Dear Doctors: I am beginning to have problems with anxiety, and recently I had trouble catching my breath. My sister says that’s one of the things that happens in a panic attack. She talked to me about the “333 rule,” and I wonder if you think it can help?

Dear Reader: Anxiety is a normal response to the stresses and challenges of daily life. Everyone is likely to experience some on any given day. Brief and moderate bouts of anxiety can have the benefit of keeping you alert and focused, ready to respond to a challenge. When anxiety becomes persistent, dread, nervousness and fear can overwhelm you and interfere with daily life.

The 333 rule your sister recommended is a coping strategy rooted in the practice of mindfulness. It focuses on easy and immediately available techniques to center and ground you. People who practice the 333 rule say it helps calm their mind and emotions and provides a solid platform to ride out an episode of anxiety.

First, you look around and name three nearby objects. Take your time. Notice the height, heft, color, texture and intended purpose of each. It can be a person, an object, even a leaf or pebble on the ground. Next, notice three things you can feel or touch, maybe something you’re wearing or holding, the sensation of a breeze or the surface you are sitting or standing on. Finally, close your eyes and identify three sounds, such as footsteps, voices, birdsong or traffic. You can also add gentle deep breathing to your 333 practice.

Each step of the 333 technique can help shift your focus from the physical and emotional distress of an episode of acute anxiety. It uses the senses to pull you out of the interior spiral of anxiety and orient you outward into your immediate environment. Other practices that have been shown to help reduce and manage anxiety include meditation, deep breathing and meditative physical exercises like tai chi, qigong and yoga. Research shows that regular aerobic exercise, such as running or dancing, can ease the intensity and frequency of episodes of anxiety. Weightlifting has also been found to be beneficial.

When anxiety becomes frequent or severe, or if it begins to interfere with the tasks and pleasures of daily life, we think it’s a good idea to check in with a medical care provider. Persistent symptoms can be a sign of an anxiety disorder that may need a more thorough and far-reaching treatment strategy. This can include lifestyle changes, therapy and, in some cases, medication. Over time, anxiety can take both an emotional and physical toll. Seeking support is an important part of personal health care.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: My blood pressure is on the edge of the normal range. My doctor wants me to think about something called the DASH diet. What is that? I want to stay healthy, but I know myself: If I can’t have a diet that is enjoyable, I’m not going to be able to stick with it for long.

Dear Reader: Here in the United States, high blood pressure is common and a serious health concern. Data shared with the Centers for Disease Control and Prevention show that close to half of all adults -- and even some children -- are living with chronic elevated blood pressure. When this goes untreated, it can cause damage to the heart muscle, circulatory system and kidneys.

Persistent high blood pressure puts the person at increased risk of having a heart attack or stroke. It can damage blood vessels in the eyes and lead to vision loss, play a role in sexual dysfunction and contribute to cognitive decline.

The DASH diet that your doctor has recommended dates to 1997, when the results of a clinical trial into its principles were published in the New England Journal of Medicine. The name is an acronym of Dietary Approaches to Stop Hypertension. The study’s authors wanted to measure how varying amounts of fresh fruits and vegetables in someone’s daily diet would affect their blood pressure.

They found that the group of study participants who ate four or five daily servings of fruit, plus four or five servings of vegetables, saw the most significant improvements to blood pressure. The DASH diet also includes several servings per day of whole grains, lean proteins and healthful fats. More than two dozen follow-up studies into this approach to eating have confirmed the original findings.

The DASH diet study was not designed to pinpoint why it improves blood pressure. However, potassium, an electrolyte that helps keep the walls of blood vessels relaxed and pliable, is widely believed to be a driver behind the impressive results.

Potassium and sodium work together to maintain fluid balance in the body. This, in turn, influences blood pressure. The optimal ratio of the two electrolytes is about three parts potassium to one part sodium.

However, the typical American diet, so heavy in sodium, often delivers the reverse. While dietary sodium has long been the focus of blood pressure management, recent research suggests the sodium-potassium ratio is more important.

With its abundance of fruits and vegetables -- many of which are rich in potassium -- the DASH diet provides an abundant supply of this crucial nutrient. People who follow the diet also get the recommended amount of fiber per day, which helps nourish the trillions of microbes in the gut. The eating plan also includes a daily sweet treat.

In recommending the DASH diet, your doctor is offering you a drug-free path that can help you gain control of your blood pressure numbers. We hope you, and perhaps some of our readers with blood pressure issues, will consider giving it a try.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Kansas City, MO 64106; 816-581-7500

Hello, dear readers, and welcome to our monthly letters column. With lengthening days and warming weather, outdoor activities beckon.

Please remember to protect yourselves from the sun, whether with sunscreen, UPF clothing or, ideally, both. Tick protection is also important when you’re venturing into the great outdoors, as the data show tick-borne illnesses are still on the rise. We’ll have a column on the topic soon. Now, on to your letters.

-- Speaking of being outdoors, we have written several columns about the mental health benefits of spending time in the natural world. We recently received a question on the topic from a reader in the Chicago area: “Do you get the same good results from being in nature if you’re on the phone the whole time?” he asked. “My brother says he wants to de-stress -- but whenever he’s hiking, he’s always wearing a headset and making or getting phone calls.”

Research has found that the sights, sounds, scents and physical sensations of being outdoors can lower cortisol and increase serotonin, each of which can help us feel better. If you’re on the phone, your awareness of these is at best diminished or, at worst, eclipsed.

Your brother’s headset habit doesn’t interfere with the physical gains of the hiking he does. However, it can create a barrier between him and the natural world, and thus diminish, if not erase, the mental health benefits.

-- A recent column discussed dandruff, a common skin condition that causes scalp flakes to develop and shed. This prompted a question from a concerned reader: “I’ve been seeing someone who has really bad dandruff and doesn’t seem to be doing anything about it,” they wrote. “The thing I’m worried about is if it’s contagious. Am I going to get dandruff if we sleep on the same pillow?”

Dandruff can be caused by dry or inflamed skin, contact dermatitis or chronic skin conditions such as psoriasis or eczema. Most often it is caused by an overgrowth of a yeastlike fungus. This fungus is naturally present in the scalp, but in some individuals, it leads to an overgrowth of skin cells and results in the flakes we know as dandruff. You will be happy to know that the condition is not contagious.

-- We continue to get letters asking for another update to the clinical trial exploring the use of stem cells in the management of Type 1 diabetes. The initial phase of the trial was quite small, with just 17 participants. However, the early results, in which several participants ceased needing injected insulin, hinted at a possible breakthrough.

A new phase of the study has been completed, and we will be back soon with a column on it. We’ll discuss the results, explore the promises and explain the potential dangers of the treatment.

Thank you to everyone who has taken the time to write. We love hearing from you. If it occurs to you, please include your city or state or region in your letter. We really enjoy knowing where you are writing from.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Kansas City, MO 64106; 816-581-7500