Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

Does the herbal product black cohosh alleviate hot flashes in menopausal women?

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No, unfortunately for millions of women seeking alternatives to hormone replacement therapy.

In a study published in December in the Annals of Internal Medicine, researchers from Washington state concluded that black cohosh does not work for menopausal symptoms such as hot flashes. The only thing that did, as has been shown repeatedly, was estrogen, either alone or with another hormone called progestin.

In the randomized, double-blind clinical trial, epidemiologist Katherine M. Newton, associate director for external research at Group Health, a large, integrated health plan headquartered in Seattle, assigned 351 women to one of five groups. One group got a placebo, or dummy medication. One group got hormone replacement therapy. The other three groups got either black cohosh alone, black cohosh in combination with other herbs, or the combination plus phone counseling to increase consumption of soy products. (Data is mixed on whether soy effectively combats hot flashes.)

Decreases in hot flashes were no different between the placebo and black cohosh groups, said Newton. Black cohosh, she said, “had no promise for relieving ” these symptoms in menopausal women.

That’s no surprise, said Dr. JoAnn Manson, chief of the division of preventive medicine at Brigham and Women’s Hospital and author of the book, “Hot Flashes, Hormones and Your Health.”

“When subjected to rigorous testing in clinical trials, black cohosh and other botanicals have been disappointing for hot flashes,” she said. “What’s more, even though black cohosh is ‘natural’ and seems to be safe, it has actually been linked to liver damage. Estrogen does have risks, but it is well-established as the most effective treatment available for hot flashes.”

For women with bad hot flashes that disrupt quality of life, it’s back to trying to balance the benefits of hormone therapy (symptom management, bone protection) against the risks, including a slightly higher risk of breast cancer, blood clots and stroke. Use the lowest dose possible for the shortest possible amount of time.

Is it true that there’s peanut oil lurking in kids’ toothpaste?

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Nope. Luckily for kids with peanut allergies, this appears to be yet another urban legend that’s making the rounds in cyberspace and, not long ago, on Boston TV.

The allegation is that AquaFresh for Kids contains peanut oil and that the product does not have to say so on the label because a law passed last year called the Food Allergen Labeling and Consumer Protection Act only mandates that food products (not non-food items like toothpaste) list 8 major allergens on product labels.

A spokeswoman for the manufacturer of AquaFresh for Kids, GlaxoSmithKline said emphatically that there is no peanut oil in any of its AquaFresh toothpastes. A spokeswoman for The Food Allergy and Anaphylaxis Network, a major nonprofit group that seeks to raise awareness of food allergies, said her group had checked the allegation carefully with Glaxo and agrees that the allegation is “not accurate.”

The fuss started several months ago when two Massachusetts mothers became concerned that their children had become sick after using the toothpaste. One consumer called Glaxo, according to the company spokeswoman said, and was told by a consumer relations person who “erred on the side of caution” that it was a “possibility” that the product contained peanut oil and that more information was not immediately available. “The consumer was told to treat it as if it may contain it [peanut oil] because they didn’t have that information,” said the spokeswoman, Lori Lukus.

There are many hazards out there, especially for kids with serious allergies, but toothpaste, thank goodness, does not appear to be one of them.

If you take low-dose aspirin for your heart, can you also take ibuprofen for pain?

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You can, but the timing is critical. If you take ibuprofen first, it fills up the same molecular site inside platelets that aspirin binds to. If ibuprofen is already there, the aspirin can’t bind, which means aspirin’s potent anti-clotting action can’t get started.

To get around this, you can take low-dose aspirin, typically 81 milligrams, in the morning, then wait an hour or two before taking ibuprofen for pain. In the evening, take your last ibuprofen dose, then wait 8 hours before taking aspirin.

At the molecular level, “the interaction of aspirin and ibuprofen is a clash of the titans which has potentially very serious consequences,” said Dr. Christopher P. Cannon [cq], a cardiologist at Brigham and Women’s Hospital. “It has flown under the radar screen of a lot of people, yet it is pretty important information.”

In a little-noticed statement last fall, the US Food and Drug Administration warned about the concomitant use of aspirin and ibuprofen (drugs like Motrin or Advil), citing studies of the way the two drugs compete for virtually the same molecular site.

The key concept, said Dr. Nauder Faraday [cq], an associate professor of anesthesiology and critical care medicine at Johns Hopkins University, is that when aspirin gets into a platelet, that binding is permanent – for the life of that platelet, typically about a week. Put differently, once aspirin is inside a platelet, an enzyme called COX-1 is permanently blocked, effectively stopping the chemical chain of events that leads to blood clotting. Because new platelets are constantly being made, you have to take low-dose aspirin every day to keep damping down the clotting process.

Ibuprofen, while effective for pain, is not a good drug at protecting against heart attacks. When it binds to the site inside platelets, it falls off in a few hours, so the anti-clotting effect is temporary.

Are “energy drinks” bad for you?

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They’re not going to kill you. But many of these increasingly popular drinks contain significant amounts of caffeine, which can make you jittery and can cause insomnia, as well as loads of sugar, which nobody needs. Worse, these drinks are often marketed to kids and teenagers, many of whom already struggle with weight and don’t need to add a caffeine addiction to their troubles.

“Energy drinks are rip-offs,” said Bruce Silverglade, legal director of the Center for Science in the Public Interest, a Washington, D.C.-based consumer watchdog group that has been trying for a decade now, unsuccessfully, to get the US Food and Drug Administration to force manufacturers to list the amount of caffeine on product labels. Most of the increased energy you feel with an energy drink is due to sugar and caffeine, added Silverglade.

In a study published last year in the Journal of Analytical Toxicology, Bruce A. Goldberger, director of toxicology at the University of Florida College of Medicine, tested the caffeine content of 10 energy drinks, including Red Bull, Red Devil and Hair of the Dog. In most energy drinks, he said, caffeine levels were higher than that allowed for sodas. While the FDA does set limits on the amount of caffeine in cola beverages – 65 milligrams per 12 ounces – it does not regulate caffeine in energy drinks. And some energy drinks, like Cocaine, contain huge amounts of caffeine – 280 mg in an 8.4-ounce serving – compared to bout 100 milligrams per 6 ounces in coffee.

Overall, caffeine “is relatively benign and is not associated with life-threatening health risks,” said psychopharmacologist Roland Griffiths, a professor in the department of psychiatry and neuroscience at Johns Hopkins University and a caffeine expert.

“But here it is being promoted in the form of energy drinks and, alarmingly, in many cases to children and adolescents,” Griffiths said. Caffeine can increase anxiety, panic, some stomach problems and some cardiac arrhythmias. For pregnant women, safety data are confusing, but the “prudent” guideline, according to the American Dietetic Association, is to keep caffeine consumption under 300 mg a day. Although some data suggest coffee can be good for you, “We should not mistake coffee or caffeine as a health food,” Griffiths said.

Can children get kidney stones?

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Yes, and more and more are getting them. In the last few months, doctors at both Children’s Hospital in Boston and the Johns Hopkins Children’s Center have become so concerned that both institutions have set up special clinics to handle the increase.

“It used to be that we saw five cases a year,” said Dr. Yegappan Lakshmanan , a pediatric urologist and codirector of the Hopkins pediatric kidney stone clinic, set up last summer. “Now it seems like one a week.”

The increase may be due to rich diets as well as rising obesity and inadequate hydration, said Dr. Caleb Nelson , a pediatric urologist at the Children’s Hospital Boston Pediatric Kidney Stone Clinic, which opened this month .

The increase may also be due to doctors spotting more kidney stones in children because of better imaging technology: “We can now see tiny stones that wouldn’t have been seen before,” said Dr. John Foreman , chief of pediatric nephrology at Duke University.

Kidney stones in children are treated much as they are in adults: with surgery or lithotripsy, which breaks up stones by shock waves. It’s also important for parents to try to catch any kidney stone a child passes so it can be analyzed to find out what kind of stone it is and the best foods to consume or avoid to prevent more stones from forming.

Is it dangerous to get your tongue pierced?

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In most cases, no, but it’s pretty stupid.

Yeah, yeah, it’s a form of self-expression. But consider the poor Italian woman, 18, whose case was written up recently in the Journal of the American Medical Association. After getting her tongue pierced, she wound up with facial pain that her doctors described as “severe, constant and paroxysmal,” meaning she had sudden bursts of extra intense pain as well. It seems, her doctors wrote, that the piercing irritated nerves that run from the tongue to the face. The doctors noted in passing that the medical literature contains reports of several other complications of tongue piercing, all, like this one, quite rare, but noteworthy nonetheless: inflammation of the lining of the heart, lockjaw (tetanus) and even abscess in the brain.

These last three “are VERY good reasons why not to ever have your tongue pierced!!!” wrote Dr. Jeffrey Dover, a dermatologist at SkinCare Physicians in Chestnut Hill, in an email. In a telephone conversation, Dover explained that the kind of facial pain suffered by the Italian woman “can ruin your life.”

Surprisingly, the risk of infection from tongue piercing appears to be relatively low, provided the instruments used to pierce the tongue is sterile, though there are no statistics on the issue. Dr. Thomas Kilgore, a professor of oral surgery at the Boston University School of Dental Medicine, said, “To be very honest, our mouths are quite resistant to our own organisms. Most bacteria in the mouth are our own bacteria, so there is a certain degree of immunity.”

There is a risk of chipping teeth from the metal stud, and if one piece of the stud gets loose at night, it could be inhaled into the lungs, possibly triggering infection. If the stud contains nickel, as a lot of jewelry does, that could also trigger nickel allergies.

Bottom line? Pierce your ears, not your tongue.

Should I consider bariatric surgery to control Type 2 diabetes?

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Yes, if you are significantly obese and have tried and failed to lose weight through diet and exercise. Obesity is a major contributor to Type 2 diabetes, in which the hormone insulin becomes less effective at its job, escorting sugar into cells; weight loss is the best way to control diabetes.

For people who can’t lose enough weight by diet and exercise, bariatric surgery is an increasingly popular option; the number of such surgeries has quadrupled since 2000, reaching 177,600 this year, according to the American Society for Bariatric Surgery.

There are two main methods – one in which the stomach is “banded” to constrict its size, and the other, a more involved but more effective approach called “gastric bypass”, in which the stomach is divided in two so that most food bypasses the larger section and goes straight to the small intestine. By making it difficult for the patient to consume much food, both procedures lead to weight loss.

In 2004, a major study called the Swedish Obese Subjects Study showed that, after 10 years, diabetes disappeared in 36 percent of patients who had the surgery, compared to 13 percent who did not.

“The improvement of diabetes control is unquestionable,” said Dr. Martin Abrahamson, medical director at the Joslin Diabetes Center in Boston. “It occurs following bariatric surgery in 80 percent of patients

With the banding approach, American patients typically lose 40 to 45 percent of their excess weight; with bypass, they lose 70 percent, said Dr. Edward C. Mun, director of bariatric surgery at Faulkner Hospital.

The procedures are not without risks. The risk of death following banding surgery is about one in 1,000 patients, said Mun. After gastric bypass, it’s three in 1000. The major risks are bleeding, infection, blood clots and leakage of intestinal fluids into the abdomen.

If you are overweight and have Type 2 diabetes and can lose sufficient weight with diet and exercise, go for it. If you can’t and your BMI, or body mass index, is 35 or higher, talk to your doctor about surgery. (For help calculating your BMI, go to www.nhlbisupport.com/bmi/.

Why does my nose run in the cold?

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Nobody knows for sure, but one reason is that the nose has to “work overtime,” when the inspired air is cold, said Dr. Ralph Metson, a sinus surgeon at the Massachusetts Eye and Ear Infimary.

The nose is a kind of “fancy air conditioner” whose job is to warm and humidify the air we inhale, Metson wrote in an email. When the air we breathe in is unusually cold, the nose kicks into high gear to warm and humidify it – blood vessels dilate, mucosal tissue swells and glands secrete extra mucus. This extra mucus manifests itself as a runny nose.

In addition, as the newly-heated, newly-moist air is exhaled, the moisture in it condenses when it hits the cooler, outside temperature, and then drips out as fluid, said Dr. Andrew Lane, director of the division of rhinology at the Johns Hopkins University School of Medicine.

For people who have a major problem with this kind of runny nose, technically called “vasomotor rhinitis,” there is a prescription nasal spray called ipratropium bromide, which may help damp down this reaction.

When should you consider having your child’s tonsils removed?

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Historically, children had their tonsils removed to reduce the frequency and severity of colds and strep throats. (The tonsils, and the nearby adenoids, all part of the immune system, catch and harbor germs, so removing them can reduce infections.)

Doctors still do take out kids’ tonsils for recurrent throat infections, though many parents these days opt for antibiotics instead. Today, most of the country’s nearly 600,000 tonsillectomies in children are done to correct breathing problems that can disrupt sleep and even lead to trouble paying attention and concentrating in school, said Dr. Dwight Jones, a pediatric otolaryngologist at Children’s Hospital in Boston.

“What happens in many children is that the tonsils get to be large – disproportionate to the mouth and throat – so when the child goes to sleep and the tongue falls back in the mouth, you get obstructive sleep apnea,” the cessation of breathing during sleep.

The result is often loud snoring, restless sleep and both hyperactivity and sleepiness the next day. Some research even links sleep-disordered breathing with ADHD, attention deficit hyperactivity disorder. Bedwetting, for unclear reasons, has also been linked to sleep apnea.

When the tonsils are removed, 83 percent of children with sleep apnea get better, meaning there is no more snoring, no labored breathing or pauses between breaths, said Dr. Stacey Ishman, an assistant professor of pediatric otolaryngology at the Johns Hopkins Children’s Center. School performance also goes up.

Removing tonsils is also getting easier than it used to be. In the old days, doctors used scalpels to remove tissue, which led to considerable bleeding. The excessive bleeding improved when they switched to electrocautery or “hot” probes that used electricity to zap blood vessels so blood did not leak out; but this often burned the throat, leading to more post-operative pain. The latest approach is coblation, which uses high frequency radio waves to sculpt away tonsils from the underlying muscles. With this technique, bleeding is minimal and so is post-op pain because the tissue is not burned.

Bottom line for parents? If your child snores or has labored breathing at night – and has trouble staying awake and paying attention in school – see a pediatric otolaryngologist.

Can badly-fitting shoes damage feet?

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Yes, and a new study, published this fall in the journal of the American Podiatric Medical Association suggested that most people do indeed wear the wrong size shoe.

The study, which involved 440 veterans, almost all of whom were male, found that only 25 percent of participants wore correctly-sized shoes. Men with diabetes — which can lead to foot infections and amputations — were five times as likely as others to have poorly fitting shoes. This is troubling because people with diabetes often have poor nerve sensation in the feet and can’t notice cuts and ulcers that can become infected. One reason so many people wear the wrong size shoes, the study suggested, is that patients with loss of sensation cannot tell when trying on shoes whether they are too tight. In addition, many people have one foot longer than the other, and unless shoes are fitted properly to the longer foot, the shoe for that foot will be too tight.

At a minimum, badly-fitting shoes can cause corns and calluses — protective layers of dead skin caused by friction of bone against SHOES, said Dr. Joseph Caporusso, a McAllen, TX podiatrist who is chairman of public education and information for the podiatric group. Poorly-fitted shoes can also exacerbate hammertoes, a condition in which the toes are bent into a claw-like position. Bunions, misaligned big toe joints that can become swollen and tender, tend to run in families but the tendency can be aggravated by too-narrow shoes, he said.

High heels, which throw the weight toward the front of the foot, can cause the Achilles tendon at the back of the ankle to shorten and disrupt the mechanics of walking, said Dr. Peter Paicos, Jr. a podiatrist and associate medical director of the wound healing center at Winchester Hospital.

A shoe is supposed to be “a protective container,” said Paicos. “But we spin fashion into it, so that changes what the container does.

Badly-fitting shoes may not pose a serious problem in young people, he added, but in older people who may already have trouble walking, they can make a bad situation worse.