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A publication of The Gazette | Spring 2012 Editor, Designer Contributing Writers

Copy/Layout Editor

Anna Joyce Karen Finucan Clarkson Mary Wade Burnside Bill Holleran Archana Pyati Kate Marsanico

Production Coordinator

John Schmitz

President and Publisher

James F. Mannarino

Advertising Director

Trina Lapier

Creative Director, Special Publications and Internet

Anna Joyce

Director of Creative Services

Lois Pruitt

The Gazette is a division of Post-Newsweek Media, Inc. Main Office: 9030 Comprint Court, Gaithersburg, MD 20877 Gazette Health is produced by The Gazette’s Special Sections, Advertising and Creative Services departments. It does not involve The Gazette’s newsrooms nor editorial departments. Send comments to specialsections@gazette.net. Content is for informational purposes only and should not be construed as medical advice, nor as a substitute for seeing your own medical professional(s). Unless identified as contributed by them, partnering hospitals do not necessarily endorse the content herein. COVER PHOTO: ISTOCKPHOTO/KATE_SEPT2004

CORRECTION

In the December 2011 issue of Gazette Health, a photo of National Institutes of Health Director Dr. Francis Collins errantly appeared next to the byline of the Expert’s Opinion column “Be Happy. Live Longer.” Dr. Collins was not associated with the article.

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healthnotes

A STUDY OF 35,000 MEN SHOWED A 17% INCREASE IN PROSTATE CANCER IN THOSE WHO TOOK A VITAMIN E SUPPLEMENT OF 400 INTERNATIONAL UNITS DAILY.

by the

Numbers

6 million Number of Americans 85 or older in the U.S. today

A

dults under 60 who have diabetes should get the hepatitis B vaccine as soon as possible, according to new guidelines from the Centers for Disease Control and Prevention (CDC). The CDC now also recommends that all boys get a form of the HPV vaccine at 11 or 12, and that males 13 to 21 receive catch-up vaccines. HPV—human papillomavirus—is the primary cause of cervical cancer in women, but can lead to other health problems, such as genital warts, and can also infect other parts of the body. Adult males with a weakened immune system, who have HIV or who have sex with men should also get the vaccine.

DROP IT.

A recent warning from the Centers for Disease Control and Prevention says that nine in 10 Americans consume too much salt. That’s a problem because salt raises blood pressure, and high blood pressure is a significant risk factor for heart disease and stroke, respectively the No. 1 and 3 causes of death in this country. While it may be a challenge to cut back since common foods such as bread, luncheon meat, poultry, soup, meat dishes and snack foods account for about 40 percent of daily salt intake, eating a lot of fruit and vegetables can help, as can restricting the amount of processed food with added sodium that you eat. That means reading labels. And, of course, dropping that salt shaker.

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DON’T LISTEN.

The next time you go out for a run, you might want to ditch the earbuds, especially if you’re a guy under 30. Serious injuries to headphone-wearing pedestrians who were hit by moving vehicles tripled in the last six years, and more than two-thirds of the victims were young males, according to researchers from the University of Maryland School of Medicine and the University of Maryland Medical Center in Baltimore. Pedestrian distraction and sensory deprivation were blamed. In almost a third of the cases studied, the oncoming car or train was sounding its horn before the accident.

Population of Americans 85 or older expected by 2050, when the youngest baby boomers will turn 86

80

Percent of people 65 or older who take at least one prescription drug

33

Percent of those 18 to 44 who take at least one prescription medication

26 million

Number of Americans who have diabetes

2x

more AfricanAmericans are diagnosed with diabetes than whites, and they are also twice as likely to die from it NATIONAL INSTITUTE ON AGING, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, DOCTORS COMMUNITY HOSPITAL, CDC

ISTOCKPHOTO: VITAMIN E, MARSBARS; MAN, OLGALIS; PRESCRIPTION, YINYANG; DIABETES, MARK HATFIELD; VACCINE, CAPIFRUTTA; SALT, BURDEM; EARBUDS, RROCIO

Do You Need These Vaccines Now?

20 million


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children’s health

DAY CARE

an opportunity to boost your child’s immunity You might be surprised to find out just how frequently it’s normal for children under 5, especially those in day care, to come down with a cold or flu. You might also be surprised about the benefits getting sick often when they’re young can provide as they get older.

P

-BY ARCHANA PYATI-

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Cross Hospital in Silver Spring. “But I would change the perception the parents and everybody else has about kids getting sick.” It takes about 50 colds or flus—that’s right, 50—to build up the immune system, says Madden. “Most children, especially in day care, get about 10 colds a year, so at that rate it would take about five years for the immune system to become competent at recognizing and fighting off colds before they become full-blown illnesses.” So it would be perfectly normal for children to come down with colds with what their parents might feel is an alarming frequency— potentially 140 days of the year—especially if they’re exposed to other children in day care, she says. Since viruses are constantly mutating, children who attend day care will likely be exposed to a variety of them. Each time exposure to a unique virus occurs, their bodies respond to the virus’ equally unique molecules, known as antigens. These antigens are what trigger the immune system to produce antibodies to fight the invading illness.

ISTOCKPHOTO/KTAYLORG

arents of children who attend day care know the routine. Just when kids seem to recover from one nasty cold or stomach bug, another one knocks them down. One classmate falls sick, and it’s just a matter of time before the virus makes its way through the entire group. Experts call it “day care syndrome”—one bout of infection after another that infants and toddlers suffer through. Yet while pediatricians recommend precautionary steps both parents and caregivers can take to minimize illnesses among young children, they also emphasize that getting sick is an essential part of growing up. Like our cognitive development, our immune system embarks on a steep learning curve before age 5; exposure to illness and recovery is how it learns, and day care provides an ideal setting for this to happen. “I wouldn’t change day cares a bit,” says Robin Madden, M.D., a pediatrician and former chair of the pediatrics department at Holy


Parents of Teens!

Children in day care often develop ‘herd immunity’—where a group shares resistance to a bug because so many were infected with it.

Concerned about your daughter getting DIABETES? Girls age 12 - 17 years with at least one family member with type 2 diabetes are invited to participate in a study at the National Institutes of Health aimed at preventing type 2 diabetes

What they’re also developing is something called “herd immunity,” says Pedro Sarmiento Jr., M.D., chief of pediatrics at Southern Maryland Hospital Center in Clinton. Herd immunity happens when a group shares resistance to the same virus because nearly everyone has been infected with it at some point. “As a group, you tend to be protected,” he says. “You share a lot of the same antigens, and your body starts developing antibodies to fight infections.” After six months, a child’s body is working hard to make up for the immunity she enjoyed in her mother’s womb. Breast-fed children maintain some of this immunity because they continue to receive disease-fighting antibodies from their mother’s milk. Illnesses suffered by breast-fed children also tend to be “milder,” and the recovery “quicker,” says Madden. COLE GILBERT, 2, SEEMS TO HAVE INHERITED THIS TYPE OF PROLONGED

immunity from his mom Stacy, who works in humanitarian assistance at the U.S. Department of State. He’s had only two fevers in his life, and she says he falls sick far less often than his classmates at Diplotots, the State Department’s day care facility. Stacy Gilbert theorizes her son’s heartiness may come from resistance she acquired through years of traveling to places such as India, Pakistan and Iraq, where she was not always hyper-vigilant about hygiene. Gilbert still travels frequently—but now with Cole in tow. The two also ride Metro for errands and their daily commute from their Takoma Park home. “Maybe it’s his exposure to all these things…that’s what built up his resistance,” she says. Now, it’s more likely that Stacy is home with the flu while Cole is off at Diplotots enjoying his day. “I am certainly getting sick more,” she says. “I get more colds and flus now. The things I would expect him to be getting, I get and he doesn’t.”

If eligible, girls will attend six 1-hour group sessions and receive monetary compensation over a 1 - year follow-up period. The NIH Clinical Center is located on the Metro red line, Medical Center stop in Bethesda, MD. For more information, Call: 1-800-411-1222 (TTY: 1-866-411-1010) Se habla español or go online, http:mir.nichd.nih.gov Refer 1842698 to STUDY # 11-CH-0239

THERE’S ANOTHER ADVANTAGE TO SO-CALLED DAY CARE SYNDROME,

experts say. Children who cycle through various viral infections in day care tend to get sick less frequently later on. That means fewer missed days in elementary school and fewer disruptions to a child’s academic development. A study published in the December 2010 issue of the Archives of Pediatrics & Adolescent Medicine concluded that while babies and young children who were in large day care groups suffered from more respiratory and ear infections than their peers, they experienced fewer of these infections in elementary school than those who were cared for at home or in smaller groups as toddlers. “Participation in large [group child care] before 2 years old, although associated with increased infections at that time, seems to protect against infections during the elementary school years. Physicians may reassure parents that infections during the first child care years do not lead to a higher overall burden of infections,” according to the study, conducted over an eight-year period in Canada. Robert Wack, M.D., director of pediatric services at Frederick Memorial Hospital, urges a more realistic understanding of the limits of hygiene practiced within day care. It’s important not to disrupt a child’s normal exploration of the world, gained through many of the behaviors that lead to the spread of infection in the first place, he says.

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children’s health

ABOUT A THIRD OF KIDS BETWEEN 2 AND 4 STILL SUCK THEIR THUMBS.

thumb sucking When should your child kick the habit?

U

-BY MARY WADE BURNSIDE-

ltrasound tests have caught images of babies in the womb sucking their thumbs. Of course, after birth, they often continue the habit, as well as require the services of a pacifier. And that is perfectly normal, says Michael Virts, a board certified pediatric dentist with Frederick Pediatric Dentistry LLC in Frederick. “This thumb sucking, and using pacifiers, those are all called non-nutritive sucking behavior. Those are considered normal in infants, babies and young children. However, problems can happen if the child sucks the thumb past 36 months,” Virts says. If they do not stop, teeth can begin to protrude, creating a cosmetic problem that may require repair. “It also can constrict the top teeth,” Virts says. “They are supposed to be in a nice round arch, but sucking the thumb can make it more like a V, and that’s not healthy because it becomes a crossbite, which is something that needs to be addressed by a pediatric dentist or an orthodontist.” Deformation in the mouth from pushing the palate up high can also occur, or the top teeth can be pulled forward, creating an overbite, says Dianna Abney, a pediatrician with Cambridge Pediatrics LLC in Waldorf who treats patients from across the greater Washington, D.C., area. EXPERTS VARY ON WHETHER THUMB SUCKING CAN BE A SYMPTOM OF

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Thumb sucking that continues past 3 can cause problems for both the mouth and the wallet, as it may lead to a crossbite or an overbite that require repair by an orthodontist.

ISTOCKPHOTO/JALLFREE

anxiety. While it can cause physical problems, Abney says she generally does not believe there necessarily are hidden, psychological reasons that compel a child to continue beyond a certain age. “Sometimes it’s just a habit and they haven’t broken that habit,” she says. “I suppose if there was a child who had stopped and started, that might be a problem. But I wouldn’t think it’s a big red flag for anxiety.” But Jacqueline Iseman, Ph.D., a licensed psychologist and owner of Hands on Health Psychological Services, a private practice in Potomac, believes that there could be underlying issues that need to be addressed. “While about one-third of children continue to suck their thumbs between the age of 2 and 4, children typically discontinue this behavior by age 5,” Iseman says. “If it continues beyond this age, it is sometimes indicative of difficulties children are having with being able to soothe themselves in other more advanced or age-appropriate ways. Often, these children have anxiety or are worriers.”


‘‘

I tell [parents] to ignore the articles that talk badly about pacifiers, pointing out that the thumb sucking leads to big orthodontic bills.” - LLOYD M. CHARLES, M.D.

These children do not always recognize their anxiety. “Instead, they unconsciously develop a habit of thumb sucking as a physical way of comforting themselves,” she says. Although many experts believe thumb sucking is normal behavior in infants and toddlers, pediatrician Lloyd M. Charles, M.D., of the Center for Health Living of Maryland in Upper Marlboro discourages it from the get-go. “I preach against allowing a child to thumb suck, telling parents on the first visit to find a pacifier the baby likes, and when they do, to buy a bunch and keep one within easy reach 24/7,” Charles says. “I tell them to ignore the articles that talk badly about pacifiers, pointing out that the thumb sucking leads to big orthodontic bills.” IN ADDITION TO DENTAL AND MOUTH DEFORMITIES, THUMB SUCKING

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Stop by one of our stores today.

For the outside of your body • Don’t dry out your skin; pamper it with creams and lotions made of entirely organic or natural elements • Make your hair shine with our shampoos, conditioners, and colorings • For a luxurious clean, try one of our wonderful soaps, scented with relaxing lavender, soothing almond, or nothing at all.

For the inside of your body, you will be amazed at • the incredible selection of fresh, organic fruits and vegetables • the vast array of items locally and sustainably produced • the bulk bins filled with healthy grains, cereals, nuts, and goodies too numerous to mention • the choice of coffees and teas, fairly traded, grown by farmers who are environmentally aware • vitamins and supplements to meet your nutritional needs.

We also have a selection of socially responsibly manufactured gifts and greeting cards, fresh flowers, candles, Organic Food v Produce v Bulk Food v Health & Beauty and household items.

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can deliver and spread unhealthy germs, especially as a child gets older and is exposed to more objects and environments. “I have not had anybody who got some horrible infection, but it’s just gross. It’s just unhealthy,” Abney says. “And not only are they getting germs from other places, but if they’ve had their hand in their mouth and touch other things, they are at risk of spreading them to the rest of the population.” Abney has had success in getting patients to stop sucking their thumbs. “Sometimes you just do redirection,” she says. “If you notice the child sucking their thumb, give them something else to do. Remind them to take their thumb out of their mouth.” Iseman warns parents about putting something such as hot sauce on thumbs as a deterrent, as well as expressly prohibiting children from sucking their thumbs. “You don’t want to create a power struggle over the issue,” she says. “Asking a young child to quit the behavior cold turkey without any replacement strategies is often anxiety provoking or frustrating to the child and is unfair.” She advises parents to ask a dentist to have a frank discussion with the child about the dangers to their teeth, and also suggests parents offer positive reinforcement when the behavior abates. “When the child is sucking his or her thumb, calmly ask if the child knows that he or she is doing it,” Iseman says. “Often, it’s an unconscious response and the mere mentioning of it is enough for the child to decide on his or her own to stop.” Abney had a mother of two patients experience great success by using redirection, as well putting gloves on her kids’ hands. “(She) said it worked so well with the first, and not only did it work, but it worked quicker for the second child,” Abney says. “She didn’t even ask me about it. She knew to do that and it worked with the second child.” Virts notes that thumb guards can also help keep kids from sucking their thumbs. The issue is an important one for him, not only as a pediatric dentist, but also as someone who did not kick the habit until he was 10. “After I stopped sucking my thumb, my self-confidence improved exponentially,” he says. “It took some coaching on the part of my parents and dentist to get me to stop, and I needed braces for many years.”

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-BY BILL HOLLERAN-

H

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WHILE THERE IS NO KNOWN DEFINITIVE

cause of osteoarthritis, “it does seem to run in families,” says Jones. Women in particular can get it through the genes they inherit, Shaw says. Obesity is another risk factor. “For every extra pound of weight a person carries, there is four times the pressure on the knee and six times on the hip,” says Zohair Alam, M.D., an orthopedic surgeon with the Joint Replacement Center at Washington Adventist Hospital in Takoma Park. Osteoarthritis can also arise as a result of a sports injury or work-related activity that causes trauma to the knees, hips, hands, lower back or neck. “The weekend warrior who injures a joint lays down the potential for secondary osteoarthritis over time,” Shaw says. Symptoms can be painful—even debilitating. “Typically, affected joints ache and become painful and stiff first thing in the morning or during or after use,” says Chatterji. Other symptoms can include knobby swelling of the joints, particularly in the hands. “In addition to joint pain and swelling, you may hear crackling in the joint,” says Jones, “and may even feel a grinding sensation inside the joint when it moves.” “WE DON’T KNOW HOW TO PREVENT OSTEO-

arthritis completely, but there are things we can do to decrease risk,” says Jones. “Physical activity and weight loss are at the top of the list. Even a little bit of weight loss can relieve tension” on joints, Chatterji says. “The key is to keep the joint moving. Even mild stretching for a half hour a day can help maintain good range of motion and flexibility. Doing weight- [continued on 30]

ISTOCKPHOTO/CARMEBALCELLS

as your back or neck been bothering you lately? When you were a college athlete, did your knees get banged up? Are you still a “weekend warrior,” trying to keep those golden memories of your athletic glory days alive despite the risk of injury to your joints? Could you stand to lose 30 or 40 pounds? If you are 45 or older and answered yes to any of these questions, then you could be at risk for osteoarthritis—a risk that increases with age. There are 135 types of arthritis, says Robert Shaw, M.D., a rheumatologist affiliated with Carroll Hospital Center in Westminster, and more than 50 percent of those 65 or older suffer from some form of it, according to the Arthritis Foundation. The most common kind is osteoarthritis, which affects nearly 27 million Americans. With osteoarthritis—arthritis caused by a breakdown of the lining of the joints—the smooth covering on the ends of bones, known as cartilage, becomes damaged or worn. “(It) takes away the gliding surface on the end of our bones and creates a rough and painful joint,” says Angela Jones, M.D., an orthopedic and hand surgeon with Capital Orthopaedic Specialists in Clinton, Lanham and Bowie. For this reason, she says, it’s commonly known as “wear and tear” arthritis. “When cartilage in the joint starts to break down and causes the bones to rub against each other, this can lead to muscle stiffness and pain and ultimately make it difficult to use that joint.” Melanie Chatterji, M.D., a staff rheumatologist at MedStar Montgomery Medical Center in Olney, who is affiliated with Olneybased Maryland Rheumatology, says four in

five patients with osteoarthritis suffer from limited movement, while one in four cannot perform major daily activities.


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500,000: NEW CASES OF CERVICAL CANCER REPORTED ANNUALLY WORLDWIDE

Simple test, vaccine, greatly reduce risk of

CERVICAL CANCER A

-BY KAREN FINUCAN CLARKSON-

major cause of death among women of childbearing years through the 1940s, cervical cancer now ranks 14th on the list of cancers afflicting U.S. women, according to the National Cancer Institute (NCI). One simple test—the Pap smear— has cut the incidence of cervical cancer in half, and a relatively new vaccine promises to reduce the incidence rate even further. “Cervical cancer is the easiest cancer to detect,” says Carolynn Young, M.D., a gynecologist and surgeon with Rockville Gynecology and privileges at Suburban Hospital in Bethesda and Shady Grove Adventist Hospital in Rockville. “Not only is screening simple to perform, but it does an excellent job telling us who’s at risk and who to focus on more closely.” “The incidence of the disease has decreased more than 50 percent in the last 30 years because of the widespread use of the Pap smear for this purpose,” says Rachel Mandel, M.D., a gynecologist with Women’s Health Specialists of Frederick and privileges at Frederick Memorial Hospital. “Death rates have gone down as well. The same decrease has not been seen in other countries…because of the lack of cervical screening programs.” Cancer of the cervix is the second most common cancer in women worldwide, according to the World Health Organization. Some 500,000 new cases and 250,000 deaths are reported each year. In Maryland, the incidence rate for cervical cancer in 2007, the most recent year for which the number is available, was 6.4 per 100,000 women, down from 9.3 in 2003. That puts the state 14th on the list of lowest incidence rates, according to the Henry J. Kaiser Family Foundation. Maryland’s cervical cancer death rate was 2.5 in 2008, identical to 2004 and the 22nd lowest among states. By way of comparison, the 2007 incidence rate for breast cancer among Maryland women was 123.2 and that death rate was 25.1 per 100,000. THE CERVIX COMPRISES THE LOWER PART OF THE

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uterus. Its opening is at the top of the vagina. While the appearance of abnormal cells on the cervix may be cause for concern, it is the out-of-control growth of those abnormalities that results in cancer. More than 99 percent of cervical cancer cases are linked to long-term infections caused by human papillomavirus (HPV), the NCI reports. There are more than 150 strains of HPV, the most common sexually transmitted virus. Fifteen of them are considered “high-risk or more aggressive,” according to Mandel, “and are closely associated with an


More than 99% of cervical cancers are linked to human papillomavirus (HPV.) Two relatively new vaccines provide virtually complete protection against it. Any female 26 or younger who is sexually active, or has “been told she has HPV, should still get the vaccine,” says Kerri Nardone, M.D., an OBGYN with Women First OB/GYN Associates in Olney and Silver Spring and privileges at MedStar Montgomery Medical Center in Olney. “We don’t HPV-type people. Presumably someone who had genital warts could still benefit by protecting herself from types 16 and 18, which cause cancer.” The HPV vaccine is not required in Maryland. “Several bills were introduced shortly after the vaccine was approved, but all were withdrawn,” says Nardone. “Now that the vaccine has been out for a good five or six years, some states are mandating it. Maryland, however, appears to be taking a wait-and-see approach.” Despite the vaccine’s effectiveness, it has not been widely embraced by parents or young women. “The CDC (Centers for Disease Control and Prevention) says only 32 percent of [eligible] women have received all three doses,” says Nardone. Those three doses, necessary for complete protection, are given over six months. HPV REMAINS COMMON. AT LEAST 80 PERCENT OF WOMEN ACQUIRE A

genital HPV infection by 50, according to CDC estimates. The good news is that “90 percent of the cases will resolve spontaneously,” says Thu Tran, M.D., an OB-GYN with Capital Women’s Care in Rockville and privileges at Shady Grove Adventist Hospital. Multiple sex partners increase a woman’s chance of acquiring HPV. Women who are not monogamous should use condoms to reduce the risk of HPV infection, according to the NCI. [continued on 24]

1848061

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IF YOU ARE PREGNANT CALL US FIRST

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increased risk of developing pre-cancer, called dysplasia, and cervical cancer.” Two HPV strains—types 16 and 18—account for roughly 70 percent of cervical cancer cases. Two relatively new vaccines, the first of which became available in 2006, provide nearly 100 percent protection against types 16 and 18 if given to a female before she becomes sexually active, says Mandel. Both Cervarix and Gardasil target the two cancer-causing viruses, but only Gardasil provides protection against HPV 6 and 11, which can cause genital warts. “Authorities believe that if the vaccine is widely implemented that we will start to see a decrease in cervical cancer within 15 to 20 years. Girls and women who are vaccinated now will reap the benefit of a lower risk of cervical cancer in the future,” she says. The vaccine is recommended for females between 9 and 26, generally before they become sexually active and are exposed to HPV. “Older women might benefit from the vaccine if they are sexually active with new or multiple partners,” says Mandel, “but the FDA has not approved the vaccine for women over the age of 26 because the studies don’t show the same benefit as with the younger age group. One explanation for this difference in benefit between the younger and older women is that the younger age group has a more robust immune response to the vaccine, allowing the recipients to develop a better and longer lasting immunity to the virus.”


600,000: NUMBER OF STROKES THAT ARE REPORTED IN THE UNITED STATES EACH YEAR

How Kelly Walker

survived a stroke

hen the laptop slid off her lap and hit the floor, Kelly Walker didn’t think anything of it. But reaching to retrieve the computer, she suddenly found herself on the floor. “I slid right off the couch, like a noodle,” says the 52-yearold Beltsville woman. “I wasn’t alarmed and didn’t feel sick—just couldn’t figure out how to get back up.” Her French bulldog, however, sensed something was wrong and began barking. Hearing the commotion, Philip Walker came down the stairs to find his wife lying supine. “He tried to help me up…but when he saw my mouth drooping on the left side—a sign of a stroke— he said, ‘I’m going to call 911.’” Over Walker’s objection, her husband placed the call—a call that ultimately saved her from permanent disability.

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Despite a congenital heart defect, Walker had always been healthy, although she admits to carrying a few extra pounds. Throughout her life she would occasionally feel her heart race. “I’m a bit of an adrenaline junkie, so I never really thought much of it.” Two weeks before her 50th birthday, the frequency of those heart palpitations began to increase. “I figured it was probably due to the new job I’d started the week before.” The morning of her stroke, Sept. 22, 2010, she felt a tightness in her chest and discomfort in her back between her shoulders. Her blood pressure, according to the home monitor, was normal. “Turns out your blood pressure can be fine and you can still be having a heart attack or stroke.” Walker also didn’t realize that her racing heart was a sign of atrial fib- [continued on 18]

Kelly Walker at her home in Beltsville with her dog Amelia, who began barking, sensing something was wrong with Walker, as she was having a stroke

-STORY BY KAREN FINUCAN CLARKSON-PHOTOS BY DAN GROSS-


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‘‘

I wasn’t alarmed and

didn’t feel sick.

I just couldn’t

get back up.”

Show off!

KELLY WALKER, continued from 16

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rillation, a condition where the heart’s two upper chambers beat chaotically and irregularly, out of sync with the two lower chambers. “They believe that the atrial fibrillation caused a blood clot that started in my heart and traveled to the brain.” AS SHE AND HER HUSBAND WAITED FOR THE PARAMEDICS TO ARRIVE,

her speech became jumbled. “That alarmed me. I knew what I wanted to say, but when the words came out, they were garbled….By the time I got to the hospital, I was talking to everyone and they could understand me.” “Kelly was alert but she was a little confused,” according to Sharon Harriston, a nurse practitioner at Holy Cross Hospital in Silver Spring, where Walker was taken. “She was able to communicate, but her speech was a little slurred.” Walker also showed significant weakness. “They kept checking my strength, comparing one side to the other. The left was clearly deficient,” she says. With a stroke, time is of the essence, according to Aman Savani, M.D., a neurologist who treated Walker in the Emergency Department at Holy Cross. The longer the brain is deprived of oxygen, the greater the likelihood of death or disability. Time also is a factor when it comes to administering tissue plasminogen activator (tPA), a clot-busting drug that can reverse the debilitating effects of an ischemic stroke, the type that afflicted Walker. This kind of stroke happens when an artery that supplies blood to the brain becomes blocked. With few exceptions, the drug must be given within three hours of the stroke’s onset. ROUGHLY 2.5 HOURS AFTER THE FIRST SIGNS OF HER STROKE, WALKER

received tPA and was moved to the hospital’s Neuro Critical Care Unit for round-the-clock monitoring. The symptoms began to dissipate. The facial droop abated and her speech returned to normal. “By the next morning, strength was returning to my left side and everything seemed to equal out,” she says. “Kelly responded as well as anyone could hope for in that situation,” says Savani. “She did not have any complications related to the medication and her symptoms continued to improve as rapidly as we would have hoped.” What didn’t improve was the atrial fibrillation. “My heart rate was between 146 and 170 a minute, double what’s normal,” says Walker. “At one point it went as high as 200. I could feel it in my chest.” Physicians performed a procedure known as cardioversion; its electrical shocks restored her heart’s rhythm. FOUR DAYS AFTER THE STROKE, WALKER WAS HOME. THREE DAYS LATER,

she was back at work. “The major side effect of the stroke was extreme tiredness,” she says. “For me, it lasted eight or nine months.” Above all else, Walker is grateful that her husband was home the afternoon of her stroke. “If I had been by myself, I would have said, ‘Oh, I’m not feeling well, let me take a nap.’ Then it would’ve been too late for the tPA and who knows where I’d be today.”

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t’s easy for men to get bogged down in the details—grams of fat and protein, milligrams of vitamins and minerals, and calories—and give up on healthy eating before they ever get started, admits Reed M. Shnider, M.D., a cardiologist with Cardiology Associates and privileges at MedStar Montgomery Medical Center in Olney. “Forget exact quantities and measuring. It’s time prohibitive and not much fun. If you eat healthy 85 percent of the time—and by that I mean good, nutrient-dense food—you’ll get what your body needs and enjoy yourself more.” There may be times when men will need to use supplements, but generally the bulk of their nutrients should come from their diet. “We absorb nutrients better through food sources than through a supplement,” says Heather Boyd, lead dietitian at the FMH Wellness Center in Frederick. “But, if men are restricting their diet to lose weight or under medical treatment for cardiovascular disease or cancer, then a supplement might be appropriate. Always follow a doctor’s recommendation.” While those on medication need to be as, if not more, vigilant about their diet than other men, many think the opposite, says Boyd. “A lot of patients taking medication for something like cholesterol think they don’t need to worry, that the medication will take care of things. You can’t eat a juicy cheeseburger and expect a pill to compensate.” A healthy diet involves more than just eating nutritious food, says Renata Ordon, a dietitian with the Cardiac Risk Reduction Center at Southern Maryland Hospital Center in Clinton. It also means limiting the consumption of foods with ingredients that can adversely affect one’s health. “The American Heart Association (AHA) recommends restricting sodium intake to less than 1,500 milligrams [daily] to [continued on 22]

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MEN’S NUTRITION, continued from 21

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diet to lose weight or under medical treatment for cardiovascular disease or cancer, then a supplement might be appropriate. Always follow a doctor’s recommendation.” While those on medication need to be as, if not more, vigilant about their diet than other men, many think the opposite, says Boyd. “A lot of patients taking medication for something like cholesterol think they don’t need to worry, that the medication will take care of things. You can’t eat a juicy cheeseburger and expect a pill to compensate.” A healthy diet involves more than just eating nutritious food, says Renata Ordon, a dietitian with the Cardiac Risk Reduction Center at Southern Maryland Hospital Center in Clinton. It also means limiting the consumption of foods with ingredients that can adversely affect one’s health. “The American Heart Association (AHA) recommends restricting sodium intake to less than 1,500 milligrams [daily] to prevent high blood pressure,” says Ordon. “This is a relatively new recommendation. It used to be 1,500 was for people on blood pressure medication, but now it’s been extended to most of the population.” A good way to reduce sodium intake is to avoid processed foods. New AHA guidelines suggest “no more than two servings weekly of processed meats such as sausages, bologna, pepperoni and ham,” says Ordon. “These meats are not only high in sodium but have nitrates in them, which have been found in studies to promote cancer cell formation.” Sports drinks also contain sodium—and sugar, says Ordon. “Most men, unless they’re athletes running marathons, don’t need sports drinks. Water is best. Sugary beverages should be limited to 36 ounces or four cups a week.” Eliminate trans fats, says Ordon. “They have been found to increase bad and total cholesterol and contribute to coronary heart disease. “Avoid trans fats and limit saturated fats as much as possible.” Healthy fats include those found in oils such as olive, canola, safflower, corn, sesame, soybean and sunflower, according to Ordon. “Fats to stay away from are found in palm, palm-kernel and coconut oils,” she says. Proper nutrition is necessary for optimal health. Not only does every system—cardiovascular, musculoskeletal and neurological, for example— have its own nutritional needs, but many diseases can also be warded off by certain substances found in foods.

Prostate Health

“There was some thought that vitamin E and selenium could reduce prostate cancer risk, but new reports say they don’t,” says Boyd. “The same is true with lycopene, which is found in tomatoes. So, we’ve stopped pushing tomato sauce.” There is no specific food known to combat prostate cancer, according to the Mayo Clinic. To maintain prostate health, current science suggests a diet rich in fruits and vegetables and low in fat and dairy products. “Cover half your plate with fruits and veggies—green, red, yellow, orange—one quarter with meat or protein and the other quarter with starch or grains….If you go back for seconds, take some of everything in the same proportion,” says Boyd. Remember to add dairy, but do it in moderation. “Some studies have shown that high levels of calcium raise the risk of advanced prostate cancer.”

Bone Health

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Some calcium, along with vitamin D, is needed to prevent osteoporosis. Roughly 20 percent of the 750,000 Marylanders afflicted with the disease are men and about a quarter of all men over 50 nationwide will break a bone as a result of osteoporosis, according to the National Osteoporosis Foundation. Adult men need 1,000 milligrams of calcium and 600 IUs (internation-

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Gazette Health | Spring 2012

A GAZETTE PUBLICATION


al units) of vitamin D daily, according to the National Institutes of Health. At age 70, calcium requirements rise to 1,200 milligrams and vitamin D to 800 IUs. Men should have at least three servings of calcium-rich foods daily, according to the Academy of Nutrition and Dietetics (AND). A serving might consist of a cup of fat-free milk or yogurt, 1½ cups of cooked edamame (soybeans), or 1½ ounces of fat-free cheese. Vitamin D, which helps bones absorb calcium, comes from sunlight as well as food. It is found in fatty fish, such as tuna and salmon, egg yolks, fortified milk, soy milk and orange juice .

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Muscular Health

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Around 25, men begin to lose muscle mass, “about half a pound per year,” says Kim Crilly, a nurse and coordinator of the Chronic Disease Prevention and Self Management program at Holy Cross Hospital in Silver Spring. While exercise is critical to building and maintaining lean muscle, there is a dietary component as well. “Protein supports higher muscle mass,” says Boyd. “To help with the development of lean muscle, it’s important to get adequate protein right after a workout. It doesn’t take much—something like yogurt or a couple of ounces of lean protein.” The Centers for Disease Control and Prevention (CDC) recommends adult males get 56 milligrams of protein daily, the equivalent of 8 ounces of meat. “Most Americans eat double what their needs are,” says Ordon.

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Maintaining an optimal weight and keeping one’s blood pressure and cholesterol levels in check can lower the risk of heart disease. Calories matter. “Calorie needs are based on height and level of activity,” says Ordon. To lose weight, a person needs to burn more calories than they ingest. To maintain, they need to find a balance between what’s eaten and what’s used. According to the CDC, potassium might help to maintain a healthy blood pressure, which is important for the heart. Sweet and white potatoes, tomatoes, lima beans and prunes are good sources of this mineral. Fiber, according to the CDC, has been shown to decrease the risk of coronary artery disease. Various beans—kidney, navy, black, pinto, lima and white—as well as chick and black-eyed peas, lentils and artichokes are rich in dietary fiber. The amount and type of fat you eat makes a difference to your heart. “Omega-3 fatty acids, a type of unsaturated fat, have been found to be helpful in preventing sudden death from heart attacks,” the AND reports. The recommendation for omega-3 fatty acids is 500 milligrams per day. That equates to about two 6-ounce servings of fatty fish each week. Walnuts and hazelnuts also are sources of omega-3s.

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Diet can affect mood, motivation and cognitive functioning, according to Shnider. “Eat brain foods—antioxidants as well as fats that coat the neurons,” he says. Chief among those fats is omega-3, a component of which, known as docosahexaenoic acid (DHA), is the major polyunsaturated fatty acid found in the brain. Recent studies have linked low DHA levels with psychiatric and cognitive problems. In August, the Journal of Clinical Psychiatry reported that U.S. servicemen with low DHA levels were 62 percent more likely to attempt suicide than their peers in the military. DHA deficiencies have been associated with Alzheimer’s and other neurodegenerative diseases. While the jury is out on whether DHA can prevent such diseases, the Alzheimer’s Association recommends a “brain healthy diet” that is high in omega-3 fatty acids.

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CERVICAL CANCER, continued from 15

The high level of HPV infection, particularly in those under 30, combined with the fact that the vast majority of cases clear up on their own, has led to changes in screening recommendations. The American College of Obstetricians and Gynecologists suggests women begin getting Pap smears at 21 and get one every other year until 30. A woman in her 30s may move to a three-year Pap regimen if she has had three normal test results in a row, no history of dysplasia and a healthy immune system. Women on the three-year Pap schedule may discontinue the test after 65 if they are no longer sexually active. These recommendations don’t “mean that women don’t need a yearly gynecologic visit for other reasons, but that the actual Pap may not need to be done at every visit,” says Mandel. WHILE THE PAP SMEAR DETECTS ABNORMAL CELLS ON THE CERVIX, A

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Gazette Health | Spring 2012

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relatively new test identifies the presence of HPV. Many gynecologists now use the HPV DNA test in conjunction with a Pap in women over 30, according to Chandra Graham-Parker, M.D., an obstetrician with Scartascini & Rogers in Greenbelt and Bowie and privileges at Doctors Community Hospital in Lanham. The test also is used as a follow-up to abnormal Pap results. Depending on the results of the HPV DNA test and the woman’s age and history, a physician may decide to monitor her or conduct further testing. “While the life span of HPV is 12 to 18 months, we can’t be sure where a woman is within that time period,” says Graham-Parker. “So, we bring her back every four to six months to repeat the test and make sure the abnormal cells are not progressing to a higher stage but are, in fact, going back to normal.” Sometimes a colposcopy is performed. “That’s where we look at the cervix under a microscope and use a vinegar solution that makes the abnormal cells turn white,” says Young. If a problem is detected, the gynecologist will remove a small sample of tissue for more detailed study. The results of a colposcopy tell the physician whether the abnormal cells are precancerous or cancerous. “If we have mild dysplasia…we usually monitor, repeating Pap smears and, depending on the person, HPV tests at about six-month intervals,” says Nardone. Moderate to advanced dysplasia usually requires the ablation or excision of abnormal cells. A LEEP (loop electrosurgical excision procedure) is commonly used to remove the abnormal tissue. “We numb the cervix and use electricity to get rid of the bad cells,” says Young. “There’s a 95 percent chance that we’ll get them all.” If cancer is detected, further tests will determine whether it is confined to the cervix or has spread to other parts of the body. At a minimum, a portion of the cervix will need to be removed, says Graham-Parker. A hysterectomy may be required. In cases where the cancer has spread, radiation and/or chemotherapy may be prescribed. “The survival rate for women whose cancer has not spread outside the cervix is 92 percent after five years,” says Tran. “The five-year survival rate for all stages of the cancer is about 75 percent.” Many cases of cervical cancer are not diagnosed until the later stages. “It’s estimated that over 50 percent of the women who develop cervical cancer have never had a Pap smear,” says Mandel. “Another 10 percent have not been screened within the five years prior to their diagnosis being made.” While it may not be possible to eradicate cervical cancer in the near term, it is possible to both reduce the rate of incidence and catch it earlier “by doing the right things,” says Mandel. The right things include, for those young enough, an HPV vaccine and, for all females, “getting screened on a regular basis, using condoms, not smoking and not engaging in risky sexual behavior.”


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M.D., a Chevy Chase psychiatrist in private practice who also sees patients at Holy Cross Hospital in Silver Spring. “A stress for the person lacking coping skills may not be a notable stress for someone else,” he says. For some, it takes a significant event, such as a death or loss of a job, to trigger stress. Others may find that life’s daily hassles—commuting or project deadlines—trigger stress. Money and work are the two most often cited sources of stress among adults in this country, according to the American Psychological Association (APA). More than three-quarters point to finances as a major stressor, while seven in 10 say their job adds stress to their lives.


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“While in most cases we can’t change the stressor, we can change how we react to it,” says Saggar. The “recommended way to combat stress is to exercise. That can include aerobic exercise, yoga, pilates, martial arts. Exercise actually stresses the body in a positive way.” Because stress manifests itself differently in different people, Wong suggests taking time to “figure out or understand where in the body there’s stress. Do you have chronic headaches, muscle tension, palpitations, or digestive problems? Once the area is identified, it can be relaxed. “I usually start with breathing,” says Wong, who has privileges at Suburban Hospital in Bethesda. “The breath is the connection between the body and the mind. Go internally and see, in a nonjudgmental manner, where the stress is in your body.” “Acupuncture (also) encourages the body toward natural healing and improved functioning,” Wong says, noting that his patients generally see improvement after one session. He advises, however, that they allow up to four sessions, once a week, for stress reduction. After that, Wong suggests maintenance treatments once or twice a month. “For someone who is really healthy, except for occasional stress, and just wants to balance his system, I’d recommend four times a year.”

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on the body—acupressure points—that are more effective in terms of massage, as they’re connected to the nervous system in a strong way,” says Wong. He recommends massaging the interosseous muscle found in the fleshy spot between the thumb and index finger; the trapezius muscle, which extends in a triangular fashion from the base of the skull to the shoulder and down the spine to the mid back; and the point between the eyebrows. “Another point is right at the heart area, between the nipples. Press, hold and do clockwise circles...” “Do something that releases you—painting, playing an instrument, reading a book,” says Saggar. “Go to those places or things that help you control your mood and reestablish a sense of balance.”

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OSTEOARTHRITIS, continued from 12

bearing exercise by walking on a treadmill or using an elliptical trainer also helps maintain good bone health and keeps bone density from breaking down over time.”

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is to relieve pain and restore function of the joint.” Anti-inflammatory drugs such as ibuprofen (Motrin and Advil) or naproxen (Aleve), says Jones, are used initially for “managing the symptoms.” Shaw “likes Tylenol, because it’s easier on the stomach and kidneys.” Changing the exercise regimen from high- to low-impact to decrease pounding on the joints can also help, according to Jones. Instead of running on a treadmill, for example, the patient would switch to an exercise bike. Anti-inflammatory medications available by prescription, says Shaw, include Celebrex, Mobic, Dolobid and Clinoril. In addition, Shaw says there are topical preparations that can be rubbed on joints, such as Pennsaid and Voltaren, which are gels, and over-the-counter capsaicin, a cream. Cortisone injections into joints by a physician are another treatment option. These “can help decrease inflammation so that you have more mobility in the joint,” says Chatterji. “Cortisone injections can be given safely three times a year and should not be given repetitively,” says Shaw. “If all of that doesn’t work, we can use mild, narcotic, analgesic pain medications such as tramadol or hydrocodone.” Alam says assistive devices, such as canes or walkers, can be part of the treatment program for patients with severe symptoms. “Eventually,” he says, “the patient may have to consider surgery, such as knee replacement or hip replacement.” Experts differ on whether dietary supplements have treatment value. The Mayo Clinic and University of Maryland Medical Center report that some controlled studies show taking glucosamine supplements might help, especially with knee pain, but Shaw believes the evidence is insufficient. According to the Arthritis Foundation, “Many people find the heat of a warm bath or heat pack eases osteoarthritis pain. Others find relief in cold packs. Still others prefer alternating the two.” Shaw thinks both heat and cold have therapeutic value, and leaves the choice up to the patient. “MOVING IS THE BEST MEDICINE WHEN IT COMES TO FIGHTING OSTEO-

arthritis,” according to the Arthritis Foundation. Shaw agrees that exercise is “very good for prevention. Keeping your body in good shape and tone protects the joints.” Chatterji recommends tai chi, pilates and yoga. The key, she says, is to find something that you can do at home and incorporate into a long-term daily regimen. While exercise can’t cure osteoarthritis, it can alleviate symptoms. “Engaging in physical activity three times a week can reduce osteoarthritis-related disability in the knee by 47 percent,” says Chatterji. Alam says exercise is important because “it builds up strength and endurance of muscles and flexibility of joints.” Strengthening muscles around an affected joint will decrease pain and stress on that joint, according to Chatterji. “If the symptoms are in your knee, then you should strengthen the quadriceps (thigh) muscles.” While there is no cure, “osteoarthritis is treatable, and in most cases it’s preventable,” says Jones. “The main thing for people to realize is that they need to be responsible about exercising and maintaining a healthy weight.” Another key, says Shaw, is early diagnosis. “If your knee, back or hip have been bothering you, see your primary care doctor or a rheumatologist, get a correct diagnosis and start treatment. If you start treating osteoarthritis early, you may not have to go see the orthopedic surgeon.”


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ISTOCKPHOTO/EMRE OGAN PHOTOGRAPHY

E

ating chocolate may have some health benefits, but the Ranganath Muniyappa, a National Institutes of Health (NIH) staff research is far from certain. The drawbacks, on the other clinician who studies diabetes and cardiovascular health. These hand, are clear. studies, he explains, look at cardiovascular risk markers—factors The idea that chocolate might be good for you stems related to heart health, such as blood pressure—not long-term outfrom studies of the Kuna Indians, who live on islands off the coast comes, such as heart disease and stroke. of Panama. They have a low risk of cardiovascular disease and Studies looking into the long-term health effects of chocolate high blood pressure given their weight and salt intake. Researchers have relied on people to recall how much chocolate they ate. realized that genes weren’t protecting them because those who Researchers have then compared those levels with health outmoved away developed high blood pressure and heart disease at comes. While such studies can find associations, they can’t prove typical rates. Something in their island environment must have the effects of a particular food. kept their blood pressure from rising. “People usually eat food in a pattern. A chocolate lover would “What was particularly striking about their environment was eat chocolate with something else,” Djoussé explains. “It could be the amount of cocoa they consumed, which was easily 10 times not so much the chocolate by itself, but chocolate in conjunction more than most of us would get in a with, let’s say, whole grain or exertypical day,” says Dr. Brent M. cise or not smoking—the pattern of Egan, a researcher at the Medical the lifestyle habit in general. It’s realUniversity of South Carolina who ly hard to separate the effects of studies the effect of chocolate on individual components.” blood pressure. Chocolate contains high levels of But Kuna cocoa is a far cry from compounds thought to help prevent the chocolate that most Americans cancer, too. But Dr. Joseph Su, an eat. The Kuna make a drink with NIH expert in diet and cancer, says dried and ground cocoa beans (the that direct evidence here is similarly seeds of the cocoa tree) along with a hard to come by. Since cancer can little added sweetener. The chocolate take many years to develop, it’s we tend to eat, on the other hand, is difficult to prove that eating chocomade from cocoa beans that are late can affect disease. Instead, roasted and processed in various researchers look to see if factors The evidence that chocolate can reduce other ways, and then combined with linked to cancer change when chocoingredients such as whole milk. late is eaten. cancer or death rates is still weak. Processing can extract two main “Right now, some studies show components from cocoa beans: really a remarkable modification of cocoa solids and cocoa butter. Powdered cocoa is made using the those markers,” Su says. But the evidence that chocolate can solids. Chocolate is made from a combination of cocoa solids and reduce cancer or death rates is still weak. “There are a few studies cocoa butter. The color of the chocolate depends partly on the that show some effect,” Su says, “but the findings so far are not amount of cocoa solids and the added ingredients. In general, consistent.” though, the darker the chocolate, the more cocoa solids it contains, Compounds called flavonols are thought to be responsible for and researchers think those solids are where the healthy com- many of chocolate’s beneficial effects. Cocoa beans naturally differ pounds are. in their flavonol levels, and because companies often remove these “We have good science on chocolate, especially about dark compounds due to their bitter taste, there’s no way to know if the chocolate on blood pressure,” says Dr. Luc Djoussé of Harvard commercial products contain high flavonol levels. Medical School and Brigham and Women’s Hospital. His research So, should you eat chocolate? It can have a lot of calories, and team found an overall drop in blood pressure among people who the importance of a healthy weight is well known. “If you’re eateat more chocolate. Laboratory studies have uncovered several ing chocolate, make sure to watch the calorie content, the fat conmechanisms that might explain chocolate’s heart-healthy benefits. tent and the sugar content,” Su says. However, it’s hard to prove whether the chocolate that most “For those who are already consuming chocolate, I would Americans eat actually has those effects in the human body. advise them to look for the darker ones,” Djoussé adds, “not the Controlling how much chocolate people eat and tracking them white chocolate or the milk chocolate. You won’t get any of the for long periods has proven challenging. “The clinical trials that benefit. It’s just going to be unneeded calories.” -NIH News in Health have been done in people have all been fairly short,” says Dr.

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