Think you know the rules of health? Sure, staying off the sugar, piling on the produce, and getting some exercise are all smart moves. But what really gets your attention at the ER? When is the worst time to have surgery? And why don’t docs choose department heads as their own physicians?
We worked hard to get the answers to these questions and more. With interviews with scores of medical professionals—from nurses to pediatricians, podiatrists, general practitioners, eye doctors, pharmacists, and more—we uncovered the facts professionals usually only reveal to one another.
In addition to these hassle-saving—and potentially life-saving—facts, we’re boldly revealing some things that usually go unsaid, like what grosses out even your doctor or what can land you next-to naked in a hospital gown (Hint: It might have less to do with how sick you are and more to do with how much you’re annoying them). Find out why your yoga instructor is OK with your bodily functions but has issues with your shorts. We even found out the number one thing never to say to a nurse. We did the work, now you get the benefits!
WHAT YOUR NURSE WON’T TELL YOUHere are some words to the wise from the one who’s often handling the needle.
1. We’re not going to tell you your doctor is incompetent, but if I say, “You have the right to a second opinion,” that can be code for “I don’t like your doctor” or “I don’t trust your doctor.”
2. When a patient is terminally ill, sometimes the doctor won’t order enough pain medication. If the patient is suffering, we’ll sometimes give more than what the doctor said and ask him later to change the order.
3. I’ve had people with brains literally coming out of their head. No matter how worried I am, I’ll say calmly, “Hmmm, let me give the doctor a call and have him come look at that.”
4. If you’re happily texting and laughing with your friends until the second you spot me walking into your room, I’m not going to believe that your pain is a 10 out of 10.
TOP SECRET! No matter how many times you use your call light, even if it’s every ten minutes, I will come into your room with a smile. However, if you don’t really need help, I will go back to the nurses’ station and complain, and this may affect how the nurses on the next shift take care of you.5. When you tell me how much you drink or smoke or how often you do drugs, I automatically double or triple it.
6. Your life is in our hands—literally. We question physicians’ orders more often than you might think. Some of the mistakes I’ve headed off: a doctor who ordered the incorrect diet for a diabetic and one who tried to perform a treatment on the wrong patient.
7. If you ask me if your biopsy results have come back yet, I may say no even if they have, because the doctor is really the best person to tell you. He can answer all your questions.
8. When you ask me, “Have you ever done this before?” I’ll always say yes. Even if I haven’t.
9. Every nurse has had a doctor blame her in front of a patient for something that is not her fault. They’re basically telling the patient, “You can’t trust your nurse.”
10. I once took care of a child who had been in a coma for more than a week. The odds that he would wake up were declining, but I had read that the sense of smell was the last thing to go. So I told his mom, “Put your perfume on a diaper and hold it up by his nose to see if it will trigger something.” The child woke up three hours later. It was probably a coincidence, but it was one of my best moments as a nurse.
11. Some jobs are physically demanding. Some are mentally demanding. Some are emotionally demanding. Nursing is all three. If you have a problem with a nurse, ask to speak to the charge nurse (the one who oversees the shift).
12. For some reason, when I ask “Are you having pain?” a lot of patients say no, even if they are. But I’ve found that if I say, “Are you uncomfortable?” people are much more likely to say yes. Please tell us if you’re in pain. We have all sorts of medications we can use to help you.
13. If a patient is incontinent, I’m just supposed to use a washcloth to clean them. But if you’re really nice, I’ll get heated wipes.
SOURCES on here.
According to the medical journal The Lancet, medical errors might be a leading cause of death, but that doesn’t mean you can’t help change the numbers. Use these strategies to help keep mistakes from happening:
Trust your instincts. If you have questions about a lab result, diagnosis, or treatment, speak up. And be persistent. After you have a lab test or diagnostic image, call your doctor to make sure he received the results. Don’t worry about hurting your doctor’s feelings. This is about you.
Choose wisely. The doctor you pick is only the first member of a team of specialists involved in your care. She’ll likely assemble the rest of the team, so finding the right doctor is doubly important. So, too, is the hospital you choose. There are no guarantees, but usually, the better the hospital, the better the team.
Read the label. Many lab mix-ups start in your doctor’s office. When giving a blood or other specimen, ask the nurse, politely, to show you the identification sticker to make sure it’s accurate.
Carry a medical passport. A summary of your vital health information is a must. It should list diseases, medications and doses, food and drug allergies, and phone numbers of your physician and nearest relative. Take it with you to every doctor you see—even the radiologist.
Get a second opinion. It’s crucial to your health. If a diagnosis requires surgery, chemotherapy, or medications with side effects, find another specialist (call the hospital’s referral service for help), and send him all your pathology and radiology lab work for review, both the images and reports.
WHAT YOUR NURSE WISHES YOU KNEWWe got so many great tips from nurses that we couldn’t fit them all on just one list. Now that you know what your nurse won’t tell you, find out what you can do to make his or her job a lot easier so you can get the best care possible.
1. The number one thing you should never say to me: “You’re too smart to be a nurse.” I went to nursing school because I wanted to be a nurse, not because I wanted to be a doctor and didn’t make it.
2. This is a hospital, not a hotel. I’m sorry the food isn’t the best, and no, your boyfriend can’t sleep in the bed with you. I know you asked for mashed potatoes, but that sound you hear is my other patient’s ventilator going off.
3. If you have a really great nurse, a note to her nurse manager that says “So-and-so was exceptional for this reason” will go a long way. Those things come out in her evaluation—it’s huge.
4. If you’re going to get blood drawn, drink two or three glasses of water beforehand. If you’re dehydrated, it’s a lot harder for us to find a vein, which means more poking with the needle.
5. Never let your pain get out of control. Using a scale of zero to ten, with ten being the worst pain you can imagine, start asking for medication when your pain gets to a four. If you let it get really bad, it’s more difficult to get it under control.
6. Never talk to a nurse while she’s getting your medications ready. The more conversation there is, the more potential there is for error.
7. Positive attitude is everything. I have seen many people think themselves well.
8. Feel free to tell us about your personal life, but know that we’re here for 12 hours with nothing to talk about. So the stuff you tell us will probably get repeated.
TOP SECRET! Don’t hold your breath when you know we’re about to do something painful, like remove a tube or take the staples out of an incision. Doing that will just make it worse. Take a few deep breaths instead.9. At the end of an appointment, ask yourself: Do I know what’s happening next? If you had blood drawn, find out who’s calling who with the results, and when. People assume that if they haven’t heard from anyone, nothing is wrong. But I’ve heard horror stories. One positive biopsy result sat under a pile of papers for three weeks.
10. Husbands, listen to your wives if they tell you to go to the hospital. Today a man kept fainting but wouldn’t go to the hospital until his wife forced him. He needed not one, not two, but three units of blood—he was bleeding internally. He could have had a cardiac arrest. Another man complained to his wife that he didn’t feel “right.” His wife finally called me to come over to their house. His pulse was 40. He got a pacemaker that evening.
11. Please don’t get mad at me because your scan was supposed to be at noon and you didn’t have it until three o’clock. Unfortunately, I have no control over that.
12. The doctors don’t save you; we do. We’re the ones keeping an eye on your electrolytes, your fluids, whether you’re running a fever. We’re often the ones who decide whether you need a feeding tube or a central line for your IV. And we’re the ones who yell and screech when something goes wrong.
13. When you’re with someone who is dying, try to get in bed and snuggle with them. Often they feel very alone and just want to be touched. Many times my patients will tell me, “I’m living with cancer but dying from lack of affection.” You can never say “I love you” too much.
SOURCES FOR BOTH NURSE SECTIONS: Mary Pat Aust, RN, clinical practice specialist at American Association of Critical-Care Nurses in Aliso Viejo, California; Kristin Baird, RN, a health-care consultant in Fort Atkinson, Wisconsin; Nancy Beck, RN, a nurse at a Missouri hospital; Linda Bell, RN, clinical practice specialist at the American Association of Critical-Care Nurses in Aliso Viejo, California; Nancy Brown, RN, a longtime nurse in Seattle, Washington; Theresa Brown, RN, an oncology nurse and the author of Critical Care: A New Nurse Faces Death, Life, and Everything in Between; Barbara Dehn, RN, a nurse-practitioner in Silicon Valley, California, who blogs at nursebarb.com; Karon White Gibson, RN, producer-host of Outspoken with Karon, a Chicago cable TV show; Theresa Tomeo, RN, a nurse at the Beth Abraham Center for Nursing and Rehabilitation in Queens, New York; Kathy Stephens Williams, RN, staff development educator for critical care at St. Anthony’s Medical Center in St. Louis, Missouri; Gina, a nurse who blogs at codeblog.com; a longtime nurse who blogs at head-nurse.blogspot.com; and anonymous nurses and nurse supervisors in California, Florida, New York City, New Jersey, Pennsylvania, and Texas.
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This Won’t Hurt a Bit…
A nurse rarely tells you when a needle will be painful. That’s because research shows that when you’re told something may hurt, you imagine the discomfort. If you overreact, your body may actually create symptoms. (It’s called the “nocebo” effect.)
WHAT YOUR DOCTOR DOESN’T TELL YOUDon’t want a grumpy, tired doctor? Stay on his good side by knowing what he’s thinking.
1. We generally know more than a website does. I have patients with whom I spend enormous amounts of time, explaining things and coming up with a treatment strategy. Then I get e-mails a few days later, saying they were looking at this website that says something completely different and wacky, and they want to do that. To which I want to say (but I don’t), “So why don’t you get the website to take over your care?”
2. When a patient isn’t listening or cooperating, I was told in school to put a patient in a gown. It casts him in a position of subservience.
3. Thank you for bringing in a sample of your (stool, urine, etc.) from home. I’ll put it in my personal collection of things that really gross me out.
4. It bugs me when you leave your cell phone on. I’m running on a very tight schedule, and I want to spend as much time with patients as I possibly can. Use your time to get the information and the process you need. Please don’t answer the phone.
5. I wish you would take more responsibility for your own health and stop relying on me to bail you out of your own problems.
6. Doctors often make patients wait while they listen to sales pitches from drug reps.
7. Those so-called free medication samples of the newest and most expensive drugs may not be the best or safest.
8. Bring a spouse, but not an entourage. I know why you’re bringing your husband and three kids, all of whom are also sick, with you today. No, they are not getting free care.
TOP SECRET! We don’t make the money you think we do. Just how much of the $100 your doctor charges for taking 30 minutes to investigate your stomach pain goes into his pocket? After paying the bills, he gets less than half.9. Avoid Friday surgery. The day after surgery is when most problems happen. If the next day is Saturday, you’re flying by yourself without a safety net, because the units are understaffed and ERs are overwhelmed because doctors’ offices are closed.
10. If you want experience, go long. In many hospitals, the length of the white coat is related to the length of training. Medical students wear the shortest coats.
11. Often the biggest names, the department chairmen, are not the best clinicians, because they spend most of their time being administrators. They no longer primarily focus on taking care of patients.
12. If a sick patient comes to me with a really sad story and asks for a discount, I take care of him or her for no charge. And though we don’t cry in front of you, we sometimes do cry about your situation at home.
13. In many ways, doctors are held to an unrealistic standard. We are never, ever allowed to make a mistake.
SOURCES: Daniel Amen, MD, psychiatrist, Newport Beach, California; cardiologist, Bangor, Maine; James Dillard, MD; ear, nose, throat, and facial plastic surgeon, Dallas/Fort Worth, Texas; ER physician, Colorado Springs, Colorado; family physician, Washington, D.C.; Vance Harris, MD, family physician, Redding, California; heart surgeon, New York, New York; internist, Philadelphia, Pennsylvania; Evan S. Levine, MD; obstetrician-gynecologist, New York City; oncologist, Santa Cruz, California; pediatrician, Baltimore, Maryland; pediatrician, Chicago, Illinois; pediatrician, Hartsdale, New York; physical medicine and rehabilitation doctor, Royal Oak, Michigan; Tamara Merritt, DO, family physician, Brewster, Washington; surgeon, Dallas/Fort Worth, Texas.
1. Study up before your visit. Research your condition, as well as any other medical conditions or concerns you may have, by gathering information from reputable websites. But don’t hand your doctor a huge sheaf of printouts and expect her to respond to them during your visit. And don’t try to diagnose your symptoms or self-prescribe your remedies. It’s still up to your doctor to do that.
2. Make a list of questions and prioritize them. In one review of 33 office-visit studies, researchers found that people who brought checklists got more time with their doctors. Once you’re in the exam room, don’t be afraid to give your doctor the list—or ask for it back so you can refer to it.
3. Rehearse. When older people practiced their questions just before a doctor’s appointment, according to one study, they were nearly twice as likely to speak up during the visit than people who didn’t rehearse.
4. Bring a family member or friend along. Another person who knows about your health and your concerns can help you listen carefully, ask the right questions, and even help you make important decisions during an appointment.
5. Carry a tape recorder. Replaying an audiotape of your visit could assist you in better understanding instructions and information that you may have missed or not fully understood at the time.
6. Bring in your meds. Get a bag, toss in all your prescription drugs as well as herbal supplements, vitamins, and over-the-counter remedies, and bring it to your appointment. This will help your doctor understand if you’re experiencing any problems with drug interactions or if you’re taking any drugs you really don’t need.
7. Ask what tests you need and when and where to get them.
8. Evaluate your doctor. Is she too bossy? Is he too deferential? Does your doctor interrupt you? Does he take your views as seriously as you’d like? Try discussing your concerns first, and make a good-faith effort to build a relationship of trust and respect with your physician. But if it’s not working out, don’t feel obligated to stay. Studies show that patients who don’t trust their doctors simply don’t get well as quickly, probably because they’re less motivated to follow advice and treatment.
If you want to get the best care possible, you have to be the best patient you can be. That means being thorough and honest. Here’s what your doctor needs to know:
Your past health history, including major illnesses, allergies, and drug reactions.
Your family’s health history that summarizes the major illnesses of your first-degree relatives (parents, aunts and uncles, grandparents). Pay special attention to medical conditions—such as diabetes—that seem to run in the family.
Your lifestyle history, such as how much you exercise, what and how you eat, whether you have a pet you enjoy, how stressed you are, whether you smoke tobacco or drink alcohol, any over-the-counter or prescription drugs (from another doc) that you take regularly. Include any risky sports you enjoy: Do you bungee-jump, skydive, or ski down the expert slopes?
WHAT YOUR ER STAFF DOESN’T TELL YOUTake special note of these life-saving ER facts they usually don’t show on TV doctor dramas.
1. We’re not in it for the money. We’re the only doctors who will take care of you first and ask questions about payment later, so we end up giving one third of our care for free—and lose about $100,000 of income a year. Yet we still do it. This is the best specialty in the world.
2. Say thank you. In the ER, nurses provide most of the hands-on care. So be nice.
3. Waiting is good. It means you’re not going to die. The person you need to feel sorry for is the one who gets rushed into the ER and treated first.
4. We mean it. If we tell you to stay in bed, do it. Some medications make you uncoordinated, and we hate it when people fall down.
5. We don’t believe you. One of our favorite lines is “You can’t fix stupidity.” If you complain of nausea and then eat a bag of chips, that’s what we’re thinking.
6. We can only do so much. Not all ERs are equally equipped to deal with children. Check with your pediatrician in advance of an emergency to see which local ER he or she recommends.
7. If you haven’t had your child immunized, admit it. That’s important information for us to have.
8. Get the details. If you don’t understand what you’re supposed to do when you leave the ER, ask—and ask again if necessary. We don’t want you to have to come back.
9. Call, don’t drive. It’s incredible how many people having a heart attack drive themselves to the emergency room instead of calling 911. That’s just dumb. What are you going to do if you’re driving and your heart stops?
10. We don’t usually speed. If the patient is stable, and 97 percent are, there’s no reason to drive 60 miles an hour on city streets. Have you ever tried to put an IV into someone’s arm in the back of a speeding ambulance?
11. Never tell an ER nurse, “All I have is this cut on my finger. Why can’t someone just look at it?” That just shows you have no idea how the ER actually works.
TOP SECRET! Use a landline. Calling 911 from a landline can save your life because we can pinpoint your location instantly. If you call from a cell phone, we waste a lot of time asking where you are or searching for you.12. Help us out. We don’t have time to read the background on every patient. So if you’re having stomach pain, and you’ve had your appendix or gallbladder removed, tell us so we don’t go on a wild-goose chase. Be honest about whatever happened. Don’t be a hypochondriac, know what medications you are on, and don’t answer yes to every question. It will only screw up your care.
13. Speak up, please. An ER in a rural area might not have a doctor who is certified in emergency medicine, and the likelihood of having specialists on staff is very low. If you wind up in one, ask to transfer to a hospital that has more resources.
SOURCES: Jeri Babb, RN, Des Moines, Iowa; Marianne Gausche-Hill, MD, emergency physician, Torrance, California; Dana Hawkins, RN, Tulsa, Oklahoma; Leora Horwitz, MD, assistant professor, Yale University School of Medicine, New Haven, Connecticut; Arthur Hsieh, paramedic; Ramon Johnson, MD, emergency physician, Mission Viejo, California; Denise King, RN, Riverside, California; Linda Lawrence, MD, emergency physician, San Antonio, Texas; Don Lundy, paramedic, Charleston County, South Carolina; Donna Mason, RN, ER consultant, Nashville, Tennessee; Connie Meyer, RN, paramedic, Olathe, Kansas; Allen Roberts, MD, emergency physician, Fort Worth, Texas; Dennis Rowe, paramedic, Knoxville, Tennessee; Joan Shook, MD, emergency physician, Houston, Texas; Robert Solomon, MD, emergency physician, Waynesburg, Pennsylvania; Joan Somes, RN, St. Paul, Minnesota; emergency medical technician, Middlebury, Vermont.
How to Save Your Own Life if You Think You’re Having a Heart Attack
If you’re experiencing crushing chest pain with or without pain in your left arm, are short of breath, or have a sense of impending doom, you may be having a heart attack. Women are more likely to have atypical symptoms like severe fatigue, nausea, heartburn, and profuse sweating. If you are having the symptoms of a heart attack, even if you’re a twenty-something, vegetarian triathlete, you need to:
Call 911 and chew one 325 mg uncoated aspirin to get it into your bloodstream fast. This will thin your blood, often stopping a heart attack in its tracks.
While waiting, lie down so your heart doesn’t have to work as hard, says Sandra Schneider, MD, a spokeswoman for the American College of Emergency Physicians.
If you think you might pass out, try forcing yourself to cough deeply. It changes the pressure in your chest and can have the same effect as the thump given in CPR, says Dr. Schneider. “Sometimes it can jolt the heart into a normal rhythm.”
If someone else goes into cardiac arrest, note that the American Heart Association now recommends CPR without the mouth-to-mouth. Call 911, then push hard and fast on the person’s chest until help comes.
WHAT YOUR PEDIATRICIAN WON’T TELL YOUFind out how to make the most out of each trip to the pediatrician with these behind-the-stethoscope secrets.
1. Want to avoid the wait? Schedule your appointment for the middle of the week, and ask for the first time slot of the morning or right after lunch.
2. When you tell me you gave a decongestant to your toddler, I cringe. Studies show that cold medicines never work well for children under age six, and the risk of overdose and side effects far outweigh any benefit.
3. Want to make vaccines less painful for your child? Ask if you can breast-feed while we give your infant his shots. Or if you have an older child, see if we can use cold spray or a numbing cream to decrease the pain.
4. Do you really believe that we’d be recommending vaccines if we had any concerns about their safety? Almost all pediatricians immunize their own children.
5. If I prescribe a newer, more expensive medication, it may be because a drug rep just left my office. They constantly bring us presents and flatter us, and their only goal is getting us to prescribe the latest medication, which is usually no better than the older ones. In fact, the older ones have longer safety track records and really should be the ones we prescribe first.
6. Don’t ask if I’ll take a “quick look” at the sibling who doesn’t have an appointment. If your mom went with you to the gynecologist, would you ever say, “Doc, would you mind putting her on the table and giving her a quick look?” Every patient deserves a full evaluation.
7. As soon as you say, “He doesn’t like it when you look in his ears,” you remind your child of the last time and set us up for another failure. Be matter-of-fact: “It’s time for the doctor to look in your ears.” Kids have also figured out that “This won’t hurt” is code for “This is going to hurt,” and they get all worked up. It’s really best not to even use the word hurt. It just creates anxiety.
8. Sometimes we have less than ten minutes per patient, so make the most of your time and ask about the most pressing problems first. If you have a lot of questions, request an extra-long appointment.
TOP SECRET! If you have an urgent concern and the front desk tells you there are no appointments available, ask for a nurse and explain your situation. Often she can work you in even if the schedule indicates there’s no time.9. Even though I tell you to let your baby cry himself back to sleep once he’s older, don’t ask me if I always followed that advice with my own kids. I didn’t.
10. Don’t tell your kid the doctor will give him a shot if he doesn’t behave. I won’t.
11. Yes, you can talk to your pediatrician on the phone. Be persistent, be polite, and explain to the staff that you have a pressing, personal issue that you think would be best handled over the phone. We’ll call back as soon as we can. This especially applies to older children, who often don’t even need a visit. It may only take a call to find out that your child’s fever, cold, sore throat, ear infection, and even pinkeye will most likely get better on its own.
12. Listen to your intuition. You know your child better than anyone, and that’s why when you tell me something “isn’t right,” my ears perk up.
13. Don’t delay treating your child because you want me to see the symptoms. People do this a lot: “I didn’t give him Tylenol, because I wanted you to feel the fever.” “I didn’t use the nebulizer, because I wanted you to hear the wheezing.” Trust me, I will believe you that the child had a fever or was wheezing. Delaying the treatment only makes your child suffer.
SOURCES: Pediatricians David L. Hill, MD, in Wilmington, North Carolina; Robert Lindeman, MD, in Framingham, Massachusetts; Allison Fabian, DO, in Grand Rapids, Michigan; Amanda Moran, MD, in Charlotte, North Carolina; Roy Benaroch, MD, author of A Guide to Getting the Best Health Care for Your Child; and a pediatrician in Virginia who preferred not to be named.
1. Go on a treasure hunt. Take your kids to a local park and set an expedition course on a map, circling various “checkpoints.” Take turns navigating to each point on the map and leading the team to each destination.
2. Hold a sports party. Rather than the typical pin-the-tail-on-the-donkey birthday party, hold your child’s birthday party in an active location, such as a roller-skating or ice-skating rink, laser tag center, wall-climbing gym, or indoor playground center. Or you can have your own “no particular reason” party. Kids won’t think of what they’re doing as exercise—but it is.
3. Wash the car together. The scrubbing is good exercise, but everyone getting wet and soapy is just plain fun for kids.
4. Plant a garden together. Digging holes, planting seeds, and pulling weeds build upper body strength. As an added bonus, research shows that children are more likely to eat the vegetables they help grow, which means your gardening forays will help your child follow a more nutritious diet.
5. Take a hike at least twice a month. Grab a backpack, plenty of water (everyone should drink eight ounces every half-hour), and a light lunch and head to a local trail for a hiking expedition. Wear hiking boots for rocky terrain or sneakers for smoother trails, and pack sunscreen and insect repellent. To make this more fun for kids, make it about something else, such as looking for a particular animal or bird, climbing to see a lake or pond, or seeing how many rocks you can scamper over without touching the ground. Kids like hiking much better when they don’t realize it’s about hiking!
6. Dance during commercial breaks. Make it a family rule that whenever you watch television, you have to stand up and dance around during the commercials. This goes for everyone! Whoever gets caught sitting on the couch during a commercial break must perform his or her least-liked household chore for one week.
7. Sign up for a race. Check your local paper for a list of 5K and 10K walk/run events in your area. Many of these events also raise money for charity, which can inspire your children to train for the event.
8. Walk around the world. Place a map of the country, state, or world somewhere prominently in your home. Work with your children to arrive at a walking destination. Then, based on your daily family walks, plot your progress on the map using thumbtacks. There are about 2,000 steps in a mile, so you can plot your progress by using a pedometer. To add some incentive, promise to actually take a vacation to your walking destination once you complete the number of steps to get there.
9. Act like a child. Remember duck-duck-goose, hopscotch, and red-light-green-light-one-two-three? You probably thought of these games as just that, games. But they also require movement and count as exercise. Teach them to your kids and play along. As you laugh, you’ll burn extra calories. Don’t forget Simon Says!
10. Place small children on the floor at least once a day—and let them crawl, move, and toddle. Children are inherently active when given the opportunity to move. Yet we often confine children and prevent the very exercise they need.
11. Design your backyard for activity. What you put in your backyard helps determine how fit your children become. If they see it, they will play. If they don’t, they will watch TV. Older children enjoy climbing on ropes or ladders and playing in forts. Make sure you have a swing set, sprinkler attachment for your hose, sandbox, wagon for hauling toys and dolls, and outdoor sporting equipment for basketball, badminton, soccer, and other games.
WHAT YOUR DENTIST WON’T TELL YOUYou can’t sneak as much past your dentist as you think you can. Here are 13 things they know about you—and what you need to do to see them less.
1. No pain doesn’t mean “no problem.” Some truly educated people think that if nothing in their mouth hurts, they’re fine. High cholesterol doesn’t hurt, either, but it’s a big problem.
2. Bleeding is not OK. If your hands bled when you washed them, you’d run to the doctor. But in the public’s mind, bleeding gums are okay. Unless you’re really whaling away with your brush, if your gums bleed even a little, that’s periodontal disease, period.
3. Your dentist does need to see you. The advice to see your dentist twice a year applies only if you have healthy gums. Most people don’t.
4. The problem might not be what you think it is. People come to me with a mouthful of tooth decay and say, “I got my grandfather’s soft teeth.” I don’t even know what soft teeth are.
5. The more time you spend, the less we have to. Proper oral hygiene requires ten minutes of brushing and flossing every day. The average adult spends two or three minutes total, and kids do even worse.
6. Chewing gum can be good. If you want to reduce the bad bacteria in your mouth, you should be all over xylitol, a sugar substitute found in chewing gum. It changes the chemistry of your mouth. Six or seven pieces of xylitol gum every day will help keep cavities away.
7. Mouthwash is a very short-term strategy. A mouthwash with alcohol dries out your mouth—you’ll smell nice and minty for a half hour, but then the bad breath comes back worse than ever.
TOP SECRET! Minty mouthwash or breath mints don’t fight bad breath! Most mouthwashes contain alcohol, which dries up saliva and makes your breath worse afterward. Mint candy is just a cover-up; it actually feeds the odor-causing bacteria more sugar! For a natural mouthwash, mix 1 tablespoon of baking soda with 1 cup of a 2 to 3 percent solution of hydrogen peroxide. The foam it kicks up has a powerful oxidizing effect that kills odoriferous bacteria.8. The electric toothbrush is one of the best things to ever happen to dentistry. The newer ones replicate professional cleaning—they won’t reach much below the gum line, but they’re far superior to regular toothbrushes. The cheap ones are okay for kids, but you’ll have to pay more than $75 for a really good brush with a warranty and replacement heads.
9. We think X-rays do more good than harm. A lot of patients are worried that dental X-rays can cause cancer, but if you’re outside for an hour, you’re exposed to more radiation than you’d get from a full set of dental X-rays. What I worry about is that if I don’t take an X-ray, I might miss something serious.
10. There’s no way to make implants cheaper. If you’re missing teeth, chances are that your insurance company won’t cover implants—only one out of 22 insurance companies I deal with covers them, even though they’re better than dentures in every way.
11. Sometimes, we can fix your headache. Misaligned teeth can cause migraine headaches. If we can align the teeth and fix the bite, the pain often goes away.
12. Teeth get whiter when they dry out. Some dentists promise that their office procedures will make your teeth four shades whiter. But if you leave your mouth open for an hour, you could easily be two shades whiter just from dehydration.
13. We need you to know what your insurance covers. People think we have a crystal ball that tells us everyone’s insurance information. We don’t. And we need to find out what’s covered before we can do anything.
SOURCES: Michael Alkon, DMD, general dentist, Holmdel, New Jersey; Damian Dachowski, DMD, general dentist, Horsham, Pennsylvania; Danine Fresch Gray, DDS, general dentist, Arlington, Virginia; Jay Grossman, DDS, cosmetic dentist, Brentwood, California; Gary Herskovits, DDS, family dentist, Brooklyn, New York; Paul Hettinger, DMD, general dentist, Orlando, Florida; Jennifer Jablow, DDS, cosmetic dentist, New York, New York; Jim Janakievski, DDS, periodontist, Tacoma, Washington; Chris Kammer, DDS, cosmetic dentist, Middleton, Wisconsin; Mark Mutschler, DDS, pediatric dentist, Oregon City, Oregon; Mai-Ly Ramirez, DDS, general dentist, San Francisco, California; Ron Schefdore, DMD, general dentist, Chicago, Illinois; Bryan Tervo, DDS, expert at JustAnswer.com; Joel Slaven, DDS, general dentist, Valencia, California; Ned Windmiller, DDS, general dentist, Stillwater, Minnesota; Careen Young, DDS, prosthodontist, Beverly Hills, California.
Dry mouth is a haven for the bacteria that cause bad breath. So find a tap, and swish the water around in your mouth. Water will temporarily dislodge bacteria and make your breath a bit more palatable.
At the end of your power lunch or romantic dinner, munch the sprig of parsley that’s left on your plate. Parsley is rich in chlorophyll, a known breath deodorizer with germ-fighting qualities.
If you can get your hands on an orange, peel and eat it. The citric acid it contains will stimulate your salivary glands and encourage the flow of breath-freshening saliva.
Cloves are rich in eugenol, a potent antibacterial. Simply pop one into your mouth and dent it with your teeth. The pungent aromatic oil may burn slightly, so keep that spicy nub moving. Continue to bite until the essence permeates your mouth, then spit it out. Don’t use clove oil or powdered cloves—they’re too strong and can cause burns.
Chew on fennel, dill, cardamom, or anise seeds. Anise, which tastes like black licorice, can kill the bacteria that grow on the tongue. The others can help mask the odor of halitosis.
Suck on a stick of cinnamon. Like cloves, cinnamon is effective as an antiseptic.
Vigorously scrape your tongue over your teeth. Your tongue can become coated with bacteria that ferment proteins, producing gases that smell bad. Scraping your tongue can dislodge these bacteria so you can rinse them away.
WHAT YOUR EYE DOCTOR WON’T TELL YOUHere are 13 things about what helps and hurts your eyes (carrots included).
1. Never use tissues or toilet paper to clean your eyeglasses. Paper is made of wood, and it will scratch your lenses. I like to use my tie because it’s silk and really smooth.
2. Polarized sunglasses are great at reducing glare, but they can make it difficult to see the LCD on your cell phone or navigation system. It’s harder to see an ATM screen when you’ve got polarized sunglasses on, too.
3. Life doesn’t go on as normal after I dilate your eyes. It’ll be two or three hours before you can do anything that requires concentrated visual attention.
4. You wear your sunglasses only when it’s sunny? That’s like saying “I only smoke sometimes.” Most people know that UV radiation can damage skin, but they don’t realize it’s also bad for eyes. Wear sunglasses big enough to block the light from above and below—they should have thick sides or wrap around.
5. Eyedrops (any kind) sting less if you keep them in the refrigerator.
6. Some doctors pressure patients to have cataract surgery right away, but if it creates financial problems for you, there’s usually no harm in waiting. Cataracts rarely hurt you—they just make it hard to see, like looking out of a dirty window.
7. Reading in dim light won’t hurt your eyes, but you might get a headache.
TOP SECRET! Carrots aren’t the best food for your eyes, despite what generations of parents have told their kids. That honor goes to spinach, kale, and other dark, leafy veggies.8. Take extended-wear contacts out before bed. Your chance of infection is 10 to 15 times greater if you sleep in them.
9. Don’t grab just any old bottle of eyedrops out of your medicine cabinet when a new problem comes up. If you have an infection, steroid drops might make the redness look better, but the infection could get worse. I’ve had to remove people’s eyes because of that!
10. Pinkeye isn’t always benign. A number of patients end up with light sensitivity and even vision loss. But many physicians treat it with antibiotics that won’t help if the cause is a virus. We do a rapid test for adenovirus—if that’s what you have, we treat it very differently than if your pinkeye is bacterial.
11. No, it’s not OK to wait for symptoms to appear. Some blinding eye diseases have few warning signs. A yearly exam is the only way to catch things early.
12. If you’re over 60, considering LASIK, and at risk of developing cataracts, wait until you develop one. Then we can fix your vision as part of the cataract surgery and your insurance may pay for it.
13. If you wear contacts, ask for UV coating.
SOURCES: Brian Bonanni, MD, an ophthalmologist at Gotham LASIK, New York City; Stephen Cohen, OD, past president of the Arizona Optometric Association; Eric Donnenfeld, MD, editor of Cataract and Refractive Surgery Today; Paul Harris, OD, associate professor at the Southern College of Optometry, Memphis, Tennessee; Janice Jurkus, OD, professor of optometry at Illinois Eye Institute; Robert Noecker, MD, an ophthalmologist at Ophthalmic Consultants of Connecticut; Robert Sambursky, MD, an ophthalmologist in Sarasota, Florida; Andrea Thau, OD, associate clinical professor at the SUNY College of Optometry.
Easy Ways to Improve Your Vision
1. Mix a cup of blueberries with a cup of yogurt for breakfast. In one study, women and men who ate the greatest amount of fruit were the least likely to develop age-related macular degeneration (ARMD), the leading cause of blindness in older people. While you’re getting fruit, why not go for blueberries, one of the richest fruit forms of antioxidants?
2. Cook with red onions, not yellow. Red onions contain far more quercetin, an antioxidant that may protect against cataracts.
3. Aim your car vents at your feet—not your eyes. Dry, air-conditioned air will suck the moisture out of eyes like a sponge. Aim the vents in your car away from your eyes, or wear sunglasses as a shield. Dry eyes can be more than an inconvenience; serious dryness can lead to corneal abrasions and even blindness if left untreated.
4. Move your computer screen to just below eye level. “Your eyes will close slightly when you’re staring at the computer, minimizing fluid evaporation and the risk of dry eye syndrome,” says John Sheppard, MD, who directs the ophthalmology residency program at Eastern Virginia Medical School in Norfolk, Virginia.
5. Walk at least four times a week. Some evidence suggests that regular exercise can reduce the intraocular pressure, or IOP, in people with glaucoma. In one study, glaucoma patients who walked briskly four times per week for 40 minutes lowered their IOP enough so they could stop taking medication for their condition. It’s also possible—although there’s no proof yet—that walking could reduce your overall risk of developing glaucoma.
6. Eat fish twice a week. A study from Harvard researchers evaluated the diets of 32,470 women and found those who ate the least amount of fish (thus getting the least amount of omega-3 fatty acids) had the highest risk of dry eye syndrome. If you can’t stand fish or are worried about mercury consumption, try fish-oil supplements to get your omega-3s.
7. Turn down the heat in your house. Heat dries out the air, which, in turn, dries out your eyes. In the winter, you might also try adding some humidity with a humidifier or even bunching a lot of plants together in the room in which you spend the most time.
WHAT YOUR PODIATRIST WON’T TELL YOUThese 13 secrets can keep your feet from hurting—or stinking—for good.
1. Your feet don’t have to smell. You use antiperspirant on your armpits to keep them from getting stinky, don’t you? The same stuff works on your feet. Try the spray kind.
2. You can fight stink without buying anything. Make some really strong black tea, then soak your feet in it two or three times a week for 20 minutes. The tannic acid has been shown to temporarily shrink sweat ducts so they don’t work as hard. Always alternate your shoes so they have a chance to dry completely, and wear socks. Otherwise, the sweat will promote the growth of bacteria that stay in your shoes.
3. Infections from nail salons keep us in business. If you want a pedicure, book the first appointment of the day, when the equipment is cleaner. Those footbaths can be especially germy. Even if technicians spray the basin between customers, many of the tubs have drains and filters that don’t get cleaned. No matter what, don’t shave before you go. Bacteria and fungus can enter the microscopic nicks on your ankle and give you an infection.
4. Toe separators, bunion splints, and “yoga toes” may help you feel better, but they aren’t going to get rid of hammer-toes and bunions. You’ve got to come to me for that. If you have a structural problem, a $6 device isn’t going to reverse anything.
5. Some podiatrists will shorten toes or do injections so you can wear high heels more comfortably. But I don’t believe in cosmetic surgery for feet. You shouldn’t have surgery if you’re not in pain, because you will have pain after surgery—that’s a guarantee. It has to be worth it. Otherwise, you’re asking for trouble.
6. Get your bunions taken care of now. If you wait until they get really bad, they’ll be much harder to fix.
7. I’ve seen all sorts of things, including people who have shot their feet. You really shouldn’t clean your loaded gun after you’ve had a couple of beers. Another dumb move: mowing the lawn in flip-flops. The first weekend of every spring, doctors see a lot of injuries.
TOP SECRET! I wear flip-flops, too, but if you wear them every day, all day, you will end up in my office eventually. Those shoes are designed for the beach and pool, not for walking all over the place.8. Over-the-counter “custom-fit” orthotics are a bit of a gimmick. They’ll help if you just need some arch support and padding, but they’re nothing like the orthotics I make after creating a mold of your feet in my office. Orthotics and arch supports should be firm. If it’s jellylike or soft and smushy, then that’s not support—that’s cushioning—and it’s probably not going to help your problem.
9. A lot of you hurt your foot or ankle exercising and head straight to an orthopedic surgeon. But unless he or she is specifically trained in the foot and ankle, coming to me is a better bet.
10. Your cuticles are there for a reason. You can push them back, but don’t cut.
11. I have people who tell me that I changed their life, and it turns out all I did was tell them to wear a bigger size shoe. I think, did that really change your life? But if they had a lot of pain, it’s a big deal.
12. When you go into a shoe store, your salesperson should measure your feet. A lot of you have been wearing the same shoe size for the past 30 years because no one measures you anymore, but feet often get bigger as you age.
13. The best socks today are not 100 percent cotton. Look for materials that promise to wick moisture away.
SOURCES: Jane Andersen, a podiatrist in Chapel Hill, North Carolina; Marlene Reid, a podiatrist in Naperville, Illinois; Carly Robbins, a podiatrist in Columbus, Ohio; Jacqueline Sutera, a podiatrist in New York, New York; Cary Zinkin, a podiatrist in Deerfield Beach, Florida.
Become an Instant Expert
Give yourself a foot massage.
When you massage the thousands of nerve endings in the foot, you can feel relaxation throughout your body. It doesn’t just feel good: Regular massage keeps the foot flexible and healthy. Treat your feet with these techniques:
To give yourself a deep massage, grip your foot in your hands with fingers on the sole and thumbs on top. Work the bones by pressing down with the thumbs and heels of the hands, and up and in with your fingers. Then move one hand up the length of the foot while moving the other hand down.
Thumb presses are great. Hold your foot with your thumbs on the sole and fingers on the top. Press in hard, firm circles over the sole. Repeat over the top of the foot. Be thorough, covering the entire area. Use your fingers to press near the ankle and heel.
Toe stretches will relieve tension. Hold the heel firmly with one hand. With the other hand, push the toes forward and backward (omit the little toe if you wish). Hold the stretch for several seconds each way, then repeat.
End off your massage with toe tugs. Gently tug each toe with your index finger and thumb. Then, starting with the big toe, twist each toe from side to side; let the thumb and forefinger slide off the end. Don’t crack the toe knuckles.
WHAT YOUR PHARMACIST WON’T TELL YOUHere’s how to spend less at the pharmacy, get what really works for you, and avoid dangerous—and sometimes deadly—pill mix-ups.
1. Don’t try to get anything past us. Prescriptions for painkillers or sleeping aids always get extra scrutiny.
2. Generics are a close match for most brand names. But I’d be careful with blood thinners and thyroid drugs, since small differences can have big effects.
3. I hate your insurance company as much as you do. Even if something’s working for you, the insurance company may insist you switch to something else. I’m stuck in the middle trying to explain this to customers.
4. We can give flu shots in most states.
5. All pharmacists are not created equal. A less-qualified pharmacy technician may have actually filled your prescription. Currently, there is no national standard for their training and responsibilities.
6. We’re human… And we make mistakes (about two million a year). Ask if we use a bar code system to help keep us from pulling the wrong drug off the shelf or giving the wrong strength of the right drug.
7. If you don’t like a generic, ask if there are alternatives. I can give you a generic refill that’s different from the one you started with.
8. We’ll save you money if we can. A good part of a pharmacist’s time is spent dealing with patients and their incomes. Part of that is suggesting generic alternatives. Or if a doctor has prescribed a newer drug with no generic alternative available, I’ll call the doctor to suggest an older drug that’s equally effective.
9. Look into the $4 generics. Chains like Target, Kroger, and Walmart offer them.
TOP SECRET! There’s not some big computer database that tracks your drugs and flags interactions for pharmacists everywhere. Use one pharmacy. If you start using a new one, make sure we know what you’re taking.10. It gets busy Monday and Tuesday evenings, since many new prescriptions and refills come in after the weekend.
11. Don’t put up with the silent treatment. Pharmacists are required by law in most states to counsel patients and answer their questions. If your pharmacist seems too busy to talk, take your business elsewhere.
12. People take too many drugs. Two out of every three patients who visit a doctor leave with at least one prescription for medication, according to the Institute for Safe Medication Practices. Drugs are an easy solution, but there are other solutions.
13. Talk to me—and check my work. Every year plenty of prescriptions are taken wrong—the FDA has recorded an incident where a man overdosed after his wife mistakenly applied six prescription painkilling patches to his skin. And many people don’t ask questions about how to use their medications. When you pick up your prescription, at least ask, “What is this drug? What does it do? Why am I taking it? What are the possible side effects? and How should I take it?” Not only does this help you to use the drug correctly; it’s also a good way to double-check that you’re getting the right drug.
SOURCES: Cindy Coffey, PharmD; Greg Collins, pharmacy supervisor, CVS/pharmacy, California; Stuart Feldman, owner, Cross River Pharmacy, New York; Dr. Daniel Zlott, oncology pharmacist, National Institutes of Health.
Plenty of online pharmacies are honest businesses—experts think they actually outnumber the sham ones—and they offer big advantages. You can shop the Internet for the best prices; you can buy certain drugs without embarrassment; and you can do it all from the comfort of your armchair.
But how can you be confident an online pharmacy is legitimate? One sure sign is if the site has the VIPPS (Verified Internet Pharmacy Practice Sites) seal of approval. That’s a certification from the National Association of Boards of Pharmacy (NABP), and the seal must be displayed prominently on the business’s website. You can also check the NABP’s website for a list of pharmacies that have earned the VIPPS seal (nabp.net).
You should be suspicious of any online pharmacy that:
Doesn’t require you to mail in a prescription.
Doesn’t speak to your doctor to ensure your prescription is valid.
Doesn’t ask you to do more than fill in an online questionnaire.
Doesn’t have a toll-free number and street address listed on its website.
Doesn’t make pharmacists available to answer questions about the medications. Be on guard, too, if the site sells only “lifestyle” medications, like drugs for impotence, obesity, or pain.
WHAT YOUR SLEEP DOCTOR WON’T TELL YOUA good night’s sleep is vital to your health and happiness. Here are 13 ways to get better sleep—and become aware of what’s really robbing you of it.
1. We expect to sleep for eight solid hours, but that’s actually not normal compared with global populations and our own evolutionary history. People naturally wake up two or three times a night. It’s worrying about it that’s the problem.
2. Digital clocks blare time at you. If you look at the time when you awaken during the night, it’s likely to increase your anxiety about not being asleep. If you need a clock to wake you in the morning, just turn its face to the wall right before bed. You’ll hear it just as well.
3. If you’re not sleeping well, you may have acid reflux, even if you don’t feel heartburn. Try elevating your head by putting blocks under the top of the bed and sleeping on your left side.
4. If you like a firmer mattress and she likes a softer one, you don’t have to compromise. Get two singles, push them together, and use king sheets. You can also buy a strap that attaches the mattresses to each other. I also tell couples that each person should have a sheet and blanket. One of the biggest disrupters of sleep is the pulling and tugging of sheets and blankets. If you pull a big comforter or duvet over the top when you make the bed, you really can’t tell. Couples call me after I suggest that and say, “Wow—you changed our marriage.”
5. Memory foam is very temperature dependent. The foam can get a little hard in a cold bedroom. And if you’re a hot sleeper, it may make you hotter.
TOP SECRET! Women aren’t used to putting their needs ahead of others’, but sleep is so necessary to health and happiness, they must. If the dog’s snoring wakes you up, put him in another room. If your partner’s snoring wakes you up, help him get treatment. If he refuses to cooperate, put him in another room.6. My research has found that any new smell, even one associated with relaxation, like lavender, can make you more alert and vigilant. You’re better off with a scent that makes you feel safe and comfortable. There really is something to cuddling up with your spouse’s undershirt.
7. Watching TV at night may seem relaxing, but it beams light into your eyes, which is an “alert” signal for the brain. Read a book before bed instead.
8. Give yourself an hour—the one right before bed. You need it to wind down and make the transition from the person-who-can-do-everything to the person-who-can-sleep.
9. To keep your room dark, use blackout draperies or shades—not blinds, because they never completely block out light. Install the shades as close to the glass as possible. If you don’t have the depth for an interior mount, extend the fabric several inches past the width of the window.
10. A hot bath will increase your skin temperature, which eventually decreases your core body temperature, and that’s helpful for sleep. Do the same thing for yourself that you’d do for a young child—make sure you take a bath a half hour or so before bedtime.
11. There’s no solid explanation for it, but studies have found that wearing socks to bed helps you sleep. It may be that warming your feet and legs allows your internal body temperature to drop.
12. A lot of people take bedtime pain relievers that contain caffeine and don’t even realize it. Excedrin has 65 milligrams of caffeine per tablet—if you take two, that’s as much as a cup of coffee. Check the label: Caffeine is always listed as an active ingredient.
13. I’m not a fan of sleeping with two pillows if you’re a back sleeper because it makes your upper back curve and strains the neck and back. If you need to sleep up high for medical reasons, get a wedge and put your pillow on it.
SOURCES: Tara Brass, MD, a psychiatrist in New York, New York; Pamela Dalton, PhD, odor-perception expert and sensory psychologist at Monell Chemical Senses Center, Philadelphia, Pennsylvania; Jan Engle, professor of pharmacy at the College of Pharmacy, University of Illinois at Chicago; Karen Erickson, a chiropractor in New York, New York; Mary Susan Esther, MD, director of the Sleep Center at South Park in Charlotte, North Carolina; Ian Gibbs, cofounder of the Shade Store in New York, New York; Colin Grey, a time-management coach in London, England; Alan Hedge, PhD, professor of ergonomics at Cornell University, Ithaca, New York; Robert Oexman, chiropractor and director of the Sleep to Live Institute in Joplin, Missouri; Patricia Raymond, MD, a gastroenterologist in Virginia Beach, Virginia; Carol Worthman, PhD, an anthropologist at Emory University in Atlanta, Georgia.
When worry drives your life, studies show you’re more likely to develop chronic insomnia. Here’s how to prevent that—and get a good night’s sleep.
Stop those thoughts. Once you hit the sheets, worry time is over—especially about sleeping. There’s a therapy trick called “thought-stopping” that works like a charm, says Mary Susan Esther, MD, director of the Sleep Center at South Park in Charlotte, North Carolina. “If you find yourself thinking about tomorrow and saying, ‘It’s going to be a bad day because I’m never going to sleep,’ immediately think: ‘STOP. Don’t go there. I know I’ve done this before. If I don’t fall asleep, I’ll get out of bed, flip through a magazine, but I am NOT going to focus on this stuff!’” Sounds simple, but once you try it, you’ll find it works.
Dump the 24/7 routine. Even if we manage to drop into bed in enough time to get our optimal amount of sleep, our minds are full of what-if’s, why-did-we’s and what’s-on-the-agenda-tomorrow’s. All this rumination and agitation ignites stress hormones that keep us in a state of perpetual arousal. That’s why we should make a serious attempt to simplify our lives, says Cecile Andrews, PhD, author of Slow Is Beautiful. Draw up your to-do list, then take a big breath and start crossing things off, she says. It’s a bit humbling to realize, but you really don’t have to do it all.
Don’t work so late. The prevailing thought is that you have to stay late to get the job done. But working right up until bedtime is bound to affect your sleep. Go home at a reasonable hour. The truth is that it’s better to go get some sleep, then come back and do more work in the morning. Studies show that after a good night’s sleep, your increased ability to concentrate means that you can work faster and more accurately.
Recognize yourself. How do you deal with stress? Pig out on chocolate mousse? Skip meals? Refill your wineglass a couple of times after dinner? All of these classic stress responses actually make falling asleep and staying asleep more difficult. But if you know your stress response will sabotage your sleep, plan ahead of time how you’re going to handle something you just know is going to raise your stress level. If you know the big sales conference is coming up next week, for example, get into bed an hour early every night this week, which will give your body a biochemical boost of stress-proofing growth hormone to ride into the week. If you know you’re going to see your ex when he drops off your daughter Saturday evening, take time out and meditate for 20 minutes before he’s supposed to arrive.
Get physical. Burn off a rush of stress with a 15-minute walk. Studies show that those who regularly exercise sleep better than those who don’t.
Forgive the past. Anger toward someone who has wronged you can trigger a cascade of stress hormones that can haunt you through the night. To prevent that effect, think about how you were hurt, your response, and how you feel right now. Then think about whether or not there’s anything in the background of the person who hurt you that explains what he or she did. If there is, put yourself in their shoes—and see if you can’t forgive them. If you can, you’ll sleep like a baby.
WHAT YOUR AEROBICS INSTRUCTOR WON’T TELL YOUWhat’s really going through your instructor’s head when she’s watching you in the gym? It’s probably not what you think!
1. Follow my lead. I get aggravated when students do a different workout than the one I’m teaching—and they’re in the front row! If you come to class but choose to do your own thing, really, what’s the point?!
2. Be careful what you complain about. When I’m cranky and short-tempered I’m more likely to make you do something hard and brutal because you whined about something else.
3. Everyone started somewhere. Don’t worry if other people are using heavier weights, higher steps, or going farther while stretching. The fact that you are there participating at all is the most important thing. Work within your own limits and abilities. If I suggest a modification for an exercise, it would be helpful if you’d follow the suggested guideline. It’s for your own good!
4. Leave your cell at home. Can you not exercise for an hour without checking your text messages?
5. Dress appropriately. Ladies, consider wearing a cami or additional liner under your low cut Lululemon or Lucy yoga tops. I get an eyeful I really don’t wish to see when you’re in downward dog. And guys, don’t forget your liner shorts! I don’t want to see anything poking through your gym shorts in class!
TOP SECRET! You hurt yourself the most when you refuse to try. Fitness is one of the only things in life where you can achieve success simply by trying harder than you did yesterday.6. It takes a lot to be entertaining, funny, and likeable… all while trying to motivate people to do things that will cause them pain. I think the ’80s thong leotards and side-ponytails gave aerobics instructors a bad rap. We’re also not all super bubbly and rail-thin.
7. Preparing is a lot of work! Pre-choreographed classes, like BodyPump and Turbo Kickboxing, take hours of prep. We’re sent materials every six weeks, and we have to review and learn all the music and choreography before we teach it to you.
8. Music helps me connect with you and lets me bring some of my personality to the table. I take requests and will download songs for my students. Who wouldn’t want an instructor to play their personal power song?!
9. I’m always learning. I prepare classes by reading, watching videos, attending workshops, and taking other instructors’ classes. I can’t tell you how many times my family’s walked into my office only to find me on the floor contorted into some unusual position for the latest ab or outer-thigh exercise that I have just discovered online. They used to ask what I was doing, but now they leave before I force them to give it a try.
10. Stop weighing yourself constantly. Newbies expect miracles without realizing that while the added muscle may not make the scale drop, it will bring the pants size down. But you can’t change your physique simply by working out; 80 percent of any change and fat loss is the result of a clean diet.
11. We don’t all have perfect relationships with health and fitness. People assume we spend our days eating salad without dressing and train ALL the time. Sometimes I’m tired, cranky, hungry, or want a pizza, but I have to put on the show. Sometimes I want to veg out and eat junk food, and sometimes I actually do!
12. This isn’t my only job, and I wish you wouldn’t assume we’re all meatheads who enjoy working out 24/7.
13. Some exercises make people fart. Get over it. Reverse crunches do especially, most particularly while squeezing and lifting a fit ball. I think it means that you’re working hard and giving a huge effort. Some people are so mortified when it happens that they leave class that day and never come back. I wish they wouldn’t care as much. I don’t!
SOURCES: Jacky Burke of BodyDefinitions.com; Keri Cawthorne of ironmountainmovement.com; Laura Dow, Josh Guerrieri, ACE; certified personal trainer of FitWit.com; Sara Hauber of sarahauber.com; Andrew Kalley of kalleyfitness.com; Lauren Lorenzo MS, ACE-CPT of Fork in the Road Consulting, LLC; Charla McMillian, JD, CSCS of FitBoot.com; Sharyn Zerello Mastropaolo of teambeachbody.com; Virginia Nicholas MA, RN of Moving Breath Pilates; A.J. Pantoni of www.oxfordathleticclub.com; Mike Tubbs, personal trainer, nutritionist, and martial arts instructor of exhalewellness.com; Cate Wade of fulcrumfitness.com.
How Much Exercise Do I Really Need?
Most healthy people should aim for at least 30 minutes, five times a week, of moderately intense activity (such as brisk walking), plus 10 to 15 minutes or so of strength-training (digging in your garden counts) two or three times a week. This is enough exercise to help you lower your risk for health conditions like high blood pressure, stroke, coronary artery disease, type 2 diabetes, colon cancer, and osteoporosis, and to prevent the natural loss of muscle mass that slows metabolism and contributes to weight gain in your thirties, forties, fifties, and beyond.
If you’re trying to lose weight, more activity is better. An hour or even 90 minutes of moderate exercise, or 30 minutes of vigorous activity such as jogging, strenuous aerobics, or fast-paced cycling, is ideal.
Of course, anything you do is better than nothing, and consistency counts. Fitting in 30 minutes most days of the week, even in 10-minute bursts, is better than playing the weekend warrior by overdoing it once or twice a week.
If you’re the type who just doesn’t enjoy going to the gym or using a treadmill, choose an activity you enjoy that you can do for 10 to 30 minutes or longer and that raises your heart rate. This could be dancing, playing tennis, chopping enough wood to heat your house for the winter, or lining up strenuous yard work or housework that feels like a workout.
WHAT YOUR DIET BOOK DOESN’T TELL YOUThese secrets reveal why your belt is too tight, beyond your chocolate addiction and french-fry love affair.
1. Your weight really is genetic. When scientists first discovered a gene in certain chubby mice, they called it simply the fatso gene. Turns out, people with two copies of the gene were 40 percent more likely to have diabetes and 60 percent more likely to be obese than those without it. Those with only one copy of the gene weighed more, too.
2. Scientists now suspect that there could be as many as 100 fat genes, each adding a pound or two here and there.
3. You might have more fat cells than your skinny neighbor does. Some people have as much as twice the number of fat cells as others. Even if you’ve lost a few pounds (or gained some), your fat-cell count remains, holding tight to the fat already inside and forever thirsting to be filled up with more. (To add insult to injury, the fat cells of overweight and obese people hold more fat, too.)
4. New fat cells emerge during childhood but seem to stop by adolescence. Those of us destined to have a lot of these cells probably start producing them as young as age two. The cells’ rate of growth may be faster, too—even if kids cut way back on calories.
5. But your “destiny” is no excuse. When researchers at Helsinki University Central Hospital studied sets of twins where one was fat and the other thin, they learned that fat cells in heavier twins underwent metabolic changes that make it more difficult to burn fat. Gaining as little as 11 pounds may slow metabolism, so as you gain more fat, it becomes harder to lose it. What helps? Physical activity.
6. Fat might be your boss’s fault. Stress fattens you up, and the most direct route is the food-in-mouth syndrome: Stressful circumstances spark cravings for carbohydrate-rich snack foods, which in turn calm stress hormones. (When researchers in one study took away high-carb food from stressed mice, their stress hormones surged.)
7. Stress hormones also ramp up fat storage. For our prehistoric ancestors, stress meant drought or approaching tigers, and a rapid-storage process made sense; we needed the extra energy to survive food shortages or do battle. Today we take our stress sitting down—and the unused calories accumulate in our midsection. To whittle yourself back down to size, in addition to your usual workout routine, make time for stress relief—whether it’s a yoga class or quality time with family.
8. Fat might be your mom’s fault. A growing body of science suggests that sugary and fatty foods, consumed even before you’re born, can mess with your weight. One study on rodents found that overweight females have higher levels of glucose and free fatty acids floating around in the womb than normal-weight ones do. These molecules trigger the release of proteins that can upset the appetite-control and metabolic systems in the developing brain.
9. Your spouse’s ice cream habit is messing with your weight. If one spouse is obese, the other is 37 percent more likely to become obese, too, according to a study in the New England Journal of Medicine. Fortunately, slimming down may be contagious, too, if one partner becomes motivated by the other’s success.
10. Obesity might be viral. Adenoviruses have been linked to fat by researchers at the University of Wisconsin, who injected chickens with the viruses and found that certain strains fattened them up. Human studies, including comparisons of twins, suggest that obese people are indeed more likely to harbor antibodies for a particular virus, known as adenovirus 36.
11. It’s hard to win against a cookie. While food is not addictive the way cocaine or alcohol is, there are some uncanny similarities. When subjects at Monell Chemical Senses Center in Philadelphia were shown the names of foods they liked, the parts of the brain that got excited were the same parts activated in drug addicts.
TOP SECRET! Your bedroom, not the kitchen, might be making you fat. Sleep deprivation upsets our hormone balance, triggering both a decrease in the hormone leptin (which helps you feel full) and an increase of the hormone ghrelin (which triggers hunger). As a result, we think we’re hungry even though we aren’t—and so we eat. Sleep may be the cheapest and easiest obesity treatment there is.12. Ear infections can taint your taste buds. In one study of more than 6,000 people, researchers found that people over age 35 who had suffered several ear infections had almost double the chance of being obese. Why? These infections can damage a taste nerve running through the middle ear. And when researchers found that former ear-infection patients were a little more likely to love sweets and fatty foods, they theorized that the damaged nerve may cause them to have a higher threshold for sensing sweetness and fattiness.
13. You may have obliterated your “stop eating” signal. Gorging on candy bars, chips, and other not-too-healthy carbs brings damaging free radicals out in droves (those are also the molecules blamed for making you look old). It’s possible that they damage the cells that tell you you’re full. Fight that with antioxidant-rich produce.
SOURCES: Zane Andrews, PhD, a neuroendocrinologist at Monash University in Australia; Louis Aronne, MD, past president of the Obesity Society and author of The Skinny; Linda Bartoshuk and Derek Snyder of the taste lab at the University of Florida; Claude Bouchard, PhD, executive director of the Pennington Biomedical Research Center at Louisiana State University System; Nikhil Dhurandhar, PhD, associate professor of infections and obesity at Pennington Biomedical Research Center, Baton Rouge, Louisiana; Kirsi Pietiläinen, PhD, an assistant professor of nutrition at Helsinki University Central Hospital; Kirsty Spalding, PhD, of the Karolinska Institute in Stockholm.
As established diet books constantly reinvent themselves to sell copies and win converts, a curious phenomenon has emerged: Ornish, Atkins, and everyone in between are sounding remarkably similar. The low-fat gurus now say that certain fats are okay, while the low-carb proponents are beginning to endorse whole grains. With every new guideline and selling point, each diet acknowledges that there are really four basic rules to healthy eating (drumroll, please):
Consume carbs in the form of whole grains and fiber.
Avoid trans fats and saturated fats.
Eat lean protein.
Fill up on fruits and vegetables.
The low-carb South Beach Diet, for example, now espouses the virtues of eating the Mediterranean way—including lots of carbohydrate-rich fruits and vegetables. The latest Atkins book emphasizes the “good carb” message, too. Weight Watchers, a champion of the points system, is now offering a “no counting” option based on healthy choices like those above. Jenny Craig is pushing Volumetrics, a high-volume, low-calorie strategy. Our new book, The Digest Diet, reveals the foods that studies show help the body release fat. And everyone gives a thumbs-down to processed and sugary carbohydrates, which cause insulin to spike and can lead to more fat and even diabetes.
The key to all of this, of course, is moderation rather than deprivation—eating in a way you can enjoy for the rest of your life.
WHAT YOUR PERSONAL TRAINER WON’T TELL YOUWhat’s a waste of energy and what really works? Find out from trainers who’ve seen it all in the gym.
1. Do not arrive at a training session in the following states: On an empty stomach, coming off a cold/stomach bug, or on four hours’ sleep. It wastes your time and mine when your body isn’t fueled, hydrated, and ready to work.
2. If you concentrate on the exercise you are doing with me with the same intensity as telling me the latest gossip about your life, you would find it easier.
3. If you’re on a budget, recruit a few friends for a small group session. These cost less per person.
4. We know you are eating more than you tell us.
5. It takes more than writing a check or showing up for training sessions to make you fit and healthy. It’s what you do before and after you meet with your trainer, including choices with food, alcohol, workouts, and a commitment to a new lifestyle.
6. Ask you trainer what she or he does to keep educated in the field. An educated trainer will get better results and provide variety to keep you engaged and motivated in your workouts.
7. When you are late it is a waste of your money, a waste of my time, and disrespectful.
8. There is a difference between pain and burn. You need to be honest with your trainer about which you’re feeling. If you push so hard that you injure yourself, we both lose.
9. Whatever the text or e-mail says, it can wait until we’re done. And no, you cannot text and put forth 100 percent effort at the same time.
10. Gear matters. Don’t expect to get maximum performance and results by working out in the ratty gym shoes and shorts you dug out of that old box of college dorm clothes. Invest in a good pair of sneakers. Your feet and joints will thank you and so will your trainer.
TOP SECRET! Drink a bottle of water on your way to the gym. If you’re dehydrated, you can’t work as hard, you don’t feel as good, and your mental function is compromised. So you won’t get as much out of your workout.11. We see through your stall tactics. “I think I need to fill my water bottle.” “Let me get a dry towel real quick.” “Oh, I need to go to the bathroom again.” Nice try. But you’re paying for the session, so make every minute count.
12. Remember that a 30-minute session at max effort is better—and cheaper—than 60 minutes of dawdling and half-effort.
13. Turn off the TV when exercising on your own. Although TV may take your mind off your workout, it also causes you to lose touch with your effort level. You unconsciously slow down or use poor form as you get caught up in what’s on screen.
SOURCES: Personal trainers in Vermont, Florida, California, and Louisiana.
1. Avoid the mirrors. Many fitness centers line exercise rooms with mirrors, yet a study of 58 women found that those who exercised in front of a mirror felt less calm and more fatigued after 30 minutes of working out than those who exercised without staring at their reflections.
2. Set a short-term workout goal. Of course, goals motivate you to work harder, and the best exercise programs include measurable goals to achieve weeks or months down the road. Sometimes, though, when your motivation is drooping, a goal focusing on what you can complete over the next 30 minutes is what you need. So pick something achievable: Maintain a sweat for 20 minutes, give your arms a good workout, or cover 2 miles on the treadmill. A target like that gives you focus to get through.
3. Invent a competition with the person on the next treadmill. If you’re on the treadmill and you’re bored, glance at the display on someone else’s nearby treadmill. If you’re walking at 3.5 miles per hour and he or she is chugging away at 4 miles per hour, see if you can increase your speed and catch up, as if it were a race. The other person won’t even know you’re racing.
WHAT YOUR WEIGHT LOSS COUNSELOR WON’T TELL YOUHere are the experts’ secrets to resisting food temptation in its many guises.
1. Eat the cake. Just decide how much ahead of time. Passing on your colleague’s cake looks as curmudgeonly as refusing to sing “Happy Birthday.” The socially acceptable way out is to ask for a thin slice, and then eat a small number of bites you’ve decided on beforehand. Or just eat the cake and leave the icing.
2. Kiddie cones are not that bad. When your best pal wants to go out for ice cream and you can’t shake off 1,360 calories and 89 grams of fat—the going rate for a banana split at Ben & Jerry’s Scoop Shops—a 3-ounce kid-sized cone weighs in at about 220 calories at the same shop. Frozen yogurt or sorbet may have even less.
3. Beer isn’t off-limits when you choose lite—or right. The most refreshing, easy-to-drink beers are the highly carbonated, lower alcohol “lite” brews. As a rule the darker the beer, the more calories, so if your yen is for craft-beer flavor, stick to the trendy new wheat and white (weiss) beers and avoid higher alcohol ales, even so-called “pale” ones.
4. You can do OK at the drive-thru. The big boys have begun to grasp that customers want some reasonable options: “395-calorie meal for $3.95” read one sign outside a fast food franchise recently. Just stay away from anything with the word “crispy”; steer clear of mayo-heavy sauces (use mustard!); and keep dressings no-fat.
5. Starbucks has low-calorie options. This chain isn’t just about additions that turn a cup of coffee into an ultra-sweet high-calorie dessert. While the tempting, calorie-rich offerings are generally at eye level, look down. Starbucks now offers sensible snacks, but they’re going to make you find them. As for drinks, begin any order with the word “skinny” and you can cut the calorie count by up to a third.
6. Don’t skip the sauce; share. A meal in a top-flight restaurant is all about the sauces and special preparations made by a chef who is closer to an artist than a cook, and you’re not going there to skip them. Instead, order less food, and be confident that the intense flavors will satisfy you.
TOP SECRET! Toast with a something-and-soda. When you hit the bar to raise a toast to Bob-in-Accounting’s promotion, have a lower-calorie cocktail that doubles easily for a soft drink, and then alternate between the two. For example, a gin (or vodka) and tonic has only 180 calories and no one will be the wiser when you make your second round an equally bubbly and transparent zero-calorie diet Sprite, dressed up with a twist.7. Appetizers to share, broth soups, and salads are great options when you’re out to eat. If you can’t resist a delectable dessert item, share that, too.
8. Nibble on the move. If you are shopping and fading from hunger, avoid settling in at the food court. Instead nibble your way through a shopping marathon. Pick up a snack, such as a hot pretzel, a small bag of roasted nuts from a kiosk, or even a chicken taco, and nibble on the move. Portable meals, of course, can still seriously weigh you down; check calorie counts before you go or on your mobile phone.
9. Have the hot dog. If the only foods at the picnic are hot dogs, hamburgers, and drenched-in-mayo “salads,” then go ahead and smell the burgers, but eat the hot dog. A dog on a bun with a smear of ketchup will set you back about 250 calories. That’s as many as the burger has in fat alone. Load up your plate with the low-calorie burger fixin’s, like lettuce, tomato and onions, to round out your meal.
10. Douse your afternoon slump or hunger pangs with water. The energy drop that hits in afternoon is likely a combination of perfectly natural factors: the result of a light lunch, mild dehydration, a momentary lack of iron, or a crash off that coffee you had at the late-morning meeting. Before wandering to the cafeteria or fridge, start your recovery with a tall glass of water, which boosts your blood flow and, as a side benefit, makes you feel full.
11. Ideal snacks for clearing a cobwebby head are hummus or almonds, but if your only option is an office vending machine, look for any hint of protein—those orange crackers with peanut butter, at 200 calories, are better than a sugary cookie. Wash it down with a cup of coffee doused in iron-rich cinnamon.
12. You can eat less and still make Mamma happy. Food is love, and when Mamma tells you “mangia” and you don’t, she acts like you’re rejecting her, not her pot roast. The answer: Have some of everything pushed at you during the holidays or a weekend visit home, but only a spoonful. That means your plate will be more of a tasting sampler than a full meal. Remember: Just one bite of a dish, preceded by a loud “I can’t resist!” will do your parents good and won’t kill you.
13. Another strategy: Make yourself useful serving people and cleaning up. It gets you away from your plate, but still makes you a vital part of the meal.
SOURCES: Marion Nestle, nutrition professor at New York University; Elizabeth Somer, author of Eat Your Way to Happiness.
Start with soup. This Japanese tradition is one of the best weight-loss strategies. That’s because eating soup, particularly the broth-based vegetable kind, before your entrée fills you up so you eat less during the meal, explains Barbara Rolls, Guthrie professor of nutrition at Penn State University in University Park, and author of The Volumetrics Eating Plan. A two-year French study of 2,188 men and 2,849 women found that those who ate soup five to six times a week were more likely to have BMIs below 23 (considered lean), compared with infrequent- or non-eaters whose BMIs tended to be in the 27 range.
Make lunch your main meal. Although they do this throughout Europe, a good explanation for eating your big meal at midday comes from ayurveda, India’s 5,000-year-old approach to wellness. “According to ayurveda, we’re actually designed to eat the larger meal at lunch because our digestive ’fire,’ called agni, is strongest between 10 a.m. and 2 p.m., so we digest more efficiently,” explains Jennifer Workman, a Boulder, Colorado–based ayurveda specialist, registered dietitian, and author of Stop Your Cravings. “I’ve seen people in my practice lose 5 to 10 pounds just by doing this.”
Think quality, not quantity. The French snub processed “diet foods” not found in nature, opting instead for high-quality meats, fish, produce, dairy, even desserts. When food is fresh and flavorful, you can be satisfied with smaller portions. This is the opposite of the American approach, which is to fill up on bland diet foods, then gorge on sweets later. “The French set the standard for small portions with their haute cuisine,” says David Katz, MD, author of The Way to Eat. “If we consider that part of eating is to induce pleasure, if you can get there with quality of choice, you get there in fewer calories.”
Big AdviceThe healthy choice isn’t always obvious. For optimal weight and health, here’s what to pick from these popular pairs.
1. Bacon or sausage?
Answer: Bacon. A slice of bacon, cooked thoroughly, has fewer calories than a typical serving of sausage. Your best bet is a slice of lean back bacon with the rind and fat cut off, rather than fatty, streaky bacon.
2. A packed lunch or a purchased lunch?
Answer: A packed lunch. It’ll be healthier; it’ll probably have fewer calories; it’ll be cheaper; and it’ll save you lots of time that you can use for walking, reading, or socializing instead.
3. Lunch or graze?
Answer: Graze. Nibble food throughout the day, rather than having a large, formal lunch. Spreading out your calories stabilizes blood sugar and insulin levels; provides more frequent relief from stress, tension and boredom; and avoids post-meal fatigue, because you don’t have a big meal. Plus, you never get really hungry and so are less likely to make the regrettable food choices that you might when you’re starving. But if you are going for meals over munching, make lunch your big one.
4. Coffee or tea?
Answer: Tea. Choose black or green tea. These are jammed with heart-healthy antioxidants that provide more than just an energy-boosting punch. As well as contributing to healthier arteries, they may also help to prevent cancer.
5. Natural sugar or white sugar?
Answer: Neither. They’re both sugar. Neither has any nutritional benefit or is any better than the other. Here’s a case where the brown color does not imply a healthier version.
6. Strawberries or blueberries?
Answer: Blueberries. Of course, both are great for you, so try to eat lots of these two fruits. But when you compare the nutrients in an equal amount of each, blueberries have a slight edge. Blueberries are particularly rich in fiber—four times that of strawberries—and contain much more vitamin E and some unique micronutrients that are good for memory.
7. Fruit juice or fruit?
Answer: Fruit. Get the real thing. Not only are most fruit juices loaded with sugar, they’ve been stripped of an important element found in fruit—fiber.
8. Broccoli or cauliflower?
Answer: Broccoli. At 2.6 grams of fiber per 100 grams, broccoli has twice the fiber oomph of cauliflower.
9. Apple or orange?
Answer: Apple. The old adage is true after all. A study from the University of Nottingham found that people who ate more than five apples a week had improved lung function, less wheeziness, and fewer asthmalike symptoms. Eat them raw, try them baked, add them diced into a salad, or sauté an apple with onions as a side dish for chicken or fish.
10. Green olives or black olives?
Answer: Green olives. Green olives haven’t ripened fully, so they contain roughly half the fat levels that they would have achieved had they ripened and blackened.
11. Sparkling water or club soda?
Answer: Sparkling water. There’s a reason soda and sodium sound similar. Club soda is based on the use of sodium bicarbonate to “carbonate” it; thus it should come as no surprise that club soda is salt-rich. With only 3 milligrams of sodium, sparkling water beats club soda’s 75 milligrams hands down.
Answer: Sirloin. A 300 grams sirloin steak contains 325 calories and 13 grams of fat, 6 of them saturated, compared to the 423 calories and 23 grams of fat (12 of them saturated) found in the same size of rib-eye steak.
13. Soup or salad?
Answer: It depends. Some soups are far healthier than some salads and vice versa. You’re better off with a salad of mixed greens and raw vegetables coupled with a light, healthy dressing over a creamy soup. You’ll get more fiber and thus more filling for your calories, not to mention the healthy dose of disease-fighting antioxidants found in raw vegetables. But broth-based soups are very healthy and contain way less fat and calories than a salad covered in a creamy dressing.
14. Bottled salad dressing or homemade?
Answer: Homemade. Homemade is healthier almost every time. Not only can you use cholesterol-lowering monounsaturated fats such as olive oil, but also many bottled dressings contain extra salt and additives.
15. Café au lait or caffe latte?
Answer: Café au lait. Café au lait comprises equal parts brewed coffee and steamed milk. A caffe latte is one or two shots of espresso with steamed milk and foam filling the rest of the cup. For a tall drink made with semi-skimmed milk, the au lait has just 91 calories and 3.4 grams of fat, while the tall semi-skimmed latte, because it uses so much more milk, has 148 calories and 5.6 grams of fat. You may find that the au lait has a bolder, more coffee-rich flavor, so you win on all counts.
16. Fresh tomatoes or tomato sauce?
Answer: Tomato sauce. Tomatoes are rich in lycopene, an antioxidant believed to reduce the risk of prostate cancer and possibly several other cancers. But only by cooking it will you release the lycopene from the tomato cell walls so that your body can absorb it. What’s more, lycopene is fat-soluble, meaning your body is better able to absorb and use it when you get it with a bit of fat—such as the olive oil found in most tomato sauces.