foods reduce your osteoarthritis symptoms? There’s no evidence that a specific diet can affect osteoarthritis. But it is critical to keep your bones strong — and that means getting enough calcium and vitamin D. For adults, the current recommended daily allowance (RDA) for calcium is 1,000 milligrams (mg) daily; for vitamin D, 600 IU daily. It’s also important to lose weight in a lasting way. Avoid crash diets and make a commitment to change what you eat. Try to eat less meat and more fruits and vegetables. Fill two-thirds of your plate with fruits and vegetables. What’s the best way to start an exercise program? First, stick to low-impact activities, like walking and bicycling. These won’t pound on those lower-extremity joints. If you need help starting a new activity, check with the Arthritis Foundation, which offers exercise programs through state health departments and local YMCAs. The foundation’s website also has information about stretching, walking and various exercises. Why does tai chi help in the treatment of osteoarthritis? Several studies show that tai chi, a traditional Eastern series of slow, controlled movements, can improve strength, flexibility and balance, including one 2009 study at Tufts Medical Center of 40 adults with knee osteoarthritis. One group attended a tai chi class; the other group did stretching exercises. Following a 12-week program, participants were instructed to continue at home. The tai chi group reported greater improvement in pain, physical function and quality of life and less depression than the stretchers. Can mechanical devices — orthotics, braces and canes — help reduce the pain of osteoarthritis? With knee osteoarthritis, supportive, flexible footwear is critical. Orthotics may help by providing arch support. This will keep your legs more stable as you walk, reducing strain on the knee. Braces can help stabilize a joint after an injury, but reliance on them should be limited. You lose strength and range of motion when you don’t use the knee for long periods. Do alternative treatments, such as massage, meditation and acupuncture, help? There’s evidence that acupuncture can help knee and hip osteoarthritis. A 2006 German study followed 3,633 patients with knee and hip osteoarthritis. One group received 15 sessions of acupuncture and regular medical treatment; the control group only received medical treatment. In three months, the acupuncture group showed “marked clinical improvement” compared with the control group. Licensed acupuncture practitioners are listed at the American Academy of Medical Acupuncture, or the National Certification Commission for Acupuncture and Oriental Medicine. Meditation and guided imagery techniques can also help you cope with pain, while massage may relax your muscles. You can find more information about managing your osteoarthritis symptoms through meditation here. Do supplements, such as glucosamine and chondroitin, help prevent osteoarthritis pain? Research shows they don’t prevent joint degeneration. A recent study indicated that patients with moderate to severe knee osteoarthritis had similar results whether they took these two supplements, the NSAID celecoxib or a placebo for pain. Glucosamine and chondroitin may be helpful for moderately severe pain, but they are expensive, and their benefit is still unclear. What other issues can affect people with osteoarthritis? They’re at risk for obesity-related conditions, including diabetes and heart disease. Half of all people with diabetes also have osteoarthritis. This is why it’s especially important for people with osteoarthritis to eat a balanced diet, stay active and lose weight: It helps lessen pain and reduces the risk of developing one of these conditions. Are there new developments in surgical treatments for osteoarthritis? Joint replacement is one option for severe, long-term osteoarthritis. Knee and hip joints are commonly replaced with metal or plastic parts, most of which last about 20 years. In 2003, the last year for which figures are available, there were approximately 418,000 total knee replacements and more than 220,000 hip replacements in the U.S., according to the American College of Rheumatology. There are efforts to develop artificial cartilage that would replace diseased tissue, the fundamental defect that leads to osteoarthritis. Check out The New Knee Replacement for more information. Learn more about this condition in our Osteoarthritis Health Center. What's Your Inflammation IQ? Inflammation has become a hot topic over the last few years. The latest scientific research indicates that inflammation is behind more than 80% of the conditions we suffer from – everything from arthritis to heart disease. Dr. Mark Hyman, author of The UltraSimple Diet, agrees that inflammation leads to a host of health problems. Fighting it can get you on track to a healthier, happier life.

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Unexplained Pain: Could Those Aches and Fatigue Be an Autoimmune Disease? Learn the Symptoms and Treatments of 6 Common Autoimmune Diseases

Are you exhausted and depressed? Do your joints ache? These are telltale symptoms of more than 80 of the autoimmune diseases that exist. Find out the 6 most common, what happens when your body turns against itself and how to diagnose and treat symptoms... When our immune systems work right, our body is able to fend off attacks from invading bacteria and viruses. But with an autoimmune disease, it fights against us. Instead of protecting, it attacks, sending armies of your body’s disease-fighters to battle your own healthy tissue, cells and organs. Up to 22 million Americans have autoimmune disorders, according to the National Institutes of Health (NIH). Nearly 80% of them are women — many in their childbearing years, according to the Centers for Disease Control and Prevention (CDC). And the numbers are growing. “Autoimmune diseases are much more prevalent now than they were 20 years ago,” says Virginia Ladd, president of the American Autoimmune Related Diseases Association. “Each disease is relatively rare, but looking at them collectively, that’s another story.” Why the increase? Unfortunately, that’s a medical mystery. Researchers suspect genetics, infection and the environment are triggers. Just as the causes are puzzle, so are the symptoms. If they appear together, three major red flags signal an autoimmune disease: joint pain, fatigue and depression, says health educator Rita Baron-Faust, M.P.H., co-author of The Autoimmune Connection: Essential Information for Women on Diagnosis, Treatment, and Getting on With Your Life (McGraw-Hill). But many other different signs also can point to an autoimmune disease. The tipoff for type 1 diabetes, for example, is excessive thirst and frequent peeing. Hair loss is a symptom of lupus. The Big 6: What You Can Do More than 80 autoimmune diseases exist, according to the NIH. Here’s a look at the 6 most common: 1. Rheumatoid Arthritis (RA) About 1.3 million Americans — adults and children — have this incurable chronic disorder, and 75% of them are women, the NIH reports. With RA, the immune system’s white blood cells attack the joint lining, causing inflammation, redness, warmth and pain. Joint damage usually appears in the first two years. Over time, the cartilage and bone destruction can cripple sufferers. Symptoms include: Pain in the wrists and fingers of both hands Tender, warm joints in both knees and elbows Morning discomfort Fatigue/loss of energy Fever How to diagnose it: Because there’s no definitive lab test and symptoms are often slow to appear, RA is difficult to diagnose. Symptoms may seem vague. A woman simply might feel under the weather and have pain in her hands or feet. Ultimately, you’ll need a combination of lab and physical exams to pinpoint RA. Blood tests can detect the presence of rheumatoid factor (RF) antibodies, but not all affected people test positive. X-rays also can track joint damage over months or years. How to treat it: Over-the-counter anti-inflammatory drugs such as ibuprofen (Advil or Motrin) may ease mild symptoms, Baron-Faust says. If joint damage, aches or pain get worse, you may need disease-modifying anti-rheumatic drugs (DMRADs), such as Methotrexate. In the short-term, corticosteroids may reduce pain and inflammation, but they have serious side effects, such as infection. Newer biologic response modifiers (Humira, Enbrel, Remicade) may help those who don’t respond to other treatments, but these also increase the risk for infections and lymphoma. Though it can be hard to manage, mild to moderate exercise is also recommended because it can strengthen muscles, increase mobility and reduce depression. To find classes, contact the Arthritis Foundation (800-283-7800) or the YMCA (800-872-9622). Research also shows that some supplements, such as omega-3 fatty acid, may help improve symptoms. But consult your doctor before turning to alternative methods. 2. Type 1 Diabetes Surprised that type 1 diabetes is an autoimmune disease? It's often lumped together with type 2 diabetes, but type 2 isn’t an autoimmune disease. With type 1, autoantibodies target the insulin-secreting beta cells of the pancreas. Insulin regulates blood sugar levels and the 3 million Americans with type 1 lack the hormone to begin with, says Walter Gaman, M.D., of Executive Medicine of Texas, a practice in Southlake. People with type 2 diabetes are resistant to insulin, but produce it. When too much sugar accumulates in the blood, the kidneys go into over-drive to get rid of it. This is why the most common early symptoms both types of diabetes are excessive thirst and frequent urination. Others include: Fatigue Vision problems Unexplained weight loss Chronic vaginal yeast infections How to treat it: Unlike other autoimmune diseases, type 1 is easily diagnosed by a urinalysis and a fasting blood glucose test. People with type 1 diabetes must monitor blood sugar levels daily and control them with insulin (administered by injection or pump). A healthy diet and exercise also work to regulate blood sugar. Uncontrolled, the disease can lead to lead to kidney damage, heart disease, blindness and stroke. 3. Lupus The Lupus Foundation estimates that 1.5 million Americans have the disease, which hits women about 10 times more often than men. Lupus attacks tissue and organs and may damage joints, kidneys, blood cells, skin, the heart, lungs — even your brain. Like snowflakes, no two cases of this chronic inflammatory disease are alike. It’s difficult to diagnose because “there’s a spectrum of different manifestations, complaints, signs and symptoms,” says Susan Manzi, M.D., M.P.H., director of the Lupus Center of Excellence at the University of Pittsburgh Medical Center. On average, a patient may see four doctors before receiving an accurate diagnosis, she says. The doctor to see? A rheumatologist. The first sign may be a butterfly-shaped rash across the cheeks and nose. But women often experience extreme discomfort and puzzling symptoms, which sometimes fade and reappear in episodes known as “flares.” Other common symptoms: Achy and swollen joints Aches and fatigue Fever Anemia Hair loss Mouth and nose ulcers Raynaud’s phenomenon (fingers and toes turn white or blue in the cold) Easy bruising Anxiety or depression Shortness of breath or chest pain Skin sores from sun exposure How to treat it: Medications that “quiet down the immune system” may keep symptoms manageable and prevent flare-ups, Manzi says. For patients with mild symptoms, the anti-malarial drug Plaquenil can ease inflammation. For moderate symptoms, the steroid prednisone — a powerful anti-inflammatory and immune system suppressor — is often prescribed, though it may increase the risk for infections, osteoporosis and other disfiguring side effects. Chemotherapy and transplant anti-rejection drugs may help patients with complications such as kidney disease or brain disorders, including memory loss and seizures. But new lupus treatments are in clinical trials. One experimental drug, Benlysta, shows promise in reducing symptoms and the need for steroids. Lupus patients have a much higher risk of heart disease, so exercise, a healthy diet and weight and stress management are important. Also avoid the sun, because ultraviolet light can trigger flares. 4. Inflammatory Bowel Disease (IBD) IBD includes Crohn’s disease and ulcerative colitis (UC), both painful, chronic conditions that attack the digestive system. UC causes inflammation in the large intestine; Crohn’s causes sores and ulcerations anywhere in the gastrointestinal tract, from the mouth down, says Ann Silverman, M.D., director of the Henry Ford Center for Inflammatory Bowel Disease in Detroit, Mich. With IBD, the immune system mistakes normal bacteria in the intestines as foreign bodies. It responds by flooding the intestines with too many white blood cells, which causes the inflammation. With chronic inflammation, the digestive tract can be damaged or infected with ulcerations, fistulas and abscesses, which result in rectal bleeding, abdominal pain and diarrhea. UC patients almost always have rectal bleeding, but that’s not always the case for those with Crohn’s; it depends on what area of the GI tract is affected. In severe cases, life-threatening perforations of the intestines and hemorrhages may need emergency surgery and blood transfusions. Inflammatory bowel disease “can look completely different in different patients,” Silverman says. It isn’t easy to diagnose because symptoms often are confused with irritable bowel syndrome (IBS), which is also characterized by diarrhea and/or constipation. IBS isn’t an autoimmune disease. So how can you tell? Waking up at night for a bowel movement, blood in the stool and anemia indicate that the problem is more severe than IBS, Silverman says. Crohn’s disease and UC are believed to be caused by a genetic predisposition and outside triggers, such as a salmonella infection. “If a patient has been someplace like Mexico, you check for amobas or a toxin,” Silverman says. “Some people start out with an infection, get better and relapse.” The infection disappears, but inflammation of the colon remains, she says. Symptoms of Crohn’s and UC include: Abdominal pain Frequent diarrhea Nausea and vomiting Fever Anemia Weight loss Night sweats Joint pain Ulcerations throughout the digestive tract Blood in the stool How to treat it: You’ll need to see a gastroenterologist. Besides taking a thorough medical history and doing a physical exam to determine if the abdomen is inflamed or tender, the specialist also should examine the anorectal area for hemorrhoids, fissures, abscesses or fistulas. A blood chemistry profile can turn up anemia from intestinal bleeding and the presence of white blood cells, indicating infection or inflammation. Among the diagnostic tests you may have: Flexible sigmoidoscopy, in which a lighted, bendable tube is inserted into the anus and colon. A small camera transmits images to a computer screen, allowing the doctor to see inflamed tissue and other abnormalities. Barium X-ray, in which a patient swallows the metallic chemical barium sulfate and has X-rays taken of the GI tract. Colonoscopy, in which a long, lighted scope is guided into the colon. Depending on the disease’s severity, anti-inflammatory drugs, corticosteroids, antibiotics and immune system suppressors, may be prescribed. Surgery is an option for chronic blockages or bleeding. Because IBD can hinder the absorption of some essential nutrients, you may need vitamins D, A, K or B12 supplements. There’s no concrete evidence that diet makes a difference with inflammatory bowel disease, but many sufferers find some relief by avoiding: Dairy products Raw fruits and vegetables Gassy foods like beans and broccoli Spicy foods Alcohol Caffeine 5. Sjogren’s Syndrome With Sjogren’s Syndrome, immune cells attack and destroy the glands that produce tears and saliva, according to the National Institute of Neurological Disorders and Stroke. About 4 million Americans have Sjogren’s — women are nine times more likely than men to be affected. At its worst, the disorder damages the kidneys, lungs, liver, pancreas and brain. It frequently causes arthritis and fatigue, and less commonly, nervous system disorders, inflammation of the blood vessels and airways, and lung disease, says Aryeh Fischer, M.D., co-director of the Autoimmune Lung Center of the Division of Rheumatology and ILD Program at National Jewish Health in Denver, Colo. Lymph nodes may swell and those with Sjogren’s have a higher risk of lymphoma. “We don’t know why people develop Sjogren’s,” Fischer says. “It’s probably a combination of genetic and environmental interactions.” Nearly everyone with Sjogren’s has dry eyes and mouth. “It’s important to distinguish it from dry eyes alone, because that symptom is so common in the general population,” Fischer says. The disorder sometimes accompanies other autoimmune diseases, most commonly rheumatoid arthritis and lupus. Other symptoms: Fatigue Joint pain Dry cough Vaginal dryness Dry skin and rashes Changed sense of taste Enlarged salivary glands Dental cavities Difficulty swallowing How to treat it: Women often discover they have Sjogren’s at the dentist or eye doctor, because mucous membranes and glands in the eyes and mouth show early symptoms. Optical tests can evaluate tear production and determine if chronic dry eye has damaged the cornea. A urinalysis can detect kidney problems and blood tests can confirm inflammation. But to be classified as Sjogren’s, a doctor must confirm autoimmunity – either by the presence of antibodies or by a salivary gland biopsy, Fischer says. Unfortunately, there’s no quick fix for dysfunctional glands. Special eyedrops, drinking more liquids, moisturizers and vaginal lubricants can help ease dryness. Prescription medications can increase saliva flow to keep the mouth moist and reduce cavities. Your doctor may recommend over-the-counter or prescription non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen) for joint pain, as well as the anti-malarial Plaquenil. Immunosuppressants, such as Methotrexate, can treat complications in the lungs, blood vessel or central nervous system. Drugs used to treat rheumatoid arthritis also can help. 6. Multiple Sclerosis (MS) The NIH estimates that up to 350,000 Americans have MS — most of them 20-40 years old. Women are more than twice as likely as men to get this central nervous system disorder. With MS, the immune system attacks the brain, spinal cord and optic nerves, says Barbara Giesser, M.D., a Los Angeles neurologist and one of the authors of Multiple Sclerosis for Dummies. It destroys myelin, the protective sheath that covers nerves. That interferes with signals between the brain and the rest of the body and causes the numbness, tremors and pain that are hallmarks of the disease. But the progression of MS is different in everyone, Giesser says, and most people with MS have a normal life expectancy. MS isn’t fatal “and it’s not contagious,” she adds. Because symptoms can be mild, intermittent and overlap other diseases, some patients go years before being diagnosed. MS can look like everything from lupus to Lyme disease to infections and metabolic and inflammatory diseases, Giesser says. “A common symptom is numbness and tingling, but there are a billion things that can cause that.” Symptoms include: Depression Numbness or weakness in legs or arms Vision problems and eye pain Tingling or pain throughout the body Tremors Balance problems Dizziness How to treat it: MS is treatable, Giesser says, “but we don’t have a cure for it.” If a doctor suspects MS, he’ll first do blood tests to rule out other ailments with neurological symptoms, such as Lyme disease. The next step is a neurologist’s evaluation. Magnetic resonance imaging (MRI) of the brain can show lesions, indicating myelin damage. Corticosteroids can reduce inflammation and other medications called interferons can slow the disease's progression over time, but may damage the liver. Physical therapy may help with mobility problems. Integrative medical specialist Andrew Weil, M.D., recommends light aerobic exercise and some natural supplements, such as ginger and turmeric, among others. Consult your doctor before considering alternative methods. And most MS patients must avoid exposure to any hot environment, because their symptoms get worse. In fact, before the use of MRIs, the disease often was diagnosed by putting patients in a hot bath. What’s Your Inflammation IQ? Research indicates that inflammation is behind more than 80% of the conditions we suffer from – everything from arthritis to heart disease. Fighting it can get you on track to a healthier, happier life.