Rabu, 21 Januari 2009

’Tis the Season for Joy, Cheer, and Dieting: What to Eat at a Holiday Party Real-life weight loss secrets from celebrity natural-foods chef Bethenny F

holiday-dieting
Istockphoto

When your calendar is packed with dozens of holiday parties, it may seem like you can’t relax and have a good time without gaining weight. But if you want to get through the season without widening your waistline, don’t make excuses just because it’s December.

Whether you’re faced with a slew of holiday parties, a big birthday, or a wedding, the secret to staying slim is to treat special occasions as just another day. Don’t build up the holiday season too much in your head or you’ll end up overdoing it—and paying for it when you step on the scale in January. Too often people rationalize that they can eat whatever they want because December comes just once a year. But unless you want to add a super-strict diet to your list of New Year’s resolutions, it’s best not to fall too far off the wagon.

Before I head out to a friend’s get-together or an office bash, I make sure I have a game plan. When in doubt, I stick to shellfish, salad, and veggies, and I keep fancy finger foods to a minimum. If the food looks complicated—think mini–quiches, puff pastries, and the like—that means it’s probably loaded with calories. I choose two of my favorite and have a small sample of each.

If you don’t have any dinner plans post-party, here’s my blueprint for a figure-friendly night out:
2 fancy hors d’oeuvres (pick from Parmesan puffs, spring rolls, tartlets, etc.)
2 cocktail shrimp with sauce
2 skinny cocktails
A heaping portion of salad and veggies at the buffet
Sponge-size serving of protein, like chicken or steak

If you’re headed out for dinner after your cocktails, stick to this:
2 fancy hors d’oeuvres
Unlimited crudités
2 cocktail shrimp with sauce
1 skinny cocktail

My most important rule is to surround myself with good company: If I’m busy chatting, I won’t even notice a tantalizing tray of hors d’oeuvres go by.

Together We Lost Over 200 Pounds


friends-walking-weight-loss
Tom Rafalovich
By Brittani Renaud
From Health magazine

Three years ago, when Amanda Bard (Right), 27, and Amber DeBeer Larson (Left), 30, started new jobs at the University at Buffalo, they discovered they had one big thing in common: They both had a lot of weight to drop. “You can’t talk to somebody who’s got 5 to 10 pounds to lose and expect them to understand what you’re going through,” says Amber, whose weight had climbed to 250 pounds at her heaviest. Amanda (who weighed 245 pounds) and Amber decided to go to Weight Watchers together. They used breaks to walk around campus. And, despite working out separately, the friends got inspiration from each other’s successes. “Amber would tell me what exercise she had done that morning, which would motivate me for my afternoon workout,” Amanda recalls.

Amber lost 115 pounds in 15 months, and Amanda reached her 96-pound goal in 23 months. Now they live in different cities but have found a great excuse to visit each other—running races together. This past May, Amber and Amanda finished a half-marathon. And even when they’re not able to talk face-to-face, they credit their bond with keeping pounds away. “Just having that person to turn to when you want to give up is so important,” Amber says.


Amber Before Now
Amanda Before Now
Pounds: 250 135 Pounds: 245 149
Size: 24 4-6 Size: 22 8-10
Total lost:
115 Total lost:
96

Their favorite snack
They both love to eat yogurt (their favorite: Dannon Light & Fit). Amanda pairs it with a bagel or a granola bar for breakfast; Amber eats it with Grape-Nuts for an after-dinner dessert.

How Amber sneaks in veggies
For a quick, low-cal dinner, she combines her favorite fresh vegetables to make a delicious stir-fry. “You can change the flavors and tastes with different spices,” she says. “It’s an easy way to get your veggie servings.”

Calorie-counting secret
“I used to grab a bag of chips, sit on the couch, and—without realizing it—eat the entire bag,” Amanda says. “Now, I’m aware of serving sizes. I write down everything that goes into my mouth on a daily basis.”

Their gift
The friends both love Ann Taylor; the retailer is giving them each a $250 gift certificate.
Congrats, ladies!

General Information About Medifast

What is Medifast?

Medifast is a portion controlled, nutritionally balanced, low fat and clinically proven program that helps people lose weight faster and more effectively than traditional diet plans. Medifast Meals come in individual packets that you mix with water and microwave or refrigerate. Medifast is available in a wide variety of foods and flavors including shakes, soups, stew, chili, oatmeal, scrambled eggs, fruit drinks, iced teas, hot beverages, bars and puddings.

How does Medifast work?
The Medifast 5 & 1 Plan was medically designed to create a calorie deficit, allowing your body to burn fat for energy. Each nutritionally balanced Medifast Meal is formulated with a proven combination of carbohydrates and protein, allowing you to successfully lose weight while maintaining lean muscle mass.

What is the average weight loss amount per week?
Clinical studies indicate that most people lose an average of 2-5 lbs per week with Medifast. The scale isn’t the only test, so check other indicators such as your waistline measurement and how well your clothes are fitting you. Individual results may vary, and are dependant upon various factors such as your weight when you start the Medifast program, targeted weight loss goal, level of exercise, presence of medical conditions, use of medications, accuracy with diet compliance, etc. As with most diets, Medifast suggests that you consult with your physician prior to starting a weight loss program.

Why is the Medifast weight loss program special?
Medifast is an effective, healthy weight loss program. Think of Medifast as a lifestyle change, not just a short-term diet or weight loss solution. Medifast is a quick, healthy diet plan, especially when compared to other diets you’ve likely experienced without success. Medifast is a portion controlled, low calorie weight loss program that leads to more rapid weight loss than traditional diets. Medifast is special because you can achieve the quick weight loss you want, and, unlike other weight loss programs and diet plans you’ve tried, Medifast is clinically proven to produce quick weight loss, typically 2-5 lbs per week.

How do Medifast weight loss products lead to fast weight loss?
The clinically tested weight loss results of Medifast are designed to create a healthy gap between the calories you take in and the amount your body burns, thus promoting effective and natural weight loss. Many times, dieters on other low calorie diets do not meet the minimum daily recommended nutritional requirements. Medifast Meals provide the optimal combination of carbohydrates, protein and other nutrients necessary to give you the quick weight loss you want and the healthy weight loss you need. The Medifast weight loss program is an extremely effective diet plan to lose weight fast. Medifast fits your busy life because Medifast Meals are quick and easy to prepare, while still being a healthy diet plan.

How easy is the Medifast weight loss program?
With the Medifast 5 & 1 Plan, you’ll eat 6 meals a day -- 5 Medifast Meals and 1 Lean & Green Meal. You can choose any 5 Medifast Meals from our menu of over 60 Medifast Meals, including Medifast shakes, bars, soups, pudding, oatmeal, scrambled eggs and more. Your daily Lean & Green Meal consists of a balance of lean protein (such as beef, chicken or fish) and vegetables, which you’ll prepare yourself.

How does Medifast help sustain your weight loss results?
Medifast won’t abandon you the way fad diets have in the past. The Medifast Transition, Maintenance, and Exercise Plans pick up where the Medifast 5 & 1 Plan ends – and teach you how to sustain your weight loss results long-term!

Does Medifast have Diabetic weight loss programs?
Medifast has special diet programs for those with type 2 diabetes. The Medifast diabetic diet plan can help you manage your type 2 diabetes and control your weight, with your doctor’s supervision.

Is Medifast safe?
Medifast has been clinically proven through a number of controlled studies. More than 15,000 physicians nationwide have recommended Medifast programs to their patients -– and more than one million customers have safely used Medifast for over 25 years.

How much does Medifast cost?
Medifast food products cost about $11.00/day or $299.50/month when you take advantage of our convenient Variety Packages (buying foods individually may cost slightly more). That's a lot less than the average of $16.00 a day the average American adult spends on food. Fully-fortified Medifast Meals can be a lot healthier than your typical food intake, considering that we don't always make the healthiest choices at the grocery store or fast-food restaurant. What's more, if you're currently spending money on prescriptions for high blood pressure, high cholesterol, or type 2 diabetes, getting to a healthy weight can reduce - or even eliminate - your need for these costly meds.

What does the Medifast 5 & 1 Plan consist of?
The Medifast 5 & 1 Plan consists of five (5) portion controlled, nutritionally balanced Medifast Meals plus one (1) Lean & Green Meal.

What does the Lean & Green Meal consist of?
The LEAN portion of the Lean & Green Meal consists of 5-7 ounces of lean meat. For a complete list of meats and portion sizes, please refer to our Lean Options List and our Meatless Options List (PDF files).

The GREEN portion of the Lean & Green Meal consists of 3 servings of low carbohydrate vegetables from our Vegetable List (PDF file).

Are there certain “approved” vegetables for the Lean & Green Meal?
All vegetables promote healthful eating; however, during the weight loss phase of your plan, we do suggest that you avoid the “higher carbohydrate” vegetables in order to enhance your weight loss results. Once you Transition to the Maintenance phase of the program, we encourage you to include ALL vegetables for long-term health.

Our Vegetable List (PDF file) will help you identify the relative carbohydrate levels of these approved vegetables. If you hit a weight loss plateau, or are having trouble achieving the fat-burning state, we recommend you choose vegetables primarily from the Green category instead of from the Orange and Blue categories. *NOTE: Carrots, corn, potatoes, peas and brussels sprouts should be avoided while in the weight loss phase of your Medifast Plan. Please add them to your diet once you transition to the Maintenance Plan.

Can I use Medifast Meals interchangeably?
One of the great benefits of Medifast Meals is that they may be used interchangeably. The bars should be limited to one (1) per day (due to their higher caloric and carbohydrate content).

What kind of snacks can I have on this program?
Medifast offers a variety of healthy, delicious snacks that can be used to augment the 5 & 1 Plan, including:

  • Soy Crisps (apple cinnamon, ranch or white cheddar flavors)

  • Crackers (multi-grain or garden vegetable flavors)

Other snacks you may have include:

  • 3 celery stalks

  • 1/2 cup sugar-free gelatin

  • 1 sugar-free Popsicle®

  • 2 dill pickle spears

  • up to 3 pieces of sugar-free gum or mints

Limit your snack intake to one (1) per day. Snacks should NOT take the place of a Medifast Meal or Lean & Green Meal.

*NOTE: Eating more than one (1) snack per day may hinder weight loss. For information on slower weight loss, please refer to our Plateau Tips (PDF file).

Can I substitute a sixth Medifast Meal for my one Lean & Green?
This is not recommended. In order to maximize effectiveness and to ensure that you get all the nutrition your body requires, the Medifast 5 & 1 Plan (5 Medifast Meals plus 1 Lean & Green Meal) should be followed – unless otherwise recommended by your physician.

Is the Lean serving size the cooked or uncooked weight?
It is the cooked weight.

How many calories are in the Medifast 5 & 1 Plan?
The Medifast 5 & 1 Plan provides 800 to 1,000 calories per day, depending on your personal selections.

Can I substitute frozen meals for my Lean & Green Meals?
Medifast does not recommend frozen dinners on the 5 & 1 Plan – primarily due to their varying calorie levels, excessive sodium content and lower protein levels.

Do any Medifast products contain MSG?
The Cream of Tomato Soup is the only product that contains MSG.

How does Medifast sweeten its products?
Medifast uses a combination of fructose and acesulfame potassium to sweeten most products. This combination is used because we have found it to make the best quality products without contributing significantly to calories, sugars or carbohydrates. For more information about acesulfame potassium, click here.

There are sugar alcohols in some flavors of Medifast Bars (Caramel Nut and Plus for Diabetics Bars). Momentum by Medifast Flavor Infusers are sweetened with Sucralose and do not contain acesulfame potassium.

What’s the difference between ‘Medifast 55’ and ‘Medifast 70’ Shakes?
‘Medifast 55’ Shakes have 90 calories and 11g of protein. ‘Medifast 70’ Shakes have 100 calories and 14g of protein. Medifast 55 Shakes are recommended for women. Medifast 70 Shakes are recommended for men and for women who are active or prefer a higher protein count.

Are there any stimulants in the Medifast Products?
Most Medifast Meals do not contain any stimulants, ephedrine, or other herbs that might be harmful to your body.

Our Momentum by Medifast product line contains 100 mg of caffeine and 90 mg of EGCG, a potent antioxidant found in green tea. This amount of caffeine is equivalent to 1 cup of brewed coffee. Using Momentum products is a lifestyle choice, so if you would rather not consume EGCG and additional caffeine you may choose other Medifast products. Momentum products are only included in Variety Packages that are labeled Momentum, and not in our standard Variety Packages for Women, Men and Diabetes.

Is Medifast covered under my insurance?
Weight loss programs are generally not covered by medical insurance, but please check with both your doctor and your insurance carrier for information relative to your individual circumstances. Some policies may cover weight loss programs in conjunction with specific medical conditions (such as primary diagnosis of type 2 diabetes or heart disease) in which obesity is a factor and weight loss can lead to management or improvement of these conditions. But again, you will need to ask your doctor and your insurance carrier this question in order to receive an accurate answer based on your coverage and medical status. Medifast does not bill insurance companies on behalf of its customers.

Does Medifast have a support system on the web?
Yes –- “MyMedifast” provides you with valuable tools, support and information that will help you with your Medifast plan AND assist you with nutrition, exercise and motivation. An easy-to-use meal-planning tool is available – plus you'll be able to connect with other people in the Medifast community just like yourself. MyMedifast is offered at no additional charge – but is available only to Medifast customers. Medifast customers can visit www.mymedifast.com to register.

What is your shipping policy?
All orders are processed within 24 hours and shipped the next business day. Allow 5 to 7 business days for standard shipping; 3 to 4 business days for expedited shipping (additional charge). V.I.P. Membership orders of $200 or more (total after coupons and discounts) get FREE standard shipping anywhere in the U.S. Non-V.I.P. Membership orders of $275 or more (total after coupons and discounts) get half-price standard shipping anywhere in the U.S.

Need your Medifast...fast? For just $9.95, you can put your order on the fast track! Add MedifastTrack Expedited Processing to your order and we'll push your order to the front of the line so you get your products faster than ever. Select this option during checkout.

Has Medifast been affected by the recent peanut recall (January 2009)?

No. There is no indication that any Medifast products are impacted by the peanut recall. Medifast has been in contact with our ingredient suppliers to ensure the safety of our products and we have verified that Medifast does not purchase any ingredients from the supplier in question. Again, we have no reason to believe that any Medifast products containing peanuts have been affected.

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Medifast Plans

Can I try Medifast for just a few days?
We recommend trying Medifast for a minimum of two weeks to allow ample time for your body to maximize its fat-burning potential. However, if you’d like to try Medifast for just a few days, there are some options:

  • Individual samples of Medifast Meals

  • Medifast 2-Week Variety Packages

Individual samples of any Medifast Meal or snack cost $2.50 each; samples of Medifast Soy Crisps are $2.00 each. You cannot order single samples online, so you’ll need to contact Customer Care at (800) 209-0878 to place your order. Customer Care is available on Weekdays 8:00 A.M. – 10:00 P.M. and on Weekends 9:00 A.M. – 6:00 P.M. (Eastern).

Medifast Variety Packages are an easy, economical way for you to order our most popular Medifast Meals. Medifast 2-Week Variety Packages come pre-packaged, so no substitutions can be made. Variety Packages for Women contain ‘Medifast 55’ Shakes (90 calories, 11g of protein) and Variety Packages for Men contain ‘Medifast 70’ Shakes (100 calories, 14g of protein).

Can I customize my Variety Package?
Our pre-packaged Variety Packages cannot be customized or changed. You can, however, design your own menu and only order the meals you prefer. Costs may vary when designing your own menu (depending on which Medifast Meals you choose).

If you're ordering online, you can either use our DESIGN A MENU feature OR you can visit our "Shop" section to select the items you would like. If you need assistance, you can call Medifast Customer Care at (800) 209-0878. Our Customer Care Representatives can answer all of your questions and assist you with placing your first order.

Does Medifast carry kosher products?
The majority of Medifast products are certified kosher by The Orthodox Union of New York. For specific information, refer to our complete list of Kosher Products (PDF file).

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Starting Medifast

How do I get started on Medifast?
You should consult with your physician or qualified medical practitioner prior to beginning (and throughout the course of) any weight loss program. You’ll want to order at least a 2-week supply (a 4-week supply is ideal) of Medifast Meals before you start, then continue ordering on a monthly basis. Schedule your re-orders at least one (1) week in advance so you don’t run out of Medifast Meals.

Can I do the program if I am a vegetarian?
Yes. There are numerous vegetarian options available within the Medifast Meal lineup. For specific information, refer to our complete list of Vegetarian Products (PDF file). You can substitute Meatless Options for the LEAN portion of the Lean & Green Meal. Additional Meatless Options are available on our Lean Options List (PDF files). Low carbohydrate vegetables used in conjunction with your Lean & Green Meal can be referenced through our Vegetable List (PDF file).

When should I start my Medifast program?
The first three days are critical to your success, so pick a start date that makes sense for your schedule. You might want to look for a time when you don’t anticipate any family, work-related or other social-type events that involve food.

What should I do when on vacation?
Medifast recommends planning ahead so you can continue your program while vacationing. If your meals aren’t with you, you can’t eat them! This may necessitate packing food items in your luggage. Pre-planning can help you continue to lose weight while you travel. Customers who are able to plan and continue the program while traveling or ordering out get the best results. Traveling presents countless eating temptations, with the availability of foods that are not part of the Medifast program. Always remember your end goals -- a healthier weight and a healthier lifestyle. If you’re unable to follow your current 5 & 1 Plan, you can try a 3 & 2 Plan (3 Medifast Meals plus 2 Lean & Green Meals). Remember to limit portion sizes in your Lean & Green Meals –- and enjoy your travel!

If your vacation involves strenuous activity (e.g., skiing or bicycling), you may contact Nutrition Support for advice about incorporating additional calories to help prevent fatigue.

How long can I stay on the Medifast 5 & 1 Plan?
You may stay on the 5 & 1 Plan until:

  • you’ve lost your desired amount of weight

  • you develop a new contraindication to the program (such as pregnancy)

  • your physician recommends you transition into Maintenance Plan

If you have significant weight to lose and plan to be on the weight loss phase of the program beyond 16 weeks, we recommend that your physician monitor your program. After you’ve completed the weight loss phase, you will transition into the Maintenance Plan. Nutrition Support at Medifast is available to guide you in this transition if you need assistance.

I'm trying to quit smoking -- could this affect my results with Medifast?
For general health, it is recommended that you stop smoking. Most individuals cannot successfully stop smoking and start a weight loss diet at the same time. Once you are no longer smoking, a weight loss program, like Medifast, is highly recommended.

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Using Medifast

How often should I have my Medifast Meals?
Every 2-3 hours. It is important to start each day with a schedule, allotting specific times for eating your meals. Build six (6) time slots for meals into your daily schedule, and strive to be as consistent with this eating schedule as possible. If you know your schedule will shift a little (perhaps on weekends), make sure to shift your meal times accordingly.

What happens if I miss a meal?
If you miss a meal, eat the rest of your meals closer together to make sure you get all the required meals in before the end of the day. Because of the low caloric level of Medifast, skipping meals will put you below the optimal nutrient level your body needs to function. This decrease in your nutrient balance makes your body conserve energy -- causing you to lose weight slower, not faster!

What if I don’t feel hungry?
It is important to get all 5 Medifast Meals plus 1 Lean & Green Meal in each day; otherwise, you are not getting all the nutrition and calories required to maximize the 5 & 1 Plan’s effectiveness.

What if I run out of Medifast?
If you happen to run out of Medifast Meals prior to the arrival of your next Medifast shipment, please contact our Nutrition Support team at NutritionSupport@ChooseMedifast.com.

Should I take vitamins?
Generally speaking, you shouldn’t need to take vitamin supplements along with the program. The Medifast 5 & 1 Plan provides you with all the necessary Recommended Daily Allowances of vitamins and minerals. Address this matter with your physician if you are currently taking additional doctor-prescribed vitamin and/or mineral supplements.

Can Medifast Meals be consumed after the best-if-used-by date?
Medifast powdered products have an 18-month best-if-used-by date. Medifast Ready-to-Drink Shakes and Bars have a 12-month best-if-used-by date. This does not mean that the product will expire, "go bad" or be harmful; it simply means that the vitamin and mineral pre-mix contained in the products may lose some of its potency, potentially rendering the product less effective. For best results, use your Medifast Meals as soon as possible and store them in a cool, dry, clean environment.

Can you provide mixing instructions for each Medifast Meal?
Use water for all Medifast Meals that require mixing. For specific information, refer to our complete list of Mixing Instructions (PDF File).

Can you mix two Medifast Meals together?
Yes. This can be a useful technique to get you through a challenging time if you are feeling hungry. Some customers say this helps them to stay on the program successfully. Remember, however, it is most beneficial to spread individual meals out throughout the day.

Can I mix my Medifast Meals ahead of time?
Medifast Meals are quick and easy to prepare whenever you're ready to eat them. You may choose to prepare certain Meals (such as the soups) ahead of time and storing them in the refrigerator or a Thermos. We recommend preparing the Meal no more than a few hours before consumption and thoroughly mixing the Meal prior to eating to prevent any settling that may occur.

You might also be interested in Medifast Ready-to-Drink Shakes, which offer a convenient way to take your shakes with you. These pre-mixed shakes are shelf-stable, can be stored easily and are interchangeable with your other Medifast Meals.

Will I ever be able to eat fruit, dairy or starches again?
Absolutely! While on the Medifast 5 & 1 Plan for weight loss, we recommend that you avoid fruits, dairy and starches because of their high carbohydrate contents. However, these foods are very healthy for you and we encourage you to re-introduce all fruits, vegetables, low fat dairy products and whole grain products during the Transition and Maintenance phases of your weight loss journey.

Can I combine other brands of diet foods?
We recommend that you stay with a single brand of products (such as Medifast products). Each Medifast product is formulated to provide you with the complete nutrition your body requires. Mixing in different product brands may lead to nutrient deficiencies.

How much water should I drink on this program?
It is important to drink at least 64 ounces of water per day while on the Medifast 5 & 1 Plan to keep your body hydrated.

What types of fluids are recommended?
We recommend drinking 64 ounces of water per day. In addition, you may drink any liquids that are considered non-caloric, which would include Medifast Flavor Infusers. This also includes unsweetened hot or iced tea, coffee or decaf, diet sodas or other calorie-free beverages. As a general rule, Medifast recommends that you try to drink as much water as possible for good health, and limit your intake of other non-caloric liquids when possible.

Can I drink alcohol?
Alcoholic beverages are not recommended on the Medifast program. Alcohol provides unneeded calories, can slow your weight loss, stimulates the appetite (encouraging additional food intake) and can deplete your body of needed water. Low carbohydrate versions of beer and other types of alcohol are not recommended because these also provide calories with no nutritional value. Those who choose to drink alcohol tend to feel its effects at lower consumption levels, due to the lower calorie level of the Medifast 5 & 1 Plan.

Why do the bars contain more carbohydrates than other Medifast Meals?
The manufacturing of a solid product requires a different processing method for binding the carbohydrates with proteins. This results in a slightly higher carbohydrate level than the powdered Medifast products. Hence, limit your bar intake to one (or less) per day during the weight loss phase of your plan.

Can I use any seasonings?
You can season your Medifast Meals and your Lean & Green Meal with most herbs, seasonings or spices. Experiment with different seasonings to find the flavors you enjoy. For general health purposes, we recommend limiting salt intake. For more specific seasoning usage information, refer to our complete list of Condiment Options (PDF file).

What are the limitations on the condiments I can use?
Some condiments are a significant source of additional calories. Of course, we do want you to enjoy your food -– but we recommend limiting condiment use in order to achieve the best weight loss results. For more specific condiment usage information, refer to our complete list of Condiment Options (PDF file).

What if I want to eat out at a restaurant?
Special occasion meals are easier to handle than you may think! Simply rearrange your Medifast Meal routine (if necessary) so that you can enjoy your Lean & Green Meal at your breakfast meeting, family brunch, awards banquet or virtually any special occasion involving food! You should have your typical Lean & Green serving of meat and vegetables as usual. Request that your meat be prepared/served without sauce if possible. If you can't avoid eating something that isn't part of the Lean & Green Meal, it may raise your daily calorie intake -- but you can get back on the 5 & 1 Plan starting with your next meal. It is still best not to skip meals, even when you think you may have over-eaten. Resume your plan as soon as you are able.

As an alternative, you can bring along a Medifast Meal and ask the waiter for hot or cold water (depending on what you are eating) to mix your meal. Then simply prepare your Medifast Meal and eat it with everyone else!

Can I chew gum?
Yes, as long as it is sugar-free gum. You can also have sugar-free mints. Make sure to limit these to no more than 3 per day. This will count as your one (1) optional snack for the day.

Can I have butter substitutes?
You can use butter substitutes such as Molly McButter®, Butter Buds® and I Can't Believe It's Not Butter® spray as great alternatives to actual butter. For more specific condiment usage information, refer to our complete list of Condiment Options (PDF file).

Can I have lattes?
Medifast offers delicious Cappuccino, Chai Latte and Hot Cocoa! These “hot drinks” can be used as part of your 5 & 1 Plan, and can also be enjoyed throughout Transition and Maintenance.

Coffee shop or other non-Medifast types of lattes are not recommended on the 5 & 1 Plan because they’re made with about 1/2 cup of milk -- and milk adds too many additional carbohydrates to your diet during the weight loss phase. Instead of a latte, try a regular cup of coffee with low fat/fat-free creamer, half & half or skim milk and sugar-free syrups or extracts for flavoring -- refer to our complete list of Condiment Options (PDF file). Once you transition to the Maintenance phase, you can include low fat dairy products.

Can I have shirataki noodles?
Yes. You can have shirataki noodles -- serving size 1-1/2 cups (12 oz). This would be considered the “Green” portion of your Lean & Green Meal.

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On the Program

Why did the scale go up?
The amount of weight you lose will fluctuate from week to week. Several situations may change the number on the scale, such as the time of day you weigh yourself, your menstrual cycle, not drinking enough water, whether or not you recently eliminated or how closely you are following your 5 & 1 Plan. Don't panic if the scale doesn't move for several days -- or even goes up slightly. If you stay on your program (and are consuming all of your meals), the scale will eventually show results. Try to weigh yourself only once a week, at the same time each week (the ideal time being immediately after you wake up).

What can I do about a weight loss plateau?
Plateaus can occur at different times for different people. They normally happen because your body is attempting to hold on to its fat stores. It's as though your body reshuffles its weight status while assessing whether it's ready to continue losing -- once it feels settled, your system will kick back in and allow your weight to drop again. If you experience a weight loss plateau, look for other indications of progress such as wearing a smaller size of clothing. Weight loss should resume if you continue to follow the program. You can contact the Nutrition Support Team at Medifast if you need assistance. For information on slower weight loss, please refer to our Plateau Tips (PDF file).

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Planning for Medifast Supplies

When should I re-order Medifast?
Re-order at least one (1) week before your supply runs out. Allow a minimum of 3-5 business days for shipping. You may request expedited shipping by calling Customer Care at (800) 209-0878 to place your order. Canadian Customers - Medifast can ship to Canada, but we cannot accept Canadian orders online at this time. Please call us at (800) 209-0878 to place your order. Our Customer Care representatives will be happy to help you.

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Medical Monitoring

Do Medifast users require medical supervision while on the program?
You should consult with your physician or qualified medical practitioner prior to beginning (and throughout the course of) any weight loss program. We strongly recommend that you participate in the program under your physician’s supervision if you:

  • are over the age of 70

  • are under the age of 18

  • have diabetes, hypertension or any other serious medical condition

  • are taking medications, especially for diabetes

Are there any special guidelines for Medifast customers over age 70?
If you are over age 70, this program should be done with your physician’s supervision. Your physician may recommend a higher caloric intake based on your individual needs. Dosages of medications may need to be adjusted, and labs and vital signs may need to be monitored. For more information, please refer to the Medifast Senior Guide (PDF file).

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Soy, Fiber, Dairy, Whey

What type of soy is in Medifast?
Medifast uses Supro® brand soy protein, a high-quality complete protein derived from soybeans. Supro® is produced by DuPont's Protein Technologies. DuPont has been conducting soy protein research for more than 30 years.

What are the benefits of soy?

  • Studies show naturally occurring isoflavones (such as those in Supro® brand soy protein) have increased the mineral content and density of bones, which may protect against the risk of bone fractures and osteoporosis.

  • Studies have indicated that a regular intake of soy foods may help to prevent hormone-related cancers such as breast cancer, prostate cancer and colon cancer.

  • Soy works to lower LDL cholesterol (bad cholesterol) levels in the blood, and each 1 percent reduction in LDL cholesterol results in a 2–4 percent reduction in heart disease risk.

  • Soy reduces triglyceride levels and increases HDL cholesterol levels (good cholesterol), which further reduces the risk of heart disease.

  • Soy isoflavones, which are natural estrogen sources, may help reduce menopausal symptoms such as hot flashes or night sweats.

  • Soy is a complete protein, providing all of the essential amino acids.

How much fiber do Medifast Meals contain?
Medifast Meals contain 0-5 grams of dietary fiber (depending on which Meals you choose). You’ll also get fiber from the “Green” portion of your Lean & Green Meal. For the amount of fiber in specific Medifast Meals, please refer to our Product Nutrition Quick Profile (PDF file).

Which Medifast products do not contain soy?
Scrambled Eggs, Hot Cocoa, Chai Latte, Cappuccino, Cranberry Mango Fruit Drink, Tropical Punch Fruit Drink, Peach Iced Tea, Raspberry Iced Tea, Cream of Chicken Soup, Cream of Tomato Soup and Cream of Broccoli Soup. For more information, please refer to our Allergen/Dietary Information (PDF file).

Which Medifast products do not contain dairy?
Medifast has one dairy-free product -- Medifast Ready-to-Drink Shakes. For more information, please refer to our Allergen/Dietary Information (PDF file).

Which Medifast products do not contain whey?
Oatmeal, Ready-to-Drink Shakes, Chocolate Pudding, Chicken Noodle Soup and Maryland Crab Flavored Soup. For more information, please refer to our Allergen/Dietary Information (PDF file).

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The Fat-Burning State and Weight Loss

What is the Fat-Burning State?
On the Medifast 5 & 1 Plan, your body enters a fat-burning state -- also known as “mild ketosis.” The nutrient balance of Medifast in combination with its low calorie level causes the body’s fat stores to release free fatty acids, which are then converted by the liver into an energy source called ketones. This mild dietary fat-burning state helps the body achieve rapid weight loss while preserving muscle tissue. The fat-burning state also helps eliminate physical hunger while providing sufficient levels of energy.

Is this Fat-Burning State harmful to me?
No, the fat-burning state achieved on the Medifast 5 & 1 Plan is very mild. The fat-burning state is a normal adaptive mechanism that your body uses to manage energy. The level achieved will protect you from losing muscle tissue (due to the amount of protein that can be consumed on the Medifast 5 & 1 Plan). Incorporating regular exercise also helps to tone and build muscle tissue.

How long does it take to get into the Fat-Burning State?
It generally takes about 3-5 days to get into the fat-burning state.

How can I tell I am in the Fat-Burning State?
The best way to determine if you are in the fat-burning state is by recognizing physical clues -- such as feeling less hungry and more energized, and losing weight at a steady rate.

Can I use ketone test strips?
Medifast does not require ketone testing. The best way to determine if you are in the fat-burning state is by looking for physical reactions -- such as feeling less hungry and more energized, and losing weight at a steady rate.

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Exercising on Medifast

Should I exercise along with the program?
Exercise is a necessary part of losing weight, improving metabolism and maintaining weight loss. If you do not exercise currently, we recommend you wait 2-3 weeks before you begin an exercise program. Start an exercise program slowly, and gradually increase time spent on an activity (and intensity of the activity) as your body allows. Choose an activity that you can enjoy regularly. Most of our customers find walking is the easiest activity to incorporate into their day.

For an individual who has an exercise program in place prior to starting Medifast, we recommend cutting the exercise program in half for the first couple of weeks to allow the body to adjust to its new calorie level. As your body adjusts to this lower calorie level, you can increase time and intensity of your exercise plan.

Listen to your body and only do what it allows. If you feel light-headed or faint, stop your exercise and take a rest before you resume. Remember to drink fluids. Fluid intake is important when you exercise. You may find that you need additional water on the days you exercise, especially if it is hot outside.

What type of exercise (and how much) is recommended?
If you haven't been exercising at all, be sure to check with your doctor first to make sure your exercise plan is appropriate for you. Once you’re deemed ready, adopt a slow pace. Start with gentle walking. You can take short walks throughout the day or go on a single long one. Make a commitment to walk every day, even if your walk is a short one. Gradually increase the distance and time spent walking once you reach a comfort level. Of course, in addition to walking, you may begin with any exercise that you enjoy. You may try incorporating a variety of exercises such as walking, stair climbing, biking, weight training, aerobics, swimming, pilates, etc. Some people choose the guidance of a personal trainer to help establish an individualized exercise program.

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Symptoms and Side Effects

*NOTE: Most of our customers report feeling energized -- and better than they did prior to starting a Medifast program. If you are ill or do not feel well, see your doctor. Unless your doctor says otherwise, you should be able to continue on the Medifast 5 & 1 Plan, as most symptoms experienced are temporary.

For further information, refer to our list of potential Symptoms and Side Effects (PDF file). If you have questions, please contact our Nutrition Support team at NutritionSupport@ChooseMedifast.com.

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Transition and Maintenance

How do I go off the program?
Once you’ve reached your goal weight, or you haven’t lost any weight in the last 4 weeks, you should begin the Transition Plan. The Transition Plan gradually adds calories back into your diet while giving your body appropriate time to adjust to the new levels of calories and carbohydrates.

Can I use Medifast products as part of my weight Maintenance Plan?
Yes, we encourage continued use of Medifast Meals so you don't re-gain the weight you lost. In fact, most people use 2-3 Medifast Meals per day as part of their ongoing Maintenance Plan. You may also use a Medifast Meal as a protein source in your regular meal, adding other foods such as fruits, vegetables, whole grains or a salad to maintain a healthy nutritional balance.

Our Momentum by Medifast line of products was specifically designed to assist with weight maintenance as it boosts your metabolism to prevent weight re-gain.

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Contraindications

What conditions would absolutely PROHIBIT my use of a low calorie diet such as Medifast?

  • Myocardial Infarction (MI) / Heart Attack within previous 3 months (unless cleared by a cardiologist)

  • Recent or recurrent CVAs and/or TIAs (stroke); uncontrolled seizures

  • Unstable angina; clotting disorders

  • Type 1 Diabetes (can be used for improved nutrition or weight maintenance but is not recommended for a weight loss program; can add Medifast Meals to regular dietary intake)

  • Severe liver disease (may require a low protein diet)

  • Severe kidney disease

  • Active peptic ulcer disease

  • Active cancers

  • Active thrombophlebitis (DVT/PE within 3 months)

  • Pregnant or lactating

  • Eating disorder (e.g., Anorexia Nervosa or Bulimia)

  • Severe psychiatric disturbance (history of major depression and/or suicide attempts)

  • Corticosteroid therapy >20 mg/day

  • Chronic illicit drug usage; addictions; alcoholism; substance abuse

What conditions could LIMIT my use of Medifast products?
Certain conditions may necessitate close supervision by your physician. Please check with your physician prior to starting the Medifast program if any of the following conditions apply:

  • Use of the medication lithium -- your physician may wish to monitor your lithium levels while on the program

  • History of seizures -- your physician may wish to monitor your seizure medication levels while on the program

  • History of peptic ulcer disease (not active)

  • Use of anticoagulant medication such as Coumadin or Warfarin -- your physician should be aware that Medifast products are fortified with Vitamin K and that your daily intake of Vitamin K will be consistent; your physician may wish to monitor your medication levels while on the program

  • Over the age of 70 -- a higher calorie and/or protein level may be necessary, so we do not recommend the standard Medifast 5 & 1 Plan; refer to our Senior Meal Plan for helpful information about using Medifast products in conjunction with a 1,200 calorie per day diet

  • Adolescent use (beyond puberty and under the age of 18) -- any weight loss program (such as Medifast) should be used only as directed by your physician

Can I use Medifast if I am currently using diuretics?
We recommend that you ask your physician if a low calorie diet is appropriate for you. Using diuretics while on the 5 & 1 Plan may result in an alteration of your sodium/potassium levels (due to increased urine output), so your physician may wish to monitor your electrolytes and/or adjust the dosage (or discontinue the use) of the diuretic while you are doing the Medifast program.

Can I use Medifast if I am currently using thyroid medications?
Individuals with hypothyroidism can use Medifast under the direct supervision of a physician. Your physician may want to monitor your labs and medications, and may suggest using a soy-free Medifast product around the time of day that you take thyroid medication. For information on soy-free products, please refer to our Allergen/Dietary Information (PDF file).

Can I use Medifast if I have had gastric bypass surgery?
We have had many individuals use Medifast prior to and after having gastric bypass surgery. Your meal plan should be adjusted based on when your surgery was completed. Medifast Meals are portion controlled, high protein, low carbohydrate and fortified with vitamins and minerals. Medifast recommends (as with any weight loss program) that you consult with your doctor prior to and throughout the weight loss process. Your physician may want to monitor your labs and medications, or may suggest a different calorie level than our standard 5 & 1 Plan. We will be happy to work with you and/or your physician to help meet your needs.

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Diabetes

What is Medifast Plus for Diabetics?
Medifast Plus for Diabetics is a specially designed line of food products formulated to meet the needs of people with diabetes. Medifast Plus for Diabetics contains fewer than 6 grams of sugar and 9 total carbohydrates per serving. Medifast Plus for Diabetics can be used as a supplement in a weight loss program or in addition to a diabetes meal plan.

Medifast Plus For Diabetics has been certified by the Glycemic Research Institute to make the claim “LOW GLYCEMIC” and is authorized to use the Glycemic Research Institute’s Seal of Approval.

How do I use Medifast Plus for Diabetics for weight loss?
Medifast recommends that you consult with your primary care physician or diabetes specialist before beginning a program using Medifast Meals –– including Medifast Plus for Diabetics. You should discuss blood sugar monitoring, oral diabetes agents and changes to your insulin regimen with your physician before starting a weight loss program. As with any weight loss program, using Medifast products may lessen your need for diabetic medications.

Who should use Medifast Plus for Diabetics?
Medifast Plus for Diabetics is intended for people with type 2 diabetes and can be used in conjunction with a weight loss and/or maintenance plan.

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Arthritis

What is Medifast Plus for Joint Health?
Medifast Plus for Joint Health is a specially designed meal replacement supplement formulated to relieve the excruciating symptoms associated with arthritis and poor joint health.

What is in the Joint Health Shakes that helps with arthritis symptoms?
Joint Health Shakes contain glucosamine and chondroitin, which may reduce pain and help repair damage caused by arthritis. To get the therapeutic benefits of these shakes, you should take three (3) Joint Health shakes each day as part of your 5 & 1 Plan. Each shake provides you with 500 mg of both chondroitin and glucosamine, and therapeutic levels are 1000 mg. You can choose any other two (2) Medifast Meals each day from soups, stew, chili, oatmeal, scrambled, eggs, fruit drinks, iced teas, hot beverages, bars, puddings or non-Health Management Specialty Shakes. If you are already using medication for arthritis, consult with your doctor before incorporating Medifast Plus for Joint Health shakes.

Who should use Medifast Plus for Joint Health Shakes?
Medifast Plus for Joint Health is recommended for individuals over the age of 18 who suffer with painful joints due to arthritis and/or injury. Be sure to consult with your doctor prior to using these shakes if you are already on arthritis medication. In many instances, Joint Health Shakes provide lower therapeutic dosages of chondroitin and glucosamine than prescription arthritis medications.

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Women’s Health

What is Medifast Plus for Women’s Health?
Medifast Plus for Women’s Health is a specially designed meal replacement supplement formulated to relieve and prevent the symptoms of menopause, such as hot flashes or night sweats.

What is in the Women’s Health Shakes that helps menopausal symptoms?
Women’s Health Shakes contain black cohosh, echinacea and chaste tree berry, which help reduce symptoms of menopause. For maximum results take 1-3 Women’s Health Shakes each day as part of your 5 & 1 Plan.

Who should use Medifast Plus for Women’s Health Shakes?
Medifast Plus for Women’s Health is recommended for women ages 35-60 who are experiencing the symptoms of menopause. These symptoms may include (but are not limited to): hot flashes, mood swings, night sweats, fatigue, vaginal dryness, loss of libido, headaches, anxiety and insomnia. However, if a woman is already on HRT, she should consult with her doctor before using these shakes. In many instances, Women's Health Shakes provide lower therapeutic dosages than alternate HRT therapies.

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Coronary Health

What is Medifast Plus for Coronary Health?
Medifast Plus for Coronary Health is a specially designed meal replacement supplement formulated to protect the heart against disease.

What is in the Coronary Health Shakes that helps with heart concerns?
Coronary Health Shakes contain Coenzyme Q10, amino acids and Pycnogenol, which provide a natural defense against heart conditions brought about by improper diets. For maximum results, take 1-3 Coronary Health Shakes each day as part of your 5 & 1 Plan. If you’re currently on heart medications, consult with your doctor prior to starting the diet.

Who should not use Coronary Health Shakes?
Medifast Plus for Coronary Health is designed as a preventive measure. If you have heart concerns, you should discuss the use of this product with your doctor first. If you are on blood thinning medication, be aware that this shake has 28 mcg of Vitamin K in it. Vitamin K acts to clot the blood.

Can I drink any combination of Health Management specialty shakes?
Do not combine the Health Management Specialty Shakes (i.e., we do not recommend mixing Medifast Plus for Joint Health and Medifast Plus for Women’s Health within your meal plan). If you currently take medications for any of the above-named health concerns, consult with your doctor prior to using the product.

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What's in Momentum?

Do the Flavor Infusers have calories or carbs?
Yes, each Flavor Infuser contains 5 calories and 2 grams of carbohydrate (1 gram coming from fiber) There is no protein or fat in a flavor infuser. We are considering these Flavor Infusers to be “free”, meaning we are not counting carbohydrates because the thermogenic effect or boost in metabolism the product provides basically cancels out its calories.

Are the nutritional profiles of the Momentum Meals the same as non-Momentum?
Yes, each Flavor Infuser contains 5 calories and 2 grams of carbohydrate (1 gram coming from fiber) There is no protein or fat in a flavor infuser. We are considering these Flavor Infusers to be “free”, meaning we are not counting carbohydrates because the thermogenic effect or boost in metabolism the product provides basically cancels out its calories.

Does Momentum contain soy?
The Banana Crème Shake does contain soy, same as the regular version of meals. The Flavor Infusers do not contain any soy.

Is Momentum a sports drink?
No, sports drinks are electrolyte replacements, whereas this product is a “calorie burner” or “metabolism booster” geared to weight loss and weight maintenance.

Is Momentum an energy drink?
In a way, but there’s a difference: Most energy drinks will give you the “pick me up” feeling from caffeine alone, but Momentum also allows your body to burn additional calories with the addition of ECGC to boost your metabolism.

Does Momentum contain Ace-K?
No—both the Meals and the Flavor Infusers are sweetened with sucralose, the main ingredient in Splenda.

Why did you choose these flavors for Momentum Meals?
They mixed well with the active ingredients (caffeine and EGCG) and tasted best.

Does Momentum decrease appetite?
Clinical studies conducted by Medifast researchers at Jason Pharmaceuticals found Momentum speeds metabolism and decreases appetite, but it does not contain a specific appetite suppressant.

How significant is a 24% boost in metabolism that you claim with Momentum?
By replacing a regular soft drink with a serving of Momentum every day for one year, even with no change in exercise habits, a person could theoretically lose up to 24 pounds.

Does Momentum have side effects?
Only those related to use of caffeine.

Is Momentum okay for long-term use?
Yes, when used as directed.

Is Momentum okay for people with diabetes?
Yes

Can I substitute Momentum for a cup of coffee to get my morning jolt?
Yes! Momentum contains about the same amount of caffeine that’s in one 8 oz. cup of coffee: 100 milligrams.

Can’t I just take 100 mg of caffeine and get the same benefit as Momentum?
No, Momentum’s combination of caffeine and EGCG induces thermogenesis to burn calories, unlike caffeine alone.

If I take Momentum at night/in the evening, will it disturb my sleep?
If you are currently able to drink caffeine at night with no problems, then you should be ok. Limit your Momentum use to earlier in the day if caffeine in the evening disrupts sleep for you.

Can I use Momentum if I’m caffeine-sensitive?
Momentum contains caffeine, so respect your caffeine limits. You may wish to discuss with your physician, especially if you have any ongoing health concerns or if you take medications. If your doctor says to avoid caffeine, follow his or her advice and do not use Momentum. Also, you should not use the product if you are pregnant or nursing, or under the age of 18.

Can I use Momentum with other weight-loss products that have ephedra-like stimulants?
We do NOT recommend it. Combining any source of caffeine with ephedra products can be dangerous to your health.

What is EGCG? Isn’t EGCG just another form of caffeine?
Epigallocatechin gallate (EGCG) is different from caffeine, and has its own health benefits. It is a potent natural antioxidant found in green tea (which contains caffeine in addition to ECGC.

Will Momentum be in variety packages?
Not yet, but we’re planning to make them available.

Do you still have the regular (non-Momentum) versions of Cappuccino, Chai Latte and Banana Crème Shake?
Yes

Is Momentum available in cases?
yes

Are the Flavor Infusers like Crystal Light?
They are packaged in the same kind of individual serving but have a much lighter flavor than Crystal Light, and the added benefits of the Momentum nutrients.

Can I mix Flavor Infusers into my shakes and other meals instead of water?
You can, but they will have their own flavor so you have to make sure that the two flavors will mix to be a taste you enjoy. The Flavor Infusers are created to mix with water.

Is a Flavor Infuser considered a meal?
No, you can have up to 3 Flavor Infusers a day in addition to your Medifast Meals. They are added to your water intake to count towards your 64 ounces of water per day. Only the Momentum meals (Chai Latte, Cappuccino, and Banana Crème Shake) are considered meals.

How do Momentum Flavor Infusers fit in with my 5 & 1 Plan?
The 5 & 1 Plan allows you 3 caffeinated beverages total each day during Weight Loss phase. One Flavor Infuser is considered 1 caffeinated beverage, even if added to 16 ounces of water because it contains the same amount of caffeine as an 8 ounce cup of coffee.

Can I take Momentum with Appetite Suppression Shakes?
Yes, it can be mixed with any and all Medifast products. The recommendation is up to 3 Momentum products per day.

Will I lose more weight if I drink more than 3 Momentum products per day?
No. Three products is the best amount—and what we recommend.

Can I make the hot Momentum Meals cold and vice versa?
Yes.

Can I double-up on Momentum Meals or should these only be taken 2-3 hours apart?
We recommend that you take all Medifast meals 2-3 hours apart, especially Momentum, because of the added caffeine.

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About Super Omega-3

Does Super Omega-3 help combat hair loss?
It’s not designed specifically for that, but healthier hair can be a benefit, as the supplement does contain flaxseed oil. You should take Omegas 3’s for your general wellness.

Does Super Omega-3 replace my Healthy Fat Serving(s)?
No, you take it in addition to your healthy fat serving. The Super Omega-3 does not contain enough fat to count as a fat serving.

Does it matter if I take it with a Medifast Meal or with my Lean & Green Meal?
No, you can take Super Omega-3 with any meal at any time of day.

Are there any side effects?
No.

Can I take Super Omega-3 if I have a shellfish allergy?
Yes.

What is the ratio of fish oil to flaxseed oil?
Super Omega-3 is composed mainly the fish oil—1200 mg—with a touch of organic flaxseed oil (50 mg.)

Does Super Omega-3 help prevent gallstones?
No, this is not enough fat in a serving. The Healthy Fat serving on the5 &1 program can help you accomplish that goal.

Can I take Super Omega-3 in addition to my multivitamin?
Yes, and you should when you’re in the weight maintenance. You do not need a vitamin if you’re in the weight loss phase of the Medifast 5 & 1 Plan.

Super Omega-3 contains 67% of the Daily Value of vitamin E – Won’t I overdose on vitamin E if I take this along with my Medifast Meals?
No, the range between RDA and upper tolerance limit is huge, Vitamin E is an antioxidant whose tolerable upper limit for adults is 1000 mg. Average vitamin E from Medifast meals is 60 IU (54.5 mg) plus 10-20 IU (9.1-18.2 mg) d-l-alpha tocopheral acetate, so even when you’re taking the supplement as directed, you are not getting near the upper limits.

Since the FDA doesn’t regulate dietary supplements, how do I know that Super Omega-3 is safe?
Our Omega-3 is third-party tested to guarantee both its purity and that the product really contains what the label states.

Is Super Omega-3 available in cases?
Yes.

Does Super Omega-3 contain soy?
The vitamin E in the product is from the base of soybean oil. Most people with soy allergies are allergic to soy protein, which should be removed from soybean oil. Although unlikely, cross-contamination is possible, so a severely allergic customer should not use this product.

Is Super Omega-3 a vitamin pill?
It’s a softgel capsule that is not a vitamin but a fatty acid dietary supplement.

Does Super Omega-3 contain calories and carbs?
Each dose contains 25 calories, no carbs.

Is Super Omega-3 kosher?
No, the soft gel capsule is made from gelatin, which is not kosher.

Is there an age recommendation for Super Omega-3?
Over 18.

Is Super Omega-3 okay for long-term use?
Yes.

Why can’t I store the bottle in direct sunlight?
Excessive heat can break down the supplement’s ingredients and cause them to spoil.

Medifast 5 & 1 Plan

5 MEDIFAST MEALS:

Choose 5 Meals from over 60 different, delicious Medifast choices, including shakes, soups, stew, chili, oatmeal, scrambled eggs, fruit drinks, iced teas, hot drinks, bars and puddings. Limit one bar per day.

Plenty of Medifast Meal choices are vegetarian-approved.

1 LEAN & GREEN MEAL:

Your Lean & Green Meal consists of lean meat plus salad and/or vegetables. Enjoy your Lean & Green Meal at any time – breakfast, lunch, dinner, or in-between – whatever works best with your schedule.

You can prepare it yourself, grab it on the go, or enjoy it in a restaurant – as long as you follow the Lean & Green Meal guidelines.

LEAN:
Choose any of the following, grilled, baked, or poached (not fried):

GREEN:
Any 3 servings from our vegetable list, such as salad greens, broccoli, spinach, eggplant, or tomatoes.

Mesothelioma: Treatment - Patient Information [NCI PDQ]

General Information About Malignant Mesothelioma

Malignant mesothelioma is a disease in which malignant (cancer) cells form in the lining of the chest or abdomen.

Malignant mesothelioma is a disease in which malignant (cancer) cells are found in the pleura (the thin layer of tissue that lines the chest cavity and covers the lungs) or the peritoneum (the thin layer of tissue that lines the abdomen and covers most of the organs in the abdomen). This summary is about malignant mesothelioma of the pleura.
Respiratory anatomy; drawing shows right lung with upper, middle, and lower lobes; left lung with upper and lower lobes; and the trachea, bronchi, lymph nodes, and diaphragm. Inset shows bronchioles, alveoli, artery, and vein.
Anatomy of the respiratory system, showing the trachea and both lungs and their lobes and airways. Lymph nodes and the diaphragm are also shown. Oxygen is inhaled into the lungs and passes through the thin membranes of the alveoli and into the bloodstream (see inset).

Being exposed to asbestos can affect the risk of developing malignant mesothelioma.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor.

Many people with malignant mesothelioma have worked or lived in places where they inhaled or swallowed asbestos. After being exposed to asbestos, it usually takes a long time for malignant mesothelioma to occur. Other risk factors for malignant mesothelioma include the following:

  • Living with a person who works near asbestos.
  • Being exposed to a certain virus.

Possible signs of malignant mesothelioma include shortness of breath and pain under the rib cage.

Sometimes the cancer causes fluid to collect around the lung or in the abdomen. These symptoms may be caused by the fluid or malignant mesothelioma. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

  • Trouble breathing.
  • Pain under the rib cage.
  • Pain or swelling in the abdomen.
  • Lumps in the abdomen.
  • Weight loss for no known reason.

Tests that examine the inside of the chest and abdomen are used to detect (find) and diagnose malignant mesothelioma.

Sometimes it is hard to tell the difference between malignant mesothelioma and lung cancer. The following tests and procedures may be used:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, exposure to asbestos, past illnesses and treatments will also be taken.
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
    Chest x-ray; drawing shows the patient standing with her back to the x-ray machine. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film.
    X-ray of the chest. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film.
  • Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
    • The number of red blood cells, white blood cells, and platelets.
    • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
    • The portion of the blood sample made up of red blood cells.
  • Sedimentation rate: A procedure in which a sample of blood is drawn and checked for the rate at which the red blood cells settle to the bottom of the test tube.
  • Biopsy: The removal of cells or tissues from the pleura or peritoneum so they can be viewed under a microscope by a pathologist to check for signs of cancer. Procedures used to collect the cells or tissues include the following:
    • Fine-needle (FNA) aspiration biopsy of the lung: The removal of tissue or fluid using a thin needle. An imaging procedure is used to locate the abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid, and a sample is removed.
      Lung biopsy; drawing shows a patient lying on a table that slides through the computed tomography (CT) machine with an x-ray picture of a cross-section of the lung on a monitor above the patient. Drawing also shows a doctor using the x-ray picture to help place the biopsy needle through the chest wall and into the area of abnormal lung tissue. Inset shows a side view of the chest cavity and lungs with the biopsy needle inserted into the area of abnormal tissue.
      Lung biopsy. The patient lies on a table that slides through the computed tomography (CT) machine which takes x-ray pictures of the inside of the body. The x-ray pictures help the doctor see where the abnormal tissue is in the lung. A biopsy needle is inserted through the chest wall and into the area of abnormal lung tissue. A small piece of tissue is removed through the needle and checked under the microscope for signs of cancer.
    • Thoracoscopy: An incision (cut) is made between two ribs and a thoracoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted into the chest.
    • Peritoneoscopy: An incision (cut) is made in the abdominal wall and a peritoneoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted into the abdomen.
    • Laparotomy: An incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease.
    • Thoracotomy: An incision (cut) is made between two ribs to check inside the chest for signs of disease.
  • Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
    Bronchoscopy; drawing shows a bronchoscope inserted through the mouth, trachea, and bronchus into the lung; lymph nodes along trachea and bronchi; and cancer in one lung. Inset shows patient lying on a table having a bronchoscopy.
    Bronchoscopy. A bronchoscope is inserted through the mouth, trachea, and major bronchi into the lung, to look for abnormal areas. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a cutting tool. Tissue samples may be taken to be checked under a microscope for signs of disease.
  • Cytologic exam: An exam of cells under a microscope (by a pathologist) to check for anything abnormal. For mesothelioma, fluid is taken from around the lungs or from the abdomen. A pathologist checks the cells in the fluid.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The stage of the cancer.
  • The size of the tumor.
  • Whether the tumor can be removed completely by surgery.
  • The amount of fluid in the chest or abdomen.
  • The patient's age and general health, including lung and heart health.
  • The type of mesothelioma cancer cells and how they look under a microscope.
  • Whether the cancer has just been diagnosed or has recurred (come back).

Stages of Malignant Mesothelioma

After malignant mesothelioma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body.

The process used to find out if cancer has spread outside the pleura or peritoneum is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the spread of the cancer in order to plan treatment. The following tests and procedures may be used in the staging process:

  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of the chest and abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of the chest or abdomen. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography. EUS may be used to guide fine-needle aspiration (FNA) biopsy of the lung, lymph nodes, or other areas.
    Endoscopic ultrasound-guided fine-needle aspiration biopsy; drawing shows an endoscope with an ultrasound probe and biopsy needle inserted through the mouth and into the esophagus. Drawing also shows lymph nodes near the esophagus and cancer in one lung. Inset shows the ultrasound probe locating the lymph nodes with cancer and the biopsy needle removing tissue from one of the lymph nodes near the esophagus.
    Endoscopic ultrasound-guided fine-needle aspiration biopsy. An endoscope that has an ultrasound probe and a biopsy needle is inserted through the mouth and into the esophagus. The probe bounces sound waves off body tissues to make echoes that form a sonogram (computer picture) of the lymph nodes near the esophagus. The sonogram helps the doctor see where to place the biopsy needle to remove tissue from the lymph nodes. This tissue is checked under a microscope for signs of cancer.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

  • Through tissue. Cancer invades the surrounding normal tissue.
  • Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
  • Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The stages of malignant mesothelioma are divided into two groups.

Malignant mesothelioma stages are grouped into localized and advanced.

Localized malignant mesothelioma (stage I)

In localized malignant mesothelioma, cancer is found in the lining of the chest wall and may also be found in the lining of the lung, the lining of the diaphragm, or the lining of the sac that covers the heart on the same side of the chest.

Advanced malignant mesothelioma (stage II, stage III, and stage IV)

Advanced malignant mesothelioma includes stage II, stage III, and stage IV.

  • In stage II, cancer is found in the lining of the chest wall and the lymph nodes on the same side of the chest. Cancer may also be found in the lining of the lung, the lining of the diaphragm, or the lining of the sac that covers the heart on the same side of the chest.
  • In stage III, cancer has spread to any of the following areas:
    • The chest wall.
    • The mediastinum.
    • The heart.
    • Beyond the diaphragm.
    • The peritoneum.
    Cancer may have also spread to lymph nodes on the other side of the chest or outside the chest.
  • In stage IV, cancer has spread to distant organs or tissues.

Recurrent Malignant Mesothelioma

Recurrent malignant mesothelioma is cancer that has recurred (come back) after it has been treated. The cancer may come back in the chest or abdomen or in other parts of the body.

Treatment Option Overview

There are different types of treatment for patients with malignant mesothelioma.

Different types of treatments are available for patients with malignant mesothelioma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Three types of standard treatment are used:

Surgery

The following surgical treatments may be used for malignant mesothelioma:

  • Wide local excision: Surgery to remove the cancer and some of the healthy tissue around it.
  • Pleurectomy and decortication: Surgery to remove part of the covering of the lungs and lining of the chest and part of the outside surface of the lungs.
  • Extrapleural pneumonectomy: Surgery to remove one whole lung and part of the lining of the chest, the diaphragm, and the lining of the sac around the heart.
  • Pleurodesis: A surgical procedure that uses chemicals or drugs to make a scar in the space between the layers of the pleura. Fluid is first drained from the space using a catheter or chest tube and the chemical or drug is put into the space. The scarring stops the build-up of fluid in the pleural cavity.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after surgery, to increase the chances of a cure, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

Biologic therapy

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment Options for Malignant Mesothelioma

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Localized Malignant Mesothelioma (Stage I)

If the malignant mesothelioma is in one part of the chest lining, treatment will probably be surgery to remove the part of the chest lining with cancer and some of the tissue around it.

If localized malignant mesothelioma is found in more than one place in the chest, treatment may be one of the following:

  • Pleurectomy and decortication, with or without radiation therapy, as palliative therapy to relieve symptoms and improve the quality of life.
  • Extrapleural pneumonectomy.
  • Radiation therapy as palliative therapy to relieve symptoms and improve the quality of life.
  • A clinical trial of anticancer drugs placed directly into the chest after surgery to remove the tumor.
  • A clinical trial of combinations of surgery, radiation therapy, and chemotherapy.
  • A clinical trial of a new treatment.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with localized malignant mesothelioma.

Advanced Malignant Mesothelioma (Stage II, Stage III, and Stage IV)

Treatment of advanced malignant mesothelioma may include the following:

  • Surgery to drain fluid that has collected in the chest, to reduce discomfort. Pleurodesis may be done to stop more fluid from collecting in the chest.
  • Pleurectomy and decortication, as palliative therapy to relieve symptoms and improve the quality of life.
  • Radiation therapy as palliative therapy to relieve pain.
  • Chemotherapy with one anticancer drug.
  • A clinical trial of combination chemotherapy.
  • A clinical trial of combinations of surgery, radiation therapy, and chemotherapy.
  • A clinical trial of chemotherapy placed directly into the chest cavity or abdominal cavity to shrink the tumors and keep fluid from building up.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with advanced malignant mesothelioma.

Recurrent Malignant Mesothelioma

Treatment of recurrent malignant mesothelioma may include the following:

  • A clinical trial of biologic therapy.
  • A clinical trial of chemotherapy.
  • A clinical trial of surgery.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent malignant mesothelioma.

Mesothelioma: Treatment - Health Professional Information [NCI PDQ]

Purpose of This PDQ Summary

This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of malignant mesothelioma. This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board.

Information about the following is included in this summary:

  • Prognostic factors.
  • Cellular classification.
  • Staging.
  • Treatment options by cancer stage.

This summary is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.

Some of the reference citations in the summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations. Based on the strength of the available evidence, treatment options are described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for reimbursement determinations.

This summary is available in a patient version, written in less technical language, and in Spanish.

General Information

Prognosis in this disease is difficult to assess consistently because there is great variability in the time before diagnosis and the rate of disease progression. In large retrospective series of pleural mesothelioma patients, important prognostic factors were found to be stage, age, performance status, and histology.[1,2] Various surgical procedures may be possible in selected patients, and they provide long-term survival without cure. For patients treated with aggressive surgical approaches, factors associated with improved long-term survival include epithelial histology, negative lymph nodes, and negative surgical margins.[3,4] For those patients treated with aggressive surgical approaches, nodal status is an important prognostic factor.[3] Median survival has been reported as 16 months for patients with malignant pleural disease and 5 months for patients with extensive disease. In some instances the tumor grows through the diaphragm making the site of origin difficult to assess. Cautious interpretation of treatment results with this disease is imperative because of the selection differences among series. Effusions, both pleural and peritoneal, represent major symptomatic problems for at least 66% of the patients. (Refer to the PDQ summary on Cardiopulmonary Syndromes for more information.) A history of asbestos exposure is reported in about 70% to 80% of all cases of mesothelioma.[1,5,6]

References:

  1. Ruffie P, Feld R, Minkin S, et al.: Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients. J Clin Oncol 7 (8): 1157-68, 1989.
  2. Tammilehto L, Maasilta P, Kostiainen S, et al.: Diagnosis and prognostic factors in malignant pleural mesothelioma: a retrospective analysis of sixty-five patients. Respiration 59 (3): 129-35, 1992.
  3. Sugarbaker DJ, Strauss GM, Lynch TJ, et al.: Node status has prognostic significance in the multimodality therapy of diffuse, malignant mesothelioma. J Clin Oncol 11 (6): 1172-8, 1993.
  4. Sugarbaker D, Harpole D, Healey E, et al.: Multimodality treatment of malignant pleural mesothelioma (MPM): results in 94 consecutive patients. [Abstract] Proceedings of the American Society of Clinical Oncology 14: A-1083, 356, 1995.
  5. Chailleux E, Dabouis G, Pioche D, et al.: Prognostic factors in diffuse malignant pleural mesothelioma. A study of 167 patients. Chest 93 (1): 159-62, 1988.
  6. Adams VI, Unni KK, Muhm JR, et al.: Diffuse malignant mesothelioma of pleura. Diagnosis and survival in 92 cases. Cancer 58 (7): 1540-51, 1986.

Cellular Classification

Histologically, these tumors are composed of fibrous or epithelial elements or both. The epithelial form occasionally causes confusion with peripheral anaplastic lung carcinomas or metastatic carcinomas. Attempts at diagnosis by cytology or needle biopsy of the pleura are often unsuccessful. It can be especially difficult to differentiate mesothelioma from adenocarcinoma on small tissue specimens. Thoracoscopy can be valuable in obtaining adequate tissue specimens for diagnostic purposes.[1] Examination of the gross tumor at surgery and use of special stains or electron microscopy can often help. The special stains reported to be most useful include periodic acid-Schiff diastase, hyaluronic acid, mucicarmine, CEA, and Leu M1.[2] Histologic appearance seems to be of prognostic value, and most clinical studies show that patients with epithelial mesotheliomas have a better prognosis than those with sarcomatous or mixed histology mesotheliomas.[2,3,4]

References:

  1. Boutin C, Rey F: Thoracoscopy in pleural malignant mesothelioma: a prospective study of 188 consecutive patients. Part 1: Diagnosis. Cancer 72 (2): 389-93, 1993.
  2. Chahinian AP, Pass HI: Malignant mesothelioma. In: Holland JC, Frei E, eds.: Cancer Medicine e.5. 5th ed. Hamilton, Ontario: B.C. Decker Inc, 2000, pp 1293-1312.
  3. Nauta RJ, Osteen RT, Antman KH, et al.: Clinical staging and the tendency of malignant pleural mesotheliomas to remain localized. Ann Thorac Surg 34 (1): 66-70, 1982.
  4. Sugarbaker DJ, Strauss GM, Lynch TJ, et al.: Node status has prognostic significance in the multimodality therapy of diffuse, malignant mesothelioma. J Clin Oncol 11 (6): 1172-8, 1993.

Stage Information

Patients with stage I disease have a significantly better prognosis than those with more advanced stages. Because of the relative rarity of this disease, exact survival information based upon stage is limited.[1] A proposed staging system based upon thoracic surgery principles and clinical data is shown below.[2] It is a modification of the older system proposed by Butchart et al.[3] Other staging systems that have been employed, including the current international TNM staging system, are summarized by the International Mesothelioma Interest Group.[4]

  • Stage I: Disease confined within the capsule of the parietal pleura (i.e., ipsilateral pleura, lung, pericardium, and diaphragm).
  • Stage II: All of stage I with positive intrathoracic (N1 or N2) lymph nodes.
  • Stage III: Local extension of disease into the following areas, e.g., chest wall or mediastinum, heart or through the diaphragm or peritoneum, with or without extrathoracic or contralateral (N3) lymph node involvement.
  • Stage IV: Distant metastatic disease.

LOCALIZED MALIGNANT MESOTHELIOMA

See description of stage I above.

ADVANCED MALIGNANT MESOTHELIOMA

See descriptions of stages II, III, and IV above.

For the purposes of the discussion of treatment in this summary, the disease is categorized as either localized or advanced.

References:

  1. Chahinian AP, Pass HI: Malignant mesothelioma. In: Holland JC, Frei E, eds.: Cancer Medicine e.5. 5th ed. Hamilton, Ontario: B.C. Decker Inc, 2000, pp 1293-1312.
  2. Sugarbaker DJ, Strauss GM, Lynch TJ, et al.: Node status has prognostic significance in the multimodality therapy of diffuse, malignant mesothelioma. J Clin Oncol 11 (6): 1172-8, 1993.
  3. Butchart EG, Ashcroft T, Barnsley WC, et al.: Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Experience with 29 patients. Thorax 31 (1): 15-24, 1976.
  4. Rusch VW: A proposed new international TNM staging system for malignant pleural mesothelioma. From the International Mesothelioma Interest Group. Chest 108 (4): 1122-8, 1995.

Treatment Option Overview

Standard treatment for all but localized mesothelioma is generally not curative. Although some patients will experience long-term survival with aggressive treatment approaches, it remains unclear if overall survival has been significantly altered by the different treatment modalities or by combinations of modalities. Extrapleural pneumonectomy in selected patients with early stage disease may improve recurrence-free survival, but its impact on overall survival is unknown.[1] Pleurectomy and decortication can provide palliative relief from symptomatic effusions, discomfort caused by tumor burden, and pain caused by invasive tumor. Operative mortality from pleurectomy/decortication is less than 2%,[2] while mortality from extrapleural pneumonectomy has ranged from 6% to 30%.[1,3] The addition of radiation therapy and/or chemotherapy following surgical intervention has not demonstrated improved survival.[2] The use of radiation therapy in pleural mesothelioma has been shown to alleviate pain in the majority of patients treated; however, the duration of symptom control is short-lived.[4,5] Single-agent and combination chemotherapy have been evaluated in single and combined modality studies. The most studied agent is doxorubicin, which has produced partial responses in approximately 15% to 20% of patients studied.[6] Some combination chemotherapy regimens have been reported to have higher response rates in small phase II trials; however, the toxic effects reported are also higher, and there is no evidence that combination regimens result in longer survival or longer control of symptoms.[6,7]. Recurrent pleural effusions may be treated with pleural sclerosing procedures; however, failure rates are usually secondary to the bulk of the tumor, which precludes pleural adhesion due to the inability of the lung to fully expand.

References:

  1. Rusch VW, Piantadosi S, Holmes EC: The role of extrapleural pneumonectomy in malignant pleural mesothelioma. A Lung Cancer Study Group trial. J Thorac Cardiovasc Surg 102 (1): 1-9, 1991.
  2. Rusch V, Saltz L, Venkatraman E, et al.: A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma. J Clin Oncol 12 (6): 1156-63, 1994.
  3. Sugarbaker DJ, Mentzer SJ, DeCamp M, et al.: Extrapleural pneumonectomy in the setting of a multimodality approach to malignant mesothelioma. Chest 103 (4 Suppl): 377S-381S, 1993.
  4. Bissett D, Macbeth FR, Cram I: The role of palliative radiotherapy in malignant mesothelioma. Clin Oncol (R Coll Radiol) 3 (6): 315-7, 1991.
  5. Ball DL, Cruickshank DG: The treatment of malignant mesothelioma of the pleura: review of a 5-year experience, with special reference to radiotherapy. Am J Clin Oncol 13 (1): 4-9, 1990.
  6. Weissmann LB, Antman KH: Incidence, presentation and promising new treatments for malignant mesothelioma. Oncology (Huntingt) 3 (1): 67-72; discussion 73-4, 77, 1989.
  7. Ong ST, Vogelzang NJ: Chemotherapy in malignant pleural mesothelioma. A review. J Clin Oncol 14 (3): 1007-17, 1996.

Localized Malignant Mesothelioma (Stage I)

STANDARD TREATMENT OPTIONS:[1]

  1. Solitary mesotheliomas: Surgical resection en bloc including contiguous structures to ensure wide disease-free margins. Sessile polypoid lesions should be treated with surgical resection to ensure maximal potential for cure.[2]
  2. Intracavitary mesothelioma:
    • Palliative surgery (i.e., pleurectomy and decortication) with or without postoperative radiation therapy.
    • Extrapleural pneumonectomy.
    • Palliative radiation therapy.

TREATMENT OPTIONS UNDER CLINICAL EVALUATION:

  1. Intracavitary chemotherapy following resection.[3,4]
  2. Multimodality therapy.[4,5,6]
  3. Other clinical trials.

Current Clinical Trials

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with localized malignant mesothelioma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References:

  1. Antman KH, Li FP, Osteen R, et al.: Mesothelioma. Cancer: Principles and Practice of Oncology Updates 3(1): 1-16, 1989.
  2. Martini N, McCormack PM, Bains MS, et al.: Pleural mesothelioma. Ann Thorac Surg 43 (1): 113-20, 1987.
  3. Markman M, Kelsen D: Efficacy of cisplatin-based intraperitoneal chemotherapy as treatment of malignant peritoneal mesothelioma. J Cancer Res Clin Oncol 118 (7): 547-50, 1992.
  4. Rusch V, Saltz L, Venkatraman E, et al.: A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma. J Clin Oncol 12 (6): 1156-63, 1994.
  5. Sugarbaker DJ, Mentzer SJ, DeCamp M, et al.: Extrapleural pneumonectomy in the setting of a multimodality approach to malignant mesothelioma. Chest 103 (4 Suppl): 377S-381S, 1993.
  6. Vogelzang NJ: Malignant mesothelioma: diagnostic and management strategies for 1992. Semin Oncol 19 (4 Suppl 11): 64-71, 1992.

Advanced Malignant Mesothelioma (Stages II, III, and IV)

Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)

STANDARD TREATMENT OPTIONS:

  1. Symptomatic treatment to include drainage of effusions, chest tube pleurodesis, or thoracoscopic pleurodesis.[1]
  2. Palliative surgical resection in selected patients.[2,3]
  3. Palliative radiation therapy.[4,5]
  4. Single-agent chemotherapy. Partial responses have been reported with doxorubicin, epirubicin, mitomycin, cyclophosphamide, cisplatin, carboplatin, and ifosfamide.[6,7,8]
  5. Combination chemotherapy (under clinical evaluation).[6,7,9] Information about ongoing clinical trials is available from the NCI Web site.
  6. Multimodality clinical trials.[10,11,12,13,14]
  7. Intracavitary therapy. Intrapleural or intraperitoneal administration of chemotherapeutic agents (e.g., cisplatin, mitomycin, and cytarabine) has been reported to produce transient reduction in the size of tumor masses and temporary control of effusions in small clinical studies.[15,16,17] Additional studies are needed to define the role of intracavitary therapy.

Many phase II trials of chemotherapy have been reported.[6,7,9] The safety and efficacy of pemetrexed, an antifolate, and cisplatin in chemotherapy-naive patients with malignant mesothelioma who were not eligible for curative surgery was demonstrated in a randomized phase III trial.[18][Level of evidence: 1iiA] This trial compared pemetrexed (500 mg/m2) and cisplatin (75 mg/m2 on day 1) with cisplatin alone (75 mg/m2 on day 1 intravenously every 21 days). With a total of 456 enrolled patients in the trial, 226 patients received pemetrexed plus cisplatin, 222 patients received cisplatin alone, and 8 patients did not receive therapy. After 117 patients had enrolled, folic acid and vitamin B12 were added to reduce toxic effects. Folic acid (350–1,000 µg orally) was given daily, beginning 1 to 3 weeks before the first chemotherapy dose and continuing daily until 1 to 3 weeks after treatment ended. A vitamin B12 injection (1,000 µg intramuscularly) was administered 1 to 3 weeks before the first chemotherapy dose and was repeated approximately every 9 weeks until treatment ended. Dexamethasone (4 mg) or an equivalent corticosteroid was administered orally twice daily for skin rash prophylaxis to all patients 1 day before, on the day of, and 1 day after each pemetrexed dose.

In an analysis of all patients who were randomized and treated, the combination of pemetrexed and cisplatin was associated with a statistically significant improvement in survival compared with cisplatin alone; the median survivals were 12.1 versus 9.3 months, respectively (P = .020). The hazard ratio for death of patients in the pemetrexed plus cisplatin arm versus those in the control arm was 0.77. Median time-to-progression was significantly longer in the pemetrexed plus cisplatin arm (5.7 months vs. 3.9 months, P = .001). This superiority in the combination arm was also demonstrated in the vitamin-supplemented subgroup. The median survivals were 13.3 and 10.0 months in the combination group and cisplatin alone group, respectively (P = .051). The principal adverse effects of the pemetrexed plus cisplatin regimen were myelosuppression, fatigue, nausea, vomiting, and dyspnea. Most grade 3 to 4 adverse effects were significantly reduced by vitamin supplementation without any decrease in efficacy.

Current Clinical Trials

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with advanced malignant mesothelioma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References:

  1. Boutin C, Viallat JR, Rey R: Thoracoscopy in Diagnosis, Prognosis and Treatment of Mesothelioma. In: Antman K, Aisner J, eds.: Asbestos-Related Malignancy. Orlando,Fla: Grune & Stratton, 1987, pp 301-21.
  2. Butchart EG, Ashcroft T, Barnsley WC, et al.: The role of surgery in diffuse malignant mesothelioma of the pleura. Semin Oncol 8 (3): 321-8, 1981.
  3. Martini N, McCormack PM, Bains MS, et al.: Pleural mesothelioma. Ann Thorac Surg 43 (1): 113-20, 1987.
  4. Bissett D, Macbeth FR, Cram I: The role of palliative radiotherapy in malignant mesothelioma. Clin Oncol (R Coll Radiol) 3 (6): 315-7, 1991.
  5. Ball DL, Cruickshank DG: The treatment of malignant mesothelioma of the pleura: review of a 5-year experience, with special reference to radiotherapy. Am J Clin Oncol 13 (1): 4-9, 1990.
  6. Chahinian AP, Antman K, Goutsou M, et al.: Randomized phase II trial of cisplatin with mitomycin or doxorubicin for malignant mesothelioma by the Cancer and Leukemia Group B. J Clin Oncol 11 (8): 1559-65, 1993.
  7. Ong ST, Vogelzang NJ: Chemotherapy in malignant pleural mesothelioma. A review. J Clin Oncol 14 (3): 1007-17, 1996.
  8. Lerner HJ, Schoenfeld DA, Martin A, et al.: Malignant mesothelioma. The Eastern Cooperative Oncology Group (ECOG) experience. Cancer 52 (11): 1981-5, 1983.
  9. Andreopoulou E, Ross PJ, O'Brien ME, et al.: The palliative benefits of MVP (mitomycin C, vinblastine and cisplatin) chemotherapy in patients with malignant mesothelioma. Ann Oncol 15 (9): 1406-12, 2004.
  10. Mattson K, Holsti LR, Tammilehto L, et al.: Multimodality treatment programs for malignant pleural mesothelioma using high-dose hemithorax irradiation. Int J Radiat Oncol Biol Phys 24 (4): 643-50, 1992.
  11. Weissmann LB, Antman KH: Incidence, presentation and promising new treatments for malignant mesothelioma. Oncology (Huntingt) 3 (1): 67-72; discussion 73-4, 77, 1989.
  12. Vogelzang NJ: Malignant mesothelioma: diagnostic and management strategies for 1992. Semin Oncol 19 (4 Suppl 11): 64-71, 1992.
  13. Sugarbaker D, Harpole D, Healey E, et al.: Multimodality treatment of malignant pleural mesothelioma (MPM): results in 94 consecutive patients. [Abstract] Proceedings of the American Society of Clinical Oncology 14: A-1083, 356, 1995.
  14. Sugarbaker DJ, Mentzer SJ, DeCamp M, et al.: Extrapleural pneumonectomy in the setting of a multimodality approach to malignant mesothelioma. Chest 103 (4 Suppl): 377S-381S, 1993.
  15. Markman M, Kelsen D: Efficacy of cisplatin-based intraperitoneal chemotherapy as treatment of malignant peritoneal mesothelioma. J Cancer Res Clin Oncol 118 (7): 547-50, 1992.
  16. Markman M, Cleary S, Pfeifle C, et al.: Cisplatin administered by the intracavitary route as treatment for malignant mesothelioma. Cancer 58 (1): 18-21, 1986.
  17. Rusch VW, Figlin R, Godwin D, et al.: Intrapleural cisplatin and cytarabine in the management of malignant pleural effusions: a Lung Cancer Study Group trial. J Clin Oncol 9 (2): 313-9, 1991.
  18. Vogelzang NJ, Rusthoven JJ, Symanowski J, et al.: Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol 21 (14): 2636-44, 2003.

Recurrent Malignant Mesothelioma

Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)

Treatment of recurrent mesothelioma usually utilizes procedures and/or agents not previously employed in the initial treatment attempt. No standard treatment approaches have been proven to improve survival or control symptoms for a prolonged period of time. These patients should be considered candidates for phase I and II clinical trials evaluating new biologicals, chemotherapeutic agents, or physical approaches.[1,2,3,4,5]

The safety and efficacy of pemetrexed, an antifolate, and cisplatin in chemotherapy-naive patients with malignant mesothelioma who were not eligible for curative surgery was demonstrated in a large phase III randomized trial.[6][Level of evidence: 1iiA] This trial compared pemetrexed (500 mg/m2) and cisplatin (75 mg/m2 on day 1) with cisplatin alone (75 mg/m2 on day 1 intravenously every 21 days). With a total of 456 enrolled patients in the trial, 226 patients received pemetrexed plus cisplatin, 222 patients received cisplatin alone, and 8 patients did not receive therapy. After 117 patients had enrolled, folic acid and vitamin B12 were added to reduce toxic effects. Folic acid (350–1,000 µg orally) was given daily, beginning 1 to 3 weeks before the first chemotherapy dose and continuing daily until 1 to 3 weeks after treatment ended. A vitamin B12 injection (1,000 µg intramuscularly) was administered 1 to 3 weeks before the first chemotherapy dose and was repeated approximately every 9 weeks until treatment ended. Dexamethasone (4 mg) or an equivalent corticosteroid was administered orally twice daily for skin rash prophylaxis to all patients 1 day before, on the day of, and 1 day after each pemetrexed dose.

In an analysis of all patients who were randomized and treated, the combination of pemetrexed and cisplatin was associated with a statistically significant improvement in survival compared with cisplatin alone; the median survivals were 12.1 versus 9.3 months, respectively (P = .020). The hazard ratio for death of patients in the pemetrexed plus cisplatin arm versus those in the control arm was 0.77. Median time-to-progression was significantly longer in the pemetrexed plus cisplatin arm (5.7 months vs. 3.9 months, P = .001). This superiority in the combination arm was also demonstrated in the vitamin-supplemented subgroup. The median survivals were 13.3 and 10.0 months in the combination group and cisplatin alone group, respectively (P = .051). The principal adverse effects of the pemetrexed plus cisplatin regimen were myelosuppression, fatigue, nausea, vomiting, and dyspnea. Most grade 3 to 4 adverse effects were significantly reduced by vitamin supplementation without any decrease in efficacy.

Current Clinical Trials

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent malignant mesothelioma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References:

  1. Rusch V, Saltz L, Venkatraman E, et al.: A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma. J Clin Oncol 12 (6): 1156-63, 1994.
  2. Markman M, Kelsen D: Efficacy of cisplatin-based intraperitoneal chemotherapy as treatment of malignant peritoneal mesothelioma. J Cancer Res Clin Oncol 118 (7): 547-50, 1992.
  3. Weissmann LB, Antman KH: Incidence, presentation and promising new treatments for malignant mesothelioma. Oncology (Huntingt) 3 (1): 67-72; discussion 73-4, 77, 1989.
  4. Boutin C, Viallat JR, Van Zandwijk N, et al.: Activity of intrapleural recombinant gamma-interferon in malignant mesothelioma. Cancer 67 (8): 2033-7, 1991.
  5. Ong ST, Vogelzang NJ: Chemotherapy in malignant pleural mesothelioma. A review. J Clin Oncol 14 (3): 1007-17, 1996.
  6. Vogelzang NJ, Rusthoven JJ, Symanowski J, et al.: Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol 21 (14): 2636-44, 2003.

Get More Information From NCI

CALL 1-800-4-CANCER

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

CHAT ONLINE

The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

WRITE TO US

For more information from the NCI, please write to this address:

NCI Public Inquiries Office
Suite 3036A
6116 Executive Boulevard, MSC8322
Bethesda, MD 20892-8322

SEARCH THE NCI WEB SITE

The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.

There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

FIND PUBLICATIONS

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

Changes to This Summary (05/22/2008)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

More Information

ABOUT PDQ

  • PDQ® - NCI's Comprehensive Cancer Database.
    Full description of the NCI PDQ database.

ADDITIONAL PDQ SUMMARIES

  • PDQ® Cancer Information Summaries: Adult Treatment
    Treatment options for adult cancers.
  • PDQ® Cancer Information Summaries: Pediatric Treatment
    Treatment options for childhood cancers.
  • PDQ® Cancer Information Summaries: Supportive and Palliative Care
    Side effects of cancer treatment, management of cancer-related complications and pain, and psychosocial concerns.
  • PDQ® Cancer Information Summaries: Screening/Detection (Testing for Cancer)
    Tests or procedures that detect specific types of cancer.
  • PDQ® Cancer Information Summaries: Prevention
    Risk factors and methods to increase chances of preventing specific types of cancer.
  • PDQ® Cancer Information Summaries: Genetics
    Genetics of specific cancers and inherited cancer syndromes, and ethical, legal, and social concerns.
  • PDQ® Cancer Information Summaries: Complementary and Alternative Medicine
    Information about complementary and alternative forms of treatment for patients with cancer.

Mesothelioma

Mesothelioma is a rare form of cancer in which malignant cells are found in the sac lining the chest (the pleura) or abdomen (the peritoneum). Most people with malignant mesothelioma have worked on jobs where they breathed asbestos, a fiber that was used in insulation materials.

Mesothelioma is a rare form of cancer that affects the membrane that covers and protects various internal organs of the body (mesothelium). The mesothelium is composed of two layers of specialized cells known as mesothelial cells. One layer directly surrounds an organ; the other forms a protective sac around the organ. The most common form of mesothelioma affects the membrane or sac that lines the lungs (pleura). Other common sites include the membrane lining the stomach (peritoneum) and the membrane lining the heart (pericardium).

The term "cancer" refers to a group of diseases characterized by abnormal, uncontrolled cellular growth (e.g., mesothelial cells) that invades surrounding tissues and may spread (metastasize) to distant bodily tissues or organs via the bloodstream, the lymphatic system, or other means. Different forms of cancer, including mesothelioma, may be classified based upon the cell type involved, the specific nature of the malignancy, the tissues or organs affected, and the disease's clinical course. Symptoms of mesothelioma vary depending upon the location, type and stage of the cancer. Approximately 70 to 80 percent of cases of mesothelioma result from exposure to asbestos. Symptoms of mesothelioma may not appear until up to 50 years after initial exposure to asbestos. However, after symptoms began apparent, mesothelioma may rapidly progress to cause life-threatening complications.

Symptoms include shortness of breath, chest pain, or pain or swelling in the abdomen.

Treatment, which includes surgery, chemotherapy, and radiation, is based on whether the cancer has spread (metastasized) and the stage of the cancer.

Selasa, 20 Januari 2009

Type 1 Diabetes : Treatment

Treatment Overview

Treatment for adults

Type 1 diabetes requires lifelong treatment to keep blood sugar levels within a target range. Treatment includes:

  • Taking several insulin injections every day, or using an insulin pump.
  • Monitoring blood sugar levels several times a day using a home blood sugar meter.
  • Eating a healthful diet that spreads carbohydrate throughout the day, to prevent high blood sugar levels after meals.
  • Regular physical exercise, because exercise helps the body to use insulin more efficiently. Exercise may also lower your risk for heart and blood vessel disease.
  • Regular medical checkups to monitor and adjust treatment as needed. Screening tests and exams need to be done regularly to watch for signs of complications, such as eye, kidney, heart, blood vessel, and nerve diseases.
  • Not smoking.
  • Not drinking alcohol if the person is at risk for periods of low blood sugar.

A regular daily schedule makes managing blood sugar levels easier. Blood sugars are easier to predict and control when mealtimes, amounts of food, and exercise are similar every day.

Many people find out that they have type 1 diabetes when they are admitted to a hospital for diabetic ketoacidosis. If their symptoms are severe, they may need to be treated in an intensive care unit. Treatment for diabetic ketoacidosis includes fluids given through a vein (intravenous, or IV) to treat dehydration and to balance electrolytes, and insulin to lower the blood sugar level and stop the body from producing ketones.5

Treatment for children

Treatment for children includes all of the above measures to keep blood sugar levels within the child's target range. Treatment for children should also allow for normal growth and development. See the topics Type 1 Diabetes: Recently Diagnosed and Type 1 Diabetes: Children Living With the Disease.

When a small child has diabetes, the parents have the responsibility for blood sugar control. As the child grows, he or she can take more responsibility for diabetes care.

Type 1 Diabetes

Topic Overview

  • Type 1 diabetes is a disease that starts when the pancreas stops making insulin. Insulin lets blood sugar—also called glucose—enter the body's cells to be used for energy. Without enough insulin, sugar builds up in the blood. Over time, high blood sugar can damage the eyes, heart, blood vessels, nerves, and kidneys.
  • There is no cure for diabetes. But with treatment, people can live a long and healthy life. They may be able to prevent or slow serious health problems.
  • Type 1 diabetes usually starts in children or young adults. But it can start at any age. The symptoms of type 1 diabetes are being very thirsty, urinating a lot, and losing weight without trying. Sometimes people also are hungrier than usual.
  • Treatment for type 1 diabetes focuses on keeping blood sugar as close to the normal range as possible. To do this, people need to take insulin every day, eat a healthy diet that spreads carbohydrate throughout the day, and get regular exercise. It’s also important that they check their blood sugar several times a day.

Is this topic for you?

This topic has general information about type 1 diabetes for people who do not have the disease. If you want to learn how to manage type 1 diabetes, one of the following topics may meet your needs:

If you are looking for information about type 2 diabetes, see the topic Type 2 Diabetes.

What is type 1 diabetes?

Type 1 diabetes is a disease that starts when the pancreasClick here to see an illustration. stops making insulin. Insulin lets blood sugar—also called glucose—enter the body's cells to be used for energy. Without insulin, the cells can't get the sugar they need, and too much sugar builds up in the blood.

Diabetes can cause sudden or long-term problems. If the body doesn't have enough insulin and the blood sugar gets very high, a sudden and very serious problem called diabetic ketoacidosis can happen. This can be deadly. Over time, high blood sugar can damage the eyes, heart, blood vessels, nerves, and kidneys.

Type 1 diabetes can occur at any age, but it usually starts in children or young adults. That’s why it used to be called juvenile diabetes.

Type 1 diabetes is different than type 2 diabetes, which is the most common form of the illness. In type 1, the body stops making insulin. In type 2, the body does not make enough insulin, or the body can't use insulin the right way. All people with type 1 diabetes need to take insulin. Some people with type 2 diabetes also need insulin, but most people can use diet, exercise, and medicine in pills to treat that illness.

There isn't a cure for type 1 diabetes. But with treatment, people can live long and healthy lives.

What causes type 1 diabetes?

The body makes insulin in beta cells, which are in a part of the pancreas called the islet (say “EYE-let”) tissue. Type 1 diabetes starts because the body destroys the beta cells. Experts don't know why this happens.

Some people have a greater chance of getting type 1 diabetes, because they have a parent, brother, or sister who has it. But most people with the illness don't have a family history of it.

Other things that increase the risk of getting type 1 diabetes are being white and having islet cell antibodies in the blood.

What are the symptoms of type 1 diabetes?

Symptoms of diabetes are:

  • Being very thirsty.
  • Urinating a lot.
  • Losing weight without trying.
  • Being hungrier than usual (sometimes).

These symptoms usually appear over a few days to weeks. Sometimes people notice symptoms after an illness, such as the flu. They may think that the diabetes symptoms are because of the flu, so they don't seek medical care soon enough.

If a person waits too long to get medical care, he or she may get symptoms of diabetic ketoacidosis. Symptoms of this problem include:

  • Flushed, hot, dry skin.
  • Not feeling hungry.
  • Belly pain.
  • Vomiting.
  • A strong, fruity breath odor (similar to nail polish remover).
  • Fast and shallow breathing.
  • Restlessness, drowsiness, or trouble waking up.
  • Confusion.

How is type 1 diabetes diagnosed?

A doctor asks questions about the person’s health and does a physical exam. A blood test measures the person’s glucose.

Some people are diagnosed with type 1 diabetes because they have symptoms of diabetic ketoacidosis.

How is it treated?

Treatment for type 1 diabetes focuses on keeping blood sugar levels as close to the normal range as possible. A person with type 1 diabetes needs to:

  • Take insulin through daily shots or an insulin pump.
  • Eat a healthy diet that spreads carbohydrate throughout the day.
  • Check blood sugar levels several times a day.
  • Get regular exercise.

When a small child has diabetes, the parents have the responsibility for blood sugar control. As the child grows, he or she can take over more of the diabetes care.

Treatment may change based on the results of daily home blood sugar tests and other tests or exams.

Can type 1 diabetes be prevented?

There is no way to prevent type 1 diabetes. But studies are being done to find ways to prevent or delay diabetes in people who are most likely to get it.

Tight control of blood sugar and blood pressure can help people with type 1 diabetes prevent or delay problems with their eyes, kidneys, heart, blood vessels, and nerves.

Cholesterol : In Real Life, Heart-Healthy Diets Can Be Work

Whether you already have heart disease or are trying to avoid it, the basics of a heart-healthy diet are the same.

• Eat a variety of fruits and vegetables.
• Eat variety of grain products, especially whole grains.
• Choose fat-free and low-fat dairy products.
• Choose legumes, poultry, and lean meats.
• Eat fish, preferably oily fish, at least twice a week.

But adopting these habits isn't easy. Paul Tasner, 62, of Greenbrae, Calif., has cholesterol that zoomed up to 298 five years ago. "That's comparable to having little bits of cheese floating around in your arteries," he says. On a fat-restricted vegetarian diet, he was able get it down slightly. But he has a hard time resisting cravings for junk food, especially when he is traveling on business.

"I still eat like a teenager," he says. "I'm kind of a chocoholic, and I love bread and baked goods." Luckily Tasner has brought his cholesterol down to 150 with medication, but a healthy diet should not be forsaken.

Cutting fat is key
For those who want to start eating healthier, cutting back on saturated fats should be a top priority, says Stanley Rockson, MD, chief of consultative cardiology at the Stanford University Medical Center.

"Across the board, too much saturated fat will raise levels of LDL cholesterol," he says. "And high LDL cholesterol is the most compelling risk factor for atherosclerosis, or hardening of the arteries."

Share Your Thoughts

What diet changes have you made for your heart's health?
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One could greatly reduce his saturated fats intake simply by cutting back on meats, says Jeffrey Frame, PhD, a registered dietitian and a professor of dietetics at Murray State University. A four-ounce chicken breast—about the size of a deck of cards—is all you need a day. (For more on portion control, visit the National Heart Lung and Blood Institute's website).

Turning a traditional diet into a heart-healthy plan
orie-platero
Orie Platero's father died of heart failure.
(ORLINDA PLATERO)
In Crownpoint, N.M., in 1999, Orlinda "Orie" Platero sat with her father as he slowly died from heart failure following decades of trouble that included bypass surgery 20 years earlier. Speaking to her in Navajo, he had asked her to promise to avoid his fate. "He told me to be strong and healthy for my boys," she says.

Platero, 50, now works for the Indian Health Service in Rockville, Md., and follows through on that promise she made. She watches what she eats. She exercises regularly. And unlike her father, she's made it well into middle age without even a hint of heart disease.

orie-platero-boys
Platero wants to stay healthy for her family.
(ORLINDA PLATERO)
Through healthy eating and active living, she has turned a looming threat into a remote possibility. "We're a native family, and we've always had a lot of animal fat," says Platero.

She bucked that tradition by cutting way back on meat and eating lots of fruits and vegetables. Her cholesterol and weight have dropped, and she's confident that she'll avoid the heart troubles that plague so many Americans.

Cholesterol : What Is High Cholesterol?

Cholesterol is a type of fat called a lipid. The body uses it for many things, such as making new cells. Your liver makes the cholesterol that your body needs. You also get cholesterol from the foods you eat.

Your body needs some cholesterol. But if you have too much, it starts to build up in your arteries. (Arteries are the blood vessels that carry blood away from the heart.) This is called hardening of the arteries, or atherosclerosis. It is usually a slow process that gets worse as you get older.

To understand what happens, think about how a clog forms in the pipe under a kitchen sink. Like the buildup of grease in the pipe, the buildup of cholesterol narrows your arteries and makes it harder for blood to flow through them. It reduces the amount of blood that gets to your body tissues, including your heart. This can lead to serious problems, including heart attack and stroke.

A simple blood test tells you how much cholesterol you have. The test results are given in mg/dL of cholesterol but most people just say the numbers. Your cholesterol numbers help your doctor know your risk of heart attack. To know this risk, your doctor will also take into account other factors like your age, blood pressure, family history, and if you smoke.

For a general idea about your total cholesterol number, compare your number to the following:
  • Best is less than 200.
  • Borderline-high is 200 to 239.
  • High is 240 or above.
What are the symptoms?
High cholesterol doesn't make you feel sick. But if cholesterol builds up in your arteries, it can block blood flow to your heart or brain and cause a heart attack or stroke.

By the time you find out you have it, it may already be clogging your arteries. So it is very important to start treatment even though you may feel fine.

Cholesterol : Good vs. Bad Cholesterol

Cholesterol travels through the blood attached to a protein. This package of cholesterol (a lipid) and protein is called a lipoprotein. Lipoproteins are either high-density or low-density, based on how much protein and fat they have.

  • Low-density lipoproteins (LDL) are the "bad" cholesterol. LDL is mostly fat with only a small amount of protein. It can clog your arteries. If you have high cholesterol, your doctor will want you to lower your LDL.
  • High-density lipoproteins (HDL) are the "good" cholesterol. HDL is more protein than fat. It helps clear the bad cholesterol from your blood so it does not clog your arteries. A high level of HDL can protect you from a heart attack.
  • Triglycerides are another type of fat in the blood that can affect your health. If you have high triglycerides and high LDL, your chances of having a heart attack are higher.
It may help to think of HDL as the "Healthy" cholesterol and LDL as the "Lousy" cholesterol. Or you could remember that HDL should be High and LDL should be Low.

Experts have come up with goals for each type of cholesterol. Your doctor will help you decide on cholesterol goals based on your risk of heart attack and stroke. Your doctor will help you know this risk. To find out your risk of a heart attack, you can use the Interactive Tool: Are You at Risk for a Heart Attack

  • LDL should be low. Your LDL goal depends on your risk of heart attack and stroke. If you are at very high risk, your goal may be less than 70. If you are at high risk, your goal is less than 100. If you are at moderate risk, your goal is less than 130. If you are at low risk, your goal is less than 160.
  • HDL should be high. A good HDL goal is 40 or higher. HDL below 40 increases your risk of heart problems. The higher your HDL, the better. A high HDL number can help offset a high LDL number.
  • Triglycerides should be less than 150. A level above 150 may increase your risk for heart problems.

Cholestrol : The Therapeutic Lifestyle Changes (TLC) Diet for Heart Disease

The first step to lowering your cholesterol is altering your fat intake. The TLC diet, explained below, is a great tool for cutting back on saturated fat and improving your overall cholesterol profile. For a complete description of the TLC diet, including an easy-to-use chart of food recommendations and serving sizes, visit our A-Z Health Library.

People have varying degrees of success in lowering their cholesterol by changing their diets. People who have high cholesterol because they eat too many fatty foods may be able to lower their cholesterol 10% to 20% with diet changes alone, while others may only achieve a 5% to 8% reduction. Those who are most successful using diet changes to lower their cholesterol are those who lose excess weight. Diet changes are usually the first step in lowering cholesterol before medicines are added.

The Therapeutic Lifestyle Changes (TLC) diet is recommended by the National Cholesterol Education Program of the U.S. National Institutes of Health. The diet's main focus is to reduce the amount of saturated fat you eat because it elevates your cholesterol. You can reduce the saturated fat in your diet by limiting the amount of meat and milk products you consume. Choose low-fat products from those food groups instead. Replace most of the animal fat in your diet with unsaturated fat, especially monounsaturated oils, such as olive, canola, or peanut. Monounsaturated fat lowers LDL ("bad") cholesterol if it is substituted for saturated fat and keeps HDL ("good") cholesterol up.

The TLC diet calls for less than 7% of your daily calories to come from saturated fat and that you eat no more than 200 mg of dietary cholesterol per day. However, the diet allows 25% to 35% of daily calories from fat, mainly from unsaturated fat. Most of the fat should be monounsaturated, and only 10% should be polyunsaturated fat. Your diet should include only enough calories to maintain your desired weight and avoid gaining weight.

Selasa, 13 Januari 2009

Asthma in Teens and Adults : Other Treatment

Other Treatment

Allergy shots (immunotherapy) may be recommended for people who have asthma symptoms when they are around substances to which they are allergic (allergens). In some people, allergy shots have been shown to reduce asthma symptoms and the need for medications.21 But allergy shots are not equally effective for all allergens. Allergy shots should not be given when asthma is poorly controlled. For more information, see:

Click here to view a Decision Point.Should I take allergy shots (immunotherapy) for allergic rhinitis and allergic asthma?

Allergy shots are similar to vaccinations, because they contain small doses of one or more substances to which you are allergic so that your body can become less responsive to them over time.

Complementary medicine

Alternative treatments such as homeopathy, acupuncture, and breathing exercises have been used to treat asthma. The research on these treatments is limited. A review of research shows:22

Some people have used ephedra—a stimulant sold for weight loss and sports performance—to try to treat asthma symptoms. But the U.S. Food and Drug Administration (FDA) has banned the sale of this dietary supplement because of concerns about safety. Ephedra, also called ma huang, has been linked to heart attacks, strokes, and some deaths.

For more information on alternative treatments, see the topic Complementary Medicine.

Living With Asthma

Living With Asthma

You can control the impact asthma has on your life by following your asthma plans consistently. A management plan can reduce inflammationClick here to see an illustration. to decrease the severity, frequency, and duration of asthma attacks. Following your plans may be difficult due to the many different factors involved.

To help yourself remain consistent in following your asthma plans:

  • Educate yourself about asthma. By doing so, you can learn to control symptoms and reduce the risk of asthma attacks. This questionnaire can help you determine what you already know about asthma and what you may need to discuss with your health professional.
  • Understand your barriers and solutions. What may prevent you from following your plans? These may be physical barriers, such as living far from your health professional or pharmacy, or emotional barriers, such as having undiscussed fears about the condition or unrealistic expectations. Discuss your barriers with your health professional, and work to find solutions.
  • Develop goals that relate to your quality of life. Being able to measure your success gives you greater motivation to follow asthma plans consistently. Decide what you want to be able to do. Have symptom-free nights? Be able to exercise on a regular basis? Feel secure in knowing you can deal with an asthma attack? Work with your health professional to see if your goals are realistic and how to meet them.

Your asthma plans generally consist of the following:

  • Seeing your health professional regularly to monitor your asthma. The frequency of checkups depends on how your asthma is classified. Checkups are recommended about every 6 to 12 months for mild intermittent or mild persistent asthma that has been under control for at least 3 months; every 3 to 6 months for moderate persistent asthma; and every 1 to 2 months for uncontrolled or severe persistent asthma. Bring your asthma plans to appointments.
  • Following your daily asthma treatment plan. This plan helps you control your asthma and describes which medications to take every day. A daily treatment plan also may include an asthma diary where you record your peak expiratory flow, symptoms, triggers, and use of quick-relief medication for asthma attacks. This valuable tool helps you and your health professional manage your asthma. A daily asthma treatment plan is often combined with an asthma action plan.
  • Following your asthma action plan. This contains directions for the management of asthma attacks at home. It helps you better control asthma attacks by being aware of symptoms and knowing how to make quick decisions about medication and treatment. See an example of an asthma action planClick here to view a form. (What is a PDF document?) .

For more information on how to monitor and treat asthma, see:

Click here to view an Actionset.Asthma: Taking charge of your asthma.
Click here to view an Actionset.Asthma: Using an asthma action plan.

To effectively manage your asthma and use your daily asthma treatment and action plans, you will have to know how to monitor your peak airflow, identify asthma triggers, and take your asthma medication correctly.

Monitoring peak expiratory flow

People often underestimate the severity of their symptoms. They may not notice symptoms until their lungs are functioning at 50% of their personal best measurement. Measuring peak expiratory flow (PEF) is a way to keep track of asthma symptoms at home; it can help you know when your lung function is becoming worse before it drops to a dangerously low level. You can do this with a peak flow meter. For more information, see:

Click here to view an Actionset.Asthma: Measuring peak flow.

Identifying asthma triggers

A trigger is anything that can lead to an asthma attack. A trigger can be:

  • Irritants in the air, such as tobacco smoke or air pollution.
  • Substances to which you are allergic (allergens), such as pollen or animal dander.
  • Other factors, such as a viral infection, exercise, stress, or dry, cold air.

Avoiding triggers will help decrease the chance of having an asthma attack and, in the case of allergens, will help control inflammation in the bronchial tubes, which carry air to the lungs. For more information, see:

Click here to view an Actionset.Asthma: Identifying your triggers.

If you have asthma triggered by an allergen, taking antihistamine medication may help you manage the allergy and thus limit its effect on your asthma.

Taking your asthma medication

Taking medications is an important part of asthma treatment. But because you often take many different medications, it can be difficult to remember to take them. To help yourself remember, understand the reasons people don't take their asthma medications, and then find ways to overcome those obstacles, such as taping a note to your refrigerator.

Most medications for asthma are inhaled. Inhaled medications give a specific dose of the medication directly to the bronchial tubes, avoiding or decreasing the effects of the medication on the rest of the body. Delivery systems for inhaled medications include metered-dose and dry powder inhalers and nebulizers. A metered-dose inhaler is used most often.

Most health professionals recommend that everyone who uses a metered-dose inhaler (MDI) also use a spacerClick here to see an illustration., which is attached to the MDI. A spacer may deliver the medication to your lungs better than an inhaler alone, and for many people it is easier to use than an MDI alone. Using a spacer with inhaled corticosteroids can help reduce their side effects and result in less use of oral corticosteroids.

It is important to keep track of the inhaler doses and discard the inhaler when you have used the number of doses indicated on the package labeling. This not only prevents you from having an empty inhaler when you need medication, but it also prevents you from inhaling only propellant after the medication has run out. For more information, see:

Click here to view an Actionset.Asthma: Using a metered-dose inhaler.
Click here to view an Actionset.Asthma: Using a dry powder inhaler.

Travel

Most people with asthma can travel freely. But if you travel to remote areas and participate in intensive physical activity, such as long hikes, you may be at increased risk for an asthma attack in an area where emergency help may be difficult to find.

When traveling, always bring your medication with you, carry the prescription for it, and use it as prescribed.

Give teens extra attention

Teens who have asthma may view the disease as cutting into their independence and setting them apart from their peers. Parents and other adults should offer support and encouragement to help teens stick with a treatment program. It's important to:

  • Help your teen remember that asthma is only one part of life.
  • Allow your teen to meet with the health professional alone. This will encourage your teen to become involved in his or her care.
  • Work out a daily management plan that allows a teen to continue daily activities, especially sports. Exercise is important for maintaining strong lungs and overall health.
  • Talk to your teen about the dangers of smoking and drug use.
  • Encourage your teen to meet others who have asthma so they can support each other.

Asthma in Teens and Adults : Medications

Medications

Medication does not cure asthma. But it is an important part of managing the condition. Medications for asthma treatment are used to:

  • Prevent and control the underlying airway inflammationClick here to see an illustration., to minimize asthma symptoms.
  • Decrease the severity, frequency, and duration of asthma attacks.
  • Treat the attacks as they occur.

Asthma medications are divided into two groups: those for prevention and long-term control of inflammationClick here to see an illustration. and those that provide quick relief for asthma attacks. Most people with persistent asthma need to use long-term medications daily. Quick-relief medications are used as needed and provide rapid relief of symptoms during asthma attacks.

Because asthma develops from a complex interaction of genetics, environmental factors, and the reaction of the immune system, different people may use different medications and doses of medications. Special consideration may be necessary if you:

  • Are pregnant. If a woman had asthma before becoming pregnant, her symptoms may become better or worse during pregnancy. Pregnant women whose asthma is not well controlled may be at risk for a number of complications.
  • Are an older adult. Older adults tend to have worse asthma symptoms and a higher risk of death from asthma than younger people. They may also have one or more other health conditions or take other medications that can make asthma symptoms worse.
  • Have exercise-induced asthma. Exercise often causes asthma symptoms. Steps you can take to reduce the risk of this include using medication immediately before you exercise.
  • Need surgery. People with moderate to severe asthma are at higher risk than people who do not have asthma of developing problems during and after surgery.

Medication delivery

Most medications for asthma are inhaled. Inhaled medications are used because a specific dose of the medication can be given directly to the bronchial tubes. Different types of delivery systems may be used to do this, and one type may be more suitable for certain people or age groups than another. Delivery systems include metered-dose and dry powder inhalers and nebulizers. A metered-dose inhaler is used most often.

Most health professionals recommend that everyone who uses a metered-dose inhaler (MDI) also use a spacerClick here to see an illustration., which is attached to the MDI. A spacer may deliver the medication to your lungs better than an inhaler alone, and for many people it is easier to use than an MDI alone. Using a spacer with inhaled corticosteroids can help reduce their side effects and result in less use of oral corticosteroids.

It is important to keep track of the inhaler doses and discard the inhaler when you have used the number of doses indicated on the package labeling. This not only prevents you from having an empty inhaler when you need medication, but it also prevents you from inhaling only propellant after the medication has run out. For more information, see:

Click here to view an Actionset.Asthma: Using a metered-dose inhaler.
Click here to view an Actionset.Asthma: Using a dry powder inhaler.

Medication Choices

The most important asthma medications are:

  • Inhaled corticosteroids. These are the preferred medications for long-term treatment of asthma. They reduce inflammation of your airways and are taken every day to keep asthma under control and to prevent sudden and severe symptoms (asthma attacks). Inhaled corticosteroids include beclomethasone dipropionate, triamcinolone acetonide, fluticasone propionate, budesonide, and flunisolide.
  • Oral or injected corticosteroids (systemic corticosteroids) to get your asthma under control before you start taking daily medication. You may also need these medications to treat asthma attacks. Oral corticosteroids are used much more than injected corticosteroids. Oral corticosteroids include prednisone and dexamethasone.
  • Short-acting beta2-agonists for asthma attacks. They relax the airways, allowing you to breathe easier. These medications include albuterol and pirbuterol.

Other long-term medications for daily treatment include:

Other medications may be given in some cases.

  • Anticholinergics (such as ipratropium) and magnesium sulfate are usually used for severe asthma attacks.
  • Other medicine such as omalizumab may be used if asthma does not improve with treatment. An asthma specialist generally prescribes this medicine.

See a chart of asthma medications for teens and adults.

What to Think About

Medications are usually added one at a time to keep the number of medications low. The dosage of each medication should correspond to the severity of your asthma. Sometimes your health professional will start you at a higher dose within your asthma classification so that the inflammation is immediately controlled. After a prolonged period of symptom improvement, the dose of the last medication added is reduced to the lowest possible dose for maintenance. This is known as step-down care. Step-down care is believed to be a better way to control inflammation in the bronchial tubes than starting at lower doses of medication and increasing the medication if the dose is not enough.19

Because quick-relief medication quickly reduces symptoms, people sometimes overuse these medications instead of using the slower-acting long-term medications. But overuse of quick-relief medications may have harmful effects, such as decreasing the future effectiveness of these medications.20 Overuse of quick-relief medication is also an indication that asthma symptoms are not being controlled. Be sure to talk with your health professional immediately.

You may have to take many different medications daily to manage your asthma. It can be difficult to remember when to take your medication and which medication to take. To help yourself remember, understand the reasons people don't take their asthma medications, and then find ways to overcome those obstacles, such as taping a note to your refrigerator to remind yourself.

Using the fewest medications possible is important for older people, because they may be taking medications for other conditions. Tell your health professional about all the medications you are taking, so he or she can select asthma medications that won't interfere with other medicines.

Some people only have symptoms during certain times of the year (seasonal asthma). If you know when you will most likely have symptoms, start using a medication to decrease inflammation before the symptoms start.

Asthma in Teens and Adults : Treatment

Treatment Overview

Although asthma cannot be cured, you can manage the symptoms with medications, especially inhaled corticosteroids and beta2-agonists. You will probably work with your health professional to develop a management plan consisting of a daily treatment plan and an asthma action plan. These plans help you meet treatment goals and get your asthma under control. The goals of asthma treatment are to:18

  • Prevent symptoms.
  • Keep your peak flow and lung function as close to normal as possible.
  • Be able to do your normal daily activities, including work, school, exercise, and recreation.
  • Prevent asthma attacks.
  • Have few or no side effects from medicine.

For more information, see:

Click here to view an Actionset.Asthma: Taking charge of your asthma.

Emergency treatment

If you have a severe asthma attack (the red zone of your asthma action plan), use medication based on your action plan and talk with a health professional immediately about what to do next. This is especially important if your peak expiratory flow (PEF) does not return to the green zone or stays within the yellow zone after you take medication. You may have to go to the hospital or an emergency room for treatment. Be sure to tell the emergency staff if you are pregnant.

At the hospital, you will probably receive inhaled beta2-agonists and corticosteroids. You may be given oxygen therapy. Your lung function and condition will be assessed. Depending on your response, further treatment in the emergency room or a stay in the hospital may be necessary.

Some people are at increased risk of death from asthma, such as people who have been admitted to an intensive care unit for asthma or who have needed a breathing tube (intubation) for asthma. These people need to seek medical care early when they have symptoms.

Medical checkups

You need to monitor your asthma and have regular checkups to keep it under control and to ensure correct treatment. The frequency of checkups depends on how your asthma is classified. Checkups are recommended:

During checkups, your health professional will ask whether your symptoms and peak expiratory flow have held steady, improved, or become worse and will ask about asthma attacks during exercise or at night. You track this information in an asthma diary. You may be asked to bring your peak expiratory flow meter to an appointment so your health professional can see how you use it.

Initial treatment

There are many components to managing asthma. After your diagnosis, your health professional may only discuss the components you need to know immediately. These include:

  • Oral or injected corticosteroids (systemic corticosteroids). These medications may be used to get your asthma under control before you start taking daily medication. In the future, you also may take oral or injected corticosteroids to treat any sudden and severe symptoms (asthma attacks), such as shortness of breath. Oral corticosteroids are used more than injected corticosteroids. Oral corticosteroids include prednisone and dexamethasone.
  • Inhaled corticosteroids. These are the preferred medications for long-term treatment of asthma. They reduce the inflammationClick here to see an illustration. of your airways, and you take them every day to keep asthma under control and to prevent asthma attacks. Inhaled corticosteroids include beclomethasone dipropionate, triamcinolone acetonide, fluticasone propionate, budesonide, and flunisolide.
  • Short-acting beta2-agonists. These medications are used for asthma attacks. They relax the airways, allowing you to breathe easier. Short-acting beta2-agonists include albuterol and pirbuterol.
  • A combination of an inhaled corticosteroid and long-acting beta2-agonist. This combination is often used to treat persistent asthma.
  • Basic education about asthma. The more you know about asthma, the more likely it is you will control symptoms and reduce the risk of asthma attacks. Keep in mind that even severe asthma can be controlled, and cases where the condition cannot be controlled are unusual.
  • Instruction on how to use a metered-dose inhaler (MDI) or dry powder inhaler (DPI). Inhalers deliver medicine directly to the lungs. If you use your inhaler correctly, you can control your symptoms and avoid asthma attacks that can send you to the emergency room. Most health professionals recommend using a spacerClick here to see an illustration. with an MDI. For more information, see:
    Click here to view an Actionset.Asthma: Using a metered-dose inhaler.
    Click here to view an Actionset.Asthma: Using a dry powder inhaler.

Your short-term goal is to control your current symptoms. Long-term, your goal is to prevent symptoms so that asthma does not impact your daily activities.

Special considerations in treating asthma include:

  • Managing asthma during pregnancy. If a woman had asthma before becoming pregnant, her symptoms may get better or worse during pregnancy. Pregnant women whose asthma is not well controlled may be at risk for a number of complications.
  • Managing asthma in older adults. Older adults tend to have worse asthma symptoms and a higher risk of death from asthma than younger people. They may also have one or more other health conditions or take other medications that can make asthma symptoms worse.
  • Managing exercise-induced asthma. Exercise often causes asthma symptoms. Steps you can take to reduce the risk of this include using medication immediately before you exercise.
  • Managing asthma before surgery. People with moderate to severe asthma are at higher risk of developing problems during and after surgery than people who do not have asthma.

Ongoing treatment

After your initial treatment for asthma, it is important to learn more about the condition and develop an overall plan to manage the disease. You and your health professional will work together to do this. Because asthma develops from a complex interaction of genetics, environmental factors, and the reaction of the immune system, no one management plan is effective for everyone.

Asthma management consists of:

  • A daily asthma treatment plan. A daily asthma treatment plan outlines in writing how to treat and control inflammation in your lungs. The plan helps you keep asthma under control and prevent asthma attacks. The plan also tells you which medications to take every day. A daily treatment plan may include an asthma diary where you record your peak expiratory flow (PEF), symptoms, triggers, and quick-relief medication used for asthma attacks. This valuable tool helps you and your health professional manage your asthma. A daily asthma treatment plan is often combined with an asthma action plan.
  • An asthma action plan. An asthma action plan contains directions to treat asthma attacks at home. It helps you identify triggers that can be changed or avoided, be aware of your symptoms, and know how to make quick decisions about medication and treatment. See an example of an asthma action planClick here to view a form. (What is a PDF document?) . For more information, see:
    Click here to view an Actionset.Asthma: Using an asthma action plan.
  • Monitoring peak expiratory flow. It is easy to underestimate the severity of your symptoms. You may not notice them until your lungs are functioning at 50% of your personal best peak expiratory flow (PEF). Measuring PEF is a way to keep track of asthma symptoms at home. It can help you know when your lung function is becoming worse before it drops to a dangerously low level. You can do this with a peak flow meter. For more information, see:
    Click here to view an Actionset.Asthma: Measuring peak flow.
  • A plan to deal with factors that can make asthma worse (triggers). Being around triggers increases symptoms. Try to avoid situations that expose you to irritants (such as smoke or air pollution) or to substances (such as animal dander) to which you may be allergic. If substances at work are causing your asthma or making it worse (occupational asthma), you may have to change jobs. See information on:
    Click here to view an Actionset.Asthma: Identifying your triggers.
  • A plan to treat other health problems. If you also have other health problems, such as inflammation and infection of the sinuses (sinusitis) or gastroesophageal reflux disease (GERD), you will need treatment for those conditions.
  • Using your prescribed medications correctly. Your health professional may adjust your medications depending on how well your asthma is controlled. Medications include:
    • Inhaled corticosteroids. These are the preferred medications for long-term treatment of asthma. Inhaled corticosteroids include beclomethasone dipropionate, triamcinolone acetonide, fluticasone propionate, budesonide, and flunisolide.
    • Long-acting beta2-agonists (such as salmeterol and formoterol), which are used along with inhaled corticosteroids.
    • Oral or injected corticosteroids (systemic corticosteroids) to treat any sudden and severe symptoms (asthma attacks), such as shortness of breath. Oral corticosteroids are used more than injected corticosteroids. Oral corticosteroids include prednisone and dexamethasone.
    • Quick-relief medication, such as short-acting beta2-agonists and anticholinergics (ipratropium) for asthma attacks. If you are using quick-relief medication on more than 2 days a week (except for exercise), you probably need long-term treatment. Overuse of quick-relief medication can be harmful.
  • Education. Continue to learn about asthma. This questionnaire can help you determine what you already know about asthma and what you may need to discuss with your health professional.

If you have persistent asthma and react to allergens, you may need to have skin testing for allergies. Allergy shots (immunotherapy) may be helpful. For more information, see:

Click here to view a Decision Point.Should I take allergy shots (immunotherapy) for allergic rhinitis and allergic asthma?

You can expect to live a normal life if you control symptoms by following your daily treatment and action plans. Control of your asthma symptoms can help keep your lungs as healthy as possible.

Special considerations in treating asthma include:

  • Managing asthma during pregnancy. If a woman had asthma before becoming pregnant, her symptoms may become better or worse during pregnancy. Pregnant women whose asthma is not well controlled may be at risk for a number of complications.
  • Managing asthma in older adults. Older adults tend to have worse asthma symptoms and a higher risk of death from asthma than younger people. They may also have one or more other health conditions or be taking other medications that can make asthma symptoms worse.
  • Managing exercise-induced asthma. Exercise often causes asthma symptoms. Steps you can take to reduce the risk of this include using medication immediately before you exercise.
  • Managing asthma before surgery. People with moderate to severe asthma are at higher risk of developing problems during and after surgery than people who do not have asthma.

Treatment if the condition gets worse

If your asthma is not improving, make an appointment with your doctor to:

If your medication is not working to control airway inflammation, your health professional will first check to see whether you are using the inhaler correctly. If you are using it correctly, your health professional may increase the dosage, switch to another medication, or add a medication to the existing treatment.

Your doctor may suggest other medications, such as leukotriene pathway modifiers (zafirlukast, zileuton, or montelukast). Less commonly, your doctor may recommend mast cell stabilizers (cromolyn sodium or nedocromil) or theophylline (Theo-Dur, Slo-bid, Uniphyl, or Uni-Dur).

If your asthma does not improve with treatment, you may require more intensive treatment, including larger doses of corticosteroids or other medication. An asthma specialist generally prescribes these medications.

If you have persistent asthma and react to allergens, you may need to have skin testing for allergies. Allergy shots (immunotherapy) may be helpful.

What to think about

If you have been diagnosed with asthma, it is important that you treat it. You may feel good most of the time—so much so that you find it hard to believe you have a long-lasting condition. But all asthma—even mild asthma—may result in changes to your airways that speed up and make worse the natural decrease in lung function that occurs as we age.3

Asthma in Teens and Adults : Prevention

Prevention

Although there is no certain way to prevent asthma, you can take steps to reduce airway inflammationClick here to see an illustration. and the likelihood of asthma attacks.

Preventing asthma attacks

The main focus of prevention is to reduce the number, length, and severity of asthma attacks. By avoiding triggers, you may be able to prevent or reduce the severity of symptoms. For more information on identifying your triggers, see:

Click here to view an Actionset.Asthma: Identifying your triggers.

If you can predict or often have asthma attacks when you exercise, use your inhaler 10 minutes before you start the activity so you can avoid an attack.

The following is information about specific triggers. If you know that any of these cause your symptoms to become worse, you should avoid or limit your exposure to them.

Irritants in the air

Common irritants in the air, such as tobacco smoke and air pollution, can trigger asthma attacks in some people.

Controlling tobacco smoke is important because it is a major cause of asthma symptoms in children and adults. If you have asthma, try to avoid being around others who are smoking, and ask people not to smoke in your house.

  • Pregnant women who smoke cigarettes during pregnancy increase the risk of wheezing in their newborn babies.
  • Exposing young children to secondhand tobacco smoke increases the likelihood that they will develop asthma and increases the severity of symptoms if they already have the disease.

Consider staying inside when air pollution levels are high. Other irritants in the air (such as fumes from gas, oil, or kerosene or wood-burning stoves) can sometimes irritate the bronchial tubes, which carry air to the lungs. Avoiding these may decrease your asthma symptoms.

Allergens

If you are allergic to certain substances (allergens), you may decrease your asthma symptoms by limiting exposure to these substances.

To help reduce your exposure to allergens:

  • Control cockroaches, especially if you live in an inner-city area or the southern part of the United States.
  • Control dust mites. House dust mites have been linked with the development of asthma in children.1
  • Control animal dander and pet allergens. If you know your pet is a trigger, you may need to think about giving it away. If that is too hard, taking steps such as keeping your pet out of your bedroom and dusting and vacuuming often may help your asthma.
  • Control indoor mold, especially if you live in an area with high humidity.

It also may be necessary to avoid exposure to other types of triggers that cause asthma symptoms.

  • Get a flu shot (influenza vaccine) every year. Have your family members get one too.
  • Control your exposure to pollens in the air. Check your local weather report or newspaper for pollen counts in your area.
  • Avoid exercising outdoors in cold weather. The air may irritate your airways. If you are outdoors in cold weather, wear a scarf around your face and breathe through your nose.
  • Avoid foods that may cause asthma symptoms. Some people have symptoms after eating processed potatoes, shrimp, nuts, and dried fruit, or after drinking beer or wine. These foods and liquids contain sulfites, which may cause asthma symptoms.
  • Avoid taking aspirin, ibuprofen, or other similar medications if they increase asthma symptoms. Consider using acetaminophen (Tylenol) instead. (Do not give aspirin to anyone younger than 20 because of the risk of Reye's syndrome.)

Asthma in Teens and Adults

Overview

Illustration of the lungs

Is this topic for you?

This topic provides information about asthma in teens and adults. If you are looking for information about asthma in children age 12 and younger, see the topic Asthma in Children.

What is asthma?

Asthma causes swelling and inflammationClick here to see an illustration. in the airways that lead to your lungs. When asthma flares up, the airways tighten and become narrower. This keeps the air from passing through easily and makes it hard for you to breathe. These flare-ups are also called asthma attacks or exacerbations.

Asthma affects people in different ways. Some people only have asthma attacks during allergy season, or when they breathe in cold air, or when they exercise. Others have many bad attacks that send them to the doctor often.

Even if you have few asthma attacks, you still need to treat your asthma. The swelling and inflammation in your airways can lead to permanent changes in your airways and harm your lungs.

Many people with asthma live active, full lives. Even though asthma is a lifelong disease, treatment can control it and keep you healthy.

What causes asthma?

Experts do not know exactly what causes asthma. But there are some things we do know:

  • Asthma runs in families.
  • Asthma is much more common in people with allergies, though not everyone with allergies gets asthma. And not everyone with asthma has allergies.
  • Pollution may cause asthma or make it worse.

What are the symptoms?

Symptoms of asthma can be mild or severe. You may have mild attacks now and then, or you may have severe symptoms every day, or you may have something in between. How often you have symptoms can also change. When you have asthma, you may:

  • Wheeze, making a loud or soft whistling noise that occurs when you breathe in and out.
  • Cough a lot.
  • Feel tightness in your chest.
  • Feel short of breath.
  • Have trouble sleeping because of coughing or having a hard time breathing.
  • Quickly get tired during exercise.

Your symptoms may be worse at night.

Severe asthma attacks can be life-threatening and need emergency treatment.

How is asthma diagnosed?

Along with doing a physical exam and asking about your health, your doctor may order lung function tests. These tests include:

  • Spirometry. Doctors use this test to diagnose and keep track of asthma. It measures how quickly you can move air in and out of your lungs and how much air you move.
  • Peak expiratory flow (PEF). This shows how fast you can breathe out when you try your hardest.
  • An exercise or inhalation challenge. This test measures how quickly you can breathe after exercise or after taking a medicine.
  • A chest X-ray, to see if another disease is causing your symptoms.
  • Allergy tests, if your doctor thinks your symptoms may be caused by allergies.

You will need routine checkups with your doctor to keep track of your asthma and decide on treatment.

How is it treated?

There are two parts to treating asthma. The goals are to:

  • Control asthma over the long term. To do this, use a daily asthma treatment plan. This is a written plan that tells you which medicine to take. It also helps you track your symptoms and know how well the treatment is working. Many people take controller medicine—usually an inhaled corticosteroid—every day. Taking controller medicine every day helps to reduce the swelling of the airways and prevent attacks. Your doctor will show you how to use your inhaler correctly. This is very important so you get the right amount of medicine to help you breathe better.
  • Treat asthma attacks when they occur. Use an asthma action plan, which tells you what to do when you have an asthma attack. It helps you identify triggers that can cause your attacks. You use rescue medicine, such as albuterol, during an attack.

If you need to use the rescue inhaler more often than usual, talk to your doctor. This is a sign that your asthma is not controlled and can cause problems.

Asthma attacks can be life-threatening, but you may be able to prevent them if you follow a plan. Your doctor can teach you the skills you need to use your asthma treatment and action plans.

How can you prevent asthma attacks?

You can prevent some asthma attacks by avoiding those things that cause them. These are called triggers. A trigger can be:

  • Irritants in the air, such as cigarette smoke or other air pollution. Don't smoke, and try to avoid being around others when they smoke.
  • Things you are allergic to, such as pet dander, dust mites, cockroaches, or pollen. When you can, avoid those things you are allergic to. It may also help to take certain kinds of allergy medicine.
  • Exercise. Ask your doctor about using an inhaler before you exercise if this is a trigger for you.
  • Other things like dry, cold air; an infection; or some medicines, such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Try not to exercise outside when it is cold and dry. Talk to your doctor about vaccines to prevent some infections, and ask about what medicines you should avoid.

Sometimes you don't know what triggers an asthma attack. This is why it is important to have an asthma action plan that tells you what to do during an attack.