Remember the “Hints from Heloise” newspaper column? She provided simple household advice passed down from mothers and grandmothers whose common ingredients for cleaning, including baking soda and vinegar, came from the kitchen cupboard.

These types of non-toxic cleaning products are making a comeback. Armed with emerging scientific data on the hazards of synthetic cleaning products, consumers are ready to get back to the basics.

We now know that as we dust, polish and scrub our way to a “cleaner” house, we may create a harmful mix of chemicals that pollute the indoor air and surfaces and compromise the health of our family and pets. Some products contain toxic substances that can cause harm if inhaled, swallowed or absorbed through the skin. Mixing certain chemical cleaners, such as chlorine bleach and ammonia, can create toxic gases. Extremely high doses of some substances may even cause birth defects or other serious health problems, including brain damage or death.

Recent studies show that many common cleaners and air “fresheners” contain chemicals that can trigger asthma. This includes products such as spray and plug-in air fresheners; toilet cleaners; and laundry products including detergents, fabric softeners and dryer sheets. A recent study published in the American Journal of Respiratory and Critical Care Medicine showed that people who used cleaning sprays at least once a week were 50 percent more likely to have increased asthma symptoms, wheeze or use asthma medications. Of the products studied, air fresheners, glass cleaners and furniture sprays had the strongest association with asthma.

Less than 10 percent of approximately 100,000 synthetic chemicals produced each year for industry, home and agriculture uses have undergone testing for long-term health effects. Some synthetic chemicals found in cleaning products are not deliberately added, but are carcinogenic byproducts of manufacturing (including formaldehyde and benzene). The U.S. Food and Drug Administration (FDA) does not require manufacturers to list chemicals used in product fragrances. In addition, there are no legal requirements for ingredient labeling on household cleaning products.

Fragrance-free products are the best solution for those at risk for asthma. This is just a rough guideline since there is no exact definition for “scent-free,” “fragrance-free” or “unscented.” Products labeled as “unscented” may actually contain ingredients to mask the smell of other ingredients.

You can also try substituting chemical cleaning products with non-toxic alternatives, just like your grandmother or Heloise used to do. For example:

• Open windows or use products scented with essential oils instead of spraying air fresheners.
• Use these non-toxic cleaning alternatives:
  • Castile soap (least toxic, vegetable oil-based)
  • Baking soda
  • Vinegar
  • Lemons and essential oils
• Use this quick recipe for a safe, effective glass cleaner:
  • 2 cups of water
  • 1 cup of distilled vinegar
  • 1 teaspoon of liquid soap

You can find more non-toxic, natural cleaning and cooking tips in Vicky Lansky’s books Vinegar and Baking Soda.

If you use chemical cleaning products, keep them in their original containers, keep them out of reach of children, and carefully follow instructions for storage and use. If anyone swallows, inhales or gets a toxic product on their skin, seek immediate medical attention.

Listed below are three organizations you can contact with questions or concerns about common household chemicals:

National Pesticide Information Center, 800-858-7378, www.npic.orst.edu

Environmental Protection Agency, 202-272-0167, www.epa.gov

National Poison Control Hotline, 800-222-1222, www.poison.org

— Cindy Russell, M.D.

Before you head out to purchase gifts for the children in your life, there are a few things you should know about toy safety. Well-chosen toys help children develop coordination, imagination and other skills, but inappropriate toys or unsupervised playtime can do more harm than good … and some toys can be dangerous.

Each year, thousands of children suffer toy-related injuries. Below are some toy-selection tips to help minimize risks to children:

• Select toys that are appropriate for the child’s age and interest.
• When buying for infants or toddlers, avoid toys with small parts. Even the button eyes on a teddy bear can be dangerous to a young child.
• When choosing toys for infants, avoid those with long strings or chords that may cause strangulation.
• For all children under age 8, avoid toys with sharp edges and points.
• Avoid toys that shoot small objects into the air, since they can cause serious eye injuries and choking.
• Look for sturdy toy construction. Avoid toys that have small or thin parts that can be broken off.
• Check for toxins or poisons. Buy paint sets, crayons and markers that are labeled nontoxic.
• Read all toy labels, and follow instructions.
• Discard all plastic wrappings, which can cause suffocation.

Providing adequate supervision when a child is playing is as important as buying the right toys. Here are some safety tips:

• Closely supervise young children while they play.
• Keep toys meant for older children out of younger children’s reach.
• Plan ahead if you buy cycles, skates or razors. Provide helmets, wrist, elbow and knee guards, and discuss safe areas for riding.
• Do not allow young children to use shooting or target toys, chemistry lab sets or electrical toys. Closely supervise older children playing with these toys.
• Teach your child to use and store toys properly.
• Keep toys in good condition, and repair or replace them when they are damaged.
• Do not allow children to play near stairs, hills, traffic and swimming pools.
• Store batteries out of reach, since they are toxic and can pose a choking hazard.

Here’s to a happy, healthy holiday season. For more information on specific toy safety, visit the Consumer Product Safety Commission Web site at www.cpsc.gov .

— Ross DeHovitz, M.D.

— The Palo Alto Medical Foundation and column editor Arian Dasmalchi provide this monthly column.

The holidays are notorious for helping us put on unwanted pounds. With all the parties and family gatherings, it’s easy to nosh on a few too many appetizers, eat an extra plateful at mealtime and sip on several high-calorie beverages.

The delicious, high-calorie foods and drinks that abound during the holidays make it easy to overindulge. In addition, stress levels tend to be higher during the holiday season — making us more prone to reach for comfort food or another cocktail.

There are a few things you can do to beat the urge to overindulge in food and drinks during the holiday season.

• Get plenty of rest. When you don’t get the proper amount of sleep (eight hours is ideal for most people), the hormones that control your appetite can become off-balance, leading to overeating.
• Recognize what causes you to overindulge. Some people overindulge in food and alcohol when they are stressed or “blue,” while others tend to eat or drink too much in social settings. Try to recognize your triggers and put a plan in place. For example, if youÕre feeling blue go for a walk instead of reaching for a cookie, or predetermine how many drinks you’ll have at a party.
• Drink water between cocktails. It’s easy to have too many cocktails at a social event. You can slow yourself down by alternating cocktails with sparkling water.
• Wait a few minutes before reaching for more. It takes our bodies about 20 minutes to process the calories we eat or drink. So if you’re feeling the urge to have a second serving of chips and dip, for example, tell yourself you can have more if you wait for 20 minutes. If you still want it after 20 minutes, you can have it, but in many cases the craving will subside and you’ll end up consuming fewer calories.
• Don’t skip meals. If you don’t let yourself get really hungry, you’ll be less likely to binge eat or drink when the opportunities present themselves. Plan regular meals and snacks at approximately the same time each day — about two or three hours apart (three meals and two to three snacks a day). This enables your body to regulate hunger so you’re hungry at mealtimes, but not so hungry that you’ll overindulge. If your stomach is full, but you still have the munchies, reach for low-calorie snacks like air-popped popcorn, raw nuts, or raw veggies with balsamic vinegar or low-calorie dressing.
• Don’t be too hard on yourself. When people try to completely avoid the foods they love, they often end up overindulging in them. Allow yourself to have a small piece of pie or cake — but not both. Select one decadent, high-calorie item from the buffet table and then load up the rest of your plate with healthy, low-calorie options.

These next couple months will be filled with opportunities to overindulge, but if you plan ahead, you can beat the temptation. I hope these practical tips will help you avoid the holiday bulge and enjoy a happy, healthy season.

— Karen Astrachan, M.S., R.D., CDE, CSSD

— The Palo Alto Medical Foundation and column editor Arian Dasmalchi provide this monthly column.

The human immune system protects us from all kinds of invaders — from practically invisible viruses, to microscopic bacteria and protozoa, to large parasitic worms. Most of the time our immune system does a great job, attacking invaders and clearing them from our bodies. But sometimes it gets fooled and mistakenly attacks something benign, causing more trouble than benefit. An example of such a mistake is the poison oak rash.

Poison oak’s scientific name is Toxicodendron diversilobum, meaning toxic tree with diverse forms. Poison oak is a leafy plant that grows as both a bush in dense thickets and as a tree-climbing vine. It’s found throughout much of western North America and is common in the open country and hills surrounding the San Francisco Bay. Poison oak has myrtle green leaves in groupings of three in the spring that gradually turn reddish green then crimson over the course of the growing season, as it fruits a white berry. In the winter, only twigs and stems are left, making it especially difficult to identify.

Poison oak produces an oily resin called urushiol, which initiates the itchy rash. Studies show that it takes less than 50 micrograms, which is less than the weight of a grain of table salt, to initiate a rash in 90 percent of humans. Urushiol attaches easily to anything brushed against the leaves or stems of the plant. It can attach directly to skin or first to clothes and subsequently to skin. It’s not uncommon to get the rash from pets that have run through, or sports balls that have bounced into, poison oak bushes. The resin is tremendously stable. Dead plant specimens over 100 years old have been shown to cause the rash. If the plants are burned, for instance when clearing brush, the urushiol can get into the lungs, causing an especially dangerous reaction.

The rash occurs when some of the urushiol resin gets on and penetrates through the skin to cause a reaction called cell-mediated immunity. This is where our immune system makes the mistake. The molecules in the urushiol attach to the proteins and cells of our own body. This alters the appearance of these proteins and cells. Our own immune system is fooled by this altered appearance into thinking that a foreign invader, for instance a parasitic worm, is trying to enter our body. Our immune system marshals its diverse forces, releasing toxins locally to try to kill or repel the invader. Unfortunately the toxins also damage body tissues, causing the rash.

How can the rash be avoided? The first and best defense is to know how to recognize the plant and avoid it. If you need to go into an area with these plants, wear long pants and a long-sleeved shirt, and carefully remove and wash these in hot soapy water immediately afterward. If your pet or sports equipment may have contacted poison oak, wear gloves and give them a bath. There is now an over-the-counter product called Ivy Block that, if applied prior to exposure, physically blocks urushiol from attaching to skin.

If you get the rash, treatments are directed at reducing the local irritation, reducing the itch or stopping the underlying immune system reaction that caused the rash. The local irritation is typically treated with lotions such as calamine, cool water baths with oatmeal or baking soda or cool compresses. The itch can be treated with over-the-counter antihistamines such as diphenhydramine (e.g., Bendryl). Steroid creams or ointments, such as over-the-counter cortisone or more potent prescription strength steroids, can be used to quiet the immune response reaction. In severe cases systemic steroids may be necessary, either in pill form or, rarely, intravenously.

Poison oak is a fact of life in California, especially in the Bay Area. It’s best avoided, but can be an irritating reminder of just how hard our immune systems work to protect us from invaders.

— Bill Black, M.D., Ph.D.

— The Palo Alto Medical Foundation and column editor Arian Dasmalchi provide this monthly column.

When a new baby arrives, many moms get lost in the whirlwind of activity that follows. As you count feedings and dirty diapers to make sure your baby is getting enough to eat, don’t forget all about your own dietary and fitness needs.

It’s important to take care of yourself—for your own good as well as your baby’s. If you feel healthy you’ll likely do a better job caring for your newborn during a time often characterized by sleep deprivation and mental exhaustion.

Following are five tips to help you stay focused on your own nutrition and fitness needs after childbirth:

1. Don’t try to lose your pregnancy weight quickly. Despite what you may see in movies, new moms don’t magically shrink down to their pre-pregnancy size as soon as the baby is delivered. Be patient and remember that it can take up to a year to get back to your pre-pregnancy weight. A crash diet can make baby blues and sleep deprivation feel even worse. Furthermore, if you’re breastfeeding you need extra calories and nutrition for your baby. Making small changes and smarter nutrition choices will help you return to your pre-pregnancy weight in a healthy way.
2. Watch your food portions. You don’t have to give up your favorite high-calorie foods, but you may need to eat less of them, and less often. A good general rule is to make half your plate vegetables, one-quarter lean protein (poultry, fish or tofu), and one-quarter starch (baked potato, brown rice or whole wheat bread). In addition, limit the amount of calorie-rich and fat-heavy “extras,” such as dressings and sauces made with cream, butter, mayonnaise and oils.
3. Take help when it’s offered. If friends or family offer to prepare meals for you, let them. It’s a nice (and usually healthier) alternative to take-out or restaurant food. When you do have time to cook, make extra batches and freeze them for later. This way you have an alternative to processed instant foods that are typically higher in calories, salt, sugar and preservatives than food prepared at home with lower-fat cooking methods such as baking, broiling, grilling, roasting or steaming.
4. Don’t skip meals. If you do, you’re likely to become overly hungry later and overeat or choose less healthy foods. One way to avoid skipping meals is to have your kitchen stocked with healthy convenience foods such as fruits and veggies (preferably washed and ready to eat). Make breakfast a priority, since it’s the most important meal of the day. Chances are you are tired from interrupted sleep, so make it easy for yourself and have healthy yet easy-to-prepare choices in your kitchen, like high-fiber cereal, whole-wheat bread and hard-boiled eggs; or yogurt and fruit.
5. Make time to exercise. Even a short walk will help you burn calories, which can help with weight loss. Moderate sunlight exposure also helps your body make vitamin D, which helps to absorb calcium and improve bone health.

In the midst of all the new-baby chaos, don’t forget to take care of yourself. By following these five simple tips you’ll feel better and have more energy to care for your new little bundle.

— Karen Astrachan, MS, RD, CDE, CSSD

If you or one of your family members has high blood pressure, you probably know all about the challenges of avoiding added salt in modern-day prepared foods. Yet salt is critical for life and has always been a critical part of human society.

The earliest-known pharmaceutical text, the Peng-Tzao-Kan-Mu, written about 5,000 years ago in China, described 40 kinds of salt and their properties. The ancient Greeks traded slaves in exchange for salt, which gave rise to the expression, “not worth his salt.” Marco Polo found salt cakes stamped with the imperial seal of Kublai Khan used as money in Tibet; and in Timbuktu, on the southern edge of the Saharan desert, salt was once traded ounce for ounce for gold. Salt enabled the early Europeans to fish the Grand Banks in Newfoundland since they could preserve their catch for the long journey home. In this respect, salt could be considered one of the first antibiotics used by humans, since it was used to kill the bacteria that would have otherwise caused the fish to spoil.

Common table salt is made up of one part sodium and one part chloride atom. It is one of the four basic flavors that all humans appreciate, along with sweet, sour and bitter. Salt is present in all the fluids and tissues of our bodies and is necessary for normal functioning of our organs. Our heart needs it to beat and our brain needs it to think. Yet too much salt can contribute to blood-pressure problems. So we ask our patients to avoid added salt and to read food labels regarding salt content.

Dietary salt is measured and displayed on food labels as milligrams (mg) of sodium. The current recommendation is that we consume less than 2,400 mg of sodium daily. That is only about one teaspoon, and this includes all salt — salt naturally present in foods, salt added to processed foods, salt used in cooking and salt added at the table. For someone with high blood pressure, a lower target — 1,500 mg daily — helps keep blood pressure down and helps blood pressure-lowering medicines work more effectively.

Salt is present in almost all of our foods. Even natural unprepared foods have some salt. Milk, a natural body fluid, has about 160 mg of sodium per cup.

Some foods are obvious culprits. Pretzels wear their salt right on the surface, and we eat potato and corn chips as much for the salty flavor as for the flavor of the baked or fried starch. But there is a surprising amount of salt in most sauces or condiments, such as spaghetti sauce and catsup. Most canned foods, including soups, stews and vegetables, are rife with added salt, sometimes 300 to 1,000 mg per serving. Prepared meats such a cold cuts and sausages are also chock full of salt.

Always read the food label for sodium (salt) content. Always check the serving size and servings per container. Though some prepared foods may appear to have only a modest salt content, a review of the food label may reveal many servings per container. If you are consuming more than one serving, your actual salt intake could be much higher than the number listed on the label. Fast foods are probably the worst offenders. It is not uncommon for fast food meals to have 1,000 to 2,000 mg of sodium in one serving.

While salt has been a critical part of human history and is critical to our body’s physiology, we want to make sure we avoid “too much of a good thing.” For additional information on the impact of salt on health, visit the following websites.

     http://www.cdc.gov/features/sodium/

    http://www.nhlbi.nih.gov/hbp/prevent/sodium/sodium.htm

    http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm181577.htm

— Bill Black, M.D., Ph.D.

Among the prominent buzzwords in today’s health-care debates is “primary care.” The conversations revolve around the shortage of primary care doctors, how primary care is essential to the success of health care reform and ways primary care can save money for everyone in the long run.

So what exactly is primary care, and why is it so important? If you Google a definition you’ll get approximately 15 responses, each one touching on some part of its essence. The one I like best is “the care of individuals with common health problems and chronic illnesses that can be managed on an outpatient basis, with an emphasis on prevention and continuity.”

The key to successful primary care lies in establishing a trusted relationship with your medical provider. This includes age-specific preventive exams and screenings, as well as treatment for more acute problems. Study after study has demonstrated that this primary-care relationship — really more of a health partnership — is the bedrock of any comprehensive and efficient health-care system.

The emerging model of primary care is a team approach, also known as the “medical home.” In this model, doctors work closely with nurses, pharmacists, dieticians, social workers, mental health providers, physical therapists, medical assistants and other members of the health care team to ensure that all problems or potential problems are addressed in a thorough and timely manner.

Successful primary care also relies on doctors having the knowledge and resources to provide appropriate convenient access to medical specialists or specialized servicesÑalong with the ability to provide a seamless flow of information among these entities.

Wherever you choose to receive your primary care, remember that you as the patient are always the driving force, and that primary care is just thatÑyour primary connection to every aspect of medical prevention, diagnosis and treatment. It is a powerful tool in achieving and maintaining good health.

— By Robert Russo, M.D.

— The Palo Alto Medical Foundation and column editor Arian Dasmalchi provide this monthly column.