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April 6, 2007 -- Moisture from a leaky roof and a faulty sprinkler system caused the recent peanut butter salmonella outbreak that sickened more at least 425 people from 44 states.

That news comes from ConAgra Foods, which made the affected peanut butter.

ConAgra Foods spokeswoman Stephanie Childs tells WebMD that the problems have been fixed and that a "thorough cleanup" has been done at the plant.

In February, ConAgra Foods recalled all varieties of its Peter Pan and Great Value peanut butter with the product code "2111" printed on the lid because of possible salmonella contamination.

Salmonella are bacteria that cause food poisoning. Typical symptoms include diarrhea, fever, and abdominal cramping.

Most cases fade within four to seven days without treatment, but complications or severe cases may require hospitalization. Elders, infants, and people with impaired immune systems are the most likely to have severe illness from salmonella.

The CDC got reports of 71 people who were hospitalized because of the peanut butter salmonella outbreak. No deaths have been linked to the outbreak.

Moisture Problem

The peanut butter was made at ConAgra Foods' plant in Sylvester, Ga.

"The company believes that moisture inadvertently entered the production process and allowed the growth of low levels of dormant salmonella in the environment that were likely present from raw peanuts or peanut dust," states ConAgra Foods in a news release.

The broken sprinkler system and the plant's roof, which leaked during an August 2006 rainstorm, are believed to be the sources of that unwanted moisture, Childs says.

"We are truly sorry for any harm that our peanut butter products caused," ConAgra Foods CEO Gary Rodkin says in the news release.

ConAgra Foods says it will begin shipping Peter Pan Peanut Butter to retailers this summer.

Good nutrition starts with smart choices in the grocery store. Cooking up healthy meals is a challenge if you don't have the right ingredients in your kitchen.

But who has time to read all the food labels and figure out which items are the most nutritious and the best buys? Grocery shopping can be a daunting task, simply because there are so many choices.

"Markets perform a great public service, but keep in mind they are designed to get you to buy (and, therefore, eat) more food, not less," says Marion Nestle, PhD, MPH, professor of nutrition at New York University and author of What to Eat: An Aisle-by-Aisle Guide to Savvy Food Choices and Good Eating.

But with a little guidance, healthy choices are a cinch to find in any supermarket.

Plan Ahead for Success

The process starts even before you head to the grocery store, experts say. Before you set out for the market, plan your meals for the week, and create a list to shop from. It takes a few minutes, but saves time in running back to the store for missing ingredients.

To save money, use coupons, check the weekly grocery ads, and incorporate sale foods into your meal planning. And don't shop hungry: An empty belly often results in impulse purchases that may not be the healthiest.

"When planning your grocery list, consult the guidelines of MyPyramid [the government nutrition web site mypyramid.gov] to make sure you are including all the foods you need for good health," advises Elizabeth Ward, RD, author of The Pocket Idiot's Guide to the New Food Pyramids.

To help meet the pyramid guidelines, you should be filling your cart with plenty of fruits, vegetables, whole grains, dairy, lean meat, fish, poultry, beans, and nuts, she says.

Most of us tend to eat the same foods over and over again. But variety really is the spice of life, says Ward.

"One of the tenets of the pyramid is variety, so instead of white potatoes, choose sweet potatoes, which are much richer in beta-carotene, or baby spinach instead of iceberg lettuce," she advises.

Be adventurous; aim to try a new fruit or vegetable each week, she advises.

Both Ward and Nestle say organic foods are a great option, but note that they may not be the most economical choice.

"You get the same nutritional benefits with fewer pesticides [with organics], but eating plenty of produce is more important than choosing organic foods," says Ward.

Money Well Spent

Convenience is often worth the extra cost, especially when you're packing lunches or are trying to control portions. Ward relies on single-serve packages of precut apples and carrot sticks for food to go for her three young daughters.

"Anything that will get you and your family to eat more fruits and vegetables is worth the extra expense, especially when you consider there is no waste associated with washed and prepped produce," says Ward.

Nestle also recommends splurging in the produce aisle for the best fruits and vegetables.

You can never be too rich or too thin. In fact, if you're not rich, you may not be able to afford to be thin.

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According to the CDC, poor diet and lack of physical activity are closing in on tobacco as leading causes of death in the U.S. Or as Secretary of Health and Human Services Tommy G. Thompson put it in a recent news conference announcing a "Healthy Lifestyles" initiative, "We're just too darned fat."

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To prove its point about the weighty problems facing our nation, the HHS, using data from the CDC, has produced a map showing a steady increase in the percentage of obese adults in all states from 1991 to 2000. In 1991, more than 20% of the adults in five different states were obese. A decade later, the problem had spread -- literally -- to 17 additional states.

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But while the data show an unequivocal gain in excess poundage throughout the country, the map also reveals a surprising inverse relationship between income and waistline. In other words, the more income grows, the lower obesity goes.

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"The states that are becoming obese are the states that are low income," says Adam Drenowski, PhD, director of the Center for Public Health Nutrition at the University of Washington in Seattle. States that rank among the lowest in household incomes -- Mississippi, Louisiana, Alabama, and West Virginia -- are those with the highest percentages of obesity. Conversely, Connecticut and Massachusetts, which are among the wealthiest states, have among the lowest obesity rates, Drenowski contends.

You Get What You Pay For

At a recent symposium on the science of obesity, presented at the Harvard School of Public Health in Boston, Drenowski argued that many Americans are obese not by choice, but because they can't afford the luxury of being thin. The economics of food production, he says, are balanced heavily in favor of cheap foods that pack a big caloric wallop.

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"Refined grain, added sugars, and added fats remain the cheapest elements of our diet," Drenowski says. "Just how cheap is something not many people appreciate. At global market rates, sugar -- refined sugar, sucrose -- costs nine cents per pound. In other words, sugar provides you with 20,000 calories for one dollar. If you look at fat at world market prices, you will be getting one pound of fat for 20 cents, which means another 20,000 calories for one dollar."

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Fats, refined grains, and sugars are among the foods highest in what nutritionists call "energy density," which means that they contribute more calories pound-for-pound to the diet than, say, lean fish, vegetables, or fruits. But many foods with low energy density are full of nutrients, such as whole grains and vegetables.

Aug. 3, 2005 -- A new tool tells women and men how fit they are -- and how that affects their risk of death.

The tool is a simple-looking chart. It lets you see how your personal fitness level matches up with the fitness of other people your age. You may be seeing it soon in your doctor's office -- and in your gym.

To use the chart, you have to know how much exercise you're able to do. This can be learned in a gym, using a treadmill or other device that gives readings in units called METs. It can also be done in a doctor's office equipped with a stress testing device. Seeing a doctor is a good idea for anyone not already exercising regularly.

Fitness charts have long been available for men. Before now, nobody had ever collected the data needed for a women's fitness chart. That's changed, thanks to the nearly 6,000 Chicago-area women who underwent exercise stress tests as part of the St. James Women Take Heart Project. Rush University researcher Martha Gulati, MD, led the team that analyzed the data.

Fitness Breeds Longer Life

"Having a good fitness level for one's age predicts better survival," Gulati tells WebMD. "If you are below the fitness level for your age, you are more likely to die."

Indeed, Gulati finds that women double their risk of death if they can't exercise at 85% of the level normal for their age.

Gulati's study appears in the Aug. 4 issue of The New England Journal of Medicine. Accompanying the paper is an editorial co-authored by Duke University researcher Pamela S. Douglas, MD. Douglas is the president of the American College of Cardiology.

"We doctors usually look at electrocardiograms [EKGs] and other tests to see heart trouble -- but it turns out how long you can exercise is almost as important," Douglas tells WebMD. "If you are well, how long you can exercise is more important than any other variable in determining how long you live."

Exercise Prescriptions

The women Gulati and colleagues studied had no obvious symptoms of heart disease. But like many U.S. women, they weren't exactly healthy. The study measured fitness in terms of METs -- metabolic equivalents -- which provide a measurement of the amount of oxygen a person can breathe at a given workload.

At rest, a person burns about 1 MET. A woman who jogs at 5 miles per hour for 30 minutes would burn about 8.7 METs, Gulati says. Some of the women in the study were able to tolerate exercise of only 1.2 to 1.4 METs.

Using the chart devised by Gulati and colleagues, an active 45-year-old woman would normally be fit enough to burn just under 11 METs.

"The important thing is how much you can push yourself," Gulati says. "We have a 30-minutes-of-exercise-a-day guideline -- but it is the intensity of the workout that counts. If your exercise feels too comfortable, it probably is. It does not push you to your fitness level."

So how can a woman or a man find out what she or he needs to be fit? Gulati recommends getting an "exercise prescription."

Get a Fitness Checkup

"I want people to know what their fitness level should be," Gulati says. "They can do this with the help of their doctors. Ask to have your fitness screened at your next visit. And ask for an exercise prescription."

What might such a prescription look like? Just as with any prescription, Douglas says, your doctor first has to be sure that exercise is right for you.

"The best program is whatever form of exercise you will do," Douglas says. "Ballroom dancing, walking, riding a bike, swimming -- it doesn't matter. You need to move."

Douglas warns that many people who think of themselves as active are getting much less exercise than they need. That's why she says pedometers are a great idea. The devices measure how many steps you really take in a day.

"Some of my patients say, 'I am active. I get out in the garden, I work around the house.' But the pedometer shows they do 3,000 or 5,000 steps -- not the recommended 10,000," Douglas says. "These people are up and out but not getting the exercise benefit they need. The good thing about the pedometer is it gives you credit for what you already do and lets you know how much more you have to do."

The Super Bowl certainly motivates the players to go all out for victory, but it motivates millions of fans as well.

It motivates them to arrange their lives so they can sit for hours in front of the TV watching every play of the game.

The Super Bowl does not, however, appear to motivate fans to embrace the essence of professional football, which is physical fitness.

Instead, football fans, like much of the population of the U.S., tend to be overweight, out of shape, and sedentary. Twenty-six percent of Americans get no exercise at all, according to the CDC. Many won't even walk up a flight of stairs if they can avoid it.

Exercise Excuses

Why do Americans tend to avoid exercise?

Many say they don't have time and find exercise boring.

Many exercise physiologists, however, suspect a bigger problem may be lack of knowledge; if people really understood the enormous benefits of exercise, they would just do it.

"Exercise seems to affect everything," says Cris Slentz, PhD, an exercise physiologist at Duke University Medical Center in Durham, N.C. "In my opinion, if you understand that exercise is really good for you, you'll make it a No. 1 priority. If you don't, you won't. I believe knowledge is a big part of it. We all have the same amount of time."

How Moderate Exercise Helps

Exercise, according to Slentz, prevents one of the biggest threats to good health -- the accumulation of fat beneath the skin and around the internal organs, such as the liver and the heart. This gives rise to abdominal obesity. Excess fat weakens the body's ability to burn glucose (blood sugar), which then accumulates in the bloodstream, setting the stage for diabetes and an array of health problems.

The good news, Slentz says, is that even moderate amounts of exercise can prevent weight gain. In a study published recently in the Journal of Applied Physiology, Slentz and colleagues demonstrated that even a brisk 30-minute walk five or six days a week was enough to prevent significant fat accumulation.

"People in the inactive group gained significant weight -- about two pounds every six months," Slentz says. "But those who exercised, even at lower intensity, had some pretty remarkable benefits. In fact, people in the low-intensity group actually had better triglyceride reduction. Some had lipid responses that were more robust than in the higher intensity group."

More exercise, however, is generally better.

"Those in the higher dose group, who jogged 17-18 miles per week, had the biggest benefits," says Slentz. Still, a growing body of research demonstrates that even moderate exercise brings significant health benefits.

Benefits of Short Bursts of Exercise

And exercise is beneficial even if it's accumulated throughout the day, according to I-Min Lee, MD, ScD, an associate professor at Harvard Medical School and Harvard School of Public Health.

"While there were few data on this question before 1995, there have been several studies since then that compare short bouts of physical activity accumulated over the day to a single longer bout -- for example, walking 15 minutes two times a day vs. 30 minutes once a day," she says. "These studies seem to suggest that we can still get health benefits if our activity bouts are as short as 10-15 minutes per session."

These findings suggest that almost anyone can find the time to do some exercise.

"That's one of the ways the exercise community has tried to make physical activity palatable to the masses," Lee says. "Pick what you like to do. It doesn't have to be vigorous; it can be moderate. It will still give you health benefits."

June 19, 2006 -- Scientists are serving up yet another reason to put vegetables on your plate: It might discourage plaque from accumulating in your arteries.

So says Michael Adams, DVM. He's a professor in Wake Forest University's pathology/comparative medicine department in Winston-Salem, N.C.

Adams and colleagues recently studied nearly 100 young male mice at high genetic risk for artery-clogging plaque. For four months, the researchers fed half of the mice a vegetable-free diet.

The other mice got the same number of calories, but 30% of those calories came from equal parts of freeze-dried corn, carrots, green beans, broccoli, and peas. Adams' team chose those vegetables because they're five of the most common vegetables in the U.S. diet, not counting potatoes.

Why not include potatoes? Because in the U.S., they're typically served drenched in fat from frying, the scientists note in The Journal of Nutrition's July issue.

Less Plaque

After four months, the scientists checked the mice's arteries. They found 38% less plaque in the arteries of mice that had eaten the vegetable-rich diet, compared with mice that had eaten no vegetables.

Mice fed the vegetable-rich diet also had modestly better cholesterol levels -- including a slight drop in LDL ("bad") cholesterol -- and had gained 7% less weight.

How do vegetables help tame plaque? That's still uncertain, write Adams and colleagues.

Adams' team checked the data to look for clues. They concluded that the differences in weight and cholesterol between the two groups of mice didn't totally account for the plaque gap.

But the researchers found another clue related to inflammation, which is associated with hardening of the arteries (atherosclerosis). Adams and colleagues found lower levels of an inflammatory marker in blood from the mice on the vegetable-rich diet, compared with those lacking vegetables.

The study was funded by the General Mills Company, which supplied the vegetables.

SOURCES: Adams, M. The Journal of Nutrition, July 2006; vol 136: pp 1886-1889. News release, Wake Forest University Baptist Medical Center.

May 3, 2005 -- America's 2005 obesity "report card" shows some progress among states but plenty of room for improvement.

Only one "A" was awarded. California took that honor for its attempt to control childhood obesity. However, California's overall grade for its efforts to address the obesity epidemic (not just among school children) was a "B."

About a quarter of states earned a failing grade for efforts to control childhood obesity, the report card states. "Given the importance of establishing healthy habits early in life, the results are very disappointing," write the researchers.

Overall Grades

Here are the grades for state overall efforts to control obesity (states listed in alphabetical order):

• A: No states.
• B: Arkansas, California, Connecticut, Hawaii, Maryland, New York, North Carolina, Oklahoma, Tennessee, Texas, Washington
• C: Arizona, Colorado, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Mississippi, Missouri, New Hampshire, New Jersey, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Virginia, West Virginia
• D: Alabama, Alaska, Delaware, Florida, Michigan, Minnesota, Montana, Nebraska, North Dakota, Vermont, Wisconsin
• F: Idaho, Nevada, South Dakota, Utah, Wyoming

Grades for Childhood Obesity

The report card also gave grades for state efforts regarding childhood obesity:

• A: California
• B: Arkansas, Connecticut, Colorado, Hawaii, Kansas, Kentucky, Maine, New York, North Carolina, Oklahoma, Pennsylvania, Tennessee, Texas, Washington, West Virginia
• C: Arizona, Delaware, Georgia, Illinois, Indiana, Iowa, Louisiana, Maryland, Massachusetts, Michigan, Missouri, Mississippi, New Hampshire, New Jersey, Nebraska, New Mexico, Ohio, Oregon, Rhode Island, South Carolina, Virginia
• D: Alabama, Florida, Minnesota, Montana, North Dakota, Wisconsin, Vermont
• F: Alaska, Idaho, Nevada, South Dakota, Utah, Wyoming

Making the Grade - or Not

The report card comes from the University of Baltimore's Obesity Initiative. Grades were based on legislation introduced and/or passed by the states on eight topics: nutrition standards; vending machine usage; body mass index (BMI) measured in school; recess and physical education; obesity programs and education; obesity research; obesity treatment in health insurance; and obesity commissions. The researchers looked at each state's most recent legislative session.

To receive an "A," states had to successfully pass a law related to obesity. Points were awarded if legislation was introduced but not passed. "Introducing legislation at least indicates some awareness and the presence of a will directed to controlling obesity," notes the report card.

Researchers working on the report card included Kenneth R. Stanton, PhD, MBA, an assistant professor of finance at the University of Baltimore's business school.

"Many states made progress in enacting legislation," write researchers. But they say some states with high obesity rates "are lagging in taking corrective steps."

For instance, the report card states that according to the CDC, Mississippi had the nation's highest obesity rate in 2001. Mississippi earned points for passing legislation on recess/physical education requirements and establishing an obesity commission. But only the recess/physical education law is likely to have any near-term impact, according to the report card.

West Virginia and Michigan were the No. 2 and No. 3 states for obesity prevalence in 2001 according to the CDC, says the report card. The researchers say both states have proposed obesity legislation but no laws were successfully passed.

"Overall, states have been slow to recognize the need for prompt actions that may have a more immediate effect," write researchers. "The absence of significant state efforts to address the epidemic is disturbing."

Hot Topics

The top three areas of proposed legislation among the states were:

• Recess/physical education requirements (27 states)
• Nutrition standards (23 states)
• Vending machine restrictions (21 states)

Fourteen states tried to pass laws regarding BMI assessment of school children, and 13 attempted to pass laws mandating curricula to address nutrition education and obesity awareness. Less than five states had proposed legislation for obesity research.

State Obesity Rates

The CDC's 2003 Behavioral Risk Surveillance Survey lists adult obesity rates for each state. States in each category are listed alphabetically.

• Adult obesity rate of 15% to 19%: Arizona, Colorado, Connecticut, Florida, Hawaii, Maine, Massachusetts, Montana, New Hampshire, New Jersey, New Mexico, Rhode Island, Utah, Vermont, Wyoming
• Adult obesity rate of 20% to 24%: Alaska, Arkansas, California, Delaware, Georgia, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Missouri, Nebraska, Nevada, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Oregon, South Carolina, South Dakota, Tennessee, Texas, Virginia, Washington, Wisconsin
• Adult obesity rate of at least 25%: Alabama, Indiana, Mississippi, West Virginia

Aug. 31, 2004 -- Many Americans start dieting at a young age, but they don't always do so wisely, according to a study in the Journal of the American Dietetic Association.

Sixty percent of 10th graders surveyed at a Los Angeles-area public high school said they had tried to lose weight. Of those students, more than half said they "often diet to control their weight," write the researchers, who were led by Laura Calderon, DrPH, RD, associate professor at California State University.

Calderon's team surveyed 146 students enrolled in the high school's health classes. Both boys and girls took part. About 27% of the teens had a body mass index greater than 25. (BMI is an indirect measure of body fat. A BMI greater than 25 is considered overweight.)

Some of the teens' strategies may sound familiar.

Among the teen dieters, 34% ate small portions, about 31% counted calories, and almost 42% counted fat grams. Nearly 65% said they sought out low-fat foods.

Then there were the extreme tactics, like skipping meals, which 44% of the student dieters had tried.

That's a bad idea. Skipping meals hasn't been shown to help lose weight.

Bad Dieting Behaviors

All too often, teens have misguided ideas about dieting and unhealthy dieting behaviors. For instance, they tend to cut calories ruthlessly, reducing the amounts of fats in their diets without compensating by increasing the amounts of fruits and vegetables they eat. They also attempt to lose weight by vomiting or using laxatives and over-the-counter diet pills, say the authors.

They also start too young, which can effect growth and development -- especially in girls. Of the female dieters in this study, nearly 36% said they started dieting by age 12, almost 85% by age 13, and the rest by age 15. More female students than male students had tried to lose weight at some time.

And while too many teens are overweight, their leaner classmates sometimes diet needlessly. About 67% of girls with a normal BMI (between 18.5 and 25.0) reported dieting, as did almost 8% with a BMI under 18.5, which is considered underweight.

None of the males whose body mass index was under 18.5 said they had dieted, but about 23% with a normal BMI said they had.

Ethnic differences also counted. Hispanics were the most likely to have dieted, followed by whites and Asians in equal numbers, with blacks last.

For any teen, dieting can be risky. Their physical development requires appropriate nutrition, and dieting has been called the most important predictor of new eating disorders.

All the more reason to start teaching safe weight control practices early, say the researchers. They want to see such efforts start by the seventh grade - early enough to catch most potential dieters before they take matters into their own hands.

Jan. 9, 2004 -- Americans are becoming disabled younger than ever before, likely because of morbid obesity. Yet the number of disabled people among the elderly is dropping a new study shows.

The RAND Corporation did the study that appears in the recent issue of Health Affairs. The study looks at the nation's health and disability statistics between 1984 and 1996.

The number of disabled people aged 30 to 39 had the sharpest increases during the 12-year period, reports researcher Darius Lakdawalla, an economist at RAND in Santa Monica, Calif.

These were people who needed some degree of help with routine tasks, or couldn't take care of themselves at all, he explains.

Also among the findings:

• The number of 30 to 39 year olds with disabilities rose from 118 to 182 in the 12-year period -- a 63% increase.
• Among 40 to 49 year olds, there was a 66% spike -- from 212 to 278.
• Among 50 to 59 year olds, there was a 53% increase; 400 people reported disabilities in 1984, compared with 453 in 1996.
• Numbers of 60 year olds with disabilities decreased by 28% -- from 792 in 1984 to 763 in 1996.

However, there was some good news for the under-50 age group. While they had the highest increases in disability, preliminary data for 1997 to 2000 in the report indicates that the growth might be leveling off.

Morbid Obesity Is the Problem

The recent rise in morbid obesity is the most likely reason for this increase in health problems, the report shows. "For each age group that we examined, the rate of morbid obesity has increased by at least 700 per 10,000 from 1984 to 1996," researchers write.

• Among the nonobese, the rates of disability have remained completely flat -- even though it has risen by 151% per 10,000 among the obese.
• Obesity accounts for about half of the increased disability among those aged 18 to 29, about one-quarter for those aged 30 to 39, and about one-tenth for those aged 40 to 45, writes Lakdawalla.

Also, incidence of diabetes doubled during the 12-year period, indicating that it is becoming an increasingly important cause of disability. The diabetes trend is likely linked with morbid obesity, he says.

SOURCE: Lakdawalla, D. Health Affairs, January/February 2004; vol 23.

Jan. 24, 2003 -- In the latest development in its campaign to crack down on false advertising in the weight loss supplement industry, the FTC announced today that it is filing a complaint in federal court against Slim Down Solution and related companies. The company ran national ads for its Slim Down Solution, a product it claimed could absorb dietary fat and lead to weight loss without diet or exercise.

The product contains D-glucosamine, a natural chemical in the body. But the company's claims about its fat-busting ability are totally untrue, said Howard Beales, director of the FTC's bureau of consumer protection.

The company's ads also claimed that independent testing using government standards had shown that D-glucosamine binds to dietary fat in the human digestive system. Those claims are false, according to the FTC.

"The sad truth is the only way to lose weight is to reduce calories taken in and to increase calories [burned] ... there's nothing out there that will get around that scientific reality," Beales tells WebMD.

Slim Down Solution was also marketed through re-sellers under labels such as Fight the Fat, and Everslim, Mini Max. FTC is seeking consumer compensation for purchase of the product. To take part, go to FTC's web site. "Consumers should contact the FTC and file their complaint so we have them on our list... if and when we get money back to consumers, then we'll contact them," Beales said at a news conference.

Adolescence is a time of tremendous change. As teens mature, they make more food choices on their own, often in the company of influential peers.

But even as teens become more autonomous, it's still up to their parents to provide them with good examples and nutritious foods. Here are some tips on how to go about doing that.

Help Teens Make Good Choices

Deciding what to eat and how much to exercise is part of growing up. But too often, a child's choices give health the short shrift. Teens may lack the skills and motivation to do what they should to stay healthy.

"Balancing school, sports, social activities, and work presents a major challenge to eating healthy," says Kendrin Sonneville, MS, RD, who specializes in teen nutrition at Children's Hospital in Boston.

On-the-go adolescents may squander opportunities for good nutrition by skimping on foods that help fuel their growth and development. Skipping meals, especially breakfast, and choosing processed and convenience foods over fresh translates into too much fat, sodium and sugar, and not enough of the fiber, vitamins, and minerals essential to a teen's health now and later.

Calcium is Critical

Calcium, critical to bone development and density, is one of the nutrients that can easily fall through the cracks.

Calcium needs are higher than ever during the teen years -- 1,300 milligrams a day. Yet calcium consumption often drops off in teenagers as they replace milk with soft drinks. Research shows that 9th- and 10th-grade girls who drink soft drinks are three times as likely to suffer a bone fracture than those who do not drink them.?

In addition to being naturally rich in calcium, milk is fortified with vitamin D, which also helps to shore up bones. Certain yogurts contain vitamin D; check the label to be sure. While they're calcium-rich, hard cheeses lack vitamin D.

Teens require the calcium equivalent of about four 8-ounce glasses of milk daily. Here are some other foods that supply as much calcium as a glass of milk:

• 8 ounces yogurt
• 1 1/2 ounces hard cheese
• 8 ounces calcium-added orange juice
• 2 cups low-fat cottage cheese.

Girls Need Extra Iron

Iron, as a part of red blood cells, is necessary for ferrying oxygen to every cell in the body. It's crucial to a teen's brain function, immunity, and energy level. Girls aged 14 to 18 need 15 milligrams per day. Boys in the same age range need 11 milligrams.

Iron deficiency is common in adolescent females and people who limit or eschew meat. Menstruating young women are at increased risk for an iron shortfall because their diets may not contain enough iron-rich foods to make up for monthly losses.

Iron is found in both animal and plant foods. The iron in animal foods is better absorbed by the body, but consuming a vitamin-C rich food along with plant iron increases uptake. Serve these iron-rich animal foods to your teen as part of a balanced diet (shoot for 4-6 ounces a day):

• Beef
• Poultry
• Pork
• Clams
• Oysters
• Eggs

Good non-meat sources of iron include:

• Vegetables (including spinach, green peas, and asparagus)
• Beans
• Nuts
• Iron-fortified breads, cereal, rice, and pasta.

A multivitamin with 100% or less of the Daily Value for iron, vitamin D and other nutrients fills in the gaps in less-than-stellar diets. But multivitamins do not contain enough calcium to make up for inadequate consumption of calcium-rich foods. Your child may need a calcium supplement too

Most of us are confused and overwhelmed by all of the tips and information out there about how to cook and care for vegetables. Is it healthier to eat your tomatoes raw, or enjoy them in a slow-cooked sauce? Should you refrigerate leafy greens?

Unless you're Popeye, you're probably not going to bulk up overnight by eating a can of spinach, no matter how it's prepared. But there are plenty of health benefits that you'll enjoy from careful care and preparation of your veggies.

The most striking benefit of plant foods is their disease-fighting potential, says Amy Joy Lanou, PhD, a nutritionist and the nutritional director of the Physicians Committee for Responsible Medicine. "Across the board, fruits and vegetables are beneficial for reducing chronic disease risk," she says. That's why we asked Lanou and nutritionist Christine Filardo to give us the scoop on proper veggie handling, so something insignificant doesn't come between you, your health, and your veggies. Here's a little food for thought.

To Cook or Not to Cook

There's plenty of conflicting information about whether vegetables and fruits are better enjoyed cooked or raw, and that's because there is no single answer. Some active nutrients in vegetables and fruits are more readily available when cooked, others are more prevalent when foods are eaten raw, says Lanou. For example, lycopene, an antioxidant, which may help prevent against prostate cancer, heart disease, and other chronic illnesses, is more prevalent in cooked forms of tomatoes -- even ketchup.

On the flip side, many of the nutrients from vegetables can get leached during cooking. The key is to watch out for cooking vegetables too long, and with too much water, says Filardo. If you cook vegetables gently -- and without a great deal of water -- you will help protect the water-soluble vitamins. Filardo recommends blanching your veggies, which is when you quickly cook vegetables in boiling water, and remove them when they're still very crisp, to help preserve the color and nutrients. The same principle applies if you're going to steam or microwave vegetables.

Not all water is bad, however; it's only when you aren't consuming the liquids that the nutrients are leached into. That's the great thing about soup, says Lanou. "You consume the water-soluble vitamins that go into the broth," she says. For the most part, it's the leaching that causes the problem, not the heat.

Parents, grandparents, and youngsters cooking together in the kitchen, sharing family recipes and secrets passed from one generation to the next, is a lost art in many households across America. These days, it's hard for busy parents even to take time out to teach their kids basic cooking techniques.

?It's true that cooking with children requires time, patience, and some extra cleanup, especially when the children are younger. But many experts think it is well worth the effort.

For one thing, cooking with children can help get them interested in trying healthy foods they might normally turn up their noses at. Susan Moores, MS, RD, a spokeswoman for the American Dietetic Association, says she has seen this happen countless times.

It's true kids will be kids -- they'll snack on chips at a school party or enjoy ice cream after a soccer game. But what is most important is how they eat most of the time, Moores says. And that's where parents can play a role. Keep in mind that for kids today, healthy eating essentially means eating more fruits and vegetables, having whole grains and beans when possible, and choosing leaner types of animal foods (even some fish every now and then.)

Encouraging kids to try healthier foods isn't the only benefit of cooking as a family. Among the recommendations in a recent American Heart Association report on overweight problems in children and teens were:

• Reducing the number of meals eaten outside the home.
• Having structured times for family meals.
• Offering healthier, low-calorie foods.
• Involving children in meal planning, shopping, and food preparation.

Indeed, cooking with children can be the gift that keeps on giving; it has both short-term and long-term payoffs.

Some of the short-term benefits:

• It encourages kids to try healthy foods.
• Kids feel like they are accomplishing something and contributing to the family.
• Kids are more likely to sit down to a family meal when they helped prepare it.
• Parents get to spend quality time with their kids.
• Kids aren't spending time in front of the TV or computer while they're cooking.
• Kids generally aren't eating junk food when they're cooking a meal at home.

Some long-term benefits:

• Learning to cook is a skill your children can use for the rest of their lives.
• Kids who learn to eat well may be more likely to eat healthfully as adults.
• Positive cooking experiences can help build self-confidence.
• Kids who cook with their parents may even be less likely to abuse drugs.

Less Likely to Abuse Drugs?

Could cooking with children mean less drug abuse? It makes perfect sense if you consider a report from The National Center on Addiction and Substance Abuse at Columbia University. In the report, Family Matters: Substance Abuse and the American Family, the center recommends 10 steps parents can take to prevent substance abuse. Among them are these three:

1. Be caring and supportive of your child.
   Parents get many opportunities to compliment and support their children while they're in the kitchen together. How important is this? Parental praise, affection, acceptance, and family bonding -- as perceived by children -- are all associated with a reduced risk of substance use. A 1999 survey showed that teens who had an excellent relationship with either parent were at 25% lower risk for substance use than the average teen. Those who had a great relationship with both parents were 40% less likely to use drugs than the average teen, according to the survey results.
2. Open the lines of communication.
   Kids having fun in the kitchen, elbow to elbow, are likely to interact with each other and with their parents. Cooking together gives parents and children time together to talk and share thoughts and stories. "Communication doesn't start when your child is 17," says Ross Brower, MD, deputy medical director for the Weill Cornell Medical Center. "It should start when your child is 3."
3. Eat dinner together regularly.
   Involving your kids in the kitchen is a big stepping-stone to getting them to appreciate family meals. Because of challenging work, school, and sports schedules, many families struggle to sit down to even one daily meal together. But you can start by maximizing weekend opportunities to eat together.

Do you smoke? Do you have a family history of cancer? Are you spiritual?

It's not often that you hear your doctor pose that last question. But a new survey of 920 adults shows that patients want their doctors to ask about their spirituality in many cases, such as when facing a life-threatening disease or a serious medical condition.

A positive spirit is often credited for helping people cope with life's toughest obstacles, such as a devastating illness. But spirituality's role in health care has long been controversial, and doctors traditionally have shied away from spiritual or religious discussion.

Evidence indicates that patients who are more spiritual or religious have lower mortality rates, reduced stress, and overall better physical and mental health. They typically require fewer health services. Lack of spiritual training, unwillingness to depart from established medical arenas, and ethical issues are some of the reasons why doctors have avoided widespread spiritual discussion with patients.

In an effort to clarify how spirituality should be encompassed in a medical setting, patients at five family physician offices (four urban, one suburban) in Ohio were asked to rate their spirituality (1 being not spiritual at all, 5 being extremely spiritual) and to describe how their beliefs played a role in their health care decisions. The survey also included questions about their medical history, experiences with a serious illness, and whether or not they had ever asked a doctor (or vice versa) about their spirituality. The majority of those surveyed were women.

Study author Gary McCord, MA, of Northeastern Ohio Universities College of Medicine, found that 83% of respondents wished to discuss their spiritual beliefs with their doctor. Spiritual discussion was most acceptable when dealing with a life-threatening illness, serious medical condition, or a loss of a loved one. It was least welcome during routine physical exams.

Among the findings:

• People aged 30 to 64 most welcomed spiritual discussions.
• 17% never wanted to be asked about their spirituality.
• 20% always wanted their doctor to be aware of their beliefs.
• 18% told their doctor about their beliefs without being asked.

Of those who wished to discuss spirituality:

• 87% wanted their doctor to understand how their beliefs helped them deal with being sick.
• 83% wanted their doctor to understand how their beliefs influenced their decisions.
• Women were more likely than men to change their medical treatment based on spirituality.
• Two-thirds believed that by having doctors know about their spiritual beliefs, they would be advised on how to take care of them when sick.
• 67% believed that by having doctors know their spiritual beliefs they would be compassionate and encourage hope.

The findings were reported in the July/August 2004 Annals of Family Medicine.

SOURCE: McCord, G. Annals of Family Medicine, July/August 2004; vol.2: No. 4.

April 30, 2003 -- Seeking -- and finding -- positive meaning in grief may boost the immune system.

There's a lot of evidence that stressful life events can harm a person's health. There's also a lot of evidence that people are capable of amazing resilience. Many people thrive after surviving tragedy.

Why? Many things must be involved. Julienne E. Bower, PhD, and colleagues at the University of California, Los Angeles, looked at one of them. They studied 43 women who had just lost a close relative to breast cancer. They also looked at a set of important immune cells -- natural killer cells -- in the women's blood.

Bower and colleagues found the women who placed the most importance on cultivating relationships, personal development, and striving for meaning in life had the most active immune cells. And over a four-week period, women who came to see these goals as more important had improved immune function.

"This study supports the possibility that a generalized form of goal engagement -- one relevant to more intrinsic goals, such as finding meaning -- may have positive [effects on immunity]," Bower and colleagues write in the Annals of Behavioral Medicine.

The women were divided into two groups at the beginning of the study. Every week, one group wrote about the death of their relative while the other group wrote about non-emotional things such as their plans for the day. Women who wrote down their feelings did not have better immune function.

The next step will be to uncover the ways in which "finding meaning gets under the skin and influences the immune system," Bower says in a news release.

New York lingerie designer Carolyn Keating was thrilled to land a job interview with Victoria's Secret. She knew that being on time was essential to making a good impression, but there was just one problem. "I had written down the address wrong. I meant to check it the night before on the computer, but I didn't." When Keating finally arrived at the correct address, she was 30 minutes late. "I felt embarrassed and it really flustered me," she tells WebMD. "I carried that insecure, worried, flustered energy throughout the interview." She didn't get the job.

Another time, Keating and several friends showed up 15 minutes late to a colleague's wedding. "The bride was already at the alter. She was basically saying 'I do' when we tumbled in, and it's hard for six or seven people to tiptoe in quietly. We were worried that we ruined the most important day of her life."

For some people, being on time seems nearly impossible -- no matter how important the event. They're always running out the door in a frenzy, arriving everywhere at least 10 minutes late. If this sounds like you, have you ever wished you could break the pattern? According to Julie Morgenstern, author of Time Management From the Inside Out, the first step is to make promptness a conscious priority.

ADHD Questionnaire: Check Your Symptoms

"Look at the costs of being late and the payoffs of being on time," Morgenstern advises. She says it's important to recognize that being late is upsetting to others and stressful for the one who is late. "I think people's stress level is very high when they're late. They're racing, worried, and anxious. They spend the first few minutes apologizing. One of the payoffs of being on time is that you eliminate the stress of the travel time and you eliminate the time spent apologizing."

The Consequences of Being Late

The consequences of being chronically late run deeper than many people realize, according to psychologist Linda Sapadin, PhD, author of Master Your Fears. "You're creating a reputation for yourself, and it's not the best reputation to be establishing. People feel they can't trust you or rely on you, so it impacts relationships. It also impacts self-esteem."

Once you feel motivated to make a change, Morgenstern says the next step is to figure out why you're always late. The reason can usually be classified as either technical or psychological.

Technical Difficulties

"If you're always late by a different amount of time -- five minutes sometimes, 15, or even 40 minutes other times -- it is likely that the cause is technical," Morgenstern tells WebMD. "That means you are not good at estimating how long things take," whether it's drive times or routine activities like taking a shower.

Keating says she falls into this category. "It's a case of bad planning, of thinking you need less time than you actually do."

The solution, Morgenstern says, is to "become a better time estimator." She suggests keeping track of everything you do for a week or two. "Write down how long you think each thing will take and then how long it actually took." This will help you find a pattern, so you can adjust your time estimates.

Keating says this strategy is helpful. "You have to be realistic about how long certain things take, especially things you do routinely. If you know it takes 20 minutes to blow dry your hair, allow yourself 20 minutes to blow dry your hair," she says, "and leave a little extra time for those days when your hair is uncooperative."

Learning to Say 'No'

Another technical difficulty for some people is the inability to say "no" to additional commitments when they're short on time. You might be a good time estimator, Morgenstern explains, but "your best-laid plans get waylaid when someone asks you for something and you can't say 'no.'"

The solution to this problem is to "practice catchphrases," Morgenstern tells WebMD. Learn to defer or decline requests by saying, "I would love to help, but I'm on a deadline" or "I'm meeting people in half an hour. I can help you tomorrow."

Sept. 24, 2001 -- Gray Scott, of Florence, S.C., has been treated for anxiety for nine years, from the time she was diagnosed with an eating disorder at age 15. Since then, she has tried a variety of medications and psychotherapy, with variable results.

?

"When the symptoms are alleviated, it becomes tolerable," she tells WebMD. "At their worst, I have felt very desperate."

?

Scott is not alone. Anxiety disorders -- including phobias, panic attacks, obsessive-compulsive disorders, and posttraumatic stress disorder -- affect more than 23 million Americans. Although treatment with a combination of drugs and therapy is very often successful, some patients go from drug to drug, and therapy to therapy, with no relief.

?

"Most people think of anxiety disorders as not terribly devastating, and easily treatable with drugs," says psychiatrist Mark George, MD, director of the brain stimulation laboratory at the Medical University of South Carolina in Charleston. "But there is a substantial core of people for whom drugs don't work and for whom there are no good alternatives."

?

That may change, however, if a new surgical treatment called vagus nerve stimulation, or VNS, proves successful.

?

On May 18, Scott became one of the first anxiety patients to receive the experimental treatment. On that day, surgeons at the Medical College of South Carolina implanted a device in her chest, similar to a heart pacemaker, and wired it to electrically stimulate the vagus nerve in her neck.

?

Named for the Latin word meaning "wandering," the vagus nerve meanders from the colon, past the intestines, heart, and lungs, and comes together at the diaphragm, where it runs as a thick cable past the esophagus and into the brain.

?

George calls the nerve "an information superhighway to the brain." Contrary to long-held wisdom, the traffic on that highway is mostly going north -- from the body to the brain, not vice versa, he says.

?

"Most people have thought of it as the way the brain controls the heart and the guts," George explains. "In fact, most of the information is actually going in the other direction. The vagus nerve is really the brain's way of interpreting what is happening in the heart and the guts."

?

That suggests an intriguing theoretical reason why VNS might work well for people with anxiety, he says.

?

"Emotions are not brain events, but the brain's interpretation of bodily events," George says. "When you feel scared, it's really your brain sensing that your heart rate is going up."

?

So by stimulating the vagus nerve, George and others hope to influence the exchange of information between body and brain, and thereby relieve the symptoms of anxiety.

?

Whether this works remains to be seen. Today, the device implanted in Scott's chest activates every five minutes, stimulating her vagus nerve with a small electrical current for a period of five seconds. When it activates while she is talking, her voice suddenly becomes mildly hoarse.

?

"Some days I think it's helping, and some days I don't know," she says. "At first I was expecting something instantaneous, but it doesn't work that way. It can take months to see any results."

Aug. 13, 2003 -- You know it as ephedra, ephedrine, ma huang -- and doctors say it's trouble waiting to happen. Strokes, heart attacks, deaths have been linked to this stuff.

But on the Internet, ephedra's dangers get little or no mention, according to a new study that looks at Internet marketing of ephedra-containing products.

It's a lightening-rod issue: Ephedra is a popular weight loss drug and there's evidence that it can work short term. Yet 140 studies link ephedra to heart attacks and strokes. A number of people have died.

The FDA is currently holding hearings, looking at whether ephedra should be removed from the market entirely.

Ephedra's Dangers Not Revealed

In this study, researchers look at web sites that market ephedra -- finding that one-third issue "statements that are undeniably misleading or incorrect," says Bimal H. Ashar, MD, professor of medicine at The Johns Hopkins University School of Medicine in Baltimore.

His report appears in the latest Mayo Clinic Proceedings.

Ashar and colleagues plugged the phrase "herbal weight loss" into four search engines. Of the 32 web sites they analyzed, they found 32 products and advertisements.

They found:

• 41% failed to disclose either adverse effects or other warnings.
• 53% did not provide dosage information.
• 34% made incorrect or misleading statements.

Among the erroneous claims, according to the researchers:

• Some suggested that their product was FDA-approved. Most commonly, it was through statements that "'the product was made in an FDA-approved laboratory or made following strict FDA guidelines,'" says Ashar. "That doesn't mean it's FDA-approved."
• On one web site, a question-and-answer section included the question, "Is this formula FDA approved?" The answer: "All products are manufactured in an FDA-approved laboratory." "That's very blatantly misleading," Ashar tells WebMD.
• One web site claimed that the product was completely safe for long-term use. "That's kind of vague. There has never been a study looking at ephedra for more than six months of use. In my mind, that's not long term. And saying 100% safe is simply incorrect."

Ephedra Not Like Sudafed

A number of web sites tried to compare ephedra with the over-the-counter sinus medication pseudoephedrine (such as Sudafed), Ashar reports. The web sites stated their product contained a lower dosage of ephedra than in children's Sudafed. But Ashar says pseudophedrine is a weaker derivative of ephedrine. "Comparing Sudafed with ephedra is apples and oranges," he tells WebMD.

Ephedra was marketed under various names, including epidonin, ma huang, and Sida cordifolia. "Consumers need to be careful," says Ashar. "Some web sites won't even list ingredients. If you don't know what it contains, don't try it. Bring a printout from the web site to your doctor."

For Answers, Look North

Donald Marcus, MD, professor of medicine and immunology at Baylor University School of Medicine, sees it all the time. "They're all false claims on the Internet," he tells WebMD. "There is little or no data on any herbals, not just ephedra. The best you can say is, there are small studies.

"These are not dietary supplements, they are not food," he adds.

His idea: Adopt changes like those occurring in Canada. Next year, Health Canada will implement 53 new regulations plus a new regulatory category called "Natural Products," which includes herbs and other supplements, says Marcus.

New warning labels will appear on all herbs and supplements produced in Canada. Also, these products must be registered with the Canadian government, so that regulations can be enforced and "adverse events" - such as heart attacks, strokes, deaths -- can be tracked. Ephedra's dangers, like others, would appear on warning labels on the products.

American companies are not required to report serious adverse events. Also, the FDA is not required to keep records of these events, Marcus says.

"The Federal Trade Commission has the responsibility to govern marketing of these products, but it's difficult to enforce any regulation of Internet marketing of ephedrine or any supplement because the Internet is such a fluid medium," Ashar tells WebMD.

Even if ephedra vanishes from the market, the supplement regulation problem still exists, says Ashar. "The FTC is left with the formidable task of trying to enforce [advertising] rules. The FTC has taken action against a number of companies, but it's impossible to keep track of the Internet. If you issue a warning to a company, they switch to a different web site."

June 21, 2002 -- Paying a few cents more for a "value meal" or an upgrade to a "super-size" snack may seem like a good deal, but a new report says your waistline winds up paying the price.

"Americans are constantly induced to spend a little more money to get a lot more food," says Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest (CSPI), in a news release. "Getting more for your money is ingrained in the American psyche. But bigger is rarely better when it comes to food."

The CSPI joined a group of more than 225 health organizations in issuing the report, From Wallet to Waistline: The Hidden Costs of Super Sizing. The report says the food industry's value marketing policy of providing more food for less money encourages overeating and contributes to obesity.

The authors found upgrading to larger serving sizes increases price only modestly, but substantially increases calorie and fat content. For example, upgrading from a 3-ounce Minibon to a Classic Cinnabon only increases the price by 24%, but packs 123% more calories.

The report also says the practice of "bundling" -- turning a fast food sandwich into a meal by adding a large serving of fries and a soft drink -- is responsible for some of the biggest caloric boosts. For example, turning a Burger King Whopper into a value meal costs only $1.69 more, but packs an extra 590 calories.

And the authors say it can cost more to purchase a smaller, lower calorie meal at a fast food chain than a larger one. They found that a McDonald's Quarter Pounder with Cheese, small fries, and a small Coke purchased separately cost 8 cents more than the Quarter Pounder with Cheese Extra Value Meal, which comes with a large fries, large Coke, and an extra 490 calories.

The problem also extends to movie theaters. Going from a small to a medium bag of popcorn only raises the price 71 cents (up 23%) -- but the calorie count jumps an astounding 125% -- 500 calories. And this is for unbuttered popcorn.

But a spokesperson for the restaurant industry says nearly all restaurants offer a variety of foods that allow customers to customize their meals to meet their needs.

"Restaurants have always offered a number of sizes and choices," says Sheila Cohn, RD, nutrition coordinator for the National Restaurant Association.

Although the report claims serving sizes have grown in recent years, Cohn says the same original sizes are still available at most fast-food restaurants.

She says restaurants are there to serve, and they are merely responding to consumer demands with value pricing programs.

"People want value," Cohn tells WebMD. "And restaurants are there to give people what they want."

Aug. 21, 2000 -- For years, I've listened to friends, friends of friends, and even complete strangers talk enthusiastically about the supplements they take. They're not touting just run-of-the-mill multivitamins, but big doses of the so-called antioxidants like vitamins A, C, E, and beta-carotene. They swallow these pills by the handful, hoping to undo the damage from too many cheeseburgers, slow down the aging process, and maybe even prevent disease. And they chide me because I'm not on this shortcut-to-good-health bandwagon.

Antioxidants, they're fond of telling me, neutralize free radicals, those pesky unstable oxygen molecules that -- left to run amok -- can damage cells and perhaps lead to cancer, heart disease, and other ailments. The supplement fans do acknowledge that antioxidants can be found in fruits and vegetables. But, they say, why settle for the relatively small quantities in food when you can get so much more by swallowing a few pills?

I've long been skeptical of these claims, wary of taking a pill to get nutrients already available to me in oranges, broccoli, and the like. But lately I've wondered: Is a nutritious diet really enough, or should I follow my friends' advice and take large doses of supplements? Government experts, interestingly enough, recently cast their vote for food and against pills. But their position has left as many questions as answers, and consumers like me are still confused.

The Science Behind Antioxidants

Here's why people are scratching their heads. According to some studies, the pills seem to have worked wonders. For instance, vitamin E in daily doses of 400 to 800 international units (IUs) reduced the risk of heart attack by 77% in people with atherosclerosis who participated in the Cambridge Heart Antioxidant Study. (Harvard University scientists conducted the research and published their findings in the March 23, 1996 issue of the Lancet.)

But a study that tracked 2,545 women and 6,996 men aged 55 and older found that those who took vitamin E for five years suffered just as many strokes and heart attacks as those taking a placebo. (See the Jan. 20, 2000 issue of the New England Journal of Medicine.) Some research has even suggested that antioxidants may increase the risk for certain ailments. For instance, in a study published in the April 14, 1994 issue of the New England Journal of Medicine, researchers looked at more than 29,000 male smokers to see if vitamin E and beta-carotene could prevent disease. They found that large doses of beta-carotene appeared to raise the risk of lung cancer, while the vitamin E had no effect.

This spring a panel of top scientists, convened by the federal Institute of Medicine, weighed in. They concluded that we should be getting our antioxidants from the foods we eat, not popping handfuls of pills.

"There is not sufficient evidence that taking antioxidants in large doses will prevent chronic diseases such as heart disease," says Norman I. Krinsky, PhD, a Tufts University biochemist who chaired the panel. Still, the verdict could change, he says, if a raft of yet-to-be-completed studies turns up enough evidence to prove that supplements are worthwhile.

For now, then, here are the doses recommended by the panel:

• Vitamin C, 75 milligrams a day for women, 90 for men, with an upper limit of 2,000 milligrams.
• Vitamin E, 15 milligrams, with a max of 1,000 milligrams a day.
• Selenium, 55 micrograms, with an upper limit of 400 micrograms a day.
• No daily recommendation was given for beta-carotene.

April 27, 2004 -- What causes obesity? Blame blood fats, a new study suggests.

Your body has a very effective way to keep you slim: It tells you to stop eating. It does this by sending out a chemical signal -- a hormone called leptin. When leptin reaches the brain, your brain says, "Enough." Hunger goes away.

But high levels of blood fats -- technically, triglycerides -- block this signal before it gets to the brain, report William A. Banks, MD, of the VA Medical Center in St. Louis and Saint Louis University, and colleagues. This is the cause of obesity, they suggest in the May issue of Diabetes.

"We figured out how obesity occurs," Banks says in a news release. "This is a big deal. We now know what is keeping leptin from getting to where it needs to go to do its work."

Evolution and Modern Man

Starvation -- not obesity -- was our ancestors' main problem during most of evolution. That explains why the body has a built-in system for keeping its hunger switch in the "on" position.

When a person badly needs food, levels of blood fats get high. This blocks leptin and keeps a person hungry and looking for food.

Unfortunately, having plenty to eat causes a new problem -- one for which we haven't yet evolved a natural solution. Obese bodies also have a lot of fats in the blood. This, too, keeps a person hungry and looking for food.

"We feel that we now understand what part of the system is broken -- why leptin isn't working," Banks says. "We have a better understanding of why people are becoming obese."

Fighting the Cause of Obesity

In their experiments, Banks' research team showed that triglycerides do indeed keep leptin out of the brains of obese mice. The more triglyceride fats they ate, the less leptin reached their brains. Vegetable triglycerides did not block leptin, but animal triglycerides did.

A triglyceride-lowering drug -- Lopid -- reversed this leptin-blocking effect in the obese mice. Such treatments might work in humans, suggests John Morley, MD, director of geriatric medicine at Saint Louis University and a member of Banks' research team.

"If you lower triglycerides, you should theoretically help the body's own leptin to work better so people can get skinnier," Morley says in a news release.

Eating a low-fat diet is a natural way to lower your blood fats. It's not clear that Lopid or other drugs will help, but much more study is needed before such treatments can be used to treat obesity.

And even if Lopid did work this wonder, it's no magic potion. A person taking the drug has to be on a low-fat diet.

June 13, 2005 -- Practice may make the brains of highly trained musicians and other skilled individuals different from the rest of us.

Researchers found that hand movements of skilled violinists create different patterns of activity in the brain than those produced by nonmusicians.

They say the results suggest that extensive practice may rewire the brain to facilitate complex movements in highly trained musicians, athletes, and others.

The results of the study were presented this week at the 11th annual meeting of the Organization for Human Brain Mapping in Toronto.

Practice May Alter the Mind

In the study, researchers used magnetic resonance imaging (MRI) scans to compare brain activity patterns triggered by finger movements in a group of eight expert amateur violinists and eight people with no musical training. All of the participants were right-handed.

Researchers recorded brain activity while the participants were cued to use one of their fingers to press a violin string on a fingerboard placed on their laps.

The results showed that finger movements of the nondominant left hand led to predictable brain activity in musicians but not in nonmusicians.

But movement of every finger of the dominant right hand led to predictable brain activity in nonmusicians but not the violinists.

Researchers say the findings show that extensive practice of specific individual finger movements in the violinists' left hands led to unique patterns of brain activity not found in nonmusicians.

In addition, the more synchronized movements of the fingers of the right hand of the violinists, which holds the bow, produced less compartmentalized patterns of brain activity for each finger than those found in the dominant hand of the nonmusicians.

Researchers say the study shows that the brain has different activity patterns related to both highly individualized and synchronized finger movements, which can be altered by intensive practice.

April 30, 2003 -- Seeking -- and finding -- positive meaning in grief may boost the immune system.

There's a lot of evidence that stressful life events can harm a person's health. There's also a lot of evidence that people are capable of amazing resilience. Many people thrive after surviving tragedy.

Why? Many things must be involved. Julienne E. Bower, PhD, and colleagues at the University of California, Los Angeles, looked at one of them. They studied 43 women who had just lost a close relative to breast cancer. They also looked at a set of important immune cells -- natural killer cells -- in the women's blood.

Bower and colleagues found the women who placed the most importance on cultivating relationships, personal development, and striving for meaning in life had the most active immune cells. And over a four-week period, women who came to see these goals as more important had improved immune function.

"This study supports the possibility that a generalized form of goal engagement -- one relevant to more intrinsic goals, such as finding meaning -- may have positive [effects on immunity]," Bower and colleagues write in the Annals of Behavioral Medicine.

The women were divided into two groups at the beginning of the study. Every week, one group wrote about the death of their relative while the other group wrote about non-emotional things such as their plans for the day. Women who wrote down their feelings did not have better immune function.

The next step will be to uncover the ways in which "finding meaning gets under the skin and influences the immune system," Bower says in a news release.

Sept. 24, 2001 -- Gray Scott, of Florence, S.C., has been treated for anxiety for nine years, from the time she was diagnosed with an eating disorder at age 15. Since then, she has tried a variety of medications and psychotherapy, with variable results.

?

"When the symptoms are alleviated, it becomes tolerable," she tells WebMD. "At their worst, I have felt very desperate."

?

Scott is not alone. Anxiety disorders -- including phobias, panic attacks, obsessive-compulsive disorders, and posttraumatic stress disorder -- affect more than 23 million Americans. Although treatment with a combination of drugs and therapy is very often successful, some patients go from drug to drug, and therapy to therapy, with no relief.

?

"Most people think of anxiety disorders as not terribly devastating, and easily treatable with drugs," says psychiatrist Mark George, MD, director of the brain stimulation laboratory at the Medical University of South Carolina in Charleston. "But there is a substantial core of people for whom drugs don't work and for whom there are no good alternatives."

?

That may change, however, if a new surgical treatment called vagus nerve stimulation, or VNS, proves successful.

?

On May 18, Scott became one of the first anxiety patients to receive the experimental treatment. On that day, surgeons at the Medical College of South Carolina implanted a device in her chest, similar to a heart pacemaker, and wired it to electrically stimulate the vagus nerve in her neck.

?

Named for the Latin word meaning "wandering," the vagus nerve meanders from the colon, past the intestines, heart, and lungs, and comes together at the diaphragm, where it runs as a thick cable past the esophagus and into the brain.

?

George calls the nerve "an information superhighway to the brain." Contrary to long-held wisdom, the traffic on that highway is mostly going north -- from the body to the brain, not vice versa, he says.

?

"Most people have thought of it as the way the brain controls the heart and the guts," George explains. "In fact, most of the information is actually going in the other direction. The vagus nerve is really the brain's way of interpreting what is happening in the heart and the guts."

?

That suggests an intriguing theoretical reason why VNS might work well for people with anxiety, he says.

?

"Emotions are not brain events, but the brain's interpretation of bodily events," George says. "When you feel scared, it's really your brain sensing that your heart rate is going up."

?

So by stimulating the vagus nerve, George and others hope to influence the exchange of information between body and brain, and thereby relieve the symptoms of anxiety.

?

Whether this works remains to be seen. Today, the device implanted in Scott's chest activates every five minutes, stimulating her vagus nerve with a small electrical current for a period of five seconds. When it activates while she is talking, her voice suddenly becomes mildly hoarse.

?

"Some days I think it's helping, and some days I don't know," she says. "At first I was expecting something instantaneous, but it doesn't work that way. It can take months to see any results."

Do you smoke? Do you have a family history of cancer? Are you spiritual?

It's not often that you hear your doctor pose that last question. But a new survey of 920 adults shows that patients want their doctors to ask about their spirituality in many cases, such as when facing a life-threatening disease or a serious medical condition.

A positive spirit is often credited for helping people cope with life's toughest obstacles, such as a devastating illness. But spirituality's role in health care has long been controversial, and doctors traditionally have shied away from spiritual or religious discussion.

Evidence indicates that patients who are more spiritual or religious have lower mortality rates, reduced stress, and overall better physical and mental health. They typically require fewer health services. Lack of spiritual training, unwillingness to depart from established medical arenas, and ethical issues are some of the reasons why doctors have avoided widespread spiritual discussion with patients.

In an effort to clarify how spirituality should be encompassed in a medical setting, patients at five family physician offices (four urban, one suburban) in Ohio were asked to rate their spirituality (1 being not spiritual at all, 5 being extremely spiritual) and to describe how their beliefs played a role in their health care decisions. The survey also included questions about their medical history, experiences with a serious illness, and whether or not they had ever asked a doctor (or vice versa) about their spirituality. The majority of those surveyed were women.

Study author Gary McCord, MA, of Northeastern Ohio Universities College of Medicine, found that 83% of respondents wished to discuss their spiritual beliefs with their doctor. Spiritual discussion was most acceptable when dealing with a life-threatening illness, serious medical condition, or a loss of a loved one. It was least welcome during routine physical exams.

Among the findings:

• People aged 30 to 64 most welcomed spiritual discussions.
• 17% never wanted to be asked about their spirituality.
• 20% always wanted their doctor to be aware of their beliefs.
• 18% told their doctor about their beliefs without being asked.

Of those who wished to discuss spirituality:

• 87% wanted their doctor to understand how their beliefs helped them deal with being sick.
• 83% wanted their doctor to understand how their beliefs influenced their decisions.
• Women were more likely than men to change their medical treatment based on spirituality.
• Two-thirds believed that by having doctors know about their spiritual beliefs, they would be advised on how to take care of them when sick.
• 67% believed that by having doctors know their spiritual beliefs they would be compassionate and encourage hope.

The findings were reported in the July/August 2004 Annals of Family Medicine.

SOURCE: McCord, G. Annals of Family Medicine, July/August 2004; vol.2: No. 4.

New York lingerie designer Carolyn Keating was thrilled to land a job interview with Victoria's Secret. She knew that being on time was essential to making a good impression, but there was just one problem. "I had written down the address wrong. I meant to check it the night before on the computer, but I didn't." When Keating finally arrived at the correct address, she was 30 minutes late. "I felt embarrassed and it really flustered me," she tells WebMD. "I carried that insecure, worried, flustered energy throughout the interview." She didn't get the job.

Another time, Keating and several friends showed up 15 minutes late to a colleague's wedding. "The bride was already at the alter. She was basically saying 'I do' when we tumbled in, and it's hard for six or seven people to tiptoe in quietly. We were worried that we ruined the most important day of her life."

For some people, being on time seems nearly impossible -- no matter how important the event. They're always running out the door in a frenzy, arriving everywhere at least 10 minutes late. If this sounds like you, have you ever wished you could break the pattern? According to Julie Morgenstern, author of Time Management From the Inside Out, the first step is to make promptness a conscious priority.

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"Look at the costs of being late and the payoffs of being on time," Morgenstern advises. She says it's important to recognize that being late is upsetting to others and stressful for the one who is late. "I think people's stress level is very high when they're late. They're racing, worried, and anxious. They spend the first few minutes apologizing. One of the payoffs of being on time is that you eliminate the stress of the travel time and you eliminate the time spent apologizing."

The Consequences of Being Late

The consequences of being chronically late run deeper than many people realize, according to psychologist Linda Sapadin, PhD, author of Master Your Fears. "You're creating a reputation for yourself, and it's not the best reputation to be establishing. People feel they can't trust you or rely on you, so it impacts relationships. It also impacts self-esteem."

Once you feel motivated to make a change, Morgenstern says the next step is to figure out why you're always late. The reason can usually be classified as either technical or psychological.

Technical Difficulties

"If you're always late by a different amount of time -- five minutes sometimes, 15, or even 40 minutes other times -- it is likely that the cause is technical," Morgenstern tells WebMD. "That means you are not good at estimating how long things take," whether it's drive times or routine activities like taking a shower.

Keating says she falls into this category. "It's a case of bad planning, of thinking you need less time than you actually do."

The solution, Morgenstern says, is to "become a better time estimator." She suggests keeping track of everything you do for a week or two. "Write down how long you think each thing will take and then how long it actually took." This will help you find a pattern, so you can adjust your time estimates.

Keating says this strategy is helpful. "You have to be realistic about how long certain things take, especially things you do routinely. If you know it takes 20 minutes to blow dry your hair, allow yourself 20 minutes to blow dry your hair," she says, "and leave a little extra time for those days when your hair is uncooperative."

Learning to Say 'No'

Another technical difficulty for some people is the inability to say "no" to additional commitments when they're short on time. You might be a good time estimator, Morgenstern explains, but "your best-laid plans get waylaid when someone asks you for something and you can't say 'no.'"

The solution to this problem is to "practice catchphrases," Morgenstern tells WebMD. Learn to defer or decline requests by saying, "I would love to help, but I'm on a deadline" or "I'm meeting people in half an hour. I can help you tomorrow."