Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
It is important to be physically active and exercise when possible.
Adverse consequences of physical inactivity and lack of exercise:
Physical inactivity and lack of exercise are
associated with heart disease and some cancers.
Physical inactivity and lack of exercise are
associated with Type II diabetes mellitus (also known as maturity or
adult onset, non-insulin dependent diabetes).
Physical inactivity and lack of exercise contribute
to weight gain.
Comments - benefits of regular exercise include:
Regular exercise can prevent and reverse the
age-related decrease in muscle mass and strength, improve balance,
flexibility, and endurance, and decrease the risk of falls in the
elderly.· Regular exercise can help prevent coronary heart disease,
stroke, diabetes, obesity, and high blood pressure.
Regular exercise can help chronic arthritis sufferers
improve their capacity to perform daily activities such as driving,
climbing stairs, and opening jars.
Regular exercise can help increase self-esteem and
self-confidence, decrease stress and anxiety, enhance mood, and
improve mental health.
Regular exercise can help control weight gain.
30 minutes of modest exercise
(walking OK) at least three to five days a week is recommended. But, the greatest
health benefits come from exercising most days of the week.
Exercise can be broken up into smaller 10-minute
Start slowly and progress gradually to avoid injury
or excessive soreness or fatigue. Over time, build up to 30 to 60
minutes of moderate to vigorous exercise every day.
People are never too old to start exercising. Even frail,
elderly individuals (ages 70-90 years) can improve their strength and
Individuals can begin moderate exercise, such as walking, without a
medical examination. The following persons, however, should consult a doctor
before more vigorous exercise:
Men over age 40 or women over age 50.
Individuals with heart or lung disease, asthma,
arthritis, or osteoporosis.
Individuals who experience chest pressure or pain
with exertion, or who develop fatigue or shortness of breath easily.
Individuals with conditions that increase their risks
of developing coronary heart disease, such as high blood pressure,
diabetes, cigarette smoking, high blood cholesterol, or having family
members with early onset heart attacks and coronary heart disease.
Eat a balanced diet that contains
carbohydrates, proteins, fats, minerals, vitamins, and plenty of fiber. Balance calorie
consumption with energy expenditure to maintain a healthy weight and avoid
weight gain. Eat less saturated fat and cholesterol. Avoid drastic diet
changes without consulting a doctor or a nutritionist.
Eating too many calories (eating more calories than the
body needs for your level of activity)
Adverse consequences of eating too many calories:
many calories causes weight gain, and ultimately, obesity.
Eat more vegetables and complex carbohydrates (such
as whole grains). Vegetables have low energy density. Low energy
density foods contain relatively few calories per unit volume. For example, you
can eat a large volume of lettuce without taking in many calories
Eat less energy dense foods such as fats, nuts, egg
yolks, fried foods, sweets, and high fat salad dressings. Energy dense
foods have a high calorie content per unit volume. Also eat fewer foods
that provide calories but little other nutrition such as alcohol and
many packaged snack foods.
Eating too much saturated fat
Adverse consequences of eating too much saturated fat:
Too much saturated fat intake promotes weight gain, increases blood cholesterol
levels and the risk of developing atherosclerosis (hardening
of the arteries). Atherosclerosis can lead to heart attacks, strokes,
and poor circulation in the legs.
Even though conclusive proof is lacking, a diet high in
saturated fat may be associated with an increased risk of colon
Recommendations (cut down on saturated fat):
Eat less red meat, dairy fat, fried foods, egg yolks, delicatessen meats,
and desserts. These foods have high energy density and most have a high
cholesterol and saturated fat content.
Cook with vegetable oil (not palm or coconut oils which are high in
saturated fats) and use unsaturated
Choose foods that contain more unsaturated fats such as certain fish.
Unsaturated fats may decrease the blood level of triglycerides (another
substance associated with the development of atherosclerosis) in some people.
Eating too much sodium
Adverse consequences of eating too much sodium:
Too much sodium in the diet can contribute to
high blood pressure. High blood pressure increases the risk of heart
attacks, stroke, and heart and kidney
Recommendations (decrease sodium intake):
Avoid adding salt to food and avoid foods prepared with lots of salt (most soups,
canned vegetables, prepared foods, many "fast" foods, delicatessen foods,
salted nuts, popcorn, and other snack foods).
It is best to prepare foods
from scratch and minimize the use of salt in the preparation.
The average woman in the US consumes less
than 500 milligrams of calcium per day in her diet, which is less than the
Vitamin D deficiency is common among the elderly.
Vitamin D comes from food and is also produced by the skin upon exposure to sunlight. House-bound
individuals and nursing home residents are thus prone to developing vitamin D
deficiency if their dietary intake is insufficient.
Adverse consequences of unhealthy eating habits (not consuming adequate
amounts of calcium and vitamin D):
Adequate calcium intake is important to maintain
healthy bone. Inadequate calcium intake contributes to osteoporosis.
Vitamin D is necessary for absorption of calcium in
food. Lack of vitamin D can therefore weaken bones.
Recommendations (assuring adequate calcium and
vitamin D intake): The National Institutes of Health Consensus Conference
on Osteoporosis recommend the following calcium intake:
800 mg/day for children ages 1 to 10
1000 mg/day for men, premenopausal women, and
postmenopausal women also taking estrogen
1200 mg/day for teenagers and young adults ages 11 to
1500 mg/day for post menopausal women not taking
1200mg to 1500 mg/day for pregnant women and nursing
The total daily intake of calcium should not exceed
The Food and Nutrition Board of the Institute of
Medicine recommended the following vitamin D intake:
200 IU daily for men and women 19 to 50 years old
400 IU daily for men and women 51 to 70 years old
600 IU daily for men and women 71 years and older
An average multivitamin tablet contains 400 IU of
vitamin D. Therefore, one to two multivitamins a day should provide the
recommended amount of vitamin D.
Excessive vitamin D leads to elevated blood calcium levels which can cause
significant toxicity. Consequently, intake should not exceed 1000 IU daily.
Those taking calcium tablets which contain vitamin D need to use caution if
their multivitamin tablet also contains vitamin D.
intake of folic acid and vitamin B
Adverse consequences of inadequate folic acid and vitamin B intake:
Inadequate folic acid intake in child-bearing women
is associated with an increased risk of spina bifida (a
form of birth defect) and other serious congenital neurological
defects in new-born infants.
Inadequate intake of folic acid and certain other B vitamins (B12
and B6, which is also known as pyridoxine) causes high homocysteine blood levels, which are associated with an increased risk of heart attacks.
Recommendation (assuring adequate folic acid and vitamin B
Even though cereals are fortified with folic acid in
the United States, women in childbearing years should consider taking a
multivitamin that contains at least 400 micrograms of folic acid daily
for the prevention of neural tube birth defects.The
multivitamin tablet should also provide the recommended minimum daily
amount of vitamins B6 (10 milligrams) and B12 (25 micrograms) as well
as that of the other B vitamins: thiamine, niacin and riboflavin.
Inadequate intake of anti-oxidants:
Antioxidants include carotenoids, vitamins A, C and E, and natural
antioxidants in fruits and vegetables.
Adverse consequences of inadequate intake of anti-oxidants:
Even though conclusive proof is lacking, some doctors
believe that an inadequate intake of anti-oxidants can increase the risk
of developing certain cancers. Not eating enough fruits and vegetables
also may deprive the body of certain cancer fighting plant
anti-oxidants called phytochemicals.
Recommendations (assuring adequate intake of ant-oxidants):
Eat at least 5
servings of vegetables and fruits daily. Fruits and vegetables are
high in fiber and are rich in vitamin C and other antioxidant vitamins
Take a daily multivitamin that contains the
anti-oxidant vitamins: (A, C, and E) and carotenoids.
Taking mega-doses of vitamins
Fat soluble vitamins (vitamins A, D, and E)
Non-fat soluble vitamins (B and C vitamins)
Adverse consequences of taking mega-doses of
Large doses of vitamins are not always safe. For example:
Only a slight excess of vitamin A can cause birth
defects and neurological symptoms in infants and children, and skin
disorders in adults.
Vitamin D in high doses can cause high
blood calcium levels which may lead to nausea and constipation, kidney
stones, and confusion.
Vitamin E in high doses can increase the blood
thinning action of Coumadin and increase the risk of bleeding in those
using that medicine.
Pyridoxine (vitamin B6) in very high doses can cause
While adverse side effects of vitamin C are rare, large doses of vitamin C may cause kidney stones,
gastric acidity, diarrhea, or anemia due to blood
cell destruction in individuals with G 6PD (glucose 6-phosphate
Comments and Recommendations:
Adults should take one multivitamin daily which provides the minimum
recommended levels of those vitamins not always readily obtainable
from a usual diet. This is a safe and inexpensive way to assure
adequate vitamin intake of all the B vitamins, vitamin D, and
Do not take high doses of any vitamin without advice
and monitoring by your doctor.
Maximum unit of vitamin A is 10,000 IU daily
Maximum unit of vitamin D is 800 IU daily
Vitamin E, 400 units daily is generous and safe
Vitamin B6, 10-20 mg daily is very generous
Vitamin C doses over 500 mg daily increases risk of gastric acidity,
diarrhea or anemia
Inadequate intake of minerals:
Inadequate intake of minerals (potassium, magnesium, iron, and the trace
minerals such as selenium, chromium, zinc, and manganese)
Adverse consequences of inadequate intake of minerals:
Low potassium and magnesium levels are associated with
Low iron can cause anemia.
Trace mineral deficiencies disrupt a number of
important metabolic processes, but are uncommon.
Recommendations (assuring intake of adequate minerals):
Potassium and magnesium are widely available in a
balanced diet and supplementation of them is generally not needed
unless the individual is taking certain diuretic (water pills)
Iron supplementation is appropriate for infants and
pregnant and menstruating women. However, in the absence of
these special needs, iron tends to accumulate in the body. Excessive levels of iron,
which are not uncommonly found in older men, may cause serious damage
to the liver, pancreas, and heart.
Supplementation with the trace minerals may be
appropriate in the minimal recommended daily doses. Little evidence
supports the use of high doses of these minerals.
Tobacco use is the most important preventable cause of death.
Tobacco use was estimated to be the cause of 17% of all deaths and 13% of
all years of life lost by adults due to death prior to age 65 in the US in
Adverse consequences of tobacco use:
Tobacco use causes an estimated 30%
of cancers in the US. Tobacco use causes
cancer of lung, mouth, lip, tongue,
esophagus, kidney, and bladder. It also further increases the risk of
bladder cancer in subjects occupationally exposed to certain organic
chemicals found in textile, leather, rubber, dye, paint, and other
organic chemical industries, and further increases the risk of
cancer among subjects exposed to asbestos.
Tobacco use causes atherosclerotic arterial disease
(hardening and narrowing of the arteries) that can lead to heart
attacks, strokes, and lack of blood flow to the lower extremities.
Tobacco use causes an estimated 20% of coronary heart disease in the US.
It also further increases the risk of heart attacks among subjects
with elevated cholesterol, uncontrolled hypertension, obesity, and a
sedentary life style.
Tobacco use causes an estimated 20% of chronic lung
diseases, such as chronic bronchitis and emphysema in the US, and
causes pneumonia in those with chronic lung disease.
Pregnant women who smoke are more likely to deliver
babies with low birth weight.
Second-hand smoke can cause middle ear infections,
coughing, wheezing, bronchitis, and pneumonia in babies, and aggravate
asthma in children.
Comments and recommendations:
smoking is difficult to accomplish; tobacco contains nicotine, which
is addictive. Some smokers can quit "cold turkey," but for most,
quitting smoking requires a serious life-long commitment and an average of
six quitting attempts before success.
smoking efforts may include
behavior modification, counseling, using nicotine chewing gum (Nicorette
Gum) and nicotine skin patches (Transderm Nicotine), and oral medications
such as Bupropion (Zyban).
Adverse consequences of excessive alcohol consumption:
Chronic, excess alcohol consumption is the major cause
of liver cirrhosis in the US.
Liver cirrhosis can cause internal hemorrhage, fluid
accumulation in the abdomen, easy bleeding and bruising, muscle
wasting, mental confusion, infections, and in advanced cases, coma and
Alcoholism accounts for 40-50% of deaths from
automobile accidents in the US.
Alcoholism is an important cause of injury and death
from home accidents, drowning, and burns.
Comments and recommendations:
There are many treatments for alcoholism. But the crucial first step to recovery
is for the individual to admit there is a problem and make a commitment to
address the alcoholism issue. The 12-step style self help programs, pioneered by
Alcoholics Anonymous, can be effective treatment. Psychologists and related
professionals have developed programs to help individuals better handle
emotional stresses and avoid behaviors that can lead to excess drinking. Support
and understanding from family members are often critical for sustained recovery.
Medication can be useful for the prevention of relapses and for withdrawal
symptoms following acute or prolonged intoxication.
Avoid unprotected sex (sex without barriers
such as a condom) outside an established, committed, monogamous
relationship and with a partner without a history of multiple partners,
previous sexually transmittable diseases, or male homosexual activity.
Unlike common acne, rosacea is not primarily a plague of teenagers but occurs most often in adults (ages 30-50), especially in those with fair skin. Different than acne, there are usually no blackheads or whiteheads in rosacea.
There are over 20 definitions of "sleep" in several dictionaries. The first, a verb, seems most appropriate: "to take the rest afforded by a suspension of voluntary bodily functions and the natural suspensi"...