Straight, No Chaser: My Back and Neck Pain Has a Name – Herniated Disks

 herniation_2

It’s quite common for someone to come to me and say, “I have a herniated disk.” I used to ask how they knew, but I came to realize the answer to be unimportant. The pain and relative disability of those suffering from low back pain can be dramatic, both physically and emotionally. Being able to place a name of what’s causing that discomfort is meaningful in and of itself.

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We’ve discussed low back pain (LBP) before on Straight, No Chaser, but herniated disks are special considerations among its causes. A herniated (aka ruptured or slipped) disk refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine. A common and effective way to understand a spinal disk is to picture a jelly donut, with a softer center captured inside of a tougher exterior. A herniated disk occurs when some of the softer portion protrudes through the exterior. Keep in mind that your spinal column runs from your neck down your lower back, so herniation may occur anywhere along the spine, although the low back is the most common site.Herniated-Disc

Herniated disks may or may not produce symptoms, and you may not even know you have one. Of course, some herniated disks are extremely painful and incapacitating. The problems with herniated disks aren’t just related to the manual eruption of the disk’s contents. You can experience irritation of surrounding nerves, which can produce pain, numbness or weakness in an arm or leg.

The most common signs and symptoms of a herniated disk are relative to the nerves affected by the herniation. Nerves have a distribution (i.e., affected areas of the body) associated with them. The following symptoms can be produced by a herniated disk and will be seen along that distribution.

  • Arm or leg pain Arm and shoulder pain may result from herniated disks in your neck, including pain that radiates down the arm. Certain motions and actions (e.g., coughing, sneezing and neck rotation) may exacerbate your symptoms. If your herniated disk is in your lower back, intense pain may be present in your buttocks, thigh, calf and part of the foot.
  • Numbness or tingling
  • Weakness Similarly, muscles that are served by nerves affected by a herniated disk tend to weaken, and this may cause stumbling and other signs of lessened strength (e.g., decreased ability to lift or hold).

Factors that increase your risk of a herniated disk may include a genetic predisposition, excess weight producing ongoing stress on the apparatus of the back,and various jobs (including those involving heavy or repetitive lifting, bending, twisting, pushing or pulling).

The next post will address treatment options and self-help considerations for herniated disks.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Straight, No Chaser: Sciatica

Sciatica

My pain has a name, and it’s sciatica. There’s always a sense of relief in patients when a name is given to a medical sign or symptom. This Straight, No Chaser places sciatica in context among various problems of the low back and gives you basic information for you to use in seeking solutions.

What is sciatica?

sciatica nerve

This is important for you to understand. Sciatica is a symptom, not a diagnosis. Sciatica is any of various clinical presentations that result from any injury to or inflammation of the sciatic nerve. The sciatic nerve is a large nerve that extends from the lower back and travels down the back of each of your legs. This nerve provides muscle control and sensation to various parts of your thighs, legs and soles of your feet.

What are the symptoms of sciatica?

sciatica screams

Once you know the distribution of the sciatic nerve, the symptoms are pretty self-evident. Simplistically, a nerve is just an electrical conductor sending signals down its distribution. The typical symptoms of sciatica include the following:

  • Pain (e.g. pins and needles, burning or aching)
  • Weakness (can progress to an outright inability to move)
  • Numbness
  • Tingling

The discomfort usually occurs on one side and worsens under certain conditions, such as the following:

  • After sneezing, coughing or laughing
  • After walking or bending backwards
  • At night
  • When standing or sitting

What causes sciatica?

sciatica spinal stenosis

If you ever get diagnosed with sciatica, your immediate next question should be “What’s next?” Be reminded, sciatica is caused by something causing irritation, inflammation or injury to the sciatic nerves. Here are some common and/or important causes of sciatica; feel free to ask your physician if these actual diagnoses are being considered if you’re told you have sciatica.

  • Bruise or fracture to one of your pelvic bones
  • Degenerative disc disease (erosion of the cushions between your vertebrae/spine; this naturally occurs with aging)
  • Infection (a rare but important cause in those with new fever and back pain)
  • Piriformis syndrome (this buttock muscle can irritate or pinch a nerve root than leads to the sciatic nerve)
  • Pregnancy
  • Slipped/herniated disk (aka pinched nerve; sciatica is the most common symptom of this condition)
  • Spinal stenosis (narrowing of the spinal canal in the lower back; it’s relatively common over age 60)
  • Spondylolisthesis (the slipping of one vertebrae/spinal bone forward over another one; it’s usually associated with a small stress fracture)
  • Tumors (this is rare; please don’t assume you have cancer if you have back pain, but do ask if your doctor has considered it if you develop new back pain after age 50. Accept “you don’t have it” as good news). 

How is sciatica treated?

If you actually have sciatica, treatment begins with identifying the underlying cause. Here are some general principles of treatment.

SCIATICA PAIN RELIEF

  • In some cases, no treatment is required and recovery occurs on its own.
  • Non-surgical treatment is best in many cases. You likely will be told to apply ice for the first 48-72 hours then use heat to reduce inflammation.
  • Over-the-counter pain medicines such as ibuprofen (aka Advil, Motrin) or acetaminophen (aka Tylenol) are the medicines you should be using. Narcotics too often are a slippery slope that are unnecessary and don’t actually address inflammation when it is a causal factor.
  • Reduced and limited activity is best for the first few days. Bed rest is not recommended.

Sciatica treatment

  • For the first 6 weeks of symptoms, you should not engage in heavy lifting or twisting of your back.
  • Wait 2-3 weeks to restart exercising. Focus on exercises that strengthen your abdomen and improve flexibility of your spine. Exercises are best if part of physical therapy.
  • Many of you try to jump straight to such measures as injection of medicines, acupuncture, chiropractic manipulation or surgery. If these measures are needed, your physician will direct if and when they will be beneficial.
  • Similarly if you have ongoing problems, your physician may refer you to a neurologist or pain specialist.

Tomorrow’s Straight, No Chaser post will focus on life-threatening causes of sciatica and other back pain. There are specific symptoms that should prompt an immediate visit to your physician or emergency room. Be sure to check back, and be aware.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Filed under Musculoskeletal System, Neurology

Straight, No Chaser: Low Back Pain

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For many, low back pain begins with a slip and subsequently becomes a slippery slope that never seems to end. This Straight, No Chaser will help you understand why you’re having pain.

Lower back pain is a tricky subject for an emergency physician, and it’s seen everyday. In fact, over 40 million Americans suffer from various forms of chronic low back pain. The lower back is a source of many life threatening emergencies, which I’ll discuss in a separate post, but for now, as always let’s give you some information to help prevent and address your routine back problems. Let’s start by understanding what the back’s trying to accomplish and how you help or hinder that process by your actions.

Remember the back is the major weight-bearing apparatus of the body and it connects the upper and lower body. It twists, turns, pulls and bends. It contains many vital nerves and muscles.

lower-back-pain-causes-2Let’s point at four situations that produce or exacerbate your back pain:

1. Bad form (born with or otherwise acquired):

  • Spinal problems you were born with can predispose you to and outright cause all manner of back difficulties. Any machine works better if well-built.
  • Obesity puts a significant strain on your back in various ways. Given that most people don’t build up their back muscles, sprains and chronic pain are quite easy when you’re front-loaded. Pregnancy produces a similar strain on your back.

2. Strains

Have you ever heard that it’s easier to lift with your legs than your back? Well, I’d never think so based on the habits of many patients, but it’s true. The lower extremities are much stronger than your back. One of the problems with back strains is once it gets weak, it gets worse. Muscle spasms, pain, more strains and protruding discs all become more likely.

3. Fractures

A broken back is no fun. A weakened back bone (vertebrae) may collapse on its own if diseased (e.g. cancer, age, arthritis, infection), it may become fractured or may be injured with significant trauma. Those with osteoporosis have this happen more commonly. These broken bones may compress spinal nerves. You may even get shorter.

4. Arthritis and Normal Deterioration (aging)

There are other forms of arthritis beside degenerative joint disease (osteoarthritis, which we all get as we age), but the resulting pain, warmth, redness, swelling and limitation in motion all forms lead to reduced function and pain that can continue for the remainder of one’s life.

Here are a few clues to help you hone in on whether your back pain requires emergency attention:

  • Direct blow to your back
  • Fever and new onset back pain
  • Loss of control of your bowel movements or bladder function
  • New onset back pain after age 65
  • Numbness and tingling in both of your legs
  • Nighttime back pain
  • Sudden sexual dysfunction
  • Weakness and/or loss of motion or sensation in your legs
  • Weight loss and new onset back pain
  • Work related back injuries

What can you do to prevent or reduce the pain at home?

  • Learn and practice good posture. Sit when you can. Keep your back straight and shoulders back. When you stand, find something upon which to prop one of your feet, like a stool (think Captain Morgan).

CaptainMorgan

  • Learn the correct way to lift (bend at the knees, not at the back – every time). If you have pain, avoid bending, stretching and reaching if avoidable.
  • Wear low-heeled shoes whenever you can, ladies!
  • Learn how to stretch your back.

LBP exercises

  • Maintain a healthy weight, and exercise to strengthen your abdomen and back (your core)
  • Sleep on your side. Try a pillow between your knees.
  • Walk. Did you know walking is the best (and easiest) exercise for your back?

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Filed under Musculoskeletal System, Neurology, Orthopedics/Bones

Straight, No Chaser: When Eating Goes Wrong, Part II – Bulimia

Bulimia…-nerviosa-1

If you read Part I of this conversation on eating disorders (anorexia nervosa), you will recall that eating disorders are a mix of an abnormal body image combined with abnormal behaviors that lead to medical consequences. Today’s Straight, No Chaser is on bulimia, yet another dangerous eating disorder.

The ‘Bizz-Buzz’ of bulimia nervosa is ‘binge-purge.’ What that means is bulimics engage in frequent episodes of eating excessive amounts of food (bingeing) followed by one of several methods of eliminating what was just ingested (purging). This methods include forced vomiting (most common), use of diuretics or laxatives, fasting or excessive exercise. It is important to note that the bulimic feels a lack of control over these episodes.

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Bulimia is an especially dangerous disease because it usually occurs in secret, and victims are able to hide it. This means symptoms will typically be further along when discovered. Bulimics usually manage to maintain a normal or healthy weight despite their behavior and may appear to be the person who ‘never gains weight’ despite ‘eating like a horse.’ This is a key differentiator between bulimia and anorexia. Otherwise, the two diseases do share some of the same psychological pathology, including the fear of weight gain and the unhappiness with physical appearance.

Treatment considerations for bulimia are similar to those for other eating disorders. A combination of psychotherapy, reestablishment of normal nutritional intake and medications usually leads to marked improvement. Again, the particular challenge with bulimics is discovering the condition in the first place. As with anorexia nervosa, treatment for bulimia nervosa often involves a combination of options and depends upon the needs of the individual. Medications may include antidepressants, such as fluoxetine (Prozac), if the patient also has depression or anxiety.

Let’s recap by revisiting where we started with our conversation on anorexia. Our society doesn’t do the job it should in promoting a normal image of health. The typically promoted American ideal of beauty sets standards that lead many to pursue unrealistic means of meeting that ideal. In the setting of an actual American population that is obese by medical standards, this becomes even more of a problem. The levels of stress, anxiety and depression resulting from this reality sometimes leads to eating disorders. Remember, eating disorders aren’t just habits. They are life-threatening conditions. If you or a loved one is suffering, please seek help immediately.

bulimia

Post-script: If you’re wondering about the above picture of the teeth, you’re viewing the effects of all that regurgitated acid on the enamel layer of your teeth.  I know. It’s not your best look.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Filed under Diet and Nutrition, Gastrointestinal, Mental Health

Straight, No Chaser: When Eating Goes Wrong, Part I – Anorexia

anorexia_nervosa11

Simply put, our society doesn’t do the job it should in promoting a normal image of health at either end of the body size spectrum. The typically promoted American ideal of beauty sets standards that lead many to pursue unrealistic means of meeting that ideal. In the setting of an actual American population that is disproportionately obese by medical standards, this becomes even more of a problem, as individuals give up on realistic goals and settle into unhealthy eating habits that lead to disease due to obesity.

Most people are aware of two eating disorders (on the low side that is; obesity is another conversation): anorexia and bulimia. It is important to note that eating disorders are real medical and mental diseases. It is equally important to understand that they can be treated. It is vitally important to understand that when left untreated these disorders lead to a much higher incidence of death than in those without these conditions. These diseases cause severe disturbances in one’s diet, so much so that individuals spiral out of control toward severe disease and death in many instances. Sufferers of eating disorders often have a distorted self-image and ongoing concerns about weight and appearance. (This is as true for those pathologically overweight and in denial as it is for those pathologically underweight.)

anorexia-nervosa

Today’s Straight, No Chaser discusses anorexia. Anorexia nervosa is an eating disorder with nearly a 20 times greater likelihood of death that those in the general population of a similar age. Why, you ask? Simply put, anorexics are suffering the consequences of starving themselves. Anorexics have a maniacal and relentless pursuit of thinness, even in the face of being extremely thin. They couple an unwillingness to maintain a healthy weight with an intense fear of gaining weight. They possess a distorted view of their bodies and severely restrict their eating in response. They are obsessed.

Other symptoms and habits of anorexics include a lack of menstruation (among females, though men suffer from anorexia, too), binge-eating followed by extreme dieting and excessive exercise, misuse of diuretics, laxatives, enema and diet medications. The medical manifestations of anorexia are serious and can include osteoporosis or osteopenia (bone thinning), anemia, brittle hair and nails, dry skin, infertility, chronically low blood pressure, lethargy and fatigue, and heart and brain damage. It’s worth noting again that people die from anorexia. It is a disorder to be taken seriously.

The key components of treating eating disorders in general are stopping the behavior, reducing excessive exercise and maintaining or establishing adequate nutrition. The pursuit of adequate nutrition is vital enough that when patients develop dehydration and chemical imbalances (i.e., electrolyte abnormalities), they need hospitalization to correct deficiencies.

Specific management of anorexia involves addressing the psychological issues related to the eating disorder, obtaining a healthy weight, and consuming sufficient nutrition. This may involve various forms of behavioral therapy and medication. Regarding medication use, although some (such as antipsychotics or antidepressants) have been effective in addressing issues related to anorexia such as depression and anxiety, no medication has been proven effective in reversing weight loss and promoting weight gain back to a healthy/normal level. Similarly, behavioral therapy has been shown to assist in addressing the roots causes of anorexia but insufficient in addressing the medical issues that the disease contributed to or caused. Ultimately, it appears that a combination of medications, other medical interventions and behavioral therapy is the most effective course. As is the case with most illnesses, the earlier treatment is initiated, the better the outcome tends to be.

Please maintain a sufficient sensitivity toward those with anorexia. It’s a life-threatening condition, not the punch line of a joke about someone’s appearance.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Filed under Diet and Nutrition, Mental Health

Straight, No Chaser: Blood Transfusions – Facts About Giving and Receiving

donate_blood_1

When was the last time you saved a life? I’m not talking about an Internet game. There are many ways in which your efforts can make a significant difference in the life of someone whose life is at risk. One such instance is donating blood. This Straight, No Chaser reviews the basics of blood transfusion because it’s Patient Blood Management Awareness Week.

You have a greater chance of needing a blood transfusion than you may think.

donate blood faq

Each year, almost 5 million Americans need blood transfusions, meaning 5 million examples of active or potential people in the midst of imminent or potential life-threatening conditions. These can include any of the following:

  • Rapid loss of blood from injuries such as gunshot or stab wounds, motor vehicle collisions or broken bones;
  • Loss of blood during operations;
  • Severe anemia from disease such as cancer, sickle-cell anemia, kidney disease or iron deficiency;
  • Bleeding disorders, such as hemophilia or thrombocytopenia.

Let’s recap why blood is so vital.

donate how_much_blood

Blood carries oxygen and nutrients to the cells of various tissues and organs throughout the body. Failure to have an adequate supply of either oxygen or nutrients causes damage and/or death to the cells affected. You recognize many diseases in which this occurs, including heart attacks and strokes. Blood itself has many components, including red cells, white cells, platelets and plasma. Whole blood contains all of these, but more often transfusions occur via individual parts.

Do you know your blood type?

donate blood

On a list of things you should know about yourself, that really ranks high on the list. When seconds count, being able to share that information can make all the difference. The blood used in a transfusion must work with your blood type. If it doesn’t, antibodies (proteins) in your blood attack the new blood and make you sick.

  • Everyone has one of the following blood types: A, B, AB, or O. Also, every person’s blood is either Rh-positive or Rh-negative. So, if you have type A blood, it’s either A positive or A negative; that classification combines the two components that measure incompatibilities between blood.
  • Type O blood is called the universal donor, meaning it’s safe for almost everyone. As such, Type O blood is used for emergencies when there’s no time to test a person’s blood type. Approximately 40 percent of the population has type O blood.
  • People who have type AB blood are called universal recipients, means they can get any type of blood.
  • If you have Rh-positive blood, you can get Rh-positive or Rh-negative blood. But if you have Rh-negative blood, you should only get Rh-negative blood. Rh-negative blood is used for emergencies when there’s no time to test a person’s Rh type.
  • All of this means if you’re AB positive, you’re in a good position to receive donor blood and are relatively less likely to have allergic reactions to blood. Any blood type is good regarding the ability to donate.

Is donated blood safe?

donation_questions

Blood banks collect, test, and store blood. All donated blood is meticulously screened for viruses, other infectious agents and other factors that could make you sick.

It’s helpful to know that not all transfusions require blood donated from a stranger. If you’re going to have surgery and if it’s surgery that is scheduled months in advance, your doctor may ask whether you would like to donate your own blood for potential use if needed during the surgery. Your blood would be drawn well in advance and stored in a blood bank. Even during surgeries, surgeons try to reduce the amount of blood lost so that fewer transfusions are needed. Sometimes blood lost can be collected and reused for the same patient.

Are there alternatives to blood transfusions?

It’s very interesting that of all the medical advances that have been made, there are still no man-made alternative to human blood. That said, researchers are trying to find ways to make blood. At this point, researchers have developed medicines that may help do the job of some blood parts. For example, some people who have kidney problems take a medicine called erythropoietin, which helps their bodies make more red blood cells. As a result, they may need fewer blood transfusions.

Will you donate blood?

donate-blood1

What this all boils down to is having sufficient blood supplies is vital to hospitals’ ability to take care of patients. Please consider this gift of life. You can easily check your ability to donate by contacting your local hospital or the Red Cross by visiting http://www.redcrossblood.org/give/drive/driveSearch.jsp. Besides, donating blood actually comes with plenty of benefits, including reducing cholesterol, improving circulation, reducing iron buildup and identifying any abnormalities you may have in your blood.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Filed under Hematology & Oncology/Blood Disorders/Cancer

Straight, No Chaser: The Health Benefits of Dark Chocolate, aka Happy Valentine’s Day!

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Happy Valentine’s Day! Got Dark Chocolate?

dark-chocolate

As you may know if you’re a regular reader, Straight, No Chaser is big on you enjoying life and making healthy choices while doing so. In that spirit, on this day of roses and chocolates, we’re here to share with you the benefits of dark chocolate.

That’s right. Chocolate does have health benefits, but all chocolate is not created equal. If your loved one gives you chocolates today, that’s great (if that’s your thing). If s/he gives you dark chocolate, that’s an extra level of loving!

Straight, No Chaser has previously discussed the health benefits of antioxidants. Here’s the thing: antioxidants are substances that prevent or delay cell damage caused by free radicals. Free radicals are molecules that are byproducts of many activities that create cell damage. Think about cigarette smoke, trauma (even excessively vigorous exercise), excessive heat and sunlight (and its radiation), to name a few examples. The process of creating and releasing these molecules is called oxidation. The key point is free radicals are unstable and too many of them lead to a process called oxidative stress. This process is implicated in the development of many illnesses, including Alzheimer’s disease, cancer, cataracts and other eye diseases, cardiovascular diseases, diabetes and Parkinson’s disease. Antioxidants fight this process; this is why foods rich in antioxidants are called superfoods!

antioxidantsawesome

Here are the known benefits of dark chocolate:

  1. It lowers blood pressure.
  2. It increases the levels of antioxidants, which reduces the incidence of heart disease of other conditions.
  3. It potential slows the onset of many (if not any) disease made likely by increased levels of free radicals. This points to benefits for brain health, slowing aging, cancer prevention and many other conditions.

dark chocolate_types1-e1423973494873

Here’s how to enjoy the benefits of dark chocolate:

  1. Remember, it’s dark chocolate (not white chocolate or milk chocolate) that provides these health benefits.
  2. Offset the extra calories you’re ingesting by exercise or otherwise eating less.
  3. Don’t drink milk while enjoying your dark chocolate; it appears to interfere with the body’s absorption of the dark chocolate.
  4. Go for European dark chocolate if available. It’s richer in cocoa phenols (the specific compounds known to lower blood pressure).
  5. Remember that a dark chocolate diet is not a thing! This is you making healthy choices even as you enjoy sweets.

dark-chocolate-health-food-get-fit-in-shape-

So if you’re going to chomp down on a truffle or bon-bon today, make it dark chocolate. And hold the milk. Happy Valentine’s Day!

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Filed under Cardiology/Heart, Detoxification, Diet and Nutrition, General Health and Wellness, Health Prevention