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2 Gazette Health | Fall 2012 A GAZETTE PUBLICATION

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GAZETTE.NET Summer 2012 | Gazette Health 3

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A publication of The Gazette | Fall 2012

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Content is for informational purposes only and should not be construed as personalmedical advice, nor as a substitute for seeing your own medical professional(s).

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GAZETTE.NET Fall 2012 | Gazette Health 5

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Giving small daily doses of egg powder tochildren with an egg allergy could pave theway to letting them eat the food safely.After 10 months, more than half of theallergic children in a new study who hadbeen eating egg powder daily showed noallergic reaction, or onlyminor symptoms. A yearlater, 30 of the 55 kidsin the study passed achallenge with evenhigher doses of eggpowder. The 30 thenavoided all egg productsfor four to six weeks, afterwhich they were given egg powder, plus awhole cooked egg. Over a third of thosechildren did not react and were cleared toeat eggs as part of their diet. A year later,they were still showing no signs of allergicreaction. Researchers said the therapy isstill in the early experimental stages. Andthey strongly caution that this type of oralimmunotherapy should never be tried athome due to the risk of severe allergicreaction. -NIH

Beating eggallergy in kids

ittle teapots with long spouts havebecome a fixture in many homes forreasons that have nothing to do withtea. Called neti pots, they are used torinse the nasal passages with a saline

solution, and have become popular as a treat-ment for congested sinuses, colds and allergies,and for moistening nasal passages exposed to dryindoor air.However, the U.S. Food and Drug Administra-

tion (FDA) warned about the risk of infectiontied to improper use, issuing a statement inAugust about safe practices for neti pots andother nasal rinsing devices.The source of water used with neti pots is the

largest concern, the FDA said. Unfiltered tapwater that is not treated in specific ways isunsafe to use for nasal rinsing. Tap water cancontain low levels of organisms, like bacteria

and protozoa, including amoebas that, while safeto swallow because stomach acid kills them, canlive in nasal passages and cause potentially seri-ous infections, according to the Centers forDisease Control and Prevention.These devices are generally safe and helpful

when used and cleaned properly, said StevenOsborne, M.D., a medical officer with the FDA.Improper use of neti pots may have caused

two deaths in 2011 in Louisiana from a very rarebrain infection that the state health departmentlinked to tap water contaminated with an amoebacalled Naegleria fowleri.Talk to your doctor to determine if nasal rins-

ing will be safe and effective for your condition.If symptoms are not relieved or worsen after therinse, then return to your health care provider,especially if you have a fever, nosebleed orheadaches while using the rinse.

Silent heart attacks—in which there are notypical symptoms like chest pain andshortness of breath—are not only morecommon than previously thought, but more

common than heart attacks withrecognized symptoms, accord-ing to a recent study of olderadults. Researchers from the

National Institutes of Healthfound the prevalenceof these heart attacks

was especially high inseniors with diabetes,

and that magnetic resonanceimaging (MRI) was more effective than anelectrocardiogram (EKG) in identifyingthem. Those who suffer a silent heartattack may mistake it for something else,such as muscle pain, indigestion or the flu,according to the Mayo Clinic.

L

Is it safe toRinse Your Sinuses? A silent killer

Taking vitamin D supplements may lower children’s risk of respiratory infections. Because the body naturallyproduces the vitamin in response to sunlight, this may be especially true in winter when that light is limited.


Brain abnormalitiesseen in hoardersUntil recently, hoarding disorder

has been considered a type of obses-sive-compulsive disorder (OCD).Now, many experts consider it aunique diagnosis.People with hoarding disorder

have trouble making decisionsabout when to throw things away.Possessions pile up, resulting indebilitating clutter.Results from a new study fund-

ed by the National Institute ofMental Health suggest that hoard-ers’ decisions about possessions arehampered by abnormal activity inbrain regions used to identify theemotional significance of things.Scientists believe that these

abnormalities are specific to hoard-ing and separate the disorder fromOCD. In addition to furtherexploring the unique traits ofhoarders, researchers are now usingthis information to help assesspotential treatments.Previous studies of brain func-

tion in hoarders implicated regions

associated with decision-making,attachment, reward processing,impulse control and emotionalregulation. But the patient popula-tions and research methods variedamong the studies, making clearconclusions difficult.In the new study, researchers

analyzed brain images of 43 hoard-ers, 31 people with OCD and 33healthy controls. Participants weregiven six seconds to make a deci-sion about whether to keep or dis-card junk mail that either belongedto them or to someone else.Participants later watched as theitems they chose to discard wereplaced in a paper shredder.The hoarders chose to keep

more mail that belonged to themthan those in the OCD or healthycontrol groups. Hoarders alsotook longer to make decisions andreported greater anxiety, indeci-siveness and sadness than the othergroups. -NIHIS

TOCKPHOTO:CHILD

WITH

COLD,TIM

SA;NETIPOT,NULLPLUS;EGG,STOCKCAM;HOARDIN

G,_IB_;MRI,JGROUP

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1861163


BY ARCHANA PYATI

Fear of the dentist is serious and has far-reaching consequences for a person’s overallhealth. According to the Centers for DiseaseControl and Prevention, only 61 percent ofU.S. adults in 2010 had visited the dentistwithin the previous year. However, 81.6 per-cent of adults in the “Bethesda, Gaithersburgand Frederick” region seen had a dentist atleast once that year.Many patients still avoid the dentist for avariety of reasons, including a lack of

insurance and basic paranoia. “If youhave fear, go and have a consultfirst,” said Michele Dozier, D.D.S.,a pediatric dentist at nusmiles inTakoma Park. “A conversa-tion—that’s where we start.”

1 Prevention of gumdiseaseGum disease is the No.1 cause of tooth lossin the United States,according to TamiPantano, D.M.D., who

recently opened AudubonDental Center of Clinton. Itbegins with gingivitis, wherebacteria in the mouth causeplaque and tartar—a hardenedform of plaque—to build upalong the bottoms of the teeth.

If left untreated, gingivitiscan progress to periodontaldisease, when plaque seepsbelow the gumline, causingthe gums to recede and boneto deteriorate. “When thathappens, that’s irre-versible,” she said, addingthat it takes six monthsfor plaque to slip downbeyond a toothbrush’s

reach. Those scraping instruments a dentistuses, called scalers, are sharp and preciseenough to remove the buildup. “Even thehealthiest mouths need cleaning every sixmonths,” said Pantano.

2 Spotting cavities before they lead toinfection or tooth loss

Like plaque, cavities are also caused bybacteria, which eat away the tooth’s enamel,creating holes. If caught when they’re smallenough, they can be filled, said Danny Dinh,D.D.S., a dentist with the Family SmileCenter in Frederick. If left to grow, cavitiescause tooth decay, which may lead to anextraction or an infection of the nerves andtissues around the tooth.“By the time [the patient is] in pain, the

cavity is huge. That’s when they need a rootcanal,” where damaged nerves and tissue areremoved and what remains of the tooth issealed and protected with a crown, said Dinh.

3 Learning the proper way to brush“I didn’t know how to brush my teeth

until I went to dental school,” said Pantano.Proper brushing, she added, is not exactly aninstinctual skill, but something that must belearned. She recommends brushing in a circu-lar motion with the brush held at a 30- to 35-degree angle.“Many patients don’t know what the

proper technique is, and they never removethe plaque effectively,” said Rimple Singh-Crawford, D.D.S., of Fenton Family Dental’sClinton office. Patients target the front teeth,she said, but aren’t always diligent aboutcleaning molars in the back of the mouth.The insides of the bottom front teeth are

another tricky area where plaque canbecome a problem, according to Pantano.The Philips Sonicare, she said, creates the cir-cular motion needed for proper cleaning.Many electric toothbrushes also have timersto make sure brushing lasts long enough.

DENTAL HEALTHISTOCKPHOTO/M

OCKER_BAT

8 to stop avoiding your dentistREASONS


4 Rule out oral cancer andother diseases that startin the mouth

Dentists check more than yourgums and teeth. They consideroverall oral health and perform anoral cancer screening on newpatients. “We examine the gums,the tooth structure…underneaththe tongue where they can’t see,”said Singh-Crawford.“A lot of systemic diseases have

oral dimensions,” said Pantano,citing HIV as an example of a dis-ease that appears in its early stagesin the mouth. “Most of the time,it’s a fungal infection, and if we seea fungal infection, that shows thepatient is immunocompromised.”

5 Fix functional orcosmetic problems

Even if you diligently brush andfloss every day, you can’t fix struc-tural problems without the help ofa dentist and, probably, an ortho-dontist. “Sometimes teeth need tobe straightened out for functionalreasons,” said Dinh, such as theinability to clean in between theteeth due to overcrowding.Braces or retainers may be need-

ed for adults if structural problemswere not corrected when they wereyounger. Under bites and overbitescould indicate a problem with thejaw and other temporomandibulardisorders, said Pantano.

6 Control halitosis, knownas bad breath

One telltale sign of periodontaldisease, said Dozier, is a distinctive,foul odor. Halitosis is caused bybacterial buildup in the mouth.Infrequent and ineffective brushingand flossing can be the culprit, ascan a failure to clean the tongue,said Dinh, who recommends atongue scraper for this purpose.Getting timely cleanings helps keepthe buildup of plaque at bay, whichwill mean fresher breath.

7 Oral hygiene and healthis critical when managingdiabetes.

Pantano recently attended a dia-betes fair in Washington, D.C.,where she reminded attendees howimportant it is to care for theirmouths and get regular checkups.“Gum disease is more severe in

diabetic patients…and one of thebiggest reasons is that the elevatedblood sugar provides extra nutri-tion for the bacteria,” she said.Due to weaker immunity, dia-

betic patients tend to be prone toinfections in all areas of their body,including the mouth. Diabetes alsomanifests itself with oral symp-toms like drymouth, said Pantano,which a dentist can help treat.“Health starts with your

mouth,” said Singh-Crawford. “Ifyou lose your teeth, you can’t eathealthy foods like fruits and vegeta-bles,” which are essential for dia-betic patients. “It’s very importantfor these patients to have healthymouths so they can chew anddigest properly.”

8 It’s better to take apreventative, rather thanreactive, approach tooral health.

In the old days, dentistry tendedto be more reactive than proactive,said Pantano. The thought “used tobe if ‘it’s broken, fix it,’” saidPantano. “Now, we’ve figured outways to prevent it from being bro-ken in the first place.”Not all of her patients, though,

have changed their mindset aboutthe importance of catching prob-lems early. She still gets calls fromemergency room doctors when oneof her patients shows up at the hos-pital in excruciating pain with anabscessed tooth. “I really push pre-vention,” she said. “I have happierpatients and a happier me whenthey don’t have problems.”

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CHILDREN’S HEALTH

BY ARCHANA PYATI


According to study published inMay in PEDIATRICS, the officialjournal of the American Academyof Pediatrics, researchers from theCenters for Disease Control andPrevention noted the prevalence ofprediabetes or diabetes jumpedfrom 9 percent in 1999 through2000 to 23 percent in 2007through 2008.Prediabetes is a precursor to

type 2 diabetes, where the bodygradually develops resistance toinsulin. Insulin is the hormoneneeded to regulate blood sugar,moving it from the bloodstreamto cells to be stored and later usedfor energy.Historically, children were more

likely to be diagnosed with type 1diabetes. Also known as juvenilediabetes, type 1 occurs when thebody produces little or no insulin,and researchers say its origin is afaulty immune system. Type 2 dia-betes, on the other hand, had beenfound mostly in adults, whosebodies stopped responding toinsulin due to weight gain andother factors.Now, that generational divide

seems a little less clear as moreoverweight and obese teenagersqualify as prediabetic. As morepatients fit this profile, doctorsurge parents to take amore aggres-sive role in ensuring their childrenstay physically active and maintaina low-carb, high-protein diet tofacilitate weight loss and maintainhealthy blood sugar levels. Whilenot fully understood, the linkbetween obesity and insulin resist-ance, a hallmark of prediabetes,has been made by scientists in

recent years, which doctors see onthe front lines of their practices.“Definitely, we’re seeing more

kids with overweight and obesity,and soon, I will see more patientswith prediabetes and type 2 dia-betes,” said Cong Ning, M.D.,who is a pediatric endocrinologistat Shady Grove Adventist Hospitalin Rockville.

Prediabetes: Why Diagnose?Prediabetes occurs when a per-

son’s fasting blood sugar is in anabnormal range—between 100 and125 mg/dL—and they have one ormore of the following: a high bodymass index; dark, velvety patches ofskin behind the neck and under-arms, known as acanthosis nigri-cans; a family history of diabetes; orhigh blood pressure. Once a per-son’s fasting blood sugar reaches126 mg/dL or higher, she’s consid-ered diabetic.While it’s not a new term, predi-

abetes among both adults andteens is being discussed withgreater frequency now becausewe’re learning more about howdiabetes and other chronic diseasework, and the definition of what’s“normal” keeps changing, saidVivek Sinha, M.D., a family physi-cian at Fort Washington FamilyMedical Center, affiliated withSouthern Maryland HospitalCenter. “Research has shown thateven patients that are at 118[mg/dL] show signs of insulinresistance…,” he said.Identifying teens who are pre-

diabetic opens up the possibility ofreversing course on a diagnosisthat once seemed

ver a nine-year period, prediabetes ordiabetes in American teenagers nearlytripled. This troubling news comes aspediatricians are treating a specific

group of patients with greater frequency: youngpeople who have developed symptoms of achronic disease more commonly found in adults.

O

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3


BY KAREN FINUCAN CLARKSON

f you think you’re immuneto whooping cough, thinkagain. “Sometimes peoplethink, ‘I got vaccinated as akid so I’m protected,’” saidCynthia Roldan, M.D., apediatric hospitalist at

Carroll Hospital Center in Westmin-ster. With whooping cough—known aspertussis—staging a comeback nation-wide, Maryland public health officialsand physicians are encouraging vacci-nation of adults as well as children.Whooping cough can be fatal, espe-

cially in infants. “Pertussis can bringon seizures or make it difficult tobreathe properly, resulting in braindamage or death,” said Avni Jain,M.D., who is a primary care physicianwith Adventist Medical Group inGermantown and privileges at ShadyGrove Adventist Hospital in Rockville.“Two-thirds of children less than 1 yearof age with pertussis are hospitalized.”Of the 111 pertussis deaths in the U.S.from 2004 to 2008, 83 percent were ininfants under 3 months old, accordingto the Centers for Disease Control andPrevention (CDC).Whooping cough cases are on the

rise. The CDC reported 21,401 casesof pertussis this year, through Aug. 4.That is more than double what wasreported for each of the last three yearsat the end of the 31st week and is ontrack to become the highest numberrecorded in more than 50 years.Maryland has seen an increase in

pertussis, though it is not on par withWashington state, where 3,202 cases have triggered an epidemic. As ofAugust, there had been 141 cases of whooping cough in Maryland this year,compared with 56 in 2011 and 64 in 2010. In Montgomery County,Registered Nurse Cindy Edwards has noticed “a significant upswing of per-tussis.” Last July there was one case, whereas this July there were 14. InApril through June of last year, two cases were reported, compared with 36in the same quarter this year. “That’s not an epidemic, but still significant,”

said Edwards, the manager of theDisease Control Program withMontgomery County’s Department ofHealth and Human Services.

THERE ARE MULTIPLE REASONS FORthe increase, according to VivekSinha, M.D., a family medicine physi-cian with Southern MarylandHospital Center’s Fort WashingtonFamily Medical Center. “Some peo-ple, worried about side effects, are notvaccinating anymore. We’re testingmore, so we’re finding it more. And,after a while, the immunity of thosewho were vaccinated wanes,” he said.As a result, “we don’t have as high

of a herd immunity,” said Edwards.Couple that with the cyclical nature ofpertussis—“every three to four yearsthere’s a resurgence in cases,” shesaid—and there’s the potential for aperfect storm.The clouds of that storm began

forming in the 1990s when a newwhooping cough vaccine was devel-oped. In response to concerns aboutpotential side effects—fever, swellingat the injection site and, rarely,seizures—associated with the original1940 vaccine, which used smallamounts of inactivated whole bacte-ria, an acellular version, containingonly fragments of bacterial cells, wassubstituted. “There is concern that theacellular pertussis vaccine doesn’t pro-vide immunity as long as the olderpertussis vaccine,” Edwards said.Vaccination, which is about 85 per-

cent effective, remains the best way toprevent pertussis or minimize the

severity of the disease, most medical professionals agree. Two vaccines—DTaP and Tdap—help protect against diphtheria, tetanus and pertussis.DTaP is a pediatric formulation, while Tdap, considered a booster, is prima-rily for adolescents and adults.Current “guidelines recommend that DTaP be given five times—at 2, 4

and 6 months, then at 15 to 18 months and 4 to 6 years of age,” said Sinha.“In adolescence, about the time they’re going into seventh grade, they should

CHILDREN’S HEALTHISTOCKPHOTO/C

HRISTOPHER

BERNARD

WHOOPING COUGHcases on the rise in Maryland

I


get Tdap. Adults between the agesof 19 and 64 should get a singleTdap vaccine.”

IN FEBRUARY, THE CDC’S ADVISORYCommittee on Immunization Prac-tices recommended Tdap for alladults 65 years and older. Givenwhooping cough’s resurgence, thecommittee is reviewing the need foradditional doses of Tdap and thetiming of revaccination of thosewho have received Tdap.Because more than 30 percent of

whooping cough cases in infantscan be traced to the mother, it isimperative that pregnant womenbe vaccinated, said Roldan. A doseof Tdap may be given to underim-munized women late in the secondtrimester or in the third, or in theimmediate postpartum periodbefore discharge from hospital.Pertussis is highly

contagious and, oncebrought into a home,infects 80 percent ofsusceptible members ofthe household. “Theonly way to protectyour infant is to protecteveryone around theinfant,” Roldan said.Jain concurred: “If you have a

small infant in the house, get every-one immunized who may come incontact—parents, grandparents,siblings, nanny.”Because pertussis initially mimics

a common cold, many cases, partic-ularly mild ones in adults, go undi-agnosed, according to RobinMadden, M.D., a pediatrician withDiscovery Pediatrics in SilverSpring and secretary/treasurer ofthe medical staff at Holy CrossHospital. While the adult may notbe terribly ill, he is contagious.Keeping those who cough or

sneeze away from an infant is sen-sible, although not always practi-cal. “If you’re a mom or dad takingcare of a baby, you’re probably notgoing to let a cough or cold keepyou from doing so,” said Sinha.Even more problematic is thatsomeone in the early stages ofwhooping cough may not know he

has it. “The incubation period lastsup to three weeks and during thattime there may not be any symp-toms, or just mild ones. You maynot feel your best or have a bit of arunny nose.”Once symptoms appear, it takes

“about a week for the cough toturn more severe,” said Roldan.“It’s a rapid, deep cough followed,at the end of the episode, by a high-pitched whoop…Older kids maynot have the whoop, but maycough so forcefully that they vomit.Like other upper respiratory infec-tions, whooping cough may wors-en at night.”Pertussis often presents differently

in infants. Cold symptoms may belacking. “Half of them have apnea,meaning they stop breathing,” saidMadden. “About 20 percent getpneumonia, 1 percent have seizures

and 1 percent die. Inabout 0.3 percent thereis brain swelling,which could be due toa lack of oxygen orfrom toxins that thebacteria produce.”Whooping cough is

treated with an antibi-otic. “After five days

on an antibiotic, [a person is] nolonger considered contagious,”said Edwards. Still, it can takeweeks to fully convalesce.In the meantime, Edwards

works to identify anyone withwhom a whooping cough patientmay have had close contact duringthe incubation period and whensymptoms were present. “Ourinvestigation involves a fairly largegroup of contacts,” she said, “andwe recommend to every single onethat they receive a prophylacticantibiotic. We coordinate withphysicians and, if a minor isinvolved, the parents.”While natural infection may

subsequently boost immunity topertussis for a period—betweenfour and 20 years, according toCDC estimates—routine vaccina-tions should be continued. “Weneed to be vigilant about vaccina-tions,” said Roldan.

More than 30percent ofwhooping

cough cases ininfants can betraced to the

mother.

1864662

SENIORS’ HEALTH




e’re all destined togo deaf if we livelong enough. If you

make it to 100, you will be hard ofhearing, guaranteed. Everyone loseshearing to one degree or another asthey age,” said Bryan C. Ego-Osuala, M.D., an otolaryngologistwith The Center for Ear, Nose &Throat at Doctors CommunityHospital in Lanham.The first signs of age-related

hearing loss, known as presbycu-sis, begin to appear in one’s late50s or early 60s, according to Ego-Osuala. High-frequency sounds—such as the chirping of a bird, theringing of a phone, or consonantsand blends such as “s” and “th”—generally are the first to go.“I was stunned when my hus-

band and children said I had ahearing problem. I thought peopleweren’t speaking loudly enough orwere mumbling,” said LeanoreCalem, 79. “I kept turning the TVup louder and louder to the pointwhen my kids would visit they’dtell me to turn it down.”The Kensington resident is in

good company. As many as half ofall people 75 and older have hear-ing loss, as do about a third ofadults from 65 to 75, according tothe National Institute on Deafnessand Other Communication Dis-orders (NIDCD).Presbycusis is progressive.

“We’re all born with a finite num-ber of hair cells in our ears—inthe cochlea or inner ear—thathelp transmit sound to the hear-ing nerve, which then takes thesound to the brain,” said Ego-Osuala. “During our lives, as the

hairs grow and are exposed tosound, they die. They do notregenerate. So, most hearing lossis permanent.”“What we’re finding is that, for

the vast majority of people, hear-ing loss doesn’t happen in isola-tion,” said Kate Scully, a clinicalaudiologist with Hearing CenterSilver Spring. There are a numberof physiological changes and age-related ailments that result inhearing loss.

“IT USED TO BE THAT AGINGalone was the No. 1 cause of hear-ing loss—and noise second. Nowit’s [the] reverse,” said Scully.“Noise has a compound effectand, over time, takes a toll.”Many baby boomers who fre-

quented rock concerts, cranked upthe stereos and blasted personal CDplayers are discovering that forthemselves. Among Americans 46to 64, about 15 percent alreadyhave hearing problems, accordingto a survey by the Better HearingInstitute (BHI).While there are conflicting stud-

ies as to whether the baby boomergeneration’s hearing loss is anymore significant than that of previ-ous generations, the large numberof aging boomers means that by2030 there may be 44 millionAmericans with some degree ofhearing loss, according to BHI.That would be about a 19 percentincrease over today’s number.

CARDIOVASCULAR DISEASE CANbring about hearing loss. “The innerear is highly dependent on a richblood supply, so vessel healthcan affect hearing,” said Scully.“Smoking also can

“W

[continued on 30]

1862402

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BY ARCHANA PYATI

magine eating a healthy diet and exercisingregularly, yet gaining weight and feeling a debil-itating fatigue for no explicable reason. Nowimagine going to your doctor, taking a bloodtest and being told you are absolutely fine.

This is precisely what happened to Abbey Black, 32, amedical assistant who lives on the outskirts ofHagerstown in Falling Waters, W. Va. Seeking a special-ist’s opinion can be important for women who sufferfrom hypothyroidism, a type of thyroid disease.It took Black a year from the “everything’s fine” con-

versation with her general practitioner to receiving adiagnosis from an endocrinologist that made sense toher: Hashimoto’s thyroiditis. The autoimmune diseaseoccurs when antibodies attack the thyroid gland, impair-ing its ability to secrete hormones that control everymajor bodily function—frommetabolism to heartbeat tohair growth to bowel movements.“It’s a frustrating disease,” said Black, whose mother

and sisters also have Hashimoto’s. “You have to work alot harder at things when you have thyroid disease.”

The American Thyroid Association (ATA) estimatesthat 20 million Americans have some form of thyroiddisease, and it disproportionately affects women.Women are five to eight times more likely to developthyroid problems, and up to 60 percent of those with athyroid disease are not aware they have a disorder.“There’s a lot of misdiagnoses,” said Majd Hakim,

M.D., the Frederick-based endocrinologist who treatedBlack. “Many patients have symptoms for many yearsbefore they get diagnosed.”Hakim said the underdiagnoses stem, in part, from a

less-than-precise blood test doctors administer to findout if a patient’s thyroid is working properly. The testmeasures the amount of thyroid-stimulating hormone, orTSH, in the blood. Secreted by the pituitary gland, TSHtriggers the thyroid to produce essential hormones T3(triiodothyronine) and T4 (thyroxine).The test range for what’s normal is fairly broad, which

causes many patients’ thyroid disorder to remain unde-tected. Symptoms, like fatigue, weight gain, insomniaand depression, persist and may even be attributed to amood disorder. “We need to look at patient family histo-ry, symptoms…a lot of times [patients]

WOMEN’S HEALTH

Sometimes a woman

can experience both

hyper- and

hypothyroidism, as was

the case with media

queen Oprah Winfrey,

who went public with her

struggles with thyroid

disease in 2009. After

putting back on the

pounds she had lost in

the mid-2000s, she

was diagnosed with

hyperthyroidism, which

then morphed into

hypothyroidism, a culprit

behind her weight gain.

“Who knew this tiny

butterfly gland at the

base of the throat had so

much power? When it’s

off, the whole body feels

the effects,” she wrote in

her essay “How Did I Let

This Happen Again?”

published in O,

The Oprah Magazine.

THYROID DISEASEwhy it may go undetected

ISTOCKPHOTO:OPRAH

WIN

FREY

BY

JASON

MERRITT/XX,EDSTOCK

CONTRIBUTOR;WOMAN

AND

DOCTOR,SKYNESHER

Up to 60percent ofthose witha thyroiddiseaseare notawareof it.

I

[continued on 33]


1866936

MEN’S HEALTHIS

TO

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O/F

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18 Gazette Health | Fall 2012 A GAZETTE PUBLICATION BY KAREN FINUCAN CLARKSON


f a keg now sits where yoursix-pack used to be, youcould end up paying a heftyprice—your health or yourlife. “Excess weight in themidsection can lead to prob-lems with cardiovascular dis-

ease, hypertension, metabolic syn-drome—which can lead to dia-betes—and some cancers, the mostcommon for men being prostate can-cer,” said Patricia Guay-Berry, clini-cal nutrition manager at SuburbanHospital in Bethesda.

With nearly 75 percent of the menin Maryland considered overweightor obese, according to The Henry J.Kaiser Family Foundation, there aremore than 1.5 million men whosespare tires could use some deflating.And the sooner the better, as belly fatis potentially lethal, according to theMayo Clinic.

What makes abdominal fat sodangerous is that it includes visceralfat, which lies deep inside theabdomen and surrounds the inter-

nal organs, said Heather Boyd, leaddietitian at the FMH WellnessCenter in Frederick.

“Visceral fat is more likely to getbroken down and go into the blood-stream, increasing lipid and triglyc-eride levels,” she said. Unhealthyblood fat levels cause plaque to formon artery walls, eventually restrictingblood flow and leading to heartattack and stroke.

Despite the label, beer does notmake a belly. “The beer belly got itsname because people who drink a lotof beer take in extra calories,” saidReed M. Shnider, a cardiologist withCardiology Associates LLC and priv-ileges at MedStar MontgomeryMedical Center in Olney, “and whenyou take in more calories than youburn, you get fat.”

In men, that fat ends up in the gut;in women, it most often plants itselfin the hips and thighs. “Men areapples and women are pears,” saidShnider. Gender plays a major role inhow fat is distributed.

Hormones seem to influencewhere fat goes in the body, accordingto Boyd. Both estrogen and testos-terone hold in check an enzymeknown as lipoprotein lipase (LPL),which promotes fat storage. In awoman’s body, the highest LPL levelsare usually found in the breasts, hipsand thighs, and in a man’s body, LPLlevels are highest in the abdomen. Ashormone levels decline with age, LPLin those areas becomes more activeand fat deposits grow.

A waist circumference of 40 inchesor more for men and 35 inches ormore for women is cause for concern,according to Boyd. It indicates anunhealthy concentration of belly fat.

“The good news [for men] is thatabdominal weight is easier to losethan weight from the hips andthighs,” said Guay-Berry. Althoughvisceral fat is buried in theabdomen, it tends to respond wellto diet and exercise.

The prevailing theory is that vis-ceral fat is more

I

[continued on 25]

Don’t thinkyou can

spot reduce.It doesn’twork. It’s acombinationof aerobicsand strengthtraining thatwill help.”–Heather Boyd, dietitian

1859212


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There were days when ChrisBarritt despaired of ever being ableto ride hismotorcycle again, let alonetake it on a much-anticipated 5,000-mile international road trip. Un-expected open-heart surgery, while alifesaver, left theMount Airy residentwith 16 weeks to “heal and buildenough strength back to be able toride again,” he said.The events that led him to an

operating room at WashingtonAdventist Hospital in Takoma Parkwere traumatic, but they undoubted-ly saved his life. As he was dressingone morning inMarch 2011, Barritt,then 57, felt a familiar heaviness inhis arm, a sensation he had dismissedon previous occasions. This time,however, something was different.“I could think words, but couldn’t

get them out of my mouth, couldn’tspeak them,” he said. “Believe it ornot, I actually hemmed and hawedabout going to the hospital. Mywife called my primary care physi-cian who said to me, ‘Listen toyourself. You can’t speak properly.Go now.’”At Carroll Hospital Center in

Westminster, physicians diagnosed atransient ischemic attack (TIA), amini stroke, which occurs whenblood flow to a part of the braintemporarily stops.Because he was healthy and

active—Barritt worked as aMercedes-Benz mechanic and wasan avid walker—the diagnosis

came as a surprise. It would, how-ever, lead doctors to yet anotherdiagnosis that had even greatershock value.As he sat in his cardiologist’s

office undergoing an echocardio-gram, he “could see something onthe screen flapping around like apiece of seaweed. I knew just enoughto know that wasn’t right.” Whathad caught his eye was a tumor.When Barritt asked the cardiolo-

gist how it could be fixed, “he toldme, ‘Open heart surgery. You’regoing to Washington Adventistnow. If it doesn’t come out, there’s ahigh possibility of a catastrophic,debilitating stroke or death. If apiece pops off, it’s a straight shot tothe brain.’”Barritt broke the news to his wife

and the couple drove from MountAiry to Takoma Park. He spent fivedays on blood thinners beforeundergoing surgery. “It was all kindof a blur and very surreal.”Five days after the operation,

Barritt was home. “God it hurt. Ithurt to sneeze, cough, laugh. Therewas a nine-inch incision that splitmy sternum.” The planned motor-cycle trip through New England andCanada seemed like pie in the sky.After a few days at home, Barritt’s

wife suggested he get out and walk.“Not far. Just to the neighbor’s mail-box and back...I wasn’t allowed towalk the dogs for fear they’d pulland injure me.” Over time, heincreased the distance, but progresswas slow.


[continued on 26]1859213

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hile fingernails alsocan become infected,toenails are more sus-ceptible to fungalinfections because of

their proximity to the floor and thesoil, said Quraishi. Toes are alsooften confined to a warm, moist,weight-bearing environment in shoes,according to the AAD.Wearing shoes and socks—one

way to help prevent nail fungus—does not always do the trick.“Even if you wear socks—some

people don’t change their socksevery day,” said Quraishi, who hasprivileges at Southern MarylandHospital Center in Clinton andFort Washington Medical Center inFort Washington.Those who have athlete’s foot,

an infection caused by fungus, canbecome reinfected from not wash-ing their socks or not spraying theirshoes with an antifungal spray. The

same can hold true for those withnail fungus. In fact, Quraishi said,many of his patients who have nailfungus have previously had ath-lete’s foot.If left untreated, a nail fungus

infection can lead to more problems,especially for those with weakenedimmune systems, such as patientswith leukemia or AIDS, accordingthe Mayo Clinic.Also, someone with diabetes who

contracts a nail fungal infection mayhave more complications.“People who are immunocom-

promised, people who have circula-tion problems in the leg, people whohave diabetes, they are more suscep-tible to getting fungus in the nail,”Quraishi said.Some people are genetically pre-

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metabolically active than subcuta-neous fat, which is found under theskin, said Boyd.In other words, bellies tend to

shrink faster than hips or thighs.And, after just a 10-pound reductionin visceral fat, “lipid levels start drop-ping. Ten pounds can make a differ-ence,” she said.In addition to diet, exercise is

critical to reducing the size of one’spaunch. “But don’t think you canspot reduce. It doesn’t work,” saidBoyd. While sit-ups and crunchesmay strengthen abdominal muscles,those muscles will be hidden undera layer of fat. “It’s a combination ofaerobics and strength training thatwill help reduce that beer belly.”While it’s important “to become

more mindful of what you are put-ting in your mouth,” said Guay-Berry, it’s not necessary to depriveyourself of the libation that gave yourgut its name. “Beer and other bever-ages can be continued, but make sureto have them in moderation.“For men, that means two beers

or two 1-ounce servings of liquor or

spirits or two 6-ounce glasses ofwine maximum per day.”“People with beer bellies can

benefit tremendously from lifestylemodification,” said Shnider. “Alter-ing the collection of fat in theabdomen is one of the most sensiblethings you can do to improve youroverall health.”

BELLY, continued from 19

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“My friend Glenn was doingeverything he could to keep up myinterest in the trip, keep me positiveabout it. But, after about six weeks,I thought, ‘There’s absolutely noway I can go.’ I was still one miser-able person.”Barritt kept walking. His stamina

increased and his outlook changed.He’d heard from others about apoint “where you suddenly walkthrough a door and realize you’reno longer a heart patient. All of asudden the curtain pulls back...OnMemorial Day weekend it was likethe sky cleared or I walked out ofthis cloud. I realized, ‘Hey, I amgoing to recover. It still hurts, but I’llbe OK.’”Recalling that, prior to the oper-

ation, his heart surgeon said therewas no reason to cancel the trip,Barritt became determined to makethe ride. He walked farther andpicked up the pace. “Riding amotorcycle isn’t really that physical-ly demanding, but, at the same time,it puts a fair amount of stress on thechest. I still wasn’t sure I could go.”

In mid-June, Barritt took a testride—to Vermont. “It was all pave-ment, no really hard riding, and Igot up there without any adverseeffects. That’s when I finallythought I could do it.” And, fourmonths after his surgery, he did.Recently, Barritt took an even

more demanding trip to Silverton,Colo., “mostly on back and dirtroads. The mountains in Coloradoare especially challenging and therewere a couple of moments—likewhen my bike slipped off the roadand went down an embankment—that gave me pause. But after thesurgery and all, this was an adven-ture I was glad I could enjoy.”

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in Rockville. Plus, the older we get,the more easily we seem to contractnail fungus, he said.“There must be some sort of a

decrease in your natural immunefunction so you can’t fight it off likewhen you are 25, so you get it easi-er,” said Green.As many as 30 percent of seniors

have had nail fungal infections—known as onychomycosis—accord-ing to the AAD.With onychomycosis, the nail can

become thick and crumbly. “Yournail gets thicker, whiter and thedebris builds up under the nail,”Green said. “That’s the most com-mon form of toenail fungus. Thereare other kinds in which you don’tget the thick and crumbly nail.”Another type, white superficial

onychomycosis, is similar, but hasless severe symptoms. In both cases,patients might not notice anychange in their nails for some timeafter being infected. “It comes onslowly,” Green said. “Some peopledon’t look at their nails. It takes awhile to develop.”Since the infection is underneath

the nail plate in the nail bed, treat-ment is difficult, according to theAAD. The slow growth rate ofnails can explain why it can taketime for someone to notice theinfection, as well as why it can takeso long to cure.It can take a year or longer to

grow a toenail, Quraishi said. “Andfor everybody it’s different.”While the condition is not neces-

sarily painful, said Quraishi, it canbe if one stubs a toe or tries to wearpointy shoes or other footwear thatpresses against the nail.Both Quraishi and Green said oral

medications are more effective thantopical ones in treating nail fungus.Quraishi prescribes the oral medica-tion terbinafine, commonly knownasLamisil, which he said has beenfound to be 85 percent effective. Hecompared this to a rate of 35 percentfor a topical medication, which gen-erally must be applied twice a day forseveral months.Before prescribing Lamisil,

Quraishi takes a culture of the nailto determine whether the patient hasa nail fungus. If that comes backpositive, blood work is done to testthe patient’s liver function.

“With Lamisil, it can have sys-temic results, and 1 percent of thepatients can get hepatitis,” he said. Ifa patient begins to have systemicsymptoms, such as nausea or vomit-ing, he should stop taking it.According to Green, a patient

taking Lamisil has “virtually” nochance of having liver problems.The medication itraconazole, mar-keted under the brand nameSporanox, requires that the liverfunction be monitored, and in rarecases may cause congestive heartfailure, according to the U.S.National Library of Medicine.Laser treatments on nail fungus

are used by some doctors, but neitherQuraishi nor Green use this form oftreatment.“It’s not covered by insurance, so

using it is out-of-pocket,” saidQuraishi. “The problem with that isthat the anecdotal evidence is good,but there are no long-term studiesbecause it’s a new treatment. It doestreat the fungal nail, but nobodyknows what the reinfection rate is.”Prevention is the best way to bat-

tle nail fungus. However, “By thetime most people come to see me,they have fungal nails, so there isvery little I can tell them in terms ofavoiding it,” Quraishi said.Some tips to protect your nails

include: wear clean socks and shoes,and spray them with an antibacteri-al spray once or twice a month; keepyour feet clean and dry, as well asdry between the toes; and if youshower at a gym, wear flip-flops,Quraishi said. “Once you get it, it’shard to get rid of it.”

FUNGUS, continued from 23

The problem with[laser treatment] is thatthe anecdotal evidence

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inevitable. “I’ve had patients who areprediabetic and not become diabeticexclusively through losing weight,”said Sinha. “The name of the game isprevention rather than treatment inpediatrics.”

Disparities in DiagnosesBelonging to certain ethnic group

may heighten the risk of prediabetes.African-Americans, Alaska Natives,American Indians, Hispanics, AsianAmericans and Pacific Islanders are ata greater risk for developing predia-betes and type 2 diabetes, accordingto the National Institute of Diabetesand Digestive and Kidney Diseases.Researchers in a study published in

BioMed Central Research Notes inJanuary noted that “nearly one out ofevery six overweight youth has predi-abetes,” and that “the burden of dia-betes falls disproportionately on eth-nic minority youth, particularlyNative Americans, Hispanic/LatinoAmericans, and African-Americans.”In its most recent National Dia-

betes Fact Sheet, the CDC noted thatfrom 2002 to 2005, new cases of type

2 diabetes were either similar to orgreater than new cases of type 1 dia-betes diagnosed among black,Hispanic, Asian/Pacific Islander andAmerican Indian 10- to 19-year-olds.Only non-Hispanic whites of thissame age group had a larger percent-age diagnosed with type 1 diabetes.While scientists are still mapping

out the genetic underpinnings of whycertain ethnicities are at greater riskfor developing type 2 diabetes, otherfactors such as household income,low levels of physical fitness and poordietary choices play a role, said Sinhaand Ning.Less than 10 percent of childhood

obesity is caused by genetics or anendocrine disorder, while diet andexercise are the main determinants,according to Ning.

Role of ParentsDoctors say parental involvement

is the game changer when it comes tolowering risk.“If a child is prediabetic, then par-

ents have to become diabetesexperts,” said Sinha. “I have seenpatients who have come out of the

prediabetes zone, but that doesn’tmean they won’t go back in.”For parents who may not know

where to start, Sinha arrangesappointments with a nutritionist tohelp them devise a sensible diet fortheir child. Food diaries, in whichpatients write down everything theyconsume, sometimes work, althoughcompliance is minimal, he said.To avoid setting a bad example,

overweight parentsmust also confronttheir own weight problem. “A lot ofkids who are overweight, their parentsare overweight as well,” said Sinha.Parental perceptions about their

child’s weight and health status aresometimes at odds with reality.“Parents perceive that a child’s diet ishealthy,” said Ning. “They don’t haveany idea what a normal diet is.” Foradolescent patients who are trying tolose weight, Ning prescribes a 1,500-calorie-a day diet.Cultural norms and attitudes about

weight and body image can also influ-ence behavior. The BioMed CentralResearchNotes study found that com-pared with parents of other races,African-American parents “were

more likely to report their over-weight child’s weight as underweightor normal and less likely to reportthey felt their child’s weight wasunhealthy.” The study also foundthat African-American girls “tolerat-ed heavier body weight and perceivedless social pressure to lose weight,resulting in infrequent pursuit oflifestyle changes.”

Emotional CostWhen talking to a prediabetic

patient, Ning prefers not to use theword “obese,” especially when theparents are overweight themselves.She places a teenager’s weight in con-text, saying instead, “You seem to beoverweight for your height.”Patients who are already motivated

academically tend to do better withtreatment plans, Sinha said. Theytend to approach their own weightloss like a challenging assignment andget excited about setting goals andcompleting tasks. Strong parentingand lots of positive reinforcement aidthe process: “You want to empowerthe child, and get them to take respon-sibility for their own health.”

PREDIABETES, continued from 11


result in vascular issues and limitblood flow to the cochlea.”More than 70 percent of those

60 to 79 live with cardiovasculardisease and, as a result, are atincreased risk for hearing loss.Cardiovascular disease, whichincludes high blood pressure, “isassociated more with low-frequencyhearing loss,” said Scully. Thatmight mean someone is less likelyto hear the rumbling of a truck orof thunder.Both heart and cancer patients

may suffer hearing loss as certainmedications can damage the ear,according to the American Speech-Language-Hearing Association.Morethan 200 drugs—some prescription,others over the counter—are consid-ered ototoxic.Diabetics are twice as likely as

the general population to sufferhearing loss, according to Scully,and risk of the disease increaseswith age. “It’s one of the first ques-tions I ask on the intake form, asthere are about 20 million diabeticsin this country and 54 million withprediabetes, and the number is ris-ing,” she said.Kidney issues have a direct corre-

lation with hearing loss. “Over 50percent of people with chronic kid-ney disease have some degree ofhearing loss,” said Scully.Age-related hearing loss tends to

run in families, according to Ego-Osuala. “If your mother becamehard of hearing at age 38, there’s ahigh chance you will too. If hearingloss began at 65, we don’t considerthat unusual,” he said. Because age-related hearing loss is incremental,many people don’t notice it at first ordon’t think the problem is significantenough to warrant treatment, saidEgo-Osuala.Such was the case with Calem,

who recently began wearing a hear-ing aid. “I must have had seriousproblems a decade before, which Ieither wasn’t aware of or didn’tacknowledge. I think I was probablyin denial.”

AFTER AN APPOINTMENT WITH ANotolaryngologist, Calem learnedthat her ears were structurallysound. The next stop was the audi-ologist’s office, where Scully“explained that I had some rather

drastic losses in certain registers. Iknew she was right, but it was anuncomfortable admission that Ididn’t like to make,” said Calem.Putting her vanity aside, Calem

opted to purchase hearing aids.“Most people, if I didn’t say any-thing, wouldn’t notice. The onlything not covered bymy hair is a tinywire that goes from what’s in my earto the battery, which is hookedbehind my ear.”Her hearing improved dramati-

cally. “The first moment was a stun-ner. It almost sounded artificialbecause for years I hadn’t been hear-ing these sounds—paper rustling,birds singing,” she said.

WHILE NEARLY THREE-QUARTERSof those who use hearing aids reportmuch better or somewhat betterhearing, according to a 2011 AARPstudy, only about a fifth of thosewho would benefit from a hearingaid actually use one, noted NIDCD.Part of the reason has to do with

cost. “Medicare does not pay forhearing aids,” said Ego-Osuala. Fewinsurance companies do. In 2010Blue Cross and Blue Shield’s FederalEmployee Plan began allowing$1,000 per ear. That may cover thecost for individuals with mild tomoderate hearing loss, but thosewith more significant hearing issueswill still have a large out-of-pocketexpense. “The cheapest hearing aidyou can get is about $900 and itgoes on up from there to about$3,000—and that’s per ear. Theworse your hearing, the higher theprice is, as there’s more processingand programming involved.”

HEARING, continued from 15

The only thing notcovered by my hair

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in my ear to thebattery, which is

hooked behindmy ear.

–Leanore Calem

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Hearing aids are not 100 percenteffective and in some cases may notbe effective at all. It’s not unusual,according to Ego-Osuala, for peoplewho wear hearing aids to continueto have trouble hearing in places,like restaurants, where there is a lotof background noise.And, if hearing loss has more to

do with the way a person’s brainprocesses the information, a hearingaid isn’t the answer. “Making some-thing louder won’t help if thesounds are jumbled in the brain,”said Ego-Osuala.“Hearing aids have come a long

way since the first digital ones wereintroduced in 1996,” said Scully.

“Today, there are devices other thanhearing aids that can help in morechallenging environments.” Shepoints to mini microphones that thewearer can use to transmit soundswirelessly to a hearing aid and tohearing aids that use Bluetooth tech-nology so that phone calls and televi-sion shows can be run through them.Getting medical help as soon as a

loss of hearing “is noticed by you orsomeone else is essential,” saidScully. “On average, people waitseven years to do something about it.Some wait decades. By the time theycome in, it’s harder to deal withbecause they may be trying to copewith other issues.”IS

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If you suspect you have hearing loss, call for a free hearing testappointment. Our licensed specialists are trained in the latest auditorytesting methods and will be the first ones to tell you if you don’t need ahearing aid. If you do have a hearing loss, we will explain your results andprovide you with a list of options.

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Benefits of hearing aids vary by type and degree of hearing loss, noise environment, accuracy ofhearing evaluation and proper fit. Beltone Hearing Care Centers are independently owned andoperated. Participation may vary by locations.

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get misdiagnosed because their hor-mone level falls within the normalrange,” said Hakim.In Black’s case, her condition result-

ed in hypothyroidism, where the thy-roid doesn’t secrete enoughT3 andT4;the sluggishness and weight gain with-out an increased appetite are a resultof the metabolism slowing down.Hyperthyroidism, a condition causedby the thyroid producing toomuch T3and T4, usually creates the oppositeeffect—loss of weight while feelinghungrier and eating more, anxiety anda rapid heartbeat.Not only can the TSH test some-

times fail to identify an overactive orunderactive thyroid, but in those whohave been diagnosed with hypothy-roidism, it may not be precise enoughto ensure a patient receives the correctamounts of hormone replacementtherapy, said Hakim.Getting the level of the T4 hormone,

known commercially as Synthroid,just right is especially critical since T4eventually converts into T3. “The bot-tom line is the problems occur when

they’re not taking the right amount ofT4 to begin with,” she said. “It’s avery, very common scenario.”Hyperthyroidism can be the result

of another underlying autoimmunedisorder—like Graves’ disease, inwhich antibodies are unleashed on thethyroid, causing it to go into overdrive.Studies have shown that stress, preg-

nancy or a viral infection can lead toan overactive thyroid, said MadhuriDevdhar, M.D., an endocrinologistwith Adventist Medical Group inMontgomery Village.While antithyroid medications are

prescribed for Graves’, they’re notmeant for long-termuse due to damag-ing side effects, including the loss of

white blood cells, said Hakim. Aniodine pill that has been radiated is fre-quently used as a one-time treatmentfor Graves’, and is generally consid-ered safe, while surgery is the less com-mon and riskier solution. Both canlead to hypothyroidism since the thy-roid becomes disabled due to the pow-erful radioactive iodine dosage or sur-gical removal. Hormone replacementtherapy, which is usually prescribed forlife, “is very benign,” and causes “verylittle problem as far as side effects,”said Hakim.Black, the medical assistant, whose

second child was due this month, hassuccessfully navigated her thyroid dis-ease along with her pregnancy. Awoman’s thyroid requirements increaseby 30 to 50 percent during pregnancysince a fetus can’t produce its own thy-roid hormone in the first trimester,according to Hakim.Black has had her Synthroid dosage

increased a few times. After her deliv-ery, she imagines life will go back to theway it was, where weight managementis the perennial issue.

THYROID, continued from 16

Symptoms ofhyperthyroidismn Weight loss, even if you eatthe same or more food

n Eating more than usualn Rapid or irregular heartbeator pounding of your heart

n Anxietyn Irritabilityn Trouble sleepingn Trembling in your handsand fingers

n Increased sweatingn Increased sensitivity to heatn Muscle weaknessn Frequent bowel movementsn Less frequent menstrualperiods with lighter thannormal menstrual flow

Symptoms ofhypothyroidismn Weight gain, even thoughyou are not eating more food

n Increased sensitivity to coldn Constipationn Muscle weaknessn Joint or muscle painn Depressionn Fatiguen Pale, dry skinn A puffy facen A hoarse voicen Excessive menstrual bleedingn High levels of LDL cholesterol

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VEGETARIANS MISS OUT ON A LOT OF FOODS, BUT THEY ALSO TEND TOmiss out on a lot of major health problems that plague manyAmericans. They generally live longer than the rest of us, and they’remore likely to bypass heart-related and other ailments.Most people think of vegetarian diets as simply eating plant foods and

not eating meat, poultry and fish, but there are many variations.Strict vegetarians, or vegans, eat plant foods and reject all animal prod-

ucts—meat, poultry, fish, eggs, dairy and sometimes honey. Those whoalso eat dairy products are called lacto-vegetarians. Vegetarians who eatboth dairy and eggs are called lacto-ovo vegetarians. Some vegetarians eatfish but not meat or poultry. They’re called pescatarians (pesce is Italianfor fish).“Then there are the so-called flexitari-

ans, or semivegetarians. These are peoplewho eat a mostly vegetarian diet, but theyoccasionally eat meat,” said Jody Engel, anutritionist and registered dietitian at theNational Institutes of Health (NIH). “Theymight say ‘I’m a vegetarian, but I need toeat my burgers every Sunday.’ People tendto follow their own rules, which is one rea-son why it’s hard for researchers to studyvegetarians. There’s so much variance.”Despite the different definitions, “there’s

tremendous agreement among nutritionexperts and health organizations that amore plant-based diet is beneficial, whetheryou’re a true vegetarian or not,” said NIHnutritionist Dr. Susan Krebs-Smith, whomonitors trends in cancer risk factors.Vegetarian diets tend to ingest fewer

calories, and have lower levels of saturatedfat and cholesterol, and more fiber, potassium and vitamin C than thosewith other eating patterns. They tend to weigh less than meat eaters, andto have lower cancer rates. “Evidence also suggests that a vegetarian dietis associated with a lower risk of death from certain heart diseases, andthat those who follow a vegetarian diet tend to have lower LDL [‘bad’]cholesterol levels,” said Engel.

IN SOME CASES, THOUGH, IT’S UNCLEAR IF CERTAIN HEALTH BENEFITScome from plant-based eating or from the healthy lifestyle of most veg-etarians. “Vegetarians are generally more physically active and havehealthier habits than nonvegetarians…,” said Krebs-Smith.To tease out the effects of diet, scientists have to conduct large, careful-

ly controlled studies that account for other factors. One of the world’slargest studies of plant-based diets is now under way at Loma LindaUniversity in California. Cardiologist Gary Fraser is leading an NIH-funded team of scientists to analyze data on 96,000 Seventh-day

Adventists in all 50 states and in Canada.Members of this religious grouphave unique dietary habits and a generally healthy lifestyle. Adventists areencouraged to follow a vegetarian diet, but about half the populationsometimes eats meat. These variable eating patterns allow scientists tocompare a wide range of dietary habits and look for links between dietand disease.To date, the researchers have found that the closer people are to

being vegetarian, the lower their risk of diabetes, high blood pressureand metabolic syndrome—a condition that raises the risk of heart dis-ease and stroke. “The trend is almost like a stepladder, with the lowestrisks for the strict vegetarians, then moving up for the lacto-vegetarians

and then the pescatarians and then thenonvegetarians,” Fraser explained.Earlier studies found that vegetarianAdventists also tend to live longer thanboth meat-eating Adventists and non-Adventists. The vegetarians also havefewer instances of coronary heart diseaseand lower rates of some cancers.

BECAUSE VEGETARIANS BY DEFINITIONdon’t eat meat, some people jump to theconclusion that simply cuttingmeat fromtheir diet will lead to health benefits.“But it’s actually more complicated thanthat,” said Fraser. “Differences in lifeexpectancy and other health mattersmight be related to the extra fruits, veg-etables, nuts and legumes—includingsoy—that vegetarians tend to eat. Youcan’t necessarily conclude it’s based onthe absence of meat.”

Experts generally agree that vegetarians who eat a wide variety offoods can readily meet all their body’s needs for nutrients. However, theyneed to be sure they take in enough iron, calcium and zinc. Studies showthat most vegetarians do get enough, in part because so many cereals,breads and other foods are fortified with these nutrients. “Vegans in par-ticular need to be certain to get enough vitamin B12 and omega-3 fattyacids,” said Rachel Fisher, a registered dietitian involved in nutritionresearch at NIH. Omega-3—found in fish, flaxseed, walnuts and canolaoil—is important for heart health and vision.Some vegetarians take dietary supplements to ensure they’re getting

everything they need. Talk to a registered dietitian or other health profes-sional if you’re a vegetarian or thinking of becoming one.Whether you’re a vegetarian or not, Fisher said, you can benefit from

the high fiber, low fat and rich nutrients of a vegetarian diet.

-Excerpted from NIH News in Health

experts’ opinionNational Institutes of Health

Is a Vegetarian Diet Healthy?

Vegetarians have fewer instancesof coronary heart disease andlower rates of some cancers.

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