Flu Shots are Important; Especially for Kids with Asthma

by Carole Jackson, Bottom Line Health

Here comes flu season — so let’s not beat around the bush. Children with asthma can be extremely vulnerable to serious — even life-threatening — complications from the flu. So with rare exceptions, they should receive the flu vaccine, according to the CDC. (Yes, it’s true that a meta-analysis published in The Lancet Infectious Diseases on October 26, 2011, showed that the vaccine was only 59% effective in people ages 18 to 64, but some protection is still better than none.)

You’re probably thinking: But my child’s asthma is under control, so why does it matter? Sure, the better-controlled a child’s asthma is, the better he/she can defend against the flu and withstand respiratory infections. But even when asthma is well-controlled, there still is extra danger when flu season starts, because a flu infection could trigger an asthma attack.

Why am I bringing this up right now? Because, according to a new survey of families with asthmatic children, a surprising one-third of parents say that they will not have their asthmatic child vaccinated against the flu. Heading up the research was Toby Lewis, MD, a pediatric lung specialist at C.S. Mott Children’s Hospital in Ann Arbor, Michigan. She worries that families may be making their decisions without having all the facts.

In the survey, the reasons that parents list for not giving their child the flu vaccine include the belief that flu is not an important trigger of asthma… the belief that the vaccine can actually cause flu… the belief that the vaccine doesn’t help prevent flu… and the belief that the flu vaccine isn’t safe. But these are incorrect.

Obviously, this is extremely frustrating news for medical professionals, but Dr. Lewis says that the purpose of the research was to better understand parents’ concerns so doctors could address them directly. Dr. Lewis has debunked each misconception, one-by-one…

Myth #1: Flu isn’t an asthma trigger.

Most people are familiar with the general misery that an influenza infection can cause — such as fever, aches and pains, severe cough and chest congestion. But for people with asthma, all of those symptoms can be accompanied by an asthma attack. At a minimum, this might mean that your child has to miss an extra day of school or take more breathing medications. But in severe cases, the asthma attack can literally “take his/her breath away” — making it difficult for your child to inhale and requiring care in an emergency room or even hospitalization.

In fact, the majority of hospitalizations for asthma are presumed to be brought on by viral infections, which include flu and nonflu infections, said Dr. Lewis. Looking at it another way, people with asthma were among those at highest risk of being hospitalized from influenza during the recent 2009 outbreak, according to a study reported in BMJ (formerly British Medical Journal), because the virus caused inflammation in the airways, triggering spasms and wheezing. A flu vaccination could keep an asthmatic child out of the hospital.

Myth #2: The flu vaccine can cause flu.

Parental anxiety on this topic comes from a misunderstanding about the way vaccines establish protection in the body, Dr. Lewis said. She describes the vaccination as a “training exercise” that teaches the body’s immune system to recognize and fight off particular germs. In the process, though, the stimulation of the immune system can sometimes create a low-grade fever and “blah” feelings for a day or two — but this is not nearly as bad as having a natural infection with the flu. The ultimate payoff for this brief response to vaccination is that when the real flu virus comes along, the immune system knows right away how to fight off the germ. (Of course, if a child’s immune system isn’t functioning well for some reason, even a vaccine might not allow it to beat back the flu.)

Myth #3: The flu vaccine doesn’t actually prevent flu.

The flu vaccine is not perfect — each season, a vaccine is produced to combat the particular strains of flu believed to be headed our way. This year’s vaccine protects against three strains of flu that are holdovers from last year (the H1N1 “swine flu” virus and two other strains that are anticipated to be going around during this flu season). But even if a brand new strain were to make a surprise appearance this year, Dr. Lewis noted, the current vaccine may still enable the body to put up greater resistance to it, making any sickness milder and, even more importantly, reducing the chance for dangerous asthma episodes.

Myth #4: The flu vaccine isn’t safe.

Some parents also express worry about the vaccine’s safety or wonder if the vaccine is right for their children. Dr. Lewis notes that there is a large body of scientific evidence supporting the safety of influenza vaccines and also encourages families who may have these sorts of concerns to talk directly with their children’s doctors.

If you’re looking for something to worry about, there is one real — but extremely rare — risk worth noting. Two studies, according to the CDC, have suggested that approximately one person out of one million vaccinated people may be at risk for Guillain-Barré Syndrome (a severe paralytic illness) associated with the seasonal flu vaccine, though doctors aren’t sure why.

While it’s safe for most kids to get the flu vaccine, there are exceptions to the rule. These are some general guidelines from the CDC as to specific medical situations that should be discussed with a doctor before getting the flu shot…

  • Children who have hepatitis or another chronic illness or who are on certain drugs, including some types of immunosuppressive therapy, should be evaluated by specialists in these areas. Then the decision about getting a flu vaccination should be made on a case-by-case basis.
  • Children who have a severe allergy to chicken eggs, as the vaccine may contain traces of egg protein.
  • Children who have had a severe reaction to an influenza vaccination or any of its ingredients, such as the preservative thimerosal. (Thimerosal-free versions of the vaccine are available for those who need it.)
  • Children younger than six months of age (influenza vaccine is not approved for this age group).
  • Children who have a moderate-to-severe illness with a fever (they should wait until they recover to get vaccinated).
  • Children with a history of Guillain-Barré Syndrome.

Doctor’s Orders

 The flu vaccine can be administered either as a shot or, for healthy children over the age of two, as a nasal spray. While many parents would prefer to choose the spray to spare their children the shot, this is not advised for children with asthma. The reason: When the vaccine is delivered through a shot, it contains only dead viruses, but the nasal vaccine contains weakened though still live viruses. Children with asthma have sensitive respiratory systems and might react to the live viruses with a runny nose and other minor cold-type symptoms.

Dr. Lewis acknowledges that even parents who don’t get their asthmatic kids vaccinated are trying to do what is best for the children. Unfortunately, she says, the decision not to vaccinate against the flu is usually based on misunderstandings of what the risks truly are. “The flu is not just a regular cold,” she said. It is a difficult sickness to go through, and the risk of having a bad asthma attack from the flu, according to Dr. Lewis, “is many times worse than the risks usually associated with the vaccine.”


Toby Lewis, MD, MPH, associate professor, department of pediatrics and communicable diseases, C.S. Mott Children’s Hospital, Ann Arbor, Michigan, and lead author of a study on asthmatic children and flu vaccine.

How Your Personality Impacts Your Weight

by Carole Jackson, Bottom Line Health

When it comes to personality and weight control, there are certain things that make perfect sense. Those undisciplined types who mindlessly munch in front of the TV or purposefully stuff down food at the kitchen table tend to be heavier, while the organized, conscientious folks — the ones who measure out their portions, for example — are more likely to keep the pounds off. But apparently, not all personality-weight associations are quite so logical. Now scientists are learning that some surprising personality traits may lead to a growing waistline.

The National Institute on Aging (NIA) recently studied the relationship between personality and weight over a substantial period of adulthood. The findings reveal that people who are aggressive, cynical and competitive are prone to gaining extra weight. Now that had me scratching my head, I must admit. Aren’t those competitive types going to be the ones most likely to do whatever is necessary to stay in control — of their weight and everything else?

To learn more about the findings, I called lead investigator Angelina Sutin, PhD, a postdoctoral fellow at the NIA’s Laboratory of Behavioral Neuroscience in Baltimore. She told me that the research, which appeared in the July issue of Journal of Personality and Social Psychology, produced a mix of results that don’t always add up as easily as we’d expect.

“We know how complex the reasons for weight gain can be, and we were extremely interested to see how psychological factors might contribute,” Dr. Sutin said.

Dr. Sutin lead the observational study, which examined data from the NIA’s Baltimore Longitudinal Study of Aging (BLSA), an ongoing research project that addresses normal aging. In the BLSA, 2,000 men and women were weighed and their body mass index (BMI) and other markers for excess fat were measured over the course of 50 years. Participants were generally healthy and highly educated. All were evaluated on what personality psychologists call the “Big Five” domains of personality — extraversion, agreeableness, neuroticism, conscientiousness and openness — along with 30 subcategories of these traits. Researchers measured which personality traits were associated with weight gain — and which ones weren’t.

Among all personality traits — and this was not unexpected — the biggest contributor toward weight gain was impulsiveness (a subcategory of neuroticism). Those who fell into the high end of the impulsivity range gained, on average, an extra 22 pounds over their life spans. “Individuals with this [characteristic] tend to give into temptation and lack the discipline to stay on track amid difficulties or frustration,” Dr. Sutin found. “To maintain a healthy weight, it is typically necessary to have a healthy diet and a sustained program of physical activity, both of which require commitment and restraint. Such control may be difficult for highly impulsive individuals.”

What other traits influenced an accumulation of pounds? Some others were obvious, like extraversion, which I can easily associate with a certain joie de vivre that could lead to weight gain. Neuroticism, conservativeness, warmth and a tendency to take risks were also traits that (unsurprisingly) were associated with weight gain. It isn’t that hard to picture a heavyset, warm, conservative person — especially if he is also a risk taker — Winston Churchill, anyone? But then there are the antagonistic people (those who are aggressive, competitive and cynical). We might expect them to be thinner because, after all, no mere plate of food is going to get the best of them! But they actually tended to gain more and more weight over the decades, until they became clearly too heavy for good health. And there may be a physiological reason for that, Dr. Sutin told me. “Antagonistic people can be very reactive to stress,” she said, “and stress increases the production of hormones that can lead to weight gain.”

And who consistently maintained their weight over the decades? No surprise here. It tended to be the people who were open, agreeable, conscientious, active, straightforward, modest, orderly and/or dutiful.

More research may yield clues as to how to apply the personality traits of thinner people to those less likely to resist fried chicken and Oreos. Until then, if you’re having trouble watching your weight, watch your stress level. It may be turning your battle of the bulge into a war.


Angelina Sutin, PhD, a postdoctoral fellow, National Institute on Aging, Laboratory of Behavioral Neuroscience, Baltimore.

Vitamin Protection from Stroke Damage?

by Carole Jackson, Bottom Line Health

Surely, by now, people are well-aware that when it comes to surviving stroke, time is of the essence. The sooner patients get treated, the more likely their brains will be spared significant damage. Is it worth considering, then, if you’re at high risk for stroke, that taking a supplement might offer your brain protection ahead of time? According to the results of a new study from The Ohio State University in Columbus, such a day may be close at hand.

Not Just Any Vitamin E

The study, funded by the National Institutes of Health, looked into whether taking a natural form of vitamin E called tocotrienols (more on that in a minute) might prepare the brain to react better after an ischemic stroke (a stroke caused by a blood clot). Most strokes (87%) are ischemic. The report, an animal study, used dogs because their brains more closely resemble those of humans than do those of commonly studied animals, such as mice and rats. For 10 weeks, researchers gave one group of dogs 200 mg a day of tocotrienols and the other group a placebo. Then, while the animals were under anesthesia, they induced strokes in both groups by blocking the middle cerebral artery in their brains for one hour. Next, researchers conducted imaging studies of the animals’ brains both one hour after and 24 hours after the induced strokes to learn what changes had taken place. What they discovered…

  • More blood flow. In the vitamin E group, minor blood vessels (collateral vessels) that are a normal part of the brain’s circulatory system became larger in the area of the blockage, enabling more blood flow to continue in that area and protect the brain. This did not happen to the same extent in the control group.
  • Less tissue damage. Twenty-four hours after the strokes, brain lesions that indicate tissue damage were 80% smaller in the vitamin E group compared with those in the placebo group.
  • Less nerve damage. In the vitamin E group after 24 hours, the brain’s internal communication network — a crisscrossing of nerves — remained relatively intact at the location of the stroke… while in the placebo group, the network showed major disruptions.

Waking Up Sleeping Arteries

The senior author of the study, Chandan K. Sen, PhD, professor in the department of surgery, has been researching tocotrienol vitamin E and its effect on the brain for more than a decade. He says that the brain contains collateral vessels that normally remain dormant. When a person has a stroke, those collateral vessels enlarge and join together to improve blood flow in the affected part of the brain. Researchers found that the tocotrienol vitamin E essentially helped “wake up” these previously inactive arteries more effectively at the time of the trauma to the brain.

Dr. Sen and his group are now preparing a clinical trial using tocotrienol vitamin E in a group of people who are at an increased risk for stroke. The participants in this trial will take 400 mg daily of tocotrienol E to see if the vitamin helps prevent stroke or, in cases when stroke occurs, if it helps reduce damage to the brain, as it did with the dogs. When asked for a recommendation for readers of Daily Health News, Dr. Sen said that he would like to wait for the outcomes of the clinical trial. But people at a high risk for stroke may want to talk to their doctors about taking natural Vitamin E as we wait for the clinical trial to be completed.

Read the Label

There are two categories of natural vitamin E — tocotrienols (which were used in the study) and tocopherols. Both types include four subtypes called alpha, beta, delta and gamma. In his research, Dr. Sen uses a mix of natural vitamin E that’s rich in alpha-tocotrienol. If your doctor advises you to start taking natural vitamin E to help prevent stroke, Dr. Sen says to look for a supplement in a health-food store or online that contains a high percentage of alpha-tocotrienol. You may notice that many vitamin E supplements contain some tocopherols, as well. This is fine, so long as the tocopherol is natural and not synthetic. Check the label, and if it includes the words synthetic alpha tocopherol — or “dl” instead of “d,” the natural form — return the bottle to the shelf and look for all-natural E.


Chandan K. Sen, PhD, professor in the department of surgery and associate dean, College of Medicine, The Ohio State University, Columbus.

The Spice That Fights Food Poisoning

by Carole Jackson, Bottom Line Health

Here’s good news for those of us who lean toward the natural way of doing things: A new in vitro study has found that the oil from ordinary coriander seeds is effective at killing bacteria that can cause food poisoning and other illnesses. With listeria still in the headlines, this is big news.

Pungent Flavor, Rich History

If “cilantro” comes to mind when you hear “coriander,” it’s because the pungent cilantro used in Mexican and Mediterranean cooking is the leaf of the same coriander plant. Coriander has been associated with good digestion for thousands of years, with evidence of its use dating as far back as 5,000 BC. It is mentioned in Sanskrit texts, ancient Egyptian papyri, the Old Testament and the writings of Greek physician Hippocrates. The Roman armies brought coriander to Europe, where it was used to preserve meats, and the Chinese believed that coriander counteracted food poisoning — in addition to serving as an aphrodisiac and bestowing immortality! That’s quite a set of endorsements, isn’t it?

Coriander oil, which is what was used for this new research, is “steam-distilled” (a process that uses low heat, so the oil’s components won’t degrade) from the seeds of the coriander plant (Coriandrum sativum L.). The resulting liquid is what’s called “coriander essential oil,” meaning its distinct properties reflect the essence of the plant.

The 21st Century Take

A research group at the University of Beira Interior in Portugal tested the antimicrobial properties of coriander oil against 12 bacteria strains, including some of the bad guys whose names you’ll recognize — E. coli, Salmonella and B. cereus (all bacteria that can cause foodborne illnesses), MRSA (methicillin-resistant Staphylococcus aureus — which can cause virulent infections throughout the body) and E. faecalis (which can cause urinary tract infections, meningitis and other health problems).

Though they had reason to believe coriander oil would be effective, the researchers were surprised at just how well it worked — 10 of the 12 strains of bacteria were killed with a relatively mild concentration of coriander oil (1.6%). In the two strains that were not effectively killed — B. cereus and E. faecalis — the coriander oil still reduced their growth significantly.

Wanting to learn more about why this particular oil had proven to be such an effective antibacterial agent, I contacted the lead researcher, Fernanda Domingues, PhD, associate professor of microbiology and toxicology. She told me that her research group was excited to have identified the mechanism by which this oil is able to kill the bacteria — it disrupts the bacterial membrane and prevents the cell from functioning.

What Will the Future Hold?

After all these centuries of use in traditional medicine for treating nausea, pain and fungal infections, coriander has some distinctly modern applications as well. Dr. Domingues said the food industry may be able to use coriander oil to protect against foodborne diseases and bacterial spoilage — and also as a safe ingredient in antibacterial food packaging that might improve the shelf life of fresh foods. It shows promise in medicine as well, specifically as a potential treatment for drug-resistant infections and a variety of hospital-acquired infections.

There is a rub, however — though the Food and Drug Administration has given coriander oil “generally-regarded-as-safe” (GRAS) status and considers it a recognized flavoring, not much is known about its toxicity in humans. So Dr. Domingues doesn’t advise people to inhale coriander oil or to take it orally… for now… until more research provides additional information. “Coriander oil might someday become a natural alternative to common antibiotics,” she told me. That’s pretty cool — and in the meantime, it is, of course, fine to use coriander seeds (whole or ground) in your cooking.


Fernanda Domingues, PhD, lead researcher, associate professor of microbiology and toxicology, University of Beira Interior, Portugal

Can Arthritis Be Stopped With a Shot?

by Carole Jackson, Bottom Line Health

Let’s say you fall and injure your knee, hip or shoulder. Once you recover, you’re likely to forget about the injured joint — that is, until you develop osteoarthritis there… maybe years later! In fact, of the 27 million Americans with osteoarthritis (the most common form of arthritis), three million of those cases were caused by the breakdown of cartilage from joint injuries. The condition is known as injury-induced or post-traumatic osteoarthritis. Once it sets in, there’s not much that conventional doctors can do but ease symptoms with painkillers or, in severe cases, suggest joint-replacement surgery. But researchers now say they may have a way to stop this type of arthritis before it ever gets started!

Attacking Yourself

When there is cartilage breakdown after a joint injury, a corticosteroid is often used to help reduce the pain. According to a new MIT study published in Arthritis Research & Therapy, doctors have found that using a similar type of steroid on an injured joint right away — even before cartilage breakdown is present — may help prevent the breakdown from happening in the first place. “The findings are very promising,” I was told by the study’s lead researcher, Alan Grodzinsky, ScD, a professor of biological, mechanical and electrical engineering and the director of MIT’s Center for Biomedical Engineering. To understand why, consider what happens after a joint injury. As you surely know from personal experience, inflammation sets in — that’s what causes much of the initial stiffness, swelling and pain after you hurt a joint.

Inflammation is actually a healing tool. When a joint is injured, cells within the affected tissues secrete proteins called cytokines, which modulate the body’s response to disease and inflammation. But, Dr. Grodzinsky explained, there’s an unfortunate consequence of this normal inflammatory response. “Cytokines cause cells in the joint to make enzymes that destroy the proteins in cartilage” — and that, of course, is the beginning of cartilage breakdown. The breakdown can take years, sometimes a decade or more, and meanwhile, you may have no idea that this is happening. So if you can keep inflammation down initially, then in theory cartilage breakdown can be avoided.

In this study, researchers explored whether dexamethasone, a steroid used for decades to relieve pain in established osteoarthritis and late-stage rheumatoid arthritis patients, could be used to prevent injury-induced arthritis. They set up a lab experiment using bovine and human knee cartilage kept alive in a lab culture. They damaged the tissue, essentially creating an injury, and then put the tissue in a fluid containing inflammatory cytokines identical to the ones that the body creates. When the damaged tissue was treated immediately with the dexamethasone, cartilage breakdown stopped. The drug also halted the breakdown of cartilage in specimens treated a day or two later — an important finding, said Dr. Grodzinsky, since patients with an injury might not realize that their injury is severe enough to require medical attention right away.

For Young… and For Old

Perhaps after more research, doctors will start to treat joint injuries immediately with a steroid — even in people who are young — as a way to prevent arthritis from developing in years to come. Dr. Grodzinsky pointed out that there is still a lot to learn. So researchers are planning animal studies to determine the most effective dose and the best method of drug delivery to restrict the steroid to the injured joint tissue and minimize side effects. Although it’s not yet certain how many treatments may be needed, if they prevent a lifetime of pain, it sounds well worth the effort.


Alan Grodzinsky, ScD, a professor of biological, mechanical and electrical engineering and the director, Center for Biomedical Engineering, MIT, Cambridge, Massachusetts.

Teen Hearing Problems — It’s Not Just About the Loud Music!

by Carole Jackson, Bottom Line Health

Most of us barely pay attention to background noises like engines, fans or groups of people talking loudly. That’s because most of us have the ability to block out those annoying distractions when we want to. But sadly, that’s not the case for a large group of youngsters whose ability to separate those sounds from what they do want to hear — for instance, a conversation in a noisy room — has already been compromised, even at their young ages, because of their exposure to secondhand smoke.

I was intrigued to learn of the situation, uncovered in a first-of-its-kind study by Anil Lalwani, MD, professor of otolaryngology, pediatrics and physiology and neuroscience at New York University Langone Medical Center in New York City, so I called Dr. Lalwani to hear more. It turns out that, on average, 12- to 19-year-olds who had been exposed to secondhand smoke were found to be nearly twice as likely as other teenagers to suffer irreversible sensorineural hearing loss (SNHL) in their teen years — even though that kind of hearing loss typically tends to occur among older adults.

About 80% of the teenagers with SNHL had no idea that their hearing had been affected. But even if damage is mild, it can impair one’s ability to function. While smoke-exposed adolescents performed worse across every sound frequency tested, their scores showed the most impairment in the mid- to high-frequency levels, which are crucial for understanding speech and for pulling any relevant sounds out of the din. Because kids who can’t always understand what’s being said in the classroom are easily distracted, they may be misdiagnosed with attention deficit hyperactivity disorder or at the very least labeled as troublemakers. And of course, their schoolwork may suffer.

Now Hear This

Dr. Lalwani pointed out that secondhand smoke has already been impacting those he calls “innocent bystanders,” since it has been linked to a wide range of other health issues — including low birth weight, sudden infant death syndrome (SIDS), childhood asthma, inner ear infections and behavioral and cognitive problems. “In the last one to two decades,” said Dr. Lalwani, “we’ve seen a huge amount of evidence mounting about the health consequences of secondhand smoke” — and now we have to add hearing loss to that list.

How did he discover this particular effect of secondhand smoke? Dr. Lalwani and his colleagues studied data on more than 1,500 12- to 19-year olds selected from the 2005-2006 National Health and Nutrition Examination Survey, which gathered health information from adults and kids around the US. First, the youngsters were evaluated by National Center for Health Statistics personnel in 2005-2006, including at-home visits to determine family medical history, whether or not smokers lived in the home and other demographic information. Then the teens were given extensive hearing tests. They were also given blood tests measuring the level of a nicotine-related substance called cotinine that can objectively tell how much secondhand smoke one has been exposed to.

Dr. Lalwani’s results were compelling — the higher the teens’ levels of cotinine, the higher their chances of having SNHL. The cotinine acted as a remarkably accurate biomarker — or barometer, if you will — of the hearing damage. His findings were published in a recent issue of Archives of Otolaryngology-Head & Neck Surgery. The study authors did note that among the drawbacks of the study was that data on noise levels in the homes was not available.

Perhaps the biggest question to be answered now is, how is it that smoke can affect people’s ability to hear — especially young people with robust constitutions? Dr. Lalwani’s study didn’t look for the cause, but he has many theories. “We know smoking leads to reduced oxygen in the blood, so that may be an issue,” he said. “The ear is a high-energy-requirement organ. We also know that smoking causes vascular issues (blood vessel problems), so a variety of factors could be contributing.”

Sound Advice

There is an obvious and surefire answer to this health problem among teens — parents who smoke should stop! Beyond that, Dr. Lalwani hopes that standard newborn hearing screenings can be expanded to include older kids, since only newborns and young children are routinely given hearing tests in the US. “I think it will happen eventually,” he said optimistically, “and I think this is part of the evidence that will drive it.” Until then, if you’re a concerned parent, discuss with your child’s pediatrician whether your child should have the test.


Anil Lalwani, MD, surgeon and researcher, professor of otolaryngology, physiology and neuroscience, and pediatrics, New York University School of Medicine, NYU Langone Medical Center, New York City.

Position Yourself for a Good Night’s Sleep

by Carole Jackson, Bottom Line Health

So many people tell me that they can’t get a good night’s sleep! Even when they try all the well-known tricks — such as darkening the room, relaxing before bed and drinking warm milk — a restful night’s sleep still eludes them. But what few people seem to consider is the position they sleep in and how that impacts the quality of their sleep. In fact, the position you choose can contribute to a whole range of sleep-interfering problems including neck, shoulder and back pain. If you sleep in a position that makes your body hurt or feel stiff, you may be forced to try positions that leave you in even more pain. On top of it all, your sleep position can contribute to acid reflux (more on that below).

To explore which sleep positions are the worst and which are the best, I called Christopher Rose, MD, medical director of the sleep center at the Covenant Medical Center in Lubbock, Texas. He gave me the pros and cons of sleeping on your side, back and stomach and suggested ways to modify each position to better assure a restful sleep.

Sleeping on Your Back

This is the ideal position for the vast majority of people.

  • Advantages: It’s most likely to keep the head, neck and spine in a healthy, neutral position… it helps prevent or lessen acid reflux… and as a bonus, it is the only position that does not contribute to facial wrinkling.
  • Disadvantages: Back sleeping is not good for those with sleep apnea, people who snore or pregnant women after their fourth month. Dr. Rose explained that when people with breathing issues lie on their backs, pressure on the airway in the back of the throat increases, triggering improper breathing. And pregnant women should avoid back sleeping in the later months to keep the weight of the growing fetus off the intestines and major blood vessels (the aorta and vena cava), so that blood flows more freely to the fetus.

Back-sleeping tips: Your pillow should be 100% comfortable for you — for most people, this means soft and not very thick. Position it so that it doesn’t force your chin toward your chest, an unnatural position that can create neck pain, said Dr. Rose. If you already have neck pain, consider a cervical pillow — a pillow with thick padding in a horseshoe-shape around the outer edges and less padding in the center and along the bottom edge. Adjust it so that your head fits comfortably in the middle and your neck is supported by the padding along the lower edge. It will align the cervical spine and support your head, preventing cervical strain. If you have pain in your lower back, place a pillow under your knees to prevent back strain.

Sleeping on Your Side

This position is second best for most of us — and the best for snorers and those with back pain.

  • Advantages: Because it elongates the spine (on your back, the vertebrae stack naturally together… on your side, they are pulled apart a bit), side-sleeping can help ease back pain. It may also prevent snoring just by the positioning of the tongue, uvula and epiglottis, and it reduces risk for acid reflux since your stomach can flop down to the side and “kink” the gastroesophageal junction a bit to slow down reflux.
  • Disadvantages: Side-sleeping puts uneven weight on the neck and shoulder — the downside shoulder bears more weight than if you distribute your weight more evenly across both shoulders on your back — so it can exacerbate problems you might have in those areas. Side-sleeping causes wrinkling on the side of the face you sleep on and, because it leaves the breasts hanging, over time it encourages them to sag.

Side-sleeping tips: Pregnant women and people with acid reflux might find it better to sleep on the left side only, said Dr. Rose. For a pregnant woman, sleeping on the left side keeps the fetus off the mother’s vena cava, assuring a healthier blood flow to her heart and to the fetus. And because the stomach is on the left side of the body and the esophagus is to its right, left-side sleeping positions your stomach below your esophagus, helping to prevent stomach acid from creeping into the esophagus. If side-sleeping makes your shoulders sore, Dr. Rose suggested that you stretch them during the day by rolling them forward and then backward, 10 times per side. Side-sleepers with hip problems should place a pillow between the knees, which keeps hips in better alignment and reduces pain.

Sleeping on Your Stomach

Without question, this position is the worst for most people.

  • Advantages: None, other than for snoring and apnea, but both these conditions are better addressed with side-sleeping, said Dr. Rose.
  • Disadvantages: Sleeping on your stomach forces the spine out of its natural S-curve alignment, potentially causing pains, numbness and tingling. It forces the head to one side or the other, further distorting the alignment of the neck and spine. More bad news: This position worsens gastric reflux.

Pillow Talk

You may have been sleeping in the same position for decades — maybe for your whole life. But that doesn’t mean that it’s the best position for your sleep or your health. To train yourself into adopting a sleep position that will better serve you, pillows are the way to go. To encourage side-sleeping, lie down as comfortably as possible in the side position and then grab two cylindrical or rectangular pillows that are about body length. Put one right behind you and one right in front of you. To convert to sleeping on your back, get two small pillows. Prop one on each side of your head on top of your main pillow.

When choosing a pillow, Dr. Rose said, just go with personal preference. There is no scientific evidence to prove that a soft pillow has advantages over a firm one or vice versa. This is also true for mattresses — despite advertisements to the contrary, there is no research proving that a soft, medium or firm mattress is best for sleep for most people. It’s highly individual.

Finally, if you are one of those rare folks who sleeps soundly and has never had a complaint about the quality of your sleep, Dr. Rose said, the best position for you is clearly the one you have — whatever that might be.


Christopher Rose, MD, medical director of the sleep center at Covenant Medical Center in Lubbock, Texas.

Can a Chinese Herbal Paste Help COPD?

by Carole Jackson, Bottom Line Health

Eastern and Western medicine often seem to take very different approaches to the concept of wellness — a perfect example is an herbal paste that has been used by the Chinese for thousands of years for treating asthma, emphysema and other kinds of breathing disorders. Is this a treatment that is applied in the way we Westerners would expect? No, not at all. In fact, it turns out that the healing paste is typically applied as a preventive during the summer season to relieve symptoms that appear in the winter! (For patients with acute problems, however, the paste can be used at any time of the year.) Another surprise, it’s applied to various points on the patient’s back — in order to bring relief to the chest! Like I said, East and West do seem to work in different directions. And yet just as often, they complement each other very effectively. I spoke with Hong Jin, DAOM, LAc, chair of Oriental medicine at the Oregon College of Oriental Medicine in Portland, for more information.

She explained that it is tradition for Chinese people with respiratory difficulties to turn to the herbal paste known as xiao chuan (XCP) to help them breathe easier. While anecdotal evidence and tradition are one thing, hard science is quite another. Dr. Jin told me that researchers have recently put XCP through the rigors of controlled studies, applauding it as it came through with flying colors.

Breathing Easier

In the first randomized, controlled study of XCP, medical investigators in Beijing assigned 142 people with chronic pulmonary obstructive disease (COPD) to receive treatment with either XCP or a placebo paste. XCP contains Chinese botanicals including ephedra. Because ephedra is banned here in the US, Dr. Jin explained, doctors substitute other herbs (Fang Feng and Gui Zhi) when XCP is used here. For the purposes of the study, practitioners applied the paste to specific acupuncture points on participants’ backs a total of four times during the eight-week period of July and August, leaving it on for four to six hours each time, as has been the practice with XCP for many generations.

The scientists then monitored the patients from November through February and discovered that those treated with XCP fared significantly better than those treated with the placebo. The XCP group…

  • Experienced fewer winter “exacerbations” of their COPD, such as shortness of breath, wheezing and/or chest tightness, that required steroid or antibiotic prescriptions… and they needed fewer hospitalizations for respiratory problems.
  • Reduced their reliance on steroid medications (which have side effects such as fluid retention, weight gain, increased blood pressure and mood swings) compared with the placebo group.

Not surprisingly, given these changes for better health, people who received XCP also reported an improved quality of life. Researchers shared these results at the American Thoracic Society’s 2011 International Conference in Denver.

Not a One-Size-Fits-All Remedy

According to Traditional Chinese Medicine (TCM), when doctors apply XCP paste to acupuncture points for lung disorders, it passes directly to the organs, said Dr. Jin. She finds the paste to be safe and effective, she told me, adding that it is also inexpensive.

On the other hand, Dr. Jin cautions that XCP is not a one-size-fits-all remedy, especially given that asthma and COPD are serious and potentially life-threatening illnesses. It’s best to consult a practitioner who is formally trained and licensed in the practice of TCM. To find a practitioner in your area, visit the Web site of the National Certification Commission for Acupuncture and Oriental Medicine at www.nccaom.org/find-an-acupuncture-practitioner-directory. To make sure you receive safe and coordinated care, be sure to tell all your health-care providers about all types of treatment you undergo for lung disease.


Hong Jin, DAOM, MD (PRC), LAc, chair of Oriental Medicine, Oregon College of Oriental Medicine (OCOM), Portland, Oregon. Dr. Jin teaches in both the master and doctoral programs at OCOM as well as in the doctoral program at the American College of Traditional Chinese Medicine in San Francisco.

What You Should Eat After Exercise

by Carole Jackson, Bottom Line Health

Gym rats are forever comparing notes on the best ways to maximize the benefits of their workouts — whether the goal is to increase endurance, get stronger or simply stay flexible. Doctors, wanting to see their patients use exercise as efficiently as possible, also want to know more. The result? Researchers are kept steadily busy studying what does and does not change the way the body responds to exercise. Sometimes, as with the study I am about to tell you about, they’re surprised at what they learn.

Shaking Up Expectations

In this small study from Colorado State University, 16 sedentary adults (ages 37 to 64) were asked to do 45 minutes of aerobic activity (all at the same intensity) three times a week for six weeks and then, immediately after each exercise session, to consume either a drink packed with protein and carbohydrates or one containing just carbohydrates. Each participant drank the same kind of drink for the whole study.

The results were surprising in three different ways…

Protein drinks weren’t better at building muscle. Both drinks were equally effective at what the researchers were measuring, which was production of new proteins in the muscle (and that leads to the building of muscle). Previous studies had led researchers to believe that the protein drink would have brought greater results.

Protein drinks were better at boosting oxygen intake. Consuming protein increased the maximum volume of oxygen participants were able to use. This oxygen intake is called VO2 max and is a measure of cardiovascular health — the more oxygen your body can use, the fitter you are aerobically and the healthier your cardiovascular system. Lead researcher Benjamin Miller, PhD, told me that the after-exercise protein drink helped boost oxygen volume by increasing the manufacture of proteins in the mitochondria (the cells that produce energy).

Exercise brought new DNA to everyone’s muscles. People in both groups also experienced an increase in the amount of new DNA (the body’s instructions for building living tissue) in their muscle. Dr. Miller called this finding the “coolest of all” because it indicates that exercise helps the body repair old damaged DNA and, he theorizes, the muscle cells likely recruit new DNA from regenerative cells outside the muscle. Dr. Miller said that it was previously thought that skeletal muscle did not replicate at all, noting that this finding may yield new insights on how exercise helps to slow the aging process.

The takeaway message for all of us? It’s helpful for us exercisers to consume protein soon after we exercise — not for building muscles, as we had thought, but to maximize our oxygen intake and build a stronger cardiovascular system.


Benjamin F. Miller, PhD, assistant professor, department of health and science, and director, skeletal muscle laboratory, Colorado State University, Fort Collins.

Xanax — Relaxing You to Death

by Carole Jackson, Bottom Line Health

Can Xanax, the extremely popular prescription drug that soothes anxiety, make a mess of your life? Yes, it can — and not only because it’s highly addictive. It can easily kill you if you take too much of it. Frighteningly, we are seeing that more and more as people are dying… or driving so unsafely that they might kill others.

Xanax is old — it was first marketed in 1981 — but boy, has our society had a hard time learning to deal with it safely. The federal Centers for Disease Control and Prevention recently issued a report announcing that Xanax has become one of the leading causes of drug overdose in the state of Florida, where fatal overdoses of prescription drugs are now four times as common as those caused by illicit drugs such as heroin and cocaine. (A news story in the St. Petersburg Times reported that Xanax is turning up along with alcohol in the blood of an alarming number of people arrested for driving “under the influence.”) According to a recent report from the Substance Abuse and Mental Health Services Administration of the US Department of Health and Human Services, benzodiazepines are more commonly used for “recreational” purposes than opioids — and among them, Xanax is the most frequently misused. Three decades after its introduction, what we have with Xanax looks to be a major problem in the making.

Something to Be Anxious About…

Xanax (or alprazolam, its generic name), an antianxiety medication, is a controlled substance for which doctors in the US wrote 37.5 million prescriptions last year, nearly 40% more than five years ago. Why does a 30-year-old drug experience such a radical surge in popularity? It is prescribed as a treatment for panic attacks and generalized anxiety disorder, but many people who have no particular medical condition take it episodically, on an as-needed basis, simply as a way to get through life’s usual stressful situations — such as disagreements with a spouse… a presentation or performance review at work… flying in stormy weather. And many doctors are only too happy to let fly Xanax prescriptions for these uses.

Regular readers of Daily Health News know well how concerned I am about our society’s propensity to try to solve problems with pills. I spoke to Ihsan Salloum, MD, professor of psychiatry at the University of Miami, who told me that in his private practice he treats many patients with anxiety disorders and panic disorders… and he said that he simply won’t write prescriptions for Xanax. There are many alternatives that work well and are far safer, he said, and in his view, “the benefits of taking Xanax aren’t worth the risk.”

Why So Deadly?

Dr. Salloum noted that as a member of the benzodiazepine class of drugs, which also includes Ativan, Klonopin and Valium, Xanax works its magic against anxiety by enhancing the brain’s production of gamma-amino butyric acid (GABA), sort of a natural tranquilizer — which explains why the side effects of Xanax include drowsiness, clumsiness, difficulty walking, slurred speech and loss of libido. Xanax is faster-acting than Klonopin and Valium and has a shorter half-life, which means people may need to take multiple doses over the course of the day to maintain their equanimity. A patient may be prescribed, say, two to four pills a day and end up taking even more as his body acclimates to the drug. It takes just a few months for physical dependence to develop, Dr. Salloum said, and with dependence comes a myriad of difficulties when it comes to withdrawal. There’s also a psychological dependence at play, a particular problem with anxious people who end up being anxious about their anxiety, taking more pills — and ending up with a problem that spins out of control.

I asked Dr. Salloum about the magnitude of problems in Florida, and he noted that not only is the use of Xanax very widespread in that state — its connection with DUI arrests is easy to explain because taking Xanax and alcohol together intensifies the effects of both. In addition, taking too much Xanax (or taking it in combination with other drugs such as narcotics) can cause severe reactions, including respiratory depression, cessation of breathing — it can even cause the heart to stop beating. Another major problem: In older people, the drug is especially prone to impair balance. “Research has shown that benzodiazepine drugs are to blame for many falls in the elderly,” said Dr. Salloum.

Xanax Is a Habit You Should Worry About

Dr. Salloum said that if you are reaching for an extra Xanax each time you feel cause for anxiety — don’t! While there are several antidepressants that have been FDA-approved for the treatment of anxiety disorders, they don’t have the same immediately soothing effect that Xanax has. Where does that leave you if you are prone to episodic anxiety? Dr. Salloum suggests learning other ways to calm yourself down, such as breathing exercises, yoga, meditation and the like.

So once again we seem to have wound our way back to the same conclusion — not only does taking a pill to make a problem go away not always work, in this case it makes the problem worse. If you are in the habit of taking Xanax for your anxiety, you’ve got reason to look for an alternative!


Ihsan Salloum, MD, professor, department of psychiatry, University of Miami Miller School of Medicine.