Diabetes: Counting Carbs

When you found out you have diabetes, your doctor might have asked you to start counting carbohydrates. Anyone with diabetes can use counting carbs to help better manage their blood sugars.

Maybe you're wondering if you can ever have cake again. Here's the good news: there is no diabetes diet. You can still eat the occasional sweet treat -- as long as it's in moderation. Learning about carbs, how they affect your body, and how to count carbs at every meal can help you manage diabetes.

"Diet is a word that we don't recommend using," says Emily Loghmani, registered dietitian and certified diabetes educator at Johns Hopkins Diabetes Center in Baltimore. "The word diet seems to conjure up unpleasant ways of eating and restrictions that people do for a certain period of time. But diabetes is a chronic illness, so we try to teach people how to eat healthy and make food choices that they'll be able to sustain for the rest of their life."

Here are the facts about carbs and your body, along with tips for carb counting.

-> Diabetes and Carbohydrates

-> Everyone needs carbs -- they fuel the body and provide energy so that we can function.

-> Foods that contain carbohydrates include:

-> Bread, rice, cereal, crackers, pasta, and other starchy foods

-> Dairy products, including milk and yogurt

-> Fruit and fruit juice

-> Starchy vegetables such as corn and potatoes

-> Beans and legumes

-> Sugary foods and snack foods such as juice drinks, sodas, cookies, candy, cake, and chips

Your body converts carbs into glucose, or blood sugar. Insulin from the body moves glucose from the blood into cells for energy. But people with type 2 diabetes either don't use insulin effectively or don't produce enough insulin. And people with type 1 diabetes don't produce insulin to be used. So excess glucose can build up in the bloodstream and over time, can cause diabetes complications.

"The challenge when you have diabetes is that you need to find the right amount of carbohydrates that will work with your diabetes medications and your physical activity to keep your blood glucose at a safe level," says Amy Campbell, RD. "That's why we put so much emphasis on counting carbs -- to try to achieve that balance." Campbell is the manager of clinical education programs at Joslin Diabetes Center in Boston.

Counting carbs helps build consistency, Campbell says. "The more someone varies their carb intake, the more their blood sugars will vary." Because carbs will have the greatest effect on blood sugars compared to proteins or fats in a meal, your goal is to try to consume a similar amount of carbohydrates every meal.

Counting Carbs: Three Approaches

Campbell and Loghmani use three different levels of carb counting with their patients. You and your doctor will choose an approach based on the type of diabetes you have, what kind of medicines you take, and your weight goals.

The Plate Method

The basic level, Campbell says, is using the plate method. "You divide your plate so that half of your plate is vegetables, a quarter of your plate is a healthy carbohydrate, like brown rice, and then a quarter of your plate is a healthy protein food like fish, chicken, or lean meat," she says. This method can help people who have just been diagnosed become more aware of carbs and learn how to identify healthier portions.

Basic Carb Counting

"Once a person is comfortable with that, we move on to basic carb counting," Campbell says. Often a person will meet with a registered dietician or diabetes educator who recommends a specific number of carbohydrates based on that person's weight goals, activity level, and gender. Most women aim for about 45 grams of carbs per meal, and men tend to have 60 to 75 per meal. Snacks should contain about 15 to 30 grams of carbs.

You have a choice of either counting carbohydrate servings or counting carbohydrate grams, says Campbell. One serving of carbs equals 15 grams. And one serving is 1 slice of bread, or 1 small fruit. Counting grams is more accurate, but it can be easier to count servings. It's really up to the person, Campbell says.

Advanced Carb Counting

The advanced level of carb counting is for people with type 1 or type 2 who use insulin before a meal. You can adjust the amount of insulin you use before a meal, which will be based on the number of carbs you eat and your pre-meal blood sugar. For example, if you were going to eat a big pasta meal, you would take more insulin. "It offers a lot more flexibility," Campbell tells WebMD.

When counting carbs, you first have to identify which foods contain carbs, figure out the portion size, then determine the number of carbs in the portion, says Loghmani. Food labels provide exact carbohydrates grams, but you need to be careful to note the serving size on the label.

There are also many resources you can use to look up the number of carbs in foods, from books to web sites -- even smart phone apps. These resources can be very helpful for people just learning to count carbs.

All carbohydrates, Campbell says, eventually turn into blood glucose. "Of course some are healthier than others so we want to promote the healthy carbs," she says

Fiber is a particularly healthy carb. "We don't digest it, so fiber doesn't really impact blood glucose," Campbell says. So it's actually good to eat more fiber for that reason, plus it helps you feel full longer.

Carb Counting: Tips for Home and Away

Because it's easy to overestimate portion sizes, Loghmani and Campbell recommend using measuring cups and scales at home. "Keep your measuring cups on the counter, get a little food scale, and keep it in full sight so that you get in the habit of checking your portions of pasta or bread," Campbell says. "It's a really good way to keep portions in check."

Learning portion sizes at home can also help you judge portions more accurately when you eat at a restaurant or at a dinner party. Loghmani and Campbell offer these tips to help you count carbs more accurately.

-> When eating at home, use the same cup, bowl, glass, and plate. "That way if you always pour your milk to a certain point on the glass, or fill your bowl a certain amount, then you know that you're eating a consistent amount of food," Campbell says.
-> Create a spreadsheet or list of foods you typically eat at home and then look up the values. Then if you typically eat a certain brand of cereal, you'll always know how many carbs you're getting.
-> Look up software programs or web sites that can help you analyze your favorite recipes.
-> Pre-portion snack foods by measuring out single servings and putting them in baggies. This can help you control your portions, carbs, fat, and calories. But be watchful of snacks. "People get tripped up with snacking," Campbell says. "It's a really bad habit -- for anybody -- to keep grabbing crackers or something out of the box." It's all too easy to forget how many you’ve eaten.
-> When eating out, if you're not sure about portion sizes, try the “hand” method:
     - A woman's fist = 1 cup
     - Tip of the thumb = 1 teaspoon
     - Whole thumb = 1 tablespoon
     - Palm of the hand = 3 oz. serving

-> Before dining out, go online and check the menu so you can plan what to order.
-> Order simple meals when you go out. Avoid fancy mixed dishes with several ingredients and sauces. Campbell recommends getting a plain meal of chicken or lean steak and a vegetable. "That can make it easier to manage," she says.

-> Speak up and ask what's in a dish and how it was prepared, whether you’re at a restaurant or a friend's house.
-> For special dinners, such as during the holidays, eat the foods that are special to you and skip others you can get any time. For example, if you really love pumpkin pie, skip the mashed potatoes and bread and make dessert your carb portion of the meal. Just be sure to watch your portion sizes.

"I think the thing that I like people to know the most is that our body needs food -- we get over 40 different nutrients a day from food. And it's perfectly okay to continue to eat and enjoy food. It's just important also to learn how to balance the food, the medication, and the activity, so that you're meeting your goals for managing your diabetes," Loghmani says.

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Stroke Risk Triples After a Decade With Diabetes

Study Finds That the Longer a Person Has the Disease, the More Their Risk Rises

The longer a person has diabetes, the higher their risk of having a stroke, according to a new study.
The risk for stroke is known to be two to four times higher among people with diabetes compared to people who don’t have the disease.

What has been less clear is whether that risk peaks with the onset of the disease or if it gradually increases over time.

“This study solidifies the idea that duration is also an important factor, beyond sort of the ‘yes or no’ of having diabetes,” says Ken Uchino, a stroke neurologist at Cleveland Clinic in Ohio.

“Over time, diabetes, probably through elevated blood sugar, injures the arteries. And [blockages] probably develop over time at a higher or more rapid rate in people who have diabetes,” says Uchino, who reviewed the study for WebMD, but was not involved in the research.

Tracking Diabetes and Stroke

The study followed nearly 3,300 seniors who lived in an ethnically diverse part of New York City. None had ever had a stroke.

About 22% of the people had diabetes at the start of the study and another 10% developed diabetes during the study. Over an average follow-up period of nine years, there were 244 reported strokes.

The study confirms that the risk of stroke is elevated in people with diabetes. It also shows that when compared to people who don’t have diabetes, the risk of stroke increases significantly every year a person lives with the disease. After 10 years of diabetes, the researchers report that stroke risk triples.

Those risks remained even after researchers accounted for other factors known to influence stroke risk, including age, smoking, physical activity, a history of heart disease, high blood pressure, and cholesterol.
“We were able to establish that the risk is really pretty robust after about 10 years,” says researcher Mitchell S.V. Elkind, MD, MS, associate chairman of neurology and epidemiology at Columbia University Medical Center in New York City.

As rates of obesity and physical inactivity rise, Elkind says, “We’re going to see people who develop diabetes at earlier ages and who will therefore have it for many years, and we expect that’s going to have a big impact on the number of strokes that occur.”

Advice to Patients

Elkind says the study also underscores the importance of diabetes prevention, through a healthy diet and regular exercise.
For people who already have the disease, he says, other research has shown that controlling other things that are bad for the heart, such as high blood pressure and high cholesterol, can also help to lower some of the risk.

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White Rice Linked to Diabetes Risk

Study: Eating White Rice Regularly Raises Diabetes Risk

Eating white rice regularly, as is commonly done in many Asian countries, may increase risk for developing type 2 diabetes, a new study shows.

Researchers looked at data from four studies: two in Asian countries (China and Japan) and two in Western countries (the U.S. and Australia). All participants were diabetes-free when the studies began.

On average, people from Asian countries ate about four servings of white rice daily. Individuals in Western countries, however, ate less than five servings a week. The study found that the more servings of white rice a person eats per day, the greater their risk for developing type 2 diabetes, the form of diabetes most closely linked to obesity.

According to the new study, diabetes risk rises by about 10% with each increased serving per day of white rice.

The study was not designed to show how white rice may increase the risk for diabetes, but researcher Qi Sun, MD, has some theories on the matter. White rice ranks high on the glycemic index, which means it can cause a sudden spike in blood sugar levels. White rice is also low in fiber that can help lower the risk for developing diabetes, Sun says. He is an instructor in medicine at the Harvard School of Public Health in Boston.

It’s not just white rice, either. Other white, starchy carbohydrates, such as white bread, white pasta, and white potatoes, will likely have the same effect if eaten often enough, he says.

Blood Sugar Control and Insulin

Swap White Rice for Brown Rice

Sun suggests choosing whole grains instead of white carbs. This is not to say that a person can never eat white rice. It is all about moderation: “Eating white rice one to two times per week is fine.”
Spyros Mezitis, MD, agrees that all white starchy foods increase the risk for diabetes when eaten in excess. He is an endocrinologist at Lenox Hill Hospital in New York City.

Anyone at risk for diabetes should focus on reducing the number of calories they eat, losing weight (if they are overweight or obese), and replacing white carbs with whole grain foods. “Always try to eat less and go for the whole grain instead of the white starch,” he says.

Tracy Breen, MD, is the director of diabetes care for North Shore-LIJ Health System in Great Neck, N.Y. She says that what you eat, and how much of it you eat, is only part of the equation. Genes also count when it comes to diabetes risk.

“It is never just one thing,” she says. “It’s what you eat, what you do, and your genes. We can’t change our genes, so it’s important to think about how food plays into our culture.”

Some experts, including Connie Diekman, RD, say that the jury is still out on whether white rice really increases diabetes risk. She is the director of university nutrition at Washington University in St. Louis.
“The observational nature of this study limits the ability to state cause and effect, [and] controlled studies are needed to determine if, in fact, white rice increases the risk of type 2 diabetes,” she says in an email.

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Understanding Sore Throat: Treatment

What Are the Treatments for a Sore Throat?

Since most sore throats from infections are caused by viruses related to colds, antibiotics -- used for bacteria -- are not usually needed to speed recovery from a sore throat. Treatment for sore throats and colds from viruses are treated to relieve symptoms, so home remedies may be just as effective as over-the-counter or prescription medicines. Some sore throats, such as that with strep throat, do require an antibiotic. Check with your doctor to be sure.

Home Remedies for a Sore Throat

• Get plenty of rest and drink a lot of fluids.
• Gargle with warm salt water (1 teaspoon of salt per glass of water).
• Suck on throat lozenges or hard candy.
• Suck on frozen treats (such as Popsicles).
• Use a humidifier.
• Sip chicken broth, or try warm tea with honey, which has been a long-standing and comforting remedy.
• To help relieve the pain, apply a warm heating pad or compress to your throat. You can also try a warm chamomile poultice: Mix 1 tablespoon dried chamomile flowers into 1 or 2 cups boiling water; steep for 5 minutes, then strain. Soak a clean cloth or towel in the tea, wring it out, then apply to your throat. Remove the cloth when it becomes cold. Repeat as often as necessary.
• A salt plaster may also help provide relief. Mix 2 cups sea salt with 5 to 6 tablespoons lukewarm water. The salt should be damp, but not wet. Place the salt in the center of a dishtowel, then roll the towel along the longer side. Wrap the towel around your neck; cover it with another dry towel. Leave on for as long as you wish.
• Try steam inhalations to ease the pain. Run very hot water in a sink. With a towel draped over your head to trap the steam, lean over the sink while the hot water is running. Breathe deeply through your mouth and nose for 5 to 10 minutes. Repeat several times a day. Always be careful not to burn yourself with the hot water or steam.
• Take acetaminophen or ibuprofen or naproxen for pain relief.

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Common Cold

Overview

Sneezing, scratchy throat, runny nose -- everyone knows the first signs of a cold, probably the most common illness known. Although the common cold is usually mild, with symptoms lasting 1 to 2 weeks, it is a leading cause of doctor visits and missed days from school and work. According to the Centers for Disease Control and Prevention, 22 million school days are lost annually in the United States because of the common cold.
In the course of a year, people in the United States suffer 1 billion colds, according to some estimates.

Children have about 6 to 10 colds a year. One important reason why colds are so common in children is because they are often in close contact with each other in daycare centers and schools. In families with children in school, the number of colds per child can be as high as 12 a year. Adults average about 2 to 4 colds a year, although the range varies widely. Women, especially those aged 20 to 30 years, have more colds than men, possibly because of their closer contact with children. On average, people older than 60 have fewer than one cold a year.

In the United States, most colds occur during the fall and winter. Beginning in late August or early September, the rate of colds increases slowly for a few weeks and remains high until March or April, when it declines. The seasonal variation may relate to the opening of schools and to cold weather, which prompt people to spend more time indoors and increase the chances that viruses will spread to you from someone else.

Seasonal changes in relative humidity also may affect the prevalence of colds. The most common cold-causing viruses survive better when humidity is low—the colder months of the year. Cold weather also may make the inside lining of your nose drier and more vulnerable to viral infection.

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Cough Medicine: Should You or Shouldn’t You?

Get the facts on cough medicine.

Coughs send more people to the doctor's office than any other specific symptom, according to experts. And Americans spend billions of dollars every year on over-the-counter medications to fight coughs, such as cough suppressants and expectorants.

Clearly we're concerned about our coughs. Clearly we rely on cough medication. What's unclear is the answer to this core question: Do cough medicines work?
"We've never had good evidence that cough suppressants and expectorants help with cough," says Norman Edelman, MD, chief medical officer at the American Lung Association. "But people are desperate to get some relief. They're so convinced that they should work that they buy them anyway."
Should you take cough medicine? Here's what you need to know about the pros and cons of common cough medicines.

Cough Medicine: The Evidence

Coughs cause a lot of misery. According to research:

• Coughs are the reason for more than 30 million doctor visits every year.
• By some estimates, coughs are the most common medical symptom. 
• Studies show that acute and chronic coughs reduce a person's quality of life.

We're desperate for an effective cough treatment. However, we don't seem to have one. No new licensed cough treatment has appeared in more than 50 years -- and the evidence for older drugs is not strong.

• A 2010 review of studies found that there is no evidence to support using common over-the-counter drugs for cough. This includes cough suppressants, such as dextromethorphan, or expectorants such as guaifenesin, which are supposed to loosen up mucus in the airways.
• In 2006, the American College of Chest Physicians surveyed a number of cough medicine studies from the last few decades. It found no evidence that these medicines help people with common coughs caused by viruses. 

It's important to understand that these studies have not proven that cough medicines don’t work. Rather, they’ve just found no proof that they do. It’s always possible that further studies could show that they help.

Cough Medicine and Children

Because of a lack of good evidence that cold and cough medicines help -- and a very small risk of serious side effects -- the FDA stated in 2008 that toddlers and babies should not use cold and cough medicines. Drug makers voluntarily changed the labeling of OTC cough and cold products, recommending them only for children aged 4 and older.
The American Academy of Pediatrics went further, saying that there's no reason that parents should use them in children under age 6.
Unfortunately, a recent survey suggests that parents aren't listening to the warnings. In a nationwide poll, more than 60% of parents with children under age 2 said they have given their kids cold or cough medicine.

Why Do We Use Cough Medicine?

Why would these medicines be so popular if they don't work very well? People find them reassuring, says John E. Heffner, MD, a pulmonologist at the Providence Portland Medical Center in Oregon and past president of the American Thoracic Society.

When we’re sick with a cough -- or worse, when our children are sick -- we’re desperate to do something, anything, to relieve it. Knowing that there’s a medicine we can use makes us feel more in control. People may also start feeling better a few days after taking a cough medicine, so they assume it's working. In fact, Edelman says, the cough may just going away on its own. The medicine may have little to do with it.
Many assume that the FDA wouldn't allow companies to sell drugs that don't have good evidence. That's true for new drugs, Heffner says. But the FDA doesn't routinely reevaluate drugs that were approved long ago. Since cough medicines have been around for decades, they're unlikely to go away.

Are Cough Medicines Safe for Adults?

Although experts agree that young children should not take cough medicine, they're safe for older children and adults. The odds of serious side effects are very small, Edelman says.
That said, anyone with a medical condition -- such as heart disease or high blood pressure -- should check with a doctor before using a cold medicine.

Heffner says that anyone with a cough that lasts longer than five to seven days -- or is accompanied by other symptoms, like a fever or rash -- should also see a doctor. Self-treating a lingering cough is not a good idea.
People should be careful not to overuse the drugs in cough and cold medicines. This can happen accidentally. A person may take more than one brand of cold and cough medicine without realizing that both contain the same ingredients.  Or a person may take multiple doses because the first dose didn't help. Edelman cautions: If one dose doesn't help, more doses won't help. Instead, you'll put yourself at risk of an overdose.

Should You Use Cough Medicine?

Experts say that although cough medicine may not help a lot, there's little harm in older children and adults using cough medicine.

There may be certain situations in which a doctor would suggest it, Heffner says. "I consider a cough suppressant in some patients who have a chronic cough that hasn't responded to other treatments," he tells WebMD.

If you're wary of using OTC cough treatments but want to try something, consider a little honey in warm tea. Some studies have found that honey is a mildly effective treatment for cough. Honey is not safe for children under age 1, however.

There is one last thing to consider before deciding whether to use cough medicine. Coughing can be good for you. Our bodies cough to clear out excess mucus and other irritants, Edelman says.
Of course, that knowledge is probably small comfort when you’re up in the middle of the night with a miserable, hacking cough that won't stop. A lot of us would really prefer a few teaspoons of cough syrup -- whether it will really help us or not.

 

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Understanding Sore Throat: Treatment

What Are the Treatments for a Sore Throat?

Since most sore throats from infections are caused by viruses related to colds, antibiotics -- used for bacteria -- are not usually needed to speed recovery from a sore throat. Treatment for sore throats and colds from viruses are treated to relieve symptoms, so home remedies may be just as effective as over-the-counter or prescription medicines. Some sore throats, such as that with strep throat, do require an antibiotic. Check with your doctor to be sure.

Home Remedies for a Sore Throat

• Get plenty of rest and drink a lot of fluids.
• Gargle with warm salt water (1 teaspoon of salt per glass of water).
• Suck on throat lozenges or hard candy.
• Suck on frozen treats (such as Popsicles).
• Use a humidifier.
• Sip chicken broth, or try warm tea with honey, which has been a long-standing and comforting remedy.
• To help relieve the pain, apply a warm heating pad or compress to your throat. You can also try a warm chamomile poultice: Mix 1 tablespoon dried chamomile flowers into 1 or 2 cups boiling water; steep for 5 minutes, then strain. Soak a clean cloth or towel in the tea, wring it out, then apply to your throat. Remove the cloth when it becomes cold. Repeat as often as necessary.
• A salt plaster may also help provide relief. Mix 2 cups sea salt with 5 to 6 tablespoons lukewarm water. The salt should be damp, but not wet. Place the salt in the center of a dishtowel, then roll the towel along the longer side. Wrap the towel around your neck; cover it with another dry towel. Leave on for as long as you wish.
• Try steam inhalations to ease the pain. Run very hot water in a sink. With a towel draped over your head to trap the steam, lean over the sink while the hot water is running. Breathe deeply through your mouth and nose for 5 to 10 minutes. Repeat several times a day. Always be careful not to burn yourself with the hot water or steam.
• Take acetaminophen or ibuprofen or naproxen for pain relief.

Continue to Read more ...

Vaccines for Adults: What You Should Know

Your Questions About the Flu Vaccine

 

People come up with all kinds of excuses to avoid getting the flu vaccine.
"I've had the flu and it's no big deal."
"The vaccine will give me the flu."
"There are toxic levels of mercury in the vaccine."
If you listen to these misconceptions and don't get your flu vaccine, you could catch the latest circulating influenza strain and spend a week or more sidelined from work and feeling miserable. Even worse, you could get really sick and wind up in the hospital.
Here are a few reasons why you absolutely need toget a flu vaccine this year:

• Influenza (the flu) circulates all over the world, and it can affect anyone, regardless of their age or health.
• The flu can lead to complications like pneumonia, ear infections, and sinus infections. It can also worsen existing conditions, like asthma or diabetes.
• Each year, thousands of people in the U.S. die from the flu and its complications.

Want to know the truth about the flu vaccine? Read through these common questions and answers to learn how it works, whether it's risky, and why you definitely need to get it.

Do I Really Need a Flu Vaccine?

If you're over 6 months old, the CDC says yes, you need to get a flu vaccination at the start of every flu season. Despite the fact that we tend to label any illness that makes us sneeze, shiver, or vomit as "the flu," true influenza isn't a trivial illness. It can do far worse than just keep you home from work or school for a few days.
"Hundreds of thousands of people each year are hospitalized with influenza. Between 3,000 and 40,000 people die during any influenza season, depending on the strain that's circulating," says Jeffrey Duchin, MD. He's chief of the Communicable Disease Epidemiology & Immunization Section at Seattle & King County Public Health, and an associate professor in medicine in the University of Washington Division of Infectious Diseases.
Although young infants, the elderly, pregnant women, and people with chronic conditions like asthma or heart disease are most susceptible to flu complications (including pneumonia), people of all ages die from the disease each year.
"It's a serious health problem for adults and children. And it's preventable," says Duchin, who is also a member of the CDC's Advisory Committee on Immunization Practices (ACIP). "We have a way for people to avoid unnecessary doctor's visits, to avoid unnecessary antibiotics, and to avoid hospitalization."

Why Do I Need to Get Vaccinated Every Year?

You might balk at having to visit your doctor or pharmacy every year for yet another dose of the influenza vaccine, but there's a good reason for the repeat visits. The flu bug is a pretty wily creature.
"The virus is sort of tricky in the way it reproduces from year to year, in that it shifts its chemical coating from season to season," explains Geoffrey A. Weinberg, MD, a pediatric infectious disease specialist and professor of pediatrics at the University of Rochester. "Even if you've been good about getting flu shots for several years you need to keep it up, because next year's flu could be very different."
The flu is far less predictable than measles and chickenpox, which only take a couple of childhood immunizations to provide full protection. "Those diseases are caused by only one strain of virus, and they don't shift," says Weinberg.
That annual flu vaccine ritual might soon be coming to an end, however. Researchers have been on the hunt for a universal flu vaccine for several years, and they may be getting close. Recently, they've discovered a more consistent target on the flu virus -- one that could help them finally develop a flu vaccine that provides long-lasting protection.

How Well Will the Flu Vaccine Protect Me Against the Flu?

Each spring, public health experts around the world predict which three flu strains are most likely to circulate and cause illness in the coming flu season. Based on their predictions, the flu vaccine is formulated to protect against those three strains. When the experts have made a good match, the vaccine is up to 90% effective in healthy adults.
Sometimes the flu virus will outsmart the experts and transform itself between their prediction and the beginning of the flu season. It might even change in the middle of a flu season. Then the flu strains in the vaccine won't match the strains in circulation.
Even if the vaccine isn't a perfect match it's still worth getting, experts say. Each vaccine protects against three different flu strains, so chances are at least one of them is circulating in any given season. Plus, when you get vaccinated against one strain of flu virus, your body makes antibodies that protect you against related strains, even if they're not exactly the same.

When Do I Need to Get the Vaccine?

Get vaccinated as soon as the vaccine is available at your doctor's office, public health clinic, supermarket, or wherever else it's offered in your area. "Many people unfortunately wait until cases of influenza are already in their community. That's not a particularly good idea because influenza is very contagious and it travels very quickly," Duchin says. The vaccine takes about two weeks to take full effect, so if your neighbor comes over coughing and sneezing and your immune system isn't yet fully primed against the flu, watch out.
Because experts are never sure exactly when in the flu season the first viruses will hit, earlier is better. Get the vaccine in August or September, and it should protect you through the whole flu season, even if it lingers until March.

Should I Get the Flu Shot or the Flu Spray?

The flu vaccine is available in two forms: the injected vaccine and the nasal spray. The shot is approved for everyone over 6 months. Neither flu vaccine should be given to anyone who has a severe allergy to eggs or any component in the vaccine, or a history of a severe reaction after flu vaccination in the past. Talk to your doctor if you have a history of Guillain-Barre syndrome. People who are moderately or severely ill should wait until they recover to get the vaccine.
If you're not a fan of shots, the nasal spray vaccine is a good alternative, but it's only approved for non-pregnant people ages 2 to 49 who are generally in good health without chronic health conditions such as asthma, heart or lung disease, or diabetes. Because the spray contains a live but weakened form of the virus, it's not recommended for people with diseases that interfere with the immune system, such as HIV. It also should not be used in children less than 5 years old with asthma or a history of wheezing in the past year, people with muscle or nerve disorders that can lead to breathing or swallowing problems, and children on long-term aspirin treatment. If you have a stuffy nose or other nasal problem that makes breathing difficult, you should get the shot.

Can I Catch the Flu From the Flu Vaccine?

You probably know at least one person who claims he or she came down with the flu days after getting a flu vaccine. Though your friend might have felt sick, the vaccine wasn't to blame for the ailment. "It's a very commonly held myth, but it's just that," Weinberg says. "It's absolutely impossible scientifically and medically to get the flu from the inactivated vaccine shot."
You can't catch the flu from the vaccine, because the version of the virus used in flu shots is dead. In the nasal spray vaccine the virus is severely weakened, so it's not likely to cause more than a few sniffles or sneezes. Chances are, your friend either had a bad cold or another respiratory infection, not the flu.
Most side effects from the influenza vaccination are mild, like soreness at the site of the shot, a low-grade fever, or a little achiness. You're actually far safer getting the vaccine then skipping it. "There's a much higher rate of getting complications if you take your chances with the real disease than if you get immunized," Weinberg says.

Can I Get the Flu Vaccine if I'm Pregnant?

You should get the flu shot if you're pregnant. "It's recommended for two reasons," says Duchin. "One is because pregnant women have a higher rate of severe influenza and hospitalizations than non-pregnant women. And if you give the vaccine to pregnant women, you protect their unborn baby for the first 6 months." Pregnant women should only receive the flu shot.

Does the Flu Vaccine Contain Thimerosal?

You might have heard the buzz about thimerosal, a mercury-containing preservative used in certain vaccines. All vaccines that are marketed for use in young children no longer contain thimerosal, but it is still found in some vaccines used in adults, including certain flu vaccines.
Researchers have studied thimerosal extensively, and they haven't found any connection between the preservative and autism or any other serious health risks. Still, if you're worried, you can ask your doctor to use a thimerosal-free vaccine.

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Cough Relief: How to Lose a Bad Cough

Try these 5 tips to manage your cough at home.

Ah, the joys of winter. Eggnog, ice skating ... (cough cough cough).
Constant cough can stop you in your tracks.

“Even a little cough can be debilitating,” says Mark Yoder, MD, assistant professor of pulmonary and critical care medicine at Rush University Medical Center in Chicago.
Cold and flu season brings on hacking coughs that can leave your chest aching. But colds and flu aren’t the only problems that cause coughing. Allergies, asthma, acid reflux, dry air, and smoking are common causes of coughs. Even medications such as certain drugs for high blood pressure and allergies can cause chronic cough.
Most of the time, people can manage their coughs at home by taking over-the-counter medicine and cough lozenges, removing potential allergens, or even just standing in a steamy shower, says Giselle Mosnaim, an allergist and immunologist also at Rush.
Try these five tips to manage your cough at home:

1. Stay Hydrated

An upper respiratory tract infection like a cold or flu causes postnasal drip. Extra secretions trickle down the back of your throat, irritating it and sometimes causing a cough, Mosnaim says.
Drinking fluids helps to thin out the mucus in postnasal drip, says Kenneth DeVault, MD, professor of medicine at the Mayo Clinic in Jacksonville, Fla.
Drinking liquids also helps to keep mucous membranes moist.  This is particularly helpful in the winter time when houses tend to be dry, another cause of cough, he says.

2. Try Lozenges and Hot Drinks

Try a menthol cough drop, Yoder suggests. “It numbs the back of the throat and that will tend to decrease the cough reflex.”
Drinking warm tea with honey can also soothe the throat. There is some clinical evidence to support this strategy, Yoder says.

3. Take Steamy Showers and Use a Humidifier

A hot shower can help a cough by loosening secretions in the nose. Mosnaim says this steamy strategy can help ease coughs not only from colds, but also from allergies and asthma.
Humidifiers may also help. In a dry home, nasal secretions can become desiccated and uncomfortable, Mosnaim explains. Putting moisture back in the air can help your cough, but be careful not to overdo it.
“The downside is if you don’t clean it, (humidifiers) become reservoirs for pumping out fungus and mold into the air and bacteria,” says Robert Naclerio, MD, chief of otolaryngology at the University of Chicago.

4. Remove Irritants in the Air

Perfumes and scented bathroom sprays may seem benign, but for some people they can cause chronic sinus irritation. This leads to chronic cough because of the production of excess mucus, says Alan Weiss, MD, a general internist at the Cleveland Clinic. Take control by avoiding such scented products.
The worst irritant in the air, of course, is smoke. Almost all smokers eventually develop the “smoker’s cough." Everyone around the smoker may suffer from some airway irritation. The best solution? Smokers need to stop smoking. (Yoder warns that severe chronic coughs can be a sign of emphysema or lung cancer in smokers, so be sure to see a doctor if you’re a smoker with chronic cough.)

5. Take Medications to Treat Coughs

When steamy showers, hot teas, and cough drops don’t help, you can turn to over-the-counter medicines to ease your cough.
Decongestants: Decongestants relieve nasal congestion by shrinking swollen nasal tissue and reducing mucus production. They dry up mucus in the lungs and open up the airway passages, says Weiss.
Decongestants come in pills, liquids, and nasal spray formulations. Oral decongestants such as pills and liquids can raise blood pressure, so people with hypertension need to be careful with their use, Mosnaim notes. Also, overuse of decongestants can lead to excessive dryness, which can trigger a dry cough.
Decongestant nasal sprays, if used for more than three or four days, can lead to rebound congestion, Mosnaim says. It’s best to use them for two or three days and then stop.
Cough suppressants and expectorants: If you’re coughing so much that your chest hurts and you’re getting a bad night’s sleep, consider a cough suppressant such as dextromethorphan, found in Delsym, DexAlone, and Vicks Formula 44, says Mosnaim. Yoder recommends using cough suppressants only at night.
When a person has a cough that is thick with phlegm, Mosnaim says it helps to take a cough expectorant such as guaifenesin, found in Humibid, Mucinex, Robitussin Chest Congestion, and Tussin. Expectorants help to thin out the mucus so one can more easily cough it up, she says.
Note: The FDA advises against giving cold and cough medicine to children under age 4. These common over-the-counter drugs can cause serious side effects in young children.

Find Out What’s Causing Your Cough

Coughs caused by the common cold usually go away in a few weeks. Chronic, persistent coughs may be caused by underlying medical problem such as allergies, asthma, or acid reflux -- or by the medications you take. To lose those coughs you need to treat the underlying problem.
Talk to your doctor if your cough lasts longer than two to four weeks, or if you are coughing up blood, or if you’re having other symptoms such as weight loss, chills, or fatigue.

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Is Your Sore Throat a Cold, Strep Throat, or Tonsillitis?

Got a sore throat? Wonder if your painful sore throat is from a cold, strep throat, or tonsillitis? Here's help with how to tell.

What's the Difference Between a Cold, Strep Throat, and Tonsillitis?

A sore throat is often the first sign of a cold. However, a sore throat from a cold often gets better or goes away after the first day or two. Other cold symptoms such as a runny nose and congestion may follow the sore throat.
Strep throat, which is an infection due to streptococcus bacteria, is another cause of sore throats and tonsillitis. With strep throat, the sore throat is often more severe and persists. 
Tonsillitis is a painful inflammation or infection of the tonsils, the tissue masses located at the back of the throat.

Is a Sore Throat With a Cold Caused by Viruses or Bacteria?

Sore throats can be caused by viruses or bacteria. The most common causes of sore throats are viruses. Viral sore throats are often accompanied by other cold symptoms that may include a runny nose, cough, red or watery eyes, and sneezing. Other causes of sore throat include smoking, pollution or irritants in the air, allergies, and dry air.

Along With a Sore Throat, What are Other Cold Symptoms?

In addition to a sore throat, other common cold symptoms include:

• Runny nose
• Sneezing
• Cough
• Mild headache
• Mild body aches
• Fever

How Are Sore Throats With Colds Treated?

Although there is no cure for a sore throat caused by a cold virus, there are ways to help you feel more comfortable. Drinking warm liquids, gargling with warm salt water, sucking on ice chips, or taking an over-the-counter medicine may relieve symptoms of pain or fever. When you are sick with a cold, it is also important to get enough rest, eat a healthy diet, and drink plenty of fluids.

Can Medications Relieve Symptoms of a Sore Throat With a Cold?

Over-the-counter cold medications may relieve cold and sore throat symptoms. However, the benefits of these drugs are minimal. Some cold medications include:

• Pain relievers, such as acetaminophen and ibuprofen and naproxen, to relieve the aches and pains of a cold and sore throat. ( Aspirin should not be given to children because of its link to Reye's syndrome, a disorder that can cause brain damage and death.)
• Sore throat sprays and lozenges to soothe your throat and numb the throat pain temporarily. (Lozenges should not be given to young children)
• Decongestant nasal sprays to relieve a sore throat caused by postnasal drip -- nasal drainage that runs down your throat. (Be sure to stop using nasal decongestant sprays after three days, or you may have an increase in congestion when you stop them.)

Antibiotics should not be used to treat a cold virus and sore throat. Antibiotics are effective only against bacteria. They will not work on sore throats associated with colds, which are caused by viruses.

How Is Strep Throat Different From a Sore Throat With a Cold?

Strep throat is caused by an infection of streptococcus bacteria. Strep throat spreads by having contact with an infected person's saliva or nasal secretions. Although strep throat is more common in children aged 5 to 15, it also occurs in adults. To diagnose strep throat, your doctor can check a rapid strep test or send a throat swab to the lab for a culture.

Is Strep Throat More Serious Than a Sore Throat With a Cold?

Strep throat can cause more serious illnesses, such as rheumatic fever, a disease that may harm the heart valves. That's why it's important to get proper medical treatment. With proper treatment, strep throat is usually cured within 10 days.

Are Strep Throat Symptoms Different From a Sore Throat With a Cold?

Strep throat symptoms are usually more severe than symptoms of a sore throat with a cold and may include the following:

• Sudden sore throat
• Loss of appetite
• Painful swallowing
• Red tonsils with white spots
• Fever

Do I Need to See my Doctor if I Think I Have Strep Throat?

The symptoms of a cold and strep throat can be very similar. If you think you have symptoms of strep throat, visit your health care provider. Your doctor will ask you about your symptoms and do a physical exam, and you may be given a strep test. 

What Is a Strep Test for a Sore Throat?

A rapid strep test checks for streptococcus bacteria infection in the throat. The test is painless and takes very little time. The tip of a cotton swab is used to wipe the back of the throat. The swab is then tested right away. If the strep test is positive, you have strep throat. If the strep test is negative, you likely do not have strep throat. However, if there are strong signs of strep throat, your health care provider can do a different throat swab test that is sent to the lab to see if strep bacteria can be grown (cultured) from it. A throat culture takes a couple of days for results. 

What Is the Treatment for Strep Throat?

Strep throat is treated using antibiotics, which kill the bacteria causing the infection. Antibiotics are often taken as pills or given as a shot. Penicillin and amoxicillin are common antibiotics used to treat strep throat. Other antibiotics are prescribed for people who are allergic to penicillin.
Follow your health care provider's instructions for antibiotic use. Take all of the medication, even if you feel better. You should feel better within a day or two. A person with strep throat should stay home until 24 hours after starting the antibiotic.

What If My Strep Throat Isn't Getting Better?

If your strep throat is not getting better, let your health care provider know right away. Do not stop taking your prescribed medicine unless your health care provider tells you to. Call your health care provider if these symptoms occur:

• Fever one or two days after feeling better
• Nausea or vomiting
• Earache
• Headache
• Skin rash
• Cough
• Swollen glands
• Painful joints
• Shortness of breath
• Dark urine, rash, or chest pain (may occur three to four weeks later)

How Is Tonsillitis Different From a Sore Throat With a Cold?

Sometimes a sore throat is caused by tonsillitis, an inflammation of the tonsils. Tonsillitis can be caused by viruses or bacteria. While the tonsils' job is to help fight infection, the tonsils can also become infected. When they do, the result is tonsillitis and a very painful sore throat.

How Are Tonsillitis Symptoms Different From Symptoms of a Sore Throat With a Cold?

In addition to a sore throat, a cold usually causes nasal symptoms, such as runny nose or congestion. With tonsillitis, your tonsils become swollen and may have telltale white or yellow spots. Other symptoms with tonsillitis include the following:

• Bad breath
• Fever
• Voice changes because of swelling
• Painful swallowing
• Swollen lymph glands in neck

How Is a Sore Throat From Tonsillitis Treated?

If the tonsillitis infection is bacterial like strep throat, then antibiotics are given. If the tonsillitis infection is viral, antibiotics will not help. The virus must run its course for the sore throat to resolve. For either type of throat infection, the following treatment measures may help:

• Getting plenty of rest
• Drinking lots of fluid
• Eating smooth, soothing foods like gelatin, ice cream, shakes, frozen desserts, and soup
• Avoiding crunchy or spicy foods
• Using a vaporizer
• Taking over-the-counter pain relievers such as acetaminophen, naproxen, or ibuprofen. Children should not take aspirin.

If the tonsillitis infections occur repeatedly, or if the tonsils are interfering with sleep and breathing, the doctor may recommend a tonsillectomy, which is the surgical removal of the tonsils.

 

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I’ve Got a Cold: What Can I Do?

What's the best treatment for a cold?

There is no cure for the common cold. The most important thing you can do is drink a lot of fluids to keep your body hydrated. This will help prevent another infection from setting in. Avoid drinks like coffee, tea, and colas with caffeine. They may rob your system of fluids. As for eating, follow your appetite. If you're not really hungry, try eating simple foods like white rice or broth.
Chicken soup is comforting, plus the steam helps break up nasal congestion. Ginger seems to settle an upset stomach. A hot toddy may help you sleep, but beware of mixing alcohol with other cold remedies.
Over-the-counter cold medicines can offer relief from aches and fever. However, doctors no longer believe in suppressing low-grade fever except in very young and very old people, or people with certain medical conditions such as heart or lung disease. Low-grade fever helps the body fight off infection by suppressing the growth of viruses or bacteria and by activating the immune system.

• Aspirin. Young people and children should not take aspirin because of the risk of Reye's syndrome.
• Decongestants can help make breathing easier by shrinking swollen mucous membranes in the nose. Use for no more than two or three days.
• Saline nasal sprays can also open breathing passages and may be used freely.
• Cough preparations are not hugely effective. For minor coughs, water and fruit juices probably help the most. The FDA and manufacturers now say that over-the-counter cough and cold medicines should not be given to children under 4.
• Gargling with salt water can help relieve a sore throat.

How effective are natural remedies like zinc, echinacea, and vitamin C?

Taking zinc, either as a syrup or lozenge, through the first few days of a cold may shorten the misery of an upper respiratory infection, according to a review of 15 studies on the subject. The review also found that zinc also appeared to prevent colds in people who used it over the course of about five months.
Some studies show that zinc nasal sprays help cut a cold's severity and duration. The theory? Zinc sprays may coat the cold virus and prevent it from attaching to nasal cells where they enter the body. But other studies show that zinc is no more effective than placebo. Recent, well-done studies on echinacea show that it is not effective in preventing colds. However, in one study, 120 people with cold-like symptoms took 20 drops of echinacea every two hours for 10 days and had briefer colds than others.
As for vitamin C's effects, a recent survey of 65 years' worth of studies found limited benefit. The researchers found no evidence that vitamin C prevents colds. However, they did find evidence that vitamin C may shorten how long you suffer from a cold. One large study found that people who took a vitamin C megadose -- 8 grams on the first day of a cold -- shortened the duration of their colds.
To prevent colds the natural way, it's best to make sure you've got a well-nourished immune system. Dark greens foods like spinach are loaded with vitamins A and C. Salmon is a great source of omega-3 fatty acids, which fight inflammation. Low-fat yogurt may help stimulate the immune system.
Regular exercise -- such as aerobics and walking -- also boosts the immune system. People who exercise may still catch a virus, but they have less severe symptoms. They may recover more quickly compared with less-healthy people.

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Colds, Cough & Sore Throat: Oh No!

Is Your Sore Throat a Cold, Strep Throat, or Tonsillitis?

 

Got a sore throat? Wonder if your painful sore throat is from a cold, strep throat, or tonsillitis? Here's help with how to tell.

What's the Difference Between a Cold, Strep Throat, and Tonsillitis?

A sore throat is often the first sign of a cold. However, a sore throat from a cold often gets better or goes away after the first day or two. Other cold symptoms such as a runny nose and congestion may follow the sore throat.
Strep throat, which is an infection due to streptococcus bacteria, is another cause of sore throats and tonsillitis. With strep throat, the sore throat is often more severe and persists. 
Tonsillitis is a painful inflammation or infection of the tonsils, the tissue masses located at the back of the throat.

Is a Sore Throat With a Cold Caused by Viruses or Bacteria?

Sore throats can be caused by viruses or bacteria. The most common causes of sore throats are viruses. Viral sore throats are often accompanied by other cold symptoms that may include a runny nose, cough, red or watery eyes, and sneezing. Other causes of sore throat include smoking, pollution or irritants in the air, allergies, and dry air.

Along With a Sore Throat, What are Other Cold Symptoms?

In addition to a sore throat, other common cold symptoms include:

• Runny nose
• Sneezing
• Cough
• Mild headache
• Mild body aches
• Fever

How Are Sore Throats With Colds Treated?

Although there is no cure for a sore throat caused by a cold virus, there are ways to help you feel more comfortable. Drinking warm liquids, gargling with warm salt water, sucking on ice chips, or taking an over-the-counter medicine may relieve symptoms of pain or fever. When you are sick with a cold, it is also important to get enough rest, eat a healthy diet, and drink plenty of fluids.

Can Medications Relieve Symptoms of a Sore Throat With a Cold?

Over-the-counter cold medications may relieve cold and sore throat symptoms. However, the benefits of these drugs are minimal. Some cold medications include:

• Pain relievers, such as acetaminophen and ibuprofen and naproxen, to relieve the aches and pains of a cold and sore throat. ( Aspirin should not be given to children because of its link to Reye's syndrome, a disorder that can cause brain damage and death.)
• Sore throat sprays and lozenges to soothe your throat and numb the throat pain temporarily. (Lozenges should not be given to young children)
• Decongestant nasal sprays to relieve a sore throat caused by postnasal drip -- nasal drainage that runs down your throat. (Be sure to stop using nasal decongestant sprays after three days, or you may have an increase in congestion when you stop them.)

Antibiotics should not be used to treat a cold virus and sore throat. Antibiotics are effective only against bacteria. They will not work on sore throats associated with colds, which are caused by viruses.

How Is Strep Throat Different From a Sore Throat With a Cold?

Strep throat is caused by an infection of streptococcus bacteria. Strep throat spreads by having contact with an infected person's saliva or nasal secretions. Although strep throat is more common in children aged 5 to 15, it also occurs in adults. To diagnose strep throat, your doctor can check a rapid strep test or send a throat swab to the lab for a culture.

Is Strep Throat More Serious Than a Sore Throat With a Cold?

Strep throat can cause more serious illnesses, such as rheumatic fever, a disease that may harm the heart valves. That's why it's important to get proper medical treatment. With proper treatment, strep throat is usually cured within 10 days.

Are Strep Throat Symptoms Different From a Sore Throat With a Cold?

Strep throat symptoms are usually more severe than symptoms of a sore throat with a cold and may include the following:

• Sudden sore throat
• Loss of appetite
• Painful swallowing
• Red tonsils with white spots
• Fever

Do I Need to See my Doctor if I Think I Have Strep Throat?

The symptoms of a cold and strep throat can be very similar. If you think you have symptoms of strep throat, visit your health care provider. Your doctor will ask you about your symptoms and do a physical exam, and you may be given a strep test. 

What Is a Strep Test for a Sore Throat?

A rapid strep test checks for streptococcus bacteria infection in the throat. The test is painless and takes very little time. The tip of a cotton swab is used to wipe the back of the throat. The swab is then tested right away. If the strep test is positive, you have strep throat. If the strep test is negative, you likely do not have strep throat. However, if there are strong signs of strep throat, your health care provider can do a different throat swab test that is sent to the lab to see if strep bacteria can be grown (cultured) from it. A throat culture takes a couple of days for results. 

What Is the Treatment for Strep Throat?

Strep throat is treated using antibiotics, which kill the bacteria causing the infection. Antibiotics are often taken as pills or given as a shot. Penicillin and amoxicillin are common antibiotics used to treat strep throat. Other antibiotics are prescribed for people who are allergic to penicillin.
Follow your health care provider's instructions for antibiotic use. Take all of the medication, even if you feel better. You should feel better within a day or two. A person with strep throat should stay home until 24 hours after starting the antibiotic.

What If My Strep Throat Isn't Getting Better?

If your strep throat is not getting better, let your health care provider know right away. Do not stop taking your prescribed medicine unless your health care provider tells you to. Call your health care provider if these symptoms occur:

• Fever one or two days after feeling better
• Nausea or vomiting
• Earache
• Headache
• Skin rash
• Cough
• Swollen glands
• Painful joints
• Shortness of breath
• Dark urine, rash, or chest pain (may occur three to four weeks later)

How Is Tonsillitis Different From a Sore Throat With a Cold?

Sometimes a sore throat is caused by tonsillitis, an inflammation of the tonsils. Tonsillitis can be caused by viruses or bacteria. While the tonsils' job is to help fight infection, the tonsils can also become infected. When they do, the result is tonsillitis and a very painful sore throat.

How Are Tonsillitis Symptoms Different From Symptoms of a Sore Throat With a Cold?

In addition to a sore throat, a cold usually causes nasal symptoms, such as runny nose or congestion. With tonsillitis, your tonsils become swollen and may have telltale white or yellow spots. Other symptoms with tonsillitis include the following:

• Bad breath
• Fever
• Voice changes because of swelling
• Painful swallowing
• Swollen lymph glands in neck

How Is a Sore Throat From Tonsillitis Treated?

If the tonsillitis infection is bacterial like strep throat, then antibiotics are given. If the tonsillitis infection is viral, antibiotics will not help. The virus must run its course for the sore throat to resolve. For either type of throat infection, the following treatment measures may help:

• Getting plenty of rest
• Drinking lots of fluid
• Eating smooth, soothing foods like gelatin, ice cream, shakes, frozen desserts, and soup
• Avoiding crunchy or spicy foods
• Using a vaporizer
• Taking over-the-counter pain relievers such as acetaminophen, naproxen, or ibuprofen. Children should not take aspirin.

If the tonsillitis infections occur repeatedly, or if the tonsils are interfering with sleep and breathing, the doctor may recommend a tonsillectomy, which is the surgical removal of the tonsils.

 

 

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Taurine May Help Women's Hearts

Amino Acid Found in Dark Meat Poultry, Fish May Protect Women With High Cholesterol, Study Suggests

Taurine, an amino acid found in dark meat poultry and other foods, may be good for some people's hearts, according to a new study.
"People with high cholesterol may have a reduced risk of coronary heart disease if they have a high level of taurine in their diet," says researcher Yu Chen, PhD, MPH, associate professor of epidemiology at the NYU Langone Medical Center in New York.
Her research looked only at women. However, she suspects the same benefit may be found for men.
The study was small. Much more research is needed, Chen tells WebMD. Her study is published online in the European Journal of Nutrition.
The American Heart Association and the National Institutes of Health funded the study.

Taurine and Heart Disease Risk: Study Details

There hasn’t been a lot of research on taurine, Chen tells WebMD. The nutrient is found in dark meat turkey and chicken. It is also in some seafood, including white fish, mussels, and clams, she says.
It's also found in energy drinks. Some think it can improve athletic performance, although in a release Chen says the taurine in drinks is man-made and is in unstudied amounts. The taurine in her study is from natural sources.
Animal studies of taurine have found it is involved in many body processes such as blood pressure regulation. It has been found to have antioxidant properties.
Chen looked at data and blood samples collected from the NYU Women's Health Study. This study enrolled more than 14,000 women ages 34 to 65 between 1985 and 1991.
For this study, Chen compared blood samples and diet information from 223 women who developed heart disease or died from it during the study follow-up from 1986 to 2006.
The researchers compared these blood samples to those of 223 others who didn't get heart disease.
They divided the women into three groups, from lowest to highest taurine in their blood.
Overall, the reduction in heart disease risk was not substantial for those in the highest group compared to the lowest.
However, Chen did find a benefit when she looked only at those women who had high total cholesterol, over 250 mg/dL. (Under 200 is considered normal.)
Among those with high cholesterol, those with the highest blood levels of taurine had a lower risk of heart disease.
"Among women with high cholesterol, those with high taurine experienced a 60% reduction in coronary heart disease," she says.
Chen can't say how much or which foods to eat to get those blood levels.
Exactly why the taurine is linked with lower heart disease is not known. She says it could be due to taurine's anti-inflammatory and antioxidant properties.
Eventually, those at risk of heart disease due to high cholesterol may be given a diet prescription in addition to medicine, Chen says.
However, she found an association, not cause and effect.

Taurine and Heart Disease Risk: Perspective

Taurine is gathering research interest, says Paramjit Tappia, PhD, a clinical research scientist at St. Boniface Hospital Research Centre at the University of Manitoba.

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Statin Risks Outweighed by Statin Benefits

What Are Statin Drugs?

The first statin drug, mevastatin, was isolated from a fungus. Red yeast rice contains mevastatin, although different batches of this natural product contain different amounts of mevastatin.
Several other statin drugs were derived from this fungal compound. Others are fully synthetic. All of them block an enzyme the body needs to create cholesterol. This lowers the amount of bad LDL cholesterol in the body.
Statin drugs include:

• Altocor, Altoprev, Mevacor (lovastatin)
• Crestor (rosuvastatin)
• Lescol (fluvastatin)
• Lipitor (atorvastatin)
• Livalo (pitavastatin)
• Pravachol (pravastatin)
• Zocor (simvastatin)

Clinical trials show that all of these cholesterol-lowering drugs cut the risk of heart disease by 25% to 30%, Nissen says.
In the U.S., an estimated 33 million adults are taking a statin drug.

Are Statin Drugs Too Risky?

"If you have heart disease, or are at very high risk of heart disease with high cholesterol, statins are one of the best classes of drugs we ever had," Nissen says. "When used thoughtfully and with good monitoring, they are safe and effective."
We all need to watch our cholesterol levels. But statin treatment is not for everyone.
"Some people are running around saying we should put statins in the water supply, and that is wrong. These are serious drugs," Nissen says. "Statins should be coupled with good diet and exercise. They are not a substitute for a healthy lifestyle."

Who Should Take Statin Drugs?

Statin drugs are for people who are at risk of heart disease.
Risk is defined by your age, your total cholesterol level, your good HDL cholesterol level, your blood pressure, and whether you are a smoker. Your blood level of C-reactive protein (CRP) and whether either of your parents had an early heart attack also are factors.
But the decision on whether or not to take a statin drug should be made in consultation with your doctor, who can take all your individual risk factors into account.
Statin drugs are not a cure-all. They should be used only along with proper exercise and a healthy diet.
And some people definitely should not take statins. Pregnant women, or women of childbearing age not using contraception, should not take statin drugs. And certain other drugs can have dangerous interactions with statins.

What Are the Risks of Statin Drugs?

Even the very best drugs carry risks. Statins are no exception.

In early 2012, the FDA told statin drugmakers to add a few of risks to the product label. These risks include memory loss, mental confusion, and a diagnosis of diabetes due to higher blood sugar.
Media reports of these risks alarmed many statin users. The Cleveland Clinic's Nissen says these risks are real, but not particularly worrisome.
The increase in blood sugar, he says, is small. But in people with already high blood sugar, this small increase may push them across the threshold of a diabetes diagnosis.
"It turns out that analyses of controlled trials show that those who cross the threshold into diabetes had exactly the same benefits of the statin," Nissen says. "So in terms of risk vs. benefit, there is no change."
As for the memory loss and confusion, Nissen says it is "rare and completely reversible." He notes that statins do reduce a person's risk of vascular dementia, which is considered to be the second leading type of dementia, behind Alzheimer's disease.
A more common risk seen with statins is muscle tenderness, which occurs in some 5% of patients. This can be extremely severe.
"A doctor should suspect a statin side effect in any patient who complains of muscle pain," Nissen says. "They can often switch to another statin. We can usually find a statin drug people can tolerate without too much difficulty."
There are several risk factors for muscle side effects linked to statins:

• Thyroid insufficiency
• Female sex
• Older age
• Liver and kidney problems
• Diabetes
• Excessive alcohol use
• Use of other medicines that affect statin metabolism

And while most people tolerate statins quite well, other common side effects include:

• Headache
• Difficulty sleeping
• Flushing of the skin
• Muscle aches, tenderness, or weakness
• Drowsiness/weakness
• Dizziness
• Nausea and/or vomiting
• Abdominal cramping and/or pain
• Bloating and/or gas
• Diarrhea
• Constipation
• Rash

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High Cholesterol Risks: Top 2 Dangers

There are usually no symptoms of high-risk cholesterol, yet the dangers are very real -- even fatal.

A lot of people don't take the risks of high cholesterol very seriously. After all, one out of six people have high cholesterol. A staggering 50% of Americans have levels above the suggested limit. Could something so common really be a serious health risk?
Unfortunately, yes. Cholesterol is a direct contributor to cardiovascular disease, which can lead to strokes and heart attacks.

"Despite all of the amazing medicines and treatments we have, cardiovascular disease is still the number one cause of death and illness in our society," says Laurence S. Sperling, MD, director of preventive cardiology at the Emory University School of Medicine, Atlanta, Ga.
The World Health Organization estimates that almost 20% of all strokes and over 50% of all heart attacks can be linked to high cholesterol.
But if you've been diagnosed with high cholesterol, don't despair. The good news is that high cholesterol is one risk factor for strokes and heart attacks that you can change. You just need to take action now, before your high cholesterol results in more serious disease.

All About High-Risk Cholesterol Numbers

When it comes to high cholesterol risks, it's tough to keep the details straight. We might have a vague idea of whether our cholesterol is "good" or "bad," but we forget the actual numbers by the time we get to the parking lot outside our doctor's office. So it may be worth reviewing the basics.
Cholesterol is a fat-like substance circulating in your blood. Some of your cholesterol comes from the foods you eat. But the bulk of it is actually made in your own body, specifically in the liver. Cholesterol does have some good uses. It is needed to make some hormones and it is important for the function of our cells. But an excess of it in the bloodstream can lead to trouble.
Cholesterol comes in several different forms, but doctors focus mostly on two: LDL cholesterol and HDL cholesterol.

• LDL is also called "bad cholesterol" -- Sperling suggests that you think of the "L" as standing for lousy. LDL cholesterol can clog your arteries, increasing the risk of heart attack and stroke. Most people should aim for a level of less than 100 mg/dL. However, people who already have heart disease may need to aim for under 70 mg/dL.
• HDL is "good cholesterol." Imagine the "H" stands for healthy, Sperling suggests. This type of cholesterol attaches to bad cholesterol and brings it to the liver, where it's filtered out of the body. So HDL cholesterol reduces the amount of bad cholesterol in your system. You should aim for 60 mg/dL or higher.
• Triglycerides are not cholesterol but another type of fat floating in your blood. Just as with bad cholesterol, having a high level of triglycerides increases your risk of cardiovascular problems. Aim for a fasting level of less than 150 mg/dL.

So although we all talk about high cholesterol risks, the term is a little misleading. What we really mean is high levels of bad LDL cholesterol and triglycerides and a low level of good HDL cholesterol.
What about total cholesterol? Although anything under 200 mg/dL is still considered the target, most experts don't focus on the number. It doesn't mean all that much. Someone can have a total cholesterol of under 200 -- which is lower than average for Americans -- but still have unhealthy levels of HDL or LDL, Sperling says. The average level for American adults is 200 mg/dL.  

Realizing the Risks: How Harmful Is High Cholesterol?

Everyone has cholesterol in their blood. But if your levels of LDL are too high, the excess can accumulate on the walls of your arteries. This build-up of cholesterol and other substances -- called plaque -- can narrow the artery like a clogged drain. It can also lead to arteriosclerosis, or hardening of the arteries, which turns the normally flexible tissue into more brittle.

Plaques can form anywhere. If they form in the carotid artery in the neck, it's carotid artery disease. When they form in the coronary arteries -- which supply the heart muscle with blood -- it's called coronary artery disease. Like any organ, the heart needs a good supply of blood to work. If it doesn't get that blood, you could get angina, which causes a squeezing pain in the chest and other symptoms.

There are other high cholesterol risks. If these plaques break open, they can form a clot. If a clot lodges in an artery and completely chokes off the blood supply, the cells don't get the nutrients and oxygen they need and die.

If a clot gets to the brain and blocks blood flow, it can cause a stroke. If a clot lodges in the coronary arteries, it can cause a heart attack.

Do We Underestimate High Cholesterol Risks?

The risks of high cholesterol are quite clear. "If you look at populations of people," says Sperling, "the higher the cholesterol, the higher the level of heart and blood vessel disease." It's that simple.

But experts say that people don't take high cholesterol risks seriously enough. According to 2007 figures from the CDC, 21.5% of American adults said they had never had their cholesterol checked.

One problem is that high cholesterol doesn't cause symptoms that make people pay attention.

"People naturally respond more to medical conditions that cause symptoms," says Nathan D. Wong, PhD, fellow of the American College of Cardiology and director of the Heart Disease Prevention Program at the University of California, Irvine. Since you won't feel your rising cholesterol levels, you won't go to the doctor about it.

By the same token, people may be less likely to stick to treatment for high cholesterol than they would be for a painful condition.

"People on cholesterol-lowering medicine don't feel any better," says Sperling. "It's not like taking a painkiller for an aching knee, where you know it's working." As a result, people may be less likely to follow their treatment plan over the long-term, Sperling says.

Also, high cholesterol risks are usually not immediate. The damage accumulates over years and decades -- high cholesterol in your 20s and 30s can take its toll in your 50s and 60s. Because the effects take time, many people don't feel real urgency in treating it. They feel they can just deal with it later.

"Unfortunately, I think that many people are too casual about their high cholesterol," says Adolph Hutter, MD, a cardiologist at Massachusetts General Hospital and a professor of medicine at Harvard Medical School. "They ignore it for years and it only gets their attention when they actually develop vascular disease."

Taking Action to Lower High Cholesterol Risks

There are many good treatments for heart disease, arteriosclerosis, and other serious conditions caused by high cholesterol. But it's a terrible shame to let things get that far when making changes now could prevent these life-threatening illnesses. Reducing your high cholesterol risks is a crucial step.

So what should you do? First, go to the doctor. "It's very important for all adults to get their cholesterol tested," says Wong. The American Heart Association recommends that every adult 20 years and older have a fasting cholesterol test at least once every five years.

Also, keep track of your cholesterol levels yourself. Write down your current numbers and, if they're high, what numbers you should be striving for.

If you do have high cholesterol, get serious. Talk with your doctor about what your goals should be and how you should achieve them. Make sure you understand what lifestyle changes you need to make. If you already have heart disease or other risk factors like diabetes, you need to be even more careful.

Whatever you do, don't ignore your high cholesterol risks. Don't put off treatment for another year.

"Having high cholesterol may not hurt you today or tomorrow," says Sperling. "But if you don't do something about it, it can have a terrible cost down the road."

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Alternative Treatments for High Cholesterol

There are alternative treatments for lowering cholesterol naturally. But before you add any supplement or alternative therapy to your diet, talk to your doctor. Some supplements may interact with other medication you may be taking or have dangerous side effects.

Supplements for Lowering Cholesterol

Some of the herbal and nutritional supplements said to lower cholesterol include:

• Garlic: According to some studies, garlic may decrease blood levels of total cholesterol by a few percentage points. Other studies, however, suggest that it may not be as beneficial as once thought. It may also have significant side effects and/or interactions with certain medications. Garlic may prolong bleeding and blood clotting time, so garlic and garlic supplements should not be consumed prior to surgery and should not be taken with blood-thinning drugs such as Coumadin (warfarin).
• Guggulipid: Guggulipid is the gum resin of the mukul myrrh tree. In clinical studies performed in India, guggulipid significantly reduced blood levels of total cholesterol and LDL cholesterol. The enthusiasm for using guggulipid as a cholesterol-lowering herbal agent, however, diminished after the publication of negative results from a clinical trial in the U.S. Further research is necessary to determine the safety and efficacy of this herb.
• Red Yeast Rice: Red yeast rice has been found to lower cholesterol in studies and was previously found in the over-the-counter supplement Cholestin. However, in 2001, FDA took Cholestin off the shelf because it contained lovastatin, a compound found in the cholesterol prescription medication Mevacor. Reformulated "Cholestin" no longer contains red yeast rice. Other red yeast rice-containing supplements currently available in U.S. contain very small amounts of lovastatin. Their effectiveness is questionable.
• Policosanol: Produced from sugar cane, policosanol was found to be effective in lowering LDL cholesterol in several trials. Most policosanol supplements found in the U.S., including the reformulated Cholestin, contain policosanol extracted from beeswax and not the sugar cane policosanol. There is no evidence that policosanol extracted from beeswax can lower cholesterol. Additional studies on sugar cane policosanol are needed to determine its effectiveness in lowering cholesterol.
• Other herbal products: The results of several studies suggest fenugreek seeds and leaves, artichoke leaf extract, yarrow, and holy basil all may help lower cholesterol. These and other commonly used herbs and spices -- including ginger, turmeric, and rosemary -- are being investigated for their potential beneficial effects relating to coronary disease prevention.

Dietary Approaches to Lowering Cholesterol

Increased consumption of dietary fiber, soy foods, and plant compounds similar to cholesterol (plant stanols and sterols) can significantly reduce LDL cholesterol, or bad cholesterol.

• Fiber: Only plant foods (vegetables, fruits, legumes, unrefined grains) contain dietary fiber. The soluble fiber found in foods such as oat bran, barley, psyllium seeds, flax seed meal, apples, citrus fruits, lentils and beans are particularly effective in lowering cholesterol.
• Soybeans: Substituting soybeans or soy protein for other proteins have been shown to prevent coronary heart disease by lowering LDL cholesterol and triglycerides. Soy protein is present in tofu, tempeh, soy milk, soy yogurt, edamame, soy nuts, and many other food products made from soybeans.
• Phytosterols: Phytosterols (plant sterol and stanol esters) are compounds found in small amounts in foods such as whole grains as well as in many vegetables, fruits, and vegetable oils. They decrease LDL cholesterol, mostly by interfering with the intestinal absorption of cholesterol. Phytosterols can be found in spreads (like the cholesterol-lowering margarines Benecol, Promise, Smart Balance, and Take Control), dressings for salads, and dietary supplements. Additional phytosterol-fortified foods include Minute Maid Heart Wise orange juice, Nature Valley Healthy Heart chewy granola bars, CocoVia chocolates, Rice Dream Heartwise rice drink, and Lifetime low-fat cheese.

Dietary fiber, soybeans, and phytosterols decrease cholesterol levels by different mechanisms. Therefore, it is not surprising that the combined dietary intake of these foods and other plant substances, along with a low intake of saturated fats, is more effective at reducing cholesterol levels than each individual substance alone.
Including foods rich in omega-3 fatty acids in your diet may also help lower cholesterol. Aim for at least two servings of fatty fish like salmon, mackerel, herring, tuna, and sardines per week. Other dietary sources of omega-3 fatty acids include flax seed and walnuts.

• Omega-3 fatty acids: These essential fatty acids have a favorable effect on cholesterol. Supplement sources include fish oil capsules, flaxseed and flax seed oil. Omega-3 fatty acids decrease the rate at which the liver produces LDL cholesterol and triglycerides. They have an anti-inflammatory effect in the body, decrease the growth of plaque in the arteries, and aid in thinning blood. If you are considering taking omega-3 fatty acids, you should first discuss with your doctor if omega-3 fatty acid supplements are right for you (especially if you are currently taking blood-thinning medication).

Avoid partially hydrogenated and hydrogenated vegetable oils. These man-made oils are sources of trans fatty acids known to increase LDL cholesterol. They lower heart-protecting HDL (good) cholesterol and increase the inflammatory response in the body. You can now find trans fats listed on the Nutrition Facts panel of packaged foods. Minimize consumption of trans fatty acid-containing food.

If a plant-based, low-fat diet alone is not effective at reducing cholesterol levels, such a diet should be combined with cholesterol-lowering medications.

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High Cholesterol: Cholesterol-Lowering Medication

Sometimes cholesterol medication is recommended in addition to a low-saturated fat, low-refined carbohydrate, and high-fiber diet to lower cholesterol.
Cholesterol is an important part of your cells and also serves as the building block of some hormones. The liver makes all the cholesterol the body needs. But cholesterol also enters your body from dietary sources, such as animal-based foods like milk, eggs, and meat. Too much cholesterol in your blood can increase the risk of coronary artery disease.
The first line of treatment for abnormal cholesterol is usually to eat a diet low in saturated and trans fats, and high in fruits and vegetables, nuts, and seeds, and to increase exercise. But for some, these changes alone are not enough to lower blood cholesterol levels. These people may need medicine, in addition to making lifestyle changes, to bring their cholesterol down to a safe level.
Cholesterol-lowering drugs include:

• Statins
• Niacin
• Bile-acid resins
• Fibric acid derivatives
• Cholesterol absorption inhibitors

Cholesterol-lowering medicine is most effective when combined with a healthy diet and exercise.

How Do Statins Work?

Statins block the production of cholesterol in the liver itself. They lower LDL, the "bad" cholesterol, and triglycerides, and have a mild effect in raising HDL, the "good" cholesterol. These drugs are the first line of treatment for most people with high cholesterol. Side effects can include intestinal problems, liver damage, and in a few people, muscle tenderness.  Statins have been shown in multiple research studies to reduce the risk of cardiovascular events like heart attacks and death from heart disease.
Examples of statins include:

• Atorvastatin (Lipitor)
• Fluvastatin (Lescol)
• Lovastatin (Mevacor)
• Pravastatin (Pravachol)
• Simvastatin (Zocor)
• Rosuvastatin (Crestor)

How Does Nicotinic Acid Work?

Nicotinic acid is a B-complex vitamin. It's found in food, but is also available at high doses by prescription. It lowers LDL cholesterol and raises HDL cholesterol. The main side effects are flushing, itching, tingling and headache. A recent research study suggested that adding nicotinic acid to statin therapy was not associated with a lower risk of heart disease. Examples of nicotinic acid medication include:

• Nicolar and Niaspan

How Do Bile Acid Resins Work?

These drugs work inside the intestine, where they bind to bile from the liver and prevent it from being reabsorbed into the circulatory system. Bile is made largely from cholesterol, so these drugs work by depleting the body's supply of cholesterol. The most common side effects are constipation, gas and upset stomach. Examples of bile acid resins include:

• Questran and Questran Light
• Colestid
• WelChol

How Do Fibrates Work?

Fibrates reduce the production of triglycerides and can increase HDL cholesterol. Examples of fibrates include:

• Atromid
• Tricor
• Lopid

Ezetimibe lowers bad LDL cholesterol by blocking cholesterol absorption in the intestine. Research studies have not found that ezetimibe is associated with a lower risk of heart disease.

What Are the Side Effects of Cholesterol-Lowering Drugs?

The side effects of cholesterol-lowering drugs may include:

• Muscle aches*
• Abnormal liver function
• Allergic reaction (skin rashes)
• Heartburn
• Dizziness
• Abdominal pain
• Constipation
• Decreased sexual desire
• Flushing with nicotinic acid

*If you have muscle aches, call your doctor immediately. This could be a sign of a life-threatening condition.

Are There Foods or Other Drugs I Should Avoid While Taking Cholesterol-Lowering Medicine?

You should limit grapefruit juice and fresh grapefruit consumption while taking statins, as grapefruit can interfere with the liver's ability to metabolize these medications. Talk with your doctor about your other medications, as it may be appropriate to adjust the dosing of your cholesterol medication depending on interactions.

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New Warnings on Cholesterol-Lowering Statins

Memory loss, confusion, high blood sugar, and type 2 diabetes are possible side effects of the popular cholesterol-lowering drugs known as statins, the FDA warns.

Brand name and generic versions of statin drugs must carry these warnings on their labels, the FDA today announced.

The products include: Lipitor (atorvastatin), Lescol (fluvastatin), Mevacor (lovastatin), Altoprev (lovastatin extended-release), Livalo (pitavastatin), Pravachol (pravastatin), Crestor (rosuvastatin), and Zocor (simvastatin). Combination products include: Advicor (lovastatin/niacin extended-release), Simcor (simvastatin/niacin extended-release), and Vytorin (simvastatin/ezetimibe).

"We want health care professionals and patients to have the most current information on the risks of statins, but also to assure them that these medications continue to provide an important health benefit of lowering cholesterol," Mary Parks, MD, director of the FDA's Division of Metabolism and Endocrinology Products, said in a news release.
The new labels will warn patients about:

• Memory loss and mental confusion. Some people taking statin drugs have experienced these brain-related effects. These effects usually have not been serious and went away when patients stopped using the drugs.
• Risk of high blood sugar.
• Risk of being diagnosed with type 2 diabetes.

There will also be a change in the current recommendation that patients on statins get routine liver tests. Those tests now will be needed only before starting statin treatment and then only as needed.
One statin drug, Mevacor, has been singled out for a special new warning. All statin drugs carry a small but serious risk of muscle injury. But this risk is particularly high for patients taking Mevacor and certain other drugs, including the protease inhibitor class of HIV drugs and some antibiotic and antifungal medications.

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Heart Disease: Exercise for a Healthy Heart

A sedentary (inactive) lifestyle is one of the top risk factors for heart disease. Fortunately, it's a risk factor that you can do something about. Regular exercise, especially aerobic exercise, has many benefits. It can:

• Strengthen your heart and cardiovascular system.
• Improve your circulation and help your body use oxygen better.
• Improve your symptoms of congestive heart failure.
• Increase energy levels so you can do more activities without becoming tired or short of breath.
• Increase endurance.
• Lower blood pressure.
• Improve muscle tone and strength.
• Improve balance and joint flexibility.
• Strengthen bones.
• Help reduce body fat and help you reach a healthy weight.
• Help reduce stress, tension, anxiety, and depression.
• Boost self-image and self-esteem.
• Improve sleep.
• Make you feel more relaxed and rested.
• Make you look fit and feel healthy.

How Do I Get Started?

Always check with your doctor first before starting an exercise program. Your doctor can help you find a program that matches your level of fitness and physical condition. Here are some questions to ask:

• How much exercise can I do each day?
• How often can I exercise each week?
• What type of exercise should I do?
• What type of activities should I avoid?
• Should I take my medication(s) at a certain time around my exercise schedule?
• Do I have to take my pulse while exercising?

What Type of Exercise Is Best?

Exercise can be divided into two basic types:

• Cardiovascular or aerobic is steady physical activity using large muscle groups. This type of exercise strengthens the heart and lungs and improves the body's ability to use oxygen. Aerobic exercise has the most benefits for your heart. Over time, aerobic exercise can help decrease your heart rate and blood pressure and improve your breathing (since your heart won't have to work as hard during exercise).
• Strengthening exercises are repeated muscle contractions (tightening).

What Are Examples of Aerobic Exercises?

Aerobic exercises include: walking, jogging, jumping rope, bicycling, skiing, skating, rowing, and aerobics.

How Often Should I Exercise?

In general, to achieve maximum benefits, you should gradually work up to an aerobic session of at least  20 to 30 minutes, at least three to four times a week. Exercising every other day will help you start a regular aerobic exercise schedule. The American Heart Association recommends working up to exercising on most days of the week. While the more exercise you can do the better, any amount of exercise is beneficial to your health.

What Should I Include in My Program?

Every exercise session should include a warm-up, conditioning phase and a cool-down.

• Warm-up. This helps your body adjust slowly from rest to exercise. A warm-up reduces the stress on your heart and muscles, slowly increases your breathing, circulation (heart rate) and body temperature. It also helps improve flexibility and reduce muscle soreness. The best warm-up includes dynamic stretching (as compared to the “touch your toes” stretches you did in high school) and the beginning of the activity at a low intensity level.
• Conditioning. This follows the warm-up. During the conditioning phase, the benefits of exercise are gained and calories are burned. If you experience chest pain, significant breathlessness, or dizziness, you should stop exercising and let your doctor know about your symptoms.
• Cool-down. This is the last phase of your exercise session. It allows your body to gradually recover from the conditioning phase. Your heart rate and blood pressure will return to near resting values. Cool-down does not mean sit down! In fact, do not sit, stand still or lie down right after exercise. This may cause you to feel dizzy or lightheaded or have heart palpitations (fluttering in your chest). The best cool-down is to slowly decrease the intensity of your activity.

What Is the Rated Perceived Exertion Scale?

The Rated Perceived Exertion (RPE) scale is used to measure the intensity of your exercise. The RPE scale runs from 0-10. The numbers below relate to phrases used to rate how easy or difficult you find an activity. For example, 0 (nothing at all) would be how you feel when sitting in a chair; 10 (very, very heavy) would be how you feel at the end of an exercise stress test or after a very difficult activity.

Rated Perceived Exertion (RPE) scale
0	Nothing at all
0.5	Just noticeable
1	Very light
2	Light
3	Moderate
4	Somewhat heavy
5-6	Heavy
7-9	Very heavy
10	Very, very heavy

When starting an exercise program, you should exercise at a level that feels 3 (moderate) to 4 (somewhat heavy). When using this rating scale, remember to include feelings of shortness of breath, as well as how tired you feel in your legs and overall.

Exercise while sitting

While performing these exercises, maintain good posture. Keep your back straight; do not curve or slump your back. Make sure your movements are controlled and slow. Avoid quick, jerking movements. Do not bounce. Do not hold your breath during these exercises.

• Ankle pumping. Sit on the floor with your feet straight out in front of you. Keeping your heels on the floor, lift your toes up as far as you can. Hold for a count of five.
• Knee straightening. Raise your foot to fully straighten your knee out in front of you. Hold for a count of five. Lower your foot to the floor. Repeat on other side.
• Hip bending. Lift one knee up toward the ceiling. As you lower this knee, raise your other knee. Alternate each leg as if you were marching in place (while sitting.)
• Overhead reaching. Raise one arm straight over your head, with your palm facing away from you. Keep your elbow straight. Slowly lower your arm to your side. Repeat with other arm.
• Shoulder touching. Sit with your arms at your sides and your palms facing up. Bend your elbows until your hands are touching your shoulders. Lower your hands to your sides.
• Single arm lifts. Sit with your arms at your sides, fingers pointing toward the floor. Raise one arm out to your side, keeping your elbow straight and your palm facing down. Slowly lower your arm to your side. Repeat with your other arm.
• Shoulder shrugs. Keeping your back straight, lift your shoulders up and forward toward your ears. Release your shoulders down and back in a smooth circular motion.
• Arm circles. Sit with your arms at your sides, fingers pointing toward the floor. Raise both arms out from your sides (about 1 or 2 feet from your body). Keeping your elbows straight and your palms facing toward you, rotate your arms in small circles.
• Single shoulder circles. Bending one elbow, put your fingertips on your shoulder. Rotate your shoulder and elbow clockwise, then counter clockwise. Repeat with each arm.

How Can I Avoid Overdoing It?

Here are a few guidelines:

• Gradually increase your activity level, especially if you have not been exercising regularly.
• Wait at least one hour after eating a meal before exercising.
• When drinking liquids during exercise, remember to consider any fluid restriction guidelines.
• Exercise at a steady pace. Keep a pace that allows you to talk during the activity.
• Keep an exercise record.

How Can I Stick With It?

• Have fun! Choose an activity that you enjoy. You'll be more likely to stick with an exercise program if you enjoy the activity. Add variety. Develop a group of several different activities to do on alternate days that you can enjoy. Use music to keep you entertained. Here are some questions you can think about before choosing a routine:
• What physical activities do I enjoy?
• Do I prefer group or individual activities?
• What programs best fit my schedule?
• Do I have physical conditions that limit my choice of exercise?
• What goals do I have in mind? (For example, losing weight, strengthening muscles or improving flexibility.)
• Schedule exercise into your daily routine. Plan to exercise at the same time every day (such as in the mornings when you have more energy). Add a variety of exercises so that you do not get bored. If you exercise regularly, it will soon become part of your lifestyle.
• Find an exercise "buddy." This will help you stay motivated.

Also, exercise does not have to put a strain on your wallet. Avoid buying expensive equipment or health club memberships unless you are certain you will use them regularly.

General Workout Tips for People With Heart Failure

• Be sure any exercise is paced and balanced with rest.
• Avoid isometric exercises such as push-ups and sit-ups. Isometric exercises involve straining muscles against other muscles or an immovable object.
• Don't exercise outdoors when it is too cold, hot, or humid. High humidity may cause you to tire more quickly; extreme temperatures can interfere with circulation, make breathing difficult, and cause chest pain. Better choices are indoor activities such as mall walking.
• Make sure you stay hydrated. It is important to drink water even before you feel thirsty, especially on hot days. But, be careful not to drink too much water. Follow your doctor's guidelines about how much fluid you can have in a day.
• Extremely hot and cold showers or sauna baths should be avoided after exercise. These extreme temperatures increase the workload on the heart.
• Steer clear of exercise in hilly areas unless you have discussed it with your doctor. If you must walk in steep areas, make sure you slow down when going uphill to avoid working too hard.
• If your exercise program has been interrupted for more than a few days (for example, due to illness, vacation, or bad weather), make sure you ease back into the routine. Start with a reduced level of activity, and gradually increase it until you are back where you started.

Exercise Precautions

There are many precautions you must keep in mind when developing an exercise program. Here are some tips.

• Stop the exercise if you become overly fatigued or develop chest pain or shortness of breath; discuss the symptoms with your doctor or schedule an appointment for evaluation.
• Do not exercise if you are not feeling well or have a fever. You should wait a few days after all symptoms disappear before restarting the exercise program, unless your doctor gives other directions.
• If you experience shortness of breath or increased fatigue during any activity, slow down or stop the activity. Elevate your feet when resting. If you continue to have shortness of breath, call your doctor. The doctor may make changes in medications, diet, or fluid restrictions.
• Stop the activity if you develop a rapid or irregular heartbeat or have heart palpitations. Check your pulse after you have rested for 15 minutes. If it's still above 120 beats per minute, call the doctor for further instructions.

If you experience pain:

• Don't ignore it. If you have chest pain or pain anywhere else in the body, do not allow the activity to continue. Performing an activity while in pain may cause stress or damage to the joints.

Warning

Stop exercising and call your doctor if you have any of the following symptoms:

• Chest pain
• Weakness
• Dizziness or lightheadedness
• Unexplained weight gain or swelling
• Pressure or pain in your chest, neck, arm, jaw, or shoulder or any other symptoms that cause concern.

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