Aches and Pains—Is Your Statin to Blame?

Muscle pain is the most common side effect of cholesterol-lowering statins.

By Harvard Health Publications

Peek inside the medicine cabinet of an American over age 50 and you're likely to spy a statin. This family of drugs is good at controlling blood levels of low-density lipoprotein (LDL), the so-called bad cholesterol. Statins reduce the chances of having a first or repeat heart attack or stroke and of dying prematurely of heart disease. They may also have other benefits that range from easing inflammation to battling memory loss and dementia. The six statins currently on the market are Crestor (rosuvastatin), Lescol (fluvastatin), Lipitor (atorvastatin), Mevacor (lovastatin), Pravachol (pravastatin), and Zocor (simvastatin).

As medications go, statins are pretty safe. Most people take one without any negative consequences. Muscle problems are the most common side effect. About one in 10 people who starts a statin reports having muscle aches and pains. In most cases, these symptoms go away on their own or stop with a lower dose or a change to a different statin. About one in 1,000 statin users develops myositis, an inflammation of the muscles that causes tenderness and fever. An even smaller number, about one in every 10,000 people, develops a serious condition called rhabdomyolysis (rab-doe-my-OLL-eh-sis). This breakdown of muscle fibers can damage the kidneys and, if not caught in time, can be deadly.

Key points About one in 10 people who take a cholesterol-lowering statin experiences muscle pain. Tell your doctor about unexplained aches or pains right away. Usually, the pain isn't due to a statin. Treatment options include reducing the dose, stopping the statin and then restarting it or switching to a different one, stopping the use of another problematic medication, or trying a non-statin cholesterol-lowering agent.

On the alert

No one knows why some people develop muscle problems when they take a statin, but these conditions probably don't strike willy-nilly. In a review of statin-related muscle problems in the journal Atherosclerosis, Dr. Yiannis Chatzizisis, a cardiology research fellow at Harvard Medical School, and his colleagues pointed out that they are more likely to occur in people who are older, who have a condition that can interfere with the breakdown of a statin (see "Setting the stage for aches"), who have conditions affecting their muscles, or who take a number of other medications. Coenzyme Q10, a substance that helps cells turn food into energy, was once thought to be involved, but ongoing research doesn't support that idea. Genes play a role, though which genes might be involved is an open question.

Statin-related muscle problems usually appear soon after a person starts the drug. In a French study that focused on such cases, about half cropped up within a month, and 85 percent within six months. Muscle problems can appear later, say after adding a new medication that can interact with a statin or starting to drink lots of grapefruit juice (which affects how the body breaks down some statins).

Setting the stage for aches Several conditions and medications increase the chances of developing statin-related muscle pain or other problems. These include: Kidney disease Liver disease Muscle disease Mitochondrial disorders An underactive thyroid gland Medications such as fibrates, some antibiotics and antifungals, protease inhibitors, fluoxetine (Prozac), verapamil (a calcium-channel blocker), warfarin, amiodarone, cimetidine (Tagamet).

Coping with statin aches

If you develop muscle pain after starting a statin, tell your doctor right away. General pain or weakness in different muscle groups is more worrisome than a problem in a leg or shoulder. The symptoms usually represent nothing more than overdoing it at the gym or the aftermath of touch football with a grandchild. But it's better to be safe than sorry.

In addition to a physical exam, your doctor should test your blood for creatine kinase. This is a protein that injured muscle cells dump into the bloodstream. A high level of creatine kinase helps identify statin-induced muscle problems, though it doesn't make for a definite diagnosis.

If the blood test shows a lot of creatine kinase, or the pain is intolerable, your doctor will have you stop the statin. Once you are back to normal, there are several options. You could try the same statin at a lower dose. Some people have no problems on the second try; others do. You could try a different statin. Fluvastatin (Lescol) is an option, since it is the least likely to cause muscle problems. You could also try non-statin approaches to lowering your cholesterol, like putting more emphasis on diet and exercise, or taking niacin or Welchol (colesevelam).

If your aches and pains are tolerable and your creatine kinase is normal or only mildly elevated, your doctor might suggest sticking with the statin for a short time. In some people, the pain fades by itself. Reducing the dose, switching to a different statin, or trying a non-statin medication are also appropriate options.

Obesity 'controlled by the brain'

Seven new gene variants discovered by scientists suggest strongly that obesity is largely a mind problem. The findings suggest the brain plays the dominant role in controlling appetite, and that obesity cannot easily be blamed on metabolic flaws. Two international studies, published in Nature Genetics, examined samples from thousands of people for the tiniest genetic changes.

Many of the seven key variants seem to be active in the brain. This suggests that the brain's impact on appetite and eating behaviour may be more important that any genetic variation which alters the body's ability to lay down or burn up fat. All seven variants were picked up by a study led by Icelandic company deCODE Genetics, while six of the seven were also identified in a second, independent study by an international team dubbed the Giant consortium. In both cases the researchers scrutinised DNA samples from thousands of people to assess the impact of tiny changes. Each of the variants identified had a small impact on obesity, but a person carrying all of them was typically around 1.5kg - 2kg heavier than average. It is estimated that as much as 70% of the variation in body mass index - a measure of obesity based on height and weight - is down to genetics, rather than environmental factors. Researcher Dr Kari Stefansson, of deCODE Genetics said: "This suggests that as we work to develop better means of combating obesity, we need to focus on the regulation of appetite at least as much as on the metabolic factors of how the body uses and stores energy." Major step forward Dr Alan Guttmacher, of the US National Human Genome Research Institute, said the research was a major step forward in understanding how the human body regulates weight. However, Professor Peter Weissberg, of the at the British Heart Foundation, expressed caution. He said: "This research adds to the growing body of evidence that some people are more at risk of becoming obese because of their genes. "It suggests that some people may be less able than others to resist the temptation to overeat because of their genetic background and it might start to explain why some people have no problem keeping their weight down whilst others struggle. "However, this cannot be the explanation for the current epidemic of obesity since these genes have been present for centuries and the obesity epidemic is a relatively new phenomenon." Almost one in four people in the UK is now classified as obese, and expert predict the proportion will continue to rise sharply.

The New Heart Risk

The key to living free of heart disease and even cancer is to reduce chronic inflammation.

By Jayne Keedle, Best Life

Numerous studies have linked inflammation to heart disease, DNA damage, diabetes, and cancer, but scientists weren't sure which came first, the illness or the inflammation. When researchers at the University of California at San Diego School of Medicine recently discovered that inflammation causes diabetes, they answered the chicken-and-egg question and hatched a new metric to measure wellness. Some physicians now recommend that people monitor inflammation, just as they do cholesterol, and take an active approach to preventing it.

"If you reduce inflammation, you reduce the risk of death from a heart attack," says Steven Nissen, M.D., chairman of the Cleveland Clinic's department of cardiovascular medicine.

Part of the body's immune response, acute inflammation is the swelling and pain you get when you stub your toe; it's a sign that the body is working to heal the injury.

"But when inflammation becomes chronic, the acute system doesn't shut off," explains Mark Miller, Ph.D., professor of cardiovascular science and pediatrics at Albany Medical College. "What follows is a constant war between damage and inadequate repair." Here's how to crush inflammation.

Test your levels: Ask your doctor for a high-sensitivity C-reactive protein blood test. A CRP level of greater than 1 mg/L means you're at risk for cardiovascular disease; greater than 3 mg/L puts you in the high-risk category. Take the test twice, a month apart, to ensure an accurate score.

Trim belly fat: "The best way to reduce CRP levels is to lose even modest amounts of abdominal fat," says Dr. Nissen. Use your waist-to-hip ratio to assess your risk. Measure your waist in inches around the belly button and divide that number by your hip measurement. A number higher than 0.9 means slim down.

Ration omegas: Experts recommend a 4:1 ratio of omega-6 fatty acids to omega-3s. But the typical American diet has 11 to 30 times more omega-6s (in saturated fats such as corn, soy, canola, and sunflower oils) than omega-3s. Doctors advise consuming 1.8 grams of omega-3s a day. That's the equivalent of eating two servings a week of fatty fish such as wild salmon or trout.

Eat the rainbow: The flavonoids found in brightly colored fruits and vegetables reduce inflammation. The most potent choices are blueberries, purple grapes, cherries, oranges, and sweet potatoes. Eat seven servings a week.

Gorge on fiber: A high-fiber diet (25 to 35 grams a day) can reduce CRP levels by as much as 14 percent, according to a recent study. Boost your fiber intake by eating more beans (especially lentils and black beans) and whole grains. Buckwheat and amaranth are good choices because they have no gluten.

Choose beef over chicken: Chicken is high in arachidonic acid, a fatty acid that prompts the body to produce inflammatory chemicals, so opt for beef instead, says nutritionist Monica Reinagel, author of The Inflammation-Free Diet Plan (McGraw-Hill, 2007). Beef tenderloin contains half as much arachidonic acid, plus higher levels of selenium and zinc, nutrients that fight inflammation. Grass-fed beef is the best, because it has a 2:1 omega-6 to omega-3 ratio. (Corn-fed cattle have a 4:1 ratio.)

Spice things up: Eating two to four grams of ginger a day suppresses the molecules in the body that promote inflammation. Recent studies suggest that it works at the DNA level, turning off the genes that trigger inflammation.

Health Food Impostors

Even if you haven't bought full-fat mayo or sugary soda since blue eye shadow was in style (the first time), you may be getting duped into less-than-stellar food choices at the supermarket. The culprit? The "health halo." "From a distance, some foods seem like healthful choices because of the way they're packaged or labeled," says Janel Ovrut, M.S., R.D., a Boston-based dietitian. "But just because a product's marketing gives it an aura of health doesn't necessarily mean it's good for you." Here, eight notorious health food impostors, plus smarter swaps that up the nutritional ante and still give you the flavor you crave.

Impostor: Baked potato chips

Yes, they're lower in fat. But they're still high in calories and low in nutrients, with little fiber to fill you up.

Smarter sub: Popcorn. You'll get the salt and crunch of chips plus fiber, and around 65 percent fewer calories per cup. Look for oil-free microwave popcorn or brands that are air-popped or popped in healthful oils such as olive or canola.

Health bonus: Heart-healthy whole grains. Adults who eat popcorn take in as much as 2 1/2 times more whole grains than people who do not, according to a recent study published in the Journal of the American Dietetic Association.

Try: Good Health Half-Naked pre-popped popcorn, made with olive oil. One serving (4 cups) has 120 calories, 0 g saturated fat, 4 g fiber.

Impostor: Gummy fruit snacks

Although these products may contain some juice, they're usually nothing more than candy infused with vitamins. They also contain high fructose corn syrup, which is linked with obesity, and heart-unhealthy partially hydrogenated oils.

Smarter sub: Fresh or dried fruit. Both are packed with filling fiber, which you'll miss if you opt for gummy snacks.

Health bonus: Cancer-fighting antioxidants. Real fruit is loaded with immune-boosting nutrients that fruit-flavored snacks could never mimic. A recent Greek study found that women who ate the most fruits and veggies were the least likely to develop any type of cancer.

Try: Peeled Snacks Fruit Picks dried fruit. One serving (one bag) of Go-Mango-Man-Go has 120 calories, 0 g saturated fat, 2 g fiber.

Impostor: Light ice cream

Light ice cream can have fewer calories than regular, but there's no guarantee. Take Häagen-Dazs Dulce de Leche light ice cream: With 220 calories per 1/2 cup serving, it's still higher in calories than the average full-fat ice cream, which has around 140 calories per serving. What's more, some light ice creams can lack the rich taste you crave, so you're less satisfied and may be inclined to eat more than one serving.

Smarter sub: Dairy-free ice cream. Soy and coconut milk ice creams may save you a few calories, and they have a creamy, satisfying texture.

Health bonus: Digestion-friendly fiber. Some dairy-free ice creams are made with chicory root, a natural source of inulin, a prebiotic fiber that can increase healthy bacteria in the gut and help the body absorb calcium and iron.

Try: Turtle Mountain Purely Decadent, made with coconut milk. One serving (½ cup) of vanilla has 150 calories, 7 g saturated fat, and 6 g fiber. (Studies show that the saturated fat in coconut may not raise cholesterol like the saturated fat in butter and meat.)

Impostor: Diet soda

In a 2008 study, researchers linked drinking just one diet soda a day with metabolic syndrome—the collection of symptoms including belly fat that puts you at high risk of heart disease. Researchers aren't sure if it's an ingredient in diet soda or the drinkers' eating habits that caused the association.

Smarter sub: Flavored seltzer water. It has zero calories and is free of artificial sweeteners but provides fizz and flavor. Beware of clear sparkling beverages that look like seltzer yet contain artificial sweeteners—they're no better than diet soda. Or try a sparkling juice; we recommend watering it down with seltzer to stretch your calories even further.

Health bonus: Hydration (without chemicals). Water is essential for nearly every body process.

Try: Your supermarket's low-cost seltzer brand. The taste is the same as the bigger name brands.

Impostor: "Calorie-free" spray margarine

Even though some spray margarines claim to be "calorie-free," labeling laws allow products with fewer than 5 calories per serving to claim to have zero calories. So, while one spritz may be inconsequential, the whole bottle could have as much as 900 calories.

Smarter sub: Spray-it-yourself olive oil. In this case, a bit of real fat is more healthful and flavorful—and within a reasonable calorie range if you watch your portions. Investing in an olive oil mister ensures you don't put on too much.

Health bonus: Decreased inflammation throughout the body, which helps your heart and lowers cancer risk, thanks to monounsaturated fatty acids.

Try: Misto olive oil sprayer. Find one at any kitchen store for around $10.

Impostor: Nonfat salad dressing

Fat-free salad dressings are often packed with sugar—so your dressing may be loaded with calories. Ironically, a salad without fat is not living up to its potential. "You need a little fat to absorb vitamins A, D, E, and K and other nutrients," says Katherine Tallmadge, R.D., spokesperson for the American Dietetic Association.

Smarter sub: Oil-based salad dressings. You'll get good-for-you fats instead of the saturated fat found in some creamy dressings. Look for ingredients like olive oil, vinegar, and herbs.

Health bonus: Vision protection. As many as five times more carotenoids—antioxidants that are essential for eye-sight—are absorbed when salads are consumed with fat rather than with no fat.

Try: Newman's Own Olive Oil & Vinegar Dressing. Two tablespoons have 150 calories, 2.5 g saturated fat, 0 g fiber.

Impostor: Low-fat cookies

Do you remember the SnackWell's craze? Low-fat cookies are still popular, and many dieters think they can indulge guilt free. The problem is that most of these snacks are made with extra sugar, which means they often have just as many calories as the full-fat version, if not more.

Smarter sub: Oatmeal cookies. These are a great way to indulge a cookie craving while also getting whole grains. Not all are created equal, though: Skip those made with high fructose corn syrup, white flour, and butter in favor of varieties made with honey or cane juice, whole wheat flour, and oil.

Health bonus: Lower cholesterol. The fiber found in oatmeal keeps your body from absorbing bad cholesterol.

Try: Kashi TLC Cookies. One cookie has 130 calories, 1.5 g saturated fat, 4 g fiber.

Impostor: 100-calorie snack packs

You might want to skip these if you're trying to lose weight. A recent study showed that people may eat more food and calories if the portions are presented in small sizes and packages. With smaller serving sizes, study participants didn't feel the need to regulate their intake, so they ate more than one portion before feeling satisfied.

Smarter sub: A small serving of almonds. Their healthy monounsaturated fat, fiber, and protein will tide you over until your next meal.

Health bonus: Stronger bones. Almonds are an excellent source of bone-building magnesium, as well as the immune-boosting antioxidant vitamin E.

Try: Blue Diamond Natural Oven Roasted Almonds. A 1-oz serving has 160 calories, 1 g saturated fat, 3 g fiber.

Seize Your Six-Pack

Exercising to lose your gut is simple—it's all about your muscles. Let me explain: Contracting your muscles requires fuel, like an engine does. So the more muscle you work, the more calories you burn. This is one reason why the best way to lose your gut is with total-body weight training. But that's just the start: Since pumping iron also builds muscle, you're simultaneously increasing the size of your engine—which helps you burn even more calories in each workout. Plus, lifting weights boosts your metabolism for hours after you train. My point: Don't dismiss this workout because it has only six exercises. They're all you need to burn fat, build muscle, and look better than ever.

Your Four-Week Fat-Loss Plan

This fast-paced workout will help you shed fat, build muscle, and boost your fitness levels to an all-time high—in just 90 minutes a week.

Directions

• Complete this workout three days a week, resting at least a day between sessions. So you might train on Monday, Wednesday, and Friday, or Tuesday, Thursday, and Saturday.
• Do the exercises in the order shown.
• Perform the workout as a circuit, doing one set of each exercise before resting for two minutes. Once you've done one set of each movement, repeat the entire circuit one or two times. That way you'll do a total of two or three sets of each exercise. When you've completed the weight workout, finish with five minutes of high-intensity cardio. Choose any cardio machine you like—treadmill, rower, stationary bike, VersaClimber—or simply hit the streets.

Your charge: Exercise for 60 seconds at the highest effort you can maintain for the entire duration. Then slow to an easy pace—say, about 30 percent of your top intensity—for another 60 seconds. Alternate back and forth for the entire five minutes.

1. Inverted Row

Secure a bar three or four feet above the floor. Lie under the bar and grab it with a shoulder-width, overhand grip.

Hang at arm's length from the bar with your body in a straight line from your ankles to your shoulders [A].

Keeping your body rigid at all times, pull your chest to the bar by bending your arms and squeezing your shoulder blades together [B].

Pause, and then lower yourself back to the starting position. That's one repetition. Do a total of 10 to 12 reps.

2. Mountain Climber

Kneel on all fours, your hands in line with but slightly wider than your shoulders.

Straighten your left leg completely and lift your right knee toward your chest.

You should be on the balls of your feet, positioned like a sprinter in the starting blocks [A].

Now quickly switch leg positions [B] as many times as you can for 30 to 45 seconds. That's one set.

3. Split Squat to Push Press

Hold a barbell at chest level with an overhand grip that's just beyond shoulder width.

Stand in a staggered stance, your left foot in front of your right [A].

Keeping your torso upright, lower your body until your front knee is bent 90 degrees [B], and then simultaneously push yourself back to the start as you press the bar over your head [C].

Lower the bar to the start. That's one rep. Do a total of eight to 10 reps, and then switch leg positions and repeat. (If desired, you can use dumbbells instead of the barbell.)

4. Dumbbell Woodchop

Hold a light dumbbell with a hand-over-hand grip, your arms extended above your right shoulder [A].

Keeping your arms nearly straight, bend at your knees and forcefully rotate your torso to the left as you draw your arms down and across your body [B]. (You should move as if you're chopping wood.)

When your hands reach the outside of your left ankle, quickly reverse the movement with the same intensity. That's one repetition. Do 10 to 12 repetitions, then switch sides and repeat.

5. Squat Thrust-Chinup Combo

Squat on the floor beneath a chinup bar and lean forward so that your hands are on the floor and you're on the balls of your feet [A].

To begin, quickly kick both legs back behind you into a pushup position [B].

Immediately reverse the move and go back to the squat position [A].

From there, jump up and grab the chinup bar with an underhand grip [C].

Pull your chest to the bar [D]. Drop back down and repeat.

That's one rep. Do a total of eight to 10 reps.

6. Pushup-Traveling Lunge Combo

Assume a pushup position, but instead of placing your hands on the floor, brace them on a pair of dumbbells [A]. Now do as many pushups as you can [B].

Then stand up with the dumbbells and perform a traveling lunge: Keeping your torso upright, take a step forward with your right leg and lower your body until your front knee is bent 90 degrees [C].

Push from your front foot and step forward into a standing position. Next, repeat, lunging forward with your left leg.

That's one rep. Do a total of six to eight reps, and then turn around and do the combo in the other direction.

Tips for a healthy pregnancy

Eating During Pregnancy
To eat well during pregnancy you must do more than simply increase how much you eat. You must also consider what you eat. Although you need about 300 extra calories a day—especially later in your pregnancy, when your baby grows quickly—those calories should come from nutritious foods so they can contribute to your baby's growth and development.

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Why it's important to eat well when you're pregnant
Do you wonder how it's reasonable to gain 25 to 35 pounds (on average) during your pregnancy when a newborn baby weighs only a fraction of that? Although it varies from woman to woman, this is how those pounds may add up:

7.5 pounds: average baby's weight
7 pounds: extra stored protein, fat, and other nutrients
4 pounds: extra blood
4 pounds: other extra body fluids
2 pounds: breast enlargement
2 pounds: enlargement of your uterus
2 pounds: amniotic fluid surrounding your baby
1.5 pounds: the placenta
Of course, patterns of weight gain during pregnancy vary. It's normal to gain less if you start out heavier and more if you're having twins or triplets—or if you were underweight before becoming pregnant. More important than how much weight you gain is what makes up those extra pounds.

When you're pregnant, what you eat and drink is the main source of nourishment for your baby. In fact, the link between what you consume and the health of your baby is much stronger than once thought. That's why doctors now say, for example, that no amount of alcohol consumption should be considered safe during pregnancy.

The extra food you eat shouldn't just be empty calories—it should provide the nutrients your growing baby needs. For example, calcium helps make and keep bones and teeth strong. While you're pregnant, you still need calcium for your body, plus extra calcium for your developing baby. Similarly, you require more of all the essential nutrients than you did before you became pregnant.

A nutrition primer for expectant mothers
Whether or not you're pregnant, a healthy diet includes proteins, carbohydrates, fats, vitamins, minerals, and plenty of water. The U.S. government publishes dietary guidelines that can help you determine how many servings of each kind of food to eat every day. Eating a variety of foods in the proportions indicated is a good step toward staying healthy.

Food labels can tell you what kinds of nutrients are in the foods you eat. The letters RDA, which you find on food labeling, stand for recommended daily allowance, or the amount of a nutrient recommended for your daily diet. When you're pregnant, the RDAs for most nutrients are higher.

Here are some of the most common nutrients you need and the foods that contain them:

Nutrient Needed for Best sources
Protein cell growth and blood production
lean meat, fish, poultry, egg whites, beans, peanut butter, tofu
Carbohydrates daily energy production breads, cereals, rice, potatoes, pasta, fruits, vegetables
Calcium strong bones and teeth, muscle contraction, nerve function milk, cheese, yogurt, sardines or salmon with bones, spinach
Iron red blood cell production (needed to prevent anemia) lean red meat, spinach, iron-fortified whole-grain breads and cereals
Vitamin A healthy skin, good eyesight, growing bones carrots, dark leafy greens, sweet potatoes
Vitamin C healthy gums, teeth, and bones; assistance with iron absorption citrus fruit, broccoli, tomatoes, fortified fruit juices
Vitamin B6 red blood cell formation; effective use of protein, fat, and carbohydrates pork, ham, whole-grain cereals, bananas
Vitamin B12 formation of red blood cells, maintaining nervous system health meat, fish, poultry, milk

(Note: vegetarians who don't eat dairy products need supplemental B12)
Vitamin D healthy bones and teeth; aids absorption of calcium fortified milk, dairy products, cereals, and breads
Folic acid blood and protein production, effective enzyme function green leafy vegetables, dark yellow fruits and vegetables, beans, peas, nuts
Fat body energy stores meat, whole-milk dairy products, nuts, peanut butter, margarine, vegetable oils

(Note: limit fat intake to 30% or less of your total daily calorie intake)
Scientists know that your diet can affect your baby's health—even before you become pregnant. For example, recent research shows that folic acid helps prevent neural tube defects (including spina bifida) from occurring during the earliest stages of fetal development—so it's important for you to consume plenty of it before you become pregnant and during the early weeks of your pregnancy.

Even though lots of foods, particularly breakfast cereals, are fortified with folic acid, doctors now encourage women to take folic acid supplements before and throughout pregnancy (especially for the first 28 days). Be sure to ask your doctor about folic acid if you're considering becoming pregnant.

Calcium is another important nutrient for pregnant women. Because your growing baby's calcium demands are high, you should increase your calcium consumption to prevent a loss of calcium from your own bones. Your doctor will also likely prescribe prenatal vitamins for you, which contain some extra calcium.

Your best food sources of calcium are milk and other dairy products. However, if you have lactose intolerance or dislike milk and milk products, ask your doctor about a calcium supplement. (Signs of lactose intolerance include diarrhea, bloating, or gas after eating milk or milk products. Taking a lactase capsule or pill, or using lactose-free milk products may help.) Other calcium-rich foods include sardines or salmon with bones, tofu, broccoli, spinach, and calcium-fortified juices and foods.

Doctors don't usually recommend starting a strict vegan diet when you become pregnant. However, if you already follow a vegetarian diet, you can continue to do so during your pregnancy—but do it carefully. Be sure your doctor knows about your diet. It's challenging to get the nutrition you need if you don't eat fish and chicken, or milk, cheese, or eggs. You'll likely need supplemental protein and may also need to take vitamin B12 and D supplements. To ensure that you and your baby receive adequate nutrition, consult a registered dietitian for help with planning meals.

Food cravings during pregnancy
You've probably known women who craved specific foods during pregnancy, or perhaps you've had such cravings yourself. Researchers have tried to determine whether a hunger for a particular type of food indicates that a woman's body lacks the nutrients that food contains. Although this isn't the case, it's still unclear why these urges occur.

Some pregnant women crave chocolate, spicy foods, fruits, and comfort foods, such as mashed potatoes, cereals, and toasted white bread. Other women crave non-food items, such as clay and cornstarch. The craving and eating of non-food items is known as pica. Consuming things that aren't food can be dangerous to both you and your baby. If you have urges to eat non-food items, notify your doctor.

But following your cravings is fine, as long as you crave foods and these foods contribute to a healthy diet. Frequently, these cravings diminish about 3 months into the pregnancy.

Food and drinks to avoid during pregnancy
As mentioned earlier, avoid alcohol. No level of alcohol consumption is considered safe during pregnancy. Also, check with your doctor before you take any vitamins or herbal products. Some of these can be harmful to the developing fetus.

And although many doctors feel that one or two 6- to 8-ounce cups per day of coffee, tea, or soda with caffeine won't harm your baby, it's probably wise to avoid caffeine altogether if you can. High caffeine consumption has been linked to an increased risk of miscarriage, so limit your intake or switch to decaffeinated products.

When you're pregnant, it's also important to avoid food-borne illnesses, such as listeriosis and toxoplasmosis, which can be life-threatening to an unborn baby and may cause birth defects or miscarriage. Foods you'll want to steer clear of include:

soft, unpasteurized cheeses (often advertised as "fresh") such as feta, goat, Brie, Camembert, and blue cheese
unpasteurized milk, juices, and apple cider
raw eggs or foods containing raw eggs, including mousse, tiramisu and Caesar dressing
raw or undercooked meats, fish, or shellfish
processed meats such as hot dogs and deli meats (these should be well-cooked)
fish that are high in mercury, including shark, swordfish, king mackeral, or tilefish
If you've eaten these foods at some point during your pregnancy, try not to worry too much about it now; just avoid them for the remainder of the pregnancy. If you're really concerned, talk to your doctor.

About fish. Fish and shellfish can be an extremely healthy part of your pregnancy diet—they contain beneficial omega-3 fatty acids, and are high in protein and low in saturated fat. But limit the types of fish you eat while pregnant because some contain high levels of mercury, which can cause damage to the developing nervous system of a fetus. Mercury, which occurs naturally in the environment, is also released into the air through industrial pollution and can accumulate in streams and oceans, where it turns into methylmercury. The methylmercury builds up in fish, especially those that eat other fish.

Because canned albacore (or white) tuna and tuna steaks are generally considered to be higher in mercury than canned light tuna, the U.S. Food and Drug Administration (FDA) recommends that you eat no more than 6 ounces a week. A 2006 review by Consumer Reports, though, showed that some canned light tuna can contain levels of mercury even higher than that of white tuna. But the FDA maintains that the levels are safe if consumption of the fish is limited, and that the current recommendations should stand.

It can be confusing when recommendations from trusted sources differ. But since this analysis indicates that amounts of mercury in tuna may be higher than previously reported, some women may want to eliminate tuna from their diet while pregnant or when trying to become pregnant. Almost all fish and shellfish contain small amounts of mercury, but you can safely eat those with consistently low mercury levels (like salmon, shrimp, clams, and tilapia). Talk with your doctor if you have any questions about how much—and which fish you can eat.

Managing some common problems
Because the iron in prenatal vitamins and other factors may cause constipation during pregnancy, try to consume more fiber than you did before you became pregnant. Try to eat about 20 to 30 grams of fiber a day. Your best sources are fresh fruits and vegetables and whole-grain breads, cereals, or muffins.

Some people also use fiber tablets or drinks or other high-fiber products available at pharmacies and grocery stores, but check with your doctor before trying them. (Don't use laxatives while you're pregnant unless your doctor advises you to do so. And avoid the old wives' remedy—castor oil—because it can actually interfere with your body's ability to absorb nutrients.)

If constipation is a problem for you, your doctor may prescribe a stool softener. Be sure to drink plenty of fluids, especially water, when increasing fiber intake, or you can make your constipation worse. One of the best ways to avoid constipation is to get more exercise. You should also drink plenty of water between meals each day to help soften your stools and move food through your digestive system. Sometimes hot tea, soups, or broth can help. Also, keep dried fruits handy for snacking.

Some pregnant women find that broccoli, spinach, cauliflower, and fried foods give them heartburn or gas. You can plan a balanced diet to avoid these foods. Carbonated drinks also cause gas or heartburn for some women, although others find they calm the digestive system.

If you're frequently nauseated, eat small amounts of bland foods, like toast or crackers, throughout the day. If nothing else sounds good, try cereal with milk or a sweet piece of fruit. To help combat nausea, you can also:

Take your prenatal vitamin before going to bed after you've eaten a snack—not on an empty stomach.
Eat a small snack when you get up to go to the bathroom early in the morning.
Suck on hard candy.
How to know if you're eating well during pregnancy
The key is to eat foods from the different food groups in approximately the recommended proportions. If nausea or lack of appetite cause you to eat less at times, don't worry—it's unlikely to cause fetal harm because your baby gets first crack at the nutrients you consume. And although it's generally recommended that a woman of normal weight gain approximately 25 to 35 pounds during pregnancy (most gain 4 to 6 pounds during the first trimester and 1 pound a week during the second and third trimesters), don't fixate on the scale. Instead, focus on eating a good variety and balance of nutritious foods to keep both you and your baby healthy.

Easy Does It

Exercise smarter rather than harder, starting as early as your 20s, and you'll reap the benefits of this gentler approach for decades to come.

Everyone can benefit from what researchers now know about exercise: Less can be more.
Mixing high-impact activities, say, running, with low-impact muscle-building and stretching workouts throughout the week is a strategic long-term approach to fitness, says Cedric Bryant, Ph.D., chief science officer for the American Council on Exercise. But there are some important steps to succeeding with a less-is-more approach to exercise. Let's call them the Less-Is-More Laws of Exercise.
"You can't begin too soon taking that smarter approach, [which is a] more thoughtful approach to how you structure your exercise," says Bryant. "In the not-too-distant past, we had the 'no pain, no gain' mantra. What we've come to understand is you can still experience significant fitness benefits and have an enjoyable experience. It doesn't have to be gut-wrenching, intense and painful to get positive results. This is true at any age, for any exerciser, whether 20 years old or 50 years old."
Why is it important to temper your workouts with what Bryant calls "recovery time" exercise?
Ask anyone older than 40, or even the hard-core recreational athlete in his or her 30s. Your body starts to feel the stress and it isn't pretty. Joints go. Backs go. Fronts go.
Bryant gives us the breakdown: "The common sites tend to be the knees, the back, the hips and the feet," he says. "A lot of people will get some foot and ankle issues—Achilles tendonitis, plantar fasciitis, runner's knee, pain right over the patella, low-back discomfort, hip discomfort. Those are really the more common sites."
Less-Is-More Law 1: Mix up your high- and low-impact workouts
The reason for body failure is that high-impact exercise causes four times more stress on the body than low-impact exercise. Simply by running outside, you expose your lower extremities to a stress level equivalent to about three or four times your body weight, Bryant says. In contrast, if a person uses an elliptical machine or a pedal-driven Stairmaster, the impact is just slightly above his or her body weight.
"Let's say, irrespective of age, you have an individual who really wants to work toward total body fitness," says Bryant. "Research shows that high-impact activity on an almost constant basis increases your chances of sustaining some type of low extremity issue. Rather than pound the pavement every day for the cardio training, it would be wise to mix it up and include some lower-impact, more joint-friendly activities so you can help protect and preserve the integrity of your skeletal muscular system."
Less-Is-More Law 2: Factor in "recovery time" workouts
To ease the stress, Bryant suggests adding recovery time workouts to your routine—low-impact exercise that allows your body to rejuvenate after an intense session. He recommends a cardio workout at least four to five times a week, alternating between high-impact, if that is what you like, with a more joint-friendly activity. If you are exercising five times a week, have three days be high-impact, and two days be low-impact.
Low-impact includes cycling, swimming, yoga, Pilates, hiking, walking, "most of your activities that end in 'ing,' " says Bryant. "The only thing that wouldn't fit would be tanning."
Sometimes it's hard to adjust when you switch to a lower-impact sport. It doesn't feel as if you're getting the same cardiovascular benefits. It doesn't feel rigorous enough. To gauge, your heart should be working at 60 percent to 80 percent of its maximum in order to benefit, but rather than getting detailed about heart rate, use what Bryant calls the "talk test" to determine the efficacy of your workout. "You want to exercise at a level where your breathing rate has increased to an amount where you can hold a basic level of conversation but you can't be chatty."
Less-Is-More Law 3: Be sure to include weight training
Bryant suggests interspersing your high- and low-impact cardio workouts with muscle-building exercise, such as weight training, to strengthen the muscles, bones and connective tissues. This makes your body more resistant to injury and more able to handle the stress that occurs when you do a high-impact sport. Add to this a workout that helps with flexibility or range of motion, such as a stretching program, yoga or Pilates. Some yoga and Pilates practices offer both muscle building and flexibility training.
Recognizing early on—say, in your 20s or 30s—the body strain of intense exercise and mixing it up with a more relaxed regimen could mean the difference between being waylaid at 40 or continuing to play soccer or ski moguls or enjoy running long after retirement. So schedule some "om" time at the yoga studio, reserve a spot in spinning class, figure out logistics for lap swimming, and do a few circuits of weights. Sensible exercise such as this, says Bryant, will not only add years to your life, but life to your years.
Less-Is-More Law 4: It is (in part) about the shoes
If your tennies have been sitting in your closet for more than six months, or if you've logged more than 300 miles on them, it's time to toss. Wear the scrappy shorts and T-shirt maybe, but compromising the quality of your athletic shoes can lead to an injury.
Over time, and with use, your shoes lose their stability and capacity for shock absorption. The midsole usually wears out before the outsole, so you won't know by appearances that the integrity has been compromised.
"Invest in some quality footwear to optimize the level of cushioning and support and protection," says Bryant. "Shoes degrade over time," he adds, suggesting you trade up after a year max, even if they're barely used. "You don’t want to go cheap on your shoes."
Less-Is-More Law 5: Exercise finally adds up
It used to be that 10 minutes plus 10 minutes plus 10 minutes of physical activity did not equal 30, at least not according to most exercise scientists. Today we know it does.
The U.S. Department of Agriculture suggests every person spend 30 minutes per day exercising, a daunting target to hit for those not already in the habit. But recent research has corroborated what we've known since a U.S. Surgeon General's report came out in 1996: Exercising in small snippets throughout the day, not just in one continuous 30-minute segment, can count toward this minimum requirement. This is good news for someone leading a sedentary life, intimidated with the idea of working out. To start making changes toward better health, all they need is 10 minutes.
"Short-term intermittent exercise is as effective for most people as a sustained amount of exercise," says Walt Thompson, professor of kinesiology and health at Georgia State University. "It is effective in both increasing cardiovascular endurance [and] strength, and it does burn calories."
If you climb the stairs for 10 minutes rather than taking the elevator; spend 10 minutes briskly walking with your co-worker to sort through an issue rather than discussing it over e-mail; or walk for 10 minutes in the mall while shopping, you reap the same fitness benefits as if you'd exercised continuously that same amount of time.
At the end of the day, says Thompson, it's the number of combined minutes of physical activity during your day that will contribute to your overall health. And more good news is that even these small amounts of exercise send your metabolism into overdrive. "Once you've exerted a little more, your body burns more, in order for the body to get back to its rested state," says Thompson. "It's not a lot, but it is more calories than you would be burning if you were sitting at your desk all day."

Pregnancy Symptoms: Top Ten Signs You Might Be Pregnant

Could you be pregnant? Most likely you won't notice any symptoms until about the time you've missed a period -- or a week or two later.If you're not keeping track of your menstrual cycle or if it varies widely from one month to the next, you may not be sure when to expect your period. But if you start to experience some of the symptoms below -- not all women get them all -- and you haven't had a period for a while, you may very well be pregnant. Take a home pregnancy test to find out for sure!
10. Tender, swollen breasts
One of the early signs of pregnancy is sensitive, sore breasts caused by increasing levels of hormones. The soreness may feel like an exaggerated version of how your breasts feel before your period. Your discomfort should diminish significantly after the first trimester, as your body adjusts to the hormonal changes.
9. Fatigue
Feeling tired all of a sudden? No, make that exhausted. No one knows for sure what causes early pregnancy fatigue, but it's possible that rapidly increasing levels of the hormone progesterone are contributing to your sleepiness.You should start to feel more energetic once you hit your second trimester, although fatigue usually returns late in pregnancy when you're carrying around a lot more weight and some of the common discomforts of pregnancy make it more difficult to get a good night's sleep.
8. Implantation bleeding
Some women have a small amount of vaginal bleeding around 11 or 12 days after conception (close to the time you might notice a missed period). The bleeding may be caused by the fertilized egg burrowing into the blood-rich lining of your uterus -- a process that starts just six days after fertilization -- but no one knows for sure.The bleeding is very light (appearing as red spotting or pink or reddish-brown staining) and lasts only a day or two. (Let your practitioner know if you notice any bleeding or spotting, particularly if it's accompanied by pain, since this can be a sign of an ectopic pregnancy.)
7. Nausea or vomiting
If you're like most women, morning sickness won't hit until about a month after conception. (A lucky few escape it altogether.) But some women do start to feel queasy a bit earlier. And not just in the morning, either -- pregnancy-related nausea and vomiting can be a problem morning, noon, or night.About half of women with nausea feel complete relief by the beginning of the second trimester. For most others it takes another month or so for the queasiness to ease up.
6. Increased sensitivity to odors
If you're newly pregnant, it's not uncommon to feel repelled by the smell of a bologna sandwich or cup of coffee and for certain aromas to trigger your gag reflex. Though no one knows for sure, this may be a side effect of rapidly increasing amounts of estrogen in your system. You may also find that certain foods you used to enjoy are suddenly completely repulsive to you.
5. Abdominal bloating
Hormonal changes in early pregnancy may leave you feeling bloated, similar to the feeling some women have just before their period arrives. That's why your clothes may feel snugger than usual at the waistline, even early on when your uterus is still quite small.
4. Frequent urination
Shortly after you become pregnant, you may find yourself hurrying to the bathroom all the time. Why? Mostly because during pregnancy the amount of blood and other fluids in your body increases, which leads to extra fluid being processed by your kidneys and ending up in your bladder.This symptom may start as early as six weeks into your first trimester and continue or worsen as your pregnancy progresses and your growing baby exerts more pressure on your bladder.
3. A missed period
If you're usually pretty regular and your period doesn't arrive on time, you'll probably take a pregnancy test long before you notice any of the above symptoms. But if you're not regular or you're not keeping track of your cycle, nausea and breast tenderness and extra trips to the bathroom may signal pregnancy before you realize you didn't get your period.
2. Your basal body temperature stays high
If you've been charting your basal body temperature and you see that your temperature has stayed elevated for 18 days in a row, you're probably pregnant.And finally...
1. The proof: A positive home pregnancy test
In spite of what you might read on the box, many home pregnancy tests are not sensitive enough to detect most pregnancies until about a week after a missed period. So if you decide to take one earlier than that and get a negative result, try again in a few days.

Vitamins, Family Style

 probably have no interest in wearing your daughter's up-to-here skirt or your son's down-to-there baggy jeans. Well, fashion isn't the only area in which a "do" for one family member can be a "don't" for another—you, your husband, your kids, and your parents all have surprisingly different requirements when it comes to nutrition, says Connie Weaver, Ph.D., head of the nutrition department at Purdue University. In fact, one may need a supplement that another should avoid. Because one size doesn't fit all, here's a guide to the shortfalls that occur at different ages—and the best ways to fill them for young, old, and in-between.

Your preteen or teen needs:

Calcium

"You get one chance in your lifetime to build a strong skeleton—and that time is adolescence," says Roberta Anding, a spokesperson for the American Dietetic Association. But kids typically get far less than the daily 1,300 mg of calcium they need.

Food or supplements?

Food. Dietary calcium helps teens gain more bone mass than supplements do because it's easier to absorb, says Dawn Jackson Blatner, a Chicago-based dietician.

Try this: "Teens often skip milk in favor of soda and juice, so limit sugary drinks to one a day," says Malena Perdomo, RD. Serve milk at every meal or stock up on calcium-rich snacks like low-fat yogurt or string cheese.

Iron

The nutrient is essential: Kids with a deficiency are 2½ times more likely to have low math scores. Girls, who lose iron during their periods, need 15 mg daily; boys need 11 mg.

Food or supplements?

Food. Never dispense iron pills without your doctor's okay—high doses can be toxic.

Try This: Give your teen a morning boost with fortified breakfast cereals; most pack 4 to 8 mg of iron per serving. To help absorption, pair high-iron foods with ones rich in vitamin C, such as black beans (a great vegetarian source of the mineral) and bell peppers.

You and your husband need:

To rethink folic acid

This vitamin seems like such a do-gooder: It helps prevent birth defects, and studies suggest that it could help adults lower heart disease risk. But recently, researchers raised the possibility that excess folic acid may increase the danger of colon cancer. Answers aren't in, but some experts say that only women of childbearing age should take 400 mcg daily — the amount in most multivitamins. Other healthy adults should pick one with lower amounts.

Food or supplements?

Food. It's still important to get folate (the natural form of folic acid) in your diet.

Try this: Put beans and dark green veggies high on your shopping list: One cup of cooked lentils contains nearly 100% of your day's folate requirement.

Vitamin D

Increasing numbers of studies suggest that it can reduce your risk of several cancers by 30 to 50 percent and lower your risk of death from any cause. Yet up to 74 percent of Americans don't have optimal blood levels of the vitamin.

Food or supplements?

Supplements. Your body produces D from sunshine, but if you live in the northern United States, the sun isn't strong enough in the winter for you to synthesize adequate amounts. Vitamin D is found naturally in few foods.

Try this: Take up to 1,000 IU per day and look for D3—the kind skin makes from sunlight.

Burn Major Calories at Home

For a cheap, convenient routine that's fast (and fun), just grab a towel: Our workout uses ordinary hand towels to boost the slimming and sculpting power of traditional exercises.
By gliding through the moves, you target more muscles to maintain your balance. Add a three-minute cardio burst after each exercise and you'll rev up your heart rate and burn even more fat—research shows that alternating strength moves with cardio intervals burns as many calories as jogging, builds more metabolism-boosting muscle than lifting weights solo, and can even shrink your waistline more effectively than cardio alone.
Best of all, you can customize the workout to the time you have—15, 30, or 45 minutes just three times a week.
The expert: Troy Meier, certified fitness trainer and wellness manager at Canyon Ranch Spa Club at the Venetian Hotel in Las Vegas, designed this routine.
Workout at a glance
What you need: Two hand towels and a smooth floor surface (like wood, tile, or linoleum). If your floors are carpeted, you can use paper plates and a single towel.
How to do it: Perform the exercises in the order shown. Start with the Main Move. If that's too difficult, do the Make It Easier variation. Not challenging enough? Try the Make It Harder version. After each move, without resting, do a three-minute cardio burst (at right). Go through the routine once if you have only 15 minutes (you'll burn up to 143 calories), or three times for a 45-minute session that burns up to 428. Aim for three or four workouts a week.
For faster results: Perform the whole routine four times through without stopping, and do 30 to 60 minutes of moderate cardio on alternate days.
The 3-Minute Cardio Burst
Choose from the list below, ranked from least intense (burns 265 calories*) to most intense (428 calories*). After each strength move, do a cardio burst for three continuous minutes (set a timer if needed), then go on to the next exercise.
1. Move and Groove: Turn on some tunes and dance—the more you shake it, the more calories you'll melt!
2. Towel Shuffle: Stand with knees slightly bent, arms extended, holding towel taut at chest height. Step right foot to right followed by left foot three times; repeat to left.
3. Knee-Ups: Holding towel, do a little hop as you raise left knee and pass towel under leg from left hand to right. Repeat with right leg.
4. Stair Sizzler: Attack a set of stairs: Walk or jog up and down or, if you only have a couple of stairs, simply step up and down repeatedly.
*For a 150-pound woman doing 45-minute plan
Stand with right foot on towel. Slide leg back, bending knees to lower into a back lunge, keeping left knee over ankle and coming onto ball of right foot.
Without lifting foot, slide right leg back to center, then forward, lowering into a front lunge, right knee bent over ankle.
Slide right leg back to center to complete a rep. Do eight times, then switch sides. (Now do a cardio burst.)
Make it easier: Do just the back lunge portion of the exercise eight times.
Make it harder: Add pulses: While in lunge, raise and lower body a few inches three to five times before sliding foot back in.
Main move: Side Slides
Stand with towel under left foot, hands on hips. Simultaneously sit back, bending right knee as close to 90 degrees as possible while keeping knee behind toes, and slide left leg out to side, keeping knee straight.
Slide leg back to center and stand. Repeat 10 times; switch sides. (Now do a cardio burst.)
Make it easier: Only bend knee halfway as you lower (to about 45 degrees) and slide foot out just one to two feet.
Make it harder: Stay low throughout all the reps, keeping stationary leg bent as you straighten opposite leg, sliding out to side and bending to return to center. Simultaneously, hold second towel by ends at chest level, arms extended, hands pulling away from one another.
Main move: Plank with Arm Circles
Start in a push-up position, body in straight line supported on hands and toes, a towel under each palm. Hold body still as you slowly slide left hand in small clockwise circle against floor.
Repeat with right hand. Do 6 circles with each hand, switching directions halfway through. (Now do a cardio burst.)
Make it easier: Do exercise from modified plank position with knees on floor, body in straight line from knees to head.
Make it harder: From modified plank with knees on floor, bend elbows to lower into push-up. Hold, and slide right arm out to side and back in. Press back up to start; repeat, sliding left arm.
Main move: Alternating Leg Extensions
Lie on back with knees bent, a towel under each foot, arms at sides. Lift hips two to three inches, press into left heel, and straighten left leg.
Bend knee and slide back in as you slide right leg out, keeping hips lifted. Do 10 reps with each leg. (Now do a cardio burst.)
Make it easier: Use just one towel, sliding foot out about 12 inches, then return to start and repeat, keeping hips lifted. Switch feet halfway through reps.
Make it harder: Simultaneously slide both legs out until they're almost straight, then back in, keeping hips lifted.

Have Sensational Skin At Any Age

As skin ages, it can start to feel dry, look dull, and lose firmness. But new research has led to products and procedures that can help. Here are some to consider.
Your at-home plan
You need to follow these steps for three to six months to see results.
1. Shield your skin daily
Most wrinkles, brown spots, and other signs of aging are due to sun exposure. So slather on sun protection (with an SPF of at least 25) every morning, no matter the season. Look for products that contain micronized zinc and titanium dioxide.
2. Increase cell turnover
Every evening, use a vitamin A-enriched skincare product. Retinoids are the most potent ingredient you can use to help increase cell turnover to give skin a youthful glow. Look for products that contain retinol or retinaldehyde.
3. Step-up exfoliation
Once a week, skip Step 2 and add an at-home microdermabrasion kit to your skincare routine. These kits help improve the texture, color, and evenness of your skin. You can find them in the skincare aisle of most mass retailers.
4. Add on overnight repair
Apply an anti-aging cream nightly to help repair and replenish skin. Look for one that contains an antioxidant such as idebenone, which helps to even skin tone, increase firmness, reduce the appearance of wrinkles, and brighten the skin.
When to bring on the big guns
If you're still not satisfied after six months, some in-office treatments can make a difference. All should be done by a board-certified doctor.
Botox will smooth away fine lines. It works by relaxing the muscles it's injected into, so overlying skin can't wrinkle for four to six months. It's used mostly on the forehead or around the eyes.
Juvéderm or Restylane can fill in and plump deep lines. These injectibles are made with hyaluronic acid, which draws water to the area, plumping it up to help reduce line depth that occurs between the nose and mouth.
Fractional resurfacing lasers are used to polish and brighten. Redness and enlarged capillaries can be zapped away with a series of three to six treatments.