Breastfeeding moms, especially new ones, often worry about whether or not they’re producing enough milk to help their infants thrive. They search for, and compare notes on, any dietary edge they can find. Now some have hit upon a perhaps unusual recommendation: The Starbucks Pink Drink.
Technically, the drink is called a Strawberry Acai Refreshers Beverage, with “accents of passion fruit … combined with creamy Coconutmilk,” but to most people it’s a Pink Drink. And some breastfeeding moms swear by it.
So says this recent article in Health.com. The writer shared women’s personal testimony about the drink’s milk-boosting benefits, then turned to UCLA Health’s Dr. Leena Nathan to explain why this might be so.
Nathan, an obstetrician-gynecologist at UCLA Health-Westlake Village, was open to the idea, but not in a bandwagon kind of way. In fact, she told Health.com:
“There is no evidence to suggest that any of the ingredients in the Starbucks Pink Drink would help with breast milk production.”
What could make a difference is the drink’s boost to electrolyte and hydration levels – and the lack of tension apparently inherent in the experience.”There is a relaxation factor involved in making a trip to Starbucks and drinking a sweet, delicious beverage,” Nathan told Health.com.
That said, women have other – read: inexpensive and non-sugary – ways to increase milk production.
“In short: Practice,” Nathan said in a separate conversation.
“Simply breastfeeding the baby or pumping breast milk more often, ideally every two hours until the milk supply is well-established, can make a big difference.”
For women to whom that sounds overwhelming, Nathan has this advice: Drink lots of fluids and stay as relaxed as possible.
Of course, “relaxed” can be a difficult state to achieve for new moms. Nathan says that some women have sworn by the herbs fenugreek and moringa, as well as oatmeal and fennel, just as much as the Starbucks Pink Drink. Herbal teas and supplements could have an effect as well. Some women may even be tempted to turn to medications known to boost milk production, but they can have significant side effects, Nathan warned.
Better to stick with the tried and true: Practice, practice, practice.
If the occasional Pink Drink is part of the practice, well, new moms deserve a treat.
Dr. Edna Elvira Biddy, Dr. Brenda Green, Dr. Jose Javier Hernandez and Dr. Olga Meave share a certain bond with their patients. They all understand barriers within health care.
For their patients in medically underserved areas of the state, one primary barrier has been a shortage of physicians. After all, the U.S. Department of Health and Human Services defines a shortage of primary care physicians as fewer than one for every 3,000 to 3,500 people – and California has 607 federally designated shortage areas, impacting a population of some 6.7 million people.
For the doctors, all trained in Mexico, the barrier has been a lack of U.S. licensing to practice medicine. They simply weren’t allowed to help people in the U.S. who needed it.
One program has benefited both the doctors and the patients: the UCLA International Medical Graduate Program. It helps legal immigrants with physician training — that is, those who have already graduated from a medical school outside of the United States, Puerto Rico or Canada — pass their U.S. licensing exams and obtain U.S. residency training in family medicine. In exchange, participants — once they’ve become residency-trained and licensed — provide care in underserved communities for two to three years after completing their family medicine residency.
For people in underserved communities, many of whom are Mexican immigrants, the impact of having a physician who understands not just their language but their culture is huge.
“Only 5% of California practicing physicians actually are Hispanic. Yet, 39 percent of the population is Hispanic,” said Michelle Bholat, M.D., executive director and co-founder of the International Medical Graduate Program. “What I think makes this special is our program has individuals themselves who are new immigrants to this country… They’ve been vetted through the same process of testing that a US student is asked to perform.”
And their ability to connect with their patients is undeniable.
“She knows how to communicate. She knows how you think, how you operate,” 57-year-old Jorge Preval said of his physician, Dr. Brenda Green, in an interview with the San Diego Union-Tribune. “I don’t know how she does it, but when I go to see her, she always figures out the problem. For me, she’s the best doctor I’ve had in my entire life.”
As for recent graduates of the IMG program, here’s what they have to say:
Dr. Edna Elvira Biddy, who recently completed a residency at Riverside University Health System and is returning to UCLA Health for a fellowship in geriatrics:
“I see it mostly in terms of culture. There are some things that are known to the Hispanic population, to Mexicans – and there are things that are proper to the culture – that maybe someone who just speaks Spanish wouldn’t understand. Knowing that I know the slang, people feel more open to discussing their problems and their medical conditions…. They feel grateful to have a doctor who knows not only their language but their culture.”
“I want to continue working for underserved communities. I know that the older patients are, the deeper their Latino roots and the less adapted to U.S. culture to they are.”
“Once you are interested in this type of thing, it’s hard to move to other medical systems. I’m hoping I’m staying here for the long run. … I think they need me more here because over there [Tijuana, where she worked previously] everyone is on the same page.”
“When I come into the room, they say, ‘I’ve never told anybody this — but this is what I’ve tried.’”
“The need for medical care here is overwhelming. So many of my patients have avoided the doctor for years because of language and cultural barriers. Now, they know there is someone who can care for them who know the language, knows the cultures and shares their heritage. It’s so rewarding knowing how much of a difference I am making in their lives.”
Dr. Olga Meave, currently a third-year resident at the Rio Bravo- Clinica Sierra Vista in Bakersfield:
“People who don’t have access to care often are the ones who most want to be healthy – but can’t. It’s not a matter of wanting to be healthy, it’s a matter of not being able to.”
“Being able to establish rapport from the first visit and being able to understand what patients mean when they speak to you in slang makes them very comfortable. That makes them more interested in their health care. I get to see the mom, and the daughter and the husband and the whole family. They spread the word.”
For pregnant women, the prospect of prenatal testing creates both hope and fear. The hope: That they’ll learn the gender of their unborn child and that it will be shown to be developing normally. The risk: That the test itself will create a health risk for them or their baby. New UCLA-led research could ultimately remove the fear.
The study, led by Hsian-Rong Tseng, a professor in the department of molecular and medical pharmacology at the David Geffen School of Medicine at UCLA, highlights a potential new way to conduct prenatal testing – one that doesn’t involve invasive sampling or the risk of miscarriage. Instead, the method uses fetal cells collected from the mother’s blood or cervix.
The research, published recently in ACS Nano and supported by the National Institutes of Health, shows promise in the use of cells known as circulating trophoblasts to create a diagnostic test. Circulating trophoblasts are fetal cells shed from the placenta into a woman’s blood early in pregnancy. These cells hold the answers to many of the questions that parents have at that stage of a child’s life. What to do about ear infections comes later.
As described in the journal, the researchers first collected blood from 15 pregnant women, eliminated the red blood cells, then applied the rest of the blood cells to a NanoVelcro microchip they developed themselves. They also attached an antibody to a marker on the cells’ surface.
Here’s a description of the impact from 360dx.com:
“The advantage over current non-invasive prenatal testing (NIPTs) that analyze cell-free circulating DNA from the mother’s blood … is that the test would analyze pure fetal DNA without any maternal DNA mixed in and, therefore, likely be suitable for diagnostics, not just screening.”
California’s rural Kings County has far fewer doctors than the patient-to-doctor ratio that defines a federal “shortage” – 3,500-to-one. It also has a high percentage of immigrant farmworkers, many with customs and perceptions of health that most U.S.-born doctors wouldn’t understand.
Both of these factors make Dr. Jose Javier Hernandez an important part of the solution to some of the area’s health care disparities – just as UCLA Health and the David Geffen School of Medicine at UCLA intended.
A first-year resident in the family medicine residency program at Adventist Health in Hanford, Hernandez is a graduate of the UCLA International Medical Graduate Program, the only program in the U.S. sponsored by an academic medical center that benefits both immigrant physicians and the underserved community.
Specifically, the program helps legal immigrants who have already graduated from a medical school outside of the United States, Puerto Rico or Canada to pass their U.S. licensing exams and obtain U.S. residency training in family medicine. In return, the participants — once they’ve become residency-trained and licensed — provide care in underserved communities for two to three years after completing their family medicine residency.
A unique program that fills a need
“What’s so unique about our program is that it often means immigrant patients, who are typically underserved in medicine, are cared for by doctors who are new immigrants themselves,” says Dr. Michelle Bholat, executive director and co-founder of the International Medical Graduate Program.
Hernandez originally attended medical school at the Universidad Autonoma Benito Juarez de Oaxaca. When he immigrated to the U.S., he could no longer practice medicine due to the country’s licensing requirements, so he worked with an interdisciplinary rehabilitation program for injured workers with chronic pain. Later, he worked at a children’s hospital, assisting asthmatic children from immigrant families to achieve better control of their symptoms.
But Hernandez was trained to be a physician. That’s what he was called to do.
So in 2015, Hernandez applied and was accepted to the UCLA International Medical Graduate Program. The program made all the difference, not only for Hernandez, but for the patients he now treats.
“Many times, when these patients come to see me, they’ve already tried many things, such as imported traditional medications from Mexico, and they’ve already self-prescribed to themselves,” Hernandez says, adding:
“Many times they don’t disclose that to American doctors. When I come into the room, they say, ‘I’ve never told anybody this — but this is what I’ve tried.’”
His patients listen to Hernandez because he understands more than their language. He understands their customs and culture.
“My dad was a seasonal farmworker for 18 years in California,” Hernandez says. “I feel really attached here, seeing people on a daily basis. I see Spanish-speaking farmworkers, not just in the Central Valley but also along the Central Coast, with very specific healthcare needs.”
A connection based on understanding
His background helps him connect. He understands that many recent immigrants have culturally based views of diagnosis and treatment.
“They have a huge attachment to traditional medicine, meaning people would rather go with natural healers or their neighbors to ask what they can do about various conditions, than to a doctor,” Hernandez says. “There are strong beliefs about someone becoming dependent or addicted to a medication within the Hispanic community; therefore, people would rather try home remedies or herbal medicine first before seeing a doctor. This can be an advantage when dealing with opioid prescriptions; however, it becomes an issue when it comes to medication compliance for chronic medical conditions such as asthma, diabetes or hypertension.”
Knowing their culture helps him form a bond, one that leads to a necessary component of any doctor-patient relationship – trust.
“I connect much faster than U.S.-born doctors,” Hernandez says. “At every level — right now I’m doing OB — I find very specific beliefs, such as about what protects the baby, what protects the mom. Oaxaca is 60% indigenous, so people have their own traditions, their own medicines. They have their own way of seeing the world.” He added:
“Having that understanding helps in many situations.”
As an example, Hernandez cites the case of one patient with high cholesterol that was not well-controlled. The patient said he was eating a low-carbohydrate diet with few tortillas and little fruit. But, as it turns out, the man was using lard to fry all his foods. Hernandez helped him understand the connection.
That one interaction illustrates the symbiotic beauty of the International Medical Graduate program. It helps patients who desperately need it while directly addressing the issue of “brain waste,” that is, the underutilization of physicians who have immigrated here legally, but are unlicensed and working far below their education levels.
In short, the program gives committed doctors a chance to do what they do best – help others.
With flu season behind us – or ahead of us, depending on your perspective – the possibility of contracting the disease is currently low. For people at high risk of complications, however, the threat of flu remains very real. That includes those with inflammatory bowel disease.
Caused by the body’s inflammatory response, inflammatory bowel disease – known individually as Crohn’s disease and ulcerative colitis – is often treated with medications that suppress the immune system. That means the flu can more easily take hold and do damage.
But first a short primer: Crohn’s disease causes inflammation and irritation within the intestinal tract, usually the end of the small intestine, and over time, scarring within the intestine. Ulcerative colitis causes inflammation in the inner lining of the large intestine, including the colon and rectum. Both conditions can cause abdominal pain and frequent diarrhea. Now to the questions…
What do diseases of the intestines have to do with the flu?
People with Crohn’s disease or ulcerative colitis who are on immunosuppressive medications can have increased susceptibility to infections, including the flu and pneumonia. These immunosuppressive medications can be important to reduce inflammation and symptoms associated with the disease. However, they can also suppress the ability of a person’s immune system to fight off infections.
Taking precautionary measures such as receiving appropriate vaccinations can decrease the chance of developing infections while on immunosuppressive therapy.
Should people with Crohn’s disease or ulcerative colitis get the flu shot as early as possible – or wait a while to see how bad the flu season is?
People who are on immunosuppressive medications should definitely be considered a high-risk group. That means they should get the shot as soon as possible – and that they should have priority access to influenza vaccinations.
What type of immunization should they get?
All patients with inflammatory bowel disease should receive the inactivated influenza vaccine – not the nasal spray flu vaccine, which is a live, attenuated influenza virus – regardless of whether he or she is on an immunosuppressive medication.
Are there any special steps that people with Crohn’s disease or ulcerative colitis should take to protect their health during flu season? Or any time of year?
People with Crohn’s disease or ulcerative colitis should receive the inactivated intramuscular influenza vaccination annually during flu season. In North America, flu season is typically from September to May, with peak months in January and February. People may worry that the influenza vaccine can trigger a flare, but studies and expert consensus suggest that the influenza vaccine does not exacerbate disease activity.
General precautionary measures such as avoiding sick contacts, washing hands frequently with soap and water and disinfecting surfaces that may be contaminated with germs are also helpful.
What should someone with inflammatory bowel disease do if they catch the flu?
If a person catches the flu, he/she should limit contact with others as much as possible to keep from infecting others. If a person has the flu, treatment within 2-3 days of symptom onset with Tamiflu or Relenza may decrease the severity or shorten the course of the flu by a few days.
If you’re a man of a certain age, or someone who loves him, the thought of prostate cancer is never far away. After all, the disease is the most common cancer diagnosis in men, and the likelihood increases with age. That’s why researchers and physicians worldwide are working to improve diagnoses and treatments.
In his review, Litwin assesses the optimal methods for the diagnosis and treatment of prostate cancer based on current evidence. That “current evidence” is important, because as evidence increases, knowledge grows. As knowledge grows, treatment evolves – and survival and outcomes improve.
This evolution is not always smooth, however. As Litwin begins:
“Although prostate cancer is common, the indolent course of many tumors and the potential for adverse treatment effects have generated controversy regarding the utility of screening and early detection. Even so, prostate cancer can threaten long-term health and remains the third-leading cause of cancer death in men. Since 2011, meaningful progress has been made in characterizing disease risk and identifying therapeutic options.”
Noting that the screening issue has been addressed (exhaustively, many would say) elsewhere, Litwin then summarizes the advances in prostate cancer diagnosis and treatment.
With diagnosis, he explores the merits and limitations of prostate biopsy and its variations, including the standard biopsy and those enhanced with new imaging technology. He also explains the various types of molecular and image-based biomarkers that could ultimately produce a clearer – and less invasive – picture of an individual’s disease and, more important, what to do about it.
Of the advances in diagnosis, he writes about staging of the disease – that is, determining how advanced it is – as well as treatment of localized disease, which currently amounts to what’s known as “watchful waiting,” surgery and radiation. Then he explores the treatment of metastatic disease and the increasingly complex options for treating it.
The topic is complex, full of data, nuance and an expert’s interpretation of science.
But Litwin’s take-home message for physicians – the audience of his article – is simple:
“Advances in the diagnosis and treatment of prostate cancer have improved the ability to stratify patients by risk and allowed clinicians to recommend therapy based on cancer prognosis and patient preference.”
The translation of that into lay language is a take-home, and equally simple, message for everyone:
Cancer treatment and diagnosis have improved. Each patient is different. Treatment is no longer one-size-fits-all.
Healthy babies start with healthy pregnancies. Most people understand that concept. But too many women don’t know that healthy pregnancies start with healthy homes.
“Women don’t always think about the hidden hazards of environmental exposure before becoming pregnant and what they can do to increase the likelihood of a healthy pregnancy and healthy child and improve their chances of becoming pregnant in the first place,” said Julie Friedman, director of the Iris Cantor-UCLA Women’s HealthEducation and Research Center. “Toxic chemicals can be found in everyday household and personal care products as well as in food. Knowing what to watch out for and selecting healthy alternatives can help reduce exposure.”
Some women are more at risk from these environmental exposures than others.
“Many lower-income women living in areas with poor air or near manufacturing facilities face added exposure to environmental containments,” Friedman said. “Because lower-income women are more likely to be exposed to potentially dangerous chemicals and pollutants, we work with community groups to help teach as many people as possible how to reduce their personal risks.”
Specifically, Friedman and her colleagues at the center are training Los Angeles health educators to spread the word on how to avoid exposure to potentially toxic substances during, even before, pregnancy. Among the tips:
Don’t spray bugs. Instead of using poison sprays, dusts or chemical bombs to fight insects, seal cracks that insects use to enter homes, clean up crumbs so they have nothing to eat, and use traps to capture them.
Avoid, and reduce, lead exposure. Use water-based paints, glues and materials for home improvements instead of lead-based materials. Also, because lead can be found in existing house paints, dust and garden soil, always wash your hands before preparing or consuming food.
Get out the mop. Household dust can contain a variety of chemicals and contaminants, so use a wet mop or clot to get rid of it. A dry cloth will simply spread the dust.
Use non-toxic products. Household cleansers can contain potentially risky chemicals, so be sure the cleaners you use are non-toxic. You could even make your own non-toxic – and inexpensive — cleaning solution by mixing 1 cup of white distilled vinegar with 1 cup of water.
Choose your fish carefully. Avoid shark, swordfish, king mackerel and tilefish, all of which can have high levels of lead. Instead, eat salmon, tilapia, Pollock, catfish, king crab, shrimp and light canned tuna, all of which have low mercury levels.
Beware of plastics with bisphenol A or polyvinylchloride. The compound bisphenol A (BPA) has been linked to infertility, cancer, obesity, diabetes, early puberty and behavorial changes in children. It’s found in some plastics and in the lining of some food cans. In laboratory animals, polyvinylcholoride has been found to affect reproduction, sexual development and the developing immune system. It’s most often found in piping and hard plastics, but can also be found in some cling wraps, plastic squeeze bottles and plastic jars.
Avoid foods that might contain pesticides or other toxic substances. Instead of eating food from cans, which might contain bisphenol A (BPA), choose fresh and frozen produce, especially those fruits and vegetables with thick skin that can peeled. Also, avoid animal fat, which can accumulate toxic chemicals.
Choose products that don’t contain fire retardants. Buy products such as crib mattresses, nap mats and other upholstered products that have been labeled as free of flame retardants.
Read labels, even on cosmetics. Beware of products containing formaldehyde, galaxolide, hydroquinone, lead, oxybenzone, parabens, phthalates, sodium laureth sulfate, thimerosal, toluene, tonalide and 1,4-dioxane.
Take your shoes off. Shoes can track contaminated dust and other pollutants into the home. Better to leave them at the door and put them on again just before you go outside.
To date, the women’s health and pregnancy experts at the Iris Cantor Women’s Health Center have worked with 10 community-based organizations to help spread knowledge of these, and other, healthy pregnancy tips through their “Healthy Home, Body, and Baby” program.
Anorexia nervosa or anxiety. Anxiety or anorexia nervosa. When it comes to treating people who struggle with both anxiety and anorexia nervosa, or the obsessive desire to lose weight, too many doctors focus on one condition or the other.
That’s a mistake, say UCLA experts in the treatment of eating disorders.
Feusner is now recruiting for a brain imaging study that could help researchers learn more about this circle of anxiety and anorexia nervosa, specifically how being in an anxious state affects the brain’s ability to experience reward, and how that relates to a person’s path of recovery.
The study will explore the relationship between the brain circuits involved in reward and those involved in anxiety. Those with anorexia nervosa are often anxious, and being in this state might diminish their brain’s ability to experience reward (the good feelings that people usually experience when, for example, they get a good grade, or win a game, or are awarded money). In addition, for some suffering from anorexia nervosa and anxiety, controlling his or her food intake or doing compulsive exercising might provide a sense of control, which can relieve the anxiety and might actually become rewarding in and of itself.
To date, the “dichotomous thinking” on this topic – treat the anxiety? treat the anorexia nervosa? – has impeded diagnosis and treatment, Feusner said. It’s not as if patients either have anxiety issues or they have anorexia nervosa. The conditions are tightly intertwined in a complex way that varies from person to person.
The study would build on what physicians are now learning about anorexia nervosa and anxiety. That additional understanding could help people with other disorders as well.
Take obsessions and compulsions, for example, which are symptoms that not only people with obsessive-compulsive disorder experience, but also many with eating disorders and those with other related problems such as body dysmorphic disorder. “Compulsions are often driven by anxiety, but at the same time perpetuate it, so if you treat compulsions, you treat anxiety at the same time.
However, if you treat the anxiety, but not the compulsion, the behaviors do not automatically go away on their own. These behaviors become very ingrained and take on a life of their own.”
Learning more about the reward circuitry involved with anxiety is an important step in developing more effective treatments.
“Not only people with anorexia nervosa, but people in general who experience anxiety might have this reduced ability to experience reward when they are anxious. We need to have a better understanding of how these systems interact in the brain,” Feusner said. “Most clinicians recognize this complex relationship between anxiety and reward, but they don’t necessarily know how to deal with it.”
“Simply stated, that to understand why in the long arc of human development some people thrive while others remain beholden to odd motives and self-defeating acts requires the subtlest appreciation of how complex processes shape behavior and self-concept; the complexity of human life, including its deviancies, is fact. So does it not stand to reason that broadly conceived approaches to behavior change should also occupy a prominent place in our attitudes about treatment when it comes to an illness that is emblematic of how challenging psychiatric treatment can be?”
Feusner reiterates the complexity of eating disorders, especially as they’re connected to anxiety: “When people are anxious, they’re less able to experience reward in terms of feeling excited or good even in doing simple things, such as looking forward to spending time with friends. If people are less able to experience such reward, there’s less of a positive motivation to get better. There’s less for them to look forward to.”
The new study could begin to unlock some of the clues to the lack of rewards, and the misplaced rewards, within anorexia nervosa and anxiety.
For the study, he and his colleagues are seeking adolescents currently in, or who have recently received, intensive treatment for anorexia nervosa, such as hospitalization, residential, or intensive outpatient therapy. They’re also seeking adolescents with mild anxiety.
Every piece of knowledge gets them one step closer to helping more people.