Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

Is it dangerous to breathe mothball fumes?

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In the past, most mothballs contained camphor, which is “quite toxic,” said Dr. Michele Burns, an emergency room physician at Children’s Hospital and medical director of the regional poison control center for Massachusetts and Rhode Island.. Camphor-based mothballs are not sold anymore in the US, she said, but many people still have supplies bought years ago.

At high doses — either eating or simply inhaling fumes close up — camphor can cause nausea, vomiting and seizures.

With the more-common naphthalene-based mothballs, the real risk is for people with a genetic problem called glucose-6-phosphate dehydrogenase deficiency, which is more common in people of African-American or Asian descent, said Dr. Stephen Traub, co-director of the division of toxicology at Beth Israel Deaconess Medical Center. These people can develop a serious kind of anemia from eating naphthalene mothballs.

The safest mothballs are those containing paradichlorobenzene, which is “pretty benign,” said Dr. Edward Boyer, a toxicologist at Children’s. The fumes from these mothballs can irritate eyes or airways if exposure is high. But generally, there is very little toxicity linked to this kind of mothball.

Bottom line? While occupational exposure, like working in a mothball factory, may pose a risk, the fumes from a box of open mothballs in the bedroom closet won’t hurt you. Eating mothballs, however, does pose more risk, so keep mothballs away from children and pets. If you’re still worried about the fumes just put the clothes you want to protect in sealed plastic containers with the mothballs.

If your cholesterol and HDL are really good, do you need to worry about your LDL?

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Probably not, but it depends.When doctors do a cholesterol blood test, they’re looking for your low-density lipoprotein, or LDL, cholesterol; your high-density lipoprotein, or HDL; and your triglycerides, or fatty acids in the blood. LDL is considered the “bad” cholesterol because is gets deposited in blood vessel walls as plaque; HDL is “good” because it take cholesterol out of the blood.

Your total cholesterol score is the sum of LDL, HDL and very low-density lipoprotein, or VLDL, which is computed by taking your triglycerides and dividing by 5.

In people without heart disease and at low or ordinary risk for it, total cholesterol should be 200 milligrams per deciliter or less, according to guidelines issued by cholesterol experts several years ago. LDL should be 130 or less. In those with heart disease or at very high risk, LDL should be less than 100 and, “better still, under 70,” said Dr. Daniel Levy, director of the National Heart Lung and Blood Institute Framingham Heart Study. HDL should be above 40. Triglycerides should be 150 or lower.

So, if your total cholesterol were, say, 208 and your HDL were 100, by mathematics alone, that suggests your LDL is admirably low, said Dr. Zoran Nedeljkovic, an interventional cardiologist at Boston Medical Center.

Still, to assess your overall risk of heart disease, doctors also need to know your age, sex, smoking history, blood pressure, family history of heart disease, whether you have diabetes, and how much you exercise. In general, if either your total cholesterol or your LDL is higher than desirable, you can try losing weight and controlling fat intake. If that doesn’t work well enough, doctors often prescribe statin drugs.

Does red wine reduces the risk of prostate cancer?

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It may but, but the data are not definitive enough to say for sure.

Last month, researchers from the Fred Hutchinson Cancer Research Center in Seattle, WA said they found that men who drank four or more glasses of red wine per week reduced their prostate cancer risk by about half.

Moreover, the researchers, led by epidemiologist Janet L. Stanford, found that beer, hard liquor and white wine did not show the same protective effect.

Perhaps even more intriguing, Stanford said in a telephone interview, red wine consumption seemed to have its most potent effects against the most aggressive kinds of prostate cancer. The key, she said, may be a well-known antioxidant, resveratrol, found in greater abundance in the skins of red grapes than white. Resveratrol may block cell growth in prostate cancer, enhance the tendency for cancer cells to commit “suicide” and weakly block, androgen, the hormone that often drives prostate cancer. It also blocks inflammation and the growth of new blood vessels that often grow around tumors.

So, should men start guzzling red wine? No, but if you ‘re a drinker, you might consider substituting red wine for the white wine, beer or spirits you already consume.

This is just one study (of about 1,500 men, half with prostate cancer and half without) in a very mixed literature of studies, said Dr. Marc Garnick, a prostate cancer specialist at Beth Israel Deaconess Medical Center and executive vice president of Praecis Pharmaceuticals, Inc.

Some researchers think that a diet low in animal fat and high in lycopene, found in cooked tomatoes, may be protective. It’s possible, though still debatable, that chocolate, vitamin A, vitamin E soy products and a mineral called selenium may also be protective.

Does it make sense to take medicine to bring down a fever?

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That is one of the most frequently asked questions in medicineand the experts disagree.

Matthew Kluger, vice president for research at the Medical College of Georgia and a fever physiologist, said that animal studies suggest that fever is beneficial. Fever is so “costly” in metabolic terms in humans, each 2 degrees Fahrenheit of fever raises heart rate by 10 percent that fever probably never would have evolved in the first place unless it did more good than harm.

In ferrets given influenza, those who were treated with aspirin had more virus in their nasal secretions than those whose fevers were left untreated. Other animal studies suggest that treating fever may even increase the mortality rate. “One can’t do [such] studies in humans,” Kluger said, “but if you extrapolate this to humans, it suggests that moderate fever is protective.”

On the other hand, leaving a fever untreated may make you feel miserable and treating an illness with Tylenol, aspirin or ibuprofen is likely to prolong it by a few hours at most, Kluger said.

Dr. Michael Shannon, chief of emergency services at Children’s Hospital Boston, comes down firmly on the side of treating fever. “Your immune system will keep fighting the infection, whether or not you bring the fever down with medications.”

When infection occurs, the immune system pours out chemicals called cytokines, including interleukin 1 and interleukin 6. These natural fever-makers trigger a cascade of other chemicals, including prostaglandins, which act on the brain to raise the body’s thermostat, or set point. At the end of an illness, other chemicals called cryogens, or antipyrogens, bring it back to normal.

If you’re an adult, call a doctor if your fever is 103 degrees Fahrenheit or higher. With a newborn, call the doctor for any temperature over 100.4. With an older child, call the doctor if the temperature is 102 or higher.

As for medications, take them if you want.

Does burning toast make it unhealthy?

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Probably not, but nobody really knows since burned toast isn’t high on the research agenda.

Cooking muscle meats — beef, pork, fowl, and fish — above 400 degrees Fahrenheit creates chemicals that are not present in uncooked meats, according to the National Cancer Institute. Researchers found that people who ate meat medium-well or well-done had three times the risk of stomach cancer, compared to those who ate their beef rare or medium-rare.

Chemicals called heterocyclic amines (HCAs) are formed when amino acids (the building blocks of protein) from the meat and creatine (a chemical found in muscles) are cooked at high temperatures. HCAs are known carcinogens in animals, and may increase cancer risk in humans, though this has not been shown definitively.

Since bread doesn’t contain creatine and it takes creatine to create HCAs, it’s unlikely that cooking, or even burning, toast would create HCAs, said Marji McCullough, a nutritional epidemiologist at the American Cancer Society headquarters in Atlanta.

Other potentially carcinogenic chemicals in meat cooked at high temperatures are the PAHs, or polycyclic hydrocarbons, said Rashmi Sinha, an epidemiologist at the National Cancer Institute. They occur in the smoke created from burned fat. In theory, burned toast could have PAHs, said Sinha, but again, this has not been established.

One potential worry is a class of chemicals called acrylamides, recently established as probable carcinogens. Acrylamides are found in starchy foods exposed to high cooking temperatures, such as potato chips or French fries. “Theoretically, acrylamides could be a problem in burned toast, too,” said McCullough.

Bottom line? Scrape the burned stuff off your toast if it bothers you. But, so far at least, there’s not much evidence that burned toast is a health hazard. Some people, Sinha among them, actually like their toast on the charred side. “I always burn my toast, usually not deliberately,” she said. “I like it.”

Are there guidelines or recommended “daily allowances” for sugar intake?

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You would think so, but the federal government’s guidelines on sugar intake are vague to the point of uselessness and the World Health Organization’s aren’t much better.
Nutritionists agree that many of us eat too much sugar, as well as too many refined carbohydrates like white bread, white rice, white pasta and, potatoes, which are just as bad as sugar, found abundantly in soft drinks, cakes, cookies, ice cream, and candy. What they can’t seem to figure out is a simple formula telling us how much sugar is too much.

The World Health Organization recommends that no more than 10 percent of daily calories come from sugar. For most of us, that’s about 200 calories (or about 50 teaspoons), which is quite a lot, said Dr. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health. Yet many Americans get double that. For example: A 20-ounce Coke contains 16 teaspoons of sugar.

Jo-Anne Rizzotto, a dietician at the Joslin Diabetes Center in Boston, said federal guidelines used to specify how many teaspoons of sugar a person should consume per day. But the government’s 2000 Dietary Guidelines for Americans aren’t specific, noting simply that people should “moderate” their sugar consumption (www.health.gov/dietaryguidelines).

The bottom line, said Willett, is to keep sugar consumption as low as possible. “Basically, it contains nothing of nutritional value outside of calories, of which we usually have an excess,” she said. Sugar also has adverse metabolic effects, including lowering “good” cholesterol (HDL) and elevating triglycerides. “There’s really no need for any sugar in the diet,” Willett said. But so many prepared foods are so highly sweetened that many of us have been conditioned to expect foods to be unnaturally sweet. If you reduce sugar gradually, Willett said, you can “decondition” yourself from this expectation.

[PUBLISHED CORRECTION – DATE: Wednesday, September 8, 2004: > Correction : Because of a reporting error, the recommended daily sugar intake was inaccurate in the answer to a reader question in yesterday’s Health/Science section. The World Health Organization says that most people should consume no more than 200 calories a day in sugar, which equals about 12.5 teaspoons.]

Can low blood pressure be dangerous?

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As long as you feel fine and your blood pressure is low naturally — and not because of too much medication to lower high blood pressure — all you need to do is count your blessings. You’re one of the lucky ones.

A blood pressure of 90 over 60 (the top number is called the systolic pressure, the bottom number the diastolic) is actually “normal for many people,” said Dr. Michael Jaff, director of the Vascular Diagnostic Laboratory at Massachusetts General Hospital.

In fact, pregnant women often have blood pressure that’s as low as 80 over 50 (because the body sends much of the blood flow to the fetus) and it does them no harm, said Dr. Richard Karas, director of the Preventive Cardiology Center at Tufts-New England Medical Center.

But many people have low blood pressure because they’re dehydrated. You can remedy this by drinking more fluids and adding salt to your diet. (People with high blood pressure should not add salt.)

Although low blood pressure is not dangerous if you feel fine, you should see a doctor if you have low blood pressure and lots of headaches, often feel dizzy when you stand up or have foggy vision. Low blood pressure plus chest pains, or shortness of breath or fever also mean you should contact a doctor.

Why can’t you skip as dose of HIV medication?

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The goal of taking drug “cocktails,” or combination therapy, with AZT, 3TC, protease inhibitors and other medications to combat HIV infection is to keep the AIDS virus from replicating in your system, said Dr. Eric Rosenberg, an AIDS specialist and associate director of clinical microbiology at Massachusetts General Hospital.

Within an hour or so of taking the drug, blood levels of the drug rise, which keeps the virus from replicating. But several hours after that – the interval varies depending on the particular drug – levels of the drug in the system begin to fall, which allows the virus to begin replicating. When the virus replicates in the presence of sub-therapeutic levels of the drug, the virus is wily enough to mutate so that it can survive in this low-drug environment. The new viruses thus produced now carry the ability to survive, even when levels of the drug are increased again. Missing just one dose usually doesn’t lead to a resistant strain emerging, Rosenberg said, though it’s possible.

“So long as the virus can’t replicate, it can’t mutate and resistance to a drug does not develop, or at least develops as a much, much slower rate,” said Rosenberg.

Dr. Clyde Crumpacker, director of virology at Beth Israel Deaconess Medical Center, noted that it has taken years for doctors to appreciate the implications of all this – specifically, that the best way to keep the AIDS virus from replicating is to hit it hard with multiple drugs all at once, rather than waiting until a patient became resistant to one drug before starting another. “This is something the developing world can learn from the American experience,” he said. “Americans had to learn it the hard way. Other countries can benefit from this.”

If you have kidney problems, are you better off avoiding meat?

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Probably. It’s easier for kidneys to process proteins from vegetable sources like soy, lentils, beans, corn and the like than to process animal proteins, said Dr. Theodore Steinman, a kidney specialist and senior physician at Beth Israel Deaconess Medical Center in Boston.

When you eat protein, you absorb the amino acids from the protein, and excrete excess sodium, potassium and other substances the body doesn’t need. If the kidney didn’t get rid of these wastes, said Steinman, the byproducts of protein metabolism would build up to the point of toxicity, as occurs with kidney failure.

Compared to vegetable protein, animal protein generally has more salt and potassium and produces much more acid. To keep the body chemistry in the correct acid balance, the kidneys must pair each acid molecule with a base to neutralize the acid. “That’s a lot of metabolic work for the kidney,” said Steinman.

Vegetable proteins contain much less acid, “so the metabolic work by the kidney is much less,” said Steinman.

Dr. David Heber, director of the Center for Human Nutrition at UCLA, agreed. Some studies suggest that when animal proteins are metabolized by the kidneys, there is increased blood flow to the kidneys which theoretically may be linked to increased risk of kidney disease. By contrast, vegetable proteins do not increase blood flow to the kidneys, so are presumed to be safer.

Bottom line? “If we were smart, we would all be vegetarians,” said Steinman, who concedes that he eats mostly vegetables but “can’t give up my love for fish, and sometimes chicken.”

Is it true that you burn fat better when exercising at a lower heart rate?

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No. What counts for losing weight is “the total number of calories burned,” said Miriam Nelson, director of the John Hancock Center for Physical Activity and Nutrition at Tufts University’s Friedman School of Nutrition Science and Policy. It’s “bogus,” she added, to think that some type or intensity of exercise will burn fat while others will not.

Dr. George Blackburn, associate director of the Division of Nutrition at Harvard Medical School, emphatically agreed: “There is no such thing as fat-burning exercise as opposed to some other kind.”

What is true is that the percentages of fuel burned change during a workout. If you start out with an empty stomach, for the first 5 minutes of exercise, said Blackburn, you burn carbohydrate that is stored as glycogen in your muscles. Then the mitochondria, the energy-producing miniorgans inside cells, “start switching over to fat” as fuel. Eventually, you’ll be burning about half and half, glycogen and fat. In other words, the ratio of fuels changes.

But that has nothing to do with your heart rate, or how hard someone exercises.

“If you go slowly, the percent of fat that you burn will be more, but the overall calories you expend will be less,” said Nelson. It’s not the percent of carbohydrate or fat in the fuel that matters, but the total amount of calories burned. And the faster the exercise, the more calories burned.

As Blackburn put it, if you walk slowly, you’ll burn about 5 calories per minute; if you run, you’ll burn 10. In other words, it takes an hour of walking (at 5 calories burned per minute) to work off a 300-calorie hamburger; it takes 30 minutes of running.