Some doctors are warning of a culture of ageism in the medical world, saying health workers commonly treat old people as though they don’t deserve the same care as younger Canadians.

The Canadian Food Inspection Agency says some bags of salads that were distributed to restaurants, hospitals and nursing homes need to be discarded because they may be contaminated with Listeria monocytogenes.

"Diet and exercise" is a phrase that goes hand-in-hand with losing weight. But what you eat or drink before, during and after your workout is key to the weight loss process. Whether you run marathons, bike to work or walk around your neighborhood a few times a week – if you really want to optimize your workout, it’s time to check in on your diet. It’s all about moderation and balancing your food groups: protein and carbs, fruits and veggies, experts say. So how do they all work together? Before a workout, it’s all about the carbs, said Carol Kelly, a dietitian at Emory University in Atlanta, Georgia. “Carbohydrate is the fuel for our bodies, fuel for our brains.  If you think of your metabolism as a fire, carbohydrate is the fuel that helps the fire burn hot.” You want a meal that includes quality carbohydrates, lean protein, heart-healthy fats and fluids.  Without a sufficient carb supply, you could be breaking down muscle when you exercise. If you’re working out in the afternoon or after work, you want to make sure to eat a balanced lunch with some carbs. Here are a few options: A turkey sandwich with a piece of fruit Whole grain pasta with low-fat tomato sauce A salad with grilled chicken Now, if you’re working out first thing in the morning for an hour or less, breakfast can wait until after your workout. That’s because the body usually stores enough glycogen (the body’s long-term energy storage molecules)  from the previous night’s dinner to fuel the workout. After exercise, refueling (a.k.a. breakfast) needs to happen within 30 to 40 minutes. That meal should look like a combination of carbohydrates and protein, but not too much protein: 10 to 20 grams, or a palm-sized piece of chicken, is enough. You can try some of these combinations: Greek yogurt and an apple Hummus and whole grain crackers Grilled chicken and a baked potato “With exercise, our bodies are constantly breaking down and need to be repaired and protein helps do that,” Kelly said. But there are still “ free radicals ” floating around in our bodies after we work out, one of the few negative effects of exercise.  These are molecules which are produced when the body breaks down cells and can cause cell damage.  The best solution to rid our bodies of free radicals is to eat lots of fruit and vegetables which help mop up damage that occurs during exercise. A salad, a piece of fruit, mushrooms, onions, even salsa — all are good plant options to fit in throughout the day, according to Kelly. If you do work out more than 60 minutes each day, you’re going to have to up your carb and protein intake. And definitely don’t delay breakfast if you’re working out  that long first thing in the morning. You’re going to need some fuel to keep you going, whether it’s some yogurt and toast or cereal with milk. You can also sip on a sports drink while you work out. Some sports beverages get a bad rap for the sugar some of them contain, but for intense workouts that last longer than an hour, they do the trick.  Stick to drinks that have a 6-to-8% solution of carbohydrates and electrolytes to help you hit your workout goal. For those of us who aren’t competing in a triathlon just yet, plain old H2O has everything you need to stay hydrated during your workout –and during the day. The important thing is to get moving first and then work your diet around your exercise routine. Filed under: Diet and Fitness , Exercise , Healthy Eating Tagged: Lindsey Bomnin – CNN Medical Intern

During a recent debate addressing whether the United States should ban college football, an argument against the sport was summed up this way: Schools should not be in the business of encouraging young men to hit themselves over the head. The reasoning behind that argument (by New Yorker magazine staff writer Malcolm Gladwell ): Concussions  are not what afflicts football, rather it is the cumulative effects of punishing, comparatively subtle, subconcussive hits. "There isn't a helmet in the world that can be designed to take the sting out of those hits," said Gladwell, at the Intelligence Squared Debate  hosted by Slate Magazine in New York last week. "What's the effect of all that neurological trauma? We know it's a condition called CTE." CTE , or chronic traumatic encephalopathy, is a degenerative brain disease found among contact sport athletes – and associated with repeated head trauma – that can lead to dramatic cognitive, memory and mood problems. What scares some people about CTE is that it resembles dementia , except that it can strike people in their prime. And considering a football player could suffer around 8,000 subconcussive hits to the head across four years of high school and college games, those hits would seem to be a recipe for neurological disaster for millions of athletes. Yet so far, studies have not proven CTE to be a compelling issue for more than a fraction of them. "The question that's being framed is, 'Is hitting your head bad for you? Is it going to lead to all sorts of terrible troubles down the road?'" said Dr. Thomas McAllister, director of neuropsychiatry at the Dartmouth-Hitchcock Medical Center . "That may be wrong question. The better question may be, 'For whom is that exposure bad?'" In a study of college football players at three Division I universities, McAllister and his colleagues found that subconcussive hits were not causing the dramatic lapses in cognition that might be considered a precursor to CTE. But when they re-examined the data, they found something slightly alarming. A significant subgroup of the contact sport athletes – 22% – performed worse than expected on tests of verbal learning, compared with only about 4% of the non-contact sport athletes. The data were gathered by nestling sensors in the helmets  of 214 varsity football and hockey players and recording subconcussive hits during one full season. The sensors measured things like the force, location and rotation caused by hits to the head. The contact sport athletes were compared to a control group of 45 athletes participating in non-contact sports like track, crew and Nordic skiing. Each group took cognitive tests before and shortly after the season. According to the study, published in the journal  Neurology , by the end of the season some contact sport players came up short on those tests. "It's a good news-bad news thing," said McAllister. "The study suggests that at a group level, a single season of contact sports is not associated with widespread systemic changes in cognition for the majority of people." "But it has to be qualified that for some, that may not be true," he added. Other data, including a similar study from researchers at University of North Carolina at Chapel Hill , suggest that subconcussive hits do not cause short-term neurological problems after one season. But there is no verdict – yet – about whether they are causing long-term problems, such as those associated with CTE. "[The McAllister study] does keep the door cracked for the possibility of season-long effects from head impacts in certain athletes," said Kevin Guskiewicz , co-author of the UNC study and chair of the department of exercise and sport science at UNC Chapel Hill, in an e-mail. "Let's say there is a subgroup," said McAllister. "What is it about those people that makes them more vulnerable to impact and how can we identify who they are in advance?" These are questions that cannot be answered by the current crop of scientific studies. And what about the risk of CTE among college football players? "It has not been proven, in my view, that everyone who has these repetitive hits to the brain gets CTE," said McAllister. "Sadly, there is a lot that we still don't know." As for the debate to ban college football – Gladwell's team, arguing in favor of banning the sport, won. Filed under: Brain , Concussion , Conditions , Traumatic brain injury Tagged: Stephanie Smith -CNN Medical Producer

Anybody who has a long daily commute knows the frustration of sitting in long lines of traffic with no ability to do anything but wait. Now, a study suggests that long commutes can take away more than just precious time. They negatively impact measures of fitness and health. Previous research has linked longer commutes with obesity. But this new research is believed to be "the first study to show that long commutes can take away from exercise time,” explained lead investigator Christine M. Hoehner of Washington University in St. Louis. Long commutes are associated with "higher weight, lower fitness levels and higher blood pressure, all of which are strong predictors of heart disease, diabetes and some cancers,” she said. One discovery that Hoehner found a little surprising was how “being exposed to the daily hassles of traffic can lead to higher chronic stress and higher blood pressure.” Here's how the research was conducted: Scientists studied 4,297 residents from the Dallas-Fort Worth and Austin, Texas, metropolitan areas. They documented their commuting distances, body mass indices, and metabolic risk, including waist circumference, fasting glucose and lipid levels and blood pressure. Participants reported their physical activity for the previous three months. What did scientists learn?  Commuters who said they drove longer distances also reported they took part in less moderate or vigorous physical activity. They had lower cardiorespiratory fitness, greater body mass index, waist circumference, and higher blood pressure. For a little historical perspective – as obesity rates have increased – so have the number of American commuters and the length of commute times. Between 1960 and 2000, workers commuting in private vehicles jumped from 41.4 million to 112.7 million, according to the U.S. Department of Transportation. And as suburbs have sprawled across the nation since the 1950s, commuter miles have increased too, along with the time drivers spend sitting behind the wheel. according to the U.S. Census Bureau. For many commuters, moving closer to work isn't an option but Hoehner said there are solutions that can lead to more exercise. Commuters should find ways to work physical activity into their work days said Hoehner, by doing things like walking during work breaks. Employers could also help, she said, by encouraging fitness break and by offering schedule flexibility to commuters, if possible. Filed under: Fitness , Obesity , Stress Tagged: Ann J. Curley – CNN Medical Assignment Manager

Here’s what’s making health news this morning: Study Damps Fears on Autism Change (WSJ):  A controversial change to the criteria for diagnosing autism turns out to “almost always” catch children diagnosed under the current guidelines, new data show. FDA Panel Considers HIV Drug for New Use (WSJ): Gilead Sciences has asked the Food and Drug Administration to consider approving its HIV treatment Truvada as a preventive medicine—a potential first—that could keep people from contracting the virus. An advisory panel will vote Thursday. Insurers Embrace “Virtual” Doctor Visits (Kaiser Health News): Some large insurers are promoting telemedicine visits to lower the cost of doctors services, though physicians worry the shift could shortchange patients. Drugmakers’ Deal With Obama Said to Be Probed by House (Bloomberg): House Republicans are probing drugmakers over an agreement forged with the Obama administration to support the 2010 federal health law. Discrepancies on Medical Bills Can Leave a Credit Stain (New York Times): As patients increasingly pay for larger shares of their health-care costs out-of-pocket, dealing with medical bills is becoming a more complicated task.

It's extremely rare for people to be diagnosed with salivary gland cancer. Most Americans who get it are older than 55. Adam Yauch, better known as "MCA" of the Beastie Boys, died Friday at age 47 after having cancer for nearly three years .  Yauch was one of the few younger patients diagnosed with the disease. Related: Beastie Boy rapper 'MCA' dies Two adults in 100,000 are diagnosed with salivary gland cancer per year, according to the American Cancer Society. "Parotid cancers are fairly unusual in general but it can appear in individuals of all ages," said Dr. Amy Chen, a head and neck cancer surgeon at Emory University in Atlanta. "It’s just in general, parotid cancer is very rare." Yauch said in July 2009 that he first noticed a lump in his throat “like you have swollen glands.” He announced he would have surgery within a week, followed by nearly two months of localized radiation treatment. He said the cancer was also in a lymph node. The survival rate depends on whether the cancer has spread to other parts of the body. If it hasn't, the five-year estimated rate of survival (Stage I) is 91%. If it has spread far from the glands (Stage IV), the rate is 39%. Watch video of Yauch talking about his diagnosis. "I always advise individuals that if you have a lump in your neck or a mass that is growing in size and it hasn’t gone away after two weeks, that you should seek medical attention for it," Chen said. "If the doctor prescribes antibiotics for it and it isn’t getting better, then you need to find another doctor." If surgeons can't completely remove the cancer from the gland it can spread to the lungs and other parts of the body, she said. Because the cancer is rare, it has been difficult for researchers to figure out what causes it. There are a few risk factors, the cancer society says, one of which is having radiation treatment to the head and neck for other medical reasons. Workplace exposure may also increase risk. "We don’t find any relation to smoking or alcohol use like some other head, neck, throat cancers," Chen said. "It’s really a little bit of an unknown to what the risk factors are for developing this disease." Most salivary gland cancers form in one of the parotid glands, as Yauch’s did, just in front of the ears. It is a difficult surgery to remove the cancerous cells, because the facial nerve goes through the parotid, according to the cancer society website. The site says both surgical methods and radiation treatments have improved in recent years.  Unfortunately, targeted drugs have not been very effective against salivary gland cancer. Filed under: Cancer , Celebrity Health Tagged: Steve Almasy — CNN

Each year one in 6 Americans is sickened by a foodborne illness.  Sometimes the culprit is E. coli or other bacteria which contaminate meat or poultry products.  On Wednesday, the U.S. Department of Agriculture announced new measures designed to detect contaminated meat and poultry faster and before it enters the human food supply.  E. coli 0157 is the most common source of foodborne illness and can cause diarrhea, illness and in severe cases even death. “The additional safeguards … will improve our ability to prevent foodborne illness by strengthening our food safety infrastructure,” said USDA Under Secretary for Food Safety Elisabeth Hagen during a conference call with reporters. “Together, these measures will provide us with more tools to protect our food supply, resulting in stronger public health protections for consumers,” says Hagan. Currently when the USDA Food Safety and Inspection Service (FSIS) performs routine E. coli testing of meat and poultry products, they need to have a “confirmed positive” test to instigate the traceback process for contaminants. Under the new rules, FSIS can begin tracebacks if meat or poultry samples result in a “potential positive" test result, which means an investigation can launch 24 to 48 hours sooner than waiting for a confirmed positive test result. Then FSIS can more quickly begin linking products, companies, and sources of the contaminated product and instigate a recall, preventing products from reaching consumers. The new procedure got a thumbs up from the health advocacy group Center for Science in the Public Interest. "Rapid traceback is essential for reducing the impact of E. coli outbreaks, and protects both consumers and the meat industry," said Caroline Smith DeWaal, the organization's food safety director. "When it comes to testing for E. coli, it makes sense to start traceback procedures upon a presumptively positive test result, and not lose valuable time waiting for a confirmation. She called on the USDA to do the same for antibiotic-resistant strains of Salmonella in meat products, which she said hospitalized nearly 50 people and sickened 167 last year. Filed under: Food Safety Tagged: Ann J. Curley – CNN Medical Assignment Manager

Chlorpyrifos , a common pesticide, may be subtly influencing brain development in children, according to a new study.  The brain abnormalities, found among a very small population of school-aged children, may have occurred while they developed in utero. What is troubling, according to scientists, is that relatively low levels of chlorpyrifos appear to have caused the cascade of brain changes. "It's out there and we do not know what the longer term impact is of lower levels," said Virginia Rauh, professor of Clinical Population and Family Health at Columbia University Mailman School of Public Health , and the study's lead author.  "But it does seem to be associated with cognitive damage and structural changes in brain." In the study, 40 children, ages 6 to 11, were given MRI scans .  Half of the children had relatively low levels of chlorpyrifos based on samples of their cord blood at birth, and the other half had relatively high levels. The abnormalities found among children with higher-than-normal exposure to chlorpyrifos included overgrowth, and undergrowth, in areas of the brain associated with attention, emotion, behavior – even IQ. "When the brain is developing and cells are migrating to various places in the brain they're intended to go, that process is being disrupted," said Rauh. But the makers of chlorpyrifos say that the small population of children studied mars the findings. "Because of the small number of blood samples and the small group of children evaluated, even a slight misclassification of 'high' vs. 'low' exposure classifications could drastically skew the results of the MRI imaging comparisons that are the focus of this article," said Garry Hamlin, a spokesperson for Dow AgroSciences , makers of chlorpyrifos, in an email. Chlorpyrifos was a common household pesticide until it was phased out for residential use by the Environmental Protection Agency in 2001, according to the study.  But it is still used commercially in public places and – most importantly for a wider swath of the population – in agriculture. One theory, which is not well-studied, is that chlorpyrifos could be entering the womb by way of the fruits and vegetables consumed by pregnant women. "The mother is exposed, the chemical crosses the placenta and essentially enters bloodstream of the fetus," said Rauh, deputy director of the Columbia Center for Children's Environmental Health .  "That is a transport system to all parts of the child's body." On its website, EPA reports that "Dietary exposures from eating food crops treated with chlorpyrifos are below the level of concern for the entire U.S. population, including infants and children." "There is this general sense that chemicals have one known function, that they only do that one thing and not anything else," said Dr. David Carpenter, director of the Institute for Health and the Environment at the University at Albany.  "This study shows that's clearly not the case… there are gross changes in the structure of brain." "I think this is a very, very important study," he added. The concern among environmental health experts is not just chlorpyrifos, but a host of other pesticides falling under the umbrella of organophosphates .  The suggestion of studies in animals, and more recently in humans, is that during critical stages of brain development, organophosphates could be irreparably altering brain development – and that the changes may persist as the child ages. An interesting finding of the current study, published in the journal Proceedings of the National Academy of Sciences , involves the possibility that chlorpyrifos interferes with sexual differentiation in the brain early in development. "We have some evidence that among highly exposed children, those differences are slightly blurred," said Rauh.  "Meaning… the brain of an average boy looks less like the brain of a boy, and a little more like the brain of a female." Since the study population is still pre-pubescent, the real world implications of that finding are not known. Filed under: Adolescent Health , Brain , Children’s Health , Environment , Pollution , Toxic America Tagged: Stephanie Smith -CNN Medical Producer

When to get a mammogram screening? Beginning at age 40? 50? Every year or every other year?  Recommendations over the past few years have been varied depending on which medical organization you look at.  Now two new studies suggest that women who are at increased risk for breast cancer will benefit from mammogram screenings every other year starting at age 40. In 2009, the United States Preventative Services Task Force (USPSTF) recommended that women ages 50 to 74 get routine mammogram screenings every two years.   The USPSTF recommended "against routine screening mammography in women aged 40 to 49 years," after reviewing existing research and looking at the evidence of the benefits and harms from younger women getting these breast exams on a routine basis. The USPSTF reasoned that the "additional benefit gained by starting screening at age 40 years rather than at age 50 years is small, and that moderate harms from screening remain at any age,"which led to their recommendation. Women ages 40 to 49 were advised to weigh risk factors, screening benefits and harms based upon personal information, according to the task force. Despite the USPSTF recommendation, many medical organizations , including the American Cancer Society, the American College of Gynecologists, and the Radiological Society of North America, have continued to or changed their guidelines to recommend that women have annual mammograms beginning at age 40. The two studies published Monday in the Annals of Internal Medicine lay out the risks and benefits for earlier screenings, including how often they should take place.  One study finds that screening women in their 40's who face twice the risk for breast cancer has the same benefits as screening normal risk women aged 50 to 74.  A second study compared annual and biennial screenings for women ages 40 to 49, who face twice the risk for breast cancer, recommending two-year intervals for screenings. “Although mammography is clearly a life-saving technology that should be used, many overestimate its role in the decrease in breast cancer death rates,” wrote Dr. Otis Brawley, CNNhealth.com contributor and Chief Medical and Scientific Officer of the American Cancer Society.  In an editorial, Brawley wrote, "mammography, like every screening test, has a potential for harm, and one must carefully weigh the harm-benefit ration for a specific woman or a specific population of women (such as those aged 40 to 49 years) before advising use of the test.” Brawley explained that the benefits of mammogram screenings include decreased death rates in the U.S., especially among younger women.  But he also noted the potential downsides of mammograms, including false positive tests, false positive biopsies, false negative tests, and radiation exposure. The findings of these two studies will add to the body of knowledge about risk and benefits of annual versus biennial mammograms, and will allow doctors to make more accurate and personalized screening recommendations for women, based upon their individual risk factors. Filed under: Breast Cancer , Cancer , Women’s Health Tagged: Ann J. Curley – CNN Medical Assignment Manager