About ALS (Lou Gehrig's Disease)

ALS is an abbreviation for the disease, Amyotrophic Lateral Sclerosis.  Also known as “Lou Gehrig’s Disease”, ALS is a progressive degenerative disease that affects the nerves that control voluntary movements and muscle power. The specific types of nerves affected are the “motor neurons”, located in the brain and spinal cord.  These are the nerves that serve as a communication link between the brain and the muscles that they control. With degeneration and eventual death of the motor neurons, muscles weaken, waste away (atrophy), and ultimately cease working.  At this time, there is no known cure for ALS with most people living only 3 to 5 years following its diagnosis.

What are the symptoms of ALS?  The onset of ALS is typically very gradual with initial symptoms being so subtle that the diagnosis may be overlooked.  Early symptoms include fine muscle twitches called fasiculations, muscle weakness affecting the hand, arm or leg, and slurred speech.  Over time, the muscle weakness may become more profound with disturbance of normal walking gait, difficulty with performing fine motor activities, such as buttoning a shirt, or excessive fatigue of the arms or legs with minimal exertion.  Eventually, the muscles that control the important functions of chewing, swallowing, and breathing are affected by the nerve degeneration.

What causes ALS?  There is no known cause for ALS, although environmental and genetic factors have been suspected.  Some of the environmental exposures suspected (but not confirmed) of causing ALS include heavy metals (e.g., lead and mercury), solvents, radiation, and agricultural chemicals.  Military veterans who were deployed to the Gulf region during the 1991 war have been approximately twice as likely to develop ALS as compared to military personnel who were not in the region, although the reason for this has not been determined.  About 5-10% of ALS cases occurs within families and is related to a genetic mutation. This is called “familial ALS” and can be passed down through generations. Genetic testing is sometimes done to look for the possibility that ALS is related to a gene mutation, but in general, this is only done when someone has symptoms of ALS in addition to having a family history of ALS.  A more thorough discussion of genetic testing for ALS and when it is most appropriately employed can be found on the ALS Association website. The great majority of ALS cases occur sporadically, with no family history of the disease. Most people who develop ALS are between the ages of 40 and 70, with an average age of 55 at the time of diagnosis.

How is ALS diagnosed?  Typically, ALS is confirmed by a neurologist after reviewing the person’s symptoms and physical signs, and performing certain tests and procedures. Tests could include magnetic resonance imaging (MRI) of the brain, muscle biopsy, electrodiagnostic testing (nerve conduction velocity and electromyography), and spinal tap.

Is there a treatment for ALS?  Motor neurons send signals to one another via chemical substances known as neurotransmitters.  In ALS, an excess of one these neurotransmitters, an amino acid called glutamate, has been found to be present in the brain and spinal cord. Too much glutamate is thought to lead to excessive nerve stimulation and damage to the nerve cells. This knowledge has led to the development of riluzole, the only currently available medication used to treat the symptoms of ALS.  Its major function appears to be a reduction in the release of glutamate by the nerve cell. Current research indicates that riluzole prolongs the life of persons with ALS by only a few months. Other than riluzole, treatment of ALS is directed primarily at its symptoms. This can include medications to help with muscle cramps or spasticity, physical therapy, nutritional support, and speech therapy.  Antidepressants may be used for accompanying pain or depression. When the muscles controlling breathing are no longer able to function, mechanical support with a ventilator becomes necessary for survival.
 
ALS is a relatively uncommon disease in the U.S. with approximately 5,600 new cases being diagnosed each year.  With up to 30,000 Americans living with the disease, however, it is one that many people have familiarity with through friends or family members.  Hopefully, future research will shed additional light on its underlying cause as well as producing an effective treatment.

What is the DASH Eating Plan?

Recently, U.S. News and World Report released its ranking of the best diets for 2014.  This list was compiled by a panel of health experts including nutritionists and physicians specializing in diabetes, heart disease, and weight loss. In this ranking, the DASH eating plan topped the list, beating out better known diets, such as the Mediterranean, Jenny Craig, and Mayo Clinic. How could a diet with an acronym that stands for “Dietary Approaches to Stop Hypertension” have received the highest overall ranking? 
While the DASH diet was originally designed to help lower high blood pressure, its nutritional components have stood the test of time in the ever changing world of nutrition.  The basic principles of the DASH Eating Plan are that it:

• Emphasizes eating a variety of foods available in most grocery stores
  
• Is low in saturated fat, cholesterol, and total fat
  
• Focuses on fruits, vegetables, and fat-free or low-fat dairy products
  
• Is rich in whole grains, fish, poultry, beans, seeds, and nuts
  
• Contains fewer sweets, added sugars and sugary beverages, and red meats than the typical American diet
  
• Is lower in sodium (salt) than the typical American diet.

By following the DASH diet, many people with hypertension have been able to lower their blood pressure readings by several points. But in addition to helping with blood pressure control, the DASH diet is consistent with the current dietary recommendations for osteoporosis, heart disease, diabetes, and cancer prevention.
The DASH plan includes daily servings from the following food groups:

• Grains---bread, cereal, rice and pasta. Whole grains are encouraged since they have more nutrients and fiber than refined grains.  Examples include brown rice, whole-wheat pasta, and whole-grain bread.
  
• Fruits---apples, apricots, bananas, dates, grapes, oranges, melons, peaches, pineapples, raisins, strawberries.  Canned fruits or fruit juices are thought to be OK as long as no sugar has been added. It should be noted that certain fruits, such as avocado and coconut are fairly high in fat (and calories) than most others.
  
• Vegetables---broccoli, carrots, green beans, green peas, kale, lima beans, potatoes, spinach, squash, sweet potatoes, tomatoes. Like fruits, vegetables are important sources of potassium, magnesium, and fiber. Fresh, frozen or canned are all acceptable choices although the sodium (salt) content of canned foods should be taken into consideration.
  
• Dairy---milk, yogurt, cheese.  These are major sources of calcium, vitamin D and protein. In general, low-fat or fat-free should be chosen. Many fat-free cheeses, however, can be high in sodium which should be avoided.
  
• Lean meat, poultry and fish. Lean cuts of meat with the fat trimmed away are recommended. Skin should be removed from chicken.  Eating fish that are high in omega-3 fatty acids (e.g. salmon, herring and tuna) is encouraged.  Broiling, roasting or poaching rather than frying is encouraged.
  
• Nuts, seeds and legumes---Almonds, peanuts, walnuts, sunflower seeds, peanut butter, kidney beans, lentils, soybeans, split peas.  These are rich sources of magnesium, protein, and fiber.  Meals centered on beans, lentils or soybean products are encouraged as a substitute to meat-based meals. Since nuts are fairly high in fat, they should be eaten in moderation.
  
• Fats and oils--- The DASH diet limits fats to 27% or less of daily calories including fat in foods and added fats or oils. Mono- and polyunsaturated fats are recommended over saturated fats. Common sources of these healthier fats are vegetable oils (canola, corn, olive, and safflower), low-fat mayonnaise, and light salad dressing. Saturated fats from meat, butter, cheese, whole milk, lard, and “tropical oils” (palm and coconut) are limited to less than 6% of total calories. Trans fat, a major cause of elevated blood cholesterol should be avoided.
  
• Sweets---Unlike many diets, the DASH plan allows for eating sweets. The key is moderation and portion control. Artificial sweeteners (NutraSweet, Equal, Splenda) are recommended sparingly.

Serving sizes of each of these vary depending on the specific group.  One “serving” of meat is considered to be one ounce.  A “serving” of sweets could be 1 tablespoon jam, ½ cup sorbet, or 1 cup lemonade. The number of servings from each group depends on the daily caloric requirement which is based on age, gender, and activity level.   As an example, a young woman who is moderately active would be allowed to eat up to 2,200 calories per day. This could include up to 8 servings of grains, 5 servings of fruits, 5 servings of vegetables, 3 servings of dairy, 3 servings of fat and oils,  6 servings (approximately 6 ounces) of meat, 5 servings (per week)  of nuts, seeds and legumes, and 5 servings (per week) of sweets.
While not developed as a weight-loss diet, the DASH food plan can be effective as part of a weight-loss strategy by slightly reducing the number of base calories and the addition of regular exercise. You can learn more about the DASH Eating Plan from the National Institute of Health.  Additionally, a DASH meal guide is available at: www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

Which is better for you: Bottled or Tap water?

Surveys have found that the primary reasons people choose bottled water over tap water are: 1) the belief that bottled water is healthier, 2) that bottled water tastes better, and 3) that bottled water offers convenience.  Which one is better in regard to taste and convenience could be debated, but according to a number of authorities, tap water and bottled water are generally comparable in terms of their safety and nutritional value.

Different federal agencies provide oversight to the processing of these two sources of water. The Food and Drug Administration (FDA) oversees bottled water, while the Environmental Protection Agency (EPA) regulates tap water.  Their standards for ensuring safety, however, including such concerns as contaminant levels, are virtually the same.

Most municipal water sources come from large wells, rivers or reservoirs.  The water is processed in a treatment plant to make sure that it meets EPA standards and is then piped to customers.   Bottled water comes from a number of sources, such as underground springs, but may also come from a municipal water supply.   Prior to bottling, however, water from a municipal source undergoes additional treatment which could include reverse osmosis, ozonation, or distillation. In general, the goal of the processing of water, whether it ends up in a bottle or coming through a tap is to make sure that it is as pure and natural as possible.

To some degree, the choice of tap or bottled water becomes a matter of personal preference. The preference for the taste of bottled water could be due to the use of chlorine disinfection used by many municipal water treatment plants to kill microorganisms or to the minerals or effervescence in certain brands of bottled water.  One other difference is the inclusion of fluoride in most tap water sources to help prevent tooth decay.

The devil’s in the details: The downside of bottled water
Most of the concerns voiced against bottled water have little to do with the quality of the water or its consumption. These concerns include:

1. The energy consumption required to transport bottled water and associated production of greenhouse gases.
2. The contribution to the depletion of underground aquifers by bottled water companies who pump from these sources.
3. Estimates that between 60 to 80% of recyclable plastic bottled water containers end up in landfills. In 2005, it was estimated that approximately 2 million tons of plastic water bottles were not recycled, ending up in landfills.
4. Ongoing research which suggests that contamination from certain types of plastic, in particular those that contain the chemical bisphenol A (BPA), have adverse health effects.
5. The additional expense to the consumer of bottling water that, in some cases, comes from municipal sources. 

In protecting their own interests, the International Bottled Water Association has offered rebuttals for most of these concerns.   The environmental group, World Wildlife Association, on the other hand, has taken the stance that the increasing use of bottled water represents a serious environmental concern.  A spokesman for that group has stated that “protecting our rivers, streams and wetlands will help ensure that tap water remains a service which delivers good quality drinking water for everyone at a fair price."

Anyone who has traveled in developing countries has probably had to find alternatives to drinking from municipal water sources.  In this situation, boiling water or buying bottled water becomes a necessity.  In the U.S., we are indeed fortunate to have a reliably safe drinking water supplydiction from municipal sources.

Lose 5 pounds this year?  Spend more time with your family?  Find a new job?  Millions of people make New Year’s resolutions, but relatively few are successful in keeping them. This is evidenced by a 2007 study conducted by British psychologist Richard Wiseman who found that 88% of all resolutions end in failure.  Not surprisingly, very little research has been published on the reasons why people are successful or unsuccessful with keeping New Year’s resolutions.  However, that
hasn’t kept a number of pundits from offering suggestions on improving your likelihood of success.

The following are some of the most practical recommendations that I have come across:

1. Make one resolution only.  Don’t make the mistake of trying to achieve too much. For example, it makes little sense to try to quit smoking and lose weight at the same time. This is a formula for failure.

2. Be as specific as possible. Instead of saying you want to lose weight, aim for a specific amount of weight (e.g. one pound) each week.

3. Focus on the positive aspects of your new behavior.  For example, if you want to quit smoking, think about the how much better off you will be---more respiratory capacity, fresher smelling clothing, more disposable income, etc.

4. Wait for the most opportune time.  If you have not planned in advance, New Year’s Day may not be the best time to begin. If so, look to a date when you will be better able to accomplish your goal.

5. Let others know about your resolution. Family members or friends can be a great source of support or accountability in keeping your resolution.

6. Take “baby steps”.  Break the goal into small, achievable steps. For example if a new job is the goal, the steps to success could include writing a resume, performing a needs analysis, talking to potential references, arranging for one interview a week, etc.

7. Write down your goals. Commit them to paper and review them periodically to see where you stand.

8. Expect setbacks. Since nobody’s perfect, you may revert to your old habits from time to time. These should be considered temporary, rather than a reason to give up on your goal.

9. Be realistic. Take time to seriously consider what you want to accomplish and don’t set the bar too high.

10. Avoid previous resolutions. This usually just leads to breaking the resolution a second time. If you do make a similar pledge, think about why you were unsuccessful and take steps to avoid a similar outcome.

One could argue about the wisdom of making New Year’s resolutions at all. Too often, they end up being something that “goes in one year and out the other”. Nevertheless, positive changes in people’s lifestyle, family circumstances, or financial situation can and do occur when the commitment is there. Hopefully, some of the tips above will help you reach your goals for the New Year.