Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

Is the Body Mass Index a good way to calculate heart disease risk?

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It’s not the best way. According to a major study published in late 2005, the waist-to-hip ratio is three times more accurate than Body Mass Index, or BMI, at predicting cardiac risk.

The BMI is a ratio of height to weight: over 25, and you’re considered overweight, over 30, and you’re “obese” (The federal government offers a BMI calculator (click HERE). Both put you at increased risk of dying early from heart disease and cancer.

But BMI can be misleading — very muscular people may get a high
score, yet be at low risk.

To calculate your waist-to-hip ratio, get a tape measure and measure your waist, then your hips, then divide the first number by the second. For women, anything over 0.85 indicates increased risk, for men, anything over 0.95, said Dr. Arya Sharma [cq], an obesity specialist at the Population Health Research Institute at McMaster University in Hamilton, Ontario and a co-author of the 2005 study of 27,000 people, with and without heart
disease.

The waist-to-hip ratio is more accurate because it reflects how much abdominal fat a person has. Abdominal fat, the deep, visceral stuff that wraps around organs, is biologically active and secretes chemicals called cytokines that trigger inflammation in blood vessel walls, raise blood pressure, increase the tendency for blood to clot, worsen cholesterol levels and lead to a pre-diabetic problem called insulin resistance.

Put differently, it’s possible to have a good BMI but still be at risk.
“Don’t fool yourself that if your BMI is 22, you’re okay, if your
waist-to-hip ratio is too high,” said Sharma.

Dr. Thomas H. Lee, editor in chief of the Harvard Heart Letter,
cautioned that it can be tricky to measure your hips in the right place. So you can just measure your waist. “If it’s over 35 inches for a woman and over 40 for a man, you’ve got a lot of abdominal fat,” he said. Which means it’s time to lose weight.

Is There a Less Invasive Way Than Traditional Surgery to Open Clogged Sinuses?

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Yes. There’s a new procedure called sinuplasty in which a balloon is threaded into the sinuses and inflated to push apart the thin bones that form the sinus cavity, making the opening bigger so mucus can drain better.

In traditional endoscopic surgery, doctors thread metal instruments into the sinuses to cut away some sinus bone. So far, data on the new technique are awaiting publication, so it’s impossible to gauge how safe and effective the procedure is.

Dr. Peter J. Catalano, chairman of otolaryngology at the Lahey Clinic in Burlington, has done sinuplasty in about 60 patients.

Doctors had worried, he said, that when the balloon was inflated, it would fracture the thin sinus bones in such a way that they would migrate to the eye or the brain. So far, in studies of both cadavers and 125 patients who have had the procedure, there appear to have been no complications. The sinuses appear to stay open in 95 percent of patients for at least six months, he said.

Dr. Andrew Lane, director of the division of rhinology at Johns Hopkins Medical Institutions, said sinuplasty is “a good idea for selected patients.”

“The trick will be figuring out who needs sinuplasty and who needs traditional endoscopic surgery,” he said.

Dr. Ralph Metson, a sinus surgeon at the Massachusetts Eye and Ear Infirmary, said he thinks sinuplasty “is a very intriguing idea.”

But, he said, it only helps people whose problems are limited to the frontal or maxillary sinuses a small percentage of those with sinus trouble.

Does using a computer for hours in a darkened room hurt teenagers’ eyes?

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Probably not, though there’s no hard proof.

“In theory, we do think that the more you use your eye muscles and the visual processes in the brain, the more likely you are to develop nearsightedness, especially at a young age,” said Dr. Sandra Cremers, an ophthalmologist at the Massachusetts Eye and Ear Infirmary. And there are animal studies suggesting this effect does occur. “But when we do randomized controlled studies in people, we don’t find it an issue,” she said. “There is controversy in this area.”

“I don’t see any clinical evidence in the last 10 or 20 years that young people who spend more hours at the computer require glasses more often than anybody else,” said Dr. Elliott Myrowitz, an optometrist and assistant professor of ophthalmology at the Wilmer Eye Institute at Johns Hopkins School of Medicine.

Teenagers, like older people, who spend long hours at the computer do report more eye fatigue, Myrowitz said, as well as more muscle strain in the eyebrow area. But teens who stare at computer screens for long periods “are not ruining their eyes,” he added.

As for staring at a bright computer in a dark room? Not to worry. “Young people have very good contrast sensitivity,” Myrowitz said, unlike their elders who do have more trouble focusing when they shift rapidly from light to dark environments.

And there’s more good news. “There’s no proof that watching TV up close in a dark room is bad, either,” said Cremers. As a matter of common sense, though, she does advise teens and adults to “have as good light as possible.”

Is MSG, the food additive, safe? Is it a cause of the obesity epidemic?

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Although these worries surface periodically on the Internet, the answers seem to be, “yes, it’s safe,” and “no, it’s not causing obesity.”

The US Food and Drug Administration has declared MSG, or monosodium glutamate, safe for most people when it is consumed in standard doses, though some people do have short term reactions such as numbness, burning, tingling, facial pressure or tightness, chest pain, headache or nausea. A typical serving of glutamate-treated food contains less than 0.5 grams of MSG; a large serving, which is more likely to provoke a reaction, would be three grams or more. MSG is more likely to provoke a reaction if consumed on an empty stomach. People with severe, poorly-controlled asthma may also be more likely than others to have a reaction to MSG.

As for the obesity question, that’s a bit murky. There is evidence (look under “MSG obese” on www.pubmed.gov) that researchers can induce obesity by giving animals MSG. “But to blame the obesity epidemic on MSG? That’s stretching it,” said Amy Campbell [cq], a dietitian at the Joslin Diabetes Center. “I’m not saying there isn’t a potential link, but given that this research has been going on since the 70s, if there truly were a connection, we’d know by now.”

Dr. George Pauli, associate director for science and policy in the FDA’s office of food additive safety, said in an email, “I can see no link with obesity unless making food taste better leads to eating more.”

Campbell summarized things this way: “There is a gap in what we know about MSG and its effects. So it’s not a bad idea to go easy on it. But don’t make yourself crazy trying to avoid it. We have other, more important, things to worry about – like trans fats and saturated fat in the diet.”

Does pulling hair out of a mole turn the mole cancerous?

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Many estheticians hesitate to rip hair from moles, but the fear that doing so would turn a mole cancerous is completely unfounded.

“You can do anything you want to a mole, pretty much,” said Dr. Bernard Cohen, interim chair of dermatology at the Johns Hopkins School of Medicine. “If you want to pluck, shave, wax or use electrolysis on a mole, there’s no evidence that this will cause a melanoma, or any other kind of skin cancer.” The only caution about moles, he added, is that it’s not a good idea to irradiate them, which means being sure to put sunscreens on moles as well as the rest of your skin.

Perhaps the fear that plucking hairs from moles is linked to cancer stems from the fact that every once in a while, “a mole may turn malignant by itself, and then you might blame what was done to it,” said Dr. Amal Kurban, a professor of dermatology at the Boston University School of Medicine. But basically, he said, “it’s very simple – removing hair from a mole usually doesn’t disrupt the cells.”

Plucking hair from a mole can lead to inflammation and perhaps infection, but that’s all.

Can tight-fitting clothes cause skin rashes?

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You bet. Tights, skin-hugging pants, panty hose and other garments, like underwear with a tight elastic band, can all cause folliculitis, an inflammation of hair follicles caused by a bacterium or fungus that is already on the skin and, because of the irritation caused by the clothing, gets pushed in deeper. Sweating exacerbates this process.

A slightly different problem called pseudo-folliculitis can be triggered, not by an infection, but by shaving too closely. When you shave hair – especially in the pubic area, in the armpit or on the face – the hair often grows back curly, cutting into the skin and causing inflammation, said Dr. Bernard Cohen, director of pediatric dermatology at Johns Hopkins University School of Medicine.

If tight clothing is the problem, wear looser garments or at least clothes designed to “wick” sweat away from the skin. You can also combat folliculitis with antibacterial soaps or benzoyl peroxide-based products such as Panoxyl soap, said Dr. John Williams, a dermatologist at Brigham and Women’s Hospital. In general, he added, “folliculitis will run its course.” If it doesn’t, oral antibiotics may be required.”

In some cases, infectious folliculitis can progress to boils, painful, pimple-like sores deeper in the skin that may have to be lanced to get rid of pus. If inflamed hair follicles large, tender or are accompanied by a fever or swollen glands, you should see a doctor.

For pseudo-folliculitis, the solution is to try not to shave too close (some electric razors do not shave as close) and shave in the direction in which hair grows. Change disposable razors daily so that the razor doesn’t pull too hard on the hair.

What are warts and how can you get rid of them?

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Warts are benign growths caused by the human papilloma virus, or HPV. Because they are caused by a virus, they can be spread from person to person by direct skin contact and indirectly by coming in contact with the shed skin of a person with warts, as can happen in public showers or pool decks.

There are more than 100 types of HPV, and each type causes infection in a specific part of the body. Some strains cause “common” warts, which grow on the fingers, feet and knees; some cause plantar warts, which grow on the soles or heels of the feet; some cause flat warts, which grow on the face. Still other types cause genital warts. And totally different strains cause genital, cervical and oral cancer.

With many warts, the best treatment often is to do nothing. “In two thirds of patients with common warts, the warts will go away on their own in two years,” said Dr. John Williams, a dermatologist at Brigham and Women’s Hospital. Warts “are not dangerous and they are not intrinsically painful,” said Dr. Bernard Cohen, director of pediatric dermatology at Johns Hopkins School of Medicine.

THERE IS ALSO NOT MUCH YOU CAN DO TO PROTECT YOURSELF AGAINST WARTS, EXCEPT FOR COMMON SENSE THINGS LIKE WEARING FLIP-FLOPS IN PUBLIC POOLS OR SHOWERS. “IT’S IMPOSSIBLE TO PREVENT PLANTAR WARTS BECAUSE THEY ARE SO UBIQUITOUS,” Williams said.

ONCE THEY’VE GOT WARTS, MANY people want to get rid of them, and remedies abound, some over-the-counter, some given only in a doctor’s office. One non-prescription solution is to put a compound containing salicylic acid on the wart daily, scraping off dead tissue as you go. Another is good old duct tape. Cover the wart for a week, then rip off the tape.

Another solution is cantharidin which a doctor “paints” on the wart. Alternatively, doctors can also use liquid nitrogen to freeze off warts. They can also burn off warts, laser them off or, as a last resort, cut them out.

Is it dangerous to have chiropractic treatments if you have osteoporosis?

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Scientifically, there is little data on chiropractic in people with osteoporosis, said Anthony L. Rosner, a Brookline biochemist who is now director of research and education for the Foundation for Chiropractic Education and Research. There is also little data suggesting that people with osteoporosis are injured by chiropractic treatment, in which the spine is manipulated to restore proper alignment of vertebrae.

Osteoporosis should not keep people from seeing a chiropractor, he said. Instead of manipulating the spine in a way that produces what laypeople call “cracking” or “popping” sounds (caused by the release of gases between joints), chiropractors can use “low-force techniques” such as massage, Rosner said.

Often, chiropractors take X-rays of patients with osteoporosis so that they can use different techniques on them. But the X-rays used by chiropractors are much less sensitive than the ones (called DEXA scans) used to gauge bone density. That means that by the time osteoporosis shows up on regular X-rays, a patient could have lost 30 to 35 percent of b one mass, said Dr. Suzanne Jan de Beur, an osteoporosis expert and chief of endocrinology at Johns Hopkins Bayview Medical Center.

And don’t let the chiropractor “crack” your mid-back if you have osteoporosis. “The biggest potential problem is in the thoracic spine,” Dr. Joseph Kornfeld, a chiropractor in Lynn. “A hard thrust can break the ribs.”

That happened to Dr. Jerry Gerrard, a chiropractor in Mesa, AZ who is on the board of governors of the American Chiropractic Association. Once, in 35 years of practice, he said, he broke an osteoporotic patient’s rib. He had warned her about the risk, he said, but she wanted to proceed anyway because of a pinched nerve. (She later recovered.)

So, if you have osteoporosis, tell your chiropractor. And ask for low-force techniques.

Does mesotherapy really get rid of cellulite? Is it safe?

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Mesotherapy is a technique, developed in France decades ago, that involves injecting hormones, enzymes, plant extracts, vitamins, asthma medications and other chemicals — none of them approved by the US Food and Drug Administration for this purpose — into various layers of the skin.

The idea, said Dr. Lionel Bissoon, a doctor of osteopathic medicine in New York, is that some of these chemicals, like phosphatidylcholine, can melt away cellulite, the lumpy deposits of fat that accumulate on the buttocks and thighs. The procedure involves many injections per treatment, with three to 10 treatments needed. The cost, which is not covered by insurance, can run to thousands of dollars.

There’s lots of hype about mesotherapy but so little solid research that mesotherapy should be considered an unproven technique.

“Competent physicians would never — and should never — use anything that has not been proved in standardized clinical testing,” added Dr. Richard Ehrlichman, a spokesman for the American Society of Plastic Surgeons and a private practitioner in Wellesley.

Last year, Dr. Alan Matarasso, a plastic surgeon and clinical professor at the Albert Einstein College of Medicine reported in the journal Plastic and Reconstructive Surgery on a few studies that hint at an improvement in the appearance of cellulite. But so far, he said, “we have nothing, no matter what you read, to permanently take care of cellulite.”

The chief side effects reported so far are minor — bruising, localized infections and redness — and there have been few reports of complications so far, said Dr. Ricardo Rodriguez, head of plastic surgery at the Greater Baltimore Medical Center.

Still, this one seems a no brainer: Save your money, at least until there’s better data.

Are there any reasons for kids to wear pajamas, as opposed to clothes, for sleeping?

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Yes. While it might seem reasonable to put a child to bed in comfy, loose-fitting clothes, there are two good reasons not to: Hygiene, and fire.

Kids come in contact with a lot of bacteria during the day, and an evening bath can rinse some of those microbes away, decreasing the risk of infection, Dr. Lisa M. Asta, a San Francisco pediatrician and spokesperson for the American Academy of Pediatrics, said in an e-mail.

Perhaps even more important: Put a child to bed in snug-fitting and/or flame retardant pajamas to minimize the risk of serious burns in case of fire. (Loose-fitting clothes can catch fire more easily than snug-fitting garments.)

Check the label on sleepwear. Pajamas “should be labeled flame retardant,” said Dr. Joanne Cox, associate chief of general pediatrics for primary care at Children’s Hospital, in an e-mail. Legally, pajamas “must pass the flame-retardant ‘flame’ test, though this does not mean added chemicals,” she said. Most cotton garments are probably not flame-retardant unless chemicals are added.

The US Consumer Product Safety Commission recommends fabrics that are difficult to ignite and tend to extinguish themselves, including 100 percent polyester, nylon, wool and silk. Tightly woven fabrics or knits and fabrics without a fuzzy or napped surface are less likely to ignite than open knits. For more details, click HERE