Welcome   to   FreeHealthFacts.com   news   page,   an online news  digest.   The   site   covers  critical  public  health  issues  from around the world. It is designed to be a resource for an international audience of  policy  makers  and  journalists  as well  as public health researchers, practitioners, and advocates.    FreeHealthFacts  offers  a  combination  of  original reporting and a digest    of   news   stories   and   commentaries   from   newspapers, magazines  and   Websites  worldwide  on  pressing  issues  in  public health.            The new do's and don'ts of cold and flu season (November 2007) With cold and flu season comes time-honored traditions for relief and prevention: Feed a fever, starve a cold. Wear warm clothes. Eat chicken soup. To curb the spread of germs, health experts recommend people sneeze into their elbows or sleeves, not directly into their hands without a tissue. But just because those instructions have been around for decades doesn't necessarily mean they're effective. Don't: Sneeze into your hands Generations of parents and teachers have told children to cover their mouths and noses when they sneeze or cough. The rule still applies, but now kids are being taught to aim into their elbows or sleeves. "With little kids especially, when they sneeze or cough into their hands, they don't always wash their hands, and then they use their hands to touch surfaces or other people," explains Dr. Priya Sampathkumar, an infectious disease specialist with the Mayo Clinic in Rochester, Minnesota. It's hoped that sneezing into the elbow will prevent the further spread of germs, for young kids and adults alike. Do: Keep your hands clean Keeping your hands clean is crucial to avoid getting sick, according to the U.S. Centers for Disease Control and Prevention. However, colds and flu are viral, not bacterial, so antibacterial soap doesn't help fight the illnesses, says Sampathkumar. "In some ways, they can actually be harmful, because environmental bacteria could become resistant," she says. Washing your hands successfully may take longer than you're used to; the CDC recommends rubbing your hands for 20 seconds -- about the length of time it takes to sing "Happy Birthday" twice. One recent study found, however, that American adults -- especially men -- don't wash their hands enough after using the bathroom. Researchers for the American Society for Microbiology found that one-third of men didn't bother to wash at all after using the bathroom, while 12 percent of women didn't. No access to soap and water? Experts say hand sanitizers also help kill germs. And an added bonus: "During winter when you wash your hands frequently, the alcohol gels can be a lot gentler on your hands," Sampathkumar says. Don't: Overload on vitamins once you're sick Scientific research on the effectiveness of herbal remedies and vitamin supplements has drawn conflicting conclusions. The therapeutic value of zinc lozenges has yet to be proved, but zinc nasal gel may have a positive effect, according to a comprehensive review of zinc studies by the Stanford University School of Medicine published in the journal Clinical Infectious Diseases in September 2007. And, after previous studies had concluded that echinacea was an ineffective cold remedy, new research has come along to muddy the waters. A study from the University of Connecticut School of Pharmacy published in the journal Lancet Infectious Diseases in September 2007 found that the herb decreased the odds of developing a cold by 58 percent and reduced the duration by about a day and a half. Nevertheless, once your nose is already stuffed, taking vitamin supplements is probably a waste of money, Sampathkumar says. If you do want to take a supplement to fight colds and flu before they start, Sampathkumar warns not to overdo it: "If you wanted to take a supplement, at most you need one multivitamin a day." Mega-doses of vitamins really have not been shown to help, and they can be harmful, she says. Do: Take it easy on the treadmill Contrary to rumors, you cannot sweat out a cold, experts say. In fact, too much sweating can dehydrate you at a time when you need extra fluids anyway, warns Dr. Richard Deichmann, an internist at the Ochsner Medical Center in New Orleans, Louisiana. Still, you don't need to eliminate all physical activity. "Pay attention to what your body is telling you," Sampathkumar says. "You don't want to run the 10 miles you do every day if you're not feeling up to it, but you don't necessarily have to stay in bed if you feel up to taking a walk or doing some moderate exercise." Don't: Overdo it with cold remedies Phenylephrine is the ingredient in nasal decongestant, which some people take to clear up a stuffy nose. But the medication won't cut short your bout with a cold or the flu, Deichmann says. Taking it orally can cause jitteriness, rapid heartbeat or sleeplessness, he adds. On the other hand, nasal sprays can also dry up a runny nose and will probably cause fewer side effects, but Deichmann doesn't recommend using them for more than three or four days. "You get a tolerance to it, such that if you don't keep using it, you get a whole lot of secretions," he says. "It's a big problem." As for kids, a Food and Drug Administration panel recently recommended against giving children under age 6 over-the-counter cold medicines. FDA: We can't recommend cold meds for those under 6 Do: Eat what feels good, hot or cold Foods' enticing smells make you want to eat them. So it's no wonder you might lose your appetite when you have a cold and your nose is stuffy. Sampathkumar recommends the old standby -- hot soup -- to open up your nasal passages and therefore improve your appetite. But she says you don't have to stop at soup; eat other things that feel good, too. "There's really nothing that says if you're cold you're going to get a cold. Colds are definitely caused by viruses." To that end, "if you have a child who has a cold and the only thing they feel up to eating is Popsicles ... that's perfectly fine," she says. Don't: Smoke Here's another reason to quit smoking: Research shows a higher incidence of flu cases in smokers compared with nonsmokers, and, worse, a higher mortality rate for smokers than nonsmokers from the flu, according to the CDC. Smokers are predisposed to get more upper respiratory infections, Sampathkumar says. "Their nasal passages, their upper airways, are somewhat inflamed just from the smoke," she says, adding that smoking can delay healing once you're sick. .......................................... Purpose of Appendix Believed found (October 2007)    Some scientists think they have figured out the real job of the troublesome and seemingly useless appendix: It produces and protects good germs for your gut. That's the theory from surgeons and immunologists at Duke University Medical School, published online in a scientific journal this week. For generations the appendix has been dismissed as superfluous. Doctors figured it had no function. Surgeons removed them routinely. People live fine without them.  And when infected the appendix can turn deadly. It gets inflamed quickly and some people die if it isn't removed in time. Two years ago, 321,000 Americans were hospitalized with appendicitis, according to the Centers for Disease Control and Prevention. The function of the appendix seems related to the massive amount of bacteria populating the human digestive system, according to the study in the Journal of Theoretical Biology. There are more bacteria than human cells in the typical body. Most are good and help digest food. But sometimes the flora of bacteria in the intestines die or are purged. Diseases such as cholera or amoebic dysentery would clear the gut of useful bacteria. The appendix's job is to reboot the digestive system in that case. The appendix "acts as a good safe house for bacteria," said Duke surgery professor Bill Parker, a study co-author. Its location _ just below the normal one-way flow of food and germs in the large intestine in a sort of gut cul-de-sac -- helps support the theory, he said. Also, the worm-shaped organ outgrowth acts like a bacteria factory, cultivating the good germs, Parker said. That use is not needed in a modern industrialized society, Parker said. If a person's gut flora dies, it can usually be repopulated easily with germs they pick up from other people, he said. But before dense populations in modern times and during epidemics of cholera that affected a whole region, it wasn't as easy to grow back that bacteria and the appendix came in handy. In less developed countries, where the appendix may be still useful, the rate of appendicitis is lower than in the U.S., other studies have shown, Parker said.  He said the appendix may be another case of an overly hygienic society triggering an overreaction by the body's immune system. Even though the appendix seems to have a function, people should still have them removed when they are inflamed because it could turn deadly, Parker said. About 300 to 400 Americans die of appendicitis each year, according to the CDC. Five scientists not connected with the research said that the Duke theory makes sense and raises interesting questions. The idea "seems by far the most likely" explanation for the function of the appendix, said Brandeis University biochemistry professor Douglas Theobald. "It makes evolutionary sense."  The theory led Gary Huffnagle, a University of Michigan internal medicine and microbiology professor, to wonder about the value of another body part that is often yanked: "I'll bet eventually we'll find the same sort of thing with the tonsils." .......................................... Understanding the Nutrition Facts Box (September 2007)   The Food and Drug Administration (FDA) determined through scientific research that there are specific nutrients that are considered public health concerns. As a result, the FDA requires that food manufacturers label their products with the Nutrition Facts box so that consumers can make the healthiest choices based on key information provided. Below you’ll find a list of the different sections of the nutrition facts box and what each section means. Serving size. Before you prepare or eat your food, look at the serving size on the package. Often, small packages can be deceiving by containing more then just one serving. For example, a package containing two cookies may have a serving size of just one cookie. At first glance, the calorie count might seem appropriate—until you realize it’s for only half of the package’s contents! Calories. You may have heard “a calorie is a calorie.” Well, that’s not necessarily true. While watching calories is very important to a healthy weight, it’s not only the number that counts. Does the calorie come from protein, carbs, or fat? Pay special attention to the calories from fat. While fat is good for you, the calories from fat should NOT make up the majority of the calories. For the healthiest snack, choose products that have a balance of fat, protein, and carbs. AND, don’t be fooled by seemingly low-cal products that are actually full of bad fat. % Daily Value. According to the FDA, the % Daily Values (%DVs) are based on daily value recommendations for a 2,000 calorie daily diet. Even though you may consume more or less calories, depending on your needs, you can use these numbers as a general guideline. Also, every food label also has a footnote. This gives you a more detailed guideline of how many grams you should eat of each nutrient throughout the day. It’s broken down for a 2,000 calorie diet and for a 2,500 calorie diet. The guide may help you a bit more in figuring out how many grams of each nutrient you should eat per day.  Note: Just because it lists 2,000 and 2,500 calorie diets, this does not mean you should eat within this calorie range. Every person is different, and you should base your daily intake on your personal goals and your level of exercise. Total Fat. On every label, you’ll see a total fat %DV, which is broken down even further by listing saturated fats and trans fats (as part of the total fat percentage). You should watch your total fat %DV, making sure most of your calories come from whole, nutrient-dense ingredients, rather than bad fats. Saturated Fats. The FDA advises that saturated fats and trans fats are of public health concern when consumed in unhealthy amounts. However, the FDA does not make a distinction between the properties of saturated fats and trans fats. Saturated fats, when consumed moderately are beneficial, while trans fats are extremely detrimental in any amount. In order to better understand fats in the diet, read the truth about fats. Trans fats. According to the FDA, “experts could not provide a reference value for trans fat nor any other information that FDA believes is sufficient to establish a Daily Value or %DV.”1 The FDA has warned that trans fats increase your risk for chronic illness such as heart disease, some cancers, and high blood pressure. The truth is NO amount of trans fat is considered good for you. The FDA, as of 2006, will require that all labels list the %DV of trans fats. ALWAYS pick foods that have ZERO trans fats. If trans fat is not listed on the nutrition facts box, look for “hydrogenated” or “partially hydrogenated” oil on the ingredients list—these are the trans fats! Avoid foods with these ingredients. Cholesterol. For the most part, snack foods that contain trans fats are also high in bad LDL cholesterol. (HDL cholesterol is good for you, while LDL is not.) Limit your intake of heavily processed, high-cholesterol products to lower your risk of atherosclerosis (clogging of the arteries). Sodium. Watch out for diet foods that claim to be “fat-free”, “low-fat”, or “low carb.” Typically, excessive amounts of salt are added to make up for the lack of taste. While moderate amounts of sodium are good for you, excessive amounts may not be healthy, especially if you have high blood pressure. Total Carbohydrates. The FDA breaks down carbohydrates into fiber and sugars (as part of the total carbohydrates). Be aware that the %DV for carbohydrates does not make any distinction between good carbs and bad carbs—your %DV for total carbohydrates should come from good carbs. In order to get a better understanding of the types of carbs you should eat, read the truth about carbohydrates. Fiber. Most Americans do not eat adequate amounts of fiber because of the heavily processed, non-nutritive foods that have been stripped of healthy fiber. Be sure to choose whole foods that contain natural fiber and add fiber supplements like flax meal to your diet. Sugars. No %DV recommendations have been made for the total sugar intake. However, it is very crucial to watch your intake of sugars, especially refined sugars. These provide empty calories and spike blood sugar levels very rapidly, overwhelming the pancreas. A sugar-loaded diet can lead to many chronic diseases including insulin resistance and type 2 Diabetes. Also, be aware that the sugar measurement on the label includes the amount of ALL sugars. 100% fruit juice may have no added sugar, but it’s still high in natural sugar, or fructose. If there is a lot of grams of sugar listed on the label, reconsider your purchase. Although the Nutrition Facts Box does not list the %DV for sugar, U.S. dietary guidelines recommend that you limit your sugar intake to 40 grams for every 2000 calories. Don’t be fooled by ZERO grams of sugar. More often than not, products that have no sugar contain artificial sweeteners like aspartame or Splenda®. Be sure to read the ingredients label to check for artificial sweeteners. Many of them cause a variety of problems, ranging from migraines to memory loss. Aspartame, for instance, contains aspartic acid, an “excitotoxin” that can damage neural cells. Splenda is produced in a process involving chlorine, the effects of which are unknown in human health. Any artificially produced ingredient that mimics a natural ingredient should be avoided for optimal health. Protein. With regards to protein, a %DV is listed only if the food is high in protein. In order to gain a better understanding of healthy protein and how much you should be eating, read the truth about protein. Vitamins and Minerals. The FDA only lists the %DV amounts for vitamins and minerals that they consider a public health concern. However, many Americans are deficient in other important vitamin, mineral, and amino acids besides those listed on the Nutrition Facts Box. .......................................... Anxiety over pregnancy linked to premature birth (September 2007)   Women who are particularly anxious about their pregnancy may be at increased risk of premature delivery, a new study suggests. Researchers found that among 1,820 pregnant women, those with the greatest concerns about their pregnancy were nearly three times more likely than those with the least anxiety to deliver prematurely. The findings are published in the journal Psychosomatic Medicine. Stress during pregnancy has been linked to a higher risk of complications in some studies, though not all. And those that have identified a link have not suggested any simple solutions to the problem.   For the current study, researchers looked specifically at women's worries related to their pregnancy - including anxiety over labor and delivery, and worries about early pregnancy problems like bleeding and nausea. The goal was to see whether the risk of preterm birth was influenced by the types of anxiety that obstetricians can fairly easily address.  For example, a woman's fears about labor might be allayed by a thorough discussion with her doctor, according to the study authors, led by Dr. Suezanne T. Orr of East carolina University in Greenville, North Carolina.   For their study, the researchers had 1,820 women complete a questionnaire on pregnancy worries during their first visit for prenatal care. The women were asked whether they were anxious about labor and delivery, the health of the baby, nausea, and pain or bleeding during early pregnancy.   They were then given anxiety "scores" ranging from 0 to 6.  Overall, Orr's team found, women who scored a 5 or 6 were at greater risk of preterm delivery than those with lower scores. This remained true when the researchers considered factors that could both fuel women's anxiety and raise the risk of preterm birth -- such as a history of problems in past pregnancies, or health problems during the current pregnancy. The findings suggest that excessive anxiety itself may contribute to premature delivery in some women, according to Orr and her colleagues. "If additional research confirms our findings," they write, "then this might suggest an avenue for intervention to reduce spontaneous preterm birth. Anxiety is a treatable condition."   They point out that pregnancy-related worries, in particular, can be addressed with education.  "Pregnant women could receive information from their healthcare providers about the signs and symptoms of a normal pregnancy and the process of labor and delivery to reduce their worries and concerns about pregnancy, and ultimately their risk of spontaneous preterm birth outcomes," the team notes. .......................................... Tuberculosis strategy for hiding in body (August 2007)   Scientists have identified a key trick that tuberculosis bacteria use to lie low in the body for years before going on the attack -- a discovery that could open a whole new approach to fighting a disease that kills more than 2 million people around the world each year. "In terms of public health, there is a long way to go. This is an important step in the right direction," said Dr. William Bishai, professor of international health and medicine at Johns Hopkins University. Researchers from Rockefeller University, Washington University School of Medicine, Albert Einstein College of Medicine and Texas A and M University reported their findings in Thursday's issue of the journal Nature. Tuberculosis infects a third of the world's population, according to the World Health Organization, and is getting more deadly as drug-resistant varieties evolve. Though drugs exist to cure TB, they must be given in a complicated regimen over six months to a year, and many people drop out too soon. That enables drug-resistant strains to develop. A hallmark of TB is that after people inhale the bacteria and their lungs become infected, the immune system walls it off but cannot kill it. The germs can live in a person for years without developing into the disease. Scientists know that the microbes hide out in white blood cells called macrophages, which normally seek out and destroy invading bacteria. When something weakens the immune system -- such as AIDS -- the bacteria go wild, bringing on the full-blown disease. The new work showed that when TB bacteria go into hiding, a phase known as persistence, the immune system triggers a change in the bacteria that lets the germs shift from feeding on carbohydrates to fatty acids. "It's that switch in metabolism that is required for the bacterium to maintain the infection," said David G. Russell, a researcher at Cornell University who was at Washington University when he participated in the work. Looking more closely at this switch in metabolism, the U.S. researchers found that an enzyme called isocitrate lyase, or ICL, is key to the process. The researchers developed a strain of TB bacteria that lacked the gene to make ICL. When they infected mice with the bacteria, the immune system was able to kill bacteria in the persistence phase. Already, the drug company Glaxo Wellcome Inc. is trying to develop compounds that lock onto the enzyme and stop it from working, making hidden TB bacteria vulnerable. "A drug that targeted persistence would be quite different from conventional TB drugs, which target processes required for bacterial growth," said John D. McKinney of Rockefeller University, who initiated the research. He said blocking ICL would have no harmful side effects. Such a drug could be used in conjunction with other TB medicines. "The hope is if we can add a drug against ICL to the existing drug regimens, the two of them together will work better than either of them alone and give us a faster cure," McKinney said. "If we can cut it down to a month or less, this will really have an enormous impact." .......................................... New Genes Discovered for MS (August 2007) The best way to understand a disease is to get at its root cause, and most of the time, that means hunting down the genes that trigger it. In three papers published this week, researchers report that they have identified two new genes that may contribute to the immune disorder multiple sclerosis (MS). The hope is that the discovery will someday lead to the development of more efficient and much-needed MS drugs, as today's therapies carry serious side effects and address the disease's symptoms, but not its cause. The new genes are the first to be linked directly to MS since the 1970s, when researchers initially identified a cluster of DNA on chromosome 6 associated with immune system function. Doctors believe MS is an autoimmune disease, in which the body mistakenly attacks its own healthy cells. But they have never been able to figure out why the body turns on itself, and they hope these new genes may offer a clue. "This is by no means the final, whole answer, but we've gotten an incredible glimpse into the cause of the disease," says Dr. David Hafler, professor of neurology at Harvard Medical School and Brigham and Women's Hospital and an author of one of the papers, which appears in the New England Journal of Medicine. In the other reports, published in Nature Genetics, two independent research teams confirmed the role of one of the genes described by Hafler's group. For decades, MS researchers have been forced to make their best guess as to what causes the disease, which affects 300,000 Americans, mostly women, between their 20s and 40s. Since 1990, thanks to work done in Hafler's lab, however, they've known that MS sufferers have hyperactive T cells — cells that cruise the body looking for bacteria, viruses and other pathogens — a condition that triggers an inflammatory response and destroys the protective myelin sheath around nerve cells in the central nervous system, which connects the brain and body. This can lead to gradual nerve damage and weakening of the muscles in the arms as legs, as well as problems with vision. What doctors didn't know was why these immune cells went into a hyperalert state to begin with. Was it caused by a virus? Was it nutritional, as suggested by a study last week in the journal Neurology, which found that having too little vitamin D, normally produced in the body during exposure to sunlight, increases the risk of MS? Or, were genes to blame for inciting the immune system to rebel? Or, was it, as most experts believe, some combination of all of the above? To get a better answer, leading MS scientists in the U.S., including Hafler, teamed up with researchers in England and formed the International Multiple Sclerosis Genetics Consortium in 2002. The plan was to take their genetic study to the next level. So, they pooled their resources and examined the entire genomes of more than 2,000 MS sufferers, their families and control subjects. "People had been studying the genetics of MS for 20 years, and nothing had come out of it," says Hafler. "I felt we needed a genetic roadmap to show us what pathways to study that would help to explain the disease." What they found were two new genes, IL2 and IL7, which code for receptors for interleukin — the proteins that regulate how T cells work in the body. People with certain forms of these genes have a 20% increased risk of developing MS. It is not, however, a defective or mutated form of the genes that causes MS; rather, it's certain forms of the genes, known as variants, that increase risk. The etiology of MS is complicated and appears to involve many genes, so the next challenge will be to figure out precisely what role these two new genetic variants play. As exciting as the discovery is, it's a small part of the story: the new genes account for less than 1% of the risk of developing MS. In addition, about 70% of the normal, non-MS affected population has the same variants. "Every single time we have looked for genes for MS, the genes turn out to have a very small effect," says Dr. Moses Rodriguez, professor of immunology at the Mayo Clinic and a leading MS researcher." That suggests that either the disease is not genetically controlled in a significant way, or that if it is, that there are at least a 100 or so more genes that account for the entire disease process." Hafler acknowledges that these findings are only the first step. Uncovering additional genes will require analyzing an even larger pool of MS patients and their families — Hafler is hoping to find at least 9,000 more patients. He calculates that with that much DNA, he'll be able to tease out 90% of the genetic culprits involved in MS. "These first genes give us a working hypothesis for what may be causing MS," says Hafler, "and a lot more work needs to be done. But we have finally begun." .......................................... Australia Hosts Global AIDS Conference  (July 2007)    The world will not be able to celebrate enormous advances in HIV diagnosis and treatment until the United Nations' long-term goal of universal access to drugs and other prevention measures is reached, leading international AIDS researchers said Sunday. "We are dealing with a preventable disease and 11,000 people are contracting HIV/AIDS every day. We are dealing with a treatable disease and more than 3 million people are dying every year," said Pedro Cahn, the president of the International AIDS Society. "Science has given us the tools to prevent and treat HIV effectively. The fact that we have not yet translated this science into practice ... is a shameful failure on the part of the global community." Lower prices for drugs that combat HIV, the virus that causes AIDS, have significantly improved access to treatment for people in poor countries, but recent World Health Organization figures show the numbers are still far short of the U.N.'s goal of universal coverage by 2010. Last year, some 2 million people in developing countries were receiving the anti-retroviral drugs that help treat the HIV infection, a 54 percent increase over 2005. But overall, only 28 percent of the world's HIV patients are receiving the life-prolonging drugs. Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said the world health community could not celebrate the great breakthroughs in the treatment of the AIDS virus since it was first diagnosed 26 years ago until greater steps are made to prevent the disease. "Of the projected 60 million infections that will occur by 2015, fully half of them are projected to be able to be prevented with already known and proven prevention methods," Fauci told reporters in Sydney. "Before we celebrate 26 years since the beginning of extraordinary accomplishments, we're actually going to be judged as a society in what we do in the next 20-26 years," he said. "We cannot sustain a successful effort with HIV without prevention." More than 5,000 delegates from 133 countries have converged on Sydney, Australia, for the Fourth International AIDS Society Conference on HIV Pathogenesis and Treatment, which runs through Wednesday. Researchers from across the globe will present their findings on the benefits of circumcision for cutting HIV rates through to the latest developments in anti-retroviral drugs. Conference participants will also be urged to sign a declaration aimed at raising more money for HIV research. The so-called Sydney Declaration calls on national governments and bilateral, multilateral and private donors to allocate at least 10 percent of all HIV-related funding to research. "We believe that without such funding we will fail to maintain a sustained and effective response to the AIDS pandemic," the declaration says. The conference organizers say this will help speed up the implementation of new drugs and technologies to prevent, diagnose and treat the infection. .......................................... Want To Lose Weight? Try Taking It Easy (July 2007) Looking to burn fat through exercise? Resting during your workout may help, Japanese researchers report.Here's the fat-burning fitness plan they tested: Exercise for 30 minutes, take a 20 minute break, and finish with another 30 minutes of exercise.That revs up fat metabolism even more than a solid hour of exercise, note the researchers, who included Kazushige Goto, Ph.D., of the life sciences department at Japan's University of Tokyo. Goto's team studied seven healthy, physically active men who were 25 years old, on average.At the researchers' lab, the men pedaled stationary bikes for an hour without taking any breaks. On another day, they rode the stationary bike for half an hour, sat in a chair and rested for 20 minutes, and then pedaled for 30 more minutes.For comparison, the men visited the researchers' lab one more time just to rest for an hour, without exercising at all. The researchers monitored the men's fat metabolism and hormone levels before, during, and after each session. As expected, an hour of pure rest was a dud when it came to fat metabolism, compared with the fat-burning effects of exercise. But resting during exercise revved up fat metabolism during and after exercise, compared with a solid hour of exercise with no breaks. The findings, published recently in the Journal of Applied Physiology, may mean that to burn fat, you're better off budgeting a breather into long workouts.But the study was small, and the men weren't new to exercise, so the researchers plan to test the theory in other groups of people.Meanwhile, if you're ready to start exercising, check in with your doctor first.