Uterine Cancer

Overview

Cancer of the inner lining of the uterus, called the endometrium, is the most common cancer of the female reproductive tract. According to the American Cancer Society, an estimated 47,130 new cases of cancer of the uterine body, most of which are endometrial cancers, will be detected in the United States in 2012, resulting in about 8,010 deaths. The good news is that the prognosis is excellent if the cancer is detected and treated early.
The vast majority of women diagnosed with endometrial cancer are postmenopausal; more than half of cases occur in women ages 50 to 69. Younger women who develop the condition tend to be obese or have a genetic predisposition. A woman has about a one in 40 chance of developing endometrial cancer during her lifetime.
Unlike ovarian cancer, endometrial cancer has a major, identifiable symptom in its early stages: abnormal vaginal bleeding or postmenopausal bleeding. This symptom occurs in 90 percent of endometrial cancer cases. Other symptoms include pelvic pressure, a pelvic mass, abnormal discharge that doesn’t look like blood, difficulty and pain during urination and pain during intercourse.
The greatest risk factors for developing endometrial cancer are obesity and abnormal precancerous changes of the uterus. Other risks include using estrogen alone,diabetes and a strong family history of colon cancer, particularly a type of colon cancer known as hereditary nonpolyposis colon cancer, or HNPCC. Additional risks include never having had children, starting having menstrual periods at a young age and having a late menopause. Together, these risks can lead to continued estrogen stimulation of the endometrial tissue. In other words, the tissue continues to grow without a break, which increases the risk of cells growing out of control, leading to precancerous and cancerous lesion of the uterus.
Although endometrial cancer is more common in Caucasian women than African-American women, more African-American women die from the disease. This is due to many factors including the fact that African-American women often have more advanced disease and more aggressive types of the disease when they are diagnosed.
A much less common form of uterine cancer is sarcoma of the uterus, which is extremely aggressive. In this rare form of uterine cancer, cancer cells originate from the muscles or other supporting tissues of the uterus. Women who have received therapy with high-dose X-rays to their pelvis have a high risk for some types of uterine sarcomas.
Many sarcomas of the uterus begin after menopause. The prognosis and choice of treatment depend on the stage of the sarcoma, how fast the cancer cells grow and the woman’s general health.

Diagnosis

The primary symptom of uterine cancer is abnormal vaginal bleeding, especially after menopause. Bleeding may be so light that it’s only a pink discharge or drainage from the vagina.
Although irregular menstrual periods are common as you get closer to menopause, when hormone levels rise and fall unpredictably, they can also be a symptom of uterine abnormalities or uterine cancer. If your periods stop for several months and then start again, discuss your symptoms with your health care professional and ask for an examination. Also, be sure to mention any menstrual irregularities during regular checkups.
If you are postmenopausal, any vaginal bleeding is abnormal and you should contact your health care professional immediately. The earlier uterine cancer is diagnosed, the better the prognosis.
Whether you are pre- or postmenopausal, the absence of visible blood with any unusual vaginal discharge doesn’t mean you don’t have uterine cancer. If you experience any abnormal discharge, discuss it with your health care professional.
Also, if you have a family history or have been diagnosed with hereditary nonpolyposis colon cancer (HNPCC), you should be screened for uterine cancer every year beginning at age 35.
Diagnostic tests for uterine cancer include:
Endometrial biopsy. During this procedure, your doctor inserts a small instrument through your vagina and cervix and uses suction to take a small tissue sample of the uterine lining. The procedure is performed in the doctor’s office and, while uncomfortable, is not significantly painful. You may have cramps or pain for a short time afterward. Your doctor will usually recommend taking ibuprofen or other over-the-counter pain relievers before and after the procedure.
Hysteroscopy. A hysteroscopy allows your health care professional to look inside your uterus. It is usually performed if the endometrial biopsy is inconclusive or symptoms persist. During a hysteroscopy, a tiny telescope is inserted into the uterus through the cervix. The uterus is expanded with saline, allowing the doctor to view and biopsy any abnormalities.
Dilation and curettage (D&C). If your endometrial biopsy is inconclusive (i.e., if not enough tissue was retrieved), your health care professional may recommend a D&C to remove pieces of the lining of the uterus. During a D&C, the opening of the cervix is dilated and the walls of the uterus are gently scraped to remove any growths. The tissue is then checked for abnormal cells. The procedure is typically performed on an outpatient basis and takes about an hour. It may require general anesthesia or conscious sedation (medication that makes you drowsy, but still awake).
Other tests may include routine blood tests, a urine test and a chest X-ray. If the biopsy or D&C is positive, further evaluation and treatment will be required to remove the cancer and properly assess the extent of disease. In some cases, you may have an ultrasound, a CT scan or other scans before surgery.
In addition, some physicians will order a blood test to check for levels of CA-125, a substance released into the bloodstream by many (but not all) cancers of the endometrium and ovary. Some physicians will use a CA-125 test to decide whether surgery should be done by a gynecologic oncologist or, if CA-125 levels were high before surgery, as a follow-up to see how well treatment is working. This level can also be used after treatment to follow the cancer growth.
Early diagnosis and treatment of uterine cancer is critical. This type of gynecologic cancer often can be successfully treated in its early stages. Before beginning any treatment, however, you may want to consult with a gynecologic oncologist, a physician who specializes in treating cancers of the reproductive tract. These doctors have the most experience in diagnosing and treating such conditions.
Staging Endometrial Cancer
After a diagnosis, your health care professional will “stage” the disease to determine if the disease has spread. The stage of the cancer provides information about treatment options and survival rates.
Stage I: Cancer is found only in the main part of the uterus. It has not spread to the lymph nodes or distant sites.
Stage II: Cancer cells have spread to the cervix, but not to the lymph nodes or distant sites.
Stage III: Cancer cells have spread outside the uterus, such as the lymph nodes, fallopian tubes, ovaries or vagina.
Stage IV: Cancer cells have spread beyond the pelvis, to other body parts, into the lining of the bladder or rectum and/or have spread to lymph nodes in the groin. Stage IV endometrial cancer may also have spread to organs farther away from the uterus, such as the lungs, liver or bones.
Recurrent: Recurrent disease means the cancer has come back (recurred) after it has been treated.

Treatment

During surgery to remove the uterus, the surgeon will determine the stage of the cancer. The most common treatment is a total or radical hysterectomy, in which the uterus, fallopian tubes, ovaries and lymph nodes in which the tumor commonly spreads are all removed. Other therapies—radiation, chemotherapy and hormone therapy—may also be used to treat this form of the disease. Ask your health care provider about the possibility of participating in a clinical trial.
Hysterectomy is major surgery requiring one to three days in the hospital. Depending on the stage of your cancer, you may have a total hysterectomy, which involves removal of the whole uterus, cervix ovaries and fallopian tubes or a radical hysterectomy, which involves removal of tissue surrounding the uterus, in addition to removing the uterus and cervix. It can be done through the abdomen or using a more minimally invasive procedure (robotic or laparoscopic).For several days after surgery, you may have problems emptying your bladder and having normal bowel movements. Normal activities, including sex, can be resumed in about four to six weeks.After a hysterectomy, you no longer have menstrual periods. If your ovaries are removed before menopause, you will immediately enter menopause and usually experience significant menopausal symptoms, including hot flashes, moodiness and vaginal dryness. Talk to your health care professionl about whether you can take medications to help reduce any symptoms.
Radiation therapy involves the use of high-dose X-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (called external radiation) or from implanting materials that produce radiation (radioisotopes) through thin plastic tubes into the cancerous area (called internal radiation or brachytherapy). Radiation is sometimes used after surgery depending on the extent of the cancer. If you’re unable to have surgery, or the disease is too advanced for surgery, radiation may be the only treatment offered. Radiation therapy also may be offered before surgery to decrease the extent of disease.During radiation therapy, you may notice a number of side effects. These include skin reactions (redness or dryness) in the area being treated, tiredness, diarrhea, nausea and frequent and uncomfortable urination and/or defecation. Treatment can also cause dryness, itching and burning in the vagina. Sex may be painful, and some women are advised not to have sexual relations during treatment. All symptoms should disappear once treatment ends, and most women can resume sexual activity within a few weeks.
Chemotherapy uses drugs to kill cancer cells. The drugs are typically infused through your veins and travel throughout your body. They’re designed to kill all rapidly growing cells, both cancer cells and healthy cells. Chemotherapy is used in the treatment of endometrial cancer, particularly if it’s spread beyond the endometrium or if it is a very aggressive type. If chemotherapy is part of your treatment, you will likely be given a combination of drugs, because combination chemotherapy is often more effective than one drug alone. The most common chemotherapy combinations include carboplatin (Paraplatin) with paclitaxel (Taxol) and cisplatin (Platinol-AQ) with doxorubicin (Adriamycin). Your provider may also recommend a clinical trial.Loss of appetite can be a serious problem for women receiving radiation therapy or chemotherapy. Yet nutrition is important because it helps you withstand the side effects of treatment. Eating well means getting enough calories to prevent weight loss and having enough protein in the diet to build and repair skin, hair, muscles and organs. If you have trouble eating right during your treatment, try several small meals throughout the day instead of three large meals, in addition to nutritional supplements.The side effects of cancer therapies vary from person to person and from one treatment to the next. Your health care professional will plan your treatment to minimize side effects. Also remember that most side effects are temporary. Still, it’s important to tell your health care professional about any reactions and side effects because he or she may be able to adjust treatments and/or prescribe other options to help you feel better.
Hormone therapy involves the use of female hormones, typically progesterone-like drugs called progestins, to slow the growth of endometrial cancer cells. The two most commonly used progestins for treating endometrial cancer are medroxyprogesterone (Provera) and megestrol acetate (Megace). Side effects of progestins include nausea, vomiting, mild shortness of breath, weakness, hot flashes, menstrual bleeding, headache, insomnia, decreased sex drive and blood clots.The anti-estrogen drug Tamoxifen, which is most often used to treat breast cancer, may also be used to treat advanced-stage or recurrent endometrial cancer. Tamoxifen works to prevent estrogens circulating in your body from stimulating the growth of cancer cells. Side effects of Tamoxifen include blood clots, endometriosis, stroke, fertility issues and thinning of hair and nails.Hormones called gonadotropin-releasing hormone agonists, which switch off estrogen production by the ovaries in premenopausal women, may also be used to reduce estrogen levels in women with endometrial cancer who still have their ovaries. By lowering estrogen levels, these drugs, which include goserelin (Zoladex) and leuprolide (Lupron), work to slow the growth of the cancer. Gonadotropin-releasing hormone agonists are injected every one to three months. Side effects include hot flashes, vaginal dryness and other symptoms of menopause. However, most women with endometrial cancer have their ovaries removed as part of treatment or their ovaries destroyed with radiation, which reduces estrogen production and may slow the growth of the cancer.
Regular follow-up exams are very important for any woman who has been treated for cancer of the uterus. Your health care professional will want to watch you closely for several years to be sure that the cancer has not returned. Most follow-up examinations include a pelvic exam and a chest X-ray, possibly a CA-125 test.
When uterine cancer is caught early, the treatment is quite effective and chances of recurrence are small. The likelihood of recurrence goes up relative to the stage of the cancer.
If uterine cancer does recur, it’s likely to happen in the first three years after the initial treatment. The best chance of a cure is if the disease recurs in the vagina or is seen during a pelvic exam. That’s why you will likely have a pelvic exam every three to four months for the first two years after hysterectomy, then annually; a Pap test every six months for two years, then annually; and a CA-125 test at each visit if your levels were initially elevated. Talk to your health care provider about what’s right for you.
Recurrence can also occur in an organ distant from the uterus.
Treatment for recurrent uterine cancer depends on the amount and the location of the cancer. If it is only in the pelvis, radiation therapy alone may be enough. More extensive recurrences may require hormonal therapy or chemotherapy.
Low-grade cancers that contain progesterone receptors are more likely to respond well to hormone therapy than higher grade cancers, which respond better to chemotherapy. If you are diagnosed with recurrent uterine cancer, you may also want to consider participating in clinical trials of new treatments.

Prevention

Some uterine cancer can be prevented by maintaining a normal weight, preventing diabetes and in some cases preventive surgery. Knowing your risk factors for this gynecologic cancer can help you be more aware of it, as well as try to find ways to avoid continual estrogen stimulation of the uterine lining, also called “unopposed estrogen.”
For example, women with a family history of early onset colorectal cancer or other reproductive cancers may have an increased risk for uterine cancer. The cancers in these families may be caused by a genetic predisposition to cancer called hereditary nonpolyposis colon cancer, or HNPCC. Up to 60 percent of women with HNPCC will develop endometrial cancer at some point in their lives. Genetic counseling is recommended for women with a family history of early onset (before age 50) colon, breast, ovary or other cancer caused by a genetic mutation.
The following may help you reduce your risk of developing uterine cancer or identify it early:
Control your weight and your risk of diabetes by eating healthy foods and exercising. Women who are slim can cut their risk of endometrial cancer by 75 percent compared to obese women.
If you still have your uterus, don’t take supplemental estrogen without also taking progestin or progesterone.
Report abnormal bleeding promptly to your health care professional and ask for an examination.
Know your family history.

Facts to Know

Cancer of the lining of the uterus, the endometrium, is the most common gynecologic cancer and ranks as one of the most treatable when identified in its earliest stages.
An estimated 47,130 new cases of cancer of the uterine body are expected to be detected in the United States in 2012, according to the American Cancer Society.
More than half of endometrial cancers are diagnosed in women between the ages of 50 and 69, although endometrial cancer can strike women in their childbearing years.
The majority of uterine cancers develop in the glandular cells, or endometrium, lining the inside of the uterine cavity. This is the same tissue that is shed each month during a normal menstrual period.
A small number of uterine cancers (about 2 percent) are sarcomas, which can originate in the endometrium or in the muscular and connective tissues of the uterus.
There is evidence that use of oral contraceptives can reduce uterine cancer risk, particularly in women who take oral contraceptives for several years. The protection continues for at least 10 years after you stop taking the pills. You should not take birth control pills just to prevent uterine cancer, however, since they carry their own risks.
Obesity, precancerous lesions of the uterus and a family history of colon cancer are the strongest risk factors for uterine cancer. Other risk factors include late menopause and never having children.
Uterine cancer is more common in Caucasians than in African Americans and other non-Caucasian women. On the other hand, African-American women who get this type of cancer are twice as likely to die of the disease.
Women who have been diagnosed with a genetic condition known as hereditary nonpolyposis colon cancer (HNPCC) have an increased risk of endometrial cancer and should begin screening for the condition at 35.
Uterine cancer can be treated with surgery, radiation, chemotherapy, and/or hormonal therapy, depending on the stage and cell type of the disease.

Key Q&A

I am 40 years old and have abnormal bleeding. What are the chances that it’s uterine cancer?Abnormal uterine bleeding has many causes. Thyroid and adrenal gland conditions, for example, can cause hormonal imbalances that affect menstrual periods. Fibroids, polyps, scar tissue, infection, trauma, atrophy and precancerous conditions also can cause irregular menstrual bleeding. You may also find that you are just beginning to experience the menstrual irregularities common to the years just prior to menopause, when hormone levels fluctuate unpredictably. However, your symptoms could be something more serious. Discuss your symptoms as soon as possible with your health care professional.
My health care professional said she suspects that I could have uterine cancer. What kind of test will tell for sure?If cancer is suspected, a tissue sample must be taken from inside your uterus. This procedure is called an endometrial biopsy and can usually be done in the health care professional’s office with minimal discomfort. Narrow instruments and suction tools are used to take the sample. You may have cramps or pain for a short time after the procedure.
I have uterine cancer and have been told I need a hysterectomy. Does that mean my sex life is over?Absolutely not. In fact, your interest in and enjoyment of sex may increase. Ask your health care professional when you may begin sexual activity after surgery. Because your vagina may be shorter, you and your partner may want to experiment with different positions to find one that is comfortable. Foreplay may enable the vagina to lengthen before intercourse.If your ovaries are also removed during your hysterectomy (called oophorectomy) and you are premenopausal, you will go through sudden menopause and experience menopausal symptoms that can interfere with your sex life, such as hot flashes, vaginal dryness, moodiness, insomnia and night sweats. Beginning therapy soon after hysterectomy and oophorectomy can reduce or alleviate these symptoms, and there are other options. Discuss the risks and benefits associated with hormone therapy with your health care professional.
What are my chances of survival after surgery?With early diagnosis and treatment, up to 90 percent of women with endometrial cancer survive for five years.

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Substance Abuse

Overview

Substance use disorders are complicated illnesses that present unique threats to women’s health. Medical research finds that women who consume alcohol, tobacco or other drugs may develop substance use disorders and/or substance-related health problems faster than men.
Recent surveys show that alcohol consumption is most common among:
women in their 20s and early 30s
women who are divorced or separated, women who are unmarried and living with a partner or women who never married
Before discussing problems with the use of alcohol, it is important to understand the different levels of drinking. Alcohol consumption occurs across a continuum related to risk and levels of consumption. At the low end is abstinence, or avoidance of alcohol altogether.
Low-risk drinking is defined as drinking within the recommended limits published by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). For men up to the age of 65, these limits are no more than four drinks in one day AND no more than 14 drinks in a week. For nonpregnant women up to the age of 65, and for both healthy men and women over the age of 65, the recommended limits are no more than three drinks in one day AND no more than seven drinks in a week. The NIAAA also recommends having some days when you do not drink. If you drink within these limits, you will reduce your chances of developing an alcohol use disorder and related health problems.
Those who drink above the NIAAA limits are engaged in what is often termed risky or hazardous use, which is a pattern of alcohol consumption that increases the risk of harmful consequences for the user or others. Harmful use is alcohol consumption that results in consequences to physical and mental health. Finally, alcohol dependence is a disorder that includes three or more of the following symptoms: tolerance, withdrawal, inability to limit amount consumed or time spent drinking, desire or unsuccessful attempts to reduce drinking, great deal of time spent drinking or recovering from effects of alcohol, neglect of important life activities because of drinking, and continued drinking despite the realization that alcohol is causing or making worse a physical or psychological problem.
For most women, responsible drinking is the consumption of no more than one standard drink per day. A standard drink contains about 14 grams of alcohol (0.6 fluid ounces or 1.2 tablespoons), which is equivalent to one 12-ounce bottle of beer or wine cooler; 8 to 9 ounces of malt liquor; one 5-ounce glass of wine; or 1.5 ounces of 80-proof distilled spirits. Keep in mind that the alcohol content of different types of beer, wine and distilled spirits can vary quite substantially.
This is intended to measure the amount consumed on a single day and does not represent an average over several days. (In other words, if you don’t drink all week and then drink seven drinks on Saturday, it’s not the same as having one drink a day.)
The limits for women over 65 are intended for healthy women. Women who havechronic health conditions or take certain medications may have increased risks from drinking alcohol. Additionally, health care providers are less likely to detect increased alcohol use in men and women over age 65.
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), women are more vulnerable to alcohol-related organ damage, trauma and interpersonal difficulties:
Liver damage: Women develop alcohol-induced liver disease faster than men even if they consume less alcohol. Plus, women are more likely than men to develop alcoholic hepatitis and die from cirrhosis (liver disease).
Brain damage: Studies of brains via magnetic resonance imaging (MRIs) show that women may be more vulnerable to alcohol-related brain damage than men.
Heart disease: Among heavy drinkers, women develop heart disease at the same rate as men, despite the fact that women consume 60 percent less alcohol than men over their lifetimes.
Breast cancer: There is emerging evidence of a link between moderate or heavy alcohol consumption and an increased risk for breast cancer.
Violence: College women who drink are more likely to be the victims of sexual abuse than those who don’t. And high school girls who drink are more likely to be the victims of dating violence than those who don’t.
Accidents: After having just one drink, a 140-pound woman reaches a blood alcohol level that increases her risk of being killed in a single-vehicle crash.
Women are more likely than men to use a combination of alcohol and prescription drugs.
Women may begin to abuse alcohol and drugs following depression, to relax on dates, to feel more adequate, to lose weight, to decrease stress or to help them sleep at night.
Poor self-esteem is a major issue for most women who develop problems with drugs and alcohol. The following factors may also increase a woman’s risk for developing substance use disorders:
A history of physical or sexual abuse. Physical and sexual violence against women is common when one or both partners have been drinking or using drugs. Women also are more likely to drink or use drugs when their partners do.
Depression, panic disorder and post-traumatic stress disorder. Women who abuse alcohol also have much higher rates of eating disorders.
Family history. Researchers know that there is a strong family (genetic) component to addiction. If you have a family history of addiction, you should be aware of your risk for developing dependency, especially during stressful periods in your life.
So, why are women more vulnerable to the effects of alcohol?
Women develop serious alcohol problems more rapidly than men, and at lower doses, a process called “telescoping.” This is partially because women’s bodies absorb alcohol faster than men’s because of a difference in the way a key enzyme works. The enzyme, alcohol dehydrogenase (ADH), breaks down alcohol before it enters the bloodstream. But this enzyme is less active in women than in men. Also, women have a smaller ratio of water to fat than men. That means there’s less water to dilute the alcohol and more fat to capture it. One positive difference: Women seem to eliminate alcohol from their bodies faster than men.
Hormonal fluctuations in women may affect how alcohol is metabolized. Some women report feeling the effects of alcohol more quickly or strongly when they drink at certain times during their menstrual cycle.
Alcohol affects almost every organ in your body. Serious health problems associated with excessive alcohol use include but are not limited to:
brain damage
cancer
pancreatitis
increased risk for sexually transmitted diseases
liver disease
high blood pressure and other forms of heart disease
malnutrition (specifically thiamine deficiency)
anemia
heavy menstrual flow, irregular cycles or premenstrual pain
premature menopause
osteoporosis
diabetes
circulation problems
respiratory disease
alcohol poisoning
sexually transmitted diseases
Alcohol poisoning occurs when high quantities of alcohol are consumed in one session. It can lead to coma and death. The lethal dose for alcohol is about .35 to .40 percent, or about five times the legal limit (0.08) in most states. However, death can occur from alcohol poisoning at lower levels, especially for women. For a 120-pound man or woman drinking very quickly, it would only take eight to 10 drinks in an hour to reach the lethal level.
Alcohol Use and College Students
For women, binge drinking is consuming four or more drinks in one session, usually within about two hours. It is most common among women between the ages of 18 to 25. This type of heavy, episodic drinking causes most of the alcohol-associated harm occurring on campuses and in students’ lives. Collegedrinkingprevention.gov, an organization supported by the NIAAA, reports the following statistics concerning alcohol use and college students:
Each year, 1,825 college students between the ages of 18 and 24 die, and 599,000 are injured as a result of alcohol-related incidents, including car crashes.
About 696,000 students between the ages of 18 and 24 are assaulted each year by a fellow student who has been drinking.
About 97,000 students between ages 18 and 24 are victims of sexual assault or rape each year due to alcohol consumption.
Each year, 400,000 students have unprotected sex and more than 100,000 students report having been too intoxicated to know whether or not they consented to sex.
About 25 percent of college students suffer academically because of their drinking habits.
More than 150,000 college students develop alcohol-related health problems every year, and between 1.2 percent and 1.5 percent of students say they tried to commit suicide within the past year as a result of drinking or drug use.
More than 3.3 million students between the ages of 18 and 24 report driving drunk each year.
Substance Use and Older Women
Substance use, including cigarettes, alcohol and misuse of psychoactive prescription drugs (sedatives, tranquilizers and other drugs that affect the mind or behavior), is also a problem for American women 60 years old and older.
Older women are at greater risk for substance use disorders in part because tolerance levels decrease as people age. Some studies suggest that older women are at greater risk for developing a substance use disorder even if they use smaller amounts than younger women. Yet this is often a hidden problem, going undetected by health care professionals, family and friends. Substance abuse symptoms in older women are often erroneously attributed to other factors, such as anxiety or depression.
Also, older women are less likely to discuss their alcohol use or misuse of prescription drugs with their health care professional, in part because of the stigma their generation attached to alcoholism and mental disorders. Additionally, health care professionals are less likely to address addiction problems in this population.
There are different types of excessive alcohol use in the elderly: early onset and late onset. Those who have been using alcohol at levels above the recommended limits for many years and reached age of 65 are called “hardy survivors” and belong to the early onset group; those who begin abusing alcohol later in life belong to the late onset group.
This distinction is particularly important in women since those who have early onset are at higher risk for alcohol-related health issues. Both groups are at increased risk for injury however, especially falls, and for depression, suicide and malnutrition.Alcohol and Pregnancy
The damaging effects of alcohol on pregnant women and their unborn babies are well documented. Like many other drugs, alcohol easily passes from a mother to her baby through the placenta. Prenatal alcohol exposure is the single greatest preventable cause of mental retardation.
One of the greatest risks of alcohol use during pregnancy is fetal alcohol spectrum disorder (FASD) and fetal alcohol syndrome (FAS), the most severe form of FASD.Low birth weight, congenital anomalies, severe behavioral and neurological problems and learning and physical disabilities are some symptoms experienced by infants and children exposed to alcohol in the uterus.
Children diagnosed with FAS suffer the severest damage related to alcohol exposure, including facial changes and mental retardation.
For the mother, alcohol use during pregnancy has been associated with high blood pressure, miscarriage, premature delivery, stillbirth and anemia.
There is no safe level of alcohol consumption during pregnancy. Women who are planning to become pregnant or who are sexually active and might become pregnant should refrain from alcohol use, since damage can occur before a woman realizes she is pregnant.
Prescription and Over-the-Counter Drug Use and Women
Misuse of, abuse of and dependence on prescription drugs are major health problems for women. Two-thirds of all tranquilizers, such as diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Xanax), are prescribed to women. Other examples of prescription drugs used frequently by women include sedatives such as triazolam (Halcion) and estazolam (ProSom); analgesics like meperidine (Demerol) or other types of painkillers such as oxycodone mixed with aspirin (Percodan) or guaifenesin mixed with codeine (Brontex); and stimulants such as methylphenidate (Ritalin), sibutramine (Meridia) and dextroamphetamine (Dexedrine).
When used to treat the medical conditions for which they were approved at the recommended dose, these drugs are safe and effective, rarely leading to addiction or abuse. But when not used properly, they can lead to addiction and death, especially when used in combination with alcohol or other drugs.
Women are more likely to use narcotic pain relievers for nonmedical use than men, and they are more likely to mix prescription drugs with alcohol.
Many women start taking a medication for a health problem, such as anxiety, muscle spasms or pain, but then use it longer and in greater amounts than intended or without close supervision by a health care professional. In most cases, developing a physical dependence on a certain drug causes your body to build up tolerance to it, requiring more of the drug to have the same effect.
In these cases, abruptly stopping use of the drug may result in rebound withdrawal signs. This doesn’t necessarily mean you were abusing the drug or developed an addiction to it, because sometimes long-term use is appropriate. That’s why it’s so important that you only take prescription drugs under the supervision of a health care professional.
Misuse of prescription drugs can cause a variety of health problems in addition to physical dependence, including headaches, confusion, drowsiness, fainting and lowered or elevated blood pressure.
For some prescription drugs, adverse effects increase dramatically if you mix them with alcohol. This combination increases the risk of injuries from falls and car accidents and can be deadly. Be sure to consult with your health care provider or pharmacist about the use of alcohol when taking any prescription drug.
Over-the-counter (OTC) pain relievers and fever reducers can also cause health problems if used with alcohol. If you have three or more alcoholic drinks a day, you may be at increased risk for liver damage or stomach bleeding if you take these medications.
Illicit Drug Use and Women
Studies have found that more than 4 million women need treatment for drug problems. The health risks of illegal drug use go beyond the effects of the drugs themselves. Illicit drug use (such as heroin, cocaine or marijuana) often leads to behavior that puts women at increased risk for HIV, hepatitis and other sexually transmitted diseases (STDs).
Heroin
Also known on the street as smack, horse, H, junk or scag, heroin is the most commonly abused narcotic. Narcotics are drugs that produce an insensibility or stupor. The term narcotic is most often used to refer to derivatives of the opium poppy (an annual poppy cultivated as the source of opium) or chemically similar synthetics created in a lab. Heroin was a commonly prescribed medicine in the early 20th century, until its addictive potential was realized. It breaks down to morphine in the body.
Narcotics act on the nervous and digestive systems to control pain, relieve diarrheaand suppress coughing. When prescribed for pain relief, narcotics are usually taken by mouth. Narcotics slow body functions such as circulation, breathing and digestion. They cause your blood vessels to relax and your heart rate to slow, lowering blood pressure. Narcotics make you feel drowsy, groggy and confused. A common characteristic of heroin use is “nodding,” a semiconscious state in which the person may appear to be nodding off to sleep.
Like most other drugs that are abused, narcotics can make you feel a sense of euphoria, contentment and physical relaxation. The “high” usually lasts about three to four hours. When heroin is injected or smoked, the abuser experiences an instant period of intense pleasure known as a “rush.” The more you use narcotics, the more tolerant your body becomes, requiring higher doses to achieve the same results. Eventually, the user reaches a plateau at which no amount of the drug is sufficient. When the user reaches this level, the person administers the drug just to delay withdrawal sickness.
Street heroin is sold in powder form and has a bitter taste. Heroin is generally inhaled or injected and sometimes smoked. There is a high prevalence of hepatitis C, HIV and AIDS among heroin users due to sharing of contaminated syringes, which has resulted in a decline in the number of intravenous (IV) users. Today, many heroin addicts sniff the powder into their nostrils or heat it on foil to inhale the vapors. Heroin is also sometimes mixed with tobacco or marijuana and smoked in a pipe or cigarette.
The consequences of heroin use include:
dry, itchy skin, skin infections and abscesses
constipation and loss of appetite
menstrual irregularity
fluctuating blood pressure and slow or irregular heartbeat
dependence, addiction
hepatitis B and C and HIV/AIDS caused by use of dirty needles
stroke and heart attack caused by blood clots
cardiac arrest, coma and death from accidental overdose
Cocaine
Cocaine is one of the oldest known drugs. In the early 19th century, this stimulant was used as an ingredient for many types of tonics prescribed to treat a variety of illnesses. However, the source of cocaine—coca leaves—has been ingested for thousands of years in mountainous regions of Peru and Bolivia where the coca bush is found. Though it can be prescribed by physicians today as a local anesthetic, cocaine is a commonly abused drug and was very popular in the ’80s and ’90s.
Cocaine comes in two chemical forms: hydrochloride salts (the powdered form) and “crack” (a smokable “freebase” form produced through a reaction with an alkaline substance such as baking soda). The powdered form can be injected into a vein after it’s dissolved in water, or inhaled. When sold by drug dealers, the powdered form of cocaine is often diluted with sugar, starch or other substances. The freebase form of cocaine can be smoked.
Cocaine stimulates the nervous system, causing your heart rate and blood pressure to increase and your blood vessels to constrict, which is why abusers often suffer heart attacks and strokes. The initial effects of cocaine use are increased alertness, energy, self-confidence and loss of appetite. However, as these effects wear off, the user is left feeling depressed, fatigued, jumpy, fearful and anxious.
Crack is the slang name for the highly potent form of freebase cocaine processed from powdered hydrochloride into a substance that can be smoked. Crack looks like white chunks, rocks or chips and “cracks” when it is smoked. Crack is less expensive to produce and buy than cocaine. It is typically smoked in a pipe, and users inhale the fumes.
The effects of crack are similar to other forms of cocaine, only more intense and more immediate. Users seem to become addicted to it more quickly than to other forms of cocaine.
The consequences of cocaine abuse are:
irregular heartbeat, heart attack and heart failure
strokes and seizures
fluid in the lungs and other lung disorders
paranoia, depression, anxiety disorders and delusions
aggressive, violent behavior
an increased risk of hepatitis and HIV for users who inject the drug intravenously
increased and indiscriminate sexual activity often accompanies use and addiction, further increasing risk of HIV and other STD infection.
Pregnant women who use cocaine have a higher risk of miscarriage and premature labor. Its use has also been associated with low birth-weight babies and developmental problems.
Marijuana
“Pot” is by far the most commonly used illegal drug. It may also be the most insidious drug, because most people don’t realize how dangerous it is. Since the 1990s, most marijuana contains significantly more THC (delta-9-tetrahydrocannabinol, the active ingredient in the drug) than marijuana used in the 1960s and 1970s. Thus, the effects of smoking part of a single 21st-century marijuana cigarette produces more profound and debilitating effects than smoking several marijuana cigarettes in the 1970s would have.
Marijuana is usually smoked, either in a pipe or a loosely rolled cigarette known as a “joint.” Joints are infrequently (and usually unknown to the user) laced with the potent hallucinogen PCP or other drugs that substantially alter the effects of marijuana. Marijuana can also be brewed into tea or mixed in baked products like cookies or brownies.
The effects of smoking are usually felt in a few minutes and peak in 10 to 30 minutes. They include dry mouth and throat, increased heart rate, impaired coordination and balance, delayed reaction time and diminished short-term memory. Marijuana can impair driving and lead to accidents, and its effects may be worse in combination with alcohol. Larger doses can cause more intense reactions such as paranoia.
The most familiar long-term effect of marijuana use is impaired learning ability. Research shows that marijuana use limits your ability to absorb and retain information. In testing, users often show a reduced ability to memorize information and demonstrate lower math and verbal skills.
Aside from the mind-altering effects of marijuana, it also carries consequences similar to cigarette smoking. According to some studies, if you smoke one joint, it is thought that you are exposed to the same amount of cancer-causing chemicals as if you smoke five tobacco cigarettes, and smokers can experience frequent respiratory infections, including chest colds, bronchitis, emphysema, asthma and sinusitis. A novice marijuana user is more likely to experience anxiety, panic attacks and paranoia.
The health consequences of associated with heavy marijuana use include:
delayed onset of puberty and reduced sperm count of men
dbnormal menstrual cycles and irregular ovulation for women
impaired perception, diminished short-term memory, loss of concentration and coordination, impaired judgment and decreased ability to judge distance and speed—all of which lead to increased risk of accidents
damage to respiratory, reproductive and immune systems
Methamphetamine
Also known as speed, crank, meth, crystal-meth and glass, methamphetamine is a powerful stimulant that produces increased alertness and elation. Its effects are similar to cocaine but last longer. Easily made with inexpensive over-the-counter ingredients in makeshift laboratories, methamphetamine is cheaper to produce than cocaine.
Methamphetamine can be swallowed, smoked, snorted or injected. In powder form, it can be mixed with water and injected in the veins or sprinkled on tobacco or marijuana and smoked. Chunks of clear, high-purity methamphetamine are called ice, crystal or glass. It looks like rock candy and is smoked like crack cocaine.
Women use methamphetamine at the same rate as men, and almost half of methamphetamine users are women, unlike with other illicit drugs, such as heroin and cocaine. Additionally, methamphetamine use is seen among women in rural areas and among middle-class women, unlike cocaine and heroin users, who are more often from poor urban populations. Treatment is often less available in rural areas.
Women may be more attracted to methamphetamine for its promise of weight loss and treatment of depression symptoms.
Low doses of methamphetamine can make you feel alert and energetic. With continued use, however, the pleasurable feelings can disappear. The user soon needs to take higher doses more often to achieve the same effects. Someone using methamphetamine is easily agitated. One minute she is calm and content, the next she is angry and fearful. Addicts may pick at imaginary bugs on their skin and become obsessed with repetitive actions.
The crash that follows a methamphetamine binge involves agitated depression and an intense craving for more of the drug. These feelings soon give way to exhaustion and long, deep sleep—again followed by severe depression. During this last phase, the potential for suicide is very high.
The consequences of methamphetamine use include:
nausea, vomiting, diarrhea and dramatic weight loss to the point of emaciation
insomnia and sleep disturbances
severe damage to the teeth
skin sores and infections as a result of picking at imaginary bugs
psychotic symptoms such as anxiety, paranoia, depression, hallucinations including the sensation of bugs crawling on the skin and feelings of hopelessness (These symptoms can sometimes last for months or years after methamphetamine abuse has ceased.)
permanent damage to the heart that can result in increased blood pressure, chest pain, headaches and increased risk for stroke and heart attack
severe structural and functional changes in areas of the brain associated with emotion and memory that may be partially reversible
increased risk of sexually transmitted diseases, such as HIV and hepatitis
Methamphetamine causes different health consequences in women than in men and requires different approaches. This is particularly true with pregnant women and women with young children.
Methamphetamine use during pregnancy can increase the mother’s blood pressure and heart rate. This can result in an increased risk of premature delivery or miscarriage, restricted fetal growth and increased lethargy in newborns. Additionally, methamphetamine constricts blood vessels in the placenta. This means there is less blood flow to the fetus, and the baby receives less oxygen and nutrients. The drug can also pass through to the placenta, which increases the fetus’s blood pressure. This can result in stroke or heart damage, as well as slow fetal growth.
Ecstasy
Also called MDMA (3,4-methylenedioxymethamphetamine), Ecstasy use has, in recent years, become increasingly popular with teenagers in club or dance settings. It is a synthetic, illegal drug that has characteristics of both stimulants and hallucinogens. It is typically produced in capsule or tablet form and is usually taken by mouth, although health care professionals have documented cases in which people injected or snorted the drug. Researchers have found that women may experience more intense psychoactive effects of Ecstasy than men. Ecstasy interferes with learning and memory and may produce damaging changes in brain structures and chemistry. It increases heart rate and blood pressure and can disable the body’s ability to regulate its own temperature.
There is now a large body of evidence that links heavy and prolonged MDMA use to confusion, depression, sleep problems, persistent elevation of anxiety and aggressive/impulsive behavior. Because of its stimulant properties, when used in club or dance settings, it enables users to dance vigorously for extended periods but can also lead to severe rises in body temperature (hyperthermia), as well as dehydration,hypertension and even heart or kidney failure in susceptible people.
Researchers at the University of Amsterdam studying brain blood flow patterns in male and female chronic users of Ecstasy found that women who use the drug may be more likely to develop neurological problems than men.
The consequences of MDMA use include:
confusion
depression and severe anxiety
sleep problems
drug craving
increased heart rate and blood pressure
involuntary teeth clenching
nausea, blurred vision, faintness and chills or sweating

Diagnosis

For women who screen positive for a substance abuse disorder, it is important to see a health care professional for further assessment. If you receive a diagnosis of alcohol or drug dependence, it is important that you seek treatment.
Since substance use disorders are chronic illnesses, treatment includes not only the initial therapy aimed at achieving abstinence from the substance, but long-term management to promote health and prevent further consequences. If you are diagnosed with substance use dependence, you are at risk for relapse throughout your life.
But substance dependence can be treated and the risk of relapse reduced using tested interventions. Researchers find that treatment issues differ between women and men. At one time, treatment programs were designed to address only the patterns and reasons behind men’s substance dependency issues, since men comprised the majority of any treatment group. Women’s issues, such as emotional, psychological or physical abuse, lack of self-esteem and family responsibilities, tended to slip through the cracks.
Yet depression and anxiety disorders are more common in women than men and are also risk factors for alcohol and drug abuse, including cigarette smoking. Thus, treating depression and anxiety disorders in women can be key to their recovery. Also, women are often reluctant to admit they have a problem and to seek or enter treatment, fearing they will lose their children or won’t be able to take care of them.
Given these differences, single-sex programs are becoming more available. Although evidence is still inconclusive as to whether women-only treatment programs are more effective than mixed-gender programs, many women prefer them. Some programs offer child care, parenting classes and therapy for children of substance users.

Treatment

Women for Sobriety (WFS) is an alternative to the well-known Alcoholics Anonymous 12-step program. Founded in 1976, WFS is based on the belief that women require a different kind of recovery program than those used primarily by men. Thirteen positive “statements” guide the WFS program. This program differs from AA in that it doesn’t include a religious focus, doesn’t ask members to examine their pasts and provides women with a female-only environment in which to express their hopes and fears.
The “New Life” WFS program encourages independence, self-reliance and leaving the past behind.
Finding a support group or therapy that feels “right” can take some time. Doing whatever it takes to stay drug-free is the goal. The key to successful treatment is that it should be individualized, because each woman’s issues are different. Lifestyle changes that reduce exposure to drug abusers and access to the drug are often critical. Similarly, emotional problems and disorders such as depression, anxiety and insomnia should be treated to improve the chances of recovery.
Behavioral therapy and in some cases medication are used to treat addiction. The use of medication is effective for many people, especially when used together with counseling and other behavioral therapies. In fact, combining these approaches can be critical to their success. Behavioral therapies include counseling, psychotherapy, support groups and family therapy. Medications offer help in suppressing withdrawal symptoms and drug craving and in blocking the effects of drugs. For long-term heroin use, pharmacotherapy with medications such as methadone is effective.
The following medications may be used to treat substance use disorders. They are most effective under a program of medical management directed by a health care professional. In some cases, they may also be more effective as part of an overall program that includes counseling, support group meetings and other treatment recommended by your health care professional.
Methadone is a synthetic opioid drug, generally a pill or liquid, used mainly in the treatment of heroin addiction. Studies show that treatment for heroin addiction with methadone combined with behavioral therapy reduces death rates and many health problems associated with heroin abuse.
Buprenorphine (Subutex, Suboxone) is the most recently approved medicine for treating heroin and related opioid disorders. It is related to morphine but does not produce the same high, dependence or withdrawal syndrome as morphine. It is long-lasting, less likely to cause respiratory depression and well-tolerated. Buprenorphine is now available in office-based settings. To find doctors trained and certified to use the medication, check with the Substance Abuse and Mental Health Services Administration (SAMHSA) at http://www.samhsa.gov.
Disulfiram (Antabuse) is a prescription medication used to help people avoid alcohol and thus overcome addiction to or dependence on alcohol. If a person uses disulfiram and drinks alcohol, the medication causes severe symptoms that can last several hours, including flushing, rapid or irregular heartbeat, dizziness, nausea, vomiting, difficulty breathing and headache. When taken according to the prescribed schedule, the medication is used to discourage someone from resuming drinking once they’ve stopped. It has been in use since the 1940s, but its long-term effectiveness has not been established.
Naltrexone (Revia) is used to help narcotic addicts and alcoholics. Naltrexone works by blocking the effects of narcotics, especially the “high” feeling that makes you want to use them. When used with behavioral treatments, it can reduce the craving for alcohol and drugs and help people avoid relapse. It does not, however,block the effects of these substances.
Acamprosate (Campral) is approved to prevent people who have already stopped drinking from starting again. Campral is thought to work by regulating the brain chemicals that have been altered by long-term alcohol use. For Campral to work, people taking it must be alcohol-free before they take their first dose and must be prepared to follow a complete alcohol treatment plan including mental and behavioral counseling.
Vivitrol, a version of naltrexone, is the first FDA-approved injectable drug to treat alcohol dependence. It is injected by a health care professional once a month. The injectable version of the drug may be preferable for some people recovering from alcohol dependence because it is easier to use consistently.
Clonidine (Catapres), a drug used to treat high blood pressure, can be used to ease opioid withdrawal symptoms but is not used to manage long-term recovery.
In general, the more treatment pursued, the better the results. If you are working to overcome an addiction, you may require other services as well, such as medical and mental health services and HIV prevention services.
The ultimate goal of all treatment is to enable you to return to a productive life. When you begin treatment for a substance use disorder, you receive assistance in meeting your immediate goals, such as reducing your alcohol or drug use and improving your ability to function while minimizing the medical and social complications of your drug abuse.
There are several types of treatment settings:
Inpatient treatment is recommended for people with other medical conditions or those in danger of withdrawal. These usually involve a three- to six-week inpatient treatment phase following detoxification.
Intensive outpatient treatment, which usually involves daily treatment in a controlled setting.
Outpatient treatment for shorter periods on a weekly basis.
Therapeutic communities, or TCs (also called inpatient long-term drug rehabs). These are highly structured programs in which you stay at a residence for six to 12 months or longer. Those in TCs include those with relatively long histories of drug dependence, involvement in serious criminal activities or seriously impaired social functioning. The focus of the TC is to help you transition to a drug-free, crime-free lifestyle.
Even after the formal treatment ends, the risk of relapse is high. But a trained health care professional can help you develop strategies to prevent relapse. Thus, if you’re trying to recover from substance abuse you should be prepared for a lifelong commitment to avoiding the pressures that lead to drug use. Many women have successfully completed treatment and now lead productive lives.
Prevention
Since research finds a strong family component to addiction, women with a family history of addiction should be aware of their increased risk for dependency, especially during stressful periods. There are three primary risk factors for substance use disorders:
Genetics: This risk factor is still being studied and further research is required. But we know that if a woman has a grandparent, parent or sibling with an addiction, she is significantly more likely to develop an addiction than a woman with no such family history.
Age of first use and duration of use: About 40 percent of women who began drinking as teenagers, specifically before the age of 15, and continue to drink will be diagnosed as alcohol dependent at some point in their lives. Women who began drinking at age 21 or older have a much lower chance of developing alcohol dependence.
Victimization: Women who have been sexually abused in childhood are more likely than other women to have alcohol-related problems. And women who seek alcoholism treatment are significantly more likely to report childhood sexual abuse and father-to-daughter verbal aggression or physical violence. One study found that women who were neglected as children but not abused were at greater risk of having alcohol-related problems regardless of any other life experience, including poverty, parental alcohol abuse, race or age.
Responsible use of alcohol—up to one drink per day, or the equivalent of one 12-ounce bottle of beer or wine cooler; 8 to 9 ounces of malt liquor; one 5-ounce glass of wine; or 1.5 ounces of 80-proof distilled spirits (NIAAA guide)—is not harmful for most women as long as they are not pregnant or trying to become pregnant. (Keep in mind that the alcohol content of different types of beer, wine and distilled spirits can vary quite substantially.) If you feel the need to increase your use of alcohol, you may be at risk for alcohol-related adverse health consequences including the possibility of developing an alcohol use disorder. Talk to your health care professional about your use of alcohol and how to drink responsibly.
The best way to prevent risky or harmful substance use is to recognize the potential for it. Alcohol and marijuana use are particularly insidious substances due to their perceived harmlessness. Also, the effects of each may be worse when used together. Although alcohol is socially acceptable when used by women above the recommended limits, it increases the risk of alcohol use disorder and serious alcohol-related health consequences, such as breast cancer. If you plan to drink, it’s important you make a conscious effort to drink responsibly.
Marijuana is the most widely used illegal drug. Although it is commonly believed to be a safe, nonaddictive recreational drug, it carries many health risks, including occupational injury and automobile accidents.
The growing increase of methamphetamine use by women is a major health issue affecting rural and middle-class women. Methamphetamine use can result in permanent adverse health consequences.
Another issue for women is the abuse of prescription drugs that are potentially addictive. The following steps can help you and your health care professional prevent an addiction to a prescription drug:
Ask your health care professional to prescribe only quantities appropriate for your condition.
Talk about why the medication is being prescribed, how to use it correctly and what side effects you may experience.
Talk about addiction and how tolerance to a drug is developed.
Follow up with your health care professional when the medication is finished.
Unfortunately, many health care professionals have little or no training in substance abuse or addiction. If in doubt, call the American Society of Addiction Medicine to find a doctor certified in addiction medicine in your area or contact the International Nurses Society on Addiction at (877) 6-INTNSA (646-8672) or http://www.intnsa.org to find a registered nurse certified in addiction. The National Institute on Drug Abuseand the National Institute on Alcohol Abuse and Alcoholism both part of the National Institutes of Health (NIH), can also provide literature and other forms of guidance.

Facts to Know

In 2008, nearly 13.4 million women (or 11.5 percent of adult women) ages 18 and older reported using an illicit drug within the past year, according to the U.S. Department of Health and Human Services.
The NIDA also reports that almost half of all women ages 15 to 44 have used illegal drugs at least once in their lifetime. Of these women, nearly 2 million have used cocaine and more than 6 million have used marijuana within the past year. Most women drug abusers use more than one drug.
Women use methamphetamine at about the same rate as men, and almost half of methamphetamine users are women, unlike with other illicit drugs, such as heroin and cocaine. Additionally, methamphetamine use is seen among women in rural areas and among middle-class women, unlike cocaine and heroin users, who are more often from poor urban populations.
The NIAAA recommended limit for alcohol consumption for women of all ages is no more than three standard drinks in one day AND no more than 7 standard drinks in a week. Pregnant women or women who may become pregnant should not consume any alcohol. A standard drink is equivalent to one 12-ounce bottle of beer or wine cooler; 8 to 9 ounces of malt liquor; one 5-ounce glass of table wine; or 1.5 ounces of 80-proof distilled spirits. Keep in mind that the alcohol content of different types of beer, wine and distilled spirits can vary quite substantially.
Women who use alcohol and drugs develop substance abuse related health problems faster than men.
Women are more likely than men to use a combination of alcohol and prescription drugs.
Women often begin to abuse alcohol and drugs following depression, to relax on dates, to feel more adequate, to lose weight, to decrease stress or to help them sleep at night.
These conditions may increase your risks for developing a substance use disorder: a history of physical or sexual abuse; depression, panic disorder or anxiety; and a family history of substance abuse.
Alcohol is absorbed faster in women’s bodies because women’s stomachs absorb alcohol more rapidly than men. And, women who drink tend to have more concentrated levels of alcohol in their bloodstream than men. Monthly hormonal fluctuations in women may affect how alcohol is metabolized.
According to the NIAAA, an estimated 5.3 million women in the United States drink in a way that threatens their health, safety and general well-being. Heavy drinking is more risky for women than men.
According to the NIAAA, despite the fact that drinking is illegal for anyone under the age of 21, the reality is that many teenage girls drink. About 37 percent of ninth-grade girls report drinking in the past month, a rate slightly higher than that for teenage boys. And about 17 percent of these same young girls report having had five or more drinks on a single occasion during the previous month. Teenagers who drink are more likely to be sexually active and not protect themselves against sexually transmitted diseases.
According to the 2010 National Survey on Drug Use and Health, prepared in part by the Substance Abuse and Mental Health Services Administration, full-time college students were more likely to use alcohol in the past month, binge drink and drink heavily than young people of the same age who were part-time college students or not enrolled in college. Among full-time college students in 2010, 63.3 percent were current drinkers, 15.6 percent were heavy drinkers and 42.2 percent were binge drinkers. Among those not enrolled in college full-time, 52.4 percent were current drinkers, 11.9 percent were heavy drinkers and 35.6 percent were binge drinkers.
Having more laws restricting underage drinking or governing the volume of sales and consumption of alcohol is associated with less drinking among underage students.
Women of any age who drink are more likely to be the victims of violence, to attempt suicide or overdose than those who do not drink.
Substance abuse and addiction to cigarettes, alcohol and psychoactive prescription drugs (tranquilizers and other drugs that affect the mind or behavior) are a problem for a significant number of American women 60 years old and older. Older women are more susceptible to alcohol or drug addiction because tolerance levels decrease as people age.

Key Q&A

How much alcohol consumption is considered acceptable?According to the NIAAA, for men up to the age of 65, these limits are no more that four drinks in one day AND no more than 14 drinks in a week. For nonpregnant women up to the age of 65, and for both healthy men and women over the age of 65, the recommended limits are no more than three drinks in one day AND no more than seven drinks in a week. Pregnant women or women who may become pregnant should not consume any alcohol. A standard drink is any drink that contains about 14 grams of pure alcohol (about 0.6 fluid ounces or 1.2 tablespoons). This is equivalent to one 12-ounce bottle of beer or wine cooler; 8 to 9 ounces of malt liquor; one 5-ounce glass of table wine; or 1.5 ounces of 80-proof distilled spirits. Keep in mind that the alcohol content of different types of beer, wine and distilled spirits can vary quite substantially.
Can I be an alcoholic even if I don’t drink hard liquor?Alcoholism has little to do with the kind of alcohol you drink. Each type of alcoholic beverage has a different amount of alcohol. For example a 12-ounce can of beer is roughly equal to 1.5 ounces of hard liquor. If you are currently drinking more than the recommended limits (no more than one standard drink per day and seven per week), you may need to cut back. If you find it difficult to cut back, you may want to seek help from a health care professional.
I only get drunk during holidays or stressful times in my life, so that means I don’t have a problem with alcohol, right?Drinking more than four alcoholic drinks for women or five for men in one sitting, usually in about two hours, is usually termed heavy episodic drinking or binge drinking. This type of consumption pattern is consistent with hazardous or risky alcohol use and may place you at increased risk for developing an alcohol use disorder. It also puts you at risk for other health issues such as injury, motor vehicle crashes and sexually transmitted diseases. If you find it difficult to reduce your drinking to three or fewer drinks at a time AND less than seven drinks in a week, you may want to seek help from a health care professional.
What is alcohol abuse?Alcohol abuse is a clinical diagnosis that differs from alcoholism (alcohol dependence) in that it does not generally include an extremely strong craving for alcohol, loss of control or physical dependence. In addition, alcohol abuse is less likely than alcoholism to include tolerance (the need for increasing amounts of alcohol to get “high”). Alcohol abuse is defined as a pattern of drinking that is accompanied by one or more of the following situations within a 12-month period:
Failure to fulfill major work or home responsibilities
Drinking in situations that are physically dangerous, such as while driving a car or operating machinery
Recurring alcohol-related legal problems, such as being arrested for driving under the influence of alcohol
Continued drinking despite having ongoing relationship problems that are caused or worsened by the affects of alcohol
When I am feeling stressed or nervous, I have a few drinks. Is there any harm in that?Yes. Women often begin to abuse alcohol and drugs following depression, to relax on dates, to feel more adequate, to lose weight, to decrease stress or to help them sleep at night. Any time the number of drinks consumed exceeds the recommended limit, it becomes a problem, and it is important to get help with the issue that is creating the pressure to drink as well as guidance to help avoid such drinking.
My 17 year-old daughter has begun drinking socially. Should I be concerned?Yes. Underage drinking is illegal. Your daughter could be arrested, and you could be held legally responsible for her actions under the influence of alcohol. Also, drinking puts your daughter at risk for being sexually active and less likely to protect herself from sexually transmitted diseases. She is also at increased risk for becoming a victim of violence, motor vehicle crashes, attempted suicide, overdosing and date rape.
Should I worry that my elderly mother has begun drinking more than one drink a day?Yes. More than one drink a day puts her above the recommended limit of no more than seven drinks in a week for women. Your mother may have a problem, and her health care provider should be consulted if her alcohol consumption is exceeding the recommended limits of no more than three standard drinks in one day AND no more than seven standard drinks per week. Tolerance levels decrease as people age, and some studies indicate that older women get addicted faster using smaller amounts than any other group. As noted by NIAAA, individual responses to alcohol vary, and drinking at lower levels may be problematic for those who are older or have coexisting medical conditions or take medications that should not be used in conjunction with alcohol.
I started taking painkillers after back surgery six months ago. I have been increasing my dosage in order to manage the pain, and I am afraid of letting my prescription run out. Could I be addicted?You may have developed a physical dependence on and tolerance to your medication. You should talk to your health care professional immediately about your concerns. He or she can help determine if this treatment is best for you, or if an alternative treatment should be tried. You can also contact the American Pain Society or American Society for Addiction Medicine if you have questions about your treatment, how to manage your pain and whether you are addicted.
Is it OK for me to have just a few drinks while I am pregnant?No. There is no known safe level of alcohol use during pregnancy. If you feel you cannot resist drinking while you are pregnant, seek the help of a health care professional.

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Vaccines

  • Overview

    The discovery and wide application of vaccines that protect against once-fatal childhood diseases like measles, mumps, rubella and diphtheria is one of the most significant medical contributions of the past two centuries. Today, newborns get their first vaccine soon after birth (hepatitis B), then, between one and two months begin a series of shots that will eventually protect them against 14 diseases. Worldwide, childhood vaccines prevent up to 3 million deaths each year.
    In recent years, however, parents are increasingly likely to under-vaccinate their children. A January 2013 study published in JAMA Pediatrics reported that nearly half of children ages 2 months to 24 months in the United States either aren’t getting all the necessary vaccines or have not been vaccinated at all. Vaccines are not just for kids. Adolescents and adults need them, too, whether to “boost” earlier immunizations that provided immunity against diphtheria, pertussis and tetanus or to protect against other diseases, such asinfluenza, pneumonia, shingles, bacterial meningitis or, for those traveling abroad,yellow fever and typhoid. Preteen girls and boys can now be vaccinated against several strains of the human papillomavirus (HPV), which cause most cervical cancers, as well as cancer of the anus, vagina and vulva. Vaccines are also being developed to prevent malaria and HIV, the virus that causes AIDS, as well as to harness the power of the immune system to fight cancer and other diseases.
    The History of Vaccines
    The roots of modern vaccines stretch halfway across the world to ancient China and India where, as early as the 10th century BC, people inhaled pus from smallpox blisters to inoculate themselves against the deadly disease. But it wasn’t until 1796 that a country doctor from England named Edward Jenner formally vaccinated a child against the disease.
    Rather than using pus or scabs from individuals infected with smallpox, he used pus from a similar, but less virulent pox disease called cowpox. He hypothesized this would protect against smallpox because milkmaids infected with cowpox never caught smallpox, even during epidemics. Two weeks after inoculating an 8-year-old boy, Jenner tried to infect him with smallpox. Nothing happened. Voila! The first successful vaccination. (Indeed, the word vaccine comes from the Latin word “vacca” for cow).
    It, however, would be nearly two centuries later before smallpox was eradicated worldwide (the last known case occurred in Somalia in 1977). Its banishment (except for samples held in Russian and American laboratories) has been heralded as one of the most significant medical achievements in history.
    We’ve come a long way from Jenner’s days, when “vaccines” were given by using a quill or ivory point to transfer the infected pus into a healthy person’s skin. Today, safe, hair-thin needles deliver nearly painless injections, while some vaccines can be given orally with drops or nasally through a spray.
    Today we have vaccines against childhood illnesses like diphtheria, mumps, rubella and measles, which used to kill millions of children each year; against tetanus and rabies; and even against cancer. Some are designed to protect against infection in the first place; others to prevent the pathogen’s replication and halt its ability to infect normal cells. In all, more than 300 approved vaccines protect against 30 diseases. Not only have vaccines saved lives, they have changed the very world in which we live.
    Vaccine Basics
    To understand how vaccines work, you first need to understand how your immune system works. There are two types of immunity: innate and adaptive. The innate immune system is a nonspecific response to any threat. Invaders such as bacteria, viruses and other pathogens display “signs” on their surface called antigens that signal immune system cells to action.
    The innate immune system includes visible protection, like skin and the mucus membranes in your nose and mouth that strain out pathogens, and invisible protection in the form of white blood cells like macrophages, which release inflammatory chemicals such as histamine and leukotrienes to destroy invaders. Sometimes this process runs amok, as when the innate immune system launches an all-out attack against harmless proteins like those from pollen or peanuts, resulting in an allergic reaction.
    A more targeted approach to threats comes from your adaptive immune system, which responds to specific antigens. The foundation of this system exists in T and Blymphocytes. These immune cells learn to recognize certain antigens. Once they identify a non–self invader, they generate specific responses to destroy that invader. B cells mature into specialized cells with antigen-specific antibodies on their surfaces that lock onto the antigen to annihilate it. T cells release toxins to destroy the invader or call other immune system cells into action. Once T and B cells are activated, they leave behind copies of themselves that are ready to spring into action again if the specific antigen appears. This is known as immunologic memory.
    These mature T and B cells enable your immune system to launch an attack against, say, a measles virus so quickly that the virus never has time to infect healthy cells and make you sick. Thus, the adaptive immune system, unlike the innate immune system, protects against reinfection.
    The problem with the adaptive immune system is that the first time it can take several days to get up to speed once it encounters a new antigen. That’s more than enough time for most pathogens to replicate and make you sick.
    Enter vaccines.
    A vaccine is designed to stimulate the adaptive immune system before you’re exposed to the virus and bacteria so when you do encounter it, specialized T and B cells already exist, ready to spring into action before the pathogen can make you sick.
    Types of Vaccines
    Vaccines may be produced in several ways:
    Live, attenuated vaccines
    Inactivated vaccines
    Subunit vaccines
    Toxoid vaccines
    Conjugate vaccines
    DNA vaccines
    Recombinant vector vaccines
    Live, attenuated vaccines. These vaccines contain a live, although significantly weakened, version of the pathogen. Measles, mumps and chicken pox vaccines are made with live viruses. The only bacterial vaccine made with live pathogens in the United States is the typhoid vaccine.
    The benefit of a live vaccine is that a single dose often provides lifelong immunity. The downside is that because viruses and other pathogens naturally mutate, or change, the virus within the vaccine could also change, possibly creating a more virulent version of itself that the immune system would have difficulty combatting. This was an issue with the early oral polio vaccines but is generally not a problem with current live vaccines, which are much safer than the virus they protect against. Only people with a suppressed immune system (such as those who have HIV/AIDS, are taking immunosuppressant drugs or are being treated for cancer) should be concerned about receiving live vaccines because they could, conceivably, become infected with the virus. Live vaccines also usually require refrigeration.
    Inactivated vaccines. These vaccines contain a killed version of the pathogen. They are more stable (meaning they don’t need refrigeration) and safer than attenuated viruses, but they don’t elicit as strong an immune response. Thus, the immunity they provide may not last as long and you might need a “booster” vaccine down the road.
    Subunit vaccines. These vaccines are made with bits and pieces of the inactivated antigen called epitopes. The advantage is that by using fewer molecules of the virus or bacteria, there is less risk of side effects. The disadvantage is that it is challenging and time consuming to identify the exact epitopes needed to stimulate the immune system.
    Toxoid vaccines. These vaccines are designed to protect against bacteria that secrete toxins. Treating the bacteria with formalin renders the toxins harmless but still retains enough of their structure to “teach” immune cells to recognize the bacteria and train them to lock onto the toxin antigen before the bacteria can release the chemical. Toxoid vaccines are used for diphtheria and tetanus.
    Conjugate vaccines. Conjugate vaccines are typically used to provide protection against certain types of bacterial infection, particularly in very young children. These bacteria, including those that cause bacterial meningitis, are surrounded by a thick capsule called a polysaccharide coating. This coating helps the bacteria hide from the immune system. Thus, antigen-presenting T cells can’t “show” the antigen to B cells. B cells can still produce antibodies against the bacterial antigens and provide some protection, albeit short-lived, but this type of protection doesn’t develop until children are about 2 years old. So many polysaccharide vaccines for adults and older children don’t work in younger children, leaving children highly susceptible to the illnesses those bacteria cause.
    Enter the conjugate vaccine. Antigens or toxoids that the baby’s immune system does recognize are attached to the polysaccharide coating. The infant’s immune system learns to recognize polysaccharide coatings as dangerous and to defend against such pathogens.
    DNA vaccines. DNA vaccines are not yet in use, though they are being tested for influenza and herpes. These vaccines are made of the organism’s genetic material, which carries the code, or recipe, for antigens. Once in the body, normal cells take up the DNA and begin making the microbe’s antigens, displaying them on their surface and stimulating the immune system to respond.
    Recombinant vector vaccines. These vaccines also are not yet approved for widespread use but are being evaluated for HIV, rabies and measles and are thought to be even safer than existing vaccines. With recombinant vector vaccines, the microbe’s DNA is inserted into another virus or bacteria that transports the DNA, enters cells and releases the DNA into the healthy cell, which then can provoke the immune response.

    When to Vaccinate

    These charts contain recommendations from the U.S. Centers for Disease Control and Prevention (CDC) for preventive vaccines. Don’t panic if you or your child has not received all vaccinations on time; the CDC has guidelines for “catch-up” vaccinations that your health care professional should be aware of.
    If you are traveling out of the country, make an appointment with your health care professional at least four to six weeks before your trip to see if you need any travel-related vaccines. Travel is also a good time to make sure you’re up-to-date on your other vaccines, as well. The only vaccines required by law are:
    Yellow fever: Required for travel to countries in sub-Saharan Africa and tropical South America
    Meningococcal vaccine: Required for travel to Saudi Arabia during the Hajj, an annual pilgrimage
    Other travel-related vaccines include typhoid, hepatitis A (for adults not vaccinated as children), Japanese encephalitis vaccine and rabies.

    The Truth About Vaccines

    Untruths and myths about vaccines have been circulated for hundreds of years. Complaints and concerns range from invasion of privacy and “bodily integrity” to concerns about safety, the use of animals to prepare and test vaccines and religious issues.
    But if only a few people vaccinate their children, vaccines would not be very effective in reducing or eliminating disease. Between 85 percent and 95 percent of a population must be vaccinated to provide protection for all (herd immunity). That’s why most states in the United States require vaccination before children enter school. The Supreme Court has upheld such laws since the early part of the 20th century.
    Even today, however, some parents refuse to vaccinate their children. The most recent controversy around vaccines stems from suspicion of a possible link to the rising rates of autism of either the preservative thimerosal, which contains mercury, or the measles component of the MMR (measles/mumps/rubella) vaccine. Parental concern led to numerous scientific investigations regarding such links, with study after study finding no connections. Nonetheless, thimerosal was phased out of most vaccines in 2001. Autism rates, however, have continued to rise.
    Vaccines are extremely safe. The Centers for Disease Control and Prevention operates an Immunization Safety Office, which continuously monitors vaccine safety, including side effects. Part of its mission is managing the vaccine adverse event reporting system, which serves as an “early warning” system to detect vaccine-related problems.
    About 30,000 adverse event reports are filed annually, but just 10 percent to 15 percent are classified as serious (causing disability, hospitalization, life-threatening illness or death), and most of the incidents are ultimately not linked to vaccination. Anyone can file a report, including health care providers, manufacturers, personal injury lawyers and vaccine recipients or their parents or guardians.
    Children or adults who are harmed by a vaccine may apply for compensation from theNational Childhood Vaccine Injury Compensation Fund.
    Other vaccine myths and truths:
    Myth: The flu vaccine can cause the flu.
    Fact: The vaccine cannot cause the flu if you’re vaccinated with the inactivated trivalent vaccine, made with killed virus. However, fever and achiness can occur after a flu vaccine. This is not the flu, however, but the result of an activated immune system.
    The nasal flu vaccine, which contains a weakened live virus, could, conceivably, cause the flu in someone with a suppressed immune system. Thus, it is only approved for use in healthy people between 2 and 49 years of age (younger and older people tend to have weaker immune systems). Studies involving hundreds of healthy children and adults showed no evidence that the nasal flu vaccine resulted in the flu.
    However, you can get the flu after being vaccinated if the viral types used to make the vaccine do not match the circulating flu viruses. These viruses change every year, which is why the vaccine changes every year and why you need an annual vaccine. Nonetheless, in any given year the flu vaccine typically protects about 60 percent of healthy adults under 65. The older you are the less effective it is, likely because of a weaker immune system.
    Even when the vaccine and viruses aren’t well matched, the vaccine still protects a considerable number of people. Plus, if you get the flu, having had a vaccine means a quicker recovery with fewer complications. And don’t forget it takes about two weeks after you’re vaccinated before the vaccine fully engages your immune system. During those two weeks, you’re still susceptible to an influenza virus, even one the vaccine should protect against.
    Myth: Adolescents don’t need vaccines.
    Truth: Adolescents (and adults) definitely need vaccines and regular boosters. Children 11 or 12 need the tetanus-diphtheria-acellular pertussis (Tdap) vaccine; the meningococcal conjugate vaccine; the influenza vaccine; and the human papillomavirus (HPV) vaccine, which helps protect against cancers of the cervix, anus, vagina and vulva.
    Plus, teens (and adults) who haven’t had chicken pox or been immunized against the disease should get a varicella vaccine. Unfortunately, while vaccination rates for young children are very good, those for adolescents are far below what they should be, though some of these rates are improving.
    According to the CDC, vaccination rates have been rising for tetanus-diphtheria (Tdap) and meningococcal-conjugate vaccine (MCV4). The increase in vaccine coverage rates for human papillomavirus (HPV) vaccine, however, is only about half the rate of the increases seen for Tdap and MCV4.
    Myth: Vaccines provide 100 percent protection forever.
    Truth: It depends on the vaccine. Most vaccines that children get in their early years provide lifetime immunity. Some, like the influenza vaccine, are required annually because the viruses causing influenza change every year. Others, like the diphtheria-tetanus-acellular pertussis (DTaP) vaccine, require “booster” shots to maintain immunity. For instance, immunity from pertussis (whooping cough) vaccination wears off, making adults and adolescents particularly susceptible to the disease. The bacterial disease can lead to significant time lost from work and school. More worrisome is the fact that it can be transmitted to children who have not been vaccinated, particularly newborns, in whom the disease can be fatal.
    Because booster shots are needed in adolescents and adults—who are less likely to get vaccinated than children—pertussis is the only vaccine-preventable infectious disease increasing in prevalence in the United States. In 2010, nearly 28,000 cases were reported to the CDC. The number of actual cases is likely triple that. That’s why the CDC added a recommendation for the adolescent booster of Tdap in 2005.
    Myth: It’s OK not to vaccinate your child if other parents vaccinate theirs.
    Truth: In our global world, it’s important to vaccinate all children. Each year, an average of 60 people in the United States contract measles. But in 2011, the number of measles cases was higher than usual at 222. Most of these cases occurred in people who were not vaccinated, and 40 percent got measles in other countries and brought the disease back to the United States and spread it to others.
    High vaccine rates are necessary to provide “herd immunity” (protecting those who have not been immunized). For instance, children under 12 months cannot receive the measles vaccine, so they are particularly vulnerable. Plus, some people cannot be vaccinated for medical reasons; high rates of vaccination in the community help protect them. Measles should not be taken lightly: it is one of the most infectious diseases known to man, able to be transmitted for up to two hours after an infected person has left the room. Before the vaccine became available in the mid-1960s, up to 450 deaths and 4,000 cases of measles-related encephalitis occurred each year in the United States.
    Myth: Giving a child multiple vaccinations for different diseases at the same time increases the risk of harmful side effects and can overload the immune system.
    Truth: There is no problem vaccinating children for different diseases at the same time. Numerous studies evaluating the effects of combinations of vaccines and of giving children several vaccines at once show this approach is as effective as giving children individual vaccines with no greater risk for side effects. Giving a child two or more vaccines during one health care visit not only provides maximum protection but reduces required office visits, saves time and money and minimizes trauma (from the shots) to the child. There are also combination vaccines, in which multiple vaccines are delivered in one shot.

    Therapeutic Vaccines

    Cancer Vaccines
    When you think of a vaccine, you think of something designed to protect you from a disease. These are called prophylactic vaccines. But vaccines are also being investigated as a way to harness the power of the immune system to fight existing disease, particularly cancer. These vaccines are called therapeutic vaccines.
    Cancer cells proliferate for two main reasons: They develop from normal cells, so they don’t register as “foreign” to the immune system, and they have developed ways to prevent detection by the immune system. The goal of therapeutic cancer vaccines is to enhance the “foreignness” of the tumor and train the immune system to recognize similar antigens as foreign.
    There is currently one vaccine approved by the United States Food and Drug Administration to help treat cancer. The vaccine, called sipuleucel-t (Provenge), is a dendritic cell vaccine that treats advanced prostate cancer that no longer responds to hormone therapy. Researchers also have several cancer vaccines in late-stage clinical trials, including one to treat breast cancer. Click each type to learn more.

    Antigen vaccines. These vaccines are created by mass producing a few antigens from the tumor cell, altering them so they are more easily recognized by the patient’s immune system and injecting them into the patient.
    Tumor cell vaccines. These vaccines are composed of cells from the patient’s tumor that have been modified so they cannot reproduce. By injecting them into the patient, it is hoped they will stimulate the immune system to attack the specific antigen for that cancer and destroy original cancer cells that are replicating.
    Dendritic cell vaccines. Dendritic cells are immune system cells that show antigens to T cells so they can produce antibodies. A dendritic cell vaccine trains the patient’s dendritic cells to recognize the tumor antigen as foreign, then injects the “trained” dendritic cells into the patient so they can “train” T cells.
    DNA vaccines. DNA vaccines use genetic material from the tumor that encodes for one or more antigens to stimulate the immune response.
    Vector-based vaccine. A vector-based cancer vaccine uses a virus, bacteria or yeast cell to “deliver” cancer antigens or DNA. The immune system responds to the vector as well as the cancer antigen, triggering a stronger immune response.
    Autoimmune Vaccines
    Therapeutic vaccines are also under investigation to treat autoimmune diseases like multiple sclerosis (MS) and lupus. These diseases result from an overactive immune system, one that fails to differentiate between “self” and “nonself” cells and attacks the body’s own tissue.
    Vaccines to treat such conditions are designed to “downregulate” the immune system by training certain immune cells to attack disease-causing immune cells. One such vaccine that has shown good results in early clinical trials is a DNA vaccine that targets the T cells that attack myelin, nerve cell sheathing, in people with MS.
    Vaccines in the Future
    Although we have made great strides in providing vaccines for many major illnesses, particularly childhood diseases, several other serious conditions remain. In addition tocancer vaccines researchers are working on vaccines to prevent malaria and HIV, the virus that causes AIDS. Vaccines are also being investigated to prevent hepatitis C, tuberculosis, Alzheimer’s disease, Parkinson’s disease and numerous other neurological and autoimmune diseases.
    Malaria vaccine. Malaria is one of the most devastating diseases in the world, affecting more than 300 million people a year and killing more than 1 million, primarily in sub-Saharan Africa. The actual figures, however, are likely up to three times higher, given the difficulty of diagnosing and tracking the disease in these countries. Scientists at the CDC have an ongoing malaria vaccine development and evaluation program that is testing potential malaria vaccines in small New World monkeys.
    HIV vaccine. Researchers throughout the world have been working on an HIV vaccine for more than 20 years without success. In the United States alone, the National Institute of Allergy and Infectious Diseases at the National Institutes of Health has conducted more than 117 HIV vaccine clinical trials to test more than 70 possible vaccines. The U.S. Military HIV Research Program and the CDC are also researching HIV vaccines.
    The challenge in developing a vaccine against HIV is that our immune system is weak when it comes to eradicating the virus. The virus also takes over the DNA of normal immune system cells, often lying dormant for months or even years. When it is activated, it’s too late for an immune response to be of use because the virus has co-opted cells to churn out millions of HIV copies. Another problem is that the virus mutates easily. A vaccine designed against today’s virus may be irrelevant in a couple of years. Even when the immune system recognizes antigens on the virus and produces antibodies against it, the virus mutates before those antibodies can do much good. This is why existing drugs against the infection eventually fail; the virus mutates and becomes resistant to them.
    However, scientists still believe a vaccine to prevent HIV is possible, and they are building on what they have learned and moving forward with the research process.

    Facts to Know

    1. Today, more than 300 approved vaccines provide protection against 30 diseases.
    2. The immune system has two components: the innate immune system, in which inflammation destroys invading pathogens; and the adaptive immune system, which “learns” to recognize certain pathogens and retains an immunologic memory so it can quickly mount a defense the next time the pathogen appears.
    3. A vaccine is designed to stimulate the adaptive immune system before you’re exposed to the virus or bacteria so you’re already protected when you encounter it.
    4. There are two main types of vaccine: prophylactic, which prevents disease; and therapeutic, which treats disease.
    5. There are several types of vaccines, including live, attenuated vaccines and inactivated vaccines. The former are made with live, although weakened pathogens, while the latter are made with killed pathogens, or parts of them.
    6. Adolescents and adults also require vaccination, including vaccines designed to protect against human papillomaviruses (HPV), which cause cervical cancer; influenza; pneumonia; and shingles. Adolescents and adults also require regular “booster” vaccines against diphtheria, tetanus and pertussis (whooping cough).
    7. Prophylactic vaccines are extremely safe, although some may have mild side effects. The most common side effects are redness, soreness and irritation at the injection site and fever.
    8. People with compromised immune systems, moderate-to-severe illnesses and/or those who have had a previous reaction to a vaccine should consult with their health care professional before getting vaccinated.
    9. Researchers are working on vaccines that treat malaria, cancer, autoimmune diseases and neurological conditions like Alzheimer’s disease and Parkinson’s disease.
    10. While many vaccines provide lifelong immunity, some require regular boosters.

    Key Q&A

    1. What is the difference between the innate and adaptive immune system?
    The innate immune system is designed to provide a kind of “shock and awe” protection against bacteria, viruses and other pathogens. When cells in the innate immune system “see” an invader, they rush in to destroy it, often by releasing inflammatory chemicals like histamines and leukotrienes. These invaders display “signs” on their surface called antigens that signal immune system cells to action.
    The adaptive immune system provides a more targeted approach. As immature T and B lymphocytes encounter antigens, they develop specific antibodies against those antigens. These “mature” lymphocytes hang out in tissue, ready to quickly spring to action when they encounter the same antigens. This creates immunologic memory and prevents reinfection.
    2. How do vaccines work?
    All vaccines are designed to affect the immune system in some way. Prophylactic vaccines are designed to stimulate a response of the adaptive immune system to a modified version of the pathogen so that when you are infected with the actual virus or bacteria, it can quickly mount a major offense against the invader before you become sick. Therapeutic vaccines are designed to strengthen the immune system’s response to a cancer or other abnormal cell.
    3. What is the difference between live and “killed” vaccines?
    Live, attenuated vaccines contain a live, although significantly weakened, version of the virus or bacteria. Measles, mumps and chicken pox vaccines are made with live viruses. The benefit of a live vaccine is that a single dose often provides lifelong immunity. The downside is that because viruses and other pathogens naturally mutate, or change, the virus within the vaccine could also change, creating a more virulent version of itself that the immune system would have difficulty combatting. This was an issue with the early oral polio vaccines, but is generally not a problem with current live vaccines, which are much safer than the virus they protect against. Only people with a suppressed immune system (such as those who have HIV, are taking immunosuppressant drugs or are being treated for cancer) should be concerned about receiving live vaccines because they could, conceivably, become infected with the virus. These vaccines also usually require refrigeration.
    Inactivated vaccines contain a killed version of the pathogen. They are more stable (meaning they don’t need refrigeration) and safer than attenuated viruses, but they don’t elicit as strong an immune response. Thus, the immunity they provide may not last as long and you might need a “booster” vaccine down the road.
    4. What types of vaccines protect against bacterial infections?
    Typically, inactivated vaccines. Many bacteria secrete toxins that damage healthy cells. Toxoid vaccines treat the bacteria with formalin, which renders the toxins harmless but still retains enough of their structure to “teach” immune cells to recognize the bacteria and train them to lock onto the toxin antigen before the bacteria can release it. Toxoid vaccines are used for diphtheria and tetanus. Conjugate vaccines are also used in young children to protect against infections caused by Haemophilus influenzae type b (such as meningitis and lung infections) and pneumococcal disease.
    5. What should I do if my child misses a vaccine?
    Call your health care professional. Children can “catch up” on nearly all vaccines, regardless of their age, except for the rotavirus vaccine, which protects infants against the severe vomiting and diarrhea caused by rotavirus.
    6. What vaccines do adolescents require?
    Preteens and adolescents should receive vaccines against the human papillomavirus, meningococcal disease and tetanus/diphtheria/acellular pertussis (Tdap). Depending on what vaccines your child received when younger, he or she may also need “catch-up” vaccines for hepatitis B, mumps/measles/rubella, polio or varicella (chicken pox). Additionally, everyone 6 months and older should receive an annual influenza vaccine.
    7. I’m traveling out of the country. What vaccines do I need?
    Make an appointment with your health care professional at least four to six weeks before your trip to see if you need any travel-related vaccines. The only required vaccines are yellow fever for those traveling to countries in sub-Saharan Africa and tropical South America and the meningococcal vaccine for travel to Saudi Arabia during the Hajj. You can learn more about vaccines required for overseas travel at theCenters for Disease Control website. Your local health department can typically provide the vaccines.
    8. I’m worried about the safety of vaccines.
    Vaccines are extremely safe. The Centers for Disease Control and Prevention operates an Immunization Safety Office that continuously monitors vaccine safety, including side effects. Part of its mission is managing the vaccine adverse event reporting system, which serves as an “early warning” system to detect vaccine-related problems. About 30,000 reports are filed annually, but just 10 percent to 15 percent are classified as serious (causing disability, hospitalization, life-threatening illness or death), and most of the incidents are ultimately not linked to vaccination. Anyone can file a report, including health care providers, manufacturers, personal injury lawyers and vaccine recipients or their parents or guardians.
    9. I heard that vaccines can cause autism.
    Some parents insist that their children developed autism after having early childhood vaccines, such as the measles/mumps/rubella (MMR) vaccine. Some suspect that a preservative once used in childhood vaccines that contained mercury caused autism. But numerous scientific investigations regarding a possible link found no connection. Today’s childhood vaccines do not have mercury-based preservatives; nonetheless, autism rates have continued to rise.
    10. I have breast cancer. I heard there is a vaccine that can treat the cancer. How can I find out more?
    There are several vaccines under investigation for cancer. These are called therapeutic vaccines because they are designed to treat, rather than prevent, disease. However, none have been approved yet. So talk to your doctor about joining a clinical trial.

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Varicose Veins

Overview

Your body has two types of blood vessels:arteries carry oxygen- and nutrient-rich red blood from your heart to your muscles and organs, while veins return the “used” bluish blood back to your heart. The deep veins located beneath the muscles carry about 90 percent of the blood traveling from your legs back to your chest. The other 10 percent flows through veins located closer to the surface, often visible, and less well supported.
While your leg muscles help your veins pump the blood upward, the real workhorse is an intricate system of one-way valves that prevent the blood from draining back down the leg under the force of gravity. In many people, women in particular, these valves stop working as well as they should, putting additional pressure on the wall of the vein.
Varicose veins results from a chronic dilatation of the veins, a condition called “varicosity.” When the vein walls are pushed apart, the valves no longer seal properly, making it difficult for the muscles to push the blood upward. Instead of flowing from one valve to the next, the blood begins to pool in the vein, increasing venous pressure and causing the vein to bulge and twist. The result is varicose veins.
In some people, varicose veins are simply a cosmetic concern. In others, the condition leads to pain and more serious problems. And in some cases, varicose veins can signal a higher risk for other conditions involving the circulatory system. When inflamed or clotted, they become hard and tender to the touch. Increasing pressure may cause itchy skin and aching in the affected limb.
If you suffer from varicose veins, you are not alone. According to the American College of Phlebology, up to 50 percent of American women have varicose veins or a related venous disorder. Spider veins, also referred to as telangiectasia or broken capillaries, are formed by the dilation of a small group of blood vessels located close to the surface of the skin and are most commonly found on the legs and face. They look like red or purple sunbursts or branched or web patterns and only rarely cause pain. Varicose veins differ from spider veins in that they are:
larger—usually more than a quarter inch in diameter—and often distended
darker purple or blue
located deeper than spider veins
tend to bulge or twist
may be painful
can be related to more serious vein disorders
Varicose veins aren’t just a cosmetic concern. They can pose a health risk. Sometimes they are associated with:
spontaneous bleeding, which occurs as the skin over the varicose veins becomes thin. The vein may be easily injured, even by bedding, clothing or a slight bump, and blood loss can be significant, without any noticeable pain.
superficial phlebitis (ST), also called superficial phlebitis, which is an inflammationof a vein just below the surface of the skin. The inflammation may be caused by decreased blood flow through the vein, damage to the vein or blood clotting (known as thromboses). Symptoms include redness and a firm, tender, warm vein. Localized pain and swelling also may occur. ST also increases a patient’s risk fordeep vein thrombosis (DVT), a potentially serious condition that involves a blood clot in a deep vein.
venous leg ulcers, which can result when the enlarged vein does not provide adequate drainage of fluid from the skin; the swollen skin receives insufficient oxygen and an ulcer forms
Certain people seem to be more predisposed to varicose veins than others, including:
Women. They are four times more likely than men to develop varicose veins. Up to 50 percent of American women may be affected at some point in their lives, according to the American College of Phlebology.
People whose family members have varicose veins. Heredity plays a major role.
Older people. Varicose veins affect one out of two people over age 50, and they are more common in women than in men. Also as women age, varicose veins become more visibly pronounced.
In addition, several factors can lead to varicose veins in people who are predisposed to them, including:
changes in a woman’s hormonal levels, which can be brought on by pregnancy
menopause
use of birth control pills, estrogen, and progesterone
obesity
leg injury
inactivity
strain in the abdominal region, from repeated heavy lifting, pregnancy orconstipation (a hemorrhoid is actually a varicose vein)
In addition to hormonal changes, pregnancy causes both an increased volume of blood and increased pressure from the abdomen, which in turn causes veins to enlarge. The good news is varicose veins due to pregnancy often improve within three months after delivery. However, with successive pregnancies, these abnormal veins are more likely to enlarge further.

Diagnosis

Many cases of varicose veins are clearly visible, with the knotted, twisted or bulging darkened veins showing beneath the skin of the thigh and lower legs. And, your legs may be swollen. If you have varicose veins, you may also experience pain in the legs, especially after standing or sitting still for a long time. Some women describe the pain as feelings of fatigue, heaviness, aching, burning, throbbing, cramping or restlessness.
Severe varicose veins can make your skin itchy or lead to a skin condition similar to eczema or even ulcers on your lower legs. Keep in mind that not all leg discomfort is caused by varicose veins. Any persistent or severe symptoms warrant a visit to your health care professional.
Vein disorders are not always visible. If you can’t see any symptoms, or, to help determine the cause and severity of the problem, your health care professional may conduct a noninvasive ultrasound or other vascular test.
Be sure to call your health care professional if swelling becomes incapacitating or if the skin over your varicose veins becomes flaky, ulcerated, discolored or prone to bleeding. In addition, if you have redness, warmth and burning pain in the area of a vein, call your health care professional, because this can be a sign of phlebitis or a blood clot.

Treatment

Because varicose and spider veins are congested with blood, they really aren’t doing their job anymore. Fortunately, there are usually plenty of other, healthy veins to take over. So most of these unwanted veins simply aren’t necessary and can be removed. But while invasive treatment is an option, don’t rush to the operating room. There are simpler things you can try first, including:
Walk regularly, which helps improve muscle tone and circulation.
Reduce your body weight.
Find several times during the day when you can elevate your legs for 10 to 15 minutes.
Wear compression hose or stockings, which can be purchased at most pharmacies. They help your leg muscles push blood upward by concentrating pressure near the ankles. Specially manufactured gradient-compression support stockings are the most effective for controlling symptoms. They may also prevent worsening of the condition and avoid the need for future treatment.
Take an over-the-counter anti-inflammatory drug such as aspirin or ibuprofen to alleviate occasional swelling and pain.
If these conservative methods don’t work to your satisfaction, you should discuss with your health care professional the possibility of trying one or more corrective measures, such as:
Sclerotherapy can be used to treat both varicose and spider veins, but it is usually reserved for people whose varicose veins are small (less than six millimeters). The procedure is performed in a health care professional’s office and causes only minimal discomfort. A tiny needle is used to inject the veins with sclerosing (hardening) solution, which irritates the lining of the vein. In response, the vein collapses and is reabsorbed. Multiple branch veins can be treated at the same sclerotherapy session, and the procedure can also be repeated if varicose veins reappear. Complications may include:
development of groups of fine, red blood vessels near the injection sites of larger vessels on the thighs, some of which disappear on their own and others require treatment
muscle cramps, which go away in 10 to 15 minutes
temporary swelling of your feet or ankles
red bumps at the sites of the injections, which fade within a few days.
bruising, which usually fades after a week or two
pigmentation (brown lines or spots) around the treated vein, which usually disappear
superficial thrombophlebitis
In addition, if you develop small painful ulcers at the injection site, inform your health care professional immediately.
Although sclerotherapy works well for spider veins, studies show that it is not as effective as surgery for treating varicose veins and that recurrence rates are high.
Endovenous chemical ablation, also known as ultrasound-guided sclerotherapy, involves the injection of a chemical irritant—called a sclerosant—into a vein while the doctor watches the process on an ultrasound screen. This process enables treatment of veins that can’t be seen because they are further beneath the skin.
External laser/light source treatments are generally used only to treat spider veins or very small varicose veins and may be combined with sclerotherapy. A laser or light beam is pulsed onto the veins to seal them and cause them to dissolve. Multiple treatments are usually required.
Endovenous radiofrequency ablation involves using radiofrequency to shrink and seal the deeper varicose veins of the legs. This method has replaced surgery for a majority of patients. Usually done in a health care professional’s office under local anesthesia, a small catheter is inserted into the damaged vein and delivers radiofrequency energy to the vein wall, causing it to heat. As it warms, it collapses and seals.
Surgery
Surgery is generally used to treat large varicose veins and has been shown to be effective, with most patients reporting satisfaction with their procedure. Surgery for varicose veins can be performed using local, spinal or general anesthesia. Most patients return home the same day as the procedure. Surgical options include:
ligation, or tying off of a vein
stripping, or removal of a long segment of vein by pulling it out with a special instrument
PIN stripping, an updated version of vein stripping that uses a “perforate invaginate (PIN) stripper.” The tip of the PIN stripper is sewn to the end of the vein, and as the PIN stripper is removed, the vein is stripped out
ambulatory phlebectomy, or removal of veins through a series of tiny incisions; often done in an office under local anesthesia
endoscopic vein surgery, which is usually reserved for advanced cases involving leg ulcers. The surgeon inserts a thin video camera into the patient’s leg to visualize and close varicose veins and then removes the veins through small incisions.
Unfortunately, no treatment can prevent veins from becoming varicose. Varicose veins sometimes recur after any form of treatment, but it’s not the same vein coming back; it’s a different vein becoming affected.
Before undergoing any procedure for varicose or spider veins, be sure to tell your health care professional if you’ve ever had blood clots in your lungs or legs.
Health care professionals who specialize in the treatment of varicose veins include:
general surgeons, physicians with a specialty in performing surgery
vascular surgeons, physicians with a specialty in treating blood vessels
dermatologists, who specialize in the diseases of the skin
phlebologists, who specialize in the field of medicine that deals with vein diseases. In 2005, the American Medical Association officially recognized phlebology as a self-designated specialty for physicians.
Unfortunately, some treatment centers specializing in varicose veins have been caught by the Federal Trade Commission making unfair promises to patients. Keep in mind that no treatment for varicose veins is ever 100 percent effective, and there is never a 100 percent guarantee that other veins in your legs won’t become varicose.
Some companies distribute herbs or over-the-counter diet supplements with claims they prevent or cure varicose veins. While some of these supplements claim to have been shown in testing to improve circulation or impact veins in other ways, keep in mind that herbs and supplements are not regulated, and there is no guarantee of quality, safety or efficacy. Also remember that there is no 100 percent cure for or prevention of varicose veins. And keep in mind that it’s important to discuss cost of treatments and out-of-pocket expenses because your health insurance may not cover the cost of the procedure.
Prevention
You can’t help being a woman, having been born into a family that suffers from varicose veins or even getting older. But there are a few things you can do to head off varicose veins or keep them from becoming more prominent, swollen and distorted, such as:
Avoid standing or sitting for long periods in the same position. Take breaks from an office job to get up and move around, or when you’re driving for long periods, get out and stretch your legs. If you work in a “standing” profession like teaching or retail sales, stretch and exercise your legs as often as possible to increase circulation and reduce pressure buildup. When possible, wear support stockings as noted below.
Try to elevate your legs when resting.
Walk for exercise, and do it regularly. Staying fit keeps your leg muscles toned, your blood flowing and your weight under control.
Include high-fiber foods in your diet since constipation can contribute to varicose veins. High-fiber foods include fresh fruits, vegetables and whole grains.
Wear graduated compression support hose.
Use regular sun protection (some unwanted spider veins on the face may be related to sun exposure).
Facts to Know

About 90 percent of the “used” blood traveling from your legs back to your chest is carried by the deep veins located within the muscles. Vein abnormalities here aren’t visible but can be painful or even result in dangerous blood clots.
The other 10 percent of the blood returning to your heart travels through veins closer to the surface; varicose veins here can be visibly swollen, knotted, twisted or bulging.
According to the American College of Phlebology, up to 50 percent of American women have varicose veins or a related venous disorder.
Varicose veins are more likely to occur in older women. Also as women age, varicose veins become more visibly pronounced.
Spider veins, also referred to as telangiectasia or broken capillaries, are formed by the dilation of a small group of blood vessels located close to the surface of the skin and are most commonly found on the legs and face. They look like red or purple sunbursts or branched or web patterns.
Pregnant women often develop varicose veins for a number of reasons: In addition to hormonal changes, pregnancy causes both an increased volume of blood and increased pressure from the abdomen, which in turn cause veins to enlarge. The good news is varicose veins due to pregnancy often improve within three months after delivery. However, with successive pregnancies, these abnormal veins are more likely to remain.
Varicose veins aren’t just a cosmetic concern. They can pose a health risk and are associated with the development of skin ulcers; phlebitis, which is an inflammation of the vein; or blood clots.
Though it may require several sessions and the veins may fade only gradually, sclerotherapy, a procedure performed in a health care professional’s office, can result in significant improvement in the appearance of spider veins. Studies show that it is not as effective as surgery for treating varicose veins, however, and that recurrence rates are high.
While there are several treatment options for small varicose veins and spider veins, large varicose veins may require radiofrequency closure and/or surgery.
No treatment for varicose veins is ever 100 percent effective, and there is never a 100 percent guarantee that other veins in your legs won’t become varicose.

Key Q&A
What causes varicose veins?Both your leg muscles and valves within your veins work to get the used blood from your legs back up to your heart. When the valves stop working as well as they should-which can be caused by heredity, abdominal pressure, increased pressure from prolonged standing, obesity, hormonal changes, aging and a number of other factors-the blood pools in the vein, stagnating there and causing the vein to bulge or twist.
Are varicose veins dangerous, or just more of a cosmetic issue?Although they can be painful and unsightly, in most cases, superficial or visible varicose veins don’t lead to further complications. If you are concerned, your health care professional can conduct some painless tests to determine the severity of the problem and ascertain if any of the deeper veins are affected.
My varicose veins are visible, but not very bothersome. Do I need to have them removed?Probably not. If only surface veins are affected, the condition is usually harmless. You would probably be feeling more pain or other symptoms if deeper veins were abnormal, which can lead to more serious problems. However, you may want to talk to your health care professional about these concerns.
My legs always seem to be tired and achy. Do I have varicose veins?Leg pain can be caused by a number of factors or conditions. If the pain seems to be brought on by standing or sitting for prolonged periods, you could have varicose veins. But if you have no visible symptoms, the only way to determine the cause of your pain is to have some tests done by your health care professional.
I’m pregnant and have developed varicose veins. Will they go away?Varicose veins due to pregnancy often improve within three months after delivery. However, with successive pregnancies, these abnormal veins are more likely to remain.
My general practitioner doesn’t think my superficial varicose veins are problematic, but I’d like to have them removed for cosmetic reasons. Who should I see?The best idea is probably to get a referral from your health care professional or from a friend or family member who has been successfully treated. The types of health care professionals best suited to treating varicose veins are most likely vascular or general surgeons, dermatologists and phlebologists.
Will my varicose veins come back if I have them removed?Once the vein is removed, it’s gone forever. However, you very well could develop varicosity in other veins.
I saw an advertisement for a “vein clinic” that made all sorts of promises about permanently making my varicose veins disappear with no risk or pain. What’s that all about?Keep in mind that no medical treatment is ever 100 percent risk-free and cannot be 100 percent guaranteed. While it’s true that once a varicose vein is removed surgically, it will not reappear, that doesn’t mean you will forever be free of varicose veins. Other veins can develop problems. Remember that surgery is a rather drastic measure. The less drastic corrective measures such as sclerotherapy or laser treatments are by no means 100 percent effective 100 percent of the time. And none of the corrective measures can be guaranteed to be totally pain-free.

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Yoga

Yoga is a physical and mental practice that involves the body, mind and spirit. The practice, which originated in India, is designed to enhance awareness, create a mind-body-spirit balance, cleanse, heal and strengthen the body, liberate the true self and, as practiced today, improve fitness. The most common form practiced in the United States is hatha yoga, which includes specific movements or postures (asana) and various breathing techniques (pranayama) and is often complimented with meditation (dhyana).
Yoga’s gentle, mindful and controlled movements can provide a non- or low-impact workout for people in almost any physical condition. Yogic exercises—and there are many—can ease tense muscles, improve flexibility and enhance strength, balance and endurance. Poses, breathing practices and meditation can also increase concentration, reduce stress and, among other therapeutic benefits, relieve back pain.
No one seems quite sure when yoga began, but it goes back thousands of years. Stone carvings in the Indus Valley depicting yoga positions date back 5,000-plus years.
Traditionally, yoga was a spiritual practice, its goal being union with the absolute or the divine. The various exercises we associate with hatha yoga were performed to prepare the body for long periods of meditation. The word “yoga” means to join or bind together, and the practice joins together the body, mind and spirit. On a spiritual level, it can refer to the union of the individual with the absolute truth or true self (Atman). It’s often associated with Hinduism, but yoga predates the religion. Hinduism has incorporated elements of yoga into its practices, as have other religions.
As it’s typically practiced in the West, the focus of yoga is more on the physical fitness aspects. Of course, it can be a spiritual experience, if you choose to use it as such.
Yoga is now practiced around the world for its psychological, physical and spiritual benefits. Americans have practiced it for more than 100 years, but it gained popularity in the 1960s as young people developed a taste for all things Eastern. According to results of a 2012 survey conducted by Sports Marketing Surveys USA on behalf of Yoga Journal, 20.4 million Americans, or 8.7 percent of U.S. adults, are believed to practice yoga.
Although this report focuses on hatha, here are some other traditional types of yoga:
Raja: Called the “royal road,” its focus is primarily on meditation; it incorporates exercise and breathing practice with meditation and study.
Jnana: Called the path of knowledge or wisdom, it is the path of yoga that uses the mind to get beyond the mind by asking questions such as, “Who am I?” “What is reality?” and “What is permanent and unchanging?
Bhakti: The path of love and devotion focuses on devotion to and concentration on the guru or chosen deity and often includes chanting.
Karma: In the yogic system of action and service, everything (including the yoga postures) is done with the mind centered on the divine; activities are done selflessly for the greater good.
Tantra: The path of ritual, it’s based on the principle of consciously embracing the whole of life to unite with deity. It uses the energies of the body— including sexual—to transcend worldly attachments.
There also are many contemporary styles of yoga, most of which are variations of hatha yoga. All yoga styles seek balance of body, mind and spirit, but they may differ in how the asanas are done and in other ways, such as the focus on postures, alignment, flow of movement or breathing. Some may be designed to suit particular groups, such as pregnant women or older people, while others may use props or vary temperature.
Many websites offer detailed descriptions of the styles available;Â lists nearly two dozen traditional styles, 42 contemporary styles, and 10 others. The site takes an objective and instructive approach to yoga and may be a good place for beginners to start.
Do your research and visit some classes if possible to decide which style and teacher best suits your needs. A few examples of some of the more popular modern yoga styles are:
Ananda: Emphasizes meditation through breath awareness, affirmations and yoga postures. Its distinct feature is the use of affirmations while in the postures.
Anusara: Means “following your heart” and respects each student’s abilities and limitations. It integrates the celebration of the heart, principles of alignment and balanced energetic actions in performance of the postures.
Ashtanga: Sometimes known in the United States as power yoga. It’s a fast-paced, physically demanding series of postures designed to create heat and energy flow.
Bikram: Sometimes known as hot yoga. This form consists of a series of 26 postures and two breathing exercises performed vigorously in a studio heated to 105 degrees with 40 percent humidity.
Forrest: Intense long-held poses designed to develop skills in awakening the senses. It uses heat, deep breathing and vigorous sequences to sweat out toxins, while also focusing on strengthening and centering your core.
Integral: Focuses on the healing power of relaxation. This form emphasizes control of breath and meditation almost as much as the postures.
Iyengar: Uses props such as straps, blankets, wooden blocks and chairs to achieve postures that focus on symmetry and alignment. Poses are usually held longer than in most other yoga styles.
Jivamukti: Uses vigorous poses in a flowing series while incorporating a variety of ancient and modern spiritual teachings. Classes provide a “yoga education” with chanting, meditation, readings, music and affirmations.
Kripalu: Emphasizes proper breath, alignment, coordinating breath and movement and honoring the body’s wisdom. It involves three stages, the final one being surrendering to the body’s wisdom, by which time the student should be able to do the postures spontaneously and unconsciously.
Kundalini: Designed to awaken kundalini energy, which is stored at the base of the spine and is often depicted as a coiled snake. The emphasis is on chanting and breathing, rather than postures.
Sivananda: Takes a gentle approach that includes postures, chanting, meditation and deep relaxation in each session. Students are encouraged to lead a healthy lifestyle that includes a vegetarian diet.
TriYoga: A systematic flowing yoga with an emphasis on the wave-like movement through the spine and on maintaining alignment through meditative transitions. Practices include basics through advanced asana, pranayama and meditation techniques.
Viniyoga: A gentle flowing form of yoga that emphasizes coordinating breath with movement. It is often used with beginners and in therapeutic settings.
Vinyasa: A general term referring to many styles of yoga that use a series of flowing postures combined with rhythmic breathing for an intense body-mind workout. It doesn’t adhere to a specific sequence of poses, but is usually based on a series of postures that together are known as sun salutations.
Is It Right For You?
Yoga is both gentle enough and athletic enough to appeal to many people. The beauty of yoga is that you don’t have to be able to do all the positions; you can work within your own limitations and tailor your practice to your specific needs.
If you decide to try yoga, finding a teacher won’t be hard. Classes are available through recreation centers, senior centers, YMCAs, YWCAs, hospitals, health centers, community centers, meditation centers and dedicated yoga studios. Many classes are relatively inexpensive—they may even be free with your membership at a gym, community center, etc. And check your health plan; some insurance companies cover the cost of classes.
Ask your regular health care professional for suggestions. He or she may know of a yoga class that meets your particular needs. There are also resources on the Web for finding classes, including  and the Yoga Journal online directory at
You can take individual lessons, too, but they will be more costly. Whether you decide to learn in a class or one-on-one, try to do so in person. Books, tapes and DVDs abound, but ideally, they should supplement what you learn from class, and they can help you as you establish your practice at home.
Before your first class, consider sitting in on a session, if this is permitted. Would you be comfortable in the class with this teacher? Is the pacing right for you? Make sure you find a class and teacher that feel right for you. If you have a particular medical condition, make sure the instructor has experience dealing with other folks in your situation. And once you find a teacher you like, be sure you tell him or her about any health problems.
Be advised, however, that there’s no licensing requirement to teach yoga, and many teachers may have done little more than complete a weekend training or correspondence course. If a yoga teacher is untrained, you may be at a higher risk of sustaining an injury in his or her class. A teacher-organized group called Yoga Alliance  recommends 200 to 500 hours of expert training. Teachers who complete the recommended training can register with the Yoga Alliance, which provides an online directory of teachers. If you have a special need, the International Association of Yoga Therapists can help you find a specialist.
Health Benefits
Yoga’s most obvious benefits relate to stress reduction, flexibility and relaxation. But as more studies are conducted, there is evidence of other tangible health benefits. While it’s no cure, yoga can be an effective adjunct therapy for a variety of conditions, including cancer, heart disease, arthritis, asthma, diabetes, depression, fibromyalgiaand migraines. Even if you are in perfect health, you can benefit from yoga. It improves strength, flexibility, coordination and range of motion. And since yoga promotes relaxation, improves circulation and reduces stress and anxiety, it enhancescardiovascular health and benefits the respiratory and nervous systems. Because it promotes relaxation, yoga also aids sleep and digestion.
Yoga can make you more aware of your own body—more conscious of its strengths, weaknesses and needs.
Medical experts aren’t exactly sure why yoga offers so many health benefits, but more studies are under way. Some of its physiological effects can be attributed to stress reduction and relaxation; since many health problems are triggered or aggravated by stress, stress-reduction can only help. And when you do yoga, especially meditation and breathing exercises, you often induce what is known as the relaxation-response, a stress-neutralizing physiological state that boasts a wide range of physical and mental benefits.
Yoga requires no special equipment or clothes, though an inexpensive yoga mat may help provide cushion and grip. You can do the exercises at home or at the office. If you have limited mobility, you can even do them from a chair or bed.
Here’s a look at how yoga can improve some specific conditions affecting women. As always, consult with your health care professional before beginning any new exercise program.
Arthritis and fibromyalgia. Yoga may ease the pain associated with these conditions, and there are classes designed specifically for people with arthritis or fibromyalgia. Few studies have been done, but anecdotal evidence indicates that arthritis sufferers find relief from yoga. A Stanford University study suggests that mind-body techniques (including yoga) are effective complementary therapies for musculoskeletal disorders, including osteoarthritis. For both arthritis and fibromyalgia, the stretching can temporarily relieve stiff joints, improve flexibility and circulation and stimulate the release of endorphins. The deep breathing and meditative aspects can help you deal with the stress of illness, especially something as frustrating as fibromyalgia.
Asthma. The breathing exercises that are an integral part of yoga seem to give some people an element of control over their breathing, thus reducing the symptoms of asthma. It also strengthens the respiratory system.
Back pain. Yoga can provide temporary relief from back pain. It can also help you avoid certain kinds of back pain by making your back and abdominal muscles stronger. Yoga stretches and strengthens back muscles; yoga and physical therapyuse some similar movements. Some postures strengthen abdominal muscles, which help support the back. Moreover, through regular practice, yoga will help you learn to spot potential trouble spots. For instance, you may be able to identify tense muscles and relax them before they become tight and sore. Alignment yoga can help realign posture, diminishing the chance of reinjury both in yoga classes and in daily life. It can also offer relief from nerve compression, which can cause back pain and sciatica.
Carpal tunnel syndrome. Research indicates that yoga is an effective treatment for this repetitive stress injury. One study, reported in the Journal of the American Medical Association, revealed that carpal tunnel sufferers who regularly attended yoga classes experienced less pain, greater flexibility and a stronger grip than those who used the usual treatment, a wrist splint.
Endometriosis. Yoga, like some other relaxation and meditative techniques, seems to provide some women with relief from the pain associated with endometriosis.
Epilepsy. Some studies suggest that yoga may help patients manage epilepsy. It may come down to stress reduction; stress can be a precipitating factor for some seizures, and yoga promotes relaxation and stress reduction. But researchers haven’t drawn any conclusions yet, contending that more studies are needed.
Chronic pain. Yoga and other relaxation techniques have been shown to help reducechronic pain. They are especially effective for chronic headache and muscle tension.
Diabetes. Yoga is well suited for diabetics in that it improves circulation and promotes a regular exercise regimen.
Heart/coronary artery disease. Yoga improves circulation and, as a stress-reducing or stress-management technique, it may play a role in halting or reversing heart disease. Health care professionals often recommend yoga or something similar for their heart patients.
High blood pressure. Evidence suggests that yoga reduces stress and increases relaxation, which may have a favorable effect on blood pressure rates. And there are studies suggesting that yoga may be effective in controlling hypertension, but more research needs to be done.
Menopause. Yogic breathing techniques seem to help some women reduce hot flashes and other symptoms. And according to the American Yoga Association, some yogic exercises stimulate the glandular and reproductive systems, helping balance body chemistry.
Insomnia. According to the National Institutes of Health, relaxation therapies and physical exercise, including yoga, can help alleviate insomnia.
Multiple sclerosis. Yoga may help women with MS to increase physical functioning. Some chapters of the National Multiple Sclerosis Society offer yoga classes, and there are specialists in yoga for MS around the country.
Osteoporosis. Since yoga is a low-to-no-impact exercise, some of the gentler postures may be appropriate even if you already have the condition; yoga may help lessen the pain associated with osteoporosis. Certain poses that position part of the body’s weight on the hands may also aid in retaining bone density in the upper extremities and spine. Care must be taken, however, to avoid excessive pressure or range of motion, such as spinal extension. Each woman’s condition varies.
Premenstrual syndrome and menstrual cramps. Yoga, when practiced regularly, can reduce symptoms of severe PMS, including anxiety and depression in some women. Some postures can reduce pressure on the uterus, relieving cramps, and yoga’s gentle stretching can ease stiffness and tension in the lower back. According to the American Yoga Association, irritability, depression and moodiness can be eased by regular meditation, which is a part of many yogic practices. The association also explains that some yogic exercises stimulate the glandular and reproductive systems, helping balance body chemistry. And, of course, a regular exercise program of any sort helps lessen the severity of cramps for many women.
Pregnancy. Prenatal yoga classes are generally gentler than regular classes, and there’s a greater focus on breathing and relaxation. Mild-to-moderate exercise during pregnancy is important for both you and your baby, and yoga’s gentle, relaxing movements may be ideal. And it can help you deal better with the stress associated with pregnancy. Consider looking for a course designed for pregnant women, and talk to your health care professional before starting any exercise program. Some methods and teachers caution that women who are pregnant or breastfeeding focus on breathing and meditation exercises rather than the more strenuous yoga poses, particularly cautioning against inverted poses for pregnant women. However, many serious yoga schools offer women’s classes with modified, supported poses that may bring strength, confidence, rest and relief to pregnant and nursing women. Yoga Alliance requires at least 85 hours of specialized training for prenatal yoga instructors.
Treatment
If you have a medical condition for which you are receiving treatment, yoga should be considered an additional therapy, not a replacement. Talk to your health care professional if you have arthritis, multiple sclerosis, fibromyalgia or other serious medical conditions. Many places offer special classes designed just for people with these conditions.
Even if you don’t need a specialized class, you need to be aware of certain warnings before starting a class. For instance, high blood pressure, glaucoma or a history of retinal detachment or heart disease may mean that you should not perform certain exercises or positions (the ones that turn you upside down, like a handstand). Again, talk to your health care professional first.
For the vast majority of women, yoga is an ideal way to improve overall health. It requires little advance preparation, so once you find a class, you can jump right in.
What To Expect
Wait at least two hours after eating before starting your yoga workout. Don’t worry about the “proper” outfit. Wear something comfortable that will allow you to move—leotards or yoga pants are good choices, but you can wear a T-shirt and shorts, too. Some instructors may not want you to wear baggy clothes because they want to be able to watch your form as you practice the postures. Also, baggy tops tend to fall up over the head during semi-inverted poses. Most people practice yoga in their bare feet.
The session will probably start with gentle warm-up exercises, probably a series of breathing exercises and gentle stretches. From there, the instructor will take you through several postures (asanas). You may hold these positions for a few seconds or a few minutes. Depending on the specific posture, you will start from a seated, standing or prone position.
You may already know some of these movements—for example, the cross-legged seated Lotus position. Others will feel like the shoulder rolls or stretches you may already do. Some will be unfamiliar, though.
Don’t worry if you can’t do each posture perfectly—as long as you keep it safe and mindful, the pose is always perfect. Yoga is about the process itself. You don’t have to do everything the class does. Go at your own pace. Eventually, you will perfect your form. Remember, the point isn’t to push beyond your limits.
During the process, be sure to breathe slowly and deeply from your diaphragm and move gently. Take breaks as often as you like, and never do anything that causes any genuine pain or discomfort.
Most yoga classes will end with a final relaxation or “corpse pose.” There may also be a short meditation.
Classes generally last 60 to 90 minutes, and you may attend class once or several times a week. It’s important to develop a daily practice. This means doing yoga on days you aren’t in class—shoot for about 30 minutes. If that sounds daunting, start with five or 10 minutes and work up. If your schedule doesn’t allow for daily practice, try for four times a week for about 45 minutes.
Aside from your regular practice, you can work on some of the seated postures during the day while at the computer. And you can practice the deep, diaphragm-based breathing techniques anywhere.
The time of day you practice depends not only on your schedule, but on your goals. In the morning, a yoga routine may energize you and prepare you for the day. That’s the preferred time of day for many folks. In the evening, relaxing poses can lead to better sleep.
Many yoga classes offer a gentler workout. While yoga is not like an aerobics class, it will still be challenging. There is a great increase, too, in the number of physically strenuous, faster-paced classes on schedules these days. Regardless of which experience you choose, when you finish, you shouldn’t feel exhausted. You should feel refreshed, relaxed and energized.
There are no negative side effects to yoga, but as with any exercise program, it’s always possible to hurt yourself, especially if you try to explore advanced postures before you are ready. While you are practicing yoga, always listen and respond to what your body is telling you. One of the fundamental concepts in yoga is nonviolence or “ahimsa,” and it begins with the self. This mindfulness will help you reduce the chances of injury, and it’s really at the heart of yoga.
At first, it’s natural to feel a little sore, especially if you haven’t been exercising lately. But if the soreness is severe or persists, talk to your instructor. If you feel pain in your joints, talk to your instructor right away. A reasonable amount of muscle soreness is normal; joint pain is not. If the joint pain persists, talk with your regular health care professional.
It’s always advisable to check with your health care professional before embarking on any exercise program, particularly if you are out of shape, over 65 or have serious health problems. You definitely need to do so if you have high blood pressure, glaucoma, arthritis (particularly rheumatoid arthritis), spinal disk injuries, a history of retinal detachment or heart disease, or if you are pregnant. And be sure to inform the yoga instructor, too. If you have any of these conditions, it may be a good idea to begin your journey with one or more private sessions so you can better understand how to tailor the practice to accommodate your needs.
You may notice that your general health improves as you continue to make yoga a regular part of your life. But no matter how good you feel, don’t stop your regular treatments. Continue to take any prescribed medications until your health care professional advises otherwise.
Facts to Know
Yoga has been practiced in the United States since the late 19th century, but it gained popularity in the 1960s.
According to results of a 2012 survey conducted by Sports Marketing Surveys USA on behalf of Yoga Journal, 20.4 million Americans, or 8.7 percent of U.S. adults, are believed to practice yoga.
Yoga has been proven to reduce stress and anxiety; accordingly, it is often recommended to relieve the pain and anxiety of chronic conditions.
Yoga is thousands of years old. Stone carvings in the Indus Valley depicting yoga positions date back 5,000-plus years.
During your practice, focus on your breathing as well as the positions and stretching of the yogic postures. Breathing is as important a part of yoga as the stretching.
A fundamental tenet of yoga is that the body, mind and spirit are inexorably connected and need to be in a state of balance.
You can work on some of the techniques throughout the day—seated at your desk, in your car, even at the computer.
Since yoga involves weight-bearing postures, the practice is especially beneficial to your musculoskeletal system and may help prevent osteoporosis. It also benefits the organs of the body through the compression and expansion of the abdomen and inversions and rotation of the body in relation to gravity.
Yoga is not a religion, but many of its elements are incorporated into various religious traditions. Practicing yoga won’t interfere with your religious practice—and it might enhance it.
Even within hatha yoga, there are various styles and approaches. When looking for a yoga teacher, it’s helpful to check out different classes to find the one best suited to your needs.
Key Q&A
Is yoga a religion?No. However, it can be part of a religious/spiritual practice.
Is yoga a replacement for conventional treatment?No. You should continue any current medication or treatment program. Yoga can help relieve the symptoms of various conditions, and it’s good for your overall well-being, but it’s not a treatment itself. And remember: If you do have specific health problems, make sure your health care provider knows you are planning to take up yoga.
I’m not that flexible. Can I still practice yoga?Of course! You may want to start with a beginner’s class. Yoga allows you to work at your own pace within your own limitations. No one expects you to be able to do advanced postures right away—or even ever. But the advantage is that yoga will make you stronger and more flexible.
Why does yoga have all these health benefits?Scientists aren’t exactly sure why yoga has physiological benefits, but at least some of its success can be attributed to stress reduction, the relaxation response and the “exercise” element with benefits that parallel other forms of exercise.
I have several books on yoga. Do I really need to take a class?Yoga practitioners generally maintain that the best way to learn is in person. If you are homebound, there are countless books, websites and DVDs available. Just remember that the best and safest way to learn is with a teacher guiding you.
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Yeast Infections

Vaginal yeast infections, also calledcandida vaginal infections or candidiasis, are common and easily treated in most women. Candida is a fungus. It commonly exists in small amounts in the vagina, mouth and gastrointestinal tract. When the fungus overgrows in the vagina, a yeast infection develops. This causes uncomfortable symptoms such as vaginal itching, burning and discharge. Uncontrolled diabetes and the use ofantibiotics, the contraceptive sponge, thediaphragm and spermicides are associated with more frequent yeast infections. Women who use hormonal birth control—birth control pills, the birth control patch or the vaginal ring—may also have more yeast infections.
Characteristics of Yeast Infections
Most women––as many as 75 percent––will have at least one diagnosis of vaginal yeast infection during their lifetimes. Yeast infections (also called yeast vaginitis or vaginal candidiasis) are one of the most common causes of vaginitis, an inflammationof the vagina characterized by discharge and irritation.
Yeast infections are more common during pregnancy. It seems that the higher levels ofestrogen in pregnancy cause the vagina to produce more glycogen (sugar), which feeds the yeast. Similarly, people with diabetes get yeast infections more frequently.
Recurrent Yeast Infections
About 5 to 8 percent of women develop recurrent vulvovaginal candidiasis (RVVC), defined as four or more symptomatic vaginal yeast infections during a 12-month period. Although RVVC is more common in women who have diabetes or problems with their immune system, most women with RVVC have no underlying medical illness that would predispose them to recurrent candida infections.
Conditions Mistaken for Yeast Infections: Bacterial Vaginosis and Trichomoniasis
Vaginal infections can also be caused by bacterial vaginosis (BV), the most common cause of vaginitis in women of childbearing age, and trichomoniasis, a sexually transmitted infection. BV and trichomoniasis are associated with more serious reproductive health concerns, such as premature birth and increased risk of contracting sexually transmitted diseases. Because these infections can have symptoms similar to those of yeast infections, yet can have more serious reproductive effects, it’s important to see a health care professional to evaluate and diagnose any vaginal symptoms. A variety of medications can treat vaginal infections, but proper diagnosis is key.
Diagnosis
Possibly because they are so common, women often self-diagnose yeast infections and self-treat with over-the-counter products.
But self-diagnosis may be a misdiagnosis. In one study, only 11 percent of women accurately diagnosed their yeast infections, and among women who had previously had a yeast infection, only 35 correctly diagnosed the condition. A handful of other vaginal infections, such as bacterial vaginosis (BV) and trichomoniasis cause similar symptoms.
Vaginal yeast infections may cause the following symptoms:
Vaginal itch and/or soreness.
A thick cottage cheese-like vaginal discharge, which may smell like yeast. A fishy odor is a symptom of BV, not of a yeast infection. The vagina normally produces a discharge that is usually described as clear or slightly cloudy, non-irritating, and having a mild odor. There may also be no discharge with a yeast infection or a discharge that is thin and watery.
A burning discomfort around the vaginal opening, especially if urine comes into contact with the area.
Pain, dryness or discomfort during sexual penetration.
Redness and swelling of the vulva and vagina
Contact your health care professional if you have any of these symptoms.
During the normal menstrual cycle, the amount and consistency of vaginal discharge varies. At one time of the month, you may have a small amount of a very thin or watery discharge, while another time of the month the discharge may be thicker. These variations are normal. The normal mid-cycle discharge is slippery.
However, a vaginal discharge that has an offensive odor with irritation is not normal. The irritation can be described as itching or burning or both and often worsens at night. Sexual intercourse typically makes the irritation worse.
To diagnose your vaginal symptoms, your health care professional will perform a gynecological examination and check your vagina for inflammation and abnormal discharge. A sample of the vaginal discharge may be taken for laboratory examination under a microscope, or for a yeast culture, test to see if candida fungi grow under laboratory conditions. Looking under a microscope also helps rule out other causes of discharge such as BV or trichomoniasis, which require different treatment.
Treatment
Antifungal medications are used to treat yeast infections. These medications are available in various over-the-counter (OTC) preparations and in one-, three- and seven-day doses. They include:
butoconazole (Gynazole, Femstat 3)
terconazole (Terazol)
tioconazole (Vagistat-1)
miconazole (Monistat)
clotrimazole (Gyne-Lotrimin)
Differences among the various OTC medications include the length of treatment indicated, preparation type and cost. The shorter course of treatment is more convenient but often more expensive. The one-, three- and seven-day durations of treatment appear to be equally effective. Prescription antifungal treatments also are available.
In general, it’s acceptable to use OTC antifungal medication to self-treat your symptoms if you’ve had a yeast infection diagnosed by a health care professional before and you are now experiencing the same symptoms.
However, if you meet any of the following circumstances, do not self-treat. Instead, contact a health care professional for guidance.
You’ve never had a yeast infection.
You have a fever and/or abdominal pain.
Your vaginal discharge is foul-smelling.
You are diabetic, HIV-positive, pregnant or nursing.
You used an over-the-counter yeast treatment but your symptoms have not gone away or they returned almost immediately.
If you take medication to treat a yeast infection—OTC medication or prescription medication—be sure to take the full course of the prescription. Don’t stop using it, even if you begin to feel better.
If your symptoms don’t respond or return shortly after they’d cleared up, consult your health care professional. Don’t just try a different over-the-counter treatment; your symptoms may not be caused by yeast.
Studies find up to an 89 percent error rate in self-diagnosis of yeast infections. Thus, if you think that you have a yeast infection, there’s a high chance you’re wrong. If your symptoms don’t ease after a few days of self-treatment with OTC medicine, or if they return promptly, see your health care professional. Keep in mind, however, that vaginal and vulvar irritation may persist for two weeks.
Yeast infections also may clear up without any treatment. However, there is a very small chance that a yeast infection may lead to a serious infection known as systematic candidal disease. This complication usually only occurs in women with compromised immune systems.
Side effects of OTC medications for yeast infections are generally minor and include burning, itching, irritation of the skin and headache. However, as with any medication, more serious side effects are possible, though rare, and may include hives, shortness of breath and facial swelling. Seek emergency treatment immediately if any of these symptoms occur.
Antifungal medications may damage condoms and diaphragms, so if you’re using such a medication, take other precautions to protect against pregnancy and sexually transmitted diseases. Also, don’t use tampons while treating yeast infections with medication inserted into the vagina.
If you see a health care professional, he or she may prescribe a single dose of oral fluconazole (Diflucan) or a generic equivalent, although this treatment is not recommended during pregnancy. Also, do not take fluconazole if you are taking cisapride (Propulsid) because this drug combination could cause serious, even fatal, heart problems. In rare cases, fluconazole has also caused liver damage, sometimes resulting in death. Also, notify your health care professional immediately if you develop a rash while taking fluconazole. Other, less serious side effects may be more likely to occur. These include:
diarrhea
headache
dizziness
stomach pain
heartburn
There have been reported drug interactions between warfarin, an anticoagulant (blood thinner) medication and topical miconazole nitrate products (such as Monistat) and oral fluconazole (Diflucan). Additionally, fluconazole may cause liver damage in rare instances, particularly in conjunction with alcohol use. Discuss all the medications you may be taking when you discuss your symptoms with your health care professional.
If you have a yeast infection, your sexual partners do not need to be treated. However, if a male sex partner shows symptoms of candida balanitis-redness, irritation and/or itching at the tip of the penis-he may need to be treated with an antifungal cream or ointment.
Medications cure 80 to 90 percent of vaginal yeast infections within two weeks or less, often within a few days with less severe infections.
About 5 to 8 percent of women experience recurrent vulvovaginal candidiasis (RVVC), defined as four or more yeast infections per year. Treatment involves a longer course of treatment—between 7 and 14 days of a topical cream or suppository or oral fluconazole followed by a second and third dose three and six days later. Your health care professional may also recommend a preventative treatment after the infection has resolved. This treatment may involve a 150 mg dose of fluconazole or 500 mg of topical clotrimazole once a week.
Prevention
Among the strategies that may prevent vaginal yeast infections are:
Keep the external genital area clean and dry.
Avoid irritating soaps (including bubble bath) and vaginal sprays.
Avoid scented soaps, powders or toilet tissue.
Avoid daily use of panty liners, which can trap moisture and prevent good airflow.
Change tampons and sanitary napkins frequently.
Wear loose cotton underwear that doesn’t trap moisture.
After swimming, change immediately into dry clothing instead of staying in your wet bathing suit.
If you have diabetes, try to maintain stable blood sugar levels.
Take antibiotics only when prescribed by your health care professional and never for longer than directed. In addition to destroying bacteria that cause illness, antibiotics kill off the “good” bacteria that keep the yeast in the vagina at a normal level. If you tend to get yeast infections whenever you take an antibiotic, ask your doctor to prescribe a vaginal antifungal agent at the same time.
Wipe from the front to the rear (away from the vagina) after a bowel movement or urination.
Don’t use douches. Douching with vinegar or other chemicals increases the rate of vaginal yeast infections because it alters the vaginal bacterial balance.
Facts to Know
Seventy-five percent of women are likely to have at least one yeast infection during their lifetime; nearly half have two or more.
Vaginal yeast infections are the second most common cause of abnormal vaginal discharge in the United States (the first is bacterial vaginosis).
Yeast infections are quite common during pregnancy. It seems that the higher levels of estrogen in pregnancy cause the vagina to produce more glycogen (sugar), which feeds the yeast. Yeast infections are also more common in women with diabetes.
About 5 to 8 percent of women develop recurrent vulvovaginal candidiasis (RVVC), defined as four or more symptomatic vaginal yeast infections in a 12-month period. Most women with RVVC have no underlying medical illness that would predispose them to recurrent candida infections.
A woman’s vagina normally produces a discharge described as clear or slightly cloudy, non-irritating and odor-free or having only a mild scent. During the normal menstrual cycle, the amount and consistency of discharge may vary.
Douching disrupts the balance of normal bacteria in the vagina and can cause more frequent vaginal infections.
Vaginal yeast infections can clear up without treatment. However, if you don’t treat a yeast infection, there is a very small chance you may develop a serious infection.
If you have a yeast infection, treatment of sexual partners is usually not generally recommended, since it’s not clear if vaginal yeast infections are transmitted sexually. However, if a woman has recurrent infections and her male sex partner shows symptoms of candida balanitis—redness, irritation and/or itching at the tip of the penis—he may need to be treated with an antifungal cream or ointment.
Medications cure 80 percent to 90 percent of vaginal yeast infections within two weeks or less, often within a few days.
Take antibiotics only when prescribed by your health care professional and never take them for more or less time than directed. In addition to destroying bacteria that cause illness, antibiotics kill off the “good” bacteria that normally live in the vagina. Stopping treatment early, even when symptoms have improved, can cause infections to return and make them resistant to the medication.
Key Q&A
I think I might have a yeast infection, but I’m not sure. Should I go ahead and try one of the over-the-counter preparations to see if my symptoms go away?If you’ve had a yeast infection before and now have the same symptoms—vaginal discharge that has a yeast-like smell,with burning, itching and discomfort—self-treatment with an over-the-counter antifungal treatment is generally acceptable. However, many vaginal infections, including some that can cause serious reproductive health conditions, such as premature birth or increased risk of sexually transmitted diseases, have similar symptoms. If you’re not sure, have never had a yeast infection before, are pregnant or have a health condition, consult a health care professional for an evaluation of your symptoms before treating yourself with OTC medications.
I’m on the third day of a seven-day treatment and my symptoms are all gone. Can I stop using the medication?No, you need to use all of the medication as directed. Your symptoms can disappear before your infection is completely treated. If you stop using the medication now, the yeast infection could recur.
I have vaginal itching and a discharge with a fishy odor. Is this a yeast infection?No, a discharge with a fishy odor is not a symptom of a yeast infection. It’s a symptom of bacterial vaginosis (BV), another common, but more serious, vaginal infection. BV requires a different treatment than that used for yeast infections. Contact a health care professional for additional guidance.
What is the risk of self-treating yeast infection for women who are pregnant or nursing or those who have diabetes or HIV?First, women who are pregnant or have diabetes or HIV have a higher risk of developing a yeast infection. Second, and most important, these woman, as well as nursing mothers, should always see their health care professional if they suspect a yeast infection rather than self-treat because yeast medications may interfere with medications needed for their other health problems (HIV, diabetes) or pose risks for the baby.
If I’m pregnant, can a yeast infection hurt my developing baby?No, but you do need to see your health care professional for treatment. Also, some treatments currently on the market, such as fluconazole (Diflucan), are not recommended during pregnancy. Be sure your health care professional and pharmacist are both aware that you are or may be pregnant.
I keep getting recurrent yeast infections. Should my sexual partner be treated?It’s not clear whether vaginal yeast infections can be transferred during sexual intercourse. However, if your sexual partner has the symptoms of candida-redness, irritation and/or itching at the tip of the penis in a male-he may need to be treated. In rare cases, treatment of partners of women with recurrent yeast infection is recommended. Additionally, recurrent yeast infections may be representative of a different problem. Thus, it is important to see your health care provider for an evaluation.
I thought douching helped keep a woman clean. What is the risk in douching?The healthy vaginal ecosystem requires just the right balance of bacteria flora. The vaginal mucosa, which protects against pathogens, is made up predominantly of healthy bacteria called lactobacillus. These bacteria make hydrogen peroxide, which keeps unhealthy bacteria from getting out of hand. This, in turn, keeps the amount of yeast at a normal level. Too much douching can disrupt the bacterial balance and lead to infection.
My health care professional has prescribed antibiotics to treat an unrelated illness. What precautions should I take to avoid getting a yeast infection?Wear loose clothing and loose cotton underwear. Keep yourself clean and dry. Avoid scented or irritating soaps, powders, and toilet tissue. Avoid douching. Use a preventive dose of yeast medication.
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Weight Management

Americans are obsessed with both food and dieting. As a nation, we love to eat. We eat out often, when meals are often higher in fat and calories than meals eaten at home; we eat larger portions; and we indulge in dozens of delicious “new” food products found on our grocery store shelves every year.
But we also spend billions of dollars a year on commercial weight-loss products and services hoping for a quick fix to our weight problem. And what a problem: with all that eating, the Centers for Disease Control and Prevention (CDC) reports that 68 percent of the nation is overweight or obese. What’s more, dieting is failure-prone, and the statistics are even worse when it comes to those who can keep the weight off.
The answer to this weight loss/weight gain cycle lies in how you manage your weight on a day-in, day-out basis. Your diet—the way you eat—is ingrained in your lifestyle. To change your weight—whether you want to lose a few pounds, or more, and keep them off—or to ensure you don’t succumb to the expanding-waistline syndrome, you must permanently adopt a healthy lifestyle.
Unfortunately, it’s not just all that tempting food that stands in the way of your efforts to achieve or maintain a healthy weight. Technology has altered Americans’ lifestyle. Most of us, most of the time can be found sitting—in front of a computer or TV, in a car, at a restaurant. About a quarter of adults—and an even greater percentage of women—report they are sedentary and engage in no physical activity during leisure time, and less than half exercise regularly. And as women age, their tendency to be sedentary steadily increases.
Being overweight increases your risk for many diseases. If you are overweight, you are more likely to develop heart disease and stroke, the leading causes of death for both men and women in the United States.
Overweight people are more likely to have high blood pressure, a major risk factor for heart disease and stroke, and high cholesterol, also a risk factor. They’re twice as likely to develop type 2 diabetes—a major cause of death, heart disease, kidney disease, stroke, amputation and blindness—as those not overweight.
Additionally, several types of cancer are associated with being overweight. In women, these include cancer of the uterus, gallbladder, cervix, ovary, breast and colon. Being overweight can also cause problems such as gout (a joint disease caused by excessuric acid), gallbladder disease or gallstones, sleep apnea (interrupted breathing during sleep), and osteoarthritis, or wearing away of the joints. Anyone with risk factors for health problems must be concerned about extra weight.
It all seems so simple: eat less, exercise, lose weight. But few people succeed in losing more than a few pounds on diets and even fewer succeed in maintaining that weight loss. An estimated 90 percent of dieters regain the weight in five years. One reason is that many factors other than overeating can play a part in weight, including your genetic makeup, cultural influences and natural hormonal and neurologic regulators.
Extreme dieting programs can sometimes be harmful and are rarely successful over the long term. Thus, weight loss should not be your only or even your primary goal if you are concerned about your health. Instead, the success of your weight-management efforts should be evaluated not just by the number of pounds you lose, but by improvements in your chronic disease risk factors, such as reduced blood pressure, cholesterol and blood sugar levels, as well as by new, healthy lifestyle habits. In fact, some experts believe that weight is not the sole cause of the diseases associated with being overweight, but that the accompanying unhealthy foods and sedentary lifestyles also contribute to these diseases.
On the flip side, some women are underweight, despite having tried to achieve or maintain a “normal” weight. Having a metabolism that burns too many calories can be as dangerous as being overweight. Underweight women are susceptible to vitamin and mineral deficiencies, resulting in a loss of bone density and muscle tissue.
A Word About Teens
Teenage girls today feel a lot of pressure from the media, friends and sometimes their own parents to be very slim. This pressure can create a distorted body image, making them see themselves as fat when they are not fat, or they see themselves as fatter than they really are.
According to the National Eating Disorders Association (NEDA), 40 percent of newly identified cases of anorexia are in girls ages 15 to 19, and over half of teenage girls use unhealthy weight-control behaviors, such as skipping meals, fasting, smoking cigarettes, taking laxatives and vomiting.
Fad dieting can keep teenagers from getting the calories and nutrients they need to grow properly. Stringent dieting may cause girls to stop menstruating and prevent girls from developing adequate muscle tone. If the diet doesn’t provide enough calcium or vitamin D, bones may not lay down enough calcium, which may increase the risk ofosteoporosis later in life.
The flip side to teenagers feeling pressured to be thin is that some may have legitimate concerns about their weight that adults dismiss. Adolescent obesity can carry serious lifelong health consequences. The best advice to teenage girls: Instead of dieting because everyone is doing it or because you are not as thin as you want to be, first find out from a health care professional or dietitian whether you carry too much body fat for your age and height. If you need to lose weight, follow the sensible guidelines laid out here. Depending on your age, your health care professional may recommend you eat more low-fat dairy products than is recommended for adults because of your heightened need for calcium.
Treatment
The key to weight management is incorporating three strategies into lifelong practices—eating healthfully, exercising regularly and, for some women, changing your relationship with food. Unfortunately, of the millions of American women who are trying to lose weight, a minority use this method.
The most important key to success is to approach any changes in diet and exercise not as punishment, but as a plan to implement pleasurable healthy substitutes for unhealthy overeating and sedentary behavior.
Eating for Weight Management
Keeping in mind the biological reason we eat—to provide our bodies the energy and nutrients it needs to carry out the tasks we ask of it—is a good way to think about food.
Since an estimated 90 percent of dieters who lose weight regain all or part of it within five years indicates that “dieting” is not the answer to weight management. The best “diet” is a way of life that you can follow for the rest of your life. Therefore, it should consist of a balance of a variety of foods.
You can ask a nutritionist or registered dietitian for guidance on the number of calories you should eat to reach and maintain your goal weight. But as a rule of thumb, you should take in about 250 calories per day less than is needed to maintain your current weight and add an exercise regime that burns an additional 250 calories a day if you want to lose weight. This regimen should help you safely lose about a pound per week.
Your basal metabolic rate (BMR) is the number of calories your body needs to maintain its basic functions. Several factors go into the calculation of your BMR, including your height, weight and age. To get an idea of your BMR, go to http://www.bmi-calculator.net/bmr-calculator. You need additional calories to provide energy for daily activities; the more active you are, the more calories you need.
A more accurate method is to keep a detailed food diary over a few days to a week during which you maintain your weight. Determine exactly how many calories you eat on an average day—several books and websites provide calorie counts for thousands of foods—and use that figure as a starting place for weight maintenance or weight loss.
After you’ve determined how many calories per day you should eat, plan daily menus. A registered dietitian or nutritionist can help you plan menus that include the types and amounts of food you should eat which, in most cases, should be based on the sensible guidelines set forth by the federal government in its 2010 Dietary Guidelines for Americans. The guidelines, available at http://www.healthierus.gov/dietaryguidelines, aim to help Americans lose weight in an effort to reduce the risk of obesity-related chronic diseases. The guidelines recommend balancing calories with physical activity and encourage Americans to eat more healthful foods, such as vegetables, fruits, whole grains, fat-free and low-fat dairy products and seafood, and to consume less sodium, saturated fats, trans fats, added sugars and refined grains.
The easiest advice to follow is to divide your plate into sections. Half your plate at main meals should consist of colorful vegetables, one quarter of grain products such as whole-grain bread, pasta, whole-grain rice and cereals, and one quarter of lean meat, fish or poultry. Several times a week, you should substitute dishes made from dried beans or peas as your main course. You should also eat plenty of fruits and get three cups of low-fat milk products like yogurt or cheese daily.
These guidelines will help reduce your calories and fat and increase the fiber in your diet, all of which have been shown to decrease the risk for heart disease. While you should try to cut back on fats and sugars, allow for an occasional treat. As soon as you label a food as “off limits,” chances are you will crave and perhaps even binge on it. A few simple ways to cut back on calories include:
Hold the sauce. Dishes that include high-fat sauces, mayonnaise and regular salad dressings should be consumed only occasionally and only in small portions.
Drink more water. And steer clear of calories hidden in drinks like juice drinks, alcoholic beverages, fancy coffee concoctions and smoothies. Avoid excessive fruit juice consumption.
Eat high-volume foods. High-volume, low-calorie foods, like most fruits and vegetables, are high in water and fiber, helping you feel fuller longer. Up your intake of vegetables and cut back on fats and sweets.
Focus on nutrient-dense foods. The 2010 Dietary Guidelines suggest replacing foods that contain sodium, solid fats, added sugars and refined grains with nutrient-dense foods and beverages. These foods include vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats, poultry, eggs, beans and nuts and seeds.
Health care professionals recommend women have moderate fat consumption, between 20 to 35 percent or less of your total calorie intake. Most fats should come from polyunsaturated fats and monounsaturated fats, which are found in vegetable sources. The Dietary Guidelines for Americans 2010 recommend consuming less than 10 percent of calories from saturated fats and restricting trans fats (also known as trans fatty acids) as much as possible. The guidelines also recommend limiting cholesterol to less than 300 milligrams per day.
Strategies for reducing saturated fat and cholesterol include:
Get 10 percent of less of your fat from saturated fat sources such as red meats, processed meats, organ meats or high-fat dairy products.
Choose low saturated-fat protein sources, such as fish, turkey, chicken, legumes (dried peas and beans), nuts and seeds.
Use lean cuts of meat and trim excess fat.
Substitute skim and low-fat milk for high-fat dairy foods.
Broil, bake or boil foods instead of frying.
Increase your consumption of fruits, vegetables and whole grains.
You’ve probably heard of “good” fats and “bad” fats. These labels refer to the effects various types of fat have on your body and health. Saturated fats are commonly found in animal-based food products, as well as in palm and coconut oils. They are solid at room temperature. Excess amounts of saturated fat are considered unhealthy because they can contribute to fatty deposits in the arteries, clogging them and leading to heart disease. Unsaturated fats are liquid at room temperature and are known as oil. Two types of unsaturated fats are monounsaturated and polyunsaturated, both of which are thought to help lower cholesterol. Examples of these fats are olive and canola oils. Monounsaturated fats also are found in avocados, nuts and olives.
Trans fats are actually unsaturated fats that have been chemically modified. Manufacturers add hydrogen to vegetable oil in a process called hydrogenation. This increases the shelf life and the flavor stability of foods containing these fats. Trans fats can be found in vegetable shortenings, some margarines, crackers, cookies, snack foods and other foods made with or fried in partially hydrogenated oils. Like saturated fat and dietary cholesterol, they raise LDL cholesterol and increase your risk for cardiovascular disease.
Essential fatty acids are a category of fatty acids found in polyunsaturated fats your body needs but cannot manufacture itself. Good sources of polyunsaturated fatty acids include soybean, corn and cottonseed oils.
When an unsaturated fat is solidified—into margarine, for example—the process turns it into partially hydrogenated oils, which contains trans fatty acids.
The Skinny On Fad Diets
Despite the ads that claim miracle weight-loss for some products, there simply is no magic formula for losing weight. Fad diets, like those based on cabbage soup, grapefruit or protein, may help you lose some pounds in the short run, but they don’t work in the long term because they’re impossible and unhealthy to maintain. The truth is permanent weight loss takes time and requires a permanent change in eating and exercise habits.
Extreme diets of less than 1,000 calories per day carry health risks and could trigger excessive overeating following the period of extreme caloric restriction. Such diets usually provide insufficient vitamins and minerals as well. Severe dieting also has unpleasant side effects, including fatigue, intolerance to cold, hair loss, gallstone formation and menstrual irregularities. Most of the initial weight loss is in fluids; later, fat is lost, but so is muscle.
It is very dangerous to be on severe diets longer than 16 weeks or to fast for more than two or three days. There have been rare reports of death from heart arrhythmia when liquid formulas didn’t have sufficient nutrients.
High-protein, low-carbohydrate diets are still used by some people for weight loss. Although a high-protein diet will lead to quick weight loss, its long-term health and safety benefits are uncertain. One byproduct of this type of diet is the release of substances called ketone bodies, which can lead to a condition called ketosis and cause nausea and lightheadedness because you are restricting your body’s source of fuel. Such high-protein diets may also be high in saturated fat and low in fiber-rich and healthful whole grains, fresh fruits and vegetables.
Carbohydrates provide your body with its main source of fuel and energy, namely, a form of glucose called glycogen. This complex carbohydrate is stored in liver and skeletal muscle. Simple carbohydrates (sucrose) offer quick energy boosts, while complex carbohydrates provide the body with fuel for several hours.
Examples of simple carbohydrates include fruit sugars (fructose) found in fruits, milk sugars (lactose) found in milk products, and other forms of sugar (sucrose) found in sweeteners such as corn syrup, honey, dextrose, high-fructose corn syrup and fruit juice concentrates. Complex carbohydrates are found in whole grains, rice, peas and dried beans, such as lentils and black, kidney and pinto beans.
Carbohydrates stored in the body are packed with water. That’s why introducing a low-carbohydrate diet leads to rapid weight loss as the body turns to stored carbohydrates for energy, eliminating large amounts of fluid from your body. After the stored carbohydrates are gone, your body turns to fat and lean body tissue for fuel, inducing further weight loss.
Many people on low-carbohydrate diets eat less but feel fuller due to the high-protein, high-fat foods they consume. However, this creates more work for your kidneys, which have to process the high amounts of protein. This is especially dangerous for people with diabetes. Additionally, excess protein excretion can cause valuable calcium to be excreted.
Many health care professionals believe that rather than adhere to a low-carbohydrate diet, it’s healthier to consume healthy carbohydrates in reasonable amounts. This means focusing on complex carbohydrates like beans, whole grains and vegetables, as well as simple carbohydrates that pack plenty of fiber, such as fruits.
Choosing A Diet Plan
With all of the fad diets circulating these days, you need to do your homework before embarking on a new weight-loss plan. The following questions will help you determine if a diet is healthy and legitimate or just a scam:
Does the plan promise dramatic and rapid weight loss? If a program is promising results that sound too good to be true, they probably are. A 10-pound loss in two weeks is unrealistic and may harm your overall health. A weight-loss goal of one to two pounds per week is a safe and effective rate for long-lasting results.
Does the plan exclude entire groups of foods? If a weight-loss plan excludes an entire group of foods such as grains, fruits, vegetables, dairy or protein, you risk missing out on essential vitamins and minerals.
Does the plan require extremely low calorie levels? Most experts agree that we need to consume at least 1,200 calories each day to maintain a healthy body. This is a minimum; most people actually need more. If a weight-loss plan restricts calories below this level, it’s not nutritionally adequate, and you’ll be in danger of nutrient deficiencies.
Are you required to buy special foods or supplements to follow the program? Weight-loss programs that rely on special foods or supplements tend to be money-making schemes to benefit the seller. These types of programs will drain your wallet without teaching you about nutrition and healthy eating habits.
Does the plan address lifestyle changes, such as increased exercise and improved eating habits? Realistic weight-loss plans should focus on the causes of your weight gain and on long-term lifestyle changes, not just on short-term losses.
Can you continue this way of eating for the rest of your life? Weight loss is difficult, but maintaining that weight loss is even harder. Any plan that allows you to lose weight should also be a plan you can continue indefinitely to maintain that weight.
The following claims and promotions should alert you to the probability of a bogus weight-loss scheme:
The plan is touted as requiring no sacrifice—no exercise or no change in your eating habits.
No reliable evidence or scientific proof is offered to back up claims that the plan is safe and effective.
Testimonialsand case histories of people who have supposedly been successful on the plan are offered as “proof” of its effectiveness. A few successes don’t prove the plan will work for everyone.
The plan is described in sensational articles, or worse, advertisements made to look like articles, in tabloids and weight-loss magazines.
The plan is promoted as “cleansing” the body of “toxins” to let the body’s “natural” curative powers help in your weight loss efforts.
Today’s most popular weight-loss programs vary greatly. No single diet is appropriate for everyone, so you’ll want to weigh factors that vary by plan, such as types of food you can eat, reliance on supplements or drugs, calorie levels allotted and support offered.
Popular Weight-Loss Plans
Mediterranean-Style DietThe Mediterranean diet is really a way of eating, rather than a particular diet. Some large studies point to the Mediterranean style of eating as a good alternative to low-fat dietary approaches as a way to reduce weight and, consequently, reduce your risk of heart disease and diabetes. Like the low-fat diets, the Mediterranean eating pattern focuses on fruits, vegetables, whole grains, nuts and seeds, but it also includes olive oil as a significant source of monounsaturated fat and wine in low to moderate amounts. The major protein sources are dairy, fish and poultry, with minimal red meat.The Mediterranean eating style allows a higher percentage of calories from fat than the low-fat diets typically endorsed by health organizations, but several recent major studies have shown that the diet is an alternative to low-fat diets, especially for lowering risk of diabetes and heart attacks, often related to weight.
Weight WatchersThis diet program, one of the most popular among health care professionals, has helped millions of people worldwide lose unwanted pounds since it was founded in 1963. In general, the plan is healthy—long on fruits and vegetables and short on fat, protein and sugar. Weight Watchers provides two options—weekly in-person meetings or Weight Watchers Online. Weight Watchers meetings offer member support. (Your weight is kept private.) Meeting leaders have achieved their own weight loss goals with Weight Watchers and have been able to maintain their goal weight. The discussions can be helpful because they focus on the common challenges you face when trying to lose weight—what to do about eating in restaurants or at a wedding, for example. They also let members exchange dietary advice on tasty alternatives or ideas for trimming calories. Weight Watchers Online offers members comprehensive guides to help them learn how to follow the Weight Watchers approach and food plan, including interactive tools and customized sites for men and women. Exercise is stressed as part of the program.In the past, Weight Watchers used a system that assigned point values to each food. Dieters were allowed to consume a specific number of points per day based on their weight, and members weren’t given much direction about how to divide those points between the various food groups. As a result, a dieter on this program could eat too much of a single, and perhaps unhealthy, type of food. However, with the Points Plus program launched in 2010, dieters get more direction on how to make healthy food choices. The program still focuses on calorie restriction, but it encourages members to choose healthful foods that are high in nutrients and low in sugar and fat.
NutriSystemThis diet is based mostly on NutriSystem’s prepackaged foods and involves reducing participants’ calorie intake to an average minimum of 1,200 calories per day for women and 1,500 for men. The NutriSystem program is now completely at-home—participants have the option to go online to chat with one of their weight loss counselors about diet and exercise. While the program was developed by registered dietitians and health educators with input from physicians, there have been some complaints in the media that the counselors are not highly trained. If you are concerned about this, you may want to ask about credentials at your center, and always discuss any diet plan with your health care professional.Because clients eat prepackaged meals, they have few food decisions to make. Thus they’re not learning how to make choices in the real world or change their lifestyles. The program also sells vitamin and mineral supplements.
Jenny CraigThis program also relies on its own brand of prepackaged foods, plus some additional supermarket foods, and provides calorie recommendations depending on your gender and current weight. Clients can attend weekly lifestyle classes and receive one-on-one counseling or choose an at-home program that allows for consultations via phone. As their comfort level grows, clients are given the option to transition to regular foods.Jenny Craig emphasizes increased physical activity, changing ingrained eating habits and learning how to balance meals and food choices. The program was developed by registered dietitians and psychologists with input from physicians.Relying on prepackaged foods makes dining out and socializing difficult and de-emphasizes behavior modification and lifestyle change that are very important to long-term weight loss. Also, Jenny Craig makes “weight-loss supplements” an integral part of the system. While vitamin and mineral supplements may be helpful to overall health, no herbal or enzymatic supplements should be relied upon for weight loss.
Liquid Fasting Programs (Optifast, HMR and New Directions)These programs consist of a highly structured dieting approach that combines medical, behavioral and nutritional knowledge and skills to support weight loss. The medical team (physician, registered nurse, dietitian or psychologist) provides medical supervision for the dieter in an out-patient medical setting. The diets use vitamin-fortified liquid-meal replacements or prepackaged foods to achieve a reduced calorie intake. Part of the structure includes mandatory weekly group sessions that support the weight-loss efforts and promote positive eating behaviors. In some settings, one-on-one counseling is available.The programs emphasize changes in lifestyle behaviors to support weight loss including daily physical activity and menu planning. Once the diet is completed, the patient transitions back to a recommended, healthy eating plan. In many locations, exercise physiologists are available to help design personal exercise plans.During the weight-loss phase of the programs, dieters use only the meal replacement products. Because of this, some dieters find it difficult to transition from liquid to regular food. The support of the trained program staff is essential to this transition. Most programs emphasize that the maintenance phase of these programs is the key to success with long-term weight maintenance.
Due to the close contact with medical professionals, these programs are beneficial for individuals with significant weight to lose or for those with serious health problems associated with their weight. Participation involves the approval of your health care professional. Some locations may also offer the opportunity to utilize prescription weight-loss medications.
Low-Carb DietsThese trendy diets, including the Atkins, Sugar Busters and Protein Power plans, claim that carbohydrates—and not fat or an overindulgence in calories—are what make people gain weight. They go against the recommendations of the U.S. Department of Agriculture (USDA), the American Heart Association, the American Dietetic Association and the American Diabetes Association.Fat and protein intake are unlimited in some of these plans, more limited in others. The higher fat and protein level of the Atkins Diet can provide more fullness with meals and snacks. Foods containing simple carbohydrates are restricted, so blood sugar surges after a high-carbohydrate meal doesn’t occur, helping control appetite. This also prevents blood sugar levels from rapidly plummeting, which contributes to hunger.These diets rebel against the past decade’s message for healthy eating—moderate fat; increased whole grains, fruits and vegetables; and moderate amounts of protein. These recommendations are based on scientific evidence that eating a well-balanced diet will decrease risks of chronic disease and increase health. While high-fiber diets rich in fruits and vegetables are shown consistently to decrease chronic diseases, diets high in animal protein continue to raise concern of possible increased risks for certain cancers.
Several recent studies found that high-protein diets have no proven effectiveness in long-term weight reduction and may damage health of those who stay on them for a long time.
Note: Because prolonged ketosis (a side effect of high-protein diets) can lead to kidney damage, people with a family history of renal disease or who have renal problems should avoid high-protein diets.
The ZoneThis diet relates excess weight to both overeating and/or to unbalanced consumption of calories from the carbohydrate, fat and protein groups. In the Zone, your diet is exactly one-third lean protein, two-thirds fruits and vegetables and a dash of monounsaturated fat. The diet claims that this is “the metabolic state in which the body works at peak efficiency.” The diet consists of one gram of fat for every two grams of protein and three grams of carbohydrates.Compared to many other low-carb regimens, this diet promotes a higher percentage of low-fat protein foods. This diet is most likely successful because it restricts caloric intake enough to lose weight. The average person eating in the Zone consumes no more than 800 to 1,200 calories a day. Some critics consider this a strict, controlled eating regimen, requiring significant effort to adhere to a complex set of rules, charts and tables.
South Beach DietThe South Beach Diet is sometimes lumped in with low-carb diets like Atkins, but it differs in some significant ways. It focuses on replacing “bad carbs” with “good carbs” and “bad fats” with “good fats.” It restricts simple carbohydrates, such as refined sugar and enriched grains, but permits complex, fiber-rich carbohydrates such as whole-grain bread and brown rice. It also allows more vegetables and focuses on the “glycemic index,” which relates to how quickly the body digests foods. Simple carbs digest quickly and cause spikes in blood sugar. It recognizes that while foods rich in “bad fats” may help control the hunger cycle, they also contribute to high cholesterol and heart disease. So the South Beach Diet replaces them with foods rich in unsaturated fats and omega-3 fatty acids, such as lean meats, nuts and fish. The three-phase diet ends with a maintenance phase to help you learn how to maintain a healthy weight.
Flat Belly DietThe Flat Belly Diet follows many of the same principles as the Mediterranean diet but also emphasizes how much and how often you should eat. It starts with a four-day “jump start” and then has a four-week plan that focuses on: eating an unsaturated fat at every meal; limiting meals to 400 calories per meal; and eating every four hours during the day. It teaches you how to eat a balanced diet with proper portions of vegetables, fruits, whole grains, nuts and seeds, low-fat dairy products and low-fat proteins, such as fish, poultry and beans. It also includes an exercise plan to help you manage your weight.
Single-Food DietsDiets that push grapefruit or eggs, cabbage soup or oranges have surfaced over the years. These diets are dangerous because they’re unbalanced nutritionally and rely on too few calories.
Liquid Meal Replacement DietsThese liquid meal replacements, such as Slim-Fast, are milk-based products that have added vitamins and minerals. If “balanced” is defined as containing adequate amounts of the nutrients the government has established as the Reference Daily Intakes (RDIs), then Slim-Fast meets the requirements. Slim-Fast users get a daily menu of three snacks, two shakes or meal bars and one balanced meal, customized to their tastes.Recent research shows that meal-replacement diet plans such as Slim-Fast work. A landmark 10-year study demonstrated that the Slim-Fast Meal Replacement Plan helped individuals lose weight and maintain body weight long-term. Participants weighed an average of 33 pounds less after 10 years than a matched group.After analyzing studies comparing several types of restricted-calorie diets, the American Dietetic Association issued a practice guideline concluding that structured meal-replacement plans could be at least as effective for losing weight as reduced-calorie diets and sometimes more effective. The guidelines also suggest that for overweight and obese adults who struggle with food selection and portion control, one or two daily meal replacements fortified with vitamins and minerals and supplemented with self-selected meals and snacks may be a successful weight loss and maintenance strategy.
Using Medication to Lose Weight
Women with increased medical risk from their obesity may benefit from adding a weight-loss medication to their nutritional and exercise regimen.
Most research-based and professional associations recommend lifestyle therapy for at least six months before embarking on a weight-loss plan using physician-prescribed drug therapy. Even then, it must be used only as part of a comprehensive weight-loss program that includes dietary therapy and physical activity. Currently available prescription medications include:
phentermine (Adipex-P, Fastin, Ionamin, Obenix, Oby-Cap, Teramine, Zantryl)
diethylpropion (Tenuate, Tepanil)
phendimetrazine (Adipost, Bontril, Melfiat, Obezine, Phendiet, Plegine, Prelu-2)
orlistat (Xenical)
Most prescription weight-loss drugs are FDA-approved for short-term use only, usually less than 12 weeks. Orlistat (Xenical) is the only drug approved for long-term use. Orlistat also is now available over the counter under the brand name Alli in 60 mg pills, half the strength of the prescription dosage in Xenical, making it the first FDA-approved over-the-counter weight loss drug. Like Xenical, Alli blocks digestion of about 25 percent of the fat eaten at a meal. Orlistat has been found to be safe and effective in combination with a low-fat (less than 30 percent fat), low-calorie diet and can help people lose 50 percent more weight than dieting alone.
Safety is an issue with some weight-loss medications. The drug sibutramine (Meridia) was removed from the market in 2010 because studies showed an increased risk for heart problems, including non-fatal heart attack and stroke. The FDA is also reviewing reports of serious liver injury in people taking orlistat. No definite association has been established, but people taking orlistat should watch out for any symptoms of liver injury, such as weakness, fatigue, fever, jaundice or brown urine and report these signs to their doctors.
Most of these drugs decrease appetite by affecting levels of certain brain neurotransmitters that affect appetite. Orlistat does not act directly on the central nervous system but instead blocks an enzyme essential to fat digestion so your body doesn’t absorb fat. In general, combining weight loss medications with an increase in activity level and a decrease in calories can help you lose 10 pounds more than what you might lose with nondrug obesity treatments.
If you are, may be or could become pregnant or are nursing, be sure to tell your health care professional. The effects of most of these drugs have not been tested on unborn babies; however, medications similar to some of the short-term appetite suppressants have been shown to cause birth defects when taken in high doses. Also, diethylpropion and benzphetamine pass into breast milk.
Before you take any product for weight loss, be sure to discuss it with your health care professional first. There are numerous potentially dangerous over-the-counter drugs and herbs that claim to help you lose weight. These over-the-counter drugs, except for Alli, and herbs have not been approved by the FDA and may cause significant health complications and even death.
Surgery
For clinically severe obesity, your health care provider may recommend surgery for weight loss. Many people, including some health care professionals, wrongly believe that obese people merely need to stop eating so much to lose weight. In reality, extreme obesity is a potentially deadly disease that sometimes requires a treatment as dramatic as surgery. Surgery is an option for carefully selected patients under the care of a health care professional. The surgery, called bariatric surgery, reduces the size of your stomach, limiting the amount of food it can hold. Most physicians consider people for the surgery who:
have tried other methods of weight loss (changes in eating behavior, increased physical activity and/or drug therapy) and are still severely obese
have a BMI of at least 40 (or 35 in addition to other medical conditions such as diabetes, hypertension and heart failure)
understand the procedure, risks of surgery and effects after surgery
are motivated to make a lifelong behavioral commitment that includes well-balanced eating and physical activity needed to achieve—and maintain—desired results
There are several types of bariatric surgery:
Roux-en-Y gastric bypass (RYGB). In this procedure, sometimes referred to as “stomach stapling,” the stomach is reduced to the size of a golf ball. The stomach is divided into a large portion and a small portion. The small portion is sewn or stapled together to make a small pouch, which holds only about a cup of food. The small pouch is then disconnected from the upper portion of the digestive tract and reconnected to a lower portion of the intestine. Not only do you eat fewer calories, but your body absorbs fewer calories because part of the intestine, the duodenum, has been bypassed.
Adjustable gastric band. This procedure is performed laparoscopically, through a small incision in the abdomen. The surgeon wraps a saline-filled silicone band around the top of the stomach to create a small pouch about the size of a thumb. The size of the pouch can be altered by increasing or decreasing the amount of saline (salt water) in the pouch. You eat less because you feel full sooner.
Other less common procedures include:
Biliopancreatic bypass with duodenal switch (BPDS). In this procedure, much of the stomach is removed, leaving only a “gastric sleeve” that is attached to the small intestine, completely bypassing the duodenum and upper small intestine.
Biliopancreatic diversion with duodenal switch is a similar procedure, but a smaller portion of the stomach is removed, and the remaining stomach (gastric sleeve) remains attached to the duodenum. The duodenum is connected to the lower part of the small intestine. As with the gastric bypass procedure, you absorb fewer calories with both of these procedures. You also eat less because your stomach is smaller. Removing part of the stomach is also thought to reduce production of an appetite-related hormone called grehlin. This procedure is generally used for people who have a body mass index of 50 or more.
All procedures can lead to complete remission of diabetes, sleep apnea, hypertension, kidney failure and other weight-related medical conditions.
While bariatric surgery is extremely safe, the greatest risks come after the surgery. Some occur soon after the operation, such as hemorrhage, obstruction, infection, hernias, pulmonary embolisms (blood clots in the lung) and leaks between the areas where tissue was sewn together.
Long-term complications include nutritional deficiencies, including malabsorption of vitamin B12, iron and calcium; and hypoglycemia, or low blood sugar, which can lead to various medical conditions, including neuropathy.
Most people undergoing bariatric surgery have rapid and extreme weight loss. It often helps patients lose as much as 50 percent of their excess body weight. Just over half of people who undergo weight loss surgery have kept the weight off five years after the procedure.
After surgery, you have to learn to eat smaller amounts of food at one time, to chew food well and to eat slowly. If you don’t adjust your eating habits, you won’t lose as much weight. Additionally, especially in the first three months after surgery, you must be sure to eat the proper amounts of protein, calories, minerals and vitamins as recommended by your health care professional and you will likely need nutritional supplements for the rest of your life.
Trying To Gain Weight?
For the underweight woman who needs to gain weight, either for health reasons or appearance’s sake, the journey can be difficult. Weight gain can be more difficult than weight loss. The underweight woman may have a higher metabolism, fewer fat cells or a genetic tendency to be leaner. She may also be taller, or just not care about food.
Winning at weight gain comes down to pairing a balanced eating pattern with regular physical activity—like any healthy lifestyle. The trick is to make sure you eat more calories than you burn. But you shouldn’t give up exercise because it has many health benefits! Consider adding a weight training program because building muscle will increase your weight. Here are some more tips that can help:
Plan ahead for extra meals and snacks. Instead of the traditional three square meals a day, add two or three substantial snacks between three moderate-size meals. By spreading out your food choices during the day, you’ll be more likely to enjoy your meals and snacks without feeling stuffed.
Concentrate on calories. Tip the scales toward weight gain by choosing foods that are calorie-dense, or high in calories. While rich desserts and fried foods quickly come to mind, the emphasis should be on foods that pack other nutrients, such as protein, vitamins and minerals, in addition to calories. These include dairy foods, nuts, peanut butter or avocados. Aim for the higher end of the recommended number of servings from each group in the Food Pyramid. And watch your use of added sugars and saturated and trans fats.
Let snacks work in your favor. Smart snacking plays an important role in gaining weight. Choose snacks that add calories, vitamins and minerals, such as powdered milk added to a yogurt or ice cream-based shake with fruit and fruit juice, nuts and seeds. Dip crackers, chips and fresh vegetable relishes into high-calorie dips made with low-fat cheese, low-fat sour cream, mashed beans or salad dressings made with mono- or unsaturated oils. Space out snacks during the day so you don’t spoil your appetite for later meals.
Physical Activity is Key to Weight Management
Daily physical activity is essential to weight management. Exercise not only burns calories, it also tempers your appetite, boosts metabolism, improves sleep and provides psychological benefits, such as an increased feeling of control and self-esteem, as well as reducing stress.
If you are over 40, have been inactive for some time, suffer from shortness of breath or weakness that interferes with daily activities, or have a chronic health condition, consult a health care professional before increasing your physical activity. Notify your health care professional about any chest pain, faintness or dizziness, or bone or joint pain you’re experiencing and any medications you’re taking.
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in energy expenditure. The best kinds of exercises for burning calories are moderate- to vigorous-intensity physical activities. The calories burned per hour are listed for a 140-pound healthy woman.
Moderate-intensity activities include:
hiking (386 calories)
light gardening/yard work (302 calories)
dancing (319 calories)
golf, walking and carrying the clubs (244 calories)
bicycling, less than 10 mph (370 calories)
tennis, singles (386 calories)
walking, 3.5 mph (370 calories)
yoga (336 calories)
Vigorous-intensity physical activities include:
aerobics, high-impact (445 calories)
calisthenics (512 calories)
running/jogging, 5 mph (580 calories)
swimming (580 calories)
bicycling, 12-14 mph (554 calories)
racquetball, casual (445 calories)
skiing, downhill (554 calories)
weight lifting, vigorous (400 calories)
While you and your health care professional should set up a detailed exercise plan based on your individual health status, the 2010 Dietary Guidelines recommend that for substantial health benefits, healthy women engage in at least150 minutes of moderate-intensity aerobic exercise or at least 75 minutes of vigorous aerobic exercise per week while not exceeding caloric intake requirements. For additional and more extensive health benefits, the guidelines recommend at least 300 minutes of moderate-intensity aerobic exercise or at least150 minutes of vigorous-intensity aerobic exercise per week. The guidelines also recommend muscle-strengthening activities that involve all major muscle groups on two or more days per week.
If you have been inactive, you need to work up slowly to this amount so you don’t get injured or overly fatigued and then become discouraged. Start with five or 10 minutes (or whatever you’re comfortable with) every other day, adding one minute every other session. Low- to moderate-intensity physical activity, like housework, gardening and walking the dog provide a great deal of general health benefits, but for weight loss, you need to up the ante and exercise at a higher intensity with more vigorous activities like brisk walking or jogging, singles tennis or other racquet sports, aerobics classes, ice or roller skating, swimming or cycling.
Because the goal of moderate to vigorous physical activity is to work your heart muscle, your exercise needs to increase your heart rate. One way to determine if you are exercising intensely enough is to measure your heart rate. After warming up and sustaining an aerobic activity for about five minutes, take your pulse by placing two fingers on the carotid artery on the side of your neck, just under your jaw line and about one to two inches in front of your ear. Count the beats for 10 seconds.
Your heart rate should be about 50 to 85 percent of its maximum, which is your age subtracted from 220.
If you’re out of shape or older than 60, aim for an intensity at the lower end of the 50 to 85 percent range of your maximum heart rate. To determine what your heart rate should be during exercise, subtract your age from 220; divide that number by six for a 10-second heart rate count, then multiply that number by 0.5 for the lower end of the range and 0.85 for the higher end. For example, if you’re 70:
220 – 70 = 150 (this would be your maximum heart rate for one minute)
150 / 6 = 25 (this would be your maximum heart rate for 10 seconds)
25 x 0.50 = 12.5 (this would be 50 percent of your maximum, or the lower end of where your 10-second heart rate should be when you’re exercising)
25 x 0.85 = 21.25 (this would be 85 percent of your maximum, or the higher end of where your 10-second heart rate should be when you’re exercising).
The following chart illustrates recommended heart rate counts based on your age. (These are rates per minute; use the instructions above to convert your 10-second count to heart beats per minute.)
20 years 100-170 beats per minute 200 beats per minute
25 years 98-166 beats per minute 195 beats per minute
30 years 95-162 beats per minute 190 beats per minute
35 years 93-157 beats per minute 185 beats per minute
40 years 90-153 beats per minute 180 beats per minute
45 years 88-149 beats per minute 175 beats per minute
50 years 85-145 beats per minute 170 beats per minute
55 years 83-140 beats per minute 165 beats per minute
60 years 80-136 beats per minute 160 beats per minute
65 years 78-132 beats per minute 155 beats per minute
70 years 75-126 beats per minute 150 beats per minute
An easier way to judge intensity is the “talk test.” You shouldn’t be exercising so hard that you can’t talk with a friend or recite a poem. If you can’t talk without gasping for breath, slow down. On the other hand, if your exercise is easy enough that you can sing a song out loud, you probably need to increase your intensity.
Another type of exercise has received much attention over the past several years for its contribution to weight loss efforts. Strength training, which includes weight lifting and isometrics, or using your own body weight as resistance, not only improves muscular strength and endurance but raises metabolism, enabling you to burn more calories.
Make sure you take a few minutes to warm up before doing any kind of exercise and stretch when you finish.
It’s best to incorporate a combination of both types of exercise into your lifestyle— moderate to vigorous physical activities to burn fat and strength training to build muscle. Neither is as effective alone.
At the same time, you need to reduce the amount of television you watch, since TV watching is independently associated with weight gain.
Some Techniques May Not Live Up to Expectations
Spot exercising, or training particular areas of your body, won’t reduce body fat in specific locations because exercise draws on fat stores throughout your body. Gimmicky devices such as bust developers, vacuum pants and exercise belts do absolutely nothing to reduce fat in specific locations or, in the case of the bust developer, to add bulk. Electrical pads wrapped around the waist, arms or thighs have been reported to cause burns and fires. Similarly, cellulite-removal creams have been shown in several studies to be ineffective. Their apparent effect on fat may simply be from constricting blood vessels and forcing water from the skin, which could potentially be dangerous for people with circulation problems.
Liposuction is an increasingly popular technique to reduce fat in specific areas on the body. Liposuction, also called lipoplasty or suction lipectomy, is a surgical procedure that vacuums out fat from beneath the skin’s surface to reduce fullness in areas such as the abdomen, hips, thighs, knees, buttocks, upper arms, chin, cheeks and neck. But depending on how much fat is removed, liposuction may not lead to weight loss, and it definitely won’t change any behaviors associated with weight gain. It is also not an appropriate strategy for everyone, as age and skin tone can play a role in how successful the technique will be.
Get Your Mind In Gear
Another key to successful weight loss is incorporating behavioral strategies into your new eating and exercise activities. These include learning about nutrition, planning what to eat and making sure you eat regularly to end impulsive and thoughtless eating.
Some specific and helpful behavioral strategies include:
Set the right goals. Your goals should focus on specific dietary and exercise changes, such as, “I will eat five servings of fruits and vegetables every day this week,” or, “I will work up to being able to walk briskly for 30 minutes at a time,” rather than just on weight loss. Select two or three goals at a time to incorporate into your lifestyle rather than trying to change everything at once. Effective goals are specific, attainable and forgiving, which means that you don’t have to be absolutely perfect. Remember, too, in setting your goals, that losing more than one to two pounds per week can be unhealthy and greatly increases the chances of regaining the weight.
Reward success. To encourage yourself to attain your goals, reward yourself for successes. An effective reward is something that is desirable and timely such as attending the cinema or taking an hour for yourself. Don’t use food as a reward!
Keep a food and exercise diary. Many behavioral psychologists believe it’s necessary to track your daily food consumption to achieve long-term weight loss. From a simple pad of paper to a computerized program that provides reports and analyses of your progress, the best tool is the one you use every day. Incorporate your goals, such as eating five servings of fruits or vegetables each day, into your self-monitoring efforts.
Monitor your weight sensibly. Keep track of your weight, but don’t weigh too often. One day’s diet and exercise patterns won’t have a measurable effect on the scale the next day, and your body’s water weight can change from day to day, which may frustrate you and derail your efforts.
Join a support group. Weekly meetings with a nearby support group or even over the Internet can help in a variety of ways. They provide accountability, helpful ideas, emotional support, an outlet for sharing frustrations and a variety of other psychological benefits.
Use positive self-talk. Take responsibility and see yourself as in control, able to talk yourself into exercising every day rather than being angry, hopeless or in denial.
Find ways other than food to respond to stress and other situations in your life. Certain cues, from stress to watching television, may stimulate unhealthy eating. In some cases, you can avoid those cues; don’t go to that Mexican restaurant where you always eat too many chips, for example. For situations that can’t be avoided, however, such as the business lunch or an argument with your spouse, relearn new ways to respond. If you track the situations surrounding your overeating in your food diary, you can more easily determine the cues you need to be aware of.
Change the way you go about eating. There are a variety of tricks—from using a smaller plate to eating more slowly—that can help you eat less. Setting an eating schedule, starting meals with a broth-based soup, only buying foods on a pre-planned menu and other similar efforts can all help.
When eating out, don’t feel compelled to finish your entire meal if portion sizes are too large. The steady growth of food portion sizes served both in restaurants and at home has encouraged the overeating that is fueling the obesity epidemic in the United States, according to survey by the American Institute for Cancer Research.
Appropriate portion size is very important. When dining out, for instance, try to take home at least half of your dish. You can ask the waiter to box up half of it before you start eating. When eating at home, serve your plate and leave the remaining food in the kitchen; do not place it on the table. Half your plate should be filled with vegetables, one quarter with a protein and one quarter with grain products such as whole-grain bread, pasta, whole-grain rice and cereals. Never, ever, supersize any kind of fast food or takeout meal.
Prevention
It’s best to use weight management techniques before you become overweight, to prevent weight gain in the first place. The federal government issues helpful dietary guidelines, spelling out how much and which food you should eat and how much you should exercise to stay healthy. The guidelines, which are revised every five years (most recently updated in 2010), are widely used by health care professionals, food makers and educators, and also form the basis of the well-known U.S. Department of Agriculture (USDA) Food Pyramid used to teach healthy eating habits based on food groups such as grains, vegetables and fats.
The 2010 Dietary Guidelines recommend:
Addressing the obesity epidemic in the United States by reducing calorie intake and increasing physical exercise
Be physically active most days of the week
Letting the Food Pyramid guide your food choices
Eating a variety of grains daily, especially whole grains
Eating a variety of fruits and vegetables daily
Keeping food safe from foodborne illness
Choosing beverages and foods that limit intake of sugars
Choosing and preparing foods with less salt
Drinking alcoholic beverages in moderation
Choosing a diet low in saturated fat, trans fatty acids and cholesterol, and moderate in total fat
Specifically, the 2010 Dietary Guidelines recommend the following for adult women; to find the amounts that are right for you (exact amounts vary based on your age), visit the Food Pyramid Web site at http://www.MyPyramid.gov:
Meats and beans (Protein)
Eat five ounces of protein every day (five and a half ounces if you are between the ages of 19 and 30) .Vary your choices of meats, poultry, fish, beans, peas, nuts and seeds).
Fruits, vegetables and milk
Eat at least one and a half cups a day of fruit (two cups if you are between the ages of 19 and 30) and two-and-a-half cups a day of vegetables (two cups if you are age 51 or older).
Eat a variety of fruits and vegetables every day and choose from all of the five vegetable subgroups (dark green, orange, legumes, starchy vegetables and other vegetables) several times per week. You may consume fresh, frozen, canned or dried; go light on fruit juices.
Drink three cups per day of either fat-free or low-fat milk or equivalent milk products such as yogurt and cheese.
Carbohydrates
Eat six servings (five servings if you are 51 or older) of grains (cereal, breads, crackers, rice or pasta) a day. At least three ounces should be whole grain, and the other three enriched or whole grain. One ounce equals about one slice of bread, one cup of cereal or one-half cup of cooked rice, cereal or pasta.
Eat fruits and vegetables that are high in fiber and choose whole grains
Try to avoid adding sugar or sweeteners to foods and beverages
Sodium and Potassium
Do not consume more than 2,300 mg (approximately 1 teaspoon) of sodium per day. Reduce sodium intake to 1,500 mg per day if you are 51 or older, are African American, or have hypertension, diabetes or chronic kidney disease.
Use little or no salt when preparing foods
Eat fruits and vegetables high in potassium such as potatoes, sweet potatoes, soybeans, bananas and spinach.
Facts to Know
About 68 percent of the nation is overweight or obese.
According to the CDC, there has been a dramatic increase in obesity in the United States over the past 20 years. In 2009, only the District of Columbia and Colorado had a prevalence of obesity less than 20 percent.
According to the National Eating Disorders Association (NEDA), 40 percent of newly identified cases of anorexia are in girls ages 15 to 19, and over half of teenage girls use unhealthy weight control behaviors, such as skipping meals, fasting, smoking cigarettes, taking laxatives and vomiting.
Obesity rates for children are 12.4 percent in those ages 2 to 5, 17 percent in those ages 6 to 11 and 17.6 percent in those ages 12 to 19.
Children and teens who are overweight often have a lifelong struggle with their weight and are at high risk for developing diabetes, high blood pressure, diseased arteries, damaged hearts and liver damage.
If a woman’s waist circumference divided by her hip measurement is greater than 0.8, she is considered to have a high amount of visceral fat, which is the type of fat that surrounds the internal organs. This is especially true if her waist measurement is more than 35 inches. This type of fat is associated with higher risk of certain diseases and conditions like diabetes and heart disease.
If you eat 250 calories per day fewer than needed to maintain your weight and exercise enough to burn an additional 250 calories a day, you will lose about a pound per week.
Your basal metabolic rate (BMR) is the number of calories your body needs just to maintain its basic functions. You need additional calories to provide energy for daily activities; the more active you are, the more calories you need. Several factors go into the calculation of your BMR, including your age, height, weight and gender. To get an idea of your BMR, go to http://www.bmi-calculator.net/bmr-calculator.
The CDC reports that compared with whites, African Americans have a 51 percent higher prevalence of obesity, and Hispanics have a 21 percent higher prevalence.
Despite the ads that claim miracle weight-loss for some products, there simply is no magic formula for losing weight. The truth is, permanent weight loss takes time and requires a permanent change in eating and exercise habits.
Key Q&A
How do I know if I’m overweight, underweight, or if my weight is normal?One measure of overweight and obesity is your body mass index (BMI), which can be determined by dividing your weight in pounds by your height in inches squared and then multiplying by 703. For example, a woman who is 5 feet 6 inches and weighs 140 would have a BMI of 22.6, as follows:
5 feet 6 inches = 66 inches
66 squared = 4,356
140 divided by 4,356 = 0.0321
0.0321 x 703 = 22.6
If a woman’s BMI is under 18.5, she is considered underweight; between 18.5 and 24.9, she is considered of normal weight; between 25 and 29.9, overweight; 30 or greater, obese. However, if she has more muscle mass than normal, these numbers won’t apply, and her health care professional should measure her body composition to determine her degree of overweight. BMI is also adjusted for age, as well as gender, for people under age 18.
My health care professional says I need to lose 10 pounds. Why should I bother with such a small amount?Being overweight, even by 10 pounds, can be bad for your health. If you are overweight, you are more likely to develop health problems including heart disease and stroke, type 2 diabetes, some forms of cancer, gout, gallbladder disease, sleep apnea and osteoarthritis.
As hard as I try, I just can’t lose that 10 pounds. Shouldn’t I just give up?No, because your weight management efforts may be paying dividends, even if you aren’t losing pounds. Eating more healthfully and adding physical activity to your day have health benefits of their own, including improvements in your chronic disease risk factors such as blood pressure, blood sugar levels and cholesterol.
I need to lose 10 pounds. Are weight-loss drugs appropriate for me?Weight-loss medications may be appropriate for carefully selected patients who are at significant medical risk because of their obesity. They are not recommended for use by people who are only mildly overweight unless they have health problems that are made worse by their weight. These prescription drugs should be used only with the careful supervision of a health care professional. When they are used, these medications must also be combined with physical activity and improved diet.
My health care professional says my weight is normal, but I need to exercise more. Why should I exercise if I don’t need to lose weight?Exercise not only improves your cardiovascular health and conditioning, but it can help ward off illnesses like cancer, diabetes and osteoporosis. Plus, it has psychological benefits and helps reduce stress.
My health care professional says I’m underweight. What’s so bad about that?Underweight women are susceptible to vitamin and mineral deficiencies, resulting in a loss of bone density and muscle tissue.
What sort of health care professional can help me set and achieve weight management goals?A physician may be the best place to start for a full health assessment and referral. An endocrinologist is a physician who specializes in metabolic conditions including obesity. A registered dietitian can evaluate your diet and suggest ways of fighting various health problems or simply becoming healthier by modifying your diet. A personal trainer provides one-on-one goal setting and professional expertise, most often in the area of fitness and exercise.
Is liposuction an effective way to lose fat?Liposuction does, indeed, remove fat from specific regions of your body. But if you haven’t learned to eat healthfully and incorporate physical activity into your lifestyle, you will regain any lost weight (although your new fat deposits may develop in different sites on your body). In addition, liposuction surgery has side effects and can have serious complications. You should talk to an unbiased health care professional, such as your primary care physician, before making any decisions about liposuction.
What is a healthy diet?Half your plate at main meals should consist of colorful vegetables, one quarter should consist of grain products such as whole-grain bread, pasta, whole-grain rice and cereals and one quarter should consist of meat, fish or poultry. Several times a week, substitute dishes made from dried beans or peas as your main course. Eat plenty of fruits. Eat three cups of low-fat milk products like yogurt each day. These proportions will help lower your saturated fat intake and increase the amount of fiber in your diet, both of which have been shown to decrease risk for heart disease. While you should try to cut back on fats and sugars, allow for an occasional treat. Also, most of your fat consumption should come from monounsaturated or polyunsaturated fats with saturated fats accounting for less than 10 percent of your fat intake.
How much should I exercise?The “Dietary Guidelines for Americans 2010” recommend that for substantial health benefits, healthy women engage in at least150 minutes of moderate-intensity aerobic exercise or at least 75 minutes of vigorous aerobic exercise per week while not exceeding caloric intake requirements. For additional and more extensive health benefits, the guidelines recommend at least 300 minutes of moderate-intensity aerobic exercise or at least150 minutes of vigorous-intensity aerobic exercise per week. The guidelines also recommend muscle-strengthening activities that involve all major muscle groups on two or more days per week.
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