Help for muscle aches and pain

Though not serious, muscle cramps or the muscle soreness that comes from overextending yourself can be very uncomfortable. And the weekend gardener is just as likely to be affected as the world-class athlete.

What It Is
There are two common types of muscle pain. The first is soreness and stiffness that develop as the result of overdoing some physical activity - whether running a marathon, digging in the garden or simply carrying a heavy bag of groceries. This kind of pain, which doctors call delayed-onset muscle soreness, typically begins a day or two after the activity and can last up to a week.

When a muscle suddenly contracts and can't relax, the result is the second type of muscle pain, known as a cramp. Most common in the thigh, calf or foot, cramps can strike at any time, even during sleep.

What Causes It
Even if you are in good shape, any new physical activity can cause muscle soreness. For example, if you are a runner, helping a friend move furniture will probably make your arms and shoulders ache. Most experts think the pain is a symptom of microscopic tears in the muscles, which rebuild themselves in a matter of days. Activities that require lengthening a muscle against force - such as running downhill or lowering a weight - are most likely to produce this kind of injury. Almost any kind of exercise or activity involves this type of movement.

In contrast, muscle cramps are not the result of an injury - though no one knows exactly why they occur. The cause may be an imbalance in the minerals that govern muscle contraction and relaxation - calcium, magnesium, potassium and sodium - or a lack of fluid. Exercising too strenuously during the day may lead to calf cramps painful enough to wake you from a sound sleep, as can wearing high heels or sleeping with your toes pointed or with bedding wrapped too tightly around your legs.

Symptoms

• Sudden tightening of the muscles during physical activity.
• Soreness and stiffness in the muscles after activity, often not beginning until 24-48 hours later.
• Muscle spasms occurring at night, usually in the calf muscle.
• A muscle that feels hard to the touch, called a knot.
• In severe cases, visible twitching of the affected muscle.

When to Call a Doctor

• If tightness or cramping occurs in the chest muscle - this may be a sign of a heart attack.
• If pain causes numbness or radiates down arms or legs.
• If muscle aches and pains are frequent and are worse for exercise.
• If night-time calf cramps are interfering with sleep.
• Reminder: If you have a medical condition, talk to your doctor before taking supplements.

How Supplements Can Help
To balance the minerals needed for proper muscle contraction, take supplemental calcium and magnesium routinely. (Most people get enough sodium in their diet.) Add vitamin E daily if you are prone to exercise-related cramps or night-time calf cramps.

For soreness, consider the herbs bromelain and white willow bark, which have the same benefits as - and can be substituted for - over-the-counter pain medications, such as aspirin or ibuprofen. In fact, they are gentler to your system and help the muscles to heal themselves. Bromelain (an enzyme derived from pineapples) is an anti-inflammatory and helps excess fluid to dram from the site of a muscle injury. Often called “nature’s aspirin”, white willow bark comes from the inner bark of white willow trees and is an effective pain reliever.

Body-builders use the nutritional supplement creatine to improve strength, and there's good evidence that it aids in repairing microscopic tears following a strenuous workout or injury. The herb valerian is a natural sleep aid that can be useful if soreness interferes with sleep. Take these supplements in any combination you like until the soreness goes away. Except for willow bark, they can also be combined with over-the-counter drugs.

What Else You Can Do

• Drink a lot of fluids before, during and after exercise.
• Warm up before exercise and stretch afterwards to help muscles relax.
• If pain is severe, apply ice to sore muscles to reduce inflammation.

Facts and Tips

• A herbal oil massage can soothe muscle soreness. Blend 15ml of a neutral oil, such as almond oil, with a few drops of any of the following botanical oils: birch, eucalyptus, evening primrose, ginger, lavender, peppermint or wintergreen. Gently rub the oil mixture into sore muscles.
• To ease a cramp in your calf muscle, flex your foot, grab your toes and the ball of your foot and gently pull towards your knee as you lie down. Massage your calf at the same time to relax the muscle. People also get relief by standing up, putting their full weight on the affected leg and bending the knee slightly.
• Stretching exercises can reduce the risk of post-exercise muscle soreness. One recommended exercise is to stand about a meter from a wall, step one foot forwards and lean against the wall with your forearms. Keeping your back heel on the ground, hold the stretch for 15-20 seconds to loosen the calf. Repeat with the other foot.
• Pregnant women should take care while they are exercising, because they are at higher risk of muscle cramps. The metabolic needs of the developing baby affect the normal balance of body fluids, making cramps more likely.

What you need to know about Multiple Sclerosis

This disabling nerve disorder can cause fatigue, impair vision and hamper mobility in previously healthy people. Conventional drugs are only partially successful against it, prompting interest in supplements that may help to slow down the progress of the disease.

What It Is
Multiple sclerosis, a progressive and degenerative nerve disorder that strikes young adults, follows a highly variable course. In some people, damage to the optic nerve or nerves in the brain and spinal cord may lead to difficulty in seeing or walking, slurred speech, loss of bowel or bladder function, clouded thinking and paralysis. But many others with multiple sclerosis experience remissions lasting years and suffer minimal disability.

What Causes It
Many experts believe multiple sclerosis is an autoimmune disorder, in which the body's immune system attacks the myelin sheaths that protect the nerves. What triggers this reaction is unknown. It may be a virus - perhaps even a common one, such as measles or herpes simplex - that's been dormant in the system for years.

Symptoms

• Early signs mimic those of many other conditions. They include blurred or double vision; tingling in the arms or legs; clumsiness or unsteadiness; and other motor, visual and sensory problems.
• The course of the disease varies greatly. Depending on its severity, a person with multiple sclerosis may experience severe fatigue; muscle stiffness and tremors; poor coordination; impaired speech; and incontinence. Symptoms often come and go.

When to Call a Doctor

• If vision or motor skills become impaired with no known cause -your doctor can rule out other neurological conditions, such as a brain tumor.
• If you suffer an acute attack.
• Reminder: If you have a medical condition, talk to your doctor before taking supplements.

How Supplements Can Help
Supplement therapy should start as soon as possible. It has several goals: to enhance antioxidant activity and protect nerve cells from the highly reactive chemicals called free radicals; to boost the production of fatty acids and other substances that build up the myelin sheath; and to decrease inflammation. All the supplements can be taken together and with conventional prescription drugs. It may take several months to notice benefits.
Vitamins C and E are valuable in treating multiple sclerosis because of their antioxidant properties. Vitamin B complex, plus extra vitamin B12 and folic acid, are important as well because they play a role in maintaining nerve structure and function. Some studies show that multiple sclerosis patients have low levels of vitamin B12 or have problems processing it.

Another supplement that may help is the ammo acid-like substance NAC (N-acetylcysteine), an antioxidant that may protect nerve cells; every other day, alternate NAC with a combination of zinc and copper to help reduce inflammation. It's also important to get extra essential fatty acids, such as flaxseed oil and evening primrose oil which reduce inflammation and, over time, help build healthy nerves. Finally, the herb ginkgo biloba may be beneficial because it acts as an antioxidant and improves blood flow to the nervous system.

What Else You Can Do

• Avoid overheating. Sunbathing, heavy exertion and very hot baths can all make symptoms worse.
• Ask your doctor about nutritional therapies. Some special diets have been developed that may slow the progress of multiple sclerosis.
• Exercise gently to improve muscle strength and flexibility - but not during an attack.
• Find out more about working from home or part-time work if a full-time job becomes physically difficult.

Facts and Tips

• Counseling may be beneficial for people and family members who are coping with the illness. Physical and occupational therapy may also help.
• In some countries, some people with multiple sclerosis swear by bee venom and regularly arrange to be stung by bees to relieve their symptoms. This therapy should be tried only with the supervision of a doctor experienced in its use - and those with a bee allergy should certainly avoid it.

Latest Findings

• Too much stress is not good for anyone; it's especially harmful if you have multiple sclerosis. A study of people with multiple sclerosis found a connection between increased levels of stress (both simple hassles and major life events) and new nerve damage in the brain.
• A recent study discovered a previously unknown facet of multiple sclerosis: it kills brain cells in a fashion similar to that seen in Alzheimer's disease or Parkinson's disease. Experts are looking into applying therapies that have shown promise in treating those conditions to multiple sclerosis patients.
• Animal research has uncovered a potential link between high vitamin D levels and immunity to multiple sclerosis. This theory may partially explain why multiple sclerosis is so rare in the tropics (where the sun boosts vitamin D levels) and in coastal Norway (where fish rich in vitamin D is a diet staple). But don't start popping extra vitamin D: it can be toxic, and more study is needed.

What is Macular Degeneration?

What It Is
In macular degeneration, the macula - the light-sensitive area in the centre of the retina that controls the central visual field and the ability to see colors - breaks down and impairs your eyesight. Though your peripheral vision - the ability to see the outside edges of the scene you are looking at - remains intact, the centre of your field of vision is blurry, grey or filled with a large blank spot. As a result, the condition may make it difficult or impossible to read, drive, watch television or even recognize someone's face.

There are two forms of this disorder. In age-related ('dry') macular degeneration, the macula thins and bits of debris gather beneath it. The condition develops slowly and accounts for 90% of all cases. In haemorrhagic ('wet') macular degeneration, new blood vessels grow underneath the retina, pushing up like tree roots cracking the pavement above. These fragile vessels often leak fluid and blood, causing scar tissue to form and central vision to deteriorate rapidly.

What Causes It
Damage from free radicals, the unstable oxygen molecules that can harm cells, is probably the leading cause of macular degeneration. A diet high in saturated fats, cigarette smoke and exposure to sunlight can lead to the formation of free radicals in the retina. High blood pressure, heart disease and diabetes may also be contributing factors because they limit blood flow to your eves.

Symptoms

• A blurry, grey or blank spot in the centre of the field of vision; peripheral vision remains sharp in one or both eyes.
• Distorted vision, in which straight lines look wavy, printed words seem blurred or objects appear to be the wrong size or shape.
• Faded or washed-out colors.

When to Call a Doctor

• If you're over the age of 50, see an ophthalmologist yearly to check for macular degeneration.
• If you develop any of the above symptoms, see an ophthalmologist immediately. Prompt diagnosis can minimize vision loss.
• Reminder: If you have a medical condition, talk to your doctor before taking supplements.

How Supplements Can Help
Working as antioxidants, vitamin C, vitamin E and different types of carotenoids can neutralize the free radicals linked to macular degeneration. The carotenoids lutein and zeaxanthin are especially important - in fact, the macula's yellow color is due to their presence. They protect the macula by filtering out the sun's harmful ultraviolet rays. Zinc plays a key role in the functioning of the retina as well. Many older people are deficient in this mineral, and some research suggests that it can slow the progression of the disorder. You may need extra copper if you're taking zinc for longer than a month.

For maximum protection, take all these supplements, plus bilberry. This herb contains antioxidant compounds and enhances blood flow to the retina. Grape seed extract or ginkgo biloba can be substituted for the bilberry. Though neither is as effective as bilberry grape seed may be a good choice if you have poor night vision, and ginkgo is useful for those who also show signs of memory loss. The prescription mineral selenium can be added in an effort to boost the body's overall antioxidant activity.

What else you can do

• Wear sunglasses and a wide-brimmed hat to protect your eyes.
• Stop smoking: it's a major contributor to macular degeneration.
• Eat lots of dark green vegetables; they're high in the antioxidant carotenoids lutein and zeaxanthin.

Facts and Tips

• Macular degeneration rarely occurs in people under the age of 50. However, a quarter of people over 65 and a third of those over 80 show signs of having the condition.
• People who smoke 20 or more cigarettes a day are more than twice as likely to develop macular degeneration as those who have never smoked. Even smokers who have given up are 30% more likely to suffer from the disease.
• People with blue or green eyes need to take special care, because they are particularly susceptible to the sun damage that can cause macular degeneration.

Latest Findings

• Having a glass of wine a day may prevent macular degeneration. A recent study of more than 3000 people aged 45 to 74 found that drinking moderate amounts of wine reduced their risk of developing the eye condition by 19%. Other alcoholic beverages were not associated with a lower risk.
• Eating spinach may prevent macular degeneration, because it's very high in lutein and zeaxanthin. In one recent study, people who ate about three cups of spinach a day were 43% less likely to develop age-related macular degeneration than people eating little of this leafy green vegetable.

Lupus - What you need to know

A butterfly-shaped facial rash may be the first sign of this auto-immune disease, in which the immune system mistakenly attacks healthy cells. The course of lupus is unpredictable, but various therapies can help ease symptoms, delay progression of the disease and boost overall health.

What It Is
A chronic inflammatory disease marked by flare-ups and remissions, lupus has been called the 'great impostor' because it can cause such a wide array of symptoms in almost any part of the body, including the skin, joints, heart, brain or kidneys. Women are affected eight to ten times more often than men. Lupus is fairly rare, and many sufferers don't even know they have it, but it is a serious disease.

What Causes It
In lupus, the immune system goes awry and produces abnormal cells that travel through the body, attacking healthy tissues. It's uncertain what causes this condition, though heredity, sex hormones or infections may play a role. Sunlight, childbirth, stress or drugs may trigger attacks.

Symptoms

• Joint pain and inflammation, skin rashes, fever, fatigue, chest pain or cough, hair loss, strong tendency to sunburn, blurred vision and swollen glands.
• There are many other symptoms, because lupus can affect almost any part of the body. Symptoms typically first appear between the ages of 15 and 35. Accurate diagnosis may be difficult.

When to Call a Doctor

• If you experience any lingering unexplained illness, especially if symptoms include fever, joint pain, weight loss, rashes or breathing difficulties. Seek an accurate diagnosis, which may take some persistence, as soon as possible.
• Reminder: If you have a medical condition, talk to your doctor before taking supplements.

How Supplements Can Help
A wide array of supplements, taken together long term may relieve symptoms, slow the progression of the disease and lessen the need for conventional drugs, which frequently have serious side effects. All can be used with conventional prescription drugs for lupus, but because lupus is a serious disease, you should take supplements only under ongoing medical supervision. Benefits may be noticed within a month.

Vitamin B complex works throughout the body to maintain the health of skin, mucous membranes, blood, nerves and joints. Along with vitamins C and E and selenium - all antioxidants - B-complex vitamins speed healing and help protect the heart and blood vessels, joints, skin and other areas that can be damaged by the inflammatory process. Vitamin E may be particularly effective for skin and joint problems.

Essential fatty acids in the form of flaxseed oil, fish oils and evening primrose oil may be beneficial. These can reduce inflammation in the joints, kidneys, skin and other areas; they may also lower cholesterol levels, which might be elevated. Doctors are finding that DHEA may reduce a lupus patient’s requirements for the prescription steroid drug prednisone. Furthermore, it may relieve symptoms and improve stamina. The recommended doses of DHEA are quite high (100 mg a day), so if you're interested in trying this treatment, talk to a doctor experienced with both lupus and DHEA. Zinc promotes healing and, along with vitamin C, may help regulate the immune system. Because zinc depletes copper stores, it should be taken with that mineral when used over the long term.

What Else You Can Do

• Minimize sun exposure and when outdoors use a high-SPF sunscreen.
• Get plenty of rest. Join a support group to help reduce stress.

Facts and Tips

• Conventional lupus drugs, including high doses of steroids and cancer medications, can have side effects as bad as the disease itself, causing weakened bones, cataracts, diabetes and other serious problems. Supplements may allow you to use lower - and therefore safer - doses of such drugs.
• People with lupus may be well advised to avoid alfalfa in any form -including sprouts, seeds, tablets and tea. It contains a substance called canavanine, which some experts think triggers flare-ups.

Latest Findings
Preliminary studies indicate a connection between lower-than-average blood levels of three nutrients -vitamins A and E and beta-carotene - and the development, years later, of lupus. Additional studies are needed to determine whether these levels contributed to the onset of lupus or if they were a result of early, undiagnosed disease activity.

Diagnosing depression

Doctors distinguish between run-of-the-mill lows that come and go in response to events in your life and the clinging cloudiness of clinical depression, which can hang around for weeks without letting up. If you're clinically depressed, medications may help. You may be clinically depressed if five or more of the following are true for at least two weeks straight:

• You feel sad, empty, anxious, or irritable just about all the time.
• You take little interest or pleasure in most, if not all, of your daily activities.
• You lack energy.
• Your normal appetite changes or you've lost or gained a significant amount of weight.
• You feel agitated or sluggish in your responses.
• You feel worthless or guilty.
• You have trouble sleeping—or you sleep more than usual.
• You have difficulty concentrating or making simple decisions.
• You often find yourself thinking about dying or suicide.

Is taking weight-loss drugs right for you?

Slimming down has the double benefit of reducing your risk of cardiovascular disease and controlling high blood sugar, which makes weight-loss drugs sound like an appealing option for people with diabetes.

While it's not possible to lose pounds just by popping a pill (you still have to exercise and eat a low-fat diet), two weight loss drugs can help if diet and exercise aren't enough. A recent German study even found that one of them, orlistat (Xenical), lowered blood sugar after eating, reducing the need for glucose-controlling medication.

Still, doctors advise approaching diet pills with caution. Orlistat, which works by blocking fat absorption in the intestines, can cause a range of unpleasant gastrointestinal side effects including having to defecate more often, fecal incontinence, and oily stools. The other common weight-loss drug, an appetite suppressant called sibutramine (Meridia), often causes headaches, dry mouth, and constipation. More important, it raises blood pressure in some people and shouldn't be used if you have hypertension. Other weight-loss drugs have been taken off the market because of concerns that they may cause heart-valve abnormalities. Check with your doctor to see if weight-loss drugs are appropriate for you.

Caveat emptor! - Read carefully before you buy

Even if studies show that an herb or a natural remedy works, there's no guarantee the one you buy will. No matter what their effects, supplements aren't considered medicines and therefore aren't subject to regulation by the Food and Drug Administration unless they prove blatantly unsafe. That leaves quality control largely at the whim of manufacturers. Among the potential problems:

Shoddy production
With no one looking over their shoulders, there is no guarantee that manufacturers will actually fill bottles with what label says is inside.

Natural variation
Even if the manufacturer does identify quality products, check the label for: care about quality, plants of the same species that are raised in different places or under different growing conditions can vary significantly in their chemical makeup.

Lack of knowledge
In many cases, nobody really knows which part of a plant produces the desired therapeutic effect (the root versus the leaves, for example). So the manufacturer may responsibly provide the herb that you want—just not the part that gives results.

Responsible manufacturers understand these problems and do their best to ensure quality. To identify quality products, check the label for:

• The botanical name if the product is plant-based
• The recommended dose in milligrams
• A batch or lot number and expiration date
• The manufacturer's name and address
• A statement that the product contains a standardized extract, which ensures a certain dose of the active ingredient.

Before you sign up for that gym membership

Potentially, the world is your workout facility. But if you want access to high-quality resistance machines, aerobics classes, and trained staff, a gym may be worth the money—especially if it helps you stick with an exercise program. But gyms make their money because many of the people who pay for them rarely show up to use them. To make sure you'll get your money's worth:

• Find a gym that's no more than 15 minutes from home or you'll have trouble getting there regularly.

• Take a tour before signing anything, and ask to have a trial workout. If possible, snag clients out of your tour guide's earshot and ask their opinion of the place.

• Make sure club supervisors have at least a bachelor's degree in exercise science, and look for staff certifications from organizations like the National Strength and Conditioning Association or the Aerobics and Fitness Association of America.

• Check out the crowd, especially at times you're most likely to be there. Is it hard-core or low-key? Will you be comfortable working out with these people?

Be clear about your needs. Some clubs offer just fitness equipment and classes, while others go a step beyond with tennis or racquetball courts, swimming pools, and even social activities. Don't sign on the dotted line if you think you might want something different in six months.

Shooting down diabetes myths

Considering all factors involved with diabetes, there’s plenty of room for misinformation. Some of the more persistent misconceptions are:

Myth: If you develop diabetes, you can never eat sugar again.
Truth: People with diabetes can eat sweets, but sugary treats must be part of a careful meal plan (as they should be for people without diabetes).

Myth: I have just a touch of diabetes.
Truth: Either you have diabetes or you don't. Even if your type 2 case doesn't require insulin injections (type 1 always does), it still demands medical attention and careful lifestyle choices.

Myth: I feel fine, so my blood sugar's fine. Truth: High or low blood sugar doesn't always produce symptoms. Regular monitoring is the only way to know for sure where you stand.

Myth: I'm a pro at self-management; checkups are just a waste of my time.
Truth: Your treatment program is never a done deal. Thanks to ongoing research, the medical community is constantly learning more about this complex condition and how best to deal with it. The best way to keep up is to keep up your regular doctor visits.

Myth: If I don't need insulin or drugs, my diabetes isn't serious.
Truth: Diabetes is always serious. Even if diet and exercise keep your blood sugar in check, your cells are still insulin resistant and your condition could get worse if you don't control it.

Getting your serving of fiber

While food labels list grams of fiber for processed and packaged products, don’t worry about “counting fiber” to get the recommended 25 to 30 grams per day. It’s much better (and easier) to simply work as many grains, beans, and fresh fruits and vegetables into your diet as you can. Here are some smart strategies:

• Bump up beans. Whether dried or canned, beans and other legumes are among the best fiber sources you can find. For example, half a cup of black beans provides about a quarter of your recommended daily fiber intake.

• Hail the whole. Whole-grain foods contain far more fiber than more processed foods, in which such fiber-containing grain parts as the bran are thrown out. For example, whole-grain bread contains about twice the fiber as bread made with refined flour.

• Preserve the peel. Routinely thrown away, the peel is often the most fiber-filled part of a fruit or vegetable. You're better off eating apples, carrots, and potatoes with the peel still on (be sure to wash them first if you eat them raw).

• Savor stems. We also often toss out the stalky stems of vegetables like asparagus and broccoli, but that's where the plant's fiber is most densely concentrated. To make them less tough, chop the stalks into small pieces and cook them a bit longer, adding the florets slightly later.

• Use fibrous fixings. Products like bran cereal, oat bran, and wheat germ make good condiments when sprinkled over oatmeal (which is high in fiber itself), applesauce, cottage cheese, or salads. In recipes that call for bread crumbs, try substituting oats.

A cure for diabetes?

In one sense, type 2 diabetes can indeed be cured if all the measures that define it indicate that the condition at issue—high blood sugar—is no longer present. But this suggests that you can carry on with your life as if you never had diabetes—or that you won't have to worry about developing it in the future. And that would be a mistake.

Diabetes is considered a disease you have for life because, while you can keep it under control and live a normal life, the fact that you are controlling it is significant. The risk of having diabetes again never really goes away. If you were to stop controlling it—went back to a sedentary lifestyle and a poor diet—your diabetes would inevitably return. Even if you continue practicing your healthful habits, it's possible that your condition will change as you get older.

Think of it like parenting: Even when your kids grow up and move out of the house, you still have children. Likewise, even after you've managed to get your diabetes under control, you still have the disease.

Are artificial sweeteners safe?

For people trying to reduce their calorie and carbohydrate intake, artificial, “nonnutritive” sweeteners have been a godsend, allowing a wide variety of foods and drinks to taste more delectable without sugar or added calories. But two of the most popular artificial sweeteners, saccharin and aspartame, have been battered by storms of controversy regarding their safety. Should you worry?

SACCHARIN
Back in the 1970s, the Food and Drug Administration banned saccharin (marketed as Sweet N' Low) after studies indicated that high doses of it caused cancer in rats. At the time, no other artificial sweetener existed, and the public, feeling the threat was overblown, clamored successfully to bring it back. But products that contained it had to be labeled with a warning. Since then, studies have suggested that differences between rat and human anatomy make the rats' risk inapplicable to people, and in 2000 saccharin was taken off the official list of cancer-causing compounds. Some consumer-advocate groups and nutrition researchers are uneasy about the change and claim the evidence of a cancer risk still warrants caution. Still, even they admit that if a risk exists, it's very small.

ASPARTAME
Heated debate preceded aspartame's FDA approval in 1981, partly because investigators found research by the manufacturer to be riddled with inconsistencies and errors. An outside advisory board recommended withholding approval, but was overruled by the FDA, which felt (after an audit) that the evidence proved aspartame (sold as NutraSweet) to be safe. Even after approval, skeptics charged that aspartame interfered with normal brain chemistry, triggering headaches, seizures, and (it was feared) brain cancer. However, numerous studies over the past 15 years have found these concerns to be groundless, and even strong advocacy groups, such as the Center for Science in the Public Interest, no longer sound alarms about aspartame.

THE BOTTOM LINE
The consensus is that in the amounts they're usually consumed, both saccharin and aspartame are safe. In addition, other nonnutritive sweeteners (such as sucralose and acesulfame-K) have come on the market, allowing food makers to blend sweeteners together, thus diluting the potential impact of any one compound.

When to test for diabetes

Because risk increases with age, diabetes tests should be given routinely at three-year intervals for everyone starting at age 45, but they’re not strictly reserved for older adults. The American Diabetes Association also recommends more frequent testing for younger people who are at high risk. This includes adults who:

• are at least 20 percent above ideal body weight

• have a parent or sibling with diabetes

• are African American, Asian-American, Hispanic-American, Native American, or Pacific Islander

• gave birth to a baby weighing more than nine pounds

• had diabetes during pregnancy

• have high cholesterol

• have high blood pressure

• have been identified with abnormal glucose tolerance

• have polycystic ovary syndrome (POS), a hormonal disorder marked by insulin resistance.

To address the recent increase in type 2 diabetes among children, the ADA also urges testing every two years, starting at age 1 0, for overweight children who have two or more additional risk factors.

Seven diet myths exposed!

Weight loss can be difficult, no thanks to popular misconceptions that have the ring of truth but can actually work against you. Among the more common myths:

1. Desserts are forbidden: The truth is, there's room in your diet for any kind of food, especially the ones you love most—as long as you control your total caloric intake (and grams of carbohydrate, if you tally them). Denying yourself your favorite foods can lead to binge eating and, ultimately, discouragement.
2. You have to lose a lot of weight to make a difference: The closer you can get to an ideal weight, the better, but small, sustained improvements at the beginning of a weight-loss program have the biggest impact on your health. Studies show that losing just 5 to 1 0 pounds can improve insulin resistance enough to allow some people with type 2 diabetes to quit medication or injections.
3. What you eat matters more than how much: Both matter, but recent research finds that the number of calories in your food is more important than where they come from. Example: A bagel might seem healthier than a doughnut hole, but dense bagels have the calorie content of six slices of bread. As long as you're not eating too much fat in other foods, the doughnut hole wins.
4. If you work out, you can eat whatever you want: That's robbing Peter to pay Paul. You can't lose weight if you reduce calories in one way but increase them in another.
5. Skipping meals make you lose weight fast: Actually, studies show that people who skip breakfast tend to be heavier than people who don't. And skipping meals tends to make you overeat later. If you have diabetes, it's important to keep up a steady intake of small portions of food throughout the day to keep your blood-sugar levels stable and reduce the risk of hypoglycemia.
6. Starches are fattening: If you are insulin resistant, your body may find it easier to convert carbohydrate calories to fat than to burn it as energy, but the fact remains that starches (and other carbohydrates) are less dense in calories gram for gram than other types of food. The main issue is calories, so if you load starchy foods with fat-sour cream and butter on a baked potato, for instance—or eat them in large quantities, the caloric load can add up.
7. You should never eat fast food: Never say never. Fast food can be worked into your meal plan if you choose well. Opt for grilled foods instead of fried, avoid or scrape away high-fat condiments like mayonnaise, and share those French fries to keep portion size down.
   

You should test for diabetes when...

Because risk increases with age, diabetes tests should be given routinely at three-year intervals for everyone starting at age 45, but they’re not strictly reserved for older adults. The American Diabetes Association also recommends more frequent testing for younger people who are at high risk. This includes adults who:

• are at least 20 percent above ideal body weight
• have a parent or sibling with diabetes
• are African American, Asian-American, Hispanic-American, Native American, or Pacific Islander
• gave birth to a baby weighing more than nine pounds
• had diabetes during pregnancy
• have high cholesterol
• have high blood pressure
• have been identified with abnormal glucose tolerance
• have polycystic ovary syndrome (POS), a hormonal disorder marked by insulin resistance.

To address the recent increase in type 2 diabetes among children, the ADA also urges testing every two years, starting at age 10, for overweight children who have two or more additional risk factors.

Knowing your health professionals and organizations

A number of health professionals are knowledgeable about vitamin, mineral and herbal supplements and can give you general information as well as specific advice.

One of the strengths of conventional medicine is the teaching of diagnostic skills, so you should see your doctor for a proper diagnosis of an ailment, particularly if you have symptoms with which you are not familiar. Naturopaths, herbalists and some chiropractors are generally more knowledgeable about the use of herbs and nutritional supplements than most conventional doctors or other health professionals, but they have less training in making diagnoses. When pursuing complementary treatment for a specific disorder, you are best served if you consult a conventionally trained doctor in the first instance.

To find a complementary health professional, first talk to your general practitioner. However, many conventional doctors are reluctant to make referrals to complementary health professionals, so you may have to turn elsewhere for suggestions. Family and friends may have suggestions based on their personal experiences. Also, your health insurance company may have a list of health professionals for referral. Some of the organizations listed on the opposite page can also provide lists of accredited professionals.

Inquire about certification and licensing requirements; this information can help protect you as a consumer. When you consult a complementary health professional, ask about his or her background and experience working with nutritional and herbal remedies. Be wary of anyone who promises cures that seem too quick or easy, or who wants to put you on a regimen that will cost a lot of money.


Holistic medical practitioner (MBBS):

The minimum qualification for a medical practitioner in Australia and New Zealand is Bachelor of Medicine, Bachelor of Surgery (MBBS). In Australia, doctors must be registered with the Medical Board (in Victoria, the Medical Practitioners Board) in the State where they practice. In New Zealand, they must be registered with the Medical Council of New Zealand. A growing number of doctors with backgrounds in conventional medicine are using nutritional and herbal supplements in their work. Often these so-called holistic medical practitioners are family doctors specializing in common medical problems. They often identify themselves in the name of their practice.


Naturopath:

Naturopaths believe in the healing power of nature - including the human body's innate resources - in treating health problems. A naturopath and patient work together to help the body promote its own well-being. To achieve this, the 'naturopath assesses the patient's lifestyle and provides recommendations on diet, exercise and other habits. Prevention of illness is the primary goal of naturopaths, who may use nutritional and herbal supplements as preventive ‘tonics'. Some naturopaths also treat health problems using therapies such as massage as well as herbal remedies.

In Australia and New Zealand, naturopaths now receive a degree from a university or college of natural therapies, where students undergo three to four years of training, including extensive courses in nutrition and herbal medicine plus, usually, homeopathy, Bach flower remedies and various bodywork therapies. It's advisable to consult a naturopath who has graduated from an accredited institution.


Herbalist:

Unlike naturopaths, who undergo rigorous training that meets established criteria, anyone can hang out a sign saying 'herbalist'. You can obtain a referral to a herbalist who has completed programs at a recognized herbal school through the National Herbalists Association of Australia. A qualified, professional herbalist will take a medical history and assess your lifestyle and any other factors affecting your health - including any allergies you have and any medications you are taking - before recommending a remedy for a specific complaint.


Nutritionist:

A good nutritionist will discuss your medical history, your eating and exercise habits and your lifestyle with you before suggesting changes to your eating patterns. Nutritionists should also be familiar with dietary supplements, but opinions often vary among them as to the importance of supplementation, and not all take an integrated or holistic approach to health. Some nutritionists are qualified dietitians, and there are also competent nutritionists who aren't dietitians. There's no registration system for dietitians or nutritionists in Australia, but 'accredited practicing dietitians' have an approved university degree. In New Zealand, dietitians must be registered with the Dietitians Board, while nutritionists who meet certain criteria can register with the Nutrition Society of New Zealand. Ask for a referral from your doctor or your local hospital, or contact the Dietitians Association of Australia in your State or one of the above-mentioned bodies.


Pharmacist:

For many people, a pharmacist is the most accessible health professional. A pharmacists training - a four-year degree course at an Australian or New Zealand university, leading to a Bachelor of Pharmacy (BPharm) - is in the use of conventional medications, but pharmaceutical journals and professional associations are increasingly addressing the use of supplements. Your pharmacist may be able to answer your questions about herbal and nutritional therapies and offer advice about the potential benefits, limitations and side effects of specific supplements. A good pharmacist will ascertain your state of health before suggesting any supplement, and may recommend that you see a doctor for evaluation. In Australia, pharmacists must be registered with the Pharmacy Board of the State where they practice. In New Zealand, they must complete a year's internship after graduation before they can be registered with the Pharmaceutical Society of New Zealand.

Children are at risk of diabetes too

Type 2 diabetes is also known as adult-onset diabetes because it's a disease that starts in adulthood — that is, until recently. The past decade has seen an alarming increase in type 2 cases in children. Before the 1990s, type 2 accounted for less than 4 percent of diabetes cases in kids. Now it makes up about 45 percent, according to the American Diabetes Association (ADA).

Why is this happening? Researchers point to a dramatic jump in juvenile obesity. Today about 25 percent of American children are overweight-twice the number in the 1 970s. In an attempt to clarify the diabetes risk to heavy kids, Yale researchers writing in The New England Journal of Medicine in March 2002 reported that, of 167 obese children and adolescents they studied, about a quarter were already glucose intolerant-one step down the path to diabetes.

"This is all very new, and we're still not exactly sure how to treat type 2 diabetes in children," says Sonia Caprio, M.D., director of Yale's Pediatric Obesity/Type 2 Diabetes Clinic. One emerging controversy is whether doctors should prescribe medications to treat kids who have type 2 diabetes or to prevent it in children who are glucose intolerant. Studies in adults suggest that drugs can significantly reduce risks, but the side effects of drug treatment in children are unknown. A National Institutes of Health study now being organized to examine the issue won't provide results until around 2008.

Less controversial are the benefits of addressing lifestyle issues that contribute to the obesity epidemic. "More food is available to children at any time of day than has ever been the case before," says Dr. Caprio. "We promote food consumption in kids, especially high-calorie snacks and soft drinks, which are available from vending machines in schools." Supersize portions are another problem. "Kids are used to immense servings in restaurants," she says. "They don't even think about it."

On top of that, children are far less physically active than they were in the past, according to Dr. Caprio. Because of distance and safety issues, children seldom walk to school, and physical education is losing ground to other curricula. According to the ADA, only 25 percent of high schools still have daily gym classes. Back at home, kids spend increasing amounts of time on sedentary activities, such as watching TV, using computers, or playing video games, says Dr. Caprio.

To counter these trends, she supports the decision by some schools to screen children for obesity and notify parents of health risks. The ADA recommends diabetes testing for overweight children with at least two other risk factors—for example family history, high blood pressure, or membership in an at-risk ethnic group (Native American, African American, Asian America, Hispanic American, and Pacific Islander). But parents are the real focus of change. "Parents need to learn more about proper nutrition and go outside to play more themselves — like most of our parents did 30 years ago."

When diabetes strikes your child

Treating diabetes in a child can be more challenging than dealing with the disease yourself. Depending on their age and temperament, children may vary in their ability – or desire – to understand what’s happening to them, take care of themselves, and follow your instructions. But you can put your child on the road to responsible self-care with either type 1 (the most common type in children) or type 2 diabetes if you bear these principles in mind:

Toddlers and Preschoolers

Learn to recognize how hypoglycemia and hyperglycemia affect your child's behavior, since she simply doesn't have the words to tell you how she feels herself. Expect some battles over insulin injections and blood-sugar tests around toilet-training time, as your child starts to assert herself more, but stick to your guns to get them done. Don't worry too much if blood sugar ranges between 150 mg/dl and 200 mg/dl (higher than what's recommended for adults): Children need more blood sugar for normal development. Forget trying to control when your child eats. Instead, accept irregular eating patterns and compensate by using shorter-acting insulin when your child does have a bite.


Elementary School Kids

As your child develops physically and mentally, he'll be better able to understand why his treatment is necessary and become more willing to cooperate with its demands. Educate him about how caring for his condition now will protect his health in the future, but don't scare him with the gory details of complications. Tighter blood-sugar control now becomes more important, especially at night, when there's a higher risk of hypoglycemia. Make sure he has a bedtime snack and doesn't skip meals. Encourage him to participate in school and social activities to build friendships, promote self-esteem, and make him feel less different from other kids. Around age eight, your child can probably start taking on some of the responsibility for injections and blood tests himself - maybe with the daytime help of teachers or classmates, who benefit from the opportunity to learn about diabetes from your child.


Pre-Teens and Adolescents

Control — over a number of things — now starts falling into your child's hands. Studies find that tight blood-sugar monitoring as early as age 13 can prevent complications in adulthood, so encourage her to take charge — but don't expect the thought of future consequences to motivate her too much. Now is not the time to completely let go of the reins: Worries about what other kids think might cause her to skip steps in her care. Make an issue of it, expect an argument — but be confident that using you as an excuse ("My parents make me do it") can help her do the right thing. Gradually give your child more responsibility as she's able to handle it. By the time she's choosing which college to attend or looking for work, responsibility should pass to her.

Safety guidelines when taking supplements

Because supplements, especially herbs, can have potent primary effects and side effects, keep these points in mind when using them:

Shop wisely
Although supplements supplied in the United States are strictly regulated, it's sensible to select brands with a reputation for quality.

Take the recommended dosages
As with conventional drugs, overdosing with a supplement can have serious consequences. With herbs and nutritional supplements, start with the lowest dose when a dosage range is given.

Monitor your reactions
At the first sign of an adverse reaction, stop taking the supplement. Also stop if the herb doesn't seem to be working for you. (But give it enough time to work - remember that some herbs may take a month, or even longer, to have a noticeable effect.)

Take a break
Doctors using conventional drugs often recommend taking 'drug holidays' for non-life-threatening conditions such as persistent headache, eczema or mild depression. The same applies to supplements: take for specified periods, then stop temporarily to see if the condition has improved. If the problem returns, you may need to take the supplement long term as a 'maintenance' medication.

Avoid risks
If you have symptoms that indicate a serious problem, don't self-treat it: see a doctor or other qualified health professional. Very young or elderly people, and pregnant or breast-feeding women, should also consult a doctor before using supplements. And always ask your doctor or pharmacist about possible interactions with drugs you are taking.

Taking supplements effectively and safely

All supplements marketed in the United States must include directions for use on their labels. The entries in this blog provide more detailed information about the benefits, uses, side effects and forms of supplements, as well as the doses that are considered safe and effective. In the back of the book, you'll find a section listing the interactions between supplements and some commonly prescribed medications. Here are some general guidelines to keep in mind.

The proper balance - All nutrients influence one another, and researchers have discovered a number of links that affect how well the body absorbs or utilizes them. For example, the fat-soluble vitamins (A, D, E and K) require some dietary fat to facilitate absorption, so its important to take these vitamins with food. Iron taken with meals is best absorbed with small amounts of meat and foods containing vitamin C. Calcium absorption is improved by taking supplements with meals, and the effect of calcium on building healthy bones is enhanced when it is taken with magnesium, zinc and silicon. Other nutrients, when taken in combination, likewise enhance one another's individual benefits. For example, biotin and other B-vitamins, taken with a mixed amino acid complex and vitamin C, all work to help the body to build the proteins needed for strong nails.

The proper amounts - Nutritional supplements are generally safe when consumed in the appropriate dosages. But it's important to remember that more isn't necessarily better - and sometimes it can be worse. For example, the mineral selenium is recommended for many purposes, from prevent­ing cataracts to protecting against cancer. But taking doses even slightly higher than those recommended can cause loss of hair and other adverse reactions. It's a good idea to avoid high doses of supplements, particularly extremely high ones ('megadoses').

Vitamins and minerals: Most vitamins can be taken in significantly higher doses than their RDIs without producing adverse reactions. However, some fat-soluble vitamins, which are stored in the body rather than excreted, may be toxic at high doses. In particular, overloading on vitamins A or D is dangerous. Although very high doses of some other vitamins - such as vitamin C — are not toxic, some people may experience side effects. Reducing the dosage can usually remedy the situation.

When taken in large doses or over time, some minerals can block the absorption of other minerals. Zinc, for instance, can hamper copper absorption. Also, large amounts of certain minerals are linked to disease - several studies show that too much iron in men, for example, increases the risk of heart disease. For these reasons, even doctors who believe the RDIs for many vitamins are too low think that the levels for minerals are generally adequate for optimal health.

Herbs: According to reviews by experts in pharmacology and toxicology, serious side effects or toxic reactions associated with herbal medicines are rare. Still, some once-popular medicinal herbs, such as foxglove and chaparral, are now recognized as toxic. Occasionally, some people exhibit serious allergic reactions to a herb, which may include hives or difficulty in breathing.


In Australia, herbal preparations are regulated under the Therapeutic Goods Act in the same way as other complementary health-care products. In New Zealand, they are regulated under the Dietary Supplements Regulations (under the Food Act). Products that contain standardized extracts may be more reliable than those that don't in terms of getting a proper dose of a particular supplement.

In addition, using some herbs for medicinal purposes can be risky for people with certain health conditions or for those on particular medications. Garlic, for example, may intensify the effects of anticoagulant drugs, while licorice - which helps to relieve digestive problems and enhances the immune system - can raise blood pressure. Some herbs may have no immediate adverse effects but may cause side effects or prove harmful when taken over the long term. When using supplements, always follow the dosage recommendations closely. In addition, always let your doctor know which supplements you are taking, and notify your doctor at once if your condition worsens or if any serious adverse reactions develop.

The issue of quality control – How do you know what a product actually contains? In the United States, manufacturers and suppliers are required to list all the active ingredients on product labels. Vitamin, mineral and herb supplements supplied must also comply with specific standards determined by the Food and Drug Adminis­tration. The contents of nutritional and herbal supplements are monitored regularly, and suppliers generally comply with the regulations. Established manufacturers and suppliers of supplements have a reputation to protect, and they also know that they face substantial penalties if they contravene government regulations.

As a general rule, the sensible course if you're not sure which brand to choose is to ask the advice of your doctor or any other health professional who regularly makes use of supplements.

Meeting the standards - know exactly what you're getting when buying health supplements

When you buy nutritional supplements, how do you know what you're getting? The official standard used in Australia for the identity, purity and potency of vitamins, minerals and herbs is a publication called the British Pharmacopoeia (commonly referred to as the BP). This is followed by the British Herbal Pharmacopoeia (BHP), the United States Pharmacopeia (USP) and the European Pharmacopoeia (EP).

The standards for materials listed in these pharmacopoeias are published after review by an independent body of experts. (There is a move towards harmonization in this area, and the BP will eventually coincide with the EP.)

Australia's Therapeutic Goods Act requires that all items covered by the BP comply with BP standards. Items not covered by the BP must comply with the standards specified in one of the other pharmacopoeias (as determined by the Therapeutic Goods Administration), or with special Therapeutic Goods Orders, which are standards that the TGA itself issues for such items. Because all products manufactured or supplied in Australia must comply with these standards, you won't find any reference to them on labels. The situation is quite different in the US, where compliance with the USP is voluntary. As a result, US manufacturers who either do comply with USP standards, or claim to do so, sometimes indicate this on the label.

Reading labels when buying supplements

Following are the key items of information that manufacturers are obliged to include on the labels of nutritional supplements.

Name of goods: Either the name of the goods (such as evening primrose oil) or, if there is no such name, the product name (that is, the proprietary or brand name - for example, the brand name of a proprietary tonic) must appear on the label.

Active ingredients: The names of all therapeutically active ingredients contained in the product must be listed. For example, the active ingredient in evening primrose oil is gamma-linolenic acid (GLA). For products such as multivitamin and mineral supplements, the active ingredients are the vitamins and minerals themselves, and all must be listed.

Amount of active ingredients: The quantity or proportion of all active ingredients must be stated. For example, in the case of evening primrose oil capsules, it might be said that each 1000 mg capsule contains 100 mg (10%) of linolenic acid. In the case of a multivitamin and mineral supplement, the amount of each vitamin and mineral the product contains must be stated (using the appropriate metric unit of measurement, as specified in the regulations). Most ingredients are given in micrograms (meg) or milligrams (mg). Fat-soluble vitamins, such as vitamins A. D and E, are usually expressed in International Units (IU).

List of excipients: Excipients are all ingredients contained in a product other than the active ingredients. These include such things as binders, fillers, coatings, preservatives and coloring agents. For consumers' benefit, manufacturers often choose to state that the product does not contain certain substances - such as colorings and artificial flavors, but also such items as yeast, dairy products, lactose, gluten and egg (to which some people are allergic).

Name of dosage form: This means the usual name of the pharmaceutical form of the product, such as tablets or capsules.

Quantity of goods: The quantity of the goods has to be specified - for example, the number of tablets or capsules in the container.

Warning statements: Where warnings apply to the product, these must be included on the label. The regulations specify the warnings required on particular categories of products. For example, iron tablets must carry the following warning: 'Use strictly as directed. Keep out of reach of children.

Batch number: The batch number of the goods must appear in one of the forms specified in the regulations. Examples are 'Batch' or 'Batch No'.

Expiry date: The expiry date must be shown in one of a number of specified forms, which include 'Expiry Date', 'Exp.’ ‘Use before' and 'Use by'. The expiry date indicates that the product will remain 'fresh' up to that date. In fact, supplements may retain their full potency for some time after the date indicated, but you cant be sure of this. It's always best to finish the product before the expiry date. This is particularly advisable in the case of the fat-soluble vitamins (A, D, E and K).

Storage conditions: Advice must be given on how best to store the product. Most nutritional supplements should be kept in a cool, dry place, which means they shouldn't be stored in the bathroom or the refrigerator, where moisture can damage them. However, there are some products that should be refrigerated after opening. If this is the case, the label will say so. Similarly, the label will say if the product should be stored below a certain temperature.

Directions for use: These directions tell you the suggested dosage (for example, one tablet swallowed whole) and when, how often and how best to take it (for example, three times a day with meals; or 30 minutes before a meal, with a glass of water). The suggested dosage is often followed by the words 'or as directed by your health professional'.

Supplier's name and address: The name and street address of the sponsor or supplier must be given. Many manufacturers include their telephone number, and some have a consumer advice number.

Statement of purpose: This specifies the purpose or purposes for which the product is intended to be used. For example, in the case of evening primrose oil, it might be stated that the product may offer temporary relief from conditions associated with a deficiency of gamma-linolenic acid (GLA), including some skin disorders and premenstrual syndrome.

Avoiding cot death

Sudden Infant Death Syndrome or SIDS (otherwise knows as cot death) is the most common cause of death for children under one year of age, with the riskiest period occurring between two and four months. The highest incidence of SIDS, in which the baby suddenly stops breathing, occurs with babies who were premature, had a low birth weight, are bottle fed and live in a household where the parents smoke cigarettes.

A useful electronic aid is a microphone monitor which transmits the sound of the baby's breathing to other parts of the house - these are a help as long as the parents are listening.

Ways to help prevent SIDS include:

• Ensuring that the baby does not become overheated - use layers of light bedding. Quilts and cot bumpers are not recommended.

• Always putting the baby to sleep on the side or back - never face down. When the baby is sleeping on the side, the lower arm should be placed well forwards so that the baby cannot roll over onto its stomach. The baby's feet should be at the bottom of the cot.

• Using a clean, firm, well-fitting mattress with no pillow. Do not let the baby sleep on a water bed or bean bag. Always ensure that the baby's environment is smoke-free.

Heavy drinking: The long-term effects

Heavy drinking over a long period of time eventually leads to ill health, and damage to some organs of the body can be permanent. Medical problems are usually accompanied, or preceded, by the social, family and workplace problems associated with alcoholism.

Alcohol-related disorders
Some of the most common problems associated with alcohol abuse include:

Liver damage. The poisonous action of the alcohol causes a drinker's liver to become dangerously fatty. Some people recover if they stop drinking alcohol altogether; others may develop dangerous complications such as hepatitis and cirrhosis.

Chronic gastric, pancreatic and anaemic disorders.

Damage to the central nervous system. This can result in the heavy drinker experiencing a 'tingling' sensation in the extremities and loss of feeling in hands and feet.

Brain damage. Memory loss, general mental confusion, impaired ability to learn new things and, sometimes, hallucinations, are all associated with alcohol-related brain damage.

Difficulties during or after pregnancy. Medical research has established a clear link between problems in pregnancy and consumption of alcohol. Statistics show that expectant mothers who drink face a greater risk of miscarriage, stillbirth and premature birth than those who avoid alcohol. The safest approach is not to drink at all, especially during the first three months of pregnancy when the fetus's organs and limbs are forming.