Berkeley Wellness offers insight into the second most common medical complaint.

Four out of every five people will experience low back pain at some point in their lives, and many will contend with repeated episodes of debilitating pain on and off, sometimes for years. Low back pain is the second most common medical complaint after headache. It’s a leading cause of doctor visits and missed days from work, second only to the common cold.

So what should you do about low back pain? Find out more in an interview with William Pereira, M.D., M.P.H., adapted from the UC Berkeley Wellness Report “How to Manage Back Pain,” of which he is the co-author. Pereira is associate chair of the editorial board of the UC Berkeley Wellness Letter and is board-certified in occupational and environmental medicine. He has more than 30 years of clinical experience in occupational, preventive, primary care, physical and emergency medicine.

Read Berkeley Wellness Q&A with William Pereira

UC Irvine study finds phenomenon more marked in developing countries.

Sarah Pressman, UC Irvine

Positive emotions are known to play a role in physical well-being, and stress is strongly linked to poor health, but is this strictly a “First World” phenomenon? In developing nations, is the fulfillment of basic needs more critical to health than how one feels? A UC Irvine researcher has found that emotions do affect health around the world and may, in fact, be more important to wellness in low-income countries.

The study, which appears online in Psychological Science, is the first to examine the emotion-health connection in a representative sample of 150,000 people in 142 countries. Previous research on the topic has been limited to industrialized nations.

“We wondered whether the fact that emotions make a difference in our health is simply because we have the luxury of letting them,” said Sarah Pressman, assistant professor of psychology & social behavior and the study’s lead author. “We wanted to assess the impact of emotions on health in places where people face famine, homelessness and serious safety concerns that might be more critical correlates of wellness.”

Against expectations, researchers found that the link between positive emotions (enjoyment, love, happiness) and health is stronger in countries with a weaker gross domestic product. In fact, the association increased as GDP decreased, according to Pressman.

People in Malawi, which has a per capita GDP of $900, show a more robust connection between positive emotions and health than residents of the U.S., which has a per capita GDP of $49,800.

“A hostile American with hypertension can take blood pressure-lowering medication. A Malawian cannot,” Pressman said. “Medical interventions might lower the impact of emotions on health.”

Using data from the Gallup World Poll, researchers noted whether participants had reported experiencing enjoyment, love, happiness, worry, sadness, stress, boredom, depression or anger during the previous day. They also measured physical health and the degree to which subjects’ basic needs were met. Security was assessed by asking if participants felt safe walking alone at night or whether they had been robbed, assaulted or mugged.

“We hope that by showing that this phenomenon is prevalent and stronger than some factors considered critical to wellness, more attention will be drawn to the importance of studying both positive and negative emotions,” Pressman said.

She co-authored the study with Shane Lopez of the Gallup Organization and Matthew Gallagher of Boston University.

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The Berkeley Wellness Letter explores the issue.

In the last few years, many blockbuster prescription medications — including some leading statins, antidepressants and drugs for hypertension, reflux disease and osteoporosis — have become available as generics, and more brands will soon join the list. About three-quarters of prescriptions in the U.S. are now for generic drugs. This has trimmed hundreds of billions of dollars from the nation’s rising health care costs and, by allowing more people to afford the medication they need, has undoubtedly saved countless lives.

The government (notably the Food and Drug Administration, or FDA, which regulates drugs), insurers and virtually all medical groups insist that generics are as effective and safe as the original products. Still, some people believe that cheaper drugs can’t be as good as the brand names and fear that switching to a generic is risky.

UC brown bag event offers nutritional tips.

Susan Algert

>>Listen to an audio recording of the event

By Alec Rosenberg

If you want to maintain a healthy weight, UC Cooperative Extension nutrition advisor Susan Algert, Ph.D., R.D., has some sage tips: snack wisely; eat more fruits and vegetables; keep a food record and stay active.

Algert shared the latest dietary advice from the U.S. departments of Agriculture and Health and Human Services with UC Office of the President employees at a brown bag event Wednesday in Oakland co-hosted by UC Health and UC Agriculture and Natural Resources.

“How many of you really watch your weight?” Algert asked the audience. “No matter how hard we try, it seems to creep up a little bit as we get older.”

Indeed, studies have shown that adults gain an average of around a pound a year. How that happens might surprise you, according to Algert, a nutrition advisor with UC Cooperative Extension of Santa Clara, San Mateo and San Francisco counties.

Research from a large representative study of women in the U.S. shows that as little as an extra 13 calories per day – the equivalent of consuming one extra ounce of soda and walking one minute less – has led to an average weight gain of 35 pounds in 28 years since the 1970s. Eating an extra chocolate chip cookie every day for life? Expect to gain 6 pounds.

“People always say, ‘I don’t know how I gained it.’ We don’t usually gain weight by eating fruits and vegetables. It’s all those goodies loaded with fat, sugar and salt that we snack on,” said Algert, who previously was a clinical research nutritionist with UC San Diego School of Medicine’s Warren Celiac Center.

Snacking is the worst culprit, Algert said. Instead of soda and chips, try fruits and vegetables, nonfat yogurt, or nuts, she said. If you drink sugar-free soda, limit yourself to one or two cans a day. Better yet, drink water flavored with cucumber or lemon.

People also need to be careful when eating out. She pointed to examples such as Cheesecake Factory’s Bistro Shrimp Pasta, which has more than 3,000 calories – 1 ½ times the recommended daily caloric intake for an average adult – and Smoothie King’s 40-ounce Peanut Power Plus Grape smoothie, which contains about a cup of sugar and nearly 1,500 calories.

“If you eat out more than a couple of times a week, you’re in trouble because you’re likely consuming more fat and calories than you realize,” Algert said. Other key factors that lead to weight gain are decreased physical activity, increased television viewing, increased alcohol intake and poor sleep.

So what should you do?

Algert said two reliable sources of nutrition information are the U.S. Department of Agriculture’s MyPlate dietary guidelines and the U.S. Department of Health and Human Services’ DASH (Dietary Approaches to Stop Hypertension) eating plan, which focuses on healthy fat, fruits, vegetables and reduced-fat dairy and limits sweets to no more than five servings a week. Also, UC offers a variety of nutrition education, including the CalFresh program, which reaches 140,000 Californians a year.

Algert encouraged people to buy fresh, local food. “Vote with your fork,” she said. “Don’t buy junk food. Support a healthy food environment by going to the community gardens and by going to the farmers markets.”

Another suggestion is to keep a food record — track what you eat, when you eat and what your mood is (do you eat ice cream when you are stressed?).

Most of all, keep trying. Even the experts wrestle with their weight.

“I am trying to increase my fruit and vegetable intake to the eight-10 per day recommended in the DASH diet. I have a bit of a sweet tooth. It is a challenge in today’s food environment!” Algert said.

UCTV airs a woman’s guide to wellness in today’s challenging world.

In today’s fast-paced world, many women face a unique set of pressures as they juggle life at home, at work, with their friends and even their appearance. This six-part UCSF Osher Mini Medical School series on UCTV investigates the origins of these stressors and their physiological impacts, as well as current scientifically-proven strategies for managing priorities, fostering wellness and achieving a balanced portfolio for health.

Programs include:

The Female Brain: Balancing Social Expectations with Your Own Health
First air date: Feb. 4

Body Image: Don’t Let “Ideal” Get in the Way of Real Health
First air date: Feb. 11

Women and Sleep: From Stressful to Restful
First air date: Feb. 18

Mind Your Heart: Stress, Mental Health and Heart Disease
First air date: Feb. 25

Family Caregiving as Fate but also Opportunity: Views from Mind and Body
First air date: March 4

Overcoming the Superwoman Syndrome: Creating Your Personal Path to Wellness
First air date: March 11

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Program taking shape on UC campuses such as UCLA.

UCLA's Danny Flores, in a warehouse at University Apartments South where he works, shed 20 pounds so far through the WorkStrong program.

Danny Flores’ New Year’s resolution has a ring of familiarity to many of us: He’s determined to eat healthier, exercise and shed 10 pounds. Fortunately for Flores, a 16-year employee with UCLA Housing and Hospitality Services, there’s a high probability that he will actually reach his goal.

That’s because Flores has gotten one-on-one help from a personal-fitness trainer, a registered dietitian and a motivational-wellness coach to put him on the road to better health. And he’s now working out at a campus gym on a free pass that’s good through April.

A special 12-week program — offered to him through the combined efforts of UC’s Office of Insurance and Risk Management, UCLA’s Occupational Health Facility and UCLA Recreation and funded by UCLA’s Office of Risk Management — has empowered him to get healthy by giving him access to UCLA’s personal coaches in health, fitness and behavior modification. And it’s paid off — he’s already taken 20 pounds off his 5-foot-8 frame over the last three months.

“Having different people right there to motivate you … it’s an unbelievable support group,” said Flores. “Honestly, if it was just me doing this on my own, I would have given up. But if I make a commitment to someone, I will come through. Obligate me, make me responsible for something, and I will come through.”

Flores is one of a small pool of UCLA employees who have been invited to join the WorkStrong program, which got under way at UCLA last April but really picked up steam over the summer. So far, 46 UCLA employees have participated and eight have completed it to date. The program was launched systemwide by the UC Office of the President to help those employees who are most prone to workplace injuries — people who have been injured on the job at least twice within a 24-month period.

Run on the Westwood campus out of the Occupational and Employee Health Facility on the sixth floor of the Center for the Health Sciences, WorkStrong is designed to help employees improve their overall health and thereby cut their risk for reinjury, said Dr. T. Warner Hudson, director of the facility.

“Many people join an employer when they are young, lean and healthy with good blood pressure and good weight,” the physician said. “But over time, people can gradually pick up weight, get high blood pressure and diabetes, develop sore backs and knees, and maybe even have heart attacks and strokes. But people can turn this around. The Centers for Disease Control and Prevention have data that show that about 75 percent of chronic health conditions can be avoided if people adopt a healthier lifestyle.”

To find out whether this holistic approach works, UC San Francisco did a pilot study with 73 employees who had been injured and gave them access to personal trainers, dietitians, smoking-cessation programs and behavior-modification coaches. After four years, researchers found only one of the participants had been reinjured.

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Related link:
Healthy Campus Initiative takes shape, thanks to innovative UCLA-wide effort

Wellness Letter: Chronic arsenic exposure from rice, other foods poses long-term health risks.

Arsenic, a naturally occurring element and industrial byproduct, poses a significant health risk to millions of people worldwide when it leaches into drinking water. It’s highly poisonous at high doses, but chronic exposure to lower levels increases the risk of bladder, lung and skin cancer, as well as infertility and possibly diabetes, heart disease and other conditions.

Though this is often thought of as a major problem only in developing countries, such as Bangladesh, the U.S. has arsenic problems of its own. In fact, it’s estimated that over two million Americans drink water from private wells that have high arsenic concentrations. This past year, arsenic made headlines on several occasions for its presence in rice and other foods, too.

Against the grain

In September, Consumer Reports released results of its analysis of 223 rice samples, which included white and brown, organic and conventionally grown, domestic and imported, and brand-name and store-brand rices. It also tested rice-based products, such as rice cereals, beverages, pasta, flour, and crackers. Virtually all were found to contain both inorganic arsenic (a known human carcinogen) and organic arsenic (considered less harmful but still of concern) — many at “worrisome levels.” In this context, the term “organic” refers to the element’s chemistry, not whether the food was grown organically.

There were wide variations in the findings — after all, there are many different kinds of rice grown all over the world and under different conditions. But some trends emerged: White rice from Arkansas, Louisiana, Missouri and Texas (where most U.S. rice comes from) had more total and inorganic arsenic than rice grown elsewhere (including California, India and Thailand). And within the same brands, brown rice had more arsenic than white rice (some arsenic is removed when the grain’s outer layer is stripped during processing to make white rice). Preliminary results from an FDA analysis of 200 rice products, also released in September, were consistent with those of Consumer Reports; results from about a thousand more samples are due out shortly.

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UC Berkeley Wellness Letter examines how effective these supplements are.

A cure or preventive for the common cold has been a holy grail for medical researchers and drug companies. So far nothing has worked — medications for colds simply relieve some symptoms temporarily, at best. No wonder, then, that people are tempted by the cold-fighting and/or immunity-boosting claims made for many dietary supplements. Do any of them stand up to scientific scrutiny?

Some supplements with purported cold-fighting ability are single nutrients or herbs. Others try to impress with a mind-numbing list of ingredients.

Airborne

The best known supplement that throws the kitchen sink at colds, Airborne contains vitamins (A, C, E), minerals (magnesium, zinc and selenium) and echinacea, ginger and a bouquet of other herbs. In 2008, the Federal Trade Commission accused the company of making unproven claims about curing and preventing colds and flu; the company had to pay a $30 million settlement. So now the ads and packages merely say that Airborne “supports” the immune system (wink, wink).

Some of the ingredients in Airborne and other formulas have been tested in controlled studies, with inconsistent results. But there have been no clinical trials testing the specific formulas, at least none that have been published in peer-reviewed journals.

Our take: Forget about Airborne and similar formulas. They’re a waste of money. And if taken often, Airborne may weaken bones because of its relatively high level of vitamin A.

Echinacea

Lab research suggests that this herbal remedy, usually Echinacea purpurea, can stimulate the immune system and have direct antiviral and anti-inflammatory effects. But human studies on echinacea’s effect on colds or immunity have had inconsistent results. Commercial preparations vary widely in the species and the parts of the plants used, making it hard to compare results. Two large, well-designed studies in 2010 and 2011 found that echinacea was not better than a placebo at preventing colds or reducing their severity.

Our take: The claims about echinacea for colds have yet to be supported by solid research.

Garlic

Despite a common belief that garlic can prevent colds, there has been remarkably little human research on this. This year a study in Clinical Nutrition found that an aged garlic extract taken for three months did not reduce the incidence of colds or flu, but did reduce their severity somewhat when they did occur.

Our take: Garlic is no more likely to keep away colds than to repel vampires, unless you eat it raw and the smell makes cold sufferers stay away from you.

Ginseng

Like echinacea, this herbal cure-all can affect certain aspects of the immune system, though it’s not clear what practical significance this has. Commercial preparations vary widely. A few preliminary studies suggest that Cold-fX, a patented standardized extract of North American ginseng, may help reduce the frequency and severity of colds (and flu) when taken twice daily throughout the winter, a claim allowed by Health Canada, which functions like the our FDA. There’s no evidence that it can provide relief once you have symptoms, though marketers have sometimes claimed or strongly suggested this. In the U.S., Cold-fX is available only online.

Our take: Cold-fX may help against colds and flu when taken daily for several months. But at about $30 a month, we don’t think it’s worth it. Moreover, long-term use raises questions about possible interactions with drugs (such as the blood thinner warfarin) and potential problems in people with certain health conditions (such as autoimmune disorders).

Probiotics

These supplements contain “friendly” bacteria that are supposed to strengthen immunity, among other proposed benefits. But studies on whether they can curb colds and other respiratory infections have been inconsistent. One problem is that supplements use countless different strains and doses. In 2011, the Cochrane Collaboration, which evaluates medical research, concluded that probiotics may help prevent acute respiratory infections, though there were limitations in the studies and no data for older people.

Our take: We don’t recommend probiotic supplements for cold prevention. We’ll discuss probiotics in an upcoming issue.

Vitamin C

This gained popularity in the 1970s when Linus Pauling claimed it could prevent and alleviate colds. However, numerous studies have failed to confirm any benefit. According to a Cochrane Collaboration review in 2010, vitamin C supplements do not prevent colds, except perhaps in people exposed to severe physical stress, such as marathon runners and skiers. And research on the vitamin’s potential role in reducing the severity and/or duration of cold symptoms when taken at their onset has yielded mixed results.

Our take: The tide has turned against vitamin C. If there were a significant benefit, it wouldn’t be so hard to prove.

Vitamin D

Some experts believe that vitamin D can help protect against respiratory infections, in part because it plays key roles in the immune system. Many studies have found that people with low blood levels of D are at increased risk for colds and other upper respiratory tract infections.

But the few clinical trials have had mostly disappointing results. For instance, a study from Winthrop Hospital in New York in 2009 found that 2,000 IU of vitamin D a day, taken for 12 weeks, did not reduce the risk of upper respiratory tract infections. And in a study from New Zealand in the Journal of the American Medical Association in October, monthly megadoses of D (100,000 IU), taken for 18 months, also did not reduce the risk. The great majority of subjects in both studies started with sufficient blood levels of D, however, so it’s not known if people who were deficient would have benefited.

Our take: There are some good reasons to take vitamin D supplements, notably for bone health — but not for cold prevention. More on vitamin D.

Zinc

This mineral is also essential for immunity. In lab studies, large amounts of zinc can block cold viruses from adhering to the nasal lining and/or replicating themselves. Earlier this year a Cochrane Collaboration review concluded that, compared to a placebo, zinc lozenges can shorten colds by about a day and reduce their severity somewhat, particularly when started within 24 hours of the first symptoms, though not all the studies found a benefit. Another 2012 research review, in the Canadian Medical Association Journal, came to similar conclusions. There is no good research showing that zinc will prevent colds, however.

Our take: Because of possible side ef­­fects (nausea, diarrhea, cramps and a bad taste in the mouth) and questions about the effectiveness of some formulations, the Cochrane authors concluded that zinc lozenges, taken during the first day of symptoms, are “advised with caution.” We agree. Prolonged use of high doses of zinc can interfere with the absorption of copper and actually impair immune function. Don’t use any zinc product that’s applied directly in the nose; this can damage the sense of smell, possibly permanently.

Bottom line

There’s no convincing evidence that any supplement can prevent or treat colds. “Cold remedies,” including many over-the-counter drugs, may well make you feel better, since they have a strong placebo effect. That is, if you expect or hope that a remedy is going to help, there’s a fair chance it will, whether it contains vitamins, herbs or just plain old sugar. And, of course, remedies may seem to work because colds go away on their own. Though we don’t recommend them, it probably can’t hurt to take such products when you feel a cold coming on, but taking them throughout cold season, as is sometimes recommended, increases the risk of adverse effects.

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The Berkeley Wellness Letter offers tips for flu season.

Each year the flu puts more than 200,000 Americans in the hospital and causes anywhere from 3,000 to 49,000 deaths. With the exception of the H1N1 flu (also called swine flu) in 2009, most of these deaths occur in people over 65. But even for healthy younger people, the flu — characterized by high fever, body aches, headaches and coughing — can be rough.

The CDC recommends that everybody over 6 months of age get vaccinated. It’s especially important for people 65 and older, anyone who has a chronic condition (such as lung or heart disease, diabetes, cancer or HIV infection), pregnant women, people on immunosuppressive drugs and health care workers. Mid-October through November is a good time to get it. Flu epidemics usually begin in January or February, and it takes a few weeks to develop immunity from the vaccination. Besides the familiar injection, a nasal spray flu vaccine is also approved for people under 50.

Still, the vaccine doesn’t guarantee that you won’t get the flu. An analysis of 31 studies covering 12 flu seasons, reported in Lancet Infectious Diseases this year, found that the most widely used flu vaccine in the U.S was just 59 percent effective, on average, for people 18 to 65. There were not enough data about older people, but there’s reason to believe the vaccine may be even less effective in them.

Unfortunately, many media reports interpreted this to mean that the flu vaccine is no good. But the results weren’t too surprising given that every year scientists have to predict months in advance which strains of flu virus will predominate in the next flu season in order to develop the vaccine in time (flu viruses are constantly mutating, even within a current flu season). If Mother Nature outwits the prediction — that is, if there isn’t a close match between the strains of the virus selected for the vaccine and the actual circulating viruses — the effectiveness of the vaccine drops. Then again, as shown in a study in Vaccine in 2010, even when the match is incomplete, the vaccine still reduces the chance of getting infected and, if you do get sick, the severity of the illness — as well as hospitalizations from the flu and pneumonia (a life-threatening complication of the flu).

What’s more, how well the flu vaccine works varies from person to person. It causes your body to develop antibodies against the virus — but people who are old and frail, are immune-compromised, and/or have a chronic illness don’t have as robust an immune response to the vaccine and thus may not be as well protected. Being overweight may also decrease your vaccine response and make you less able to fight the flu if you do get infected. On the other hand, some research has shown that getting the vaccine annually may provide cumulative benefits in older people — more reason not to skip a year.

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The Berkeley Wellness Letter makes sense of the science behind the hype.

Twenty-five years ago the term “antioxidant” was new to the public. Today it’s big business, with sales of products making antioxidant-related claims reaching $65 billion in the U.S. in 2011.

You’ll find antioxidant claims made not just for dietary supplements, but also for everything from juice, cereal and power bars to tea, chocolate and even bottled water. “Antioxidant” — a substance that helps mop up cell-damaging free radicals — has become synonymous with overall good health and disease prevention.

A more recent trend is for companies to advertise specific antioxidant levels or “scores,” or to compare their products to others in antioxidant power. For instance, new cereals from Silver Palate boast 7,300 ORAC units per 100 grams, while Mystic Harvest Purple Corn Tortilla Chips list 6,000 ORAC units (ORAC, which stands for oxygen radical absorbance capacity, is one of several measures of antioxidant status developed by scientists). A baobab fruit powder that you add to oatmeal, yogurt or other foods lists an ORAC value of 1,400 per gram. And tea extracts from Green Cell Technologies claim to have ORAC scores of up to 1.7 million per 100 grams.

It’s hard to say what all those numbers mean. But they probably don’t mean a whole lot in terms of health. The science and significance of antioxidants is much more complicated than a single number on a package can convey. The FDA has issued warnings against Lipton and other companies for making misleading and illegal claims about antioxidants — but many other iffy ones slip through the cracks.

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The Berkeley Wellness Letter explores “good” and “bad” cholesterol.

After years of having it drilled into their heads, most people now know that LDL (low-density lipoprotein) is the “bad” cholesterol package that increases the risk of cardiovascular disease, and HDL (high-density lipoprotein) is the “good” type that helps reduce it by removing cholesterol from artery walls. So if your HDL number is high, you’ve probably patted yourself on the back; if it’s low, you may have tried to raise it by, for instance, exercising more, losing weight, drinking a daily glass of wine, or even taking medication, such as high-dose niacin.

But before you get too hung up on HDL, you should know that while the benefits of lowering elevated LDL are proven, the evidence for raising HDL by itself remains uncertain. That’s why standard cholesterol guidelines have focused almost exclusively on lowering LDL, which is the main purpose of statin drugs (they have little effect on HDL). And recently a study in The Lancet raised fundamental questions about the supposed benefits of raising HDL.

Genetic factors help determine HDL levels, sometimes very strongly. In The Lancet paper, an international team of researchers analyzed data from 20 studies involving people with genetic variants that raise HDL but do not affect LDL, triglycerides or related blood lipids. They did a special kind of genetic analysis (called Mendelian randomization) that allowed them to determine whether high HDL, in and of itself, reduces coronary risk. Surprisingly, the evidence indicated that it does not.

An iffy link

Researchers and doctors have focused on HDL for good reason: Observational studies have consistently found that people with high HDL levels are at decreased cardiovascular risk. But just because there’s an association between low HDL and heart disease, that doesn’t mean that low HDL causes it—or that raising HDL will help prevent it. Many factors in the blood can be higher or lower with certain diseases, but relatively few actually cause the diseases. Low HDL tends to go along with other metabolic abnormalities that could directly increase risk for coronary disease, such as high levels of smaller LDL particles and increased triglycerides (fats in the blood).

So the question remains, is low HDL an independent risk factor for cardiovascular disease or merely a marker for it?

What about drugs to raise HDL?

The Lancet study was not the first disappointing finding about the potential benefits of raising HDL. According to the accompanying commentary, the study confirms previous genetic analyses that “refute a causal role of HDL in coronary heart disease.”

Moreover, in recent years two high-profile HDL-boosting drugs were scrapped after they failed to produce the expected benefits in pre-approval studies; one actually increased cardiovascular risk. And as we reported last year, a major study called AIM-HIGH found that prescription niacin did not further reduce the risk of heart attacks or other cardiovascular events in high-risk people who had already lowered their LDL levels via high-dose statins — even though niacin raised HDL. (Niacin also lowers LDL and triglycerides, which may explain why it was shown to be beneficial in prior studies.) Other drugs are being developed to raise HDL substantially, but in ways different from the previous drugs.

The relationship between HDL and cardiovascular disease is complicated, largely because the biochemistry of HDL is so complex. Not only does HDL interact with other lipids in the blood, but all HDL is not alike. Some HDL may do a good job at keeping arteries healthy, while other HDL may not. HDL particle size and levels of various subparticles, as well as levels of inflammation and oxidative stress in the body, may determine if, and how much, HDL is cardioprotective.

Bottom line

There are many unanswered questions about HDL. It’s becoming increasingly clear that there’s more to it than that single number from a basic blood test. Still, low HDL is, at the very least, a marker for increased cardiovascular risk, and should be considered in the context of your other risk factors. It may, for instance, lead your doctor to order advanced blood tests for additional cholesterol-related components such as small LDL particles. A low HDL number may also lead your doctor to more aggressively lower your LDL by medication. If you have low HDL, you should still exercise, quit smoking and lose excess weight. Such steps help protect the heart in many ways, regardless of their effect on HDL.

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In UCTV series, UCSF Mini Medical School explores advances in primary care.

Ideal primary care is comprehensive, continuous, accessible and patient-centered with a focus on wellness that uses the best medical evidence for prevention and treatment of common clinical conditions. But great primary care also requires well-informed, motivated patients who can work with physicians and other health professionals to make the best personal medical decisions. In this UCTV series from UC San Francisco Osher Mini Medical School, faculty in primary care internal medicine present the latest information on a wide variety of common clinical dilemmas so that patients may be able to actively dialogue with their physicians and take steps to improve their health.

Programs include:

Controversies in Cancer Screening
First air date: Aug. 13

Obesity in America: Diet, Drugs or Surgery?
First air date: Aug. 20

Osteoporosis: Update on Diagnosis and Treatment
First air date: Aug. 27

Updates in the Diagnosis, Treatment and Prevention of Alzheimer’s Disease
First air date: Sept. 3

Immunizations for Adults and Adolescents
First air date: Sept. 10

The ABC and D’s of Vitamin Supplements and Health
First air date: Sept. 17

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