Category Archives: Health

The Importance of Mental Health Days

Earlier this month, Madalyn Parker, a Michigan-based web developer shared an email interaction with her boss in which he supported her need to take off work to focus on her mental health. While mental health issues are not new, only recently has acceptance of these issues grown. It’s because of the stigma that still surrounds mental illness that this tweet was so widely discussed.

Adults, like Parker, may use their sick days to focus on mental health. However, young people aren’t generally able or encouraged do so, even when they need a day off.

Childhood and adolescence are more challenging than adults may acknowledge. In addition to navigating everyday growing pains, young people are juggling friendships, schoolwork and extracurricular activities. It seems that today’s youth have more to manage than kids did in years past and face even more pressure to succeed.

Many children and teens struggle with mental health conditions. According to the National Institute of Mental Health, 1 in 5 kids ages 13 to 18 have a mental healthdisorder. Often, mental health issues are minimized and young people are essentially told to “get over it” or that their struggles are just a part of life, and they’re left to deal with them on their own.

Opening a discussion about mental health early on teaches young people that it’s OK to feel overwhelmed and ask for help, to take care of yourself and to say that you aren’t feeling your best emotionally. Addressing mental health worries means better school performance and less physical illness. Taking a mental health day can help improve focus, performance and overall mental strength. Having more candid conversations about mental health issues will also help reduce stigma and increase acceptance.

Here are some signs parents should heed that children might need to take a mental health day:

  • They are physically present but not engaged.
  • They are more emotional than usual, easy to anger or tearful.
  • They get frustrated more easily than usual.
  • They appear depressed or are isolating themselves.
  • They start avoiding school and schoolwork.
  • They aren’t interested in being social or doing anything they love.
  • They are overwhelmed and need that day to focus on a project or studying for a test. Be mindful that this isn’t more than a day or two. More than that may be indicative of a bigger problem. If you have concerns that a child may be dealing with a mental health condition, such as depression or an anxiety disorder, make sure they see a mental health professional.

A mental health day needs to be about re-energizing and focusing on relaxing and regrouping. Whatever that looks like to your child should be encouraged, within reason. If your child needs to focus on that project and feels that will help her manage anxiety, let her. If he needs to sleep on and off all day, that’s fine. Maybe your child wants to spend the day with you, just connecting and being around you; encourage that if you can.

The reality is, it’s not just about recharging on a single mental health day. It’s about developing healthy stress management skills every day. The more positive experiences your child has, the less likely he or she will be to become overwhelmed. Here are some other ways parents can help kids develop these skills and be more resilient:

  • Encourage kids to do things they love outside of school. Finding opportunities to do things they enjoy and be with friends and family will boost their spirits and equip them to better manage when they face challenges.
  • Teach them how to take care of their physical health. Parents should stress the importance of getting regular exercise, and do so themselves to lead by example. Also, work as a family to eat healthy. Food can have a negative impact on your mood, so try to incorporate positive choices. When kids don’t feel well physically that will impact how they feel mentally.
  • Talk about mental health. Encourage kids to talk about their concerns. Validate that feeling anxious and sad is a typical part of life. Be available to them when they need to talk about how they are feeling.
  • Set limits so your child isn’t overextended. Kids don’t know how to do this themselves. If you notice that your child is doing too much, talk about how to cut back and find downtime.
  • Take time off as a family. It needn’t be a huge amount of time. For example, you might make sure the house is quiet for a few hours and focus on self-care.

It’s easy to think that by allowing your child a mental health day you are treating them as fragile or coddling them. The truth is, we all need mental health days. When we are struggling to manage the day-to-day ins and outs of life, we just need to hit the pause button sometimes.

If we can shift our way of thinking toward promoting self-care, we teach our young people that it’s OK to stop and take a breath, and that taking care of themselves is vital. This lesson is one that can only serve them well throughout their lives.

Is Your Child Drinking and Smoking in the Summer

There are many reasons I love the summer. One, in particular, is having the opportunity to work with my high school and college patients during a time of year when they’re less stressed, more relaxed and often open to making needed emotional shifts that they’re too anxious and overwhelmed to focus on during the school year.

But while this more relaxed time has its benefits, there’s a downside as well: Research has consistently found that kids are much more likely to try alcohol and drugs for the first time during the summer months. For those teens and young adults already interested in alcohol, marijuana, other illegal substances or prescription drugs, the summer is an invitation to party. They have no academic obligations, and for many, the summer is spent with very little structure or adult supervision. Even for kids that hold a job or who have some form of structure, there is plenty of downtime after work and on the weekends to relax, which for a great many includes drinking alcohol or doing drugs.

I am learning more and more about drinking on the beach, partying at the park and smoking or vaping during sleepovers. The warm weather makes it particularly easy to partake because there is no need for an indoor space – making it far less likely that kids will be caught by adults. Boredom and peer pressure are also contributing factors to teens using alcohol or drugs. They spend much more time with their friends in the summer doing absolutely nothing. Except for the serious athletes, there are no summer sports, and most other activities are suspended.

As a parent, it can be difficult to assess whether your child is using alcohol or drugs, especially if you are at work and they are without supervision most of the day. Even if you’re home, it’s not practical to keep older kids under a parent’s watch at all times. Nevertheless, it’s important to be open to the possibility that your child is using alcohol or drugs, if you can’t imagine your child would do so. I have seen countless parents in my last 26 years of practice who have insisted that their child would never do that, and then the teens of said parents tell me all their war stories.

Regardless of your suspicions, you must do your very best to limit your child’s access to alcohol and drugs. There are a few ways to do this. Note that almost all of these strategies work throughout the school year as well:

  • Keep all medications safely stowed away so that they can’t be easily accessed by your kids. Be particularly careful with anti-anxiety medications, pain killers and attention deficit hyperactivity disorder medications.
  • If you give your child money, keep track of how much you are giving them and how quickly they spend it. Most teens get their money for alcohol and drugs from their unknowing parents who think it’s being spent on food. Watch credit card bills, too. Sometimes kids will pay for a meal for all their friends, and then their friends will give them cash. All parents see is money spent on food. If the bill seems high, question your child.
  • Give your child chores or activities to do to keep them busy throughout the week.
  • Request that at least some evenings and weekends be spent with family, and schedule activities your teen will enjoy, such as going to the beach or out to dinner at a restaurant they like. Offer to bring a friend along.
  • Pay attention to how late your child stays out at night. For kids under college age, you can set a reasonable curfew and be up when they get home to see if they seem sober.
  • If you are suspicious, it’s within your bounds to limit sleepovers at other people’s homes.
  • Pay attention to how your child’s clothing and room smell. It’s not always possible to detect drug or alcohol use this way, but sometimes it is. In addition, check pockets when you do laundry. Many parents find clues to drug use forgotten in a pocket.
  • Check on your child at night before going to bed yourself. I repeatedly hear from high school and college students that they use marijuana at night, alone, before bed to just “chill out.” There are some who would argue that this is no different than having a drink to relax at night. But, until your child is 21, this is still illegal in all states in the U.S. And under no circumstances is it OK for your teen or young adult to be drinking alone in their bedroom.

The summer is a wonderful time for kids and parents to decompress and get ready for the next school year. However, this shouldn’t include letting even teens run free. A great deal of harm can come from kids drinking and using drugs regularly in the summer – and it could be the start of an addiction.

Why the Risk for Amputations Jumps If You’re Poor and Have Diabetes

When you have diabetes, you’re at a higher risk for an amputation, particularly an amputation of a lower limb or a toe.

In fact, the American Diabetes Association reports that about 60 percent of lower-limb amputations in adults that are not caused by trauma occur in people with diabetes. The risk is present for both Type 1 and Type 2 diabetes.

And the five-year death rate for those who have had an amputation caused by a diabetic foot ulcer ranges from 35 percent to 80 percent. That percentage is even worse than some cancers, says Dr. Katherine A. Gallagher, associate professor of surgery at the University of Michigan in Ann Arbor.

This higher risk comes from a cycle of uncontrolled blood sugar over time and unnoticed and untreated infections. Someone with poorly controlled diabetes may not even know they have an infection because they’ve also developed a complication called peripheral neuropathy, which can take away feeling in the feet. These infections, if not detected or treated, can lead to the need for an amputation.

People who are economically disadvantaged and who have diabetes are at a higher risk for amputations. In fact, there’s an area of the country identified as the “diabetes belt” by the Centers for Disease Control and Prevention because of the high rates of diabetesthere. The diabetes belt includes parts of 15 states in the Southeast such as Alabama, Kentucky, Tennessee and West Virginia. “The diabetes belt counties also have high rates of poverty, low levels of college educational attainment, and the residents were predominantly African-American,” says Judith Wylie-Rosett, a registered dietitian and professor and division head of health promotion and nutrition research in the Department of Epidemiology & Population Health at Albert Einstein College of Medicine in New York City. The areas in the diabetes belt also have higher incidences of stroke and cardiovascular disease compared with other parts of the U.S., Wylie-Rosett adds.

 Other research has pinpointed that in areas with less available medical care – which often means poorer areas – the risk for amputations is higher among people with diabetes.

So why is the risk for amputation higher in those with lower incomes?

First, access to care can be more difficult, Gallagher says. Someone with a lower income may not have health insurance – or they may have it but still have trouble with related health costs. They may have a harder time getting off work or away from child care or other obligations. If you live in a rural area, it could be hard to make it to a doctor’s faraway location. All of that makes it harder to get to the doctor for regular checkups or when a problem occurs. By the time a problem gets particularly bad, there may be an infection that’s too severe to treat – and an amputation may be required.

“There may not be the money or resources except for emergency care,” says Dr. Rob Pedowitz, medical director of the Family Practice of CentraState in Freehold, New Jersey.

“Often, secondary complications, such as nonhealing wounds and peripheral neuropathy, are not detected early, making the complications much more devastating,” Gallagher says.

There’s also less knowledge about taking control of your own care, says Dr. Misty D. Humphries, assistant professor, Division of Vascular and Endovascular Surgery at the University of California–Davis Medical Center. “Patients do not realize they have control over their care. They frequently become ‘passive observers’ of their own care,” she says. However, diabetes care is largely self-managed, so when you have it, you need to take an active role.

Another issue is the high cost of healthier food, says anesthesiologist and pain physician Dr. Sheetal DeCaria of the University of Chicago. Meals with less-healthy simple carbohydrates are cheaper and often easier to obtain than fresh meals with fruits and vegetables. “For example, fish is more expensive than beef, and an avocado is more costly than a candy bar,” DeCaria says.

Despite these hurdles, if you’re living with diabetes and want to take better care of your health, keep these guidelines in mind:

  • Take your diabetes diagnosis seriously – and plan changes right away to help yourhealth. Although medications are important, they’re not the only resource to treat diabetes. “The truth is the only way to fix these conditions is a lifestyle adjustment, not simply medications,” Gallagher says.
  • See a doctor regularly. This may seem hard to do at first. However, preventing future health problems and treating any current ones while they are still minor will save you money and time (not to mention pain) in the long run, Pedowitz says. Aim to visit a doctor who can check your diabetes every three months.
  • Take better care of your feet. When you visit your doctor every three months, ask him or her to check your feet for any infections or health concerns, Pedowitz recommends. Inspect your feet daily for nicks, cuts or scrapes. Always wear protective footwear, even in the house. And see a foot doctor once a year.
  • Educate yourself about diabetes. Ask your doctor about a local certified diabetes educator or registered dietitian who you can see. A diabetes educator or dietitian can fill you in on more details about diabetes care. And look out for community healthworkshops or support groups that provide screening and education related to diabetes. “Education about the condition and how to change your life can put you in the driver’s seat of your health care and ensure that amputation is not an issue you have to deal with,” Humphries says.
  • Follow common-sense good health practices. This includes moving more, eating less sugar and simple carbohydrates (like white bread or pastas) and not smoking.

There are programs funded by the Centers for Disease Control and Prevention to help meet the challenges of addressing patients who are lower-income, living in rural areas and have other factors that are associated with diabetes and diabetes complications, Wylie-Rosett says.

The Real Facts About Eating Disorders

I am a psychologist specializing in children and teens who have an eating disorder such as anorexia nervosa, bulimia nervosa and avoidant restrictive food intake disorder, or ARFID. When I tell people what I do for a living, I’m often bombarded by harsh, judgmental comments such as “they could stop if they wanted to” or “there must be something wrong with that mother.” When I tell them I work in the Bronx, the comments are often along the lines of: “You must not be that busy – only rich, white kids have eating disorders!” In discussing this with other psychologists and mental health professionals, I am frequently met with “I could never treat them – they are so difficult.” The most difficult part of hearing these statements, especially by fellow mental health practitioners, is that they perpetuate the stigma associated with eating disorders that lead many to self-blame and delay or avoid treatment. My mission is to promote the actual facts about eating disorders to mental health professionals, parents, teachers, kids, pediatricians and the public. So here some of the things everyone should know:

Eating disorders can be fatal.

Anorexia nervosa is the most fatal of all mental health disorders, with approximately 50 percent of those deaths attributed to suicide. Anorexia nervosa and bulimia nervosa have high rates of suicide, self-injury, cardiac-arrest, early-onset osteoporosis, kidney failure and pancreatitis, just to name a few. Binge eating disorder often leads to morbid obesity and other health problems resulting from obesity, including diabetes, heart disease and high blood pressure. If these facts surprise you, you are not alone. Most mental health specialists are not aware of the high fatality rates and suicidality among patients with an eating disorder.

Eating disorders come in all shapes, sizes and genders.

When you think about a person with an eating disorder, whom do you picture? At least 10 percent of people diagnosed with an eating disorder are men and boys, and this number is probably an underestimate, as often boys and men are not screened for eating disorders and tend to under-report symptoms. Also, often surprising to many people is the fact that the highest prevalence of bulimia nervosa is among Hispanics, regardless of their level of income. Finally, eating disorders occur among people of all weights and sizes. There is no way to tell from looking at someone whether or not they have an eating disorder.

Eating disorders start for many reasons.

Emerging research supports a genetic predisposition to an eating disorder. That being said, genetics alone do not cause an eating disorder. The most common way an eating disorder starts is with a diet. For most people, the diet works or it doesn’t work, and they do not develop an eating disorder. For others, rapid weight loss can trigger an eating disorder. Once the eating disorder takes over, it’s very hard for someone to escape the grip on their own. Some find comfort, even companionship, with their eating disorder and have difficulty breaking up with their friend. Many of my patients tell me that restricting, binge eating and purging give them relief from other stressors in their life. Although this relief is short term, it’s difficult for many to break this cycle. Still another way an eating disorder, such as ARFID, might start is with a choking episode or a severe allergic reaction. Following this, some children are afraid to eat some or all foods. Even though they may not have a concern about how their body looks, they lose a lot of weight, and medically their body doesn’t know (or care) how the weight loss started or what’s maintaining it – our bodies just know they’re malnourished.

Eating disorders rarely occur in isolation.

Weight, shape and eating are only part of the story when it comes to eating disorders. It’s rare for someone to have a diagnosis of only an eating disorder. Eating disorders are associated with anxiety, depression, post-traumatic stress disorder, history of sexual abuse, substance abuse and personality disorders. Treatment must look at the big picture. Without this, as one problem gets fixed, other problems tend to pop up quickly.

Eating disorders can be treated.

One of the most dangerous myths about eating disorders is that they can’t be treated and that once you have an eating disorder, you can never be fully better. You can be free from your eating disorder. Yes, eating disorders are serious and some are difficult to treat at times; however, we have effective treatments for patients suffering with an eating disorder, and the treatments really work.

So What Can I Do If I Think My Child Has an Eating Disorder?

  • Seek help: Early intervention is the best way to treat an eating disorder. Even if you think it’s “not quite” an eating disorder, have your child evaluated as soon as possible.
  • Seek help from someone who knows how to recognize and treat eating disorders. Not all mental health practitioners and pediatricians have specific training in eating disorders. Ask the person evaluating your child how many patients with eating disorders they treat, and ask if they have specialized training in this area. See if the treatment they are using is evidence-based. This means that there’s scientific research supporting the effectiveness of the treatment.

The most important advice I give to parents who are worried their child might have an eating disorder is to listen to your instincts. Most parents know their children better than the doctors. If you’re worried that your child might have an eating disorder and your doctor minimizes your concerns, get another opinion. It’s critical that you feel heard by your team and that they make you and your child feel hopeful that things will get better.

You can find a list of therapists who specialize in eating disorders through the National Eating Disorders Association or through the Academy of Eating Disorders. Don’t wait until it’s too late; get help today.

How Big the Risk of Alcoholic Drinkers to Be Exposed to Breast Cancer

For years, a seemingly endless march of studies has pronounced that moderate consumption of alcohol could be beneficial for heart health. If you like a glass of wine with dinner, you’ve probably welcomed this news. But if you have other risk factors for breast cancer, you might want to scale back on your alcohol consumption.

Alcohol and the Heart

According to the Mayo Clinic, some of the studies suggesting that alcohol has heart-protective properties have focused on the potential health benefits of compounds in red wine called flavonoids, which are antioxidants that have been linked with reduced inflammation in the body and other health benefits that can reduce your chances of developing heart disease. Other studies have noted that a substance called resveratrol could be at work, and that moderate intake of alcohol can lead to a small increase in HDL cholesterol – that’s the good kind – and anti-clotting properties that can also be beneficial to heart health.

Therefore, some researchers and doctors have offered that drinking in moderation could be good for you. The American Heart Association defines drinking in moderation as one to two drinks per day for men and one drink per day for women. A drink is measured as about 10 grams of alcohol, which translates to one 12-ounce beer, four ounces of wine, 1.5 ounces of 80-proof spirits or 1 ounce of 100-proof spirits.

However, despite the fanfare surrounding some studies, the data on potential health benefits of alcohol is still mixed. The American Heart Association “does not recommend drinking wine or any other form of alcohol to gain these potential benefits, ” but it does recommend lowering your cholesterol and high blood pressure, getting plenty of physical activity, eating a healthy diet and controlling your weight.

Alcohol and Breast Cancer Risk

These health guidelines are similar to those offered by the American Cancer Society for helping to reduce your risk of cancer, which says limiting alcohol intake lowers the risk of developing breast cancer. “Even a few drinks a week is linked with an increased risk of breast cancer in women,” the ACS reports. “This risk may be especially high in women who do not get enough folate (a B vitamin) in their diet or through supplements. Alcohol can also raise estrogen levels in the body, which may explain some of the increased risk. Cutting back on alcohol may be an important way for many women to lower their risk of breast cancer.”

Dr. Melissa Pilewskie, a breast surgeon oncologist at Memorial Sloan Kettering Cancer Center in New York City, says “what we know from the data is that there is a low to moderate risk association with alcohol consumption and breast cancer risk.” She says women who drink one or more alcoholic drinks per day have a greater risk of developing breast cancer than women who don’t drink or drink just one drink per day. “Basically,” Pilewskie says, “women who don’t drink or have an occasional drink, there doesn’t seem to be an increased risk. But for those who drink more than, on average, one drink per day, we do see an increase in breast cancer risk.”

The size of this risk is similar to other “small risk factors, such as having a family member with breast cancer, obesity and things like that,” Pilewskie says. A 2017 reportproduced by the World Cancer Research Fund and the American Institute for Cancer Research pooled data from 16 studies looking at the connection between alcohol and premenopausal breast cancer and another 15 studies that examined the connection between alcohol and postmenopausal breast cancer. The report states that women who drank one alcoholic drink per day had a 5 percent increased risk of developing premenopausal breast cancer while postmenopausal women who drank one alcoholic drink per day had a 9 percent increased risk of developing breast cancer.

It seems clear that there’s a link between alcohol consumption and breast cancer. But what’s different about the risk associated with alcohol intake versus other risk factors, Pilewskie says, is that “this is something that we have control over. We don’t have control over our sex or our family history,” but we can decide to not drink. “I counsel women that if they’re concerned or have other risk factors for breast cancer that they should limit their alcohol consumption to one drink per day or less,” she says.

Unlike with some of the heart health findings, there does not seem to be any variation in risk associated with different types of alcoholic drinks. And as Hollie Zammit, an outpatient oncology dietitian at UF Health Cancer Center, Orlando Health, notes, ethanol – the alcohol that’s in all our drinks regardless of whether it’s beer, wine or liquor – “is a group 1 carcinogen, and it can increase our risk for several cancers.” The International Agency for Research on Cancer maintains the list of carcinogens and defines group 1 carcinogens as substances that are known to cause cancer in humans. This group also includes asbestos, plutonium, radon and talc, among more than 100 other substances and compounds.

 Although we know there’s a connection between alcoholic beverages and breast cancer, the causal mechanism is still being studied. “We don’t really understand where the association comes from. Is it alcohol itself or other changes in the body that occur in women who drink?” Pilewskie says. “We also don’t really know if having one drink per day is the same as not drinking every day and then having seven drinks in a day. That is another gray zone. Whether it’s consumption at one time or cumulative consumption is also an unknown,” she says.

Pilewskie says awareness and education about the potential risk surrounding alcohol is the key. “It’s something to be aware of and something that, from a physician standpoint, I think is often not communicated.” She says a study she was involved in found that “about 20 percent of our high-risk patients drank more than one drink per day, so that’s a population where we can have impact in providing education on this. I think it’s important for women to know, but also for physicians to talk about this as a risk factor.”

Zammit agrees, saying “for my patients who don’t drink, I tell them, ‘don’t start.’ For my patients who have a couple glasses of wine, we encourage them to cut back or cut it out if they can.”

Dr. Raquel Reinbolt, assistant professor of internal medicine at The Ohio State University Wexner Medical Center, also recommends moderation and common sense when it comes to alcohol consumption. “From a common-sense point of view, we know that for anyone, a lot of alcohol is not a good thing.” In addition to the potential for increased risk from the alcohol itself, alcoholic drinks are high in calories with no nutritive value. As such, it’s easy to pack on the pounds when you’re drinking too much. This is a problem because patients who are overweight are at a higher risk of developing breast cancer. So be mindful of how much you drink and as much as possible opt for a low-sugar soft drink or water instead of an alcoholic beverage. “In a practical sense, moderation is appropriate. If I were an internal medicine doctor, I would be telling patients the same thing – the data is interesting, and we should caution patients to be moderate and use common-sense ” in regard to deciding whether and how much to drink.

7 Things Not to Say to Someone With Diabetes

For the more than 29 million Americans who have diabetes, living with the disease is challenge enough. However, awkward, ill-informed or insensitive remarks can add to the difficulties faced.

Well-meaning friends, family members, co-workers or strangers can inadvertently make comments that can be judgmental or are based on stereotypes or myths about diabetes. To address misconceptions, it’s important to know what not to say to someone with diabetes. Based on my experiences as a certified diabetes educator and registered dietitian, here are some of the most common diabetes faux pas, paired with the facts and advice on how best to show your support:

1. “Why do you have diabetes – did you eat too much sugar?” Diabetes is not caused by eating too much sugar. Diabetes and its risk factors are complicated. Type 1 diabetes is caused by an autoimmune response in your body (the body’s immune system attacks itself), genetics and still-to-be discovered factors that trigger its onset. Right now, we have no way to stop the onset of Type 1 diabetes. The onset of Type 2 diabetes is caused by a combination of genetics, lifestyle and many unknown factors. While research has shown that, for some, we can prevent or delay Type 2 diabetes, there is no single cause for diabetes.

2. “Are you sure you should be eating that?” People living with diabetes have to think about what they eat for every meal and snack. However, there is no such thing as the “diabetes diet.” A well-balanced diet is recommended for everyone, not just for people with diabetes. It’s best to avoid giving unsolicited advice if you’re trying to help someone meet their nutrition goals. Instead, show your support by making healthy food choices yourself and by having healthy food options available when sharing a meal.

3. “You don’t look like you have diabetes.” Do not assume there is a certain look for diabetes. While being overweight can raise a person’s risk of developing Type 2 diabetes, many people with Type 2 diabetes are not overweight or obese. Anyone can have diabetes.

4. “Oh, you have to take insulin. Do you have the bad type of diabetes?” Diabetes affects each person differently. It’s a common misconception that a person who requires insulin injections has a more severe form of the disease, as compared to someone who takes pills or manages their diabetes with diet and exercise alone. People with Type 1 diabetesneed to take insulin multiple times every day because their body does not produce any insulin. People with Type 2 diabetes do produce insulin. However, Type 2 diabetes can change over time, and medication needs may change and one may require insulin to keep their blood sugar in a healthy range. There is no good or bad type of diabetes. Neither does taking insulin or any diabetes medication reflect how well a person manages their diabetes or signal any type of failure. Everyone with diabetes has different needs, and by working with their health care team, they can determine the best food, activity and medication plans for them.

5. “I didn’t know you’re diabetic.” Although this statement may be said in a caring manner, calling someone “diabetic” appears to label them by their chronic illness. Some find this stigmatizing and offensive. Rather, say, “I didn’t know you have diabetes.”

6. “Your blood sugar is high. Did you do something wrong?” Blood sugar levels are key in making diabetes management decisions. That being said, glucose levels are not an indicator of success or failure, but one of many metrics monitored to provide feedback. Keep in mind that there are many variables that affect blood sugar levels, some of which are beyond a person’s control. Instead of asking someone if they did something “wrong,” offer positive, encouraging support.

7. “I hope you don’t get diabetes complications like my aunt.” People with diabetes are well aware of the potential complications of the disease. You do not need to highlight them. Listen to the person in your life who has diabetes, and hold off on sharing stories about unfortunate complications your friends and loved ones may have experienced. Many advances in diabetes care have greatly reduced the rates of complications. Healthcare teams and diabetes education programs can help guide and support each person with diabetes and their family members to determine the best care plan for each individual.

How To Increase Cholesterol Level That Is Good For You

Cholesterol gets a bad rap. But the truth is, you need it to live, let alone lead a long, healthy life. Without this waxy, fat-like substance, you couldn’t make sex hormones such as estrogen and testosterone, adrenal hormones that help regulate blood pressure and metabolism, or essential nutrients such as vitamin D.

Floating through your bloodstream, two different fat- and protein-containing carriers, called lipoproteins, carry cholesterol to and from your cells. At healthy levels – ideally less than 100 milligrams per deciliter – low-density lipoprotein, or LDL, delivers the cholesterol you need into your tissues for cell stability and healthy function. Meanwhile,high-density lipoprotein, or HDL, scavenges the excess cholesterol and carries it to your liver, which breaks down the cholesterol and removes it from the body, says Dr. Nauman Mushtaq, medical director of cardiology at Northwestern Medicine Central DuPage Hospital in Illinois. Hence the name “good cholesterol.”

However, when HDL levels are low – typically defined as less than 40 mg/DL – LDL can build up in the blood vessels, earning it the reputation of “bad cholesterol.” This buildup can cause plaque to form in the arteries, increasing your risk of heart attack or stroke.

Thankfully, research has shed new light on several lifestyle changes you can make to ensure your good cholesterol stays ahead of the bad. Here, experts share their top six methods for raising HDL levels and keeping your heart happy:

1. Be a cardio bunny. Cardiovascular exercise can help keep your weight down and HDL levels up. For instance, in one study published in the Journal of Sports Sciences, by walking or running 50 to 60 minutes per day, five days per week for 12 weeks, overweight men significantly decreased their body fat, insulin resistance, blood pressure and “bad cholesterol” levels while upping their “good cholesterol.” Meanwhile, an analysis in the Archives of Internal Medicine found that moderate-intensity aerobic exercise (e.g., walking, cycling or continuous swimming for at least 15 minutes) consistently increases HDL levels.

Increase your HDL levels: Perform at least 20 to 30 minutes of moderate-intensity aerobic exercise daily, Mushtaq says. Examples include brisk walking or light jogging, swimming or cycling. On a scale of 1 to 10, you should feel like you’re working at about 4 to 6.

2. Quit smoking. Smoking can do a number on more than your lungs, actually reducing the body’s concentration of HDL cholesterol. Fortunately, it’s never too late to quit: One review published in Biomarker Research concluded that HDL levels can rise by as much as 30 percent within three weeks of quitting.

Increase your HDL levels: Giving up cigarettes isn’t easy, but it can be done. According to Mushtaq, quitting cold turkey is the most effective method. Research in the Annals of Internal Medicine found that people who quit abruptly were more likely to be smoke-free at four weeks than those who gradually cut back (49 percent versus 39.2 percent). Try nicotine patches and gum to help tamp down cravings.

3. Go nuts. Eating a small serving of almonds (about eight kernels) daily is enough to raise HDL levels by as much as 16 percent after 12 weeks, according to research published in the Journal of NutritionResearchers believe the nutrients in almonds help limit the amount of LDL cholesterol that the body absorbs from foods while increasing the amount expelled by the body.

Increase your HDL levels: Pair a small handful of almonds with a piece of fruit for a snack, add slivered almonds and berries to yogurt or use sliced almonds as a topping for green beans or grain salad, recommends registered dietitian nutritionist Libby Mills, spokeswoman for the Academy of Nutrition & Dietetics.

4. Stick to moderate amounts of alcohol. Higher alcohol consumption can drastically increase your risk of heart disease (not to mention other conditions), but drinking moderate amounts of alcohol has been shown to raise HDL. A study in PLoS One suggests that low-to-moderate alcohol consumption – defined as one drink per day for women and two for men – may help increase the transfer of proteins involved in moving HDL through the bloodstream.

Increase your HDL levels: If you don’t drink, there’s no need to start. However, if you do drink, keep yourself in check by limiting yourself to one drink per day if you’re female and two drinks per day if you’re male. One drink equals 12 ounces of regular beer, 5 ounces of wine or 1.5 ounces of distilled spirits.

5. Limit processed foods. The average American diet is rife with processed foods, which contain high amounts of trans and saturated fats. When consumed in excess, trans and saturated fats have a negative effect on cholesterol levels, according to Mills. Trans fatsin particular have been shown to lower HDL levels.

Increase your HDL levels: Check food labels for hydrogenated and partially hydrogenated ingredients, which contain trans fats, Mills says. Cut back on prepared desserts, packaged snacks, fried foods and powdered creamers.

6. Get your fiber. Fiber does more than regulate bowel movements. According to a report published by the National Heart, Lung, and Blood Institute, once ingested, soluble fiber (which, unlike insoluble fiber, absorbs water during digestion) helps to block the absorption of cholesterol in the bloodstream. Unfortunately, the average American gets only about half the daily recommended intake of 25 to 30 grams.

Increase your HDL levels: According to Mills, some of the best cholesterol-lowering sources of fiber include beans, lentils, apples, blueberries, flax seeds and oatmeal. However, adding too much fiber too quickly can cause gastric distress (think: constipation or diarrhea). Mills recommends increasing your fiber intake slowly and drinking plenty of water to help keep your gut happy.

Easy Tips to Test Your Blood Sugar at Home

When you have diabetes, it’s important to keep a constant check on your blood sugar numbers. Your numbers help determine what causes your blood sugar to spike. Testing your blood sugar – also called blood glucose – once or a few times a day can help show if your diabetes medications and insulin are working the way they should.

The way you keep track of your blood sugar is with at-home testing kits – also called point-of-care glucose monitoring devices. You can find the devices at pharmacies and larger supermarkets. You’ll want to share your blood sugar readings with your doctor to look for trends. Yet ultimately, blood sugar testing has another purpose. “The testing is really for you,” says Susan M. De Abate, a nurse and certified diabetes educator and team coordinator of the diabetes education program at Sentara Virginia Beach General Hospital in Virginia Beach, Virginia. By tracking blood sugar trends, you get a better handle on how to manage your numbers.

Here are some tips and tricks to maximize blood sugar tests for better health when you live with diabetes.

Use a branded meter instead of a generic one. “The branded meters have gone through quality testing and are appropriately scrutinized,” says Dr. Michael Bergman, a clinical professor of endocrinology at NYU Langone Medical Center in New York. Although all blood glucose meters need to have a certain level of accuracy, the branded ones are more likely to have reliable results, he believes. If you have health insurance, the insurance company likely will want you to purchase a specific type of meter, and it often will be a brand-name one.

Learn the ins and outs of your meters – and ask for help. Some meters come with extra bells and whistles that appeal to tech-minded folks (for instance, they can track your physical activity), while others are more straightforward. If you have dexterity or vision issues, find a meter that’s easy to grip or easy to see. Don’t be afraid to ask for help if the monitor seems overwhelming at first. “Over 90 percent of inaccuracy with the meters is operator-dependent,” Bergman says, reflecting on experience with his own patients. The result: Meters used incorrectly could result in risky medication errors based on faulty readings. Consult with a certified diabetes educator to learn how to use your meter properly, Bergman recommends.

Buy test strips made for your specific meter. The test strips add to the cost of blood sugar monitoring, especially if you have to check your numbers several times a day, says Erin Kelly, a nurse educator and certified diabetes educator at Joslin Diabetes Center, which is part of Harvard Medical School in Boston. Buy the test strips made for your meter to ensure accurate results.

Make sure there’s enough blood to fill the landing section of each strip. Otherwise, your meter may not be able provide a correct reading. Some devices require slightly more blood on the test strip than others.

There’s more to managing your health than eliminating white foods or gluten.

Wash your hands before using the meter. If you have any food on your hands – say, you just peeled an orange and the juice is still present on your fingers – it can affect your reading.

Use the device on the sides of your fingers, not on the fingertips. “If you stick the fingertip, that’s where you have more nerve endings,” says Lucille Hughes, a certified diabetes educator and director of diabetes education at South Nassau Communities Hospital in Oceanside, New York. That can cause a slight pinch. If you use the sides of your fingers, it’s painless. Kelly also advises people to regularly change the fingers they use with their monitor. “Don’t play favorites,” she says.

Know your goal numbers. This will be a decision you’ll make with your doctor, and it will depend on the time of day when you check your blood sugar, what you’ve eaten and whether you’ve exercised recently. However, generally speaking, a safe reading is between 80 and 180, Kelly says. “We don’t like to see numbers above 250,” she adds, as this indicates uncontrolled blood sugar.

Track your blood sugar readings. This can be challenging for many people with diabetes. After all, who has time to make a note of all that information? However, without the numbers, your health care team will have a hard time determining if your blood sugar levels are within a reasonable range or if you need any changes in medication, Hughes says. Poor blood sugar control could lead to serious health complications. “Diabetes is about self-management,” Hughes says.

Another advantage of tracking numbers: You learn if there are certain foods that spike your blood sugar. Hughes got a blood sugar meter when she found out she has prediabetes. She learned that white flour tends to raise her blood sugar, but when she eats Greek yogurt, her blood sugar “reacts beautifully,” she says.

Some meters nowadays will capture numbers from readings and download them to an electronic device of your choice. When you have readings that are higher or normal than usual, you should also make note of what you ate before those readings.

Check your blood sugar at different times of the day. Doctors often ask patients to check fasting blood sugar in the morning. However, sticking to only that could steer patientsaway from spotting other times of the day when readings can spike higher, De Abate says. If you always test your blood sugar at the same time, the numbers may not accurately reflect what’s happening throughout the day. “We try to encourage doctors to go beyond fasting blood sugar as everyone’s different,” she says.

Check your blood sugar before your drive or before you operate heavy machinery. You don’t want to take the chance of having a high number, experiencing side effects and causing an accident.

Keep your meter out of the freezing cold or extreme heat. “The meter should never be in direct sunlight,” Kelly says.

One last point: The U.S. Food and Drug Administration, which approves and monitors blood sugar devices, allows for a little variation in numbers when you test your blood sugar. So, if you take your reading twice within a few minutes and see some variability, don’t panic. “That’s always a teaching point for us,” Kelly says.

A1C Hemoglobin Test at Home can help you monitor Blood Sugar

If you have diabetes, you probably already use a glucometer, which allows you to check your blood sugar at home. Just like there are at-home blood sugar testing devices, there are also at-home devices to check your hemoglobin A1C. Your hemoglobin A1C gives you and your health provider a better idea of your average blood sugar level over a two- to three- month period.

Usually, you go to a lab to check your hemoglobin A1C. So why would you want to check it at home?

There are two kinds of patients who tend to use the hemoglobin A1C at-home testing kits, says Grace Derocha, a certified diabetes educator and registered dietitian with Blue Cross Blue Shield of Michigan. “It’s usually patients who are really compliant and want to know every 90 days, ‘Am I still there?’” she says. These same patients may have such good diabetes numbers that they are only required to get their A1C checked every six months, so they use the monitors at the three-month mark.

On the other end of the spectrum, Derocha has recommended that some patients use the A1C test if they having trouble with blood sugar control. “I want it to be a motivator or a reminder for them,” she says.

Although certified diabetes educator Anna Simos, a diabetes education and prevention program manager at Stanford Health Care in California, supports seeing a health provider regularly for lab work and diabetes care, she has seen patients use the hemoglobin A1C tests at home when they can’t get lab work done every three months, be it for scheduling or financial reasons.

Simos also has seen patients who are not diagnosed with prediabetes or diabetes but who have a family history of the disease, so they use the at-home testing kits to self-monitor. Yet one other kind of patient using these devices is someone nervous about seeing lab numbers in front of the health provider. This person would rather know their A1C number ahead of time. “The A1C is like your report card, and there’s anxiety about having to check that,” Simos explains.

Imprecise A1C Readings May Hamper Diabetes Diagnosis or Management

Experts recommend additional testing, in some cases to ensure timely detection and proper care.

Another way the handheld A1C devices are used is in some primary care clinics, says Edwin Torres, a nurse practitioner with the endocrinology department at Montefiore Health System in Bronx, New York. The device can provide an immediate picture of average blood sugar control, and that helps the health care provider give instant feedback and guidance to the patient.

The devices are easy to use; in fact, they work similar to a glucometer. “I tell people they just need a bigger drop of blood,” Derocha says.

The devices are regulated by the U.S. Food and Drug Administration to ensure accuracy. They could give slightly off results, but so can standard lab tests, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

This is where diabetes care experts share a major caution about at-home hemoglobin A1C devices: Don’t use them to make major decisions about your care on your own. Instead, use any readings you obtain to share with your health provider so he or she can advise you accordingly. Your health care provider will want to consider your A1C results along with a variety of other lab and physical findings.

“It’s a good place to start a conversation. You may say, ‘I took my A1C at home. How does my result from home compare with my lab work?’” Torres recommends.

Derocha has seen patients who get favorable A1C results and think that means they can treat themselves to extra ice cream or not take a certain medication dose. Don’t make those decisions alone. Always talk with your health care provider first.

Another caution is that hemoglobin A1C findings can be deceptive at times. In other words, you may have a great hemoglobin A1C reading, but your blood sugar has fluctuated from low to high on a day-to-day basis. So, your overall blood sugar control may not be great even if the A1C reading is favorable. “The number needs to be taken in perspective,” Torres says.

How Hemoglobin A1C and eAG Indicate Your Diabetes Control

Get a better understanding of these important diabetes numbers.

Here are some tips to maximize your use of at-home hemoglobin A1C testing kits:

Buy one from a reputable brand. The larger companies have done their homework to make their devices reliable, Simos says.

Make sure the packaging for the device is sealed before you use it. Also check that the device has not expired.

Wash and warm your hands before use. If your hands are not clean, you may get a false reading. Also, warmer hands will help your blood flow, making it easier to take a small blood sample.

Keep the device away from extreme hot or cold. Simos gives the example of buying an A1C testing kit in a place like Arizona and then keeping it in your hot car while you do other shopping. “You could fry part of the device. It’s sensitive,” Simos says. The same idea applies in extreme cold.

Read the instructions. If your instinct is to tear something open and use it right away, you’re not alone – but that’s not the best approach, Simos cautions. Take the time to read the instructions or watch any related instructional videos.

Don’t pull away when you poke yourself. You need to stay still to capture a blood sample, Derocha advises.

Share the results with your doctor or other health provider. He or she will want to consider your A1C along with high blood pressure, cholesterol and other key numbers to make important care decisions.

Use the device only every two to three months. Any more than that, and the results will not vary much, Derocha says. However, you still need to do your regular at-home glucometer checks, she adds.

Talk with your health care provider about factors that may affect your A1C readings. This could include if you have anemia or if you have just had surgery.

The Truth about Vitamins and Herbal Supplements

Alice arrived in Wonderland and promptly downed a vial that said “drink me,” and we can probably all agree she was being a bit of an idiot. Magical land or not, she’s a child, she has no idea where that conveniently placed tube came from, and come on—“drink me”? That’s in the textbook definition of “gullible.”

But if we’re being honest, is taking a supplement you bought at the drug store any smarter?

The bottles don’t say “swallow me,” but they might as well. Instead they’re emblazoned with promises. The yellow ones will make you stronger. Red will increase your energy levels. Purple will heal your scars. It’s a veritable rainbow of cures. They offer quick and easy solutions in a way that medicine can’t—because medicine is bound by evidence. Supplements aren’t.

Which is why every 24 minutes the U.S. Poison Control Centers get a call about bad reactions to supplements. That’s 274,998 exposures from 2000-2012. Those numbers come from a recent study in the Journal of Medical Toxicology, but the idea isn’t new: Supplements aren’t likely to kill you, but they’ve never been particularly safe either. And the companies producing them have shockingly little oversight.

Exposures are increasing, especially for certain herbal supplements and homeopathic remedies

From 2005 to 2012, the rate of reported dietary supplement exposures increased 49.3 percent. Homeopathic cures and ma huang-containing pills were responsible for most of that uptick. Homeopathy is the line of thinking that says if you take a solution of water and an active ingredient, then dilute it many times over until the active ingredient is no longer detectable, the water somehow retains the memory of the active ingredient and will have some medicinal effect on your body. There is absolutely no evidence to support it. Ma huang is a plant extract that contains ephedrine and pseudoephedrine, which stimulate your nervous system and can be deadly.

Between the two of them, homeopathy and ma huang account for a large chunk of the total adverse outcomes related to dietary supplements. The problem is that we’re only finding this out years after they’ve happened.

The Food and Drug Administration can’t review supplements for safety OR efficacy before they hit the market

The FDA is literally not authorized to evaluate a supplement’s efficacy or safety. It’s up to the manufacturer to make sure their product is safe and as effective as they claim. They’re also tasked with policing themselves to ensure the supplements aren’t contaminanted. This near total lack of oversight means that a huge fraction of botanical supplements either contain an entirely different active ingredient from what they claim or contain a filler like rice powder.

One study of the supplements sold at GNC, Target, Walgreens, and Walmart found that four out of every five products didn’t contain the ingredient they claimed. In cases where you just get filler, all you’ve done is waste your money. But what if those pills contain allergens that aren’t listed on the package? Or if the secret active ingredient interacts with another medication you’re taking? If you don’t know what’s in your supplement, you could get sick and have no idea why.

That’s why there are reporting tools to tell the FDA—or poison control—when you have an adverse outcome. The trouble is that lots of people don’t. The FDA estimates that some 90 percent of adverse reactions go unreported. Some people report the problem straight to the company, who are supposed to self-report to the FDA. But it’s basically an honor system. One shampoo company got tens of thousands of complaints and never passed a single one on to the FDA. It wasn’t until people whose hair started falling out complained directly to the FDA that they realized the problem (though it’s worth noting that shampoo hasn’t been definitively proven to cause hair loss).

Between under-reporting and self-policing, there’s plenty of room for supplement companies to shirk best practices.

Companies can get away with all of this because people don’t speak up

When you stand in the supplement aisle in the drug store, you’re faced with decisions. How do you choose between the generic store version and that all natural herbal option? Every supplement company out there has invested time and money into making their packaging look appealing. They want you to trust them. They want that lovely green label to say “this is natural and harmless.”

It can be hard to ignore that psychological effect. And regardless of which brand you pick, if you have a weird reaction you’re probably not likely to tell anyone. Even if you mention it to a friend, you’ll probably chalk it up to a personal issue—maybe your gut is just finicky, or the pills contained an ingredient you’re slightly allergic to.

This is why it’s hard for deceptive companies to get caught. You’re not likely to tell your doctor if that echinacea tablet you had last month seemed to give you a stomach ache, and you almost certainly won’t report it to the FDA. Because it’s easy to think of supplements as safe by definition. They seem like a medication, and medications have to be approved before they’re sold. And in addition to that veneer of medical approval, supplements are also gilded with supposed wholesomeness. After all, when is the last time you thought twice about taking some Vitamin C? It’s all natural.

But it’s important to remember, as you stand in that drug store aisle, that almost none of the products before you were tested by any kind of regulatory agency. The only way the FDA will test them is if people start having problems—and start complaining.

What you can do to stay safe

You often can’t be 100 percent sure that a supplement is safe. Even if you have a way to test for the claimed active ingredient—which you probably don’t—you’d be hard-pressed to test for other potential contaminants.

But there is one good option. The United States Pharmacopeial Convention runs a voluntary testing program for supplements, testing vitamins and supplements to ensure they actually contain what they claim to in the amounts listed. Plus they test to make sure the products are contaminant-free and made with clean, safe manufacturing practices. They maintain a list of all the supplements that are certifiedon their website, and it contains shockingly few brands. It’s basically just NatureMade and Costco’s Kirkland Signature brand. You can also look for their USP certified label on the supplement itself.

Apart from that list, you’re in the wild west. Melatonin pills might as well be sugar tablets and echinacea drops could easily be herb-flavored water. Drink me.