Dear Doctor: Apparently one size does not fit all when it comes to the Mediterranean diet, because a recent study found that rich people benefit from it and poor people don't. It can't be as simple as that. What gives?

Dear Reader: We confess that after reading several of the news reports generated by the release of this study, we were tempted to write our own headlines. The gist would be: "Let's Ignore Significant Details So We Can Come to Flawed But Provocative Conclusions!"

It's true that the researchers did find a link between income and the health outcomes of the subjects of their study who followed the Mediterranean diet. Specifically, individuals with more money reaped measurable health benefits, and those who had less money did not. But as you suggest, the how and why of these results is more nuanced than simply rich versus poor.

Whether it set out to or not, this study adds to a body of research that examines how economics and education affect our health. People with lower income levels not only have less money to spend on food, but they also have fewer options when it comes to shopping. It's an important topic that the National Institutes of Health classifies as environmental justice. But let's pull back a bit and get to the details of the study at hand.

First, the Mediterranean diet. It cuts out refined and processed foods, unhealthy fats and limits sugar. Instead, the emphasis is on a variety of fresh fruits and vegetables, leafy greens, nuts, legumes, unrefined grains and cereals, olive oil, and modest consumption of fish, lean meat and dairy products. Past studies have tied the diet to improved cardiovascular health, lower cancer risk and increased longevity. So when researchers in Italy analyzed four years of self-reported dietary data from 19,000 women and men, they weren't surprised that those who followed the Mediterranean diet had a lower incidence of heart problems.

But there was a catch. After the participants were further sorted according to levels of income and education, the benefits of the diet were not universal. People with lower income levels didn't show a reduction in cardiovascular risk. Digging deeper, the researchers learned that while everyone in the study adhered to the basic principles of the Mediterranean diet, when it came to the specific foods being eaten, marked differences emerged. That's where education -- yet another interesting twist -- comes in.

According to the study, participants with more education ate the widest range of fruits and vegetables. Individuals with higher income levels ate the most nuts, whole grains, fresh fruits and fish. The diets of those on the lower end of the education and income scale included more meat, less fish, less variety in fruit and vegetable choices, and cooking methods that were less healthful.

The authors acknowledge the pitfalls of drawing conclusions from studies with self-reported data. At the very least, when it comes to the health outcomes of the Mediterranean diet, we've learned that details matter. And in the bigger picture, the differences in income and education meant everyone in the study wasn't on the same diet after all.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I have been plagued with clear nasal drip for a couple of years. The constant dripping is most prevalent when I eat, lift something heavy or even just get up from a chair. I have tried various antihistamines and nasal sprays. What else is there?

Dear Reader: First, let's look at the root of your problem: rhinitis, the inflammation of the mucous membranes within the nose. This common condition, which can cause nasal congestion, runny nose and post-nasal drip (the symptom you describe), affects 10 to 40 percent of the population in industrialized countries.

People may think that allergies are the cause of their symptoms, but chronic nonallergic rhinitis is the cause a third of the time. Notably, although people with allergic rhinitis often have a history of congestion before the age of 20, 70 percent of those with nonallergic rhinitis have no nasal symptoms until after age 20.

Many doctors, including myself, previously referred to the condition as autonomic rhinitis because of its connection to the autonomic nerves that go to the nose. These nerves can become hyper-responsive, leading to nasal congestion and runny nose upon exposure to environmental stimuli, such as changes in temperature, especially cold temperatures. Autonomic nerves can also cause nasal symptoms when a person eats spicy foods, consumes hot foods or drinks, exercises, lifts heavy objects or simply changes position.

But the autonomic nerves may not be the only factor at play. An inflammatory response can also occur with nonallergic rhinitis, caused by white blood cells that become active in response to chemical irritants like cigarette smoke, perfume, cologne, scented products and pollution. This inflammatory response can compound the autonomic response; it could also potentially be the root cause of your post-nasal drip.

The first aspect of treating nonallergic rhinitis is to rule out an allergy or specific environmental stimulus. The second step is to assess the use of nasal decongestants, such as Afrin or Sudafed. Chronic use of these medications by tablet or spray can cause a rebound of congestion when the medication is stopped. Heartburn, or acid reflux, also should be addressed because it can lead to rhinitis as well.

As for treatment, the oral antihistamines often used to treat allergies may not be helpful against nonallergic rhinitis, because allergies aren't the cause. Nasal antihistamines have shown benefit in treating nonallergic rhinitis, however. So too have nasal steroids, which decrease the inflammation in the nose. The latter drugs need to be used for more than a week to show an effect, however, and some doctors are concerned about longer-term use.

It seems likely you have an autonomic component to your symptoms. If so, talk to your doctor about ipratropium nasal spray (Atrovent). It blocks nerve receptors in the nose that are part of the autonomic nervous system. Your doctor may recommend its use before eating, before heavy exercise and, if necessary, before exposure to cold and dry conditions. If that doesn't work, a nasal steroid and possibly a nasal histamine are other options.

Some patients with nonallergic rhinitis may eventually develop allergies and even asthma, so please follow up with your doctor if your symptoms worsen.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Please tell me more about the recent story in the news about the young woman who spent time on a ranch and then found worms living inside her eyes. We are cattle ranchers, and now I'm worried about my husband and kids.

Dear Reader: You're correct -- a 26-year-old woman from Oregon discovered that she was infected with Thelazia gulosa, a parasite commonly known as the cattle eye worm. Dogs and other canids, cattle and horses are the most common hosts. We hope that you'll be reassured to learn that this is the first reported case of infestation of the cattle eye worm in a human host.

For those of you who missed the (fairly robust) media coverage of the story, here's the gist. In 2016, a young woman who was working on a commercial fishing boat in Alaska thought she felt an eyelash in her eye. Although she rubbed her eye and flushed it with water, the scratchy, itchy sensation persisted. After a moment of looking in a mirror, she finally saw something above the lower lid of her left eye and lifted it out. Instead of one of her own brown lashes, she was looking at a slender white thread about a half-inch long -- a living worm.

She went to an urgent care clinic and an ophthalmologist before seeing an infectious disease specialist. A team of parasitologists at the Centers for Disease Control and Prevention eventually nailed the diagnosis. In all, a total of 14 worms were removed from the young woman's eye. It was by reading a research paper written in Germany in 1928 that a scientist from the CDC's Parasitology Reference Diagnostic Laboratory finally identified the cattle eye worm.

So how did this happen?

Infestations of Thelazia, a genus of nematode worms that live as parasites in the eye and its surrounding tissue, are most commonly seen in animals and birds. Their spread to humans is extremely rare. In fact, just 10 other cases of eye worm infestation have ever been reported in North America. The most recent case in the United States was reported more than two decades ago. None of those 10 cases involved the cattle eye worm.

Although it's impossible to know for sure, the thinking is that the young woman may have picked up the parasite while spending time at an inactive cattle ranch. The worms are carried by the flies that you see buzzing around the faces of cattle and horses. The worm larvae, which reach maturity inside the digestive tracts of the flies, move to their next host when the fly lands on the cow's eyeball to drink. There, the eye worm grows to adulthood and produces more larvae, which are then picked up by new flies.

The good news is that because eye worms need the flies to reach maturity, their life cycle ends in a human host. With those 14 worms removed from her eyes, the young woman's infestation was over. No permanent damage was done.

As for the rest of us, even if we spend time near cattle or horses, the chances of picking up the parasite are extremely small. Be sure to keep flies away from your face and eyes, and if one lands, remove it promptly.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)