Should docs practice what they preach?

Should docs practice what they preach?

Anthony Youn, M.D., is a plastic surgeon in Metro Detroit. He is the author of “In Stitches,” a humorous memoir about growing up Asian American and becoming a doctor.

What do you call a chain-smoking, morbidly obese, soda addict who just graduated medical school?

Yep. Doctor.

How would you feel if he were your doctor? Would you listen to him if he asked you to adopt a healthier lifestyle?

My third year of medical school during my family medicine rotation, I was assigned to follow Dr. Ben, one of the residents in the outpatient clinic. Dr. Ben didn’t look like any other doctor I’d met. He was 5 feet 6, weighed well over 300 pounds, chain-smoked during his lunch break and hauled around a twelve-pack of Mountain Dew, which he polished off by the end of his shift.

Dr. Ben was also well-read, intelligent, dedicated and caring.

My first day with Dr. Ben, a steady flow of patients arrived in the clinic with conditions ranging from ear infections to sprained ankles. They all listened to his advice carefully and agreed to undergo any necessary tests and take the proper medications to treat their ailments.

Then in walked Joe, 55, an overweight desk jockey with hypertension and type 2 diabetes. Joe smoked, drank and the only exercise he got was lifting himself off the couch to waddle over to the fridge for another beer. He came to the clinic for a follow-up visit to check on his high blood pressure. Dr. Ben and I entered the exam room, introduced ourselves and looked over Joe’s chart. After a brief physical, Dr. Ben shook his head.

“Joe, I have to be honest with you. Your blood pressure is way too high. You need to eat healthier, lose weight and stop smoking. You’re putting yourself at risk for a heart attack, lung cancer, or stroke, and I’m just getting started. Do you exercise?”

Joe raised an eyebrow. “Me? No.”

“If you don’t change your lifestyle, there’s nothing I can do. All the medication in the world won’t help you.”

“Are you serious?” Joe paused. “Look at you. No offense. When’s the last time you skipped a meal?”

I felt my checks redden. I’d never heard a patient talk to a doctor this way.

Dr. Ben blushed. “I’m not the patient,” he said.

“Fine.”

As Dr. Ben scribbled a prescription refill for a hypertension medication, Joe tapped his foot impatiently. Once Dr. Ben ripped the prescription from his pad, Joe grabbed it, flung open the door, took a last look at him, and rolled his eyes. As he lumbered down the hall I heard him mutter, “When’s the last time you saw your feet?”

Out of earshot, Dr. Ben barreled into the kitchen, popped open his sixth Mountain Dew of the day, chugged it and belched.

Fifteen years later, I offer full disclosure: I am not Dr. Perfect. Far from it. I try. I have a healthy BMI, I don’t smoke, and I exercise regularly. I also enjoy a Bud Light or two, drink a Pepsi every day at lunch, and - I admit it - my name is Tony and I’m a fast food addict. To me, the height of decadence would be to fly to Los Angeles for lunch just to gorge myself on In-N-Out cheeseburgers “animal style.”

As physicians, we are advocates for our patients’ health and well-being. But what if we’re not advocates for ourselves? Does that make us lesser physicians? Will our patients follow our recommendations? Are we supposed to be role models?

I think we should be. Dr. Ben was an outstanding doctor, but the way he looked interfered with his ability to practice medicine. If we don’t work at attaining a healthy lifestyle, why should we expect our patients to? Do as we say, not as we do? That doesn’t work for parents or doctors.

And I’m kidding. I’d never fly to In-N-Out for lunch.

But I’d love them to deliver.

How sugar, fat feed our emotions

How sugar, fat feed our emotions
Study offers clues to emotional eating
By Anne Harding

Anyone who's sought solace in pizza or a pint of ice cream knows that food can be comforting. But experts still don't know exactly why we gravitate toward fatty or sugary foods when we're feeling down, or how those foods affect our emotions.

Taste and the pleasant memories associated with junk foods surely play a role, but that may be only part of the story. According to a small new study, hormones in our stomachs appear to communicate directly with our brains, independent of any feelings we have about a particular food.

Most research on food and emotion has looked at the overall experience of eating -- the tastes, smells, and textures, in addition to nutrients. In this study, however, the researchers took that subjective experience off the table by "feeding" the volunteers through an unmarked stomach tube.

Health.com: Is emotional eating the trick to staying slim?

Even in this artificial environment, saturated fat appeared to fend off negative emotions. The study volunteers were more upbeat after listening to sad music and seeing sad faces if their bellies were full of saturated fat versus a simple saline solution, which suggests that emotional eating operates on a biological as well as psychological level, researchers say.

The study is among the first to show that the effect of food on mood is "really independent of pleasant stimuli," says Giovanni Cizza, M.D., an obesity and neuroendocrinology researcher at the National Institute of Diabetes and Digestive and Kidney Diseases, in Bethesda, Maryland, who was not involved in the study. "It is even more rooted in our biology."

The biological mechanism at work is still unclear, but the findings suggest that the stomach may influence the brain by releasing hormones, says Lukas Van Oudenhove, M.D., one of the study authors and a postdoctoral fellow at the University of Leuven, in Belgium.

Health.com: Foods that boost your mood

The deep-seated connection between our stomachs and our brains helped keep humans alive when food was scarce (as it was during most of human history), but it may have outlived its usefulness and may be contributing to modern health problems such as obesity, Van Oudenhove adds.

"Evolution has made every aspect of feeding as rewarding as possible," he says. "These days it may not be a good thing anymore. When food is available anywhere, then it may be a bad thing, leading to obesity or eating disorders in some people."

The study drives home just how difficult it can be to eat healthy and resist so-called emotional eating in our stressful world, says Susan Albers, Psy.D., a psychologist at the Cleveland Clinic and the author of "50 Ways to Soothe Yourself Without Food."

"Given the strong soothing effect of food on a biological level, we have to work even harder to find ways to soothe and comfort ourselves without calories," Albers says. "This is important in the long run for managing your weight, improving your self-esteem, and protecting your overall health."

Health.com: 25 diet-busting foods you should never eat

The study, which appears in the August issue of the Journal of Clinical Investigation, included 12 healthy, normal-weight volunteers.

Van Oudenhove and his colleagues infused one of two "meals" into the stomachs of the volunteers: a solution of saturated fatty acids, or a saline control solution. (The researchers used a fat-based solution because comfort foods are often fatty, and because they were familiar with the brain's response to the solution from earlier research.)

After the feeding, the researchers induced feelings of sadness in the volunteers by playing sad classical music and showing them images of faces with sad expressions -- techniques that have proven to be downers in previous experiments.

Brief mood surveys administered throughout the experiment revealed that the participants found the sad music considerably more depressing after receiving the saline solution than after the fat solution.

Health.com: Why we eat junk food when we're stressed and how to stop

Functional MRI brain scans taken during the experiment echoed these findings: Compared to the saline solution, the fatty solution appeared to dampen activity in parts of the brain that are involved in sadness and that responded to the gloomy music.

The fleeting feelings of sadness experienced by the study volunteers pale in comparison to some of the emotions that people try to address with food in real life, Albers says. "Think about how this compares to some real-world problems people face, like illness, loss of a job, or a divorce," she says. "We are often under a constant state of stress."

Therapy or other treatments that "teach people how to deal with strong emotions would likely...help people improve their eating habits," she says.

Health.com: America's healthiest superfoods for women

In an editorial accompanying the study, Cizza and a colleague at the NIDDK say that the "most important" question raised by the study is whether obese people respond to fatty foods in the same way as the normal-weight volunteers.

For instance, he says, the brains of obese people may resist soothing signals from the gut more strongly than the brains of leaner people.

But there's nothing wrong with occasionally eating unhealthy comfort food, Cizza adds.

"Evolution has provided us with, if you wish, an over-the-counter anti-anxiety or anti-sadness product," he says. "Maybe if you're sad and you feel like that chocolate could help you, go for it. Don't feel too guilty, but try to limit what you eat and maybe later cut down on something else."

7 un-fun health milestones

7 un-fun health milestones

By Meryl Davids Landau


How to handle braces, casts, stitches and more -- without the drama:

1. A broken bone

You watch as if in slow motion as your child crashes his scooter or falls from the jungle gym, your worst fears realized as he screams and clutches his arm or leg. If the bone is actually protruding, don't move him; call 911.

Otherwise, call your doctor or head to the ER, says Meridith Sonnett, M.D., director of pediatric emergency medicine at the Morgan Stanley Children's Hospital of New York-Presbyterian.

The ouch factor

"Breaking a bone hurts right away and usually a lot," Dr. Sonnett says, so expect your child to reprise the Home Alone scream -- over and over. Younger kids may hate holding still for the x-ray, not to mention it could be uncomfortable depending on how they need to be positioned.

And, of course, being immobilized for weeks or months in a tight, itchy cast is awful. Fortunately, if the doc does need to manipulate the bone extensively -- a horribly painful procedure -- your child will be sedated.

On-the-spot soothers

Ask for pain relief right away -- in fact, insist on it. You'll be there for a while, and there's no need for your child to suffer needlessly. Then distract, distract, distract. "When my ten-year-old son broke his arm last year, we talked and giggled about the science-fiction books he'd been reading while we waited in the ER," says Frances Schagen of Kentville, Nova Scotia, Canada.

Littler kids will feel better just snuggling with you -- ask if he can sit on your lap for the x-ray or even the casting. If your child is at least 8, look into whether he can have a removable, soft cast; if a hard one is inevitable, consider a waterproof variety.

"The downside is it may start to smell after a while and so need to be replaced a few times. But for some kids, being able to swim all summer is worth it," Dr. Sonnett says. You'll still need to cover it at bathtime so that it will last longer.

Thinking ahead

Okay, no one really prepares for a broken bone, but if it does happen, try to take extra care about the words you use while waiting for the doctor. Even "broken bone" could conjure images of shattered glass in your child's head.

Instead, you might simply want to say that it's hurt or injured, cautions Betsy Cetnarowski, a child life specialist at Akron Children's Hospital in Ohio. Older kids can handle more detail, so use simple medical terminology and walk them through what they may see, hear, and feel.


2. A from-the-vein blood draw

Most baby and toddler screening blood tests involve a quick prick of the finger. But to get a firm diagnosis, your child's doctor needs a bigger sample -- and that means inserting a needle into a vein.

The ouch factor

The tension of the band hurts, the needle pinches -- and the trauma of holding still with the thing dangling out of her arm is worst of all. Depending on your child's age, you may be asked to restrain her -- which could be more upsetting for you than her! "My son had his first big blood draw when he turned one," says Elizabeth Shaw, Parenting's deputy editor.

"The lab tech instructed me to lie across his shoulders so he couldn't move. As he screamed and looked at me with these big, pleading eyes, I cried right along with him." Plus, a small number of kids will actually experience a blood or needle phobia that could cause fainting, says Martin Antony, Ph.D., a psychologist at Ryerson University in Toronto and author of Overcoming Medical Phobias.

On-the-spot soothers

Before the technician gets started, ask for a topical anesthetic. If your child gets light-headed during the procedure, instruct her to tighten all the muscles in her body except the ones being used for the draw, Antony advises; this should raise dipping blood pressure enough to stave off a swoon.

For some kids, pointing out interesting aspects of the experience can relieve fear, says Lori Gottwein, a child life specialist at the Children's Hospital of Wisconsin in Milwaukee.

That's what Jennifer Harshman did for her 14-month-old son, Alexander. Knowing his fascination with how things work, the Carmi, IL, mom turned it into a science experiment of sorts. "As the technician laid out her supplies, I told him, 'Look, she's getting ready to take some blood from your arm with those tools,'" Harshman recalls. "Then I encouraged him to watch the blood flow into the tubes."

Alexander stared intently -- and never cried. But if you think your child is better off not watching, by all means have her look away.

Thinking ahead

Before arriving at the lab, give your child a brief explanation of what's going to happen and, most important, why. Try not to downplay the pain, but avoid overdramatizing it if you can.

Instead, Gottwein says, use age-appropriate, sense-oriented explanations, such as "The nurse will wrap something like a rubber band around your arm, which will feel tight." You can also do some pretending with a doll at home to help toddlers and preschoolers get the gist of what to expect.

One other tip: Do your best to control your own anxiety, suggests Antony. "Kids learn that a situation is okay by seeing that their parents aren't afraid."


3. Filling a cavity

More than one in four children now has a cavity by preschool, and half of kids have one by age 9. Dentists blame the usual (too much exposure to juice and sugary snacks).

The ouch factor

It's not as bad as you're imagining, since in kids, a much smaller area of the mouth needs to be anesthetized; that limits the awful rubber-lip, exploding-face feeling.

And as with adults, most dentists will use a numbing agent before inserting the needle, says Michael J. Hanna, D.M.D., a pediatric dentist in Pittsburgh. Some offices now use a laser instead of a drill to clean out the decay-causing bacteria. The benefit? It's painless.

On-the-spot soothers

Let him break out his iPod (or borrow yours) and escape into music or an audiobook. And try not to let your own dental dread infect him.

If you cower in the corner or ask if it hurts, his fear level may rise. Instead, sit quietly and (fake) calmly, or read a book (okay, the same passage over and over).

Thinking ahead

Ask about the office policy on parents in the treatment room. Not all allow you to accompany your child (even toddlers), so if you know that will never fly with your kid, look for someone else.

As the appointment draws near, do a little role-playing: Two days before 4-year-old Grace Graham was to get a small cavity filled, her dad, Brock, lessened her anxiety by having her play dentist herself. The Gilbert, AZ, dad drew a black dot on a piece of wood in their garage.

"I told her the wood had a cavity, and we could use my electric rotary grinder to clean it out," he says. Then she filled the hole with wood putty.

You can also alleviate anxiety just by giving it a positive spin: "For young children, we say we're going to drip medicine around the tooth to make it fall asleep, and then we're going to power-wash the dark spot away," Dr. Hanna says.

4. Getting stitches

It's usually not too hard to tell which gashes need more help than can be found in your first-aid kit: anything that's more than a quarter-inch deep (especially on the head) or gapes open is usually worthy of stitches.

The ouch factor

The blood, the gore, the idea of taking a needle and thread to the skin -- don't be surprised if there's anxiety from the minute your child's injured until the deed is done. And the needle delivering anesthesia can add (momentarily) to the pain. Smaller wounds may be glued instead of sewn shut, and that may sting, too.

On-the-spot soothers

Ask if a topical numbing gel can be applied before the anesthesia is injected. "You have to wait half an hour for it to kick in, but it's worth it," Dr. Sonnett says.

Thinking ahead

Remember that cuts -- especially on the head or face -- bleed profusely. (Using a red or other dark-colored cloth to cover the injury may help ease queasies.) Then be honest about what's to come.

"This way, your child can rely on what you say if something similar occurs in the future," Dr. Sonnett says. "I'd suggest something like 'The numbing medicine may pinch at first, but after that you won't feel anything.'?"

And if you're going to head to the emergency room, try to grab some books, toys, or a music player on the way out -- you could be in for a long wait.


5. Having a hospital procedure

Maybe your child was born with a problem that now must be surgically corrected. Or perhaps he needs to stay overnight for tests. Or it could be that he got nabbed by appendicitis. Whatever the cause, he's in good company. More than 2 million kids under age 15 are admitted to hospitals annually.

The ouch factor

Some procedures often done on check-in -- giving blood, inserting a catheter -- are inevitably painful. But being in a foreign place with bunches of strangers poking and prodding is often more upsetting.

On-the-spot soothers

When a technician had to insert an IV into 2-year-old Jona Jaffe's hand, her mom, Jaelline, had her take a deep breath and blow a huge, fake bubble. As the technician proceeded, Jaelline told a story in great detail of them entering the bubble and flying over their favorite sites in Disneyland.

Also effective: Try to give your child choices whenever possible, to make him feel more empowered. "You can't say, 'Do you want this shot?' But you can say, 'Left arm or right arm? Sitting on my lap or lying down?'" child life specialist Cetnarowski advises. Finally, if the experience will be particularly unpleasant, feel free to resort to bribery. New deluxe Play-Doh set, anyone?

Thinking ahead

Many hospitals hold kids' orientation programs and tours, which your child attends a few days to a few weeks beforehand to help him visualize what's coming. "If yours doesn't, ask if there's someone who can give you a private walk-through," Cetnarowski says. She also warns about using words that have a scary double meaning. For example, "If your child will get general anesthesia, never say he's being 'put to sleep,'" she says. "He knows you did that to your dog!"

6. Getting braces
Her gap-toothed, crooked smile might be cute for a little while -- but not so much when she grows up.

The ouch factor

Holding still can be a challenge during the x-rays the orthodontist will take of her jaw and skull. To keep her from moving, tiny rods are placed on the outside of her ears -- awkward but painless.

Gagging may kick in during the next phase of the process: impressions. The child must bite into molds holding a plasterlike material. The braces don't hurt when the orthodontist puts them on, but -- as my 11-year-old daughter unhappily discovered -- the pressure of teeth shifting causes achiness (sometimes severe) several hours later and for days after.

On-the-spot soothers

If your child's a gagger, ask the orthodontist if he can use a numbing spray on the back of her throat prior to taking the impressions, says Bob Bray, D.D.S., president-elect of the American Association of Orthodontists. It can disable the reflex.

If it's allowed, just holding her hand and reminding her to breathe deeply through her nose (some kids may feel like they can't breathe well with the trays in) can help her relax. And after the braces are applied, some orthodontists offer a special wafer to munch.

"Chewing stimulates blood flow to the nerve sockets, which lessens the pain," Dr. Bray says. If yours doesn't, ask about using sugarless gum. Be sure to have an over-the-counter pain reliever for when you get home, and plan on having soup and applesauce for that first night's supper.

Thinking Ahead Just give your child a heads-up about what's going to take place. If she's worried about her appearance, it can help to remind her that all her friends will probably have them soon, too -- and that the payoff will be well worth it: gorgeous teeth for life!

7. Swallowing a pill

For years your child has taken liquid medicines, or you've emptied capsules into applesauce and mixed melted pills into oatmeal. But now she needs to take a slow-release or coated pill, and there's no way around it: You've got to help her get it down.

The ouch factor

Your child might gag as soon as the pill hits her tongue; or she could worry so much about choking that her throat will instinctively tighten.

On-the-spot soothers

Let her take a few sips before the pill goes in; a dry mouth makes swallowing tougher. "This also reminds her that swallowing is a natural process, one her throat will do automatically if she lets it," says Paul Doering, professor of pharmacy practice at the University of Florida in Gainesville.

But forget the widespread advice to toss the head back; that actually closes the esophagus, says Cooper White, M.D., a pediatrician at Akron Children's Hospital.

Instead, have her slide the pill to the back of her mouth, slightly dip her chin toward her chest, and take a sip of water. If the pill feels stuck or is going down too slowly, just tell her to keep drinking. It won't take long before that feeling disappears.

Thinking ahead

Ask if there's a choice between a tablet and a capsule, and if so, choose the latter, says Doering. "Capsules float lightly on top of water, while a tablet sinks like a rock on the tongue," he says.

It can also help to practice with teeny bits of food. Toronto mom Audrey Ciccone had her son Michael, then 7, wash down grains of rice and then pill-size pieces of apple before moving on to his actual medicine, which he was able to swallow on the first try. Way to go!

When you're losing weight, where does the fat go?

When you're losing weight, where does the fat go?
By Madison Park

Multiple chins, bulging tummies and flabby arms: It's easy to see where fat accumulates on the body.

When a person starts losing weight, where does the fat go? And what parts of the body can you expect to see results?

Headlines from fitness magazines promise exercises to blast away belly fat and activities to spot-reduce flab. The scientific evidence, unfortunately, doesn't back those sexy headlines.

Here are three things to know about weight-loss and body fat.

You can't change your shape, just your size.

You can't cherry-pick where you shed fat; weight loss doesn't work like a point-and-shoot.

MRIs, CT scans and dexa scans, which use X-ray beams to measure body composition, show no evidence for spot reduction.

"Basically, when we lose weight, we lose weight all over in exactly the proportion that's distributed throughout our body," said Susan Fried, director of the Boston Obesity and Nutrition Research Center at the Boston University School of Medicine.

This dexa scan of a woman who underwent bariatric surgery shows where she lost her body fat.

A pear-shaped woman who loses weight will remain a pear, just a daintier one, say researchers who specialize in body fat. More women tend to be pear-shaped, with fat around their hips and thighs. Men tend to be apple-shaped, because they have fat that accumulates around their waist.

"People come in with unrealistic expectations from magazines and spot-reducing," said Gary Foster, director of Temple University's Center for Obesity Research and Education. "That doesn't happen. When you start to lose fat, it's proportionate throughout your body, whether it's your neck, waist, ankle circumference. You'll come out smaller but have the same body shape."

Maggie and Andy Sorrells in 2002, before the couple started a faith-based weight loss program.

That was the case with Maggie Sorrells, 37, who lost nearly 300 pounds through diet and exercise in less than five years.

Her body was pear-shaped even when she weighed about 500 pounds. She reduced her portion sizes and attended weekly faith-based weight loss meetings called Weigh Down. She noticed that her face and hips were getting smaller.

"My hips were like 73 inches," Sorrells said. They're now down to 39 inches.

"It's crazy to think how much they've come down."

See her iReport: Andy & Maggie 550 down

She and her husband, Andy, who live in Nashville, lost more than 500 pounds combined.

Sorrells essentially retained her pear shape, although she's 300 pounds lighter. "I'm still rounder in the bottom part of my body. I'm still pear-shaped," she said.

Maggie Sorrells said she essentially retained her pear shape, although she is 300 pounds lighter.

For most people, the problem is their weight, not their body shape, Foster said. Whether you're a pear or apple may be determined by genetics or hormones.

Not all body fat is created equal.

When Joe Dragon, an insurance company supervisor in Albany, New York, started losing weight from his 425-pound frame, he noticed the biggest difference in his stomach.

"I was never heavy on the bottom; it was more the gut, belly area," the 34-year-old said. "The differences I noticed, I have a flat stomach. It used to be huge round ball."

See his iReport: Joe from Albany

Joe Dragon lost 135 pounds on Weight Watchers and exercise.

Like Dragon, men tend to be apple-shaped and carry more belly fat, known as visceral fat. This is a dangerous type of fat because it surrounds abdominal organs and is metabolically active.

Essentially, it disturbs the regular mechanisms in your body.

The fat cells release biochemicals that lead to inflammation, which could lead to heart attacks, strokes and joint and muscle pain. This accumulates in the liver, said Dr. Robin Blackstone, surgeon and medical director of Scottsdale Healthcare Bariatric Center in Arizona.

"Fat is basically a store of energy," she said. "When you need energy, you break down the fat. That breaks down into a component called free fatty acid and goes into the liver for energy. When you have a lot of excess fat, it generates so much free fatty acid, the liver can't handle it, so it stores it."

That triggers a host of problems including non-alcoholic fatty liver disease, insulin resistance and diabetes.

"Belly fat is much more harmful than the so-called big butt," Foster said.

The fat in the hips causes much alarm because that part of the body is highly visible. Called subcutaneous fat, the masses of this fat may be unsightly, but scientists believe they're not as dangerous as internal abdominal fat.

For cosmetic or social reasons, women are more likely to seek obesity treatment than men.

"What that says is that men are likely to need obesity treatment more than women, but women, likely due to stigma socially for being overweight, are more likely to present for treatment," Foster said.

Where does the fat go?

Fat cells expand when people consume more energy than they can burn. During weight loss, the cells shrink.

"The fat is a very specialized cell, and it takes basically the fat we eat and it stores it in form of triglycerides," said Fried, who researches how fat is deposited. "It's doing that for the purpose of releasing it when other parts of the body need it."

Humans carry about 10 billion to 30 billion fat cells. People who are obese can have up to 100 billion.

"If anyone of us overeats long and hard enough, we can increase the number of fat cells in our body," Fried said. "When we lose weight, we don't lose the number of fat cells."

The size of the cells shrinks, but the capacity to expand is always there.

Liposuction can remove fat cells, but this procedure is ideally for people who are not obese.

"The fat cells are actually being removed," said Tony Youn, a plastic surgeon who performs liposuctions. "It doesn't mean that fat cells that remain can't get bigger."

Despite the extraction of fat cells, the ones remaining can always get bigger or smaller depending on a person's diet and fitness.

16 Guilt-Free Ways to Enjoy Soda

The Best Natural Sodas: Our Taste Test Results

America's health-conscious crusade against soda has made it crystal clear that we're not supposed to drink the stuff -- it's bad for us, period. But it's important to note that not all sodas are the enemy; mostly just the type laden with high-fructose corn syrup and artificial ingredients. So when you're craving something sweet and sparkly, what to do?
The KitchenDaily editors gathered 16 different brands of all-natural sodas to find the best in a blind taste test. Not a single one of these brands contains high-fructose corn syrup -- most are flavored with cane syrup, agave nectar, or other noted natural sweeteners. With a few exceptions, we were pleasantly surprised by the whole pack of contenders -- and we were happy to find that the two winners (there was a tie!) were unknown to all of us. We're excited to help you discover some new favorites, too!

Comments: "Amazing. So fresh and different. Tastes homey." "The flavors are great, and maybe a little dessert-like." "Spiced apple tasted like apple pie. Yum!" "The Premium Ginger Ale tasted like pumpkin pie spices, and the ginger beer … !!!"

Notable flavors: Premium Ginger Ale, Spiced Apple, Ginger Beer

One in 5 restaurant calorie listings is off

One in 5 restaurant calorie listings is off
By Elizabeth Cohen

You think you're being smart when, in an effort to eat more healthfully, you check a restaurant's website to see how many calories are in a dish you plan to order.

It turns out perhaps that effort isn't worth as much as you think. A new study by Tufts University nutrition researchers shows nearly one out of five restaurant dishes has at least 100 more calories than what a restaurant states on its website.

The underestimated foods came from several restaurant chains, including Chipotle Mexican Grill, Olive Garden, Boston Market and Outback Steakhouse.

"I think restaurants have a lot to answer for here," said Susan Roberts, senior author of the paper published in this week's Journal of the American Medical Association.

The study looked at 269 food items at 42 fast-food and sit-down restaurants in Massachusetts, Arkansas and Indiana between January and June 2010. Lead author Lorien Urban, then a Tufts graduate student, and others purchased the foods without telling the restaurants they were for a study. They brought the foods to the lab at Tufts, analyzed the calories and then compared them with the calories listed at that time on the restaurants' websites.

On average, the calorie counts were accurate. However, the lab analysis showed that 19% of the foods tested had 100 or more calories in excess of what was on the website.

"One food had more than 1,000 calories more than it was supposed to," Roberts said, referring to a side order of chips and salsa at On the Border Mexican Grill & Cantina. "It was just shocking."

Sit-down restaurants were more likely to have inaccurate readings. Roberts said she thinks this is because individual workers have some leeway in how they prepare the foods, whereas the process is more automated in fast food restaurants.

In fact, several restaurants have caveats such as the one on the Outback Steakhouse website, which states that "menu items are hand-prepared and caloric values may vary from the stated amount."

A new federal law will require calories to be stated on menus at large chain restaurants in the next year. Due to this new rule, the National Restaurant Association said, "Many restaurant chains are looking at tighter kitchen quality control standards."

The Tufts researchers looked at information on the restaurants' websites, which listed the number of calories absorbed by the body, which is different from the total number of calories in a dish. Using information from the restaurants' websites, the researchers estimated the total number of calories in the food and then tested the food in the lab and made a comparison.

According to the Tufts lab analysis, Chipotle's burrito bowl with rice, black beans, peppers, onions, lettuce, green tomatillo salsa and cheese had 703 total calories -- 249 more than what was expected based on information from the restaurant's website.

In a statement, Chipotle acknowledged there could be calorie differences between what's posted on its website and what's served to customers because of "the seasonality of ingredients, adherence to recipes, and cooking from scratch."

At Olive Garden, Tufts found the chicken and gnocchi soup had 529 calories, which was 246 more than what would be expected based on the restaurant's website.

Olive Garden told CNN the numbers on its website "are as accurate as they can be for dishes that are individually crafted by hand."

At Boston Market, three pieces of dark meat chicken (two drumsticks and a thigh) had 572 calories, according to the lab analysis -- 215 calories more than what would be expected from the restaurant's nutrition information. Boston Market did not respond to CNN's request for comment.

Some foods with the biggest discrepancies were lower-calorie items such as salads, which dieters would be more likely to choose. For example, the Tufts lab analysis showed the classic blue cheese wedge side salad at Outback Steakhouse contained 1,035 calories -- 659 calories more than what would be expected based on what was on the restaurant's website.

Joe Kadow, executive vice president of OSI Restaurant partners, which owns Outback Steakhouse, said he suspected the Tufts researchers tested an entrée-size salad rather than a side salad.

Urban said she's sure she ordered the side salad.

"Looking at it, I think the issue is they put on a lot of dressing -- more than they normally put," she added.

Roberts, author of "The 'I' Diet," said these discrepancies help explain why some people in her diet groups have had trouble losing weight even when they used a restaurant's website to select lower calorie dishes.

"If you have 100 calories more than you think (every day), that's something like 10 or 15 pounds of extra weight you gain over the course of the year," she said.

She advises dieters to order items such as dressing, cheese and sauce on the side, so they can have better control over calories.

Power Nutrients You May Not Know

Prebiotics: Power Nutrients You Don't Know About

To reap all the benefits of probiotics, these good bacteria need to be fed correctly. Find out how prebiotics help boost your digestive health.

By Madeline Vann, MPH

Medically reviewed by Lindsey Marcellin, MD, MPH

You’ve stocked your fridge with enough probiotics-rich low-fat or no-fat yogurt to feed a small army, but what can aid those “good” bacteria even more? The answer is the nutrient getting a lot of attention recently: prebiotics. A varied diet rich in fruits and vegetables, as well as prebiotic supplements, can support probiotic organisms and other beneficial bacteria in the gut and maximize the benefits of probiotics.

Although the field of research on prebiotics is relatively new, preliminary data suggests that eating foods that contain prebiotics could help anyone feel full longer and manage weight more effectively, as well as helping women maintain healthy bones.

You may already know about probiotics: If your doctor gives you a hefty antibiotic and recommends that you eat yogurt or take a probiotic supplement, that’s to restock the “good” bacteria in your gut that help the digestive process.

Recently, nutrition experts and physicians have been exploring what these good bacteria need to remain effective, and the answer seems to be prebiotics.

Prebiotics: Form and Function

Your intestines are inhabited by many kinds of bacteria, many of which help you stay healthy and also help you digest your food efficiently. When you eat digestion-friendly foods containing prebiotics, the digestive process creates an atmosphere that favors the probiotics you are eating in that yogurt. This shifts the balance toward the good bacteria, which can boost your digestive health.

“Prebiotics are a special form of dietary fiber that are available in plant foods, such as onions, leeks, and bananas,” says Shannon Rentz, RD, LD, adult clinical outpatient dietitian at Oregon Health Sciences University in Portland. “The prebiotics help work with probiotics to keep the chain of events going. They are the fuel for the probiotic bacteria’s growth.”

Getting Prebiotics Into Your Diet

You have two options for adding prebiotics to your diet: Eat them naturally in whole fruits and vegetables, or take a prebiotic supplement. “As with all nutrients, dietitians recommend always trying to get prebiotics from food first,” says Rentz.

Foods that contain fiber which acts as prebiotics include:

• Artichokes
• Jerusalem artichokes
• Leeks
• Onions
• Garlic
• Wheat
• Oats
• Soybeans

The more varied the fruits and vegetables you include in your diet, in combination with probiotic-rich yogurt, the better your digestive balance is going to be. “That’s why experts encourage five servings of fruits and or vegetables a day as a minimum,” says Rentz.

Many gastroenterology practices offer their own prebiotic supplement formulas, and you can find them online as well. However, prebiotic supplements can be pricey, ringing in at about $40 on average for a month’s supply, says Rentz.

For an added boost to your digestive health, incorporate more foods with prebiotics into your diet, along with probiotic-friendly yogurt. Together, prebiotics and probiotics pack a one-two punch for your health.

Jonah Hill Shows Off Dramatic Weight Loss

Jonah Hill Shows Off Dramatic Weight Loss

It's no secret that Jonah Hill has been working hard to shed some weight, and the '21 Jump Street' star showed off a svelte new figure at the ESPY Awards Wednesday night.

Earlier this spring, it was reported that Hill set a goal to shed 30 pounds for his demanding role in the action-packed '21 Jump Street,' and it looks like he achieved -- if not surpassed -- that goal.

According to Us Weekly, the actor gained weight when he first started training for the role, but once he teamed up with a nutritionist and trainer, the weight started coming off.

'21 Jump Street,' which also stars Channing Tatum, is slated for a March 2012 release.

Who Should Eat Gluten-Free Food?

Who Really Should Be on a Gluten-Free Diet?

It's no question that people with celiac disease and gluten sensitivity feel better on a gluten-free diet, and it's becoming increasingly popular in the mainstream as well. But sticking with a truly gluten-free diet is challenging. Find out if going "g-free" is right for you.

By Madeline Vann, MPH

Medically reviewed by Lindsey Marcellin, MD, MPH

A gluten-free diet is as trendy as the latest purse. Elisabeth Hasselbeck, co-host of "The View," wrote a book about it — G-Free Diet: A Gluten Survival Guide — and even celebs with no known gluten sensitivity, like Gwyneth Paltrow and Oprah Winfrey, swear by it for the health benefits and detox effects.

For people who have celiac disease or gluten sensitivity like Hasselbeck, it can make a significant difference in quality of life. For that relatively small group of people, a gluten-free dietfunctions as a detox diet by relieving their system of an irritant.

For people who aren't fighting gluten sensitivity, avoiding gluten is not a health necessity, but it can be a way to construct a new diet. In fact, if you decide to go gluten-free and you aren't gluten sensitive, you could find that you feel better just because you are eating more healthfully.

A gluten-free diet is a return to foods that are good for you, says Shannon Rentz, RD, LD, adult clinical outpatient dietitian at Oregon Health Sciences University in Portland. "Fruits, vegetables, rice, corn — all those are healthy."

When a Gluten-Free Diet Is a Must

People who need to go on a gluten-free diet usually have one of these conditions:

• Celiac disease. People who have celiac disease actually have damage to villi (tiny fingerlike tissues that aid in digestion) in theirdigestive tract because of the chronic inflammation caused by gluten. When they eat even a tiny amount of gluten, they experience symptoms such as bloating, cramping, or specific types of skin rashes. People with celiac disease might also become lactose intolerant and have iron deficiency anemia, says Rentz. Celiac disease is diagnosed using blood tests and a small bowel biopsy. About 1in 133 people has celiac disease, according to the National Institutes of Health.
• Gluten intolerance or sensitivity. People with non-celiac gluten sensitivity do not have damage to their intestinal lining. However, they experience headaches, bloating, fatigue, or diarrhea after eating foods containing gluten. As a result, they find that a gluten-free diet improves the quality of life. It's hard to get a good estimate on the number of people with gluten sensitivity. It's more common than celiac disease and probably more common than we know — possibly as many as one in 10 people.

"If you suspect gluten's a problem, you should still eat the foods that contain gluten and ask for a blood test," says Rentz. If you stop eating gluten foods before the blood test, the results will be normal. She stresses that before she helps clients construct gluten-free diets, she wants them to go through all the testing and get a proper diagnosis to know if they have to be "100 percent compliant," she says.

The good news for people who are going gluten-free is that they have more options than ever before. "There have never been more products available for the consumer," she says, adding that in many major urban areas restaurants are increasingly catering to gluten-free diet needs. As always, it is important to read labels because even products like soy sauce can contain gluten. Also keep in mind that "wheat-free" doesn't mean gluten-free, reminds Rentz. And just because a product is gluten-free doesn't mean it is also going to meet your dietary needs for nutrients or that it is low calorie, low fat, or low sodium.

For people with celiac disease, your entire kitchen may need to be revamped because cross contamination from cooking instruments, pots, and pans that have been used for gluten-containing foods can cause symptoms. "This is a very difficult life change for people," says Rentz.

People with gluten sensitivity can occasionally have small amounts of gluten-containing foods if they aren't too troubled by the symptoms this causes.

When a Gluten-Free Diet Is a Choice

Certainly, you can try a gluten-free diet even if you don't medically need to do so. If you focus on a wide variety of whole foods such as fruits, vegetables, lean meats, dairy, and non-gluten grains like quinoa, you can probably build a diet that is healthy and nutritious, but skip the usual suspects — wheat, rye, and barley — that provide gluten. However, if you don't have a gluten sensitivity, then a gluten-free diet isn't a "detox" diet because gluten isn't a toxin for your system.

Also, says Rentz, one of the most surprising signs of a gluten sensitivity or celiac disease is a lack of iron due to poor absorption, and this can also be a problem for people who rely too heavily on prepackaged gluten-free products that might not provide you with all the nutrients you need. So giving up gluten when you don't have to for medical reasons means you may be giving up vital nutrients in the process. Read labels and consider a daily multivitamin supplement if you decide to try eating gluten-free.

Another drawback, especially for those who aren't celebrities, is that gluten-free foods can be costly.

So if you haven't been diagnosed with celiac disease or gluten sensitivity, it's okay to buck the gluten-free diet trend — you don't have to cut out gluten because the stars are doing it. Do drop gluten if you are having a reaction to it, but only after seeing your doctor and getting the testing needed for a diagnosis.

What That Heartburn May Really Mean

Recognize the Symptoms of GERD

Symptoms of GERD can interfere with your quality of life. You can ease symptoms and lessen your chances of reflux with medication and lifestyle changes.

By Dennis Thompson Jr.

Medically reviewed by Niya Jones, MD, MPH

You’ve just finished a delicious meal, but instead of feeling satisfied, you’re quite uncomfortable — there’s a burning sensation in your stomach moving up toward your chest and throat, and it may get worse when you lie down. What’s going on?

You may be experiencing gastroesophageal reflux disease, or GERD, a condition in which stomach acid backflows into the esophagus, an event also known as acid reflux. This acid irritates the lining of the esophagus, leading to a number of uncomfortable symptoms. If left untreated, GERD can cause serious complications.

GERD Symptoms

The main symptom of GERD is heartburn, a painful, burning sensation that begins in the stomach and spreads upward through your chest and throat. Heartburn usually occurs after a big meal or an activity that encourages stomach acid to move up into your esophagus. Heavy lifting, bending over, or lying down can all trigger acid reflux.

People with GERD may notice particularly intense heartburn symptoms at night. Keep in mind, however, that the amount of pain doesn't necessarily correlate with the degree of underlying damage being done. In some people, GERD can lead to serious, long-term damage to the esophagus despite few symptoms, while others may experience severe heartburn with minimal esophageal irritation.

Besides heartburn, other common GERD symptoms in adults include:

• Dyspepsia. Also known as indigestion, dyspepsia leads to stomach discomfort or pain. People with dyspepsia may also feel nauseated after meals.
• Acid regurgitation or reflux. People may note a sour taste due to stomach acid flowing into their mouths. This symptom may be accompanied by uncomfortable belching.
• Chest pain. Some people with GERD report feeling like food is stuck in their chest adjacent to the breastbone.
• Throat problems. GERD can cause irritation of the throat and airways, leading to sore throat, hoarse voice, dry cough, or a sensation of a lump in the throat. As a result, people with GERD may feel the need to clear their throat often.
• Chronic nausea. GERD can sometimes cause nausea that lasts for months. Excessive acid reflux can lead to vomiting as well.

GERD Symptoms in Children

GERD can occur in infants and children, but it may be hard for parents to recognize the symptoms. Most young children don't experience heartburn as a result of GERD reflux, but instead display a set of symptoms very different from those of adults. These symptoms include:

• Frequent regurgitation, "wet burps," or vomiting, especially after meals
• Persistent coughing or wheezing
• Difficulty swallowing
• Failure to thrive or gain weight
• Refusal to eat food
• Irritability

Some of these symptoms can occur in infants as a result of other problems besides GERD, including food allergies, respiratory disorders, and even the normal teething process, but GERD should be considered as a potential contributory factor.

The weight and other growth parameters of babies and small children with these symptoms should be monitored closely to prevent complications such as anemia and other nutritional deficiencies.

Managing GERD Symptoms

People with mild GERD symptoms like heartburn may find that over-the-counter (OTC) antacids help offset their symptoms. Other OTC medications like the H2 blockers famotidine (Pepcid) and cimetidine (Tagamet) and proton pump inhibitors such as omeprazole (Prilosec) may be useful if antacids don't help.

But if you find yourself popping more and more antacids or other OTC medications, talk to your doctor about your symptoms. Stronger medications available by prescription can be used to alleviate your symptoms. Or your doctor may perform special tests to figure out whether another condition is causing your symptoms.

There are also a number of lifestyle changes you can make to lessen or eliminate GERD symptoms:

• Avoid foods that irritate the stomach and may promote reflux. These include foods with caffeine, spicy foods, chocolate, peppermint, fried foods, and acidic foods.
• Don't lie down for about three hours after you eat.
• Quit smoking and limit or eliminate alcohol intake.
• Lose weight.
• Raise the head of your bed about half a foot by placing blocks under the headboard. This elevates your upper body and discourages acid reflux. Keep in mind that extra pillows won't do the trick.

GERD can be painful, but the good news is you don’t have to live with the pain. Talk to your doctor about medications and try these lifestyle changes to lessen — and even prevent — your symptoms.