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Monday, March 10, 2014

Oil Pulling: Is There a Kernel of Truth?

By Arefa Cassoobhoy, MD, MPH

coconut oil

In a short time, I’ve gone from wondering ‘what is this crazy new fad of oil pulling?’  to respecting the research going on around the world to improve oral health. As a WebMD medical editor, I read the health news every day and keep up with medical developments. When I heard about the fad of oil pulling I was intrigued.  What is this ancient practice from my ancestors’ home in India that’s all over the Internet and social media as a potential cure-all?

Can there really be a medical silver bullet? Of course not.  But I do believe most health practices – if they’ve stood the test of time – probably have a kernel of truth. In this case, the test of time has lasted thousands of years. But, as a doctor, I believe even that’s not enough. It also must “do no harm.”

Let’s start from the beginning and I’ll share my findings.

What is oil pulling?

Oil pulling refers to swishing a vegetable oil — like sunflower oil, sesame oil, or coconut oil — in your mouth.  The way you swish is important. The oil is supposed to half-fill the mouth and then be sucked back and forth through the teeth. The oil and saliva mix as you swish sideways and back and forth for about 10 minutes.

Where did oil pulling come from?

The practice goes back to the Ayurvedic health habits in ancient India, where it was believed to cure many diseases, from headaches to high blood pressure to diabetes and asthma. And, of course, it helped with oral and dental health.

This is where the kernel of truth comes in.

I suspect that back in ancient India, the people who had the leisure time to swish valuable oils in their mouths and then spit them out were not struggling for existence. They were the wealthy or the honored of India.  These were likely people who did not toil in the fields to bring home a little rice.  But rather they took part in all the wonderful Ayurvedic therapies and rituals we now know about and practice — like yoga and meditation.

My point is that this group would have suffered less from illness than those who barely have enough food to feed their families. Was it really the oil pulling that made all the difference in their health?

Why is it in the news now?

So here we are 2014, and oil pulling is in the news, which brings me back to the kernel of truth.

One key to preventing dental cavities and gum disease is regularly getting rid of the plaque buildup on your teeth (just like they say on toothpaste commercials).  Apparently, the swishing and “pulling” of the oil for a long period of time in your mouth decreases plaque and gingivitis.  The study where I got my information was a small one, but it was logical.  It was done at a dental school in India – where this could be an important part of daily oral health.

Today, in India, the cost of swishing cooking oil every day is much less than swishing a mouth rinse. And the poor don’t get 6-month dental checkups. In that light, oil pulling could be an important way to improve oral hygiene and worth further research.

Will I start oil pulling?

So, does oil pulling cure everything from headaches to asthma? That hasn’t been proven and probably won’t ever be. But it does seem to keep your mouth cleaner by cutting plaque.  And that could be very useful information for many in today’s world.

For me, I want to learn from the Ayurvedic way of the past. But as long as I have easy access to floss and the electric toothbrush, I’m sticking with that and skipping oil pulling.

Posted by: Arefa Cassoobhoy, MD, MPH at 3:41 pm

Tuesday, February 25, 2014

Why Your Pediatrician is Your Best Choice

doctor examining child

By Hansa Bhargava, MD
WebMD Medical Editor

If you’re a parent, it’s likely this has happened to you. You’ve had a hectic morning: getting ready for work, making breakfast and getting the kids ready for school. And then a wrench is thrown in: your child comes down with a sore throat and fever. If your child is sick, where do you take him?

Many parents would opt for what seems to be convenient solution: the retail clinic in the pharmacy down the street. Over the last decade there has been a large rise in retail based clinics. In a recent study, close to 25% of patients said they used them. Most thought about going to their pediatrician first but didn’t, mostly because the retail clinic seemed more convenient.

Recently, the American Academy of Pediatrics has taken issue with the use of retail clinics to treat children. The AAP’s statement specifically points out that retail based clinics are not appropriate for kids. Not only do these clinics often lack a pediatrician to provide the best care, there is also a lack of continuity of care for the child. Continuity of care means that the doctor at that clinic does not know your child and does not have his medical record. The lack of information could have significant medical consequences. What may seem like a small issue may be part of a bigger problem that could go unrecognized if the doctor does not know your child’s history.

From a medical standpoint, your doctor should know the most about your child and your family. This includes the previous illnesses he might have had, family history, allergies, medications previously taken and in certain cases, even social circumstances. All of this information can impact the diagnosis and the treatment. For example, if a child has had multiple strep throats, he may be a carrier and may need to be tested when he doesn’t have symptoms.

Seeing a pediatrician can also get you the best quality of care. Recently I saw a 3-year-old who was diagnosed with ‘bronchitis’ at a retail clinic and given an injection of steroids. It turned out that this child had a respiratory virus and did not need such a strong medication.

Good quality of care is especially important in cases of sports injuries, such as a fracture or concussions. Often, fractures in kids are difficult to see, so a wrist or elbow fracture may be missed if the provider at the clinic is not used to seeing children. And concussions definitely need to be followed, as they can affect a child’s ability to go back to sports and school.

Another benefit of a visit with your pediatrician? The chance to ask your doctor about other concerns that may have fallen off the radar, such as, ‘By the way, his grades have slipped’ Or, ‘He complains about not seeing the board at school’. These issues are important for the developing child.

As a working mom of two kids, I do understand the need for ‘quick care.’ And there are some cases, like when you are traveling, that you need to use retail clinics. But at all other times, seeing your pediatrician is the best choice. The good news is that more pediatric offices are adapting to the needs of busy parents. Most offices have open slots so you can get an appointment that day. Nurses are always available on the phone during the day to help you decide whether your child needs to come in. The majority of offices have weekend hours and a doctor on call in the evenings to help you at other times. And many doctors’ offices are trying to reduce wait times as they realize how this can impact the family.

So next time your child gets sick or injured, take your child to the doctor who knows him best and knows how to treat children best. Because, for all of us, getting the best care for our children is our most important priority.

Posted by: Hansa Bhargava, MD at 4:08 pm

Friday, February 7, 2014

Expert QA: CDC’s Tom Frieden on CVS and Tobacco

CDC Director Tom Frieden

Medscape’s Susan Yox, RN, EdD, interviewed CDC Director Tom Frieden, MD, MPH, about the news that national drug store chain CVS Caremark Corporation will stop selling tobacco products at its 7,600 stores by October of this year.

What is your reaction to this news? Do you believe that this will put pressure on other retailers to do the same?

We’re delighted that CVS has done this. It’s a great step. I think they’ve recognized that trying to be both a healthcare facility and selling tobacco is just a paradox that’s unhealthy and untenable. And I join Secretary of Health and Human Services Kathleen Sebelius in hoping that others will follow their lead.

When pharmacies decide not to sell tobacco products, is the primary benefit the reinforcing of the social unacceptability of tobacco?

I think that is important. In fact, one of my first jobs was in a mental health hospital where we were still using tobacco as a behavior modification modality — as in, “If you behave well you can get 5 cigarettes.” It’s a very shameful history of the healthcare sector. When we look back at advertisements from the 1950s of doctors recommending one brand or another of cigarettes, they look completely anachronistic to us. And I think that in a few years we’ll look back on pharmacies selling tobacco in very much the same way.

It’s important that this happened for 2 broad reasons. First, the fewer places that sell tobacco and advertise it in their stores, the fewer kids who smoke, it appears. Second, we don’t want the halo of healthcare provision to rub off in any way on the deadliest legal product that we have out there — tobacco.

Do you think that other retailers (pharmacies, grocery stores, or big-box stores) will follow CVS’s lead?

I’m optimistic that others will follow the lead of CVS. I think CVS has done a great thing in deciding that it will no longer sell tobacco products, and I hope others do follow their lead.

How many people in the United States still smoke? How much illness and death is related to smoking in 2014?

More than 40 million Americans still smoke, and tobacco use remains the leading preventable cause of death in this country. It causes 480,000 deaths per year and many times that number of severe illnesses. The Surgeon General’s report just released a number of new statistics on this; your readers may want to review the very latest facts.

Can you talk a bit about what else should be happening in the United States to reduce/prevent smoking?

Broadly, there are 2 things that we need to do. First, we need to implement what we know works; in all too many places that’s not yet happening. Second, we need to find new ways to help people quit smoking and prevent kids from starting. So we need to both maximize our currently proven interventions and continue to innovate new ways to protect our communities and our kids from smoking. Unless we take urgent action, 5.6 million kids alive today will be killed by tobacco.

Posted by: WebMD Blogs at 11:05 am

Thursday, February 6, 2014

What Weekend Warriors Can Learn from Shaun White

By Arefa Cassoobhoy, MD, MPH
WebMD Medical Editor

Shaun White

When I heard that Shaun White was not going to compete in slopestyle at the Olympics because of the risk of injury, I thought, “Wow, what an extreme case of managing risks and benefits.” And what bravery to pull out, although not everybody sees it as bravery.

But how do you know when you shouldn’t do more? Especially during those years where you don’t work out as often or as intensely as you did years before.

I’m talking about the rest of us. We like to play sports but have no time for a league any more. No more jumping on your bike racing to a friends’ house to play pick-up basketball.

Now it’s occasional hikes in the mountains, swimming at the lake, maybe skiing in the winter.  Or more likely we’re sweating with a home improvement project.  Paint brush up and down.

You know where I’m going with this – the weekend warrior.  So why do I bring all this up? I’m an internist and a person in the same boat. Realizing our limitations and owning up to them is a big deal.  If we want to ski or bike in the mountains we need to realize, adults need protection from injury. That’s true whether it’s actual trauma or an injury from muscles you didn’t realize you had.

I want all of us to avoid the trauma and overuse injuries that cause the sprains, strains, fractures, and pulled ligaments and tendons of the weekend warrior.  Here are a few tips I share with my patients and try to remember myself:

  • Wear the appropriate gear: helmets, mouth guards, elbow/knee pads, and proper shoes.
  • Exercise during the week to build up for your weekend adventures.
  • Focus on endurance with aerobic work outs and strength with resistance training.
  • Cross-train to get all around fitness.
  • Warm up, cool down and increase your flexibility.
  • Listen to your body. Stop when you are tired.

Posted by: WebMD Blogs at 3:16 pm

Thursday, January 2, 2014

Winter Storm Survival Tips

By Valarie Basheda
WebMD Health News

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Winter is here, and with it often come storms that can keep you trapped inside. Or even worse, you may lose power. Here are some tips to help you prepare ahead of time and keep you safe after, both indoors and out.

Before the Storm

Get together needed supplies ahead of time as much as possible, including:

  • Extra food, including foods that don’t need to be refrigerated.
  • Bottled water.
  • Flashlights and batteries and other battery powered items in case the power fails.
  • An ice melting product for slippery sidewalks.
  • A non-electric can opener.
  • Extra blankets and sleeping bags.

Get other tips from the New York State Division of Homeland Security and Emergency Services.

If the Power Goes Out


  • Refrigerated foods will stay cold for about 4 to 6 hours; keep doors closed to increase that time.
  • A full freezer stays at that temp for about 48 hours, a half full freezer about 24 hours.
  • Eat leftovers, meat, poultry and any foods with milk, cream, soft cheese or sour cream first. Discard them and other perishable foods after 4 hours without power.
  • Frozen foods that contain ice crystals may be cooked and eaten if power comes back.
  • These foods are generally keep safe at room temperature for a few days: butter, margarine, hard cheese, fresh fruit and most vegetables, fruit juice, dried fruit, opened jars of vinegar-based salad dressing, jelly, relishes, taco sauce, barbecue sauce, mustard, ketchup and olives. The USDA has an extensive list of what foods are safe to keep.
  • If it doubt, throw it out.


If your medicine needs to be refrigerated, throw it out if the power has been out for a long period of time. The exception: if you can’t get new medication and you need it, continue to take it.


  • Close off unneeded rooms; stuff rags or towels under cracks in doors.
  • Ventilate a fireplace or wood stove properly if you use one.
  • Dress in loose layers that you can add to or take off as needed.
  • Only use a portable generator outdoors.

Preventing Frostbite

Try to avoid being outside. If you have to go out, follow these tips from the National Weather Service:

  • Dress as warmly as possible in lightweight layers. Wear a hat, cover your mouth, use mittens instead of gloves.
  • Recognize frostbite symptoms: a loss of feeling or a white or pale looking toes, fingers, ear lobes, or the tip of the nose.
  • Get medical help right away if you think you have frostbite.
  • Get to a warm area and remove wet clothing. If you can’t do that, use your body heat to warm the frostbitten area.
  • If you are shivering uncontrollably, slurring speech or having memory loss, you could have hypothermia. Get medical help ASAP.

 Shoveling Snow

The Beth Israel Deaconess Medical Center offers these tips:

  • Don’t shovel if you have a history of heart disease or heart attack or stroke, or are not in good physical condition.
  • Take frequent breaks.
  • Don’t drink alcohol before or after.
  • Don’t eat a heavy meal before or after.

Posted by: Valarie Basheda at 4:25 pm

Wednesday, November 27, 2013

Cotton Ball Diet is Dangerous Fad

By Arefa Cassoobhoy, MD, MPH
WebMD Medical Editor

cotton balls

I have a 10-year-old daughter, so reading about the cotton ball diet really struck a raw chord. This new fad seems to be all over You Tube and the internet. As a physician, I’m just as horrified.

Teenagers and younger girls ages 9 to 16 are dipping cotton balls in juice and smoothies and swallowing them. The idea is the cotton will act like “fiber,” keep them full, and replace real food that comes with calories.

Seems simple, but it’s actually dangerous. The cotton balls aren’t usually even cotton, but rather some other artificial fiber containing unknown chemicals. By eating this nonfood, the girls are a set up for malnutrition with all the consequences associated with other eating disorders like anemia, fatigue and a whole list of medical conditions. They could choke on the cotton balls or even get a blockage in their intestines called a bezoar. That’s the same thing as the hair ball a cat spits up, and it requires surgery to remove.

Of course, the cotton ball diet isn’t an isolated fad – or just a special diet gone extreme. In a young adolescent girl it could mean more. It could be a part of a spectrum of psychiatric illnesses with odd names like trichotillomania, where a person pulls their hair, and pica, where a person eats nonfood like the cotton balls or starch, all in the realm of obsessive compulsive disorders and eating disorders.

As a mother, I now see this entire story so differently from how I would have straight out of medical school. How do we recognize when our younger generation is showing the first signs of a possible illness versus just making a poor decision? How do we teach the girls around us to respect themselves? When my daughter is out swimming or playing basketball – I want her to think – “My body is getting stronger every day.”

I want her to want to eat foods that taste good and give her quality fuel. I want her to feel beautiful because of that strength – just like some of the commercials and songs we see and hear every day. The cotton ball fad raises many issues for us to consider — and food for thought for the young women out there vulnerable to what the search engine on their computer brings up for them to read.

What can we do for our youngsters out there? Of course we have to start at home with our own body image and our own view of what’s a healthy lifestyle. But beyond that we need to be informed. Diet fads aren’t healthy, and eating disorders are a group of real illnesses which are very common. Ignoring the signs won’t make it go away. A child may need talk therapy or medication. Start by talking with your child and then get a professional involved if needed. I will.

Posted by: WebMD Blogs at 10:25 am

Wednesday, September 11, 2013

First Lady Visits Military Brain Injury Center

First Lady Michelle Obama

By Rita Rubin
WebMD Health News

First Lady Michelle Obama toured a new outpatient center for active-duty service members diagnosed with traumatic brain injury and then met privately with some of their caregivers.

On the anniversary of the Sept. 11 terrorist attacks, the first lady started her visit by helping children of wounded service members make patriotic banners and crafts. “Do you realize you guys are heroes?” she said to the children at Fort Belvoir’s USO Warrior and Family Center, the largest USO center in the world.

Michelle Obama has focused on helping military families as part of her mission.

The Intrepid Spirit One, at an Army installation just south of Washington, D.C., is the first of nine satellites of the National Intrepid Center of Excellence, based on the campus of the Walter Reed National Military Medical Center in Bethesda, Md. Center patients have mild-to-moderate traumatic brain injury complicated by mental health issues such as post-traumatic stress disorder.

The Fort Belvoir facility, which opened in July, expects to work with 600 patients and their families each year, says director Heechin Chae, MD, a neuropsychiatrist. A second satellite center has just been completed at Camp Lejeune, a Marine Corps base in North Carolina, and ground has been broken for a third at Fort Campbell, an Army installation that straddles the Kentucky/Tennessee border.

The 25,000-square-foot center at Fort Belvoir includes a spacious gym, featuring an anti-gravity treadmill that can simulate a low-gravity environment and gradually increase it as patients become stronger. A functional studio apartment helps simulate scenarios patients might encounter in real life, such as performing multiple tasks—answering the phone while loading laundry into a washing machine, for example—at the same time.

Besides physical activity, the center addresses shortcomings in patients’ sleep and nutrition habits, both of which play key roles in their recovery, Chae says. Up to 40 percent of people with traumatic brain injury also have sleep apnea, compared to fewer than 10 percent of the rest of the population, he says.

Michelle Obama ended her visit by talking privately to caregivers of wounded service members.

Photo: Rita Rubin

Posted by: WebMD Blogs at 10:32 pm

Friday, July 19, 2013

How to Beat the Heat

By Michael Smith, MD

man drinking water

As much of the country is under scorching heat, remember to keep you and your family safe, including your four-legged loved ones.

When the temperature rises above 90 to 95, your body has a tough time staying cool. And since many of us walk around already somewhat dehydrated, this excess heat can be a recipe for disaster, especially for children, the elderly, and your pets.

What’s the big deal with dehydration? Heat exhaustion and heat stroke, which is a life-threatening medical problem. While heat stroke is an extreme that occurs when your body temperature gets to dangerously high levels, in extreme heat kids and the elderly have a particularly tough time keeping their bodies cool. Be especially concerned if someone stops sweating. That means the body’s ability to stay cool is shutting down and they need immediate medical attention.

If your kids have an outdoor event, give them plenty of water – probably more than they want to drink. And you have to start early – a couple of hours before the event – and keep it up. Make sure they take a break at least every 20 minutes. Simple steps can help keep them safe.

Even healthy adults can suffer serious effects of dehydration in this heat, especially if exercising outdoors. Now is the time to take that workout indoors or exercise early in the morning before the heat really kicks in. And know the signs of dehydration, so you can be prepared and take action fast.

And remember, if you’re hot, so is your pet. My first recommendation—keep them inside and limit outdoor time and activity. If they have to be outside for a period of time, make sure to give them plenty of water and keep them in the shade. Dogs and cats can dehydrate just like the rest of us, with potentially devastating effects. So know the warning signs of overheating in pets.


Posted by: Michael Smith, MD at 4:29 pm

Tuesday, June 4, 2013

President Obama Hosts Conference on Mental Health

By Kristin Hammam

Photo: President Barack Obama delivers remarks during the National Conference on Mental Health in the East Room of the White House, June 3, 2013. Standing with the President, from left, are: Health and Human Services Secretary Kathleen Sebelius, Education Secretary Arne Duncan, and Veterans Affairs Secretary Eric Shinseki. (Official White House Photo by Pete Souza)


It’s estimated that one in five Americans has a mental illness such as depression or post-traumatic stress disorder. That’s more people than have high cholesterol or break an arm each year. But as common as mental illness is, there’s still a stigma surrounding it. People don’t like to talk about it for fear of being judged by schools, employers, and even friends and family.

President Barack Obama opened a national conference at the White House Monday to bring mental health “out of the shadows.”

“The brain is a body part too; we just know less about it,” President Obama said. “And there should be no shame in discussing or seeking help for treatable illnesses that affect too many people that we love. We’ve got to get rid of that embarrassment; we’ve got to get rid of that stigma.”

WebMD joined the conference along with mental health professionals, faith leaders, administration officials, and veterans’ groups. Actor Bradley Cooper, who played a man with bipolar disorder in the movie Silver Linings Playbook, also attended the conference  along with actor Glenn Close. Close  talked about her personal experiences with her sister, diagnosed with bipolar disorder, and a nephew with schizoaffective disorder.

In the spirit of starting a national conversation about mental health, many groups shared their efforts to both reduce stigma and help people seek treatment.

MTV spotlighted its program, “Half of Us,” designed to help connect college students to the appropriate resources to get help. President Obama announced the Department of Veterans Affairs will direct health care centers to hold mental health summits over the summer to help support veterans and their families. And Health and Human Services Secretary Kathleen Sebelius announced the launch of a new website – – featuring personal stories from people with mental illnesses.

“For many people who suffer from a mental illness, recovery can be challenging,” President Obama said. “But what helps more than anything, what gives so many of our friends and loved ones strength, is the knowledge that you are not alone”

What can WebMD do to better help reduce the stigma of mental illness and help people seek treatment? We’d love to hear your ideas to keep the conversation going.

Posted by: WebMD Blogs at 1:22 pm

Friday, December 7, 2012

Top News Stories: Nov. 30-Dec. 6

Supreme Court

The year in health, a diet for damaged hearts, changes to psychiatry’s ‘bible’ of disorders and more of this week’s top news stories:

2012 Year in Health
Health reform, West Nile virus and the rest of the top health stories from the last 12 months. Read more

Healthy Diet Helps Damaged Hearts
It’s never too late to help your heart: a new study finds that older people with established heart disease who ate a heart-healthy diet had a much lower risk of dying or having another heart attack or stroke than those who ate unhealthy diets. Read more

Do Older Adults Need Vitamins, Supplements?
Although at least half of adults aged 65 and older take daily vitamins and supplements, only a fraction actually need them, and most could get the same benefits from an improved diet. Read more

Big Changes in Psychiatry’s ‘Bible’ of Disorders
After a decade, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, which defines what is and what is not a mental illness, will go to press in 2013 with some major changes, some of which have caused controversy in the psychiatric field. Read more

Are Primary Care Doctors a Vanishing Breed?
New research has shown that few medical residents in general internal medicine programs plan to pursue that career path. Instead, they’re increasingly favoring becoming specialists. Read more

Photo: iStockphoto

Posted by: WebMD Blogs at 7:43 am

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