October 2014 Health Bulletins

	Ask the Doc Dr. Davis Smith is director of health services at Westminster School, Simsbury, Connecticut

“What are the long-term consequences of using prescribed stimulant medications?”
— Chicora O., Temple University in Philadelphia, Pennsylvania

The short answer
Studies have not shown long-term negative effects resulting from the use of prescribed stimulant medication. 

The thorough answer
Before prescribing any drug, the medical provider should be confident the diagnosis is correct, and then aim for the lowest effective dose of the safest, most cost-effective medication. 

When talking about potential adverse effects of a medication or class of medications, we think in multiple overlapping categories: 

• Contraindications to use (reasons not to use it that are specific to the patient)
• Side effects
• Long-term complications 

Possible contraindications for stimulant use
Stimulant medications are used to treat attention deficit disorders (ADD or ADHD). It’s recommended that the prescriber check for these conditions, which might suggest a need for caution:

• A history of sensitivity to the medication
• Any medical contraindication (e.g., cardiovascular disorder, seizure disorder, or Tourette’s syndrome)
• A history of anxiety
• A history of substance abuse 

Possible side effects of stimulant use
Patients taking stimulants prescription should be monitored for beneficial effects, as well as these side effects:

• Insomnia
• Appetite suppression
• Jitteriness
• Mood fluctuation
• Rebound effects of short-acting medications 

The provider might need to adjust the dosage or try an alternative stimulant or formulation (e.g., switch to a long-acting formula).  

Coming off stimulants
After several years of treatment, patients who have shown stable improvement might be able to come off medication. This often happens naturally with typical life changes, like graduating from college.

Questions about cardiovascular effects
Stimulants increase the heart rate and blood pressure. Some studies suggest an increased risk of heart attack, stroke, and alterations to normal heart rhythms. This is controversial and an area of ongoing research.

Benefits of treatment
For individuals with ADD or ADHD, the benefits of stimulant use usually outweigh any adverse effects. Effective treatment might help people stay in school or work and reach their academic and employment potential. Median weekly earnings for those who have earned a Bachelor’s degree are $1,108, compared with $651 for those with only a high school diploma, according to government data. Treatment can also facilitate successful relationships. 

Deciding against treatment
Treatment isn’t for everyone. There are certainly cases of individuals who have succeeded despite, if not because of, untreated attention deficit disorders. That said, it’s the bias of medicine to treat conditions that are treatable.

Non-treatment of attention deficit disorders may lead to depression or other conditions that increase the risk of substance abuse.

	Ask the Trainer Frankie Romeo is a certified personal trainer, small group training coach, and graduate student at Lipscomb University in Nashville, Tennessee

“What are some easy workouts that could be done at work?”
— Bahareh J., Johns Hopkins University in Baltimore, Maryland

Many people work in a sedentary environment. Just contemplating ways to get adequate physical activity is a great first step! Below are five work-friendly exercises that cover each plane of movement to make for an efficient workout. Equipment and athletic attire are not required.

1   Knee & hip flexion

• Bend one knee so that the heel comes towards the buttocks.
• Maintain this bend as you raise the knee as high as possible, shortening the angle between the thigh and stomach.
• Relax the leg and return the foot to the ground before the next repetition.
• Isolate each leg and keep an upright posture throughout the movement.
• Hold a stable surface to assist with balance.
• Perform 10-20 total repetitions, alternating each leg.

2   Resisted head extension

• Waffle the hands and place them behind the head towards the top.
• Provide gentle resistance by pulling the head forward.
• Use the posterior neck muscles to lower and raise the head in a controlled manner. This will look like an exaggerated nod.
• Perform 20 slow repetitions.

3   Waffled chest pull

• Again, waffle the hands. Bring them in front of the chest with straight arms. Palms should be facing towards you.
• Try to pull the hands apart without actually doing so—maintaining a waffled grip. This engages the shoulders’ external rotators and back muscles which assist posture.
• Bend the arms to bring the hands towards your chest as if you’re pulling something towards you, then extend the arms back out in front of you. Maintain a constant outward pull with the hands.
• Perform 20-30 repetitions.

4   Gluteal squeeze & crunch

• Squeeze the buttocks by tilting your hips forward.
• Tighten your stomach and crunch slightly forward at the same time. This activates both the gluteal and abdominal muscles for a stronger postural foundation.
• Perform 20-30 repetitions. 

5   Engaged T-twists

• With arms straight and extended to form a T, tighten your stomach and twist side-to-side as far as possible without moving the feet.
• Maintain a tightened stomach throughout to activate the abdominal muscles.
• Perform 25-50 total rotations.

For a greater inventory of exercises and workout possibilities, try using an exercise band. These are appropriate for use in most workplaces during break hours. See the next issue of Student Health 101 (November 2014) for video demonstrations.

	Ask the Nutritionist Karen Moses, director of wellness and health promotion at Arizona State University in Phoenix

“Cooking really intimidates me. What are some easy ways to get started?”
—Al P.*, American University, Washington DC
*Name changed for privacy

As with any new skill, start simple.

I recommend limiting yourself to one recipe per meal. Complement it with simple foods such as a steamed vegetable, sliced tomatoes, and French bread.

Try one new recipe a week, and over a year you’ll become 52 recipes closer to confidence in the kitchen.

What you’ll need

• A beginner’s cookbook, online recipe, or demonstration video
• Basic cooking tools, e.g., measuring cups and spoons, knives, and a cutting board
• Cookware
• Basic ingredients: Search “pantry essentials” online for a list. It will probably include vegetable oil, salt, herbs and spices, rice, and pasta.

Keep in mind

• Add to your inventory of staples as you buy items for new recipes.
• Read the labels for info on appropriate storage.
• Keep cooking surfaces clean to reduce the chance of food-borne illness. 

How to cook

• Choose a recipe. Cookbooks are typically arranged by type of dish — entrée, dessert, salad, etc. — and indexed by food item.
• Read the recipe instructions from beginning to end. Do you have everything you need: ingredients, time, equipment? If you haven’t cooked anything like this before, allow extra time.
• Assemble the ingredients and tools.
• Follow the instructions step by step. If the recipe uses unfamiliar terms or techniques, search for them online.
• Consume.
• Celebrate.
• For inspiration, education, and practice, search online for cooking demonstrations, or take a beginners’ cooking class in your school or community.

	Ask the Counselor Peter Welch, MA, teaches at the University of New Hampshire, and is a wellness educator and counselor

“How can one control anger within a college or work environment?”
— Name and college withheld   

Your question is important. Anger is a normal human emotion with a wide range of expressions, from feeling irritated to outright rage. Anger can be a motivator to help you stand up for yourself or fight an injustice. Mismanaged or inappropriate anger, however, can lead to problems with your health, work, and relationships.

Strategies to help you manage anger

Recognize Acknowledge your anger as a likely reaction to a perceived threat or some underlying feeling—e.g., hurt, vulnerability, embarrassment, or shame.  Recognize, too, that sometimes anger is unreasonable, regardless of its trigger.

Time out Stop for ten seconds. Cool down, gain some perspective, and rethink your response.

Relax Learn techniques to settle yourself down, like deep breathing or meditation. Come up with a calming word or phrase, e.g., “This moment will pass.”

Know your triggers Understand what pushes your buttons, and work toward averting those situations. If your triggers are unreasonable—e.g., you unfairly blame others for your anger—seek professional help immediately (see below).

Exercise Slow exercise, like stretching or yoga, might help you develop a quiet mindset so your typical anger triggers are less unsettling.

Rethink Change the way you think about your angry feelings. Walk yourself through an alternative scenario for your anger. Does road rage really help you feel better?

Do something else Think about a funny moment. Help someone. Pet an animal. Give someone a hug. Doing something incompatible with anger will help you redirect.

Patience and forgiveness Give yourself time to learn new strategies for managing your anger. Learn to forgive others who have hurt you.

Seek professional help If your anger is intense, unreasonable, or involves you treating others harshly, it is your responsibility to work actively on your emotional and behavioral self-regulation. Many professional counselors and therapists are trained to help clients manage anger and typically use cognitive behavior approaches (helping you change the way you think about a particular issue). Find a local therapist.

Anger management techniques from HelpGuide.org

How would you react to a cow in your parking spot? A Zen approach to overcoming anger.

Millennials are poised to claim the midterm elections

By Chris Stuck-Girard

Ready to feel empowered? Next month could kick-off an era of Millennial political dominance. People born between 1980 and 2000 make up the largest generation in American history, and now that most of us can vote, we could prove pivotal to this year’s midterm elections.

Midterms are often unfairly written off as inconsequential placeholders that dot the years between presidential contests. But there’s a bunch at stake this year.

Get this

We Millennials number 80 million in the US—and only slightly more Americans (82.5 million) voted in the 2010 midterms.

Shaking up Congress
As you read this, 468 members of the US Congress are running for re-election, each hoping that young voters will boost them like they boosted now-President Obama in 2008.

Republicans think they can take control of the Senate by capitalizing on Obama’s low popularity. Democrats are hopeful that an improving economy—and a Supreme Court decision that threatens employee access to some forms of birth control—will convince voters to put them back in charge of the House of Representatives.

College costs & environment
Thirty-eight states and territories will elect governors—who play a pivotal role in environmental protections and college affordability.

Minimum wage & marijuana
In a handful of states, including Massachusetts, voters will choose whether to raise the minimum wage. Citizens in Florida and three other states will vote on proposals to loosen restrictions on marijuana, Ballotpedia reports.

Students pushing for change
In New York City, students have joined parents and teachers to protest the Common Core education standards. In North Carolina, students established the #DebtFreeUNC campaign for fairer student loan terms. They delivered more than 18,000 red squares—each representing a University of North Carolina graduate with loan debt—to the governor and to a leading candidate for the US Senate, The Nation reported.

The new dietary supplement: food

By Chris Stuck-Girard

Are you among the 34 percent of Americans aged 20-39 who take a dietary supplement each day? Maybe your parents raised you on Flintstones-shaped vitamins to get you excited about the habit. But should you keep popping those pills? According to an increasingly robust body of research, the answer is no.

Young adults most commonly cite health improvement or health maintenance as their reason for taking supplementary vitamins, according to a 2013 study in JAMA Internal Medicine. Their faith is misplaced. “We believe that the case is closed—supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful,” concluded an editorial in the Annals of Internal Medicine last year. “These vitamins should not be used for chronic disease prevention. Enough is enough.”

Vitamins linked to earlier deaths
Certain vitamins taken with the goal of preventing intestinal cancers actually increased mortality, according to a 2004 review of studies by the Cochrane Collaboration. Three years later, a study of 11,000 men by the National Cancer Institute found that those who took multivitamins were twice as likely to die from advanced prostate cancer as those who did not. In 2012, another research review by Cochrane found that beta-carotene and vitamin E supplements “seem to increase” the risk of earlier death.

Dietary supplements aren’t necessary
“Most people who eat a reasonable diet will get everything they need in the food that they eat,” Dr. Paul Offit, chief of the division of infectious diseases at Children’s Hospital of Philadelphia, told The Guardian newspaper last year. (The exceptions might be people on certain special diets, like vegans or people who live in climates that are never sunny, he added.)

Where did the supplement myth come from?
Claims to the contrary are likely founded in flaky research methodology and misunderstandings. “Supplement users tend to be wealthier and healthier than non-users,” wrote pharmacist Scott Gavura in a post for Science-Based Medicine last year. “It’s the ‘healthy user’ effect which shows up throughout epidemiological studies, confounding evaluations of outcomes. That is, we shouldn’t assume supplement use make you healthier, any more than assuming that supplement use makes you wealthier.”

How then to get your vitamins?
It seems we must resort to food. Eat produce of all colors in the rainbow. Each hue represents a different blend of nutrients, and if you cover the spectrum you’re well on your way to complete nutrition.

It’s always useful to remember food writer Michael Pollan’s nutrition maxim: “Eat [unprocessed] food, mostly plants, not too much.” That’s a message even a caveman can understand.