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Expert
january 2011
8
Special report
Why minerals matter
2
editor’s note
Doctors and drug
companies
health wire
• Bedtime and blood
pressure • Secrets of happy
people • Bone-drug risk
3
upfront
Flu poll
6
health-care savvy
Airline scanners
7
getting personal
Laugh, sing, pray
10
illustration by meredith Hamilton
drugs & herbs
When to stop taking
a drug
11
office visit
Browsing the
tangled Web
12
on your mind
• Vitamins and the flu
• Chilblains • Aspirin
Independent
Nonprofit®
Volume 23 Number 1
$3
Are you better than average?
I
f you’re like most people, you know it’s important to
eat right, exercise, and take common-sense steps like
watching the speed limit and wearing a bike helmet.
But if you’re like most people, you probably don’t do
too well on following through on those measures.
With the scorecard at right and on page 5, you
can track your performance on several important
indicators of good health, largely drawn from the U.S.
government’s Healthy People 2010 initiative, which
measures the nation’s progress toward meeting established
health goals.
Exercise
Average minutes of moderate exercise a day for
U.S. adults: 26 for men, 19 for women.
the goal: At least 150 minutes a week of moderate
activities, such as biking, gardening, or walking, or 75
minutes of vigorous activities, such as running.
what to do: For cardiovascular benefits, exercise
should last at least 10 minutes. You’ll get additional
benefits by increasing to 300 minutes a week (150
minutes for vigorous exercise) and by adding strength
training two days a week.
why it matters: Exercise builds cardiovascular
fitness, slows age-related muscle loss, reduces body fat,
and helps maintain cognitive function.
Weight
Average weight: A body mass index of 28 for
men and women, and a waist circumference of
39.7 inches for men and 37 inches for women.
the goal: A BMI (which correlates weight to height)
of less than 25 and a waist circumference of less than 37
inches in men and 32 inches in women.
Continued on Page 4
© 2011 by Consumers Union of United States, Inc. All rights reserved.
reproduction in whole or in part is forbidden without prior written permission.
01, 04-05 FEATURE.indd 3
11/8/10 1:24:38 PM
consumer reports
on health
James a. guest
president
john sateja
executive Vice President
Kevin Mckean
vice president and editorial director
Greg daugherty
executive editor, franchises
ronni sandroff
editorial director, Health & Family
alison france
Marvin M. Lipman,
M.D., Chief
copy editor
orly avitzur, M.D.
Medical Editors
nicole sarrubbo
editorial associate
Christopher
hendel
George Arthur
associate director
Design Director
Irwin D. Mandel,
tim lapalme
D.D.S.
Dental Adviser
creative director
melissa virrill
managing Editor
joel Keehn
senior editor
NANCY METCALF
senior proGRAM
editor
jamie kopf HIRSH
associate editor
teresa carr,
alan cassels,
Catherine
Machalaba,
kevin mccarthy,
joe rojas-burke,
susan stellin
Contributing writers
Janice Hogan
art director
David Fox
Director, editorial
operations
nancy crowfoot
associate director,
editorial scheduling
letitia hughes
Production
associate
TARA
MONTgomery
director, health
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Editor’s note
Doctors and drug companies
Would you trust a doctor who moonlights for a drug company
promoting its products to other doctors? Many Americans are
skeptical about such arrangements, according to a recent survey
of 1,250 adults in the U.S. by the Consumer Reports National
Research Center. And 77 percent of respondents said they would
be concerned about the quality of care from a doctor who accepts
such payments.
The poll was prompted by a report by ProPublica, a nonprofit
organization that does investigative journalism. It identified
more than 17,000 health-care providers (mostly doctors) who have accepted payments
from seven drug companies—AstraZeneca, Cephalon, GlaxoSmithKline, Johnson
& Johnson, Lilly, Merck, and Pfizer—since 2009. Of those, 384 collected more than
$100,000, 43 made more than $200,000, and two earned more than $300,000. You can
look up the names on ProPublica’s website, at http://projects.propublica.org/docdollars.
Under the new health-care reform law, all drug firms must disclose their financial ties
to doctors by 2013.
In our poll, most respondents said that doctors should tell patients if they’ve
received money from a company whose drugs they are about to prescribe. And 54
percent said they’d feel comfortable asking their doctor about the issue. It’s time for
doctors to come clean.
ronni sandroff, editor
health wire health wire health wire
To boost weight
loss, exercise. That’s
the finding of a study of
130 obese adults in the
Oct. 27, 2010, issue of
the Journal of the American
Medical Association.
People who dieted
for six months lost
an average of
18 pounds,
while those
who also
exercised for
an hour a day
five days a
week lost 24
pounds.
Bedtime and blood
pressure. People with
hypertension are particularly
likely to have heart attacks
overnight, in part because
their blood pressure
typically doesn’t go down
then as much as it should.
A five-year study in the
September 2010 issue
of Chronobiology
International found that
people who took at
least one of their
blood-pressure pills at
night were less likely to
have heart attacks than
those who took all their
pills in the morning.
Skip surgery for
spinal compression
fractures. A common
surgery called vertebroplasty, often used to treat
spinal fractures caused by
osteoporosis, doesn’t work,
according to the American
Academy of Orthopaedic
Surgeons. It pointed to two
recent trials that found that
people who had the
operation had the same
levels of function and pain
as those who didn’t have it.
Risk of bone drugs.
The U.S. Food and
Drug Administration
warned in October 2010
that women with
osteoporosis who take
bisphosphonates—such as
alendronate (Fosamax and
generic), ibandronate
(Boniva), and risedronate
(Actonel and generic)—for
2 • january 2011 • Consumer Reports on Health
© 2011 by Consumers Union of United States, Inc. All rights reserved.
reproduction in whole or in part is forbidden without prior written permission.
02-03 Upfront.indd 2
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11/8/10 1:25:55 PM
h
a
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UpFront
™
•
5 bad reasons for skipping the flu shot
F
ifty-five percent of the adults in a
recent survey by the Consumer Reports
National Research Center didn’t get the
seasonal flu shot last year. Here are their
reasons—and our response.
1 I believe in building my natural
immunity (60 percent).
The vaccine builds immunity, too, without the risk of disease or its complications.
And since flu viruses change from year to
year, the protection you develop one season
might not help much the next.
2 I don’t get the flu (41 percent).
That’s probably just good luck. You can
also get the flu with symptoms so mild you
don’t even notice them—yet still spread
the disease.
3 Medicine and other remedies can
treat the flu (38 percent).
The antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) can make
flu symptoms less severe and shorten the
duration by a day or two. But they work
best if they’re started within two days of
the onset of symptoms.
4 I worry about side effects or getting
the flu from the vaccine (36 percent).
Side effects are usually limited to soreness at the injection site, aches, low-grade
fever, and, in very rare cases, serious
allergic reactions or possibly Guillain-Barré
syndrome, a neurological disorder. But
the shot’s benefits against illness far outweigh its risks. It contains an inactivated
virus and can’t cause the flu. The nasal
spray contains a weakened live virus and
might cause mild symptoms but not a
full-blown infection.
5 I don’t like shots (24 percent).
The flu shot uses a small-bore needle
so it causes little pain for most people.
If that doesn’t reassure you, look away.
Lying down and standing slowly afterward can help prevent fainting if you are
prone to it. Or ask your doctor if you’re a
candidate for the nasal spray.
health wire health wire
a minimum of five years
might face an increased
risk for femoral, or thigh,
fractures.
3 healthy habits for
preventing breast
cancer. A study that
followed nearly 86,000
postmenopausal women
for an average of 5.4
years found that those
who exercised at least
moderately hard a
minimum of five times a
week for 20 minutes a
session, had no more than
seven drinks a week, and
maintained a body mass
index of less than 25 were
less likely to develop breast
cancer. That was true even
among women who had a
family history of late-onset
breast cancer.
The secret of happy
people. It’s not
professional or financial
success, according to a
25-year study published
online by the Proceedings
of the National Academy of
Sciences in October 2010.
Instead, it’s community
involvement, healthy
Say yes? Say no?
Cold champagne. Corks
in warm
bottles are
more likely to
pop unexpectedly, so chill
champagne to
45° F or colder
before
opening.
✖
OTC chelation therapy.
The Food and Drug
Administration recently warned
about over-the-counter chelation
products—which supposedly
remove toxic metals from the
body—that are marketed to
prevent or treat Alzheimer’s
disease, heart disease, and
macular degeneration. The
products don’t have FDA
approval and can be harmful.
Six miles a week.
People 65 and older who
walked at least six to nine miles a
week cut their risk of developing
memory problems later in life
compared with people who
walked less, according to a
recent study.
✖
relationships,
and helping
others.
Vitamin D and
skin cancer.
Patients with a genetic
predisposition to a
form of basal cell skin
cancer are three times
more likely to be deficient
in vitamin D than other
people, says an October
2010 study in the
Archives of Dermatology.
Other research has
linked low levels of the
vitamin— common in
many adults, especially
older ones—to an
increased risk of other
cancers as well.
Dryer lint. Lint-filled dryer
ducts cause 4,500 fires a
year in the U.S. So keep the lint
basket clean, check the outside
vent to make sure that exhaust
escapes, keep the area around
the dryer uncluttered, and
consider having a professional
clean the interior of the chassis.
Winter sunscreen.
Reflection from snow can
nearly double the strength of
ultraviolet light, increasing the
risk of sunburns. That’s a
particular
concern when
you’re at high
altitudes
because the
thinner air filters
out less radiation.
Consumer Reports on Health •
january 2011
• 3
© 2011 by Consumers Union of United States, Inc. All rights reserved.
reproduction in whole or in part is forbidden without prior written permission.
02-03 Upfront.indd 3
11/8/10 1:26:06 PM
Blood pressure
Cover story
Are you better than average? •
Average blood-pressure levels: 127
millimeters of mercury for the
systolic (upper) level and 77 mmHg
for the diastolic (lower) level.
Continued from page 1
do :
To calculate your
BMI, divide your weight in pounds by
your height in inches squared, and then
multiply by 703. Or use our calculator at
www.ConsumerReportsHealth.org/BMI.
To measure your waist, wrap a tape
measure around your bare abdomen at
about the belly button. Relax, exhale,
and measure the inches. If your BMI
or waist size are high, commit to a
weight-loss plan.
why it matters : People with a BMI
of less than 25 have lower rates of heart
disease, high blood pressure, type 2
diabetes, and premature mortality than
those with a score of 25 or more. A
BMI of 30 or more means you’re obese
and multiplies your risk of disease and
death further. Even if your BMI suggests
you’re not overweight, having a largerthan-average waistline can sharply
increase health risks.
what
to
the goal: A systolic under 140 mmHg
DIET
Average daily servings of fruit and
vegetables: Less than three for men
and less than four for women.
the goal: At least two to four daily
servings of fruit and three to five daily
servings of vegetables.
what to do : Work produce into
your day by adding fruit to your cereal
or yogurt, for example, and having it as
a main course or even dessert at dinner.
Make veggie omelettes for breakfast,
add shredded carrots or bean sprouts to
salads or sandwiches, and thicken soups
and gravies with puréed vegetables.
why it matters: A diet high in fruit
and vegetables can reduce the risk of
many causes of premature death. Fruit
and vegetables supply important nutrients and disease-fighting compounds,
and giving them prominence in your
diet can help avoid excess weight gain.
and, preferably, under 120 mmHg; and a
diastolic under 90 mmHg and, preferably,
under 80 mmHg.
what to do : To lower high blood
pressure, lose excess weight, exercise
regularly, cut back on sodium, eat lots
of produce, and consider medication.
why it matters : High blood pressure is the leading risk factor for heart
attacks and strokes, and also contributes
to kidney disease and cognitive decline.
CHOLESTEROL LEVELS
Average cholesterol levels: 119 milligrams per deciliter for LDL (bad)
cholesterol and 53 mg/dL for HDL
(good) cholesterol.
the goal: An LDL under 100 mg/dL
and an HDL over 60 mg/dL.
what to do : To improve your
cholesterol levels, lose excess weight,
To find out how long you’ll live, find out how fast you walk
walking speed In a hallway, mark start and finish
lines six meters (19 feet, 8 inches) apart. Have a
partner time you. Walk briskly but don’t run, and stride
past the finish line without slowing. Divide the time in
seconds by six to get meters per second.
Average: 0.9 meters per second for people over 50.
one - leg balance
With bare feet, stand with your
arms folded across your chest. Raise one foot slightly
off the ground and have someone start a stopwatch,
stopping when you uncross your arms, move the leg
you’re standing on, or touch the raised foot to the floor.
(Stand next to a counter or piece of furniture.)
Average: 43 seconds for 18- to 39-year-olds; 40
seconds for 40- to 49-year-olds; 37 seconds for 50- to
59-year-olds; and 27 seconds for 60- to 69-year-olds.
(With eyes closed: 9 seconds for 18- to 39-year-olds;
7 seconds for 40- to 49-year-olds; 5 seconds for 50- to
59-year-olds; and less than 3 seconds for those older
than 60.)
chair stands (for people 70 and older) Stand up
from a chair five times in a row as quickly as possible
without stopping. Keep your arms folded across your
chest, come to a full standing position each time, and
sit all the way down each time. The clock should be
stopped when your bottom hits the seat the fifth time.
Average: 14.28 seconds for women and men.
sit - ups (for people younger than 70) Lie on your
back with your knees bent at a right angle and your
feet flat on the floor. Place your hands palms down
on the ground next to your body, and with your lower
back kept flat on the ground, curl up your shoulders so
your fingers slide forward about 3.5 inches, then return
your shoulders to the floor. Count the number you can
complete in one minute.
Averages for women: 25 for women 40 to 49; 31
for those 50 to 59; and 12 for those 60 to 69.
Averages for men: 33 for men 40 to 49; 39 for those
50 to 59; and 18 for those 60 to 69.
4 • January 2011 • Consumer Reports on Health
© 2011 by Consumers Union of United States, Inc. All rights reserved.
reproduction in whole or in part is forbidden without prior written permission.
01, 04-05 FEATURE.indd 4
11/8/10 1:24:57 PM
illustration by meredith Hamilton
Your walking speed and ability to rise from a chair are
surprisingly effective at predicting your longevity. In a
study of more than 3,000 healthy retirees, for example,
those with the slowest gait were about 50 percent more
likely to die within seven years. Take these tests to see
how you compare.
exercise regularly, drink alcohol in
moderation (if at all), minimize foods
high in saturated fats, and eliminate
trans fats, which are found mainly
in baked goods such as store-bought
cookies and pastries, as well as fast
foods. If those measures aren’t sufficient,
prescription medication can help. We
recommend generic lovastatin, simvastatin, or pravastatin for most people.
why it matters : A high LDL or low
HDL increase your risk of a heart attack
or stroke.
heart rate
illustration by meredith Hamilton
Average resting heart rate: 75 beats
a minute for men, 77 for women.
the goal: Less than 60 beats a minute
for men; less than 64 beats per minute
for women.
what to do : To measure your heart
rate, sit quietly for 5 minutes, then use
your fingertips to find a pulse at your
wrist or neck. Count the number of
beats in 30 seconds and multiply by
two. If your rate is above 75, consider
consulting with a health-care provider.
why it matters : Women with a
resting heart rate above 90 beats per
minute were three times more likely to
die of heart disease than those with a
rate below 60 beats a minute, according
to a 2010 study of 22,000 people. Men
with rates above 90 were twice as likely
to die of heart disease. Research sug-
gests that risk starts to rise substantially
at about 75 beats per minute.
alcohol
percent increase in speed results in a 43
percent rise in accident fatality, research
suggests. And making phone calls while
you drive is as risky as driving drunk.
Adults who drink more than is
healthy: 28 percent.
biking
what to do : Aim for no more than
an average of two drinks a day if you’re
a man or one a day if you’re a woman.
Also avoid binge drinking, which is
considered consuming five or more
drinks at any one sitting. Watch how
much is in each drink, too, because it’s
easy to underestimate. A glass of wine
or beer served at a restaurant or bar
typically contains far more alcohol than
health researchers consider the equivalent of one drink.
why it matters : Moderate drinking might protect the heart, but excessive drinking can raise blood pressure,
make certain cancers more likely, cause
devastating emotional and family problems, and bring on an early death.
DRIVING
Drivers who always stay within
speed limits: 33 percent.
what to do : Don’t speed, talk on
your cell phone, or text while driving.
Don’t tailgate, either. Leave two seconds
between you and the car in front.
why it matters : Nearly 5 million
people injured in traffic accidents each
year require hospital treatment. A 10
Bicyclists who wear helmets for all
or most trips: 35 percent.
what to do : Try helmets for comfort, fit, and style before buying. It should
fit snugly and sit level on your head, and
not expose your forehead or tilt forward
and cover your eyes. Replace any helmet
that has been in a crash whether you can
see any damage or not.
why it matters : A properly fitting
helmet can prevent up to 88 percent of
bicycle-related brain injuries.
Flu shots
Adults who got the flu vaccine during the 2009 and 2010 flu season:
41 percent.
what to do : Get a flu shot every
year, as soon as it’s available.
why it matters : Vaccination cuts
flu risk by 20 to 90 percent depending
on your age, health status, and how well
the vaccine matches the strains that
year. Even when the shot doesn’t stop
the flu it can ease symptoms. And it reduces the chance you’ll spread the disease, a crucial matter if you live or work
with infants, older adults, or those with
chronic health problems. ■
Consumer Reports on Health •
January 2011
• 5
© 2011 by Consumers Union of United States, Inc. All rights reserved.
reproduction in whole or in part is forbidden without prior written permission.
01, 04-05 FEATURE.indd 5
11/8/10 1:25:12 PM
l
HealthcareSavvy
™
Are the new airport scanners safe?
I
f you haven’t seen the new screening
machines that are popping up at U.S.
airports, chances are you will soon.
The Transportation Security Administration (TSA) is replacing most metal
detectors with imaging devices that
reveal items hidden underneath passengers’ clothing. But some experts worry
that the new machines could expose
travelers to health risks. And there are
concerns about privacy issues, too.
There are actually two types of
scanners, both of which require you to
step into a booth and raise your arms.
Millimeter wave machines use electromagnetic waves to create an image of
the body, while the more controversial
backscatter devices beam low-energy
X-rays to produce a picture. The government says the radiation emitted from
those devices is minimal, equal to the
natural exposure during 2 minutes of
Millimeter wave scanners (left)
might be safer than X-ray devices.
flying, though some research suggests
it’s higher.
Because the backscatter machines
use low-energy X-rays, most of the radiation is absorbed by the skin and doesn’t
penetrate the body, as medical X-rays do.
But some experts think that could raise
the risk of skin cancer or sperm mutations, especially in frequent flyers.
Other concerns involve cancer
patients, children, pregnant women, and
anyone with a compromised immune
system, all of whom are more vulner-
able to radiation risks. But perhaps
the biggest fear about using X-ray
scanners at airports is the possibility of
a software glitch or operator error that
exposes passengers to excessive doses
of radiation.
Although the TSA says the scans are
safe, you’re allowed to skip them and
pass through a metal detector instead.
But if you choose that option you’ll be
subject to a hand search, which can take
extra time. And some people consider
them to be more intrusive.
You might encounter resistance
from airport screeners when declining
to be scanned, so print the FAQs from
the TSA’s website (www.tsa.gov), which
state that you have that right. You can
also ask at the airport if the device uses
the more worrisome X-ray technology.
You don’t have to be as concerned about
the millimeter wave machines. ■
One-minute consult
Should you join a clinical trial?
Jerry Menikoff, M.D.,
J.D., director, federal
Office for Human
Research Protections;
author, “What the Doctor
Didn’t Say: The Hidden
Truth About Medical Research” (Oxford
University Press, 2006).
What are some of the benefits of
enrolling in a clinical trial?
You might get a treatment that you
otherwise wouldn’t have gotten if the
study is testing something that’s not
yet approved by the FDA. That can
be especially beneficial if the existing
treatments for your condition aren’t that
effective—although there’s no guarantee
that you will be in the group that gets the
study treatment rather than a placebo or
older therapy. A trial also might give you
a chance to be treated at a university or
by a doctor that you otherwise wouldn’t
have access to or couldn’t afford. Some
people sign up for trials because the
new information benefits society. No
matter how much testing we do in
animals or computer models, biological
beings are very complicated, and until
you can test the treatment in a human,
you’re not certain how well it works.
What are some downsides?
You will not have a choice about being
assigned to get either the new treatment being tested or an older treatment,
or maybe no treatment at all. If you
are happy with the treatment you are
6 • january 2011 • Consumer Reports on Health
06 Healthcare Savvy.indd 6
already getting, a clinical trial might
not be a good choice. You also have to
understand that the purpose of a clinical
trial is to answer a research question,
and that can mean extra tests and extra
procedures. The treatment won’t be as
personalized as it would be if you went
to your own doctor. For example, the
doctor can’t always change the dose up
or down based on how you’re responding.
How can you find a clinical trial?
The ClinicalTrials.gov website is an
excellent starting point. You can search
by disease, type of treatment, or other
factors. Each page will have contact
information for the people running the
trial. Before you call, you might want to
Google the drugs that are being tested
to learn more about them. People also
find out about trials from advertisements
or are referred by their own doctors.
© 2011 by Consumers Union of United States, Inc. All rights reserved.
reproduction in whole or in part is forbidden without prior written permission.
11/8/10 1:26:57 PM
GettingPersonal
™
l
Laugh, sing, pray
H
umor, music, and spirituality
can obviously boost your mood,
but growing evidence suggests
that they offer physical benefits, too—
without co-payments or side effects.
Photo upper right courtesy of laughteryoga.org
humor for your health
A hearty laugh appears to have a number
of physiological effects, including:
Increased blood flow. Watching
30 minutes of a comedy film (“There’s
Something About Mary”) caused the
arteries of volunteers to expand, according
to a 2006 study from the University of
Maryland Medical Center, while scenes
from a stressful film (“Saving Private
Ryan”) caused them to constrict.
Strengthened immunity. Laughter
might stimulate production of diseasefighting T cells and natural killer cells,
and reduce levels of inflammationtriggering cytokines in people with
rheumatoid arthritis. Watching funny
movies might also help ease allergy
symptoms and help people with asthma
resist flare-ups.
Reduced muscle pain. Laughter
provides distraction and causes muscles
in the abdomen, face, and shoulders to
relax, which might ease muscle tension.
Lower blood sugar. People with
type 2 diabetes had smaller increases
in blood glucose when they watched a
comedy show after a meal than when
they sat through a boring lecture.
Burn calories. Laughing boosted
energy expenditure by 10 to 20 percent
among people in a 2007 study.
What to do: If funny movies aren’t
your thing, or if life of late hasn’t given
you much to laugh about, consider
“laughter yoga,” a variation designed to
induce joyful, prolonged laughter.
music for your brain
Reading music and singing might boost
your brain’s auditory and languageprocessing functions, while playing an
instrument strengthens reaction speed
and manual dexterity. Other research
has linked choral singing with good
physical and emotional health. In addition, music might improve symptoms of
several health problems:
Alzheimer’s disease. Listening to
music might reduce aggression, irritability, restlessness, and the tendency to
wander in people with the condition.
Insomnia. Listening to 45 minutes
of soft music before bed improved selfreported sleep time and daytime drowsiness in a study of 30 older adults.
Pain. People recovering from hernia
or varicose-vein surgery who listened to
music reported less pain than a control
group did in a trial of 182 patients.
Music might also ease the pain and
distress of arthritis, childbirth, colonoscopy, fibromyalgia, and herniated disks.
Parkinson’s disease. Listening to
rhythmic music can help patients move
more easily.
Stress. Listening to mellow music
can reduce stress, blood pressure, and
heart rate during and after eye surgery.
And people who had music therapy
after knee-replacement surgery experienced less depression.
Stroke. Singing might help patients
regain the ability to speak more clearly
after a stroke.
What to do: Choose music you find
relaxing. If someone you care about is
in a health-care facility, consider asking
about music therapy.
Laughter can boost immunity, ease
pain, protect the heart, and help
control blood sugar levels.
a spiritual life
Regularly attending traditional religious
services or practicing meditation appear
to offer several health benefits, research
suggests.
Traditional
religion. Regularly
attending church was linked to a lower
incidence of death from cardiovascular
disease in a review of 69 studies. And a
2009 study found that men who attended
church in their 40s had better physical
health at 70 than men who hadn’t attended
church, possibly because they tended to
drink and smoke less.
Meditation. The evidence is especially strong for an easy-to-learn form
called mindfulness, in which people focus
on the present while practicing measured
breathing. Meditation induces rapid
physiological changes, including reduced
blood pressure, heart rate, and muscle
tension. It might also reduce cardiovascular risk, ease depression, and help
people with chronic pain, fibromyalgia,
headaches, irritable bowel syndrome,
multiple sclerosis, psoriasis, and type 1
diabetes.
What to do: If you already participate
in an organized religion, these findings
provide more reason to continue doing
so. To try meditating, look for a class or
teach yourself with the help of a book or
recorded program. Try for at least 10 to
15 minutes a day, the minimum amount
linked with the benefits above. ■
Choral singing might help improve
emotional and physical health.
Consumer Reports on Health •
january 2011
• 7
© 2011 by Consumers Union of United States, Inc. All rights reserved.
reproduction in whole or in part is forbidden without prior written permission.
07 Getting Personal.indd 7
11/8/10 1:27:50 PM
special report
Minerals that really matter
Stay up-to-date on changing recommendations.
W
ant to lower your blood
pressure? Hide the salt
shaker. Strengthen your
bones? Pop a calcium pill. But this
conventional wisdom might be oversimplified, according to new research.
For example, the salt we add to food
ourselves is a minor source of sodium
in our diet, and other nutrients also play
a role in regulating blood pressure. And
it takes more than calcium to protect
bones, and supplements of the mineral
might carry risks. Here’s a look at the
health effects of those and other minerals.
Potassium
sodium’s foil
In the dietary battle against high blood
pressure, sodium restriction gets the
glory but potassium is the unsung hero.
It helps rid the body of sodium and
protects cells that line blood-vessel
walls. In fact, the DASH diet (Dietary
Approaches to Stop Hypertension) works
not just by minimizing sodium but also
by emphasizing fruits, vegetables, and
low-fat dairy foods, all of which are
good sources of potassium. In addition
to blunting the effects of sodium, a
potassium-rich diet is also associated
with a reduced risk of bone loss, kidney
stones, strokes, and type 2 diabetes.
Unfortunately, nearly all Americans
consume too much sodium and far too
little potassium. “There’s a mismatch
between what our biological systems are
designed for and what we try to make
them handle,” says R. Curtis Morris,
Jr., M.D., a professor of medicine at the
University of California, San Francisco.
A September 2010 study suggests
what might happen if people corrected
the sodium-potassium ratio. It found
that even if sodium consumption stayed
high, increasing potassium to the recommended levels (4,700 milligrams a
day) could reduce the risk of heartdisease mortality by up to 11 percent
and stroke mortality by up to 15 percent.
So is it enough to simply take potassium supplements or use salt substitutes
made with the mineral? Probably not.
“Those are different forms of potassium
and likely will not provide the same
benefit as the form found naturally in
foods,” says Morris, a member of a panel
convened by the Institute of Medicine to
establish potassium recommendations.
Too much potassium is not a problem for most people, but certain conditions and drugs can interfere with the
body’s ability to get rid of the excess.
So talk with a doctor before increasing
your potassium intake, even from food,
if you have a disorder that causes potassium retention, such as diabetes, heart
failure, or kidney disease. Also seek
a doctor’s opinion if you take ACE
inhibitors, such as lisinopril (Prinivil
and generic) and ramipril (Altace and
generic); angiotensin receptor blockers
(ARBs), such as losartan (Cozaar and
generic) and valsartan (Diovan); and
potassium-sparing diuretics, such as
spironolactone (Aldactone and generic).
Magnesium
a vital partner
Another benefit of the DASH diet is that
it provides lots of magnesium, which,
together with potassium, helps bolster
bone by improving calcium absorption. Magnesium also protects against
abnormal heart rhythms, blood clots,
and high glucose levels.
Magnesium might be especially
important for warding off or controlling
type 2 diabetes. Several large studies
have found that people who consume
the most magnesium are less likely to
develop type 2 diabetes or a contributing
factor for it called insulin resistance.
People who already have the disease
might want to talk with a doctor about
magnesium supplements, since some
evidence suggests that they might help
with long-term blood sugar control.
Sodium
keep watching
For lowering blood pressure, the most
striking effect comes from cutting sodium
while boosting intake of potassium,
magnesium, and calcium. People who
slash sodium intake to around 1,500 mg
daily and follow the DASH diet can drop
their systolic (upper) pressure by an
average of 11 millimeters of mercury.
Watching your sodium intake has
other benefits, too. Some studies have
linked sodium to worsened asthma
and an increased risk of stomach
cancer. And because sodium increases the
excretion of calcium in urine, it could
cause bone loss and kidney stones.
Because most sodium comes from
processed, packaged, and restaurant
foods, it’s hard to cut back to 1,500 mg
without cooking from scratch most of
the time and eating more fresh foods.
For people with normal blood pressure
and no risk factors, a more modest goal
of 2,300 mg daily, achievable by adopting
the DASH diet alone, might help ward
off the upward creep of blood pressure
that tends to occur with age.
Making the extra effort to cut back
even further is warranted if you’re
African-American or have a family history
of high blood pressure, or if your blood
pressure is high or high-normal.
Calcium
new concerns
About 60 percent of men and 80 percent
of women don’t get enough calcium from
their diet. For years, the advice has been
to make up the shortfall with supple-
8 • january 2011 • Consumer Reports on Health
© 2011 by Consumers Union of United States, Inc. All rights reserved.
reproduction in whole or in part is forbidden without prior written permission.
08-09 SPECIAL.indd 8
11/8/10 1:28:58 PM
ments, but new research provides an
argument for getting more from food.
The analysis, published online in
August 2010 by the British Medical
Journal, combined the results of 11 trials
involving some 12,000 older people.
Researchers concluded that treating
1,000 people with supplemental calcium
for five years would prevent 26 fractures
but also lead to an additional 14 heart
attacks, 10 strokes, and 13 deaths.
However, the analysis didn’t look at
studies that used calcium with vitamin
D, and some evidence suggests that the
combination more effectively prevents
fractures. And consuming healthy
amounts of calcium, especially from food,
might protect health in other ways, such
as lowering blood pressure, helping to
prevent breast and colon cancer, and
easing premenstrual syndrome.
Altogether, the research provides
an argument for getting most of your
calcium from dietary sources. Aim for
at least three daily servings of dairy or
other calcium-rich foods. If you do opt
for a calcium pill, consider one that also
contains vitamin D. And look for products with the “USP verified” seal on the
label, which indicates that they meet
quality standards set by the nonprofit
U.S. Pharmacopoeia.
Iron
check your levels
Iron deficiency is a risk mainly for strict
vegetarians, premenopausal women who
have heavy periods, and older people,
who might have reduced amounts of
the stomach acid needed to absorb the
mineral. But because excess iron can be
dangerous, you should consider getting
a blood test before taking iron supplements. In fact, iron overload is so risky
that our experts think all adults should
consider having a one-time blood test
for hemochromatosis, a relatively common genetic disorder that causes people
to absorb the mineral so efficiently that
it gradually accumulates in the body’s
organs and can lead to liver or heart
failure, premature menopause in women,
and impotence in men. Diagnosis is
often delayed because doctors might not
connect the damage to iron buildup. ■
Foods that are rich in the minerals you need
The average American falls short in getting enough of the minerals listed
below. To boost your intake, it’s best to focus on foods, which tend to be
high in other nutrients—vitamins C, D, and K, B vitamins, and fiber—that
might also help prevent certain cancers, heart disease, osteoporosis, and
other diseases. Supplements don’t always provide the same benefits and
in some cases can be risky, especially if you overdo it.
Good dietary sources
Amount (mg)
POTASSIUM
Potato, baked: With skin (1 medium)
Avocado (/1 2 cup)
Yogurt: Plain, low-fat (8 oz.)
Beans, boiled: Black, lentils, lima, kidney, pinto (/1 2 cup)
Greens, cooked: Spinach, Swiss chard (/1 2 cup)
Orange juice (8 oz.)
Squash: Winter (/1 2 cup) Artichoke (1 medium)
Banana (1 medium)
Milk: Skim (8 oz.)
925
585
575
305 to 485
420 to 480
475
450
425
420
410
Recommended daily intake
n Men and women: 4,700 mg.
No upper limit.
MAGNESIUM
Halibut (3 oz.)
Nuts: Almonds, cashews, peanuts (1 oz.)
Spinach, cooked: (/1 2 cup)
Potato, baked: With skin (1 medium)
Yogurt: Plain, low-fat (8 oz.)
Beans: Baked, kidney, pinto (/1 2 cup)
Avocado (/1 2 cup)
Banana (1 medium) Cereal: Oatmeal, no milk (/1 2 cup)
Milk: Skim (8 oz.)
90
50 to 80
75
50
45
35 to 40
35
30
30
30
Recommended daily intake
n Men: 420 mg.
n Women: 320 mg.
Upper limit from supplements: 350 mg. (no limit from food)
CALCIUM
Yogurt: Plain, low-fat (8 oz.)
Sardines: With bones, canned (3 oz.)
Milk: Skim (8 oz.)
Tofu: Firm, made with calcium sulfate (/1 2 cup)
Cheese: Cheddar, mozzarella (1 oz.) ⁄
Pink salmon: With bones, canned (3 oz.)
Greens, cooked: Kale, spinach, turnip greens (/1 2 cup)
Beans, boiled: Great Northern, navy, white (/1 2 cup)
Nuts: Almonds, Brazil (1 oz.)
Orange (1 medium)
415
325
300
205
185 to 205
180
50 to 120
60 to 80
45 to 70
60
Recommended daily intake
n Men younger than 50 and premenopausal women: 1,000 mg.
n Men 50 to 65: 1,200 mg.
n Men older than 65 and postmenopausal women: 1,200 to 1,500 mg., depend-
ing on bone density.
Upper limit from food and supplements: 2,500 mg.
⁄Hard cheeses tend to have more calcium than soft ones.
Consumer Reports on Health •
january 2011
• 9
© 2011 by Consumers Union of United States, Inc. All rights reserved.
reproduction in whole or in part is forbidden without prior written permission.
08-09 SPECIAL.indd 9
11/8/10 1:29:11 PM
l
consultants
Every month we contact health authorities
and medical researchers from across the
country and around the world. Here are
some of the experts we consulted this month:
David J. Brenner, Ph.D., D.Sc.,
Higgins Professor of Radiation Biophysics; director,
Center for Radiological Research, Columbia
University Medical Center, New York City.
JEROME D. COHEN, M.D., professor emeritus
of cardiology, St. Louis University School of
Medicine, Missouri.
DON Husereau, B.SC.PHARM., M.SC.,
senior adviser, Canadian Agency for Drugs
and Technologies in Health, Ottawa.
JAMES mccormack, PHARM.D.,
professor, faculty of pharmaceutical sciences,
University of British Columbia, Vancouver,
Canada.
R. CURTIS MORRIS, JR., M.D., professor
of medicine, University of California, San
Francisco.
Peter rez, PH.D., professor, department of
physics, Arizona State University, Tempe.
JOHN SEDAT, PH.D., professor emeritus,
department of biochemistry and biophysics,
University of California, San Francisco.
Ann skingley, PH.D., senior
researcher, Sidney De Haan Research
Centre for Arts and Health, Canterbury Christ
Church University, University Centre Folkestone,
Mill Bay, Folkestone, England.
TÖRES THEORELL, M.D., PH.D., Stress
Research Institute, Stockholm University, Sweden.
Kristi l. storti, PH.D., M.P.H., visiting
assistant professor, department of epidemiology;
director, Physical Activity Resource Center for
Public Health, University of Pittsburgh Graduate
School of Public Health.
The information in Consumer Reports on
Health should not substitute for professional
or medical advice. Readers should always
consult a physician or other professional for
treatment and advice.
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drugs, medical treatments, hospitals,
healthy-living products, and more, subscribe
to www.ConsumerReportsHealth.org.
DrugsandHerbs
™
When to stop a drug
N
early 40 percent of adults in the
U.S. 60 or older take at least five
prescription drugs, and there’s
a good chance that at least one of them
is unnecessary. Maybe they’re drugs
like sleeping pills that many people take
long-term even though they generally
shouldn’t. Perhaps they’re drugs that
are no longer needed because lifestyle
changes have helped resolve the problem. Or maybe they were improperly
prescribed in the first place.
Whatever the reason, unnecessary
medication poses needless risks and
expense. But knowing when it’s safe
to stop isn’t always easy. And even
when stopping is OK, knowing how can
be complicated, since it often requires
tapering off over weeks to prevent withdrawal reactions. Here are some tips:
Don’t stop on your own. Call your
doctor before stopping unless you’re
having a severe allergic reaction or other
life-threatening side effect.
Do a drug check. Bring all of your
drugs to your doctor at least once a year
to ask whether any can be eliminated.
Make a plan. For drugs that can be
discontinued, work out a withdrawal
schedule that includes follow-up visits.
Know the warning signs. Get a list
of the symptoms that can be triggered
by stopping the drug you’re taking, and
call your doctor if you notice any. ■
Medications often taken too long
Drug
1
Risks of long-term use
2
Risk of stopping abruptly
2
Antidepressants, such as fluoxetine
(Prozac), paroxetine (Paxil), and
sertraline (Zoloft)
Dependence, sexual dysfunction,
and weight changes
Agitation, anxiety, confusion,
insomnia, nightmares, nausea, and
worsened, severe depression
Benzodiazepines, such as alprazolam
(Xanax), lorazepam (Ativan), and
triazolam (Halcion), used for anxiety,
insomnia, and panic attacks
Dependence, dizziness, impaired
coordination, memory loss,
sexual dysfunction, and weight
changes
Agitation, anxiety, fast heartbeat,
hallucinations, insomnia, seizures,
sweating, tremors, and nausea
Cholesterol-lowering statins, such
as atorvastatin (Lipitor), lovastatin
(Mevacor), and simvastatin (Zocor)
Cataracts, kidney or liver
dysfunction, and muscle
damage
Rebound high cholesterol levels and
heart attack
Corticosteroids, such as beclomethasone (Beconase AQ, QVAR),
fluticasone (Flonase, Flovent), and
hydrocortisone, for asthma, arthritis,
rhinitis, and certain skin problems
Bone loss, cataracts, glaucoma,
elevated glucose levels, infection,
menstrual irregularities, and
impaired ability of the adrenal
gland to produce cortisol
Fatigue, low blood pressure, muscle
aches and pain, nausea, and weight
loss
Heartburn drugs, such as esomeprazole
(Nexium) and omeprazole (Prilosec)
Fractures, gastrointestinal
infections, and pneumonia
Rebound heartburn
Hormone therapy, such as estrogen
(Premarin) and estrogen with
progestin (Prefest, Prempro)
Blood clots, heart attacks,
strokes, and breast and endometrial cancers
Menopausal symptoms, such as hot
flashes, flushes, and sweating
Nonsteroidal anti-inflammatories
(NSAIDs), such as celecoxib (Celebrex)
and ibuprofen (Advil), and aspirin
Gastrointestinal bleeding. With
NSAIDs, heart attacks and
strokes
Heart attack (when you abruptly stop
aspirin) and headaches (when you
stop NSAIDs).
Opioids, such as hydrocodone,
oxycodone, and propoxyphene
Constipation, dependence,
drowsiness, mood swings, and
nausea
Agitation, chills, cramps, diarrhea,
hostility, insomnia, muscle pain, and
vomiting
Sleep aids, such as eszopiclone
(Lunesta), zaleplon (Sonata), and
zolpidem (Ambien)
Dependence, memory loss,
dizziness, nightmares, sleep
driving, and worsened sleep
Anxiety, muscle cramps, nausea, and
seizures
1 Many of the listed drugs are also available as generics. 2 Not all of the risks apply to all of the listed drugs.
10 • january 2011 • Consumer Reports on Health
© 2011 by Consumers Union of United States, Inc. All rights reserved.
reproduction in whole or in part is forbidden without prior written permission.
10 Drugs N Herbs.indd 10
11/8/10 1:29:43 PM
OfficeVisit
™
•
Marvin M. Lipman, M.D.
Browsing the tangled Web
The Internet has no equal as an information
storehouse. The trick is to know how to get
right to a source of useful information and not
waste time on websites that are biased, trying
to sell you something, or just plain wrong.
Two patients I saw one recent morning illustrate the hazards and promise of online health research.
“Doc, I know what I’ve got and it’s not good,” the 54year-old high school math teacher fearfully admitted. He had
midback pain for the past month, and after a Google search
netted him a mere 6.5 million results, somehow settled on an
abdominal aortic aneurysm (a worrisome bulge in the body’s
main blood vessel) as the logical explanation. No reassuring
words on my part served to ease his apprehension. It took a
sonogram to convince him that he wasn’t at death’s door.
The second patient, a 60year-old librarian, was referred
to me after her primary-care
physician told her she had
Graves’ disease (an overactive
thyroid). She arrived for her
appointment armed with computer printouts of useful, accurate information, and was fully
prepared to discuss the pros
and cons of treatment options
for her problem.
In my professional memory, nothing has changed the
doctor-patient relationship as radically as the Internet. As recently
as 1995, about one of 10 American adults had online access;
today, about three of four adults and just shy of 100 percent
of teenagers use it to get information and communicate with
others, according to the Pew Research Center. The one-way
flow of health information from doctor to patient is now a
dialogue, or even, at times, a debate.
Illustration by Art Glazer
CaveatEmptor.com
Google and Yahoo are among the most used search engines.
But almost anyone can pay these websites to display advertisements—called “sponsored links.” And anyone with something
to sell can set up a website with few, if any, checks and balances
on what it says.
While information sites like AOL sometimes post paid
links, many links are nothing more than ads for individual
products. Just the other day I searched Google for “flu symptoms”
and up popped ads for Kleenex, Tylenol, and the homeopathic
preparation called Oscillococcinum.
The top “natural” (i.e. unpaid) search results might also
include some sites marketing a specific product. For instance,
a recent Google search I did on “enlarged prostate” yielded
information from the Mayo Clinic and the National Institutes
of Health, but also the website for an unproven herbal product.
To complete the confusion, major sites like WebMD.com
provide reliable noncommercial content as well as content
sponsored by commercial interests, such as drug companies.
The other dots
What’s left are the generally commercial-free government
websites (with addresses that end in “.gov”) and academic
ones (“.edu”).
Some not-for-profit organizations run websites (“.org”)
that are ad-free (including our
own ConsumerReportsHealth.
org, which charges for some
of its information) and some
take advertising. Others are
littered with advertising, and
some are fronts for industries
or manufacturers with a commercial agenda.
Consumers visiting an unfamiliar website should always
check the “About Us” section
for clues about who is funding the content.
Figuring out the pecking order among websites requires
narrowing the choices to those few that provide up-to-date,
reliable, and understandable information. Many qualify. No
doubt your doctors can recommend personal favorites. This is
my own current Top 5 list:
l www.cancer.gov for information about cancer.
l www.cdc.gov for information about infectious diseases, travel
medicine, and epidemiology.
l www.fda.gov for information about drugs.
l www.medlineplus.gov for information about diseases.
l www.usp.org for information about medicine and nutritional
supplements. ■
Marvin M. Lipman, M.D., has been Consumers Union’s chief
­ edical adviser since 1967. He is a diplomate of the American
m
Board of Internal Medicine (certified in endocrinology and
metabolism) and is clinical professor emeritus of medicine at
New York Medical College.
Consumer Reports on Health •
january 2011
• 11
© 2011 by Consumers Union of United States, Inc. All rights reserved.
reproduction in whole or in part is forbidden without prior written permission.
11 Office Visit.indd 11
11/8/10 1:30:14 PM
Have
Questions?
We’ll answer those of
general interest. Write
to CRH, 101 Truman Ave.,
Yonkers, NY 10703 or go to
www.ConsumerReports.
org/crh to contact us
by e-mail.
OnYourMind
™
l
Tip of the month
lotions and corticosteroid creams can
help relieve symptoms while the skin
heals. In rare cases, the condition can
lead to skin ulcers and infections, or
can indicate an underlying disorder like
lupus or rheumatoid arthritis. So see
a doctor if your skin doesn’t improve
after a week, is very painful, or if you
have poor circulation or diabetes.
Can taking vitamins help prevent the flu?
—M.G., Cincinnati
Probably not. It’s true that an adequate intake of vitamins A, C, E, and
the B vitamins, as well as iron, zinc, and healthful probiotic bacteria, help
to maintain a strong immune system, which improves your ability to fight
off illness. But there’s no solid clinical-trial evidence that supplements of
vitamins offer additional protection against the flu. A small, recent study
found that taking 1,200 international units of vitamin D a day during the
winter—about triple the recommended intake—cut the risk of developing a
common strain of seasonal flu by 42 percent in children. More research is
needed to confirm that benefit. But it might be another reason to consider
a vitamin D supplement to help you meet the optimal levels of the vitamin,
which research has linked to a number of disease-preventing benefits.
Combating constipation
Q
A it. Getting 20 to 30 minutes of
Yes—and being inactive can worsen
Aspirin for heart attacks
Cold-weather woes
If you think you’re having a heart
attack, is it better to chew an
aspirin tablet or take a powdered aspirin
product, like BC Powder?
—T.W., Nashville, Tenn.
I get patches of blue, itchy skin in
the winter. Why, and what can I
do about it?
—G.S., Youngstown, N.Y.
Q
A
Chew the aspirin tablet. BC
Powder combines 845 milligrams
of powdered aspirin (about 2.5 times
the amount in a regular 325-mg adult
aspirin) with 65 mg of caffeine, roughly
the amount in a cup of instant coffee.
That can be helpful for easing headaches, since caffeine can enhance the
effects of pain relievers. But caffeine can
also increase your heart rate and blood
pressure, making the heart work harder,
and it might cause extra heartbeats in
people who are sensitive to it. And while
powdered aspirin enters the bloodstream
faster than a whole pill, chewing the
aspirin has the same effect.
Can exercise ease constipation?
—A.M.D., Brooklyn, N.Y.
Q
A called pernio, a skin condition
You could have chilblains, also
that’s caused by sudden warming after
exposure to cold temperatures, which
can damage the small blood vessels
under the skin. It appears as red or blue
patches of skin, usually on the cheeks,
ears, nose, fingers, and toes, and affects
more women than men. Chilblains usually subside on their own. Moisturizing
aerobic activity a day—say, walking—
can make it easier to pass stools by
speeding up digestion. If you have
limited mobility, doing light exercises
for the legs and abdomen might also
help. If exercise, drinking more fluids,
and eating more fiber don’t improve
symptoms, talk with your doctor, who
might order tests to see if you have
an intestinal problem or a condition
that could contribute to constipation,
such as irritable bowel syndrome or
a neurologic or endocrine disorder.
Biofeedback and pelvic-floor (Kegel)
exercises can improve bowel movements
if constipation stems from inadequate
muscle tone in the rectum.
In future issues
Blood pressure first
Get it under control, even
if you don’t do anything
else to protect your heart.
Head-to-toe check
What changes to your
nails, skin, and tongue
say about your health.
Stomach remedies
Can ginger, peppermint,
or any other supplement
ease nausea or indigestion?
12 • january 2011 • Consumer Reports on Health
© 2011 by Consumers Union of United States, Inc. All rights reserved.
reproduction in whole or in part is forbidden without prior written permission.
12 OYM.indd 12
11/8/10 1:31:01 PM