Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

What is plantar fasciitis and how is it treated?

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Plantar fasciitis – a painful inflammation of the tendon-like tissue that runs from the heel bone to the ball of the foot – is the most common cause of heel pain. It affects between 1 to 2 million Americans a year.

Luckily, simple, noninvasive treatments are usually “very successful,” said Dr. Jim Christina, director of scientific affairs for the American Podiatric Medical Association.

For starters, it often helps to put ice on the bottom of the foot several times a day for not more than 20 minutes each time. Over-the-counter anti-inflammatory drugs such as ibuprofen, aspirin, and naproxen can also help. Stretching calf muscles may also reduce heel pain, as does stretching the bottom of the foot. (You can do this by resting the affected foot on top of the opposite knee and using one hand to flex the toes upward while the other hand massages the bottom of the foot near the heel.)

If that doesn’t help enough, you can try physical therapy using ultrasound and electrical stimulation of fascia tissue to stimulate blood flow. You can also buy over-the-counter insoles or custom-made orthotic devices, which support proper foot function. Shoes with good arch support, such as athletic shoes, are important, too. If none of that helps, you can try cortisone injections into the painful area of the foot, although this can weaken tendons and muscles in the foot, said Dr. Joseph S. Fox, a podiatric surgeon at the Gramercy Surgery Center in New York.

Roughly 90 percent of patients get better with these low-tech approaches. For those who don’t, shockwave therapy, which uses high-energy sound waves to increase blood flow around fascia tissue, may help. So may a new technique called coblation therapy in which a doctor makes a small incision near the heel and uses low-temperature radiofrequency waves to destroy nerve fibers in the inflamed area.

Finally, there’s surgery, often done through tiny incisions, to cut a portion of the fascia tissue, a procedure that can “release” tight fascia tissue by lessening tension from the fascia to the heel bone. While surgery is generally covered by insurance, the other procedures often are not.

But the best bet is to prevent plantar fasciitis by wearing supportive shoes, warming up before athletic activities, and stretching the feet and calves before and afterward.

Are there any health benefits from tai chi exercises?

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Tai chi, the slow, graceful Chinese exercise program that is sometimes called a “moving meditation,” was originally created centuries ago as a martial art. It does appear to have some health benefits, though rigorous studies are hard to come by.

The National Center for Complementary and Alternative Medicine, an arm of the National Institutes of Health (nccam.nih.gov) notes, “It is not fully known what changes occur in the body during tai chi, whether they influence health, and if so, how.” But so many Americans now practice the slow-moving exercise – 1.3 percent, according to a 2002 survey – that the government is now funding a number of studies to see what health benefits tai chi may hold.

Among the best-documented health effects for tai chi is its ability to improve balance, said biologist Peter Wayne, director of Tai Chi Research Programs from Harvard Medical School’s Division for Research and Education in Complementary and Integrative Medical Therapies. In a systematic review of the published literature, Wayne and his colleagues found that 20 of 24 studies support the hypothesis that tai chi improves balance.

A recent study in the Journal of the American Geriatric Society found that tai chi can also boost immunity and protect older adults against shingles, a painful disease caused by reactivation of the chicken pox virus, which can linger in the body for decades. In this study, 112 adults age 59 to 86 were randomly assigned to tai chi or health education classes for 16 weeks.

Those who got tai chi had nearly twice as much immunity against the chicken pox virus (all participants had had chicken pox) measured by a blood test, as well as a stronger immune response to the chicken pox vaccine.

Tai chi has also been shown in a number of studies to lower blood pressure in people with hypertension.

But whether tai chi is any better for health than some other mind-body practices such as yoga and meditation remains to be seen, said Wayne. Tai chi teachers are not licensed by state boards, so a word of caution: If you are new to tai chi, check out several teachers and pick one with the most experience.

What is ‘green light’ laser therapy to treat an enlarged prostate?

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In the last several years, many hospitals have switched to “green light” treatment for men with benign prostate enlargement, a nearly universal affliction of older men.

The job of the prostate gland is to squeeze fluid into the urethra (the tube through which urine passes) as sperm pass through during ejaculation. As a man gets older, the prostate gland enlarges and pushes on the urethra, eventually causing the urethra to become narrowed; urination becomes more difficult, as well as more frequent, especially at night.

For years, the best treatment options were medications or various procedures using microwaves, radiofrequency waves or surgical techniques to get rid of excess prostate tissue. The most common surgical procedure, called TURP, typically results in a 2-3 day hospital stay and can lead to considerable bleeding.

Green light laser therapy is different. It uses a very precise laser to vaporize and remove enlarged prostate tissue.

“The beauty of ‘green light’ treatment. . . . is that there is no bleeding,” said Dr. Kevin Loughlin, a senior surgeon at Brigham and Women’s Hospital. Moreover, patients go home the same day and results are as good as a TURP, the so-called “gold standard” of care, said his Brigham colleague, senior urologic surgeon Dr. Michael O’Leary.

An additional advantage of “green light” therapy is that “some patients even on blood thinners can have it, patients who would not have been candidates for a TURP,’ said Dr. Shahin Tabatabaei, a urologic surgeon at Massachusetts General Hospital. This means that many men who are on anticoagulant medications to prevent strokes can now have treatment for their benign prostate problems without having to go off their medications.

Is it true that grapefruit juice has more nutrients than other fruit juices?

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Yes, according to a new study by researchers at the University of Florida Institute of Food and Agricultural Sciences. But read on, because grapefruit and grapefruit juice aren’t risk free.

The study, led by nutritionist Gail Rampersaud, whose position is supported by the state of Florida Department of Citrus, looked at six formulas for computing the density of nutrients per calorie in seven types of juice: apple, grape, orange juice, pink grapefruit, white grapefruit, pineapple and prune.

Pink grapefruit juice came out tops in the nutrients-per-calorie race according to five of the six formulas, said Rampersaud, with orange juice second, followed by white grapefruit. Among the nutrients prevalent in these citrus fruits are vitamin C, folate, thiamin, vitamin A and potassium. The advantage of drinking grapefruit juice, as opposed to eating grapefruit, said Rampersaud, is that it is more convenient; on the other hand, eating the fruit itself provides more fiber.

But before you tank up on grapefruit or grapefruit juice, be careful. Chemicals called furanocoumarins in grapefruit interfere with an enzyme called CYP3A in the intestine whose job is to break down certain drugs. The furanocoumarins inactivate this enzyme, which means that higher levels of certain drugs get into the bloodstream, said David Greenblatt [cq], chairman of the department of pharmacology and experimental therapeutics at Tufts University School of Medicine.

There are no significant grapefruit-drug interactions with over-the-counter medications, said Bill [cq] McCloskey [cq], executive director of the center for drug information and natural products at the Massachusetts College of Pharmacy and Health Sciences. But some prescription drugs may interact with the fruit. Among them are anti-seizures drugs such as Tegretol ; an anti-anxiety drug, BuSpar; statins such as Zocor and Mevacor; the tranquilizer, Valium; and some calcium channel blockers for high blood pressure such Plendil.

Does being bilingual delay the onset of Alzheimer’s disease or other dementias?

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It may, according to recent research by psychologist Ellen Bialystok, a scientist at York University and the Rotman Research Institute of Baycrest Hospital in Toronto.

Three years ago, Bialystok’s team showed that people who had been bilingual all their lives did better at paying attention and doing the kind of intellectual tasks that the prefrontal cortex of the brain (right behind the forehead) is responsible for: planning, being able to tune out distractions and making judgments. That led Bialystok to wonder whether bilingualism might also protect against Alzheimer’s disease. Bilingualism has been shown to boost the power of the prefrontal cortex because, in order to speak one language, the speaker must activity “inhibit”or tune out the other language.

In a study published in February in the journal Neuropsychologia, she looked at the hospital records of people who had visited Baycrest’s memory clinic, two-thirds of whom had Alzheimer’s and one-third, other kinds of dementia. Roughly half were “perfect bilinguals,” she said, meaning that they had been speaking at least two languages every day for 50 years or more, typically English plus Polish, Russian, or Yiddish.

The rest were monolingual. “What we found is that all else being equal – education, occupational skills, marital status, money, etc.” – the age of onset of dementia was on average 71 for the monolinguals and 75 for the bilinguals, she said. “That difference is huge,” she said. “The neurologist on the team was astonished.”

It doesn’t appear that learning learning a second language in midlife would carry the same benefit. Dr. Charles De Carli [cq], a neurologist and director of the University of California, Davis Alzheimer’s Disease Center, was skeptical. “The brain is most ‘plastic’ during early life,” he said, meaning that it can most easily learn new tasks and use one region to compensate for another if necessary. “It’s not clear what suddenly taking on a second language at age 60 would do.”

Bialystok is studying that now, and so far, is finding “that there is a much diminished effect for later bilinguals.”

Do scales that calculate body fat really work?

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Sort of. The devices, which cost $100 and up, send a mild, unnoticeable electrical current up through one foot to the waist, then down the other leg to measure how much body fat a person has. Since fat is a poor conductor of electricity compared with water (the main component of muscles, liver, brain, etc.), the current flows more slowly through fat tissue. Using complex formulas that include age, sex, height, and activity level, the devices — Tanita and HoMedics are the big players — can thus calculate what percent of a person’s weight is attributable to fat.

The devices are “surprisingly accurate,” said exercise physiologist William J. Evans, director of the Nutrition, Metabolism, and Exercise Laboratory at the University of Arkansas for Medical Sciences. But the accuracy depends on hydration — how much water you have in your system. “The things that can throw off the measure are excessive alcohol consumption and heavy exercise or sweating, in other words dehydration issues,” he explained in an e-mail.

Dr. David Ludwig, director of the Optimal Weight for Life program at Children’s Hospital is less sanguine about the scales. “The devices are moderately but not extremely accurate,” he said. They “do give people a number, and lots of people like following numbers, so that may provide some motivation” for weight control. On the other hand, he said, many people are too obsessed with numbers on a scale already.

Personally, I would say save your money (or use it to buy some good walking or running shoes). Instead, calculate your BMI (body mass index), for which formulas abound on the Internet. Even better, take a tape measure and measure your waist and hips, then divide the first number by the second. For example, if your waist is 30 inches and your hips are 29, the ratio is 1.03. For women, if the result is over 0.85, you’ve got too much fat around the middle; for men, it’s 0.95.

Do masks provide real protection for healthy people in airplanes?

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Nope.

To be sure, sitting on a crowded plane surrounded by people who may be harboring nasty bugs raises fears of catching something awful, especially since TB patient Andrew Speaker’s famous escapade.

But infectious diseases specialists insist that, while it makes sense for people who do carry germs to wear masks to protect others, the benefits of healthy people wearing masks to protect themselves are negligible.

At the Centers for Disease Control and Prevention, infectious disease specialist Dr. Phyllis Kozarsky said that the masks are “difficult to wear and minimally effective” for healthy people. “The biggest thing is, if you are wearing the mask, then taking it off to eat, you get the germs on your hands. Your biggest risk is not inhaled air, but getting germs on your hands,” she said. “And everybody should practice ‘respiratory etiquette,’ which means covering your mouth when you cough and sneeze and disposing of your own tissues, not leaving them on the seat.”

Dr. Marc Siegel, an associate professor of medicine at the New York University School of Medicine and author of “False Alarm: The Truth about the Epidemic of Fear,” added that the HEPA filters used on planes “filter out 99 percent of bugs, much better than any of these masks,” though “if someone in row C sneezes on someone in row B, these filters don’t help.” In any case, he said, “everybody uses the bathroom,” which means germs are on the faucets and every other surface touched by passengers.

The minimal effectiveness of masks is bad news for Internet companies now touting designer masks, though frankly, even these masks don’t look very pretty to me.

Bottom line? If you’ve got a respiratory illness, wear a mask to protect others. Whether you’re sick or healthy, wash your hands early and often.

Is resveratrol, the putative anti-aging ingredient found in red wine, on the market yet?

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Yes. There are a number of resveratrol products on the market as dietary supplements, but as with many such supplements, these products have not been rigorously tested or approved by the US Food and Drug Administration. Researchers at Sirtris Pharmaceuticals in Cambridge hope to have a real resveratrol drug (not a supplement) on the market to combat Type 2 diabetes and other illnesses by 2012.

Resveratrol has been shown by researchers at Harvard Medical School and elsewhere to prevent mice fed a high-calorie diet from developing signs of incipient diabetes and to prolong life. Scientists suspect, but have not proved, that resveratrol activates an enzyme called SIRT1 that may forestall the effects of aging. Scientists theorized that the enzyme may increase the number or efficiency of mitochondria, the tiny organelles inside cells that produce energy. Red wine is famous for containing resveratrol, but the amounts are so tiny that it would take hundreds of bottles a day to get enough resveratrol to see the same benefits in humans that have been shown in mice, said molecular biologist David Sinclair, the Harvard scientist who studies resveratrol and was the co-founder of Sirtris.

Bill Sardi, president of Resveratrol Partners, LLC, which makes Longevinex,, a resveratrol supplement, said his company is working on human safety studies now. While he said he believes resveratrol supplements are safe, he suggested that people not take them along with medications because they may result in higher levels of certain medications in the bloodstream.

Mark Holman, vice president for marketing for NFI Consumer Products, which makes Resvinatrol Complete, said that company, too, is continuing to study its products.

Bottom line? Caveat emptor, as usual. Since some supplements now on the market contain other ingredients that have not been fully tested in combination with resveratrol and since the animal studies at Harvard suggest high doses may be necessary to achieve benefits, it’s probably too soon to take resveratrol supplements. Taking high doses of insufficiently tested supplements is just too risky.

Can group therapy extend life for breast cancer sufferers?

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No, according to a new study being published today in the journal Cancer by Dr. David Spiegel, associate chair of psychiatry at Stanford University School of Medicine.
The new Spiegel study is important because in 1989, Spiegel published findings that electrified the world of cancer patients and their doctors. In that study, he found that women whose cancer had spread beyond the breast and who participated in group psychotherapy lived an average of 18 months longer than those who did not get group therapy. That study fed hopes that reducing emotional stress might not only help patients feel better but live longer.

That study also stirred tremendous controversy and ended up being an “unintended cruel hoax” in the view of psychologist and medical sociologist Barrie Cassileth , chief of the department of integrative medicine services at Memorial Sloan Kettering Cancer Center in New York. The idea that people with cancer could improve their survival chances with group therapy played into the very American belief “that if you try hard enough, you can conquer anything. It’s an unkind burden to place on patients,” she said. Cassileth applauded the new findings as much more realistic.

Since the original study, other researchers have tried, and often failed, to duplicate the results.

Today’s results were “disappointing,” conceded Spiegel, though he added that group therapy can reduce anxiety, pain, and the stress of coping with cancer. “We change patients’ ways of handling emotions so that they are less suppressive of their own feelings,” he said. By expressing their deepest fears and sadness instead of shying away from such feelings patients “feel better, not worse.”

One strange wrinkle: for a subgroup of women — those whose tumors were not responsive to the hormone estrogen — there appeared to be a survival advantage to being in group therapy though it’s not at all clear why this would be

Can you lose fat in a specific area of the body by targeting your workout regimen to that area?

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The short answer is no. “You can’t pick where on the body you want to lose fat,” said Eric Ravussin , a physiologist at the Pennington Biomedical Research Center in Baton Rouge, La. If you lift weights, for instance, you can build up muscle beneath the fat. But unless your achieve a net calorie deficit — that is, expending more calories than you consume — you will not lose weight, in the spot where you would like to lose it or anywhere else.

In general, “we know that if you exercise your arms, you do not lose fat from your arms, but from all over,” said exercise physiologist William J. Evans , director of the Nutrition, Metabolism, and Exercise Laboratory at the University of Arkansas for Medical Sciences . Exercise stimulates production of an enzyme called hormone sensitive lipase, which acts on fat stores all over the body.

But there is a wrinkle to this, albeit one you can’t control, Evans added in an e-mail. The extent to which lipases are “turned on” appears to vary to some degree from one part of the body to another, and from person to person. “So, some women have a very difficult time losing fat from their legs, but no problem losing fat from their breasts or arms,” he said.

In other words, you can lose weight, by using up more calories than you consume, but you have no control over where you lose it. And you can’t turn fat into muscle, because the processes of losing fat and building muscle are separate.