Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

I hear a lot about probiotics. What are they and what are they good for?

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Probiotics are “good” bacteria and they’ve been consumed, in yogurt and other products, for hundreds of years in Europe and Asia to prevent and treat a variety of gastrointestinal ailments. Their popularity in the US is growing as dietary supplements designed to restore a healthful balance between good and bad bacteria in the gut. Restoring this balance can be especially important while you’re taking antibiotics, which kill off good as well as bad bacteria, leaving many people with cramps and diarrhea.

Probiotics are classified as dietary supplements, which are not approved before marketing by the US Food and Drug Administration.

“Probiotics definitely help with acute diarrhea,” said Dr. Sherwood Gorbach, an infectious disease specialist at Tufts University School of Medicine who, with his colleague, Barry Goldin, a biochemist, developed Culturelle, which contains the bacterium Lactobacillus GG.. Gorbach is upfront about his financial ties to Culturelle. “There is a conflict of interest here,” he said. Still, more than 250 studies have shown LGG effective for gastrointestinal and allergy problems.

The National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, is now funding a study using an Italian product, VSL#3, for fatty liver disease at Johns Hopkins. The lead investigator on that study, Dr. Steven Solga, a gastroenterologist, said he believes probiotics may also prove useful for allergies, asthma, eczema, inflammatory bowel disease and other problems.

Probiotics are classified as dietary supplements, which are not approved before marketing by the US Food and Drug Administration.

If you buy probiotic supplements, look for those containing at least 1 billion to 10 billion CFUs, or colony forming units, enough to have an effect, according to the May issue of the Harvard Women’s Health Watch. Goldin of Tufts suggests looking for strains containing Lactobacillus and Bifidobacterium. These include L. acidophilus, L. bulgaricus, L. reuteri and L. casei and B. longum.

But buyer beware – probiotics are classified as dietary supplements, which are not approved before marketing by the US Food and Drug Administration, meaning you can’t be sure what’s really in the products.

If you prefer to get probiotics from yogurt, make sure the label says “live” or “active” cultures.

What should you pack in a family First Aid Kit when you travel?

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That depends, obviously, on who’s in your family, what medical conditions they have, and whether you’re trekking in the Himalayas or hanging out closer to civilization.

At a minimum, said Josh Baker, director of health and safety for the American Red Cross of Massachusetts Bay, you should include:

Adhesive tape

Antiseptic ointment

Band-Aids of assorted sizes

Blanket (can be a metallicized emergency blanket that folds to the size of a cigarette pack)

Cold pack (the kind that gets cold when you squeeze it)

Disposable gloves

Gauze pads and rolls of gauze

Hand sanitizer, such as Purell

Scissors and tweezers

Small flashlight and extra batteries

Triangular bandage to use as a sling or splint.

If anyone in the family is known to have life-threatening allergic reactions, be sure to take an EpiPen, which is available by prescription, said Dr. Richard Rothman, an emergency department physician at Johns Hopkins. You should also carry all other prescription and over-the-counter medicines the family needs, including antibiotics if you’ll be far from medical help, said Dr. Gary Fleisher, pediatrician in chief at Children’s Hospital in Boston. This includes antihistamines like Benadryl (for bee stings or allergic reactions), hydrocortisone ointment (for poison ivy), some Tylenol, aspirin or ibuprofen for pain and Visine or artificial tears for coping with sandy or irritated eyes.

You should also pack a thermometer and a small book on first aid, as well as a list of emergency phone numbers and the toll-free number to call in case of a poisoning emergency (1 800 222 1222).

If you buy a commercial First Aid kit, be sure to add whatever else your family needs. And make sure that all medications – and alcohol wipes – are up to date.

What are the health benefits of green tea?

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So far, green tea has been shown to help prevent second heart attacks in people who have already had one, to reduce the infectivity of viruses and bacteria, and to help protect against prostate, breast, stomach and colon cancer.

In the last five years, the US government has funded more than 150 studies on green tea and its constituent chemicals, including an antioxidant, or catechin, called EGCG. Antioxidants can gobble up dangerous forms of oxygen called free radicals and can disrupt chemical pathways inside cells, especially cancer cells. (The concentration needed to kill cancer cells is lower than that which kills normal cells, for unclear reasons.)

Earlier this month, researchers from the University of Rochester
presented data at a conference on diet and cancer in Washington, D.C. suggesting that EGCG seems to targets a particular protein, called HSP90, that is present in higher levels in cancer cells than in normal cells.

At a meeting in April of the American Association for Cancer Research, Italian researchers showed that men at high risk of prostate cancer who took the equivalent of three to four cups of green tea a day as supplements were less likely to develop the cancer than similar men given a placebo.

Hasan Mukhtar, a biochemist and professor of cancer research at the University of Wisconsin School of Medicine has shown that green tea catechins block a substance called insulin-like growth factor-1, thus thwarting the ability of prostate cancer cells to grow.

Black tea, which has more complex antioxidants than green tea, also appears to have health benefits, especially for the heart, said Dr. Murray Mittleman, director of cardiovascular epidemiology at Beth Israel Deaconess Medical Center.

Do cheap sunglasses protect the eyes as well as expensive ones?

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Yes. All you need to protect against sun damage is a pair of glasses that offers 99 or 100 percent protection against both UVA (ultraviolet A) and UVB (ultraviolet B) rays. Those labeled “UV 400” are also effective.

“If your sunglasses block 100 percent of UVA and UVB, you don’t have to spend $250 for designer glasses,” said Dr. Kathryn Colby, director of the clinical research center at the Massachusetts Eye and Ear Infirmary.

Epidemiological evidence suggests that decades of exposure to the sun’s rays can lower the age at which people get cataracts, or cloudiness of the lens inside the eye.

Normally, people begin to get cataracts in their 70s and 80s, but fishermen and others who work in the sun may get cataracts in their 50’s and 60s, said Dr. Elliott Myrowitz [cq], assistant professor of ophthalmology at Johns Hopkins. Cataracts are highly treatable with a surgical procedure in which doctors remove the old, cloudy lens and insert an artificial one.

Cancer of the surface of the eye, though rare, may also be linked to sun exposure.

Aside from basic UVA and UVB protection, the only thing to consider when buying sunglasses is that they are physically comfortable enough that you don’t keep taking them off, Myrowitz said, and that they are not so dark that your vision is impaired.

Are electric toothbrushes better than manual ones?

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One brand is – the Braun Oral B plaque remover, according to a review published in April by the Cochrane Database of Systematic Reviews, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.

That review, an analysis of 42 pooled studies involving 3,855 patients, was an update of a similar one published two years ago.

The new review showed that electric toothbrushes with a “rotation oscillation action” such as the Braun product removes plaque (the sticky stuff that collects on teeth near the gums and serves as food for bacteria) 11 percent more effectively than manual toothbrushes and reduced gingivitis (gum inflammation) 6 percent more effectively over a three-month period.

When studied for up to six months, the Braun product still fared well, yielding a 17 percent reduction in bleeding when gums were probed. The other six types of electric toothbrushes studied “offered no consistent advantage,” said the lead author, Dr. Peter Robinson of Sheffield University in England in an email interview. There was no statistically significant effect for plaque after three months, but it is unlikely that there would be a long-term benefit for gingivitis without an underlying change in plaque, too, he said.

Dr. Richard Niederman, director of the DSM-Forsyth Center for Evidence-Based Dentistry in Boston, said the new study was conclusive. “The only power toothbrush more effective than the manual is the Braun Oral B.”

But Cliff Whall, a medical physiologist who heads the “seal of acceptance” program for the American Dental Association, was less convinced. “There is nothing magical about a power toothbrush,” he said. If a person does things right – brushing with bristles angled toward the gum line twice a day and flossing once a day – a manual toothbrush can be just as good. “There no need for anyone to feel they are doing themselves harm by not using an electric toothbrush.”

How important is it to stretch before or after exercise

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Coaches and exercise gurus have long advocated stretching before exercise to avoid injuries. But what little research there is doesn’t support that idea. Instead, experts suggest stretching after you’re warmed up to increase overall flexibility.

In a paper published last year in the journal of the American College of Sports Medicine, researchers from the federal Centers for Disease Control and Prevention analyzed the limited number of studies available and concluded that “stretching had no effect in reducing injuries.”

A separate paper in the March issue of The Physician and Sports Medicine noted that stretching may even slightly impair performance because, as with weight lifting, muscle force decreases slightly, by 2 to 5 percent, immediately after stretching.

After your workout or race, when muscles and tendons are warm, is the time to really stretch to improve overall flexibility, said Dr. Edward Phillips, director of outpatient medical services at the Spaulding Rehabilitation Hospital. Or, use hot packs before stretching. Scientists demonstrated the value of hot stretching decades ago in rats, or more precisely, rat tails, which could be stretched farther and with less damage when they were warmer.

Physiologically, stretching increases the elasticity of muscles, and tendons and to a lesser extent, ligaments. Ideally, you should hold a stretch for 20 to 30 seconds without bouncing or pushing, said Dr. Brian Krabak, a physiatrist at Johns Hopkins. Then repeat this two or three times, several times a week at least, daily if you can.

Phillips makes a distinction between stretching and warming up. Instead of worrying about lengthening muscles at the beginning of a workout, he suggests jogging slightly or moving your limbs around to get your heart rate up a bit. The idea, he said, “is to go through the motions you will do in your event or workout.”

Are there any new treatments on the horizon for endometriosis? All I’ve heard about is hormonal drugs and surgery.

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In the near term, traditional hormonal drugs and surgery (a last resort) will continue to be the main treatments for endometriosis, in which tissue from the lining of the uterus grows around the ovaries, Fallopian tubes and elsewhere, triggering pain and infertility. Overall, an estimated 10 to 12 million American women of reproductive age have chronic pelvic pain, most of which is caused by endometriosis.

But new, non-hormonal drugs are now being tested in baboons, and even the hormonal options are improving. In March, the US Food and Drug Administration announced approval of depo-subQprovera104, a new, easier-to-use formulation by Pfizer of an existing injectable contraceptive.

Both the old and new Depo-Provera drugs work by stopping the pituitary gland from pumping out the hormones that stimulate ovulation, essentially creating a state of “pseudo pregnancy.” Without ovulation, the ovaries also pump out less estrogen, and less estrogen means less stimulation of uterine tissue, both inside and outside the uterus. The result is less swelling and pain.

On the downside, these hormonal drugs – and a stronger one called Lupron – can decrease bone mineral density, but so far this has not been linked to an actual increase in fractures, said Dr. Lee Shulman, a reproductive geneticists at Northwestern University and a consultant to Pfizer on the new drug formulation.

Researchers are now pursuing other hormonal approaches, including the use of selective estrogen receptor modulators such as Evista and other drugs that block estrogen known as aromatase inhibitors.

A completely different approach is also showing promise in baboons – controlling pelvic inflammation and pain by blocking certain chemicals pumped out by the immune system. If all goes well with this and other research, “the landscape for medical treatment for endometriosis will be dramatically different in the next five to seven years,” said Dr. Mark Hornstein, director of the division of reproductive endocrinology and infertility at Brigham and Women’s Hospital.

Is there any way for a woman to tell her fertility is declining before it’s too late?

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Many women assume that as long as they are still getting their
periods, they have plenty of healthy eggs left. But this is not quite true. There may be some eggs, but they tend to be of such poor quality that they stop dividing soon after fertilization or implantation in the uterus.

Although menopause — the permanent cessation of periods – happens, on average, at age 51.5, fertility begins to decline around age 35. By 38, this decline accelerates and by 40, “it nosedives,” said Dr. David Keefe, medical director of reproductive medicine at Tufts-New England Medical Center.

In addition to age, other predictors of declining fertility include: a
family history of menopause before 35, smoking, surgery to remove an ovary or a cyst on an ovary, and having had chemotherapy or radiation for cancer, said Dr. Howard Zacur, director of the division of reproductive medicine and infertility at Johns Hopkins.

There is a blood test for a hormone called FSH (which stands for
follicle stimulating hormone) which can to some degree predict a woman’s fertility. FSH, made in the pituitary gland, tells eggs in the ovaries to mature. As a woman ages and her ovaries begin to run out of eggs, FSH levels rise.

Fertility clinics use FSH tests (usually done on day 2, 3 or 4 of a
woman’s cycle) to tell if she is likely to get pregnant with in vitro
fertilization. In general, if the FSH level is over 10 International Units per milliliter, a woman is unlikely to get pregnant.

Although FSH levels can fluctuate from month to month, in general,
“you are only as fertile as your worst FSH score,” said Keefe. It’s like a gas gauge on a car, he said. Once the needle registers empty, even if that’s only when you’re turning a corner, you are close to having an empty tank.

In the future, better tests may be available that directly measure a
hormone secreted by a developing egg. Until then, Keefe recommends reading a book called “What Every Woman Should Know About Fertility and Her Biological Clock,” by Cara Birrittieri.

Do special sun protective fabrics really work?

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Yes, though most studies have looked at their ability to prevent sunburn, rather than skin cancers, which can take years to develop.

Even regular clothing can keep some ultraviolet (UV) light from reaching the skin. A normal, white cotton T-shirt, for instance, provides the equivalent of a sun protection factor (SPF) of 7, though this drops to 3 when it gets wet, said Dr. Susan Weinkle , an assistant clinical professor of dermatology at the University of South Florida in Tampa. A dark, long-sleeved denim shirt, which among other things is more tightly woven, offers great protection — an SPF of 1,700 — though obviously such garments are also hotter.

The ability of clothing to protect against the sun’s rays depends on fabric construction, fiber content and weave, fabric color, finishing processes and the presence of additives that absorb UV light, said Weinkle, a spokesperson for the American Academy of Dermatology.

Sun protective clothing can be pricey — $50 for a shirt — and is sold by companies with names like Sun Precautions, Inc. of Seattle, WA, and Coolibar, Inc. of Minneapolis. You can boost the UV protectiveness of regular clothing with photoprotective laundry additives such as Rit Sun Guard,cq which carries a “seal of recommendation” from the Skin Cancer Foundation, a private, nonprofit group in New York.

So, what do the experts say?

“If you are extremely sensitive to the sun, sun protective clothing makes sense,” said Dr. Bernard Cohen , interim chairman of dermatology at Johns Hopkins University School of Medicine.

And from Dr. Terry Hadley , a dermatologist at Mount Auburn Hospital: “I think they’re a great addition.”

I’ve heard that creatine helps build muscle. Is this true? And is it safe?

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Widely used by athletes, creatine supplements do help build muscle, they are believed to be safe and, unlike other performance-enhancing substances, are allowed by the International Olympic Committee, the National Collegiate Athletic Association and other major sports groups.

Creatine is a natural substance found in meat and fish — “but you don’t get any benefit from eating meat unless the meat is raw,” said exercise physiologist William J. Evans, of the University of Arkansas for Medical Sciences. And eating raw meat is dangerous because it contains harmful bacteria. Besides, said Evans, to get enough to build muscle, “you would have to eat 10 pounds of fresh, uncooked steak per day! So creatine supplements are the only way to go.”

The supplements come in powder, tablet or drink form, all of which are equally effective.

Biochemically, creatine works by combining with phosphate in cells to produce phosphocreatine, which helps create adenosine tri-phosphate, the body’s main source of energy, said Dr. George Blackburn, associate director of nutrition at Harvard Medical School.

Interestingly, creatine does not boost performance in aerobic, endurance events like marathons, according to the American College of Sports Medicine. But it can enhance performance in short, anaerobic events like weight-lifting or sprinting where muscles work hard and powerfully for brief periods.

Anecdotal reports suggest creatine may cause stomach cramps and diarrhea, but research on athletes who have taken creatine for longer than a year showed no adverse effects. In large doses, creatine “can adversely affect the kidneys,” though this is reversible, said Dr. Doug McKeag, director of the Indiana University Center for Sports Medicine.

Although some researchers have wondered whether creatine might help battle neuromuscular diseases like multiple sclerosis or ALS amytrophic lateral sclerosis, or Lou Gehrig’s disease), so far the answer is no.