Blood Pressure and the Brain – risk for Alzheimer’s?

Provided by Psychology Today

The next time a nurse inflates a blood pressure cuff around your bicep, pay attention. Those numbers are not just important for your heart, but for your brain as well.

It's becoming increasingly clear that high blood pressure, or hypertension, is at the root of much cognitive decline that has previously been attributed to aging. The more that scientists scrutinize brain function, and especially memory, the more they conclude that we have the ability to keep our memory and spirit strong well into old age. But it depends on how well we nourish our brain throughout life.

Hypertension is defined as blood pressure of 140/90 or above. The first number is the measurement of the blood's force against artery walls when the heart is beating. The second number is the pressure between beats. A person is hypertensive if either number is too high.

Most people think salt is the culprit in high blood pressure. In the vast majority of hypertensives, salt isn't the root of the problem. Only about one third of people with high blood pressure are what doctors call "salt sensitive."

"The rest of the folks can eat all the salt they want without seeing much change in their blood pressure," says Shari Waldstein, Ph.D., associate professor of psychology at the University of Maryland at Baltimore County, who studies the cognitive consequences of hypertension. People whose diets are not to blame can pinpoint the problem through a trial of medications that target differing pathways in the body. Blood pressure is affected by many of the body's systems, including kidney function, hormones such as insulin and the sympathetic and parasympathetic nervous systems.

Regardless of cause, high blood pressure is extremely dangerous, especially for people who don't know they have it, typically people who rarely see a doctor. Hypertension has few symptoms; some sufferers complain of headaches, nosebleeds or shortness of breath but for the most part the body suffers in silence.

High blood pressure does its damage by weakening the blood vessels, over time leading the inner lining to slough off. Vessels can be weakened to the point that they tear, causing sudden death or disability via a stroke or aneurysm. Hypertension can also lead to heart attacks.

But long before it creates a health emergency, hypertension takes a subtle toll on mental faculties. It can reduce attention, learning, memory and decision-making skills in ways that can be clearly seen in studies.

"Generally, whatever problems impact cardiovascular health also affect cognitive functioning," says Merrill Elias, Ph.D., a professor of epidemiology at Boston University who has studied hypertension for 35 years.

Indeed, some researchers now believe that a substantial amount of age-related mental decline has little to do with age and much to do with blood pressure. Waldstein says there's a large body of research linking hypertension directly to brain function, but scientists don't yet know how it causes damage at the cellular level.

Elias says high blood pressure exerts a constant stress on the brain and cardiovascular system that appears to be cumulative. "It's more of a problem for people who don't go to the doctor," he says. "Just think of it as your brain taking a hit every day."

The damage to the brain can come in a variety of forms. In the elderly, more than half of whom suffer from hypertension, the damage can be detected on MRIs in the form of "white matter lesions." These are pinpoint lesions in the brain's message-carrying axons that affect cognitive function, especially weakening memory and reasoning and significantly impacting quality of life.

High blood pressure can also cause small strokes that may go unnoticed, but which diminish the brain's capacity to function. Other people who have chronic hypertension actually have small spots on their brain where the tissue is dead, says Elias.

But that doesn't mean that high blood pressure is a disease of old age. For one thing, many people who are in their 20s and 30s suffer from it as well. It's especially important for younger people to control their blood pressure so that the damage doesn't start early and snowball over time.

But neither is high blood pressure inevitable with age. Blood pressure can be kept in check by keeping cholesterol low, not smoking and limiting salt. But perhaps the most important factor is keeping obesity at bay, a struggle most Americans are not winning.

"Weight is a biggie," says Elias. "The more you weigh, the more pressure there is."

Too much belly fat can be downright risky

By Michael Jensen, M.D., an endocrinology specialist at Mayo Clinic, Rochester, Minn.,

If you are carrying a few extra pounds — whether in the form of belly fat, love handles, a beer gut or potbelly — you're not alone. In recent years, the number of people who are overweight has increased dramatically worldwide. Two-thirds of American men are overweight or obese. But this is one case where following the crowd is not the best idea, because extra weight — especially belly fat — can be downright risky. And while women often put on extra pounds in the hips, thighs and legs, men are much more likely to gain belly fat.

How can you tell if you have too much belly fat?

Not surprisingly, how big around you are at the waist is a good indicator of whether you have too much belly fat. Although measurements that compare your hip and waist circumference (waist-to-hip ratio) or compare your height and weight (body mass index) are more precise and can be useful for research, your waist size alone can give you a pretty good idea of how much belly fat you have.

For most men, the risk factors for heart disease and other diseases increase with a waist size over 40 inches (102 centimeters).

To accurately measure your waist:

• Place a tape measure around your bare abdomen just above your hipbone.
• The tape measure should be snug — but not so tight it pushes into your skin.
• Check to make sure the tape measure is level all the way around.
• Relax, and measure your waist after you breathe out — no sucking in your belly!

Can you reduce belly fat with sit-ups?

Sit-ups will make your abdominal muscles stronger, sure. And, you may look thinner by building your abdominal muscles because you can hold in your belly fat better. But strengthening your stomach muscles alone will not specifically reduce belly fat.

There are no particular "spot" exercises that are best at reducing belly fat. But most people do lose belly fat before losing fat in other parts of their body when they get more exercise of any kind.

Is belly fat inherited?

While some men are more likely to put on extra pounds because of their genes, for the vast majority of men, the problem has a lot more to do with lifestyle than inherited traits. Simply put, when you take in more calories than you burn — the excess calories are stored as fat.

We've had a huge change in our environment. Men — and women — used to have much more active lifestyles. But our lifestyles today allow us to live and work with virtually no opportunity for physical activity. About 60 percent of American adults get no vigorous exercise in their leisure time at all. We are also eating larger amounts of high-calorie foods than we used to, such as "fast food" that is high in fat and carbohydrates. People are responding to this change in the way you'd expect — by gaining weight. Men need to be more active — to get out and keep moving.

Can you really get a beer belly from drinking?

We do know that there is a link between drinking excess alcohol and gaining belly fat — the "beer belly." However, it isn't just beer that can increase belly fat. Drinking too much of any kind of alcohol can have that effect. We know that alcohol is high in calories and increases appetite, but still aren't exactly sure why drinking too much causes increased belly fat in particular.

If you drink, the key is to drink in moderation. While increased belly fat is most noticeable in people who drink to excess, keeping it to less than two drinks a day will reduce the amount of calories you consume and help you avoid putting on belly fat. It is also better for your overall health.

Turning dreams of a baby into reality

Many couples experience fertility problems. Sometimes, having a child does not always happen as easily as expected. Unfortunately for many people, conceiving can be difficult.

Samitivej Sriracha Hospital in collaboration with Superior Assisted Reproduction Technology (A.R.T) from Sydney, Australia offers excellence in clinical expertise and state-of-the-art technology for fertility treatments to couples who are having fertility problems.

Since the first IVF baby over 29 years ago, assisted reproductive technology has been greatly enhanced, leading to better outcomes for couples desiring children. Present technology includes IVF or in vitro fertilization, a method of assisted reproduction where fertilization of a woman’s eggs is done outside of her body. The sperm provided by the male partner is afterwards mixed with eggs that have been aspirated from the woman’s ovaries. After a few days, one or more fertilized eggs are then transferred to the woman’s uterus (womb), with the hope that pregnancy will occur. This procedure has helped hundreds of couples to conceive and have healthy babies.

In addition to this, embryo testing for diagnosis of any genetic disorders before putting it back into the womb is also possible. This technique is called PGD or Pre-implantation Genetic Diagnosis. This involves the genetic testing of embryos created through IVF for harmful, heritable genetic conditions known to be present in the family of the couple seeking treatment. It allows couples previously at risk of producing a child with a genetic disorder to select the best quality embryo without a genetic disease for transfer.

Through the use of superior facilities and techniques Samitivej Sriracha Hospital offers fertility treatments that are customized to fit the individual patient and maximize her chances of pregnancy. These are treatments that help infertile couples not only conceive, but also help those who carry a mutation for single gene disorders such as beta thalassemia to have a healthy baby. Couples, who have an existing child with a variety of disorders, can select an embryo which is a HLA (Human leukocyte antigen) match to the child with the disorder. After the birth of the new baby, cord blood can be donated for stem-cell extraction to aid in the treatment of the baby’s elder sister or brother.

At Samitivej Hospital in Sriracha, one hour South of Bangkok, patients are treated with compassion and understanding as we work with couples to fulfill their dreams of building a family. These treatments will benefit not only couples with infertility problems but also couples requiring gender selection for medical reasons. These would also greatly benefit patients who have experienced repeated miscarriages or couples carrying a genetic disorder. Samitivej has now enabled couples to choose from a wide range of state-of-the art fertility techniques that would help patients turn their dreams of a baby into reality.

Avoiding unnecessary surgery

By Herb Denenberg

Here are more guidelines for avoiding unnecessary surgery and getting only high quality surgery you actually need.

1. Check out the hospital. In selecting a surgeon, remember that he will usually be tied to one or possibly several hospitals. So make sure both the surgeon and the hospitals where he is admitted to practice deliver quality care. Consumers' Checkbook publishes one of the best rating systems on hospitals: Consumers' Checkbook Guide to Hospitals, with rating of 4,500 hospitals. It rated hospitals in the 71 major Metropolitan Statistical Areas in the nation. Checkbook has a Web site at www.checkbook.org. You can see the ratings on the top 50 hospitals at www.modernmaturity.org.

The Checkbook ratings of 4,500 hospitals are based on medical and surgical mortality, accreditation score from the national organization that rates all hospitals, the opinions of physicians and the training programs available to the hospital's doctors.

The Joint Commission on Accreditation of Healthcare Organizations reviews hospitals against established standards, and after inspections, it rates them. The hospitals studied by Checkbook had ratings of 71 to 100. The commission has a Web site with information on hospitals and how to select them (www.jcao.org) as does the American Hospital Association (www.aha.org). The commission also maintains a site of hospitals out of this country at www.jointcommissioninternational.com. There is also a book on medical tourism (going out of the country to get surgery or other care). It is by Josef Woodman and is entitled Patients Beyond Borders. However, medical tourism is a subject beyond the scope of this guide.

There are many other books and periodicals that rate hospitals. One of the best-known ratings is published by the magazine, U.S. News and World Report.

More and more surgery is now carried out in doctors' offices and outpatient clinics, some of it quite substantial and serious. For example, there are plastic surgeons that do most of their work in their own office. This should be approached with special caution, because unlike a hospital-based or hospital-related facility, the doctors' offices are subject to little or no regulation. These surgeons may be top quality, but make sure they have the emergency-room type capabilities on premises in case something goes wrong.

2. Make your visit to the doctor count. Often the excitement and stress of a visit to a doctor means that the patient remembers little or nothing. So take a long a relative or friend who can perhaps take notes or help you remember what is said. You may want to also take notes or perhaps tape record the entire visit. A doctor should not object to that, as they know better than others how little many patients remember from a visit.

Take a list of questions with you and get answers to all of them. For example, what will the surgery be likely to accomplish and what are the chances of success? What are the other benefits and risks? How long does it take to recover, and what is your situation likely to be during the recovery process? If you don't understand something, ask the doctor to explain it again. If you are in doubt about your understanding, try to restate the doctor's answer and ask whether you got it right.

You want to know how many times the surgeon has performed the operation, and what has his success rate been. The same for the hospital because it is well established that especially for complex operations, practice makes perfect.

Depending on your insurance situation, you may want a clear understanding about fees. This is most important in the case of uninsured surgery, most notably plastic surgery, which is rarely covered. If the fees seem to high, don't hesitate to ask the doctor if some adjustment downward is possible.

3. Get a second opinion. And if you think you need more information or advice, don't hesitate to get a second, a third or whatever it takes. When your life and health are on the line, invest in what it takes to get the right medical outcome. Many insurance companies and HMOs will pay for second opinions and even multiple opinions beyond the second one. In some cases, they may require a second opinion as a condition of paying for the operation.

A second opinion serves multiple functions. It sheds light on whether the initial recommendation makes sense or is the best alternative. It also educates the patient in the process, providing additional understanding, raising questions that need to be answered, and clarifying alternatives and risks. It may also educate the surgeon when he has the benefit of other opinions.

But you have to make sure the second opinion isn't just a rubber stamp of the first opinion. You don't want the surgeon's partner or other associate giving the second opinion. You should try for a totally independent opinion and perhaps another viewpoint. So you may want to go to another office or to a doctor admitted at other hospitals. In some cases, you may want to go out of town.

Keep in mind that doctors are extremely reluctant to criticize a fellow practitioner. So sometimes it is a good idea not to let them know what the recommendation was that you are checking.

But you want that second opinion from a true expert. Many advise going to one of the academic medical centers of excellence. Here in eastern Pennsylvania, you have access to some of the nation's leading surgeons and leading institutions in Philadelphia, Baltimore, New York and even beyond if necessary.

You may want to get opinions from different kinds of specialists. For example, urologists are likely to recommend surgery for prostate cancer. Radiologists and radiation oncologists are most likely to recommend radiation. Other specialists might recommend hormone treatment, perhaps no treatment at all or perhaps some other treatment.

Some hospitals have so-called second opinion services to bring together a large interdisciplinary team of doctors and other health-care providers to render a second opinion (or perhaps multiple opinions if the team doesn't agree). This is an efficient method of getting many different viewpoints from many different experts wrapped into a second opinion. For example, the Lehigh Valley Hospital and Health Network maintains a Urologic Cancer Second Opinion Service. The main drawback of this approach, despite obvious advantages, is that the group usually comes from the same hospital.

Experts agree that second opinions often change the initial thinking of the patient. The Johns Hopkins Family Health Book cites a study showing that the rate of Caesarian sections dipped from 18 to 11 percent when second opinions were required. Even if the second opinion doesn't change the decision, as we've seen, it is still likely to add to the understanding of the medical problem and better equip the patient to make a sound decision and also to carry through with the recommended treatment.

Another kind of second opinion involves the pathology report. Just as doctors often disagree over the need for surgery, there can be dramatic disagreement over a pathology report. One expert may say it's cancer, the other that it is not. So the second opinion on pathology is sometimes as important or even more important than the surgery opinion itself. Whenever findings are ambiguous or otherwise subject to doubt, a second opinion on pathology is a good idea.

When opinions differ, the patient has to make an informed decision, often with the help of the family doctor, other advisers and the doctors whose opinions are in conflict.

4. Be especially on guard if one of the operations most often unnecessarily performed is proposed for you. Among those, according to Charles Inlander of the People's Medical Society, are hysterectomies, Caesarian sections, cataract surgery and prostatectomy (removal of the prostate).

Some critics would add that women should also be especially wary of surgery because of the surgical statistics involving operations performed only on females, which seem to be done in excessive numbers. Laurence and Weinhouse, in their book Outrageous Practices, write, "A list of the country's most common inpatient operations is dominated by surgery performed exclusively on women. ... That the most common operations in the country are procedures for which only half the population is eligible is truly astonishing."

5. The patient, not the doctor or surgeon, is supposed to - and is entitled to - make the decision on whether to have surgery. Listen to the experts. But remember, it's still your decision. You're the one that will have to live the consequences of surgery, whether good or bad. You also want the decision to reflect your values and objectives. You're entitled to have the facts you need and you're entitled to decide whether or not to go ahead with the surgery. As the title of the old television show goes, "This is your life."

Herb Denenberg, a former Pennsylvania insurance commissioner and professor at the Wharton School, is a longtime Philadelphia journalist and consumer advocate. He is also a member of the Institute of Medicine of the National Academy of Sciences. His column appears daily in The Bulletin. You can reach him at advocate@thebulletin.us.

It's not just what you eat, but also what you write

It's scientifically proven: The key isn't just what you eat, it's what you write.

If you're anything like me, you have no idea how much food you take in on a day-to-day basis. Thanks to multitasking, grabbing grub on the go, parking myself in front of the TV while munching, and various other weight-loss crimes, I often barely register that I'm eating. Take last week: I was totally oblivious that I was popping jelly beans into my mouth until my nephew complained that I was about to polish off his bag (sorry again, Jake). It's tough to watch every mouthful you eat, even if you're an expert. Researchers at Louisiana State University asked dietitians to estimate their daily caloric intake — and even the professionals low balled the number by 10 percent. That may explain why it's so hard to shed pounds, no matter how good the plan is.

But there's a simple solution: Keep a food diary. Studies show that a journal doesn't just aid weight loss — it turbo-charges it. When researchers from Kaiser Permanente Center for Health Research followed more than 2,000 dieters who were encouraged to record meals and snacks, they found that the single best predictor of whether a participant would drop weight was whether the person kept a food diary. It trumped exercise habits, age, and body mass index. The number of pounds people lost was directly related to the number of days they wrote in their log. (It's no coincidence that Weight Watchers, one of the most successful diet programs, asks participants to track what they eat.)

Here are five more reasons to start a journal today — even if you swore off diaries in middle school.

1. You'll get a reality check about how many calories you consume.

Americans typically underestimate their daily intake by about 25 percent, reports nutritionist Carrie Latt Wiatt, author of Portion Savvy. The situation gets even more complicated when you eat out. In a 2006 study led by Cornell University, 105 diners in fast-food restaurants were asked how many calories were in their orders. For the small items, almost everyone guessed correctly; for the larger orders, the diners underestimated the calories by a whopping 38 percent. It may be an issue of perception, says study author Brian Wansink, Ph.D. The larger the quantity, the harder it is to make an accurate guess — the same is true for distances and heights.

Even professionals can be tricked by hefty portion sizes. When an NYU researcher asked 200 dietitians to estimate the calorie count of four popular restaurant dishes, the experts lowballed the number for each by a whopping 250 to 700 calories.

So stop assuming and start calculating. A good manual, like the classic Calorie King Fat & Carbohydrate Counter, makes it easy by giving you the calorie counts and fat grams for a huge number of foods. Or try nutritiondata.com, which also lists the stats for many foods.

2. You'll cut back on between-meal munching.

Make a mental checklist of what you ate yesterday. Sure, you can probably remember breakfast, lunch, and dinner — but what about that mini Snickers you snatched from your coworker's stash? Or that spoonful of mashed potatoes you took off your husband's plate?

It's easy to overlook bites, licks, and tastes (known as "BLTs" to professionals). But that's a huge mistake — there are 25 calories, on average, in each mouthful. Translation: Six little bites a day add up to around 15 extra pounds a year.

"I remember one client who was keeping a diary and couldn't understand why she wasn't losing weight," says Bethany Thayer, R.D., spokesperson for the American Dietetic Association. "We were discussing the problem when she took out a peppermint. I asked her how many she ate every day, and she said, ‘A bag.' They're nine calories each, but the whole bag is several hundred."

Writing everything down can also help you make smarter food choices. If you often order a Starbucks Grande Dulce de Leche Latte, entering the data will bring you face-to-face with the fact that your beloved drink packs 440 calories, versus 23 calories for the same-size regular coffee with milk.

3. You'll discover where your diet detours.

"I thought I ate a lot of vegetables — it seemed like I was constantly cooking spinach, broccoli, or Brussels sprouts," says Melissa Smith, a 32-year-old mom from Omaha who's been keeping a food diary for the past 18 months. "But looking back over a few weeks of my journal, I was surprised to realize that I was only eating veggies once or twice a week." So she made salads a regular part of dinner and noticed that it helped her eat less of her entrée. Her analysis and follow-up action paid off: She's lost more than 27 pounds.

A balanced diet is the key to weight loss, says Suzanne Farrell, R.D., who owns Cherry Creek Nutrition in Denver. "Whole grains, low-fat dairy, green vegetables, orange veggies, beans, nuts — science shows that we need to eat these regularly to reach a healthy body weight. So when I flip through my clients' journals, I always look for what I'm not seeing."

To find out how many servings of each food group you should be eating, go to mypyramid.gov. This tool will calculate the correct portions based on your age, gender, height, weight, and level of physical activity. It'll also tell you the number of calories you should aim for daily to lose weight.

4. You'll learn why you pig out.

Experts suggest that, to help break bad habits, you record not only what you eat, but the circumstances that prompt you to eat. For example, maybe you indulge in more sweets at work because you sit close to the vending machine. Maybe you have a milkshake several times a week because you pass Wendy's on the way home. Or maybe every time you worry about money, you retreat into the kitchen for chips.

When you begin to notice these patterns, you can figure out ways to change them. If the vending machine is a constant temptation, stock your desk drawers with fruit and granola bars. If you can't resist a fast-food sign, MapQuest a new route to work. If you eat when you're under pressure, steer clear of snacks and take a short walk instead (it's a scientifically proven stress buster).

Another bonus: "When you increase awareness of what's going into your mouth," says Thayer, "you'll feel fuller sooner than if you were just mindlessly munching."

5. You'll see real results — quickly.

Your food diary can be as revealing as the one you kept in fifth grade. For example, to get a glimpse into how much you've improved your diet, compare the entries in week one (Twinkie-filled) to week four or five (ideally, veggie-filled). You can also discover which decisions translated into pounds lost — for instance, that week you had fish for dinner twice might've helped you lose weight.

Food journals also let you give yourself credit where credit is due (personally, I reward myself with a gold star each day I resist eating candy). And that positive reinforcement is essential for shedding pounds.

How to Write Off Pounds: A Cheat Sheet to Get Your Food Diary Started

Choose Your Medium

If you're using pen and paper, buy a regular spiral notebook. Or go for a pre-organized book like the DietMinder. Computer addicts should check out online journals, such as myfooddiary.com ($9 per month) and nutrihand.com (free for a basic plan; $10 per month for extras). If you can't live without your PDA, visit weightbydate.com and download the software (starting at $19).

Start Recording

The crucial info to write down: the time you ate, what you ate, and how much you ate. Make a habit of jotting notes right after you eat. "If you wait until the end of the day, it's too easy to leave things out," warns Suzanne Farrell, R.D. Tracking your diet online? Remember to take paper with you to restaurants, so you can write down every ingredient and calculate its nutritional content afterward.

You may also want to invest in measuring cups — they'll help you learn what a one-and-a-half-cup portion looks like (it's a lot less than you think) — as well as a calorie-counter book and a calculator. Armed with these tools, you can track your calories like a nutritionist would.

Get Personal

Customize your diary so it reflects the info that's most useful to you. For example, if you're someone who eats whenever food is in front of you, create columns in your journal to rate how hungry you were before and afterward. If you snack your way through hard days, add a column to describe how you were feeling when you ate. Trying to figure out when you're most drawn to junk food? Record where you were when you indulged and what was going on at the time. Also, if you're trying to break a specific habit, like scarfing down ice cream at night, create a column for that, so you can give yourself a star for each day you resist the urge.

Be Honest

Include every single bite, lick, and taste (anything larger than a crumb counts). And don't forget to keep track of your sips. Even the most diligent diarists often forget to include the glass of white wine they had at dinner (120 calories) and their 3 p.m. can of Coke (155 calories).

Find Your Favorites

Counting calories is easier for creatures of habit: If you have a bowl of cereal for breakfast almost every morning or a turkey sandwich three times a week, you won't have to look up the number each time.

Keep Your Diary Close

"I'm forgetful, so I always need to put the journal where I can see it — on my kitchen table, on my desk at work. I carry it a lot in my hand, too, as a reminder," says Melissa Smith, 32, of Omaha, who lost 25 pounds keeping a food diary.

You can also try this trick from Maryellen Mealey, 42, of Chicago, who lost big (188 pounds) keeping a journal: "I made a deal with myself that I wouldn't eat anything unless I wrote it down first. It's obsessive, but I'm a mindless snacker and putting everything in the book really helped me be more conscious," she says.

Examine the Evidence

No matter how diligent you are, a food log won't help in the behavior-changing department if you don't analyze it. At night, sit down and calculate how many calories you consumed. Tally up what food groups you're eating, and make adjustments. (A big plus of online tools is that they do a lot of the analysis for you, totaling everything with a click of a button and often giving you charts to show what you can improve.)

You may also want to consult a registered dietitian. A professional may see things in your diary that you don't (cost: usually $50 to $300 for an initial consultation). A two-year study from Fred Hutchinson Cancer Research Center in Seattle showed that participants who consulted a dietitian had better success keeping off weight than those who followed their usual diet.

Reward Yourself

"I read that it takes 28 days to build a habit," says Mealey. "So when I have a new goal — like eating veggies more often — I do it for a month, then treat myself by shopping or going to a movie with a friend. Rewards give me an incentive to keep going."

Weight loss - just the facts

Keeping is simple is the best way to not only lose weight, but keep it off, too. There are some clear-cut certainties, rules, unchanging facts and formulas regarding weight loss that really never vary. If followed, you will lose weight.

So, for just a moment let’s look only at the facts - take emotion, psychology, and personal history out of the equation, and let’s look at the simple rules of weight loss.

Just the Facts:

1. If you spend more calories than you take in, you will lose weight. Just like your bank account, if you spend more than you put in, your bank account or, in this case your body, will shrink.

2. Adding (more) exercise, and not changing your diet at all, will cause weight loss only if you are burning more calories than you are taking in (as it states in rule 1). So if you are exercising enough to push the equation over to the deficit column (where you are basically in the red with calories - spending more than you are taking in), then you will begin to lose weight.

3. Reducing your food/caloric intake and not adding exercise will result in weight loss only if you have reduced food intake enough to tip the energy balance to the negative, whereby you are taking in less than you are expending.

4. Obviously, adding exercise, and reducing your caloric intake, will make it more likely that your equation will swing over to the negative – the weight loss side. And of course, the greater the difference between intake and expenditure, the faster the weight loss (or gain, depending on which way the equation swings).

To maximize your health and weight loss benefits, add exercise and reduce food intake.

I am not belittling the difficulty of losing weight, but there is a kind of simplicity to the plain facts. Still, few of us, if any, are able to be totally objective and mathematical about weight loss.

We have managed (or our society has) to make our bodies and our weight, emotional and social and psychological subjects, making it tough to take weight off simply, and harder to keep it off. And believe me, I understand, I am no different from you.

But I do realize one thing: Whether you are agonizing over losing 2 lbs or 200 lbs, looking at weight loss as a formula can provide you with some simple, practical, and effective steps that can be taken. And just knowing that this formula is fact, and works, just looking at the black and white of it and seeing that there are absolute and realistic steps that will lead to weight loss, may help someone, maybe you, who is struggling with body issues and weight loss.

So if you can, even for a brief period of time, separate out the discomfort, frustration, personal reasoning, and self resentment from prior attempts at weight loss that have failed, you may find the objective willingness to just keep moving forward in the equation – taking out a few calories here, adding a little exercise there, and so on – until the weight starts to fall away. And it will, if you stick to the rules.

I hope this helps you stay, or get back on, your road to better fitness.

Peace and Happy Trails-
Debbie Rocker

British woman had a 4cm hole in her heart

A woman dismissed as lazy by her PE teachers at school has survived for 23 years with a 1.5in (4cm) hole in her heart.

Louise Banks would collapse during physical exercise and was branded a "fainty child".

The condition, dismissed as epilepsy by doctors, could have killed her.

But a new GP sent her for an ultrasound scan which revealed the hole, four times bigger than that normally considered a large defect.

Miss Banks, 23, had open heart surgery and is now home in Exeter, Devon, with her partner Matthew Folland, 30, and their son Ben, four.

She is looking forward to a normal life, playing sport and dancing.

She said: "I always knew there was something wrong, I could feel my heart start and stop. It was like a baby wriggling in my chest.

"I don't feel angry with the doctors for missing it."

Tips for a Healthy Lifestyle for Men

Here are some helpful tips from the CDC.

Eat Healthy

"An apple a day keeps the doctor away." There's more truth to this saying than we once thought. What you eat and drink and what you don't eat and drink can definitely make a difference to your health. Eating five or more servings of fruits and vegetables a day and less saturated fat can help improve your health and may reduce the risk of cancer and other chronic diseases. Have a balanced diet, and watch how much you eat.

Maintain a Healthy Weight

Obesity is at an all time high in the United States, and the epidemic may be getting worse. Those who are overweight or obese have increased risks for diseases and conditions such as diabetes, high blood pressure, heart disease, and stroke. Eat better, get regular exercise, and see your health care provider about any health concerns to make sure you are on the right track to staying healthy.

Get Moving

More than 50 percent of American men and women do not get enough physical activity to provide health benefits. For adults, thirty minutes of moderate physical activity on most, preferably all, days of the week is recommended. It doesn't take a lot of time or money, but it does take commitment. Start slowly, work up to a satisfactory level, and don't overdo it. You can develop one routine, or you can do something different every day. Find fun ways to stay in shape and feel good, such as dancing, gardening, cutting the grass, swimming, walking, or jogging.

Be Smoke-Free

Health concerns associated with smoking include cancer and lung disease. Smoking triples the risk of dying from heart disease among those who are middle-aged. Second-hand smoke - smoke that you inhale when others smoke - also affects your health. If you smoke, quit today! Helplines, counseling, medications, and other forms of support are available to help you quit.

Get Routine Exams and Screenings

Sometimes they're once a year. Other times they're more or less often. Based on your age, health history, lifestyle, and other important issues, you and your health care provider can determine how often you need to be examined and screened for certain diseases and conditions. These include high blood pressure, high cholesterol, diabetes, sexually transmitted diseases, and cancers of the skin, prostate, and colon. When problems are found early, your chances for treatment and cure are better. Routine exams and screenings can help save lives.

Get Appropriate Vaccinations

They're not just for kids. Adults need them too. Some vaccinations are for everyone. Others are recommended if you work in certain jobs, have certain lifestyles, travel to certain places, or have certain health conditions. Protect yourself from illness and disease by keeping up with your vaccinations.

Manage Stress

Perhaps now more than ever before, job stress poses a threat to the health of workers and, in turn, to the health of organizations. Balancing obligations to your employer and your family can be challenging. What's your stress level today? Protect your mental and physical health by engaging in activities that help you manage your stress at work and at home.

Know Yourself and Your Risks

Your parents and ancestors help determine some of who you are. Your habits, work and home environments, and lifestyle also help to define your health and your risks. You may be at an increased risk for certain diseases or conditions because of what you do, where you work, and how you play. Being healthy means doing some homework, knowing yourself, and knowing what's best for you... because you are one of a kind.

Be Safe- Protect Yourself
What comes to mind when you think about safety and protecting yourself? Is it fastening seat belts, applying sunscreen, wearing helmets, or having smoke detectors? It's all of these and more. It's everything from washing your hands to watching your relationships. Did you know that men at work die most frequently from motor vehicle incidents, machine-related injuries, homicides, and falls? Take steps to protect yourself and others wherever you are.

Be Good to Yourself

Health is not merely the absence of disease; it's a lifestyle. Whether it's getting enough sleep, relaxing after a stressful day, or enjoying a hobby, it's important to take time to be good to yourself. Take steps to balance work, home, and play. Pay attention to your health, and make healthy living a part of your life.

164 pounds lighter in 14 months

At 164 pounds lighter than he was 14 months ago, Roshon Vance is a living example that gastric bypass surgery can work.

But unlike the estimated 140,000 or more Americans who stay stateside for the procedure, the Shreveporter is one of an increasing number of people who have searched the globe for a better price.

Vance received his bariatric surgery for $9,000 in Mumbai, India, in December 2006. A price that compares to the $35,000 he was told it would costs stateside. His insurance would not cover the procedure.

He also decided to have a hair transplant for $1,400 and received almost an entire set of crowns and some bridge work for $3,200.

"I did extensive research before I went and I have no regrets whatsoever," said Vance, who is returning to Mumbai on Friday for a face-lift and perhaps a body-lift. "In the U.S., the same procedures would have cost me over $75,000."

It's not possible to track exactly how many Americans are traveling abroad for health care, but some experts estimate as many as 1 million Americans will travel for health care to another country in 2008 and that the industry could be worth $20 billion by the end of the decade.

"Medical tourism has definitely been a consumer-driven phenomenon," said Neilesh Patel, founder and CEO of not-for-profit Healthcare Tourism International, which provides unbiased health travel information to consumers and provides accreditation for health tourism companies.

"Nobody has been able to explain how they achieved those industry numbers," said Patel in a phone interview. "But we know it's an industry that is growing and we know its growing very rapidly."

Health care experts are following close behind, pushing a global standard of care.

In November, top health leaders from six countries (Canada, Germany, the Netherlands, New Zealand, the United Kingdom and the United States) met in Washington, D.C., to sign a letter of intent to support efforts of a special World Health Organization (WHO) Action on Patient Safety Initiative. The collaborative initiative, known as the High 5s Project, seeks to improve the safety of patients around the world.

A growing number of overseas hospitals also have sought accreditation under the Joint Commission International, the international arm of the Joint Commission on Accreditation of Healthcare Organization, which accredits U.S. hospitals and other facilities.

A list of those hospitals, which include eight in India and three specifically in Mumbai, can be found on the Joint Commission International Web site.

Vance didn't initially seek a foreign hospital for his gastric bypass surgery. Before choosing Mumbai, he'd gone to a bariatric surgeon with the hopes his insurance would cover the cost.

"I was 370 pounds and my blood pressure had skyrocketed," said Vance, who knew he had to make a change. "My doctor recommended me for the surgery, but my insurance wouldn't cover it. I contacted 15 other hospitals and nobody would even take partial payments. They all wanted the $35,000 up front."

Vance didn't give up. Instead, he remembered a special on medical tourism he saw on "60 Minutes" a year before.

"I knew there had to be a solution," said Vance, a former disc jockey at radio station Magic 102.9 who relocated to Shreveport in April. He was living in Atlanta at the time of his surgery and will become operations manager of a station in Little Rock, Ark., at the end of March.

Vance found three hospitals he was considering; one in Thailand, one in Buenos Aires, Argentina, and the other in Mumbai.

His communication with the staff at Mumbai was so good, he choose to travel to India even though it was the farthest away.

"I didn't know what to expect, but found the hospital to be state-of-the-art," said Vance, who met four other Americans and several other foreigners the month he was there. "The medical care I received was great. I am also impressed by the fact that these people could have taken my money or discharged me and never contacted me again, but I hear from them almost weekly."

Vance took all of his records with him to India and came back with all of his new records, too.

"Unlike an American hospital, the checkout is a four- to five-hour process," Vance said. "They go through every bit of medical information."

Vance's face lift, which will include a neck lift and brow lift, will cost him about $3,000 to $6,000, which he estimated would have cost him $15,000 in the United States. His body lift also will be about $3,000, which he found would have been about $20,000 in the United States.

Vance did his research, but Patel and others speculate many patients don't.

"The issue in developing countries is that health care quality is much more varied than in the United States," Patel said. "Some may be better and others worse."

Also, because the number one motivator for Americans to go abroad seems to be the cost, it makes patents more vulnerable to risks, he added.

"Many of these patients do not have other affordable options in the United States. This desperation has made some more likely to overlook normal precautions," Patel said.

Many U.S. surgeons also are wary of risks.

The American Society of Plastic Surgeons has issued a briefing on the subject, cautioning potential patients of the difficulty in assessing credentials.

Shreveport surgeon Kenneth Sanders agrees.

"I don't have as big a problem where someone has a procedure, as much as I have a problem with it being treated as a commodity," said Sanders, a board-certified surgeon in facial plastic and reconstructive surgery. "You look for a price break at the grocery store, do you really want to take that (type of thinking) all the way to surgery?"

Sanders' concern would be for consumers to be knowledgeable about the credentials and standards being used by a foreign hospital and its surgeons.

"There's so many standards here when someone tells you something is sterile, it's sterile," he said.

Patel's organization hopes to help patients make safe decisions with information on its Web site at healthcaretrip.org.

"We expect that patients will eventually use our Web site to find accredited medical tourism operators and other companies that provide health tourism services," said Patel, whose company takes no sides on the issue. "Individuals need to weigh that out for themselves if traveling abroad is right for them. We represent all the groups involved in health travel, including patients. We thought the industry needed a neutral organization."

"I'd recommend it to anyone," Vance said. "I'm proud to be an American. But the health care in the United States is almost cost prohibitive; and if I see something that will benefit me, I'm going to try it."

Massachusetts struggles with health reform law

Massachusetts Gov. Deval Patrick has been boasting that his state's health reform initiative has reduced the number of uninsured by half, with nearly 300,000 more people added to the health insurance rolls. What he doesn't say is that four out of five of them are relying heavily on taxpayer subsidies for their coverage.

Of the 293,000 people newly insured in Massachusetts:

• 160,000 earn less than $63,600 (for a family of four) and are enrolled in taxpayer-subsidized plans. More than half of them pay no premiums, and most others pay only a modest amount.

• 70,000 people were added to the rolls through expansion of the state's Medicaid program.

• Only 63,000 -- or about one in five -- have purchased private insurance.

Further, about 60,000 are being exempt from the mandate that all citizens must buy coverage, showing how elusive the goal of universal coverage will be, even for a state that had a relatively low uninsured population to begin with.

And costs are still an issue:

• Massachusetts now estimates that its spending on the new program for the uninsured may exceed its budget by nearly $150 million.

• The penalty for not complying with the mandate is steep. Individuals who don't get insurance this year -- or don't get an exemption -- will face a fine of $912, four times last year's penalty and scheduled to increase each year.

• The state "negotiated" with the health insurers participating in the Commonwealth Connector to keep premium increases to about 5% this year. But the insurers said in order to keep their prices down, they warned they have to increase copayments and/or deductibles and/or cut benefits. Many newly-insured say they have trouble finding primary care physicians who will see them.

• And to show how hard it will be to get to a point that everyone will be able to get "coverage as good as members of Congress have," in Massachusetts, a gold-plated Blue Cross Blue Shield plan in the Connector would cost a family of four about $23,000 a year.

Further, the state is trying to figure out what to do with those businesses that already are offering coverage but whose policies don't comply with the higher standards set by the government. Should they be exempted, forced to pay for more expensive coverage, or be fined?

Gov. Patrick and other governors were in town this week pleading with Congress to reverse the administration's Medicaid and SCHIP reform policies, saying they would threaten their ability to expand or even sustain coverage. That's because Massachusetts and other states rely heavily on federal payments for their expansion plans. The president wants them to focus on covering poor children and needy citizens first.

Since the Bay State's initiative is being seen by many as a model for the nation, it's important to pay attention. There is clearly no Massachusetts miracle here. Other states should certainly be cautious before proceeding.

Health care debate in the USA

One of the flash points in the Democratic party primary battle between Barack Obama and Hillary Clinton is the debate about health care in the United States.

Millions of Americans live without medical insurance, and many of them are not waiting for the government to act.

The following is a transcript from KXAN Austin News' Jim Swift, who has a special report on the experiences of two Austinites who ventured into the world of medical tourism.

Perhaps you are one of those living without medical insurance.

If not, imagine for a moment that you are, and that you face every day hoping nothing goes wrong.

Then it does. What would you do?

Much of what we hear about India is evidently true. There are lots of people, for one thing, leading to lots of traffic and lots of pollution. Monkeys are not limited to the jungle, and cows are not limited to the barn.

We get fresh evidence of all this from Austinite Steve Roach, who arranged a medical tourism trip to India with his friend Frank Murphy.

"You got a good deal here," Roach says."There's a typical tourist," Murphy says.
Last year, Roach, who has only the bare minimum of health insurance, discovered he needed triple-bypass heart surgery.

"Come on now, they were quoting me $48,000 to $85,000, just for the hospital here," Roach says. "That's not the doctor or the anesthesiologist, and you could get 11 days there, all costs, for $12,000. Quite a difference."

"If this alternative had not been available to you, what would you have done?" Swift asks."I would have had to have gotten it here," Roach says."And how would you have paid for that?" Swift asks."Bankruptcy, I imagine," Roach says. "I wouldn't have much choice."

"Based on your experience, watching Steve, is this something you would do if you needed to?" Swift asks.

"If I had to," Murphy says. "Thank God I'm on Medicare, and I don't have to worry about the expenses the way Steve did. But if I were in a similar situation, as far as needing it and not being able to afford it here, yeah, I'd do it."

"People, when they hear you went to Thailand for medical care or a dentist, they kind of have a cultural prejudice, I think," says Leighton Hodges. "People have this stereotype of Thailand of just substandard care, and it's just not the case."

Hodges, another medical tourist from Austin, so thoroughly ground his teeth that his dentist told him he needed major work.

"The dentist said with this dental gum surgery and everything it would be thirty-seven thousand, five hundred and something dollars," Hodges says. "And I took a deep breath, and I said, 'Thank you very much.'"

"This is Tom Cruise and see how he smiles? I think now your smile should be better than this," says a Thai dentist.

Hodges spent more than three months in Thailand and only spent $10,000.

"The lady really knew what she was doing," Hodges says. "So I got a lot of compliments, and people would say, 'You look younger,' or, 'You look better somehow.'"

"In my opinion, you get what you pay for and I really, as a dentist of 20 years, the dentistry I've seen from foreign countries, even with a dentist from America, it is just, it's not good," says Dr. Merrily Sandford.

"There's plaque; this is plaque underneath the crown; this tooth had decay," Sandford says.

As it turns out, the seals leaked on four of Hodge's mouthful of new crowns.

"but even with the four that I'm going to have to, that I'm in the process of replacing, I'm still saving a whole lot of money, and I had a wonderful vacation," Hodges says.

Hodges did his own research and set up his own contacts in Thailand.

Roach, on the other hand, arranged his trip to India through Healthbase, a company that connects patients to more than 200 medical, cosmetic and dental procedures in eight countries around the world.

Weight loss surgery in Thailand

At www.medicaltourisminthailand.com we focus on helping our clients select the best doctors and hospitals at the most competitive price, for their particular procedure. Here is a typical detailed response for a patient requesting details on lap-band surgery:

My recommendation for this particular procedure - lap-band or stomach banding, is Samitivej Hospital in Sriracha, about 40 minutes outside of Pattaya. The Director there, Dr Somchai, is not only a skilled surgeon but also is a graduate from Harvard Business School and he has assembled a fine team of surgeons to work with him. His hospital is widely used by the CEO's and employees and families of the several large Japanese companies in Sriracha, and the hospital is keen on attracting International patients. For this reason you will find that the pricing is very competitive and you will love the friendly approach and welcoming attitude of the doctors, nurses and international staff. Their prices are considerably lower than at Chiangmai Ram, Bangkok Hospital Pattaya, Bangkok Hospital Phuket, Bangkok Medical Center and Bumrungrad Hospital - although I would be happy to refer you to the best doctors at these hospitals if you prefer.

Dr. Somchai and his team will spend all of the time necessary with you, finding out exactly what you would like to achieve, and then they will meticulously perform the procedure to your satisfaction. Recently the hospital has had many American patients from Iraq for abdominal surgery - tummy tucks, liposuction, gastric banding and lap-band. The first patient came over and she was so pleased with her surgery, the doctors and the hospital, that within a few weeks several of her friends came over for similar procedures.

Regarding the surgeons' qualifications Dean, all are certified surgeons having completed advanced training, Fellowships or Internships in the United States, Europe or Australia following their medical school training at various Universities in Thailand. All are very experienced in their particular field of surgery (for instance they normally specialize in one particular area of competence; facial surgery say, or abdominal surgery, breast surgery or bariatric or weight loss surgery, and typically, each year they will perform many more surgeries in their particular field than their counterparts in the USA, Europe or Australia.

Samitivej Hospital, Sriracha - near Pattaya:
Lap band surgery including 3 nights in hospital: 320,000 baht (about AUD $10,670, US $9,145) .
Note that these are all inclusive treatment prices with no additional fees added to surprise you later. Initial tests and diagnostics, the procedure and all doctor, nursing and hospital care, medications and follow up visits while in Thailand. There is no waiting time for the surgery and the hospital will schedule the procedure at your convenience Dean

BMC, Bangkok (also highly recommended but more expensive)
Lap band surgery including 3 nights in hospital: 420,000 baht (about AUD $14,000, US $12,000). Expect additional costs for pre op tests and diagnostics and follow up visits with the doctor.

If you can afford the time Dean, I would spend at least 2 weeks first at the Lamphun (near Chiangmai) weight loss program (www.thailand4wellnessprograms.com)

2 week course: US $1,590
3 week course: US $2,260
4 week course: US $2,850

I have seen some amazing results there and it's well worth trying before you go to the expense and trauma of surgery. Even if it did not result in the weight loss you are looking for, this initial weight loss would be a great help in the ease and success of the surgery - the more weight you lose before the procedure, the easier the surgery. I spent a day there recently and cannot imagine a better place to effectively lose weight.

Dental prices also attached Dean, in case you are interested in dental treatment. This is a new clinic that recently opened in Pattaya and many of the expats that live here prefer Dr. Nan and his team at Thai Smile to the much more expensive hospital dental clinics. I'm presently having a complete dental makeover there after seeing the results with two Australian ladies who came over recently. Laser teeth whitening for instance is 6,000 baht or about AUD $200 or US $175.

One especially nice thing about Samitivej - their quote during your initial consultation with your doctor is the exact, all inclusive price with no extra costs added as they do in many hospitals. It includes any pre op tests and diagnostics, the procedure, hospital stay if any with doctor and nursing care and any follow up visits. Compare this with the other hospitals where they charge up to 3,000 baht (about US $85 or AUD $100) for the initial consultation and the same for any follow up visits - plus inflated prices for medications etc.

It costs you nothing extra to book your appointment through Thailand4Healthcare, but it does give you the advantage of an independent assessment of the wide choice of doctors and hospitals. Don't make the mistake of relying on the hospital to select your surgeon from their duty list. We also provide friendly assistance during your complete stay in Thailand, making sure that you have a wonderful experience here and providing any liaison with the doctors, hospitals and hotels. You pay the hospitals and hotels directly at their normal rates (although our company does review the hospital charges to make sure you are not being overcharged).

If you decide to go ahead Dean, please book your appointment on line at http://medicaltourisminthailand.com/applicationform.htm . We will take good care of you while you are in Thailand, and Janey (your Concierge, photo attached so you will recognize her) will be there to help with transportation, hotels, appointments etc.

Here's a list of the hospitals and clinics we represent in Thailand :

* Bangkok International Medical Center
* Bumrungrad Hospital
* TRSC Lasik Center, Bangkok
* Bangkok Hospital Pattaya
* Bangkok Hospital Phuket
* Samitivej Hospital, Sriracha
* Chiangmai Ram Hospital
* Thai Smile Dental Clinic
* Ram Hospital, Chiangmai
* Wellness and Weight Loss Centers in Lumphon and Phuket
* Stough Hair Restoration Clinic, Bangkok

Looking forward to welcoming you to Thailand soon Dean - Pattaya (www.squidoo.com/relocatingtopattaya) is a great place to start enjoying yourself while making a real difference in your life. I will spend all of the time you need going over all of the options - but plan on at least a month here if possible. Taking just few weeks out of your life now could benefit you for a lifetime. And if you have never been to Thailand you are in for a wonderful experience. Warm regards - Pete

Dental care in UK is highest in Europe

Dental treatment in England is the most expensive in Europe, according to an unprecedented survey which is likely to fuel the exodus of patients seeking treatment abroad.

The survey of nine European countries found the total cost of a standard filling ranged from €156 (£117) in England to €8 in Hungary. That total included the cost of x-rays, materials, drugs and overheads, as well as the dentist's time.

The findings come amid growing dissatisfaction with dentistry in Britain and shrinking NHS provision. The Government admitted last March that two million patients who wanted NHS treatment were unable to get it, eight years after Tony Blair pledged at the Labour Party conference in 1999 that everyone would have access to an NHS dentist.

Dentists have dramatically increased their private work over the past decade, at the expense of their NHS work, and when a new NHS practice opens, desperate patients queue to register.

Dentists with their own practices earned an average of £105,000 in 2004-05. More than half their total income (52.4 per cent) came from private work, up from 41.8 per cent in 1999-2000. In 1990 it was 6 per cent.

While England topped the table as the most expensive country for dentistry at €156 for a filling, it was closely followed by Italy (€135) and Spain (€125). Costs in the other western European countries were less than half as much, ranging from €67 in Germany to €46 in France.

In all European healthcare systems, the greater the cost of carrying out dental work, the greater the level of government subsidy required to keep the price of dental treatment down for patients.

The cheapest countries for treatment were Poland (€18) and Hungary (€8), the main destinations for dental tourists from Britain. Savings of thousands of pounds are promised by agencies that arrange treatment in these countries, even after paying the cost of flights and hotel bills.

It is the first time that the cost of carrying out a dental filling has been compared across Europe. Siok Swan Tan, of the Institute for Medical Technology Assessment, at Erasmus University Rotterdam, and lead author of the study, said differences in dentists' earnings were the most important reason for the variation in costs. "Without exception, labour costs were the most important cost driver in all countries and practices," she said. "They accounted for 70 per cent of total costs in England. They ranged from €0.09 per minute in Hungary to €2.88 a minute in England."

The figure for England included material costs which "makes straightforward comparisons difficult", she said. The procedure was a filling in a molar tooth in a 12-year-old child.

High costs and the difficulty of finding NHS dentists have combined to make dental tourism the fastest growing category of medical tourism. Of 77,000 travellers from the UK who went abroad in 2006 for medical treatment recorded in the International Passenger Survey, an estimated 43 per cent sought dental care, according to the agency Treatment Abroad.

Keith Pollard, its managing director, said: "Dentistry is the biggest part of the business. The number of providers targeting the UK at the moment is phenomenal. It is driven by the high prices charged in the UK and the difficulty of finding an NHS dentist. When you find a private dentist the prices are shocking."

NHS patient charges are in three bands ranging from £15.90 for a check-up and x-ray to £43.60 for one to six fillings, to a maximum of £194 for crowns or root treatments. Private charges are two to three times higher.

The British Dental Association rejected the research as "deeply flawed". Peter Ward, its chief executive, said it was based on a sample of four practices out of 10,000, and was "riven with problems".

"It is a very small sample, it is not representative and it is not comparing like with like," said Mr Ward. "The dentists selected were community dentists who normally care for patients with special needs who need more staff and take longer to treat. It is impossible to make a sensible comment on a set of flawed data."

The survey is part of a wider study, commissioned by the European Commission, comparing the cost of a range of medical procedures among the nine countries and is published in the journal Health Economics.

Professor Reinhard Busse, of the department of health management at the Berlin University of Technology, who led the research, said: "We wanted to see if we could explain differences in the costs. The aim of the research is to help governments plan what levels of reimbursement may be necessary if, as we expect, cross-border medical tourism increases." The European Commission is due to publish draft plans which would open EU borders to medical tourists, allowing citizens of any of the 27 member states to seek treatment in a neighbouring country with the home country, in certain circumstances, picking up the bill. If the proposals are approved, it will focus attention on the performance of the NHS against other health systems.

The dentistry survey showed that in all cases the total cost of providing a filling exceeded the charge to the patient and in most it exceeded the payment from patient and government combined.

'I had to ask if the treatment was really needed'

Kath Diamond says her daughter Meg, aged 10, has "great teeth". So when she took her for a routine check-up at an NHS dentist in Putney a month ago, she didn't expect to embark on a series of appointments that would end in a bill for several thousand pounds.

But that's what happened after Meg was referred to an orthodontist in West Hampstead, who "immediately" said her teeth were not of the standard to qualify for further NHS treatment. According to the orthodontist, Meg had an "overshot" jaw and "mild crowding" in the lower jaw.

The proposed solution? A night-time head-brace and a removable day-brace for six months, plus 12 to 18 months of "railway track" braces on the upper and lower jaw.

After that she would need another brace every night for a period, followed by a day-brace a couple of times per week for the next decade – until she was 20 years old. After a "long consultation process", a bill was presented for £2,500 on Tuesday.

Mrs Diamond was staggered. "In the end," she says, "I asked, 'Is there a physical need for this treatment?'. They said Meg's teeth would be difficult to clean when older, and I think that is probably not true. It was all to give her the 'perfect' set of teeth."

With understatement, Mrs Diamond adds: "But that would have involved invasive treatment." Reflecting on the episode, she says: "There wasn't a sense of openness about it being what was, essentially, cosmetic surgery".

One in seven Americans lack health insurance

BRONX, N.Y. -- One in seven Americans don't have health insurance -- where do you go for help? Many are headed overseas for surgery. Traveling for health care that's not available, accessible, affordable or acceptable in the United States is a growing trend. Whether you don't have insurance -- or are refused treatment -- more and more people are headed overseas to get their medical needs met. For many, it's a life-saving trip that also saves them money.

"You're going to die because you don't have insurance … that's a scary thought," Kevin Stewart said.

"I was in the beginning stages of congestive heart failure, and so without the surgery, I would have died," Tom Hiland said.

"I can't afford it here. I'm one of those people who's just out of luck," Jeff Schult added.

Stewart, Hiland and Schult -- men left with few options and little time. Stewart's liver was failing -- without a transplant he would die.

Cost of care across the border
One in seven Americans don't have health insurance -- where do you go for help?

"I started feeling really lousy," he recalled.

Stewart is one of 45-million Americans who don't have health insurance. Many will either not get the health care they need -- or will need to look to other countries for more affordable care. In the United States, the out-of-pocket cost for Stewart would be $330,000. In India -- the cost -- $57,000!

"I could afford it. It was like, 'Hey, I can live. I don't have to die,'" Stewart continued.

Hiland also needed a life-saving surgery he couldn't afford. Congestive heart failure was threatening his life.

"I would probably not be here today if I had not had the surgery," Hiland said.

Denied insurance again and again. Surgery in the United States would set him back $200,000. In India, the 23 night hospital stay cost him $15000. The operation … done by an American-trained surgeon.

"I said is this possible that there could be such affordable treatment and high quality care compared to what we're brainwashed into believing in the U.S. … that we have the best medical system in the world?" Hiland asked.

Doctors in the United States are divided on the issue.

"Price is not the main mediator of service anywhere, but especially in health care," said Mark Solomon, M.D., a member of the American Society of Plastic Surgeons.

"It may be a reasonable decision if something that you need and you just cannot afford it here to take the risk," explained Arnold Berlin, M.D., associate professor of surgery at Albert Einstein College of Medicine in Bronx, N.Y.

But is care being comprimised? United States based Johns Hopkins now works with hospitals in Panama City, Panama and in Singapore, China. The Cleveland clinic owns facilities in Canada and Austria. Harvard is affiliated with facilities in India, and a new report by the National Center for Policy Analysis shows the 20-day mortality rate for patients undergoing heart bypass surgery is 0.8 percent -- the United States' national average is 2.9 percent. More and more Americans are deciding to go abroad -- using medical tourism companies to guide them.

No one can guarantee a good outcome, and many countries have no recourse for anything that goes wrong. But for many people desperate for affordable care, it's their only option. Schult is author of Beauty From Afar -- a book about his experience going overseas -- a divorced dad, with no extra cash and a mouth-full of rotting teeth.

"I stopped smiling. I had lost my smile," Schult added.

He did have insurance -- it would cover the cost of dentures -- but only if he waited for his teeth to fall out.

"I joke now, but I was kinda bitter about it," Schult continued.

He saved 70 percent to 80 percent by going to Costa Rica.

"I had a smile again. I had really given up on that and they gave it to me. I was very grateful," Schult said.

A feeling Hiland and Stewart share.

"It's a great thing to be feeling better every day and better than I have in well over a year," Stewart added.

"I like to say, two and a half years after having mitral valve surgery in India, that I'm still kicking, and my heart is still ticking," Hiland said.

Overseas surgery -- a big decision for anyone, but for these three men … it paid off.

The medical tourism industry has caught the eye of congress. Last year, the Senate held a hearing on the globalization of health care to determine what is at the root of the growing trend. It found the ease of international travel and the growth of quality care facilities in developing countries plays a role, as well as soaring costs of medical care in the United States.

Handshake saves British man's life

A man's life was saved by a chance handshake with a doctor, who diagnosed him with a life-threatening tumour.

Mark Gurrieri, 36, was working at a restaurant when a friend there for lunch introduced him to his dining partner, GP Chris Britt, 46, of Woodford Green, Essex.

The two men shook hands and Dr Britt noticed Mr Gurrieri's huge, spongy-feeling hand and his large facial features as symptoms of acromegaly - a tumour at the base of the brain, which can be deadly if untreated.

Mr Gurrieri had the 2cm tumour diagnosed last month after doctors confirmed the rare condition.

"My mum thinks Chris is my guardian angel," he joked.

"I could have lost my sight, or I could have had a number of other ailments, so I think I owe my life to Chris - and a few meals at the restaurant."

Dr Britt said he hadn't seen a case of acromegaly since he was a medical student. "It's the sort of diagnosis you might make once in a career if you're lucky. It's so rare most GPs wouldn't have seen patients with it."

Laser Hair Removal at BMC, Thailand

Bangkok Medical Center has a well equipped International Dermatology Center with expert dermatologists having a great deal of experience with Laser hair removal.

The Dermatologist can provide an accurate quotation based upon an initial evaluation with the patient, but here are some typical prices. The number of sessions will be determined by the area and density of the hair to be removed.

Area	1 session	2 sessions	4 sessions
	Price in baht	Price in baht	Price in baht
Face	7,500	13,500	25,000
Bikini	6,000	11,000	20,000
Under arms	5,000	9,000	17,000
Chest or back	10,000	18,000	34,000
Whole legs	20,000	36,000	68,000
Shin	10,000	18,000	34,000

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6 Simple Steps forWomen to look Younger

Six simple steps for women to look younger without surgery.

There's no way around it: by the time you finish reading this column, you will be older. You can't stop time. But perhaps you can cheat it a little. We're not talking about surgery here. That's a topic for another column. Instead, here are six relatively simple steps to looking younger in the new year that don't require a scalpel.

1. Get an eye exam
If you're 40 or older, you may have noticed that it's getting harder and harder to read fine print or to see close objects. That's because the lens of your eye becomes less flexible as you get older, leading to a condition called presbyopia or farsightedness. We know, it's hard enough to find time for regular physical and gynecological checkups. You've probably put a visit to the eye doctor on the back burner. But the National Institute on Aging recommends that after age 40 you should have your eyes checked every one to two years by an ophthalmologist or optometrist. That's not just good for your sight but for your appearance. Squinting a lot to see not only makes you look older but it will give you new wrinkles in the eye area, which you definitely don't want. So instead of straining your eyes or pointing to menu items and ending up with mystery meat, get an exam and invest in some reading glasses. Don't worry: that doesn't mean donning granny glasses. There are plenty of trendy pairs from which to choose. Who knows? Wearing a cool pair of specs might even make you look younger (or hipper, at least).

2. Get fitted for a new bra
Next time you're out shopping, take a look at the women around you. Chances are you'll see a lot of saggy boobs, which are instantly aging. Industry experts estimate that four out of five women are wearing the wrong size. Even five pounds lost or gained can affect your bra size. Your size may also change when you start or stop exercising and when you're pregnant or nursing. Because of these shifts, the average adult woman can go through six bra sizes in her lifetime. We suggest going to a specialist at a department store or a lingerie store for a fitting. She'll take two measurements. The band size is determined by the width of your chest at the smallest part of your back (and is usually measured under your breasts). If the number is even, you add 4; if it's odd, you add 5. To get the cup size, you put the tape around your breasts at the fullest point. The difference between that number and your band size tells you your cup size. For example, between a half inch and one inch is an A cup, two inches is a B, and three inches is a C. A new bra should be snug at the loosest setting. That way it will still fit on tighter settings after repeated wear and washing. The bra band should be parallel to the floor. Straps should not cut into your shoulders; if they do, it means they are carrying too much of the weight of your breasts. It's really the band that's supposed to do most of the supporting. Your breasts should fill the cups and not fall out of the sides or top. If the cop is puckered, that means it's too big. Even after you find the correct size, you may have to try on different styles to find one that works for you. Bras from different manufacturers may fit differently. Also, consider investing in a sports bra for exercising.

3. Use moisturizer
As you age, your skin becomes less taut. In your mid-30s you may begin to see fine lines around your eyes and mouth. These generally get more pronounced as you get older. The speed of skin aging depends on a combination of heredity and environment. Some people are born with skin that looks young forever; others appear to be 50 when they're only 35. But your skin will age faster if you smoke or have been out in the sun a lot without sunscreen. Women whose weight has fluctuated a lot also often have skin that's less firm. Using moisturizers won't provide a permanent fix, but it can provide a temporary lift. Look for a product that includes sunscreen, which you should also be using. We especially like tinted moisturizers with sunscreen: one-stop face care. And you don't have to spend a week's salary on face care products. Dermatologists tell us that drugstore brands (Oil of Olay or Neutrogena, for example) are every bit as effective as the fancy stuff sold in department stores.

4. Lift weights
Women are often afraid to lift weights because they think it will make them look bigger. But women generally don't build muscle the way men do—unless they go on an all-out weightlifting binge. In fact, increasing muscle mass may actually make you look leaner. Also, greater muscle definition makes your arms and legs look younger. You could be younger in other ways as well. Some research has shown that strength training may help your memory as you get older and helps stop the bone loss in aging that could lead to osteoporosis. Finally, muscle burns more calories than fat, so the more muscle you have, the more calories you burn. Many midlife women find they gain a pound or two a year. That may not sound like much, but it adds up. Holding the line is critical. In a 2006 University of Pennsylvania study of overweight and obese women, strength training dramatically reduced the increase in belly fat, which is important, because too much abdominal fat puts you at risk for heart disease and diabetes. If you haven't been exercising regularly, talk to your doctor before starting, to make sure you don't have any medical issues that would cause a problem. For people over 40 who are generally sedentary, the American College of Sports Medicine recommends weight training an average of three times a week for about 20 to 45 minutes per session. Also, let muscle groups rest 48 hours between sessions. Generally, the ACSM says working with machines is probably safer in the beginning than using free weights. You might also invest in a few sessions with a qualified personal trainer to learn how to use the machines correctly.

5. Smile more
Take a look in the mirror and you'll see that gravity does a number on your face as you age. You may think your expression is set at neutral, but to others the downward drooping may make it look as if you're scowling. So try to smile more and lift your look. Researchers have also found that smiling can benefit your mood. It's one of those "fake it 'til you make it" phenomena. Studies have indicated that moving the muscles that make you smile may trigger chemicals in the your brain that actually make you feel better.

6. Get enough sleep
If you're tired you automatically look older. People who don't get enough sleep—at least seven hours a night for adults—are also more likely to be at risk for heart disease and diabetes, among other medical problems. So resolve to pay attention to your sleep habits. Try to get up and go to bed at roughly the same time every day. Keep your bedroom somewhat cool, dark and quiet. Use it only for sleeping and sex—not to watch TV or pay bills (stimulating or stressful activities that can keep you up). If these measures don't help, talk to your doctor about any underlying emotional or physical issues that may be interrupting your sleep.

Yes, you're not getting any younger. But if you follow these six simple steps you may look and feel younger, which is as good as it gets. And, remember, when the compliments start coming, just smile!