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Oct. 10, 2002 -- Southerners may be famous for their hospitality, but they could become infamous for their poor health, according to a new list of America's least healthy states. Seven of the top ten unhealthiest states are south of the Mason-Dixon line, and researchers say an unhealthy lifestyle and high-fat diet are putting the health of the millions who call the South home at risk.

Mississippi topped the list of unhealthy states that was released this week by the Physicians Committee for Responsible Medicine (PCRM), followed by West Virginia and Tennessee. The group compiled the list after analyzing the most recent data from the CDC on the rates of three major health-related killers -- heart disease, diabetes, and obesity.

According to PCRM, the least healthy states in the US are:

1. Mississippi
2. West Virginia
3. Tennessee
4. Michigan
5. Louisiana
6. Texas
7. Kentucky
8. Illinois
9. Missouri
10. Arkansas

The PCRM is launching a monthlong healthy eating campaign designed to help the residents of these states lower their risk of disease. The organization has also offered the government of each state a nutrition makeover.

"Americans are in the midst of a health crisis, and, as a physician, it's my job to make a diagnosis and prescribe treatment options. In this case, it's a meat-based diet that is putting these folks at risk for diabetes, obesity, and heart disease," says Neal Barnard, MD, president of PCRM, in a news release. "Our studies show that a low-fat, vegetarian diet is the most effective method of treatment and prevention for those diseases. Unfortunately, that prescription has not gotten to those who need it most -- the people in these 10 states." -->

Dec. 5, 2000 -- If you're like a lot of Americans, you probably could stand to lower your cholesterol. A new study shows that the choice to do so is up to you -- well, sort of. The researchers tell WebMD that genes may have more power than sheer will in the fight against high cholesterol.

"We were looking into why people differ in their response to cholesterol lowering diets," says study leader Margo A. Denke, MD, associate professor of medicine at the University of Texas Southwestern Medical Center in Dallas. "Some people try very, very hard on a diet, but can't even budge their cholesterol levels. We were trying to determine how much of that was due to genetics."

Between 1997 and 1999, 56 families -- 92 adults and 134 children -- in the Dallas-Ft. Worth area followed two special diets.

During the study, all members of a family got their fat -- 20-25% of total calories -- in the form of either saturated fat-laden butter or margarine with unsaturated fat. For each regimen, families were provided with specially formulated breads, baked snacks, and spreadable fat for cooking. After five weeks, they went back to their normal diet for a month, then switched to the other diet for five more weeks. Cholesterol levels were measured at different intervals during the study.

The research -- which, luckily for the study participants, was halted between Thanksgiving and Christmas each year -- is published in the Dec. 6, 2000 issue of The Journal of the American Medical Association.

"In our study, 80% of people had lower cholesterol levels when they consumed margarine compared to butter," Denke, who is also at the UT Southwestern's Center for Human Nutrition, tells WebMD. Although the overall trend was for cholesterol levels to drop with less saturated fat intake, genetics definitely played a role. Parents who responded -- whose cholesterol went up and down with diet -- had children who responded as well. "And if the parents don't respond, neither do the children," she says.

People are powerless over their genes but one take home message "is that margarine is a better choice than butter, which is one of the most potent cholesterol-raising fats," says Denke. There is increasing evidence, including a recent study looking at the blood vessels of children who'd died in car accidents, that plaques that clog blood vessels begin forming much earlier than previously thought. "What you eat really is very important," she says, "and it is especially important to start out right. There will be big pay-offs as you get older for learning a good diet when you're young."

The second, less obvious point, she says, is that heavier people reap much less benefit from cholesterol-lowering diets than do thinner folks. "A person who's overweight gets into trouble for two reasons. Being overweight itself raises their cholesterol," she explains, "and even when they try to lower cholesterol by diet, they won't get as much cholesterol lowering."

People "should realize that being overweight has very major consequences, and the only way to undo those consequences is to get thin. And "the only way" to do that, says Denke, is by eating fewer calories.

Exercise is more helpful for maintaining -- rather than spurring -- weight loss, says Denke. "We can undo an hour's worth of exercise with one little cookie. People will overeat for five minutes, not realizing that it will then take them five hours to burn off those calories with exercise. We have to focus on what we're putting in our mouth. Our study shows that it's really important to make good, sensible choices."

In the struggle with genes, Denke recommends switching from higher-fat choices to lean meats and low-fat dairy products, such as 2% or lower milk and low-fat sour cream.

In today's on-the-run society, where sitting down for a meal is sometimes an impossible luxury, the emergence of nutrition bars may seem to be just what the doctor ordered. Though these pocket-sized bars once found favor primarily with serious athletes looking for a competitive edge, now anyone who feels the need for a nutritional boost may keep a few stashed in a purse or a briefcase.

In the current bar-wars environment, there are literally hundreds of these prewrapped and portable products competing for shelf space at gyms, health-food stores, and supermarkets, with names ranging from PowerBar and Luna Bar to Balance Bar and MET-Rx. But nutritionists agree that not all bars are created equal. There are high-carbohydrate bars, protein bars, energy bars, breakfast bars, brain-boosting bars, meal-replacement bars, diet bars, and women-only bars. And with so much to choose from, consumers hungering for a quick nutritional fix -- whether they're recreational athletes, workaholics tied to their desks, or overcommitted moms with barely a moment to spare -- may feel dizzy from all the product overkill and heavily hyped claims.

Digesting the Bar Facts

Without a doubt, grab-and-gobble nutrition bars are great for people who race nonstop from sunup to exhaustion. "They're a convenient alternative for someone who would otherwise be reaching for a doughnut or using the vending machines for snacks at the office," says Liz Applegate, PhD, lecturer in nutrition at the University of California at Davis. "But there's nothing magical about these bars. Most of them are fine, but some are too high in fat."

Dawn Jackson, RD, spokeswoman for the American Dietetic Association, concurs, noting that the bars are convenient, especially when you're physically active. "You wouldn't put a turkey sandwich in your pocket when you go on a bike ride, but you could easily bring one of these bars with you." However, she cautions, "some of the bars have as much sugar and as much saturated fat as a candy bar. So use them in moderation."

Steve Hertzler, PhD, RD, assistant professor of medical dietetics at Ohio State University, conducted a study showing that endurance athletes may not get the sustained energy boost that they're expecting from certain bars. In his research, he compared the effects on blood glucose levels of two popular energy bars -- the Ironman PR Bar and the PowerBar.

Hertzler found that the Ironman PR Bar provided increases in blood sugar levels that remained fairly steady, which could translate into enhanced performance for endurance athletes. By contrast, the PowerBar produced a quick rush of blood sugar, but it was followed by a rapid decline -- not much different than occurs with a Snickers bar.

The composition of the Ironman PR bar -- 40% carbohydrate, 30% fat, and 30% protein -- may have been responsible for its more sustained effect on blood glucose, says Hertzler. For endurance events, he "research shows that consuming a little bit of carbohydrate every so often during a race is going to improve performance."

Nutritionist Nancy Clark, MS, RD, points out that anything that provides calories will give you some energy. "Bananas give energy," says Clark, director of nutrition services at SportsMedicine Associates in Brookline, Mass. "Twinkies give energy. Energy bars give energy. That's because they all provide calories."

It's five hours until her holiday dinner is to be served, and Evelyn Tribole's gargantuan kitchen is already cluttered and humming. Every pot and pan she owns is out, sharing space on the countertops with enough food to feed an army. Wearing a cobalt blue apron, she's ready to work her magic.

By 3 p.m., if this holiday dinner is typical, she will serve the 30 guests she routinely expects, and the meal will look like many of those traditionally served in any other home. But Tribole has a secret: Her fare is festive but not overly fattening.

A longtime dietitian and cookbook author, Tribole has learned to make holiday dinners with a fraction of the fat and calories of many holiday menus, without ruining the taste or making her guests feel deprived. In fact, according to her, most have been unaware of her culinary sleight of hand. She says she can't recall any scrunching their noses and asking, "Is this one of those low-fat dishes?"

If you've had guests skeptical of eating holiday food that's been "healthified" (read: ruined), there may be hope. Most cooks try too hard to eliminate calories from holiday dinners, Tribole says. "They try to get out all the fat." That's not the goal, she says. The key is modifying with moderation -- and maintaining the perspective that holiday meals should be special.

To learn more, WebMD asked Tribole and two other dietitians to tell us more about their holiday menu strategies.

The Tribole Plan

Stick with your favorite holiday dishes, Tribole suggests, but change one fattening ingredient to reduce fat and calories. "If you change one ingredient and don't like the result, you'll know what the problem is," says Tribole, MS, RD. For instance, if she makes quiche, she may substitute evaporated skim milk for cream.

She cautions not to go overboard, however. While substituting low-fat ingredients can work, resorting to nonfat foods can spoil the taste of a dish. "I will use light butter instead of regular," she says, to top off dishes and at the table. For a fruit mold, she often uses sugar-free gelatin. "You can't tell," she promises. "I use light cream cheese instead of regular, but I never use fat-free cream cheese alone. It's too blah. I might mix fat-free with light cream cheese for a dessert."

For twice-baked potatoes, she uses nonfat milk, light butter, and light cheese (never fat-free cheese, she says). For more healthful gravy, she uses nonfat milk and skims the fat off the meat juices with a fat separator. She uses cornstarch instead of flour and butter to thicken the gravy. And for her vegetable side dish of asparagus, she drizzles some olive oil over it. "My goal is not to end up with zero fat."

But, again, knowing when to leave well enough alone is important. Certain ingredients, she says, should remain. "I don't mess with chocolate," she says. "I'd never use carob instead of chocolate."

The Hampl Strategy

Jeff Hampl, PhD, RD, an assistant professor of nutrition at Arizona State University in Mesa, cooks Christmas dinner for family and friends and knows all about substitution, too. He suggests replacing oil with an equal amount of applesauce when baking cakes. "No one can tell," promises Hampl, a spokesman for the American Dietetic Association.

Spreading out the high-fat foods over the course of the dinner is another strategy. "It's a shame not to prepare [some traditional] foods," he says. "Modify the recipe as much as you can." Then just don't serve them all at once. His main course, for instance, is goose -- high in fat. A 3.5-ounce serving with skin has 305 calories and a whopping 21.9 grams of fat. But he limits the damage by using a turkey baster to remove the fat from the pan every 45 minutes.

March 3, 2004 -- If weight loss is your goal, a 15-minute walk might not be enough, one study shows.

"Fifteen minutes is good for your heart and your psyche, but not if you're not going lose weight," researcher Michael Costanza, PhD, a biostatistician at the University of Geneva in Switzerland, tells WebMD.

His paper appears in the current issue of the American Journal of Public Health.

Some researchers suggest that people could battle obesity by cutting 100 calories out of their diets -- or by burning an extra 100 calories through 15-minutes a day of a moderate or brisk walking, he says.

His study provides "a more realistic look" at the calorie burn from these recommendations. People have to walk a whole lot farther to walk off those extra pounds, Costanza tells WebMD.

In his study, Costanza uses five years of lifestyle surveys completed by 6,010 Swiss adults aged 35 to 74 years old. He then projected the calories burned by following a daily physical activity recommendation that involved walking. The participants walking program involved 15 or 30 minutes of daily walking done at a pace that was either slow, moderate, brisk or athletic-brisk -- the pace followed determine what the metabolic rate was and how many calories would be burned.

If the population as a whole followed the recommendation for physical activity his findings showed that:

• The average adult who walked 15 minutes per day at a slow pace would burn only an additional 9 calories per day.
• The average adult who walked 30 minutes a day at a slow pace would burn only an addition 25 calories per day.

Assuming that the population as a whole participated in harder levels of the physical activity, the following results would be expected:

• Walking moderately for 15 minutes per day burned 36 calories per day, where as moderate walking for 30 minutes burned only 85 calories per day.
• Walking briskly resulted in an increase in the calories burned. Fifteen minutes of a brisk walk per day resulted in 60 calories burned, whereas 30 minutes a day of a brisk walk resulted in 129 calories burned.

"If your goal is to burn 100 calories a day, 15 minutes just won't do it," says Costanza. "There's very, very little calorie burn in a slow walk. Walking briskly for longer periods will provide a fairly substantial boost in calorie burn. Then you will lose weight."

That's not true, says Madelyn Fernstrom, PhD, director of the Weight Management Center at the University of Pittsburgh Medical Center.

"You can lose 10 pounds with a 15- or 20-minute slow walk -- if you do it daily -- and even if you didn't cut back on calories," Fernstrom tells WebMD. "That 100 calories you burn will give you that 10-pound weight loss in a year's time."

What gets people into trouble is eating an extra 150 calories to compensate for all that activity, she explains. People waste their weight-loss efforts.

Fernstrom dislikes public health messages that "overwhelm" people -- messages about walking 10,000 steps, or for 45 minutes or an hour every day -- for weight loss. "People end up think nothing is good enough," she says.

She advises setting realistic goals: Start with a half-mile, 30-minute walk; then do a mile in 15 minutes; then two miles in 30 minutes. "The idea is, can you get more activity into the time you have," says Fernstrom.

For faster weight loss, cutting back on calories will also help -- "but exercise allows you to barter for a little more food," she explains. "Say you're cutting back 500 calories a day to lose 1 pound a week. If you get some exercise every day, you only have to cut out 350 calories. And let me tell you, 150 calories are really precious when you're trying to lose weight."

"Sure, you can lose weight by cutting back on eating, without the physical activity component," Fernstrom says. "There are a lot of books out there that tell you how to do it. But weight loss is much easier with physical activity."

March 7, 2007 -- Once happy, always happy? Once grumpy, always grumpy? Maybe not, according to a new review of happiness research.

The review focuses on the "happiness set point" theory, which suggests that people have a happiness set point, a natural level of happiness they gravitate to, despite temporary rises and falls in happiness.

But your happiness set point may not be carved in stone, suggests Michigan State University professor Richard Lucas, PhD.

Major life events such as getting divorced, losing a job, or becoming disabled may reset your happiness set point, writes Lucas.

"Happiness levels do change; adaptation is not inevitable; and life events do matter," Lucas says.

His review appears in the April edition of Current Directions in Psychological Science.

Psychology of Happiness

Lucas reviewed data from a German study of nearly 40,000 people and a British study of more than 27,000.

The German study lasted 21 years; the British study for 14 years. Participants annually rated their life satisfaction and reported any major life changes they had experienced in the past year.

As the happiness set point theory suggests, people tended to adapt to major life events. But that process sometimes took many years and didn't always lead back to previous levels of life satisfaction.

For instance, Lucas notes that it takes about seven years after the death of a spouse for widows and widowers to return to the level of life satisfaction they had before their spouse died.

Meanwhile, the temporary bounce in happiness after getting married generally fades "within just a couple of years," writes Lucas. That doesn't mean married people are unhappy, just that -- within a few years -- they become about as happy as they were before saying "I do."

Lucas also noticed that, understandably, people reported less life satisfaction after getting divorced or losing a job. But he didn't see people bounce back to their previous level of life satisfaction after those events.

That doesn't mean getting divorced or losing a job always lowers long-term happiness.

Not all marriages or jobs are happy and satisfying. So for some, divorce and job loss may ultimately lead to a better life.

People also vary a lot in how much they adapt to life events, Lucas notes.

The researcher doesn't dismiss the happiness set point theory. He says happiness is "moderately stable" over time but warns that people can still experience "large and lasting changes" in the feeling.

Nov. 8, 2004 (New Orleans) -- Wedded bliss has its rewards: Being married and having a strong social network may help protect against heart disease, a new study suggests.

The study of nearly 15,000 men and women shows that those who have a spouse, go to church, join social clubs, and have a lot of friends and relatives have significantly lower blood pressure and other heart disease risk factors than unmarried loners.

People who are married and have a strong social network are also less likely to smoke than their unmarried, less social counterparts, says Chris J. Armstrong, PhD, research associate in the division of epidemiology and community health at the University of Minnesota in Minneapolis.

Men seem to get an added bonus from taking a trip to the altar: "Married men with strong social support are also more likely to engage in physical activity, though this doesn't hold true for women," Armstrong tells WebMD.

High blood pressure and smoking are classic risk factors for heart disease, while physical activity can help ward off the nation's No. 1 killer.

For the study, presented at the annual meeting of the American Heart Association (AHA), the researchers interviewed nearly 15,000 Minnesotans between 1990 and 2002. Participants were asked about their marital status, church attendance, membership in social clubs such as the PTA, bridge club, or runner's club, and how many friends and relatives they had to help them through the good and bad times. All the men and women also underwent a physical exam looking at risk factors for heart disease.

Though the study was not designed to look at how family and social ties protect against heart disease, Armstrong says he suspects that "at least as far as smoking [goes], spousal and peer pressure are involved."

Coronary heart disease is the single largest killer of American men and women, responsible for more than one in five deaths in the U.S. in 2001, according to the AHA. About every 26 seconds an American will suffer a coronary event such as a heart attack, and about every minute, someone will die from one.

Importance of Social Ties

Raymond J. Gibbons, MD, the Arthur and Gladys D. Gray professor of medicine at the Mayo Clinic in Rochester, Minn., tells WebMD that the new research is one of a series of recent studies showing that social support in general and marriage in particular may be important for our heart health.

Another study presented at the meeting, for example, shows that married people who receive implantable defibrillators to correct heart disease due to abnormal heart rhythms have significantly less anxiety and depression than those who live alone.

Although the subject of a flurry of recent reports, the connection between social support and heart health has probably always been there: It was just a matter of looking for it, says Tim Gardner, MD, professor of surgery at the Hospital of the University of Pennsylvania in Philadelphia.

"We haven't looked at the impact of behavior on health as much as we should," he says. "Especially within the scientific community, the emphasis has been on new drugs."

But health conditions such as obesity are actually both a medical problem and a behavioral problem, Gardner says.

"We need to pay more attention to the behavioral aspects of our health," he tells WebMD.

Sept. 9, 2003 -- Reaching for the cookie jar at the first sign of bad news may actually be healthy.

New research suggests that high-fat, high-carbohydrate comfort foods actually fight stress by stemming the tide of stress-related hormones that are released when people are acutely exposed to stress.

But there's a hitch.

Researchers say those same ingredients in your favorite comfort foods that work to reduce stress and decrease stress hormones also pile on the pounds around the waist and increase the risk of obesity when stress is chronic. The researchers say that over the long haul habitual use of these comfort foods may cause an increase in those same hormones, leading to increased amounts of abdominal fat -- a risk factor for heart disease.

Comfort Food Fights Short-term Stress

In the study, which appears in the Proceedings of the National Academy of Sciences, researchers investigated the effects of comfort foods on stressed-out rats.

They found that when rats exposed to stress ate foods high in carbohydrates and fat, an unknown component in the foods acted like a brake on the cascade of stress-related hormones, such as the steroid cortisol, and hormones that are related to the "fight or flight" syndrome.

Stress sets off this syndrome and causes non-vital bodily functions to shut down. Meanwhile, adrenaline levels increase, heart rate quickens, and the immune system gets a boost.

Although this type of reaction is good if you're staring down a grizzly bear, researchers say chronic exposure to stress puts the body into overdrive, continuously stimulating these hormones, which can increase long-term health risks.

In addition, researchers say that their findings suggest that this constant exposure to stress can also trigger a potentially dangerous urge to indulge in rich comfort foods.

"There is no doubt that eating high fat and carbohydrate comfort foods cheers people up and may make them feel and function better," write researcher Mary F. Dallman, of the University of California, San Francisco, and colleagues.

"However, habitual use of these foods, perhaps stimulated by abnormally elevated concentrations of cortisol as a consequence of underlying stressors, results in abdominal obesity," they write. Unfortunately, this type of obesity is strongly associated with type 2 diabetes, cardiovascular disease, and stroke."

Researchers say occasionally indulging in mom's macaroni and cheese or chocolate chip cookies is probably useful to relieve anxiety in the short-term. But habitually using comfort foods to combat chronic stress is likely to be bad for long-term health and could be contributing the current epidemic of obesity in the U.S.

Oct. 16, 2002 -- Cancer patients are avid users of herbal remedies and dietary supplements. They're also much more willing than others to talk to their doctor about it. And researchers say that's good news for their health.

Two new surveys show cancer patients are about 30% more likely than others to tell their healthcare provider about herbal or dietary supplement use.

"Cancer patients are very forthcoming with their doctors about everything they're taking," says researcher Jessie A. Leak, MD, of M.D. Anderson Cancer Center in Houston, in a news release. "We don't know why, but perhaps they feel the need to disclose everything about themselves to better their chances of getting well."

Leak presented the results of the surveys today at the annual meeting of the American Society of Anesthesiologists in Orlando, Fla.

Researchers say doctors are concerned about their patients' use of herbs and dietary supplements because some of the preparations have been linked to potentially hazardous drug interactions, or shown to reduce the effectiveness of cancer surgery and chemotherapy drugs.

Products linked to negative side effects include ephedra, licorice, St. John's wort, ginkgo biloba, valerian, feverfew, ginger, and echinacea. The effects of these supplements can linger long after the body has processed them.

In the first survey, researchers asked 300 cancer patients scheduled to undergo surgery about their use of alternative treatments. About 18% reported using at least one herbal or other supplement. That rate of use is roughly comparable to that seen in the general population.

But 70% of the patients said they told at least one physician about their herbal use, and that's about one-third higher than the rate at which other types of patients report herbal use to their doctors. Researchers say previous studies have shown about 40% of preoperative patients tell physicians about using herbal products.

In a second survey, researchers looked at 154 cancer patients being treated in the center's pain management clinic. They found that 43% of these patients were using herbals, and like the other group, about two-thirds said they'd informed their doctor.

Leak says the fact that the patients in the pain clinic were more than twice as likely to be using herbals may be due to the fact that they were farther along in their cancer treatment and probably had spent more time educating themselves about alternative options. -->

Upon its release this Ash Wednesday, Mel Gibson's new film The Passion of Christ is sure to add to the passionate debate already surrounding the film. In the process, the film is poised to join a select list of films that highlight the unique ability of movies to sometimes go beyond mere entertainment to something more universal ... call it movie magic?

For a start, The Passion of the Christ is one of the first R-rated movies in a while that has moviemakers and marketers encouraging young and old alike to see the film.

The Passion of Movies

But what is it about movies, in particular, that can affect us with emotions, insights and inspiration ?

The Passion of the Christ has a lot of impact because there is a lot of charge surrounding it, says Oakland, Calif.-based cinema therapist Birgit Wolz, PhD.

However, Wolz tells WebMD, "an article or book would not have this much impact because all of our senses are affected through movies," Wolz says. "Our psyche is much more directly impacted by movies, especially when we hear music that arouses emotions as we watch."

Movies affect us through more than the story they are telling, she says. "They also elicit emotions by stimulating our senses: sight through visual images and hearing through music and other sounds. Directors use visual effects, spatial relations, timing, sound effects, and music to prompt the emotions of the audience in a particular direction, thus widening the range of their perception."

For Better or for Worse ...

"Movies are like a proverbial hammer, you can use them for good or for bad," she says. "They can re-traumatize people if they are so powerful and violent, and if people are not treated, they can worsen anxiety and depression."

For example, families may be re-traumatized when they see Holocaust movies such as Schindler's List and The Pianist. Other movies, too, can remind viewers of a traumatic event or loss.

Vietnam-era movies like Platoon and Born on the Fourth of July help raise consciousness about what happened in Vietnam. The effect "really depends who is seeing it, but I believe that these movies can make us more aware of what's happening in a war and learn compassion and empathy," she says.

Suspended Disbelief at Play

Gary Solomon, PhD, MPH, MSW, author of The Motion Picture Prescription and Reel Therapy and a professor of psychology at the Community College of Southern Nevada, agrees with Wolz when it comes to the power of movies.

"Movies are very visual as opposed to books, where we must visualize the story on our own, so with movies we are getting a story along with visual image, and that creates a very powerful impact," he says.

Suspended disbelief is also at work, Solomon says. "This is a process where we view something and for an hour-and-a-half to two hours and suspend our disbelief about the story and what's going on around us and accept the concept for what it is," Solomon explains.

"People will undoubtedly look at [The Passion of the Christ], suspend their disbelief, and will, for whatever period of time, believe that this is exactly the story that took place," Solomon says.

That has left many people fearful that the film will spark anti-Semitic sentiments because of how the film portrays the involvement of Jews in Jesus' death.

Thanks to the Internet, becoming a hypochondriac is much easier than it used to be.

The easy availability of health information on the web has certainly helped countless people make educated decisions about their health and medical treatment, but it can be disastrous for people who are likely to worry. Hypochondriacs researching an illness used to have to scour books and ask doctors for information. Now a universe of information is available with a few mouse clicks.

"For hypochondriacs, the Internet has absolutely changed things for the worse," says Brian Fallon, MD, professor of psychiatry at Columbia University and the co-author of Phantom Illness: Recognizing, Understanding and Overcoming Hypochondria (1996).

So far, no studies have been conducted on just how hypochondriacs use the Internet, Fallon says. But the phenomenon is common enough to have a snappy name -- "cyberchondria."

Understanding Hypochondria

The medical condition called hypochondriasis is defined as worry over an imagined illness with exaggeration of symptoms, no matter how insignificant, that lasts for at least six months and causes significant distress. It tends to develop in the 20s or 30s, and it affects men and women equally. It sometimes comes on following the illness of a friend or family member, and it can also occur as a secondary illness to depression or generalized anxiety disorder.

Although it's often seen as harmless, sufferers know that it can shift from a quirky, neurotic character trait into a devastating obsession.

"Illness often becomes a central part of a hypochondriac's identity," says Arthur Barsky, MD, of Harvard Medical School and the author of Worried Sick: Our Troubled Quest for Wellness (1988). As a result, a hypochondriac's work and relationships suffer. And those with the condition aren't the only ones who pay the price: According to Fallon, hypochondria costs billions of dollars a year in unnecessary medical tests and treatments.

Contrary to what some skeptics think, hypochondriacs are not pretending or just trying to get attention. "They're absolutely not fakers or malingerers," says Barsky. "They really feel the distress they're talking about. It's just that their feelings don't have an obvious medical basis."

"What hypochondriacs have trouble accepting is that normal, healthy people have symptoms," says Barsky. Hypochondriacs tend to be very aware of bodily sensations that most people live with and ignore. To a hypochondriac, an upset stomach becomes a sign of cancer and a headache can only mean a brain tumor. The stress that goes along with this worry can make the symptoms even worse.

Web Can Be Misleading

Hypochondriacs are often not particularly careful about where they get their health information. To many sufferers, Gray's Anatomy, a half-remembered TV movie, and a harrowing health story about your hairdresser's friend's grandmother are all equally legitimate sources.

This can lead to serious trouble for hypochondriacs using the vast and unregulated web.

"A lot of the stuff on the Internet, especially on health-related bulletin boards, is pure impression and anecdote," says Barsky, "and they just don't have a lot of scientific validity."

Even the most reputable health web sites with the most accurate information can cause trouble for the hypochondriac. "Hypochondriacs tend to latch onto diseases with common or ambiguous symptoms or that are hard to diagnose," says Fallon. For example, illnesses such as HIV or lupus, and neurological disorders including multiple sclerosis can cause vague symptoms like fatigue, swollen glands, and strange physical sensations.

With symptoms as common as these, it's easy for hypochondriacs to become convinced they're sick.

Sept. 22, 2004 -- As any parent who's been through it knows, croup can be a terrifying experience. The unmistakable barking cough that keeps everyone up all night usually resolves and rarely leads to severe problems, but try telling that to a parent trying to calm an inconsolable baby or young child in the wee hours.

Steroids are an effective treatment for kids with moderate to severe croup and have been shown to reduce the need to put these children on breathing machines. Now, new research shows that steroids can also be used in mild cases of croup.

For children with mild croup, treatment with the steroid dexamethasone shortened the duration of the disease and reduced the need for follow-up medical care in a study reported by researchers from the University of Calgary.

The findings are published in the Sept. 23 issue of The New England Journal of Medicine.

"This is an effective treatment without apparent side effects that can shorten the duration and severity of croup in children with mild symptoms," researcher David W. Johnson, MD, tells WebMD. "The evidence is unequivocal that children with croup can benefit from treatment with steroids regardless of the severity of their symptoms."

Most Cases Mild

Each year, approximately 3% of children under the age of 6 develop croup, a condition in which the airways become inflamed, leading to a characteristic seal-like barking cough. Because the coughing usually begins in the middle of the night, many kids with croup end up in hospital emergency departments even though the majority will not develop serious respiratory problems.

Children with mild symptoms and no evidence of respiratory distress are often sent home from the emergency department.

Only a few studies have evaluated steroid treatment in this group of patients, but the findings have been far from conclusive.

In this study Johnson and colleagues evaluated outcomes in 720 children with mild croup seen in hospital ERs, half of whom were treated with a single dose of dexamethasone and the other half with placebo.

Compared with kids in the placebo group of the study, half as many children treated with the steroid needed follow-up medical care and half as many still had croup symptoms 24 hours after treatment. In addition, the average amount of sleep loss, because of cough, was reduced by 30% in the steroid treated group, and the amount of stress experienced by the primary parent caregiver was also reduced.

"Oral dexamethasone therapy is simple, inexpensive, and effective," the researchers wrote. "Therefore, although the long-term effects are not known, we advocate dexamethasone treatment for essentially all children with croup."

Treatment Appears Safe

In an editorial accompanying the study, Boston pediatrician and professor of pediatrics Perri Klass, MD, writes that the small but important gains seen in the study population represent potentially major differences in the course of a single child's illness.

"A case of croup that is seen by the doctor as reassuringly mild can nevertheless mean sleepless nights, anxiety, and misery for the whole family," she writes. "That's still no reason to offer an intervention that doesn't actually help, but it's an excellent reason to offer one that shortens the illness and helps everyone get a better night's sleep."

In an interview with WebMD, Klass says steroids have been used for years in higher doses to treat children with asthma, but more study is needed to confirm their safety in children with mild croup.

"Mild croup certainly doesn't endanger the child's life, but it is still an illness that results in tremendous concern and misery to the child and the child's family," she says. "Croup is scary looking and scary sounding, and it is very hard for a parent to watch their child suffer with the awful sounding cough. We can now offer them a treatment that has a clear benefit."

March 31, 2004 -- The largest study to date on the proposed link between childhood vaccination and type 1 diabetes suggests that common vaccines do not increase the risk of the disease.

The Danish study followed nearly 750,000 children, comparing the risk of developing type 1 diabetes between vaccinated and non-vaccinated children, and found no evidence of an association between common vaccines and the disease.

"Overall, there were no more cases of diabetes among the vaccinated children than in the unvaccinated children," says researcher Anders Hviid, of Statens Serum Institute in Copenhagen, Denmark.

The findings appear in the April 1 issue of TheNew England Journal of Medicine.

Type 1 diabetes (formerly known as juvenile or insulin-dependent diabetes) occurs when insulin-producing cells in the pancreas are destroyed by the immune system. The exact cause of the disease is unknown, but a combination of genetic and environmental factors is thought to influence the risk of developing the condition.

Diabetes and Vaccination Linked by Timing Alone

Researchers say the fact that type 1 diabetes cases have risen by 3% each year in developed countries over the last 50 years has fueled speculation that various environmental factors, such as diet, lifestyle, and exposure to infectious agents, early in life might play an important role in the development of the disease.

In addition, the rising incidence of type 1 diabetes in recent years has coincided with the introduction of a growing number of childhood vaccines. Current guidelines for infant vaccination call for up to 18 injections that protect against 12 different infectious diseases by the time children reach 2 years of age.

"There has been this temporal association between increased immunization and the occurrence of type 1 diabetes," says Richard Insel, MD, executive vice president for research at the Juvenile Diabetes Research Foundation. He says the groups that say type 1 diabetes is caused by immunization base this on very little data.

"In my opinion, this article is very important because it will lay to rest the accusations that have been made suggesting that childhood immunization causes childhood diabetes," Insel tells WebMD.

Vaccinations Don't Increase Diabetes Risk

In the study, researchers looked at all the children born in Denmark from 1990 to 2000 for whom detailed information on vaccinations and type 1 diabetes was available.

Among this group of 739,694 children, 681 were diagnosed with type 1 diabetes. Researchers compared the risk of developing the disease among unvaccinated children with children who had received at least one dose of the following common childhood vaccines and combinations:

• Haemophilus influenzae type b

• Diphtheria, tetanus, and inactivated poliovirus

• Diphtheria, tetanus, acellular pertussis, and inactivated poliovirus

• Whole-cell pertussis vaccine

• Measles, mumps, and rubella (MMR)

• Oral poliovirus

The study showed that there was no significant increase in diabetes risk associated with single or escalating doses of any of the vaccines.

In addition, the study also looked at the period following vaccination and did not find any clustering of diabetes cases in the time period after vaccination.

An increase in the number of new type 1 diabetes cases in children within a few years following vaccination is often cited as a sign that the vaccines might be to blame in triggering the disease, but the study found no such clustering.

Finally, when researchers looked at children who were genetically predisposed for the development of type 1 diabetes because they had a sibling with the disease, they found no increase in risk among those who had been vaccinated compared with unvaccinated high-risk children.

Closing the Door on Vaccine-Diabetes Debate?

Hviid says it is always easier to come up with a hypothesis rather than to refute it, but this study comes as close as possible to closing the door on the debate on whether there's a cause-and-effect relationship between childhood vaccination and the development of type 1 diabetes.

"The design and size of this study makes our results very robust, and we couldn't find any indication of association," Hviid tells WebMD. "I can't see how it's going to be conducted larger or better anywhere else."

In an editorial that accompanies the study, Lynne Levitsky, MD, of Massachusetts General Hospital and Harvard Medical School in Boston, agrees and says the results of study "conclusively demonstrate that there is no relationship between vaccination history and the development of type 1 diabetes.

"The scientific community should now move on to the most important tasks: identifying the genetic, immunologic, and environmental phenomena that are actually responsible for the development of diabetes and finding the means to prevent and treat this chronic disorder," says Levitsky.

Much to her nanny's surprise and chagrin, Betsy Davidson, now slightly more than 2 years old, was fully potty trained by her first birthday.

And Betsy is not the only toddler who is giving up her diapers for a turn on the toilet. A growing group of parents are fast-tracking the toilet training process and teaching their children to use the potty before they can walk, talk or even turn 2.

"I started potty training Betsy at eight months because she had very regular bowel movements. I would feed her, put her down and take a shower and when I got out of the shower, she would have a poop in her diaper," Betsy's mom, Emily Jean Davidson, MD, MPH, an attending physician at Children's Hospital Boston, tells WebMD. When Davidson began to sense that early toilet training was possible for her daughter, she did research and contacted a nonprofit group called Diaper-Free Baby, which comprises 77 local groups in 35 states that promote and teach the elimination communication method to interested parents such as Davidson.

"My nanny thought we were crazy for trying this," she says. "But after a few months when Betsy was around 1 year old, the nanny said, 'she was crying and turning red and scooting, so I put her on the potty, she pooped and then she was happy.'"

Davidson explained to her nanny that Betsy was really signaling that she had to go. It is this signal/response process that is the key to early potty training. Moms like Davidson merely respond differently to cues and take their baby to the toilet -- instead of the changing table.

For the Davidson's, the method worked. "We had a very positive experience," she says. "Once we started, there were maybe 10 to 20 times that we had to change a poop diaper. She became pretty consistently dry by around 16 months."

Recognizing the Cues

Known as elimination communication, such early potty training relies on a parent's ability to read and recognize the signs that their infant needs to eliminate -- much as they would if their child was tired or hungry. Signs of impending bowel movement or urination can include facial expression, grunting, and bearing down. Advocates suggest that such early toilet training enhances interaction and communication between parents and babies, prevents diaper rash, avoids the struggles associated with diaper changing, saves money on diapers, and is better for the environment -- as 22 billion disposable diapers end up clogging landfills in the U.S. each year. Detractors, however, have their own reservations about this practice -- namely that an infant's muscles are simply not developed enough for toilet training before they turn 2.

But "in terms of communication, elimination communication is better because the child learns to understand what's going on with their body and realizes if they let you know, you can do something about it," Davidson says. "There's also less diaper rash because they are not sitting in their poop."

Davidson likens elimination communication to how parents teach children to eat. "How do we know when a child needs to feed? We just have a sense and we feed them," she says.

"There's a nice logic to the elimination communication method," agrees Leslie Rubin, MD, a pediatrician at the Morehouse School of Medicine and Emory University School of Medicine, both in Atlanta. "If you become aware and sensitive to what the little ones are doing, you can respond accordingly. It may not be absolute because just like with feeding, sometimes you can't feed an infant when it's time to feed because for whatever reason, you might be distracted."

Sept. 1, 2005 - When it comes to maintaining a healthy weight, most nutritionists agree that breakfast really is the most important meal of the day. But what you eat is as important as when you eat, and two new studies show that cold-cereal eaters may have an edge.

In a study of girls followed from age 9 to age 19, regular cereal eaters had fewer weight problems than infrequent cereal eaters, with the risk for being overweight increasing by 13% among girls who ate cereal only occasionally.

Eating cold cereal for breakfast was also found to be more closely associated with maintaining a healthy weight than eating breakfast in general in a separate study that included adults of both sexes.

The studies were paid for by the nation's two largest cereal manufacturers -- one by General Mills and another by Kellogg.

But a dietitian who calls herself a "cereal advocate" but says she has no ties to the cereal industry tells WebMD that she isn't surprised by the findings.

"I don't work for the cereal companies, but I really do think that cereal is a pretty good food for kids and adults to eat," says American Dietetic Association spokeswoman Bonnie Taub-Dix, RD.

"You wouldn't believe how many people skip breakfast or grab cookies or doughnuts. Cereal with milk is quick and easy, and if you choose the right cereal you get calcium, fiber, and plenty of nutrients."

Teens Tend to Skip Breakfast

Both new studies are published in the September issue of the Journal of the American Dietetic Association.

In one, researchers reanalyzed data from a government-funded study that followed more than 2,000 young girls through their teens to identify risk factors for obesity. The original study was conducted from the mid-1980s through the 1990s.

Nearly one in three adolescent girls are overweight or obese in the U.S.

Breakfast skippers tended to weigh the most through their teen years and girls who regularly ate cereal for breakfast weighed the least. Those who ate other foods for breakfast were somewhere in the middle, says statistician Bruce Barton, PhD, who led the research team.

Other findings from the look-back analysis included:

• Breakfasts that did not include ready-to-eat cereal averaged 60% higher in fat content.
  
• The number of girls skipping breakfast doubled from age 9 to age 19.
  
• Fewer than one in 10 18-year-olds reported eating cereal for breakfast every day.
  
• Regular cereal eaters tended to have healthier diets overall.

"They tended to eat less fat and cholesterol and their nutritional profile was much better," Barton tells WebMD. "We can't say if eating cereal is the reason. But most cereals are heavily fortified with mineral and vitamins, and many are also high in fiber."

In addition to Barton, who is president and CEO of Maryland Medical Research Institute, researchers from General Mills took part in the study.

Breakfast and Weight Control

In the second study, researchers from Michigan State University and Kellogg analyzed data from the National Health and Nutrition Examination Survey, 1999-2000, to evaluate the relationship between eating breakfast and body weight among adult men and women.

The researchers found that regular breakfast eaters were more likely to be older, female, and white than breakfast skippers. They were also more likely to exercise regularly.

Women who ate breakfast regularly tended to take in more calories overall during the day, compared with nonbreakfast eaters. But eating cereal for breakfast was more closely associated with maintaining a healthy body weight than breakfast eating in general.

Overall fat intake was also lower for men and women who reported regular cereal consumption than for those who ate other foods for breakfast.

Not Just Any Cereal

The studies did not include information on what types of cold cereals the subjects ate, and it is clear that eating a cereal loaded with sugar straight from the box is not a particularly healthy breakfast option, says Taub-Dix.

Her more ideal breakfast is a cereal with no more than 3 grams of sugar per serving and roughly 5 grams of fiber, topped with skimmed milk and berries.

If your child has to have his Cocoa Puffs, which has 13 grams of sugar per serving, she recommends cutting the sugar by mixing it with a low-sugar cereal like Cheerios or Kix.

"It will still look and taste like chocolate, but you can literally cut the sugar in half and your kids may never notice," she says.

Feb. 5, 2005 -- A healthy diet with lots of milk, fruits, and vegetables in your diet can help you keep up your strength as well as manage your money.

Previous research has shown that nutrition is a key factor in maintaining a good quality of life and preventing disability. And calcium, vitamin D, and antioxidants have been shown to play a significant role in this regard.

So Denise K. Houston, PhD, an epidemiologist at the University of North Carolina at Chapel Hill, took a look at how much dairy, fruits, and vegetables people ate. Dairy is rich in calcium and vitamin D and fruits and vegetables are packed with antioxidants.

Her study appears in this month's American Journal of Clinical Nutrition.

In this study, Houston set out to examine how three key elements of a healthy diet -- milk, fruits, and vegetables -- affected middle-aged men and women over a nine-year period.

At the study's beginning, 940 people she studied -- aged 44 to 64 -- were all healthy and strong. Each volunteer gave detailed information about foods they regularly ate.

Dairy foods included milk, yogurt, and cottage cheese. Fruits included fresh apples or pears, oranges andorange juice, bananas, and other fruits. Vegetables included everything from green beans and broccoli to lima beans and sweet potatoes.

Men reported eating fewer daily servings of fruits and vegetables than the women did. Blacks had fewer daily servings of dairy, including milk, than whites did.

Put a Little Pep in Your Step

Nine years later each volunteer completed a survey about their ability to perform various physical activities, such as climbing stairs and lifting a 10-pound object. Normal everyday activities were also evaluated, including chores around the house and managing money.

The people were divided into low, medium, and high groups based on the amount of fruits, veggies, and dairy they ate.

Researchers found that people who ate a healthy diet with the most dairy, fruits, and vegetables were physically the strongest. In addition, they were better able to handle what the researchers called "instrumental" activities, such as managing money and preparing meals.

Black women especially benefited from getting enough milk and dairy. Those getting the most were better able to perform daily-living activities.

Other studies have shown similar results of a healthy diet: In one study, middle-aged women -- but not men -- who ate an "unhealthy" diet with no whole-grain bread, no low-fat milk, and less than one fresh fruit or vegetable a day increased the risk of poor physical function five years later.

According to just released dietary guidelinesjust released dietary guidelines, two to five servings of fruit, two to eight servings of vegetables, and two to three servings of dairy should be eaten every day.

Aging: everyone does it, yet some people seem relatively unaffected by getting older. Could good nutrition be the key to a healthier, longer life?

Does Aging Equal Illness?

"Aging is often associated with the development of one or more chronic diseases, but it doesn't have to be that way," says Jeffrey Blumberg, PhD, professor at the Friedman School of Nutrition Science and Policy at Tufts University.

It's not always just a matter of time before you have a heart attack or stroke, get type 2 diabetes or cancer, break a hip because of osteoporosis, or develop Alzheimer's, even though these conditions are often associated with aging, Blumberg says.

Your risk for disease and disability increases with inadequate physical activity, genetic susceptibility, and poor diet.

Aging: Defy It With Diet

So what's the best eating plan for preventing, delay, or minimizing the conditions associated with aging, including inflamed joints, flagging memory, and failing eyesight?

"The most beneficial diets rely heavily on fresh vegetables, fruits, and legumes -- foods that are naturally lower in calories and packed with nutrients," says Bradley Willcox, MD, MPH, co-author of The Okinawa Diet Plan and professor of geriatrics at the University of Hawaii.

Experts suspect the antioxidant compounds found in produce, legumes, and whole grains are largely responsible for holding back the march of time.

Antioxidants, such as vitamins C and E, and other compounds, including polyphenols and anthocyanins, battle free radicals -- unstable forms of oxygen that damage cell function. Free radicals form from normal metabolism. Your body also produces them in response to strong ultraviolet rays from the sun; air pollution; smoking; and secondhand smoke.

The buildup of free radicals contributes to the aging process and to the development of a number of age-related diseases such as cancer, heart disease, and inflammatory conditions, including osteoarthritis. What's worse, aging increases free radical production. That means your diet should be healthier than ever with the passage of time.

The question, of course, is how do we do that?

Anti-Aging Nutrition

Antioxidants generate a lot of buzz when it comes to longevity, but aging well takes more. You must optimize a myriad of beneficial nutrients, including protein, calcium, and vitamin D, and minimize detrimental dietary components including saturated and trans fats.

While none of these foods is the "Fountain of Youth," including them on a regular basis as part of a balanced diet can reduce the toll time takes on your body.

Nuts

Nuts are cholesterol-free protein sources, and are worthy substitutes for fatty meats. Research published in the American Journal of Clinical Nutrition found that in a group of nearly 35,000 women, those who ate foods rich in vitamin E, including nuts, lowered their risk of having a stroke.

Top picks:

Almonds for their high vitamin E levels; pecans, for their antioxidants; and walnuts, for omega-3s.

Tips:

• Top breakfast cereals, yogurt, salads, and cooked vegetables with an ounce of chopped nuts.
• Snack on an ounce of whole almonds (about 24) for almost half the vitamin E you need for the day.
• Enjoy a nut butter sandwich on whole-grain bread.
• Concoct a smoothie by blending a medium frozen banana, 1/2 cup plain fat-free yogurt, 1/4 cup chopped walnuts, and 2 teaspoons sugar (optional).

Fish

According to the American Heart Association, fish harbors omega-3 fats that reduce the risk of plaque buildup in your arteries; decrease blood triglyceride (fat) levels; help lower blood pressure; and lessen the odds of sudden death. Fish is a wise protein choice because of its relatively low saturated fat and cholesterol content.

Top picks:

Salmon, sardines, and canned tuna are among the fish with the highest levels of omega-3 fatty acids.

Tips:

• Have at least two fish meals a week instead of fatty meats.
• Add canned light tuna or canned salmon to salads instead of chicken or cheese.

June 2, 2006 -- Been sitting on the sidelines from exercise for awhile? Think you're past the point of no return? Think again.

New research shows that middle-aged, overweight adults who have been sedentary for six months can overcome the negative health effects of inactivity with just six months of exercise.

"Many of the detrimental effects of physical inactivity can be reversed with a similar period of exercise training," write Duke University exercise physiologist Jennifer Robbins and colleagues.

What's more, people with the steepest health setbacks from inactivity seem to reap the biggest benefits from getting back to exercise, Robbins' team reports.

Robbins presented the findings at the American College of Sports Medicine's 53rd annual meeting in Denver, this week.

Sedentary for 6 Months

In the study, Robbins and colleagues looked at 53 middle-aged, overweight people who had been sedentary for six months.

Before and after the six-month period, researchers checked participants for 17 traits, including:

• Body mass
• Minimal waist size
• Fat that is deep inside the abdomen (visceral fat)
• LDL ("bad") cholesterol
• Time to exhaustion (how long it takes to become exhausted by exercise)
• Sensitivity to insulin, a hormone that controls blood sugar

As you might guess, six months of physical inactivity weren't good for those traits.

During the sedentary period, participants' waists expanded. They added more visceral fat, became exhausted by exercise quicker, and showed more signs of the metabolic syndromemetabolic syndrome, a cluster of risk factors that makes heart diseaseheart disease and diabetesdiabetes more likely.

Getting Back in the Game

After six months of sedentary life, participants started exercising in one of three programs designed by the researchers.

Thirty-three participants stuck with their exercise program for six months. At the end of that time, they showed improvement in 13 of the 17 traits measured. Their readings for those traits either returned to where they had been before the sedentary period or became even better.

"In addition, we observed that individuals who experienced the greatest decline while inactive appeared to obtain the largest improvements during the exercise regimen that followed," wrote Robbins and her colleagues, who included other experts from Duke and from East Carolina University in Greenville, N.C.

Grueling Workouts Not Required

Participants didn't have to crank their workouts to extremes to reap the benefits.

"When looking at the group as a whole, we found that it wasn't the participants with the highest intensity of exercise who accounted for the combined beneficial effects," Robbins said, in a Duke news release.

"That should be reassuring for people to know they don't have to do a high-intensity workout to get these benefits of exercise," Robbins added.

Keep in mind that participants didn't just decide to hit the gym after a long idle period without getting medical clearance.

Anyone who's been inactive -- especially for health reasons -- should get a doctor's OK before starting a new workout program. Newcomers and long-time exercisers alike should also take care not to push themselves too hard, too soon.

Robbins' study showed that better fitness is within reach for people who decide to stop being sedentary. The keys are patience, consistency -- and making the decision to get started (with appropriate medical help, of course).

SOURCES: American College of Sports Medicine's 53rd Annual Meeting, Denver, May 31-June 3, 2006. News release, Duke University School of Medicine.

Sept. 24, 2004 -- Regular stretching cuts your risk of a sports or workout injury. But stretching just before an activity slows performance, researchers conclude.

These surprising conclusions come from a systematic review of all published studies of stretching by Ian Shrier, MD, PhD. Shrier is past president of the Canadian Academy of Sport Medicine and a researcher at SMBD-Jewish General Hospital in Montreal, Quebec, Canada.

"If strength or power is important to you, don't stretch before exercise. If you enjoy stretching, stretch after exercise, or at other times," Shrier tells WebMD in an email interview. "There are certain exceptions to these rules where performance depends only partly on force and power, and partly on aesthetics and range of motion -- a good example is ballet."

Shrier examined 23 articles on "acute stretching" -- stretching just before exercise. He found that:

• 22 of the 23 reports showed no benefit in terms of force, torque, or jumping height.
• One study showed that stretching before exercise made for more efficient running.
• Of the four articles that looked at running speed, one showed that stretching before exercise was helpful, one found it slowed runners, and two had "equivocal" results.

Shrier examined nine articles on regular stretching -- either after exercise or at some other time. He found that:

• 7 of the 9 reports showed a benefit.
• The two reports showing no benefit looked only at running economy.
• None of the reports found any harm in regular stretching.

"An acute bout of stretching will decrease pain temporarily but will not prevent injury," Shrier says. "Stretching over weeks to months will increase your force, power, and speed of running, and may prevent injury. Both an acute bout of stretching and regular stretching over weeks to months will increase range of motion."

Many Still Recommend Before-Exercise Stretching

Despite these studies, Shrier notes that many fitness experts still advise stretching before exercise. One of them is certified athletic trainer and physical therapist Michele Raya, PhD, assistant professor of physical therapy at the University of Miami in Coral Gables, Fla.

"In my opinion I do think it prevents injury. The benefits are pretty clear," Raya tells WebMD. "I do recommend to the athletes I am working with to stretch before activity. And I work with athletes at the high school, college, and professional level in running and jumping sports."

Raya says that stretching before exercise:

• Helps to regulate imbalances between opposing muscles
• Helps minimize musculoskeletal injuries by reducing stress to the tissues involved
• Helps with shock absorption
• Helps runners conserve energy by loosening tight muscles

Shrier notes that the effect of acute stretching on running speed has yet to be determined. However, he finds no proof that stretching before exercise cuts injury risk.

"If you don't like stretching, don't worry about it. Just remain active and work your muscles through their full range of motion when possible -- bench press, for example," he says. "If you do like to stretch, the general recommendation is to stretch after your activity or at other times. Exceptions to this rule are when the range of motion is more important than the force or power you need from your muscles, such as aesthetics in ballet."

How to Stretch

Shrier and Raya both agree that a warm-up before stretching is essential. And while he doesn't recommend acute stretching, Shrier strongly advises warm-up before exercise. What kind of warm-up is best?

"Use the muscles you plan to use in the activity. Start slow, increase gradually," he says. "If jogging, start with walking, then jog slow and then slowly increase the speed until you are running at your regular pace -- maybe five to 15 minutes depending on your level of fitness. If you are planning to race, don't worry about tiring yourself out. Do this before the race to have the best race time. Don't stretch before."

Regular stretching improves flexibility, Shrier and Raya agree.

Raya says that people who want to improve their flexibility should stretch every day. Those comfortable with their flexibility, she says, need to stretch only three times a week. She advises athletes preparing for a specific event to be sure to stretch the all the muscles they'll be using in the sport.

"It is real important to maintain the stretch for 30 seconds," Raya says. "If you hold a stretch for less than 30 seconds, there's no proof you lengthen the muscle. And if you hold it longer, you do no extra good beyond the first 30 seconds."

Raya warns that bouncing while stretching -- known as ballistic stretching -- seems particularly unhelpful. She advises against it unless a person has specifically trained to perform these kinds of stretches.

Want to be sharper at work? Feel less tired at home? Spend some quality time with your spouse? How about enjoying a cookie without guilt?

If you answered "yes" to all of these questions (and who wouldn't?), exercise is the answer.

Being physically active offers benefits far beyond the obvious. (Of course, an improved physique and a clean bill of health aren't too shabby, either.)

If you've been looking for the motivation to begin an exercise program or get back into working out regularly, here are 10 fitness facts that may help inspire you to get off the couch.

1. Exercise Boosts Brainpower

Not only does exercise improve your body, it helps your mental function, says certified trainer David Atkinson.

"Exercise increases energy levels and increases serotonin in the brain, which leads to improved mental clarity," says Atkinson, director of program development for Cooper Ventures, a division of the Cooper Aerobics Center in Dallas.

All that makes for a more productive day.

"It is clear that those who are active and who exercise are much more productive at work," says Todd A. Astorino, assistant professor of kinesiology at California State University-San Marcos.

Improved productivity not only makes you a better worker, it makes things better for everyone in the workplace. Companies with less wasted work hours and less sick time end up with lower health care costs -- and an improved bottom line, Astorino says.

2. Movement Melts Away Stress

As much as it may stress you out just to think about exercising, once you actually start working out, you'll experience less stress in every part of your life.

"Exercise produces a relaxation response that serves as a positive distraction," says Cedric Bryant, chief exercise physiologist for the American Council on Exercise. He says it also helps elevate your mood and keep depression at bay.

You're not the only person who will benefit from more happiness and less stress in your life. When you're less stressed, you're less irritable, Atkinson says -- and that could improve relationships with your partner, kids, and co-workers.

3. Exercise Gives You Energy

You might be surprised at how, say, popping in a workout tape for 30 minutes in the morning can change your whole day. When endorphins are released into your bloodstream during exercise, says Astorino, "you feel much more energized the rest of the day."

And when you improve your strength and stamina, it's easier to accomplish everyday tasks like carrying groceries and climbing stairs. This also helps you feel more energetic over the course of the day.

A common excuse among Atkinson's clients is that they're too tired to exercise, he says. While exercise may make you feel more tired at first, he says, that won't last long.

The physical tiredness you feel after working out isn't the same as everyday fatigue, he says. Besides, once your body adjusts to exercise, you'll have more energy than ever.

Sure, chest exercises help give a man a nice physique, but working out the chest can help women, too, by lifting sagging chests and breasts.

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Think of anything you do that involves pushing and you've discovered what you use the chest muscles for. Whether it's pushing a lawn mower, baby carriage, or grocery cart, strong chests help us perform these tasks.

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In addition, chest muscles are essential in sports like tennis, free-style swimming, and all sports where you throw a ball.

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"Just because of the forward motion of daily life, the pectorals tend to get used," says Richard Cotton, an exercise physiologist in San Diego.

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Things like driving or working at a computer all day keep chest muscles activated at a low level. That's good and bad, he says.

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"The challenge is too much pec exercise," says Cotton. For example, someone who sits at a computer eight hours a day can really suffer negative effects from having continually engaged pectorals.

Posture Is Key

"We tend to get shorter muscles from working keyboards," he says. Shorter muscles mean a tighter chest and that usually translates to weak back muscles.

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This can become a postural problem, having rounded shoulders and not being able to stand upright. It can also lead to shoulder injuries as the arms suffer a decreased range of motion.

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When sitting at a desk, be conscious of posture, says Lisa Cooper, fitness director of Little Rock Athletic Club in Arkansas.

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"Think about dropping your shoulders down and pulling your shoulder blades back and together; visualize holding a pencil between the blades while keeping your abdominals engaged to support the back," she says.

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Cotton says working the chest is great when done in balance.

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"Chest exercises need to be integrated into a whole-body workout including other major muscle groups, especially the abdominals," he says.

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Cooper agrees.

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"People need to think of working muscles in pairs, doing equal amounts of exercises with opposing muscle groups. If you're working chest, you should also work back. If you're working biceps, you should also work triceps."

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And, she says, if you alternate between the two opposing muscle groups, you don't have to rest between sets, which can cut down your workout time.

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If done correctly, many chest exercises simultaneously recruit and work other muscles groups.

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"If you're pushing a car or a lawn mower," explains Cotton, "naturally the back and abs are also very activated. Having weak abs is going to hurt your back."

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Chest exercises primarily use the chest but recruit supporting muscle groups to assist. In a push-up, for example, not only are the pectorals engaged but the abdominals, the latissimus dorsi in the back, the deltoids in the shoulders, and the triceps in the back of upper arms are involved.

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Experts say pectorals are not usually a neglected group among those developing a workout program. Quite the contrary.

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"The show muscles [such as pecs and abs] are usually something that people that are motivated to exercise are going to try to build -- men especially," says Cotton.

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Many men focus solely on their upper bodies and particularly their chests, says Cooper, because they can see the progress.

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But everyone should be wary of sacrificing balance in a zealous desire to have a nice chest.

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"This is not a muscle group you want to overemphasize to the detriment of the opposing back muscles," Cotton says. "You should balance the two for a healthy program."

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For women, chest exercises, done in balance can help to lift a sagging chest, strengthening the muscles that help lift the breast tissue, particularly in someone who's overweight, losing weight, or has just had a baby.

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"Getting the chest in shape lifts the chest," says Cotton. "It may appear that you have a bigger chest (whether you're striving for that or not), but it's a healthier look. It's better posture."

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Women concerned with building bulk shouldn't be, he says.

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"Only 10% of women actually gain significant muscle mass doing chest exercises," says Cotton.

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"You'd have to be on a pretty serious body-building regime to get that bulk," says Cooper. "And you'd have to be genetically predisposed to it."

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"It would take heavy weights and low repetitions to create size," says Cooper. Women are generally doing higher repetitions with lower weights so bulk is not really an issue.

Aug. 23, 2006 -- Scientists may have figured out how high-fiber diets help digestion.

Basically, fiber (sometimes called "roughage") roughs up the outer membrane of gut cells a bit. As those cells heal, they release mucus, which helps move food along the digestive tract.

The process is detailed by Paul McNeil, PhD, and Katsuya Miyake, PhD, in the early online issue of Public Library of Science Biology.

McNeil and Miyake work at the Medical College of Georgia, located in Augusta, Ga.

"When you eat high-fiber foods, they bang up against the cells lining the gastrointestinal tract, rupturing their outer covering," McNeil explains, in a Medical College of Georgia news release.

"What we are saying is this banging and tearing increases the level of lubricating mucus. It's a good thing," he adds.

How Much Fiber?

McNeil and Miyake studied roughage in a lab. But what about the real world, where fiber goes on your plate, not into test tubes?

Fiber is a cornerstone of the latest dietary guidelines issued by the U.S. Department of Agriculture (USDA).

In those guidelines, issued in 2005, the USDA recommends getting 14 grams of dietary fiber for every 1,000 calories you consume.

So if you consume 2,000 calories per day, you should get 28 grams of dietary fiber that day.

Fiber is found naturally in fruits, vegetables, whole grains, and legumes. How much fiber will you get from different foods? Here's a list from the USDA:

• Navy beans, 1/2 cup, cooked: 9.5 grams
• 100% bran cereal, 1/2 cup, ready to eat: 8.8 grams
• Sweet potato, medium-sized and baked, including peel: 4.8 grams
• Whole-wheat English muffin: 4.4 grams
• Mixed vegetables, 1/2 cup: 4.0 grams
• Raspberries, 1/2 cup, raw: 4.0 grams
• Apple, medium-sized, including skin: 3.3 grams
• Whole-wheat spaghetti, 1/2 cup, cooked: 3.1 grams
• Banana, medium-sized: 3.1 grams
• Broccoli, 1/2 cup, cooked: 2.8 grams
• Collard greens, 1/2 cup, cooked: 2.7 grams

For instance, a breakfast of a medium-sized banana and half a cup of 100% bran cereal yield 11.9 grams of dietary fiber.

Add an apple as a morning snack, a half cup of Navy beans with an equal amount of mixed vegetables at lunch, and whole-wheat spaghetti at dinner, and you've reached 31 grams of dietary fiber -- more than the 28 grams recommended for a 2,000-calorie diet.

Of course, that's just an example, not a menu recommendation. Each person is different, and not every food that you eat has to be loaded with fiber.

The take-home message: Mix and match fruits, vegetables, whole grains, and legumes to help you get recommended amounts of dietary fiber as part of a healthy diet.

March 3, 2006 -- Yoga could be a way for overweight teens to get in shape and lose weight, new research shows.

According to the CDC, the percentage of young people who are overweight has more than tripled since 1980, with 16% of children aged 6-19 considered to be overweight.

In a recent study, high school students practicing yoga and breathing exercises on a regular basis shed an average of 6 pounds and trimmed their BMI (body mass index) by nearly 6%.

The finding comes from Anand Shetty, EdD, of Hampton University in Yorktown, Va.

"I recommend 30 minutes of pranayama [breathing exercises] and yoga, three to four times a week," Shetty says in an American Heart Association news release. "This also can easily be incorporated at home during leisure time with other family members."

Shetty's study is being presented in Phoenix, at the American Heart Association's 46th annual conference on Cardiovascular Disease Epidemiology and Prevention.

Striking a Yoga Pose

Shetty studied 60 high school students for three months.

He randomly assigned half of the students to do yoga and breathing exercises for 40 minutes, four days per week, during the study. The breathing exercises used "quiet, deep, forced breathing," Shetty says. Yoga includes postures that help build overall well-being.

For comparison, the other students did their normal activities, without the yoga program.

At the study's start, average BMI was 22.8 in the yoga group and 22.3 in the comparison group. Those BMIs aren't considered overweight for adults. But teens are different, because they're still growing taller and BMI relates height to weight.

"Therefore, by adult BMI standards, we underestimate the normal BMI for teens," Shetty says. "For this study, only students with a BMI greater than 22 were selected."

Yoga Group Slimmed Down

When the study ended, the yoga group had lost 6 pounds and 1.3 points on their BMI, on average.

Dieting wasn't required. The yoga group's weight loss may stem from the exercises, or perhaps they ate less, Shetty says.

The yoga and breathing exercises used the teens' abdominal muscles. Using those muscles temporarily contracts the abdomen, including the stomach, Shetty notes.

He didn't study stomach size but suggests future research on the relationship between stomach size and hunger, as well as yoga's effects on brain function, feelings of fullness, and hormones related to metabolism.

Aug. 3, 2005 -- Overweight people are less likely to receive recommended preventive care services, such as mammograms, Pap smears, and flu shots, according to a new study.

Overweight women are more likely to get breast and cervical cancer, and overweight elderly people have a higher risk of complications from flu, says researcher Truls Ostbye, MD, PhD, a professor of community and family medicine at Duke University, in a news release.

Despite this, overweight people are less likely to receive preventive services, he says.

More Weight, Less Services

Researchers found that the more overweight middle-aged white women were, the less likely they were to receive mammography or Pap smears to screen for these diseases.

For example, white women of normal weight were more than 50% more likely to receive a mammogram than a severely obese white woman in 2000.

Even moderately overweight women were less likely to receive mammograms and Pap smears.

In addition, elderly obese white men and women and were less likely to get their recommended flu shots.

However, the study showed that the link between obesity and less frequent use of these three preventive care services was not found among black men or women.

The results appear in the September issue of the American Journal of Public Health.

Obese Miss Out on Cancer Screening, Flu Shots

In the study, researchers analyzed the relationship between body mass indexbody mass index (BMI, a measure of weight in relation to height used to indicate obesity) and use of the following preventive care services: mammograms to screen for breast cancer, Pap smears to screen for cervical cancer, and flu shots to reduce the risk of influenza.

Researchers found that as BMI increased, the likelihood of receiving each of the three recommended preventive care services decreased in 1995-1996 and in 2000, although overall use of these services increased during this time period.

• Mammograms. 75% of normal-weight women had received a mammogram for breast cancer screening within the last two years compared with 67% of obese women in 1996. The same trend held true in 2000, although a greater proportion of all women received screening mammograms.
• Pap tests. 73% of normal-weight women vs. 66% of obese and 54% of severely obese women (BMI over 40) received Pap smears in 2000.
• Flu shots. 78% of normal-weight men and women received flu shots in 2000 compared with 70% of moderately obese people and 56% of severely obese.

The higher a person's BMI the less likely they were to receive any of the preventive services. In other words, normal-weight people most likely received these services, followed by overweight people and then obese people.

Missing Out on Screening Risky

Researchers say delaying or avoiding cancer screening can make the difference between life and death in some cases. Earlier detection and treatment leads to better chances of survival.

In addition, failure to get a flu shot among the elderly increases the risk of potentially deadly complications from influenza.

Ostbye says the study suggests that income, education, and access to health care were not important reasons for the discrepancies in preventive care services. Instead, researchers say significant reasons may include social stigma, avoidance of health care by patients, and bias by health care providers.

They say these results present an example of the "inverse care law" in which people who need health care services the most are often the least likely to get them.

Everyone, including normal- and overweight people, needs to discuss the need for preventive services with their doctor.