FDA-Approved Painkiller Zohydro Concerns Critics

By Rita Rubin
WebMD Health News

Reviewed by Michael W. Smith, MD

Feb. 27, 2014 -- A new narcotic painkiller is due to come on the market in March, and critics want the FDA to reverse its approval of the drug, Zohydro ER. They claim it could become the next OxyContin, another opioid that’s become a popular drug of abuse.

Critics of the FDA's ruling include attorneys general from 28 states and FED UP!, a union of consumer groups, addiction treatment providers, drug and alcohol prevention programs, and other interested groups. They have petitioned FDA Commissioner Margaret Hamburg, MD, to prevent Zohydro from coming on the market. The FDA approved the drug even though its advisory committee voted 12 to 2 against approval.

"I firmly believe that the benefits of this product outweigh its risks," the FDA’s Bob Rappaport, MD, wrote in the summary review explaining why he approved Zohydro last October. Rappaport is director of the FDA's Division of Anesthesia, Analgesia, and Addiction Products. "Many patients in the U.S. suffer from untreated or poorly treated chronic pain. Further limiting access to potential treatments is not the answer when new treatments are critically needed.”

Opioids are a man-made type of narcotic pain medication. They subdue the central nervous system, ease pain, and induce sleep. They can have serious side effects if not used properly.

Here are some commonly asked questions about Zohydro, made by Zogenix, a San Diego company.

Q. Why do people want the FDA to reverse its approval of Zohydro?

A. Zohydro is too easy to abuse, critics say. It is the only approved extended-release product that contains the man-made opioid hydrocodone. It will be available in doses as high as 50 milligrams per pill -- five times the amount in immediate-release hydrocodone pills. Even though it is meant to release hydrocodone slowly over 12 hours, the pill could be tampered with to release a large dose all at once, says Andrew Kolodny, MD, co-founder of the group Physicians for Responsible Opioid Prescribing.

Two members of the FDA’s controlled substance staff warned about the potential for abuse in materials presented to the advisory committee. “If approved and marketed, Zohydro ER will be abused, possibly at a rate greater than that of currently available hydrocodone combination products,” wrote medical officer Lori Love, MD, PhD, and pharmacologist James Tolliver, PhD.

Zogenix is “currently evaluating two different technologies to ensure we develop the most effective formulation to minimize misuse and abuse,” says company spokeswoman Julie Normart. The company is also taking other actions to lower the risk of abuse, according to a statement supplied by Normart. These include locking pill bottle caps and an external “safe-use board” made up of experts in abuse, misuse, and diversion.

Jason Jerry, MD, an addiction specialist at the Cleveland Clinic, questions why Zogenix doesn’t wait to introduce Zohydro until they develop a version of it that's harder to abuse. “I’m not sure why there’s this great rush to get this to market,” Jerry says.

source : FDA-Approved Painkiller Zohydro Concerns Critics

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Doctors' Germ-Laden Stethoscope May Spread Nasty Bacteria

Cleansing after each use should be part of good patient care, study says

WebMD News from HealthDay

By Dennis Thompson

HealthDay Reporter

THURSDAY, Feb. 27, 2014 (HealthDay News) -- Stethoscopes help diagnose and heal, but this primary tool of physicians also has significant potential to spread germs from patient to patient, a new study reports.

The diaphragm of a stethoscope -- the round piece placed against a patient's body -- can become filthy with antibiotic-resistant bacteria such as potentially deadly MRSA, researchers found.

They discovered that a diaphragm will pick up more bacteria during a patient examination than any part of the doctor's hand except the fingertips.

The tube of the stethoscope also can become laden with bacteria, and the contamination level of both the diaphragm and the tube increases with the amount of bacteria on the doctor's fingertips, the study said.

"Germs are acquired from the patient's skin in contact with the stethoscope, the same way hands usually get colonized with the patient's germs," said study senior author Dr. Didier Pittet, director of the Infection Control Program at University of Geneva Hospitals, in Switzerland.

"The important implication is that the stethoscope, whether used by a doctor, a nurse, an assistant nurse or any staff, needs to be cleansed after each use," said Pittet, who also heads the World Health Organization's Collaborating Centre on Patient Safety at the hospitals.

The potential of health care professionals to inadvertently spread disease through their tools or attire is becoming an area of focus because of concerns about the rise of antibiotic-resistant "superbugs."

Epidemiologists -- experts who study disease patterns and causes -- raised the possibility in January that doctors may want to ditch their traditional attire of white coat and necktie, since the articles of clothing can become contaminated and are not easily washed between patients.

The new study compares the level of contamination on physicians' hands and stethoscopes.

In the study, physicians examined 71 patients using sterile gloves and a sterile stethoscope.

After doctors completed the examination, researchers measured the bacteria on the tube and diaphragm of the stethoscope. They also tested the fingertips, ball of the thumb, palm and back of the physicians' hands for bacteria.

They found that the stethoscope and the fingertips tended to be more contaminated than all other parts of the physicians' hands, both with bacteria in general and MRSA (methicillin-resistant Staphylococcus aureus) specifically. They also found that the contamination level of the stethoscope increased with contamination of the hands.

"Although infection cross-transmission from one patient to another has not been demonstrated in this study, it seems clear that staff and doctor stethoscopes constitute an extension of their fingertips in terms of risk for germ's cross-transmission," Pittet said.

"Hand hygiene remains the primary measure for the prevention of hospital infections, and appropriate handling of stethoscopes -- their cleansing immediately after use -- should be part of good patient care practices," Pittet said.

source : Doctors' Germ-Laden Stethoscope May Spread Nasty Bacteria

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Gene Study Offers Clues to Why Autism Strikes More Males

Girls seem to tolerate more genetic mutations than boys do before showing symptoms of disorder

WebMD News from HealthDay

By Mary Brophy Marcus

HealthDay Reporter

THURSDAY, Feb. 27, 2014 (HealthDay News) -- A new DNA study begins to explain why girls are less likely than boys to have an autism spectrum disorder.

It turns out that girls tend not to develop autism when only mild genetic abnormalities exist, the researchers said. But when they are diagnosed with the disorder, they are more likely to have more extreme genetic mutations than boys who show the same symptoms.

"Girls tolerate neurodevelopmental mutations more than boys do. This is really what the study shows," said study author Sebastien Jacquemont, an assistant professor of genetic medicine at the University Hospital of Lausanne, in Switzerland.

"To push a girl over the threshold for autism or any of these neurodevelopmental disorders, it takes more of these mutations," Jacquemont added. "It's about resilience to genetic insult."

The dilemma is that the researchers don't really know why this is so. "It's more of an observation at a molecular level," Jacquemont noted.

In the study, the Swiss researchers collaborated with scientists from the University of Washington School of Medicine to analyze about 16,000 DNA samples and sequencing data sets from people with neurodevelopmental disorders, including autism spectrum disorders.

The investigators also analyzed genetic data from almost 800 families affected by autism for the study, which was released online Feb. 27 in the American Journal of Human Genetics.

The researchers analyzed copy-number variants (CNVs), which are individual variations in the number of copies of a particular gene. They also looked at single-nucleotide variants (SNVs), which are DNA sequence variations affecting a single nucleotide. Nucleotides are the basic building blocks of DNA.

The study found that females diagnosed with any neurodevelopmental disorder, including attention-deficit/hyperactivity disorder and intellectual disability, had more harmful CNVs than males who were diagnosed with the same disorder. Females with autism also had more harmful SNVs than males with the condition.

"There's a well-known disparity when it comes to developmental disorders between boys and girls, and it's been puzzling," Jacquemont said. "And there have been quite a bit of papers trying to investigate this bias that we've seen in the clinic."

The study authors pointed out that autism affects four boys for every one girl. The ratio increases to seven-to-one when looking at high-functioning autism cases.

It's an interesting study, said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at the Steven & Alexandra Cohen Children's Medical Center of New York.

"It's not an easy study to read, but certainly the take-away suggests it tries to lend further support to the assumption that the ratio of males to females [who have autism] is affected by genetic vulnerabilities -- that it has a genetic underpinning," Adesman said.

What do the findings mean for parents and patients?

source : Gene Study Offers Clues to Why Autism Strikes More Males

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Enlarged Prostate (BPH) Supplements and Natural Remedies

To treat an enlarged prostate, some people use herbs, from flaxseed to stinging nettle to prickly pear cactus. At typical doses, experts say that most plant extracts are probably safe for BPH, or benign prostatic hyperplasia. But do they work?

Some supplements may help. Others -- including the most popular, saw palmetto -- might not. And a few, including zinc, may actually put you at risk for getting BPH.

Supplements Most Likely to Work

Beta-sitosterols may help your urine flow better and leave less in your bladder. They may be worth a try, especially if you have high cholesterol. Beta-sitosterols, a plant version of cholesterol, are also used to lower cholesterol and are in some cholesterol-lowering margarines. Try 60 to 130 milligrams a day.

Pygeum, also known as African plum extract, could cut down on the times you have to get up to urinate at night and can improve urine flow. It may not work as well as standard treatments like alpha-blockers, though. Try 75 to 200 milligrams a day. Experts encourage using only sustainably harvested pygeum.

Supplements That May Help

Two studies showed that rye grass pollen extract may relax the muscles of the tube that urine flows through and help bladder muscles contract. You may have less dribbling after urinating and need to get up less often at night to urinate. In one study, it also appeared to shrink prostate size. If you want to try it, it's probably safe for up to 6 months.

Some older research suggests that Harzol, an extract of African wild potato (South African star grass), may ease urinary symptoms. That's probably because it's high in beta-sitosterols. But it may also lower blood sugar levels. So if you have diabetes, you may want to skip products with this plant. And if you do try it, watch your blood sugar closely.

The Latest Science on Saw Palmetto

Extract of the berries from this small palm tree is a favorite remedy for BPH, but studies are mixed on how well it works. Early studies showed that taking 320 milligrams a day could ease urinary symptoms. Some even showed that it worked as well as the BPH drug finasteride.

But newer and larger studies have shown that saw palmetto works no better than a placebo -- even at higher doses. And it doesn't shrink your prostate gland, just its lining.

The benefits of saw palmetto seem to be modest at best. If you want to try it, look for a fat-soluble extract that contains 85% to 95% fatty acids and sterols.

Tips for Taking Supplements

Before you take any natural remedy, talk to your doctor. They can interact with drugs you're already taking or with other herbs and supplements.

Because the FDA doesn't regulate supplements, it's not always certain what's in them. So try a product with one ingredient only -- just pygeum, for example. You don't have to buy a brand that costs a lot. But if a standardized extract was studied in human trials, start with that one.

If your doctor says it's OK, give it a month or two. If your symptoms don't get better, try another brand or a different dose for a month or two. If that doesn't help, you could switch again. But if that doesn't help, give up on that supplement.

Herbal remedies or supplements may not help your symptoms. You may get more relief with a BPH drug.

source : Enlarged Prostate (BPH) Supplements and Natural Remedies

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FDA's New Food Labels Would Focus on Calories, Sugar Content

Another goal: give consumers a better understanding of realistic serving sizes

WebMD News from HealthDay

By Margaret Farley Steele

HealthDay Reporter

THURSDAY, Feb. 27, 2014 (HealthDay News) -- The U.S. Food and Drug Administration formally proposed Thursday updating the "nutrition facts" labels on food products to better reflect Americans' current eating habits and health concerns.

Among the highlights: the new labels would replace out-of-date serving sizes, highlight calorie content and draw attention to "added sugars."

First Lady Michelle Obama said Thursday that America's families will benefit from the proposed label makeover, which the FDA first unveiled last month.

"Our guiding principle here is very simple: that you as a parent and a consumer should be able to walk into your local grocery store, pick up an item off the shelf, and be able to tell whether it's good for your family," Obama said in an FDA news release. "So this is a big deal, and it's going to make a big difference for families all across this country."

Nutrition labeling was introduced two decades ago, and the FDA says the science and recommendations behind food labeling has changed since then. The proposed revisions take into account current knowledge of the link between diet and chronic diseases such as obesity, diabetes and heart disease.

"By revamping the Nutrition Facts label, FDA wants to make it easier than ever for consumers to make better informed food choices that will support a healthy diet," Michael Taylor, the FDA's deputy commissioner for foods and veterinary medicine, said in the news release.

Highlights of the proposal include:

• Calorie content and serving sizes would be featured more prominently to help address obesity, "one of the most important public health problems facing our country," Taylor said. "What and how much people eat and drink has changed since the serving sizes were first put in place in 1994," the agency said. Also, foods that can be consumed in one sitting would feature calorie and nutrition information for the whole package.
• Labels would need to show the amount of "added sugars" in a food product to help people distinguish between the natural sugars found in fruit and milk, for instance, and sugars added arbitrarily. Americans consume too much sugar and need to reduce their intake, according to 2010 Dietary Guidelines for Americans.
• Potassium and vitamin D -- nutrients that help ward off high blood pressure and bone loss, respectively -- would be listed on labels. Food makers could also include vitamins A and C, but they will no longer have to.
• "Daily values" for various nutrients such as salt, dietary fiber and vitamin D would be revised. These values are used to calculate the "Percent Daily Value" on the label, which helps consumers understand the nutrition information in the context of a total daily diet, the FDA said.
• "Total Fat," "Saturated Fat" and "Trans Fat" would remain on labels, but not "Calories from Fat." It's now known the type of fat is more important than the amount.

source : FDA's New Food Labels Would Focus on Calories, Sugar Content

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Study Sees No Evidence Linking Diabetes Drugs With Pancreatic Cancer

But FDA assessment calls for further look at injectable type-2 treatments

WebMD News from HealthDay

By Serena Gordon

HealthDay Reporter

WEDNESDAY, Feb. 26, 2014 (HealthDay News) -- There's no firm evidence that the type 2 diabetes medications known as incretin-based drugs cause pancreatitis or pancreatic cancer, U.S. and European health officials say.

But it's too early to say there's definitely no link between the injectable drugs and pancreatitis or pancreatic cancer, according to the safety assessment by the U.S. Food and Drug Administration (FDA) and its counterpart overseas, the European Medicines Agency (EMA).

"Both agencies agree that assertions concerning a causal association between incretin-based drugs and pancreatitis or pancreatic cancer, as expressed recently in the scientific literature and in the media, are inconsistent with the current data," states the report in the Feb. 27 issue of the New England Journal of Medicine. "The FDA and the EMA have not reached a final conclusion at this time regarding such a causal relationship."

Incretin-based drugs are among the newest medications available to treat type 2 diabetes, a chronic condition characterized by high levels of sugar in the blood. Nearly 26 million people in the United States and 33 million in the European Union have diabetes, and type 2 is by far the most common type.

There are two types of incretin-based medications: GLP-1 agonists and DPP-4 inhibitors.

Examples of GLP-1 agonists include exenatide (Byetta) and liraglutide (Victoza). Exenatide, the first incretin-based drug approved by the FDA, was approved in 2005.

Examples of DPP-4 inhibitors include sitagliptin (Januvia) and saxagliptin (Onglyza). Sitagliptin was the first DPP-4 inhibitor approved by the FDA, receiving consent in 2006.

GLP-1 agonists slow stomach emptying and increase insulin secretion, which help keep blood sugar lower. They also suppress secretion of a hormone that raises blood sugar levels.

DPP-4 inhibitors slow the absorption of carbohydrates through the stomach, help increase insulin levels and suppress the blood-sugar elevating hormone, said Dr. Robert Ratner, chief scientific and medical officer at the American Diabetes Association.

One of the challenges in diabetes control is keeping blood sugar levels low while avoiding hypoglycemia, or dangerously low blood sugar. "The clinical data suggests these are very [effective] drugs that don't cause hypoglycemia," said Ratner.

Also, unlike some diabetes drugs that promote harmful weight gain, GLP-1 agonists cause weight loss, while DPP-4 inhibitors are weight neutral. Weight loss often improves diabetes.

After the drugs received approval, the FDA and EMA received reports of pancreatitis (inflammation of the pancreas) and pancreatic cancer in people taking the drugs.

"There was a disproportionate reporting of these adverse events detected," said the lead author of the safety assessment, Dr. Amy Egan, deputy director for safety in the FDA's division of metabolism and endocrinology products.

However, the risks of pancreatitis and pancreatic cancer are already elevated in people with type 2 diabetes, said Egan. In addition, because they can aid weight loss, GLP-1 agonists are often prescribed to heavier people. Obesity is also a known risk factor for pancreatitis disease, Egan noted.

source : Study Sees No Evidence Linking Diabetes Drugs With Pancreatic Cancer

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Quick Vision Test May Help Spot Concussions on Sidelines

Combined with two other simple screenings, all cases of head injury were caught, researchers report

WebMD News from HealthDay

By Amy Norton

HealthDay Reporter

WEDNESDAY, Feb. 26, 2014 (HealthDay News) -- A simple vision test given on the sidelines can help identify athletes who've suffered a concussion, a new study finds.

Researchers found that the test -- known as the King-Devick, or K-D -- was able to detect 79 percent of concussions among college athletes who were followed over a season. When the results were combined with those of two other screening tests, all of the concussions were caught.

The findings were released Wednesday by the American Academy of Neurology (AAN), ahead of its annual meeting this spring.

Experts said the study bolsters evidence that the K-D is a reliable way to help spot athletes' head injuries -- though the test, by itself, is not enough.

"People have been looking for quick, on-the-field screening tests," said Steven Broglio, an athletic trainer and director of the NeuroSport Research Laboratory at the University of Michigan in Ann Arbor.

The new findings suggest the K-D is "one option," said Broglio, who was not involved in the study. "But it's not definitive, and you wouldn't want to rely on this alone," he added.

The K-D takes a minute or two, and it can be given by an athletic trainer, coach or even a parent right on the sidelines. It requires test-takers to read a few rows of single-digit numbers that are unevenly spaced, as quickly and accurately as possible. If they are slower to finish than they were on their "baseline" test -- taken before the season starts -- that's a potential sign of a concussion.

There are other sideline screening tests already in use, including ones that test balance and short-term memory.

But the K-D test "fills a gap" by looking for vision-related problems, explained study co-author Dr. Steven Galleta, chair of neurology at NYU Langone Medical Center in New York City.

Concussions can cause a wide range of symptoms that are often subtle at first. Symptoms like worsening headache, dizziness, nausea, fatigue and confusion might not become obvious until hours after the knock to the head. Plus, even when athletes are suffering immediate problems, they might not tell anyone.

"Some athletes don't recognize the symptoms, and some try to hide them because they want to stay in the game," Galleta said.

A number of professional groups, such as the AAN and National Athletic Trainers' Association, say that athletes who've potentially suffered a concussion should be taken out of the game or practice immediately.

For the new study, Galleta and his colleagues followed 217 athletes at the University of Florida -- including male football players, and female lacrosse and soccer players.

At the start of the season, they all took the K-D, as well as two other sideline screening tests: the BESS, which measures balance; and the SAC, which measures abilities such as short-term memory (asking the athlete to memorize and recall five words) and "orientation" (asking the player to name the day, month and year).

source : Quick Vision Test May Help Spot Concussions on Sidelines

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A Better Test for Down Syndrome?

New gene-based screen for chromosomal disorders is more accurate than current methods, study says

WebMD News from HealthDay

By Maureen Salamon

HealthDay Reporter

WEDNESDAY, Feb. 26, 2014 (HealthDay News) -- A new test that examines fetal DNA from a mother's blood is more accurate at spotting chromosomal abnormalities such as Down syndrome than standard tests offered to pregnant women, a new study indicates.

Scientists found that the blood test, known as cell-free DNA, performed up to 10 times better than other noninvasive tests currently used to screen for "aneuploidy" -- one or more missing chromosomes that can signal conditions such as Down or Edwards syndromes. Both can cause intellectual and physical disabilities. Infants born with Edwards syndrome rarely live beyond one year.

"We had suspected the DNA test would perform well, but what was needed was this head-to-head comparison with the current standard of care," said study author Dr. Diana Bianchi, executive director of the Mother Infant Research Institute at Tufts Medical Center in Boston. "The cell-free DNA has a much lower false positive rate, which means fewer women will be alarmed unnecessarily and fewer will have to go to a genetic counselor or have an invasive procedure" to determine if their baby has a chromosomal defect.

The study, funded by Illumine Inc., the San Diego manufacturer of the new test, is published Feb. 27 in the New England Journal of Medicine.

Noninvasive prenatal screening began in the 1970s. Current tests looking for abnormalities include ultrasound imaging and maternal blood tests measuring a protein that's considered an indicator for Down syndrome.

If these screening tests predict an increased risk for chromosomal defects, pregnant women are typically urged to undergo invasive testing such as amniocentesis or chorionic villus sampling, which extract fetal DNA from the amniotic fluid or placenta, respectively. While these procedures can tell for certain if a fetus is abnormal, they also raise the risk of miscarriage.

At 21 centers in the United States, Bianchi's team collected blood samples from more than 1,900 pregnant women, average age 30, undergoing standard aneuploidy screening. The researchers compared the results with those obtained from cell-free DNA tests.

While the new technique, available since 2011, had been tested previously among women at high risk of bearing children with chromosomal abnormalities, this trial was the first among a general population of pregnant women with typical risks.

The study found that incorrect or "false positive" results for chromosomal defects stemming from cell-free DNA testing were significantly lower than those with standard screening -- 0.5 percent compared to 4.2 percent for Down and Edwards syndromes combined.

"I think this is a stronger test," said Dr. Edward McCabe, senior vice president and chief medical officer of the March of Dimes, who was not involved in the study. "I think more research is needed ... but I'm comfortable with the conclusion here that if your [cell-free DNA] test is negative, that's a strong indication your baby's not affected" by aneuploidy.

Bianchi agreed that additional research is needed before the cell-free DNA test can replace standard screening tests among low-risk pregnant women. She also noted that the cost of the new test is a concern -- from $500 to $2,000 depending on different factors, although insurance companies typically cover it for high-risk women. Obstetricians would also need to be educated about its use, she said.

source : A Better Test for Down Syndrome?

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Are Kids Born to Older Dads at Risk for Mental Health Woes?

Large Swedish study found higher rates of autism, ADHD and other disorders, but expert says the risk is small

WebMD News from HealthDay

By Steven Reinberg

HealthDay Reporter

WEDNESDAY, Feb. 26, 2014 (HealthDay News) -- Children born to older fathers are at higher risk for various psychiatric and learning problems than once thought, a large new study suggests.

Among more than 2 million children born in Sweden, researchers found that those born to fathers aged 45 and older were more prone to problems such as autism, attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, schizophrenia, attempted suicide and drug abuse. Other problems include poor grades in school and low IQ scores.

"We were shocked by the findings," lead researcher Brian D'Onofrio, an associate professor in the department of psychological and brain sciences at Indiana University, said in a university news release. "The specific associations with paternal age were much, much larger than in previous studies."

D'Onofrio, however, doesn't want people to think that all or even most children of older fathers will have these problems.

"We are not saying that all children born to older fathers will have psychiatric or educational problems," D'Onofrio said in an interview.

"Rather, the study found that advancing paternal age at childbearing is associated with greater risk for serious problems," he said. "As such, the study adds to a growing body of research that suggests families, doctors and society as a whole must consider both the pros and cons of delaying childbearing."

While the new study uncovered an association between older fathers and increased risk of mental health and learning problems in their children, it didn't prove cause-and-effect.

And a child behavioral specialist not involved with the study said the findings should be kept in perspective because the actual risk of having a child with any of these problems is small.

The new report was published in the Feb. 26 online edition of JAMA Psychiatry.

For the study, D'Onofrio and colleagues collected data on about 2.6 million children born in Sweden from 1973 to 2001.

Compared with a child born to a 24-year-old father, a child born to a 45-year-old father was 3.5 times more likely to have autism and 13 times more likely to have ADHD, the study found.

In addition, children born to 45-year-old fathers were twice as likely to have a psychotic disorder, 25 times more likely to have bipolar disorder and about 2.5 times more likely to have suicidal behavior or a drug abuse problem, the authors noted.

Over the past 40 years, the average age when men and women start a family has been increasing. In the United States, the average age for mothers having their first baby has gone up about four years, from 21.5 to 25.4 years old, the news release noted. For men the average increase is three years.

source : Are Kids Born to Older Dads at Risk for Mental Health Woes?

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Germs and Bacteria: How Clean Should We Be?

By Mary Jo DiLonardo
WebMD Feature

Reviewed by Michael W. Smith, MD

Your baby drops a cracker on the floor. Does the 5-second rule apply, or do you quickly throw it away?

Or could those germs actually be good for him? Well, kind of.

There's a belief that says exposing people -- especially babies and young children -- to different kinds of germs early in life can keep them from developing illnesses like asthma, allergies, and other diseases that affect the immune system. The theory, called the “hygiene hypothesis,” is that our bodies need "practice" fighting germs.

Looks like that message has gotten through. In a survey by the Hygiene Council, 77% of moms with kids under 5 thought their children should be exposed to germs to help build stronger immune systems. The Hygiene Council, a group of health experts focused on hygiene, is funded by an educational grant from Reckitt Benckiser, a WebMD sponsor.

"In the 20th century we started changing the way we live. We live in very clean boxes. Water is immaculate. Food is nearly sterile. Exposure to bacteria and soil is less common," says Joel Weinstock, MD, chief of gastroenterology and hepatology at Tufts Medical Center and professor at Tufts University.  But being super clean may not be good for growing immune systems.

“Certain diseases that were essentially unknown in the 18th century and earlier are becoming common now." But we’re also not dying from cholera and the plague. So does this mean we can stop washing our hands and can eat food off the floor? Not so fast.

"We're not encouraging kids to go out and eat dirt or forgo vaccinations,” says Kathleen Barnes, PhD. “But there's probably something to be said for not sheltering children from exposure to routine (germs) during childhood and the sort of overboard way we go."

But that doesn't mean you should throw cleanliness to the wind. According to the "old friends theory," which takes the hygiene hypothesis further, it's true that exposure to some friendly germs helps us. But we still have to limit being around germs that cause serious illnesses. So where should we draw the line?

What You Can Stop Worrying About

Pets

Barnes cites studies that show that kids who grow up around pets are less likely to get asthma. Kids in day care who are exposed to kids with colds and other germs are less likely to end up with allergies, asthma, and other health problems.

Sterilizing Everything

You can probably lay off all the antibacterial soaps and cleansers. Even the FDA is skeptical. They are asking antibacterial soap makers to prove that the products are more effective than regular soap. There are also questions about the safety of some of the ingredients, so there may be more risks than benefits. "The vast amount of types of bacteria and viruses and fungi that we see in everyday life don’t hurt us at all. They're just there," says Weinstock “Only a handful” are likely to make you sick, he says.

To get rid of germs when washing your hands, encourage your kids to lather up for as long as it takes to sing “Happy Birthday” twice.

source : Germs and Bacteria: How Clean Should We Be?

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Gluten: How to Find It on a Food Label

How to recognize gluten that's not obvious on the label.

By Heather Hatfield
WebMD Feature

Reviewed by Kathleen M. Zelman, MPH, RD, LD

Going gluten-free? Gluten is not always obvious on food labels, so you'll need to get up to speed on gluten's many disguises.

When Katie Falkenmeyer of Sherrill, NY, decided to go gluten-free, the learning curve in front of her was a little daunting. Figuring out which foods were really gluten-free wasn't easy. But after a few trips to the grocery store -- and with the support of her nutritionist -- identifying gluten on an ingredient list is now second nature.

"It took time -- and a lot of ingredient label-reading -- to figure out what foods were gluten-free," Falkenmeyer says.

You probably know that gluten -- a protein -- is in anything containing wheat, rye, triticale, or barley. But did you know it's also in some less obvious products, such as lunch meats and soy sauce?  

Here's what to look for.

Gluten-Free Diet Slideshow

Going Gluten-Free?

Some people go gluten-free because they have celiac disease, which damages the small intestine and makes it harder to absorb nutrients from food. People who have celiac disease can't tolerate gluten.

Others avoid gluten because they're sensitive to it, but don't have celiac disease.

"If someone has celiac disease or a gluten-sensitivity, the solution is pretty much black and white," says Daniel Leffler, MD, director of research at Boston's Celiac Center at Beth Israel Deaconess Medical Center. "They need to eliminate gluten from their diet totally in order to experience an improvement in their health."

Sticking to a gluten-free diet can be tricky -- but it's possible.

Gluten Ingredients

Checking the ingredient label for wheat, barley, and rye is just the beginning. Gluten also goes by other names, and some of them aren't that obvious.

"Reading the ingredients label on the foods you buy and knowing what to look for are the keys to identifying and avoiding gluten," says Shelley Case, RD, author of Gluten-Free Diet: A Comprehensive Resource Guide.

Here are some of gluten's guises on ingredient labels, according to Case's book:

• Barley (flakes, flour, pearl)
• Breading and bread stuffing
• Brewer's yeast
• Bulgur
• Durum (type of wheat)
• Farro/Faro (also known as spelt or dinkel)
• Graham flour
• Hydrolyzed wheat protein 
• Kamut (a type of wheat)
• Malt, malt extract, malt syrup, and malt flavoring
• Malt vinegar
• Malted milk
• Matzo, matzo meal
• Modified wheat starch
• Oatmeal, oat bran, oat flour, and whole oats (unless they are from pure, uncontaminated oats)
• Rye bread and flour
• Seitan (a meat-like food derived from wheat gluten used in many vegetarian dishes)
• Semolina
• Spelt (a type of wheat also known as farro, faro, or dinkel)
• Triticale
• Wheat bran
• Wheat flour
• Wheat germ
• Wheat starch

These other ingredients may be less familiar to you, but they also contain gluten:

• Atta (chapati flour)
• Einkorn (type of wheat)
• Emmer (type of wheat)
• Farina
• Fu (a dried gluten product made from wheat and used in some Asian dishes)

source : Gluten: How to Find It on a Food Label

Read more →

Top 10 Smart Foods for College Students

Coasting by on popcorn and energy drinks? Find out which foods really fuel your brain.

By Matt McMillen
WebMD Magazine - Feature

Reviewed by Kathleen M. Zelman, MPH, RD, LD

Poring over textbooks, organizing lecture notes, and prepping for tests takes a toll on your brain. Give your gray matter the fuel it needs to help you stay focused and absorb what you learn in the classroom.

Milk and yogurt. Low-fat dairy products are packed with protein and B vitamins that may help you concentrate and work efficiently, says dietitian Marjorie Nolan, RD, a nutrition counselor and personal trainer in New York City. She recommends plain, nonfat Greek yogurt, which is super high in protein and has no added sugar. Milk and yogurt are fortified with vitamin D, which also supports brain health.

Oats. It's hard to beat oatmeal at breakfast. Oatmeal is a minimally processed whole grain, which you digest slowly, letting it provide steady energy to your brain and body.

And you get a bowlful of B vitamins and fiber as well as potassium, zinc, and vitamin E. "Most people don't realize how important all that is for brain health," says Nolan. The B vitamins aid memory while vitamin E works to prevent cognitive deterioration.

UCLA neuroscientist Fernando Gomez-Pinilla, PhD, says, "Vitamin B9, or folic acid, is particularly important for cognitive function, though we don't yet know why."

Blueberries. One of nature's perfect foods, blueberries are packed with antioxidants and phytochemicals, the compounds that make them a deep-blue color. Blueberries may help maintain peak brain performance by ridding the brain of harmful molecules called free radicals. A recent study indicates that blueberries may improve both learning and working memory.

Nolan recommends two servings (about one and a half cups) of fresh or frozen blueberries a day.

Salmon. "We need fat for our brains," says Nolan. Salmon is the best source of omega-3 fatty acids, healthy fats that studies suggest may aid brain development, protect the brain from deterioration, and enhance brain function. "The brain can't synthesize omega-3s, so they are an essential component for the diet," Gomez-Pinilla says.

He recommends enjoying your salmon Indian style: "Curried salmon gives you omega-3s mixed with turmeric, which is also good for the brain." Both wild-caught and farm-raised salmon provide omega-3s. The American Heart Association recommends two 3.5-ounce servings of fish per week.

Walnuts. While all nuts provide brain fuel in the form of protein and both omega-3 and omega-6 fatty acids, walnuts are best, Nolan says. One study found that students who regularly ate walnuts were better at deductive reasoning. The healthy fat in nuts is still fat, so you don't want to eat too many. Stick to a daily 1-ounce serving -- just enough to fit in the palm of your hand.

Hempseed. Hempseed is a real superfood, Nolan says, adding that it provides brain-powering protein, omega-3s and -6s, and a variety of antioxidants and other nutrients. Often packaged as a powder, the seeds of Cannabis sativa -- better known as hemp -- are totally versatile. Their nutty flavor blends well with lots of breakfast foods and baked goods. Stir a couple of spoonfuls into oatmeal, mix with milk or yogurt, sprinkle on cereal, or bake into muffins. 

source : Top 10 Smart Foods for College Students

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8 Healthy Facts About Grapes

Our guide to the origins, health benefits, and varieties of grapes -- plus a delicious recipe for Grilled Shrimp and Grape Salad.

By Chloe Thompson
WebMD Magazine - Feature

Reviewed by Kathleen M. Zelman, MPH, RD, LD

Grape Origins

Spanish explorers introduced the fruit to America about 300 years ago.

Grapes Are Berries!

Yes, grapes are a kind of berry. They have a leathery covering and a fleshy inside, similar to blueberries.

The Grape Family

There are more than 8,000 grape varieties from about 60 species. The main types are American and European.

Grape Nutrition

One cup of grapes, with about 100 calories, provides more than a quarter of the daily recommended values of vitamins K and C. Grape seeds, which are edible, are chock-full of antioxidants.

Grapes Into Wine

It takes about 2.5 pounds of grapes to make one bottle of wine.

Grapes Into Raisins

Raisins are dried, sweet grapes. The drying occurs naturally when the grapes are left in sunlight.

Origins of Concord Grapes

These plump blue grapes get their name from Concord, MA, where they were developed. They have a distinctive taste and can survive colder climates.

Grape Colors

Grapes come in many colors, including green, red, black, yellow, pink, and purple. "White" grapes are actually green.

Healthy Recipe: Grilled Shrimp and Grape Salad

Makes 4 servings

Ingredients

Dressing

2 Tbsp Champagne or white balsamic vinegar

2 tsp olive oil

¾ tsp Dijon mustard

¼ tsp salt

½ tsp ground pepper

Salad

cooking spray

1 pound large shrimp, peeled and deveined

2 Tbsp chopped walnuts

1 cup shelled edamame

4 cups washed arugula, baby spinach, or mixed greens

1 cup seedless green grapes, halved

1 cup seedless red or black grapes, halved

1 large yellow bell pepper, thinly sliced

¼ cup fresh tarragon, chopped (or 1 tsp dried)

2 Tbsp crumbled goat cheese

¼ cup sliced green onions

Directions

1. To prepare dressing, combine first five ingredients in a jar or blender; process until smooth.
2. Preheat grill or griddle to medium high. Spray with cooking spray. Grill shrimp 2–3 minutes per side with grill cover closed.
3. Preheat toaster oven to 350°F. Spread walnut pieces on a rimmed baking sheet. Bake walnuts for 5 to 8 minutes, stirring every 2 minutes, until just toasted.
4. Combine edamame and 3 Tbsp water in a bowl; cover with plastic wrap. Steam edamame in microwave on high 3 minutes. Let stand 2 minutes; drain.
5. Place shrimp, greens, grapes, edamame, yellow pepper, and tarragon in a large bowl. Drizzle with dressing; toss gently to coat. Garnish salad with goat cheese, walnuts, and green onions.

Per serving: 335 calories, 31 g protein, 25 g carbohydrate, 13 g fat (3 g saturated fat), 176 mg cholesterol, 4 g fiber, 14 g sugar, 372 mg sodium. Calories from fat: 35%

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source : 8 Healthy Facts About Grapes

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Gluten: How to Find It on a Food Label

How to recognize gluten that's not obvious on the label.

By Heather Hatfield
WebMD Feature

Reviewed by Kathleen M. Zelman, MPH, RD, LD

Going gluten-free? Gluten is not always obvious on food labels, so you'll need to get up to speed on gluten's many disguises.

When Katie Falkenmeyer of Sherrill, NY, decided to go gluten-free, the learning curve in front of her was a little daunting. Figuring out which foods were really gluten-free wasn't easy. But after a few trips to the grocery store -- and with the support of her nutritionist -- identifying gluten on an ingredient list is now second nature.

"It took time -- and a lot of ingredient label-reading -- to figure out what foods were gluten-free," Falkenmeyer says.

You probably know that gluten -- a protein -- is in anything containing wheat, rye, triticale, or barley. But did you know it's also in some less obvious products, such as lunch meats and soy sauce?  

Here's what to look for.

Gluten-Free Diet Slideshow

Going Gluten-Free?

Some people go gluten-free because they have celiac disease, which damages the small intestine and makes it harder to absorb nutrients from food. People who have celiac disease can't tolerate gluten.

Others avoid gluten because they're sensitive to it, but don't have celiac disease.

"If someone has celiac disease or a gluten-sensitivity, the solution is pretty much black and white," says Daniel Leffler, MD, director of research at Boston's Celiac Center at Beth Israel Deaconess Medical Center. "They need to eliminate gluten from their diet totally in order to experience an improvement in their health."

Sticking to a gluten-free diet can be tricky -- but it's possible.

Gluten Ingredients

Checking the ingredient label for wheat, barley, and rye is just the beginning. Gluten also goes by other names, and some of them aren't that obvious.

"Reading the ingredients label on the foods you buy and knowing what to look for are the keys to identifying and avoiding gluten," says Shelley Case, RD, author of Gluten-Free Diet: A Comprehensive Resource Guide.

Here are some of gluten's guises on ingredient labels, according to Case's book:

• Barley (flakes, flour, pearl)
• Breading and bread stuffing
• Brewer's yeast
• Bulgur
• Durum (type of wheat)
• Farro/Faro (also known as spelt or dinkel)
• Graham flour
• Hydrolyzed wheat protein 
• Kamut (a type of wheat)
• Malt, malt extract, malt syrup, and malt flavoring
• Malt vinegar
• Malted milk
• Matzo, matzo meal
• Modified wheat starch
• Oatmeal, oat bran, oat flour, and whole oats (unless they are from pure, uncontaminated oats)
• Rye bread and flour
• Seitan (a meat-like food derived from wheat gluten used in many vegetarian dishes)
• Semolina
• Spelt (a type of wheat also known as farro, faro, or dinkel)
• Triticale
• Wheat bran
• Wheat flour
• Wheat germ
• Wheat starch

These other ingredients may be less familiar to you, but they also contain gluten:

• Atta (chapati flour)
• Einkorn (type of wheat)
• Emmer (type of wheat)
• Farina
• Fu (a dried gluten product made from wheat and used in some Asian dishes)

source : Gluten: How to Find It on a Food Label

Read more →

8 Healthy Facts About Grapes

Our guide to the origins, health benefits, and varieties of grapes -- plus a delicious recipe for Grilled Shrimp and Grape Salad.

By Chloe Thompson
WebMD Magazine - Feature

Reviewed by Kathleen M. Zelman, MPH, RD, LD

Grape Origins

Spanish explorers introduced the fruit to America about 300 years ago.

Grapes Are Berries!

Yes, grapes are a kind of berry. They have a leathery covering and a fleshy inside, similar to blueberries.

The Grape Family

There are more than 8,000 grape varieties from about 60 species. The main types are American and European.

Grape Nutrition

One cup of grapes, with about 100 calories, provides more than a quarter of the daily recommended values of vitamins K and C. Grape seeds, which are edible, are chock-full of antioxidants.

Grapes Into Wine

It takes about 2.5 pounds of grapes to make one bottle of wine.

Grapes Into Raisins

Raisins are dried, sweet grapes. The drying occurs naturally when the grapes are left in sunlight.

Origins of Concord Grapes

These plump blue grapes get their name from Concord, MA, where they were developed. They have a distinctive taste and can survive colder climates.

Grape Colors

Grapes come in many colors, including green, red, black, yellow, pink, and purple. "White" grapes are actually green.

Healthy Recipe: Grilled Shrimp and Grape Salad

Makes 4 servings

Ingredients

Dressing

2 Tbsp Champagne or white balsamic vinegar

2 tsp olive oil

¾ tsp Dijon mustard

¼ tsp salt

½ tsp ground pepper

Salad

cooking spray

1 pound large shrimp, peeled and deveined

2 Tbsp chopped walnuts

1 cup shelled edamame

4 cups washed arugula, baby spinach, or mixed greens

1 cup seedless green grapes, halved

1 cup seedless red or black grapes, halved

1 large yellow bell pepper, thinly sliced

¼ cup fresh tarragon, chopped (or 1 tsp dried)

2 Tbsp crumbled goat cheese

¼ cup sliced green onions

Directions

1. To prepare dressing, combine first five ingredients in a jar or blender; process until smooth.
2. Preheat grill or griddle to medium high. Spray with cooking spray. Grill shrimp 2–3 minutes per side with grill cover closed.
3. Preheat toaster oven to 350°F. Spread walnut pieces on a rimmed baking sheet. Bake walnuts for 5 to 8 minutes, stirring every 2 minutes, until just toasted.
4. Combine edamame and 3 Tbsp water in a bowl; cover with plastic wrap. Steam edamame in microwave on high 3 minutes. Let stand 2 minutes; drain.
5. Place shrimp, greens, grapes, edamame, yellow pepper, and tarragon in a large bowl. Drizzle with dressing; toss gently to coat. Garnish salad with goat cheese, walnuts, and green onions.

Per serving: 335 calories, 31 g protein, 25 g carbohydrate, 13 g fat (3 g saturated fat), 176 mg cholesterol, 4 g fiber, 14 g sugar, 372 mg sodium. Calories from fat: 35%

Find more articles, browse back issues, and read the current issue of

source : 8 Healthy Facts About Grapes

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7 Healthy Facts About Radishes

Though it's small in size, the earthy radish brings big flavor to the table. Try it in our Red Radish and Greens Salad recipe.

By Ana Ferrer
WebMD Magazine - Feature

Reviewed by Kathleen M. Zelman, MPH, RD, LD

History of Radishes

First cultivated in China, radish crops spread through the Northern Hemisphere and into Europe in the 1500s. Radishes had reached Massachusetts by 1629.

The Radish Family

Radishes are members of the Brassicaceae (mustard or cabbage) family. The root is related to kale, broccoli, cauliflower, and horseradish, among others.

Radish Calories

Radishes are a great low-cal snack; one cup of sliced radishes has only 19 calories.

Radishes and Wasabi

Radishes are related to wasabi, a type of horseradish, which in paste form is a staple condiment of Japanese cuisine.

Radish Production

Most states grow radishes, but California and Florida boast the biggest crops in the United States.

Radish Cultivation

Because they grow rapidly, radish plants are ideal for children's gardens. The scientific name for the genus that includes radishes is Raphanus, Greek for "quickly appearing."

Radish Varieties

Several varieties of radishes are available year-round. They vary in size, taste, and color but share nutritional values.

Red Radish and Greens Salad

Makes four servings.

Ingredients:

Dressing

1 Tbsp lime juice

2 Tbsp orange juice

1 Tbsp white balsamic vinegar (or red wine vinegar)

3 Tbsp walnut or olive oil

1 tsp Dijon mustard

¼ tsp pepper

dash of salt

Salad

4 cups mixed greens

1 cup thinly sliced red radishes

1 large apple, quartered, cut into julienne strips

1 orange, peeled, membranes removed and separated into sections

½ cup shredded carrots

½ cup jicama, peeled, cut into julienne strips

¼ cup coarsely chopped walnuts, toasted

¼ cup feta cheese

Directions

1. Place dressing ingredients in a large bowl, whisk together, and set aside.

2. Combine greens, sliced radishes, apple strips, orange sections, shredded carrots, and jicama strips in a large salad bowl.

3. Toss salad with dressing and place on four plates.

4. Garnish each plate with walnuts and feta cheese.

Per serving: 248 calories, 5 g protein, 8 g carbohydrate, 18 g fat (3 g saturated fat), 8 mg cholesterol, 5 g fiber, 13 g sugar, 175 mg sodium. Calories from fat: 62%.

source : 7 Healthy Facts About Radishes

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Should You Sprout Your Grains, Nuts, and Legumes?

What to know about sprouting grains, nuts, and legumes.

By Tammy Worth
WebMD Feature

Reviewed by Kathleen M. Zelman, MPH, RD, LD

Sprouts are making a comeback, and not just at the salad bar.

You may have read that sprouts are packed with nutrients and are easy to digest. But you may also have heard about food safety issues and recalls of sprouts.

So should you sprout your grains, nuts, and beans, or skip this trend?

What Is Sprouting?

Seeds sprout after a few days in a warm, moist climate. The process usually lasts 3 to 7 days, depending upon the conditions and kind of seeds being used.

You've probably heard of bean sprouts. But many foods can be sprouted, according to the International Sprout Growers Association, including:

• Grains, such as barley, wheat, and spelt
• Legumes, such as lentils, peas, and pinto, kidney, and lima beans
• Radish and broccoli seeds

Some people also sprout nuts, including almonds, cashews, walnuts, and peanuts.

Sprouting Chemistry

Sprouts are said to be more nutritious than their unsprouted counterparts.

When a seed germinates, a chemical reaction takes place. This process is thought to make it easier for a body to absorb nutrients including iron, zinc, and vitamin C, says Reem Jabr, RD, a nutrition therapist in the Boston area.

Sprouts may have some other nutritional perks. Steve Schwartz, PhD, an Ohio State University professor of food science, has studied broccoli sprouts and their possible link to cancer prevention.

Broccoli sprouts, Schwartz says, contain compounds called glucosinolates. When eaten, those compounds convert to isothiocyanates, which curbed the growth of bladder cancer cells in lab tests on animals.

"Sprouts have a higher concentration of these compounds [glucosinolates] than broccoli itself," Schwartz says. "There are a number of animal studies that show they have reduced the number and size of tumors, and there is a lot of interest in how that could translate into the human diet."

But it's too soon to know if that also happens in people.

Digestion Benefit

Sprouts may be easier to digest than the unsprouted version of the same food.

Sprouting breaks down a seed. That means less work for your digestive system, says Elisabetta Politi, RD, nutrition director at the Duke Diet & Fitness Center in Durham, NC.

"It would be a good choice for someone with a sensitive gut," she says. "For people with problems digesting certain foods, sprouted germs might seem better for them, and they are less allergenic to people with grain protein sensitivities."

This was the case for Avery Pittman, a 22-year-old senior at the University of Vermont. In high school, Pittman took methacycline for acne, which she says led to a lot of "gastrointestinal issues." Having tried various kinds of diets, she says that eating sprouts helps her prevent stomach problems.

Pittman buys mung beans (a small, greenish legume) and lentils in bulk and sprouts them herself. She eats them in salads and tries to eat them daily.

"They are pretty energizing and I enjoy the taste of them," she says. "I feel better when I eat them. I know some foods cause me to have stomachaches, but these prevent it."

source : Should You Sprout Your Grains, Nuts, and Legumes?

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7 Healthy Facts About Radishes

Though it's small in size, the earthy radish brings big flavor to the table. Try it in our Red Radish and Greens Salad recipe.

By Ana Ferrer
WebMD Magazine - Feature

Reviewed by Kathleen M. Zelman, MPH, RD, LD

History of Radishes

First cultivated in China, radish crops spread through the Northern Hemisphere and into Europe in the 1500s. Radishes had reached Massachusetts by 1629.

The Radish Family

Radishes are members of the Brassicaceae (mustard or cabbage) family. The root is related to kale, broccoli, cauliflower, and horseradish, among others.

Radish Calories

Radishes are a great low-cal snack; one cup of sliced radishes has only 19 calories.

Radishes and Wasabi

Radishes are related to wasabi, a type of horseradish, which in paste form is a staple condiment of Japanese cuisine.

Radish Production

Most states grow radishes, but California and Florida boast the biggest crops in the United States.

Radish Cultivation

Because they grow rapidly, radish plants are ideal for children's gardens. The scientific name for the genus that includes radishes is Raphanus, Greek for "quickly appearing."

Radish Varieties

Several varieties of radishes are available year-round. They vary in size, taste, and color but share nutritional values.

Red Radish and Greens Salad

Makes four servings.

Ingredients:

Dressing

1 Tbsp lime juice

2 Tbsp orange juice

1 Tbsp white balsamic vinegar (or red wine vinegar)

3 Tbsp walnut or olive oil

1 tsp Dijon mustard

¼ tsp pepper

dash of salt

Salad

4 cups mixed greens

1 cup thinly sliced red radishes

1 large apple, quartered, cut into julienne strips

1 orange, peeled, membranes removed and separated into sections

½ cup shredded carrots

½ cup jicama, peeled, cut into julienne strips

¼ cup coarsely chopped walnuts, toasted

¼ cup feta cheese

Directions

1. Place dressing ingredients in a large bowl, whisk together, and set aside.

2. Combine greens, sliced radishes, apple strips, orange sections, shredded carrots, and jicama strips in a large salad bowl.

3. Toss salad with dressing and place on four plates.

4. Garnish each plate with walnuts and feta cheese.

Per serving: 248 calories, 5 g protein, 8 g carbohydrate, 18 g fat (3 g saturated fat), 8 mg cholesterol, 5 g fiber, 13 g sugar, 175 mg sodium. Calories from fat: 62%.

source : 7 Healthy Facts About Radishes

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What Your Parents Got Wrong About Food

Dessert as a reward, snacks that wreck your appetite, and other parental nutrition myths.

By Lisa Fields
WebMD Feature

Reviewed by Kathleen M. Zelman, MPH, RD, LD

Are you still following eating maxims that your parents taught you decades ago? It's time to see if that advice stands up to the test of time -- or if some of the things your parents taught you about food are your family's diet myths.

Diet myths are "handed down for generations," says Kathleen Fuller, PhD, author of Not Your Mother's Diet. "To undo a myth or belief, it takes some practice."

Here are five outdated ideas about food that you may have learned from your parents -- and the grown-up realities.

1. No snacking! You'll ruin your appetite!

If you heard this when you were a kid, you should know that the thinking about snacking has grown up.

Snacking can be healthy and help meet nutrient requirements, as long as you choose wisely and don't wreck your calorie budget.

"It keeps blood sugar stable" and keeps you from getting too hungry between meals, says Debra Waterhouse, RD, author of Outsmarting the Mother-Daughter Food Trap.

Of course, you can't just snack with abandon. Those calories count, and you want the biggest nutritional payoff per calorie. So some types of snacks are better options than others.

Update: Try cutting back slightly on meals to allow for one or two daily snacks between 100 and 200 calories. Healthy options include nuts, fruit, yogurt, vegetables with dip, or other low-fat, low-sugar, high-fiber options.

"My general rule is going no longer than 4 hours without eating something, whether a meal or a snack," says Constance Brown-Riggs, RD, a spokeswoman for the Academy of Nutrition and Dietetics.

2. Finish everything on your plate.

Did you grow up hearing that at every dinner? Did your parents make you stay at the dinner table until you'd finished everything on your plate? And are you still eating that way today? If so, you may not be heeding your body's signals that you're full and that it's OK to stop eating.

"I'm constantly telling my patients, 'You don't have to join the Clean Plate Club,'" Brown-Riggs says. "It's fine to leave a little food over and not eat mindlessly. Get in tune with your body to know when you've had enough."

Update: Try leaving something on your plate. But more importantly, stay in tune with how you're feeling. Are you full? Are you eating just because there is still food on your plate? Be particularly careful when you're eating out -- the food is appealing, the plates are huge, and you may want to eat it all because you paid for it. "The Clean Plate Club is usually more of a problem when you're eating out," Brown-Riggs says. "If there are large portions, ask for half now and have them box the other half, so you don't run into trouble."

source : What Your Parents Got Wrong About Food

Read more →

What Your Parents Got Wrong About Food

Dessert as a reward, snacks that wreck your appetite, and other parental nutrition myths.

By Lisa Fields
WebMD Feature

Reviewed by Kathleen M. Zelman, MPH, RD, LD

Are you still following eating maxims that your parents taught you decades ago? It's time to see if that advice stands up to the test of time -- or if some of the things your parents taught you about food are your family's diet myths.

Diet myths are "handed down for generations," says Kathleen Fuller, PhD, author of Not Your Mother's Diet. "To undo a myth or belief, it takes some practice."

Here are five outdated ideas about food that you may have learned from your parents -- and the grown-up realities.

1. No snacking! You'll ruin your appetite!

If you heard this when you were a kid, you should know that the thinking about snacking has grown up.

Snacking can be healthy and help meet nutrient requirements, as long as you choose wisely and don't wreck your calorie budget.

"It keeps blood sugar stable" and keeps you from getting too hungry between meals, says Debra Waterhouse, RD, author of Outsmarting the Mother-Daughter Food Trap.

Of course, you can't just snack with abandon. Those calories count, and you want the biggest nutritional payoff per calorie. So some types of snacks are better options than others.

Update: Try cutting back slightly on meals to allow for one or two daily snacks between 100 and 200 calories. Healthy options include nuts, fruit, yogurt, vegetables with dip, or other low-fat, low-sugar, high-fiber options.

"My general rule is going no longer than 4 hours without eating something, whether a meal or a snack," says Constance Brown-Riggs, RD, a spokeswoman for the Academy of Nutrition and Dietetics.

2. Finish everything on your plate.

Did you grow up hearing that at every dinner? Did your parents make you stay at the dinner table until you'd finished everything on your plate? And are you still eating that way today? If so, you may not be heeding your body's signals that you're full and that it's OK to stop eating.

"I'm constantly telling my patients, 'You don't have to join the Clean Plate Club,'" Brown-Riggs says. "It's fine to leave a little food over and not eat mindlessly. Get in tune with your body to know when you've had enough."

Update: Try leaving something on your plate. But more importantly, stay in tune with how you're feeling. Are you full? Are you eating just because there is still food on your plate? Be particularly careful when you're eating out -- the food is appealing, the plates are huge, and you may want to eat it all because you paid for it. "The Clean Plate Club is usually more of a problem when you're eating out," Brown-Riggs says. "If there are large portions, ask for half now and have them box the other half, so you don't run into trouble."

source : What Your Parents Got Wrong About Food

Read more →

Your dog can tell you a lot by the way he acts. Know what to look for.

By Suz Redfearn
WebMD Feature

Reviewed by Amy Flowers, DVM

How many times have you wished your dog could talk so you could know exactly what he’s thinking?

But he doesn’t need to speak to clue you in. Veterinary behaviorists say if you learn to read your dog’s actions, it’s not hard to figure out what’s going on in his head.

Debra Horwitz, veterinary behaviorist and lead editor of Decoding Your Dog, says the key is looking at your whole dog, rather than a portion of him, like just his tail. Observing what your dog does with his face, body, and tail in any given situation will let you know if he’s feeling relaxed, concerned, scared, or aggressive.

When you look at your dog, what do you see?

Is he happy?

“When a dog is happy, his whole body looks soft,” Horwitz says. “And when a happy dog wags his tail, the tail wags his whole body. He has relaxed ears, a soft pant, eyes are soft. Everything about him says, ‘I’m cool. I’m good.’”

Is he interested and stimulated?

A dog that’s doing what his genes tell him to is a happy dog, Horwitz says. When a retriever is fetching, her body language screams, “I’m totally into this!” Same thing goes for a terrier who gets a chance to sniff out a critter or whip a new toy back and forth, and a border collie that’s being directed through an obstacle course. Presented with a mere hint of these activities, the dog may run out of pure joy, wag its tail, bark, grin, and spin in circles.

Once you find out what makes your dog happy in this way, offer him this activity as often as you can.

Is he concerned?

Let’s say you’re outside with your dog, and another dog suddenly shows up on the scene. If your dog doesn’t know this dog, he’s likely to show his concern by stiffening his tail and wagging it in a way that doesn’t wag the body.

“That kind of tail wag says, ‘I’m thinking, I’m assessing,’” Horwitz says.

The wagging tail may go straight up, which shows a heightened alert.

When a little nervous, your dog may draw his ears closer to his head and pant a little faster, or may close his mouth to enable him to sniff to check everything out. He may also open his eyes wider to let in more light.

Is he fearful?

Dog owners often confuse fear in a dog with shame or guilt, says Melissa Bain, assistant professor of clinical animal behavior at UC Davis School of Veterinary Medicine.

You come home from work to find your dog has had an accident in the house, or maybe he’s chewed your shoe. You express strong disapproval, giving him a stern talking-to. He reacts by holding his body close to the ground, pinning his ears back, and tucking his tail between his legs.

source : Your dog can tell you a lot by the way he acts. Know what to look for.

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Most Teens With Fibromyalgia Suffer Pain, Fatigue as Adults

Four of five continued to experience symptoms, while half had full-blown disorder, study finds

WebMD News from HealthDay

By Dennis Thompson

HealthDay Reporter

WEDNESDAY, Feb. 26, 2014 (HealthDay News) -- Four out of five teens suffering from juvenile fibromyalgia will continue to have pain and other symptoms in adulthood, a new study finds.

About half of these children will end up as grown-ups with full-blown adult fibromyalgia, the researchers found.

"Half of the former teens we studied met the full criteria for adult fibromyalgia, and another 35 percent of them continued to have symptoms of fatigue, pain and sleep difficulty, but did not meet all the criteria for fibromyalgia syndrome," said study author Susmita Kashikar-Zuck, research director in behavioral medicine and clinical psychology at Cincinnati Children's Hospital Medical Center.

The study, published in the March print issue of Pediatrics, stemmed from research into juvenile fibromyalgia, Kashikar-Zuck said.

Fibromyalgia is a mysterious disorder that causes muscle pain and fatigue. People with the syndrome complain of sensitive places in their body that hurt when pressure is applied.

"It appears to be caused by a pain hypersensitivity in the central nervous system," Kashikar-Zuck said. "It's sort of like the volume is turned up on pain, and now they are exquisitely sensitive to pain."

Doctors aren't certain what causes fibromyalgia, although genetics may play a role. "Many of the children we see who have fibromyalgia have a parent with fibromyalgia," Kashikar-Zuck noted.

Between 80 percent and 90 percent of fibromyalgia patients are female, according to the U.S. National Institutes of Health.

Juvenile fibromyalgia can drastically affect a teen's life, causing missed school days and withdrawal from social activities, Kashikar-Zuck said.

Researchers wondered if these problems continued into adulthood, and decided to follow a group of 94 teenagers with juvenile fibromyalgia for six years. The teens were diagnosed with the disease between 2002 and 2010, with an average age at diagnosis of 15.

The study authors found that 51 percent of the patients, now young adults with an average age of 21, continued to have symptoms that meet the American College of Rheumatology's criteria for adult fibromyalgia.

More than one-third did not meet the standards for a full diagnosis but still complained of specific symptoms related to fibromyalgia. These included pain, fatigue and difficulty sleeping.

When compared to healthy young adults their age, the patients who had experienced juvenile fibromyalgia reported significantly higher pain, poorer physical function, greater anxiety and more visits to the doctor.

Dr. Anne Eberhard, a pediatric rheumatologist at Cohen Children's Medical Center of New York in New Hyde Park, said these results make sense given the major role that stress plays in fibromyalgia.

"It is not surprising that the symptoms are still seen and persist into early adulthood, where major life decisions are being made," Eberhard said.

The study also found that juvenile fibromyalgia patients were more likely to be married as young adults compared with healthy folks their age, but were less likely to have attended college. About 62 percent had attended some college or obtained a degree, compared with 76 percent of the healthy control group.

source : Most Teens With Fibromyalgia Suffer Pain, Fatigue as Adults

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Necks, Butts Growth Areas for U.S. Plastic Surgeons

By Mary Elizabeth Dallas

HealthDay Reporter

WEDNESDAY, Feb. 26, 2014 (HealthDay News) -- Eyelid surgery and facelifts are up. So are butt augmentations and neck lifts, according to new figures from the American Society of Plastic Surgeons that show a steady increase in cosmetic and reconstructive surgery procedures in the United States.

This was the fourth consecutive year of growth, the society reported, noting more than 15 million cosmetic surgeries and minimally invasive procedures were performed in 2013, an increase of 3 percent from the year before.

Nose jobs, liposuction and laser hair removal missed the boom, however. These procedures declined from the previous year, the report said.

Meanwhile, reconstructive surgeries increased by 2 percent, the society reported.

Better technology and new products, including a facial filler that uses hyaluronic acid to treat mid-face volume loss as well as two types of silicone gel breast implants recently approved by the U.S. Food and Drug Administration, are likely the reason behind the upward trend, the society noted.

"The demand for plastic surgery remains strong, with our statistics showing increases in both cosmetic surgical and minimally invasive procedures," said society president Dr. Robert Murphy.

"Facial rejuvenation procedures were especially robust last year, with more Americans opting for facelifts, forehead lifts, eyelid surgery, fillers and peels," Murphy said in a society news release. "With new devices and products hitting the market each year, there are more options and choices available to consumers wanting to refresh their look or [undergo] a little nip and tuck."

Of the 13.4 million minimally invasive procedures performed in 2013, the most common included:

• Botox injections: 6.3 million injections, up 3 percent
• Soft tissue fillers: 2.2 million procedures, up 13 percent
• Chemical peels: 1.2 million procedures, up 3 percent

With more people taking steps to smooth out their wrinkles and folds, the report noted that Botox injections jumped 700 percent since 2000. And hyaluronic acid facial fillers have increased 18 percent since 2012.

There were also 1.7 million cosmetic surgeries in 2013, up 1 percent from a year ago. Among the most common procedures:

• Breast augmentation: 290,000 procedures, up 1 percent
• Nose jobs: 221,000 procedures, down 9 percent
• Eyelid surgery: 216,000 procedures, up 6 percent
• Liposuction: 200,000 procedures, down 1 percent
• Facelifts: 133,000 procedures, up 6 percent

Silicone implants were used in 72 percent of all breast augmentations, while saline implants were chosen for 28 percent of these surgeries. The experts noted new technology offers women more natural looking and feeling results.

Butt augmentation with fat grafting and neck lifts are two new procedures also on the rise in the United States, according to the report.

There were 10,000 butt augmentation procedures performed in 2013, up 16 percent from 2012. More than 55,000 neck lifts were also performed last year, up 6 percent from the year before.

Reconstructive plastic surgery to improve both the appearance and function of abnormalities also increased 2 percent in 2013. The top reconstructive procedures performed last year include: tumor removal, up 5 percent from 2012; laceration repair, with 254,000 procedures; and scar revision.

Breast reconstruction, with 96,000 procedures, was up 4 percent last year.

"It's promising to see breast reconstruction rates rising," noted Murphy. "Less than 20 percent of breast cancer patients undergo breast reconstruction because they are not always informed of their options, although studies show that reconstruction greatly improves quality of life."

source : Necks, Butts Growth Areas for U.S. Plastic Surgeons

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U.S. Obesity Rate Shows Signs of Leveling Off

CDC study finds very young children seem to be slimming down, but more older women are obese

WebMD News from HealthDay

By Mary Brophy Marcus

HealthDay Reporter

TUESDAY, Feb. 25, 2014 (HealthDay News) -- Obesity still looms large in the United States but the scale's relentless climb may have leveled off, according to the latest results of a U.S. Centers for Disease Control and Prevention study.

One-third of adults and 17 percent of children and teens are obese, said CDC researchers who focused on more than 9,000 adults and children in 2011-2012 and compared them to five previous obesity analyses dating back to 2003-04.

"We found overall that there was no change in youth or adults," said study author and epidemiologist Cynthia Ogden.

But within specific age groups, weight shifts were apparent. More older women are obese, but very young children seem to be slimming down.

One specialist in childhood obesity was pleased with the overall findings.

"I tend to be an optimist. The fact that we are seeing a leveling off is actually a good thing," said Dr. Sara Lappe, a pediatrician at Cleveland Clinic Children's who specializes in childhood obesity.

Obesity in adults is defined as a body mass index (BMI) of 30 or above. BMI is a calculation of body fat based on height and weight. A 5-foot 9-inch adult who weighs 203 pounds has a BMI of 30 and is considered obese, for example.

Obesity in kids is defined as a child who has a BMI at or above the 95th percentile for children of the same age and sex.

Ogden said the results for preschool-age children are a bright spot in the findings.

"We found among preschoolers, 2- to 5-year-olds, there was a significant decrease in obesity," Ogden said. Prevalence of obesity in children that age dipped from 14 percent in 2003-2004 to about 8 percent in 2011-2012, she noted.

Cleveland Clinic's Lappe said: "I think this piece of the study is actually good. There are a lot of early intervention programs in Head Start and preschools, and education directly to parents that may be starting to pay off."

"Hopefully," Lappe added, "as they [the children] get older, we'll see the numbers come down."

The authors of the study, published in the Feb. 26 issue of the Journal of the American Medical Association, report that many preventive health programs and efforts have been launched by the government in recent years to combat the obesity epidemic in the United States.

These include new food labeling measures by the U.S. Department of Agriculture, as well as state and community programs sponsored by the CDC, and First Lady Michelle Obama's Let's Move program.

Even so, the overall numbers haven't inched down. In fact, obesity prevalence ticked up in women 60 and older, from less than 32 percent in 2003-2004 to more than 38 percent in 2011-2012.

source : U.S. Obesity Rate Shows Signs of Leveling Off

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FDA Explores '3-Person' Embryo Fertilization

Meant to prevent genetic diseases in children, the procedure raises ethical issues

WebMD News from HealthDay

By Dennis Thompson

HealthDay Reporter

TUESDAY, Feb. 25, 2014 (HealthDay News) -- U.S. Food and Drug Administration hearings opened Tuesday on a controversial fertilization technique that uses the DNA from three people -- two women and one man -- with the goal of preventing inherited genetic diseases.

The technique involves the unfertilized eggs, or "oocytes," from two females. Parts of each egg are combined to weed out inherited genetic disorders contained in one woman's DNA, and the resulting healthy egg is then fertilized using a male's sperm.

The FDA's two-day hearing is meant to provide a forum for discussing how this technique might be tested in human clinical trials.

But the discussion is expected to veer into the ethics of manipulating human genetics to produce "perfect" babies.

"The potential benefits are huge, but the potential harms are also huge," said Dr. Michelle Huckaby Lewis, a faculty member at the Johns Hopkins Berman Institute of Bioethics and the Genetics and Public Policy Center, in Washington, D.C.

The procedure could have unintended health consequences both for newborns and for future generations, as the genetic tinkering reverberates through time, Lewis said.

In addition, she said, the technique raises troubling questions of parental rights and family structure.

"When you use a technology in a new way like this, it really challenges our notions of what it means to be a parent and what it means to be a family," Lewis said.

The hearing was prompted by the work of Shoukhrat Mitalipov, an associate scientist at Oregon Health & Science University (OHSU).

Mitalipov has used the fertilization technique to produce five healthy monkeys, and is seeking FDA approval to begin human trials involving women who carry defective genes that could pass on severe illnesses to their children.

He is on hand at the hearing to explain the process, which he described Monday to the Associated Press as "gene correction" rather than "gene modification."

"We want to replace these mutated genes, which by nature have become pathogenic to humans," Mitalipov told the AP. "We're reversing them back to normal, so I don't understand why you would be opposing that."

The procedure is aimed at preventing illness caused by defective DNA in a mother's mitochondria, the tiny structures that produce energy to power individual cells.

During reproduction, an embryo inherits nearly all the maternal mitochondria present in the egg. That means any genetic mutations present in the mitochondria will be passed on from mother to child, according to the OHSU website.

About one in every 5,000 American children inherits genetic illnesses from their mother's mitochondrial DNA. These diseases can lead to health problems as far-ranging as blindness, organ failure, epilepsy, cancer and diabetes, the OHSU noted.

The new technique seeks to avoid this by using an egg from a healthy female donor that contains undamaged mitochondria. The nucleus DNA of the prospective mother is implanted into the donated egg, replacing the nucleus DNA of the donor.

source : FDA Explores '3-Person' Embryo Fertilization

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U.S. Obesity Rate Shows Signs of Leveling Off

CDC study finds very young children seem to be slimming down, but more older women are obese

WebMD News from HealthDay

By Mary Brophy Marcus

HealthDay Reporter

TUESDAY, Feb. 25, 2014 (HealthDay News) -- Obesity still looms large in the United States but the scale's relentless climb may have leveled off, according to the latest results of a U.S. Centers for Disease Control and Prevention study.

One-third of adults and 17 percent of children and teens are obese, said CDC researchers who focused on more than 9,000 adults and children in 2011-2012 and compared them to five previous obesity analyses dating back to 2003-04.

"We found overall that there was no change in youth or adults," said study author and epidemiologist Cynthia Ogden.

But within specific age groups, weight shifts were apparent. More older women are obese, but very young children seem to be slimming down.

One specialist in childhood obesity was pleased with the overall findings.

"I tend to be an optimist. The fact that we are seeing a leveling off is actually a good thing," said Dr. Sara Lappe, a pediatrician at Cleveland Clinic Children's who specializes in childhood obesity.

Obesity in adults is defined as a body mass index (BMI) of 30 or above. BMI is a calculation of body fat based on height and weight. A 5-foot 9-inch adult who weighs 203 pounds has a BMI of 30 and is considered obese, for example.

Obesity in kids is defined as a child who has a BMI at or above the 95th percentile for children of the same age and sex.

Ogden said the results for preschool-age children are a bright spot in the findings.

"We found among preschoolers, 2- to 5-year-olds, there was a significant decrease in obesity," Ogden said. Prevalence of obesity in children that age dipped from 14 percent in 2003-2004 to about 8 percent in 2011-2012, she noted.

Cleveland Clinic's Lappe said: "I think this piece of the study is actually good. There are a lot of early intervention programs in Head Start and preschools, and education directly to parents that may be starting to pay off."

"Hopefully," Lappe added, "as they [the children] get older, we'll see the numbers come down."

The authors of the study, published in the Feb. 26 issue of the Journal of the American Medical Association, report that many preventive health programs and efforts have been launched by the government in recent years to combat the obesity epidemic in the United States.

These include new food labeling measures by the U.S. Department of Agriculture, as well as state and community programs sponsored by the CDC, and First Lady Michelle Obama's Let's Move program.

Even so, the overall numbers haven't inched down. In fact, obesity prevalence ticked up in women 60 and older, from less than 32 percent in 2003-2004 to more than 38 percent in 2011-2012.

source : U.S. Obesity Rate Shows Signs of Leveling Off

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Retail Clinics for Kids: No Sub for Pediatricians

By Rita Rubin
WebMD Health News

Reviewed by Hansa D. Bhargava, MD

Feb. 25, 2014 -- Like many busy parents, Ellen Hoffman likes the convenience of the MinuteClinic, a handful of which can be found in CVS pharmacies within a few miles of her home in Bethesda, MD.

Her two daughters, 14 and 12, often get ear infections or colds that are going around. “I used to take them [to MinuteClinic] all the time because my pediatrician’s office was a pain in the neck,” Hoffman says. “I could never get in there.”

Eventually, though, her local MinuteClinics became so popular that their wait times were as long as those at the pediatrician’s office. Still, Hoffman says, she takes her girls to MinuteClinics in Florida when they come down with something while visiting their grandparents.

“It’s better than not having that resource, but it doesn’t replace having your own doctor,” Hoffman says.

That’s the message the American Academy of Pediatrics (AAP) is trying to get through to parents in a new update of its 2006 policy statement about retail-based clinics in pharmacies, supermarkets, and “big box” stores.  The group continues to oppose the retail clinics, calling them “an inappropriate source of primary care for pediatric patients.”

Compared to 2006, “there’s a lot more of them, and our patients are using them,” says Geoffrey Simon, MD, a pediatrician in Wilmington, DE. He chairs the AAP’s Committee on Practice and Ambulatory Medicine, which issued the updated statement. 

While most retail clinic patients are adults, polls cited in the policy statement found that 15% of children were likely to be taken to one.

Advice for Parents

Consider these tips if you take your child to a retail clinic:

• They're designed only to handle common illnesses such as pinkeye, strep throat, and ear infections, as well as minor injuries. They're not meant to replace primary care doctors.
• Tell the health-care provider at the clinic if your child is allergic to any medications.
• Bring contact information for your child’s doctor so the clinic can forward information about the visit.

According to CVS, MinuteClinic is the largest and fastest-growing retail clinic provider in the country, with more than 800 locations inside CVS pharmacies in 28 states and the District of Columbia. They're staffed by nurse practitioners and physician assistants -- they are not doctors but are licensed to practice medicine. 

Walgreens runs about 400 Healthcare Clinics staffed by nurse practitioners in 20 states and the District of Columbia. And nearly 100 Walmart stores in 20 states offer clinics that are owned and run by independent companies.

source : Retail Clinics for Kids: No Sub for Pediatricians

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New ACA Insurance Causes Headaches In Some Doctors' Offices

By Jenny Gold

Mon, Feb 24 2014

Sheila Lawless is the office manager at a small rheumatology practice in Wichita Falls, Texas, about two hours outside of Dallas. She makes sure everything in the office runs smoothly – scheduling patients, collecting payments, keeping the lights on. Recently she added another duty--incorporating the trickle of patients with insurance plans purchased on the new Affordable Care Act exchanges. 

Open enrollment doesn’t end until March 31, but people who have already bought Obamacare plans are beginning to use them. “We had a spattering in January—maybe once a week. But I think we’re averaging two to three a day now,” says Lawless. 

That doesn’t sound like many new customers, but it’s presented a major challenge: verifying that these patients have insurance. Each exchange patient has required the practice to spend an hour or more on the phone with the insurance company. “We’ve been on hold for an hour, an hour and 20, an hour and 45, been disconnected, have to call back again and repeat the process,” she explains. Those sorts of hold times add up fast. 

In the past, offices have been able to make sure patients are insured quickly, by using an online verification system. But for exchange patients, practices also have to call the insurer to make sure the patient has paid his premium. If he hasn’t, the insurance company can refuse to pay the doctor for the visit, or come back later and recoup a payment it made. 

That’s because of a provision of the law that gives exchange patients who neglect to pay their premium a “grace period” of up to 90 days. During the first 30 days, insurers have to pay any claims incurred by the patient. But for the next 60 days, nothing is guaranteed. If the patient visits the doctor, the insurer can “pend” the claim – that is, wait to pay the doctor until the patient pays his premium. At the end of the 90-day grace period, if the patient has not paid the premium, the insurer can cancel the coverage and refuse to pay the pended claims, or recoup the payments it’s already made.  And that puts the doctor’s office at risk. 

So Lawless is checking first with the insurer to make sure that everything is in order before proceeding with the visit. If the premium has not been paid, Lawless gives the patient the option of rescheduling the appointment or paying in cash and then applying to his insurer for the payment. 

“Most small practices run lean and mean – you’ve got one or two people to do this process plus do their other job duties that day as well, which is tend to the patients in front of them,” says Lawless. To manage the new workload, she’s had other staffers, including nurses, step in to answer the phone. And that means longer hours, more overtime, and higher overhead expenses. And then there’s the plain old annoyance factor. 

source : New ACA Insurance Causes Headaches In Some Doctors' Offices

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