Grapefruit Mixed With Many Drugs Can Kill

This is not as upbeat as most of our articles, but it is very important and often unknown.  Grapefruit juice, and possibly other citrus, can rapidly increase uptake of many medicines, including causing some time-released medicines to instantly release.  If you are taking medications, please check to see if they are one you should not drink grapefruit juice or eat grapefruit while taking.

Grapefruit Is a Culprit in More Drug Reactions

Photo illustration by The New York Times

Advice on money and health.

The patient didn’t overdose on medication. She overdosed on grapefruit juice.

The 42-year-old was barely responding when her husband brought her to the emergency room. Her heart rate was slowing, and her blood pressure was falling. Doctors had to insert a breathing tube, and then a pacemaker, to revive her.

They were mystified: The patient’s husband said she suffered from migraines and was taking a blood pressure drug called verapamil to help prevent the headaches. But blood tests showed she had an alarming amount of the drug in her system, five times the safe level.

Did she overdose? Was she trying to commit suicide? It was only after she recovered that doctors were able to piece the story together.

“The culprit was grapefruit juice,” said Dr. Unni Pillai, a nephrologist in St. Louis, Mo., who treated the woman several years ago and later published a case report. “She loved grapefruit juice, and she had such a bad migraine, with nausea and vomiting, that she could not tolerate anything else.”

The previous week, she had been subsisting mainly on grapefruit juice. Then she took verapamil, one of dozens of drugs whose potency is dramatically increased if taken with grapefruit. In her case, the interaction was life-threatening.

Last month, Dr. David Bailey, a Canadian researcher who first described this interaction more than two decades ago, released an updated list of medications affected by grapefruit. There are now 85 such drugs on the market, he noted, including common cholesterol-lowering drugs, new anticancer agents, and some synthetic opiates and psychiatric drugs, as well as certain immunosuppressant medications taken by organ transplant patients, some AIDS medications, and some birth control pills andestrogen treatments. (The full list is online.)

“What drove us to write this paper was the number of new drugs that have come out in the last four years,” said Dr. Bailey, a clinical pharmacologist at the Lawson Health Research Institute, who first discovered the interaction by accident in the 1990s.

How often such reactions occur, however, and how often they are triggered in people consuming regular amounts of juice is debated by scientists. Dr. Bailey believes many cases are missed because doctors don’t think to ask if patients are consuming grapefruit or grapefruit juice.

Even if such incidents are rare, Dr. Bailey argued, they are predictable and entirely avoidable. Many hospitals no longer serve juice, and someprescriptions carry stickers warning patients to avoid grapefruit.

“The bottom line is that even if the frequency is low, the consequences can be dire,” he said. “Why do we have to have a body count before we make changes?”

For 43 of the 85 drugs now on the list, consumption with grapefruit can be life-threatening, Dr. Bailey said. Many are linked to an increase in heart rhythm, known as torsade de pointes, that can lead to death. It can occur even without underlying heart disease and has been seen in patients taking certain anticancer agents, erythromycin and other anti-infective drugs, some cardiovascular drugs like quinidine, the antipsychotics lurasidone and ziprasidone, gastrointestinal agents cisapride and domperidone, and solifenacin, used to treat overactive bladders.

Taken with grapefruit, other drugs like fentanyl, oxycodone and methadone can cause fatal respiratory depression. The interaction also can be caused by other citrus fruits, including Seville oranges, limes and pomelos; one published case report has suggested that pomegranate may increase the potency of certain drugs.

Older people may be more vulnerable, because they are more likely to be both taking medications and drinking more grapefruit juice. The body’s ability to cope with drugs also weakens with age, experts say.

Under normal circumstances, the drugs are metabolized in the gastrointestinal tract, and relatively little is absorbed, because an enzyme in the gut called CYP3A4 deactivates them. But grapefruit contains natural chemicals called furanocoumarins, that inhibit the enzyme, and without it the gut absorbs much more of a drug and blood levels rise dramatically.

For example, someone taking simvastatin (brand name Zocor) who also drinks a small 200-milliliter, or 6.7 ounces, glass of grapefruit juice once a day for three days could see blood levels of the drug triple, increasing the risk for rhabdomyolysis, a breakdown of muscle that can cause kidney damage.

Estradiol and ethinyl estradiol, forms of estrogen used in oral contraceptives and hormone replacement, also interact with grapefruit juice. In one case in the journal Lancet, a 42-year-old woman taking the birth control pill Yaz developed a very serious clot that threatened her legseveral days after she started eating just one grapefruit a day, said Dr. Lucinda Grande, a physician in Lacey, Wash., and an author of the case report.

But Dr. Grande also noted that the patient had other risk factors and the circumstances were unusual. “The reason we published it as a case report was because it was so uncommon,” she said. “We need to be careful not to exaggerate this.”

Some drugs that have a narrow “therapeutic range” — where having a bit too much or too little can have serious consequences — require vigilance with regard to grapefruit, said Patrick McDonnell, clinical professor of pharmacy practice at Temple University. These include immunosuppressant agents like cyclosporine that are taken by transplant patients to prevent rejection of a donor organ, he said.

Still, Dr. McDonnell added, most patients suffering adverse reactions are consuming large amounts of grapefruit. “There’s a difference between an occasional section of grapefruit and someone drinking 16 ounces of grapefruit juice a day,” he said.

And, he cautioned, “Not all drugs in the same class respond the same way.” While some statins are affected by grapefruit, for instance, others are not.

Here is some advice from experts for grapefruit lovers:

¶ If you take oral medication of any kind, check the list to see if it interacts with grapefruit. Make sure you understand the potential side effects of an interaction; if they are life-threatening or could cause permanent injury, avoid grapefruit altogether. Some drugs, such as clopidogrel, may be less effective when taken with grapefruit.

¶ If you take one of the listed drugs a regular basis, keep in mind that you may want to avoid grapefruit, as well as pomelo, lime and marmalade. Be on the lookout for symptoms that could be side effects of the drug. If you are on statins, this could be unusual muscle soreness.

¶It is not enough to avoid taking your medicine at the same time as grapefruit. You must avoid consuming grapefruit the whole period that you are on the medication.

¶In general, it is a good idea to avoid sudden dramatic changes in diet and extreme diets that rely on a narrow group of foods. If you can’t live without grapefruit, ask your doctor if there’s an alternative drug for you.


Local Governments Win Healthcare Awards

Three major awards were given out by the Valley Schools Employee Benefits Trust (VSEBT) to major employers in Arizona for their outstanding efforts in providing healthcare and other employee benefits to their employees.  During the same event, gifts were donated by employees at their expense for the Toys for Tots Drive:


logo vsmg


The three major awards earned were:

Outstanding Achievements in Wellness 2012BALSZ School District.  This award goes to employers who focus on wellness programs for their employees and show marked improvement in costs and positive life outcomes as a result.


Laurie Colter & Lisa Apley

Best Business Practices 2012The Town of Queen Creek .  This award is achieved by following all proscribed laws, accounting, financial practices and HIPAA requirements and having the most timely payments, documentation and fewest errors.


Deb Davis and Nina Waters

Lowest Per Member Per Month Costs – Tolleson Elementary School District (TESD) – This award goes to the employer with the lowest claims costs on a per member per month basis.  This is usually do to a well-structured plan with a focus on wellness initiatives.  Much of this particular award is due to the last few years of conversion by TESD over to health savings accounts plans which allow their employees and families to keep unused funds each year in their account.


Lisa Rafferty of Aon/Hewitt, Andrea Billings of VSEBT, and Darlene Kracht of VSEBT


Congratulations to these three employers for their outstanding achievements!

Health Holiday Eating Chat Online Tomorrow – Tune In

HealthTalk: Chat Live With Experts & Advocates

#HealthTalk With Rachel Begun, MS, RD: Healthy Holiday Eating

Who: Rachel Begun, R.D.

What: #HealthTalk Twitter Chat


When: Tuesday, December 18th from 12:00-1:00pm EST

Why: Yes, it’s possible. The holidays can be nutritious and delicious! With lots of big meals and parties ahead, join our conversation with Rachel Begun, MS, RD, CDN on how to make healthy choices.

Learn more about our co-host:

Whether writing, speaking, consulting for the food industry or conducting a media interview, Rachel comes to the table with the same philosophy: good nutrition and delicious eating must co-exist for healthy habits to be sustainable. This philosophy is the driving force behind her work with health organizations, food manufacturers and foodservice providers to assist them in developing, implementing and communicating their nutrition and culinary education platforms, products and services. As The Gluten Free RD, a particular area of expertise for Rachel is working alongside chefs and foodservice providers to serve safe and healthful gluten free options for consumers.

As a national media spokesperson for the Academy of Nutrition and Dietetics, Rachel regularly conducts interviews with the media. She has contributed her knowledge to many outlets, including USA Today, CNN, Consumer ReportsEating WellFitnessUs WeeklyWoman’s DayBetter Homes and Gardens, Today Health/MSNBC, and Doctor Radio Sirius Satellite.

Rachel is a scientific/medical/nutrition advisor to several organizations, including the National Foundation for Celiac Awareness, Delicious Living Magazine and The Creative Kitchen.

Rachel graduated Phi Beta Kappa from Emory University in Atlanta, GA with a B.A. in biology and a concentration in pre-medical studies. She earned her M.S. degree in nutrition education from Teachers College, Columbia University and completed her internship for registered dietitian certification there as well.

Blog: The Gluten Free RD
Twitter: @RachelBegunRD
Facebook: Rachel’s Facebook Page, The Gluten Free RD

World’s Top 25 Healthiest Foods


World’s Top 25 Healthiest Foods

25 Ridiculously Healthy Foods

Pile your plate with these nutrition superstars

The Healthy Superfoods You Need

The following healthy power foods can claim big bragging rights: They can fend off serious diseases like diabetes, cancer, and heart disease; fortify your immune system; protect and smooth your skin; and help you lose weight or stay slim. If you’re eating most of these healthy foods already, good for you! If not, now’s the time to load up your shopping cart and supercharge your health!

1. Eggs

Egg yolks are home to tons of essential but hard-to-get nutrients, including choline, which is linked to lower rates of breast cancer (one yolk supplies 25% of your daily need) and antioxidants that may help prevent macular degeneration and cataracts. Though many of us have shunned whole eggs because of their link to heart disease risk, there’s actually substantial evidence that for most of us, eggs are not harmful but healthy. People with heart disease should limit egg yolks to two a week, but the rest of us can have one whole egg daily; research shows it won’t raise your risk of heart attack or stroke. Make omelets with one whole egg and two whites, and watch cholesterol at other meals.

More from Prevention: Foods That Burn Belly Fat

2. Greek Yogurt

Yogurt is a great way to get calcium, and it’s also rich in immune-boosting bacteria. But next time you hit the yogurt aisle, pick up the Greek kind—compared with regular yogurt, it has twice the protein (and 25% of women over 40 don’t get enough). Look for fat-free varieties like Oikos Organic Greek Yogurt (90 calories and 15 g of protein per 5.3-ounce serving).

3. Fat-Free Milk

Yes, it does a body good: Studies show that calcium isn’t just a bone booster but a fat fighter too. Recent research from the University of Tennessee found that obese people who went on a low-calorie, calcium-rich diet lost 70% more weight than those who ate the least. Vitamin D not only allows your body to absorb calcium, it’s also a super nutrient in its own right. Research shows that adequate D levels can reduce heart disease risk, ward off certain types of cancer, relieve back pain, and even help prevent depression, but most of us don’t get nearly enough of the 1,000+ IU daily that most experts recommend. A splash of milk in your morning coffee isn’t enough to provide the calcium and vitamin D you need. Use milk instead of water to make your oatmeal, have a glass with breakfast, or stir some chocolate syrup into it for an after-dinner treat.

4. Salmon

Salmon is a rich source of vitamin D and one of the best sources of omega-3s you can find. These essential fatty acids have a wide range of impressive health benefits—from preventing heart disease to smoothing your skin and aiding weight loss to boosting your mood and minimizing the effects of arthritis. Unfortunately, many Americans aren’t reaping these perks because we’re deficient, which some experts believe may be at the root of many of the big health problems today, like obesity, heart disease, and cancer. Omega-3s also slow the rate of digestion, which makes you feel fuller longer, so you eat fewer calories throughout the day.

More from Prevention: Healthy Salmon Recipes

5. Lean Beef

Lean beef is one of the best-absorbed sources of iron there is. (Too-little iron can cause anemia.) Adding as little as 1 ounce of beef per day can make a big difference in the body’s ability to absorb iron from other sources, says Mary J. Kretsch, PhD, a researcher at the USDA-ARS Western Human Nutrition Research Center in Davis, CA. Beef also packs plenty of zinc (even minor deficiencies may impair memory) and B vitamins, which help your body turn food into energy. If you can, splurge on grass-fed. Compared with grain-fed beef, it has twice the concentration of vitamin E, a powerful brain-boosting antioxidant. It’s also high in omega-3 fatty acids. Because this type of beef tends to be lower in overall fat, it can be tough—so marinate it, and use a meat thermometer to avoid overcooking.

More from Prevention: Healthy Beef Recipes

6. Beans

It’s hard to imagine a more perfect food than beans. One cooked cupful can provide as much as 17 g fiber. They’re also loaded with protein and dozens of key nutrients, including a few most women fall short on—calcium, potassium, and magnesium. Studies tie beans to a reduced risk of heart disease, type 2 diabetes, high blood pressure, and breast and colon cancers. The latest dietary guidelines recommend consuming at least 3 cups of beans a week—3 times the measly 1 cup we usually get. Keep your cupboards stocked with all kinds: black, white, kidney, fat-free refried, etc. Use them in salads, stuffed baked potatoes, and veggie chili or pureed for sandwich spreads.

7. Nuts

In a nutshell: USDA researchers say that eating 1½ ounces of tree nuts daily can reduce your risk of heart disease and diabetes. Walnuts are rich in omega-3s. Hazelnuts contain arginine, an amino acid that may lower blood pressure. An ounce of almonds has as many heart-healthy polyphenols as a cup of green tea and 1/2 cup of steamed broccoli combined; they may help lower LDL cholesterol as well. The key is moderation, since nuts are high in calories. Keep a jar of chopped nuts in your fridge, and sprinkle a tablespoon on cereal, salads, stir-fries, or yogurt. Or have an ounce as a snack most days of the week.

8. Edamame and Tofu

Soy’s days as a cure-all may be over—some claims, such as help for hot flashes, don’t seem to be panning out—but edamame still has an important place on your plate. Foods such as tofu, soy milk, and edamame help fight heart disease when they replace fatty meats and cheeses, slashing saturated fat intake. Soy also contains heart-healthy polyunsaturated fats, a good amount of fiber, and some important vitamins. Soy’s isoflavones, or plant estrogens, may also help prevent breast cancer. Some researchers believe these bind with estrogen receptors, reducing your exposure to the more powerful effects of your own estrogen, says Prevention advisor Andrew Weil, MD. But stick with whole soy foods rather than processed foods, like patties or chips, made with soy powder. Don’t take soy supplements, which contain high and possibly dangerous amounts of isoflavones.

9. Oatmeal

Fiber-rich oats are even healthier than the FDA thought when it first stamped them with a heart disease-reducing seal 10 years ago. According to new research, they can also cut your risk of type 2 diabetes. When Finnish researchers tracked 4,316 men and women over the course of 10 years, they found that people who ate the highest percentage of cereal fiber were 61% less likely to develop type 2 diabetes. To reap the benefits, eat 1/2 cup daily—preferably unsweetened. For a versatile breakfast, top with different combinations of fruit, yogurt, and nuts. You can also use oats to coat fish or chicken or add texture to meatballs.

10. Flaxseed

Flaxseed is the most potent plant source of omega-3 fats. Studies indicate that adding flaxseed to your diet can reduce the development of heart disease by 46%—it helps keep red blood cells from clumping together and forming clots that can block arteries. It may also reduce breast cancer odds. In one study, women who ate 10 g of flaxseed (about 1 rounded tablespoon) every day for 2 months had a 25% improvement in the ratio of breast cancer-protective to breast cancer-promoting chemicals in their blood. Sprinkle 1 to 2 tablespoons of flaxseed a day on your cereal, salad, or yogurt. Buy it preground, and keep it refrigerated.

11. Olive Oil

Olive oil is full of heart-healthy monounsaturated fats (MUFAs), which lower “bad” LDL cholesterol and raise “good” HDL cholesterol. It’s rich in antioxidants, which may help reduce the risk of cancer and other chronic diseases, like Alzheimer’s. Look for extra virgin oils for the most antioxidants and flavor. Drizzle small amounts on veggies before roasting; use it to sauté or stir-fry, in dressings and marinades, and to flavor bread at dinner in lieu of a layer of butter or margarine.

More from Prevention: 7 Grossest Things In Your Food

12. Avocado

These smooth, buttery fruits are a great source of not only MUFAs but other key nutrients as well. One Ohio State University study found that when avocado was added to salads and salsa, it helped increase the absorption of specific carotenoids, plant compounds linked to lower risk of heart disease and macular degeneration, a leading cause of blindness. “Avocados are packed with heart-protective compounds, such as soluble fiber, vitamin E, folate, and potassium,” says Elizabeth Somer, RD, author of 10 Habits That Mess Up a Woman’s Diet. But they are a bit high in calories. To avoid weight gain, use avocado in place of another high-fat food or condiment, such as cheese or mayo.

More from Prevention: Healthy Avocado Recipes

13. Broccoli

Pick any life-threatening disease—cancer, heart disease, you name it—and eating more broccoli and its cruciferous cousins may help you beat it, Johns Hopkins research suggests. Averaging just four weekly servings of veggies like broccoli, cabbage, and cauliflower slashed the risk of dying from any disease by 26% among 6,100 people studied for 28 years. For maximum disease-fighting benefits, whip out your old veggie steamer. It turns out that steaming broccoli lightly releases the maximum amount of sulforaphane.

14. Spinach

We’ll spare you the Popeye jokes, but spinach has serious health muscles. For one thing, it contains lots of lutein, the sunshine-yellow pigment found in egg yolks. Aside from guarding against age-related macular degeneration, a leading cause of blindness, lutein may prevent heart attacks by keeping artery walls clear of cholesterol. Spinach is also rich in iron, which helps deliver oxygen to your cells for energy, and folate, a B vitamin that prevents birth defects. Cook frozen spinach leaves (they provide more iron when cooked than raw) and serve as a side dish with dinner a few times a week.

15. Tomatoes

Tomatoes are our most common source of lycopene, an antioxidant that may protect against heart disease and breast cancer. The only problem with tomatoes is that we generally eat them in the form of sugar-loaded jarred spaghetti sauce or as a thin slice in a sandwich. For a healthier side dish idea, quarter plum tomatoes and coat with olive oil, garlic powder, salt, and pepper. Roast in a 400°F oven for 20 minutes, and serve with chicken.

More from Prevention: 6 Tasty Tomato Recipes

16. Sweet Potatoes

One of the best ways to get vitamin A—an essential nutrient that protects and maintains eyes, skin, and the linings of our respiratory, urinary, and intestinal tracts—is from foods containing beta-carotene, which your body converts into the vitamin. Beta carotene-rich foods include carrots, squash, kale, and cantaloupe, but sweet potatoes have among the most. A half-cup serving of these sweet spuds delivers only 130 calories but 80% of the DV of vitamin A. Replace tonight’s fries with one medium baked sweet potato (1,096 mcg) and you’re good to go—and then some.

More from Prevention: 6 Super Smoothies

17. Garlic

Garlic is a flavor essential and a health superstar in its own right. The onion relative contains more than 70 active phytochemicals, including allicin, which studies show may decrease high blood pressure by as much as 30 points. High consumption of garlic lowered rates of ovarian, colorectal, and other cancers, according to a research review in the American Journal of Clinical Nutrition. Allicin also fights infection and bacteria. British researchers gave 146 people either a placebo or a garlic extract for 12 weeks; garlic takers were two-thirds less likely to catch a cold. The key to healthier garlic: Crush the cloves, and let them stand for up to 30 minutes before heating them, which activates and preserves the heart-protecting compounds, according to a 2007 study from Argentina.

18. Red Peppers

Citrus fruits get all the credit for vitamin C, but red peppers are actually the best source. Vitamin C may be best known for skin and immunity benefits. Researchers in the United Kingdom looked at vitamin C intake in 4,025 women and found that those who ate more had less wrinkling and dryness. And although getting enough vitamin C won’t prevent you from catching a cold or flu, studies show that it could help you recover faster. Vitamin C has other important credentials too. Finnish researchers found that men with low levels were 2.4 times likelier to have a stroke, and Australian scientists recently discovered that the antioxidant reduces knee pain by protecting your knees against arthritis.

19. Figs

When you think of potassium-rich produce, figs probably don’t come to mind, but you may be surprised to learn that six fresh figs have 891 mg of the blood pressure-lowering mineral, nearly 20% of your daily need—and about double what you’d find in one large banana. In a recent 5-year study from the Netherlands, high-potassium diets were linked with lower rates of death from all causes in healthy adults age 55 and older. Figs are one of the best fruit sources of calcium, with nearly as much per serving (six figs) as 1/2 cup of fat-free milk. Serve by chopping and adding to yogurt, cottage cheese, oatmeal, or green salads. Or enjoy them as a savory snack: Cut a slit in the side and stuff with 1/2 teaspoon of a low-fat version of a soft cheese such as chevre or Brie.

20. Blueberries

Blueberries may very well be the most potent age-defying food—they’re jam-packed with antioxidants. When researchers at Cornell University tested 25 fruits for these potent compounds, they found that tangy-sweet wild blueberries (which are smaller than their cultivated cousins) packed the most absorbable antioxidants. Research shows a diet rich in blueberries can help with memory loss, prevent urinary tract infections, and relieve eyestrain. Add up to 1/2 cup of blueberries to your diet a day for maximum health benefits, recommends Ronald Prior, PhD, adjunct professor of food science at the University of Arkansas in Fayetteville. This alone provides just about double the amount of antioxidants most Americans get in 1 day.

21. Asian Pears

One large Asian pear has a whopping 10 g of cholesterol-lowering fiber, about 40% of your daily need. People who ate the most fiber had the lowest total and LDL cholesterol levels, according to a recent study of Baltimore adults. The same researchers found that people who ate the most fiber also weighed the least and had the lowest body mass index and waist circumference. Serve by dicing it into a salad of Boston lettuce, crumbled goat cheese, walnuts, and mandarin oranges. Or make it a dessert: Add peeled and cored pears to a saucepan with 1 cup white wine, 1 teaspoon honey, 1 teaspoon grated fresh ginger, and enough water to cover the pears. Cover and simmer 40 minutes or until pears are soft.

More from Prevention: 20 Ways To Feed Your Family For $100 A Week

22. Lychee

A French study published in the Journal of Nutrition found that lychee has the second-highest level of heart-healthy polyphenols of all fruits tested—nearly 15% more than the amount found in grapes (cited by many as polyphenol powerhouses). The compounds may also play an important role in the prevention of degenerative diseases such as cancer. Serve by peeling or breaking the outer covering just below the stem; use a knife to remove the black pit. Add to stir-fries or skewer onto chicken kebabs to add a sweet, grapelike flavor.

23. Apples

One of the healthiest fruits you should be eating is one you probably already are: the apple. The Iowa Women’s Health Study, which has been investigating the health habits of 34,000 women for nearly 20 years, named apples as one of only three foods (along with pears and red wine) that are most effective at reducing the risk of death from heart disease among postmenopausal women. Other massive studies have found the fruit to lower risk of lung cancer and type 2 diabetes—and even help women lose weight. In fact, one of the only things that could make an apple unhealthy is mixing it with sugar, flour, and butter and stuffing it into a mile-high pie. Instead, have one as an afternoon snack with a tablespoon of peanut butter, or add slices to sandwiches or salads.

More from Prevention: Healthy Apple Recipes

24. Guava

Native to South America, this tropical fruit is an excellent source of skin-healing vitamin C, with 250% of your RDA per serving. One cup of guava has nearly 5 times as much C as a medium orange (377 mg versus 83 mg)—that’s more than 5 times your daily need. It’s also loaded with lycopene (26% more than a tomato), which may help lower your risk of heart disease. And according to research by microbiologists in Bangladesh, guava can even protect against foodborne pathogens such as Listeria and staph. You can buy guava juice, or simmer chunks in water as you would to make applesauce. Guava also makes a super smoothie: Blend 1/2 banana, 1/2 ripe guava, a handful of strawberries, 1/2 cup soy milk, and a few ice cubes.

25. Dark Chocolate

Thank you, dark chocolate, for making us feel good—not guilty—about dessert. Dark chocolate is filled with flavonoid antioxidants (more than 3 times the amount in milk chocolate) that keep blood platelets from sticking together and may even unclog your arteries.It may also help with weight loss by keeping you feeling full, according to a study from Denmark. Researchers gave 16 participants 100 g of either dark or milk chocolate and 2 hours later offered them pizza. Those who consumed the dark chocolate ate 15% fewer calories than those who had milk chocolate, and they were less interested in fatty, salty, and sugary foods. Try a chocolate with 70% or more cocoa. Two tablespoons of dark chocolate chips with fresh berries as a midafternoon snack or after-dinner dessert should give you some of the heart-healthy benefits without busting your calorie budget.

Read more:

Holiday Care 24 Communication!

United Healthcare Offers its premium program, Care 24, to members of the Valley Schools Employee Benefits Trust (VSEBT).  Many of those members are school districts around Arizona that take breaks during different parts of the year, in conjunction with the school year.  Accompanying this email, was a brochure as well.  It is good to see that a health carrier and a trust like VSEBT are able to provide such extensive and timely information in advance of the holidays!



Dear Districts:

Happy Holidays…Wishing you good health and happiness this holiday season and throughout the coming year!

Attached you will find the Care24 Calendar and Tip Sheet along with information about the HCR W-2 reporting requirement. Other topics of interest this month include additional information about our upcoming Pharmacy Migration, Negotiations with Emergency Physicians Southwest P.C.
and more…

Monthly Care24 Topic:

Please find the attached the monthly Care24 Tip Sheet and Care24 Calendar.
This month’s topic is Holiday Stress and attached are some important tips to remember and share with your employees:

Stress less this season.

Festive though it may be, the holiday season can also drain us of time, energy and dollars. If you sense that the stress in your life might be growing out of control, take note and take action. You can manage your stress level any time of year by:

* Just saying no if you may have taken on too much
* Not demanding perfection from yourself or others
* Making the most of your support network – talking it out with a
friend or family member
* Trying relaxation techniques to help push your stress aside for awhile
* Exercising, getting enough rest and eating a well-balanced diet

To learn more about coping with stress, go to<>.

Make the most of our Care24 service. When you call, you get one-to-one help from experienced nurses who are here for you and all your health and wellness concerns. All calls are completely confidential. Call 1-866-271-7340 to get started.


What’s New on UHC.TV?

Is There A Healthy Holiday Cookie?<
Managing Stress–BBC Brainsmart<
Joy Bauer: Weight Loss Strategies<

Links to videos:

Remember UHC.TV is our online television network that presents relevant, focused, educational and entertaining video programs about good health and living well to help people get inspired to grow healthy and live better.
From expert advice on healthy living to side-splitting comedy, it’s available online anytime. Visit for ready- made materials to promote UHCTV at your workplace.

logo vsmg


Copy and place the following UHC.TV links in your employee communications.

Source 4 Women<;

Source4Women offers free online seminars and events focused on keeping you and your family healthy. These one-hour seminars are fully interactive and include audio and video of the speaker. Best of all, there is a question and answer period with the speaker immediately following the presentation.

Upcoming Online Seminars:

December 11th: Holiday Social Weight Maintenance

January 1s: Best Weight Loss Tips Ever

Register at:

Wellness Online: December

Wellness Online is designed to educate your employees and their families on key health issues based on National Health Observances. The monthly emails will include health and wellness information, UHC product information, health tips and recipes. All you need to do is simply forward the below Wellness Online link to your employees for distribution.

Webcast Discusses Upcoming Pharmacy Transition

Get up to date on how consolidating UnitedHealthcare’s pharmacy benefit programs internally through OptumRx will affect you and your employees Learn More<

Employers Must Report Cost of Coverage on 2012 W-2 Forms

Employers filing 250 or more W-2 forms are required to report to employees the total cost of their employer-sponsored group health plan coverage under the Patient Protection and Affordable Care Act (PPACA). The W-2 reporting requirement will begin with the 2012 W-2 forms furnished to employees in January 2013.

The cost of coverage generally includes both the portion of the cost paid by the employer and the portion of the cost paid by the employee, regardless of whether the employee paid for that cost through pre-tax or after-tax contributions.


As a reminder, it is the number of W-2 forms filed in the previous year, not the number of employees, that the Internal Revenue Service (IRS) considers when determining which employers are obligated to report the cost of coverage.

At this time, employers filing fewer than 250 W-2 forms do not need to report cost of coverage on W-2 forms. This transition relief will continue until further guidance is issued.

Keep in mind that this requirement is informational only and does not mean that employer-sponsored coverage is subject to income tax.

Ultimately, it is the employer’s responsibility to accurately determine which employees should receive cost of coverage information. Employers are encouraged to consult with their legal counsel or tax preparer for advice on what should be reported to meet the W-2 reporting requirement.

Who Receives Cost of Coverage Information It is important to note that only the plan subscriber (the primary
policyholder) requires the cost of coverage information on his or her W-2 form. Spouses and dependents would not have the cost of coverage on their W-
2 forms. Report the cost within box 12 with a code DD<; of the W-2 form designated for cost of employer-sponsored health coverage.

Employers are not required to report the cost of coverage issue for non- employees currently receiving health coverage such as retirees, former employees not receiving compensation from the employer or an individual to whom the employer is not otherwise required to issue a W-2.

W-2 Reporting Recap
The W-2 Reporting: IRS Recap of What to
UHCEW579805.pdf> outlines what coverage should and should not be reported on the W-2 form.

What Not to Report

Health Insurance Portability and Accountability Act (HIPAA) “excepted benefits” plans (accident, disability income, supplemental liability, workers’ compensation insurance) are not subject to the W-2 reporting requirements. Stand-alone dental and vision plans are also not subject to the requirements. Amounts contributed to a health savings account (HSA) or an Archer medical savings account are not reportable on the W-2. Health flexible spending accounts (FSA) funded solely through employee salary reductions are not reportable. Employers are required to report the FSA value when it exceeds the employee’s cafeteria plan election for all tax favored benefits. In addition, coverage under a health reimbursement account/arrangement (HRA) may be reported on the W-2 at the option of the employer.

Finding Cost of Coverage Data for Employees

* Review the 2012 bills from UnitedHealthcare.
* Talk to payroll vendor and request data for each employee.
* Fully insured clients on the UNET platform may log on to Employer
eServices<; to view monthly invoices to find the premium costs per employee.
* Self-funded clients should reach out to their COBRA vendor for COBRA
rate, if applicable.

Available Upon Request

UnitedHealthcare Benefit Operations Billing and Enrollment will provide supporting data to employers to assist them meeting this requirement. This data will only be made available upon request. For fully insured employer groups, billing operations can provide a member premium audit report that recaps the premiums charged for the calendar year. The premium audit report is a detailed listing for all subscribers invoiced under the policy and will include the subscriber name, subscriber ID, and total premium charged for each coverage month in 2012 for which the subscriber was invoiced.

Requests can be submitted to the dedicated billing analyst or through the broker and employer call center.

Video: W-2 Reporting
Negotiations Continue with Emergency Physicians Southwest November 27, 2012 We are in negotiations with Emergency Physicians Southwest P.C. to renew its contract, which expires on Dec. 31, 2012. Despite several months of intense negotiations, we have not yet reached an agreement.

Member Notification

If we cannot renew our contract, effective January 1, 2013, Emergency Physicians Southwest P.C. will no longer be considered a network emergency hospital-based physicians for members. Per regulatory and contractual obligations, we will provide notification to affected members (including retirees if applicable) as follows:

· In an emergency, members should always seek care at the nearest

· Members will be advised they can find other contracted
facilities/participating physicians at or by calling the customer care telephone number on the back of their medical ID card.

· We will work closely with patients and their physicians on a
transition of care plan to ensure continuity of care for members receiving ongoing medical treatment at Emergency Physicians Southwest P.C. Members with pre-planned services through Emergency Physicians Southwest P.C. are advised that they may be eligible for network benefits for these services during a transition period as part of our continuity of care program.

Members are advised to call the customer care number listed on their ID card to determine eligibility.

Many of our network physicians have privileges at other local hospitals. We will actively assist physicians with sole privileges at Emergency Physicians Southwest P.C. in obtaining privileges at alternate facilities.

Our Mission

It’s important for you to know that as the steward of health care dollars, we do everything possible to contain the rising cost of health care.
Continuity and access to top quality, affordable health care for members are key priorities. We work hard to ensure that contracted hospitals are reimbursed at rates that are not only fair and reasonable, but consistent with trends in their respective local markets. We understand that employers and consumers have limited budgets, and they count on us to provide them access to affordable in-network hospitals.

Negotiations Continue

We continue to be engaged in discussions with Emergency Physicians Southwest P.C. and we are working hard to bring these negotiations to a fair and successful conclusion.
We regret any inconvenience Emergency Physicians Southwest P.C. potential termination may cause you or your members. We will keep you apprised of our progress through future communications.

Resources Available for Hispanic/Latino Members

Provide your Hispanic/Latino members with access to materials in a culturally-relevant and bilingual format to help improve their health care experience through our Latino Health Solutions website. Fotonovelas or photo novels (in English) are bilingual photo stories depicting how a family discusses common health concerns can be shared with members

The fotonovelas, entitled, “¿Que le dijo el medico?” (What did the doctor tell you?) contain brief vignettes that depict a series of dialogues between family members discussing topics such as diabetes, hypertension, physical activity, nutrition, tobacco use and depression.

The fotonovela information is presented in a format that lends itself to helping Hispanic/Latino members and their families make informed decisions on their health and well-being. It’s another tool that will help them better understand prevention and wellness and guide them to take action by providing them with helpful tips on health-related issues.

View the
language/en-US/Default.aspx>” and other health and wellness information in Spanish and English at our Latino Health Solutions website <; or on your mobile device at

Costco Optical Announcement for Vision

UnitedHealthcare Vision is pleased to announce the addition of Costco Optical to our growing network of vision providers effective January 1, 2013. The retail chain adds 420 store locations nationally and over 420 optometrists to our national network of 35,000 access points.

We recognize the importance of choice for our members in selecting a provider for their eye care needs. That’s why we pride ourselves on being able to offer a robust and well-balanced network of both private practice and retail chain locations on a national and regional basis. This addition to our network will be an exciting option for members who enjoy the added value and convenience that Costco offers.

Members will be able to find participating Costco providers by visiting, and searching for participating locations in their area.

Please keep in mind that UnitedHealthcare Vision members must have a valid Costco membership in order to purchase materials at Costco Optical. A Costco membership is not required to receive an exam.



When will this occur?
As of January 1, 2013 Costco Optical will be part of UnitedHealthcare Vision/ Spectera Eyecare Networks, serving all UnitedHealthcare vision members.

How many store locations are included?
The retail chain adds 420 store locations nationally and over 420 optometrists to our network of 35,000 access points.

Are all Costco Optical locations included in our contract?
Yes, all Costco locations with Vision Centers.

How can I locate a participating provider?
Members will be able to find participating Costco providers by visiting<;, and searching for participating locations in their area.


When will the Costco locations be loaded onto the online Provider Directory?
Costco providers will be available in the directory beginning December 2012
as they are loaded into the system. The load will be complete by January
1, 2013 and will reflect all of the Costco providers at that time.

Does a UnitedHealthcare Vision member need to be a member of Costco in order to utilize their benefit at a Costco Optical location?
UnitedHealthcare Vision members must have a valid Costco membership in order to purchase materials at Costco Optical. A Costco membership is not required to receive an exam.

Thank you for being a valued customer and please let me know if you are having any service issues or concerns.

How to evaluate online pet health articles

How to evaluate online pet health articles

by THERESE on JANUARY 31, 2010


If you’re like me, when one of my pets is diagnosed with a major illness, one of the first places I turn is to the Internet. Type any pet related health condition into your favorite search engine and you’ll find something – probably a lot of somethings! The question is, how accurate is the information you find? A savvy pet owner will not only read what’s online, but will evaluate the source of that information. Here are a few tips to help you decide whether or not the articles you find online are worth the time it takes to read them.

Consider the source
Look for articles written by researchers and other experts at veterinary schools, organizations that do research on animal health, and well-known websites. Cornell University College of Veterinary MedicinePet, and are just a few of the many highly respected websites that cover pet health.

If you see an article on a website that doesn’t seem to have any credentials, look on some of the websites that do offer credentials to see if they have any corroborating info. As the old saying goes, “don’t believe everything you read.”

Look for current articles
While older articles are definitely worth reading, if you’re doing research on something like feline cancer (which I’m in the midst of learning about with Tequila), also try to find articles that are as up-to-date as possible. The newer articles will likely cite recent studies and/or advancements made about the condition you’re dealing with in your pet.

Look for articles by respected authors
Writers like Christie Keith and Gina Spadafori(from Pet Connection) Dr. Patty Khuly (from Doolittler)Lew Olson (from B-Naturals), and Mary Strauss (from are all well respected pet health writers. Anything you see written by them is going to be well-researched and based on facts. On the other hand, not every Joe Blow who sets up a website and posts his theory on how to heal dogs of cancer is going to be worth your time. Some of the information you find, will be written by people who mean well, but just aren’t qualified to be offering medical advice. And of course, be wary of the scammers who have the miracle cure you’re looking for. Chances are, the only thing you’ll be making healthier by sending them your money is their bank account!

Evaluate personal accounts carefully
Regardless of what type of illness your pet has, you’re probably going to want to hear from others who have gone through the same thing with their pets. I know I did when when Lydia was diagnosed with cancer in 2008 (and I do now that Tequlia’s been diagnosed with cancer). I wanted to hear from others who have dealt with the same type of cancer. I wanted to know how the pets were treated, what they fed them, what supplements they gave their pet, how the disease progressed. And of course, I wanted to hear from people who had dogs who survived! I found happy and sad stories, but every time I read something I reminded myself that Lydia’s situation was unique, and that her story wouldn’t be identical to any other. It’s important to keep this fact in mind no matter what type of problem you’re facing with your pet. Not every disease in every pet is going to progress in the exact same way. Get input from others, but don’t get too hung up on exactly how things progressed in their pets.

Being faced with a major illness in one of your pets is stressful enough without wasting time reading articles that prove to be harmful, or inaccurate at best. Finding information online about your pet’s condition is the easy part – evaluating it can sometimes be a bit tricky. So, before going too far into what you’re reading take the time to decide whether it’s worth reading. It could save you a lot of time and heartache.

USDA will allow more meat, grains in school lunches following criticism

USDA will allow more meat, grains in school lunches following criticism

Published December 08, 2012

WASHINGTON –  Let them eat meat.

The Agriculture Department plans to do away with limits on the amount of meats and grains that students can have in their school lunches, following complaints from parents and lawmakers alike.

Agriculture Secretary Tom Vilsack wrote to members of Congress Friday announcing that his department would scrap daily and weekly maximums for the foods. It comes after lawmakers wrote to his department saying kids weren’t getting enough to eat under the rules, and school administrators complained that the regulations were hindering their ability to plan daily meals.

“This flexibility is being provided to allow more time for the development of products that fit within the new standards while granting schools additional weekly menu planning options to help ensure that children receive a wholesome, nutritious meal every day of the week,” Vilsack said in a letter to Sen. John Hoeven, R-N.D.

The new guidelines, which took effect in September, were intended to address increasing childhood obesity levels. They set limits on calories and salt and phase in whole grains. Schools must offer at least one vegetable or fruit per meal. The department also dictated how much of certain food groups could be served.

While nutritionists and some parents have praised the new school lunch standards, others, including many conservative lawmakers, refer to them as government overreach.

The rules triggered a burst of news coverage this past fall regarding students who complained they weren’t getting enough food, and even the parody YouTube video “We Are Hungry,” posted by students in Kansas.

Though broader calorie limits are still in place, the rules tweak will allow school lunch planners to use as many grains and as much meat as they want. In comments to USDA, many had said grains shouldn’t be limited because they are a part of so many meals, and that it was difficult to always find the right size of meat.

The new tweak doesn’t upset nutritionists who fought for the school lunch overhaul.

Margo Wootan, a nutrition lobbyist for the Center for Science in the Public Interest, says the change is minor and the new guidance shows that USDA will work with school nutrition officials and others who have concerns.

“It takes time to work out the kinks,” Wootan said. “This should show Congress that they don’t need to interfere legislatively.”

Congress has already interfered with the rules. Last year, after USDA first proposed the new guidelines, Congress prohibited USDA from limiting potatoes and French fries and allowed school lunchrooms to continue counting tomato paste on pizza as a vegetable.

The school lunch rules apply to federally subsidized lunches served to low-income children. Those meals have always been subject to nutritional guidelines because they are partially paid for by the federal government, but the new rules put broader restrictions on what could be served as childhood obesity rates have skyrocketed.

School kids can still buy additional foods in other parts of the lunchroom and the school. Congress two years ago directed USDA to regulate those foods as well, but the department has yet to issue those rules.

Montana Sen. Jon Tester, a Democratic senator among the lawmakers who wrote to USDA about the rules, praised the move.

“Schools need flexibility to make sure kids get the nutrition they need to focus on their studies,” he said.

The Associated Press contributed to this report.

Read more: