Health Matters: Top 10s

Top 10 Food Contamination Culprits
By Chris Iliades, MD
Medically reviewed by Pat F. Bass III, MD, MPH

According to a report by the nonprofit Center for Science in the Public Interest, food contamination sickens millions of Americans every year. The report ranks the top 10 riskiest foods regulated by the U.S. Food and Drug Administration (FDA) based on reported cases of foodborne illness from 1990 to 2006. The riskiest food is not raw hamburger, as you might suspect, but rather leafy green vegetables, which were associated with 363 outbreaks of foodborne illness. "Consumers need to know about the risks, but they also need to know we have the safest food supply in the world," says Joan Salge Blake, MS, RD, clinical associate professor at Boston University in Massachusetts.

SPINACH AND OTHER LEAFY GREENS
You may remember the 2006 outbreak of foodborne illness from bagged spinach that was contaminated with the E. coli bacteria. Leafy greens account for almost 30 percent of all foodborne illnesses in foods regulated by the FDA. "The problem with leafy greens is that we eat them raw, so they really need to be washed before eating. But contamination can occur in the home as well as on the farm. Make sure you don't wash meats and greens in the same sink or cut them on the same counter. And watch out for meat dripping down into your refrigerator's vegetable bin," warns Blake.

EGGS
Next on the list of risky foods are eggs, which have been linked to 352 outbreaks of foodborne illness. Food contamination in eggs is almost always due to the bacteria salmonella. The U.S. Centers for Disease Control and Prevention (CDC) estimates that for every reported case of salmonella, 38 cases go unreported. You might be wondering how those bacteria get inside an egg. The most prevalent type of salmonella infects the ovaries of hens that lay the eggs. "The best way to protect yourself is to cook your eggs so they are not soft or runny," says Blake.

TUNA
Tuna is No. 3 on the list with 268 reported outbreaks of illness. The big problem with tuna is not mercury, but a naturally occurring toxin called scombrotoxin. This toxin can build up in tuna flesh if it is not kept cold enough after the fish has been caught and, unfortunately, you can't get rid of it even by cooking. Symptoms include headache, nausea, and palpitations.

RAW OYSTERS
Coming in at No. 4 with 132 outbreaks are oysters. "Oysters are another risky food because people want to eat them raw," notes Blake. Most oyster outbreaks are traced to restaurants. Two microbes, known as norovirus and vibrio, cause most of the foodborne illnesses from oysters. The vibrio organism is the more dangerous. It is closely related to the bacterium that causes cholera, an acute intestinal infection. Oysters can be contaminated from the water they grown in or by improper handling.

THE COMMON POTATO
You would think this American staple would be safe because almost no one eats raw potatoes. The food safety issue here, linked to 108 outbreaks, usually involves potato salad. Salmonella is the main problem again. More than 40 percent of potato outbreaks can be traced back to restaurants and delis where cross contamination has occurred. Salmonella usually causes mild cramps and diarrhea, but in severe cases can cause kidney failure.

SOFT CHEESE DURING PREGNANCY
Cheese is at No. 6 on the list with 83 outbreaks. Pasteurization makes cheese safer, but many cheeses are not pasteurized. Recently consumers in California were warned about the danger of bacterial food contamination in some Latin American cheeses made with unpasteurized milk. Pregnant women may be in danger from soft cheeses like feta, Brie, and Camembert because they are more likely to be infected with the organism listeria. The CDC says that pregnant women are 20 times more likely than others to be infected by listeria and recommends that they avoid soft cheeses. Although listeria infection may be mild in most people, it can cause a miscarriage in a pregnant woman.

ICE CREAM
Associated with 75 outbreaks, ice cream is No. 7 on the list. Salmonella and staphylococcus bacteria can cause food contamination in ice cream. In 1994, an ice cream-linked outbreak of salmonella sickened thousands of people across 41 states. Soft ice cream, like soft cheeses, may contain listeria and could be hazardous for pregnant women. "Ice cream food contamination may be more common in homemade ice cream due to raw eggs," warns Blake.

TOMATOES
In both 2005 and 2006, tomato contamination with salmonella was big news as hundreds of people became sick across the country. Salmonella can enter a tomato through the soil by way of the plant's root system. Tomatoes can also be contaminated by bacteria or norovirus through cracks in the skin during handling or preparation in a restaurant. Once the tomato has been infected, the only way to avoid foodborne illness is by cooking it.

RAW BEAN AND SEED SPROUTS
Sprouts are increasingly popular in salad bars and in the American diet in general. This food, which is the germinating form of seeds and beans, grows best in a warm and moist environment. Unfortunately, E. coli and salmonella thrive in the same environment. There have been 31 outbreaks of foodborne illness due to sprouts. The FDA has been urged to place warning labels on raw sprouts.

BERRIES
Cyclospora is a type of parasite that you get when the eggs of the parasite cause food contamination. Raspberries from South America have caused outbreaks. Hepatitis A, a virus that affects the liver, has also been a berry food safety problem. In 1997, 2.6 million pounds of strawberries were recalled because of hepatitis A virus contamination. Berries, linked with 25 food contamination outbreaks since 1990, round out the list of top 10 risky foods.

THE BOTTOM LINE ON FOOD CONTAMINATION
Legislation is now working its way through Congress to strengthen the FDA food safety program. "Food safety is everybody's responsibility," says Blake, "including the FDA, growers, shippers, handlers, and consumers. The best way to protect yourself is with the four C’s: clean, cook, combat cross contamination, and chill. Don't shy away from fresh produce. It's an important part of your diet. Just use the fifth C — common sense."

Top 10 Things That Cause Bad Breath
By Lynn Yoffee
Medically reviewed by Cynthia Haines, MD

If you're constantly popping mints or chewing gum to cover up bad breath, also known as halitosis, you're not alone. Many people have halitosis for a variety of reasons. Most cases of halitosis are caused by improper dental hygiene. If you don't brush and floss your teeth after every meal, bits of food that get stuck in your teeth and gums and on your tongue will begin to decay and emit foul odors.

An unclean mouth also means that bacteria can grow, potentially leading to gum disease, which is also one of the causes of bad breath. In addition, certain foods and drink are more likely to cause bad breath, including:

• Garlic
• Onions
• Cheese
• Orange juice
• Soda, including diet varieties

After these foods or drinks are digested, their oils make their way into your bloodstream and are then carried into your lungs. The odor is then released through your breath.

Other Causes of Bad Breath

Aside from what you eat and drink, bad breath can also be linked to:

A dry mouth. Saliva is your mouth's natural cleanser, so when your mouth is dry, dead cells can build up, which is what causes morning breath. This is an even bigger problem if you sleep with your mouth open. Smoking and certain medications can also cause dry mouth. In more extreme cases, you could have a problem with your salivary glands that leaves your mouth unusually dry.

Chronic diseases. Sometimes underlying health conditions can cause bad breath. Lung infections, cancers, kidney or liver failure, diabetes, and gastroesophageal reflux disease (GERD), for example, are all associated with halitosis.

Respiratory, mouth, throat, and nose conditions. These conditions are also often associated with bad breath. For example, discharge from a sinus infection is known to cause bad breath. If you have an upper respiratory infection such as bronchitis, the sputum coughed up can also cause halitosis.

Tobacco products, particularly smoking. Tobacco products can dry your mouth and result in bad breath. People who use tobacco are also at greater risk of developing gum disease, poor general oral health, and oral cancers.

Malnutrition. Starvation or intense dieting can result in bad breath due to ketoacidosis, which is a breakdown of chemicals that occurs during fasting.

Beating Bad Breath
To combat bad breath, try the following:

• Avoid foods and beverages that you know cause bad breath; this may also mean minimizing your intake of alcohol.
• Brush for two to three minutes after every meal and floss your teeth at least once a day.
• Brush your tongue gently to remove dead cells, including the back of your tongue, because that's where bacteria often collect.
• Drink lots of water to keep your mouth moist and clean. And water really is what's best here: Other beverages, particularly caffeinated beverages, don't work as well as water for halitosis treatment and prevention.
• Eat less meat and more vegetables and fruits each day.
• Get dental checkups at least twice a year that include an exam and cleaning.
• If you wear dentures, bridges, or removable braces, clean them thoroughly at least once a day.
• Suck candy or chew gum (preferably sugarless) to stimulate saliva production, which helps wash away food particles and bacteria.

When to See Your Dentist About Bad Breath
If you still feel like you have bad breath after trying these tips, ask someone who is close to you for confirmation. Sometimes, you really are your own worst critic. If it is indeed an issue, make an appointment with your dentist to try to uncover what could be causing your bad breath.

Avoid drinking, eating, chewing gum, or brushing your teeth before your dental appointment. Skip the perfume or other scented products too, so that your dentist can truly assess your halitosis. Your dentist will likely ask you a number of questions, ranging from your dental hygiene habits to your general health.

In some cases, halitosis may be due to a buildup of plaque, which is a layer of bacteria on your teeth. If this is the case, the dentist may have you use a special antimicrobial mouth rinse.

If your dentist determines that the bad breath is due to gum disease, you'll be treated or referred to a gum disease doctor, called a periodontist. Also called periodontal disease, gum disease causes your gums to recede from the teeth and leaves pockets that gather bacteria and plaque. A periodontal cleaning, or more extensive treatment, may be needed.

If your dentist isn't able to uncover the reason for your bad breath, a trip to your primary care doctor for a physical exam would be the next step to determine the underlying causes of your bad breath.

Top 10 Foods That Boost Healthy Skin
By Madeline Vann, MPH
Medically reviewed by Pat F. Bass III, MD, MPH

"The skin is the window to the entire body,” says dermatologist Joely Kaufman-Janette, MD, assistant professor and director of the Aging and Geriatric Skin Center at the University of Miami Leonard M. Miller School of Medicine. “Part of choosing a diet for good looking skin is just eating to keep yourself healthy because your health is reflected through your skin.” Many of the nutrients and “good” fats we eat as part of a healthy diet enhance the skin’s elasticity and help create the appealing glow of healthy skin. Eat well and avoid foods high in saturated fat, says Dr. Kaufman-Janette, and you’ll see how it can result in good skin.

BLUEBERRIES
Antioxidants help fight the signs of aging skin, and blueberries are a great source. Rich in vitamin C, blueberries can play a healthy role in an otherwise decadent dessert and taste great as a cereal topping and tossed into salads. Other sources of antioxidants that you can include in your healthy diet are red wine and dark chocolate. Kaufman-Janette also offers this tip: Eating fruits and veggies in their fresh, raw form provides more antioxidants than when cooked.

FISH
Fish that are rich in omega-3 fatty acids should be part of a healthy skin diet. “Omega-3s are a great source of oil for the skin without clogging the pores,” says Kaufman-Janette, clarifying that omega-3s must be eaten or taken as supplements. Many people try to cut all fats from their diet, but without some fat, your skin may suffer. Omega-3 fatty acids are considered healthy fats, and a diet that is too low in healthy fats can lead to “dull, dry skin,” she warns.


WHOLE WHEAT
Think of whole-wheat bread and other whole-grain products as smart food for your skin — they’re a healthy alternative to refined white bread or pasta, says Kaufman-Janette. “The white breads and white pastas create a spike in insulin, which isn’t good for your skin,” she explains. Whole grains are also packed with fiber, which promotes healthy digestion, and Kaufman-Janette points out that digestive problems are often reflected in unhealthy skin.

WATER
“There are molecules in the skin that actually bind water,” explains Kaufman-Janette. “Your skin will not be as plump if you are dehydrated.” Skin also becomes dry when it loses too much water, so you need to drink plenty of liquids to replace daily water loss. Water is also a good alternative to sugary beverages that could negatively affect your skin by causing insulin levels to rise and fall dramatically.

GREEN TEA
Green tea has two benefits for your skin: It contains antioxidants, which may fight the effects of aging, and drinking it is a good way to stay hydrated. When given the option, choose green tea over beverages that don’t promote skin health. This is one of Kaufman-Janette’s recommended strategies for healthy skin — and overall health. She says, “If you can substitute a good choice at every single meal for a bad choice, you’ll start to look and feel healthier.”


LOW-FAT YOGURT
Yogurt is often recommended for a healthy diet because it contains probiotics, or “healthy” bacteria, which are beneficial for digestive health. “Yogurt may help ease digestive troubles, which can improve related skin conditions such as rosacea or skin inflammation,” says Kaufman-Janette, who recommends that people with these skin conditions include yogurt in their healthy diet plan. Probiotics are increasingly used in skin care lines, but she cautions that these may not be the same bacteria that are found in yogurt.

SWEET POTATOES
Sweet potatoes give you a healthy dose of vitamin A, which has been found to help reduce wrinkles and other signs of aging. There are several topical creams on the market that contain vitamin A, but Kaufman-Janette cautions against using too many of these skin products, which can be drying and irritating. It’s better to include sweet potatoes and other foods rich in vitamin A as part of a healthy diet.


BROCCOLI
Broccoli and other green vegetables are great for the skin. The richer the color of veggies and fruits, the more likely they are to contain the nutrients you need for a healthy diet. “Darker is better,” Kaufman-Janette stresses. Darker broccoli florets provide more vitamins A and C, and both of these vitamins help fight fine lines and wrinkles.

AVOCADOS
Avocados are rich in healthy fats, vitamins A and C, and fiber, make them an almost perfect healthy food that enhances your complexion and fight aging skin. Avocado is also a common ingredient in homemade or natural skin masks, but Kaufman-Janette says you are better off putting avocado in your salad than on your face. “Masks with avocado can cause clogged pores,” she says. “Definitely avoid them if you are acne prone.”

VITAMIN D
Vitamin D isn’t found naturally in the diet, but it is important for healthy skin, especially as people age, says Kaufman-Janette. People usually get Vitamin D through sun exposure, but if you live in a less sunny area or stay inside a lot, you need to get it through your diet. You can drink vitamin D-enriched beverages, eat foods fortified with vitamin D, or take a supplement in order to help slow the aging process on your skin.
 
 
10 Ways to Fight Fatigue
By Chris Iliades, MD
Medically reviewed by Pat F. Bass III, MD, MPH

If you suffer from a chronic disease like rheumatoid arthritis, chronic fatigue syndrome, fibromyalgia, or depression, you may be sick and tired of feeling tired. Fatigue may also be due to a lack of exercise, too much stress, or trouble sleeping. In any case, if you find yourself fighting fatigue, you are not alone. Fatigue is one of the most common complaints that bring people to their doctor’s office. Here's how to fight fatigue with some simple lifestyle changes.

START BY SEEING YOUR DOCTOR
Your doctor will evaluate your condition and order tests, as necessary. "If you suffer from chronic fatigue, the first step is to see a doctor to rule out a treatable medical problem such as anemia,” advises Elizabeth Araujo, MD, a rheumatologist at the University of Cincinnati. “If you have a chronic condition like fibromyalgia or rheumatoid arthritis, work with your doctor to make sure your disease is being treated and controlled properly.” Get the appropriate blood work and make sure you are not having any reaction to a medication.

GET ENOUGH SLEEP
Fatigue can be one of the most difficult aspects of living with a chronic illness. “Sleep that is deep and restorative and in the range of seven to eight hours a night is ideal to help replenish important neurochemicals like natural endorphins [pain modulators] and serotonins. Sleep also allows joints and muscle to heal and rest," explains Rochelle Rosian, MD, a rheumatologist at the Cleveland Clinic in Ohio.

AIM FOR MORE RESTFUL SLEEP
If you want to get refreshing sleep that helps you feel less tired when you wake up, plan your evenings carefully. "Avoid big meals, caffeine, alcohol, and television before bedtime," suggests Dr. Araujo. You should also avoid caffeine late in the day. And keep in mind that while a nightcap may help you fall asleep, it’s likely to cause you to wake up later and distract you from a restful night. Finally, consider going to bed earlier so that you can wake up earlier and ease into your day at a more leisurely pace.

EXERCISE FOR ENERGY AND TO HELP YOU SLEEP
Regular exercise not only boosts your energy, it makes it easier for you to fall asleep at night. "Engage in daily low-level exercise, such as gentle stretching and walking. Exercise will help with stress and improve sleep, as well as help maintain strength, balance, and flexibility," says Dr. Rosian. The best time to exercise to fight fatigue is early in the day. Avoid exercising in the evening because the stimulation of exercise can interfere with sleep.


EAT WELL
A nutritious diet can help energize you throughout the day. A diet high in fruit, vegetables, and grains is best, with moderation in other food groups including dairy, meat, and oils. “It's important to remember that an ideal body weight is best for the weight-bearing joints, especially the knees, feet, and ankles,” says Rosian. "I’m not a big fan of fad diets. I believe that moderation is critical when it comes to diet and exercise."

STEP INTO SUNLIGHT
One way to fight fatigue is to pay attention to your internal clock. Sunlight tells your brain and body when to get active. For some people the winter months can be the hardest time to fight fatigue due to short days and lack of sunshine. Besides bundling up and getting outside, fight winter fatigue by arranging your home and office environment to allow for maximum sun exposure. Aim for at least 30 minutes of sunlight every day.

MAINTAIN A HEALTHY WEIGHT
Obesity has been called an epidemic in America, and it’s affecting young people as well as adults — one-third of children between 2 and 19 are overweight or obese. Being overweight is not just bad for your body and your self-esteem, it’s also bad for sleeping patterns. Being overweight has been shown to contribute to sleep disorders and to low energy levels. Fight fatigue by cutting back on calories, especially sugary beverages and other sweets, and increasing your exercise level. If you’re concerned about your — or your child’s — weight, talk to your doctor about creating a weight-loss plan.

MANAGE STRESS
One of the most common causes of fatigue is stress. The way you respond to stress can make a difference in the effect it has on you. Even if you can't avoid stress in your life, try to deal with it in a constructive way. Learning relaxation techniques such as progressive muscle relaxation, meditation, tai chi, and self-hypnosis will lessen stress and keep those tired feeling at bay. "A daily walk or a yoga class can also help you reduce your stress, control your weight, and fight fatigue," advises Araujo.

TRY AROMATHERAPY
Aromatherapy uses the essential oils from plants and other sources to lessen the effects of stress and promote well-being. The oil is usually either rubbed into your skin or inhaled. Some laboratory studies performed on animals support the effectiveness of essential oils in promoting energy. Essential oils, such as those made from geranium, lavender, and cedarwood, may send chemical messages to your brain that improve your mood and cause you to feel more relaxed and energized.

BE GOOD TO YOURSELF
If you have a debilitating disease like rheumatoid arthritis or chronic fatigue syndrome, or if you have just been pushing yourself too hard, you need to accept feeling a certain amount of fatigue. Getting frustrated and angry about being tired only worsens fatigue. Consider making accommodations in your work schedule, or at least counter some of the time spent at work with activities that bring you joy and satisfaction — compromise and balance are necessary. "People who stick to a sensible schedule and a regular regimen do better at fighting fatigue in the long run," says Rosian.


Top 10 Soda Alternatives
By Adrienne Rayski

Do you always reach for a soda when thirst hits? You may want to consider some alternatives. Not only are regular soft drinks full of empty calories, but studies have linked the consumption of both regular and diet soda to an increased risk for heart disease and diabetes. To broaden your thirst-quenching choices, here are 10 suggestions that will help you kick the soda habit and leave your taste buds satisfied.

Spruce Up Water
Flavored waters have been popping up all over the place, but many still contain sugar or artificial sweeteners. A healthier choice is natural flavoring: Just add slices of your favorite fruits and veggies — lemons, oranges, watermelon, cucumber, mint, or limes — to a pitcher of ice-cold water for a refreshing and flavorful drink. Another great option is to put chopped-up fruit in an ice cube tray, add water, and freeze. Place these colorful fruit cubes in your beverage for instant flavor and color!

Go Natural With Green Tea
Studies of green tea have shown that it may help reduce the risk of several types of cancer, heart disease, hypertension, kidney stones, and possibly even cavities. In addition to this, green tea is calorie-free (if you have it without milk or sugar) and naturally high in antioxidants. You can pick any flavor you enjoy, because green tea is available in many varieties. It can be drunk hot or iced, and if you want a little sweetening, a few drops of honey will serve you well — though most people enjoy it au naturel.

Juice + Seltzer = Jeltzer!
There's no need to purchase sugary sodas or pricey vitamin-enhanced waters, which also pack calories. Mixing 100 percent juice with seltzer yields a tastier, healthier, and less expensive drink. A thick, tart juice, such as cranberry, pomegranate, or grape, makes for a great jeltzer base in addition to supplying health benefits. Studies have shown that cranberry juice might protect against urinary tract infections and kidney stones; pomegranate juice is a great source of vitamins C and B; and grape juice has antioxidants that may help protect your brain and blood vessels. Mix one part juice with three parts seltzer to create this light and bubbly concoction.

Stir in Some Sweet Stevia
Stevia is an herb with a very sweet taste, but it has no carbs or calories. Research has also found it to be beneficial in managing obesity and glucose intolerance. Once banned in the United States because of limited research, stevia is now growing in popularity among holistic and organic food markets as a dietary supplement. It can't as yet be sold as a sweetener, though. Available in powder form, flavored stevia is inexpensive, sweet, and easily dissolves in cold water for a delicious drink that will help you forget about soda.

Tonic and Lime... Minus the Gin!
Traditionally used as a mixer for alcoholic drinks, tonic has a distinct taste that makes it such a popular base. But you don't need the alcohol to enjoy tonic — simply add a few slices of lemon or lime (or both) and a sprig of fresh mint for a unique and delicious beverage. Many tonic brands contain high-fructose corn syrup or other sugars, so opt for a diet tonic, if possible.

Red Wine Is Fine
Red wine, when consumed in moderation, has been widely reported to reduce the risk for cardiovascular disease. And research on the benefits of this fermented fruit doesn't stop there — red wine may also lower your risk of a heart attack, Alzheimer's disease, and even cancer. The National Institutes of Health recommends that women limit consumption to one drink per day (4 ounces of wine), and men to two drinks per day, in order to reap the benefits. Look for wine without additives, such as sulfites, which can cause headaches and other allergic reactions.

Drink Your Vegetables!
Vegetable juice offers a quick, low-calorie way to get all the benefits of veggies. It also contains much less natural sugar than fruit juices. But vegetable juice can be high in sodium, so opt for a low-sodium version whenever possible. Better yet, make your own fresh juice easily at home with a juicer. Simply add your favorite veggies, and even a few slices of fruit if you want to sweeten your drink, to the juicer — no chopping required! If you prefer a little kick, add some black pepper and a drop of hot sauce.

Move Over, Milk — Time for Soy
Soy beverages are naturally sweet and are now offered in a variety of flavors, including almond and vanilla. They are a great alternative to milk for those who are lactose intolerant or those who don't consume dairy. Studies on soy's benefits show that soymilk may reduce your risk for heart disease and osteoporosis. Look for low-fat, unsweetened soy beverages to reduce calories while enjoying a healthy, great-tasting beverage! Also, pick soymilk that has been fortified with nutrients such as calcium and vitamin D, especially if you're drinking it as a substitute for milk.

Let Loose With a Tea Infuser
Loose tea is a low-calorie option that allows you to get tea's health benefits and flavor from the actual tea leaf, without any additives. Brewing loose tea in an infuser, a device that holds tea leaves in a mesh chamber that you submerge in water, works wonderfully to bring out the flavor of your tea of choice. Enjoying a hot cup of loose tea — such as white, green, oolong, or black—is a relaxing pleasure that's also great for your health.

Java-licious
More and more evidence is showing that coffee in moderation can be a healthy part of your diet. Without cream or sugar, coffee contains zero fat and only a couple of calories. What's more, coffee drinkers may have a lower risk of developing heart disease, type 2 diabetes, and certain types of cancer. And — as if you didn't know it already — coffee's caffeine can help with mental alertness and physical performance, as long as you don't overdo it. Too much caffeine can leave you jittery and anxious, so dietitians generally recommend that you drink no more than three cups a day (depending on the way it's prepared). That said, some people are more sensitive to caffeine than others. Pregnant women and those trying to become pregnant may want to avoid it, though research on this is mixed.