Category Archives: For Your Body

Getting Over a Cold or the Flu?

Joseph Feuerstein, MD
Bottom Line Health


When you’re sidelined by the fever and head-to-toe body aches of the flu or even the endless sneezing and coughing of a cold, it’s tempting to want to get back to normal life at the first sign of feeling better. Wait! These illnesses take a toll on your body, and the flu, in particular, can set you up for serious complications. When flu turns deadly: While the flu itself can quickly lead to lethal respiratory failure if the lungs are overtaken by inflammation, complications of the flu, such as pneumonia or sepsis, are often the actual cause of death. In some cases, being run down from a bad cold can even set the stage for pneumonia. Whether you’re battling the flu or a cold, here’s a natural six-step recovery plan that will also help fortify you against serious complications:

• Get tested. If you’re sure you’ve got a cold, you might be able to tough it out on your own. But symptoms of the cold and flu can be similar. The distinguishing characteristics are typically the flu’s rapid onset and extreme fatigue, but both illnesses can cause headache, coughing and a runny nose. A fever is more common with the flu, but not everyone with the flu will run a fever.  That’s why if you’re not sure what’s causing your illness—especially if you’re over age 65…have had a heart attack or stroke…or have a chronic condition such as lung disease, diabetes or ­cancer—talk to your doctor about getting tested for the flu. Some nasal or throat swab tests can provide an answer in 30 minutes or less. If you do have the flu, your doctor may want to closely supervise your recovery—in some cases, with monitoring in a hospital if you’re frail and/or have a chronic health problem. Important: Don’t assume that a cold is harmless. If it improves but then worsens…lingers for more than 10 days without getting better…and/or causes fever that lasts for more than three days, consult your physician. This could signal a complication such as bronchitis or pneumonia. If you have a cold or the flu and experience shortness of breath, chest pain or a fever over 103°F, call your doctor or 911. Caution: Respiratory infections (particularly the flu) are linked to increased risk for heart ­attack­—especially in the week following a flu diagnosis.

• Stay “horizontal.” There’s a reason you’re tired and feverish and have no appetite. Your body is forcing you to stop all activity so that it can wage an all-out effort to fight the virus. In most cases, fever is an integral part of the process—it actually stimulates your immune system to work harder than normal. What you need is lots of sleep, fluids (see below) and bed rest! Don’t let a hectic schedule or guilt over missing obligations keep you from listening to your body. It usually takes about a week to get over a cold, but the flu can set you back for up to two weeks. It may take even longer if you were run down before getting sick or if you’re managing a chronic condition, such as lung disease or diabetes, that was already stressing your system. Important: When you must get up (to, say, go to the bathroom), do so in stages—sit up…swing your feet over the side of the bed…then stand for a few seconds before you start to walk. Prolonged bed rest can lower your blood pressure, which can cause dizziness and even fainting if you stand up too quickly. 

• Consider taking elderberry and echinacea. Even though some people prefer to take a pharmaceutical such as oseltamivir (Tamiflu) for the flu, elderberry and echinacea are worth considering. While some modern research on these botanicals has been mixed, both have been used for centuries to ease cold and flu symptoms and a comprehensive 2017 study published in the Journal of Evidence-Based Complementary & Alternative Medicine found that elderberry and echinacea were effective against cold and flu viruses. The phytonutrients that give elderberry its deep black-purple color have been found to help stop virus cells from multiplying. Black elderberry extract is available in liquid, tablets, and lozenges. Sambucol, Black Elderberry is particularly effective. Echinacea purpurea (one of the various species of echinacea) has been shown to have immune-stimulating properties. It’s available in capsule, extract, and liquid form. Note: If you have allergies or asthma, be sure to check with your doctor before trying echinacea. Some cold and flu products, such as Gaia Herbs’ Quick Defense with Echinacea & Elderberry…and Solaray’s Echinacea & Elderberry, contain both herbs. A combination tea, Echinacea Plus Elderberry, is available from Traditional Medicinals. Also: To treat your fever, consider alternating the lowest possible dose of acetaminophen (Tylenol) and a nonsteroidal anti-inflammatory drug, such as ibuprofen (Motrin). This helps minimize the side effects of each medication. Zinc supplements have been shown to significantly reduce the length and severity of cold symptoms. For a cold, try zinc lozenges within 24 hours of the start of your symptoms and for the duration of the illness. 

• Drink more fluids than you think you need. You don’t have to force yourself to eat solid foods, but liquids are essential—and you may not realize how much water you’re losing when you’re sweating from a fever. This can lead to dehydration, another reason for dizziness when you go from lying to standing. My rule of thumb: Drink enough to make your urine clear. Listen to your body and stick with broth and other soups at first to avoid straining your digestive system.

• Spice up your chicken soup. To amp up the healing power of chicken soup, add immune-boosting, anti-inflammatory spices such as turmeric and ginger, along with garlic. Use as much as you can tolerate of each to taste. When you are ready for solid food, start with healthy starches such as oatmeal and whole-wheat toast. It takes more effort for your body to digest raw fruits and vegetables, so try to avoid them until you’ve recovered. 

•Pace your reentry. The common rule of thumb is to wait at least 24 hours after your fever is gone before returning to your usual activities, but that can be too soon. Whether it’s work, household chores or hobbies, the more physical activity that’s involved—even standing for long periods of time—the more gradual your return should be. As for resuming your exercise regimen, wait until you have gone back to your normal diet…and start with slow-to-moderate walking for 10 minutes. It could take a week or more to get back to your full workout schedule.

Top Cold and Flu Preventive

With its antioxidant and antimicrobial properties, the herbal remedy American ginseng (Panax quinquefolius) has strong research supporting its use as a cold and flu preventive. In a study involving nursing-home patients that was published in the Journal of the American Geriatrics Society, it reduced the risk for flu by 89% compared with a placebo. The study participants took 200-mg capsules twice daily of a product called Cold-FX, which is usually taken throughout the cold season. Important: For cold and flu prevention, it’s American ginseng that should be used, rather than Asian, Siberian or other ginseng varieties.

Exercise as a Couple and Double Your Results

Dr. John Raglin
Bottom Line Health

You know all about the motivational advantages to working out with an exercise buddy, but are they the same when the buddy is your spouse or life partner? The answer is yes and perhaps more so. Working out with your spouse or partner can strengthen your relationship along with your muscles. Here’s how to start off on the right foot.

Commit to an Exercise plan

Sticking with an exercise program isn’t easy. The average dropout rate is 50%, most often after just a few months. But exercising with your significant other can change that. I studied married people who joined a fitness program by themselves and as a couple. After 12 months, the couples had a better-than-90% adherence rate—that’s remarkably high when you consider average adherence is about 50% after 12 months for people joining without their spouse. Most interesting was that they didn’t need to be doing the exact same exercise program, provided they went to the gym together, so the issue of “he’s stronger than I am” or “I don’t like the same machines” doesn’t matter. You don’t have to work out side by side—you just have to make the commitment to exercise at the same time and place. For busy working couples, it even can create date-night closeness. It’s a terrific alternative to sitting silently in a movie. 

Keys for Exercise Success

Account for your differences. Most couples have different fitness ­levels, and you need to create a plan that accounts for those. If you’re working out with machines in a gym, it’s easy to simply go together for a set period of time or go to a class together. But if you want to go running or biking together and one of you can handle a greater pace and distance than the other, you’ll have to make accommodations. Try this: Agree to separate distance goals. Start off together at the same speed, but pick a point where the person with less stamina will stop and allow the other to continue or where the one who is in front will pause and wait for his/her partner. Hint: Make your route a repetitive loop that goes past your car or your home to make it convenient for one person to stop if needed. Don’t put yourselves in the position of having to navigate differences on the fly when one of you suddenly runs out of gas at the midway point of the route. 

How to Stop a Stroke Before It Happens

Feeling perfectly healthy? Chances are, your doctor still orders certain tests—called “screening tests”—that check for conditions such as colon cancer or osteoporosis that might be lurking and could be treated.So why not a screening test for stroke risk?We know that people living in the US have nearly 800,000 strokes each year and that 80% to 90% of those strokes are caused by blood clots. Many of these strokes originate from clogged carotid arteries—large arteries in the neck that feed blood to your brain. Like the arteries that feed your heart, these can be narrowed by plaque buildup as you age.

This may surprise you: There is a test that can detect such blockages. It’s a simple ultrasound of your neck that costs about $70 to $300 (depending on where you live) and sometimes is covered by insurance.However, no major medical group advises checking the carotid arteries of all adults—due to concerns that many questionable results will turn out to be wrong, leading to needless worry, costly follow-up testing and risky surgeries.But some medical groups, such as the Society for Vascular Surgery, the American Heart Association and the American Stroke Association, think it makes sense to test certain people who are at increased risk for a stroke from a clogged carotid artery.

The danger: Without testing, too many people, while clinically asymptomatic, will unknowingly suffer one or more symptomless “silent strokes”—small, repeated insults to the brain caused by inadequate blood flow, which over time can lead to decline in cognitive function. Unsuspecting people with blockages also may ignore signs oftransient ischemic attacks, or TIAs (also known as “ministrokes”)—brief attacks that produce passing stroke symptoms that may last only for a few minutes, such as weakness of an arm or leg, brief loss of vision or difficulties speaking. Ministrokes can be the precursor to a bigger and permanently damaging stroke. Still other people will get no warning before a stroke that leaves them disabled or dead, further adding rationale for the screening test.

Should You Get Scanned?

While guidelines from medical groups vary, many doctors—including myself—say that you should consider a potentially lifesaving scan of your carotid arteries if one or more of the following apply to you…

A “bruit” in your neck is detected by your doctor. This abnormal sound, detected by a stethoscope during a routine physical exam, can indicate a narrowed artery—especially when it’s accompanied by other stroke risk factors, such as high blood pressure. Note: Your doctor should listen for a bruit on both sides of your neck. In some cases, patients actually can hear a “whooshing” sound in their ears.• You are over age 65and have multiple stroke risk factors, such as smoking, elevated cholesterol, high blood pressure and/or diagnosed coronary artery disease.

You have been diagnosed with peripheral artery disease (PAD). This narrowing of the leg arteries can cause leg pain, particularly when walking. If the arteries feeding your limbs are clogged with plaque, the arteries in your neck may be, too.

You have worrisome results from an ankle-brachial index test. With this test, your doctor compares your blood pressure readings at your ankle and upper arm. The test can indicate PAD, so it’s recommended for people with suspicious symptoms in their legs, including pain, numbness or weakness, but also is sometimes used as a broader screening tool for artery health.

You have had symptoms of a ministroke. This might include weakness or numbness on one side of your body or slurred speech. Even if the symptoms lasted for just a minute or two, they are serious. People who have a ministroke are at high risk for a bigger stroke, most often in the first few days, but also in the months and years ahead. If you have possible ministroke symptoms in the future: Treat them as a medical emergency, and call 911 right away.

Important: If you decide, in consultation with your doctor, to get a carotid ultrasound, make sure that you get the gold-standard test, called a carotid duplex ultrasound, from a laboratory accredited by the Intersocietal Accreditation Commission (IAC). The test, which requires no preparation, can take up to 30 to 60 minutes. You will be asked to wear loose-fitting clothing that allows the technician to access your neck. If there is significant plaque in a carotid artery, the lab report should say how extensive the blockage is and describe the characteristics of the plaque in a way that will help your doctor assess your risks.

You have worrisome results from an ankle-brachial index test. With this test, your doctor compares your blood pressure readings at your ankle and upper arm. The test can indicate PAD, so it’s recommended for people with suspicious symptoms in their legs, including pain, numbness or weakness, but also is sometimes used as a broader screening tool for artery health.

You have had symptoms of a ministroke. This might include weakness or numbness on one side of your body or slurred speech. Even if the symptoms lasted for just a minute or two, they are serious. People who have a ministroke are at high risk for a bigger stroke, most often in the first few days, but also in the months and years ahead. If you have possible ministroke symptoms in the future: Treat them as a medical emergency, and call 911 right away.

Important: If you decide, in consultation with your doctor, to get a carotid ultrasound, make sure that you get the gold-standard test, called a carotid duplex ultrasound, from a laboratory accredited by the Intersocietal Accreditation Commission (IAC). The test, which requires no preparation, can take up to 30 to 60 minutes. You will be asked to wear loose-fitting clothing that allows the technician to access your neck. If there is significant plaque in a carotid artery, the lab report should say how extensive the blockage is and describe the characteristics of the plaque in a way that will help your doctor assess your risks.

What’s Next?

If your carotid scan shows no significant blockage, continue taking steps to lower your stroke risk—control blood pressure and cholesterol, maintain a healthy body weight and don’t smoke.What if your carotid testing indicates trouble? Here are the rules of thumb…

If less than 50% to 60% of your artery is blockedand you have no symptoms, you will likely be advised to continue or add medications that reduce your stroke risk, such as a statin for high cholesterol, aspirin to reduce clotting and medication to lower your blood pressure. If you smoke, you will have a powerful new reason to quit.

If your blockage is 60% or more but you have no symptoms, surgery (called a carotid endarterectomy)to remove the plaque may be needed, depending on the severity of the narrowing and the character of the plaque…or if there has been increased narrowing over time. If surgery is not indicated, drugs and lifestyle changes are recommended, and scanning should be repeated every six to 12 months to watch for progression.

If you have a blockage of 50% to 99%and symptoms, the choices are clearer. Unless you have a condition, such as severe, noncorrectable coronary artery disease, heart failure or severe chronic obstructive pulmonary disease (COPD), that makes such procedures too risky, endarterectomy or a stent to open your clogged artery likely will be offered. Stenting is considered more appropriate for symptomatic patients who are too high risk for endarterectomy.

Caution: These procedures can reduce your long-term stroke risk, but they both carry risks of causing an immediate stroke or death by dislodging plaque and sending it to your brain.

My advice: If you are considering one of these procedures, look for a highly experienced surgeon and hospital—and ask for their complication rates. With a top-notch team, stroke or death rates following endarterectomy or stenting should be no more than 2% to 3% for asymptomatic patients…and no more than 5% to 6% for symptomatic patients.

Source: Bruce A. Perler, MD, MBA,a practicing vascular surgeon at Johns Hopkins Medicine and the Julius H. Jacobson II, MD, Endowed Chair in Vascular Surgery at Johns Hopkins University School of Medicine, both in Baltimore. Dr. Perler is author of nearly 200 peer-reviewed medical journal articles and textbook chapters and has edited several textbooks, including Rutherford’s Vascular Surgery and Endovascular Therapy. Date: March 1, 2019 Publication: Bottom Line HealthMeasureMeasure

For Relief from Common Aches and Pains, Change the Way You Sleep

Whether you like to curl up on your side or sprawl flat out on your stomach, you probably have a favorite sleeping position. But did you know that if you suffer from common aches and pains, this familiar position might be aggravating your pain?Here’s how to adapt your preferred sleeping style for pain relief and bettersleep

Neck Pain

Back-sleeping is often said to be the best position for neck pain. But back–sleeping can actually increase neck discomfort when using a pillow that’s too thick (which causes the head to flex forward) or too thin (which causes the head to flex backward).For back-sleepers: Be sure to use a pillow that keeps the neck in a neutral position, in line with the spine. When viewed from the side, the ear should be in line with the shoulders or slightly above them.For side-sleepers: Add a thin pillow or rolled-up bath towel between the neck and the mattress in addition to your regular pillow to provide neck support and prevent the spine from bending to either side.For stomach-sleepers:This position is the worst for neck pain because you’ll need to turn your head to one side or the other, which puts strain on the neck. It’s best to try another position, if possible.

Low-Back Pain

Many people say that their backs feel better when they sleep on their backs, particularly if they use a pillow or two to slightly elevate the knees. But side-sleeping often feels more natural.For side-sleepers: Lie on one side in a “stacked” position, with your shoulders, knees and hips in up-and-down alignment and knees slightly bent. Helpful: Place a pillow between your knees. This helps to prevent the top leg from rolling over the bottom, which can twist the spine.For stomach-sleepers: This position can strain your lower back. However, if you find it difficult to try the positions above, place a pillow under your stomach to reduce excessive spinal extension.

Knee Pain

With knee pain, back-sleeping can be painful because the knees are extended all night…but side-sleeping can cause irritation where the knees touch.For back-sleepers: Try placing a pillow under the knees to prevent them from overstraightening. Note: This position can be painful for some people.For side-sleepers: Sleep with a pillow between your knees or use cloth knee pads (such as those that volleyball players wear), turning them sideways so that the area where the knees touch is well padded.For stomach-sleepers: This position can put painful pressure on your knees. But if it’s tough for you to switch to one of the above positions, put a pillow under your stomach to take some pressure off the knees.

Hip Pain

For back- or stomach-sleepers: People with arthritis-related hip pain often have more pain when sleeping on their back or stomach. It’s best to try side-sleeping (see below). However, a small pillow under the knees (when lying on your back) or under the stomach (when lying on your stomach) may provide some relief.For side-sleepers: Side-sleeping is usually best for arthritis-related hip pain. Helpful: Keep your knees slightly bent and use a pillow (a body pillow works well) between the knees and thighs to keep the hip in a more neutral position. If lying on one side is more painful than the other, switch sides.

You Can Change How You Sleep

When you get into bed, start in the position in which you would like to sleep. Then spend about a minute visualizing yourself staying in this position for the night. If you wake up and are out of position, calmly go back to the position you are trying to change to. In most cases, good progress can be made in four to six weeks, but it’s something you’ll need to keep working on—it’s easy to fall back into old habits.

Source: Matthew O’Rourke, PT, DPT, CSCS, OMT, adjunct professor of physical therapy at Simmons University in Boston and a physical therapist in the outpatient clinic at Lahey Hospital & Medical Center in Burlington, Massachusetts. Date: March 1, 2019 Publication: Bottom Line HealthMeasureMeasure

7 Smart Ways to Control Nighttime Eating

Staring into the fridge again? Whether you’re trying to lose weight or simply not gain any, nighttime snacking can spell disaster. In fact, the calories we eat at night may play a more significant role in weight gain than the ones we eat at breakfast and lunch simply because of how the body works.A Japanese study found that, in a perfect world, we should stop eating two hours before going to bed. While that might work in Japan, the American lifestyle often means staying up late, past 11 pm or even midnight because of work deadlines or social demands, and you may want a snack at night.Willpower weakens as you get fatigued, so having a strategy to deal with nighttime noshing is key. Here’s advice from Stephen P. Gullo, PhD, a health psychologist who has specialized in weight control for four decades.


Don’t mistake sleepiness for hunger. In the hours after dinner, as your body moves into sleep mode, there’s no more need for food. But if instead of going to bed, you stay up to read a book, watch TV or pay bills, you may feel the urge to eat. Acknowledge that this snack attack isn’t true hunger because you’ve probably already eaten enough for the day. Satisfy the urge with a glass of water or a cup of caffeine-free herbal tea. If you make it so hot or cold that you can only sip it, you can trick yourself into feeling full.

Identify your snacking patterns. Many evening activities lend themselves to mindless or mood-triggered eating. You may munch as you watch TV or pay those bills, not noticing as the food disappears. Or perhaps you’re anxious about the day’s events, so you eat to forget your troubles. Separate mood from food, and find other ways to express emotions, such as journaling, calling a friend or distracting yourself with a novel. It also helps to acknowledge your “food genes.” Are you wired for sweets or for salty foods? Be especially mindful of the tastes you typically crave—you’ll want to avoid these triggers when making snack choices. For instance, one cookie won’t satisfy someone with a sweet tooth, but one salty chip might. Don’t feel guilty about your likes—just work with them.Reality check: Think historically, not just calorically. For one week, write down what and how much you eat at night…and what you’re doing and how you’re feeling as you snack. Then, to change your habits, plan your snack schedule in advance, listing healthful foods in your journal and what time you will eat them. Eating meals with a definite structure may also help squash nighttime temptation. Having small amounts four or five times a day optimizes metabolic efficiency and keeps blood sugar stable. Result? Less hunger and mindless eating.

Make a “no-shopping” list. To keep food out of mind, keep it out of house. When nighttime cravings kick in, people rarely rush out to the store to buy them—they satisfy their cravings with what’s already on hand. Do you keep your kitchen stocked with favorite snacks? This opens the door to constant temptation. Availability creates craving, and variety stimulates consumption. It’s easier to resist just once…when you’re at the supermarket.Smart: On your shopping list, include a separate section for foods you won’t buy. Review your shopping cart before you hit the checkout line and put back anything on that list. Make a point of creating a shopping list of healthy options—if berries and carrots aren’t written down, you may not remember to buy them.

Eat a better dinner. Make this meal high in protein—eggs, white meat (turkey or chicken) or seafood—and vegetables that are low in starch and sugar. Avoid high-starch foods such as potatoes, rice, corn and pasta (as well as pizza and burritos). They stimulate insulin production, which causes the body to store more calories as fat—and nighttime is when you’re most vulnerable to fat storage. If you’re going to eat high-starch foods, have them at lunch. On the other hand, don’t confuse a light dinner with a small dinner—you can have a large volume of shrimp and green beans, for instance.


It’s hard to go cold turkey with nighttime noshing, but it’s possible to snack smarter if you can’t shake the habit completely. And sometimes you’re truly hungry because you forgot to eat or have to work late and can’t focus without food. That’s fine—as long as you stick mostly to healthful foods and reasonable portions. Yet it’s all too easy to overindulge. You might be too distracted to notice how much you’re nibbling, so eat mindfully.

Eat dinner—again. If you find yourself wanting to eat nonstop at night, your behavior is saying that you’re seeking greater volume and a longer eating time. For many, having a small sweet treat stimulates rather than satisfies the appetite, so a paltry-yet-calorie-dense smidgen of fudge only leads to frustration or, worse, acts as a trigger for eating more. Have a satisfying, high protein mini-meal instead. For people whose habit is to nibble all through the evening, having this extra meal, which takes some time to prepare and eat, will be much more satisfying than a snack that can be gobbled down in four spoonfuls, such as a diet pudding.Consider: An egg plus an extra egg-white (to add volume without too many calories) omelet with sautéed veggies…a shrimp cocktail with a green salad…homemade tuna salad made with a tablespoon of light mayo or no-fat plain Greek yogurt…or zucchini “pasta” with a tablespoon of fresh Parmesan cheese. Be sure that your favorites from these choices make it onto that shopping list above. And because foods placed at eye level in the front of the fridge will seem to call your name, put them there.

Choose wisely when a packaged snack is your only option. Caught at a convenience store on your way home or on the road? Shop for a premeasured high-protein snack that clocks in at about 100 calories. Choose a food low in carbs and sugar. A container of plain Greek yogurt with fresh fruit, a cheese stick, nuts, high-fiber crackers or a low-calorie ice cream or frozen yogurt bar are all acceptable choices. Do a reality check before choosing: Does the food satisfy or stimulate? For instance, if you know that once you eat a bag of salty crackers, you’ll be reaching for another one, firmly say to yourself, “That choice doesn’t work for me,” and pick something else. Also pay attention to packaging size. Look for single servings—no large bags or containers that encourage mindless overeating.

Close the kitchen. After you’ve had your last meal or smart snack, turn off your kitchen lights. People don’t like to go into a dark room, so this simple step can help keep you from going back to the fridge just one more time. Then go brush and floss your teeth—no one wants to floss twice in an evening!

Source: Stephen P. Gullo, PhD, psychologist and expert in the behavioral nutrition approach to weight loss, president of the Center for Health and Science, New York City, and author of The Thin Commandments Diet: The Ten No-Fail Strategies for Permanent Weight Loss

Get an Extra Edge Against Cancer

from Bottom Line Health

Get an Extra Edge Against Cancer

More than one-third of American adults reach for vitamins, herbs or other natural medicines when they have colds or other routine (and hopefully mild) health problems. Similar remedies can help when you have cancer.
To learn more about the best and safest ways to use natural therapies—also known as complementary and alternative medicine (CAM)—to fight cancer and its complications, Bottom Line Health spoke with Mark A. Stengler, NMD, a naturopathic physician who treats cancer patients.


Research has shown that many so-called “alternative” treatments can enhance the effects of conventional cancer care such as surgery, radiation or chemotherapy…reduce treatment side effects…and possibly improve survival.
This type of integrative care doesn’t replace conventional cancer treatments. Rather, with the guidance of a doctor, complementary therapies are added to a patient’s treatment plan.
Important: To ensure that the therapies described below would be appropriate for you, consult the Society for Integrative Oncology ( to find an integrative oncologist near you…or check with The American Association of Naturopathic Physicians ( to locate a naturopathic doctor who also treats cancer patients. Also: Be sure to ask the doctor you choose to be in touch with your oncologist. Here’s how CAM can help with problems that plague most cancer patients…
Get relief from “chemo brain.” It’s estimated that three-quarters of cancer patients will experience some degree of mental cloudiness. Known as “chemo brain,” it can include mood swings, memory loss and mental fatigue. It eventually improves, but some patients will feel like they’re in a mental fog years after their treatments have ended.
What helps: The omega-3 fatty acids in fish oil supplements—a typical daily dose is 1,000 mg total of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) combined—help regulate acetylcholine, a neurotransmitter that increases nerve growth factor and improves memory as well as energy levels.
The omega-3s also increase the effectiveness of 5-fluorouracil and other chemotherapy drugs, according to a study published in Clinical Nutrition Research. In research published in Cancer, lung cancer patients who took fish oil along with chemotherapy had a greater one-year survival rate than those who didn’t take the supplements.
Note: Fish oil may cause stomach upset in some patients, along with bleeding in those who are taking anticoagulant medications such as warfarin (Coumadin), apixaban (Eliquis) and rivaroxaban (Xarelto).
Boost energy levels. Ginseng is one of the more effective supplements for cancer patients. A number of studies have shown that it reduces treatment-related side effects, including weakness and fatigue. A double-blind study in Journal of the National Cancer Institute found that patients who took ginseng had less fatigue than those given placebos.
My advice: The American form of ginseng (Panax quinquefolius) is more effective than the Asian form. Typical dose: 1,300 mg to 2,000 mg daily. It rarely causes side effects, although it may lower blood sugar in those with diabetes.
Also helpful: Glutathione, a “super antioxidant” that can be combined with chemotherapy to reduce toxin-related fatigue and other side effects. It’s usually given in an IV solution. Side effects are unlikely, but it may interfere with some chemotherapy drugs. Be sure to consult an integrative oncologist to see whether you will/won’t benefit from glutathione.
Improve immune response. Turkey tail is one of the best–studied medicinal mushrooms. Available in capsule form, the supplement has chemical compounds (beta–glucans) that stimulate many aspects of the immune response, including antibody activity—important for inducing the death of cancer cells.
Impressive research: A study published in Cancer Immunology and Immunotherapy found that postsurgical remissions in colorectal cancer patients were twice as common in those who were given turkey tail. Typical dose: 3,000 mg daily. Side effects are unlikely.


Conventional oncologists receive little training in nutrition, but it’s a critical issue for cancer patients. One study found that 91% of cancer patients had nutritional impairments, and 9% were seriously malnourished. Research shows that malnutrition contributes directly or indirectly to a significant number of cancer deaths due to poor appetite and the disease process of advanced cancer.
Loss of appetite is a major cause of malnutrition and muscle loss (cachexia). I advise patients who are losing weight to address these problems by getting more calories.
With every meal, include high-fat foods such as olive oil, coconut oil, avocado, nuts and seeds. A 10-year study, published in Archives of Internal Medicine, looked at more than 380,000 adults and found that a Mediterranean-style diet, which is high in olive oil and other healthy fats, reduced cancer deaths in men by 17% and 12% in women.
Also helpful: Protein shakes. They can provide the extra protein that’s critical for cancer patients. Up to 80% of those with advanced cancer experience muscle loss. Protein shakes can help reverse it. Best option: Ready-made whey protein or pea protein shakes—both are nutritious, have 5 g of sugar or less per serving and are readily available in health-food stores.
My advice: Get 1 g to 1.2 g of protein per kilogram (2.2 pounds) of body weight daily. This means that someone who weighs 150 pounds will need about 68 g to 82 g of protein daily. You can get that much from two or three servings of a typical whey protein beverage, which comes ready-mixed or in powdered form. Caution: If you have moderate or severe kidney disease, check with your doctor for advice on your protein intake.


Cancer care is rarely a straightforward process. From the time you are diagnosed until your treatments end, your care will depend on the opinions of a surprising number of specialists—and good communication among those experts can strongly affect how well you do.
Important recent finding: Among nearly 5,000 patients with colorectal and lung cancers, those whose doctors participated in weekly tumor boards lived longer, according to a study presented at a symposium of the American Society of Clinical Oncology.
To ensure that the medical center where you’re being treated relies on a tumor board’s guidance, you should seek out a cancer center designated by the National Cancer Institute or accredited by the Commission on Cancer.
Large cancer centers usually have separate tumor boards for different types of cancer. At smaller programs, a single board will review all or most cancer cases.
Tumor boards provide important oversight because what seems like a perfect treatment plan can fall short in real-world circumstances. For example, chemotherapy might be the recommended treatment for a specific cancer, but a tumor-board oncologist might argue that a particular patient isn’t healthy enough to withstand the treatment. A psychologist or social worker at a meeting might point out that the patient will need transportation to and from the chemotherapy clinic.


At MD Anderson Cancer Center and other large cancer centers, virtually all cases are discussed at a tumor board, although doctors give most of their attention to rare/complicated cases. There’s no separate charge to patients for the review.
My advice: If you’re not sure that your case has been discussed at your treatment center’s tumor board, ask your doctor whether it has been (or will be). Your doctor should not be offended by this question—especially if he/she will be presenting the case. If your case hasn’t been reviewed, ask why not. You have the right to request a tumor board review, but it might not be available at a smaller medical center.
Most tumor boards meet weekly or twice a month and are comprised of a dozen or more specialists, including surgeons, medical oncologists, radiation oncologists and pathologists. Depending on the cancer, other doctors—gynecologists, urologists, etc.—may participate. Meetings often include a nutritionist, nurses, mental health experts and a social worker.


Your case might go before a tumor board prior to treatment…after a preliminary treatment plan has been initiated…or during treatment when there is an important change in clinical circumstances.
Important finding: When the records of more than 200 pancreatic cancer patients collected from various institutions without tumor boards were later evaluated by a panel at Johns Hopkins University School of Medicine that included medical and radiation oncologists, surgical oncologists, pathologists and other experts, treatment changes were recommended in nearly 25% of these cases.
Research also shows that patients tend to have better outcomes in terms of treatment responsiveness, recovery times and survival, among other factors, when their cases are discussed at a tumor board.
Also: Patients whose cases are reviewed are more likely to be guided to a clinical trial—one that their primary oncologist might not be aware of. Many cancer patients are eligible for these trials, which provide excellent care…yet only about 3% of patients ever participate. The more patients there are enrolled, the more quickly important clinical questions can be answered.
The National Cancer Institute website lists thousands of clinical trials that are looking for participants—to compare drug treatments, study new surgical techniques or radiation treatments, etc. Most tumor boards have a “checklist,” which includes the question of whether there is a trial for which the patient might be eligible.


The services provided by tumor boards go beyond the nuts and bolts of treatment. For example, many cancer patients lose weight during chemotherapy or radiation treatments. If poor nutrition is threatening your recovery—or even your ability to continue treatments, a nutritionist might recommend nutritional counseling, or even help you find a free meal service in your area.
Many cancer patients suffer from mental health issues—depression, bipolar disorder, etc. The best cancer plan won’t help if you’re unable (or unwilling) to continue treatments. A tumor board will attempt to address—or correct—all the issues that can affect how well or poorly you respond to treatments.
Patients don’t typically attend tumor boards. Many different cases are reviewed at any one meeting. The presence of a patient would affect the confidentiality of others’ personal health information.
Source: Richard A. Ehlers II, MD, associate professor, department of breast surgical oncology and associate vice president in the Division of Houston Area Locations at The University of Texas MD Anderson Cancer Center. He is also adjunct assistant professor in the department of surgery at The University of Texas Medical Branch at Galveston. Date: May 1, 2018 Publication: Bottom Line Health

The Right Team to Treat Your Cancer

If you or a loved one is being treated for cancer, you may not be aware of so-called “tumor boards.” But if you’re getting care at a major academic or cancer-specific medical center, these regular face-to-face gatherings of cancer specialists—oncologists, radiologists, surgeons, pathologists, psychologists and others—play a key role in assessing individual cases. This may involve reviewing the pathology report…tracking disease progression…and discussing the treatment options for different types of cancer.
What gets reviewed: If your case comes before a tumor board, the doctors likely will address a variety of issues. Is surgery an option or will radiation and/or chemotherapy be more appropriate? If surgery can be done, should it or chemotherapy be used first, followed by other treatments? Is this patient battling mental health issues…or getting the runaround from insurance to get coverage for certain drugs?


Stop A Migraine Before It Happens

Date: January 1, 2017
Publication: Bottom Line Health

The best options aren’t prescribed often enough…

There are more than 37 million Americans who suffer from migraines, but the odds aren’t in their favor when it comes to drug treatment.

Sobering statistics: Preventive drugs work for only about half of the people who have these awful headaches—and even when the medication does help, migraine frequency is reduced by only about 50%.

The drugs that stop migraines once they’ve started—mainly prescription triptans (such as sumatriptan, rizatriptan and almotriptan) …as well as OTC nonsteroidal anti-inflammatory drugs, such as ibuprofen (Motrin), and Excedrin Migraine, which contains acetaminophen, aspirin and caffeine—are not always effective. They work best when they’re taken soon after the pain begins. Some of the drugs also cause side effects, such as fatigue or gastrointestinal bleeding. And taking them too often can lead to more—and more severe—headaches, known as overuse headaches or “rebound” headaches. So preventive drugs may be needed to avoid overuse of these medications.


Why are migraines so hard to manage? Experts once believed that migraines were mainly caused by the dilation (widening) of blood vessels in the brain. That’s why drugs usually prescribed for other conditions, such as propranolol, a blood pressure drug, have been used to reverse these changes.

But we now believe that migraines have more to do with overstimulation of the trigeminal nerve in the face and head—this can cause blood vessels in the brain to expand and become inflamed. Treatments that affect this nerve (see below) are often very effective.

Important: Everyone who suffers from migraines should pay attention to possible triggers that precipitate attacks. Some people react to strong scents. Others are vulnerable to specific foods (such as bacon, ripened cheeses or alcohol)…food additives such as monosodium glutamate (MSG)…emotional stress…bright lights, etc. Avoiding triggers can be an effective way to prevent some attacks.


Preventing a migraine is always better than trying to treat one that’s already taken hold. Unfortunately, not all doctors are aware of the more recent effective migraine-prevention approaches. Among the best…

Cefaly. Nearly three years ago, the FDA approved the first device for migraine prevention. Cefaly is known as an external trigeminal nerve stimulationunit. It electrically stimulates branches of the trigeminal nerve, which transmits sensations to the face and head.

How it works: The prescription-only device, which blocks pain signals, includes a battery-powered headband with a reusable, self-adhering electrode. Patients position the headband around the forehead, just above the eyes. It may cause a slight tingling, but no pain. It’s used for 20 minutes once a day. Anyone who has an implanted device in the head, a pacemaker or an implanted defibrillator should not use Cefaly.

Scientific evidence: One study found that more than half of migraine patients who used Cefaly were satisfied and intended to keep using it. The unit costs about $350 and is usually not covered by insurance. The device manufacturer offers a 60-day guarantee, so people can get their money back if it doesn’t seem to help.

Biofeedback. Emotional stress is one of the most common migraine triggers. A biofeedback machine allows people to monitor skin temperature, muscle tension, brain waves and other physical stress responses that affect blood flow in the brain. The idea is that once people feel how they react to stress—with tightened forehead muscles, for example—they can modify their reactions with things like deep breathing, muscle relaxation, etc.

Scientific evidence: There’s strong research showing that biofeedback can reduce both the frequency and severity of migraines by 45% to 60%—but only for patients who are willing to practice.

Biofeedback can work about as well as many drugs, but it takes most people a few months before they’re good at it. It can also be costly because you have to work with an instructor at first. To find a certified biofeedback practitioner, go to the website of the Biofeedback Certification International Alliance, Insurance often won’t cover it.

Supplements. Some people do well when they combine one or more of these supplements with the previous approaches…*

Riboflavin, a B vitamin, may improve oxygen metabolism in cells. In one study, migraine frequency was reduced by 50% in patients who took riboflavin (400 mg daily).

Feverfew is an herbal headache remedy. Some research shows that 50 mg to 125 mg daily can help prevent and ease migraines, while other studies suggest that it’s no more effective than a placebo. For some people, it might be a helpful addition to more mainstream treatments.

Magnesium (500 mg daily) can help reduce the frequency of migraines in people with low levels of the mineral.


Known for smoothing facial wrinkles, these injections were FDA-approved for chronic migraines in 2010. Botox is a good treatment option for patients who have 15 or more days of headaches each month.

We still do not know how Botox works to prevent headaches. It probably deactivates pain receptors in the scalp and blocks the transmission of nerve signals between the scalp and the brain.

How it’s done: The drug is injected in multiple locations on the head and neck—and the injections are repeated every three months. It sounds terrible, but the injections are only mildly painful. The procedure takes about 15 minutes, and it’s usually covered by insurance if drugs or other treatments haven’t worked. Botox treatments are given by headache specialists. Side effects may include swallowing problems, blurred vision and speech difficulties.

Important: I advise patients to commit to at least three treatments. If Botox relieves your pain, you and your doctor can decide how frequently you need additional treatments. If you haven’t noticed relief after three treatments, Botox is unlikely to be a good choice for you.

*Check with your doctor before taking these supplements, since they can interact with certain medications and/or cause side effects such as diarrhea.

Source: Mark W. Green, MD,a professor of neurology, anesthesiology and rehabilitation medicine at Icahn School of Medicine at Mount Sinai in New York City, where he directs Headache and Pain Medicine and is the vice chair of Neurology for Professional Development and Alumni Relations. He is coauthor of Managing Your Headaches and several medical textbooks.

Guide: How to Lose Bad Habits—and Start Good Habits

 from Bottom Line’s Health News Daily
October 21, 2014 (Updated 12/29/15)
Health Insider
. .

You know when a habit is bad for you. But a bad habit can seem impossible to break—no matter how hard and how many times you try to stop, for instance, eating junk food…or procrastinating…or overspending…or being late…or biting your nails…or staying up late in front of the TV every night…or whatever—inevitably you keep doing it. And then you feel frustrated and discouraged and blame yourself for not having enough willpower.

Well, you can stop beating yourself up—and you can stop having that bad habit! Because we have just what you need in the Bottom Line Guide to How to Lose Bad Habits—and Start Good Habits. These proven strategies from our top experts will help you conquer your self-sabotaging behavior. You’ll learn why willpower works better when you don’t rely on it…four secrets to successful self-help programs and how to make them work for you…how this kind of keeping score can break a bad money habit….why couples should make a daily “weather” check a regular practice…how a timer can help you complete projects…and much more.

Get started right now! Read below for how to lose the bad habits that hold you back, and create new good habits that will improve your life…

Ditching What Holds You Back

How to Break a Bad Habit for Good

Kick Bad Habits In Four Simple Steps

Do You Have Any of These Costly Money Habits?

Good-Bye, Excuses

The Surprising Secret of Willpower

How to Avoid Assuming the Worst

How to Stop Interrupting

I’m Kicking the Sugar Habit!

Getting a New Good Habit…

14 Little Things You Can Do for a Healthier Heart

#1 Way to Stick to a Healthier Habit

Retrain Your Brain—and Break Free from the Patterns That Are Holding You Back

Can’t Get Yourself to Exercise?

Habits of Happy Couples

If You’re Feeling Scattered or Forgetful…

World-Renowned Choreographer Twyla Tharp Explains How to Get the Creative Habit

Health-Boosting Hot Cocoa Recipes


By the time you’re halfway through this article, I hope you’re craving a nice toasty-warm mug of hot cocoa. Not the super-sweet stuff you remember from kidhood—made with high-fat milk and a sugary fake “chocolate-flavored” syrup—but a palate-pleasing yet calorie-conscious grown-up version.

Why do I want you to head for the stove? Because hot cocoa’s key ingredient (the cocoa!) is packed with nutrients that benefit your body and brain.

For instance, recent research suggests that cocoa’s antioxidant flavanols and other healthful components may help prevent clogged arteries, improve circulation and reduce blood pressure…combat inflammation…keep your mind and memory sharp…and even make it easier to keep weight under control.

For tips on transforming sticky-sweet kid-style hot cocoa into a super-healthful and tasty beverage with adult appeal, I turned to Janet Bond Brill, PhD, RD, LDN. As a nutrition, health and fitness expert and author of Cholesterol Down: 10 Simple Steps to Lower Your Cholesterol in 4 Weeks—Without Prescription Drugs, she had lots of smart suggestions and creative recipes to share.


For the healthiest, yummiest hot cocoa you’ve ever had, start by selecting the right main ingredients…

Cocoa. Use natural unsweetened cocoa powder. Stay away from “Dutched” cocoa or anything labeled “processed with alkali,” Dr. Brill recommended—it undergoes processing, including alkalizing, that depletes disease-fighting antioxidants.

Milk. If you go with cow’s milk and want to limit your fat intake, Dr. Brill suggested using 1% or fat-free milk. But cow’s milk isn’t your only option—there are plenty of unsweetened alternatives to choose from. (If you do choose a presweetened brand of milk for any of the recipes below, eliminate or reduce the amount of sweetener suggested in the recipe.) Tasty options to try: Almond milk, which has fewer calories than skim cow’s milk and is rich in calcium and vitamin E…oat milk, which provides a type of fiber that may help reduce cholesterol…hemp milk (derived from shelled hemp seeds), which contains fatty acids believed to fight heart disease and arthritis…rice milk, which tastes much like cow’s milk but can be tolerated by some people who are allergic to cow’s milk…or regular or light (reduced-fat) soymilk, which contains heart-healthy soy protein.

Sweetener. Experiment to see how little sugar you can add to your hot cocoa and still satisfy your taste buds. You may be pleasantly surprised at how the other flavors come through when they’re not overpowered by sugar. Or swap sugar for a low-calorie sweetener, such as Splenda or stevia.

Spices. Cinnamon, nutmeg and ginger are packed with disease-fighting antioxidants. Experiment with these and other favorite spices and flavorings to put your own personal spin on your cocoa.


Dr. Janet’s Quick-n-Healthy Hot Chocolate

2 Tablespoons natural unsweetened cocoa powder

2 packets (4 teaspoons) Splenda…or other low-calorie sweetener or sugar, to taste

12 ounces soymilk or other type of milk

⅛ teaspoon vanilla extract

Nutmeg, ginger and/or other spices to taste, optional

In a large microwavable mug, mix cocoa powder with sweetener. Stir in milk, vanilla extract and other spices if desired. Microwave on high for 60 seconds. Stir, then microwave for another 60 to 90 seconds or until steaming (do not allow to boil over).

Cinnamon-Almond Hot Chocolate

12 ounces almond milk

1 vanilla bean

1 cinnamon stick

2 packets (4 teaspoons) Splenda…or other low-calorie sweetener or sugar, to taste

⅛ teaspoon vanilla extract

2 Tablespoons natural unsweetened cocoa powder

Place almond milk in a small, thick-bottomed saucepan over low heat and bring to a low simmer, whisking as needed so milk doesn’t stick to the pan. Add the vanilla bean and cinnamon stick. Remove from heat and steep for 10 minutes. Strain the milk, discarding vanilla bean and cinnamon. Return the milk to the saucepan and place over low heat until simmering. Add sweetener, vanilla extract and cocoa powder. Whisk vigorously until cocoa has blended. Heat over low heat for four minutes or until steaming, constantly stirring.

European-Style Thick Soy Cocoa

⅓ cup natural unsweetened cocoa powder

2 packets (4 teaspoons) Splenda Brown Sugar Blend…or other low-calorie sweetener or sugar, to taste

2 teaspoons cornstarch

⅛ teaspoon ground cinnamon

12 ounces unflavored or vanilla soymilk or other type of milk

Fat-free whipped topping, optional

In a saucepan, mix cocoa, sweetener, cornstarch and cinnamon. Whisk in six ounces of the milk to dissolve dry ingredients and create a thick paste (like chocolate frosting). Add the remaining six ounces of milk and whisk until smooth. Place over low heat and stir until steaming (do not boil). If desired, top with fat-free whipped topping to complete your guiltless splurge.

Source: Janet Bond Brill, PhD, RD, LDN (licensed dietitian/nutritionist), is a nationally recognized nutrition, health and fitness expert who specializes in cardiovascular disease prevention and weight management. She is the author of three books, including Cholesterol Down: 10 Simple Steps to Lower Your Cholesterol in 4 Weeks—Without Prescription Drugs and Blood Pressure Down: The 10-Step Plan to Lower Your Blood Pressure in 4 Weeks—Without Prescription

Alert: The Worst Antibiotics for Your Gut Health


From Bottom Line Health

How bad are antibiotics for your digestion and gut health, really?

Here’s the answer: Worse than you may have ever imagined.

The latest study finds that the damage from certain common kinds of antibiotics may unsettle the beneficial bacteria in your gut for months, even a year—in ways that could lead to diseases such as inflammatory bowel disease, even increase risk for colon cancer.

But some other antibiotics disturb your gut for only a week or so. Here’s information on which antibiotics are the most dangerous for your gastrointestinal health—and how to protect yourself from them.


We humans are more colonies than individuals. We rely on multitudes of beneficial bacteria in our gut and our mouths to thrive. To find out what happens to our gut microsystem during a single course of antibiotics, Swedish and British researchers gave healthy adults either a placebo or an oral antibiotic. They collected samples of saliva and feces before and after a course of antibiotics.

Four common types were studied…

• Amoxicillin. Class: Penicillin-like. It’s prescribed to treat bronchitis, gonorrhea and infections of the ears, nose, throat, urinary tract and skin.

• Minocycline. Class: Tetracycline. It’s prescribed to treat respiratory infections, acne and other skin conditions, as well as urinary and genital infections.

• Ciprofloxacin. Class: Fluoroquinolone. It’s prescribed to treat urinary tract infections, as well as anthrax. It’s commonly called “Cipro.”

• Clindamycin. Class: Lincomycin. It’s prescribed for infections of the lungs and skin and for vaginal infections.

Not surprisingly, all of the antibiotics knocked out many of the beneficial bacteria both in the study participants’ saliva and in feces. The good news is that in the mouth, the “good” bugs repopulated pretty quickly after all four kinds of antibiotics.

But the gut didn’t do so well. For the amoxicillin, the concentration of good gut bugs was disturbed for about a week. For monocyline, it was about a month. But for the heavy hitters ciprofloxacin and clindamycin, the damage was more lasting. They wiped out many of the beneficial bugs.

In particular, they destroyed several kinds of common gut bacteria that produce a short-chain fatty acid called butyrate—which is increasingly being recognized as one key to a healthy colon. Butyrate inhibits inflammation, acts as a powerful protective antioxidant and helps stop cancer from forming. When good-for-you bugs are killed and stop producing butyrate, other studies have shown, that can contribute to digestive disorders such as inflammatory bowel disease.

In this study, ciprofloxacin and clindamycin wiped out the butyrate producers for several months—and in some cases, as long as a year.

Does this study mean you should never accept a prescription for these antibiotics? That’s going too far, since some infections that can be treated by these and other antibiotics can be life-threatening. But if you are prescribed antibiotics in the fluoroquinolone or lincomycin classes, discuss with your doctor if there are alternative classes of antibiotics that may work for your specific infection.

And there are many situations where antibiotics are prescribed when they’re not needed at all. That contributes to the worldwide epidemic of antibioticresistance, may increase the risk for diabetes—and, according to this study, may in some cases damage the digestive system in ways that can contribute to long-term health problems.

So take ’em if you really need ’em. But never take them lightly—and consider your alternatives.

SOURCE: Study titled “Same Exposure but Two Radically Different Responses to Antibiotics: Resilience of the Salivary Microbiome versus Long-Term Microbial Shifts in Feces” by researchers at University of Amsterdam, VU University Amsterdam, Swammerdam Institute for Life Sciences, The Netherlands, TNO Earth, Life and Social Sciences, The Netherlands, Karolinska University Hospital, Sweden, Helperby Therapeutics Limited, United Kingdom, UCL Institute of Child Health, United Kingdom and UCL Eastman Dental Institute, United Kingdom, published in the American Society for Microbiology’s journal MBio.