UVA Health System Blog

Stories about the patients, staff and services of UVA


Lung Cancer in Women: Time to Face the Facts and Get Screened

On November 24, 2014 | At 10:30 am

Which cancer do you think kills the most women? Chances are, you guessed breast cancer. Incorrect! Believe it or not, lung cancer is the leading cause of cancer death among women. In a recent study by the American Lung Association to measure awareness of lung cancer risk, only 1 percent of women surveyed selected lung, compared to 87 percent who selected breast.

Lung cancer surpasses pancreatic, ovarian and other types of aggressive cancer as the leading cause of cancer deaths in both women and men. Although smoking is a major risk factor of the disease, approximately 20 percent of patients diagnosed with lung cancer have never smoked. Of this 20 percent, most are women.

Richard Hall, MD, UVA Cancer Center

Richard Hall, MD is a medical oncologist at UVA Cancer Center who specializes in lung cancer.

“When looking at lung cancer across the board in the United States, the number of patients who are diagnosed with the disease is almost the same in both men and women. However, when I look at my practice and consider patients who were never smokers, almost all of my patients happen to be female,” says UVA medical oncologist Richard Hall, MD.

The Myth of the Smoker’s Disease

Hall adds that in other parts of the world, the majority of women who develop lung cancer never smoked. That’s especially true in East Asian countries such as:

  • Japan
  • South Korea
  • China
  • Taiwan

Lung Cancer: The Leading Cause of Cancer Deaths

Because the incidence of lung cancer in non-smoking women is higher than in non-smoking men, organizations such as the American Lung Association (ALA) are trying to raise women’s awareness of the disease. The ALA surveyed 1,000 women to measure awareness, knowledge and perceptions about lung cancer and found:

  • Only 1 percent selected lung cancer as a leading cause of cancer death among women, compared to 87 percent who selected breast cancer.
  • Only 1 in 5 women knew that less than half of all women diagnosed with lung cancer would live a full year after diagnosis.

Lung cancer has one of the lowest 5-year survival rates of all cancers, with only 18 percent of patients surviving at least 5 years, as reported by the ALA.

According to Hall, women who have never picked up a cigarette are shocked upon diagnosis of lung cancer. “Naturally it raises questions of other environmental exposures that contribute to their diagnosis, and unfortunately, there is still a lot we don’t yet understand.”

The first step to improving the statistics surrounding lung cancer is educating the public about the disease. Although we have a lot to learn about what causes lung cancer, there are critical steps you can take to prevent the disease: Quit smoking and get screened.

Quit smoking

Quitting smoking is the #1 way to reduce your chances of developing cancer.

Smoking cessation is the single most important thing someone can do to reduce their risk of developing lung cancer. It also helps them save money. Screening is the second most important action to take, especially for patients with a history of smoking,” says Hall.

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) approved CT screening for patients who qualify based on age and smoking history. The United States Preventative Services Task Force recommended the CMS approve lung screening after the results of the National Lung Screening Trial showed that people who underwent CT chest screening lived longer than those who underwent annual chest x-rays.

UVA offers a comprehensive Low-Dose CT Lung Screening Program and encourages those at high-risk to get screened.

Treating Lung Cancer

Without screening, lung cancer is generally diagnosed at later stages, making it more difficult to treat.

However, certain lung cancers can be treated by targeting the genetic changes in lung tumors, stopping the growth and survival signals of cancer cells at the molecular level.

While UVA provides these treatments, Hall and his team are also conducting clinical trials to identify additional therapies for patients at all stages of disease.

If you…

  • Are concerned about lung cancer symptoms
  • Are high risk and would like to be screened
  • Want a consultation with the lung cancer team at the UVA Cancer Center

Call 434.924.4246 to make an appointment.

Related Podcast: Lung Cancer: Myths vs. Facts

Filed under : Cancer,Pulmonary,Women's Health | By
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The Detective Work of Autoimmune Disease

On October 31, 2014 | At 8:25 am

Angela Crowley, MD, is up-front about it. Accurately diagnosing an autoimmune disease can be tricky.

UVA rheumatologist Angela Crowley finds autoimmune diseases fascinating.

UVA rheumatologist Angela Crowley, MD, finds autoimmune diseases fascinating.

“People on average see six doctors over a period of 4 years before they get a diagnosis.”

This is because, in general, autoimmune diseases tend to arrive unpredictably, disguised as other conditions, offering only confusing clues as to what they are.

Why Are Autoimmune Diseases So Mysterious?

One reason is that the list of what’s considered to be autoimmune is long and ranges from the very common to the extremely rare.

Did you know? The following are all autoimmune diseases:

  • Celiac disease
  • Diabetes type 1
  • Multiple sclerosis (MS)
  • Psoriasis
  • Inflammatory bowel disease

While very different, all these disorders have one thing in common: They occur when a person’s immune system decides to attack healthy body cells. Instead of fighting infection with antibodies, the body produces autoantibodies. The body is essentially fighting itself.

Where and how this self-attack occurs determines the disease and its symptoms. But the occurrence of these symptoms is not simple, clear or predictable. Other situations make diagnosis problematic:

Asymptomatic or Delayed Symptoms. You can have osteoporosis, for example, and have no symptoms at all — only getting diagnosed after a bone fracture. Or with ankylosing spondylitis, the average diagnosis timeframe is 10 years — about how long it takes for the condition to be visible on an X-ray.

Common symptoms. Or you could have severe joint pain as a result of any number of autoimmune diseases, but lack any other symptoms to help doctors determine exactly which one you have. Vasculitis, for instance, is systemic, which means, along with causing inflammation of blood vessels, it can cause pain anywhere and everywhere in your body.

Co-Conditions. Your celiac disease or Grave’s disease could lead to or just show up with rheumatoid arthritis; having both means one condition can mask the other.

Misconceptions. You might be in pain and avoid seeing a doctor. “People ignore their pain, thinking they are too young to have arthritis, which isn’t true,” says Dr. Crowley. “It can happen to kids. Rheumatoid arthritis and osteoarthritis are two different things.”

Mimics. Dozens of diseases can look like MS, for instance, from lupus to other neurological conditions. And it takes time to rule out.

Uniqueness. Lupus in one person can show up with a set of symptoms completely different than the ones that show up in another person. Doctors can’t rely on symptoms alone to determine the nature of the affecting disease.

Diagnosing Autoimmune Disease

Varied, numerous and inherently elusive, the diagnosis of autoimmune disease can be tough detective work.

But what might seem daunting to others is precisely why Crowley became a rheumatologist. “I find it to be fascinating. Everyone is different, so I’m surprised and challenged daily. It’s really rewarding to be able to identify a rare disease and to be finally able to give a patient an answer to symptoms and something that can help them. Or to find a rare presentation of a common disease.”

So how does one diagnose if you can’t count on symptoms entirely?

Myth vs. Fact: Celiac Disease

The proliferation of gluten-free options at restaurants and grocery stores might look like just another trend. But celiac disease is a serious autoimmune disease. And though sometimes treated as such, it is not an allergy one can grow out of or ignore. If a person with celiac disease ingests gluten, she can trigger a number of symptoms, not all stomach-related; over time, eating gluten can give rise to more autoimmune diseases.

Diagnostic tests include, but are not limited to:

  • Antinuclear antibody (ANA) test—the presence of autoantibodies does not automatically mean you have an autoimmune disease, but a high level can indicate lupus, scleroderma, juvenile arthritis, others
  • Comprehensive metabolic panel
  • Tests associated with inflammation and arthritis
  • Urinalysis

Rheumatoid arthritis I can usually diagnose in the first visit; it’s normally straightforward.” Which is good, since it’s very important to be diagnosed early. “The earlier we can treat it, the more likely it is that it will be easier to treat later on and you won’t need as much medication.”

Which is why Crowley is excited about the advances being made in the field.

The latest? “We have a new imaging technique, a new type of CT scan, to diagnose gout. We’ve never been able to do it with imaging before. I’ve had patients who didn’t know it was gout until we used this technique. To diagnose gout you have to look at joint fluid and see gout crystals, but there’s not always a big collection of joint fluid to examine. Or you can look at uric acid, but some people have high levels of uric acid and no gout. You might suspect, from the symptoms and the blood tests, that the person has rheumatoid arthritis. Which is a problem, as rheumatoid arthritis and gout require very different treatments.”

But with the dual-energy 3D CT scan, diagnosis is straightforward. “The gout crystals look green. Fun pictures,” adds Crowley.

Flares & Triggers: Autoimmune Disease

While an ultimate cause for autoimmune disease remains unknown, research has shown that:

  • People can have a genetic propensity for an autoimmune disease
  • A trigger can activate or turn on the gene
  • Suspected triggers include environmental, chemical, sunlight, stress, drugs and infection factors
  • These triggers can cause a disease to “flare” up
  • These disorders can appear at any and all ages, making it difficult to pinpoint exact causes

Another thing is clear to Crowley and others in the field. “In the last two decades, we’ve seen a significant increase in autoimmune diseases, and a lot of experts think it’s the environment.”

Specific research has shown that tobacco use can turn on these genes, and gum disease can turn on rheumatoid arthritis genes.

But as with most aspects of autoimmune disease, these are hints, not answers. “We suspect it’s not just one thing, not one sole cause.”

No Quick Fixes: Treatments and Hope

There are no known cures for autoimmune diseases. Rheumatologists look to medications, supplements and physical therapy for the relief of symptoms and suppression of the immune system.

Crowley says that’s no reason to lose hope. “There is a lot of good research going. We have a lot of great treatment options. One hot topic in research is trying to predict the right treatment for each person. We have to do trial and error to see what can put someone in remission, but with more knowledge about disease features and genetics, we can narrow down the options and go straight to the most appropriate medicine right away.”

Stress and Self-Care

Along with medication, Crowley advises her patients to practice good self-care. She knows living with an autoimmune disease can be stressful. “People break down into tears in my office at least once a day,” she says.

But stress can make symptoms worse. “People get flared up when stressed, so I tell people we can’t fix the situations, but we can control the response. Good sleep and exercise are things we can work on. Tai chi and yoga are good for the body and mind (and there’s free videos for these on YouTube),” and can help manage symptoms. She also checks patients’ vitamin D levels, which are important for bones and the immune system.

Open for Business: UVA Rheumatology on Pantops

You can visit Crowley at her office on Pantops, where there’s plenty of free parking and friendly staff. View clinic directions, hours, contact info.

And while there aren’t published studies showing that diet benefits autoimmune diseases, she does see that diets can affect individuals, some of whom find that removing gluten, dairy, meat, sugars, fats and artificial ingredients help.

Even without a cure, Crowley finds her work rewarding. “We can put someone in remission and take them from not being able to do much of anything to being able to return to work and play ball with their kids. I get to develop relationships with people. It’s a team approach between us and our patients.”

And because an autoimmune disease can affect various parts of the body, Crowley also teams up with doctors in other fields. She doesn’t just treat one thing, she says. “We treat the person as a whole.”

Do You Have an Autoimmune Disease?

It’s hard to know without the care of a specialist like Crowley. If you have inflammation, joint pain or other vague symptoms, see your primary care physician for a referral. You can even schedule an appointment with Crowley herself!


Podcast Tuesday: Preventing and Treating PCOS [AUDIO]

On September 9, 2014 | At 10:45 am


Podcast Tuesday: Reducing Your Ovarian Cancer Risk [AUDIO]

On June 24, 2014 | At 8:34 am

Filed under : Cancer,Podcast Tuesday,Women's Health | By
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Do Mammograms Work? A Recent Study Says No: A Response

On May 15, 2014 | At 8:32 am

A study questioning the effectiveness of mammograms in preventing breast cancer has recently hit the news and caused a lot of women to wonder what to do. Jennifer Harvey, MD, a UVA radiologist who specializes in breast cancer treatment and research, offers her take on the study and its implications. 

About the Mammogram Screening Study

This article reports the combined follow-up data at 25 years for two Canadian mammography screening trials: One study of women ages 40-49 and the other for women ages 50-59. The study finds that annual mammography in these women during the study period did not reduce mortality from breast cancer compared with women who had only clinical examination.

The Mammogram Study in Perspective

The important context of this study is that this is one of nine randomized clinical trials that were performed between the late 1960s and the 1980s. Of those nine trials, seven showed a reduction in breast cancer mortality with screening mammography; the Canadian trial was not one of those seven. The fact that the results did not change at 25 years of follow-up is not news. This trial was also one of the most highly criticized, due to likely randomization errors and quality control.

We should also consider the time frame of this study. Today’s mammogram is not your mother’s mammogram. Mammograms obtained today are considerably better in quality than those that were used in the study, which took place when I was a child! Mammography was also in its youth at that time. Mammograms, like our phones and cameras, have advanced in technology over the years.

The Evolution of Mammograms in Pictures

This slide shows the technical changes in mammography over time. Most of the randomized trials were performed in the 1970s and 1980s. Although randomized trials are the “gold standard” for judging a test, the technical changes make the results a bit outdated. Mammography today is far more advanced, and now includes tomosynthesis (3D mammogram). I’ve changed a bit over the years, too!

Mammography today is far more advanced, and now includes tomosynthesis (3D mammogram).

Mammography today is far more advanced, and now includes tomosynthesis (3D mammogram).

Does Mammography Work?

Yes. All countries that have adopted routine screening mammography have experienced a significant reduction in breast cancer mortality, including the United States. While mammography is imperfect and does not detect all cancers at an early stage, it does reduce breast cancer mortality by at least 25%.

Improving Mammography: A Look Ahead

This and other studies have raised a good point, however. We do need to screen smarter. As we better understand breast cancer and breast cancer risk factors, we should work to tailor screening to an individual woman’s risk. Women who are low risk, or at risk for low-grade disease, could be screened less frequently. Women who are at higher risk or at risk for aggressive disease could be screened more frequently with tools other than mammography, such as ultrasound or MRI.

We are not there yet. Current risk models are not very good at telling which women are going to develop breast cancer and which are not. At the UVA Breast Care Center we are currently developing a breast cancer risk model that includes breast density. We believe this will help women better understand their breast cancer risk and make decisions about screening based on that information.

What type of mammography is right for you?

Visit UVA Breast Care Center to find out about the options, including 3D mammograms.


From Cystic Fibrosis to Marathon Ambitions: How a Lung Transplant Changed a Mom’s Life

On April 14, 2014 | At 8:07 am

Tina Tinsley’s dream was to be a mother, and her wish was granted after years of trying. But because of cystic fibrosis, she couldn’t do basic tasks that most moms take for granted. She couldn’t go to the grocery store or give her children baths. When she left the house, she had to take an oxygen tank along with her.

Tina Tinsley with her husband, Phillip and twins Sara and Cole

Lung transplant recipient Tina Tinsley with her husband, Phillip, and twins Sara and Cole

It wasn’t always this way. Tinsley, now 38, was a physically active child, but cystic fibrosis changed all that as she got older.

A hereditary condition that develops during childhood, cystic fibrosis primarily affects the respiratory system, pancreas and sweat glands. The body produces excess mucus that clogs the bronchi, which are the main passageway into the lungs. This leads to breathing difficulties and infections.

Infertility and IVF

Cystic fibrosis also causes infertility. Tinsley, who lives in Staunton, Va., was told she’d never have children, but she wasn’t one to take no for an answer. She and her husband, Phillip, kept trying. After numerous procedures and two in vitro fertilization (IVF) attempts over eight years, they were successful, and twins Cole and Sara were born in 2009.

Her faith in God kept her going through the long and often-disappointing process, she says. The twins were in the NICU for many weeks after their birth. “UVA took excellent care of them and made sure they were coming home,” she says.

After the birth of the babies, her cystic fibrosis symptoms worsened. “My husband says it really took a toll on my body,” she says. “But even if I knew that, if I had been warned, I don’t know if I would’ve listened. I really wanted to have kids.”

Family History of Cystic Fibrosis

Things took a turn for the worse in October 2013, when Tinsley was admitted to UVA with a lung infection and put on a ventilator and feeding tube. “I nearly left here. I almost died,” she says. For Tinsley, that was a very real possibility. Her brother died of cystic fibrosis three years ago at the age of 39. She also has two cousins with the condition, one of whom died from it.

Antibiotics controlled her infection, and eventually she was strong enough to be put on the lung transplant waiting list. Still, she wasn’t ready to admit she needed a transplant. She thought she might still get better and needed the convincing of her doctor, Max Weder, MD. “He said I wasn’t going to live if I didn’t have the transplant,” Tinsley says. “He’s by far the best physician I’ve ever had. We make a good team. The whole transplant team is just phenomenal.”

Tinsley also got support from other members of the transplant team at UVA, including social worker Bill Potts and pre-transplant coordinator Heidi Flanagan, RN.

“Heidi knew how nervous I was, and she was so compassionate. She told me to look ahead a year to what my life was going to be like.”

Potts, she says, asked her what she wanted from the rest of her life. “I told him I just wanted to be a mama to my babies. He said, ‘Transplant can give you that.’”

Lung Transplant and Recovery

While Tinsley was in the hospital, Phillip, Tinsley’s husband of 18 years, would drive 40 miles from Staunton to Charlottesville to be with her and then drive home to be with their children.

Christine Lau, MD, performed Tinsley’s lung transplant, which lasted almost 10 hours. Tinsley was removed from the ventilator the first day after her surgery. “I was up sitting in a chair the next day and walking in the hallways the day after that.”

She stayed in the MICU (medical intensive care unit) for two weeks following the surgery and worked with a respiratory therapist, physical therapist and nutritionist to regain normal function. Tinsley also takes immunosuppressants, drugs that prevent her body from rejecting her new lungs. Transplant recipients take anti-rejection medications for the rest of their lives.

Weder says Tinsley’s case is a special one. It’s not often that patients go from being near death to walking out of the hospital several weeks later. “She is a unique case and serves as a great example of how everyone on our MICU and transplant teams work together in difficult transplant cases.”

Along the way, the Tinsley family received lots of help. People in their Staunton community raised funds to help cover some of their transplant medical expenses. Another group made sure the children had presents under the tree this past Christmas when neither parent had the time or resources to go shopping. The Tinsleys’ church community donated weeks of meals during her hospitalization. The Tinsleys also received a grant from a nonprofit that paid for one round of their IVF procedure.

Tinsley, whose motto is “Live to fight another day,” says she feels better now than she’s felt since she was a child. She can give her children those baths, she goes to the grocery store and the oxygen tank is gone. She hopes to share her story with local churches and maybe write a book someday. Her new goals also include running a marathon. “I know I can do it,” she says.

More Transplant Information

Find out more about UVA’s lung and other transplant programs.

Meet Dr. Weder

Learn more about his interests and research.


The Magic Week: Waiting for a Healthy Baby

On February 26, 2014 | At 8:07 am

To many women, having a baby at 37 weeks may seem about the same as having the baby at 39 weeks. Why endure another two weeks of backaches and swelling when you could induce labor?

Pregnant belly image

Babies born at 37 weeks are more likely to require NICU admission than babies born at 39 weeks.

Does it really make a difference for your child?

UVA obstetricians sometimes see expecting parents who want to schedule an induction at 37 or 38 weeks for logistical reasons. And that used to be considered OK.

But now doctors know that there’s a big difference between 37 and 39 weeks. Babies do best if delivered at 39 weeks or later.

The “Magical Gestational Age” of 39 Weeks

At 39 weeks, babies have better developed organs, including the brain and lungs, and:

  • Maintain temperature better
  • Eat better
  • Have a lower risk of breathing problems
  • Are less likely to need extensive medical care and interventions, including the neonatal intensive care unit

“It’s important to mention that most babies born spontaneously or due to medical necessity between 37-39 weeks do well,” says obstetrician Vanessa Gregg, MD. “But statistically, 39 weeks or beyond is best for babies.”

That’s why UVA does not schedule expecting moms for elective early deliveries, which is induction or Cesarean section before 39 weeks. The March of Dimes recently recognized UVA and just 12 other hospitals in Virginia for low elective early delivery rates and for implementing a delivery policy.

UVA had no elective early deliveries in 2012 and the first half of 2013 (numbers are not yet in for the second half of last year), compared to a national mean of almost 8 percent of all births.

“When we explain to women and their families that babies are better off if born after 39 weeks, they’re receptive to waiting until that magical gestational age for delivery,” Gregg says.

Earlier Deliveries

However, deliveries before 39 weeks can still happen if the mother goes into labor on her own. There are also medical reasons to induce, including:

  • Maternal high blood pressure
  • Maternal diabetes
  • Twins or other multiples
  • Fetal anomalies that need special care outside the womb
  • Abnormal placental development
  • Prior uterine surgeries that make the uterus too fragile to wait
  • Growth restrictions due to the fetus getting too big

Are you pregnant or thinking about having a baby? Find out more about our:

Filed under : Children's Hospital,Women's Health | By
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Vim & Vigor: Angelina Jolie, Genetic Testing & Controlling Diabetes

On February 7, 2014 | At 8:39 am

In August 1982, Thomas P. Loughran Jr., MD, was working in Seattle when a woman with a mysterious blood illness was transferred to his hospital. That patient and her condition changed the path of Loughran’s research forever.

Sudden cardiac arrest patient Helen Trimm with dog

Read about patient Helen Trimm’s cardiac arrest scare in Vim & Vigor.

Loughran and his research are featured in the Spring 2014 issue of UVA’s family health magazine, Vim & Vigor. Check it out for stories about:

  • Angelina Jolie’s double mastectomy and BRCA1 and BRCA2 genetic testing
  • Controlling diabetes without drugs
  • How much to hover when your kids are playing
  • The jobs that are hardest on your heart

Read the online version now.

Live in Virginia? Sign up to get Vim & Vigor in the mail for free.


Sleep, Belly Fat, and Making Weight-Loss Last: Q&A Part 5 Fad Diets

On January 25, 2014 | At 9:16 am

In this final installment of our Fad Diets Q&A series, UVA nutritionists Carole Havrila and Katherine Basbaum explain how sleep and belly fat relate and give us their best advice for sticking to a diet plan.

Healthy foods & a balanced diet still rank the as the best way to lose weight and stay fit.

Healthy foods and a balanced diet still rank as the best way to lose weight and stay fit.

Q: Tell me about how sleep and belly fat relate to weight-loss.

Havrila: There is science that validates that elevated cortisol levels (a stress hormone) happen when we lack enough sleep or are consistently stressed out. While these states are correlated with higher cortisol levels and more belly fat, the only way to get that off is to care for the whole body. You must reduce calories and exercise to lose total body weight.

Basbaum: The stomach or abdominal area is indeed one of the more dangerous places on the body to carry excess weight: As fat accumulates and “pads” the spaces between the abdominal organs (“visceral fat”), you have increased risk of metabolic disturbances, cardiovascular disease and type 2 diabetes.

Regarding lack of sleep, that can indeed lead to weight gain; there are specific hunger and satiety hormones (ghrelin and leptin) that can get thrown off if you’re consistently not getting a good night’s sleep. This means that not only will you be likely to consume more calories throughout the day, you will also have more trouble burning them off.

Q. Best tips for sticking to a diet or weight-loss plan?

Havrila: Accountability is a very powerful thing, so if you are really worried you will gain weight then keep a daily log of what you are eating/drinking (you can do this online with apps like MyFitnessPal or Sparkpeople). These keep a tally of your calories and can be helpful to keep you on track when you are considering that extra cookie.

Fad Diets: Final Thoughts

Fad diet advertisements often distort key facts about the body in order to sell their products.

Here are 5 things from this series to remember the next time you’re tempted to believe otherwise:

  1. Detox-diets, cleanses and any plan that removes a food group entirely could put you at risk of missing nutrients you need. If you have health issues, fasts and cleanses can even hurt you.
  2. Diets that focus on eating large amounts of saturated fat found in many meats, butter, full-fat dairy, etc., can be bad for your heart, and that hurts your overall health.
  3. Extreme diets are often so hard they backfire.
  4. You don’t need to cleanse; your body detoxifies itself.
  5. Every weight-loss plan requires diet and exercise to be successful.

What do YOU think?

Was this series helpful? What surprised you? What diet will you try — or try to avoid — next? Tell us below.

Filed under : Healthy Living,Nutrition,Women's Health | By
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Detox, Gluten-Free, Vegan: Best & Worst Diets, Q&A Part 4 Fad Diets

On January 24, 2014 | At 9:08 am

Which are worth trying, which will prove a wash?

Gluten-free foods are gaining popularity.

Gluten-free foods are gaining popularity. But are they really healthy for everyone?

In this fourth installment of our Fad Diet Q&A series, UVA nutritionists Carole Havrila and Katherine Basbaum make their picks for best and worst diets on the popular market.

Q. What about the diets that got top ratings in a recent US News & World Report article: DASH, TLC diet, Mayo Clinic, Weight Watchers, Flexitarian, Volumetrics, Biggest Loser, Ornish, Engine 2, Flat Belly diet, Abs diet?

Havrila: I believe that these diets mentioned do work and can work if followed, and the calories are not severely limited (below 1200 calories for women and 1500 for men). The DASH diet, Mayo Clinic, Weight Watchers, Flexitarian, Volumetrics and vegan/vegetarian diets are all reasonable diets that work successfully when followed. Vegan diets require planning to make sure that important nutrients are included but are healthy diets in general.

Basbaum: For the fourth year in a row — when taking into consideration ease of use, nutrition, safety, effectiveness for weight loss and protection against diabetes and heart disease — US News & World Report has named the DASH diet as the best overall diet for 2014. Why? Because it’s smart, balanced, realistic, tried and true.

 Q. What fad diet makes you cringe the most?

Havrila: Detox diets that advocate large amounts of dietary supplements in addition to restrictive diets and enemas or other detoxification methods. These could potentially be dangerous to those on prescription medications and/or having cancer treatment.

Basbaum: Definitely the gluten-free craze that has been happening for the past couple of years. If you have a genuine, medically diagnosed intolerance to gluten, or if you have celiac disease, then a gluten-free diet is warranted. But as a weight-loss tool, it’s potentially dangerous and may even cause weight gain if you don’t do it right.

Next Up: Sleep, Belly Fat, and Making Weight-Loss Last, Fad Diets Q&A Part 5