Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

Do garlic – and garlic supplements – have genuine health benefits?

by

Hundreds of studies suggest the answer is yes, but the data is hard to interpret because some studies are sponsored by manufacturers of garlic extracts, sold as dietary supplements, while others simply track health outcomes in people who do, or don’t, eat lots of garlic.

In October, 2000, a government report by the Agency for Healthcare Research and Quality found that while garlic may lower some types of cholesterol in the short term, it did not appear to offer long-term protection against cardiovascular disease. The study also found no evidence that garlic had a beneficial impact on blood pressure or diabetes.

On the other hand, a randomized, double-blind clinical trial of 152 people in 1999 by German researchers found that over four years, those taking the supplement Kwai showed less buildup of plaque in their arteries than those not on the pills.

Another randomized, double-blind study of 19 people by researchers at the Harbor-UCLA Medical Center used a different supplement, Kyolic. Dr. Matthew Budoff, a cardiologist and the lead researcher, said the 2004 study suggested that the extract slows progression of calcification, a marker of plaque, in coronary arteries.

As for cancer, the National Cancer Institute says on its website that “a host of studies provide compelling evidence that garlic” can slow the cancer process, particularly for cancers of the stomach and prostate. But the studies were mostly simple correlations between garlic intake and cancer – not true experiments showing that garlic caused the reduction in cancer.

Mark Blumenthal, executive director of the American Botanical Council, a Texas-based, nonprofit group supported by the herbal industry, the government and health professionals, said the chemistry of garlic is so complex that it’s hard to extrapolate from research on supplements, which differ among themselves, into recommendations for consuming raw or cooked garlic.

Cooking destroys many of the chemicals with potential medicinal value. To get some health benefits from raw garlic, he said, you have to eat one to two raw cloves a day. No problem for me – I love the stuff.

Is it okay to take sleeping pills for extended periods?

by

Yes, at least some kinds.

So far, the only sleeping pill approved by the US Food and Drug Administration for long-term use is Lunesta, which has been shown to remain effective for at least six months, unlike some drugs that lose their effectiveness over time, prompting people to take more and more of them.

But two other medications that are chemically similar to Lunesta — Ambien and Sonata — are probably just as safe to take long term, researchers said, though they haven’t been specifically studied for that.

All three drugs are selective non-benzodiazepines, which means they are chemically different from the benzodiazepines (like Valium), which were once vastly over-prescribed. At normal doses, neither the benzodiazepines nor the non-benzodiazepines are addictive in the sense that they cause physiological withdrawal symptoms when a person stops using them, said Edward Stepanski, director of the sleep disorders service and a board member of the American Academy of Sleep Medicine.

“If you stop taking either the older benzodiazepines or the Ambien, Sonata and Lunesta drugs, you run the risk of not sleeping and that’s it,” said Stepanski, who gets research funding from several companies that make sleeping pills. Some people, however, do become psychologically dependent on the pills.

There are no studies of people using these drugs for years and years, “but the anecdotal evidence is that there is no harm in doing so, Stepanski added, noting that if there were significant adverse effects, they would probably have emerged by now.

The big advantage of the Lunesta, Sonata and Ambien sleeping pills is how quickly the body gets rid of them, said Dr. John Winkelman, medical director of the Sleep Health Center at Brigham and Women’s Hospital. Sonata has the shortest “half-life,” which means it is substantially gone from the body in about four hours — which is great if you’ve only got four hours to sleep, but not as good if you’re trying to sleep for 8, said Winkelman, who consults for the manufacturers of all three drugs. Ambien lasts a bit longer and Lunesta, the longest — about 8 hours in older people.

Don’t be afraid of sleeping pills if you have chronic or acute insomnia. But take them according to instructions and call your doctor if you develop problems.

Are the blood pressure machines in supermarkets reliable? Are the home kits?

by

The blood pressure machines in supermarkets are generally not reliable because it’s impossible to know how well-maintained they are. But the kits for home use are, and hypertension specialists recommend them for anyone who needs to monitor blood pressure regularly.

“I encourage patients to do home monitoring,” said Dr. Randall Zusman, director of the hypertension service at Massachusetts General Hospital. “It gives patients feedback and tends to promote compliance” with medications and efforts to stick to a good diet and exercise program. It may also give more typical readings than those obtained in a doctor’s office because a person is less likely to exhibit “white coat hypertension,” the rise in blood pressure due to the stress of being at the doctor’s office.

Studies in recent years have shown that the good home kits correlate well – within 5 millimeters of mercury – with the readings obtained in doctors’ offices, said Dr. Roger Blumenthal, director of preventive cardiology at Johns Hopkins Medical Institutions.

High blood pressure is a major risk factor for stroke, heart attack and kidney disease. Normal blood pressure is defined as a reading of 120 mm over 80 mm. High blood pressure is a reading of 140 systolic (the upper number) over a diastolic (the lower number) reading of 90. Numbers between 120 over 80 and 140 over 90 are a potential sign of pre-hypertension and may suggest treatment is necessary. Nearly everyone over 55 will eventually become hypertensive, said Zusman.

It’s a good idea to bring your home kit to the doctor to calibrate it with the doctor’s machine. According to the June, 2003 issue of Consumer Reports, home kits – which cost $35 and up – that use automatic arm cuffs were the most reliable; those using wrist cuffs or arm cuffs that had to be inflated by squeezing a bulb were less dependable.

Is it really unsafe to use cellphones in hospitals?

by

Cellphones are safe to use, so long as you have a relatively new, that is digital, phone (not the old, clunky analog devices) and you stay at least three feet away from from patients and medical devices such as pacemakers, ventilators, and electrocardiogram machines that may be near them.

In the bad old days, — like five years ago — researchers at the mayo Clinic in Rochester, Minn. found that with older phones and older medical equipment, there was a troubling 7.4 percent rate of :clinically significant interference.” The radio frequency energy emitted by the old phones was picked up as electromagnetic interference by the machines, sometimes skewing readings, said, Jeffery L. Tri, a Mayo Clinic electrical engineer.

But a new Mayo study published in October found that, with newer phones and equipment, the rate had dropped to 1.2 percent. “What’s gotten better is that the phones themselves have changed and medical devices have been ‘hardened’ so there is less chance of radio frequency energy causing interference at these power levels.

Dr. John Halamka, chief information officer for the Harvard Medical School and Beth Israel Deaconess Medical Center, noted that older cellphones were 3-watt devices, “so they generated a lot of power.” The new, digital ones put out only “a small fraction” of that — 50 milliwatts.

In other words, Halamka said. “we believe the use of cellphones in hospitals in 2005 is safe as long as you understand the guideline of three feet.”

But some hospitals, like Newton-Wellesley, still keep the warning signs up. “It’s safe to use some cellphones in some parts of the hospital,” said spokesman Brian O’ Day, “But we’d rather err on the side of caution when it comes to someone’s health.

With home heating prices so high, how low can I safely set my thermostat?

by

The American College of Emergency Physicians recommends that you keep home temperatures no lower than 65 degrees during the day and 55 degrees at night.

The big danger of setting the thermostat too low is hypothermia, or a body temperature of 95 degrees Fahrenheit or less, said Dr. Rick Blum [cq], president of the doctors’ group. “Hypothermia can have an insidious onset in older adults,” Blum added. And since muddled thinking is among the first signs, people often don’t realize they’re in danger. Some go to sleep and never wake up.

It is also “a big no-no” to try to stay warm by using your oven for heat, said Mary-Liz Bilodeau, a critical care nurse in the burn unit at Massachusetts General Hospital. Not only do you run the risk of burning yourself on the oven, drafts in the kitchen can pull flames out of the oven, potentially starting a fire.

If you use a space heater, be exceedingly careful. Don’t leave the house or go to bed with it on and don’t put it near anything flammable – curtains, clothes, furniture.

Carbon monoxide, a poisonous gas produced by burning anything with carbon in it, is another serious wintertime threat, said Dr. Tracy Wimbush, an emergency room physician at MGH. Improperly vented wood stoves, furnaces, generators – and gas grills brought inside – can all release carbon monoxide.

As with hypothermia, many people lie down to sleep – and die. (Never put children in a running car in which the exhaust pipe is blocked by snow; by the time while you shovel out, the children may have succumbed to CO.) In addition to installing smoke detectors, you should install CO detectors.

If you need help paying for fuel, you can call the National Energy Assistance Referral Project, 1 866 674 6327 or www.energynear.org. Many states also offer fuel assistance; in Massachusetts, the state number is 1 800 632 8175.

Is it normal for an adult to occasionally wet the bed?

by

Although bedwetting is fairly common in children, who usually grow out of it, it’s much less common in adults. That said, doctors from the Mayo Clinic estimated in a paper published nine years ago that as many as 1.5 to 3 percent of the adult population had “persistent nocturnal enuresis,” or chronic nighttime bedwetting..

An adult who wets the bed only occasionally and has no other voiding problems, is unlikely to have anything seriously wrong with the urinary tract, said Dr. Dianne Sacco, a urologist at Massachusetts General Hospital. Occasional bedwetting often occurs at a time of “excessive emotional stress,” she added. If the problem becomes persistent or the person has voiding problems during the day, too, it’s wise to see a doctor.

The potential causes of bedwetting, in kids and adults, are many. Some researchers think it’s a psychological problem. Others note that bedwetting runs in families, suggesting a genetic trigger.

Still others believe it’s caused by sleeping too deeply, especially in children, or by reduced bladder capacity, urinary tract infections, neurological abnormalities (in which nerves to the bladder fire too often) or a decrease in the secretion of so-called anti-diuretic hormone, which regulates the amount of urine made. In older adults, other conditions may also trigger bedwetting, including congestive heart failure and sleep apnea.

The sleep disorder hypothesis is particularly controversial. Shelly Morris, a former adult bedwetter who now runs the Enuresis Treatment Center of America in Cape Coral, FL, believes that some people sleep so deeply they can’t wake up to urinate. Her program uses moisture alarms that wake the sleeper (or family members) at the first drop of urine- in time to get to the bathroom.

But Dr. John Winkelman, medical director of the Sleep Health Center at Brigham and Women’s Hospital, doubted deep sleep was a common cause for adult bedwetting except when it was caused by medications because “excessively deep sleep is unusual for adults – adults usually have excessively light sleep.”

If you have a bedwetting problem, try training yourself to wake up with a bedwetting alarm, available on the net. You can also try drugs such as Tofranil, DDAVP or Ditropan, Detrol, Vesicare, Sanctura or Enablex. But bedwetting may recur if the drugs are stopped.

Are the eyeglasses you buy in a drug store as good as prescription ones?

by

In many cases, yes, especially if your main problem is presbyopia, the age-related decline in the ability to see small print up close because the eyes lose their ability to change shape and focus at different distances.

As you approach 40, this focusing ability deteriorates, and while distance vision often remains good, close vision does not. “Presbyopia happens to everyone,” said Dr. Elliott Myrowitz, an optometrist and assistant professor of ophthalmology at the Wilmer Eye Institute at Johns Hopkins School of Medicine.

Store-bought glasses are fine for presbyopia if your eyes are equal and healthy, said Dr. Bonnie Henderson, director of the comprehensive ophthalmology service at the Massachusetts Eye and Ear Institute. But because the store-bought lenses are equal in magnification, they may not help as much if one eye is stronger than the other.

Nor do they help if you have astigmatism, in which the cornea (the clear dome in the front of the eye) is abnormally shaped. That needs to be corrected with a prescription.

Store-bought glasses can sometimes help compensate for mild vision problems, either up close or far away.

Since drug store glasses are cheap — $15 or so — it makes sense to try these first before handing over at least $100 for prescription glasses.

But get your eyes checked every year or so, especially after age 40, anyway, to make sure you don’t have glaucoma or problems with your retinas. You should also consider switching to prescription glasses if your drug-store lenses cause eye fatigue, headaches, excessive blinking or problems re-focusing between close-up and far-away tasks. Neither store-bought nor prescription glasses weaken or damage your eyes, so use them as often as you need to.

How long are you contagious when you have a cold?

by

It depends on which virus is causing the cold, and there are lots – including rhinoviruses, adenoviruses and coronaviruses, to name a few, said Dr. Lindsey Baden, an infectious disease specialist at Brigham and Women’s Hospital.

Typically, you are most likely to spread the virus to other people from just before symptoms appear and through the first few days of an illness, when symptoms such as coughing and sneezing, and nasal mucus production, are highest.

Dr. Jack Gwaltney, professor emeritus of internal medicine at the University of Virginia School of Medicine has done research that shows the virus starts reproducing within half an hour of entering the nose; it takes only 8 to 12 hours for new virus to appear in nasal mucus. This rapid production of virus lasts about three days – the days when you are most contagious – and then falls off as the immune system gears up and finally begins to kill the virus. One study showed that when one spouse is experimentally infected with a virus, the other spouse typically gets infected within the first three days.

Since it’s mucus from the nose that is the main carrier of viruses, you should dispose of tissues yourself. It also pays to wash your hands, whether you’re the one who’s sick or the one trying not to become the next victim.

Once you start feeling better, the virus may still be present in your nose for as long as two weeks. But you are much less contagious. As for antibiotics, they don’t do anything for viruses. But if your “cold” is actually a bacterial infection, antibiotics will help with that and will make you less contagious while you are taking them.

If exercise generates free radicals and free radicals are bad, why is exercise good?

by

Free radicals, forms of oxygen that are missing an electron, are actually not all bad.

Although they can destroy cell membranes and DNA, scientists have also discovered that they are also “good,” said Dr. John McDonald, a neurologist at the Kennedy Krieger Institute and Johns Hopkins. For instance, they help with cell signaling, the process of chemical communication that tells a cell, among other things, when to activate certain genes.

Exercise does generate free radicals but it also boosts production of molecules that sop up free radicals, said William J. Evans, an exercise physiologist at the University of Arkansas for Medical Sciences in an email.

In other words, regular exercise actually “trains the anti-oxidant system,” boosting production of natural anti-oxidants such as SOD (superoxide dismutase), catalase and glutathione, said Dr. David Systrom, Director of the Cardiopulmonary Exercise Laboratory at Massachusetts General Hospital.

Which leads to one of the hottest questions in exercise research: Should athletes take extra anti-oxidants, particularly vitamins C, E and beta-carotene? Some data suggest that performance and muscle recovery are enhanced with the supplements. But other data suggest that “anti-oxidants can become pro-oxidants – in other words, free radicals – when taken to excess,” said Systrom. “Nobody knows where to draw the line.”

How often can you safely whiten your teeth?

by

It’s not fully clear, but once or twice a year seems to cause no problems, said Dr. Dan Nathanson, chair of the department of restorative sciences and biomaterials at the Boston University School of Dental Medicine.

“No one has shown categorically that there is a danger in doing it too much, but we are cautious. It’s probably not good to be a whitening addict,” he said.

The basic ingredient in tooth whitening gels, whether administered in a dentist’s office or at home, is hydrogen peroxide, which penetrates the porous enamel on the outside of the tooth and the inner layer, dentin, lightening the tooth as it goes.

Whitening does not seem to destroy either the enamel or the dentin. All forms of bleaching can cause temporary tooth sensitivity.

There are some differences — including financial — between whitening done at home and that done at the dentist’s office. In the office, dentists use a stronger concentration of peroxide gel, 30 to 35 percent, and the procedure can run about $1,500 for three treatments.

With the middle-priced option, a dentist takes impressions of both upper and lower teeth, which costs about $800, and makes retainer-like arches. The patient fills the arches with gel and inserts them every night for a set number of days.

Over-the-counter whitening strips, which cost roughly $30, use the weakest concentrations of peroxide, but still “do a pretty good job,” said Nathanson. The strips only reach from one canine (“eye”) tooth to the other “and most people have bigger smiles than that,” though, said Dr. Howard Strassler, professor of operative dentistry at the University of Maryland Dental School. And if your teeth aren’t perfectly straight, they may not bleach evenly.