PREPARED Doctors wearing protective gear with a possible flu patient in Mexico City.
By
CARL ZIMMER Evolutionary biology may sometimes seem like an arcane academic pursuit, but just try telling that to Gavin Smith, a virologist at Hong Kong University. For the past week, Dr. Smith and six other experts on influenza in Hong Kong, Arizona, California and Britain have been furiously analyzing the new swine flu to figure out how and when it evolved.
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Centers for Disease Control and Prevention
H1N1 An image of the newly identified swine flu virus. Partly because they can mutate very fast and can mix genes, viruses are turning out to be astonishingly diverse.
The first viruses from the outbreak were isolated late last month, but Dr. Smith and his colleagues report on their Web site that the most recent common ancestor of the new viruses existed 6 to 11 months ago. “It could just have been going under the radar,” Dr. Smith said.
The current outbreak shows how complex and mysterious the evolution of viruses is. That complexity and mystery are all the more remarkable because a virus is life reduced to its essentials. A human influenza virus, for example, is a protein shell measuring about five-millionths of an inch across, with 10 genes inside. (We have about 20,000.)
Some viruses use DNA, like we do, to encode their genes. Others, like the influenza virus, use single-strand RNA. But viruses all have one thing in common, said Roland Wolkowicz, a molecular virologist at San Diego State University: they all reproduce by disintegrating and then reforming.
A human flu virus, for example, latches onto a cell in the lining of the nose or throat. It manipulates a receptor on the cell so that the cell engulfs it, whereupon the virus’s genes are released from its protein shell. The host cell begins making genes and proteins that spontaneously assemble into new viruses. “No other entity out there is able to do that,” Dr. Wolkowicz said. “To me, this is what defines a virus.”
The sheer number of viruses on Earth is beyond our ability to imagine. “In a small drop of water there are a billion viruses,” Dr. Wolkowicz said. Virologists have estimated that there are a million trillion trillion viruses in the world’s oceans.
Viruses are also turning out to be astonishingly diverse. Shannon Williamson of the J. Craig Venter Institute in Rockville, Md., has been analyzing the genes of ocean viruses. A tank of 100 to 200 liters of sea water may hold 100,000 genetically distinct viruses. “We’re just scratching the surface of virus diversity,” Dr. Williamson said. “I think we’re going to be continually surprised.”
Viruses are diverse because they can mutate very fast and can mix genes. They sometimes pick up genes from their hosts, and they can swap genes with other viruses. Some viruses, including flu viruses, carry out a kind of mixing known as reassortment. If two different flu viruses infect the same cell, the new copies of their genes get jumbled up as new viruses are assembled.
Viruses were probably infecting the earliest primordial microbes. “I believe viruses have been around forever,” Dr. Wolkowicz said.
As new hosts have evolved, some viruses have adapted to them. Birds, for example, became the main host for influenza viruses. Many birds infected with flu viruses do not get sick. The viruses replicate in the gut and are shed with the birds’ droppings.
A quarter of birds typically carry two or more strains of flu at the same time, allowing the viruses to mix their genes into a genetic blur. “Birds are constantly mixing up the constellation of these viruses,” said David Spiro of the J. Craig Venter Institute.
From birds, flu viruses have moved to animals, including pigs, horses and humans. Other viruses, like H.I.V. and SARS, have also managed to jump into our species, but many others have failed. “It’s a very rare event when a virus creates a new epidemic in another species,” said Colin Parrish of Cornell University. In Southeast Asia, for example, a strain of bird flu has killed hundreds of people in recent years, but it cannot seem to move easily from human to human.
Only a few strains of influenza have managed to become true human viruses in the past century. To make the transition, the viruses have to adapt to their new host. Their gene-building enzymes have evolved to run at top speed at human body temperature, for example, which is a few degrees cooler than a bird’s.
Influenza viruses also moved from bird guts to human airways. That shift also required flu viruses to spread in a new way: in the droplets we release in our coughs and sneezes.
“If the virus settles down on the floor, then it’s gone,” said Peter Palese, chairman of microbiology at Mount Sinai School of Medicine. Winter is flu season in the United States, probably because dry air enables the virus-laden droplets to float longer.
Up to a fifth of all Americans become infected each flu season, and 36,000 die. During that time, the flu virus continues to evolve. The surface proteins change shape, allowing the viruses to evade the immune systems and resist antiflu drugs.
ALEXANDRIA, Va. — For nearly a day after a car slammed into bicyclist Kris Gulden, sending her flying over its hood, her hospital chart referred to her as "Delta Doe." She had not been carrying an ID, and all she could tell doctors and nurses was that her name was Kris and that she had a headache.
She knows this only because someone told her about it later. She has no memory of the time between when she filled up water bottles for her bike ride and when she awoke from surgery five days later to discover that her own body "felt like a foreign place to me."
On a sunny May afternoon in 1998, she had suffered a spinal cord injury that left her a paraplegic. Gulden, now 42, is one of 5.6 million Americans living with some degree of paralysis, according to a just-released survey commissioned by the Christopher & Dana Reeve Foundation.
In some ways, though, Gulden is far from typical.
Teaching criminal justice
The former police officer in Alexandria (a handcuffs key on the keychain tucked beneath her bicycle seat led to her sergeant identifying her) and triathlete teaches criminal justice full time at Alexandria's sprawling T.C. Williams High School — featured in the 2000 film Remember the Titans.
She retired from the police department on disability in 2000 and, for a time, "traveled and fooled around. In some ways, living was a full-time job." When a new REI store opened near her home in Arlington, Va., she took a job as a saleswoman, figuring "I'll meet like-minded people."
Police department friends told her about the opening for a criminal justice teacher at T.C. Williams. "I had come to realize that I really like kids," Gulden says, so she applied for the job.
Although she taught three years at the police academy, this is her first year teaching high school. One day last week, she asked her students what they liked most about a recent field trip to see the Alexandria jail and courthouse. Said one girl: "The best part for me was how Miss Gulden knew everybody."
Relatively few Americans with spinal cord injuries are employed, the new survey suggests. It found that 42% have an annual household income of less than $15,000, while that's true for only 13% of the general population. More could work, says Joe Canose of the Reeve Foundation, but they'd lose Medicare coverage if they earned too much.
An eloquent "ambassador" for the Reeve Foundation, Gulden has testified on Capitol Hill about the need for stem cell research.
Last month, she was among the invited guests at the White House when President Obama announced he was reversing the Bush administration's limits on federal financing of embryonic stem cell research.
She presented the president with a pair of Superman dog tags from the Reeve Foundation for his daughters. Pretty heady stuff for a Northumberland, Pa., native who credits actress Angie Dickinson in the 1970s TV show Police Woman for her interest in law enforcement.
'It doesn't get easier'
But if Gulden seems upbeat when you first meet, do not tell her that she seems to have adjusted well to life in a wheelchair.
"I may just be having a good day," says Gulden, who was injured while training for a 330-mile ride to raise money for AIDS. "It doesn't get easier. It just gets different."
Not surprisingly, people living with paralysis have an increased risk of depression, says Edwin Trevathan, director of the Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention in Atlanta. Being in a wheelchair also raises their risk of obesity and related diseases, such as diabetes, Trevathan says, as well as bladder and kidney problems.
Pressure sores also are a problem. To reduce her risk, several times an hour Gulden grasps the top of her chair's wheels and pushes straight down, raising her bottom off the seat for a second or two.
Nearly 11 years after her accident, living still is nearly a full-time job for Gulden.
She awakes at 4 a.m., because it takes her an hour and a half to get ready, much of that time in the bathroom. And this is a woman with very close-cropped dark hair who doesn't wear makeup.
She drives her station wagon to T.C. Williams, where she arrives a little after 6 a.m. "There's just so much to do, I can't get it all done between 8 and 8:30," when her first class begins. She returns home at 4:45 p.m. Every other day, after letting her yellow Lab outside to do his business, she starts her "bowel program." That requires sitting on the toilet for an hour and a half.
"Who spends 2½ hours a day in the bathroom?" Gulden says.
At least she can get into her bathroom. When she visits her brother in California, she must stay in a hotel because his bathroom doorways aren't wide enough for her wheelchair. When visiting friends close to home, she has to keep her stay short for the same reason.
Other barriers are attitudinal.
Despite her many accomplishments, Gulden says, "there's still an attitude that because I'm in a wheelchair, I can't do anything."
When her faculty mentor introduced her last summer to another teacher at T.C. Williams, that teacher addressed questions about her to the mentor instead of Gulden.
Says Gulden: "We're all a bunch of 'Delta Does.' "
U.S. manufacturers, including major drugmakers, have legally released at least 271 million pounds of pharmaceuticals into waterways that often provide drinking water — contamination the federal government has consistently overlooked, according to an Associated Press investigation.
Hundreds of active pharmaceutical ingredients are used in a variety of manufacturing, including drugmaking: For example, lithium is used to make ceramics and treat bipolar disorder; nitroglycerin is a heart drug and also used in explosives; copper shows up in everything from pipes to contraceptives.
Federal and industry officials say they don't know the extent to which pharmaceuticals are released by U.S. manufacturers because no one tracks them — as drugs. But a close analysis of 20 years of federal records found that, in fact, the government unintentionally keeps data on a few, allowing a glimpse of the pharmaceuticals coming from factories.
As part of its ongoing PharmaWater investigation about trace concentrations of pharmaceuticals in drinking water, AP identified 22 compounds that show up on two lists: the EPA monitors them as industrial chemicals that are released into rivers, lakes and other bodies of water under federal pollution laws, while the Food and Drug Administration classifies them as active pharmaceutical ingredients.
The data don't show precisely how much of the 271 million pounds comes from drugmakers versus other manufacturers; also, the figure is a massive undercount because of the limited federal government tracking.
To date, drugmakers have dismissed the suggestion that their manufacturing contributes significantly to what's being found in water. Federal drug and water regulators agree.
But some researchers say the lack of required testing amounts to a 'don't ask, don't tell' policy about whether drugmakers are contributing to water pollution.
"It doesn't pass the straight-face test to say pharmaceutical manufacturers are not emitting any of the compounds they're creating," said Kyla Bennett, who spent 10 years as an EPA enforcement officer before becoming an ecologist and environmental attorney.
Pilot studies in the U.S. and abroad are now confirming those doubts.
Last year, the AP reported that trace amounts of a wide range of pharmaceuticals — including antibiotics, anti-convulsants, mood stabilizers and sex hormones — have been found in American drinking water supplies. Including recent findings in Dallas, Cleveland and Maryland's Prince George's and Montgomery counties, pharmaceuticals have been detected in the drinking water of at least 51 million Americans.
Most cities and water providers still do not test. Some scientists say that wherever researchers look, they will find pharma-tainted water.
Consumers are considered the biggest contributors to the contamination. We consume drugs, then excrete what our bodies don't absorb. Other times, we flush unused drugs down toilets. The AP also found that an estimated 250 million pounds of pharmaceuticals and contaminated packaging are thrown away each year by hospitals and long-term care facilities.
Researchers have found that even extremely diluted concentrations of drugs harm fish, frogs and other aquatic species. Also, researchers report that human cells fail to grow normally in the laboratory when exposed to trace concentrations of certain drugs. Some scientists say they are increasingly concerned that the consumption of combinations of many drugs, even in small amounts, could harm humans over decades.
Utilities say the water is safe. Scientists, doctors and the EPA say there are no confirmed human risks associated with consuming minute concentrations of drugs. But those experts also agree that dangers cannot be ruled out, especially given the emerging research.
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Two common industrial chemicals that are also pharmaceuticals — the antiseptics phenol and hydrogen peroxide — account for 92 percent of the 271 million pounds identified as coming from drugmakers and other manufacturers. Both can be toxic and both are considered to be ubiquitous in the environment.
However, the list of 22 includes other troubling releases of chemicals that can be used to make drugs and other products: 8 million pounds of the skin bleaching cream hydroquinone, 3 million pounds of nicotine compounds that can be used in quit-smoking patches, 10,000 pounds of the antibiotic tetracycline hydrochloride. Others include treatments for head lice and worms.
Residues are often released into the environment when manufacturing equipment is cleaned.
A small fraction of pharmaceuticals also leach out of landfills where they are dumped. Pharmaceuticals released onto land include the chemo agent fluorouracil, the epilepsy medicine phenytoin and the sedative pentobarbital sodium. The overall amount may be considerable, given the volume of what has been buried — 572 million pounds of the 22 monitored drugs since 1988.
In one case, government data shows that in Columbus, Ohio, pharmaceutical maker Boehringer Ingelheim Roxane Inc. discharged an estimated 2,285 pounds of lithium carbonate — which is considered slightly toxic to aquatic invertebrates and freshwater fish — to a local wastewater treatment plant between 1995 and 2006. Company spokeswoman Marybeth C. McGuire said the pharmaceutical plant, which uses lithium to make drugs for bipolar disorder, has violated no laws or regulations. McGuire said all the lithium discharged, an annual average of 190 pounds, was lost when residues stuck to mixing equipment were washed down the drain.
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Pharmaceutical company officials point out that active ingredients represent profits, so there's a huge incentive not to let any escape. They also say extremely strict manufacturing regulations — albeit aimed at other chemicals — help prevent leakage, and that whatever traces may get away are handled by onsite wastewater treatment.
"Manufacturers have to be in compliance with all relevant environmental laws," said Alan Goldhammer, a scientist and vice president at the industry trade group Pharmaceutical Research and Manufacturers of America.
Goldhammer conceded some drug residues could be released in wastewater, but stressed "it would not cause any environmental issues because it was not a toxic substance at the level that it was being released at."
Several big drugmakers were asked this simple question: Have you tested wastewater from your plants to find out whether any active pharmaceuticals are escaping, and if so what have you found?
No drugmaker answered directly.
"Based on research that we have reviewed from the past 20 years, pharmaceutical manufacturing facilities are not a significant source of pharmaceuticals that contribute to environmental risk," GlaxoSmithKline said in a statement.
AstraZeneca spokeswoman Kate Klemas said the company's manufacturing processes "are designed to avoid, or otherwise minimize the loss of product to the environment" and thus "ensure that any residual losses of pharmaceuticals to the environment that do occur are at levels that would be unlikely to pose a threat to human health or the environment."
One major manufacturer, Pfizer Inc., acknowledged that it tested some of its wastewater — but outside the United States.
The company's director of hazard communication and environmental toxicology, Frank Mastrocco, said Pfizer has sampled effluent from some of its foreign drug factories. Without disclosing details, he said the results left Pfizer "confident that the current controls and processes in place at these facilities are adequately protective of human health and the environment."
It's not just the industry that isn't testing.
FDA spokesman Christopher Kelly noted that his agency is not responsible for what comes out on the waste end of drug factories. At the EPA, acting assistant administrator for water Mike Shapiro — whose agency's Web site says pharmaceutical releases from manufacturing are "well defined and controlled" — did not mention factories as a source of pharmaceutical pollution when asked by the AP how drugs get into drinking water.
"Pharmaceuticals get into water in many ways," he said in a written statement. "It's commonly believed the majority come from human and animal excretion. A portion also comes from flushing unused drugs down the toilet or drain; a practice EPA generally discourages."
His position echoes that of a line of federal drug and water regulators as well as drugmakers, who concluded in the 1990s — before highly sensitive tests now used had been developed — that manufacturing is not a meaningful source of pharmaceuticals in the environment.
Pharmaceutical makers typically are excused from having to submit an environmental review for new products, and the FDA has never rejected a drug application based on potential environmental impact. Also at play are pressures not to delay potentially lifesaving drugs. What's more, because the EPA hasn't concluded at what level, if any, pharmaceuticals are bad for the environment or harmful to people, drugmakers almost never have to report the release of pharmaceuticals they produce.
"The government could get a national snapshot of the water if they chose to," said Jennifer Sass, a senior scientist for the Natural Resources Defense Council, "and it seems logical that we would want to find out what's coming out of these plants."
Ajit Ghorpade, an environmental engineer who worked for several major pharmaceutical companies before his current job helping run a wastewater treatment plant, said drugmakers have no impetus to take measurements that the government doesn't require.
"Obviously nobody wants to spend the time or their dime to prove this," he said. "It's like asking me why I don't drive a hybrid car? Why should I? It's not required."
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After contacting the nation's leading drugmakers and filing public records requests, the AP found two federal agencies that have tested.
Both the EPA and the U.S. Geological Survey have studies under way comparing sewage at treatment plants that receive wastewater from drugmaking factories against sewage at treatment plants that do not.
Preliminary USGS results, slated for publication later this year, show that treated wastewater from sewage plants serving drug factories had significantly more medicine residues. Data from the EPA study show a disproportionate concentration in wastewater of an antibiotic that a major Michigan factory was producing at the time the samples were taken.
Meanwhile, other researchers recorded concentrations of codeine in the southern reaches of the Delaware River that were at least 10 times higher than the rest of the river.
The scientists from the Delaware River Basin Commission won't have to look far when they try to track down potential sources later this year. One mile from the sampling site, just off shore of Pennsville, N.J., there's a pipe that spits out treated wastewater from a municipal plant. The plant accepts sewage from a pharmaceutical factory owned by Siegfried Ltd. The factory makes codeine.
"We have implemented programs to not only reduce the volume of waste materials generated but to minimize the amount of pharmaceutical ingredients in the water," said Siegfried spokeswoman Rita van Eck.
Another codeine plant, run by Johnson & Johnson subsidiary Noramco Inc., is about seven miles away. A Noramco spokesman acknowledged that the Wilmington, Del., factory had voluntarily tested its wastewater and found codeine in trace concentrations thousands of times greater than what was found in the Delaware River. "The amounts of codeine we measured in the wastewater, prior to releasing it to the City of Wilmington, are not considered to be hazardous to the environment," said a company spokesman.
In another instance, equipment-cleaning water sent down the drain of an Upsher-Smith Laboratories, Inc. factory in Denver consistently contains traces of warfarin, a blood thinner, according to results obtained under a public records act request. Officials at the company and the Denver Metro Wastewater Reclamation District said they believe the concentrations are safe.
Warfarin, which also is a common rat poison and pesticide, is so effective at inhibiting growth of aquatic plants and animals it's actually deliberately introduced to clean plants and tiny aquatic animals from ballast water of ships.
"With regard to wastewater management we are subject to a variety of federal, state and local regulation and oversight," said Joel Green, Upsher-Smith's vice president and general counsel. "And we work hard to maintain systems to promote compliance."
Baylor University professor Bryan Brooks, who has published more than a dozen studies related to pharmaceuticals in the environment, said assurances that drugmakers run clean shops are not enough.
"I have no reason to believe them or not believe them," he said. "We don't have peer-reviewed studies to support or not support their claims."
By BETH DeFALCO, Associated Press Writer Beth Defalco, Associated Press Writer NEWARK, N.J. – State regulators on Friday temporarily suspended the medical license of a doctor who health officials suspect is linked to a hepatitis B outbreak.
Nearly 3,000 of Dr. Parvez Dara's patients have been warned to get tested after five cancer patients tested positive for the disease, which is transmitted through exposure to infected blood and can cause serious liver damage.
On Friday, the state presented evidence about the conditions at the oncologist's Toms River office. Investigators said they found blood on the floor of a room where chemotherapy was administered, blood in a bin where blood vials were stored, open medication vials and unsterile saline and gauze.
Inspectors also cited problems with cross-contamination of pens, refrigerators and countertops; use of contaminated gloves; and misuse of antiseptics, among other health code violations.
"This was not a one-time episode," Deputy Attorney General Siobhen Krier told regulators. "This is a case of egregious, bad medical judgment displayed over a long period of time."
A special committee of the state Board of Medical Examiners issued the suspension, effective immediately, on an emergency basis. The full board will consider whether to continue the suspension on Wednesday.
During the hearing Friday, Krier said Dara had a history of health code violations dating to 2002 and posed "a clear and imminent danger to the public."
Since 2002, Dara has paid nearly $56,000 in fines for infection control health code violations, court records show.
Dara said he only used sterile supplies and equipment and took steps correct the violations. He questioned whether the patients may have contracted the disease some other way, such as from a hospital or from surgery, and suggested some may have been latent carriers — meaning they had the virus but it was dormant — until they began receiving chemotherapy, which can suppress the body's immune system.
"It's not that rare," Dara said.
In making its decision, the committee said Dara showed "a significant and gross deficiency in judgment" and that that could not be remedied by changing office practices.
"Dr. Dara's own testimony has not persuaded the committee that he has an appreciation for the gravity of multiple breaches of basic infection control practices," the committee said in its order to suspend Dara's license.
Dara did express sympathy for his patients: "This is hurting them so much more than it's hurting me."
A March 28 letter was sent to his patients warning them of the risk and suggesting they be tested for the liver diseases hepatitis B and hepatitis C and for HIV, the virus that causes AIDS.
Dara, originally from Pakistan, has been practicing at his Toms River office for 23 years. He estimated that he sees between 45 and 60 patients a day, with about a dozen receiving chemotherapy each day.
His attorney, Robert Conroy, argued to the board that there was no direct evidence the hepatitis cases were linked to Dara's office. He characterized the state's investigation as sloppy and said the fact that the outbreak investigation is ongoing should have precluded regulators from drawing any conclusions.
"There's no proof," he said. "This is a rush to judgment ... before they get test results back."
Conroy said Dara plans to immediately appeal the decision.
COMMACK, N.Y. – The investigation into a nationwide salmonella scare over pistachio nuts has spread from a California nut processor to its sister plant in New York, where inspectors last month found cockroaches and rodent droppings.
The Food and Drug Administration said Thursday it was investigating Commack-based Setton International Foods Inc., which shares key staff and packages food with a plant in central California that earlier this week recalled 2 million pounds of nuts over fears of possible salmonella contamination.
Setton Pistachio of Terra Bella Inc. is the nation's second-largest pistachio processor. A spokesman for both companies said the California plant supplies all pistachios used in the Long Island processing facility, which makes chocolate- and yogurt-covered nuts and dried fruit.
Last month, New York agricultural authorities discovered nearly two dozen dead cockroaches, rodent droppings and one live cockroach on an ingredient rolling rack inside the Commack plant. It failed its state health inspection.
Production Manager Lee Cohen said Thursday the plant is now spotless and the problems — completely unrelated to the recall over salmonella concerns — were fixed immediately. The facility, which is among the 36 wholesalers that got nuts from the California operation, plans to recall some of its nuts and trail mix voluntarily in the coming weeks, he said.
"Our facility in New York is beautiful and clean. You can eat off the ground it is so spotless," Cohen said in an interview with The Associated Press. "We took actions immediately to respond once we heard there was a problem, and have been responsible from the beginning."
State inspectors went back for a visit Wednesday to swab the plant and take food samples to be tested for salmonella and other pathogens as part of the pistachio recall, said Jessica Chittenden, a spokeswoman for the New York State Department of Agriculture & Markets. The test results are pending.
"Right now nothing is moving out of that plant. They're holding all products with pistachios in them," Chittenden said. "When we were in there yesterday to collect samples, they were cooperative, and we observed that they are working on the issues that we had outlined in our last inspection."
Chittenden said she was told federal inspectors also had visited the plant this week. The FDA said the agency was "investigating all aspects of the company's operations" but could not disclose details.
The two companies share a CEO, Joshua Setton, and label foods with both plants' names, FDA spokesman Mike Herndon said.
During a tour of the sprawling factory Thursday, a company consultant told the AP that pistachios are being kept separate from Setton's other products until the FDA advises the firm how to proceed.
Thousands of boxes of pistachios were wrapped in plastic, placed on pallets, stacked to the ceiling and cordoned off from the rest of the warehouse with yellow police tape. Roasting machines and polished stainless steel equipment appeared clean, and visitors were required to wear hair nets.
William Schwemer, a retired FDA investigator hired as a consultant, said there were no exposed food products in the room where mouse droppings were found last month.
So far, there have been no confirmed reports of illness linked to the recalled nuts.
Still, federal health officials warned people this week to avoid eating all pistachios and products containing them while the government determines what foods could be tainted.
In the meantime, a range of products from nut bars to ice cream and cake mixes remain in limbo on grocery shelves, and the number of recalled products continues to grow.
Setton International Foods has not issued its own recall, Chittenden said.
Kraft Foods Inc. first alerted the FDA to the contamination after its manufacturer in Skokie, Ill., turned up salmonella in a routine test of roasted pistachios that workers planned to add to trail mix.
Private auditors hired by Kraft found problems they think caused the contamination when they traveled to Setton Pistachio's processing facility in Terra Bella, a remote town in California's farm belt.
Cohen said Tuesday he suspected that roasted pistachios at the facility could have been contaminated by salmonella-tainted raw nuts they were processed with.
The last time California health inspectors visited the Terra Bella plant, they found no violations that would pose a health threat.
In April 2008, a California Department of Public Health inspector made note of minor violations, such as insulation hanging over some equipment and packaging equipment that was temporarily repaired using tape.
Neither violation is thought to pose a threat to human health, and the company corrected both a few days later.
Records obtained by The Associated Press show that the New York plant has passed nine health inspections since 2000, despite receiving some violations for unsanitary conditions. Chittenden called that an "excellent history."
In January 2004, five dead cockroaches were found on the floor of the chocolate mixing room. In January 2007, a state inspector noted that three bins of raw almonds in the roasting area had been left unattended and uncovered while they were not in use. Last month, an inspector spotted something similar: two bins of raw cashews were left out and uncovered in the roasting area.
The company failed its March inspection because of "critical deficiencies" — including the detection of one live cockroach on an ingredient rolling rack in the chocolate tank.
The plant was set to get a second, unannounced inspection in addition to Wednesday's visit, Chittenden said.
What if someone told you that the way you eat could whittle your waistline? Sure, you'd think. Give up carbs and rely on rabbit food. Not true! I'm happy to tell you that there are other, yummier ways to go. Certain foods and styles of eating can indeed help flatten your belly (and everywhere else, for that matter). Try these tips and you'll uncover an amazing middle in no time.
Gimme a C: I love pink grapefruit and that's a good thing, since research has found that foods that are naturally rich in vitamin C—think citrus fruit, cantaloupe and red peppers—can help reduce fat absorption. In fact, skip it and you may see your middle expand, since diets low in vitamin C have been linked to bigger waistlines. Meet your daily goal of 75 milligrams by snacking on an orange or a cup of strawberries. See how these small changes can add up to big results.
Tea up: Women with the highest consumption of catechins, the plant-based antioxidants in tea that may boost fat burn, put on fewer pounds over 14 years than those who drank less tea, The American Journal of Clinical Nutrition reveals. Try to choose green or white varieties, which contain the most catechins. Learn how to maximize the benefits of tea and other superfoods.
Peel it off: Reach for a banana and you'll banish bloat faster than you can say Buddha belly. The fruit contains 422 mg of potassium, which controls the amount of puff-producing sodium in your system. Toss a banana in your bag for a fabulous ab-flattening snack. Try our Flat Abs Fast plan for more bloat-reducing tips and tricks.
Go low: Consuming just one meal of low-glycemic-index foods, those that your body digests slowly, can help you feel fuller all day so you're less likely to pack your tummy with treats, a study in the Journal of the American College of Nutrition reports. Low-GI foods include oatmeal and vegetables (sorry, not potatoes), as well as some fruit like grapefruit and blueberries. Oatmeal Meatballs are a tasty way to curb cravings.
Stroll away your sweet craving: Loco for cocoa? Me, too. A little dark chocolate is fine, but if you've already hit your limit, try lacing up your sneakers! Chocolate lovers who walked for 15 minutes reported reduced hankerings during the walk and even afterward, according to a study in the journal Appetite.
Ditch high-fructose corn syrup: Scan labels and you're likely to see high-fructose corn syrup on many ingredient lists...even on things like tomato sauce! When you do, put down that jar and look for something else. Why? High-fructose corn syrup can cause a surge in your blood sugar, and some research suggests it messes up your hunger and satiety signals, like leptin, leaving you less satisfied and causing you to eat more. When leptin responses fail, it's tougher to control appetite. The result: Extra calories get deposited as fat. To prevent this, trade packaged foods with high-fructose corn syrup for ones with healthy fats and fiber—think veggies, hummus, nuts or sunflower seeds.
Snap your snack: Taking a photo of your plateful of food can keep you slim. People who took pictures of everything they ate for five days reported consuming fewer snacks and being less likely to go back for seconds than during a week-long period in which they kept a written food diary, a study from the University of Wisconsin at Madison finds. Try capturing your meals for a week to help eyeball portion sizes as well as color variety—aim for more green, less white (unless it's cauliflower). See an example of this, and get ideas for healthy, photo-worthy meals of your own, at Eat Like Me.
ORLANDO, Fla. - Warning to weekend warriors: Swim-bike-run triathlons pose at least twice the risk of sudden death as marathons do, the first study of these competitions has found.
The risk is mostly from heart problems during the swimming part. And while that risk is low — about 15 out of a million participants — it's not inconsequential, the study's author says.
Triathlons are soaring in popularity, especially as charity fundraisers. They are drawing many people who are not used to such demanding exercise. Each year, about 1,000 of these events are held and several hundred thousand Americans try one.
"It's something someone just signs up to do," often without a medical checkup to rule out heart problems, said Dr. Kevin Harris, a cardiologist at the Minneapolis Heart Institute at Abbott Northwestern Hospital. "They might prepare for a triathlon by swimming laps in their pool. That's a lot different than swimming in a lake or a river."
He led the study and presented results Saturday at an American College of Cardiology conference in Florida. The Minneapolis institute's foundation sponsored the work and tracks athlete-related sudden deaths in a national registry.
Marathon-related deaths made headlines in November 2007 when 28-year-old Ryan Shay died while competing in New York in the men's marathon Olympic trials. Statistics show that for every million participants in these 26.2-mile running races, there will be four to eight deaths.
The rate for triathletes is far higher — 15 out of a million, the new study shows. Almost all occurred during the swim portion, usually the first event.
"Anyone that jumps into freezing cold water knows the stress on the heart," said Dr. Lori Mosca, preventive cardiology chief at New York-Presbyterian Hospital and an American Heart Association spokeswoman. She had no role in the study but has competed in more than 100 triathlons, including the granddaddy — Hawaii's Ironman competition.
Cold water constricts blood vessels, making the heart work harder and aggravating any pre-existing problems. It also can trigger an irregular heartbeat. On top of this temperature shock is the stress of competition.
"It's quite frightening — there are hundreds of people thrashing around. You have to keep going or you're going to drown," Mosca said.
Swimmers can't easily signal for help or slow down to rest during swimming as they can in the biking or running parts of a triathlon, said Harris, who also has competed in these events. Rescuers may have trouble spotting someone in danger in a crowd of competitors in the lakes, rivers and oceans where these events typically are held, he added.
For the study, researchers used records on 922,810 triathletes competing in 2,846 USA Triathlon-sanctioned events between January 2006 and September 2008.
Of the 14 deaths identified, 13 occurred during swimming; the other was a bike crash. Autopsies on six of the victims showed that four had underlying heart problems. Two others had normal-looking hearts, but they may have suffered a fatal heart rhythm problem, Harris said.
A search of the Minneapolis registry and the Internet found four other triathlon-related deaths from 2006 through 2008 beyond those that occurred in the officially sanctioned events.
"While not a large risk, this is not an inconsequential number," Harris said.
Fundraising triathlons have enticed many runners to try to expand into areas like swimming, which they may not have learned to do very efficiently, to benefit particular charities, Mosca said.
"They're really recruiting people to do these events," she said. "It can be a recipe for disaster."
Doctors offer these tips to anyone considering a triathlon:
_Get a checkup to make sure you don't have hidden heart problems.
_Train adequately long before the event, including open-water swims — not just in pools.
_Acclimate yourself to the water temperature shortly before a race, and wear a wetsuit if it's too cold.
_Make sure the race has medical staff and defibrillators on site.
If there's one thing that gets in the way of you being your healthiest, it's stress. For anyone who's found themselves standing in front of the freezer inhaling spoonfuls of Coffee Heath Bar Crunch ice cream (not my real name!) to avoid finishing a project, or waking up three times in the wee hours of the night in anticipation of a difficult conversation, here's some not-so-shocking news: Research shows that anxiety can make you sleep fewer hours, get sick more often, remember less, become more prone to long-term disease and—as if you needed reminding—eat more. No wonder up to 90 percent of doctor visits are for stress-related complaints, a fact that I suspect too many of you know firsthand (though you experience it as GI distress, back pain, a headache or other physical symptom).
In a recent Self.com poll, 85 percent of women said that worries interfere with their ability to catch zzz's, while 71 percent say they're more irritable due to stress. And given the recent headlines about the state of our economy, it's not surprising that 52 percent of women say they are under considerably more stress than they were six months ago. (What is your stress level?)
Grim, yes, but there IS hope. Just as our bodies are wired to react to stress, we're all also programmed to know how to wind down, whether it's by watching a funny movie, sitting in the sauna, sipping some chamomile tea (while dunking a cookie, of course!) or drinking a glass (or two) of wine with dinner. These activities switch on the brain's pleasure centers, blocking the production of the stress hormone cortisol and churning out happiness-inducing chemicals like serotonin instead.
When I feel a tightening in my back or neck coming on, I cope by doing things I love, like going for a long, slow run in the park with my dog. Try a few of these instant soothers, and watch your own stress go from ARGH! to Ahhh.
Turn up the tunes. Listening to music that has a steady (not frenetic) beat may cause brain waves to keep time and relax you, research from a music symposium at Stanford University in California reports. Load your iPod with a playlist of the songs that make you happiest.
Phone a friend. Pouring your heart out to pals can help you cope with bad feelings and brainstorm new ways to solve problems. And don't forget to return the favor: Lending an ear and offering support can make you feel needed and reduce anxiety. (Or drop them an e-card to say thanks!)
Break a sweat. Exercising for 30 minutes makes your body release chemicals that dull the physiological effects of stress response for up to a full day. But the effect only works when the activity is something you really want to do, so make sure you're psyched about channeling your energy in that cardiovascular direction.
Use a better bulb. Outfit your office lamp with an incandescent bulb, particularly if your cubicle is brightened by fluorescent lights. Incandescent and fluorescent lights work together to more closely mimic outside light. And it's sunshine (or the perception of it) that regulates the body's biorhythms. Not getting enough of it can affect hormone levels, suppressing the immune system and increasing the probability of mood swings, depression and sluggishness.
Pamper yourself. Whether you get a pedicure or splurge on a blowout, giving yourself special treatment reduces your blood pressure and gets your mind off what’s bothering you. Science supports this coping mechanism as well: A warm bath can activate neurons that increase serotonin, and a study from Bowling Green State University in Ohio found that a 15-minute massage can significantly cut anxiety levels. Not up for a splurge? Get the same effect from an at-home pedicure, manicure or blowout.
Dine by candlelight. The effect won't just make you look gorgeous. The dim setting actually signals your brain to release melatonin, the good-for-you sleep hormone which ensures a better night's rest. And catching enough zzz's helps keep your stress levels under control and your immune system humming. Can't sleep? See what your stress dreams are trying to tell you.
Snuggle with your sweetie. A simple 20-second kiss or hug increases endorphin levels, while having sex releases more calming hormones than any other form of sex play, researchers at the University of the West of Scotland at Paisley note.
Keep a journal. Jotting down your stressful thoughts can help you look at them more logically, potentially easing anxiety, mentally and physically. A study in the Journal of Health Psychology finds that a mere month of expressive writing can help reduce hypertension. Keep a pretty notebook handy at all times.
Anticipate something awesome. Or something tiny that makes you smile. The point is to look forward to something each day, whether it’s enjoying your morning java or counting down to an exotic vacation. Practicing this will keep your mind from focusing on what could go wrong that day.
Exhibit your exhilarating moments. Tape up pictures of three amazing days you’ve experienced, such as dancing at your wedding or crossing the finish line of a half-marathon. Honing in on the images for at least 10 seconds can lower muscle tension and stabilize your heartbeat.
Give someone props. Go on, pay a compliment to someone deserving. Research has shown that the more warm personal connections you make, the better your body is at jettisoning the effects of stress.
Stress-eater? Snack away the tension with these stress-busting foods.
BY DELTHIA RICKS | delthia.ricks@newsday.com
Two new studies into PSA (prostate-specific antigen) screening for prostate cancer this week raised more questions than they answered, according to the American Urological Association. Dr. Felix Badillo, chief of urology at St. Francis Hospital; Dr. Howard L. Adler, medical director of Stony Brook University's prostate care center; and Dr. Louis Kavoussi, chairman of urology at North Shore-LIJ Health System, offered clarity.
Does PSA screening reliably detect cancer?
Yes and no. It also spots inflammation in the prostate, which may sound a false alarm, a reason its reliability has been questioned. Even when cancer is present, Adler noted, a PSA also cannot help distinguish between aggressive and indolent tumors. Indolent cancers, slow-growing malignancies, are less likely to spread, requiring nothing more than "watchful waiting."
The new studies, one by Americans and the other by Europeans, drew different conclusions. The Americans found "no benefit" from PSA screening; the Europeans found a negligible benefit. Why the difference?
The studies involved different investigational techniques and different populations. The urological association issued a statement saying studies such as these are just part of the national discussion about PSA testing. An overwhelming body of evidence exists supporting the value of the test and the potential to save lives.
The studies suggest there is no "survival benefit" from routine screening. What does that mean?
When the PSA was developed in the 1980s, experts theorized a widespread mortality reduction, as was seen with mammography and breast cancer. That didn't happen. However, Badillo emphasized that the benefits of screening far outweigh the risks of forgoing the test, especially for men at risk because of family history or those between the ages of 50 and 75.
What about men who are older?
Men in their 80s and 90s can choose to be screened less frequently. As men age, the prevalence of prostate cancer increases - but the tumors tend not to be lethal in the oldest age groups, explained Kavoussi. It's a cancer phenomenon that's not fully understood.
Ethic companies should be able to describe their products without exaggerating the truth or omitting to say something about the disadvantages. However, this is not a good strategy for their profits and if every company would state the negative parts offered by their anti-wrinkle creams, they would go bankrupt.
This is why, when reading an anti- wrinkle cream review, you should believe what you're seeing, but you can question it and search for more information. Unfortunately, some companies are not happy with just omitting the disadvantages which their product can have, but they also lie and overstate their qualities.
This is exactly why you should check both types of anti-wrinkle cream reviews before making your decision. The internet is the perfect source for consumer-reviews. There are thousands of forums, blogs and websites which are specialized on this area: reviews. Clients have no reason to lie about the products which are sold by the third party, so this is probably the most reliable source.
In term of the best anti-wrinkle cream review, you can surely find it from a person who has used that certain product. If you want to make everything perfect, you can read a few reviews before buying the cream. Because user reviews won't always be available, there is a third option.
Companies can't lie about the ingredients they use - this is illegal. At the same time, people have no reason to lie about the effects of an ingredient. You can search for the ingredient list of each product and see how it works from a professional review. Experts will tell you exactly what each ingredient does and, in the end, you will find out if the anti-wrinkle cream will be efficient or not.
So there you have it, these are the three ways to find the best anti wrinkle cream review, and the best product on the market.
Men may have once been fine with aging naturally, but today they are on a quest to look and feel their very best.
Our society does place a great deal of importance on how a person looks, and that isn't limited to only the appearance of women.
It is important to understand that the right anti wrinkle cream for men is different from those for women. Some of the ingredients are the same but there are enough differences to take note of. The skin care needs of men and women are different which is why it is important for their products used to be different as well. Let's review why men and women both suffer from aging.
As a person gets older, it is natural for the body to stop producing high levels of collagen and elastin. Yet, these proteins are what result in the skin being very healthy and smooth. They also will determine the tone and texture of your skin as well. Sagging skin is a direct result of the loss of collagen and elastin in the body.
Free radicals are the other powerful cause of the aging process. That is why any anti wrinkle cream for men needs to contain plenty of antioxidants. This way they can fight the free radicals off before they ever have a chance to damage the healthy skin cells. There are some reasons why men age that women don't though.
For example, shaving daily is common in men but it can result in the skin being damaged. Inflammation occurs due to the process no matter what type of razor you are using. Many aftershave products are designed to smooth the skin but they do contain alcohol. This alcohol base though will result in the skin becoming dried out.
In addition to such ingredients, for best wrinkle creams for men that you use should also have some natural emollients found in them. These too will help to soothe the skin and to reduce the effects of irritations. As a result, the skin is less likely to be inflamed. You can find much more information about natural substances for healthy skin on my website.
Whatever the cause of cellulite, it's important to know that there aren't any miracle products, treatments, or medicines that can make it go away. For example, some fancy salon treatments that promise to get rid of cellulite simply cause your skin to puff up through deep massaging, temporarily reducing the appearance of cellulite.
Treatments like liposuction (surgery to remove fat) and mesotherapy (injection of drugs into cellulite) are either expensive or may produce only temporary improvement. Many doctors even warn that liposuction is not an effective treatment for cellulite because liposuction is designed to remove deep fat instead of cellulite, which is close to the skin.
WHAT IS CELLULITE?
Before attempting to find the best cellulite treatment solution and to understand how cellulite reduction is possible, you must have a little background on some important cellulite information and understand the exact definition of cellulite and also the cause of cellulite.
Cellulite is the expression used to describe pockets of fat which are trapped and cause dimpling in the skin. This dimpling is irregular and patchy and has been identified with orange peel.
Cellulite is a combination of fat globules, waste matter, and water, accumulated in connective tissue (collagen and elastin fibres).
Deposits of unattractive dimpled skin or dimpled fat are found on the thighs and buttocks and other body areas, where large areas of fat are found in close proximity to the skin.
Underneath the dermis and epidermis are three specific layers of fat. Cellulite tends to develop in the subcutaneous fat layers. This layer of fat is unique in its structure compared to the other layers because its fatty parts are structured into specific chambers by strands of linked tissue around it.
The subcutaneous fat layer in a woman is organized into large upright chambers allowing fat to be stored. In men, these chambers are organized into small slanting units. These store smaller fat quantities and are not likely to form cellulite.
The scientific theory of cellulite is that the skin's underlying supports called fibrous septae do not hold the skin together evenly and this uneven support causes the irregular bulging and dimples.
Underneath your skin is a mesh work of collagen fibers (septae) that resemble "fish net stockings." In the subcutaneous level of your skin, your fat cells are held in place by this fish net. When your fat cells are not "bloated" with water and/or fat, nothing sticks through the threads and everything looks nice.
And here is where the drainage problem comes in, when water and/or fat enters the fat cells, they bulge, if your cellulite metabolism is working right, your body makes the corrections necessary and drains the area. If it is not working correctly or is overloaded (unfortunately this is what happens in over 90% of women) the fat cells expand against the collagen threads of your fish net stocking and the fat cells bulge out and like sausage links that are twisted at the ends, cannot escape! The cellulite is here to stay because it cannot be drained out no matter how much you exercise or diet.
It does not matter if you are obese, overweight, normal weight, or underweight, cellulite is not a condition dependant on how much you weigh. Although it is often mistaken for obesity, cellulite is not actually obesity related because it can also take place in thin lean women.
Even die-hard exercisers and dieters are battling hard with cellulite reduction as well.
Cellulite affects 90%-95% of women, but it is very hardly ever seen in men. In women, fat cells are arranged a little bit differently than men (which is why cellulite does not usually affect men) because women, since the birth of time, carry more fat and less muscle than men.
CELLULITE CAUSES
Several changes in metabolism and physiology may cause cellulite or contribute to cellulite.
Hormones:
Hormones play a dominant role in the formation of cellulite. They have a crucial role in fat, blood circulation and connective tissue in the body. Cellulite can be developed when women are going through stages of hormonal changes such as puberty, pregnancy and menopause.
Pregnancy can cause cellulite. In preparing your body to give birth, it secretes hormones that "loosens" things up to allow parts of you to stretch more than you would believe possible. This means that a lot of connective and supportive soft tissue is becoming weak or "lax" and not holding things (including fat) in place.
Pregnancy also causes "The Drainage Problem." This is why you retain water in your legs and ankles, pregnancy causing problems of circulation, effecting that very drainage system needed to get rid of water and fat in your fat cells in your subcutaneous skin level in your butt, thighs and hips.
Another factor which may contribute to the formation of cellulite is poor blood circulation.
Predisposing factors:
Several genetic factors have been shown to be necessary for cellulite to develop. Cellulite may also be hereditary.
Aging:
Another factor that contributes to the development of cellulite is due to aging. As you age, the surface of skin thins and loses its elasticity; causing fat deposits under the overlying skin becomes more noticeable.
Overweight:
Though cellulite affects everyone regardless of size, weight or body type, it is more common to those who are overweight or have a higher level of body fat percentage. Excess weight or obesity are prone to cellulite formation. Obesity in itself may not cause cellulite, but it will make the situation look a lot worse
Food:
Excessive amounts of fat, carbohydrates, salt, alcohol or too little fiber can all contribute to an increased cellulite.
Lifestyle:
Smoking, drugs, tight clothes, high heeled shoes, and sitting or standing in a single position of long periods have all been correlated with an increase in cellulite. A high stress lifestyle will cause an increase in the catecholamine hormones.
Lack of Exercise:
Lack of exercise and the inactivity of our lifestyle contribute to the formation of cellulite. When you exercise and burn calories off the body, the less likely you will gain weight. It helps to improve blood flow, hence, decreasing the chances of developing cellulite or at least reducing the ugly effect as much as possible.
One or more combinations of factors may be the culprit for the cause of cellulite.
CELLULITE TREATMENT
Whatever the actual cause individual sufferers, the result is that fat cells are effectively trapped, and locked up in the collagen and elastin fibres. The local circulation is often slowed and the nerve endings may become compressed and tender. Cellulite is in essence imprisoned fat, and cannot be eliminated by diet or exercise alone. It can be treated in a variety of ways, with varying success.
Finding the cellulite cause can be useful before pursuing cellulite treatment.
* Do you exercise, consume adequate amount of water, eat healthy food?
* Do your parents or grandparents suffer from cellulite as well? Did you just give birth to a baby?
While there are variety of cellulite treatment products and techniques available in the market that may help you to reduce the appearance of cellulite – anti cellulite cream, cellulite lotion and pills, it is a widely known fact that none of these can successfully get rid of cellulite completely and for ever. All these cellulite treatments are useful to temporarily reduce the appearance of cellulite.
Cellulite creams, which marketers claim will dissolve the fat and smooth the skin are not a permanent solution. Cellulite creams are somewhat effective, but only if they are used on a regular basis.
Many products alone are ineffective in the treatment of cellulite. There are also creams available which contain herbs, antioxidants, minerals and vitamins. These assist the skin to become softer, healthier and smoother and allow it to repair itself more easily.
Creams which contain antioxidants and anti-inflammatories are more effective when treating cellulite as they stimulate the flow of blood. The areas which are affected by cellulite are usually dry and damaged therefore needing additional moisture, increased blood supply and protection. The appearance of cellulite can be reduced temporarily by increasing moisture to the affected area. It needs to be remembered cellulite needs to be treated from the inside as well as the outside.
The best defense against cellulite is to:
* practice a healthy diet to improve your inner nutritional health, consume adequate amount of fluid to keep your body hydrated quit smoking, avoid alcohol, avoid excessive coffee intake, reduce salt consumption – salt causes water retention, cut down sugar and fat
* exercise regularly to improve blood circulation. People who stay in good shape or who have less total body fat seem to have fewer problems with cellulite (exercise program aimed for fat burning is not enough - appropriate exercise program is the one that tones the underlying muscle).
* massage can be effective if performed very vigorously. Ten to twenty sessions are needed to see the results. (Ultrasonic cellulite treatments are often combined with massage and brushing of the skin. The treatment requires 20 to 40 sessions, but is effective.)
* liposuction can remove cellulite fat and the strings of tissue that pull the fat down by scraping under the surface of the skin to disconnect them from the fat. This works best in younger persons. However, in older persons liposuction may cause more dimpling of the skin.
Cellulite's formation is a result of complex physiological changes that occur in the subcutaneous fat layer. Regular exercise and well balanced diets do not always reverse or prevent its formation, although an unhealthy lifestyle will make the overall appearance worse over time due to poor nutrition, weight gain and lack of sufficient water intake.
There is no magical cellulite cure. The most practical, safest and long lasting way to prevent or reduce cellulite once and for all is a combination of regular exercise, proper food, healthier lifestyle and massage with cellulite creams.
The best thing to reduce the amount of cellulite is to decrease excess body fat. Eat fewer calories and most important - exercise more! Experts agree that an exercise routine that combines aerobic exercise with strength training is the best weapon against cellulite.
Offering to give a relaxing massage to a friend or loved one can be one of the best gifts that you can provide for someone who has had a bad or stressful day or week.
Few people will turn down a massage, especially if you know how to properly give one. A good massage isn’t necessarily all about great technique, although that is important. You also need the right tools, be able to set the mood conducive to a relaxing massage.
It’s fairly easy to set the right mood. Ask the recipient of the massage if they have any musical requests. If they do not, find music that is soft and relaxing. Purchase some candles. Again, ask the person who is receiving the massage if they have a personal favorite. If they do not, pick something that you like which is soothing, smells nice and promotes relaxation. If you have no idea, try a lavender candle.
After you have chosen the music and the candles, it’s time to purchase massage oil. Using massage oil allows you to give a massage that feels good. You won’t be roughly rubbing on the skin, but gliding over it. It will also prevent your hands from getting tired quickly. Jojobo and almond oils are good picks. You will also find great options at local, specialty shops or online.
Once you have all of your supplies, grab two of your biggest, fluffiest towels and place them in the dryer for a few minutes. This will get them nice and warm. Place one of the towels underneath the person that is getting the massage and the other one on top of them so that they are not overly exposed.
Now if you are unsure about massage techniques, you may want to invest a little money and purchas a good book or video on the subject. However, if you avoid massaging too hard or too soft, you should be fine. Make sure that you get feedback and ask your partner to tell you when it feels good. Focus on the arms, back, legs and buttocks (if appropriate). Use your fingers, thumbs and fists to lightly knead and place pressure on the various muscle groups.
Giving a relaxing massage to someone can be a great gift. With the day-to-day pressures that most people live with, being pampered and tended to with a massage can be extremely enjoyable. When giving a massage, be sure to set the mood with soft, soothing music, burn some candles and make sure the temperature is right. Turn down the lights and focus on gently and firmly massaging the major muscle groups with your hands, fists and thumbs.
Occurring of acne is common. The irony is that as you grow up and become conscious of your looks and appearance acme develops. In girls it develops in early teens while in boys it develops in later teen years.
Almost every one faces it. Woman who had not faced it in her teen years is likely to face it in late twenties. It is a natural part of growing up and is caused by hormones. Acne prevention is not possible though proper care and some precautions can reduce its intensity.
How can one prevent something that is quite natural? Here are some tips that can help one face the problem of acme which is mainly cosmetic and psychological, barring some cases of severe incidence which may require help from a physician.
• It is not a disease and is not incorrigible either but in most of the cases it doesn’t require any treatment.
• It develops slowly, stays for some time- some months or years- and goes away.
• It is not caused by lifestyle but gets aggravated by some chemicals used in cosmetics.
• Washing your face twice or thrice a day and drinking lots of water makes acne spots vanish faster.
Some dietary precautions can help. Do not eat fast food and heavy oily things and avoid too much sugar. To prevent acne concentrate on thins which are rich in vitamin A and vitamin E. It is observed that those who develop severe acme have lower vitamin A compared to those who don’t. Likewise those who have lower vitamin E in their body girls are likely to have more acne.
Pregnant women with bad eating habits and excess weight run the risk of giving birth to an unhealthy baby. Furthermore they may even be risking birth related complications for themselves. Hence it is all the more important to take care of your health in these situations.
As it is you have the responsibility of another life hanging upon you so would want to be doubly cautious. Achieving weight loss during pregnancy is not as hard as it may seem. It is true that pregnant women generally will not feel like exercising or restricting themselves from eating food but there are certain compromises that one has to make in order to ensure one's own health and that of one's baby.
The secret to giving birth to a healthy bay is to have a healthy diet coupled with light yet effective exercise. There are many good diet programs that have been especially devised for pregnant women. These diets will give them basic guidelines on the do's and don'ts related to food.
A pregnant woman must not make the choice to follow any diet program on her own because certain diets can be devastating for her health. This is why certain diet programs state clear warnings warning pregnant women not to go with the program. The South Beach diet is one particular diet that pregnant women can go with but that too only from phase two. Phase One of this Atkins diet like program is definitely not recommended for pregnant women.
Foods that need to avoided
There are certain foods that fall in the category of definite no-no in these especially composed diets for pregnant women. These foods will not only make the pregnant women put on weight but they can also lead to poor health for both the mother and the baby. These include.
• Fish: Shark, king mackerel, swordfish, tilefish. These items contain a high level of mercury which is dangerous for the babies nervous system
• Tuna and albacore
• All sorts of junk food
• Alcohol
• Caffeine
Food that is imperative for pregnant women
There are certain foods rich in vitamins and nutrients that are essential for pregnant women. The reason why women will need food rich in vitamins and minerals is because they will be producing blood for the baby. So they will need iron for the blood and calcium for the bones and folic acid for the prevention of diseases during the early stages of pregnancy, especially related to the brain and spine.
For this purpose pregnant women are highly encouraged to increase the intake of fruits and vegetables. Since the demand for minerals during pregnancy is increased women must increase their intake as well. There are also special mineral supplements that women can take during pregnancy that will help them to maintain the desired amount of minerals in their body.
Exercise for weight loss during pregnancy
Since a pregnant woman cannot go on strict diets due to the fact that her body requires an increased number of nutrients and minerals she has to couple her little dieting efforts with exercise. You will find most of the weight loss programs for pregnant women to have exercise routines that pregnant women can manage. Of course the exercises wont be as intense as they could have been under normal circumstances but it will require some physical movement and breaking of sweat for the pregnant woman.
When these efforts are coupled with a sensible way of eating which means a diet based on a moderate fat content the results can be fruitful. The diet should be in sensible quantity and from various sources sighted by the professionals such as whole grains, fruits and vegetables along with which the exercise pattern should be strictly followed in order to achieve weight loss and maintain it during the nine long months of pregnancy.
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The hobby of chewing gum is not useless. Summary chew increase blood circulation so that oxygen is sent to the brain more and more, so more fresh thinking, and concentration of the strong.
In addition, the jaw movements during chewing gum can stimulate facial muscles that create the effect facial skin becomes more taut. That, chewing gum to give a sense rileks, reduces stress, and the saturation. That is just a few of the benefits obtained with the chewing gum. A line of other benefits are:
Channel digested post-restore operation. A study involving 158 patients, who made St Mary's Hospital, London, said, those who chew gum after undergoing intestinal surgery, digestive function of the channel more quickly return to normal. In clinical testing, a group of patients who chew gum 5-45 minutes three times a day after surgery compared with patients who did not chew gum. The result, patients who chew gum would remove the waste gas or wind average 0.66 times than not chew approximately 1.10 times gas. As known, the channel functions normally digested by the post-operation dispose wind. In other words, those who chew gum more quickly recover and no longer need to stay in the hospital.
Teeth cleaning dirt. Chewing gum on a regular basis can help lift the dirt and clean the remaining teeth. Chew sugar-free chewing gum can also protect teeth from damage. In addition, the chewing gum can replace the polish teeth after eating due to chew gum while the mouth will produce saliva that can neutralize acid and prevent rotten teeth in the top 40%.
Reduce drowsiness. Chewing activity will reinforce the circulation of blood to the brain so useful to improve the performance associated with the concentration, vigilance, and attention. So, when you're driving and feel sleepy, it's chewing gum because it can reduce the feeling of drowsiness at the same time increase the concentration.
Increase the recall. In fact, according to research conducted at the University of Northumbria and the Cognitive Research Unit (Reading) in the UK, the ability to remember the words can be increased to 35 percent. Its scientific explanation, chewing increases the heart that lead to tap more oxygen and nutrients are pumped to the brain. In the end, this process will stimulate the brain associated with higher recall.
Reduce the tension. As already mentioned before, chewing gum can reduce the tension. Chewing gum is also provided to a U.S. soldier on duty, since World War I until now. The athlete is also always seen chewing gum during practice or competes.
Streamline. How is this possible? Maybe. According to research conducted at Glasgow Caledonian University in the UK, those who chew gum after meals will consume fewer calories during a meal the next day. In addition, a chewing gum containing only 5-10 calories, and chew it for one hour can burn 10 calories.
However, not only means that the chewing gum with the auto body become slim. The food and sports remain successful diet is the key to you
