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Sanjay Gupta MD

The Truth About Caffeine; Health Care: Is Our Government Getting Too Involved or Not Doing Enough?; Cold Versus Allergies

Aired January 26, 2008 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

SANJAY GUPTA, CNN HOST: This is HOUSE CALL. We're making the rounds this morning with some of the most intriguing medical stories of the week.
First up, what's the truth about caffeine? Is it good for you or bad for you?

Plus, most Americans think our health care system is broken. Is our government getting too involved or are they not doing enough?

And your sniffling and you're sneezing, you have a stuffy nose. Seems like it's a cold, but could it be allergies?

We start, though, with a new study raising serious concern about the risk of caffeine in pregnant women. Researchers say caffeinated beverages harm the baby. And new guidelines are needed to inform expectant moms. If you're pregnant or planning to get pregnant, how do you know how much caffeine is too much?

(BEGIN VIDEOTAPE)

GUPTA (voice-over): For many people, a cup of coffee provides a much needed morning boost. But for expecting moms, that same cup can mean danger for the baby.

JENNIFER WU, DR., OB-GYN, LENOX HILL HOSPITAL: So we think that caffeine affects cellular development and also that it can constrict the blood vessels in the placenta so there's decreased flow to the baby.

GUPTA: A new Kaiser of over 1,000 pregnant women find those who consume more than 200 milligrams of caffeine a day, that's about two cups of coffee, have twice the risk of miscarriage when compared to those who consume no caffeine at all.

New York obstetrician Dr. Jennifer Wu says several factors can contribute to the loss. But for some, the caffeine impact may be delayed.

WU: The majority of miscarriages are genetically based. And caffeine would have nothing to do with that. But we do know that caffeine is linked to later miscarriage in the first trimester. And that typically is not genetically based.

GUPTA: The March of Dimes says pregnant women should drink no more than 300 milligrams of caffeine a day. And The American College of Obstetricians and Gynecologists has no current recommendations. The Kaiser researchers hope their study will lead to more concrete guidelines in the future. But for now, they encourage pregnant women, or women who wish to become pregnant to reduce or eliminate their daily caffeine intake.

And for women who just can't kick the caffeine, no more than six to eight ounces of coffee, tea, soda or hot chocolate per day is advised.

(END VIDEOTAPE)

GUPTA: Now, all the news about caffeine may be a little confusing right now. Another study coming out this week links caffeine to a lowered risk of ovarian cancer. But keep in mind, this study involved women who were not pregnant or taking hormones.

Other research suggests caffeine may also be good for reducing the risk of Type 2 diabetes, Parkinsons Disease, colon cancer, even improving your memory. Don't use this as an excuse to supersize your coffee. Doctors say too much caffeine can lead to restlessness, anxiety, and headaches. They say keep your intake to two or three cups of coffee a day.

Well, every week, we bring you ways to be empowered with your health care. But can you cross the line and be too vocal or just plain annoying? CNN medical correspondent Elizabeth Cohen is here with hints on when you may have gone too far. We want patients to be empowered, but there might be a little of a fine line there.

ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: It is a fine line. Doctors are telling me, you know what, sometimes becoming empowered can cross that line. Empowered is going to the Internet, educating yourself, arming yourself with good questions for your doctor. Annoying is, hi, doctor, I went on the Internet, I know what I have, and please give me this drug. That's annoying.

GUPTA: I mean, is it -- some say you have to be that way to get care, though, or to get what you need?

COHEN: I think that's how some patients feel. Some patients feel like this is what I have to do.

But the doctors I've talked to said, look, if you're obnoxious, we're not going to like you so much. And of course we're going to still take care of you.

GUPTA: Right.

COHEN: But you're going to get more out of us if you're a nice person. Actually, I have a couple of tips...

GUPTA: OK.

COHEN: ...for what to do, for how not to be obnoxious.

And the first thing is respect your doctor's time. If you feel like you have some new problem, and you're going to need a lot of time, say more than 15 minutes, ask them, is today a good day for this? Is this OK or should I make another appointment? Or try to book two appointments back to back. That's another idea.

GUPTA: (INAUDIBLE).

COHEN: And also arrive organized. So if you have questions, write them down so you don't ramble. If you have new symptoms, write them down, so you can be concise when you get in there.

GUPTA: You mentioned the Internet. And you know, it's sort of an interesting thing because we're obviously medical correspondents so we provide information to a lot of viewers. But people will look on the Internet, they'll get certain bits and pieces. What's the best way for them to use the Internet and take it to their doctor?

COHEN: OK, the wrong way to do it is to go in and say, I read it on the Internet, I know this is true. This guy went to medical school and you didn't.

GUPTA: That's right.

COHEN: Right, exactly, that's not good.

The better way is to say here's what I learned on the Internet. And I want to ask you, what do you think about this, doctor and what are some Web sites that you think I ought to go to. Arrive with questions, not with demands.

GUPTA: I think that's really good advice. And I think all doctors will be amenable to that.

COHEN: Absolutely.

GUPTA: Elizabeth, thank you very much. Make sure to check out Elizabeth's column as well on this very topic at cnn.com/health. Just look for her picture and click on the link. Every week, she writes about ways you can empower yourself to get the most out of your health care.

And for those who might love to count calories, you may soon be toasting to your health. That's next in our quick medical headlines.

And how a bus ride changed this woman's life and health. We're back in 60 seconds.

(COMMERCIAL BREAK)

GUPTA: Some quick medical hints now. Type 2 diabetics who are obese may benefit from surgery. That's right. A small two year study compared diabetics who had standard care, diet and medicine, with patients who had weight loss surgery. The surgery group saw the biggest change. And 73% of them had complete remission from their diabetes.

And do you know how many calories are in your wine? Well, you may soon find out. A new proposal would require companies that make beer, wine, and liquor to put nutrition and alcohol content labels on their labels. And could your menu soon be filled with calorie counts? The answer is yes, if you live in one U.S. city. Find out if it's yours later.

(COMMERCIAL BREAK)

GUPTA: Just about any expert you talk to will agree, our health care system needs fixing. And it's not just about the uninsured. Even those with the gold standard employer sponsored insurance are feeling the pinch.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): As an optometrist in South Carolina, Jim Matthews was making about $100,000 a year. But he got sick. A serious heart condition forced him to sell his practice.

DR. JIM MATTHEWS, OPTOMETRIST: It was a chronic condition. And I had open heart surgery, which cured it.

GUPTA: Then doctors found an aneurysm in a major artery. He may need major surgery again.

MATTHEWS: And you'd like to try some contacts?

GUPTA: At age 55, Matthews would like to slow down, but no job means no health insurance. So that's just not an option.

MATTHEWS: If you have health problems, you're not poor enough for Medicaid, you're not old enough for Medicare, and you don't have health insurance through your work, you're really out of luck unless you have wealth.

GUPTA: According to the Kaiser Family Foundation, today, more than 158 million Americans rely on their jobs for health coverage. But in the past eight years, thousands of companies have stopped offering health insurance. Those who still do are asking workers to pay a whopping 55% more. Some health analysts say getting it from your employer is not the answer.

REGINA HERZLINGER, HARVARD UNIVERSITY: We wouldn't want them to buy our cars, our houses, our clothes, but we trust them to buy something that's so important to us, which is our health insurance.

GUPTA: But it can be a big gamble, especially for anyone with a pre-existing condition. When Jim Matthews went looking for individual health coverage, it wasn't just expensive, it was non-existent.

MATTHEWS: They basically laughed at me. They said, you know, you don't have a hope with open heart surgery of having any broker write you a policy in the state of South Carolina. You are uninsurable.

GUPTA: Today, Matthews leases a small office at a Wal-Mart. It makes him eligible for a small business policy. Even for that, he's paying through the nose.

MATTHEWS: It's a little under $18,000 this year for a policy that if you add up co-pays and co-insurance, deductibles and medicine, it will be about $23,000 this year.

GUPTA: So Matthews has to keep working.

MATTHEWS: I have no hope of retiring until I'm 65. I mean, I'm just crawling for the ropes to reach Medicare.

(END VIDEOTAPE)

GUPTA: Problems with the health care system aren't limited to the uninsured. As we said, people who have health care, even employer sponsored plans, are seeing these huge cost increases. In fact, one survey finds health insurance premiums have increased 87 percent since 2000.

So Gerri Willis joins us now with her top tips on how to save money on your health insurance.

Geez, Gerri, how much are people paying today?

GERRI WILLIS, CNN PERSONAL FINANCE EDITOR: Sanjay, a single person pays an average premium of about $4500 a year. Now family coverage, the average premium, is about $12,000. You should know out of pocket costs rose 115 percent since 2000. Workers in small firms have higher deductibles than those in larger companies.

GUPTA: So what are some options out there?

WILLIS: Well, bottom line, don't go without coverage. Try to get group insurance, that's the best. People who bought individual policies had higher costs and more limited coverage. And in a recent study, 76 percent of people without insurance said they couldn't even afford an individual plan. If you belong to a professional organization, see if there are any health insurance options available to you.

Now if you were laid off, you can use COBRA. This guarantees group coverage for up to 18 months, but it's expensive. And if you're a recent college grad or you're between jobs, research short-term health plans. These policies can last up to a year, but it won't cover preexisting conditions or even preventative care like a check- up.

Now if you have a preexisting condition, or you want to change your health insurance plan, go to health insuranceinfo.net. This is a Web site that summarizes what protections you have as a consumer and whether you're safer to buy high risk insurance pool.

GUPTA: All right, Gerri, thanks a lot. Good information there. Be sure to tune in to Gerri's own show called "OPEN HOUSE" right here on CNN every Saturday at 9:30 a.m. Eastern, and both Saturday Sunday on "Headline News" at 3:30 Eastern.

That winter cold you just can't shake, could it really be an allergy? We'll tell you the difference. That's coming up next.

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL. Well, you know the symptoms, sneezing, runny nose, sore throat. They may sound and feel like a cold. But even in the winter, they could be signs of allergies. The question is, how can you tell the difference? On cnn.com, you voted to learn more about distinguishing between colds and allergies.

And here to explain, Dr. Linda Guydon. She's an allergy specialist with the Atlanta Allergy and Asthma Clinic.

First of all, thanks for joining us, Dr. Guydon.

LINDA GUYDON, DR., ALLERGY SPECIALIST: Thank you so much for having me.

GUPTA: What are your top three ways to distinguish between the two?

GUYDON: It is difficult sometimes to distinguish between allergies and a cold. The history is very important. Signs and symptoms and your physical examinations are your best tools.

With respect to symptoms, the color of nasal drainage can be helpful. Generally, it's clear with allergies. It can be milky or discolored with a cold. Sneezing fits tend to be more associated with allergies, but can be associated with colds.

Also fever. Fever's probably one of the best symptoms to help distinguish between a cold and allergies. There typically is no fever associated with allergies. Whereas with a cold, one does have a fever.

Sore throat, there's more pain with a cold. More scratchy throat with allergic rhinitis. And swollen and tender lymph nodes can help distinguish, as they are more common with a cold.

Certainly, the season of the year can help distinguish. Spring and fall tends to be more of an allergy season. The winter time colds are more common. With respect to intensity and duration, colds generally last a week, if two at the most, whereas allergic rhinitis or allergies can last as long as the season.

GUPTA: Now people may think if the symptoms are similar, then so should the treatment be. Is the treatment different?

GUYDON: Well, the entities are quite different. With respect to causality, colds are caused by viruses. Allergic rhinitis is caused by an overly sensitive immune system response to allergens, such as tree pollen, grass pollen, mold spores, cat and dog dander. So the causality is different. And thus, given the causality is different, so is the treatment.

Treating a cold, unfortunately, much of it is palliative. Using fluids and Tylenols, medications to help with symptom control. But essentially, you have to let it run it's course.

With respect to allergic rhinitis, the whole causality is different. And thus, the management also is. First, you have to identify what the allergens are. And this is where an allergy evaluation becomes very important. You're able to identify the allergens either through a blood test or by standard skin testing. Once you identify the allergen, the next mode of therapy is medications.

And a number of different medicines are used. Intranasal steroids, antihistamines, lucotrymodifiers (ph), decongestants. What is -- whatever's necessary to control the symptoms.

And third and most importantly, as a goal standard for allergy treatment or allergic rhinitis treatment is immune therapy, which is actually desensitization to the allergens that you are allergic to. It's a very effective method. And it is a long term solution for control of allergic rhinitis, which can be complicated by sinusitis, ear infections, and the like.

GUPTA: So when should they come see you, see a doctor?

GUYDON: I think once you have tried all the remedies available to you, whether they are previous medications prescribed, over-the- counter medications, and you're not getting better. Whether it's a cold, or whether it's due to allergic rhinitis, they can overlap and co-exist.

But when you've reached the point you're not getting better, that's the time to see your doctor. You may require a physical examination. You may require an allergy evaluation, but your doctor is going to be able to put your history and your physical exam together in order to make the appropriate diagnosis and render the correct therapy.

GUPTA: All right, Dr. Linda Guydon, thank you so much.

Now you've made them at home, but the question is, are you sticking with them? Keeping you honest with your New Year's resolutions. Motivation you can't miss. Next on HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: Welcome back to HOUSE CALL. Well, we're keeping you honest with your New Year's resolutions. This week's celebrity trainer and best selling author of "The 12-Second Sequence" Jorge Cruise is here to motivate you.

(BEGIN VIDEOTAPE)

JORGE CRUISE, "THE 12-SECOND SEQUENCE": When you start off any kind of New Year's resolution to exercise, to be realistic. Because if you're not realistic, you're not going to follow through. And say less is more. I'd rather someone exercise twice a week and do it consistently than five days a week. I tell people if they want to get in shape, and they want to tone up for the New Year is avoid starchy carbohydrates at night. What matters most what time of day to work out is what time you're going to be more consistent. 80 percent of my clients say if they don't do it in the morning, things come up. Life comes up, work. Research shows morning is better for metabolism, but what's most important is just to do it.

The most successful people I ever met are morning people, too. If you really want to get in shape, what I'd recommend is twice a week you do strength training with all the research showing that strength training can build muscle, which we all know that it burns fat. And that can even target belly fat.

It's about getting results that feel the burn through strength training using dumbbells or even your own body weight in a very controlled fashion, so you get results quickly.

Cardio is real important for the heart. And it's something I recommend you can do in the morning for a few minutes every day, 20 minutes or so. And that's something you can do daily.

A lot of the clients I work with don't want to go to the gym. They want to work out at home. And that's fine. I mean, you can strength train at home.

So whether it's doing your own isometric type of exercises, or something slow that you can do with your body weight, or with just simple dumbbells and a ball, you don't have to go to a gym.

The basic thing for people to start getting exercise into their life, starting today, you don't have to commit to going to something complicated. And I would commit to doing some basic things, basic leg squats for lower body and maybe a knee push up for the upper body. And everyone wants beautiful abs. So we should do something for the abdominals.

And I think if you cover the lower body, the middle, and the top of your body with some basic three moves, you can do at home, my phrase for the New Year is quality, not quantity.

(END VIDEOTAPE)

GUPTA: So you want to stay in the fit winter, but how long can you stay outside before it starts to get dangerous? Hypothermia and frostbite are your biggest threats. Hypothermia happens when the body's temperature falls below 95 degrees.

Here are some of the signs. You start to shiver, of course. And as it gets worse, confusion may set in. If you're wet and you're cold, hypothermia can happen in just 15 minutes. And if it's windy, that's when you really have to worry about frostbite.

There are ways to protect yourself against the cold weather. More than 70 percent of the body's heat escapes through the head. So make sure to wear a hat, earmuffs, drink water. Your body is fighting to stay warm and that requires water. You can get dehydrated even without being active. The secret is layering. Layering can help regulate your temperature and keep you warm and dry.

Next up, imagine carrying a 100-pound load up a never ending flight of stairs. Why one woman's body almost crumbled under the weight and what she did to lighten the burden.

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL. Every week, we're bringing you stories of weight loss success, showing that whether you've lot 20 pounds or 120 pounds, you can succeed. CNN's I-reporters are showing you how.

(BEGIN VIDEOTAPE)

HEATHER DAVIS, LOST 110 POUNDS: My name's Heather Davis and I've lost is 110 pounds.

GUPTA (voice-over): Heather was thin in elementary school, but as she grew older, things changed.

DAVIS: We had a meat and potatoes family. And we had that for dinner. And we had desert every night. And I was a member of the clean your plate club. So it catches up with you after a while.

GUPTA: Weight gain took a toll, both mentally and physically.

DAVIS: Just picture yourself with a 100-pound backpack on. And that's what it felt like. My knees hurt, my back hurt, my shoulders hurt a lot.

GUPTA: At 22, Heather weighed 250 pounds. She tried all the popular diets, low carb, low fat, even starvation. But one day in graduate school, she says it just clicked.

DAVIS: I was on my campus shuttle and saw the Gold's Gym in Rosslyn out of the corner of my eye. And I said I can either go down into the Metro and go home and eat my Ben and Jerry's, or I can go over there and really just do this, like do it. That first 15 minutes on the treadmill at the gym was killer for me. And now I'm trying to train for a half marathon. And I'm up to six miles.

GUPTA: Good old hard work, determination and healthy eating fuelled Heather's success. She logs an hour of cardio a day, lifts weights three times a week, and joined a rowing team. Now 110 pounds lighter, Heather has more confidence and a new career.

DAVIS: I'm working right on my master's degree in public health because now I feel like I have a very personal contribution to make. And I will be able to relate to people on a very personal level.

(END VIDEOTAPE)

GUPTA: And you can check out Heather's tips as well on keeping that weight off. That's on our Web site, CNN.com/fit nation. We also want you to share your own weight loss success story by sending us an I-report. We'd like to profile you.

Unfortunately, that's all the time we have for today. Remember, this is the place for the answers to all of your medical questions. Thanks for watching.

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