Philip S. Chua M.D (31)


Heart to Heart

Food contamination

What is Food Poisoning?

Food poisoning is a variety of illnesses caused by eating food contaminated with bacteria, toxins or chemicals. This is more common during holidays and summertime. The symptoms usually include diarrhea, abdominal pains and vomiting. The diarrhea and vomiting could be so severe as to cause extreme dehydration, which, if untreated and unabated, could be fatal.

How does bacterial contamination occur?

Raw food may have bacteria in it or may be contaminated by unsanitary handling. These bacteria then grow and multiply, and when the “infected” food is eaten, the growth and multiplication of the bacteria continue in the stomach or bowel, producing symptoms of food poisoning. This leads to abdominal pains, diarrhea and vomiting, which are part of the body’s defensive ways of getting rid of the offending bacteria. The most common bacteria causing food poisoning is Listeria Salmonella, usually from poultry or infected eggs, specifically duck eggs), Clostridia (contamination by dirt or flies), and Shigella and Escherichia coli (fecal contamination of food and/or water).

What about toxins?

Food that is kept in a warm place, or improperly preserved, can produce chemicals called toxins. One of the commonest is the Staphylococci toxin from Staphylococci bacteria that can be transmitted by a food careless handler with a boil or infected wound full of the Staph bacteria. Botulism (due to Clostridium Botulinum), from badly tinned or bottled food, is not very common but can be fatal. When the contaminated food is ingested, severe gastrointestinal symptoms may occur.

What chemical poisons are found in food?

There are some common food items that contain natural chemical poisons. Some fungi are very poisonous even when eaten in tiny quantities, causing irregular heart beat, coma or even death. The green areas on potatoes which have been exposed to the light, uncooked kidney beans, some nuts, etc. contain poisonous chemicals, which can cause symptoms of food poisoning if inadequately cooked. Not properly washing fruits and vegetables that are contaminated with pesticides can also cause food poisoning. Some mushrooms are poisonous and not edible.

What bacteria grows on cooked rice?

Bacillus cereus thrives and multiples in cooked rice and can cause food poisoning. The bacteria produces chemical toxin which is very resistant and not destroyed even by high temperatures. The best way to prevent this is by refrigerating left over rice, which should be consumed within 48 hours. The symptoms of food poisoning usually start fairly suddenly with abdominal pains, frequently cramping in nature and soon followed by diarrhea. The pains can be persistent for a few days and become worst before an episode of diarrhea or vomiting. Throwing up may cease after a few hours but the diarrhea may continue for days. If the illness is due to bacterial contamination, the symptoms appear about 12-24 hours after ingestion, but if it is due to toxins, the onset of symptoms comes rapidly, usually within minutes after eating the contaminated food. Severe Botulism begins after about 12 hours with vomiting, abdominal cramps, and may culminate in paralysis and coma.

Is Food Poisoning dangerous?

Obviously, yes, as discussed above. In young children and among the elderly, dehydration is the main danger. Vomiting and diarrhea can result in a rapid loss of body fluids and electrolytes. This can disrupt the very delicate chemical balance in the body and, if not treated early, can lead to coma and even death. Botulinum and Staph toxins are in themselves dangerous, and the poisoning can be fatal, if not managed in a timely and proper fashion.

How do we prevent food poisoning?

Good environmental and personal hygiene, proper food preparation, handling and storage, avoidance of questionable food (fruit or potato salad and dishes sautéed with tomato that have been exposed for more than an hour at a party or picnic under hot weather, mussels and other shelled foods that remain closed after cooking, poultry or meats (hamburgers, etc) that are not thoroughly cooked, and can goods that are of questionable freshness, that are “expired,” or with bulging top, are some basic preventive measures that can be taken to prevent food poisoning. The prudent practice and common sense dictum is “if in doubt, discard.”

What is the mainstay of therapy?

This depends on the cause of the food poisoning: bacteria, toxin or chemical. But basically, oral and/or intravenous fluid replacement is the key to prevent further dehydration from fluid and electrolyte loss from diarrhea and vomiting, which could be life-threatening. Young children and the elderly can become very ill fast, since they succumb rapidly to dehydration, so medical consultation, or even hospitalization, may be needed early. Antibiotics may be given where indicated to clear up the infection, but as a rule they are usually not used because they may sometimes worsen the condition. Fortunately, most of the food poisoning cases respond well to fluid replacement. Possible botulism patients should be hospitalized without delay. The stomach may be pumped out and botulism anti-toxin given to counteract paralysis. Those who are very ill may need ventilator support in the ICU. An antidote may be needed for fungal food poisoning. All the evaluation and decision on the management are best handled by the attending physician. After surviving the acute stage, the patient is expected to recover fully with excellent prognosis. However, just like most other illnesses, food poisoning is best prevented. In majority of situations, this is within our power.

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Queries from readers

Queries from readers

What is Holiday Heart Syndrome?

Prevalent during holidays, this symptom complex is mainly characterized by cardiac arrythmias (heart rhythm irregularity), mostly due to alcoholic binges. The excitement brought on by the festivities and ingestion of a lot of caffeine (coffee, chocolate, cola drinks) during the holidays could also play a role in this syndrome. The symptoms are transient, unless the person has other complicating health problems.

Last Christmas I was happy and also sad. Why?

The feeling is called Christmas Blues or Holiday or Birthday Blues. This is not uncommon. The sadness could be due to sorrowful memories of past events recalled during this season, or feeling sorry for yourself, some family members, friends, or even strangers for certain negatives occurrences or misfortunes in your or their lives, personal problems, financial worries, some guilt for things you did or failed to do, or some things you want to do but couldn’t. Any of these can explain the sadness one feels during a festive occasion like the Christmas season. This is usually seasonal and temporary, unless the problem causing it lingers on

Is MSG safe?

Eating food with “Betsin” (MSG: Monosodium Glutamate, flavor enhancer) could cause a condition known as “Chinese Food Syndrome,” which could sometimes mimic a heart attack. It causes chest pains, facial pressure, and burning sensations throughout the body, sometimes with dizziness or fainting, which are mostly temporary. This phenomenon is a pharmacologic reaction to Monosodium Glutamate, a popular white powder food seasoning used in cooking. The symptoms are due to individual sensitivity or reaction and are dose-related. Most people are not bothered by MSG, but some react to it more severely. Although death is very rare, some people could actually be allergic to it and die from it. Those who develop any of the symptoms enumerated above after eating food cooked with MSG should clearly request chefs or cooks in restaurants, at home, or anywhere else, not to use MSG in preparing their food. Because of this syndrome, many Chinese (and other) restaurants today no longer use MSG. If in doubt, ask the manager or waiters, and instruct them accordingly.

At 72, can Viagra still improve my performance?

Your feat, albeit not as perfect as you want it to be, is amazing. Majority of men, even 20 years younger, are unable to do it as often as you do. Weakly perhaps, but not weekly. Viagra (Sildenafil Citrate) is a marvelous pill, truly a giant step for man, would help, but you must consult with your physician to make sure you are not on any form of nitrates (heart medications), which is dangerous when taken in combination with Viagra, and that you do not have any health risk that will contraindicate the use of this very effective pill for erectile dysfunction.

I have bleeding after sex, what is wrong?

Trauma is the most common cause, especially among virgin females. Infection can cause cervical inflammation, abrasions or excoriations that bleed on contact. Hormonal problem or cancer can also lead to vaginal bleeding. If you have bleeding, even staining, every time you have sex, then it is most prudent for you to seek consultation with a gynecologist. Recurrent vaginal bleeding, with or without sex, is abnormal and should be investigated to make certain no serious medical condition exists.

Can fright kill?

Yes, sudden or extreme fright can, among other possible effects, lead to an instant and steep rise in adrenalin (and other neuro-chemical) level in the blood circulation, leading to dangerous or fatal arrhythmia (heart irregularity) called ventricular fibrillation followed by cardiac arrest. This is especially true among those with heart disease to begin with. Death by fright is not very common but it does happen.

Do pets help sick people in their recovery?

Yes, pets, like dogs for instance, greatly help patients recover from their illness. Medical literature is replete with reports where even terminally ill people gained greater strength and more will to live when their pet is near them. The security, unconditional loyalty and love of “man’s best friend” have infinite medicinal value to the suffering patient, much like the love and compassion of human loved ones. And more often than not pets, especially dogs, are more loving, forgiving, and loyal than even some of our friends and relatives.

Why do my feet swell in the evening?

Edema (swelling) of the legs and feet, when present all the time, could be due to excess salt intake, heart failure, kidney disease, Beri-Beri (vitamin B-1 deficiency), some tropical parasitic infestations, and other even rarer diseases. Since yours happens only in the evening, and since you stated in your email that you were otherwise in perfect health, then I sus pect the edema to be due to some leg vein insufficiency, where the valves in your leg veins are somewhat incompetent allowing back flow of blood and pooling of blood in your lower extremities by gravity. Elevation of your feet at least 4 inches higher than your knees whenever you can, especially when you get home at night, will help the venous circulation of your legs and minimize, if not eliminate, edema. Low salt diet, and wearing support stockings (when you are on your feet) will also help. The best is for you to have a medical check-up by your physician if the swelling persists.

Are eyeshades beneficial?

Yes, dark glasses to protect our eyes from the glaring brightness of any source, like the sun and its UV rays. These rays (UVA and UVB), and laser lights cause eye damage (cataracts,, etc.) premature skin aging, and skin cancers. Using eyeshades daily and staying under a shade or umbrella to reduce sun exposure are healthy behaviors. Polarized dark glasses with UV ray protection are best, with our without prescription. Consult with your optician or ophthalmologist to find out what is best for you.

The main objective of this column is to educate and inspire people live a healthier lifestyle to prevent illnesses and disabilities, and achieve a happier and more productive life. Any diagnosis, recommendation or treatment in our article are general medical information and not intended to be applicable or appropriate for anyone. This column is not a substitute for your physician, who knows your condition well and who is your best ally when it comes to your health.

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Coffee and longevity

Twelve years ago, we wrote that drinking coffee reduced the risk for type II diabetes, based on a new study then (involving 42,000 healthy men and 84,000 health women from 1980 through 1998) by the Harvard School of Public Health and Brigham and Women’s Hospital published in the Annals of Internal Medicine on January 6, 2004.

Compared to those who did not drink coffee, men who had more than 6 cups of caffeinated coffee a day lowered the risk of developing Type II diabetes by 50%. Among women, there was a 30% reduction in the risk.

Caffeinated coffee was found to be more beneficial than the decaffeinated or the hyped-up mocha, cappuccino, or latte, etc., variety.

Unclear rationale

The exact mechanism is still unclear. In another research (Nurses Health Study), it shows that the 2000 women coffee drinkers in its survey had significantly lower (13%-14%) levels of C-peptide hormone, a component of insulin in our body, compared to non-coffee drinkers. Higher level of C-peptide, which indicates the body is unable to use insulin (called insulin resistance) are linked to the increased risk of developing adult-onset diabetes. The good effect was more apparent among obese and overweight women, 22% and 18%, respectively. So, if coffee reduces C-peptide, then the risk is reduced.

Some hormones

This is still not fully understood. Both regular and decaffeinated coffees have a lot of antioxidants in them, like chlorogenic acid (the ingredient that gives the “addicting” coffee flavor), phyto-estrogens, and magnesium. These chemicals improve sensitivity to insulin and may play a vital role in lowering adult onset diabetes. Caffeine itself is also known to affect insulin secretion.

How much coffee?

The Harvard study stated 6 or more cups per day. The research on the same subject in Finland (which has the highest per capita coffee consumption in the world), involving 15,000 healthy men and women (ages 35-64), as reported in The Journal of American medical Association, showed that women who consumed 10 or more cups a day had 79% lower risk, and men, about 55%.

Effect on longevity

Two recent major international studies (US and European) suggested that coffee lovers may also live a longer life compared to those who do not imbibe coffee.

The International Agency for Research on Cancer (IARC) and Imperial College of London, which reviewed more than half a million people with variable habits and customs across 10 European countries, was the first study. This showed “those who drank about three cups a day tended to live longer than non-coffee drinkers; they also had a lower risk of death from any cause, and specifically for circulatory diseases, and digestive diseases.”

The second one, done in the United States, involved 180,000 subjects of different ethnic, social, and career backgrounds. The findings revealed that drinking coffee “benefits longevity whether the coffee was caffeinated or decaffeinated…and coffee drinkers had a lower risk of death due to heart disease, cancer, stroke, diabetes, and respiratory and kidney disease.” One cup a day drinkers “were 12 percent less likely to die compared to those who didn't drink coffee; those who drank two or three cups per day saw an even higher 18 percent reduced risk of death.”

"We cannot say drinking coffee will prolong your life, but we see an association," stated Veronica Setiawan, lead researcher and an associate professor of preventive medicine at the Keck School of Medicine of University of Southern California.

Drinking coffee is reported to impart anti-oxidant benefits and may improve liver function too, but it is not recommended for pregnant women and children. Also, drinking any very hot beverage in general is suspected to increase the risk for cancer of the esophagus (food pipe).

A professor at the University of Cambridge, David Spiegelhalter,described the research as "huge in size and carefully done," but nevertheless unable to prove cause and effect. "If these estimated reductions in all-cause mortality really are causal, then an extra cup of coffee every day would on average extend the life of a man by around three months, and a woman by around a month," he added.

While drinking coffee appears to help in reducing the risk for Type II diabetes, heart disease, Alzheimer’s, and cancer, and now claimed to prolong life, more clinical studies are still needed to make this an evidence-based medical fact.

Coffee trivia

Second to water, coffee is one of the world’s most consumed beverages. Over 16 billion pounds of beans are produced in 70 countries annually. More than 2.25 billion cups are consumed each year globally.

The Netherlands (population: 17,035,938) is the highest consumer of coffee in the world at 260.4 liters per capita, compared to 115.2 per capita in the United States (population: 325,416,914), where about 400 million cups of coffee are consumed each day. Almost 85 percent of Americans drink coffee daily. Ninety-three percent of households in the Philippines (population: 105,589,888) drink coffee, the country consuming 100,000 metric tons year. Coffee, “first brought to the Philippines by a Franciscan friar in 1749, is the most consumed beverage next to water, and second most bought item next to sauces and seasonings,” according to one study.

In the United States, McDonald’s “is the leading coffee seller, with 14.32% of the market…second place goes to Dunkin' Donuts with 13.75% share and 185.3 million servings, followed by Starbucks with 11.80% share and 159.1 million servings.”

How many cups are safe?

Since the long term effects of coffee (especially caffeinated) on diabetes, cardiovascular diseases, other illnesses, and longevity are not totally clear, the so called “safe level” becomes an individual issue. One cup of regular coffee may be too much for one person, who might develop heart beat irregularity, like palpitation, or insomnia, when taken before bedtime. Three cups a day may not be enough to satisfy another. This should be tailored to personal tolerance. The final word on this issue is not settled, but the preliminary results as presented above are most encouraging. More long term studies are definitely needed before this becomes a medical dogma.

In the meantime, let me finish my second cup of Columbian espresso.


The main objective of this column is to educate and inspire people live a healthier lifestyle to prevent illnesses and disabilities, and achieve a happier and more productive life. Any diagnosis, recommendation or treatment in our article are general medical information and not intended to be applicable or appropriate for anyone. This column is not a substitute for your physician, who knows your condition well and who is your best ally when it comes to your health.

Visit Email: This email address is being protected from spambots. You need JavaScript enabled to view it.


Fascinating history

As the year comes to a close, allow me to take you back in time to revisit some of the great moments in medical science which made possible the great strides man has made in the treatment of cardiovascular diseases that benefit all of us today.
I had the great fortune and privilege in 1972 to have trained as a Fellow in Cardiac Surgery under one of the world’s giants in heart surgery, Dr. Denton A. Cooley, founder and cardiac surgeon-in-chief of the Texas Heart Institute in Houston.
The management of heart diseases was still in the Dark Ages during my undergraduate years in the late 50s. Physicians then did not know how to treat heart diseases, much less, save the lives of patients with these ailments. Looking back, the physicians at that time did not even know that simple aspirin had any potential role in the prevention or treatment of heart attacks. Treatment was mainly symptomatic, using pain pills or pain shots. The most sophisticated pill was the nitrate pill, a vasodilator that “relaxes open” the coronary artery, since the “current” knowledge in physiology then said angina pectoris (chest pain) was due to spasm in the coronary arteries which supply the heart muscles with oxygen and nutrition.
The first milestone that started it all was in 1628 when an English physician first described blood circulation. Inspired by that, these historical events followed:
1706 Raymond de Vieussens, a French anatomy professor, first described the structure of the heart’s chambers and vessels.
1733 Stephen Hales, an English clergyman and scientist first measured blood pressure.
1816 Rene T. H. Laennec, a French physician, invented the first stethoscope.
1903 Eillem Einthoven, a Dutch physician, developed the first electrocardiogram.
1912 James B. Herrick, an American physician, first described heart disease resulting from hardening of the arteries, a fundamental concept that led to the modern therapy of today.
1938 Robert E. Gross, an American surgeon, performed the first heart surgery (close-heart, not open-heart).
1951 Charles Hufnagel, an American surgeon, developed a plastic valve to repair the aortic valve.
1952 F. John Lewis, an American surgeon, performed the first successful open heart surgery.
1953 John H. Gibbon, an American surgeon, introduced the heart lung machine (which he published as a
concept in 1937) and first used this mechanical heart and “blood purifier” to do the first “real open heart surgery” utilizing the heart lung machine, precursor of the modern day cardiopulmonary bypass machine.
1950 John Hopps, a Canadian, invented the external heart pacemaker. That same year, Willem Greatbatch introduced the concept of an implantable (internal) heart pacemaker.
1960 The first self-contained implantable heart pacemaker made by Medtronic was inserted by W. C. Lillihei. Over the years, this has been improved, made more versatile, smaller, better, and longer lasting.
1961 J. R. Jude, an American cardiologist, led a ream in performing the first external cardiac massage to re-start the heart, the foundation for today’s CPR.
1960s Denton A. Cooley of Houston, Texas, rose to world fame for his extraordinary dexterity in performing thousands of congenital heart surgeries in infants, and for being the first to successfully remove pulmonary emboli (clots in the lungs).
1965 Michael De Bakey and Adrian Kantrowitz, American surgeons, implanted mechanical devise to help the diseased heart.
1967 Christian Barnard of South Africa, performed the first whole heart transplant from one person to another.
1968 Denton Cooley performed the first heart transplant in the United States on a 47-year-old man, using a donor heart from a 15-year-old. The patient lived for 204 days. He had done 22 heart transplants over the next year, a record at the time.
1969 Denton A. Cooley implanted the first artificial (mechanical) heart on a man to “tide him over” and keep him alive while waiting for a donor heart.
1972 In the field of clinical application, Denton A. Cooley had, by this time, performed more than 10,000 open heart surgeries, more than any other surgeon in the world. That year, in his honor, the Denton A. Cooley Cardiovascular Surgical Society was founded. Its members are the more than 800 heart surgeons from 50 countries around the world whom he trained at the Texas Heart Institute (THI) in Houston. (As a Filipino-American heart surgeon, I was truly humbled to be elected as its first president.) The THI has been doing more than 30 open-heart surgeries per day since then.
1970s Michel Mirowski, M.D., and his associates, Morton Mower, Stephen Heilman, M.D., Alois Langer, PhD, and a company called Medrad in Pittsburgh, developed the automatic implantable cardiac defibrillator. In 1980, the prototype AICD was implanted at Johns Hopkins to prevent sudden cardiac death.
1982 Willem DeVries, an American surgeon, implanted a permanent artificial heart, designed by Robert Jarvic, also an American physician. O. H. Frazier and his team under Dr. Cooley at the Texas Heart Institute has performed more than 600 heart transplants, and doing extensive works on artificial (mechanical) hearts. Someday, they will be available on the shelf like pacemakers today, and heart bypass and cardiac valve surgeries would be a thing of the past.
A Crazy Idea
A most worthy pioneer was Werner Forssmann, who, as a surgical resident in Germany in 1929, experimented with himself by inserting a catheter through a vein in his arm and into his heart. He walked to the basement where the X-ray machine was, and x-rayed himself to prove that the catheter was in his heart. In another experiment, he injected dye to his heart through that catheter and took x-ray film. Many of his fellow physicians were outraged by his “daring and insane” acts.
This, by the way, was the origin of what we know today as coronary or heart angiogram or cardiac catheterization, that made possible life-saving procedures, like angioplasties and heart bypass surgeries all over the world. Thanks to Forssmann’s “crazy idea.” In 1956, Forssmann was awarded a Nobel prize, shared with Dickinson Richards and Andre Cournand, physicians in New York who studied heart function and physiology using catheters.

NEXT WEEK: Part II - Conclusion


Medical Journal updates

Today, about 1.25 billion people smoke cigarettes, and one billion deaths from tobacco-related illness are expected this century, ten times more compared to the toll in the 20th century. The deadly habit accounts for one in five (or, 1.4 million)  cancer deaths all over the world annually. Each year, around the world, 10.9 million tobacco-related cancer of the lungs are diagnosed. This does not even include other pulmonary, gynecological and cardiovascular disabilities and death tolls as a consequence of smoking.

"We know with cancer, if we take action now, we can save 2 million lives a year by 2020 and 6.5 million by 2040," said Dr. Judith Mackay, a World Health Organization senior policy adviser.

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New studies have shown that even light activities in and around the house, like daily mundane endeavors of daily living (climbing stairs, cleaning the house, cooking, running after the kids, garden works, etc) help prolong life. Especially the ones that make you perspire. Of course, daily regimented exercises will do a lot more. But simple household chores have a positive health effect on longevity as well.

“Elderly couch potatoes were much more likely to die within about six years than those whose lives included regular activity no more strenuous than washing dishes, vacuuming, gardening and climbing stairs”, according to the study of adults aged 72 to 80 published in the Journal of the American Medical Association.

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Macular degeneration, the leading cause of blindness in old age can be prevented by eating a diet rich in fish, according to two new studies in the US Archives of Ophthalmology. Omega-3 fatty acids (fish oil) abundant in fish are already proven to protect the heart and the brain, to reduce the risk of developing heart attack, stroke and Alzheimer’s.

“A study of 681 elderly American men showed that those who ate fish twice a week had a 36 percent lower risk of macular degeneration…In the other study, which followed 2,335 Australian men and women over five years, people who ate fish just once a week reduced their risk by 40 percent,” according to the report. The American study also revealed that smokers double their risk of developing macular degeneration and blindness. Those who do not like fish may take good quality fish oil capsules. Check with your physician if this is right for you.

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The American Journal of Clinical Nutrition reported that “probiotic yogurt --Lactobacillus- and Bifidobacterium-containing yogurt (AB-yogurt) -- enhances the effectiveness of quadruple therapy for eradicating residual Helicobacter pylori (stomach) infection.” This bug is the cause of gastric ulcers, which used to be treated with surgery, but since the discovery that gastric ulcer is caused by Helicobacter pylori, it is now a medical disease, treated with pills. A big boon to better quality evidence-based patient care.

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Exercise-induced muscle damage, which happens to most athletes, can be minimized to a great extent by drinking tart cherry juice, reports the British Journal of Sports Medicine. For those who exercise at home, drinking tart cherry juice will certainly not hurt. This is, indeed, a welcome new to those who  exercise. 

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Soft drinks, which I call liquid candies, are toxic to the body, especially to children. All of them -- cola or uncola, regular or diet, caffeinated of decaffeinated -- increase the risk for metabolic diseases. The harm to our body does not manifest immediately; it takes years to develop. By then, the damages would have been done. Prevention is obviously the key.

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To prevent cardiovascular illnesses, metabolic diseases and cancer, diet alone is not enough. Daily exercise, abstinence from tobacco and moderation in alcohol intake are a must. The American Heart Association has revised its former decades-old recommendation that stressed mainly healthy diet as the regimen to prevent these illnesses. 

"The previous recommendations mainly stressed the importance of a healthy diet; the new (revised) ones broaden that concept to include the importance of a healthy lifestyle pattern”, lead author and chair of the AHA's Nutrition Committee Alice Lichtenstein, DSc, from Tufts University in Boston, Mass, said in a news release. "The two go together — they should be inseparable."

A simple walk around the block (or brisk-walking if tolerated) for about 30 minutes does wonders to our cardiovascular, pulmonary, and immune systems, warding off not only cardiovascular and metabolic diseases but also deadly cancers.

Warning: Processed foods increase the risk for cancer and cardiovascular diseases. Sample of these are hot dogs, sausages and other deli meats, and other food items that have gone though processing. Fresh is better and healthier than processed food items.

The AHA 2006 detailed recommendations are as follows:

  • Consume an overall healthy diet. 
  • To maintain a healthy body weight, balance calories consumed with calories burned. 
  • Increase awareness of calorie content of foods for portions typically consumed and of daily caloric requirements. 
  • Set a goal of at least 30 minutes of physical activity daily. 
  • Consume a diet rich in a wide variety of fruits and vegetables (not fruit juices), especially those that are deeply colored (spinach, carrots, peaches, and berries). 
  • Prepare fruits and vegetables, minimizing saturated fats from red meats and transfats.
  • Choose nuts and high-fiber foods. 
  • Consume 2 servings of fish, especially those relatively high in omega-3 fatty-acids (eg, salmon, trout, and herring) at least twice weekly. 
  • Children and pregnant women should follow Food and Drug Administration (FDA) guidelines for avoiding mercury-contaminated fish (eg, shark, swordfish, king mackerel, and tilefish). 
  • Limit intake of saturated fat, trans fat, and cholesterol by choosing lean meats, vegetable alternatives, and fat-free (skim) and low-fat (1% fat) dairy products and minimize intake of partially hydrogenated fats. 
  • Minimize intake of beverages and foods with added sugars. 
  • To consume NO more than 2300 mg of sodium daily, choose and prepare foods with little or no salt. Middle-aged and older adults, African Americans, and those with hypertension should consume no more than 1500 mg of sodium daily. 
  • Limit alcohol intake to not more than 1 drink per day for women and 2 drinks per day for men (1 drink = 12 oz of beer, 4 oz of wine, 1.5 oz of 80-proof distilled spirits, or 1 oz of 100-proof spirits). 
  • When eating out, be aware of portion size; select vegetables and fruits; and avoid foods prepared with added saturated or trans fat, salt, and sugar. Eating fruits first before the meal is better than eating them after the meal for physiologic reason.

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Antibiotic Stewardship

At the 103rd Annual Clinical Congress of the American College of Surgeons last week in San Diego, California, I met several surgeons from the Philippines who flew in to attend the ACS Congress. As a Fil-Am surgeon, I always enjoy and savor meeting my colleagues from my native land. One of them happened to be an old friend, Dr. Enrique T. Ona, former Secretary of Health of the Philippines. This yearly continuing surgical education event attracts hundreds of surgeons from all over the world.

One of the hot topics at this international convention was Antibiotic Stewardship, a vital global program ACS is spearheading that could save humanity as a whole from deadly superbugs that could wipe out civilization, if not prevented or contained, an issue I have discussed in a previous column.

According to the World Health Organization, “antibiotic resistance is one of the major threats to human health, especially because some bacteria have developed resistance to all known classes of antibiotics.”

Improper use
The United States Centers for Disease Control and Prevention (CDC) reported that “30 percent to 50 percent of prescribed antibiotics in hospitals are administered in settings where an antibiotic is unnecessary or is ineffective against the pathogenic organisms…. Increased and inappropriate antibiotic use leads to increased risks of antibiotic resistance, as well as contributing to clostridium difficile (C. difficile) infections.”
Pandemic of superbugs
While terrorism is holding peace hostage around the world today, a more rampant but under the radar killer is on the loose and becoming more widespread, wiping out lives, as the medical community helplessly battles this pandemic situation of super bugs resistant to all drugs we currently have. Being at the mercy of these powerful and defiant microorganisms is a most scary situation. And they seem to be ahead of us.

Pneumonia and wound infections killed hundred of millions of people globally before penicillin was discovered in 1928 by Alexander Fleming, Professor of Bacteriology at St. Mary's Hospital in London. Today, these conditions and hundreds of other infections respond well to penicillin and the other more sophisticated antibiotics, savings hundreds of million of lives every century...until now, with the explosion of super bugs!

Scary statistics

At least 2 million Americans develop drug resistant infections a year and more than 23,000 of them die, 10 million deaths a year worldwide. This translates to $100 trillion sacrificed gross national products. Most of these scary infections occur in hospital settings, but they are also noted in the general community. These could be the commonly known conditions, like pneumonia or wound infection, but this time caused by drug-resistant bacteria, and hence, deadly. It is like retro-transporting us back to the early 1900, the pre-penicillin era.

Lessons from the past

While two of the most devastating outbreaks of the Black Death (plague) that wiped out more than half of the population of Europe in the 14th Century killing about 75 million, leading to the final demise of the Roman Empire, was caused by two different strains of infectious agents from the black rats, one drug resistant infection today could kill much more around the globe.

Just like us, humans, bacteria are active living microorganisms, with survival “instinct,” and when exposed to the drugs that aim to kill them, have the capacity to adapt by mutation and replication to become resistant to the drugs, When they become super bugs, they are untouchable killers, unless we develop new drugs effective against them.

Who to blame

We cannot blame the bacteria, who simply want to survive just like all living things. We, humans, healthcare providers and lay people, who abuse antibiotics, are to blame. Whether prescribed indiscriminately or purchased over the counter by self-medicating individuals, the widespread abuse of antibiotics make the bacteria mutate and grow resistance to them.

Currently, there are at least six common pathogens that are drug-resistant, Klebsiella pneumoniae, E. Coli, and MRSA, and 3 global diseases: HIV, TB and malaria. There are many others. Unless science discovers fast ways to fight and kill these resistant superbugs with new drugs or methodology and we, the people, do not abuse their use, any and all of them will continue to kill humans and other animals with impunity around the world.

Bacteria are on ALL surfaces

These microorganisms are on our skin, on our entire body. They are also all around us, in all surfaces, in our kitchen (which has more bacteria than our bathroom), all over our home, and in all public areas, like escalator hand rails, door knobs, cabinets, microwave oven door handle, countertops, tables, chairs, etc.. Paper money and coins are loaded with bacteria. If bacteria are on our skin and everywhere, why do we not always get infected? The reasons are factors like our skin integrity. If our skin is intact, the bacteria cannot invade us, except though our mucus linings (in our eyes, nose, mouth, ears, anus). This is where personal hygiene is essential. Touching our face contaminates it with bacteria. The other factor is the type and dose (number) of bacteria. Even if we have a skin abrasion or cut, if we thoroughly wash the affected area right away, the dose of bacteria will be so reduced our immune system can handle them to prevent infection. If the dose is not reduced, then we get skin infection. This is why all wounds must be washed clean immediately after sustaining them.

Simple hand-washing

On the prophylactic side, the simple habit of washing our hands religiously, at least 8 times a day (after going to the bathroom, before and after eating or working around the house or outside) can prevent contamination and infections, eliminating the need for antibiotics. This practice can also prevent viral infections, like common cold, for which some misinformed or uninformed individuals might opt to take antibiotics. Viral infections do NOT respond to antibiotics. This is just a waste of money, and worse, it will “encourage” bacteria in our body to develop antibiotic resistance. When treated longer than necessary, even bacterial infections commonly sensitive to specific antibiotics will increase the risk of the bacteria developing resistance. Skin sanitizers, preferably with skin moisturizer, in liquid, gel or foam, are helpful in minimizing infection. Those with sixty to 95 percent alcohol are most effective

Antibiotic Stewardship is also our individual responsibility as a member of society. Let’s all help prevent a super bug pandemic that could wipe us out of this wonderful world.

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Renal calculi, features, prevention, treatment

What are renal calculi?

Renal calculi (kidney stones) are chemical crystals that form into a hard salt solid structure that looks like and feels like a common stone we find on the streets. They vary in size, shape, and consistency, according to their chemical composition. They could be calcium oxalate stone, cystine stone, uric acid stone, infection stone, or even a combination.

Where do these stones come from?

Our two bean-shaped kidneys are important blood filters which eliminate chemical waste from our body and excreted into the urine. Without our kidneys, the build up of chemical waste in our body could reach a poisonous, even deadly, level within a few days. In people who have a high risk of forming stones, these chemical crystals solidify in the kidney calices (cup-shaped areas of the kidney). Some of these stones could travel down the ureter (a small muscular tube the connects each kidney to the bladder), causing severe colicky pains from ureteral irritation and spasm.

How large are these stones?

Renal stones vary in sizes, from the size of a grain of sand to as large as a golf ball. Many small stones (silent stones) are passed naturally. Medium stones are often crushed with ESWL (Extracorporeal Shock Wave Lithotripsy), popularly known as Lithotripsy for short. Large stones may need Percutaneous Lithotripsy. Very large stones may need surgical removal, especially the staghorn calculus, which “staghorn” shape and large size lodge it in the kidney pelvis (main chamber) and prevent it from entering and passing down the small ureter. Some stones have round, smooth, surface, and could pass down the ureter to the bladder with lesser pains. Others have sharp, jagged edges, causing more pains when they travel down, or get caught, in the ureter.

What increases the risk for stones ?

Not drinking enough fluids, dehydration, eating certain foods, urinary tract infection, living in hot climate, and family history of kidney stones are the more common factors that increase the risk of kidney stone formation. Metabolic or endocrine problems are rarer causes.

How much water should one drink a day?

In a normal average daily situation, it is advisable to drink about 8 glasses of fluids (water, juices, preferably not pop) a day, whether one had kidney stones before or not. Those who had kidney stones in the past are advised against cola drinks, tea, chocolate, spinach, and peanut, which are high in oxalate, and dairy products which are high in calcium. Those with cystine stones are advised against eating foods high in Methionine, like fish.

Is renal colic really more painful than childbirth?

Yes, women who had kidney stone colics and had given birth say so. The pain is most excruciating, and in men, it could radiate down to the lower abdomen and to the scrotum of the affected side where the stone is. One thrashes around to find a more comfortable position, only to find none. Narcotic shots are given for the relief of the severe renal colic. Sometimes, renal colic could mimic, or be confused with, acute appendicitis. In some patients, there could be blood in the urine, from the irritation of the ureter where the stone is lodged.

What are the diagnostic tests for kidney stones?

After a thorough history-taking and physical examination, your physician may order urinalysis, urine culture (for bacteria), blood count, blood chemistry (including calcium, phosphorus, BUN, creatinine, uric acid, and electrolytes) a KUB (plain x-ray of kidney, ureter, bladder), an IVP (intravenous pyelogram, x-ray with dye to see locate the stone), an Ultrasound (a “3-Dimensional” picture of the kidney); and/or a CT Scan (Computed Tomography, an X-ray technique showing cross-sectional images of the abdominal area to locate and identify the stone). Twenty four-hour urine sample may also be taken to find out the levels of stone-related chemicals in the urine. Provocative Tests may also be done to see how the kidneys handle chemicals. Stone analysis is essential to determine the chemical composition of the stone, which will help identify the cause of the stone formation and aid in the preventive treatment in the future.

Are some stones dissolved by medications?

Yes, bicarbonate/potassium citrate may dissolve uric acid stones and cystine stones. This is why it is important strain the urine when one suspects kidney stones, to find out what the chemical composition of the stone is. Medications prescribed to dissolve kidney stones are taken for a lifetime. Unfortunately, not all stones are dissolved by medications. However, many kidney stones are passed naturally. Sometimes alpha blocker drug is used to relax the muscles of the ureter to allow passage of larger stones. Newer extracts to dissolve all types of kidney stones (and gallstones also) are being researched in laboratories around the world.

How does one prevent renal stones?

Uric Acid stones are found among those who overproduce uric acid (gout), and can be worsened by a high-meat diet (high in purines), especially pork and beef. Allupurinol is one drug that reduces uric acid. Cystine stones come from too much cystine (amino acids) in the body, caused by an inherited condition. Penicillamine or Tiopronin reduces cystine. Prevention in this case includes diet low in methionine (a normal chemical found in fish). Infection stones, as the name suggests, is caused by a rinary tract infection. Antibiotics are given before the stones are removed. In all these three conditions, drinking lots of water helps a lot in preventing recurrent kidney stones. Popular old-fashioned lemonade is effective in reducing kidney stone formation.

What is ESWL?

If the stone or stones cannot be dissolved by medications or are too large to pass down the ureter, Extracorporeal Shock Wave Lithotripsy is an option. There are several types of ESWL but the principle is the same for all. The patient lie down or sits up in a water bath, high-energy shock waves from the high-tech machine are precisely aimed at the stone (with pin-point accuracy). The waves, passing through the water cushion, travel at a high speed, pass through the soft tissues of the body without harming them and “shatter” the stone (only) into very fine sand. The procedure is done with mild sedation, and may last about an hour and done as an outpatient or on an overnight stay.

What is the surgical treatment?

If all of the above therapies fail, invasive or surgical approach is the final option. This includes fishing out the stone in the ureter with a Ureteroscope. Percutaneous Lithotripsy is used for stones larger than one inch in diameter and where ESWL did not work. A small skin incision is made in the affected flank and the stone is shattered by painless ultrasound, or removed by Percutaneous nephrolithotomy. With the available modern technology today, open surgery is now reserved only for those with very large or oddly located kidney stones.

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Candidate for a stroke?

In the United States, one person is diagnosed with a stroke every 40 seconds. This dreaded and debilitating illness is so common it victimizes more than 2,000 individuals each day and killing about 133,000 each year. In the Philippines, the prevalence is between 1.9% to 6.59 %.

I have friends who had developed a stroke of one type or another, with varying degrees of severity. It is a life-changing ailment that adversely affects the life of the entire family involved, especially the spouse. If the victim is the bread-winner, the devastation is even greater.

Prevention is best, and luckily about 80 percent of stroke is preventable, but when it happens, speedy diagnosis and treatment spells the difference between full or partial recovery, minor or major residual disability.  HYPERLINK "" \o "Educational Slideshow" \t "_blank" Stroke is the fifth leading cause of death in the United States and the leading cause of major disabilities among adults, 

What are the types and causes of a stroke?

To simplify it for our layman readers, the most common two types and causes of a stroke are artery blockage or bleeding. Arterial obstruction (carotid “neck” artery stenosis) is due to arteriosclerosis (hardening of the artery), which could cut off circulation to the brain. The other form of arterial blockage is from a clot coming from the heart moving up to block a brain artery (usually among persons with atrial fibrillation, where the left upper chamber of the heart quivers instead of beating normally, thus accumulating clots in the left atrium, which could break off and flow upwards to obstruct the brain artery). The second type of a stroke is caused by bleeding on top of the brain from a fall (trauma) or bleeding within the brain tissues itself, which is more dangerous.

What is Atrial Fibrillation?

Popularly known as A-Fib, atrial fibrillation is the most common type of heart irregularity. Some are related to heart valve disease. About 6.4 million Americans have A-Fib not related to any haeart valve problem. A-Fib increases the risk for a stroke by 5 times. The actual cause of A Fib is not clear. It is more common among seniors and 10% has of those 80 and older have AFib. The patient may have no symptom at all and not know they have A-Fib. The common symptoms are tiredness and shortness of breath. Most patients feel their heart beat skips once in a while. The A-Fib won’t go away on its own. To reduce the risk of heart failure or a stroke, medical consultation is mandatory.

What is TIA?

Transient Ischemic Attacks (TIA) is the temporary episode of a mild stroke that disappears rapidly. This is caused by spasm of an artery to the brain or by a tiny soft clot that blocks an artery to the brain, which dissolves spontaneously, allowing normal circulation to resume. TIA is a warning, and immediate medical attention is warranted. The various imaging studies available for carotid arteries (located on the left and right side of the neck which supply blood to the brain) include ultrasound (and doppler), and if these are not diagnostic or clear, one of the following may be used: angiography, magnetic resonance angiography (MRA), and CT angiography.

What is carotid endarterectomy?

When a person develops TIA or a mini-stroke and confirmatory tests show there is significant blockage in one or both carotid arteries, the calcified plaques blocking these neck arteries could be removed by a surgical procedure called carotid endarterectomy. This is a brain-saving procedure which must be performed reasonably urgent, in accordance with the evaluation of the surgeon, before a major or massive stroke follows.

Can a lay person diagnose a stroke?

A non-medical individual, actually anyone at the scene, could make a rapid diagnosis using the acronym FAST. In most articles, this stands for Facial drooping, Arm weakness, Speech difficulties, and Time to call emergency services. For me, I prefer for Tongue deviation, all four letters to represent physical abnormalities. Calling 911 for emergency rescue is vital. But any two of the above four signs are enough to suspect a stroke. Facial drooping becomes evident when you ask the person to smile. Comparing the strength of the two arms will show you which side is weaker. Asking the patient to talk will reveal slurred speech or inability to talk..The tongue usually points to the side of the facial droop and the weaker arm, opposite the side of the brain affected. The right side of the brain controls the left side of the body, and the left half of the brain, the right side of the body. The active dynamics of the pathology must be assessed without delay and treatment started immediately. Brain cells could die within minutes. In stroke, every minute counts.

Do you have the risk factors for a stroke?

Genetics is one, but since we cannot alter our genes as a standard of care for stroke prevention with our current science and technology, there practical strategies we can apply to minimize the risk for the development of a stroke. Someday, preventive genetic engineering and manipulation for all diseases will be available. In the meantime, here are some tips to greatly reduce the risk for having a stroke, heart attack, and even cancer, basically by living a healthy lifestyle or making necessary lifestyle changes.

Eat healthy, mostly fish, vegetables of various colors, nuts, and some fruits. Minimize intake of red meats (especially processed foods, which are toxic to the body) and cut down on carbohydrates, like rice, bread, sweets in general, which catapults the risk for T2 diabetes. The Philippines has one of the highest rate for T2 diabetes in the world, courtesy of “kanin.” No-rice hi-protein legume and vegetable diet is now becoming very popular and a trend.

Drink about 8 glasses of filtered water daily. Stay away from soft drinks which are toxic and increase the risk for metabolic syndrome for children and adults. Any form of this “liquid candy” causes eight gain and is harmful to the body. 

Do daily exercises. Simple brisk walking for 30 minutes each day improves overall health by strengthening muscles, equilibrium and balance, and boosts the immune system, and ward off major illness, including Alzheimer’s and even cancer.

Practice stress management with R&R, even at work, and especially during the weekend with the family

Discontinue tobacco use and take alcohol beverage in strict moderation. These two items are the causes of most of our infirmities today. They are not worth developing a stroke or heart attack for.

Regular medical and dental check-ups are essential. Take your medications religiously and follow the advice of your physician, including a low-fat, low carbs, and low-salt diet.

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Red meat and cancer

We have discussed this red meat-cancer link in this column a few years back, but recent studies have sparked new interest on this medical controversy, and confirmed fundamental findings which might be of interest to you. After all, everyone wants to be as healthy as possible and live as long as our telomeres would maximally allow.

What are telomeres?

Telomeres are the protective caps at each end of our DNA. They shorten with age and could also be affected by good or bad lifestyle. Avoiding bad habits and bad diet (living a healthy lifestyle) will slower its shortening, therefore, maximizing life span.There are now on the market DNA tests that will track cellular age (telo-years) based on telomere length, for $129 per test.

But why test for the amount of “poison” in our system and spend that amount for a test when the better way is to stop taking in known “poisons” and simply live a healthy lifestyle thru exercise, diet, abstinence from tobacco, moderation in alcohol intake, and stress management with RRR (regular rest and relaxation).

As far as diet is concerned, red meat is on the spotlight again.

What’s with red meat?

Red meat (beef, pork, veal, lamb, mutton, goat, and other mammalian muscles), fresh or processed, are both suspected to increase the risk for cancer and other major illnesses. The processed ones are deemed worse. Some of the processed red meats are sausages, bacon, ham, patties, hamburgers, bologna, corned beef, salami, pepperoni, pastrami, most deli-meats, and canned meats.

How much red meat is consumed in the USA?

In the United States last year, it is estimated that one person consumed about 106.6 pounds of red meat. Over the years, the consumption of red meat has gone down from 145.8 pounds per individual in 1970 to almost 40 pounds less today. The past ten years alone saw the red meat eaten has gone down about 10 pounds per person. The lowest on record was in 2014, at just 101.7 per person. Indeed, red meat intake has dramatically fallen the past four decades because of widespread news of colorectal cancer and other forms of malignant tumors, and their link to consumption of red meat.

Why are so many eating less red meat?

Besides being more expensive than white meat and plant-based food items, the damaged reputation of red meat as being unhealthy for us and its link to increased cancer risk, and the warning being on the internet and all social media today, people around the world are becoming more educated and health conscious. Their desire to live healthier and longer is encouraging them to stay away from red meat and instead eat fish, legumes (the various types of beans and garbanzos) and/or chicken as sources of protein. For breakfast, many have switched to the old fashioned oat meal and some fruits, instead of high carb foods (like rice, bread, pancakes, waffles, soft drinks (liquid candy), etc.) and processed foods which are also high in saturated fat (bacon, sausage, ham.)

Is read meat really that bad?

The World Health organization in October 2015 highligted in a report that “when it comes to red meat intake, cancer is perhaps the most well-established health implication.” It concluded that red meat is "probably carcinogenic to humans," meaning that there is some evidence that it can increase the risk of cancer, a cancer-causing agent. It has been found that those who eat a lot of vegetables, legumes, fish daily (instead of red meats) are healthier and less prone to cancer. The Cancer Council recommends no more than 455 g of red meat a week, if any at all. Many abstain from red meat and opt for fish, vegetables, legumes, which are protective against many forms of cancer, like colorectal, stomach, breast, prostate, and pancreatic cancers

What are processed meats?

The World Health Organization defined processed meat as "meat that has been transformed through salting, curing, fermentation, smoking, or other processes to enhance flavor or improve preservation," and as such is "carcinogenic to humans." There is sufficient evidence today that processed meat intake increases cancer risk.

What in red meat is cancer-causing?

Studies have shown that two groups of toxic agents (cancer-causing), Heterocyclic amines (HCAs) and polycyclice aromatic hydrocarbons (PAHs) are formed when muscle meat (beef, pork, poultry and fish) is cooked at high temperature, like pan frying or grilling directly over an open flame. HCAs and PAHs are known to damage DNA and suspected to increase the risk for cancer formation. The World Health Organization says ”that each 50-gram portion of processed meat - which primarily includes pork or beef - consumed daily increases the risk of colorectal cancer by 18 percent.” The burned (charcoal black) portions of fried or grilled meats are toxic.

How did WHO come to that conclusion?

The WHO’s International Agency for Research on Cancer (IARC) reviewed more than 800 independent studies analyzing the effects of red meat and processed meats on the different types of cancers. The evidence uncovered reveled that those who ate red meat had increased risk for colorectal, pancreatic and prostate cancer. There are ongoing studies about the role of HCAs and PAHs in human cancer risk.

Why the shift to plant-based foods?

There are approximately 8 million adults in the United States who are vegetarians or vegans for animal welfare, the 2016 Harris Polls reported. But there are millions more who are switching from red meat to plant-based diet because it is healthful. A position paper from the Academy of Nutrition and Dietetics in December 2016 suggested that “a plant-based diet can lower the risk of type 2 diabetes by 62 percent, as well as reduce the risk of heart attack and stroke.” Actually, what entice people is not only the health benefits of consuming plant-based foods but the significant link of eating red meat and cancer.

What are the options?

As we grow older, health becomes more significant and a priority. The adage “Health is Wealth” is most valid and true. Just ask those millionaires or billionaires who are going blind from a disease with no cure, or who are dying from cancer, or losing their mind from Alzheimer’s. They would give up their material wealth in an instant just to regain their health.

We have options. Since we do not know if our genes (DNA) can tolerate and survive regular red meat consumption without developing cancer and major cardiovascular illnesses, it behooves us to enjoy a diet of fish, vegetables, legumes, and nuts daily and stay away from, or significantly reduce, our red meat intake, in view of the scientific evidence before us. Or, we can continue our red meat diet and accept the consequences of killer diseases and of premature death. Like anything in life, it is a matter of choice.

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Kidney stones? drink lemonade, not pop !

Nothing to date can dissolve kidney stones, in spite of various marketed herbal substances or “natural and home” remedy potion or pills which claim to be able to do so. Don’t be fooled by false advertisements which are only after your hard-earned money.

If you are prone to develop kidney stones, drink lemonade. It cannot dissolve kidney stone crystals, but it can slow down the development of stones. It is a delicious way to control your stone formation.

"When treating patients in our kidney stone center, we put everyone on lemonade therapy," says Steven Y. Nakada, chair and professor of urology at the University of Wisconsin, a previous annual meeting of the American Urological Association in Atlanta.

Potassium citrate is usually prescribed for patients with kidney stones. Citrate is a kidney-stone preventing substance, and lemonade (lemon juice) is full of citrate. The pill is more potent but the citrate in lemonade has been found to also slow down kidney stone formation. An alternative to “another pill” to take.

Liquid biopsy?

The term biopsy conventionally means cutting a piece of solid tissue for microscopic analysis to make a diagnosis. Liquid “biopsy” is a new promising procedure for detecting early-stage cancers by blood test, which replaces cutting a “solid tumor,” hence termed “liquid biopsy.” The article about this future much less invasive way of finding cancer at its early stage, edited by William E. Chavey, MD, MS, was published in the New England Journal of Medicine and Science Translational Medicine.

The report says “the technique allows assessment of sequence changes in circulating cell-free DNA. Researchers used the method to look for alterations in nearly 60 cancer-related genes in blood samples from 44 healthy individuals and 200 patients with colorectal, breast, lung, or ovarian cancer. None of the healthy patients showed genetic changes related to solid cancers, while the test detected genetic alterations in 60%–70% of those with stage I or II cancer. The researchers say the approach could "in principle" be implemented for cancer screening, pending validation studies. Early detection and intervention are likely to be the most effective means for reducing morbidity and mortality of human cancer. When it is validated and accepted as a standard diagnostic procedure, “Liquid Biopsy” could save hundreds of millions around the globe.

Your teeth, sleep, and diabetes

Most people do not know or realize that poor dental health and impaired sleep increase our risk for diabetes T2 and, in turn, this metabolic disease adversely affects our teeth and sleep. It is a vicious cycle of cause and effect highlighted by the American Dental Association.

The ADA “two-way-street” clarification: “Blood sugars fueling the acidity that leads to tooth and root decay and gum disease, and dental disease that leads to infection and boosts blood glucose when the body’s immune system responds. The 2017 publication recognizes the close association of dental disease and diabetes, even though ADA acknowledges that causes and effects aren’t yet universally understood.”

Also, dental/oral infection, and infection (inflammation) in any other parts of the body increase our risks for cardiovascular diseases and cancer too.

This is why dental hygiene and regular visit to the dentist is paramount.

Sleep and diabetes

Impairment in sleep raises our risk for metabolic disease, like diabetes, obesity, cardiovascular illnesses, like heart attack, stroke, and even cancer. Yes, lack of restful sleep leads to increased proneness to all these major ailments, including deadly cancers. Indeed, sleep is that important to our health and well-being.

More and more, physicians today are far more vigilant about Obstructive Sleep Apnea (OSA) as a most common cause of impairment of sleep and its association and role to the development of (and as a worsening factor) for the major illnesses listed above. For emphasis, I wish to highlight cancer is on that list.

About 3-7 percent (roughly about 10 to 16 million) of the US population have sleep apnea, more among men. There are countless undiagnosed OSA cases. Almost 25 percent of individuals with diabetes T2 also have OSA,

Then, there is Sleep-disordered breathing (SDB), affecting about 60 percent of the adult and elderly population, where the person does not stop breathing but breathes shallower and gets about 30 percent less airflow for 10 seconds. In OSA, there is frequent (could be hundred times a night) breath holding, severely reduced oxygen level, and the person wakes up gasping for breath. Some do not even wake up at all, suffering anoxia and heart attack or fatal heart-rhythm problem. The constant reduction in oxygen due to OSA every night also leads to fatigue, sleepiness during the daytime, lack of concentration, poorer decision-making, and inferior performance. Depriving the body oxygen and rest also increase the risk for those major diseases mentioned above, including cancer.

Among diabetics, SDB, OSA, and all stresses, impair the metabolism of our body in general and, among those with diabetes, the body’s ability to allow the medications to work fully.

Metformin, the most popular drug for diabetes T2, which acts to reduce the glucose production in the liver and reduce the cell insulin resistance, acts less than 100 percent when the patient has an untreated sleep disorder, most frequently sleep apnea. This makes the treatment less optimal. And the same thing is true among those patients with high blood pressure or other major ailments on treatment. A good restful sleep every day is essential for all of us.

After a Sleep Study has confirmed the diagnosis of Obstructive Sleep Apnea, the best treatment is the use of CPAP (Continuous Positive Airway Pressure) whenever going to sleep. CPAP has saved and improved countless lives.

SEATCA Statement: Secret operations of tobacco

Secret operations of tobacco companies to undermine global health governance

Bangkok, 14 July 2017: New explosive investigative reports by Reuters and The Guardian have exposed how transnational tobacco companies, particularly Philip Morris International (PMI) and British American Tobacco (BAT), are running secret campaigns to block or undermine the implementation of the WHO Framework Convention on Tobacco Control (FCTC) and governmental negotiations at the FCTC Conference of Parties (COP).

The investigations reveal multiple tobacco industry offensives across at least 14 countries in Africa, America, and Asia, including Vietnam, and how they subvert the treaty on multiple levels. The COP was targeted because it is a venue where government delegates gather to decide on important FCTC and tobacco control decisions. The industry also lobbies and infiltrates government delegations, and challenges government by filing cases at the country level, where treaty decisions are implemented. For example, PMI targeted Vietnam at the sixth and seventh sessions of the COP in 2014 and 2016, corroborating civil society observations of how Vietnam’s COP statements frequently mirrored PMI’s positions on tobacco control regulations.

Besides undermining the COP sessions, PMI also targets tobacco control NGOs, including SEATCA, of which PMI says, “We’re still building ASEAN-wide counterweights to SEATCA, the major ATO [anti-tobacco organization] in Asia.”

​SEATCA's Executive Director Ms. Bungon Ritthiphakdee reacted positively, "PMI's identification of SEATCA as 'the major anti-tobacco organization in Asia' and its work to counter our activities show SEATCA is effectively protecting public health in our advocacy for strong tobacco control policies," she said.​

PMI also complained of “attacks on our fiscal arguments and allies”, citing SEATCA’s critique of the PMI-funded report on illicit tobacco trade by the International Tax and Investment Center (ITIC) and Oxford Economics.

“These investigative exposés clearly show that transnational tobacco companies have not changed despite their recent rhetoric about less harmful products and a smoke-free future. They will continue to interfere with government efforts and stringent tobacco control legislations and attack civil society groups that protect public health,” added Ritthiphakdee.

The best antidote for tobacco industry tactics such as those revealed in the investigations, is to implement FCTC Article 5.3 that protects governments and public health policies from tobacco industry interference.

Tobacco use kills about 500,000 people per year in the ASEAN region. Tobacco use in ASEAN not only impoverishes the users but also burdens national economies with more than USD10 billion in healthcare costs annually due to tobacco-related illnesses and premature deaths.


Wendell C Balderas, Media and Communications Manager – SEATCA

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Related links:

Inside Philip Morris’ campaign to subvert the anti-smoking treaty – Threats, bullying, lawsuits: tobacco industry's dirty war for the African market -


SEATCA is a multi-sectoral non-governmental alliance working to promote health and save lives by assisting ASEAN countries to accelerate and effectively implement the evidence-based tobacco control measures contained in the WHO FCTC. Acknowledged by governments, academic institutions, and civil society for its advancement of tobacco control movements in Southeast Asia, the WHO bestowed on SEATCA the World No Tobacco Day Award in 2004 and the WHO Director-General's Special Recognition Award in 2014.

Metformin: anti-cancer

Long-term use of metformin has been associated with increased homocysteine levels[65] and malabsorption of vitamin B12.[66][67] Higher doses and prolonged use are associated with increased incidence of vitamin B12 deficiency,[68] and some researchers recommend screening or prevention strategies.[69]

Lactic acidosis[edit]

The most serious potential adverse effect of biguanide use is metformin-associated lactic acidosis (MALA). Though the incidence for MALA about nine per 100,000 person-years,[70] this is not different from the background incidence of lactic acidosis in the general population. A systematic review concluded no data exists to definitively link metformin to lactic acidosis.[71] Lactic acidosis can be fatal.

Phenformin, another biguanide, was withdrawn from the market because of an increased risk of lactic acidosis (rate of 40-64 per 100,000 patient-years).[70] However, metformin is safer than phenformin, and the risk of developing lactic acidosis is not increased except for known high-risk groups.[71]

Lactate uptake by the liver is diminished with metformin administration because lactate is a substrate for hepatic gluconeogenesis, a process that metformin inhibits. In healthy individuals, this slight excess is cleared by other mechanisms (including uptake by unimpaired kidneys), and no significant elevation in blood levels of lactate occurs.[28] Given impaired kidney function, clearance of metformin and lactate is reduced, increasing levels of both, and possibly causing lactic acid buildup. Because metformin decreases liver uptake of lactate, any condition that may precipitate lactic acidosis is a contraindication. Common causes include alcoholism (due to depletion of NAD+ stores), heart failure and respiratory disease (due to inadequate tissue oxygenation); the most common cause is kidney disease.[72]

Metformin has been suggested to increase production of lactate in the large intestine, which could potentially contribute to lactic acidosis in those with risk factors.[73] However, the clinical significance of this is unknown, and the risk of metformin-associated lactic acidosis is most commonly attributed to decreased hepatic uptake rather than increased intestinal production.[28][72][74]

Lactic acidosis is initially treated with sodium bicarbonate, although high doses are not recommended, as this may increase intracellular acidosis.[75] Acidosis that does not respond to administration of sodium bicarbonate may require further management with standard hemodialysis or continuous venovenous hemofiltration.


A review of metformin overdoses reported to poison control centers over a five-year period found serious adverse events were rare, though the elderly appeared to be at greater risk.[76] A similar study in which cases were reported to Texas poison control centers between 2000 and 2006 found ingested doses of more than 5,000 mg were more likely to involve serious medical outcomes in adults.[77] Survival following intentional overdoses with up to 63,000 mg (63 g) of metformin have been reported.[78] Fatalities following overdose are rare.[75][79][80] In healthy children, unintentional doses of less than 1,700 mg are unlikely to cause significant toxic effects.[81]

The most common symptoms following overdose include vomiting, diarrhea, abdominal pain, tachycardia, drowsiness, and, rarely, hypoglycemia or hyperglycemia.[77][80]

Amazing anti-cancer compound derived from the French Lilac: Galega officianalis (metformin)

Aug 29, 2011 Brian D. Lawenda, M.D.

Metformin is a medication derived from the herb Galega officinalis (French lilac, also known as Goat’s Rue or Italian Fitch) and has been used as a traditional botanical (tea infusion) for over 3,000 years to relieve polyuria (frequent urination) and halitosis (sweet odor on the breath), both are now well known symptoms of diabetes. Approved for the treatment of hyperglycemia in Britain since the late 1950’s, Canada in the 1970’s and U.S. in 1995, metformin is the most widely prescribed diabetes drugs (over 120 million prescriptions filled yearly worldwide).

Although the mechanism of action of metformin in diabetes is only partially understood, metformin treatment reduces levels of both blood glucose and insulin. The primary mechanism of action in diabetes is on the liver through reduced production of glucose. (ref)

Scientists have recognized for years that certain cancers (i.e. breast, prostate, colon, endometrial, pancreatic, lung, etc.) thrive in the presence of elevated blood sugar and insulin levels, eventually leading to higher rates of tumor development, progression and metastases. By keeping blood sugar levels low (either by diet or medications), cancer development and progression is impaired. (I have written more extensively about the role of sugar and insulin in cancer development and progression on the IOE website.)

Anti-cancer effects of metformin:

Over the last decade, numerous studies have discovered that metformin (compared with other glucose-lowering therapies) appears to have powerful anti-cancer effects that extend far beyond simply lowering blood sugar and insulin: (ref)

activation of AMP-kinase (AMPK):suppression of human epidermal growth factor receptor-2 (HER-2) AMPK inhibits glucose production in the liver (indirectly reducing insulin and insulin-like growth factor, IGF-1, levels)AMPK increases insulin sensitivity (reducing blood sugar levels) by increasing glucose uptake in muscleAMPK activation blocks gene expression of cancer promoting proteins, leading to inhibition of tumor cell growth (induction of cell cycle arrest and apoptosis)AMPK inhibits the genetic signaling of the molecular complex, mTOR (mTOR activation is implicated in cancer development and chemotherapy resistance)

selective killing of cancer stem cells (often chemotherapy resistant cells)aromatase inhibition (decreasing estrogen production in the body)increases the effectiveness of chemotherapy (higher pathologic complete response) and radiation therapy (radiation sensitization)significantly decreases body mass index (via effects of maintaining lower blood sugar levels and appetite suppression); obesity increases systemic inflammation, estrogen levels, free radicals (all of which can stimulate cancer growth and progression)lower blood sugar levels maintain lower insulin secretion (insulin and its’ associated hormone, IGF-1, are tumor growth factors)

Metformin & breast cancer:

56% reduction in the risk of developing breast cancer among those taking metformin versus not taking metformin (ref)24% of diabetics breast cancer patients taking chemotherapy with metformin had a complete remission versus 8% who were not taking metformin (ref)

Metformin & colon cancer:

42% reduction in precancerous tissue changes among those individuals taking metformin for 1-month versus no change among matched controls not on metformin (ref)

Metformin & lung cancer:

24-45% improved progression free survival and 35% improved overall survival among type-2 diabetics treated with chemotherapy and metformin for non-small cell lung cancer versus those who were treated with chemotherapy without metformin (ref)

Metformin & prostate cancer:

44% reduction in the risk of developing prostate cancer among those taking metformin versus those not taking metformin (ref)

Metformin & pancreatic cancer:

62% reduction in the risk of developing pancreatic cancer among those taking metformin versus those not taking metformin (ref)

Ongoing clinical trials of metformin and cancer:

Currently, a number of clinical trials examining the use of metformin as a cancer therapy are underway including studies in prostate, breast, endometrial and pancreatic cancer patients. Increasingly, published data support the anti-cancer effects of metformin not only in diabetics but also among those without diabetes. Therefore, many of these clinical trials are enrolling cancer patients with or without diabetes. One of the largest studies was recently initiated by the National Cancer Institute of Canada Clinical Trials Group (NCIC MA.32) examining the effect of metformin versus placebo in over 3,500 non-diabetic women with early stage breast cancer. These clinical trials will be integral to the development and effective use of metformin as an anticancer therapy.

Metformin dosage and contraindications:

The typical metformin dosages are 250-850 mg taken 2-3 times each day (before meals).

Read more about the contraindications for metformin here.


Metformin is a promising anti-cancer therapy with multiple mechanisms of action that extend beyond its classical role as an anti-diabetes agent. As one of the most widely prescribed, well-studied, safe and inexpensive (generics have been available for years) medications on the market, metformin stands a good chance of becoming one of the standard adjuvant therapeutic agents in our war against cancer development, progression and recurrent

Metformin is used with a proper diet and exercise program and possibly with other medications to control high blood sugar. It is used in patients with type 2 diabetes. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual function problems. Proper control of diabetes may also lessen your risk of a heart attack or stroke. Metformin work, s by helping to restore your body's proper response to the insulin you naturally produce. It also decreases the amount of sugar that your liver makes and that your stomach/intestines absorb.

HealthDay Reporter

Latest Thyroid News

Flame Retardants Tied to Thyroid Cancer RiskHigh Thyroid Hormone Levels Tied to Stiff ArteriesCheck Your Neck for Thyroid AbnormalitiesCan You Blame Your Headaches on Your Thyroid?Restrictive Diets May Cause Thyroid TroublesWant More News? Sign Up for MedicineNet Newsletters!

WEDNESDAY, May 24, 2017 (HealthDay News) -- When your thyroid isn't working properly, it can cause a lot of problems. It's important to understand what your thyroid does and to be aware of signs that can signal a health issue.

The thyroid is a small gland located near the base of your neck. Its primary job is to produce the hormones that control many bodily functions, including how fast you burn calories and how fast your heart beats.

If your thyroid produces too many hormones, your metabolism quickens. This problem, called hyperthyroidism, can cause symptoms like anxiety and irritability, weight loss and a rapid heart beat. You may have muscle weakness or trembling in your hands or fingers.

Hypothyroidism is when your thyroid doesn't produce enough hormones. You might feel tired or sluggish and even depressed. You might experience weight gain, muscle weakness and possibly constipation.

In either case, symptoms can develop slowly, sometimes over years. At first, you may not even notice or know you have a problem. And when symptoms do start, it's easy to mistake them for other health problems.

So if you're just not feeling like yourself, talk to your doctor. It could be your thyroid. A simple blood test might be all you need to know for sure. And the right treatment could be as simple as taking a daily pill when you wake up in the morning.

Truth aboutMiddle-aged and older folks with elevated levels of a thyroid hormone may face a higher risk of developing hardened blood vessels, a new Dutch study suggests.

Hardened blood vessels (atherosclerosis) develop when plaque builds up on blood vessel walls. This condition is a risk factor for heart disease.

"Coronary heart disease and stroke remain a leading cause of mortality worldwide, despite advances in prevention and treatment," study author Dr. Arjola Bano said in a news release from The Endocrine Society.

Therefore, identifying additional modifiable risk factors for hardened blood vessels is important, he said.

"These findings suggest that thyroid hormone measurement can help identify individuals at risk for atherosclerosis, and may have future implications for the prevention of atherosclerotic morbidity and mortality," Bano said. He's a doctoral candidate at Erasmus Medical Center in Rotterdam.

To explore the issue, the researchers spent an average of eight years tracking about 9,800 Dutch men and women. The participants were about 65 years old, on average.

During the study, nearly 600 participants were determined to have died due to plaque build-up in the blood vessels. Roughly 1,100 experienced some kind of a problematic event related to hardened blood vessels.

The research team concluded that those who had higher levels of what's called "free thyroxine," or FT4, faced a higher risk for plaque build-up and heart disease complications.

Bano and his team presented their findings Saturday at a meeting of the Endocrine Society in Orlando, Fla. Findings presented at meetings are typically viewed as preliminary until they've been published in a peer-reviewed journal.

THURSDAY, Jan. 26, 2017 (HealthDay News) -- Regular self-exams play an important role in early detection of thyroid disease, a specialist says.

That's a timely reminder because January is Thyroid Awareness Month.

"The number of cases of thyroid cancer is rising, and while in most cases the outcomes of treatment are favorable, some patients present with disease that has progressed and may be more difficult to treat," said Dr. Ilya Likhterov. He is an ear, nose and throat doctor in New York City.

About 200 million people worldwide have thyroid disease. Of more than 20 million Americans with thyroid disease, only four out of 10 know they have it, according to the American Thyroid Association.

"While in most patients thyroid cancer develops without signs or symptoms, patients who have had significant exposure to radiation or who have first-degree family members with a history of thyroid cancer need to be especially cautious, since they are at a higher risk," Likhterov added.

All patients must pay attention to sudden voice changes or masses in the neck, said Likhterov, an assistant professor of otolaryngology at Icahn School of Medicine at Mount Sinai in New York City.

If undetected and untreated, thyroid disease can cause depression, constant exhaustion, joint pain, muscle aches, weight gain and hair loss, according to a Mount Sinai news release.

To perform a thyroid self-exam, use a mirror to view the lower middle area of your neck, above the collarbones, and below the larynx. This is where the thyroid is located.

While focusing on this area, tip your head back, take a drink of water and swallow. As you swallow, watch for any bulges or protrusions, Likhterov said.

It's important not to confuse the Adam's apple with the thyroid, which is located farther down on your neck, closer to the collarbone.

If you detect any bulges or protrusions in this area, see your physician, Likhterov said. You may have an enlarged thyroid or a thyroid nodule. A doctor can determine if cancer is present or if you require treatment for thyroid disease.

-- Robert Preidt

People with migraines and other headache disorders have a greater risk of a thyroid disease known as hypothyroidism, a new study suggests.

Hypothyroidism occurs when the body doesn't produce sufficient amounts of thyroid hormone. This can cause mood swings, weight gain, hair loss, fatigue, constipation and irregular menstrual cycles, according to researchers at the University of Cincinnati College of Medicine.

The study included more than 8,400 people. The volunteers were followed for 20 years as part of a medical monitoring project.

People with pre-existing headache disorders -- such as cluster or tension headaches -- had a 21 percent higher risk of hypothyroidism, the investigators found. And people with a possible migraine disorder had a 41 percent greater risk.

The findings suggest that people with migraines are particularly susceptible to hypothyroidism. However, the study doesn't prove that one condition causes the other.

Migraine affects about 12 percent of Americans. Hypothyroidism affects about 2 percent. The conditions are rarely life-threatening. But these conditions can cause decreased quality of life if patients don't get adequate treatment, the study authors noted.

What might link headaches to hypothyroidism isn't clear, the researchers pointed out.

"It is possible that the development of hypothyroidism in a headache patient might further increase the frequency of headache, as past studies have found that treatment of hypothyroidism reduces the frequency of headache," study co-author Dr. Vincent Martin, a professor of medicine, said in a school news release.

"Regardless, physicians should be more vigilant in testing for hypothyroidism in persons with headache disorders," concluded Martin. He's also co-director of the Headache and Facial Pain Center at the UC Gardner Neuroscience Institute.

The thyroid is a gland at the base of the neck that is part of the endocrine system. Thyroid hormones control the rate of many of the body's activities, including heart rate and how fast you burn calories.

The study was published online Sept. 27 in Headache: The Journal of Head and Face Pain.

-- Robert Preidt

TUESDAY, May 10, 2016 (HealthDay News) -- Two cases of children who developed iodine deficiency highlight the risks of putting too many restrictions on young kids' diets, researchers say.

The doctors said that the children -- aged 2 and 5 -- developed iodine deficiency because their diets lacked salt, dairy products, bread and other sources of the mineral.

Iodine deficiency is common in developing countries, but was virtually eliminated in the United States after iodized salt was introduced almost a century ago.

However, it can still happen if a child's diet is strictly limited, said study author Dr. Brigid Gregg. She is a pediatric endocrinologist at the University of Michigan's C.S. Mott Children's Hospital.

"Parents should be aware that if they're really restricting the foods their children eat, iodine deficiency is a possibility," Gregg said.

The body needs iodine to make thyroid hormones, which help control metabolism and other essential functions. Lacking iodine, the thyroid gland can become underactive -- what's known as hypothyroidism.

In infants and young children, that can result in stunted growth and even brain damage, Gregg pointed out.

Still, she said, when a young child is not growing well, hypothyroidism is "not the first thing that jumps to mind." And when hypothyroidism is suspected, doctors would not immediately think iodine deficiency is at the root of the problem, she added.

"We don't typically think of it in this country, because we've considered the problem 'solved' in the U.S.," Gregg said.

One of the children her team treated was 5 years old and had been diagnosed with autism. His parents were keeping him on a gluten-free, casein-free diet -- which meant he wasn't getting the dairy products and grains that are major iodine sources in the typical American diet.

His parents brought him to the pediatrician because he was suffering from fatigue and chronic constipation, which are two symptoms of hypothyroidism. The doctor discovered the boy had a goiter, or an enlarged thyroid gland.

From there, the boy was tested for autoimmune thyroid disease, in which the immune system mistakenly attacks the gland. But there was no evidence that his immune system had turned against him.

Instead, it turned out to be iodine deficiency.

The second case involved a 2-year-old boy with stunted growth and a limited diet -- both because he refused many foods, and because of his parents' restrictions. They'd replaced cow's milk with coconut milk, avoided processed foods and used sea salt instead of table salt.

Those were well-intended moves, Gregg said. The problem was, the child's diet had no good iodine sources.

Neither sea salt nor coconut milk contain the mineral, said Marina Chaparro, a clinical dietitian and spokesperson for the Academy of Nutrition and Dietetics.

"I'd recommend using iodized salt," said Chaparro, who was not involved in the study. "That's probably the easiest way to make sure your child is getting enough iodine."

And it doesn't take a lot, she noted: A half teaspoon of iodized salt each day would be enough for a child.

Milk, yogurt and commercially made breads are probably the most child-friendly food sources of iodine, according to Chaparro. But fish and seaweed also contain it, she said.

To Chaparro, the two cases highlight a broader issue: Children with restricted diets could be at risk of various nutritional deficiencies if parents aren't well-informed.

"Children aren't small adults, and we need to be mindful about placing our own dietary restrictions on them," Chaparro said.

She suggested that when parents do eliminate certain foods -- such as meat or dairy or gluten-containing grains -- they talk to their pediatrician or a dietitian about how to best replace those foods.

Chaparro also cautioned parents against getting caught up in diet trends. "Never put a child on a fad diet," she said.

The findings were published online May 10 in the journal Pediatrics.

coconut water

Coconut water (buko juice) is a popular drink in Asia and South America. The top ten countries on the list of world-leading coconut producers according to volume are: Indonesia, Philippines, India, Brazil, Sri Lanka, Vietnam, Papua New Guinea, Mexico, Thailand, and Malaysia. The Philippines export more than $1 billion worth of coconuts to the United States alone.

What actually is coconut water?

Coconut water is the clear liquid inside coconuts which, in early development, “serves as a suspension for the endosperm of the coconut during its nuclear phase” of growth. The endosperm matures into “cellular phase and deposits into the rink of the coconut meat.” The coconut water and the soft meat of young coconut is a delicacy, popular among locals and tourists in those tropical countries and others where coconuts thrive. They are sold fresh on the street by vendors with machetes who cut a hole at the top for drinking, with or without a straw. They are also available bottled, soft-packed, and canned, usually consumed chilled.

What are the other coconut products?

Besides its water and meat, other coconuts products include copra, coconut oil and coconut cream for cooking and for cosmetics, palm sugar, flower syrup, butter, desiccated coconut, powdered sugar, jelly, milk-cream, kefir (probiotic), flour, vinegar, nata de coco fruit jelly, etc.

Can it reverse Alzheimer’s?

The popular claim that coconut oil products can reverse Alzheimer’s disease is baseless and unfounded. There is no scientific evidence to this effect. The same is true with the other medicinal claims for other illnesses. As a matter of fact, there is a controversy that coconut oil and products can be detrimental to the consumer’s blood cholesterol/lipids levels and cardiovascular health, if consumed regularly, except for the virgin coconut oil. Fresh uncontaminated coconut water is deemed acceptable and safe. Scientifically, the use of coconut oil for hair and skin as conditioner-moisturizer has been proven to be of good cosmetic value.

What are the nutritional values of coconut water?

Coconut water is 95 percent water and 100 ml provides only 19 calories, 4 percent carbohydrates, under 1 percent protein and fat. It does not contain any vitamin or dietary minerals of any significant amount.

While this has been marketed as “natural energy drink or sport drink,” claiming it has significant electrolyte content, this is not true. The potassium, magnesium, calcium and sodium in unprocessed coconut water per 100 ml are insignificant and not balanced. The health benefit claims, that it is antiviral, that it lowers cholesterol and regulates blood sugar, are false, and the US Food and Drug Administration has warned producers against misleading marketing.

Various firms have faced class action lawsuits over false advertisements that coconut water was “super-hydrating,” nutrient-packed,” and “mega-electrolyte” source. The suit was settled with a US$10 Million award in April 2012.

Was coconut water used as IV fluids?

During World War II, coconut water was used as intravenous fluids for rehydration when medical fluids was not available during emergencies. It is actually not similar in composition as our plasma. Intravenous coconut water is not accepted as within safe standard of care today and must not be performed at all as it would be malpractice. Drinking it is the safer way to take coconut water.

Is excessive consumption safe?

No, drinking a large amount of coconut water is unsafe. As a matter of fact, coconut water is used in southern districts of Tamil Nadu, India, for senicide of the elderly, a traditional accepted practice performed by family members called thalaikoothal, an involuntary euthanasia for those incapacitated and seriously ill, where “the elderly is made to drink an excessive amount of coconut water, eventually resulting in fever and death.”

Are you at risk for a stroke?

FRIDAY, May 12, 2017 (HealthDay News) -- Every 40 seconds someone in America has a stroke.

But fast action and quick treatment can save lives and reduce disability.

"Stroke statistics are alarming. It's the fifth leading cause of death in the United States and the leading cause of serious adult disabilities," said Dr. Randolph Marshall, chief of the stroke division at NewYork-Presbyterian/Columbia University Medical Center.

"The most effective method in saving a stroke victim's life is to diagnose and treat immediately after a stroke occurs," said Dr. Matthew Fink, neurologist-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center. Both hospitals are in New York City.

"Strokes kill nearly 133,000 people a year. The good news is that approximately 80 percent of strokes can be prevented," Marshall said in a NewYork-Presbyterian news release.

As part of Stroke Awareness Month, the two experts offered stroke prevention tips.

Certain lifestyle changes greatly reduce the risk of stroke.

High blood pressure is a leading cause of stroke. Cutting your salt intake is one of the best ways to achieve a healthy blood pressure. Instead of salt, use a variety of spices to flavor your food.

Eating a heart-healthy diet can prevent high cholesterol and maintain a healthy balance between good and bad cholesterol. This will reduce your risk of heart disease and stroke.

Don't smoke. Smokers have twice the risk of stroke because smoking damages blood vessels, raises blood pressure and speeds up the clogging of arteries.

Get regular exercise and maintain a healthy weight. Being overweight or obese increases the risk of high cholesterol, high blood pressure, diabetes and stroke

FRIDAY, May 12, 2017 (HealthDay News) -- Reports of new hepatitis C infections in the United States nearly tripled over five years, reaching a 15-year high, federal government data show.

The highest number of new infections were reported among 20- to 29-year-olds. Many stemmed from the growing use of injected drugs linked to the current opioid epidemic, officials said.

The number of reported cases rose from 850 in 2010 to 2,436 in 2015, according to the U.S. Centers for Disease Control and Prevention.

But nearly half of people who have the liver infection don't know it, so most new cases are never reported. The CDC estimated there were actually about 34,000 new hepatitis C infections nationwide in 2015.

"We must reach the hardest-hit communities with a range of prevention and treatment services that can diagnose people with hepatitis C and link them to treatment. This wide range of services can also prevent the misuse of prescription drugs and ultimately stop drug use -- which can also prevent others from getting hepatitis C in the first place," said Dr. Jonathan Mermin in a CDC news release.

He is director of the agency's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

The virus can be spread by sharing drugs and needles, the stick of a contaminated needle, and through sex. A child can also catch it if born to an infected mother.

More Americans die from hepatitis C than any other infectious disease reported to the CDC. Nearly 20,000 Americans died from hepatitis C-related causes in 2015, and most were age 55 and older, according to the new report.

Three-quarters of the 3.5 million Americans infected with hepatitis C are baby boomers, born between 1945 and 1965. They are six times more likely to be infected than people in other age groups and have a much higher risk of death from the virus, the CDC said.

Recent CDC studies also show that hepatitis C infections are rising among women of childbearing age, putting a new generation at risk.

New medicines can cure hepatitis C in as little as two to three months, but many people who need treatment can't get it, according to the CDC.

"Stopping hepatitis C will eliminate an enormous disease and economic burden for all Americans," said Dr. John Ward, director of CDC's Division of Viral Hepatitis.

"We have a cure for this disease and the tools to prevent new infections. Now we need a substantial, focused and concerted national effort to implement the National Viral Hepatitis Action Plan and make effective prevention tools and curative treatment available to Americans in need," Ward said.

The federal action plan sets goals for improving prevention, care and treatment of viral hepatitis and eliminating new infections.

Drug Expiration Dates — Do They Mean Anything?

Reaching for imodium (loperamide) in your medicine cabinet for your bothersome diarrhea caused by what you had for dinner, you find that your savior medication expired five months ago. It’s past ten in the evening. What do you do?

It you took the “expired” medication anyway, chances are you would get the relief you expected, for the reason we shall discuss below.


Updated: September 2, 2015 FDA

Published: November, 2003

With a splitting headache, you reach into your medicine cabinet for some aspirin only to find the stamped expiration date on the medicine bottle is more than a year out of date. So, does medicine expire? Do you take it or don't you? If you decide to take the aspirin, will it be a fatal mistake or will you simply continue to suffer from the headache?

This is a dilemma many people face in some way or another. A column published in Psychopharmacology Today offers some advice.

It turns out that the expiration date on a drug does stand for something, but probably not what you think it does. Since a law was passed in 1979, drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug.

Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date.

So the expiration date doesn't really indicate a point at which the medication is no longer effective or has become unsafe to use. Medical authorities state if expired medicine is safe to take, even those that expired years ago. A rare exception to this may be tetracycline, but the report on this is controversial among researchers. It's true the effectiveness of a drug may decrease over time, but much of the original potency still remains even a decade after the expiration date. Excluding nitroglycerin, insulin, hormones, and liquid antibiotics, most medications are as long-lasting as the ones tested by the military. Placing a medication in a cool place, such as a refrigerator, will help a drug remain potent for many years.

Is the expiration date a marketing ploy by drug manufacturers, to keep you restocking your medicine cabinet and their pockets regularly? You can look at it that way. Or you can also look at it this way: The expiration dates are very conservative to ensure you get everything you paid for. And, really, if a drug manufacturer had to do expiration-date testing for longer periods it would slow their ability to bring you new and improved formulations.

The next time you face the drug expiration date dilemma, consider what you've learned here. If the expiration date passed a few years ago and it's important that your drug is absolutely 100% effective, you might want to consider buying a new bottle. And if you have any questions about the safety or effectiveness of any drug, ask your pharmacist. He or she is a great resource when it comes to getting more information about your medications.

Irritable Bowel Syndrome


WEDNESDAY, May 3, 2017 (HealthDay News) -- Parents worry -- often rightly so -- about how much time their kids are spending in front of screens.

Now, new research suggests that when children at risk of mental health problems spend a lot of time on smartphones or other digital technology, they're more at risk of attention and disruptive behavior issues.

But the news isn't all bad. The researchers also saw a positive benefit from screen time. When kids sent more text messages on any given day, they seemed less anxious and depressed.

"These findings suggest that for already at-risk teens, high usage may amplify existing problems," said study co-author Candice Odgers.

But, Odgers added, "we cannot say that technology use is causing these problems."

She is a professor of psychology and neuroscience at Duke University's Sanford School of Public Policy in Durham, N.C.

Electronic devices such as smartphones and tablets have become so pervasive that a 2015 study found that most babies used them before they reach the age of 2 years.

Other research suggests that social media sites such as Facebook have distinct benefits for kids, including opportunities for education and connection. But there are also potential risks such as cyberbullying.

Odgers and her colleagues recently reviewed the findings of previous studies. And they found "much more evidence for positive associations between teen technology use and their social relationships than would be expected amid the widespread fears about the rising use among adolescents," she said.

However, Odgers said, "we still know very little about whether adolescents' constant connectivity or patterns of usage have effects on their mental health, relationships and development."

For the new study, the researchers gave smartphones to 151 children between 11 and 15 years old. The kids lived in poor U.S. neighborhoods and were considered at risk for mental health problems. About 60 percent of the participants were white.

The smartphones beeped three times a day for a month, alerting the participants to briefly answer questions about how they were feeling.

The kids also answered questions about how much they were using digital technology each day.

MONDAY, May 1, 2017 (HealthDay News) -- Taking certain types of antibiotics during pregnancy may boost the risk of miscarriage, a large study suggests.

Macrolides, quinolones, tetracyclines, sulfonamides and metronidazole were associated with an increased risk of "spontaneous abortion," meaning loss of pregnancy before the 20th week of gestation.

The study doesn't prove cause and effect. But, it does tie use of certain medicines to a higher risk of miscarriage -- up to double the risk for some classes of antibiotics, the researchers said.

"Some seem to be safer when it comes to the risk of spontaneous abortion, and some aren't," said study author Anick Bérard, a professor at the University of Montreal's Faculty of Pharmacy.

However, the new evidence does not suggest that pregnant women should stop taking antibiotics to treat bacterial infections.

"It [miscarriage] is still a rare outcome," Bérard added.

The reason some antibiotics appear to be riskier than others may be related to how each drug works in the body, Bérard said.

Tetracycline, for one, is not recommended in pregnancy because it permanently discolors fetuses' teeth and may affect fetal bone growth, she said.

There's also animal data showing that quinolone affects DNA, Bérard said.

On the other hand, nitrofurantoin appears to be a safer option. It was not associated with an increased risk of miscarriage and may be a good alternative for treating urinary tract infections, the study authors noted.

Bérard said urinary tract infections are the most common type of infection in pregnancy.

Penicillin also seemed to be a good choice, added Dr. Errol Norwitz, who was not involved in the study.

While the association between antibiotics and adverse pregnancy outcomes isn't new, evidence related to spontaneous abortion hasn't been as robust, explained Norwitz, chairman of obstetrics and gynecology at Tufts University School of Medicine in Boston.

"I think the consensus is that there probably isn't an association, but this study suggests that maybe there is," he said.

"Overall, it [the study] was quite well done," Norwitz added.

To tease out the effects of antibiotics, Bérard and her team at the University of Montreal matched 8,700 cases of spontaneous abortion with more than 87,000 controls by gestational age and year of pregnancy.

The researchers used data from women ages 15 to 45 who were covered by Quebec's drug insurance plan.

Roughly 16 percent of the women who had miscarriages were exposed to antibiotics during early pregnancy, compared to less than 13 percent of the controls.

Norwitz was surprised that so many women received antibiotics before 20 weeks gestation. "I didn't think it would be that high," he said.

Azithromycin and clarithromycin, which belong to the macrolide class of antibiotics, were linked to a 65 percent and twofold increased risk of miscarriage, respectively.

Norfloxacin, a type of quinolone, was associated with more than a fourfold increased risk, the study showed.

The study's biggest deficiency, in Norwitz's view, is that it did not address underlying genetic problems, which he said account for the vast majority of miscarriages.

There is no way to know for sure who had a prenatal diagnosis that could have explained the spontaneous abortion, Bérard conceded.

The researchers also couldn't rule out that the severity of women's infections may have influenced the results. But they don't think such differences fully explain their findings.

So what's a woman to do if she's pregnant and has a bacterial infection?

The best approach is to aim for the "lowest effective dose" using the most appropriate antibiotic, Norwitz said.

The study appears in the May 1 issue of the Canadian Medical Association Journal.

Copyright © 2017 HealthDay. All rights reserved.

SOURCES: Anick Bérard, Ph.D., professor, Faculty of Pharmacy, University of Montreal, Canada; Errol Norwitz, M.D., Ph.D., chairman, obstetrics and gynecology, Tufts University School of Medicine, Boston; May 1, 2017, Canadian Medical Association Journal

THURSDAY, April 27, 2017 (HealthDay News) -- When a woman chooses to stop smoking during her pregnancy, the potential effects to her baby are probably on her mind.

But a new British study hints that smoking in pregnancy could even affect the health of a woman's grandchildren -- specifically, their risk for autism.

"We already know that protecting a baby from tobacco smoke is one of the best things a woman can do to give her child a healthy start in life," said study co-author Jean Golding of the University of Bristol. "Now we've found that not smoking during pregnancy could also give their future grandchildren a better start, too."

The study can't prove cause-and-effect, but one U.S. autism expert who reviewed the findings said the researchers' conclusion is not farfetched.

While the finding is new, "the mechanism by which it might be occurring has been a focus of study for half a decade," noted Alycia Halladay. She's chief science officer for the Autism Science Foundation.

Halladay believes that when a woman smokes in her pregnancy, this could affect the developing eggs of a female fetus in the womb. And that, in turn, might affect the odds that her daughter's children are at higher autism risk, she suggested.

In the new study, researchers analyzed data from more than 14,500 children born in the United Kingdom during the 1990s.

The study found that people with a maternal grandmother who smoked during her pregnancy had a 53 percent increased risk of developing autism.

The findings also showed that girls whose maternal grandmother smoked during pregnancy were 67 percent more likely to have autism-linked traits -- symptoms such as poor social communication skills and repetitive behaviors.

The researchers agreed with Halladay: Exposure to cigarette smoke while in the womb could affect a female's developing eggs, causing changes that may eventually affect the development of her own children.

Still, the study authors stressed that further investigation is needed to determine what those molecular changes might be, and to find out if the same associations occur in other groups of people.

Another U.S. autism expert said the findings were intriguing.

"There are innumerable reasons why people should not smoke," said Dr. Andrew Adesman. "This study provides more reason: women who smoke during pregnancy put their granddaughters at increased risk of an autism spectrum disorder."

But "the overall increase in risk related to smoking is somewhat modest," added Adesman. He is chief of developmental and behavioral pediatrics at Cohen Children's Medical Center, in New Hyde Park, N.Y.

"Although a woman's exposure to cigarette smoke prenatally appears to be linked decades later to autism spectrum disorder in her own offspring, women who smoke or who were themselves exposed to cigarette smoke prenatally should take some comfort in knowing that their risk of having a child with an autism spectrum disorder is still very low," Adesman said.

For her part, Halladay said it's typically been tough for scientists to assess how behaviors affect multiple generations of offspring, and so most of the research in this area "has been done in animal models."

But the U.K. database used in the new study "has the data to assess grandparental exposures," she believes.

Because the database the researchers drew on was so detailed, the researchers said they were able to rule out possible other factors that might account for the link.

Autism spectrum disorder affects about one in 68 children in the United States, with boys affected far more often than girls.

The study was published April 27 in the journal Scientific Reports.

-- Robert Preidt


WEDNESDAY, April 19, 2017 (HealthDay News) -- A new study hints that young blood may harbor clues to a "fountain of youth" for older brains.

Researchers say blood from human umbilical cords appears to have helped reverse memory loss in aging mice.

The findings suggest that something in young blood is important in maintaining mental acuity.

No one, however, is saying that cord blood could be a magic bullet against Alzheimer's or other forms of dementia.

For one, any effects seen in elderly rodents may fail to translate to humans.

Instead, the findings might set the stage for new drugs that target the dementia process, said study lead author Joseph Castellano. He's an instructor in neurology at Stanford University School of Medicine.

"Part of what makes this exciting is that it suggests there's more communication between the blood and brain than we've thought," Castellano said.

The study builds on earlier work by the same Stanford team. There, the researchers found that old lab mice benefited from infusions of plasma (the liquid portion of blood) from young mice.

Specifically, the old mice showed improvements in learning and memory. This was measured by the ability to accomplish tasks like navigating a maze or building a nest.

The aim of the new study, Castellano said, was to see whether injections of human plasma given to mice could have similar effects.

It turned out that they did -- at least when the plasma came from umbilical cords. Plasma from young adults had less of an impact. And plasma from older adults, ages 61 to 82, had no benefit at all.

That led to a critical question: What is it about umbilical cord blood that's special?

The researchers found evidence that it might be a protein called TIMP2. It is present in high levels in cord plasma, they said, but declines with age.

What's more, injections of TIMP2 benefited older rodents' brains in the same way that cord plasma did.

Castellano said it was "surprising" that a single protein had such effects.

But, he noted, TIMP2 could be "upstream" of many biological processes. It belongs to a family of proteins that regulate other critical proteins. Those proteins, in turn, have the task of "chopping up" yet more proteins that exist in the matrix surrounding body cells.

But researchers know little about how TIMP2 acts on the brain, Castellano said.

"Now, we really need to get a better understanding of what it's doing in the brain," he said. "We are not saying we've found the protein that's responsible for brain aging."

Dr. Marc Gordon is a professor at the Litwin-Zucker Center for Alzheimer's Disease and Memory Disorders at the Feinstein Institute for Medical Research in Manhasset, N.Y.

He agreed that the study identifies a protein "target" that should be studied further.

"But this is not saying that cord blood is a cure for aging," Gordon stressed.

And it's probably unrealistic to use cord blood as a dementia treatment, said Castellano.

Nor can anyone predict whether TIMP2 will point researchers toward new drugs for dementia. Findings in lab animals often fail to pan out in humans.

Plus, Gordon said, this study involved mice that were old, but did not have an "animal model" of Alzheimer's. That refers to lab mice that are genetically modified to have Alzheimer's-like brain pathology.

"What this could mean for human disease is purely speculative," Gordon said.

Drugs for age-related brain disease have so far been "elusive," Castellano said. The available medications for dementia symptoms have limited effects, and cannot stop the disease from progressing.

"We're excited," Castellano added, "about this knowledge that there are proteins present in the blood that evolve over the life span, and may affect brain function."

The findings were published April 19 in Nature.

Copyright © 2017 HealthDay. All rights reserved.

SOURCES: Joseph Castellano, Ph.D., instructor, neurology and neurological sciences, Stanford University School of Medicine, Stanford, Calif.; Marc L. Gordon, M.D., professor, Litwin-Zucker Center for Alzheimer's Disease and Memory Disorders, Feinstein Institute for Medical Research, Manhasset, N.Y., and chief, neurology, Zucker Hillside Hospital, Glen Oaks, N.Y.; April 19, 2017, Nature, online

SAN FRANCISCO — A new study found that non-obese Filipino Americans aged 5 and over have a mch hig\her revalence of diabetes

than non-Hispanic white Americans (7.6 percent vs. 4.3 percent).

The study was conducted by researchers at the University of Toronto, University of Victoria and University at Albany, SUNY.

“Even after taking into account many of the risk factors of diabetes such as age, sex, fruit and vegetable consumption, exercise, smoking, poverty status, non-obese Filipino Americans had almost three times the odds of diabetes compared to non-Hispanic whites,” stated co-author Adity Roy a recent graduate of the University of Toronto.


The study could not explain why Filipino Americans are at such higher risk of diabetes, reported lead author Professor Esme Fuller-Thomson, Sandra Rotman Endowed Chair at the University of Toronto’s Factor-Inwentash Faculty of Social Work and Institute for Life Course and Aging.

“In future research we hope to investigate ethnic variations in central obesity, dietary patterns (particularly white rice consumption), insufficient sleep, low birth weight, and hypertension, among other risk factors for diabetes that may disproportionately disadvantage the Filipino population in North America,” Fuller-Thomson said.

The study examined a representative sample of community-dwelling Californians aged 50 and over from combined waves of the 2007, 2009 and 2011 California Health Interview Survey (CHIS). The study sample was restricted to Filipino Americans (1,629) and non-Hispanic whites (72, 072) who were non-obese, defined as having a body mass index (BMI) of less than 30.

“We were interested in what factors are associated with diabetes among older, non-obese Filipinos. We found considerable variation by sex. For Filipino men, older age, living in poverty, and cigarette smoking, were associated with increased odds for diabetes. For Filipina women, age was the only significant predictor for increased rates of diabetes,” said co-author Karen Kobayashi, Associate Professor in the Department of Sociology and Institute on Aging and Lifelong Health, at the University of Victoria.

The number of Filipinos in North America has increased dramatically in recent years. There are now approximately 3.9 million Filipino Americans in the USA and one in every 50 Canadians is of Filipino descent.

“We found that 70 percent of Filipino Americans with diabetes are not obese. This highlights the urgent need to screen non-obese Filipino Americans for diabetes and to target them for prevention efforts, because preventive approaches with lifestyle intervention have been shown to be effective in preventing and/or postponing the onset of diabetes in other high-risk non-obese populations,” stated co-author Keith Tsz-Kit Chan, Assistant Professor, School of Social Welfare, University at Albany, SUNY.

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Hep C

Q:Nothing can relieve the symptoms of morning sickness. True or False?

A:False. Actually, morning sickness is a misnomer because it can occur at any time of the day and it is not a sickness. Nausea and vomiting are normal characteristics of early pregnancy. In some cases, nausea and vomiting can be controlled. Nausea and vomiting associated with pregnancy can be affected by the amount of food eaten and what time it is eaten. Avoiding greasy, fried, or spicy food might help pregnant women manage their nausea. Pregnant women may also try to eat smaller meals, frequent meals, and bland foods like toast and crackers.

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Q:Occasionally, small amounts of alcohol are fine for pregnant women. True or False?

A:False. There is no safe amount of alcohol a woman can drink during her pregnancy. Drinking anything that contains any amount of alcohol can cause problems for babies. When a fetus is exposed to alcohol, fetal alcohol syndrome (FAS) can result, potentially causing problems in later life. The exact amount of alcohol that leads to problems in pregnancy is not known, so pregnant women are advised to abstain from alcohol completely.

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Q:Fetal alcohol syndrome describes birth defects caused by alcohol consumption during pregnancy. True or False?

A:True. The term fetal alcohol syndrome describes the sum total of the damage done to the child before birth as a result of the mother drinking alcohol during pregnancy. Fetal alcohol syndrome (FAS) always involves brain damage, impaired growth, and head and face abnormalities. The brain damage can lead to problems with mental capacity, learning, and other functions.

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Q:Preconception health should be addressed five years before a planned pregnancy. True or False?

A:False. Talking to a doctor at least three months before pregnancy can improve the chances or getting pregnant, having a healthy pregnancy, and having a healthy baby. Women who are trying to get pregnant may benefit from talking to a doctor about how her health conditions and risk factors could affect a baby's health. Doctors can also discuss what to do to improve the health of the mother before pregnancy. Bear in mind, some women need more than three months to get their bodies ready for pregnancy.

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Q:Exercise is dangerous for pregnant women and should be avoided during pregnancy. True or False?

A:False. It is not dangerous to exercise or to be physically active during pregnancy. In fact, doctors recommend it for most pregnant women. Women who exercised before pregnancy should continue to do so. Women who wish to become active during pregnancy may feel free to do so and should start slowly. If you are pregnant and would like to start exercising, check with your health care professional before beginning an exercise program.

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Q:Physical activity during pregnancy can lessen the discomforts associated with pregnancy. True or False?

A:True. Physical activity and regular exercise during pregnancy can improve common discomforts such as backache and fatigue, and can increase the likelihood of early recovery after delivery. In general, most kinds of aerobic, resistance, and flexibility exercises like yoga are safe during pregnancy.

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Q:High blood pressure caused by pregnancy is called preeclampsia. True or False?

A:True. Preeclampsia or gestational hypertension, refers to high blood pressure (hypertension) caused by pregnancy. Many pregnant women with high blood pressure have healthy babies without serious problems.

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Q:If you are pregnant and traveling by air, the seat over the wing of a plane will provide the smoothest ride. True or False?

A:True. Domestic travel is usually permitted for a woman who is pregnant until she is in week 36 of gestation, and international travel may be permitted until weeks 32-35, depending on the airline. Keep in mind: An aisle seat at the bulkhead will provide the most space and comfort, but a seat over the wing in the midplane region will give the smoothest ride. A pregnant woman should be advised to walk every half hour during a smooth flight and flex and extend her ankles frequently to prevent phlebitis. Dehydration can lead to decreased placental blood flow and hemoconcentration, increasing risk of thrombosis. Thus, pregnant women should drink plenty of fluids during flights.

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Q:Folic acid is a very important vitamin to take during pregnancy. True or False?

A:True. Pregnant women need 400 to 800 micrograms of folic acid every day. All women who are sexually active and able to become pregnant need this amount of folic acid every day. The best way to ensure that you are getting the necessary amount of folic acid is by taking prenatal vitamins.

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Q:Folic acid helps in the development and formation of a baby's brain and spine. True or False?

A:True. Folic acid, a member of the family of B vitamins, aids in the development and formation of a baby's brain and spine, and can prevent serious types of birth defects. Research studies indicate that insufficient intake of folic acid in the mother's diet is a key factor in causing spina bifida and other neural tube defects.

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Q:Since a pregnant woman is eating for two, she needs an additional 1,000 calories per day. True or False?

A:False. During pregnancy, the body needs more nutrients to provide for the baby to grow properly and be healthy. A pregnant woman is eating for two, but this does not mean that she must ingest excessive calories, or double her caloric intake. Most pregnant women only need to consume 300 extra calories per day!

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Q:All women should aim to gain 25-30 pounds during pregnancy. True or False?

A:False. The amount of weight a woman should gain during pregnancy depends on her body mass index (BMI) before she became pregnant. The American College of Obstetricians and Gynecologists (ACOG) provides these guidelines: Women at a healthy weight before pregnancy should gain about 25 to 30 pounds. Women who were underweight before pregnancy should gain between 28 and 40 pounds. Women who were overweight before pregnancy should gain between 15 and 25 pounds. Women should gain weight throughout the pregnancy. Most of the weight should be gained in the last trimesters. Generally, doctors suggest that women gain weight at a rate of 2-4 pounds total during the first trimester, and 3-4 pounds per month during the second and third trimesters.

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Q:Not including the baby, pregnancy weight gained is all fat. True or False?

A:False. For an average pregnancy, only about 7 pounds accounts for added pregnancy weight. So, where does the added weight go? Pregnancy weight is added because of the baby, the placenta, amniotic fluid, uterus growth, breast growth, blood and body fluids and, protein and fat. The typical gain in weight can be broken down as follows: baby: 6 to 8 pounds; placenta: 1½ pounds; amniotic fluid: 2 pounds; uterus growth: 2 pounds; breast growth: 2 pounds; mom's blood and body fluids: 8 pounds; mom's protein and fat: 7 pounds.

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Q:Sex during pregnancy can harm a growing baby. True or False?

A:False. There is no reason to change or alter a sex life during pregnancy unless a doctor advises otherwise. Intercourse or orgasm during pregnancy will not harm the baby, unless there is a medical problem. An unborn baby is well protected in the uterus by the amniotic fluid that surrounds him or her.

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Q:It is impossible to prevent stretch marks from occurring during pregnancy. True or False?

A:False. According to George Kroumpouzos, MD, PhD, a dermatologist at South Shore Medical Center in Norwell, Massachusetts, more than 90% of pregnant women will develop stretch marks in response to the pulling and stretching of underlying skin during pregnancy. Dr. Kroumpouzos adds, "Exercise and use of lotions or creams with alpha-hydroxy acids can be used to prevent stretch marks from occurring."

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