Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

What causes bad breath and how can I get rid of it?

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Bad breath (halitosis) is often caused by bacteria in the mouth or upper airway that produce sulfur-containing compounds. Usually, it can be banished by flossing and brushing teeth twice a day and brushing and scraping the tongue. If bacteria are also lurking in deep “pockets” in the gums, a dental professional must scrape them out.

But even with excellent oral hygiene, some people need more dramatic approaches.

About 90 percent of bad breath is caused by bacteria in the mouth itself, and a only small percentage is caused by bacteria in the tonsils, said Dr. Richard Price, a retired Newton dentist and a spokesperson for the American Dental Association.

But an Israeli scientist, Dr. Yehuda Finkelstein, director of palate surgery in the department of otolaryngology, head and neck surgery at Meir Medical Center is testing out a high tech solution for bacteria lodged in tonsils: Lasers that burn away small “crypts” or hollow spaces in apparently normal tonsils that harbor bacteria.

In a study of 53 people, one 15-minute laser session got rid of halitosis in 50 percent of people; the rest needed two or three treatments, Finkelstein said in a telephone interview. A seemingly simpler solution, antibiotics, does not work well against the bacteria found in tonsils, he said.

In Boston, Bruce Paster, a microbiologist at the Forsyth Institute also turned to sophisticated technology to study bad breath. He and his team used DNA sequencing to study bacteria from tongue scrapings in people with and without halitosis. The people with halitosis often had “bad” bacteria on their tongues, while the sweet-breathed people had an abundance of “good” bacteria, he said. The solution in the Forsyth study was an initial scraping of bacteria from the tongue and antimicrobial mouthwashes for a week, followed by tongue-brushing with a zinc chloride gel for a year. Result? The “bad” bacteria disappeared, he said, and were replaced by “good.”

Does going out with wet hair, even in the winter, raise the risk of getting a cold?

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Probably not. “People think there is a connection between being cold and getting a cold, because colds get spread in the wintertime when people are in close quarters,” said Timothy Springer, an immunologist on sabbatical from the Harvard-affiliated CBR Biomedical Research Institute. “But the only way to get a cold is by getting the virus.”

Catching colds actually “has nothing to do with lowered immunity,” said Dr. Jack Gwaltney, a leading cold researcher and professor emeritus at the University of Virginia School of Medicine.

Colds result from cold viruses directly entering the nose. When cold viruses are experimentally introduced into the noses of volunteers, nearly all of them get infected, even those who are happy, healthy and, presumably, immunologically strong. But only three-quarters actually get sick, and those who do get runny noses and sneezing may have an excessive immune response, not a weak one.

“So it may be backwards from what people think,” said Gwaltney. People who get sick pump out high levels of kinins, specific immune system chemicals, while people who get infected but not sick pump out low levels. Both groups get better at roughly the same rate, suggesting that the exaggerated kinin response, while causing lots of symptoms, doesn’t do much good.

The only way to be sure never to catch a cold, Gwaltney added, “is to stay away from humans, especially human children.” Failing that, wash your hands after you’ve been in contact with people with colds or objects they’ve touched.”

I’ve heard that there are cancer vaccines. If I get one, will it prevent cancer?

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Unfortunately, no.

Although many cancer vaccines are now being studied, so far, none has been approved by the US Food and Drug Administration, said Jeffrey Schlom, [cq], chief of the Laboratory of Tumor Immunology and Biology at the National Cancer Institute.

And when they are approved, they will be aimed not at preventing disease, like the flu and polio vaccines, but to keep cancer from coming back after treatment.

Cancer vaccines are “therapeutic,” that is they are designed to rev up the immune system to fight a cancer that’s already present, or to keep the immune system primed to notice and fight any cancer cells that recur.

There are vaccines to prevent some viral infections that can lead to cancer. There is an approved vaccine against hepatitis B, and an experimental vaccine against hepatitis C; both viruses are associated with liver cancer. And there is a promising vaccine against HPV, human papilloma virus, which is associated with cervical cancer.

For the cancers not associated with viruses, researchers are designing vaccines designed to directly attack proteins called antigens on the surface of cancer cells. Sometimes, the same antigens pop up in diverse malignancies – breast cancer, lung cancer and colorectal cancer, which means that the same vaccine could be used against all these. In other cases, cancer cells carry a unique antigen, which means a special vaccine would have to be developed just against that cancer. In still other cases, researchers are also working on individualized vaccines that would attack antigens unique not just to the cancer but to the particular person.

Among the more promising vaccines are those to fight melanoma, the deadly skin cancer, said Dr. Stephen Hodi, clinical director of the melanoma program at Boston’s Dana-Farber Cancer Institute. There are dozens of such melanoma vaccines now in clinical trials, though one vaccine has been approved in Canada. (Melacine)

As the therapeutic vaccines become approved and widely used, researchers believe it will be important to give them soon after a patient’s initial treatment with surgery, radiation or chemotherapy is over – before the cancer has time to come back in force.

I’ve heard you can get liver failure from taking Tylenol and drinking. Is this true?

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There’s no clear answer because no one really knows “what constitutes the minimum threshold for alcohol consumption” in people who take Tylenol, said Dr. Ray Chung, medical director of liver transplantation at Massachusetts General Hospital.

A small woman, for instance, could be at risk of liver damage if she regularly consumes as few as 2 to 3 drinks a day plus eight Extra Strength pills of 500 milligrams each of Tylenol (acetaminophen), said Dr. Rudrajit Rai, medical director of liver transplantation at Johns Hopkins Medicine. A healthy man probably can get away with a little more alcohol and the same dose of Tylenol.

It’s not difficult to reach these levels if you’re in constant pain and often have a couple of glasses of wine with dinner. It’s also not difficult given that acetaminophen comes in many medications besides Tylenol, including cold and sinus remedies.

Combining alcohol and acetaminophen is dangerous because of basic liver biochemistry. Chronic alcohol use causes an enzyme to break down acetaminophen into more toxic metabolites.

The label on Tylenol bottles may be overly reassuring. It states: “If you consume three or more alcoholic drinks every day, ask your doctor whether you should take acetaminophen or other pain relievers/fever reducers. Acetaminophen may cause liver damage.”

“This may leave readers with the sense that they can get away with three drinks a day or less” and still take Tylenol safely, which may not be true, Chung said.

Even without alcohol, acetaminophen can cause acute liver failure at doses higher than 24 extra-strength (500 milligram) pills or more within 24 hours. A prescription drug called Mucomyst can reverse liver damage if taken soon enough.

Bottom line? If you’re taking Tylenol, Chung said, stick to one drink a day or less.

In the wake of the Vioxx fiasco, is there any place a consumer can get reliable information on drugs?

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Ideally, the kind of information consumers want would be readily available in user-friendly form from the US Food and Drug Administration. But the FDA has been having major problems keeping on top of emerging problems with drugs it already has approved.

In November, the FDA itself asked the Institute of Medicine, an arm of the National Academy of Sciences, to try to figure out what is wrong with its system.

Last week, the editors of the Journal of the American Medical Association called for a new, independent drug safety board to oversee such surveillance, noting that it is “unreasonable” to expect the same agency that approves drugs to seek evidence “to prove itself wrong.”

On top of these problems, the FDA’s website can be so cumbersome to use that it’s difficult to sort out even the information that is there.

Imagine, for instance, that you want information on Ambien, the popular sleeping pill. If you go to the FDA website, at www.fda.gov, and search for “Ambien,” you end up drowning in everything from correspondence between the FDA and the drug manufacturer to highly detailed biochemistry that only a neuroscientist could love.

There are a few other places to turn, said Dr. Jerry Avorn of Brigham and Women’s Hospital, who recently wrote a book about prescription drugs called “Powerful Medicines.” about prescription drugs. One is www.PDRHealth.com, which gives consumer-friendly information based on the Physicians’ Desk Reference, the doctors’ bible of drug information. Another user-friendly site, www.safemedication.com, is provided by the American Society of Health-System Pharmacists.

You can also “Google” a drug like Ambien, though the information you get is not vetted by any medical authority, which means company propaganda and consumer complaints are all mixed in together.

Additional sites should be available soon. On Dec. 9, Consumer Reports will launch a free new website, www.crbestbuydrugs.org, that will allow consumers to check on drugs by category, such as medications to control cholesterol. This program, said project manager Gail Shearer, will start with three drug categories and expand up to 20, and will provide information on effectiveness as well as cost.

Is thyroid cancer is on the rise in the US? If so, is it due to Chernobyl?

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Cancer of the thyroid, a butterfly-shaped gland in the neck that secretes hormones, is on the rise in this country, and is expected to strike 23,600 Americans this year and kill 1,460, said Dr. Michael Thun who heads epidemiological research for the American Cancer Society in Atlanta. Most of the increase is due to better detection, because of CT or ultrasound imaging that can find small tumors that would have been missed in the past.

In its most common forms, the survival rate with thyroid cancer is 85 percent at 40 to 50 years, said Dr. Marshall Posner, medical director of the head and neck oncology program at Dana-Farber Cancer Institute.

Anaplastic thyroid cancer, the type Rehnquist is believed to have, is rare, but far more deadly, typically killing victims in three to six months.

As for Chernobyl, despite some data studies suggesting a possible link, that appears unlikely. In the 1986 accident in Ukraine, large quantities of radioactive iodine were spewed from the nuclear reactor onto the ground, where cows ate contaminated grass and produced contaminated milk, said Elaine Ron, a senior investigator in the radiation epidemiology branch of the National Cancer Institute. Radioactive iodine is taken up by the thyroid gland, where it can cause cancer. Researchers have documented a sharp increase in thyroid cancer in people who were under 18 and lived near Chernobyl at the time of the accident.

In the US, radioactive fallout occurred in parts of the West after nuclear weapons testing in the 1950s, but there has been no proven link to an increased risk of thyroid cancer, according to the National Cancer Institute. There is a link, however, between receiving radiation to the head and neck as a child and subsequent thyroid cancer.

Can disposable contacts harm my eyes?

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There are all sorts of contact lenses on the market, from rigid, gas-permeable lenses that are relatively stiff and that you change once a year to soft, very flexible disposables that you change every day, every two weeks, once a month or once every three months. The US Food and Drug Administration, which must approve contact lenses for marketing, believes all these devices are safe and effective if used according to manufacturers’ instructions, a spokeswoman said.

“Most people can safely wear disposable contact lenses for years. We have some patients in their 90s who have been wearing contacts for decades,” said Jill Beyer, an optometrist and clinical director of the contact lens service at the Massachusetts Eye and Ear Infirmary.

Of all the contacts now available, “the one-day disposable is the safest,” said Elliott Myrowitz, an optometrist at the Wilmer Eye Institute at Johns Hopkins University in Baltimore. That’s because you are putting in a fresh, sterile lens every day, he said, thus minimizing the risk of infection and the buildup of proteins from tears on the lens.

Other disposables are OK also as long as you soak the lenses in the solution that your optometrist suggests to “kill any bugs round the lens,” said Lawrence Phillips, an optometrist at For Eyes in Cambridge. It’s also important, Phillips said, to make sure lenses are fitted to the exact curvature of the eye: “A contact lens is not something that you just take off the shelf and put on. It has to be fitted and monitored.”

In general, optometrists say, contact lens wearers should be on the alert for three possible warning signs: Eyes that feel dry or gritty, eyes that look red or irritated, and vision that is not clear with contacts in place.

“Very few people have these complications,” Beyer said, “if they come in for an annual eye check and follow the correct hygiene procedures.”

I hear so much about Pilates. Is it a good exercise program?

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Pilates is an increasingly-popular form of exercise designed to strengthen the “core,” or abdominal and back muscles, which many fitness-wannabes forget in their focus on fitter hearts and bigger biceps.

First introduced to this country in the 1920s by its inventor, Joseph Pilates, a German boxer, the technique involves working out on mats or on specially-designed equipment. It’s kind of a combination of the deep, focused breathing and meditative focus of yoga plus the challenge of doing abdominal exercises over and over.

“It’s excellent. It really strengthens the core,” said Miriam Nelson, an exercise physiologist at Tufts University. “It focuses more on strength and muscular endurance than aerobics. It’s also a good complement to weight training.”

But finding a good Pilates teacher can be tricky.

“There are huge injury issues from poorly-trained instructors who don’t know what they don’t know,” said Kevin Bowen, chief executive officer of the Pilates Method Alliance, a non-profit group based in Miami.

There are many different schools of Pilates and vastly different levels of training – in some cases, just a weekend workshop. So far, there is no national certification system, although Bowen’s group is trying to do just that.

In the meantime, it pays to ask your potential Pilates teacher how long they have trained and how much teaching experience they have. You should also shop around for a teacher, said Kathy Van Patten [cq], a Pilates teacher who runs BodyWorks Studios in Boston. “Go to different classes and different studios and see which teacher you connect with.”

Can a recovering alcoholic safely eat food made with vanilla extract, wine, etc.?

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It depends – on how much alcohol you use, how long you cook it and, perhaps, how long you’ve been sober.

Many people believe that if you pour lavish amounts of red wine into your coq au vin, the alcohol all burns off with cooking, leaving only the lovely taste. Wrong. Some of the alcohol burns off, but lots – from 10 to 85 percent, doesn’t, according to the US Department of Agriculture.

In a study published in 1992 in the Journal of the American Dietetic Association, Rena Cutrufelli [cq] found that, depending on how and how long the food is cooked, varying amounts of alcohol remain. Cutrufelli is a supervising nutritionist at the USDA’s Nutrient Data Laboratory, part of the Agricultural Research Service.

If you flambe something, say, bananas with rum, to make a fancy dessert, 75 percent of the alcohol remains. If simmer that hearty wine-soaked chicken stew for two hours, only 10 percent remains. If you add alcohol to a recipe, don’t heat it and store it overnight, 70 percent remains. If you simply stir alcohol into hot liquid, 85 percent remains. (For more information, visit www.nal.usda.gov/fnic/foodcomp.)

Though recovering alcoholics are understandably fearful of even the tiniest traces of alcohol in food, a teaspoon or so of vanilla extract in a batch of chocolate chip cookies is probably trivial. The extract contains 40 percent alcohol, and if you bake the cookies for 15 minutes, only 40 percent of the alcohol remains, Cutrufelli said.

The biggest danger of cooking with alcohol, especially for people in the first months or years of sobriety, is having a tempting, open bottle of booze in the kitchen, said Dr. Mark Willenbring [cq], director of the treatment and recovery division of the National Institute on Alcohol Abuse and Alcoholism. Vanilla extract, he said, probably poses much less danger of relapse than the alcohol in mouthwashes and cough syrups. But recovering alcoholics taking Antabuse (disulfiram) may experience the same unpleasant nausea and flushing from eating food cooked with alcohol as they would from a drink.

I think I may have seasonal affective disorder. What is SAD and what can I do about it?

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Seasonal affective disorder (SAD), also known as winter depression, is a problem all too familiar to New Englanders and others who live in northern latitudes. SAD is “not just feeling bummed out because it’s winter,” said Janis Anderson, director of the seasonal affective disorder service at Brigham and Women’s Hospital. It includes physical changes such as trouble getting up in the morning, lack of energy, gaining weight and problems concentrating, for weeks or months at a time. Symptoms typically start in the fall and lift in the spring.

SAD is actually a bad name for this common disorder, which to a mild or moderate degree affects 25 percent of people living at latitudes like New England’s and strikes 5 percent so badly they meet the criteria for major depression. A better name would be “light deprivation disorder,” said Dr. Dan Oren, a SAD specialist and psychiatrist at Yale University and the Veterans Affairs Medical Center in W. Haven, CT.

Given that SAD appears to be triggered by lack of sunlight, it’s not surprisingly that the most effective treatment is to restore this bright light, either by getting outside even in winter or by sitting in front of a light box for 30 to 90 minutes a day, preferably in the morning.

No one knows biochemically how exposure to light affects behavior and mood, though most animal species are sensitive to light’s effects. But a number of studies shows that light therapy does work for SAD, as do antidepressants like Prozac.

But consumer beware: Not all light boxes sold on the Internet are safe and effective because some wave lengths, especially those used for tanning, can damage eyes, said Anderson. For information on SAD and light boxes, visit www.sunboxco.com, www.cet.org/cet2000 (the Center for Environmental Therapeutics) or www.sltbr.org (the Society for Light Treatment and Biological Rhythms.) Be sure to get a light box with fluorescent bulbs that provide 10,000 lux (a measure of intensity). (That’s a lot more than ordinary room light.) The boxes can cost around $400, but most insurers now pay.