Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

Is there any safe way to grill foods?

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Yes, but it depends more on what you grill than how you grill it.

The problem with grilling any kind of protein – red meat, poultry, fish – is that the process causes formation of two cancer-causing agents: HCAs, or heterocyclic amines, and PAHs, polycyclic aromatic hydrocarbons, said Karen Collins, nutrition adviser to the American Institute for Cancer Research. Laboratory data show these substances trigger the cancer process, and while data in humans are limited, there is suggestive evidence that they can also trigger cancer in people.

Happily, grilling vegetables produces no HCAs or PAHs, nor does grilling fruit. Formation of the nasty chemicals also seems to be reduced if you marinate meat, even briefly, before grilling, though it’s unclear why this would be.

Reducing the temperature also helps reduce the risk (grill, don’t char) and cut away fat before grilling because fat dripping down onto the grill causes smoke, which contains PAHs.

But it’s also important to take this advice with a grain of salt. It’s fine to grill meat, even red meat, once a week or so during cookout season, said Dr. George Blackburn, a nutritionist at Beth Israel Deaconess Medical Center and associate director of the Division of Nutrition at Harvard Medical School.

As usual, it’s a question of moderation. As Blackburn put it, “We don’t want to ruin the joy of family get-togethers.”

I have the auto-immune disease lupus, and I’m discouraged because there’s been no new approved lupus drug for 45 years. Is there

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There is, thanks to an explosion in knowledge about how cells “talk” to each other chemically in the immune system, which goes awry in SLE, or systemic lupus erythematosus. But it will be five to 10 years before a truly effective drug hits the market because a number of recent, albeit methodologically imperfect, studies, have been disappointing.

In lupus, which strikes 1.5 million Americans, mostly women, the immune system “can attack any organ” in the body, including the skin, joints, kidneys, brain, lungs and the lining of the heart, said Dr Joan Merrill [cq], medical director of the Lupus Foundation of America. Aspirin has long been used to treat lupus.

But the first prescription drugs specifically approved for lupus by the US Food and Drug Administration were the steroids, prednisone and prednisolone, and that was back in 1964. These drugs damp down the immune system, quieting lupus. But as with other immune suppressants such as Immuran, which is used in organ transplant patients, these drugs raise the risk of infection, as well as serious weight gain, acne, diabetes and bone-thinning.

Anti-malarial drugs such as Plaquenil are also approved for lupus. They quiet the immune system by acting on so-called “toll-like receptors,” said Dr. Lee Simon [cq], a rheumatologist at Beth Israel Deaconess Medical Center.

Despite the lack of a blockbuster drug, “it’s an incredibly exciting time,” Simon said, because of other drugs in the pipeline and basic research into the genetic abnormalities in lupus, in particular, a gene for alpha-interferon that might be too active in lupus patients. “The pipeline of new drugs is incredible,” said Merrill. Both Simon and Merrill consult for multiple companies making new lupus drugs.

In April, hopes were dashed when a drug called Rituxan made by Genentech and already on the market for non-Hodgkins lymphoma and rheumatoid arthritis, failed to reduce the severity of lupus. But another study of Rituxan for lupus patients whose kidneys are affected is still ongoing.

Other drugs now being tested for lupus include Riquent, Lymphostat B, Ocrelizumab, Epratusumab, Cellcept, and Orencia (already approved for rheumatoid arthritis). So, there is hope, but it’s going to take time.

Couldn’t the probiotic bacteria in yogurt actually be dangerous?

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Possibly. But for the most common probiotics, there’s no evidence that it’s harmful.

“The good thing about the probiotics that are used now, lactobacillus and bifido bacteria, is that both of those just completely lack the genes that are required to cause disease,” said Gary Huffnagle, a professor of immunology and microbiology at the University of Michigan School of Medicine. “So even from a theoretical standpoint, it would be extremely difficult to cause disease. And from a practical standpoint, we have never seen in, despite billions of doses in billions of people.”

On the other hand, said Huffnagle, the author of “The Probiotics Revolution,” “I would be worried about” some other probiotics on the market, particularly those taken from the soil called “homeostatic soil organisms,” or HSOs. “There’s not enough evidence of safety for probiotics from the soil. But lactobacillus and bifidobacterium are all found in food and you are safe when dealing with food bacteria,” he said. He added that he has no financial ties to any of the companies that make yogurt or probiotic supplements.

If you are immunocompromised, hospitalized, or recovering from surgery, skip probiotics until you are well again, Huffnagle said.

Is it better to exercise in the morning or evening?

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“Unless you are an elite athlete, it doesn’t matter,” said Miriam Nelson, director of the John Hancock Center for Physical Activity and Nutrition at Tufts University, in an e-mail. “The most important thing is to find a time of day that you like best and when you can exercise most consistently.”

And this advice is especially true for aerobic exercise like brisk walking or cycling. For aerobic workouts, “it doesn’t much matter when you do it. Basically, it’s whenever you can,” said Michael R. Deschenes, a physiologist and neurobiologist at the College of William and Mary in Virginia.

For building muscle strength through weight training, though, “you’re better off in the late afternoon or early evening because core body temperature is higher and muscles perform better when core temperature is higher,” Deschenes said.

The most important message, said Deschenes, is consistency: “Exercise regularly whenever you can at moderate intensity.”

So far, most of the research on exercise and “chronobiology,” the study of biologic rhythms over a 24-hour cycle, has been done in men, and relatively young men at that. There’s some evidence, said Deschenes, that the timing of exercise may matter even less with age “because circadian rhythms get less pronounced as you get older.”

Even so, the basic idea is still to exercise when it suits your own schedule.

“If you are an evening person and someone tells you to exercise in the morning, you will never enjoy it (and not stay with it). So the best message is to exercise when you feel most comfortable,” said William J. Evans, a physiologist at the University of Arkansas for Medical Sciences.

Does singing in a chorus make you healthier?

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It appears to. And that’s great news for the 29 million adults and children who sing in America’s 250,000 professional, community, church, and school choruses, according to figures from Chorus America, a service organization.

It’s not clear how much of the health benefit is due to hanging out with other people and how much to the artistic challenge, but a handful of studies suggest that, for whatever mix of reasons, choral singing is good for your health.

In 2006, Dr. Gene Cohen, a psychiatrist and director of the Center on Aging, Health and Humanities at George Washington University, published results of a federally funded study on 300 people aged 65 to 103 in three cities. In each city, half of the participants attended an arts program and half did not.

In the Washington, D.C., group, the arts program consisted of singing in a chorale led by Jeanne Kelly, a professional opera singer. “I have done all kinds of things in my musical career,” Kelly said recently. “And this is the best thing I have ever done. I just love to see these folks so darn happy.”

After one year, the singers reported better health than at the outset of the study, while the health of the control group was worse, said Cohen. The singers also had fewer falls and greater improvement in measures of depression, loneliness, and morale.

“If a person is actively involved in an arts program, especially with other people,” said Cohen, “that’s doing very good things for health.”

In a paper published in 2004, Gunter Kreutz, a musicologist and research fellow at the Royal Northern College of Music in Manchester, studied 31 choral singers before and after a one-hour rehearsal and found that an immune marker in saliva called IgA increased, as did mood.

“We must turn more attention to culture and arts as part of healthy living,” he said in an e-mail.

Do allergies really cause grumpiness?

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They sure can, according to a new survey conducted by Harris Interactive for Schering-Plough/Merck Pharmaceuticals, a corporate joint venture that makes allergy medications.

The survey involved more than 1,000 consumers (people with and without allergies), 1,000 allergy sufferers, and 300 physicians.

An allergic reaction involves the release of inflammatory substances that cause sneezing, nasal congestion, runny nose and eyes, and other symptoms. An estimated 50 million Americans have indoor and outdoor allergies, some of which get worse in the spring.

The consumer portion of the survey revealed that, while most people feel sorry for allergy sufferers, more than one-third think allergy sufferers overstate their symptoms or use allergies as an excuse to get out of something.

“People see the outward signs but don’t recognize what the allergy sufferer is going through emotionally,” said Belinda Borrelli, a professor at Brown University’s Alpert Medical School and a clinical psychologist at Miriam Hospital in Providence who helped designed the survey. People with allergies often skip the activities they enjoy, which can lead to further mood deterioration.

In their part of the survey, more than half of allergy sufferers said allergies made them feel annoyed, 48 percent said they felt irritable, and some felt their symptoms rendered them unattractive or self-conscious.

Allergy specialists were far more sympathetic than the public at large, saying that they believed their patients were not exaggerating their symptoms.

Dr. Frank Twarog, an allergy specialist in Concord and Brookline and a clinical professor at Harvard Medical School who was not part of the survey, said the link between allergies and emotions can work both ways. “If you have hay fever and you can’t sleep well because you can’t breathe and your ears are full and your eyes are itchy, you’re going to be irritable the next day.” But emotions, like the stress of final exams, can make allergies and asthma worse.

The best bet, he said, is to see a doctor and get allergy symptoms treated properly.

What should I do to make sure I’ll get good results from LASIK surgery?

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LASIK surgery, in which doctors use small laser cuts to reshape the surface of the cornea to correct vision, is usually a safe and effective procedure. It corrects near- and far-sightedness, and hundreds of thousands of Americans have the operation every year.

But, as recent testimony before an advisory panel to the US Food and Drug Administration made clear, in perhaps 5 percent of cases, it can be ineffective or lead to side effects, including severe dry eye, eye pain, blurred vision, and an inability to drive at night. (Check out fda.gov and search for “LASIK,” which stands for laser-assisted in situ keratomileusis)

Prospective LASIK patients should be evaluated ahead of time for dry eye, which affects an estimated 10 million Americans and is a painful condition in which there is a reduction in either the quality or quantity of tears, which are necessary to keep the eye lubricated. Contact lens use can lead to “dry eye,” as can birth control pills, antihypertensive medications, and antihistamines.

If you have a tendency toward moderate or severe dry eye before LASIK surgery, you should go into surgery with it well-controlled, because the eye will certainly be drier afterward, said Dr. Ernest Kornmehl, a LASIK surgeon in Wellesley and a spokesman for the American Academy of Ophthalmology.

Kornmehl warns that some surgeons don’t see their patients until the day of surgery – leaving initial checks to someone else – and making it more likely that such preexisting conditions will be missed.

Patients should also ask surgeons how many LASIK procedures they’ve done and look for a doctor who is fellowship-trained in corneal diseases, to maximize the chances of a good outcome.

“You have to choose your physician carefully,” said Darlene Dartt, director of scientific affairs at Schepens Eye Research Institute. “And go to a reputable place where you are carefully screened, to make sure your eye is properly evaluated.”

Do antidepressants help with back pain?

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That depends on which study you read and what kind of back pain you have.

In a review of 10 studies on back pain and antidepressants published recently by the Cochrane Collaboration, an international organization that reviews medical studies, Australian researchers found no clear evidence that antidepressants are more effective than sugar pills in helping patients with low-back pain. The finding is somewhat perplexing because, as the Australian researchers themselves noted, there is evidence that antidepressants can help with other types of chronic pain.

The Australian findings conflict with recent guidelines issued by the American Pain Society, which does recommend antidepressants for back pain, said Dr. Roger Chou [cq], director of the guideline program. But he cautioned in an email that antidepressants are not recommended as the “first line” treatment for low back pain partly because they can have side effects and partly because the benefit of antidepressants for back pain is “small to moderate.”

While some people may be surprised that antidepressants might alleviate pain, it actually makes sense, said Dr. Daniel Carr[cq], a pain specialist at Javelin Pharmaceuticals, Inc. in Cambridge. “We call a drug an antidepressant because it works against depression, but that doesn’t mean it can’t work against other conditions. A drug that influences processing in some parts of the brain can certainly influence other parts of the brain and spinal cord.”

“Back pain can be due to so many different conditions,” Carr said. “Antidepressants don’t help much with back pain that is caused by muscle spasms or by a spinal disc pressing on a nerve. But if the pain is caused by a nerve injury, such as nerves that were cut during surgery or chronic nerve pain from shingles or HIV, antidepressants are worth a try.”

Some antidepressants are more likely to help with back pain than others. The ones that help most are SNRIs, that is, drugs that increase levels of two neurotransmitters, serotonin and norepinephrine. Older antidepressants called tricyclics such as Elavil also help.

If your back pain persists more than a few weeks, it’s wise to see a doctor to figure out the cause and to see if antidepressants might help. That’s especially true if you have both back pain and depression, as many people do.

Does breastfeeding protect a woman against breast cancer?

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Yes, according to an analysis published in January by the American Institute for Cancer Research, a nonprofit group based in Washington, D.C., that fosters research on nutrition and cancer.

After analyzing data from 98 studies on lactation and breast cancer risk, the group said the evidence is now “convincing” that breastfeeding lowers the risk of both pre-menopausal and post-menopausal breast cancer. There is a 2 percent drop in breast cancer risk for each five months of breastfeeding. The research on breastfeeding to lower the risk of ovarian cancer is suggestive, but not convincing, the group added.

The most likely explanation for the reduced risk is that lactation works through hormones to delay ovulation and the return of a woman’s monthly cycles, Karen Collins, a registered dietitian and nutrition adviser to the group, said in an e-mail. It has long been known that the fewer menstrual cycles a woman has over the course of her life, the lower the risk of breast cancer.

Lactation, like a full-term pregnancy, may nudge breast cells to become more differentiated and mature; mature cells are less sensitive to the DNA damage that can lead to cancer.

It may not make sense to breastfeed if the only goal is to reduce cancer risk, said Dr. Eric Winer, director of the Breast Oncology Center at the Dana-Farber Cancer Institute, “because you have to breastfeed for a fairly long time to have an impact on risk.” But there are plenty of other reasons to breastfeed, he noted, including the fact that breast-fed infants are less likely to become obese.

How safe are dental X-rays and how often do you need them?

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Dr. W. Mark Donald, a general dentist in Louisville, Miss., and spokesman for the Academy of General Dentistry, says that, in general, adults and children should have two to four “bite wing” X-rays twice a year to make sure all incipient cavities and other problems are caught early.

But he and other dentists caution that this is just a general recommendation and that the actual frequency of X-rays varies significantly among patients, depending on the patient’s history of dental problems and the dentist’s judgment.

If a patient is at low risk for dental problems, never has new cavities, eats a healthy diet and practices excellent oral hygiene – brushing and flossing daily – he or she may need X-rays only once every two to three years, said Dr. Dara Cunnion, a pediatric dentist at the Boston University School of Dental Medicine.

But you should be assertive in talking to your dentist about X-rays, and how often you really need them, said Frank Masse, a retired MIT nuclear physicist who now runs a consulting service for hospitals and medical clinics. Masse said he allows his dentist to take X-rays “only if there is a real need,” adding that “it’s been many, many years since I had a whole-mouth exam.”

The good news is that dentists now use “fast speed film or digital X-rays that can decrease exposure by 80 percent,” said Cunnion. If the dentist uses the fastest film available, the radiation exposure from four bite wings is roughly equivalent to about two days of natural, background radiation from simply living on earth, or about 20 to 38 microsieverts.

That “is not a lot of exposure,” Masse said. But “my advice is the same with any radiation – be cautious. Do it only if necessary – if it’s likely to yield some important information.”