MAYO CLINIC HEALTH LETTER
Reliable Information for a Healthier Life
VOLUME 34 NUMBER 12 DECEMBER 2016
Inside this issue
An inflamed organ
HEALTH TIPS . . . . . . . . . . . . . . . . . . . . 3
Preventing dehydration.
NEWS AND OUR VIEWS . . . . . . . 4
Shingles elevates stroke risk —
Vaccine may help. Fruits and
vegetables add zip to your step.
OUTER EAR INFECTION. . . . . . . 4
Prompt care is best.
KEEPING TIME . . . . . . . . . . . . . . . . 6
Adjusting your internal clock.
BELLY FAT. . . . . . . . . . . . . . . . . . . . .
Underdetected and deadly.
SECOND OPINION
Pancreatitis
..7
. . . . . . . . . .. . 8
The sudden pain in your upper abdomen was so piercing that it caused you
to double over. It radiated from your
upper abdomen directly to your back.
Lying flat made the pain worse. Curling
up into a ball helped only a little. Your
breathing was shallow because taking
deep breaths caused even more pain.
Your doctor said your symptoms
were typical of acute inflammation of
the pancreas (pancreatitis). An attack
of acute pancreatitis is often sudden,
severe and steady. Mild cases generally
improve within a week. Moderate to
severe cases may require hospitalization and take longer to improve.
Inflammation of the pancreas can
become chronic over time, damaging
pancreatic tissue and producing intermittent episodes of pain that may build
up more gradually. Chronic pancreatitis
may cause serious permanent changes
to the pancreas, but earlier diagnosis
and evolving treatments are improving
the chances of a better outcome.
Getting to know your pancreas
The pancreas is an important part
of your digestive system. The organ is
a long, flat gland tucked behind your
stomach. The pancreatic duct connects
the pancreas to the small bowel and to
the common bile duct. The pancreatic
juices and enzymes empty into the
upper section of the small intestine.
The pancreas has two main functions. Those functions are:
The pancreas is a long, flat organ behind your stomach. It produces juices and enzymes
that aid in digestion and hormones that help regulate sugar (glucose) metabolism.
Q Producing digestive juices and
enzymes that break down fats, carbohydrates and proteins in the small intestine.
Q Secreting into the bloodstream the
hormones that help keep blood sugar
from getting too high or too low. These
hormones include insulin, glucagon
and somatostatin.
Inflammation of the pancreas may
disrupt these functions. Usually the
disruption is mild, but it can be severe.
Acute vs. chronic
Acute pancreatitis is often caused
by gallstones or grit-like material (sludge)
that becomes lodged in the common
bile duct and may obstruct the opening
to the pancreas. The blockage causes
backflow into the pancreas tissue, and
the enzymes that normally remain
inactive until they reach the small
intestine are prematurely activated in
the pancreas. This causes inflammation
of the pancreatic cells, leading to
abdominal pain that ranges from mild
tenderness to a deep, boring pain.
Bending forward or curling up in a ball
may ease the pain, while eating or
drinking tends to make it worse. Nausea
and vomiting also may occur.
Typically, the blockage is temporary,
lasting a few days, and the symptoms
disappear when the gallstone is
dislodged. In some cases, an attack can
be severe enough to cause some pancreatic tissue in the gland to die, and
organs — such as the heart, kidneys or
lungs — to fail. Organ failure often
resolves with intensive care, but in a
small number of cases it can be fatal.
Persistent alcohol abuse is another
common cause of sudden attacks of
pancreatitis. Over time, the pancreas
can become chronically inflamed,
often as a result of long-term, heavy
alcohol use. It’s unclear how alcohol
causes pancreatitis, but it’s likely to be
more harmful in those who are genetically susceptible to pancreatic damage.
It may also be that alcohol directly
injures pancreatic tissue. Smoking is
another important risk factor.
If a person who has pancreatitis has
no history of alcohol use and no sign
of gallbadder obstruction, other less
common causes are considered, but
often no cause can be found.
People with chronic pancreatitis
typically experience intermittent
episodes (flare-ups) of upper abdominal
pain or a chronic dull ache. As inflammation persists, it slowly destroys tissue
in the pancreas. The gland becomes
less able to produce the enzymes and
hormones necessary for digestion. In
advanced cases, this can lead to diffi-
culty digesting nutrients, particularly
fat, causing weight loss and the passage
of fatty stools that are loose, foul-smelling and oily in appearance. Eventually,
insulin-producing cells also may
become impaired, leading to diabetes.
Long-standing chronic pancreatitis is a
risk factor for pancreatic cancer.
Diagnosis
To diagnose acute pancreatitis,
your doctor will generally look for at
least two of these factors:
Q Severe, constant upper abdominal
pain
Q Abnormally high levels of certain
pancreatic enzymes in the bloodstream
Q Visual evidence of inflammation,
duct obstruction or tissue damage based
on imaging tests, such as a CT scan,
ultrasound or MRI of the abdomen
If you have the first two factors with
mild pancreatitis, an imaging test may
not be necessary.
MAYO CLINIC HEALTH LETTER
Managing Editor
Aleta Capelle
Medical Editor
Daniel Roberts, M.D.
Associate Editors
Rachel Bartony
Joey Keillor
Associate Medical Editor
Amindra Arora, M.B.,
B.Chir.
Medical Illustration
Michael King
Editorial Research
Deirdre Herman
Abbie Brown
Operations Manager
Christie Herman
Administrative Assistant
Katie Palbicki
New option for pancreatic cancer
Chronic pancreatitis can put you at risk of pancreatic cancer. Pancreatic
cancer is often deadly as there are no screening tests to catch it early. It’s
often diagnosed at a late stage, after the cancer has spread and surgery to
remove the tumor isn’t truly effective.
Doctors are working to change this. Traditionally, advanced pancreatic
cancer has been treated with surgery first, if possible, then chemotherapy.
If surgery isn’t going to be helpful, chemotherapy may be used alone but it
can only prolong life by so many months.
Mayo Clinic and other hospitals are using an innovative method by first
using aggressive new chemotherapy drugs and radiation to control cancer
growth, then following up with surgery to remove as much of the tumor as
possible. This is often followed by further chemotherapy.
Evidence so far suggests that this method can increase survival significantly compared with performing surgery first. More research and experience
are needed, but the hope is that this approach will be an improved option.
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December 2016
Copy Editing
Miranda Attlesey
Alison Baker
Julie Maas
EDITORIAL BOARD
Shreyasee Amin, M.D., Rheumatology; Amindra
Arora, M.B., B.Chir., Gastroenterology and
Hepatology; Brent Bauer, M.D., Internal Medicine;
Lisa Buss Preszler, Pharm.D., Pharmacy; Bart Clarke,
M.D., Endocrinology and Metabolism; William Cliby,
M.D., Gynecologic Surgery; Clayton Cowl, M.D.,
Pulmonary and Critical Care Medicine; Mark Davis,
M.D., Dermatology; Kellen Lambeau, DNP, APRN,
CNP, Family Medicine; Timothy Moynihan, M.D.,
Oncology; Daniel Roberts, M.D., Hospital Internal
Medicine; Phillip Sheridan, D.D.S., Periodontics; Peter
Southorn, M.D., Anesthesiology; Farris Timimi, M.D.,
Cardiology; Matthew Tollefson, M.D., Urology; Debra
Zillmer, M.D., Orthopedics; Aleta Capelle, Health
Information. Ex officio: Rachel Bartony, Joey Keillor.
Mayo Clinic Health Letter (ISSN 0741-6245) is
published monthly by Mayo Foundation for Medical
Education and Research, a subsidiary of Mayo
Foundation, 200 First St. SW, Rochester, MN 55905.
Subscription price is $31.52 a year, which includes a
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Diagnosing chronic pancreatitis,
especially in the early stages, can be
challenging. Blood and stool tests, pancreatic function tests, and imaging tests
may be used. In the later stages of the
disease, results typically reveal structural and functional damage that points
to chronic pancreatitis. But in the early
stages, tests often yield normal results.
Endoscopic ultrasound is an imaging procedure that’s frequently used in
evaluating people for the presence or
absence of chronic pancreatitis when
other tests are normal.
During endoscopic ultrasound,
you’ll be mildly sedated and a thin,
flexible tube (endoscope) will be
passed through your mouth into the
esophagus, stomach and small intestine.
A small ultrasound device (transducer)
at the tip of the endoscope produces
Endoscopic therapy
A procedure called endoscopic
retrograde cholangiopancreatography (ERCP) can be used to
detect pancreatic duct obstruction and treat it. The method uses
a long, flexible tube (endoscope)
with a camera on the end to take
pictures of your pancreas and bile
ducts. The tube is gently inserted
through your mouth and threaded
through your digestive system.
This helps your doctor visualize
if any gallstones are blocking the
bile duct. If present, the stones
can be removed by using tools
passed through the endoscope.
ERCP can trigger an episode
of acute pancreatitis. As a result,
it’s typically used to provide
therapy rather than for diagnostic
purposes. However, it can be a
very helpful treatment — in
removing bile duct stones or
placing stents to widen narrowed
ducts — delaying or even
eliminating the need for surgery
in some people.
sound waves that are used to create an
image of the surrounding tissue, including the pancreatic duct and associated
tissue, as well as the gallbladder and
bile ducts. Normal results generally
rule out chronic pancreatitis, while
highly abnormal results confirm it.
Treatment
People with acute pancreatitis often
require hospitalization to control pain,
avoid dehydration and monitor for
complications — such as infection,
organ failure, or collections of fluid in
and around the pancreas. If a gallstone
blockage is causing the attack, your
doctor may recommend a procedure
to remove the stones — and eventually the gallbladder if gallstones are a
recurring problem. If alcohol was
thought to cause the attack, avoiding
alcohol is essential.
The main goals in treating chronic
pancreatitis are to control pain and
treat digestion problems and other
complications. Your doctor may
prescribe pain relievers in addition to
pancreatic enzyme supplements to
replace those no longer produced by
the pancreas. If alcohol or tobacco is
damaging your pancreas, treatment
usually involves therapies to help you
quit drinking, smoking or both.
If these measures don’t help relieve
pain, your doctor may recommend an
endoscopic or surgical procedure to
clear an obstructed pancreatic duct,
block pain-sensitive nerves or remove
damaged pancreatic tissue. U
Gallstones lodged in the bile duct are a
common cause of acute pancreatitis.
December 2016
Health tips
Preventing
dehydration
As you age, proneness to dehydration increases in part because the
sensation of thirst declines. Thus,
older adults may need to be sure
they are getting adequate fluids.
This may include having set times
to have a drink, keeping a daily
drink log or making sure to have
enjoyable drinks within reach.
Extra vigilance may be needed in
the following situations:
Q During an illness — Vomiting
or diarrhea can quickly lead to
serious dehydration. Other symptoms that may contribute include
fever, nausea, a sore throat or
simply not feeling well enough to
get up to drink.
Q With chronic disease —
Untreated or undertreated diabetes can cause increases in
urination and thus fluid loss.
Kidney disease and heart failure
are other diseases that can contribute to dehydration. Urinary
incontinence may prompt you to
drink less to avoid going to the
bathroom so often or to avoid
embarrassing accidents.
Q When taking certain medications — These include laxatives
and blood pressure drugs that
decrease body fluid.
Q In certain environments —
Being at a higher altitude or in a
hot, humid environment can
increase your rate of fluid loss.
Sweating from exertion also
causes fluid loss.
To maintain hydration, water
is the refreshing, zero-calorie beverage of choice. Sports drinks or
electrolyte solutions may be preferred during prolonged exercise
or with vomiting or diarrhea. U
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3
News and our views
Shingles elevates stroke risk — Vaccine may help
Shingles is a painful, blistering skin rash caused by the re-emergence of
dormant chickenpox (varicella) virus, which can lead to long-term, lingering
pain (postherpetic neuralgia) once the rash heals.
Two recent studies have found that stroke risk — and possibly heart
attack risk — markedly increases in the months after developing shingles.
A 2016 study, published in Mayo Clinic Proceedings, found that older
adults with shingles were 53 percent more likely to have a stroke in the first
three months after developing shingles than were older adults without
shingles. Another 2016 study, published in PLOS Medicine, found that stroke
risk more than doubled in the first week after older adults developed shingles.
The risk of stroke remained elevated for the first three months. The same
study found that heart attack risk also increased by 68 percent in the first
week after developing shingles, and similar to stroke risk, remained somewhat
elevated for about three months.
Mayo Clinic doctors expect that if the shingles vaccine prevents shingles,
it may prevent the shingles-related rise in stroke risk. However, it’s not known
how much the vaccine may help reduce the elevated stroke risk if you
happen to get shingles despite the vaccine. Another study found that taking
an antiviral drug within 72 hours of getting a shingles rash — as is recommended — appears to limit the shingles-related increase in stroke risk. U
Fruits and vegetables add zip to your step
Most people know to eat their fruits and vegetables because, well, they’re
good for you. But it appears researchers recently uncovered some morespecific benefits in a study of older adult participants in Western Europe.
The researchers were concerned with how well fruit and vegetable
consumption might protect against age-related frailty. They looked at specific
measures such as exhaustion, low physical activity and slow walking speed.
In particular, researchers wanted to see how the number of servings of fruits
and vegetables consumed each day would affect levels of frailty.
Analysis of the data confirmed that the more fruits and vegetables eaten
a day, the lower a person’s risk of tiredness, inactivity and slow walking
speed. The strongest associations with reduced risk of frailty were found
with three servings of fruit and two servings of vegetables a day. Five or
more daily servings of fruits and vegetables equaled approximately a 70
percent reduction in risk of frailty compared with those who consumed less
than one serving a day.
It’s not exactly clear what in fruits and vegetables is responsible for the
findings. However, fruits and vegetables are naturally rich sources of
antioxidants, phytochemicals, dietary fiber and other nutrients. Antioxidants
— such as vitamin C, vitamin E and beta carotene — help fight the effects
of aging and keep cells functioning properly. Phytochemicals have strong
anti-inflammatory properties. Dietary fiber protects against cardiovascular
disease and obesity, and nutrients such as potassium help preserve muscle
mass and bone density.
So keep those fruits and veggies coming — not just for a healthier and
longer life, but for a quicker step, as well. U
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December 2016
Outer ear
infection
Prompt care is best
Swimmer’s ear is often associated with
kids, swimming and summertime. It’s
true that swimmer’s ear is common
among children, especially during the
summertime when they’re spending
more time swimming.
However, swimmer’s ear — also
known as an outer ear infection or otitis
extrema — can occur at any age and at
any time of the year. In addition, swimming is only one of many possible
causes of an outer ear infection.
In contrast to a middle ear infection,
which occurs behind the eardrum, an
outer ear infection occurs in the ear
canal between the surface of your ear
and your eardrum. An outer ear infection
can cause:
Q Itching, redness or swelling in the
ear
Q Ear pain or pain when touching or
tugging on the outer ear
Q Clear fluid or pus draining from the
ear
Q A feeling of fullness in the ear
Q Decreased or muffled hearing
As severity increases, pain levels,
drainage amount, and degree of redness
and swelling often increase.
Talk to your doctor if you suspect an
outer ear infection. A medication
can be prescribed to quickly clear up
most infections. Prompt treatment is
especially important for older adults —
particularly those with diabetes — as
they’re at increased risk of a life-threatening complication, in which the
infection spreads to the bone of the skull.
Self-cleaning system
The outer ear canal’s main defenses
against infection are glands in the canal
that secrete earwax (cerumen). Earwax
forms a protective, water-repellent
surface on ear canal skin that inhibits
bacterial growth. Earwax also collects
dead skin cells, dirt and debris and
naturally helps move them out of the
ear. In this way, the ear canal has a
self-cleaning system that doesn’t
require you to do the cleaning.
An outer ear infection is most often
caused by bacteria but can sometimes
be caused by a fungus or a virus. In
general, infections occur when there’s
a breakdown of ear canal skin and the
protective earwax. This makes it easier
for bacteria, fungi or viruses to penetrate the skin, causing an infection.
Treatment
The treatment course for an outer
ear infection may begin with a cleaning
of the ear canal to remove excess
earwax, flaked-off skin or other
infection-related material.
A cleaning and exam give your doctor a chance to look for the possibility
of a ruptured (perforated) eardrum,
which can change the treatment plan.
An eardrum can become perforated
due to a number of causes, including
an ear infection, sudden changes in air
pressure, loud sounds or blasts, foreign
objects in the ear, or severe head trauma.
The cleaning also helps clear the
way for the application of some type of
eardrops, such as antibiotic, antiseptic,
anti-inflammatory or antifungal eardrops. Eardrops are highly effective for
outer ear infections. If the ear canal is
swollen enough to block eardrops — as
can occur with a severe infection — a
wick can be placed into the ear that
allows eardrops to penetrate into the
ear canal. Pain medication also can be
taken as needed.
Usually, oral antibiotics aren’t
needed. However, they may play a role
if the infection is severe, if you aren’t
responding to eardrops or if you have
a weakened immune system.
During treatment, avoid getting
your ears wet. Avoid swimming for
seven to 10 days, and when bathing,
block your ear canal with a petroleum
jelly-coated cotton ball. Try to avoid
wearing hearing aides or earphones. U
Minimizing your risk of an outer ear infection
Several specific factors put you at risk of an ear infection. These include:
Q Swimming or excess moisture — Swimming on a regular basis or allowing
water to remain in your ears after water contact can soften skin in the ear
canal or change the natural pH. In addition, a moist environment favors
bacterial growth and can change the mix of bacteria in your ear canal.
Avoid it by … using swimmer’s earplugs when you swim. Alternatively, dry
your ear canals after getting them wet. To do this, shake and wiggle each
ear until you feel the water drain out. Dry the canal gently with a hair dryer
on the cool setting or use swimmer’s eardrops.
Q Cleaning or scratching the ear canal — Cleaning the ear canal removes
protective earwax. Additionally, cleaning or scratching the ear canal with
a finger, cotton swab, tissue or bobby pin can damage ear canal skin.
Avoid it by … following the old saying “Don’t put anything smaller than
your elbow in your ear.” If you feel you have excessive earwax or if your
ear canal itches, talk to your doctor about safe routes to address the problem.
Q Objects in the ears — Whether it’s hearing aids, earphones or earplugs,
having something inside the ear canal for a prolonged period of time can
damage the skin.
Avoid it by … removing hearing aids at night and regularly cleaning them.
Q Skin conditions — Skin conditions, such as psoriasis or eczema, can
occur on skin inside the ear canal, leading to damaged skin. An allergic
reaction (contact dermatitis) caused by hair spray, shampoo, jewelry, cosmetics — or even ear medications — also can damage ear canal skin.
Avoid them by … talking to your doctor about itchy ears. It could be that
treatment of a skin condition — or identification of an allergen — may help.
Block the ear canal with a petroleum jelly-coated cotton ball if you use a
product that might get into the ear.
An outer ear infection occurs in the ear canal between the surface of your ear and your
eardrum. In contrast, a middle ear infection occurs behind the eardrum.
December 2016
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5
Keeping time
Adjusting your
internal clock
These days, most people tell time
by looking at their smart phones —
but you prefer your old wristwatch. A
masterpiece of minute engineering, it’s
still ticking along as reliably as ever.
There’s a similar feat of engineering
going on deep inside your brain. A small
network of nerve cells within your hypothalamus — the suprachiasmatic
nucleus — forms a master timekeeping
clock system. The system maintains the
daily rhythms that influence your sleep,
metabolism, hormone production and
other key processes.
If this internal clock is disrupted —
by disease, environmental changes or
aging, for example — it can result in a
number of problems. Disturbed sleep
is one of the most common results. Yet
there are some simple steps you can
take that may help adjust your internal
clock and help it keep better time.
Your internal clock
Your suprachiasmatic nucleus contains nerve cells that tick or oscillate on
a cycle that runs just slightly longer than
24 hours. This cycle is your circadian
rhythm. The timing of the cycle is
programmed internally, but it also relies
on cues from your environment.
The most powerful external cue
comes from light exposure. Special cells
in your eyes relay information about
light and dark to your suprachiasmatic
nucleus. This helps your internal clock
adapt to the earth’s day-night cycle.
Light exposure reduces the production of the hormone melatonin. As it
gets dark out, your circadian system
signals the production of melatonin,
usually about an hour and a half to two
hours before bedtime. When daylight
approaches, melatonin levels are
suppressed, improving wakefulness.
Social and cultural norms also can
affect your circadian rhythm. An alarm
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clock can help you wake before dawn,
and most people stay up past sunset.
Research suggests that average bedtime
varies by country — people in Germany
and the U.S., for example, typically go
to bed an hour earlier than do people
in Spain and Singapore.
When the timing is off
A number of factors can disrupt
your internal clock or cause it to
become desynchronized from your
environment. These might include:
Q Night shifts, jet lag — When work
or air travel forces you to be awake
when you would normally be asleep,
it can disrupt your circadian rhythm.
Q Aging — Over time, your internal
clock tends to reset to an earlier time.
That means you’re likely to feel sleepy
earlier in the evening and you wake up
earlier in the morning. Perhaps due to
aging nerve cells in your suprachiasmatic nucleus, your circadian signals
tend to become a little quieter, too,
sending weaker signals to keep you
awake during the day or asleep at night.
Q Blindness — Blindness can result in
a disconnect between your internal
clock and the 24-hour-day cycle.
Because no light cue is present, your
internal clock tends to run based on its
own signals, shifting progressively later.
Q Dementia — Neurodegenerative
diseases such as Alzheimer’s can impact
the hypothalamus in the brain and
disrupt the circadian system. People
with dementia often have irregular and
fragmented sleep-wake patterns.
Q Mood disorders — It’s not clear
whether mood disorders lead to
circadian disruptions or vice versa.
However, depression, bipolar disorder,
seasonal affective disorder and other
mood disorders are common among
people with delayed sleep-wake phase
disorder — in which sleep doesn’t
arrive until the early-morning hours.
Your sleep tends to suffer the most
as a result of a disrupted circadian
rhythm, with consequences such as:
Q Excessive daytime sleepiness and
low energy — Trying to stay awake
December 2016
when your circadian alerting signal is
low and sleep urge is high can lead to
sleepiness and fatigue.
Q Inability to function well during the
day — Lack of sleep can affect your
ability to think and concentrate, causing slowed reaction time, errors in
judgment and accidents.
A little fine-tuning
When your internal clock is off,
several measures may help bring it
back into alignment with your desired
daily schedule.
These steps can involve:
Q Behavioral modifications — Getting
plenty of sunlight during the day can
help synchronize your internal clock
with the course of the day and promote
better sleep. If you find yourself falling
asleep earlier than you’d like in the
evening, it may be helpful to spend the
last few hours of daylight outside to
prolong your wakefulness period.
Q Light therapy — Another option for
lengthening your awake time in the
evening is to use light therapy. With
this therapy, you sit near a special light
box for an hour or two in the evenings
to keep yourself from becoming
prematurely sleepy. Light boxes are
readily available at retail stores and
online. Ask your doctor to help you find
the best one for you. Light therapy also
may be helpful in regulating sleepwake patterns in people with dementia,
and it has been used to treat depression
and seasonal affective disorder.
Q Melatonin — For those who can’t
fall asleep until the wee hours of the
morning, strategically timed doses
of melatonin — usually a few hours
before bedtime — may be appropriate.
Melatonin comes in supplement form
and thus doesn’t undergo the rigorous
approval process that drugs do. Generally, formulations that are verified by
the U.S. Pharmacopeial Convention are
considered most reliable. Talk to your
doctor before taking melatonin, though,
as there are cautions for people who
take certain drugs, including warfarin
(Coumadin, Jantoven). U
Belly fat
Underdetected and deadly
Santa Claus is a jolly fellow in a seemingly perpetual state of good health
— this despite a belly that shakes like
a bowlful of jelly. But unless you live
at the North Pole and have a team of
flying reindeer, belly fat isn’t an asset.
On the contrary, fat that accumulates
in the belly area around your internal
organs — which often leads to having
an apple-shaped midsection — is the
most dangerous type of fat in terms of
your health and longevity.
It’s of particular concern for older
adults because it can sometimes be less
well-recognized as a health risk.
Storage unit
Determining if you’re at a healthy
weight, overweight or obese usually
involves measuring your weight and
comparing it with your height. The body
mass index (BMI) is the tool used to do
just that, and your BMI measurement is
the easiest method to estimate body fat.
The BMI is a reasonable screening tool
for most people. However it’s inaccurate in estimating body composition,
particularly for older adults.
One flaw with the BMI is that it
doesn’t tell you where excess fat is
located on your body. Two common
fat-storage areas are:
Q The hips, thighs and buttocks — Fat
storage here generally occurs just under
the skin (subcutaneous) and leads to a
body that has a pear shape.
Q The belly — Fat storage here may
occur in part due to fat stored just under
the skin. Importantly, belly fat can also
be stored as visceral fat, meaning it’s
stored deep within the abdomen,
surrounding your internal organs.
Excess visceral fat — even in people
with a healthy BMI — is strongly linked
to elevated blood sugar, high blood
pressure, undesirable cholesterol
levels, fatty liver and inflammation
throughout the body. These factors fuel
the development of heart disease, liver
disease, diabetes and cancer — and
increase your risk of premature death.
In contrast, fat stored just under the
skin, such as in the hips, thighs and
buttocks, isn’t as damaging — even if
that fat causes you to be categorized as
obese on the BMI scale.
For older adults, muscle mass
declines with age — and even more so
if you’re not physically active. Your
height also can decrease and so can the
amount of subcutaneous fat you have
just under the skin. This exposes a
second potential flaw with the BMI. The
decline in muscle-related weight and
“healthy” subcutaneous fat can lead to
a BMI that’s in the normal range. But
doesn’t mean that you’re not carrying
too much body fat or belly fat. This is
often called normal weight obesity, and
is fairly common in older adults.
An easy measurement
Measuring your waist circumference
is an easy way to assess your belly fat.
A recent, large review of research on
waist circumference found that risk of
death over a median time span of nine
years steadily increased as waist size
increased. In addition, men with a 43inch waist had a 52 percent greater risk
of death over nine years than did men
with a 35-inch waist. Women with a
37.5-inch waist had an 80 percent
greater risk of death over nine years
than did women with a 27.5-inch waist.
Slimming down
A foundation of losing excess body
fat is a healthy diet that includes:
Q An emphasis on portion control
Q Minimally processed plant foods
such as vegetables, whole grains, fruits
and nuts, and lean sources of protein,
such as fish and low-fat dairy products
Q Minimizing or eliminating highcalorie drinks, such as soda or alcoholic
beverages
Exercise and physical activity
appear to be of particular benefit when
it comes to losing belly fat and offsetting the health risks it causes. Exercise
doesn’t always directly help with weight
loss. However, it helps improve body
composition by increasing muscle mass
and enhancing fat loss — particularly
belly fat — when combined with
healthier eating and calorie control.
The benefits of becoming more fit
also include reduction in risks related
to most diseases fueled by belly fat,
including diabetes, high cholesterol
and blood pressure, and heart disease.
Try for at least 30 to 60 minutes of moderately intense exercise every day. U
While standing, use a flexible measuring tape to measure around your abdomen, just
above your hipbones. Pull the tape measure until it’s snug, but doesn’t press into your
skin. Make sure the tape measure is level all the way around.
December 2016
www.HealthLetter.MayoClinic.com
7
Second opinion
Q
A
Are scorpion bites dangerous?
Contrary to popular belief,
scorpions don’t bite, they sting,
using the stingers in their tails. Although
painful, the stings are mostly harmless.
In the U.S., only the bark scorpion,
found mainly in the desert Southwest,
has venom potent enough to cause
severe symptoms. Elsewhere, lethal
scorpion stings occur predominantly in
Mexico, South America, and parts of
Africa, the Middle East and India.
Mild signs and symptoms of a scorpion sting include pain and numbness,
tingling, or slight swelling in the area
around the sting. Cleaning the wound,
applying cold compresses, elevating the
affected area and using nonprescription
pain relievers can provide relief.
More-serious signs and symptoms
can include difficulty breathing,
seizure-like movements, drooling,
sweating, vomiting, rapid or irregular
heart rate, and very high or low blood
pressure. These require emergency
assessment and possible hospitalization.
Treatment in the hospital may include
bed rest and the use of medications to
control muscle spasms, elevated blood
pressure, agitation and pain. An
antivenom (Anascorp) is available to
reduce severe symptoms from stings of
the bark scorpion.
The very old and the very young
are most at risk of fatal complications
such as heart or respiratory failure
occurring some hours after an untreated
sting. Few deaths from scorpion stings
have been reported in the U.S.
Bark scorpions are nocturnal and
like to hide under rocks, and among
logs and firewood. You’re more likely
to encounter them when working
outdoors, hiking or camping, but they
can also hitch a ride home on clothing
or in luggage or containers. If you’re
outside in an environment where
scorpions are common, wear shoes and
long sleeves. Heavy gloves can be
helpful if moving rocks or firewood.
If you’re concerned about a
scorpion sting — even if your reaction
is minor — first call your local poison
control center. To reach a poison
control center in the U.S., call Poison
Help at 800-222-1222. U
Q
A
What’s the difference between
tendinopathy and tendinitis?
The bark scorpion, above, is about 2.5
inches long.
Some people are more familiar
with the term “tendinitis” rather
than “tendinopathy” or “tendinosis.”
Tennis elbow, jumper’s knee and other
common tendinopathies were often
referred to as tendinitis. The “itis” refers
to inflammation, so the word technically
means inflammation of the tendon.
However, contrary to common
belief, inflammation doesn’t play much
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Research. All rights reserved.
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are marks of Mayo Foundation for Medical Education and
Research.
8
www.HealthLetter.MayoClinic.com
of an ongoing role in these kinds of
injuries. It may be present at first, but
what’s more likely is an incomplete
repair of small tears in the tendon that
develop with overuse. The chronic pain
most people feel is caused primarily by
damage, degeneration and disorganization of tissue, with the development
over time of tiny, new blood vessels in
the area. Thus, doctors now prefer to
more accurately describe the conditions
with the terms “tendinopathy,” which
describes any tendon disorder, or
“tendinosis,” a more specific term that
may be used when imaging studies
document tendon degeneration.
The same is true for plantar fasciitis.
Doctors now often refer to it as plantar
fasciopathy or plantar fasciosis, but
many people still use the older, more
familiar term. U
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Mayo Clinic Health Letter supplements the advice of your personal
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We do not endorse any company or product.
December 2016
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