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Aug. 2, 2004 -- Babies born one or two weeks early are generally believed to be as healthy as full-term infants, but new research shows this is often not the case.

When compared with newborns delivered at 37 weeks and beyond, delivery at 35 or 36 weeks was linked to more serious medical problems and higher hospital costs. This is one of the first studies to examine health issues associated with near-term birth.

Specifically, the near-term newborns were far more likely than full-term infants to develop early respiratory problems, jaundice, and low blood sugar and have difficulty maintaining a normal body temperature. Researchers from Boston's MassGeneral Hospital for Children say their findings suggest that even though these babies may look as healthy as full-term infants, they are more likely to have certain medical problems.

"There is a conventional wisdom that babies born close to term are clinically the same as full-term newborns, and up until now there has been little in the literature to support or counter this idea," lead researcher Marvin L. Wang, MD, tells WebMD.

Too Posh to Push

Wang says the findings have implications for women who choose to have their babies delivered before their due dates by elective C-section for reasons of convenience or because they perceive surgical delivery as less damaging to their bodies.

Early, planned C-section is reported to be a growing trend among Hollywood celebrities -- and this trend has even spread to other areas of the country. Known as "too posh to push," the term is based on news reports claiming that ex-Spice Girl Victoria Beckham had her babies this way.

"There can be valid medical reasons for delivering early, but our study calls into question the presumption that elective delivery at 35 or 36 weeks poses no risk to the infant," Wang says.

In his role as co-director of the newborn nurseries at Massachusetts General, Wang says he routinely saw more post-delivery health problems among near-term infants than among those born at 37 weeks or more, but he was surprised to find that few researchers had studied this newborn population.

Wang and colleagues examined the records of infants born at the hospital over a three-year period and randomly selected 95 full-term infants, born at 37 weeks or more, and 90 near-term infants, born at 35 or 36 weeks.^.

Near-Terms 'Masquerade' as Term

Both near-term and full-term babies had similar Apgar scores -- measurements and observations made at birth to determine a newborn's health. In addition, both groups of babies had similar post-delivery hospital stays. However, nearly all other measured clinical outcomes differed significantly between the near-term and full-term newborns.

Overall, 78% of near-term babies were diagnosed with some medical problem, compared with 45% of full-term infants. Hospital costs averaged $2,600 more for the near-term infants as a result.

Nearly 30% of the near-term infants had clinical evidence of respiratory distress, compared with closer to 5% of the full-term newborns. And just over 50% developed jaundice, compared with just under 40% of full-term babies.

The researchers concluded that near-term infants "masquerade" as term infants because they look more like healthy babies than preemies.

Neonatal specialist David Adamkin, MD, says problems such as difficulty feeding, jaundice, and temperature regulation are commonly seen among infants born in this 35 and 36 week gray area.

"These babies are often around six pounds. Since they are a healthy weight, that leads to the assumption that they are healthy," says Adamkin, who is director of the division of neonatal medicine at Louisville's Kosair Children's Hospital. "But they are not the same as full-term infants from a maturation standpoint. They have their own set of health issues."

Jan. 12, 2004 -- Kids complain about schoolwork; adults balk at night classes. But is a BA, an MBA, or a PhD really a bunch of BS? Can one succeed without the sheepskin? What are the secrets of success?

A new study looks at the issue of intelligence tests and the role they play in one's future success in the real world.

"The kind of intelligence that leads to success in school is also related to success in the working world," lead researcher Nathan R. Kuncel, PhD, a psychology professor at the University of Illinois at Urbana-Champaign, tells WebMD.

"You can call it being clever, smart, or whatever, but it is broadly important to success," he adds.

In their examination, Kuncel and his co-authors analyzed 127 studies involving some 20,000 people -- studies that looked at college admissions test scores, job performance test scores, and faculty ratings on internship performance.

All sorts of personal characteristics emerge from such tests: creativity, ability to perform complex tasks, and career potential, he explains.

Who succeeded? Those people who did well in school, whether they got advanced degrees or not.

"People who do well in school tend to be more focused, more conscientious," Kuncel tells WebMD. "Success in school reflects an ability to learn complex processes. It involves acquiring job-specific knowledge."

Actually, most bright people feel compelled to get advanced degrees simply because they enjoy it, he adds. Nevertheless, "having a degree isn't necessarily the key, but it tends to be related," says Kuncel. "There definitely are lots of very bright, clever people who do very well in life who don't get PhDs or MBAs."

Indeed, clever people exist outside of academia -- their success fueled by forces not measured on standardized tests. For them, the secrets to success lie in their savvy, people skills, and other personal qualities.

Noted psychologist and researcher Robert J. Sternberg, PhD, of Yale University, has conducted his own studies of success, focusing on practical intelligence, emotional intelligence, creativity, and personality.

What he defines as practical intelligence -- common sense -- is one of the crucial secrets of success, he tells WebMD. "Some people can have very high IQ scores, but they're not so successful in their relationships with other people or in running their own lives. They make a mess of their lives, so they don't achieve the success they want."

Other people are very strong in communication or creativity, even though they don't have the highest IQ scores, he adds.

"Motivation, conscientiousness, and openness to experience are all qualities that create success," says Sternberg. "People who believe that their abilities can be increased do better work than those who believe that intelligence is fixed."

Being born with intelligence -- that's no secret to success, Kuncel adds. "There's no guarantee you will succeed. Wonderful teachers, parents, and a nurturing environment are very important, there's no doubt about it."

Feb. 18, 2005 -- Vitamin D may reduce the risk of prostate cancer, or at least prevent it from becoming aggressive, a new study suggests.

"Our findings suggest that vitamin D plays an important protective role against prostate cancer, especially ... aggressive disease," says lead researcher Haojie Li, MD, PhD, a research fellow at Brigham and Women's Hospital and Harvard University School of Public Health, in a news release.

"This research underscores the importance of obtaining adequate vitamin D through skin exposure to sunlight or through diet, including food and supplements," Li says. Li presented the report at the 2005 Multidisciplinary Prostate Cancer Symposium.

Prostate cancer is one of the most common types of cancer in men in the U.S., and it's the second leading cause of cancer death in men, according to the American Cancer Society. Almost 232,000 new cases will be diagnosed this year, and about 30,000 men will die of prostate cancer.

The cause is unknown, although many risk factors exist that increase the risk of this cancer. Older age, family history, and a diet high in red meat increase the risk of prostate cancer.

Experts have known that vitamin D can help stop the growth of certain cancers. Some studies have shown that the rate of prostate cancer is lower in Southern states, where sunshine is more abundant. Sunlight helps the body make vitamin D.

Vitamin D Protects Against Prostate Cancer

The study involved 1,029 men with prostate cancer and more than 1,300 healthy men. Researchers analyzed the men's blood, looking for several factors including levels of vitamin D. They found that men with the highest levels of vitamin D had significantly lower overall risk (45%) of prostate cancer, including aggressive prostate cancer, Li reports.

Also, men with a specific receptor that helps vitamin D work got greater protection if they also had high levels of vitamin D in their blood. Those men had 55% lower risk of prostate cancer and 77% lower risk of aggressive prostate cancer.

The researchers conclude that vitamin D plays a role in reducing the risk of prostate cancer and its aggressiveness.

March 29, 2007 -- Getting more exercise during your free time may lower your risk of developing a repetitive strain injury at work.

Engaging in moderate levels of physical activity during leisure hours appeared to protect against work-related carpal tunnel syndrome and other arm- and shoulder-repetitive injuries in a newly reported study from Canada.

The impact was modest, with people who exercised three or four times a week showing a 16% reduction in risk. But the study is among the first to suggest that physical activity helps protect against these injuries, researcher Charles Ratzlaff, PhD, tells WebMD.

"If someone is sitting 40 or 50 hours at a desk, it makes sense that getting out for three or four half-hour walks during the week will be helpful," he says.

Work and Repetitive Strain Injuries

Ratzlaff, who is a physical therapist and epidemiologist, says he became interested in studying physical activity levels in people with repetitive strain injuries (RSIs) after noticing that many of his RSI patients had sedentary jobs and were not very active in their off time. Repetitive strain injuries are also known as repetitive stress injuries.

Because repetitive sports like tennis, baseball, and golf can cause RSIs, Ratzlaff and colleagues with the University of British Columbia at Vancouver also set out to determine if people who engaged in these activities were at higher risk for work-related injuries.

The researchers analyzed data derived from a 2003 Canadian health registry. The study included 58,622 full-time workers who ranged in age from 15 to 74.

All of the workers had reported upper body repetitive strain injuries serious enough to limit normal activities within the previous 12 months. And all had provided information on the leisure-time activities they participated in.

Consistent with other studies, the researcher found that roughly half of upper body RSIs reported by the study population were work related. The most common areas of injury included wrist/hand (39%), shoulder (29%), and elbow (26%).

Being female, being a smoker, and being obese were each also linked to increased risk for an upper body RSI.

The researchers found no evidence that engaging in repetitive sports like tennis, baseball, golf, or weight training increased the risk for developing a work-related upper body RSI.

But they were not able to assess the impact of engaging in these activities more often than once a week on average.

'Recipe for RSI'

Ratzlaff says exercise may benefit people at risk for work-related RSIs by restoring balance to the musculoskeletal system.

"Sitting in front of a computer all day and other at-risk jobs can lead to muscle weakness and tightness, and that is a recipe for causing a repetitive strain injury," he says.

Ejaz Shamim, MD, who also sees many patients with repetitive strain injuries, says it is no surprise that less active people may be more at risk.

Shamim is a clinical fellow with the National Institute of Neurological Disorders and Stroke.

"When you are sedentary, you are much less agile and more prone to injury," he tells WebMD. "I learned that the hard way a few months ago when I twisted my ankle at work largely because my wife was pregnant and I wasn't exercising like I normally do. It never would have happened otherwise."

How much do you know about what makes up a healthy lifestyle? Here's a pop quiz.

1. How do you define working out?

a. Going to the gym.
b. Turning the jump-rope for the neighbor's kid.
c. Playing Frisbee with your dog.

2. How do you define good nutrition?

a. Eating a vegetable at every meal.
b. Eating two vegetables at every meal.
c. Drinking a fruit smoothie for breakfast.

3. Which of these is a healthy activity?

a. Push-ups, sit-ups, or running the track.
b. Walking the dog after dinner.
c. Spending Saturday afternoon snoozing on the sofa.

Believe it or not, the correct answer to every question is A, B, and C -- even that Saturday afternoon snooze! According to the growing "Stealth Health" movement, sneaking healthy habits into our daily living is easier than we think.

"You can infuse your life with the power of prevention incrementally and fairly painlessly, and yes, doing something, no matter how small, is infinitely better for you than doing nothing," says David Katz, MD, MPH, director of Yale University's Prevention Research Center and of the Yale Preventive Medicine Center. Katz is also co-author of the book Stealth Health: How to Sneak Age-Defying, Disease-Fighting Habits into Your Life without Really Trying.

From your morning shower to the evening news, from your work commute to your household chores, Katz says, there are at least 2,400 ways to sneak healthy activities into daily living.

"If you let yourself make small changes, they will add up to meaningful changes in the quality of your diet, your physical activity pattern, your capacity to deal with stress, and in your sleep quality -- and those four things comprise an enormously powerful health promotion that can change your life," says Katz.

And yes, he says, a nap on the couch can be a health-giving opportunity -- particularly if you aren't getting enough sleep at night.

Nutritionist and diabetes educator Fran Grossman, RD, CDE, agrees. "You don't have to belong to a gym or live on wheat grass just to be healthy," says Grossman, a nutrition counselor at the Mt. Sinai School of Medicine in New York. "There are dozens of small things you can do every day that make a difference, and you don't always have to do a lot to gain a lot."

Sept. 5, 2006 -- Most children who are lactose intolerant can and should eat some dairy foods to ensure they get enough calcium and vitamin D, the nation's leading pediatric group says.

In a report published today, the Committee on Nutrition for the American Academy of Pediatrics recommends against eliminating dairy products as the primary treatment for lactose intolerancelactose intolerance. The condition is extremely common among many racial and ethnic groups, including Asians, Native Americans, Hispanics, and blacks.

"Not enough kids are getting enough calcium in their diets, and one of the reasons is that parents often eliminate dairy, thinking that it is the cause of stomach pains and the other discomforts that are associated with lactose intolerance," committee member Melvin B. Heyman, MD, MPH, tells WebMD.

Instead of banning dairy foods from a sensitive child's diet, the report recommends slowly introducing them to determine the child's level of tolerance.

"Some children are able to tolerate one glass of milk, but get symptoms with a second," Heyman says. "Some can't tolerate milk, but can tolerate yogurt because the lactose is partly broken down by bacteria; and some can tolerate hard cheese."

AAP Recommendations

People often confuse lactose intolerance, in which the body has a hard time digesting milk sugar (lactose), with cow's milk protein intolerance, which is an allergic reaction triggered by the immune system.

Lactose intolerance is caused by a shortage of the enzyme lactase, which breaks down lactose in the small intestine.

Typical symptoms of lactose intolerance include abdominal pain, nausea, bloating, flatulence, and other digestive discomforts.

While uncomfortable, the symptoms do no permanent damage to the bowel, Heyman points out.

The AAP report stresses the importance of accurately diagnosing lactose intolerance.

Parents can get a good feel for their child's tolerance by systematically eliminating and then reintroducing specific dairy foods over time, carefully recording changes in symptoms.

Other recommendations include:

• Drink small portions of milk (4 to 8 ounces) with meals and other foods throughout the day.
• Try yogurt, which may produce fewer lactose intolerance symptoms.
• Choose aged cheeses, which have less lactose than other varieties.
• Drink lactose-free or lactose-reduced milk, which is easily found in most grocery stores; or take lactase-replacement capsules.

Alternate Calcium Sources

Although it is possible for children to get the calcium they need for strong bones without dairy, it isn't easy.

Broccoli, brussels sprouts, dried figs, and sardines are among the most calcium-rich nondairy foods -- but good luck getting the typical child to eat them.

Calcium-fortified cereals and orange juice may be a more realistic option. But the AAP has also warned parents to limit fruit juices, which contain a lot of sugar.

The group recommends no more than 6 ounces per day of fruit juice for children age 1 to 6, and 12 ounces for older kids and teens.

While calcium supplements may help, children on lactose-free diets appear to have a harder time absorbing calcium in this or any form.

"Recent evidence indicates that dietary lactose enhances calcium absorption and, conversely, that lactose-free diets result in lower calcium absorption," the report says.

Thus, lactose intolerancelactose intolerance (and lactose-free diets) may, in theory, predispose people to inadequate bone development.

The Racial Divide

According to the AAP report, as much as 70% of the world's population is lactose intolerant to some degree, meaning they are deficient in the lactase enzyme.

Not surprisingly, racial and ethnic groups which have historically had little exposure to dairy foods are the most intolerant, while those with the most exposure are the least.

Nearly 100% of Asians and Native Americans have a lactase deficiency, while 80% of Hispanics and 60% to 80% of blacks produce insufficient quantities of the enzyme. Only 2% of northern Europeans are lactose intolerant.

Children in high-risk ethnic groups may develop symptoms with dairy exposure as early as age 2 or 3, but white children rarely develop symptoms before 4 or 5, the report states.

While most people with lactase deficiency develop symptoms in their teens or adult years, approximately 20% of Hispanic, Asian, and black children younger than age 5 show evidence of the deficiency.

Oct. 3, 2005 -- Want to keep extra weight off as you age? You might want to develop a strategy that lasts a lifetime.

In a lengthy study, many people who had a normal body mass index (BMI) in middle age eventually became overweight, and some became obese.

Consider these before-and-after results:

• Between a tenth and a quarter became overweight in just four years.
• More than half became overweight in 30 years.

The study appears in the Annals of Internal Medicine. The researchers included Ramachandran Vasan, MD, of the Framingham Heart Study.

Short-Term Trends

Vasan's study included more than 3,700 white men and women who were enrolled in the Framingham Heart Study.

Participants had their BMI measured at least twice, four years apart, during the 30-year study.

Middle-aged men packed on weight relatively quickly. Over four years, more than a quarter of the men with normal BMI became overweight. For men with normal and overweight BMI values, up to 9% became obese in four years.

A smaller percentage of women (14% to 19%) became overweight in four years' time. Between 5% and 7% of normal and overweight women became obese in four years, the study shows.

Long-Term Results

As the years gathered, so did the pounds. Here are the results over 30 years:

• More than half of all participants became overweight.
• About a quarter of participants became obese.
• 1 in 10 participants became severely obese.

Over the long haul, similar percentages of men and women became overweight or obese. People who were overweight when the study started were more likely to become obese.

"These estimates suggest that the future burden of obesity-associated diseases may be substantial," write the researchers. However, their report doesn't give details on participants' health.

Heart disease, some cancers, and osteoarthritis are among the conditions that have been linked to weight problems. Of course, not all overweight people have those health issues.

Study's Limits

BMI is calculated from height and weight. It isn't a perfect measure of fatness.

For instance, people often lose lean body mass as they age. That can raise body fat percentage while leaving BMI unchanged, the researchers note. Resistance training is one way to maintain or build muscle mass.

BMI also doesn't reflect shifts in the location of body fat. Past research has linked fat around the waist to health problems including heart disease and diabetes. It's not clear if that fat causes or just accompanies those problems.

The study only tracked weight gain starting in middle age. Other age groups might have different results, write the researchers.

Lastly, since all participants were white, results aren't known for other racial and ethnic groups.

Lifelong Habit

Diet crazes come and go. Many health experts recommend making lasting changes instead of following the latest diet fads.

Your doctor can give you pointers. The U.S. government recommends these general steps for healthy living:

• Get at least 30 minutes of physical activity five or more days per week.
• Choose whole grains for at least half of the grains you eat.
• Eat a mix of five to nine servings of fruits and vegetables daily.
• Favor lean sources of protein (including leaner cuts of meat and poultry, fish, and beans).
• Choose low-fat or fat-free dairy products.
• Cut back on foods containing saturated fat, trans fats, and cholesterol.

Don't forget about calories. You've got to burn more calories than you consume to lose weight, so make your choices wisely.

Nov. 8, 2004 -- Obesity not only takes its toll on men's waistlines, but it may also wind up costing them at their local pharmacy. New research shows that middle-aged obese men spend three-and-a-half times as much on prescription drugs than normal-weight men.

The study shows that obese men pay about $80 a month in prescription drug costs compared with an average of about $23 in monthly prescription drug costs among normal-weight men.

Researchers say the findings offer a new perspective on the health problems associated with obesity as well as the financial costs of treating them.

"These are what we call 'real and immediate costs.' These are not the costs associated with an operation or serious event like a heart attack that might happen at some time in the future. Rather, this is what the men, or their employers, spend month after month on their prescription drugs," says researcher Thomas G. Allison, PhD, MPH, of the Mayo Clinic in Rochester, Minn., in a news release.

The results of the study were presented this week at the American Heart Association's Scientific Sessions 2004 in New Orleans.

Prescription Drug Costs Rise With Weight

In the study, researchers compared the prescription drug costs among a group of 328 male business executives who had physical examinations as directed by their company's health plan between January 2001 and May 2002.

Researchers divided prescription drug costs into medications prescribed to treat heart disease risk factors, such as high blood pressure and cholesterol, and those used to treat other medical conditions related to weight, such as gout and erectile dysfunction.

The study showed as men's weight increased, so did their prescription drug costs.

• For normal-weight men, monthly prescription drug costs for heart disease-related drugs were $9.89 and for other drugs, $12.96.
• For overweight men, monthly prescription drug costs for heart disease-related drugs were $18.41 and for other drugs, $20.86.
• For obese men, monthly prescription drug costs for heart disease-related drugs were $42.02 and for other drugs, $38.29.

"Previous studies looking at the cost of obesity might be underestimating the toll," says Allison. "The men in this study were in a health program that exceeds the type of physical examination that a normal healthcare plan would offer."

May 24, 2004 (Orlando, Fla.) - As the number of children defined as overweight and obese continues to rise, researchers say new studies now show that obese children are more susceptible to lung damage from air pollution than lean youngsters.

"Given the epidemic of obesity in children, it might be we're developing a population more vulnerable to pollution's negative effects on the airway," says Heike Luttmann-Gibson, PhD, statistician and research associate in the Environmental Epidemiology Program at Harvard School of Public Health.

When exposed to the same amount of pollution, obese boys and girls had more trouble breathing than kids of normal weight, she reports.

Obesity's Far-Reaching Health Effects

The findings offer one more reason to put overweight and obese youngsters on a diet and exercise program. Consider the facts:

• The number of overweight and obese children has nearly tripled since the 1970s.

• There has been a tenfold increase in the number of children with type 2 diabetes over the past five years. Once called 'adult-onset' diabetes, type 2 diabetes is linked to obesity and inactivity.

• Overweight kids are more likely to become overweight adults, increasing their risk of obesity-related health conditions such as heart disease, stroke, and bone fracture.

David B. Peden, MD, MS, professor of pediatrics and center director of the Center for Environmental Medicine, Asthma and Lung Biology at the University of North Carolina in Chapel Hill, says, "Being overweight clearly causes a lot of bad things to happen. But even a modest reduction in weight can have a big effect on a child's health, including [lung problems tied to] air pollution."

Problems Expand Along With Ballooning Waistlines

In the study, 611 fourth and fifth graders, who were participating in a larger study on the long-term effects of air pollution, were tested for lung function. About one in 10 was obese. Parents of the children helped fill out questionnaires asking about general and respiratory health.

After analyzing the information, the researchers showed that the effects of air pollution on lung function were two to five times stronger for obese children than for those of normal weight, Luttmann-Gibson reports.

The researchers found that children exposed to nitrogen dioxide -- an irritant that is found in car exhaust -- had a drop in lung function. Obese kids exposed on one day had an 11% dip in lung function the following day, while lean youngsters exposed to the same levels of the pollutant had only a 2% drop in lung function.

The more obese the child, the greater the effects of air pollution on lung function, says Luttmann-Gibson. "Any decline in lung function is bad, and obesity makes it even worse."

Luttmann-Gibson says she suspects that air pollution and obesity pack a double whammy to the airways. Researchers know that chemicals relating to inflammation in the body are elevated in obese persons, she explains. "And air pollution increases inflammation in the airways. Being obese is setting you up to be more susceptible to the inflammatory effects of air pollution."

And that, researchers say, may mean that an increased risk of asthma should be added to the list of obesity-related health conditions.

Peden tells WebMD, "If obesity is resulting in more inflammation, the risk of developing asthma might be further increased, too."

Although further study is needed to prove the association, it's a link many doctors already suspect, Peden says. "It's intriguing, a new and exciting area of interest."

June 30, 2003 -- Daily injections of low-dose growth hormone may help overweight people lose body fat while maintaining muscle mass, according to early research from St. Louis University. Obese patients who got the injections lost modest amounts of weight, but researchers caution that it is too soon to know if the findings are significant.

The research was presented at the 85th annual meeting of the Endocrine Society in Philadelphia.

In the study, 59 people who averaged 40% above their ideal body weight were told to follow a calorie-restricted diet and exercise program. They also got either daily self-administered shots of low-dose growth hormone or placebo injections.

One third of the original participants dropped out during the six-month treatment phase, but only one patient left the study because of side effects. The rest did not want to follow the lifestyle guidelines or give themselves the daily injections.

In earlier studies using higher doses of growth hormone, potentially serious side effects were commonly seen. These side effects included arthritis and insulin resistance, which can lead to diabetes.

Modest Weight Loss

At the end of the study, the people who got the growth hormone had lost an average of five pounds of body fat, while those who did not receive the hormone lost nothing. The growth hormone group saw a 19% improvement in HDL, or good, cholesterol levels with no change in LDL, or bad, cholesterol levels.

Lead researcher Stewart Albert, MD, says he does not believe growth hormone was directly responsible for the weight loss but it might have made it easier for people to maintain a healthier lifestyle.

"If the growth hormone had any benefit, it was to allow people to continue with the diet and exercise," Albert tells WebMD. "It may be that growth hormone has a beneficial effect on appetite control or that because people didn't lose muscle mass they were able to exercise more. It will take much larger studies to answer these questions."

Clinical endocrinologist Lawrence Frohman, MD, tells WebMD that the high dropout rate in the study and the moderate weight reductions in the growth hormone group make him skeptical about the clinical potential of this treatment.

There are numerous over-the-counter products marketed as growth hormone for weight loss, sold over the Internet or in health stores. Frohman says the products are not growth hormone and they have not been subjected to clinical scrutiny to determine if they are safe.

"Anything that is sold over the counter cannot be growth hormone, because growth hormone is regulated by the FDA," he says. "It is hard to get the actual content of what is in these products, but they are of limited to no value."

Your heart and mental health may depend on your ability to reduce hurt and anger, even at yourself. So effective is forgiveness -- if we could find a way to learn and teach it -- that Stanford University is undertaking a project to learn how forgiveness can enhance health and relationships and even prevent disease.

But first, you might have to forgive yourself. Did you cheat on your spouse? Hit a child in anger? Steal something? Go off the wagon? The list of potential human misdeeds is long.

If someone else did these things, you might learn to forgive them or at least let go of the anger. That's because it's easier to forgive others. After all, they don't live in your head, reading you the same old riot act. All the world's major religions preach the power of forgiveness. But forgiveness is such an elusive act, quicksilver in its ability to be strongly felt one moment and then dart away beyond reach the next.

According to Stanford's call for volunteer subjects, the definition of forgiveness is a simple one, not a near-impossible requirement that a person apply for sainthood. "Forgiveness," it says, "consists primarily of taking less personal offense, reducing anger, and the blaming of the offender, and developing an increased understanding of situations that lead to hurt and anger."

When You Need to Try to Forgive Yourself

Sharon A. Hartman, LSW, a clinical trainer at the Caron Foundation, a drug and alcohol treatment center in Wernersville, Pa., deals with the need to forgive every day. "These are such shame-based diseases," she says. "Forgiving oneself is of the more difficult parts of recovery."

A chronic state of anger and resentment interferes with life, Hartman points out. Countless studies also show stress and anger can cause or worsen diseases, such as cancer, heart disease, and various autoimmune disorders. "When resentment is interfering with your life, it's time to forgive yourself," she says. "So many people have a constant, critical voice in their heads narrating their every move." She says she calls her critical voice "Gertrude" and tries to counteract Gertrude's eternal litany with positive affirmations -- that she is getting better, that she is less angry. "Forgiving doesn't mean not being angry with yourself, but not hating yourself.

"No one," Hartman adds, "can beat us up better than we beat ourselves up."

Forgiving Requires Specificity

"I think people often try to forgive themselves for the wrong things," says Joretta L. Marshall, PhD, a United Methodist minister and professor of pastoral care at the Eden Theological Seminary in St. Louis. "We think we ought to forgive ourselves for being human and making human mistakes. People don't have to forgive themselves for being who they are -- gay or lesbian, or having some kind of handicap. Forgiveness means being specific about what we did that needs forgiving."

"I think forgiveness is often confused with condoning or lack of accountability," Hartman says. "This is a world with high performance standards. People think they need to be perfect. Yet people do things -- intended or not -- that hurt others. You may not intend to harm, but the other person is no less hurt." That's when you need to stop at some point and forgive yourself.

Hanging on to Resentment Can Have Advantages

"It's about relinquishing a source of pain and letting go of resentment. People think forgiving yourself means you are letting yourself get away with whatever it was you did," Hartman goes on. "The pain and anger you are feeling are supposed to be your punishment."

People want to feel pain and resentment? "Oh," exclaims Hartman, "resentment is a very attractive way of putting a barrier around yourself as protection against being hurt again."

Do You Need a Therapist?

If toting around self-loathing like a heavy backpack has advantages, how do you set it down?

It can be done without formal therapy, Marshall says. "But not without community of some kind. It is in the context of our relationships (whether with therapists, pastors, counselors, churches, families, and friends) that we experience the grace of being forgiven and forgiving others." Grace, of course, is a peace of mind bestowed regardless of whether we deserve it or not.

"You need to talk to someone as a rule," Hartman says.

Nov. 10, 2005 -- Slow production from the same company that caused last year's flu vaccine shortage is now causing vaccination delays at clinics and doctors' offices across the country, a federal health official acknowledged Thursday.

Vaccine makers are expected to produce a near-record number of flu shots this year. But so far smaller health clinics and individual doctors' offices are having trouble obtaining vaccines and have been forced to turn patients away.

The delays can be traced to Chiron Corp., said CDC Director Julie Gerberding, MD.

Last year the company's plant in Liverpool, England, was shut down by British regulators because of safety problems. That move left the U.S. without 48 million expected vaccine doses and caused shortages across the country during the last flu season.

The Chiron plant is again making vaccines, but production is slower than expected, Gerberding said. The company, which sells vaccines to many doctor offices and individual clinics, has also announced that it will produce fewer than the 18 million vaccine doses it originally projected for this year.

"We're sorry that we have another frustrating year for some people," Gerberding said. She urged people seeking vaccination to "be persistent" until supplies arrive.

Uneven Distribution

Meanwhile, large drugstores and supermarket chains in many cities are offering vaccinations while doctors' offices go without supplies. "People who place large orders for vaccine tend to get preferential treatment from distributors," Gerberding told reporters.

Republican Rep. Fred Upton complained to federal health officials at a hearing earlier this week that more than 9,000 residents in his western Michigan district have complained that they can't get vaccines.

Gerberding said that the spread of seasonal flu so far is light in most states. "This gives us time to get vaccines out there," she said.

She added that flu vaccine demand is probably up in many parts of the country, both because of last year's shortages and widespread attention on separate preparations for a possible bird flu pandemic.

"Influenza's been on people's minds," she said.

Chiron and three other manufacturers who supply the U.S. market with flu vaccine have already produced about 71 million doses. The companies are expected to distribute between 10 million and 12 million more doses by December, though the companies say they don't yet know exactly how much they will produce.

Sanofi-Pasteur is the only manufacturer that makes flu shots in the U.S. The company has already produced 55 million doses this year.

March 14, 2006 (Atlanta) -- Stopping cholesterol-lowering statin drugs after long-term use packs not one, but two potentially deadly punches to the heart.

That's the bottom line of a new study that shows that people who discontinued taking the drugs experienced rapid rises in both C-reactive protein (CRP) and LDL cholesterol levels. These data provide support for the acute increase in cardiovascular risk associated with statin discontinuation, they write.

Statins lower not only cholesterol, but also reduce CRP, a marker of harmful inflammation in the arteries that can lead to blood clots, says researcher Folkert Asselbergs, MD, PhD, of the University Medical Center Groningen in The Netherlands.

Dozens of studies have now shown that CRP, like cholesterol, is an important, independent predictor of heart attack and stroke risk, he says.

"If you stop statins, it's a double whammy," Asselbergs tells WebMD. "Statin withdrawal leads to a rapid and significant increase in CRP, independent of the parallel LDL increase.

"If you're on a statin, keep on your medication!" he says.

Findings a Wake-Up Call

Asselbergs and colleagues studied 566 people who had been enrolled in a study pitting the cholesterol-lowering statin drug Pravachol against placebo.

Four years into the study those on Pravachol had:

• a 16% drop in CRP
• a 27% decrease in LDL "bad" cholesterol levels

In contrast, those on placebo had:

• a 4% increase in CRP
• Stable levels of LDL "bad" cholesterol

But when the participants on pravastatin stopped their medication, both CRP and LDL "bad" cholesterol shot up to pretreatment levels.

James H. Stein, MD, co-chairman of the cardiology meeting and associate professor of medicine at the University of Wisconsin Medical School in Madison, says the findings are a wake-up call.

"I can't tell you how many people say they feel better and want to stop their medication," he tells WebMD.

"While it might seem like common sense that you would get worse if you do that, many people don't believe it," Stein says. "A study like this shows us the magnitude of how bad things can really get."

Stein moderated a news conference to release the findings at the annual meeting of the American College of Cardiology.

June 24, 2000 -- It's 4 in the afternoon, and her baby boy wants to nurse -- again. "You find out after they're born: You can't go anywhere. When he needs to eat, he needs to eat," says Robin, a New York mom who has been at home with her newborn for two weeks now.

Like many women, Robin felt pressured to at least try breast-feeding. "My husband was very adamant," she tells WebMD. But she worries: She's had difficulty getting the baby started nursing. And she has no idea whether he is getting enough milk.

"My husband and I never realized how difficult this would be," she says. "If you want to measure how much they're eating, you can't do that with the breast. You don't have an ounce meter on your nipple."

New mothers often hear that "breast is best." In fact, the American Academy of Pediatricians (AAP) recommends that mothers breast-feed for at least 12 months. In a policy statement, the AAP says breast-feeding is "primary in achieving optimal infant and child health, growth, and development."

But ask mothers and you'll find that breast-feeding is not as easy as it looks. "For some women, it's not a nice experience at all," pediatrician James Sargant, MD, tells WebMD. "I can say from my own experience that some mothers feel relief when I talk to them ... [and] make them feel OK about quitting." Sargant is an associate professor of pediatrics at Dartmouth Medical School in Lebanon, N.H.

A recent study involving 350 mothers in New Zealand showed that most new mothers stop breast-feeding when the baby is about 7 months old. In that study, only 30% of the mothers continued to breast-feed for a year.

"The most common reason for stopping, especially in the early months, was a belief that milk production was inadequate," writes A. Vogel, the study's author. "Later, many mothers simply felt that they had breast-fed their infants long enough." Vogel is with the department of pediatrics at the University of Auckland in New Zealand.

Other factors affecting a woman's decision to quit breast-feeding, pediatricians say, are problems with nipples as well as mastitis, an inflammation of the mammary glands. Also, giving babies pacifiers and formula in the early days seems to deter long-term breast-feeding.

The pressure of returning to work also is an issue, Vogel says: In the study, "younger women [under 25] and those returning to work full time in the first year were relatively likely to stop, as were those who originally planned to stop by age 6 months."

Doctors agree that any amount of breast-feeding -- even during just the first few weeks -- offers the baby a host of health and developmental benefits. To help new mothers get past the barriers to long-term nursing, WebMD turned to a lactation consultant and a pediatrician for advice.

How can mothers know whether they are producing enough milk?

Lactation consultant Cynthia Garrison, BS, IBCLC, of Magee-Womens Hospital in Pittsburgh, tells WebMD: "We often send mothers home with a "feeding log," a real simple chart where they can keep track of the numbers of feedings, wet diapers, and dirty diapers in a 24-hour period, so they see that it's falling within the ranges of normal.

"Because what goes in must come out, we instruct mothers that if baby is having 4-6 wet diapers within the first day, increasing [along with the baby's milk intake] to six to eight, and they're having at least two dirty diapers every day, then life is going quite well. They can be a little more relaxed and understand that as the baby matures, they will start spacing feedings out; they won't need to feed as often. The babies' stomachs are getting bigger."

Babies' elimination habits can vary, adds Andrea McCoy, MD, chief of pediatric care at Temple University Children's Hospital in Philadelphia. "So even though the baby may stool with every feeding, I caution mothers not to be overly concerned if the baby doesn't stool every day."

A good medical follow-up is essential for babies, because assuring that they are gaining enough weight is the best way to be sure the mother has an adequate milk supply, McCoy tells WebMD.

Nov. 29, 1999 (New York) -- Nobody is quite sure where schizophrenia -- a mental illness characterized by hallucinations, delusional, and/or disordered thinking -- comes from. Most researchers agree there is a genetic or hereditary component involved, but clearly many people who have no family history develop the disease. One theory is that exposure in the womb or in childhood to infectious agents, like the influenza virus, can put a person at risk. But studies looking at these theories have yielded mixed results.

In one of the largest studies to date, Danish investigators report they were unable to find an association between exposure to influenza before birth and subsequent development of schizophrenia. But the study authors did find that children from large families, where there is potentially a higher risk of childhood infections, had a slightly increased risk for schizophrenia, especially when the births of the children were closely spaced together, according to a report in the November issue of the Archives of General Psychiatry.

"Our findings do not support the hypothesis that schizophrenia is associated with prenatal exposure to common infections or influenza. However, they are compatible with the hypothesis that environmental exposure, perhaps to common infections in childhood, may be a risk factor", write Tine Westergaard, MD, and colleagues. Westergaard is with the Statens Serum Institut in Copenhagen, Denmark.

Using data from a national registration system, the investigators utilized information from a database that included all Danish-born women born since 1935 and all their offspring who were alive on April 1, 1968 or born in the twenty years since. Of the nearly two million people who were followed, schizophrenia was identified in over 2,600 people using information from the Danish Psychiatry Case Register.

Monthly reported cases of influenza in Denmark were obtained from 1950 through 1988. The authors focused on the prevalence of influenza three to five months prior to the births of the study patients when investigating the association between schizophrenia and number of reported influenza cases in the population.

The number of children in a family (sibship size) correlated to the risk of developing schizophrenia, with the highest risk in those families with four or five children. No association was found between birth order and schizophrenia risk. Short intervals (less than two years) between the birth of the person with schizophrenia and the birth of the nearest oldest or youngest sibling also correlated to an increased risk of schizophrenia. More than 10% of the cases of schizophrenia came from large families or those with close spacing between siblings. "The association between sibship size and schizophrenia risk could be indicative of a possible association between schizophrenia and exposure to infections in childhood," say the authors.

No association was found between schizophrenia risk and prevalence of influenza three, four, or five months prior to birth, during any month prior to birth, or during the month of birth. "[O]ur study does not support the hypothesis that in utero [in the womb] exposure to influenza or other common infections may increase the risk of developing schizophrenia", writes Westergaard.

"I think this is an excellent paper. The investigators use the Danish Registry Data which has been developed over decades which is just now bearing fruit for schizophrenia research", Ezra Susser, MD, DrPH, tells WebMD. "They looked at things rarely examined in schizophrenia research: birth order, sibship size, space between siblings. As far as the small interval between siblings, you can't make too much of the findings yet but they're really intriguing."

"They tested the influenza hypothesis in a much better way than previous studies," he says. Susser, the head of the Epidemiology of Brain Disorders program at the New York State Psychiatric Institute and Columbia University, was not associated with the Westergaard research.

Other experts aren't so sure. "This study casts further doubt that influenza is an important infection in causing later cases of schizophrenia. However, I take serious exception to the conclusion that in utero infections are not important," E. Fuller Torrey, MD, tells WebMD. "Increasingly research, including our own, has shown that infections both in utero or in early childhood may well play a role in later development of both schizophrenia and bipolar disorder." Torrey, who also is not associated with the study, is from the developmental neurovirology laboratory of the Stanley Research Foundation for Research in Schizophrenia and Bipolar Disorder in Bethesda, MD.

"It's important to stress that there is no database in the world as good as the database they are using, which consists of the entire population of Denmark, to answer the kinds of questions they're asking", says Torrey. "However, the big problem with these influenza studies is that it doesn't tell you whether the mother [of the schizophrenia patient] actually had it or not. You're not going to be able to measure what's going on in utero by measuring the incidence of maternal symptoms or infections in the community." He suggests there may be women who have influenza but do not report it to the medical authorities or perhaps are asymptomatic or only mildly symptomatic.

Torrey adds, "Pregnancy is like a black box. It's conceivable that there's a whole series of things going on, including infections, and we only have the vaguest idea of what's going on. We can only measure the most extreme ends of the spectrum."

Vital Information:

• It is unknown what causes schizophrenia, but scientific theories suggest there is a genetic component, possibly combined with an exposure to infections either in the womb or during early childhood.
• A new study finds that having a lot of siblings, especially ones that are closely spaced, is associated with a higher risk of schizophrenia.
• This finding adds evidence to the hypothesis than an infection during early childhood is somehow related to schizophrenia, since a family with many, close siblings will likely have more exposure to infections.

Nov. 22, 1999 (Minneapolis) -- Aggressive behaviors in elderly patients can be difficult for family and health care workers to control. That's why scientists continue to look for effective and safe medications to treat dementia. Characterized by a decline of memory, concentration, and judgment, dementia can result in physical violence such as hitting, yelling, and grabbing people. These behaviors may result in injury to the patient and to the caregiver.

"Agitation and aggression are major concerns for clinicians and families, and [form] the single greatest cause of nursing home admission," Gary Small, MD, director of the Center on Aging at UCLA, tells WebMD. "Current treatments are only partly effective," he says, "so efforts to find innovative approaches to minimize the problem are very important."

Now, a small study by Harvard researchers of 14 patients with dementia has shown promising early results using estrogen, a hormone most commonly used to control the symptoms of menopause in women. Although the investigation was conducted over a short period -- four weeks -- researchers say changes in behavior of the elderly patients after estrogen therapy "were encouraging." In addition, no negative side effects from the estrogen were observed.

Nurses' aides, who worked regularly with the patients, participated in the study by documenting the patients' behaviors. The aides measured five aggressive behaviors: verbal aggression, physical aggression, resistive or defiant behavior, sexually aggressive behavior, and aggression against oneself.

Eight patients received estrogen therapy; six received a placebo, or sugar pill. The patients' average age was 84. Following the one-month study, the researchers found estrogen therapy was associated with a decreased frequency of physical aggression among the patients. In addition, verbally aggressive behaviors were also decreased, although this effect was not as great.

While many patients with dementia are successfully treated with sedative-type drugs, the majority of patients do not respond well to them. "It's important that another treatment option might be helpful for patients with moderate-to-severe dementia but who cannot tolerate or do not respond to other medication," the author of the study, Helen Kyomen, MD, MSc, tells WebMD. Kyomen is a geriatric psychiatrist and is on the faculty of the Harvard Medical School in Boston.

Researchers were "encouraged" by their findings, but larger studies need to be done to provide further support for using estrogen therapy in this way, Kyomen says. Currently, other studies are looking at the possibility that estrogen therapy may reduce the risk of Alzheimer's disease.

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Sept. 27, 2005 -- A pomegranate a day may keep prostate cancer away, according to early results that suggest the antioxidant-rich fruit may both prevent and treat the deadly cancer.

Researchers found pomegranate juice killed human prostate cancer cells in laboratory tests and significantly slowed the progression of prostate cancer in mice.

"Our study -- while early -- adds to growing evidence that pomegranates contain very powerful agents against cancer, particularly prostate cancer," researcher Hasan Mukhtar, PhD, professor of dermatology at the University of Wisconsin Medical School, says in a news release.

"There is good reason now to test this fruit in humans -- both for cancer prevention and for treatment."

Breaking New Ground

Prostate cancer is the second-leading cause of cancer death in American men, behind lung cancer.

Researchers say the study, published in the Proceedings of the National Academy of Sciences, is the first to evaluate the effects of pomegranate extract on human prostate cancer cells.

Previous studies have shown that the ruby-seeded fruit native to the Middle East is rich in antioxidants and has anti-inflammatory effects. In fact, researchers say pomegranate juice has higher levels of antioxidants than red wine and green tea, which have also been investigated as potential cancer treatments.

More Pomegranates, Less Cancer?

In this study, researchers examined whether pomegranate juice would not only kill cancer but also help prevent prostate cancer from starting or progressing.

In the first experiment, researchers treated human prostate cancer cells with various doses of pomegranate juice in the laboratory. The results showed that the higher the pomegranate dose, the more prostate cancer cells that were killed.

In the second test, researchers divided mice injected with human prostate cancer cells into three groups. One group drank water and the other two groups drank either 0.1% pomegranate extract or 0.2% pomegranate extract.

Researchers say the dose of pomegranate juice given to the mice equates to about one or two pomegranates -- or 8 to 16 ounces of pomegranate juice.

The results showed that mice who drank the higher concentration of pomegranate extract experienced a significant slowing in their cancer progression and a decrease in prostate-specific antigen (PSA) levels. PSA is used to indicate the presence of prostate problems, including cancer, in humans.

Now, researchers say the next step in evaluating pomegranates as a potential prostate cancer treatment is to conduct studies in humans.

April 24, 2002 -- Everyone knows that exercise is good for you. And most agree that breast milk is the single best source of nutrition for a growing baby. But some research has suggested that exercise and breastfeeding don't mix. The theory is that exercise increases the amount of lactic acid in mothers' milk, and babies don't care for the taste. Not true at all, new research shows.

The latest findings "support the hypothesis that moderate- or even high-intensity exercise during lactation does not impede infant acceptance of breast milk consumed one hour postexercise," write Kc S. Wright, MS, and colleagues from the University of New Hampshire in Durham.

The researchers had 24 nursing moms of 2- to 4-month-olds complete three separate tests. Each woman pumped her breast milk and bottle fed her infant one hour before and one hour after 30 minutes of vigorous exercise, 30 minutes of moderate exercise, and 30 minutes of resting. The nursing sessions were videotaped and reviewed by lactation, or breastfeeding, experts who didn't know which type of exercise the woman had recently completed.

"There were no differences [before or after each session] in maternal skin temperature, breast milk temperature, and infant milk acceptance as judged by either the mothers or the lactation consultants," the researchers write.

Breast milk lactic acid levels remained the same after the moderate-exercise or rest sessions. And although lactic acid levels did increase slightly after the intense exercise session, it made no difference in the babies' acceptance of their mother's milk.

"The benefits of physical activity for women have been well-documented and include improved cardiovascular fitness; decreased body fatness; enhanced bone [strength]; decreased risk of colon cancer, [high blood pressure], and diabetes; and improved mental health," they write.

The country's obesity epidemic is evidence of how few women are getting sufficient exercise, and for a variety of reasons, few new moms heed the American Academy of Pediatrics' recommendation of breastfeeding their babies for at least 12 months.

But findings such as these "that support the compatibility of exercise and lactation, may help to reduce the sociocultural inhibition of extended breastfeeding," the researchers write.

March 20, 2006 -- Is teen drinking more common among teens who own clothes, hats, or other gear bearing the names of alcohol brands?

Maybe, report Auden McClure, MD, and colleagues in the American Journal of Preventive Medicine. McClure works in the pediatrics department at Dartmouth Medical School in New Hampshire.

McClure's team isn't blaming alcohol-branded gear for teen drinking. But they want to see more research done on the topic. Meanwhile, a leading beer company notes the limits in McClure's study.

About the Study

The study included nearly 2,400 teens -- most of whom were white -- in rural New England. In middle school, the teens had taken surveys about smoking and drinking.

On those surveys, all of the teens denied ever drinking beer, wine, or other alcohol without their parents' knowledge. In follow-up interviews a year or two later, 15% admitted drinking beer, wine, or other alcohol without their parents' knowledge.

In the follow-up interviews, the researchers also asked whether the students owned any alcohol-branded merchandise, such as a T-shirt, hat, or backpack; 14% said yes. Teens who owned such gear were more likely to admit having drunk alcohol without their parents' knowledge.

Which Came First?

The researchers note that their study doesn't prove that owning alcohol-branded gear caused any teens to start drinking, and that they don't know whether the teens got those items before or after they started drinking without their parents' knowledge.

The surveys didn't cover alcohol use by the teens' parents or the teens' drinking habits. The findings need confirmation and might not apply to other groups of teens, the researchers state.

The study doesn't focus on any particular brand of alcohol. However, Anheuser-Busch Companies emailed WebMD a statement from John Kaestner, Anheuser-Busch's vice president for consumer affairs, about McClure's study.

Company's Response

"Anheuser-Busch is adamantly opposed to underage drinking," Kaestner states, underscoring the limits noted in the study.

"The most influential factor in teens' drinking decisions -- parents -- was not fully examined in the study, with parent alcohol use and the way in which the student acquired the alcohol-branded merchandise being unmeasured," states Kaestner.

"According to the Roper Youth Report, a nationally representative survey of youth (aged 13-17), teens say their parents are the No. 1 influence on their decisions to drink or refrain from drinking," Kaestner adds.

The study didn't represent teens nationwide, notes Kaestner.

Merchandise Intended for Of-Age Adults

"We direct our marketing to our customers, adults 21 and older," Kaestner continues.

"Our promotional clothing and merchandise are intended for adults, come in adult sizes, and are placed in adult sections of stores. The agreements we have with our licensees only permit their retailers to market, sell, and distribute our beer-branded merchandise to adults of legal drinking age."

Kaestner also mentions past research that has shown that many teens who drink say they get alcohol from their parents or other adults. "If teens can't get alcohol, they can't drink it," Kaestner states.

July 1, 2004 -- The diet usually recommended to reduce the risk of the nation's two leading causes of death -- heart disease and cancer -- is now linked to a lower risk of the third -- stroke.

Once again, researchers say the best edible insurance for reducing the risk of strokes -- which strikes an American every 45 seconds and kills one every three minutes -- is to eat more fruit, vegetables, and other high-fiber fare, and less of what most folks usually eat.

After tracking nearly 72,000 women for 14 years, researchers found that women who ate the most fruits, vegetables, fish, and whole grains were less likely to have a stroke than those who ate less of this healthy fare.

The less-healthy diet was more typical of the American way of eating -- more red and processed meats, refined grains, and sweets.

While these findings may seem obvious, there is a new twist. Past studies have investigated a possible link to stroke with individual foods and nutrients. "But this is the first study to examine how overall dietary habits impact stroke," says lead researcher Teresa Fung, ScD, a nutritionist at Simmons College of Health Studies in Boston and at Harvard School of Public Health. "Its importance is in pointing people to a general direction in their diet."

Familiar Advice

Of course, it's a direction you've heard before.

"Eat a plant-based diet that contains at least five servings of fruits and vegetables a day and goes up to include as many vegetables as you can handle," says Fung.

"That doesn't necessarily mean eating vegetarian -- you can have fish and chicken," she tells WebMD. "But you should eat as unrefined as possible, having healthy foods in their whole state. Even if you look beyond stroke, this kind of prudent diet significantly lowers risk of cardiovascular disease, colon cancer, and other conditions."

In her study, none of the participants -- between ages 38 and 63 -- had known heart disease or diabetes when the research began in 1984. The study is published in this week's rapid access issue of Stroke.

Every two to four years, they provided information about their diet, lifestyle habits, and overall health. The women were assigned a ranking based on the lowest to highest amounts of foods they ate in a category of either a produce-rich "prudent" diet or the fattier "Western" diet.

By the end of the study in 1998, Fung found that women who ate the highest amounts of red and processed meats, refined grains, and sweets had a 58% higher risk of stroke compared with those who ate the lowest amounts.

In the "prudent" diet plan, those who ate the most fruits and vegetables were 22% less likely to have a stroke than those who ate less produce.

Lessons Already Learned

These findings back previous studies that looked at how individual types of food affect stroke -- with similar results.

Last month, some of the same researchers working with Fung found a 40% lower risk of ischemic stroke -- the most common type that's caused by a blood clot that impairs blood flow to the brain -- among men who ate the most fruits and vegetables compared with those eating the least. Researchers speculate it's due to the effects of a particular group of antioxidant vitamins, noting that those with the lower stroke risk ate foods with the most vitamins A and E, beta carotene, lycopene, lutein, and other beneficial nutrients.

These nutrients are in vegetables such as squash, carrots, pumpkin, kale, and spinach. Interestingly, that study follows one from last September on some 40,000 Japanese men and women tracked for 18 years that indicates the risk of death from stroke was 26% lower in those who ate yellow or green vegetables each day than those who ate them weekly.

Meanwhile, processed foods might increase stroke risk because they are often high in fats and salt. Some experts suggest that up to 75% of "hidden" salt might come from canned foods and other overly processed fare like deli meats.

"The role of saturated fats as it pertains to stroke is still under investigation, but saturated fats could play some role," Fung tells WebMD. "In essence, an ischemic stroke is much like a heart attack that occurs in your brain, and can result from atherosclerosis."

SOURCES: Fung, T, Stroke: Journal of the American Heart Association, July 2, 2004, rapid access issue. Teresa Fung, ScD, assistant professor of nutrition, Simmons College School for Health Studies, Boston; adjunct assistant professor of nutrition, Harvard School of Public Health, Boston. Hak, A. Stroke: Journal of the American Heart Association, June 4, 2004; vol 35. Sauvaget, C. Stroke: Journal of the American Heart Association, Sept. 19, 2003; rapid access issue.

Feb. 17, 2004 -- The format may look familiar, but experts say the new "Atkins Lifestyle Food Guide Pyramid" has little in common with the food pyramid issued by the USDA.

"It's completely flipped from what was always been done -- the whole grains are at the top and the meats are at the bottom," says registered dietitian Debbie Strong of the Ochsner Clinic Foundation's Heart and Vascular Institute in New Orleans.

Protein sources, such as poultry, fish, beef, pork, and soy products, form the base of the Atkins Lifestyle Food Guide Pyramid. Green vegetables and cauliflower form the next layer, followed by fruits, such as blueberries, raspberries, pears, and avocados. Vegetable and seed oils, cheese and dairy, nuts, and legumes are near the top with whole grains at the peak of the pyramid.

But the Atkins-based food pyramid is only the latest entry into an already crowded field of proposals about what the country's next official nutritional guide should look like.

The original food guide pyramid, which emphasizes bread, cereal, rice, and pasta at the base and limits fats and sweets at the peak, was developed in 1992. Federal officials have acknowledged it needs updating and have solicited comments from experts and the public on the process. A revised version is expected in 2005.

In the meantime, experts say we can expect a flood of food pyramids as groups continue to promote their own versions.

"The problem is we get so many pyramids out there," says registered dietitian Wahida Karmally, DrPH, spokeswoman for the American Dietetic Association. "Anybody can have their own food pyramid, and that's why it's really confusing. It really does a disservice to the American population who is already confused about what they have to eat."

The Food Pyramid, Atkins Style

Last week, the Atkins Physicians Council presented its version of the food pyramid to federal officials in Washington, D.C., and began a media campaign to educate the public about it.

"Clearly the standard food pyramid has not produced the results anticipated with obesity rates doubling among adults and children," says Stuart Trager, MD, chairman of the Atkins Physicians Council.

Trager says the Atkins Lifestyle Food Guide Pyramid serves as a graphic representation of the group's approach to weight loss and weight maintenance.

"With over 30 million people following controlled carbohydrate nutritional programs, we feel it was important to present our version of what a controlled carbohydrate nutrition pyramid would look like, and it was important to clear up misconceptions about what Atkins is and isn't," Trager tells WebMD.

Trager says those misconceptions and confusions come from opponents who try to paint Atkins in an incorrect light by suggesting that it's just about red meat and even some of the copycat diets that have tried to repackage Atkins and market themselves as a "healthier" version.

The pyramid contains no guidelines for number of servings or type of food source in each of the categories. Instead, it makes broad recommendations, such as "Limit and control certain carbohydrates to achieve and maintain a healthy weight" and "Eat until you are satisfied."

The Atkins pyramid also rewards increased physical activity with additional food choices, allowing people to eat more carbohydrates if they are more active.

"As more energy is expended and activity level is increased, people can increase their individualized optimal level of carbohydrates," says Trager.

Building a Better Pyramid

Experts say interpreting those broad guidelines or finding an "individual carb level" may be problematic for many Americans.

"It means you're leaving a lot to people to figure out what they need," says Karmally. "Here they say, 'Discover your individual carb level to achieve and maintain a healthy weight.' How does person without a background in nutrition find out what is good for them?"

Strong agrees that the Atkins pyramid is too vague.

"It just says eat until you're satisfied," Strong tells WebMD. "I don't think anyone really knows the definition of satisfied. We eat what we're given."

Strong acknowledges that most Americans are eating too many refined carbohydrates, such as sugar and white bread. But other types of carbohydrates, such as whole grains and oats, are a valuable source of energy, fiber, and B vitamins and shouldn't be so severely limited.

"I don't like them being at very top of the Atkins pyramid," says Strong. "I could understand refined sugars, simple sugars and things like that, being at the very top but not the whole grains."

Although the current food guide pyramid may be flawed, both Karmally and Strong say there's just too little evidence to support the Atkins pyramid as a healthy choice.

"What we need to tell the American public is how to eat healthily based on science," says Karmally. "The current pyramid was developed with the science that was available at the time it was developed, which was really focusing on a plant-based diet."

"The Atkins food guide pyramid is really not based on science, she says. "We need a lot more science to know what long-term effects of eating so much more protein are."

Gardening can be a great workout and boost for body and soul -- if you do it right.

Sharon Lovejoy, author of Country Living Gardener: A Blessing of Toads, tells WebMD she started gardening as an infant. Her grandmother, not her mother, was the gardener in the family. "I think it often skips a generation," she says.

The key, Lovejoy says, is to see gardening not as a punishment but a joy. "You should feel lucky to be outside in the garden," she says.

And maybe healthier, too. And not just from eating veggies you grew yourself.

Aerobic Gardening

Gardening provides all three types of exercise: endurance, flexibility, and strength.

Jeff Restuccio, author of Fitness the Dynamic Gardening Way, is a first-degree black belt but found he was getting more exercise playing in the garden with his kids. "I like gardening because it's purposeful," he tells WebMD. "With food so cheap in the stores, you may not save money growing your own, but the chances are, if you grew it, your family will eat it."

He suggests making your gardening into a structured exercise routine, alternating light activities with heavier ones, then a light one, and so on. Rake for a while, then dig holes, then prune. "Exercise 30 to 60 minutes, then quit, whether everything is planted or not," he advises.

"Stretch first!" Lovejoy begs. "You'd stretch before going to the gym, wouldn't you?"

Restuccio also recommends concentrating on deep breathing while you work -- and increasing your range of motion, exaggerating the raking motion or the digging motion. "You can use up 500 calories an hour that way," he says (official counts put gardening activities at the 100- to 200-per-hour calorie-burning level).

He also recommends raking right-handed 15 times, then left-handed 15 times.

"If you think double digging (going down a foot, turning the soil over, then down another foot, bringing that soil to the top) isn't exercise," he says, "you haven't tried it."

Gardening is something parents and kids can do together. "Never make cutting the grass or helping a punishment," she urges.

"When I go into the schools, I see so many more obese kids than I did 20 years ago," Lovejoy says. "I think parents are afraid to let them out."

You never know where those seeds, if you will pardon the expression, will fall or when they will sprout. "Many of us probably had to weed the garden," Sandra Mason, an extension educator in horticulture and environment at the University of Illinois, tells WebMD. "A lot [of people] come back to gardening later -- maybe when [they] purchase a home."

Gardening as Therapy

The American Horticulture Therapy Association concentrates on the cleansing, calming benefits of being in the natural world.

• Lovejoy says studies have shown a link between ADHD and insufficient outdoors time.
• "Hospital patients also do better when looking at a plant rather than a cinderblock wall," she says. "Maybe that is how bringing flowers to the hospital got started."
• Older people, even those with memory problems, thrive in a community gardening situation, according to the AHTA.
• Special gardens have also sprung up for the blind, the wheelchair-bound (raised beds), and people with mental disabilities.(2)

  Just walking into a fragrant, warm greenhouse can change someone's whole mood, Lovejoy points out.

May 24, 2004 (Orlando, Fla.) - As the number of children defined as overweight and obese continues to rise, researchers say new studies now show that obese children are more susceptible to lung damage from air pollution than lean youngsters.

"Given the epidemic of obesity in children, it might be we're developing a population more vulnerable to pollution's negative effects on the airway," says Heike Luttmann-Gibson, PhD, statistician and research associate in the Environmental Epidemiology Program at Harvard School of Public Health.

When exposed to the same amount of pollution, obese boys and girls had more trouble breathing than kids of normal weight, she reports.

Obesity's Far-Reaching Health Effects

The findings offer one more reason to put overweight and obese youngsters on a diet and exercise program. Consider the facts:

• The number of overweight and obese children has nearly tripled since the 1970s.

• There has been a tenfold increase in the number of children with type 2 diabetes over the past five years. Once called 'adult-onset' diabetes, type 2 diabetes is linked to obesity and inactivity.

• Overweight kids are more likely to become overweight adults, increasing their risk of obesity-related health conditions such as heart disease, stroke, and bone fracture.

David B. Peden, MD, MS, professor of pediatrics and center director of the Center for Environmental Medicine, Asthma and Lung Biology at the University of North Carolina in Chapel Hill, says, "Being overweight clearly causes a lot of bad things to happen. But even a modest reduction in weight can have a big effect on a child's health, including [lung problems tied to] air pollution."

Problems Expand Along With Ballooning Waistlines

In the study, 611 fourth and fifth graders, who were participating in a larger study on the long-term effects of air pollution, were tested for lung function. About one in 10 was obese. Parents of the children helped fill out questionnaires asking about general and respiratory health.

After analyzing the information, the researchers showed that the effects of air pollution on lung function were two to five times stronger for obese children than for those of normal weight, Luttmann-Gibson reports.

The researchers found that children exposed to nitrogen dioxide -- an irritant that is found in car exhaust -- had a drop in lung function. Obese kids exposed on one day had an 11% dip in lung function the following day, while lean youngsters exposed to the same levels of the pollutant had only a 2% drop in lung function.

The more obese the child, the greater the effects of air pollution on lung function, says Luttmann-Gibson. "Any decline in lung function is bad, and obesity makes it even worse."

Luttmann-Gibson says she suspects that air pollution and obesity pack a double whammy to the airways. Researchers know that chemicals relating to inflammation in the body are elevated in obese persons, she explains. "And air pollution increases inflammation in the airways. Being obese is setting you up to be more susceptible to the inflammatory effects of air pollution."

And that, researchers say, may mean that an increased risk of asthma should be added to the list of obesity-related health conditions.

Peden tells WebMD, "If obesity is resulting in more inflammation, the risk of developing asthma might be further increased, too."

Although further study is needed to prove the association, it's a link many doctors already suspect, Peden says. "It's intriguing, a new and exciting area of interest."

They used to say that Chicago stockyard workers used "everything but the squeal." If you use everything but the gobble, you need to remember several important rules to make sure that table full of lukewarm, breathed-on food is safe to eat later.

William Stallings, MS, RD, clinical dietitian at Temple University Hospital in Philadelphia, says to remember the "2-2-4" formula. This means:

• 2 hours. Store all leftovers in the refrigerator or freeze no more than two hours after cooking. If food has been out more than two hours, toss it.
  
  
• 2 inches. Use shallow containers, about two inches deep, to store food. This will allow it to cool quickly and evenly, foiling pesky bacteria.
  
  
• 4 days. Eat leftovers within four days. Holiday food kept longer than that should be thrown out. Freeze anything that is not going to be used within four days.

It also is important to keep the fridge at 34 to 40 degrees at all times. Don't forget, while preparing the feast, you probably opened it a lot. The setting may need to be lowered a little at least temporarily.

It is also important during prep time, Stallings tells WebMD, to wash your hands frequently and avoid preparing raw meat on a porous surface, such as a wooden cutting board, that might soak up contaminated juices and transfer them to other foods.

Some Foods Keep Better Than Others

Constance Garrett, RD, MS, MA, nutrition and family consumer science adviser at the University of California Cooperative in San Bernardino, tells WebMD that stuffing doesn't keep well. At the very least, it should be removed from the turkey cavity if some of it was placed there. While inside, the dressing may flavor the turkey -- and be flavored by it -- but it might not get hot enough to thoroughly scourge harmful bacteria.

These days, many people put an onion and herbs inside the turkey and prepare the dressing in a separate pan as a side dish.

Stallings says it's OK to cook the stuffing inside, though, if you use a meat thermometer and make sure the stuffing reaches 165 degrees Fahrenheit.

"People also put a lot of delicate stuff in mashed potatoes at Thanksgiving," Garrett says. "They can be risky to keep unrefrigerated."

Sweet potatoes, however, contain sugar and are also prepared using sugary ingredients (such as those excellent little marshmallows). "Sugar," Garrett notes, "acts as something of a preservative."

What about that creamy greenbean/onion ring casserole? "It only contains three-fourths of a cup of milk," Garrett says, "so it keeps fairly well."

She also recommends that some dishes be prepared ahead, frozen or refrigerated, and then microwaved, giving you another shot at zapping harmful bugs. "This keeps the food safe a little longer."

May 8, 2000 -- The ancient pyramids have long conjured up visions of King Tut, golden statues, and the dusty sands of Egypt. Our own homegrown version of the pyramid symbolizes something a little less exalted: good nutrition. Even so, the U.S. Department of Agriculture's (USDA) Food Guide Pyramid, the nation's official advice on diet, promises the key to a long and healthy life.

But in an age of ethnic and fusion cuisines, when was the last time you saw tortillas and jalape?os on the pyramid? Or bok choy and edamame soybeans? They don't appear, of course, which is just one reason why critics have complained recently about the official guidelines. Instead of reflecting the fast-changing face of America, they charge, the pyramid remains culturally biased. Worse yet, it's out of touch with current nutrition research. Some critics say that the pyramid places too much emphasis on dairy and meat products. Others worry that it encourages people to eat more meat than is healthy.

Most Minorities Can't Take Lactose

More immediate are the severe cramps, diarrhea, and gas that millions of lactose-intolerant Americans can suffer from eating the dairy products emphasized on the pyramid. Without the ability to digest the sugars in milk, people with lactose intolerance, including 90% of Asians, 70% of African-Americans and Native Americans, and 50% of Latinos, aren't likely to get enough bone-strengthening calcium. They avoid dairy products without substituting other foods that are also rich in calcium.

To remedy that situation, the Physicians' Committee for Responsible Medicine (PCRM), a pro-vegetarian advocacy group, is currently lobbying health officials to list other calcium-rich foods on the pyramid. Broccoli, collards, and other dark-green leafy vegetables are great sources of calcium, says Milton Mills, MD, an associate director of preventive medicine at PCRM.

Other good alternatives are lactose-free dairy products, available in many grocery stores, and yogurt or buttermilk. Though these last two are officially dairy foods, both contain bacteria that digest lactose.

No Limits Needed on "Good" Fats

Another disagreement centers on how much fat a healthy diet should contain. The USDA Dietary Guidelines proposed for the year 2000 recommend that no more than 30% of the day's total calories should come from fat. But people who follow the traditional heart-healthy Mediterranean diet typically consume as much as 45% of their daily calories as mono- and polyunsaturated fats.

In the days of lard and tropical oils, it made sense to cut back on total fat. But if you use unsaturated oils like canola and safflower oils, says Meir Stampfer, MD, professor of epidemiology and nutrition at the Harvard School of Public Health, there's no need to fret about how much you consume.

"I wanted them to get rid of the restriction on 'total fat' entirely," Stampfer says. It is true that saturated fats are directly linked to elevated cholesterol levels. He goes on to explain that mono- and polyunsaturated fats, like those found in olive and canola oils, have been shown to prevent blood cholesterol levels from climbing.

Yet even those findings may require slight refinement. Recent work presented at the March 2000 meeting of the American College of Cardiology in Anaheim, Calif., comparing canola, fish, and olive oils found that olive oil, unlike the other two types that continued to show heart-healthy benefits, may be nearly as dangerous as saturated fats when it comes to clogging arteries. See: Best Heart Benefits From Canola and Fish Oils -- Not Olive Oil.

At the moment it would appear that, unless you have a weight problem and need to cut back on calories, you can't go wrong by adding salmon, mackerel, soybeans, nuts, and avocados -- all rich in unsaturated fats -- to your diet. Consider avoiding olive oil in favor of canola and fish oils, and go easy on saturated fats such as palm and coconut oils, and animal fats, such as lard, butter, and cream.

March 12, 2004 -- You've seen them -- those diet ads with "before-and-after" pictures of obese people. They only perpetuate hurtful stereotypes, according to a new study.

"Given that these ads reach millions of people every day, their potential for harm is vast," writes researcher Andrew Geier, a psychology graduate student at the University of Pennsylvania. His study appears in the current issue of Eating and Weight Disorders.

"Significant social stigma and weight discrimination occur in many important areas of life, including employment, medical care, and education," he says.

"Despite no clear relationship between certain character traits and weight, negative judgments are routinely made about those who are overweight." writes Grier.

A major contributor to the stigma is the impression that individual can easily control their weight and that there is a lack of self-discipline and personal failure that are responsible for excess weight. Societal messages can enhance these stigmas and contribute to antifat attitudes, he writes.

In Geier's study, 59 female college psychology students aged 18-21 completed a few questionnaires about their life satisfaction and life experiences.

Then, they were shown various advertisements. One set was a "before-and-after" diet type of ad with side-by-side pictures of obese people and slim people. The other type was a "joy of gardening" ad featuring a well-groomed, pleasant-looking person who was either obese or slim. Volunteers were not told the study involved obesity -- although a few said they suspected it was. His intention was to see the impact of exposure to "before-and-after" diet ads.

The volunteers then assigned various adjectives to subjects in each ad: lazy, motivated, ugly, good, blameless, bad.

• Overall, volunteers showed a "strong" antifat bias.
• Having a close friend or relative who was obese appeared to have a lessening effect on general antifat attitudes but it did not influence the belief that weight is controllable.
• Those who indicated greater satisfaction in their own lives showed less negativity toward the obese people in the ads.

Studies of racial stereotyping have found a similar effect -- that negativity is greatest among those who are less satisfied with their own lives, writes Geier.

His study also found that:

• Subjects rated the woman in the 'before' picture as more attractive when she was in the before-picture-only ads than when she was in the 'before-and-after-picture' ads.
• They found that the students also rated 'after' pictures as more attractive in the 'after' pictures only ads than in the 'before-and-after' ads.

One explanation for this, writes the author, is what is termed 'the caterpillar to butterfly' effect'. Once a subject has witnessed the appealing future, the present suddenly emerges as more attractive, says Geier.

"Most agree that stigma is wrong, but fewer appreciate how damaging stigma can be on the psyche and the physical health of the targeted individual," he says.

One thing that should be obvious is that shaming obese people is not the same as helping them, Geier concludes.

SOURCE: Geier, A. Eating and Weight Disorders, December 2003; vol 8: pp 282-288.