Q: I just got the results of the blood tests that my doctor did at my checkup, and there's nothing on there about my homocysteine level. I've heard that too much homocysteine increases your risk for heart disease and stroke. Shouldn't she have tested for it?

A: Not necessarily. If you are getting enough folate (400 micrograms), B6 (4 milligrams), and B12 (25 micrograms) from diet or vitamins, you would be very unlikely to have an elevated homocysteine level. Those nutrients bring homocysteine down, so you should focus on getting them, rather than the test.

There are, however, two times you should get the test. One, if you have a strong personal or family history of cardiovascular disease, but don't have any risk factors, such as high LDL cholesterol or high blood pressure. And two, if you're in an Executive Health Program like the Cleveland Clinic's, where risk/benefit—not cost—determines whether the test is ordered.

Why we worry about homocysteine: It's a normal byproduct of digesting protein, and most of us pee it out or reprocess it. But too high a level seems to cause homocysteine to act like glass shards or small crystals in your bloodstream, making microscopic nicks in your arteries, which leads to plaque and inflammation (and heart disease and stroke). Bottom line: Make sure you get your nutrients: It's as important as filling your tires with air.

Q. Are generic drugs really the same as brand-name products? I've started taking the generic drug for Effexor, but I think the brand-name pill worked much better.

A. Generics are mostly the same. The FDA requires them to contain the identical drug and have the same quality, purity and strength as the brand-name product.

But there is some wiggle room within these regulations that may affect how the drug works in you. For example, the amount of generic drug that gets into your blood after you take it—called bioavailability—must be within 20 percent of the branded drug. That means if 100 percent of a brand-name drug gets absorbed into your blood, maybe only 80 percent of the generic gets in. In addition, generics can contain up to 7 percent above or below the dose stated on the prescription (so instead of 100 milligrams, you might be getting only 93). Further, the inert ingredients and the formulation (meaning, what else is in there to make it into a pill or tablet) may change in the generic form, and this can alter your absorption of the drug too. Together, all these factors could add up and lower (or raise!) the drug's effect on you. But most don't.

That said, some generics do not perform as well in treating the symptoms of a disease as the branded drug does. Thyroid medication seems to be particularly prone to this not-as-good-as-brand-name effect. But for the vast majority of patients and drugs, generics are equally effective—and they're less expensive.

Q: My husband was recently diagnosed with cancer and is starting chemotherapy soon. What can I cook for him if he's feeling unwell? We generally eat a healthy diet.

A: First, it may seem cruel but don't deliver the food to him, because it's essential that he keeps walking—it usually turns on a gene that mutes several cancer growth factors. Next, while loss of appetite can be a big challenge before, during and after treatment, these strategies may make meals easier for both of you:
  • Vary texture, temperature and taste. One day, a crunchy, cold mixed fruit salad may hit the spot. On another, something warm, bland and smooth is more comforting. Keep meals small, and offer them frequently. Freeze small servings of a variety of entrées so you have options, depending on how your husband is feeling. If friends ask what they can do—and they will—recommend that they make a healthy soup, casserole or pasta dish for freezing. Have healthy snacks—whole-grain crackers, nuts, avocados and both fresh and dried fruit—within reach.
  • Steer clear of saturated fats. These turn on a family of genes that increase cancer growth rates. And we know we don't need to say it, but we can't resist: Avoid sweets and other foods made with anything but healthy fats as if they cause homicide—because they do, and you'll be arrested by the YOU Docs police (or should be).
  • Avoid foods that can overwhelm. Go easy on the spices, especially hot ones, unless your husband has diminished taste. And take care not to overpower his senses with strong smells.
  • Don't force it. If he doesn't feel like eating, that's okay. Sometimes the best you can do is offer a smoothie loaded with great fats and great taste. If a complete lack of appetite persists, ask your doctor about liquid meal replacements. Making sure your husband has at least something in his system can be as necessary as having at least a teaspoon of gas in your car's tank.
For more from the YOU Docs, visit

6 things you don't know about your fat belly.

As a reminder, always consult your doctor for medical advice and treatment before starting any program.


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