Sunday, 24 September 2017

Mark and Chris Faced Alzheimer’s Together: A Caregiver’s Story

Alzheimer's caregiver story

By Mark Donham, Special to Everyday Health

What happens when you face Alzheimer’s in your mid-forties?

My wife, Chris, and I had a great life together. But when she was 43, she was diagnosed with younger-onset Alzheimer’s disease, and our world changed forever.

In the early stages of Alzheimer’s, her progression was slow, which allowed us time to cope with the subtle changes she experienced.

Even so, having a timely diagnosis and time to come to terms with the disease was critical. It provided us time to tend to legal matters, including wills, healthcare directives, and power of attorney.

After taking care of these necessities, we lived in what we called “healthy denial.” Doing so allowed us to make the most of every day and to make decisions aimed at living our lives fully (as much as possible) in the time we had left together.

No Regrets: A Caregiver’s Commitment

Alzheimer's caregiver Mark Donham and his wifeI knew I would be there for Chris throughout this disease, so we made the decision that I would leave my job to care for her full-time. This decision had a big financial and personal impact, as it does for so many caregivers. Alzheimer’s is the most expensive disease in the United States, and it hits caregivers and families hard.

But we made our choice with no regrets.

Faith, hope, and courage were the words I focused on as Chris’ Alzheimer’s progressed. As the disease advanced, so did my role as a caregiver, eventually expanding to include dressing, showering, and toileting Chris.

During her decline, it was hugely painful to watch a previously vibrant woman disappear, requiring care in every aspect of her life. Even as her brain was slowly damaged by the plaques and tangles of Alzheimer’s disease, we chose to honor our initial goal to live the best life possible.

We laughed often, said “I love you,” and made the most of each moment.

Turning Point: In the ER With Heart Attack Symptoms

Alzheimer's caregiver Mark Donham and his wifeAs Chris declined, the stress of caregiving took its toll, and at one point I ended up in the emergency room. My doctor thought I was having a heart attack, but it turned out to be stress. At that point, I knew I needed to make some changes in how I cared for my lovely wife.

I secured extra help, but ultimately decided to place Chris in a care home so I could stay healthy while I cared for her through the end of her life.

It was not an easy decision. In fact, it was the hardest one of my life — and one with which many families and caregivers struggle. I made my decision so I could provide Chris the best care possible. In the end, it was one of the smartest things I did, because it allowed me the opportunity to spend more time loving Chris and managing her care.

In the little spare time I had, I teamed up with the Alzheimer’s Association, eventually serving as president of their Oregon chapter. Today, I run a support group for men caring for wives who are struggling with Alzheimer’s. For the past eight years and counting, I have been an advocate for people living with the disease, as well as their families and caregivers.

Chris passed away in January 2011, at age 54. I was there, holding her hands. Her passing marked the end of our lives together. It was an honor and privilege to love and be loved by Chris. We did our best to live our life together fully, in spite of this devastating disease. We stayed the course of our marriage for better and worse.

Mark Donham lives in Portland, Oregon. For Alzheimer’s & Brain Awareness Month, he will be motorcycling across the country as part of the Longest Day, a team event to raise funds and awareness for the Alzheimer’s Association. The association works with caregivers to enhance care and support for all those affected by Alzheimer’s and other dementias. Call their 24/7 helpline at 800-272-3900 for more information.

Sound the Mosquito Alarm, Across the USA

These two species of mosquitoes can transmit viruses that cause Zika, dengue, chikungunya and yellow fever.

Two species of disease-transmitting mosquitoes could likely flourish in most of the United States, government researchers report.

Specifically, Aedes aegypti and Aedes albopictus could survive and reproduce for at least part of the year in three-quarters of the counties in the lower 48 states if introduced there, according to researchers from the U.S. Centers for Disease Control and Prevention. These two species can transmit viruses that cause Zika, dengue, chikungunya and yellow fever.

The range where Aedes aegypti could survive includes much of the eastern United States south of the Great Lakes, as well as parts of several southwestern states. The range where Aedes albopictus could survive extends farther into the northeast but is more limited in the southwest.

The study and accompanying maps were published online Sept. 21 in the Journal of Medical Entomology.

This research can help efforts to control mosquitoes and the diseases they carry, according to the CDC team.

"Surveillance efforts can be focused in counties where Aedes aegypti and Aedes albopictus could survive and reproduce if introduced to an area during the months when mosquitoes are locally active or at least survive during summer months if introduced," senior author Rebecca Eisen, a research biologist with the CDC, said in a journal news release.

"Additionally, the maps can help health care providers and the public understand where these types of mosquitoes could be found so that they can take steps to protect against mosquito bites and possible infection," she added.

The study and maps don't address mosquito abundance or risk of virus transmission, researchers said.

They also noted whole counties might not be suitable for the mosquitoes. For example, warmer city environments may be good habitats for the two mosquito species, while cooler rural areas may not.

Temperature is the strongest factor in determining whether the two species can survive and reproduce, the researchers said.

They added that standing water from rain is a more important factor in egg laying for Aedes albopictus than for Aedes aegypti. That may explain why the range of Aedes albopictus is greater in the eastern U.S. and lesser in the drier southwest.

5 Illnesses Linked to Vitamin D Deficiency

Not getting enough vitamin D? You could be at risk for some serious health conditions.

You probably know that the primary source of vitamin D is right outside your door and up in the sky. The sun helps synthesize vitamin D in the skin — promoting the growth of strong muscles and bones, lowering blood pressure, easing fibromyalgia pain, and slowing the progression of multiple sclerosis. But just as vitamin D can promote good health, a lack of it may lead to health issues.

What Are Some Common Symptoms of Vitamin D Deficiency?

Symptoms of vitamin D deficiency include bone pain, muscle weakness, increased blood pressure, and depression. While many factors can influence those symptoms, if you haven’t changed your lifestyle recently, such conditions may be signs of vitamin D2 or D3 deficiency. If you fit this description, consider voicing your concerns to your primary care provider or a registered dietitian. These professionals can work with you to modify your diet or lifestyle and correct the problem.

What Are the Risks of Not Getting Enough Vitamin D?

Depending on where you live, your sun exposure during the wintertime may be minimal, leading to lower levels of vitamin D. As noted, a vitamin D deficiency can harm your mental health, but it’s also true that not getting enough vitamin D may raise your risk for other diseases and conditions — some of them life-threatening. Here’s a handful:

1. Dementia and Vitamin D Deficiency

A study published in August 2014 in the journal Neurology found that moderate and severe vitamin D deficiency in older adults was associated with a doubled risk for some forms of dementia, including Alzheimer’s disease. Dementia involves a decline in thinking, behavior, and memory that negatively affects daily life. Alzheimer’s disease is the most common form of dementia, accounting for as many as 80 percent of dementia cases, according to the Alzheimer’s Association.

The above study analyzed more than 1,600 people age 65 or older who did not have dementia at the beginning of the study. Compared with people with normal vitamin D levels, those with low levels of the vitamin had a 53 percent increased risk of developing all-cause dementia, while those who were severely deficient had a 125 percent increased risk, researchers observed. Also, study authors found people who had lower levels of vitamin D were about 70 percent more likely to develop specifically Alzheimer’s disease, and that those who were severely deficient were over 120 percent more likely to develop that neurodegenerative disorder.

Considering the devastating toll that dementia can have on patients and their families alike, those findings may seem alarming. But researchers noted their study was observational, meaning they didn’t prove a direct cause-and-effect relationship with vitamin D deficiency and dementia and Alzheimer’s. Nonetheless, they theorized that the sunshine vitamin might help clear plaques in the brain that are linked to dementia.

Regardless of the relationship between vitamin D and dementia, know that following tried-and-true health advice, like eating a healthy diet, exercising regularly, and tending to your mental health can help reduce your risk of dementia.

2. Prostate Cancer and Low Vitamin D

A study published in May 2014 in the journal Clinical Cancer Research found a link between low blood levels of vitamin D and aggressive prostate cancer in European-American and African-American men.

Researchers looked at vitamin D levels in 667 men ages 40 to 79 who were undergoing prostate biopsies. The connection between vitamin D and prostate cancer seemed especially strong in African-American men, with results suggesting that African-American men with low vitamin D levels were more likely to test positive for the cancer than the other men with normal vitamin D levels.

Though these findings were also observational — that is, the study didn’t prove low vitamin D leads to prostate cancer — you may help reduce your potential risk of the disease by ensuring you get adequate vitamin D. You can also make regular doctor’s visits, and watch out for common prostate cancer symptoms to receive a prompt diagnosis and treatment if you’re affected.

Also know that prostate cancer occurs mostly in older men, with the average age of diagnosis being about 66, according to the American Cancer Society. It’s the most common cancer in men, and the second most common cause of cancer death in American men.

3. Severe ED Linked to Low Vitamin D

A small study of 143 subjects published in August 2014 in the Journal of Sexual Medicine found that men with severe erectile dysfunction (ED) had significantly lower vitamin D levels than men with mild ED.

Study authors theorized that vitamin D deficiency may contribute to ED by impeding the arteries’ ability to dilate — a condition called endothelial dysfunction and a heart-disease marker that has been associated with vitamin D deficiency in other research.

For instance, a study published in July 2011 in the Journal of the American College of Cardiology suggested that lack of the vitamin was indeed linked with arterial stiffness in healthy people. One of the requirements for achieving an erection is proper function of the arteries, which are responsible for supplying the penis with blood so it can become engorged.

ED is the most common sexual problem among men, affecting up to 30 million American men, according to the National Institute of Diabetes and Digestive and Kidney Diseases. ED can stem from other health conditions like diabetes, prostate cancer, and high blood pressure.

Common ED treatments include hormone replacement therapy, counseling, and lifestyle changes like quitting smoking, limiting alcohol, and eating a balanced diet.

4. Vitamin D and Risk of Schizophrenia

Schizophrenia is a severe brain disorder that affects about 1.1 percent of American adults, according to the National Institute of Mental Health. Symptoms of schizophrenia, which commonly appear between ages 16 and 30, include hallucinations, incoherent speech, withdrawal from others, and trouble focusing or paying attention.

People who are vitamin D deficient may be twice as likely to be diagnosed with schizophrenia compared with people with sufficient vitamin D levels, suggests a review published in October 2014 in the Journal of Clinical Endocrinology & Metabolism. Researchers reviewed findings from 19 observational studies that analyzed the relationship between schizophrenia and vitamin D deficiency and observed a link between the two factors.

While they noted randomized controlled trials would be needed to determine whether treatment for low vitamin D may help prevent schizophrenia, they explained that the condition is more prevalent in places with high latitudes and cold climates, and that studies suggest children who relocate to colder climates appear to be at a higher risk of developing the condition compared with their parents. Considering what we know about the role of vitamin D in mental health, the researchers’ findings may have merit.

Although there is no cure for schizophrenia, treatments for schizophrenia include medication, psychosocial therapy, cognitive behavioral therapy, and even family education and support groups.

5. Vitamin D Deficiency and Heart Disease

Numerous studies have shown an association between low vitamin D blood levels and heart disease and related complications, according to a review published in January 2014 in Circulation Research, but science has not clearly established if supplementation can reduce these risks. The review cites research that points to vitamin D levels as a potential culprit for health problems related to heart disease such as atherosclerosis, hypertension, diabetes, and stroke.

You can reduce your risk of heart disease by maintaining a healthy weight, exercising regularly, and eating a diet rich in lean meat, nuts, and fruits and veggies, according to the American Heart Association.

How Much Vitamin D Do You Need, and How Do You Get It?

While some foods — like fortified dairy, egg yolk, beef liver, and fatty fish like salmon and canned tuna — can help you get vitamin D2, or ergocalciferol, direct sun exposure can help you get your fix of vitamin D3, or cholecalciferol. Sun exposure can also help your body better absorb calcium — a crucial nutrient for strong bones, according to the National Institutes of Health (NIH).

Most people need 600 international units (IU) of vitamin D daily, according to the NIH, but just a few minutes outdoors in the sunshine with some skin exposed can help you meet some of those needs. Just be sure to wear sunscreen if you spend an extended amount of time outdoors, as excess sun exposure can contribute to your risk of skin cancer.

If you are unable to get regular sun exposure because of your geographic location or weather conditions, consider taking a vitamin D supplement. You can work with a registered dietitian or your primary care provider to discover whether you need a high dose of vitamin D or a low dose of vitamin D, as well as which type you’re deficient in.

9 of 10 Docs Unprepared to Prescribe Marijuana

Marijuana is now legal — at least for medical purposes — in more than half the states in the country

Although it's becoming more commonplace, medical marijuana is rarely discussed in U.S. medical schools, a new study shows.

"Medical education needs to catch up to marijuana legislation," said senior author Dr. Laura Jean Bierut, a professor of psychiatry at Washington University School of Medicine in St. Louis.

"Physicians in training need to know the benefits and drawbacks associated with medical marijuana so they know when or if, and to whom, to prescribe the drug," she explained in a school news release.

Marijuana is now legal -- at least for medical purposes -- in more than half the states in the country, the researchers said.

Curriculum deans at 101 medical schools completed surveys about marijuana education. Just over two-thirds said their graduates weren't prepared to prescribe medical marijuana. One-quarter said their graduates weren't even able to answer questions about medical marijuana.

The researchers also surveyed 258 medical residents and fellows from across the country. Nine out of 10 said they were unprepared to prescribe medical marijuana. Eighty-five percent said they hadn't received any education about medical marijuana.

A look at the Association of Medical Colleges database revealed that only 9 percent of medical schools taught their students about medical marijuana.

"As a future physician, it worries me," said study first author Anastasia Evanoff, a third-year medical student.

"We need to know how to answer questions about medical marijuana's risks and benefits, but there is a fundamental mismatch between state laws involving marijuana and the education physicians-in-training receive at medical schools throughout the country," Evanoff said.

She added that physicians are now getting better training on opioids.

"We talk about how those drugs can affect every organ system in the body, and we learn how to discuss the risks and benefits with patients," Evanoff said of opioids. "But if a patient were to ask about medical marijuana, most medical students wouldn't know what to say," she said.

The research was published online in the journal Drug and Alcohol Dependence.

10 Foods High in Potassium

What’s the Big Deal About High-Potassium Foods?

What’s the Big Deal About High-Potassium Foods?
High-potassium foods are an essential part of any balanced diet. The mineral helps regulate your body’s fluid levels, aids in muscular function and waste removal, and keeps your nervous system functioning properly. Research shows that potassium reduces blood pressure in people with hypertension and may lower the risk for stroke.

"It’s essential for maintaining normal blood pressure and keeps your heart beating regularly,” says Frances Largeman-Roth, RDN, a New York Times bestselling author and nutrition expert in Brooklyn, New York. “This electrolyte is necessary for muscle contractions and also helps keep sodium levels in check. Many of us don’t get enough potassium each day, so focusing on adding potassium-rich foods to our diets is smart for overall health."

If your potassium levels are too low, a condition known as hypokalemia, it can result in fatigue, insomnia, depression, muscular weakness or cramping, and cardiovascular issues such as an abnormal heart rhythm. Hypokalemia can be due to a lack of potassium in your diet, though more commonly it’s the result of taking certain prescription medications. While low potassium in the body is a concern, it’s also possible to get too much, leading to blood potassium levels that are too high — called hyperkalemia. This is something you need to be especially aware of if you have kidney problems.

The kidneys help regulate the amount of potassium in your body, but if they’re not functioning properly, too much potassium can get into the bloodstream, causing weakness or numbness, and potentially, arrhythmia and heart attack. A variety of medications, such as ACE inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), and certain diuretics, can also bring potassium levels too high. Though some people need to avoid eating too many foods that are high in potassium, most healthy adults should aim for an intake of about 4,700 milligrams (mg) a day.

When people think of potassium in foods, they often think first of bananas. And yes, bananas are indeed a good source of the nutrient, but there are plenty of other colorful, tasty, and nutritious ways to work the right amount of potassium into a healthy diet. To help you do that, we’ve come up with some options, such as sun-dried tomatoes tossed into a salad or on top of a pizza, dried apricots and other fruits made for snacking, avocado smoothies, and roasted acorn squash. Leafy greens, beans, potatoes, fish, and dairy are some additional great ways to get the potassium you need.

Bake All Kinds of Potatoes — Sweet, White, or Red

Whether they’re red, white, or sweet, potatoes can be a great source of potassium; about 900 mg of the nutrient can be found in just one medium russet potato. These popular starches are also high in vitamin C, vitamin B6, and are a good source of fiber (especially in the skin) and iron. Refrain from frying your potatoes; baking potatoes is one of the healthiest ways to prepare them, but make sure to avoid adding fats such as sour cream and melted cheese. Opt for a dollop or two of homemade hummus or guacamole instead. 

Toss Sun-Dried Tomatoes Into Your Salads

Fresh tomatoes contain potassium, but you’ll get even more from tomatoes in other forms like tomato paste, tomato sauce, and even sun-dried tomatoes, which contain more than 1,800 mg of potassium per cup (or around 50 percent of your daily recommended amount). Low in fat (when not packed in oil, or when drained), sun-dried tomatoes are also high in fiber and vitamin C, are a good source of protein, and help to promote both digestive and immune system health. They make a delicious addition to salads and sandwiches, and can be a great topping for pizza night with the kids.

Add Kidney Beans to Burritos, Salads, and More

If you enjoy kidney beans, finding more ways to add them to your meals may be just what you need to get more potassium into your diet. “Kidney beans are a great source of potassium, with more than 600 mg per cup,” says Largeman-Roth. “They’re also high in fiber.” She recommends adding them to your salads or mashing them up with salt and pepper to use as a burrito filling. Other beans high in potassium include white beans, lima beans, and pinto beans.

Snack on Dried Fruits: Apricots, Peaches, and Figs

For a great potassium-rich snack that can also satisfy a sugar craving, try dried apricots. Apricots are actually most beneficial to your health when served dry, or dehydrated, which causes nutrient levels to become more concentrated. Just one cup can get you about one-third of the recommended daily potassium level, or about 1,500 mg. If dried apricots aren’t your thing, try dried peaches, raisins, or dried figs, which are also high in potassium and available all year round. Look for unsweetened dried fruit to avoid added sugar.

Slice Up Bananas, Cantaloupe, Kiwi, and Other Fresh Fruits

If you’ve heard about any potassium-rich foods, you probably know that bananas are a good source, containing more than 400 mg of potassium each. Bananas make a healthy high-energy snack that's also high in vitamin B6 and a good source of fiber and vitamin C. Other high-potassium fresh fruits to enjoy are cantaloupe, kiwi, oranges, and strawberries.

Eat Avocado for Breakfast, Lunch, or Dinner 

If avocado isn’t a staple in your house yet, start adding it to your grocery list. This nutrient-dense food is rich in potassium — 975 mg in one avocado — as well as vitamins and heart-healthy fats, plus they're naturally free of cholesterol and very low in sodium. Luckily, avocado is so versatile that you can incorporate it into any meal of the day. For breakfast, try adding it to your morning smoothie. Largeman-Roth recommends using one of her favorite avocado recipes from her cookbook, Eating in Color. “You blend ½ avocado with ½ banana, ¼ cup low-fat vanilla yogurt, ¼ cup ice, 1 cup coconut water, 1 teaspoon of agave nectar, and ¼ teaspoon ground cinnamon,” she says. If you’re vegan, you can still enjoy this recipe by substituting silken tofu for the yogurt.

Add Fish Such as Wild Salmon and Halibut to the Menu

Fish lovers, rejoice: Most fish will give you at least 10 percent of the recommended daily amount of potassium. Certain fish — like wild salmon, some varieties of tuna, halibut, trout, flounder, and Pacific cod — are better sources than others; a 3-ounce piece of wild Atlantic salmon contains around 500 mg of potassium. Some fish, such as salmon, are also rich in omega-3 fatty acids and vitamin D. Make sure to purchase varieties that contain low or no mercury, and avoid breading or frying. In addition to seafood, red meat (including lean beef), chicken, and turkey also provide potassium.

Roast Acorn Squash for a Sweet, Healthy Treat

You may not think of it that often when preparing meals, but acorn squash is a food rich in fiber, antioxidants, vitamins, and minerals — especially potassium, with one cup of cooked squash containing almost 650 mg. Steaming or roasting it keeps you from adding any unnecessary fat. “Cut it in half, scoop out the seeds, slice it into rings, and roast it with a little salt, pepper, and brown sugar,” Largeman-Roth says. “It gets so tender and sweet. Kids will love it — and they can eat it like a slice of watermelon!” Largeman-Roth adds that she’s “also not opposed to drizzling it with some olive oil,” which would increase the absorption of the beta carotene in the squash. 

Don’t Overlook Dairy — Milk and Yogurt Provide Potassium, Too

Though fruits and vegetables are among best food sources of potassium, dairy products can also add the mineral to your diet. A cup of whole milk has more than 300 mg of potassium, while the same amount of nonfat milk contains almost 400 mg (in general, the lower the fat in the milk, the higher the potassium). Yogurt contains between 350 and 500 mg per cup, depending on the variety — yet another reason to make protein-packed yogurt a part of your healthy breakfast or snack.

Load Up on Dark Leafy Greens like Spinach and Bok Choy
Some of the best sources of potassium are dark leafy greens such as spinach, which when cooked has more than 800 mg of potassium per cup; bok choy, which contains around 600 mg per cup when boiled, and Swiss chard, which has almost 1,000 mg per cooked cup. Leafy greens are a nutritional powerhouse — low in calories and high in a plethora of vitamins and minerals — so you can feel good about eating them every day. 

Thursday, 21 September 2017

6 More Food Pairs for Diabetes to Help Manage Blood Sugar

Diabetes Diet Tip: Pair Your Food Wisely

You already know it’s crucial to eat foods low on the glycemic index (GI) when you have type 2 diabetes. That’s the scale that ranks foods on how much they tend to spike blood sugar levels, and it can help people with diabetes make sure they’re eating the appropriate foods to reach their blood sugar level goals.

Another theory that is less known but has made its rounds in the community is the idea that always pairing carbs with protein or fat can similarly help you keep diabetes in check. For instance, if you’re going to have a banana, spreading some almond butter on top will help boost its value. The underlying idea is that adding protein may delay your peak glucose level compared with when you consume carbs alone, seeing as carbs are processed like sugar in the body — going straight into the bloodstream and increasing the risk of blood sugar spikes.

But surprisingly, the research hasn’t borne out this theory, says Martha McKittrick, RD, CDE, a certified health and wellness coach in New York City. For an example, she says, think of a milk chocolate bar. “It would seem that adding fat to all that sugar would keep blood sugar lower, but studies don’t really show that,” she says.

That means this idea is actually a generalization — and there’s really no hard and fast rule for eating carbs when it comes to pairing, though it is crucial to keep carb portions moderate and space them out throughout the day when you have diabetes. Counting carbohydrates, perhaps by maintaining a food journal, is a good way to track your intake.

That said, keep in mind that some carbs do have a place in the diabetes diet: Fresh fruit, for example, is a great substitute for processed candies, and a small bowl of whole-wheat pasta is significantly safer for people with diabetes than is a heaping plate of white pasta, as these alternatives lie low on the GI, according to the American Diabetes Association (ADA).

When in doubt, look for foods that contain fiber and fat, which tend to be lower on the GI, the ADA points out. While fiber is known to be good for blood sugar levels because the body only digests a portion of it, healthy fat is satiating, meaning you’ll be less likely to reach for unhealthy foods and pack on unwanted weight, which can contribute to insulin resistance.

Another way to help improve insulin sensitivity and potentially lose weight? Believe it or not, keeping in mind certain food pairs. Again, while there’s no set rule for pairing carbs with fat and protein, some carbs are indeed better for diabetes when paired smartly. In addition to other known diabetes-friendly food pairs, here are five more snack and dish ideas to help you better manage your blood sugar. 

Enjoy Whole-Grain Toast With Creamy Avocado

While consuming foods that contain carbs, like toast, can have a direct effect on the rise of blood sugar, opting for the fiber-rich whole-grain variety, and mixing it with a healthy fat like avocado, helps make this breakfast staple more diabetes-friendly.

While fiber can help control high blood sugar, “fat takes longer to digest. It sits in your stomach longer, so you feel fuller longer,” McKittrick explains. And that can help someone with diabetes in their quest for weight control. After all, shedding excess pounds if you’re overweight or obese can help increase insulin sensitivity. According to an article published in June 2015 in the journal Diabetes Care, losing only 5 to 10 percent of body weight may help reduce the amount of diabetes medication you need to take.

Plus, feelings of fullness may affect blood glucose in the long run. That’s because if you’re hungry all the time, you may keep eating carbs in an effort to feel full, and that will raise your blood sugar, she says. Avocado is packed with healthy monounsaturated fatty acids, making it ideal to spread on toast.

Add Chia Seeds to Your Breakfast Smoothie

These little seeds are bursting with fiber, which may help lower blood sugar after eating a higher carb meal, says McKittrick. “Adding them to the mix can keep you feeling full longer and slow digestion for a slower rise in blood sugar,” she says, explaining that a smoothie can often be high in carbs.

Beyond fiber, chia seeds are unique because of their texture — they absorb liquid and expand, turning into a gel in your stomach. While all fiber is great, soluble fiber specifically can help slow blood sugar’s rise. When building the ideal diabetes-friendly smoothie, keep carbs in a range of 15 to 45 grams (g), and lean toward the lower end if this is a snack. McKittrick recommends blending together a serving of fruit, chia, protein (a serving of Greek yogurt, nut butter, or protein powder), almond milk, and leafy greens.

Snack on a Fiber-Rich Apple and a Handful of Nuts

“Almonds and other nuts can help regulate and reduce the rise in blood sugar after meals,” says McKittrick. She points to a study published in April 2011 in the journal Metabolism, which showed people who ate about 2 ounces (oz) of almonds per day for four weeks reduced their levels of fasting insulin — a measure that can be used to help identify if you have insulin resistance — by 4 percent compared with a control group.

The combination of healthy fat, fiber, and protein all work together to lower blood sugar, she notes. Magnesium also plays an important role in blood sugar management, and people with diabetes are often deficient in this, which can impair insulin secretion. In fact, low magnesium levels can increase insulin resistance, the hallmark of type 2 diabetes, according to an article published in August 2015 in the World Journal of Diabetes.

One serving of almonds contains about 20 percent of your daily value for magnesium. When it comes to choosing an apple, the size — rather than the type — is most important, says McKittrick. A woman may want to choose a very small apple (15 g of carbs), while a larger or more active person can go for a medium apple (30 g of crabs). 

Pair a Fish Meal With a Delicious Glass of Wine

“A small glass of wine may actually help lower blood sugar in some people,” says McKittrick. What might surprise you is that most dry wines, like chardonnay, pinot grigio, and merlot, may contain just 4 g of carbs or less per serving. Research published in October 2015 in the journal Annals of Internal Medicine found that people with well-controlled type 2 diabetes who were “slow ethanol (alcohol) metabolizers” and drank 5 oz of white or red wine with dinner while following a Mediterranean diet had better glycemic control compared with those who were “fast ethanol metabolizers.”

The researchers also found that starting to drink 5 oz of red wine with dinner nightly was safe and decreased cardiometabolic risk factors — that is, they increased HDL, or “good,” cholesterol levels — in people with well-controlled diabetes. If you choose to drink after getting the green light to do so from your doctor, be sure to mind drink recommendations from the ADA: one drink per day if you’re a woman, and two drinks per day if you’re a man. 

Also, if you’re on certain diabetes drugs that causes low blood sugar, you should avoid drinking alcohol on an empty stomach because of a risk of hypoglycemia, says McKittrick. Talk to your doctor before imbibing. If you’re not taking insulin, you can figure out whether you’re a slow or fast ethanol metabolizer by observing whether your blood sugar dips or spikes one hour after sipping a glass of dry wine. 

White Potatoes — Yes, White! — With Vinegar

This may sound like a strange combination considering potatoes are usually seen as off limits with diabetes, but with the right approach, you can enjoy them responsibly. Though a decade ago there was a list of foods people with diabetes should avoid, the tide has turned to showing that people can have these foods as long as they mind portion size and monitor how their body uniquely responds to these foods.

Not only do individual foods have an impact on your blood sugar, but how they’re prepared makes a huge difference, too. One study published in November 2005 in the European Journal of Clinical Nutrition suggested that eating 50 g of potatoes that were boiled and then cooled in the refrigerator reduced the rise of insulin in healthy people compared with the same amount of freshly cooked potatoes, likely thanks to the resistant starch in the cold taters, the researchers point out. “Eating cooked potatoes that have been cooled can help slow the rise of blood sugar, but portion size and total number of carbs is what's most important,” says McKittrick.

Even more effective for the blood sugar response: Eating those cold potatoes with vinaigrette (a mix of olive oil and vinegar). A half-cup of homemade potato salad contains about 14 g of carbs. Because everyone’s needs are different, consider how this falls into your carb range for the meal, and for your day.

Rheumatoid Arthritis: Best Fall Breakfasts

Colorful leaves and cool temps mean autumn has arrived.

Warm up your morning meal by choosing seasonal breakfast foods that have anti-inflammatory properties to help soothe the pain of swollen joints and other symptoms that often accompany rheumatoid arthritis (RA). What’s more, these smart breakfast ideas require minimal fine motor maneuvers, so you can prepare them despite morning stiffness symptoms.

You can, of course, enjoy these delicious fall foods year round; buying in season simply means ingredients are more affordable and easier to find. Most importantly, these wholesome meal ideas are much healthier than the high-fat, processed convenience foods that can be tempting to grab when you’re on the go.

Consider making these meals that feature good-for-you ingredients:

Greek Yogurt or Cottage Cheese Topped With Fruit

For an easy morning meal that needs little prep time, top a serving of cottage cheese or Greek yogurt with fall fruits, such as apple slices, applesauce, or pureed pumpkin. For a twist, try yogurt or cottage cheese with veggies such as sweet potato, butternut, or acorn squash.

Greek yogurt is higher in protein than non-Greek yogurt, and many yogurts are fortified with vitamin D, which is important for people with rheumatoid arthritis, according to Sonya Angelone, RDN, the owner of a nutritional counseling firm based in the San Francisco area.

Overnight Chia Pudding

Chia is a seed that’s high in omega-fatty acids, which help reduce inflammation. When mixed with liquid, chia seeds gel into a pudding texture, notes Robin Foroutan, RDN, an integrative medicine dietitian based in New York City. Mix 4 tablespoons of chia into 2 cups of water or a nondairy drink, like almond or hemp milk, and leave it in the refrigerator overnight, she suggests. The next morning, season it to taste.

Sweet versions can include cinnamon, orange zest, preserves or marmalade, honey, or maple syrup, while savory flavors could incorporate anti-inflammatory spices turmeric or ginger, as well as black pepper or cardamom. Experiment with different combinations of spices to determine what you like best. These puddings can be eaten cold from the refrigerator, heated up in the microwave, or simmered over a low heat.

Quick or Overnight Oatmeal

Add ½ cup of instant oatmeal to a ½ cup of water, then heat for a minute in the microwave. For satisfying steel-cut oats, either simmer for 20 to 30 minutes over low heat with water and add a dash of salt, or, the night before breakfast, put the oats and water into a slow cooker for 5 to 7 hours. Top oatmeal with fruit or a nut or seed butter. For extra anti-inflammatory benefits, mix in blueberries and powdered ginger, which gives the meal “a nice punch,” Foroutan says. Top with crumbled walnuts, which are high in omega-3 fatty acids, for extra benefits.

Cold Water Fish Paired With Eggs or Avocado

Did you know that wild salmon season lasts through early fall?

Fish that swim in cold water are packed with healthy fats that have been shown to help people with rheumatoid arthritis, according to research published in the journal Epidemiology, as well as a study published in June 2017 in the journal Arthritis Care & Research. These fatty-fish include salmon, tuna, sardines, and anchovies, as well as omega-3 fish oil supplements, researchers found. Some ideas to increase your fish intake include mixing smoked salmon into an omelet, poaching salmon, or eating individual-sized, easy-to-open packages of salmon or tuna paired with an avocado or a hard-boiled egg. “Purchase tuna or salmon in foil packs instead of cans, because they are easier to open,” says Angelone. “Even the newer ‘easy-open’ cans with tabs are not that easy to open for someone with rheumatoid arthritis.”

5 DIY Tricks to Calm Scalp Psoriasis Irritation

Talk to Your Doctor About These Scalp-Saving Ideas
Psoriasis symptoms can show up anywhere on your body. Itchy or sore patches of raised, red, dry skin known as plaques can occur on the face, arms and hands, legs and feet, and the back. One of the most common types of psoriasis affects the scalp. According to the National Psoriasis Foundation (NPF), at least half of the 7.5 million Americans who have the disease have it on their scalp.

How you treat any type of psoriasis depends, to some degree, on how severe it is. The symptoms of scalp psoriasis can range from mild scales and flaking to moderate and severe plaques that cover the entire scalp and can cause the hair to thin in areas. Severe scalp psoriasis can go beyond your hairline, across the forehead to your neck and around the ears. 

Depending on your symptom severity and how much of your skin is affected, your doctor may recommend a variety of treatment options. Fortunately, if one treatment doesn’t work or stops being effective, there are likely to be others that you can try.

“We have so many fantastic ways to clear psoriasis and to treat scalp psoriasis,” says Melodie Young, NP, RN, an advanced practice nurse focusing on gerontology and dermatology at Baylor Scott and White Modern Dermatology in Dallas.

For milder cases of scalp psoriasis, shampoos with ingredients such as coal tar extract and salicylic acid can be helpful. "Liquid or foam topical medications are easy to apply to the scalp," says Dina D. Strachan, MD, a dermatologist and assistant clinical professor of dermatology at NYU Langone Medical Center in New York City.

Severe flares may require the use of oral or injectable medication in conjunction with such topical treatments.

Dermatologists will sometimes treat mild scalp psoriasis with steroids, injecting scalp lesions with the medication. The steroids act to locally reduce the inflammation that causes this frustrating buildup of scaly skin cells.

Doctors don’t typically prescribe systemic medicines for scalp psoriasis alone, but if you have moderate-to-severe psoriasis on the scalp, you’re likely to have it elsewhere too. In that case, systemic medication can really help, says Colby Evans, MD, a dermatologist in Austin, Texas, and chairman of the board of trustees for the NPF.

Even though the symptoms of scalp psoriasis may appear to come and go, it’s important to remember that psoriasis is a chronic condition that will need to be treated and managed over time.

If you have flaking, itchiness, or redness caused by scalp psoriasis or another form of irritation, try one of these five easy, at-home treatments to control your symptoms. But always be careful to check with your doctor before trying any at-home treatments, to make sure they'll be safe and effective for you. And remember that the worst thing you can do is scratch an itchy scalp. That'll just worsen the psoriasis and raise the risk for infection if you create an open wound.

Olive Oil Soothes the Scalp, Loosens Flakes

Olive oil is good for your dietary health, but it also has many benefits when applied to the scalp and hair. An olive oil mask, for example, can help tame frizz and add shine. Olive oil also helps loosen flakes associated with psoriasis, says Soheil Simzar, MD, a clinical instructor of dermatology at the UCLA David Geffen School of Medicine in Los Angeles.

To get these benefits, massage 1 to 2 tablespoons of oil directly into the scalp. Depending on the severity of the plaques, you can leave the oil on anywhere from 10 minutes to overnight before washing it out. (Wear a shower cap to bed to keep the oil off your pillowcase.) Prior to rinsing, use a fine-toothed comb to gently remove the loosened scales.

Apple Cider Vinegar Can Relieve Psoriasis Itch

Thanks to its anti-bacterial properties, apple cider vinegar has the ability to ease the irritation of everything from bug bites to blisters. When it comes to your scalp, apple cider vinegar can help relieve the itch associated with psoriasis.

Try it by saturating your scalp with a mixture of 1 to 2 parts water and 1 part vinegar several times a week for 10 minutes — but don’t try this at-home treatment if you have cracked or bleeding skin.

Use a comb to gently remove scales once they’ve plumped up from the moisture, then shampoo and rinse as usual. You can also use the same apple cider vinegar rinse to remove dulling product buildup. Be sure to follow up with a deep conditioner to prevent your hair from drying out. 

Oatmeal Helps Fight Inflammation

Oatmeal isn’t just a cholesterol-lowering breakfast option — it’s a major skin soother, too. An oatmeal bath is a popular at-home treatment option to help alleviate the pain of rashes caused by poison ivy, chickenpox, and sunburns. And when applied to the scalp daily, oatmeal can help with inflammation associated with psoriasis or dryness, says Jennifer Burns, ND, a naturopathic doctor and founder or the Bienetre Center in Phoenix.

For this easy at-home treatment, mix uncooked oatmeal with water to your desired consistency (you can even add some oil to the mix to help loosen scales). Smooth the paste onto your scalp and leave it in place for at least 10 minutes before rinsing.

Create Your Own Dead Sea Salt Treatment

A study published in February 2005 in the International Journal of Dermatology found that magnesium salts, the minerals found in the Dead Sea, help improve skin barrier function in people with inflammatory conditions such as psoriasis.

Here’s how to create your own salt scalp treatment: Combine Dead Sea salts (or Epsom salts) of a fine to slightly coarse grain with olive or coconut oil until you reach a paste-like consistency. Gently rub a small amount of the mixture into your scalp anywhere from once a week to once a day, depending on the severity of the plaques, then wash it off, Dr. Burns says.

Store any unused scrub in an airtight container. While the salt may dissolve over time, you can add more to bring it back to the thickness you like.

Tea Tree Oil Keeps the Scalp Infection-Free

Tea tree oil, an essential oil distilled from the leaves of a plant native to Australia, has anti-bacterial and anti-fungal properties that can help keep the scalp free of infection,which may result from frequent scratching.

If you have dandruff, psoriasis, or a dry, itchy scalp, mix 1 part tea tree oil to 10 parts olive oil and dab the affected areas with a cotton ball. Leave it on for five minutes before rinsing out.

"While there is no scientific evidence to support the use of tea tree oil for psoriasis, some people report it works,” says Stefan C. Weiss, MD, a dermatologist at the Weiss Skin Institute in Boca Raton, Florida. But Dr. Weiss cautions that it can cause an allergic reaction in others. If you're thinking of trying tea tree oil, test it first by applying a small dab on a healthy patch of skin on the inner arm before using it on your scalp.

Tuesday, 19 September 2017

Surgeons Play Big Role in Women's Choices for Breast Cancer Care

A breast cancer patient's choice of surgeon can have a major effect on her treatment, according to a new study.

That's because surgeons have a strong influence on whether early stage cancer patients have both breasts removed even when cancer is found in only one breast -- a procedure called contralateral prophylactic mastectomy (CPM).

Researchers surveyed more than 3,300 women with early stage breast cancer and 349 surgeons who treated them. About 16 percent of the patients had both breasts removed.

Only 4 percent of those whose surgeons heavily favored breast-saving surgery and were most reluctant to remove both breasts had the procedure. That compared to 34 percent of patients whose surgeons were most willing to do the surgery, the study found.

"That difference is huge. Even for a procedure that is very patient-driven, we see that surgeons account for a lot of the variability in the community and those surgeon attitudes really matter in terms of whether a patient does or does not get CPM," said study senior author and professor of medicine Dr. Steven Katz in a University of Michigan news release.

The most common reasons surgeons cited for removing both breasts on request were to give the patient peace of mind, avoid conflict and improve cosmetic outcomes.

Because removing the unaffected breast does not improve survival in most women with early stage breast cancer, many experts question whether the dual surgery is excessive.

"More extensive treatment than is needed equals more harm and more side effects. There's a sea change going on among cancer doctors who increasingly recognize potential overtreatment and strive to reduce it," said study author Dr. Monica Morrow. She is chief of breast surgery service at Memorial Sloan Kettering Cancer Center in New York.

Unsure what to do? Katz offered this advice: "If a patient does not feel 100 percent confident with what their doctor is discussing and recommending, they should seek a second opinion."

10 Healthy Foods That Are Great Sources of Iron

 Iron Is Essential for Metabolism, Muscles, and Normal Bodily Functions
If you’ve been told you’re not getting enough iron in your diet, you are not alone. Iron deficiency is the most common nutritional deficiency globally — especially among children and pregnant women — and the only nutrient deficiency that is widely prevalent in developed countries, according to the World Health Organization. And that’s a big problem because the mineral plays a number of really important roles in our bodies’ daily functioning.

Iron gets used by the body to help make the hemoglobin in red blood cells, which then carry oxygen throughout the body, from our lungs to our muscles and other organs. Blood cells also use hemoglobin to help carry carbon dioxide from other parts of the body to the lungs, where we exhale it out of the body. Plus, the body needs iron to make some hormones and connective tissue.

It’s not a nutrient that you want to be lacking in. Not getting enough iron, a condition termed iron deficiency anemia (or just anemia), makes it difficult for your blood cells to deliver the oxygen your tissues and organs need. Symptoms you’ll notice can include feeling tired or not having any energy, having an upset stomach, finding it difficult to concentrate or remember things, having trouble keeping your body temperature regulated, or easily catching infections or getting sick.

So how much should you be getting? Women between 19 and 50 should be getting 18 milligrams (mg) of iron per day — and a whopping 27 mg if they’re pregnant. (The amount of blood in your body increases when you’re pregnant because you are delivering oxygen to the baby’s organs as well as your own; that requires more iron.) Women over 50 need less iron — only 8 mg per day — since women need less iron after they stop menstruating. Men age 19 and older need 8 mg of iron every day. And kids and babies need between 7 and 15 mg per day, depending on their age, according to recommendations from the National Institutes of Health. (Note: You can get too much iron. Don't exceed 45 mg per day for teens and adults and 40 mg per day for children 13 and younger.)

The good news is that a lot of common foods are high in iron — from spinach and pumpkin seeds to fortified cereals and red meat.

“There are two types of iron: heme iron from animal sources and non-heme iron from plant sources,” says Frances Largeman-Roth, RD, author of Eating in Color: Delicious, Healthy Recipes for You and Your Family and a nutrition counselor in private practice in Brooklyn, New York. Heme iron is more easily absorbed by the body than plant-based non-heme iron, so it’s important to get both types of the nutrient in your diet, she adds. You’ll need to aim for nearly twice as much iron per day if you’re relying on plant sources alone. Here are 10 foods high in iron that can help you get all of the mineral you need.

Eggs, Red Meat, Liver, and Giblets Are Top Sources of Heme Iron 

Lots of animal proteins have heme iron, including egg yolks (1 mg in two large egg yolks), red meat (2 to 3 mg per 3 ounces), poultry (2 mg per 3 ounces of dark-meat turkey), and pork (0.5 to 1 mg per 3 ounces).

Organ meats like liver and giblets are especially rich in iron. Supplying more than a quarter of the daily requirement for an adult woman, beef liver "is incredibly high in iron at 5 mg per 3-ounce slice," notes Largeman-Roth. Pork liver is an even smarter option, as it’s slightly leaner and has higher levels of both iron (a whopping 15 mg per 3-ounce serving) and vitamin C.  Just be sure you’re eating liver in moderation because its high vitamin A level may put you over the recommended limit if you eat too much; pregnant women should avoid liver all together because of its vitamin A, which has been associated with birth defects. Finally, liver is also high in cholesterol for those watching. 

Oysters, Mussels, and Clams Are Rich Sources of Iron

Go ahead and splurge on the seafood appetizer — it comes with a generous side of iron! Bivalve mollusks like clams, mussels, and oysters are loaded with the important nutrient (plus zinc and vitamin B12). Five medium oysters deliver more than 3 mg of iron. Make your own at home with this supersimple 15-minute recipe.

If oysters, mussels, and clams aren't on your regular menu, common fin fish — like haddock, salmon, and tuna — have some iron, though not as much as mollusks.

Chickpeas Are a Vegetarian-Friendly Iron Powerhouse

These legumes provide your body with almost 5 mg of iron per cup, plus a hearty dose of protein, making them a smart option for vegetarians. Chickpeas (also called garbanzo beans) are a tasty addition to salads and pasta dishes and can be an unexpected way to mix up salsa. If you're not a fan of the texture, puree chickpeas to create homemade iron-rich hummus! Adding lemon juice to your hummus will increase the vitamin C in the snack and help your body more easily absorb the non-heme iron in the legumes.

Fortified Breakfast Cereals Can Be Packed With Iron

Is a bowl of cereal your breakfast of choice? Opt for a fortified version to start off your day with a dose of iron. Check the nutrition label for the amount of iron per serving: Many varieties offer 90 to 100 percent of the daily recommended value, along with other important vitamins and minerals, such as fiber, zinc, calcium, and B vitamins.

Pumpkin Seeds May Be Small, But They Have Lots of Iron

Don’t underestimate these crunchy seeds. A 1/4-cup serving of pumpkin seed kernels contains more than 2 mg of iron, providing an easy iron boost to a variety of dishes. Add the seeds to homemade trail mix or bread or muffin recipes, or use them as a crunchy yogurt, cereal, or salad topping. Or try them alone for a quick and healthy snack. (That 1/4 cup of seeds also packs nearly 10 grams of hunger-squelching protein.) 

Soybeans Are Filled With Iron and Other Essential Nutrients, Too

A cup of these legumes contains more than 4 mg of iron, plus they're an excellent source of important minerals like copper, which helps keep our blood vessels and immune system healthy, and manganese, an essential nutrient involved in many chemical processes in the body. In addition, soybeans (also called edamame) are high in protein and fiber as well as many vitamins and amino acids. Largeman-Roth recommends including soybeans in stir-fries or making an edamame dip. Soy beans also make a tasty addition to pasta dishes, like this Edamame Lo Mein, or just enjoy them on their own, simply sprinkled with a little sea salt.

Prepare Black Beans With Vitamin-C-Rich Veggies for an Iron Win 

Black beans serve up 4 mg of iron per cup. Looking for ways to incorporate beans into meals? Pair them with foods like kale, bell pepper, broccoli, and cauliflower, which are all high in vitamin C, a nutrient that helps with the absorption of non-heme iron in the body, says Largeman-Roth. Add beans to a salad, puree them into a dip to eat with raw veggies, or toss them into a stir-fry. The recipe possibilities for a can of black beans are endless! And if you’re looking for more variety, kidney, pinto, and fava beans all have iron, too.

Lentils Are Another Legume With Lots of Iron

Another legume worth an honorable mention in the iron department is lentils. Cooked lentils offer more than 6 mg of the mineral per cup and are loaded with fiber that fills you up, may help lower cholesterol, and may help stabilize your blood sugar. Lentils are also an extremely versatile ingredient in the kitchen — they're a great addition to everything from soups and salads to burgers and chili.

Spinach (Bonus: Cook It to Get an Even Higher Dose of Iron)

Both raw and cooked spinach are excellent sources of iron, though cooking spinach helps your body absorb its nutrients more easily. Just 1 cup of cooked spinach delivers more than 6 mg of iron as well as protein, fiber, calcium, and vitamins A and E. While the leafy green often gets a bad rap in the taste department, especially among kids, it's an easy ingredient to sneak into recipes undetected for a secret iron-boost (and as a non-heme iron source, it's especially beneficial when paired with foods high in vitamin C, like some veggies). “I love using sautéed spinach in vegetable lasagna,” says Largeman-Roth. “It also works well in mini frittatas, which my kids love.” 

Sesame Seeds Taste Nutty — and Have a Kick of Iron

“Sesame seeds have a wonderful nutty taste and are a rich source of iron,” says Largeman-Roth. The seeds, which contain 20 mg of iron per cup, are packed with a slew of essential nutrients, like copper, and they contain phosphorus, vitamin E, and zinc as well. An easy way to incorporate the seeds into your diet is to add them to a salad: Each tablespoon sprinkled on top will add over a milligram of iron to your daily count. Or get creative and give Largeman-Roth’s Ultimate Power Ball recipe a try for a sweet, iron-packed snack.

Why Spotting Psoriatic Arthritis Early On Is Key

Psoriatic arthritis often goes undiagnosed, but identifying signs of the disease early on could lead to significantly better outcomes.

“Early diagnosis means an opportunity to initiate early treatment, which can improve the symptoms of arthritis,” says Lihi Eder, MD, PhD, a rheumatologist from the University of Toronto and Women’s College Hospital Research Institute in Canada.

The Dangers of Waiting

Research shows that putting off treatment can result in permanent joint damage for people with psoriatic arthritis.

A study published in February 2014 in the journal Annals of the Rheumatic Diseases found psoriatic arthritis patients who had a delayed diagnosis of more than six months had worse bone and joint deterioration and didn’t respond as well to treatment.

A delay of more than a year reduced a person’s chance of experiencing drug-free remission.

“Many of the available treatments can prevent the development of joint damage as a result of arthritis,” Dr. Eder says.

Biologic drugs, which target certain parts of the immune system, have been shown to slow or stop joint damage in people with psoriatic arthritis if they’re given early.

A Difficult Diagnosis

In a paper published in August 2015 in the Journal of the American Academy of Dermatology, investigators found about 15 percent of psoriasis patients have undiagnosed psoriatic arthritis.

“Diagnosis can be tricky,” says Arthur Kavanaugh, MD, professor of medicine at the University of California in San Diego School of Medicine. “About 25 percent of patients with psoriasis will get the inflammatory arthritis that we call psoriatic arthritis, yet almost all humans will have occasional pains in and around the joints, and almost all will eventually develop non-inflammatory arthritis (osteoarthritis) in some joints.”

Psoriatic arthritis can also produce symptoms that mimic those of other conditions. To further complicate matters, there’s no single diagnostic test to identify psoriatic arthritis.

“The physician is taking into consideration many factors when making the diagnosis,” Eder says.

Know the Symptoms

Some signs of psoriatic arthritis to watch out for include:

  • Pain, stiffness, swelling, or tenderness in and around the joints
  • Fatigue
  • Swollen fingers and toes
  • Morning stiffness
  • Nail changes
  • Wrist, lower back, knee, or ankle pain
  • Pain or redness in the eye
  • Psoriatic arthritis can develop slowly or quickly, and symptoms may be mild or severe.

For about 85 percent of people, psoriasis happens before the joint disease. But, there’s no link between the severity of the psoriasis and the severity of the psoriatic arthritis.

The bottom line: If you have psoriasis and start to experience aches and pains, let your doctor know right away.

“Work with your healthcare provider to assess persistent joint problems,” Dr. Kavanaugh says.

Can Aromatherapy Help Ease Ulcerative Colitis Symptoms?

If you have ulcerative colitis (UC), you may already be taking medication, such as an anti-inflammatory or corticosteroid, to address symptoms and to help stave off flare-ups. And while conventional medical treatment can be effective, many longtime UC sufferers are continually casting about for alternative treatments to go along with what their doctor has prescribed — from therapy to reduce the stress that can trigger symptoms, to acupuncture or herbal concoctions.

Aromatherapy, or the use of naturally derived aromatic oils from various plants as a health and wellness aid, is another tack to try.

“Studies have shown that ingredients in essential oils used in aromatherapy may have anti-inflammatory or analgesic [pain-relieving] properties, and some may help boost your mood and energy,” says Hallie Armstrong, ND, a naturopathic physician at Beaumont Health in West Bloomfield, Illinois. “It may be that these properties can help you manage symptoms, like pain and fatigue, that come with UC.”

There is research to support the effectiveness of aromatherapy in treating a range of medical conditions. A review published in August 2015 in the Asian Pacific Journal of Tropical Biomedicine found that essential oils extracted from plant parts can effectively reduce inflammation, relieve symptoms of indigestion, and treat skin infections, among other benefits.

Most essential oils should not be ingested. Instead, you can try adding a few drops of an essential oil to a neutral carrier oil, such as jojoba, and massaging that into your stomach. Or you can pour the oil into an aromatherapy diffuser to enhance well-being through inhalation of essential oils.

Here are some essential oils you can try using to relieve symptoms of UC:

Patchouli Used as a medicinal aid in Eastern cultures for centuries, patchouli oil may be helpful for ulcerative colitis sufferers. A study published in July 2017 in the journal Pharmacological Research found that mice with induced colitis that were given patchouli (in the form of patchouli alcohol) had better repair of their intestines than those treated with an anti-inflammatory drug.

Peppermint Oil This aromatic oil helps with general digestive symptoms, mostly because it has anti-spasmodic (soothing) properties. It can also ease complaints like gas and bloating, says Dr. Armstrong. Peppermint can be sold as oil or as a supplement that you take orally. If using peppermint as a supplement, Armstrong says to be sure you choose enteric-coated capsules for best absorption.

Basil Oil The essential oil derived from this delicious herb acts as a carminative, which means it can help ease gastric upset, potentially by calming intestinal spasms. Eating basil leaves or making basil tea may also have stomach-soothing benefits.

Turmeric Oil You may know and use this spice, often enjoyed in Indian dishes, but turmeric can also be used as an essential oil. The active ingredient in turmeric is curcumin, which has been shown to reduce inflammation, a key factor in ulcerative colitis. A report published in September 2011 in the Indian Journal of Pharmacology found that oil of turmeric offers significant anti-inflammatory properties.

Finally, notes Armstrong, be sure the oil you buy is pure. To find out, “release a drop on a white piece of paper. After it evaporates, a pure oil won’t leave a stain.” Also, she adds, don’t stop taking medication, and tell your doctor about any essential oils or supplements you may try.

Any alternative therapy is a complementary therapy, which means that it should work alongside your conventional treatment. Check with your doctor before trying any alternative therapy, including aromatherapy, says Armstrong.

5 Common Causes of Hip Pain in Women

Does your hip hurt? As with other types of chronic pain, women tend to experience it more than men. But because hip pain can have a number of different causes, determining the correct one is the key to getting the best treatment.

The Diagnosis: Is It Your Hip?

When you tell your doctor your hip hurts, the first thing she should do is confirm that your hip is actually the problem. Women might say they have hip pain, but what they may mean is that they have pain in the side of the upper thigh or upper buttock, or they may be experiencing lower back pain, says Stephanie E. Siegrist, MD, an orthopedic surgeon in Rochester, New York, and a spokeswoman for the American Academy of Orthopaedic Surgeons. Hip pain is often felt in the groin or on the outside of the hip directly over where the hip joint (a ball-and-socket joint) is located.

Causes of Hip Pain in Women

When a female patient comes to Dr. Siegrist complaining of hip pain, she considers the patient's age, build, and activity level. If the patient is a thin 20-year-old runner or a heavy, sedentary 80-year-old grandmother, “the possibilities at the top of my list will be different,” she says.

Among the most common causes of hip pain in women are:

1. Arthritis Chronic hip pain in women is often due to arthritis, particularly osteoarthritis, the wear-and-tear kind that affects many people as they age. “The ball-and-socket joint starts to wear out,” Siegrist says. Arthritis pain is often felt in the front of your thigh or in the groin, because of stiffness or swelling in the joint.

2. Hip fractures Hip fractures are common in older women, especially those with osteoporosis (decreased bone density). Symptoms of a hip fracture include pain when you straighten, lift, or stand on your leg. Also, the toes on your injured side will appear to turn out, a sign that can aid your doctor’s preliminary diagnosis.

3. Tendinitis and bursitis Many tendons around the hip connect the muscles to the joint. These tendons can easily become inflamed if you overuse them or participate in strenuous activities. One of the most common causes of tendinitis at the hip joint, especially in runners, is iliotibial band syndrome — the iliotibial band is the thick span of tissue that runs from the outer rim of your pelvis to the outside of your knee.

Another common cause of hip pain in women is bursitis, says Marc Philippon, MD, an orthopedic surgeon in Vail, Colorado. Fluid-filled sacs called bursae cushion the bony part of the hip that is close to the surface. Like the tendons, these sacs can become inflamed from irritation or overuse and cause pain whenever you move the hip joint.

4. Hernia In the groin area, femoral and inguinal hernias — sometimes referred to as sports hernias — can cause anterior (frontal) hip pain in women. Pregnant women can be susceptible to inguinal hernias because of the added pressure on the wall of their abdomen.

5. Gynecological and back issues “Hip pain in women can have gynecological causes,” Siegrist says. “It’s important not to just assume that the pain is caused by arthritis, bursitis, or tendinitis. Depending on your age and other health issues, the pain in your hip could be coming from some other system.”

Endometriosis (when the uterus lining grows somewhere else) can cause pelvic tenderness, which some women describe as hip pain. Pain from the back and spine also can be felt around the buttocks and hip, Siegrist says. Sciatica, a pinched nerve, typically affects one side of the body and can cause pain in the back of the right or left hip — the pain from sciatica can start in your lower back and travel down to your buttocks and legs.

Treatment Options for Hip Pain

Treatment for hip pain depends on the diagnosis, but pain that's caused by overuse or sports injuries is often treated with heat, rest, and over-the-counter anti-inflammatory medication. To prevent injuries, it is important to stretch before exercising and wear appropriate clothing, especially good shoes when running, Dr. Philippon says.

If certain activities or overuse are causing hip pain, stop those that aggravate the discomfort and talk to your doctor. Excess weight can put pressure on the hip joint, so losing the pounds can provide relief and help you avoid further problems. Some causes of hip pain, such as fractures or hernias, may need surgical repairs. If your hip pain persists, talk to your doctor about the possible causes and treatments.
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