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The information presented here is of a general nature, and is intended for educational and entertainment purposes only. It is not meant to diagnose, prescribe for, or treat any illness or health condition. This website does not provide specific medical advice for individuals, and it is not a substitute for the guidance of licensed healthcare providers and the personal care that they are able to provide. No content on this site, regardless of its date, should ever be used as a substitute for the personalized medical advice that can only be provided by your own doctor and other qualified professionals.
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May 3, 2024
Enjoy the Lull
Recent CDC data shows that covid-related hospital admissions have reached an all-time low of 5,615 per week. As of May 1, the CDC mandate expires, and hospitals will no longer be required to report data on admissions, occupancy, and other indicators of possible healthcare system stress caused by respiratory infections. This marks a turning point in the government’s real-time tracking of airborne pathogens.
More immune-evasive and potentially more dangerous mutations of the SARS-CoV-2 virus keep emerging. Influenza season isn’t over, measles is on the rise, and the H5N1 bird flu is spreading to mammals, including humans. Epidemiologists are now concerned about H5N1 mutations that might enable human-to-human transmission.
The new KP.2 coronavirus variant shows more than three times the resistance to being neutralized by antibodies produced by the monovalent XBB.1.5 vaccine. Initial testing suggests that the increased immune resistance ability of KP.2 is partially contributing to its rapid spread in multiple regions. KP.2 and its related “FLiRT” variants now account for more than a quarter of all new U.S. infections.
Over the winter, JN.1 spread globally and was responsible for 95 percent of new COVID-19 cases in the U.S. There is compelling evidence that the latest booster did not give good protection against JN.1 infection, but did reduce its severity. Wastewater levels of SARS-CoV-2 have recently shown an increase, pointing toward an upcoming summer surge. To avoid becoming infected, masking is still your best protection, and boosters can help to prevent the worst complications.
It is now recommended that all persons aged ≥65 years receive an additional dose of an updated COVID-19 vaccine, administered ≥4 months after the previous dose of an updated COVID-19 vaccine. Those who are moderately or severely immunocompromised should receive an additional updated COVID-19 vaccine dose ≥2 months after the last dose of updated vaccine. Further additional doses may be administered, as determined by the person’s healthcare provider.
Supplements
Maybe you, like most busy Americans, don’t eat as healthy a diet as you should. Perhaps you are older, and despite a relentless pursuit of better health and greater longevity, you aren’t absorbing the nutrients in your food as well as you did when you were younger.
Taking a few nutritional supplements can be a way to cover your bases. Although not nearly as good as the broad array of vitamins and minerals that you’d get from a balanced diet, they are certainly better than nothing. Here are the nutritional supplements recommended for most healthy adults:
Your need for calcium is 1,200 mg per day up to the age of 50, when it increases to 1,500 mg/day. Calcium citrate is recommended for best absorption. Post-menopausal women are at the highest risk of getting osteoporosis, so calcium supplements are especially important for them. As with any supplement, check to make sure they have USP certification for purity and potency.
Vitamin D3 goes hand-in-hand with calcium, since it is necessary for calcium absorption. It also has anti-inflammatory, antioxidant, immune enhancement, and neuroprotective properties. Although our bodies can make vitamin D when our skin is exposed to sunlight, UV damage and an increased risk of skin cancer tilt the scales in favor of supplements. Before age 70, your daily requirement is 600 IU a day. After 70, it goes up to 800 IU.
Women over the age of 30 should be getting 320 mg a day of magnesium, and men 420 mg a day of magnesium, preferably in a more easily absorbed form, such as magnesium citrate, lactate, or glycinate. Magnesium carbonate is the least bioavailable form.
People over age 50 could have a problem absorbing enough vitamin B12, and vegetarians may not get enough of it from their diet. It would be a good idea to take a daily B12 tablet as 500 mcg of cyanocobalamin. It is available as an injection for those with a chronic B12 deficiency.
In addition to the above, taking a USP-certified multivitamin daily won’t hurt, and could be good insurance. Talk to your doctor to see if there are any other nutritional supplements recommended for your specific health needs. The NIH has hundreds of fact sheets covering almost everything that people take as supplements.
The Sweet Life
For years, I have been trying to convince people that while fiber is their friend, the fructose that’s found in table sugar and other sources of sucrose, and in high fructose corn syrup (HFCS), is their foe. Fructose, in excessive amounts, without accompanying fiber to slow its assimilation, is our mortal enemy! The reason is that biochemical reactions produce toxic by-products when fructose cannot be fully metabolized by the liver if it is presented with too much in too short a time.
The damage done by fructose is widespread and includes the brain. According to a recent study, eating too much sugar in the form of fructose and sucrose more than doubles one’s risk for dementia. If you value your brain, you will want to avoid candies, pastries, and sweetened beverages. Research suggests that blood sugar spikes and high insulin levels from the consumption of sugars and other simple carbohydrates contribute to the risk of developing Alzheimer’s disease.
Fructose acts upon the body somewhat like alcohol. It’s a poison, but comes without the buzz that so many regular drinkers seem to enjoy, despite it being detrimental. Fructose is known as the sweetest poison, yet in a cruel ironic twist, natural selection has endowed our species with a craving for sweets that can become obsessive, or even rise to the level of an addiction. If you must have a daily dose of ice cream, please get professional help.
An innate craving for sweets enhanced our survival in the calorie-sparse environment of prehistoric times, but today it has become a killer. With the present abundance of sweets, the challenge for our species is how to satisfy our craving while doing the least amount of harm to our bodies. That’s where natural sugar substitutes come to our rescue. Considering factors such as taste, calories, and glycemic impacts, our three best choices are stevia, monk fruit and erythritol.
All three are generally recognized as safe by the FDA when consumed in “moderate amounts,” whatever that means. They are all calorie-free, and do not raise blood sugar levels, so they are a good option for people with diabetes and anyone who wisely wants to reduce their sugar intake. However, some non-sugar sweeteners are blended with other ingredients, such as inulin or dextrose. These ingredients can add calories or raise blood sugar levels, so as always, be sure to read the ingredients labels carefully.
Stevia glycosides are extracted from the leaves of a plant (Stevia rebaudiana) that’s native to the southern Amazon rainforest. It is the most studied of the natural sweeteners, with strong evidence that it is safe to use as a sugar substitute. A recent study has shown that regular consumption of stevia does not alter the composition of the human gut microbiome. Stevia is available in a powdered form that is 250–300 times sweeter than cane and beet sugar, so a little bit goes a long way.
There is a minor downside to stevia, similar to the genetically determined aversion to the soapy taste of an aldehyde found in cilantro. Some people are predisposed by their DNA to experience a bitter aftertaste, or to perceive the taste of licorice whenever stevia meets their tongue. For some, that may be a small price to pay for better health, while for others it may be intolerable.
Monk fruit is a more recent arrival on the natural sweeteners market, with few studies of its long-term safety. The extract comes from the dried gourds of vines (Siraitia grosvenorii) that are native to southern China. It is generally well tolerated by the gastrointestinal tract, and does not have an aftertaste. It is sold as a white, odorless powder that is typically 100-250 times sweeter than table sugar.
Erythritol is a sugar alcohol that occurs naturally in some fruits and is commercially produced by fermentation. It is only about 70 percent as sweet as table sugar, so more of it is necessary to produce equivalent sweetness. Unlike some other sugar alcohols, erythritol does not cause digestive problems. However, a recent study found an association between high blood levels of erythritol and blood clots causing heart attacks and strokes. This study has been criticized, and more research will be necessary to determine erythritol’s safety.
Other natural sweeteners include allulose, a sugar found in fruits such as figs and raisins. Its taste is very similar to that of sugar, while it is almost calorie-free and has a minimal glycemic effect. Yacon syrup, made from the tubers of a Peruvian jicama plant (Smallanthus sonchifolius), is light brown in color and has a consistency similar to molasses. It contains a fructosan that isn’t digested, and consequently has a low glycemic index. It causes digestive problems in about a third of the people who use it. It is higher in calories than the other natural sweeteners.
When it comes to the industrially produced chemicals known as artificial sweeteners, such as aspartame (Equal, NutraSweet), sucralose (Splenda), saccharin (Sweet’N Low), and acesulfame (Sweet One), they all could have an adverse impact upon the gut microbiome, and could lead to an increased craving for sugar. Neotame (Newtame) has been linked to intestinal damage and IBS. I recommend avoiding all artificial sweeteners. Their presence as an ingredient is a clue to foods that are ultra-processed and unhealthy.
The American Diabetes Association (ADA) recently settled a lawsuit that took them to task for promoting 203 recipes on their website that include the artificial sweetener Splenda, despite research published in the ADA’s own scientific journal showing that the use of artificial sweeteners can increase people’s risk for type 2 diabetes. The complaint alleged a conflict of interest due to the ADA receiving a million dollars from the manufacturer of Splenda.
According to the complaint, “The defendant’s conduct shows that they were party to a scheme to defraud the American people by approving and endorsing recipes submitted by Splenda to be lauded by the ADA as a healthy choice for people with diabetes, when the ADA knew that those recipes were contrary to the ADA’s guidelines and well-established and emerging scientific principles.” This is another sad example of the corrupting influence of money on America’s most trusted institutions.
My recommendation: If you can’t overcome your craving for sweets, and find the taste of stevia acceptable, use it in place of sugar, but sparingly. Some things just have to be sweetened, such as plain cocoa powder used for hot chocolate, or lemon juice when making lemonade. A little bit of stevia nicely solves the too bitter or sour problem. Even people who have genes that make them stevia-shy might find it useful in these specific situations.
There are over 200 stevia brands and formulations on the market, and they vary as to which steviol glycoside(s) they contain, as well as what fillers are employed. Some forms of stevia are derived from the leaf extracts, while other forms going under the name of stevia are entirely synthetic. There is a buyers’ guide to help cut through the confusion.
NOW Foods Organic BetterStevia gets high marks for being a pure stevia leaf extract. It doesn’t contain any bulking fillers such as maltodextrin or other sweeteners such as erythritol or allulose. It is among the better tasting stevia extracts because it contains a broad variety of steviol glycosides, including rebaudiosides M and D. It’s cost per ounce is quite low when purchased in the larger quantities.
A new study compared what happens to the brains of mice when they are fed various sugar substitutes. The results suggest that stevia could be the most brain-compatible replacement for sucrose. The next step will be to study the human brain’s response to different sweeteners using functional magnetic resonance imaging (fMRI). If your taste buds or brain won’t embrace stevia, then give monk fruit extract a try.
Baking Fructose Free
Fructose consumption increases the risk for obesity and dyslipidemia (high cholesterol and triglycerides), and contributes to the development of hypertension and cardiovascular disease. Honey, maple syrup, agave syrup, molasses, golden syrup, and corn syrup are all high in fructose, and should therefore be avoided. In order to eliminate fructose from your diet as much as possible, you will want to stop using fructose-containing sugar for baking.
Sugar, also known as sucrose, is a disaccharide molecule that’s half fructose and half glucose. It is much healthier to use only glucose, in the form of dextrose monohydrate powder, as a sugar substitute in almost all of your baking, as long as you don’t have diabetes or an elevated hemoglobin A1c. For doughs that require yeast, glucose is necessary for the chemical reaction that produces the carbon dioxide that makes the dough rise.
Glucose is produced in nature by chlorophyll-containing plants that employ the biochemical process of photosynthesis; water and carbon dioxide are combined in a reaction that’s driven by the energy of sunlight. Every cell in our body requires energy, and that energy mainly comes from the metabolism of glucose when it is converted back to carbon dioxide and water. In a very real sense, our bodies, made of stardust, run on starlight.
The only downside to consuming glucose is when we absorb too much over too short a period of time. That results in blood sugar and insulin spikes that can put a strain on the pancreas and contribute to the development of type 2 diabetes. Dietary fiber and protein can help to slow the intestinal absorption of glucose, so take that into consideration in your recipes and meal planning. People who have diabetes should avoid glucose as well as sucrose.
Sucrose (table sugar, confectioner’s sugar, brown sugar, etc.) is extracted from sugar cane and sugar beets, while dextrose is made by the hydrolysis of corn starch. If you are addicted to sugar, dextrose will not taste as sweet because the fructose in sucrose is super-sweet. The upside to dextrose is that with about 20 percent less sweetness, the taste of the other ingredients such as vanilla will come through a lot better when using it.
When baking with dough that uses yeast, dextrose will work better than sucrose. That’s because the yeast will readily metabolize glucose and produce carbon dioxide, which causes the dough to rise. If you’re using a bread-maker, put the yeast on the bottom, then the dextrose powder, then the flour. The “quick-bake” setting may be preferable when making bread with dextrose.
If a recipe calls for 1 cup of granulated sugar, then use 1 cup of powdered dextrose instead. However, if a recipe goes by weights, it becomes a little more complicated. A cup of sugar weighs approximately 250 grams, while a cup of dextrose powder weighs approximately 180 grams. So, you will need to multiply the sugar weight by 0.72 to calculate the equivalent weight of dextrose.
Some recipe adjustments will need to be made because dextrose powder will soak up more liquid than granulated sugar. If you don’t want your baked goods to be too dry, you will need to use 10-12% more butter, oil, water, milk, yogurt, etc. than the recipe requires You will also want to use larger eggs.
Baked goods made with dextrose will be done sooner. You will want to turn down the oven to a slightly lower temperature (about 10°C/18°F less), and keep an eye on things as they get close to being done.
April 23, 2024
Seniors and Sex
Sexual activity can be a beneficial pastime for older adults, contributing to their physical and emotional health and sense of wellbeing. Studies suggest that sexual activity may be linked to a reduced risk of health problems such as heart disease, some cancers, and possibly dementia. Sex has also been shown to boost immune system activity in ways that can reduce inflammation and fend off infections.
Engaging in sex can provide aerobic exercise and release chemical neurotransmitters such as beta-endorphins, dopamine, and oxytocin, that relieve pain, improve mood, reduce stress, and contribute to emotional bonding, thereby strengthening feelings of intimacy and connection with one’s partner. Sex can also contribute to a better body image and improve our self-esteem, especially when attitudes towards one’s own body tend to become less positive as we age.
Despite a widespread social stigma against sexuality in later life, especially for those who identify as LGBTQ, a growing body of evidence shows that sexual pleasure is integral to broader physical and mental health. Sexual pleasure can produce overall improvements in wellbeing, while declining sexual activity is associated with higher rates of anxiety and depression. Among older adults, there is a linear relationship between the amount of sexual activity and feeling well and contented with life.
According to the National Institute on Aging, “Many older couples find greater satisfaction in their sex lives than they did when they were younger. They may have fewer distractions, more time and privacy, and no worries about getting pregnant. They also may be better able to express what they want and need, which can offer an opportunity for greater intimacy and connection.”
Loss of interest in sex as one ages may be due to lower levels of estrogen or testosterone. It can also be caused by psychological issues or problems with the relationship, and people are never too old to benefit from counseling. Common obstacles to sexual pleasure such as arthritic pain, impotence (erectile dysfunction), and vaginal dryness or atrophy causing painful intercourse (dyspareunia), can be addressed medically. If advanced cardiovascular disease does not increase the risk, physicians should encourage their senior patients to remain sexually active.
Many, if not most adults aged 65 years and older, continue to engage in sexual activities, or would like to do so. According to surveys, at least 10 percent of men and women over 90 years old are still sexually active. Despite a decline in sexual functioning, relationship satisfaction and feelings of sexual wellbeing can be maintained throughout old age, especially when the sexual connection involves emotional closeness and mutual support.
Sexual urges in older adults are adversely impacted by a broad range of psychosocial factors, including unfounded beliefs about growing older that can morph into self-fulfilling prophecies. There are also pernicious religious doctrines that extol celibacy and warp the human spirit by instilling negative beliefs about recreational sex.
Cultures with prohibitions against sex outside of marriage, and sexually repressive religions that consider sex sinful, add to an already ample burden of human misery. Not only do they abrogate women’s autonomy over their own bodies, as the religiously devout member of SCOTUS have recently accomplished, these religions also create permanently damaging scars in the impressionable minds of children about sex, while engendering priesthoods in which pedophiles are able to run rampant.
In those cultures where extramarital sex by women is treated as a criminal offense, we find the most vile aspects of human behavior. They have dress codes for women that are enforced by brutal morality police, sex trafficking and sexual slavery, polygyny, honor killings, and the most perverse practice of all, the grooming of young suicide martyrs who believe their reward will be a harem of virgins in the afterlife.
There are, of course, reasonable precautions that should be taken when it comes to sex, especially in non-monogamous relationships. Cheating is always a risky business, regardless of one’s age. The rate of sexually transmitted infections has been increasing among seniors, as well as in the overall population. The medical guidance for safe sex still applies to the older generation, and comes with an added caveat: If you’re past the age of 50, your partner should know how to perform CPR.
Staff biases about senior sexuality can reduce tolerance of sexual activity in long-term healthcare and assisted living facilities. Although the prevalence of sexual dysfunction increases with age, and cognitive impairment can reduce both the frequency of and the satisfaction derived from sexual activity, surveys of sexual satisfaction reveal that only a small minority of seniors report experiencing any significant sexual distress.
Older adults are able to remain joyfully active sexually well into their later life, and their children and grandchildren need to stop cringing about it. Couples need not be married, either formally or under common law, in order to have a mutually satisfying relationship, whether or not they cohabitate. Despite a couple’s best efforts, marriage continues to be the leading cause of divorce.
In fact, some married couples will choose to divorce when faced with the possibility of one spouse’s long-term disability. That’s because, for married couples, nearly all of their combined assets must be depleted before the disabled person is eligible for medical assistance and long-term care through Medicaid. By not being married, at least one person is able to protect their assets. If you are married and older, I suggest that you seek legal advice regarding this matter, and learn what is most appropriate for your situation.
As people age, the youthful notion of sex being about penetrative intercourse tends to evolve into an intimacy-based, partner-centered activity. Seniors tend to have an increased enjoyment of sexual fondling and a greater concern for their partner’s pleasure, along with a willingness to engage in more varied expressions of physical and emotional intimacy. There is also a greater congruity between women’s and men’s understandings of what contributes to satisfying sex in later life.
It is therefore important for all of us to recognize, accept, and affirm that for a great many older adults, their sexuality is an essential component for enjoying a high quality of life.
April 18, 2024
Why We Aren’t Carnivores
A new study has found an association between eating red meat and an increased risk of kidney disease due to high levels of Trimethylamine N-oxide (TMAO) in the blood. TMAO is a gut microbiota-derived metabolite of dietary phosphatidylcholine and carnitine, which are found in significant quantities in red meat. Higher TMAO levels have been associated with a more rapid decline in kidney function as people age. This is one instance of our modern gut microbiome working against when fed the wrong kind of food.
Although our early human ancestors were apex predators and likely ate a lot of red meat, over the last two million years we’ve inherited genes that enable our bodies to derive nutritional benefits from a broad range of food sources. It was only with the acquisition of fire, a relatively recent occurrence in the evolutionary time scale, that early humans were able to obtain substantial quantities of essential amino acids from their diet by cooking their meat. Humans lack the key genetic adaptations, found in strictly carnivorous mammals, that are responsible for the synthesis of enzymes necessary for digesting specific animal proteins and bones.
Our DNA determines our omnivorous nature. Our survival requires the intake of essential vitamins and minerals, only some of which can be obtained from plants, while others are only available from animal sources. Vegetarians and vegans risk iron, zinc, calcium, vitamin B12, and vitamin D deficiencies. Vitamin C (ascorbic acid), which is only found in plants, is a necessary cofactor for 15 important enzymes. Studies show that vitamin C cannot be synthesized by humans because of a genetic mutation that occurred in anthropoid primates about 61 million years ago.
For optimum health, adult humans need to consume at least 25 grams of dietary fiber every day, which can only be found in plants. High fiber foods include legumes, whole grains, nuts, seeds, and the skins of vegetables. The lesson here is that modern humans are generally healthier when they consume a diverse diet that is heavily skewed toward whole, natural, plant-based foods.
Gut Feelings
Our intestinal microbiome, an enormous commensal population rivaling the number of cells in our bodies, continues to make medical headlines. Recent studies have uncovered relationships between the composition of our gut microbiome and the functioning of our liver, kidney, muscle, and brain. Chemical communication between our microbe and our cells seems to also play a role in hunger, satiety, and the development of obesity.
Consequently, we are advised to be kind to our microbiome. Our diet plays a major role in its composition and how it works on our behalf. Our beneficial intestinal passengers thrive upon high-fiber, plant-based foods, such as whole grains, seeds, tree nuts, and legumes.
While no official definition exists for high-fiber foods, some experts suggest applying it to foods containing at least 5 grams of dietary fiber per serving. Because such foods can also be high in total carbohydrates, it is important to consider a food’s fiber density. Prioritize high-fiber foods that have at least one gram of dietary fiber for every five grams of total carbohydrates, or several grams of fiber per 100 calories. For most processed foods, aim for a fiber content that is close to or higher than the carbohydrate content.
Our gut microbiome welcomes the company of probiotic bacteria found in fermented foods such as yogurt, kefir, sauerkraut, and kimchi. On the other hand, you will want to avoid foods that can adversely impact your intestinal flora, such as sugars (especially fructose), artificial sweeteners, refined carbohydrates like white flour, saturated and trans fats, red meat, ultra-processed foods (especially those containing preservatives or emulsifiers), and toxins such as alcohol.
People differ in the kinds of resident microbes living in and on their bodies. The trillions of microorganisms in the human gastrointestinal tract influence digestion and overall health. Populations of harmful gut microbes have been associated with increased risks for illnesses such as type 2 diabetes, liver disease, cancer, autoimmune diseases, and cardiovascular disease. As important as they now seem, there are still many unknowns regarding the exact mechanisms involved in their relationships to health and illness.
In a new study, researchers identified several species of bacteria whose populations had an influence upon cholesterol, triglyceride, and blood glucose levels. Higher populations of Oscillibacter sp. were strongly associated with lower levels of LDL (“bad”) cholesterol. The organism’s impact on cholesterol levels appears due to the presence of bacterial enzymes that break down cholesterol in the intestine.
In a Pickle
Cucumbers are thought to have originated in India in the Himalayan foothills. Archeologists and anthropologists believe that the ancient Mesopotamians employed pickling practices around 2400 BCE, from a necessity to preserve food. Pickling likely developed independently in multiple regions around the world. There is evidence that people living in the Tigris Valley, now in present-day Iraq, were pickling cucumbers brought from India around 2030 BCE.
National Pickle Day is celebrated on November 14, but you can enjoy the prickly-sour taste of pickled cucumbers, gherkins, and cornichons any day of the year. Commercially made pickled fruits and vegetables are produced either by fermentation in a salt-water solution or by soaking them in a vinegar solution. Only fermented, unpasteurized pickles can bestow probiotic benefits via the gut microbiome.
Jars of vinegar-pickled cukes found on grocery store shelves usually contain preservatives such as polysorbate 80 and sodium benzoate, both of which should be avoided if you want to maintain an amiable relationship with your gut microbiome. However, vinegar pickling is really easy to do at home, and does not come with the downside of adding copious amounts of sodium to a person’s diet the way that brine pickling does. Simply make a 1:1 vinegar to water solution, using a pasteurized vinegar with at least a five percent acetic acid content.
The upside of pickling with brine is that lacto-fermentation involves the proliferation of beneficial bacteria, while vinegar pickling kills gut-healthy bacteria and prevents fermentation from taking place. Unfortunately, there are very few brands of commercially produced fermented pickles (kept in the store’s refrigerated case) that will actually contain live, active cultures of probiotic bacteria, so check their ingredients labels carefully.
Fermented pickle aficionados may need to do a lot of sweating to get rid of their excess salt, but vigorous exercise and saunas are good for you. The trade-off is that fermented vegetables can contribute to a health-promoting diversity in the composition of the human intestinal flora.
There are lots of vegetables that can be lacto-fermented, such as beets, cabbage, carrots, cauliflower, cucumbers, garlic, green beans, kohlrabi, peppers, radishes, snap beans, tomatoes, turnips, and zucchini. To make your own pickled veggies, the first thing you need to do is make some pickling brine, which requires water and salt.
You will need either bottled water, or you will have to remove any chlorine from your tap water because it will inhibit the growth of the fermentation bacteria. You can pass the tap water through an activated carbon (charcoal) water filter, or boil it before using. Boiling water for 20 minutes will remove all of the chlorine. Another way is to leave a jug of water uncovered at room temperature for at least 24 hours. Exposure to sunlight will accelerate the evaporation of chlorine.
Some municipalities treat drinking water with chloramine instead of chlorine. Both disinfectants are harmful to your gut microbiome. Catalytically activated granular carbon filtration is one of the few methods that can successfully remove chloramines from drinking water, but the filtration rate must be slow enough for it to be successful. Check with your water department, and if they are using chloramine, use bottled water to make the brine.
Pickling salt is what’s recommended. Don’t use any salt that contains iodine and/or anti-caking agents. The ratio of salt to water will depend upon the recipe you use. There are two approaches. Some recipes specify the volumes of salt and water and the size of the pickling container, while others go by the weights of all the ingredients. The latter method is more precise, but require a digital kitchen scale.
Pickling varieties of three to five inch, thin-skinned cucumbers, such as Northern, Boston, and Nash, are best because they contain less water, have fewer seeds, and don’t have a waxy skin. Kirby and Persian cucumbers are also popular for pickling, along with miniature-size and cocktail-size English cucumbers. Just make sure that they are very fresh and sweet-tasting. Some cukes will be bitter, and pickles made from them will also be bitter.
Gently wash the cukes and cut off both ends, then completely cover them in the brine, either tightly packing them or using non-reactive weights to keep them submerged. Larger cucumbers can be cut in half lengthwise or made into spears to shorten the curing time.
If you want your pickles to be really crunchy, plant tannins will help, so consider adding a grape leaf or two to the pickling jar, or some green tea. Add other herbs and spices as desired; garlic, black pepper corns, mustard seeds, dill heads, parsley sprigs, etc. Fresh dill heads can be frozen to extend the season for making dill pickles. Adding just a little bit of cider vinegar after the fermentation is completed can enhance the flavor without killing the microbes.
Since lacto-fermentation is an anaerobic process, the cucumbers must not have any contact with the air. Loosely attach the pickling jar’s lid or use a Fido jar that will allow carbon dioxide to escape. For best results, keep the jar at room temperature 65-72°F (18-22°C). It is normal to see gas bubbles and for the brine to become cloudy.
Half-sour pickles will develop a mottled green appearance and can be refrigerated after three to five days at room temperature. Skim off any scummy surface yeast, keep the pickles fully submerged, and let them sit three more days in the refrigerator before tasting. They will continue to slowly acidify during refrigeration, so they should be eaten within a month.
Full-sour pickles will usually need to ferment for a week or two before they turn from bright green to a uniform olive-drab color. Depending upon the ambient temperature, after five to ten days you can remove any yeast scum floating on the surface and refrigerate them in their brine. Make sure they are completely submerged, and they will keep well for at least six months.
Everyone seems to have their own favorite recipe, but I suggest you avoid adding sugar and/or vinegar to the brine, despite what a recipe might say. Your own taste preferences for salty and sour should guide your experiments. Keep notes regarding the brine’s salinity, pickles used (variety, size, and freshness), fermentation temperature and duration, and the pH of the brine (optional). You’ll eventually arrive at a recipe that’s just right for you, and you will want to be able to repeat it.
After you’ve made your first batch of pickles, you can use some of the brine as a starter culture for your next batch. It will be teeming with bacteria that can shorten the fermentation of the next batch by a day or two. In many parts of the world, people drink the leftover brine as a beverage, or use it to make soups. However, consuming excessive amounts of salt is unhealthy in many ways, and the brine’s acidity can damage tooth enamel.
Acetaminophen Dangers
This commonly used, non-prescription fever and pain reliever (brand name Tylenol) has been cited by the National Institutes of Health (NIH) as the leading cause of severe liver damage requiring transplantation. The drug has been responsible for about 250 unintentional deaths per year in the U.S. In other parts of the world, the drug is called paracetamol (brand name Panadol). Due to the risk of hepatotoxicity, many countries limit the number of doses that can be sold over-the-counter (OTC).
For an average, healthy, young adult, the daily dosage should not exceed 4,000 mg. However, liver toxicity has been associated with much lower daily doses when acetaminophen is taken by older people. For daily use, it is recommended that seniors and those with chronic illnesses limit intake to 3,000 mg per day.
Acetaminophen capsules and tablets may contain 325 to 650 milligrams of the drug. It is best to use the lowest strength that provides adequate relief, since taking more than necessary increases its toxic impact on the liver. With “extra-strength” pills it is easier to exceed the maximum dosage. If you take OTC medications for allergies or colds, check their ingredients to see if they contain acetaminophen. If they do, you had best do the math.
Drug interactions are also a concern. Anti-seizure meds, blood thinners, and some supplements can adversely interact with acetaminophen. Check with your pharmacist to find out if there are warnings about acetaminophen in connection with any of the medications you are taking.
You should also be aware that drinking alcohol results in the production of greater quantities of acetaminophen’s toxic metabolites. Coupled with the hepatotoxicity of alcohol, this dangerous combination greatly increases the risk of liver failure. Please be careful, because this is not a benign drug.
March 7, 2024
Our Sicko Nation
Overall, the U.S. has the highest death rates for avoidable or treatable illnesses. Obesity, diabetes, and heart disease are associated with a higher risk for more severe COVID-19 infections. While the number of severe cases have declined, coronavirus infections remain at levels similar to those in previous years. There are still about 20,000 hospitalizations and about 2,000 deaths a week caused by the disease, with a total of nearly 1.2 million deaths since the pandemic began. COVID-19 is still among the top ten leading causes of death in the United States.
Despite the risks, the CDC has issued new isolation guidelines, a blanket policy covering all respiratory virus infections despite their disparities in the rate of severe complications and death. Many experts are concerned that relaxing testing and isolation protocols will inevitably lead to an increased spread of COVID-19 and result in an increased number of deaths among the most vulnerable.
The updated guidance states that if a person with symptoms of a respiratory infection is fever-free for 24 hours without using fever-reducing medications, and their other symptoms are improving, they no longer need to remain in isolation. When returning to work or school, the CDC suggests that for the next five days they avoid close contact with others, wear a well-fitting mask, and self-test ahead of any gatherings. To me, that sounds like wishful thinking.
The CDC justified its guidance change in a 25-page document. Although coronavirus infections are continuing at high levels, fewer people are dying. Agency officials acknowledged that most people were ignoring the previous guidance, and that having different protocols for different viruses made it harder for people to know what to do when they were no longer testing for COVID-19. Many businesses no longer offer employees who test positive five paid sick-leave days to stay home.
Protect Yourself
If you are someone who is at greater risk for a severe outcome from the flu, RSV, or COVID-19, be advised that your chances for being infected by members of the public have now increased, and you need to double-down on your protective measures. Those measures include wearing an N95 or equivalent mask in indoor public spaces, and asking people to test before spending time in close contact with them.
It is also recommended that you get another COVID-19 booster if you are age 65 or older, or are immunocompromised, and it has been at least four months since your last booster, or at least three months since a confirmed coronavirus infection. A recent study found that switching arms increased the antibody response. Because there may be a new vaccine approved for the Fall of 2024, eligible people should get a second dose of the current vaccine no later than June.
The coronavirus continues to evolve, and updated vaccines are likely to remain necessary. For younger people, the protection against severe disease afforded by frequent boosting is more modest. However, microsimulation models suggest that frequent booster programs covering all age and risk groups lead to lower transmission rates in the population as a whole, with additional benefits conferred upon those in the highest risk groups.
So far, only about 22 percent of those aged 18 and up have received the newest vaccine, and only 42 percent who are 65 and older. More than 95 percent of covid-related hospitalizations are among those who are not up to date on their vaccinations. CDC data indicates that 67 percent of COVID-19 hospitalizations from October, 2023 to January, 2024 were in those aged 65 and older, as were 88 percent of in-hospital deaths.
Covid Survivors’ Risks
The CDC estimated that by the end of 2023, 98 percent of Americans who survived the pandemic have antibodies from vaccination, prior infection, or both, reducing the risk for fatal consequences. However, breakthrough and repeated infection with the novel coronavirus can still lead to a plethora of problems, including decreased scores on IQ tests, the development of autoimmune disorders, and the debilitating symptoms of Long-COVID.
A new study has shown that the prevalence of Long-COVID symptoms at 30 and 90 days post-infection was 43 to 58 percent lower among adults who were fully vaccinated before their breakthrough infection. Persistent Long-COVID symptoms have a significant potential to cause major disruptions to one’s daily life, as well as becoming a source of long-term disability.
The risk of severe illness from COVID-19 continues throughout the year for older adults. Unlike the seasonal flu virus and RSV, coronavirus surges have also occurred in the Spring and Summer. So, even though we are heading into Spring, if you are eligible for a booster, get it now!
Macaroni and Cheese
When I picked up my mail from the post office the other day, I saw that someone had left a bag of canned and packaged foods, including a couple of boxes of macaroni and cheese. That prompted my investigation into the health risks and benefits of this classic American comfort food.
The prevailing wisdom is that it’s best to treat cheese as an add-on to a meal, rather than being a prominent feature of its main course. The healthiest cheeses are generally soft cheeses such as ricotta or mozzarella made from low-fat or skim milk, because they are lower in saturated fats. It is generally advisable to limit daily cheese consumption to a one-ounce serving.
Boxed mac and cheese is typically high in sodium, unhealthy fats, refined carbohydrates, and artificial flavors and preservatives. As with other ultra-processed foods, it can contribute to health problems such as heart disease, diabetes, and high blood pressure.
Macaroni is low in fiber and protein, high in empty calories, and provides little in the way of essential vitamins and minerals. It has a high glycemic index, causing blood sugar spikes. The creamy cheese sauce served in restaurants is very high in calories and saturated fat, and may even contain trans-fats.
There are ways to make the dish healthier and more nutritious: Whole-wheat macaroni will provide more fiber and more nutrients, compared to the white flour varieties. Make your own cheese sauce using low-fat cheeses or Greek yogurt. Enhance the dish with roasted vegetables and legumes for a more balanced and nutritious meal. Finally, don’t make mac and cheese your main course, even if it is a healthier version.
Ground Cinnamon Contamination
FDA testing has found elevated levels of lead, and has determined that prolonged exposure to the following brands of ground cinnamon may be unsafe: El Chilar, La Fiesta, Marcum, MK, MTCI, Supreme Tradition, and Swad. Check the lot numbers in the FDA alert for specific lots.
February 24, 2024
Revisiting the Common Cold
It has been more than four years since I’ve caught a cold, thanks to the COVID-19 pandemic and all the precautions I’ve been taking against airborne infections. I’m not exactly sure how I caught it, but reviewing my memory of the preceding day gave me a clue: The woman who delivered my groceries handed me a print-out of my order, then took out a tissue and blew her nose.
It is likely that she also blew her nose before handing me the paper. With virus-laden droplets of mucous on her hands transferred to the paper, it could act like a Trojan horse. I should have sanitized my hands right after putting the paper away, but failed to do so. It took less than 24 hours for my symptoms to appear; sneezing, coughing, runny nose, a slightly elevated temperature, and generally feeling crummy from head to toe.
Since my immune system had not been challenged by any cold viruses for so long, it was caught off-guard. Consequently, this cold was a doozy. Although I was up-to-date on both my flu and COVID-19 vaccinations, breakthrough infections are still possible. Just to play it safe I took the highly sensitive nucleic acid amplification test (NAAT) provided by eMed as part of their free Test-to-Treat program. eMed services include the rapid delivery of test kits for influenza A and B, and COVID-19, 24/7 tele-health visits, and anti-viral prescriptions. Thankfully, I tested negative for all three viruses.
There are more than 200 “common cold” viruses that can make someone feel the way that I did. On a year-’round basis, rhinoviruses, most active in early fall and late spring, cause 10-40 percent of all colds. People will feel really miserable if they catch one of these, but this family of viruses rarely makes people ill enough to require hospitalization.
In the winter and early spring there are three or four coronaviruses doing most of the dirty work. They cause about 20 percent of all colds. An additional 20-30 percent of colds in adults are due to as-yet unidentified viruses. About 10-15 percent of virus-related upper respiratory infections in adults are caused by agents responsible for more severe illnesses, such as the respiratory syncytial virus (RSV) and parainfluenza virus. Those infections can lead to bronchitis and pneumonia, especially in young children and the elderly.
Cold viruses are highly contagious and easily spread to others via tiny droplets that are coughed or sneezed into the air by an infected person, and then inhaled by someone else. Colds can also be transmitted when a person with live viruses on their hands touches inanimate objects or surfaces (known as a “fomites”) that you then touch and unwittingly transfer the virus to your eyes, nose, or mouth. They can also be spread through handshakes and hugs.
Among those who develop symptoms, expect them to typically last about a week, but can take up to two weeks to fully resolve. Prevention involves steering clear of people showing cold symptoms, masking with a well-fitted N95 (or equivalent mask) in crowded, indoor public spaces, as well as being meticulous about hand-washing with soap and water.
An alcohol-based hand sanitizer should be carried in one’s vehicle and purse. Keep your hands away from your face, unless they have just been washed. If someone in your household has a cold, frequently disinfect objects and surfaces that they might touch, such as light switches, countertops, and doorknobs.
There are no medications that will prevent or cure the common cold. To facilitate your body’s natural immune response, stay well hydrated, eat enough protein, and get lots of rest. Gargling with salt water or sucking on lozenges can help ease a sore throat. Over-the-counter pain and fever relievers can lessen some of the discomfort. Decongestant pills and nasal drops or sprays, along with cough suppressants, are not suitable for everyone. It is advisable to check with your primary healthcare provider for specific recommendations.
One of the biggest mistakes that doctors make is succumbing to patient pressure and prescribing antibiotics for a viral upper respiratory infection. The over-prescribing of antibiotics has contributed to the evolution of bacteria that are resistant to multiple drugs. It is possible for a virus to pave the way for a secondary bacterial infection, and that should be treated appropriately if it occurs. Until such time, the best thing a doctor can prescribe for a patient with a common cold is chicken soup.
Free Paxlovid
Paxcess is a new patient support program offered by Pfizer that can help patients get the COVID-19 antiviral treatment, Paxlovid, for free or at a substantially reduced cost. First, one must have a prescription for Paxlovid. Then, simply go to the website and enroll in the program. You will then receive a voucher to give the pharmacist who is filling your prescription.
The program is the result of an agreement reached after extensive negotiations between Pfizer, the drug’s manufacturer, and the Biden Administration’s Department of Health and Human Services. It is designed to ease the transition from the government paying to the commercial market charging for the prevention and treatment of COVID-19.
February 23, 2024
Hypertension
High blood pressure or hypertension (HTN), known as the “silent killer,” has reached epidemic proportions, yet this disease is still not being adequately addressed. Hypertension was the primary or contributing cause of almost 700,000 deaths in the United States in 2021. Nearly half of all American adults have the condition, yet only about one in four have their blood pressure under proper control.
While patient non-compliance is sometimes the culprit, the larger problem is that many physicians are failing to prescribe the correct medications in the first place. With so many classes and combinations of drugs available, and a plethora of patient variables including different underlying causes, choosing the correct treatment regimen is a very complicated problem that often exceeds the capacity of human information processing.
Artificial Intelligence (AI) technology has been developed in order to remedy this problem, but it is currently available in only a few locations. AI algorithms input the patient’s electronic health record and analyze all the relevant variables to generate a personalized list of recommended medications, often calculated down to the milligram.
One important information source is an impedance cardiography (ICG) test that helps identify what’s causing the patient’s hypertension. The ICG test, usually used to assess heart failure, measures hemodynamic parameters, including stroke volume, cardiac output, heart rate, and total peripheral resistance.
Regardless of its cause, all hypertensive patients should be prescribed non-pharmacologic therapy including lifestyle modifications such as dietary changes and increased physical activity. It may be possible to avoid medications for patients who are diagnosed with grade 1 hypertension if they don’t have cardiovascular disease, chronic kidney disease, diabetes, or organ damage.
The 2017 guidelines of the American Heart Association and the American College of Cardiology changed the criteria for adult HTN diagnosis from 140/90 to 130/80 mm Hg, regardless of age. In contrast, the European Society of Hypertension guidelines recommend different targets for different age groups. A 2023 update suggests that people over the age of 80 should only be medically treated if their systolic blood pressure exceeds 160 mm Hg.
If a doctor does not have access to the aforementioned AI technology, best practices suggest that patients with primary (essential) hypertension who meet selection criteria for drug therapy should begin medication with either one drug (monotherapy) or two drugs (combination therapy). For monotherapy, doctors should choose one drug from among the following medication classes:
Angiotensin-converting enzyme (ACE) inhibitor
Angiotensin receptor blocker (ARB)
Calcium channel blocker
Diuretic
When used as monotherapy, all four drug classes achieve similar benefits regarding cardiovascular endpoints. Long-term data shows negligible differences in mortality among hypertensive adults treated with a diuretic (chlorthalidone), calcium channel blocker (amlodipine), or ACE inhibitor (lisinopril).
If there are no compelling reasons to select a specific drug class, initiating monotherapy with an ACE inhibitor or ARB, or a dihydropyridine calcium channel blocker, rather than a diuretic, is currently recommended.
Patients with a systolic pressure 10 to 20 mmHg above goal, and/or a diastolic pressure 10 mmHg above goal, should be started on combination therapy using low to moderate doses of two agents having complementary mechanisms of action. The combination of an ACE inhibitor and a dihydropyridine calcium channel blocker seems to provide superior protection against cardiovascular events.
Combination therapy lowers blood pressure more than monotherapy, and increases the likelihood that target blood pressure will be achieved in a reasonable amount of time. In addition, using two drugs often allows attainment of blood pressure goals with lower doses of each medication, reducing the risk of dose-related side effects. Taking two drugs as a single pill improves adherence, but single-pill combinations are often more expensive, may not be paid for by prescription drug plans, and vary in their availability.
Most patients with chronic kidney disease (CKD) will require the inclusion of a diuretic to achieve blood pressure goals. Patients with CKD are typically treated with diuretics such as chlorthalidone or indapamide. There are only two single-pill medications that combine an ACE inhibitor or ARB with a diuretic; perindopril-indapamide and azilsartan-chlorthalidone.
I don’t usually get this detailed about specific recommendations, but I’ve recently become concerned about hypertension treatment seeming rather haphazard. By being an informed consumer of medical care, you will be in a better position to work collaboratively with your healthcare provider in order to achieve optimum results in the treatment any chronic condition. This may be especially true when it comes to hypertension.
The risk of developing hypertension in the first place can be reduced by implementing consistent lifestyle changes, such as lowering sodium intake, ideally to not more than 1,500 mg/day. Limit your consumption of processed foods, canned goods, and don’t add table salt to your food.
The DASH diet (Dietary Approaches to Stop Hypertension) emphasizes fruits, vegetables, whole grains, low-fat dairy, and lean protein, while limiting saturated and trans fats. Foods rich in potassium, such as fruits, vegetables, and legumes, can help to counteract the effects of sodium on blood pressure.
Excessive alcohol intake (defined as more than one drink per day for women and two drinks per day for men) can contribute to high blood pressure. Engaging in at least 30 minutes of moderate-intensity exercise, such as brisk walking, swimming, cycling, and dancing, when done most days of the week, can significantly lower blood pressure. It is also important to maintain a healthy weight and manage stress effectively with techniques such as yoga, tai chi, meditation, or deep breathing exercises.
Don’t smoke, and avoid exposure to secondhand smoke and air pollution. Get 7-9 hours of sound sleep each night. Finally, check your blood pressure regularly, either through home readings or at regular doctor visits, and be aware that conditions such as diabetes, kidney disease, and a family history of HTN can increase your risk and warrant closer monitoring.
February 21, 2024
Covid Vaccination Risks vs. Benefits
Out of sight, out of mind… the CDC is no longer tracking weekly deaths due to COVID-19, but make no mistake, the disease is still killing people. Most of those deaths continue to occur among seniors (age 65 and older) and those who are medically compromised by chronic illnesses or immune deficiencies, who who are also not up-to-date on their vaccinations.
Researchers estimate that between one in a thousand to one in 200 (0.1–0.5%) of all COVID-19 infections may become persistent, lasting for at least 60 days. Shedding live viruses and remaining infective is different from experiencing typical Long-COVID symptoms. This puzzling syndrome involves a multiplicity of etiologies, including immune system dysfunction. Of particular concern to epidemiologists is that persistent SARS-CoV-2 infections with ongoing viral replication can give rise to new and more dangerous mutations.
Nationally, an average of 6.4 percent of American adults reported having experienced Long-COVID symptoms (95% CI = 6.2%–6.5%). That’s about one out of every 16 adults. Prevalence reports ranged from 1.9% (95% CI = 0.9%–4.1%) in the U.S. Virgin Islands to 10.6% (95% CI = 9.5%–11.8%) in West Virginia. The prevalence of Long-COVID exceeded 8.8% in seven states.
A recent study showed a much lower prevalence of Long-COVID among vaccinated individuals, compared to those who were unvaccinated prior to the onset of COVID-19. The prevalence of 30-day long COVID was 43 percent lower among the vaccinated group (prevalence ratio [PR], 0.57; 95% confidence interval [CI], 0.49 to 0.66). The adjusted prevalence of 90-day long COVID was 58 percent lower among the vaccinated group (PR, 0.42; 95% CI, 0.34 to 0.53). Another study involving nearly 1.2 million people found that the more COVID-19 vaccinations a person has received, the less likely they are to develop Long-COVID after a breakthrough infection.
The Global COVID Vaccine Safety study found a small percentage of nearly 100 million vaccinated individuals across eight countries who had experienced adverse events after administration of the Pfizer, Moderna, or AstraZeneca vaccines. The multi-country analysis validated the pre-established safety signals for myocarditis, pericarditis, Guillain-Barré syndrome, and cerebral venous sinus thrombosis.
Researchers looked for 13 specific adverse events of special interest. They found 124 excess cases of Guillain-Barré syndrome; 190 cases, when only 66 were expected. None of those cases were associated with the mRNA vaccines. They also found 69 cases of cerebral venous sinus thrombosis, compared to a baseline of 21 expected cases. The risk was 1.49 times higher after the Pfizer vaccine’s first dose, and 1.25 times higher after the second dose.
Comparing the observed to expected numbers of pericarditis cases, researchers found a statistically significant safety signal for homologous administration of the Moderna mRNA vaccine, but not for the Pfizer mRNA vaccine. The observed-to-expected ratio (O/E) for myocarditis, although statistically significant for both mRNA vaccines, was not high enough to generate a safety signal for either vaccine.
The observed numbers of pericarditis and myocarditis cases, relative to the number of vaccine doses administered, was minuscule. Although most COVID-19 vaccine-related incidents of myocarditis have been mild and temporary, 28 deaths were reported. The condition occurred primarily among males aged 16-24 years.
Moderna’s highest O/E for myocarditis was noted following first and second doses. Excess myocarditis events in the month following vaccination are estimated at between one and ten per million vaccinated people, compared to 40 extra myocarditis cases per million people following a SARS-CoV-2 infection.
COVID-19 vaccines have saved countless lives, and have been proven safe and effective for the overwhelming majority of the people who’ve received them. A recent study estimated that if everyone in the UK had been fully vaccinated, about 18 percent of severe outcomes, including deaths, could have been avoided. The risk/benefit analysis for COVID-19 vaccination is clear: One cannot rationally justify foregoing vaccination based upon the infinitesimally small risks associated with vaccines.
As for the issue of “body autonomy,” adults who have not been judged incompetent do have a right to refuse vaccination, and knowingly accept the potential consequences. Vaccine refusal is a personal choice. Attempting to influence the choices of other people by using persuasion tactics other than simply presenting the preponderance of scientific evidence is malicious and irresponsible. Should someone be harmed or die as a result of misinformation or disinformation, civil litigation should be warranted.
January 21, 2024
Recommended Reading
Tracking Respiratory Virus Activity Levels
Staying Healthy During the Holidays
Identifying Brain Health Risks
December 31, 2023
Our Nation’s Epidemic of Type 2 Diabetes (T2D)
Something that’s often ignored during the holiday season, when people are most prone to excesses of eating and drinking, is how our behaviors contribute to the development of T2D, a disease that is rapidly rising among children, teens, and younger adults. Every year, 1.2 million Americans receive a new diagnosis of diabetes. According to National Center for Health Statistics data for 2022, 9.6 percent of all U.S. adults aged ≥18 years had been diagnosed with diabetes, and one in five adults aged ≥65 years had the disease. The American Diabetes Association has published new care guidelines for 2024 in order to better deal with this public health crisis.
Life expectancy in the United States has been steadily declining since 2014, and now lags behind that of all other nations with a high GDP. An increased prevalence of chronic diseases, such as heart disease, cancer, obesity, and diabetes, are the main contributors to shortened lifespans, but you can’t expect much help from the government. Politicians’ careers are at the behest of big, for-profit corporations, including those that comprise the healthcare industry.
In America, treating illness is far more profitable than keeping the populace healthy. Even the gigantic health insurance industry has minimal investments in prevention. It is the fear of catastrophic illnesses that motivate people to purchase policies, and companies can always remain profitable by raising rates and reducing services. As long as “the little people” continue to stoke the economy by producing, consuming, and paying taxes, their health and welfare aren’t going to be a political priority. Consequently, protecting your health is left mainly up to you!
An expert consensus from the American College of Lifestyle Medicine, endorsed by American Association of Clinical Endocrinology, is that diet and exercise can be the only treatment for T2D to achieve lasting remission. Although lifestyle modifications are typically recommended as an adjunct to conventional therapy, the diabetes remission goals were a hemoglobin A1c less than 6.5 percent and a fasting blood glucose less than 100 mg/dL, maintained for at least 3 months, without surgery, medical devices, or drugs.
As it turned out, a recent randomized, controlled trial (RCT) of an intensive “food-as-medicine program” showed no difference in A1c between the treatment group and a control group that received no interventions. As with many other wonderful concepts that are biologically plausible and are supported by positive observational studies, this one failed the RCT acid test. This example reinforces the ever-present need for scientists to couple their cautious optimism with healthy skepticism.
The Benefits of Dining In
One of the unanticipated blessings of the coronavirus pandemic has been that it weaned me off restaurant food and allowed my taste buds to recover their inherent appreciation for the delicious, subtle tastes of whole, natural foods. I have learned to select what I eat based upon the nutritional value of the ingredients, rather than allowing appearance, smell, and taste to dictate my food preferences. That sharply contrasts with my previous cravings for the tasty poisons known as snacks and desserts.
Since then, my goal has been to help other people become healthier by eating more sensibly. We all need to be better stewards of what we put in our mouths, and that’s really hard to do when we dine out, even if we only order soup and salad. Restaurant foods tend to contain excessive amounts of salt, sugar, saturated fats, and highly processed ingredients, all of which delight our taste buds while placing our health at risk.
The best arguments for going out to eat are that it gives the household cook a well-deserved break, and their “support personnel” respite from doing the dishes. Dining out with friends, family, or business associates can also provide a good opportunity to socialize, without having to prepare a meal, entertain, and then clean up afterward. Just be aware that you’ll being paying a price, in addition to the tab and tip.
What I’ve tried to do with home cooking is make it less of a hassle while providing a much healthier alternative to dining out. Home cooking not only saves money and reduces the risk of food-borne illnesses, it also offers those doing the cooking an opportunity to playfully exercise their creativity. If you begin with whole, natural foods, it’s hard for cooking experiments to go wrong.
My approach is to keep my pantry, freezer, and refrigerator well stocked with a variety of basic, healthy ingredients, and then let whimsy inspire what I choose to cook that day. I minimize special ingredients that aren’t used fairly often. A large number of mathematical permutations and combinations can be generated from relatively few ingredients, so meals don’t have to lack variety, and when my culinary creativity produces something awesome, I don’t mind eating it again and again. In fact, too much food variety tends to make people overeat.
Around the world, with the exception of Italy, women do most of the home cooking. I’d like to change that. I’m currently working on a new book especially for men to help them make meals that are less complicated and easier to prepare. Women, please encourage the men in your life to help out with the cooking, and remind them that innumerable male chefs have been responsible for the world’s most spectacular gastronomic experiences.
Nudging people to eat more meals at home won’t put restaurants out of business. There will always be plenty of people who are willing to pay exorbitant prices for food of dubious quality, just so they don’t have to cook and/or do the dishes themselves. For some, being waited on by others makes them feel special, but as a wise man once said, “your ego is not your amigo.”
Those who recognize that their good health is their most precious possession make health considerations a priority when deciding what to do. They prefer to take charge of their food’s ingredients, ensure safe food handling, and avoid consuming the industrially manufactured, ultra-processed, ingestible concoctions that shockingly pass for food. None of those things can be accomplished when dining out.
The Benefits of Physical Activity
Humans have been shaped by evolution to be physically active and perspire freely. Both hunting and gathering are physical activities that require lots of energy. Human brains were able to grow much larger after people started cooking the animals that they hunted, making more protein available for digestion and assimilation. Modern humans, with all the conveniences that agriculture and food technology offer, have become sluggish and sedentary, much to their detriment.
Physical activity is defined as movements produced by skeletal muscles that require energy expenditure. Lower levels of activity are associated with higher all-cause mortality. Consequently, every move you make counts. The more physical activity people have as a part of their daily lives, the greater their average life expectancy, all other things being equal.
Clearly, sitting at a desk all day at work, then becoming a couch potato when we get home, does violence to our human nature and is a formula for future health disasters. Our bodies are built for long-distance walking and running. According to a recent study, prolonged sitting poses a significant risk for cardiovascular disease, with a 34 percent higher mortality. The authors suggest that society needs to denormalize this common deleterious behavior, similar to how smoking tobacco has been denormalizing, and changes in the workplace are needed to address this occupational hazard.
Another study has quantified the optimal amount of daily light activity and moderate to vigorous physical activity as being a little more than two hours each. One should sit for no more than six hours a day, and not stand still for more than five hours. That leaves about eight hours for a healthy amount of sleep, aiming for 7.5–9 hours per night.
While jogging outdoors is preferable, a home treadmill can be a good investment, especially when the weather is nasty. If you want to improve your current level of cardiovascular and respiratory fitness, walk at a brisk enough pace to increase your breathing rate, and maintain that pace for at least 20 minutes a day, seven days a week, or 30 minutes a day, five days a week.
Casual walking for 60 minutes, three days a week, should help you maintain your present cardiovascular fitness level, but anything less almost guarantees that your fitness will decline over time. In addition to activities that increase cardiovascular fitness and overall endurance, it is recommended that people also engage in strength-building activities that involve all the major muscle groups, at least twice a week.
Even small amounts of moderate physical activity are far better than none at all. Taking the stairs rather than an elevator or escalator, or parking further from your destination, can contribute to your activity level. When taking your dog for a walk, don’t let the dog set a slow pace for you. If your canine companion is too old or too fat to keep up, take a brisk walk by yourself after they have done their business.
While an intense exercise program can’t make up for an unhealthy diet, regular physical activity is an equally important aspect of healthy living. While all-cause mortality reduction is greatest for vigorous exercise, the moderate-intensity activities of daily living are still beneficial, albeit to a lesser extent, according to a well-done meta-analysis.
Some of the specific benefits of physical activity include a reduced risk of heart attacks and strokes, lower blood pressure, less risk of type 2 diabetes, cancer, and respiratory diseases, better posture, improved strength, endurance, balance, coordination, and flexibility, increased bone density with less fracture risk, burning off excess calories that helps with weight loss, preventing age-related frailty, improved sleep quality, enhanced immunity, better digestion and bowel function, greater brain volume with improved memory and concentration, overall stress reduction, and better mental health, including a lower risk of depression.
The secret to sticking with a new physical activity routine is to do the kinds of activities that you most enjoy. There are a great many possibilities that you can experiment with. Look for things that fit best with your personal interests, fitness level, health limitations, and the time and space that you have available. It is easier to make excuses than to just do it, and it will require a measure of self-discipline to get going. May the Force be with you!
Sleep Soundly, Dream Sweetly, Wake Up Happy
Rest is a necessary foundation for all physical and mental activity. Adequate sleep is vital for the body’s physiological regulation and restoration, and is a pillar of a healthy lifestyle. Research has shown that sleep deprivation can damage the brain and heart. Insufficient or poor quality sleep contributes to mental health disorders and chronic illnesses. Poor quality and quantity of sleep has created a public health problem for many Western nations, including the United States.
There is clearly a “sweet spot” for the duration of nightly sleep, which seems to be seven to nine hours for most healthy adults. There is also evidence for the health benefits of a daily nap. What and when we eat and drink before bedtime, when and how we exercise, the illumination, temperature, and humidity of our sleeping environment, our body position, and the time that we go to bed and get up, all have an important influence upon our sleep.
Benjamin Franklin’s observation about “early to bed, early to rise” is especially true today, since healthy sleep patterns make use of our body’s natural circadian rhythms and are influenced by natural and artificial light. Taking melatonin or drinking a glass of wine at bedtime are common strategies that can do more harm than good. Melatonin is a hormone sold over-the-counter, with its purity and potency poorly regulated and its safety inadequately studied. Wine contains ethanol, a carcinogenic neurotoxin, no amount of which is healthy.
The medical treatment of both acute and chronic insomnia comes down to two drugs; lemborexant and eszopiclone. However, eszopiclone may cause substantial side effects, and safety data on lemborexant is inconclusive. While benzodiazepines are effective for the short-term treatment of insomnia, they all have unfavorable safety profiles. Consequently, improving one’s sleep hygiene naturally seems to be a far better course of action.
The use of cannabis products as a sleep aid remains controversial. In states where marijuana is legal, short-term use of indica-leaning strains at bedtime may increase the amount of deep sleep, but at the expense of decreasing REM sleep. That’s the time spent dreaming, and dreams are important for processing emotions and solidifying memories. The Sleep Foundation has an in-depth article on the use of cannabis for insomnia.
From a health standpoint, the oral route for cannabis administration is preferable to smoking or vaping. However, ingestion takes longer to have an effect, and can prove harder to titrate doses. Note that the FDA does not have active oversight of herbal medicines, and does not monitor their purity, potency, safety, and efficacy. The FDA will only take action after adverse events are reported. Any oversight of non-prescription cannabis products would have to come from the states in which they are legal. Let the buyer beware.
Conditions such as obstructive sleep apnea (OSA) tend to be over-diagnosed, and CPAP machines are over-prescribed. The best conclusion that could be drawn from a well-conducted clinical trial is that for patients who complain of chronic sleepiness, CPAP might help them feel better if their OSA is moderate or severe. Quite often, simply losing weight and/or changing one’s habitual sleeping position can reduce snoring and adequately address the obstructive problem.
What we do during our last hour of wakefulness can have an impact upon our dreams. Stressful stimuli and the light emanating from computers, tablets, and smart phones should be avoided. Watching the 11 o’clock news before going to bed is bound to be stressful, and it is past a healthy bedtime, anyway. Printed reading materials with soothing themes can be a bedtime soporific, as is listening to a guided relaxation recording, calming music, the sounds of nature, or even “white noise.” The Sleep Foundation offers a collection of tips for better sleep.
A good strategy for falling asleep, especially when your mind is way too busy, is something like “counting sheep,” but more meditative. Start by paying attention to your breathing while taking on the role of a detached observer. Then, begin to mentally count each exhalation. When you reach ten, begin again. If your mind wanders, begin again. If you lose count, begin again. Your chattering mind will eventually give up its bid for your attention, become bored with the counting, and take refuge in sleep.
Why the Coronavirus Is Winning
The evolution of the SARS‐CoV‐2 virus has been relentless, and its transmission is still being facilitated by the emotionally-driven behaviors of its human hosts. Human beings are at best a gullible and superstitious species. A substantial proportion of the human population consists of people with below average intelligence who also believe that they are smarter than they actually are. Narcissism runs rampant, and maladaptive attitudes range from infantile rebellion against being “told what to do” (such as wearing a mask), to a general mistrust of science and experts, and can culminate in the embrace of conspiracy theories and blatant misinformation.
Although the coronavirus is still causing significant numbers of hospitalizations and deaths worldwide, most Americans are no longer concerned about an illness they consider a nuisance rather than a threat. As a result, repeated COVID-19 infections, with a range of serious, long-term consequences, have been occurring. One of the more concerning complications of repeated infections is immune system dysregulation and dysfunction. According to a recent article, there have been significantly higher rates of autoimmune diseases such as rheumatoid arthritis, lupus, inflammatory bowel disease, and psoriasis, following SARS-CoV-2 infections.
Along with chronic disabilities due to Long-COVID, even mild coronavirus infections are capable of causing lasting damage to the heart, lungs, blood vessels, kidneys, gut, and brain. This is quite alarming, from both a personal and a public health perspective. Good luck to people whose cavalier attitude toward this dangerous disease results in multiple infections.
Vaccine Safety
This topic has been the target of a seemingly endless disinformation campaign. While localized vaccine reactions, such as redness, swelling, and tenderness at the injection site can occur, and less commonly systemic effects such as low-grade fever and malaise, severe adverse reactions are quite rare. Therefore, it makes absolutely no sense for people to fear vaccines that have established records for overall safety, particularly when the diseases that they offer protection against can be so much worse.
That hasn’t stopped the anti-vax miscreants (some of whom are doctors, including Florida’s surgeon general) from exaggerating the risks, citing debunked theories, and dissuading people from vaccination. This has resulted in countless preventable deaths. Vaccine hesitancy and unfounded fears of myocarditis have kept people from receiving the latest monovalent mRNA boosters that target currently circulating Omicron variants such as the now dominant JN.1, despite their being more than 70 percent effective in keeping people out of the hospital.
According to the latest CDC data, receipt of the updated 2023-24 COVID-19 vaccine is only 8 percent for eligible children, and 19 percent for adults 18 years of age and older. Adults aged 65 years and older currently have a 37 percent vaccination rate, which is deplorable, considering the much higher risk of deaths due to COVID-19 in this demographic. Public health authorities are now concerned that vaccine hesitancy may be approaching a dangerous tipping point.
An extensive literature review has found that most of the vaccine-induced cases of myocarditis and/or pericarditis occurred after the second dose of the initial mRNA COVID-19 vaccine series, primarily involving males 12 to 39 years old, with the majority of cases in those who were 18 to 25 years old. The clinical course of those with vaccine-related myocarditis was generally mild and without lasting consequences.
The risk of myocarditis from a SARS‐CoV‐2 virus infection was estimated to have been at least 15 times greater than the risk from the initial two-dose series. This risk/benefit ratio greatly favors vaccination, especially for older adults and those with medical conditions that put them at greater risk for severe complications. Even mild cases of COVID-19 can result in damage to the heart and brain. Just as it would be foolish not to use your seat belt in a motor vehicle because of the risk of seat belt injuries, so it is with the protections afforded by vaccinations.
Facing Reality
With the abysmal ignorance, nonsensical thinking, and irrational behavior evident in people today, I find it hard to have much hope for humanity. Looking beyond mass shootings and public health fairs, I am particularly dismayed by the power of oligarchs and the rise of autocratic, anti-democracy ideologies, both at home and abroad. Rather than become pessimistic about this drastic state of affairs, I see it as an urgent call to action, and hope that you do, too.
A 20-year observational study found that pessimism was associated with increased cardiovascular and all-cause and mortality. The study also showed that optimism doesn’t mitigate those risks. As might be expected, people living under better economic conditions and having stronger social networks tend to be more optimistic, and are also generally healthier. Consequently, economic and social influences must be accounted for in any analysis of optimism versus pessimism.
I continue to encounter vulnerable people who aren’t up-to-date with their vaccinations, and wonder why they are living dangerously. A recent article explores the human tendency toward unrealistic optimism, and how it leads to risky behaviors and failures to take appropriate action. People might ignore reality, but they cannot escape the consequences of ignoring it. When it comes to the impacts of global climate change, widespread destruction of the earth’s ecosystems, and populations exceeding the carrying capacity of the environment, being in denial creates obstacles to adequately addressing these very real threats to the survival of our species.
I think of a realist as someone who is neither a “glass half-full” optimist nor a “glass half-empty” pessimist. Rather, realists tend to see things as they actually are. Realists can play an important social role as slayers of illusions. People whose perceptions are better aligned with reality are more inclined to change the things that need to be changed.
By ascertaining the relevant facts and understanding causal relationships, realists leave little up to luck. When it comes to endeavors such as remaining covid-free, squarely facing reality is essential. It can greatly benefit us to seek outside perspectives, and we can ask for a little help from our friends in illuminating our blind spots.
For those who are counting on good luck and their optimism to keep them safe from the winter surge in airborne virus infections, when that fails there’s a totally free, test-to-treat telemedicine program that covers both covid and flu. It could prove to be a lifesaver for anyone who doesn’t have easy access to medical care.
December 7, 2023
Why All the Links?
The short answer is that reading headlines and skimming articles is not enough if you want to learn more about a subject. That’s especially true when it comes to something that catches your eye in the popular press. I’m specifically referring to digital media online, where the articles are accompanied by paid advertisements, and their headlines are click-bait.
For example, you may have seen headlines proclaiming that “Wasabi Boosts Memory.” Sorry, but that’s just not true. It’s a gross distortion of a well-done study in Japan that used one substance (6-MSITC) extracted from the rhizome of the Eutrema japonicum plant. Unfortunately, you can’t get any smarter by eating wasabi paste. Besides, what passes for wasabi in American sushi bars is actually common horseradish with green coloring, not genuine wasabi.
The other reason that I provide links is so my readers will know that I’m not making stuff up. There actually is science backing up my carefully curated summaries of published articles. As you must know by now, most medical research suggests possibilities and probabilities, rather than providing firm conclusions, and that’s okay. Science is always a work in progress, continually being refined as more data is accumulated, but it’s still very useful, nonetheless. You wouldn’t be able to read this newsletter if it wasn’t for science.
Alarmingly, a new Pew Research poll shows that more than one in four Americans aren’t sure about scientists acting in the public’s best interest. This is a marked change from a 12 percent response to the same question in April, 2020. People expressing the highest level of trust in scientists fell from 39 percent in 2020 to 23 percent in 2023.
It seems that many people were disillusioned about science when early in the COVID-19 pandemic the experts were frequently wrong. That’s because they were dealing with a novel virus, and very little was known about it at the time. Then came an epidemic of misinformation, some of it intentionally malicious, and sometimes perpetrated by other nations hoping to exacerbate the public health disaster and destabilize American society.
I can also point a finger at the inadequacies of U.S. science education for not conveying a realistic picture of how science actually works. Science does not offer certainties, and many people are uncomfortable with that. For them, religious dogma may offer comfort. For those who had “faith” in science without a complete understanding of the scientific method and how scientific research advances, the high degree of uncertainty during the early stage of the pandemic might have shaken their faith.
Scientists are constantly confronted with new evidence that challenges their assumptions and reminds them to treat their preconceived notions and cherished “truths” with a degree of humility. Introspection and a default skepticism are essential qualities, not only for scientists, but for anyone who is committed to their own emotional and intellectual growth. People can improve their critical thinking skills through games such as Cranky Uncle, and by developing a “baloney detection” toolkit of discriminating questions.
Since the majority of the information that I share with my readers is based upon provisional interpretations of evidence gained from observational studies, which by their nature are unable to demonstrate cause and effect relationships, I’m usually not in a very strong a position to make specific recommendations. What I try to do in most cases is provide people with the information, and leave it up to them to decide what lifestyle changes they might want to implement.
The Good News About the Latest COVID-19 Booster
Although there are large differences in the spike proteins between the booster’s XBB.1.5 target and the exponentially increasing variant, JN.1, there is good evidence that the neutralizing antibodies produced by the current booster are effective against JN.1. What this means is that getting the latest monovalent booster will reduce your risk for developing a severe infection that can result in hospitalization and death.
The bad news for public health is that only 16 percent of eligible American adults are up to date on their vaccinations, and a new surge of infections is already in progress. For the week ending December 2, there were 22,513 new hospital admissions due to COVID-19, and a 25 percent increase in deaths, according to CDC data. Since hospitalizations and deaths are lagging metrics, the current wave is still building. If you’re not boosted, then you’re gambling with your life.
Vaccination Likely Reduces Long-COVID Risk
Since the pandemic began, about 28 percent of people who were infected with the SARS-CoV-2 coronavirus experienced Long-COVID symptoms. Currently, nearly one in ten who have COVID-19 will develop the Long-COVID syndrome, and a quarter of whom will experience debilitating, long-lasting symptoms.
A systematic literature review and meta-analysis of the latest research has shown that Long-COVID risk is reduced by 69 percent among adults who received three vaccine doses before becoming infected. The risk reduction was 37 percent for those who received two doses. Experts say that this research provides a strong argument for people being up-to-date with their COVID-19 vaccinations.
So, if you haven’t received the latest booster, please get with the program. And, while you’re at it, ask for your seasonal flu vaccine, and the RSV vaccine if you are someone at risk. Remember the value of an ounce of prevention.
November 21, 2023
Now that the holiday season is here, I encourage you to implement strategies to prevent the transmission of respiratory viruses while celebrating with others indoors. Although being up-to-date with your vaccinations protects you from the worst consequences of virus infections, it may not reduce the risk of transmitting the disease to others. A small study found that there was no significant difference in the potential contagiousness of vaccinated versus unvaccinated children who were infected with the COVID-19 Omicron variant.
When to Resist
Anytime you can! I’m not only talking about resisting the economy’s insistence upon unnecessary consumption and concomitant waste that is amplified during the holiday season. I’m also talking about resisting the physical and psychological inertia that makes it difficult to improve one’s physical fitness level.
Fitness requires engaging in activities that promote strength, endurance, flexibility, balance, and coordination. Of these, gaining strength through resistance exercises or other effort-requiring activities is the single, most valuable thing that a person can do to preserve their functional independence as they age.
Building strength and increasing muscle mass can improve metabolic health, ward off type 2 diabetes, and lower one’s risk of injuries. It can also contribute to people’s health-span, according to a recent review. Only 30 to 60 minutes a week is needed to see a significant beneficial effect. Of note, diminishing returns were found after an hour a week of strength training, and a plateau was reached after two hours a week. How about making strengthening activities part of your lifestyle? Just a small investment of time and energy will pay big health dividends.
Healthier Sitting
If that sounds like an oxymoron, it’s because I’ve previously pointed to research showing that prolonged sitting is bad for your health, and that you are better off standing or laying down. Our paleolithic ancestors squatted. Try it; you might like it. That said, if you must sit, then have your feet flat on the floor, with your back and arms supported. A recent study showed people who sat that way had lower blood pressure readings.
Lower is Better
When it comes to blood pressure, a meta-analysis of trials of different levels of blood pressure reduction all pointed to the same thing: The lower your blood pressure, the better the health outcome, as long as you don’t become light-headed or faint. Be on the lookout for orthostatic hypotension, a condition in which blood pressure drops when standing up from a seated or lying position. Seniors, and those taking medications, are at increased risk.
Hitting a target for systolic pressure of 120 mm Hg or less can have big health benefits, according to a new finding in the ESPRIT clinical trial. Intensive blood pressure lowering treatment for three years resulted in a 39 percent lower cardiovascular mortality, and 21 percent lower all-cause mortality, compared to the standard treatment goal of a systolic pressure below 140 mm Hg.
A highly effective strategy for lowering blood pressure is to reduce your sodium intake. A recent study found that lowering salt consumption by only one teaspoon a day significantly lowered blood pressure for most middle-aged and elderly adults, regardless of their hypertension status or use of antihypertensive medications.
Also worth noting is that when it comes to cholesterol lowering interventions, the lower one’s LDL-C (“bad” cholesterol), the better. Studies exploring the potential risks of having too low LDL-C found that there were no downsides. So, this is another area where lower is considered better.
More Free Covid Tests
Four more free COVID-19 rapid antigen home test kits are now available to each household. If you did not receive four free test kits from September’s offer, your household is eligible to receive eight tests now. Testing is an important part of prevention and treatment strategies. Go to this link to order your kits now. If you have older, unused test kits, the expiration dates on the packages may have been extended by the FDA. Go to this link to find the new expiration dates.
Does Paxlovid Treatment Prevent Long-COVID?
An observational study, involving 191,057 non-hospitalized, mostly male, Veterans Administration patients with a first positive COVID-19 test from January through July, 2022 showed no significant differences in Long-COVID symptoms between those who were treated with Paxlovid, compared to untreated matched cohorts. Only thromboembolic events were found to have a lower incidence with Paxlovid treatment. Another observational study involving Medicare enrollees suggests that antivirals might slightly reduce the risk of developing Long-COVID in adults aged 65 and older.
As scientists continue searching for effective ways to treat Long-COVID, it was hoped that early intervention with antiviral medications during the course of a SARS-CoV-2 infection could lessen the risk of developing the post-covid condition. For now, it seems that vaccination is still your best bet for doing that, according to a new study from Sweden.
The best reason for at-risk people to take Paxlovid early in the course of their illness it is to reduce the risk of severe complications. Just make sure that there are no contraindications for your specific medical situation. Note that for patients who are sick enough to require hospitalization, intravenous administration of the antiviral Veklury (remdesivir) is the preferred treatment.
Pets and COVID-19
CDC recommendations say that as long as you are testing positive for COVID-19, you should avoid contact with household pets and other animals, and take precautions to protect them from infection, just as you would with people. As you know, COVID-19 has been found in a number of mammalian species, including domestic dogs and cats, and is being transmitted in the wild among American white-tailed deer, mule deer, and mink.
Indoor Air Quality
One of the good things that has come from the pandemic is that many buildings have upgraded their HVAC systems in order to improve indoor air quality. Private homes, however, are another matter. One thing that can help your home’s air quality is using a better filter in your central air-handling system. While a MERV rating of 16 is ideal, MERV 13 is likely to be the highest rating you’ll find for typical residential HVAC filter sizes.
Don’t concern yourself about a filter’s allergen rating. Some filter brands use other filtration scales, such as the FPR or MPR systems, but the MERV rating should also be printed on the packaging or in the product’s description online. HEPA (high-efficiency particulate air) filters, while found in some portable room air purifiers, provide such tight filtration that they are impractical for most residential forced-air systems.
When entertaining guests, if you have a central heating/cooling system but heating or cooling isn’t needed, simply run the fan by itself so that recirculated air will be passed through the filter. If you don’t have a central system, be aware that using ceiling fans in enclosed spaces can spread airborne viruses. You’ll need to open windows and doors when using room fans, in order to replace the indoor air with outdoor air.
More Blood-Suckers
No, I’m not referring to the IRS. There’s another tropical disease called cutaneous leishmaniasis that is spreading in Texas, according to a 2018 report. Disease-causing protozoans are harbored by rodents (“reservoir”) and transmitted to humans (“host”) by female sand flies (“vector”). The blood-sucking insects are about one-fourth the size of a mosquito and can inflict a painful bite. Sandflies are currently found as far north as Ohio, and their range is expected to expand due to global warming.
Leishmania mexicana, the parasite that produces this disease, has a complex life cycle alternating between insects and mammals. Infection can produce a persistent ulcerating skin lesion at the site of the bite. Because available treatments can be worse than this disease, an ounce of prevention can pay big dividends. In areas where leishmaniasis has become endemic, such as the Gulf of Mexico region, keeping the skin covered and using an insect repellant such as DEET is advised during the hours from dusk to dawn.
Don’t Be Fooled By Bread Labels
Just because the front of the label says “Healthy Multi-Grain Bread” or “Hearty Grains and Seeds,” you still need to carefully read the ingredients list. If the bread contains refined or enriched flours, emulsifiers, preservatives, and other substances you wouldn’t find in a home kitchen, if it has excessive levels of sodium and sugar, or low levels of dietary fiber and protein, it should be classified as an ultra-processed food and considered unfit for consumption by any humans who value their health.
When it comes to finding healthy grocery store bread, there aren’t many as healthy as Ezekiel 4:9 Sprouted Whole Grain Bread. Each dense 34-gram slice has 80 calories and contains 0.5 g fat (0 g trans and saturated fat), 75 mg sodium, 15 g carbs (3 g dietary fiber, 0 g total sugars), and 5 g protein. It’s organic flour is made from sprouted wheat, barley, millet, lentils, soybeans, and spelt. It costs about $8 per 20-slice loaf.
Dave’s Killer Bread Organic Thin Sliced Powerseed Bread might be a runner-up, with 60 calories per 28-gram slice. It is basically a whole wheat bread with added grains and seeds, and sweetened with fruit juices. Total fat per slice is 1.5 g (0 g trans and saturated fat), 90 mg sodium, 12 g carbs (3 g dietary fiber, 2 g total sugars), and 3 g protein. Its cost is about $6.50 per 21-slice loaf, and can often be found on sale.
November 16, 2023
November 16, 2023, was designated as “National Fast Food Day.” I’m not kidding! I do hope you missed it. The glorification of fast food is a disgrace. How silly America must appear to those in countries where the health of its citizens is a national priority. That’s almost everywhere else in the world, where healthcare is not a for-profit enterprise.
Making Ultra-Processed Foods (UPFs) Even Worse
UPFs are industrial formulations manufactured in a complex way using ingredients not usually found in kitchens (eg. maltodextrin, hydrogenated oils, modified starches) and cosmetic additives (eg. emulsifiers, flavorings, colorants, artificial sweeteners). They are typically cheap, highly palatable, and widely available as ready-to-eat products that are often consumed in excessive quantities, replacing more nutritious foods in the diet.
Tyson Foods has recalled 30,000 pounds of frozen chicken nuggets after consumers reported finding metal pieces in the product. These unhealthy ultra-processed foods are called “Fun Nuggets.” In 2019, Tyson recalled more than 36,000 pounds of chicken nuggets because of contamination with rubber particles. Tyson recalled more than 75,000 pounds of frozen chicken nuggets in 2014 after consumers discovered that they contained small pieces of plastic.
There are indictions that contaminants from processing machinery and the packaging materials of snacks and fast foods may contribute to the adverse health effects of UPFs. Independent testing by Environmental Health News has found evidence of PFAS “forever chemicals” in packaging from McDonald’s, Starbucks and KFC. A new California food packaging law banning PFAS in food packaging materials went into effect on January 1, 2023.
Garbage In, Trouble At the Other End
What you put in your mouth can have a deleterious effect on the other end of your digestive system. Analysis of three large U.S. prospective dietary studies has found an association between high ultra-processed food consumption and the risk of colorectal cancer, the third most commonly diagnosed malignancy in American men and women. The rate of colon cancer has risen rapidly among people in their twenties and thirties.
Ultra-processed foods (UPFs) make up nearly three-quarters of the entire U.S. food supply and contribute nearly 60 percent of total daily calories in the typical adult diet. Recent evidence suggests some of these foods may be as addictive as tobacco. Carcinogens may be formed during the processing and cooking of meats, and UPFs can contain additives that alter the gut microbiome and promote inflammation. .
Men appear to be more at risk from their dietary choices than women. The high consumption of UPFs by men carried a 29 percent higher risk of developing colorectal cancer, compared with men who ate the least amount of UPFs. Consumption of “heat-and-eat” foods was associated with an increased risk of colorectal cancer for both sexes. Dietary calcium intake appeared to have a protective effect.
The study identified UPFs as breakfast bars, cold cereal, English muffins, bagels, rolls, bread, crackers, processed meat sandwiches, bologna, hot dogs, salami, sausages, French fries, breaded fish sticks, brownie mixes, coffee cake, pies, cakes, cookies, donuts, muffins, biscuits, sweet rolls, candy, granola bars, energy bars, protein bars, apple sauce, jams, jellies, fruit preserves, ketchup, chili sauce, salsa, salad dressings, mayonnaise, margarine, soy sauce, non-dairy coffee creamer, cream cheese, frozen yogurt, sherbet, ice cream, sweetened or flavored yogurt, carbonated beverages, canned and bottled juices, coffee and tea drinks, heat-and-eat dishes, frozen pizza, bouillon, canned soups, and anything containing artificial sweeteners.
Another study found that higher intakes of alcohol and white bread are associated with an increased risk for colorectal cancer, while dietary fiber, calcium, magnesium, phosphorus, and manganese are associated with a decreased risk. The findings come from a large-scale association analysis using U.K. Biobank data.
The takeaway: Since I value an intact colon, I’m willing to forego frozen pizzas (especially those topped with bacon, ham, sausage, or pepperoni), avoid sub sandwiches, and pass up anything from the deli case in supermarkets. My diet continues to improve as I find more ways to identify UPFs in the ingredients labels on packaged foods.
Appreciating Subtle Tastes
The tastes that we find most pleasant are partly due to our genetics and partly due to learning from life experiences. Unfortunately, being exposed to a continual assault on our sense of taste by industrially processed and restaurant manipulated foods that are intended to be addictive has resulted in a reprogramming of our taste preferences, to the detriment of our health.
When I became curious about what plain, unseasoned food really tastes like, I progressively cut back on seasonings. Much to my surprise and delight, allowing the food’s natural flavors to shine through opened up a whole new world of enjoyment.
Trusting the wisdom of our body to select the foods that we actually need to eat, and to avoid those that aren’t good for us, requires being in touch with our senses of smell and taste. If something isn’t palatable without seasonings or so-called “flavor enhancers,” we probably shouldn’t eat it. Experiencing rancid odors as being repugnant has survival value. Your nose knows.
At the turn of the 20th century, spoilage was a common problem with perishable foods that were transported and stored without the benefit of refrigeration. “Ketchup” (or “catsup”) was the generic term for any product used to hide the putrid taste of spoiled meat. In 1907, the H.J. Heinz Company cornered the ketchup market with some legislative help from Congress, after a successful lobbying effort that eliminated most of their competitors.
Today, Heinz Tomato Ketchup is a UPF that contains tomato concentrate, distilled vinegar, high fructose corn syrup, corn syrup, salt, spice, onion powder, and “natural flavoring,” which includes oleoresins, essential oils, and spice extracts. Two tablespoons of ketchup count as a “vegetable” in school lunches, thanks to congressional lobbying efforts by the big food corporations.
I’m not suggesting that we should forego the exotic flavors of traditional dishes from around the world, or even a good barbecue sauce, for that matter. It’s still a treat for me to eat Tom Kha, Paella, Yakisoba, Masala, Cioppino, or Adobo. However, for day-to-day cooking, I like to keep it simple, and still tasting good without any added salt, sugar, or saturated fats.
Learning to appreciate the wonderful, subtle flavors of unadulterated whole foods took some time, but for me it has been worth it. Now, the thought of putting ketchup on any food seems akin to putting lipstick on the Mona Lisa. As the saying goes, “If it ain’t broken, don’t fix it.”
Eating More Plant-Based Foods
There is increasing evidence that shifting away from animal-based foods by substituting plant-based foods has a positive effect upon cardio-metabolic health and reduces mortality risk. A new meta-analysis of 37 prospective studies found that substituting nuts, legumes, whole grains, and olive oil for red and processed meat, poultry, eggs, dairy, and butter, found a moderate reduction in cardiovascular disease and type 2 diabetes, and even greater effect in reducing all-cause mortality, including deaths from cancer.
As I previously showed, getting enough complete protein on a daily basis is a significant challenge for vegans (ie. strict vegetarians). When it comes to cardio-metabolic health, a recent randomized clinical trial involving 22 pairs of healthy adult identical twins over an eight-week period showed that a vegan diet is superior to a healthy omnivorous one. However, changes in muscle mass were not evaluated.
My personal strategy is to make plant-based foods the major part of my diet, not the entirety. Despite occasional forays to the “dark side” for a burger or ribs, I’m minimizing the amount of saturated animal fats that I consume. Processed meats are a no-go. Cheese is preferably reduced fat on non-fat. Eggs are from organically raised, free-range hens. However, chicken presents a quandary: Breasts and tenders have the lowest amount of fat, but when it comes to taste….
I leave it to you to find the optimum balance for your own health and happiness. Is a longer, boring life better than a shorter one that’s been enjoyed to the max? You tell me. Just remember that in most cases your life is not entirely about you. Hopefully, you will have loved ones to also consider when making your healthy living decisions.
Banana Buzzkill
In a previous issue of this newsletter I presented research about how bananas, which contain high amounts of the enzyme polyphenol oxidase, can reduce the bioavailability of some flavonoids by as much as 84 percent. Flavonoids can have beneficial antioxidant and anti-inflammatory properties.
The study looked at a particular class of flavonoids called flavanols, also known as catechins or flavan-3-ols, high concentrations of which are found in green and black tea, dark chocolate, and berries, especially blackberries. It didn’t matter whether the bananas were mixed in a smoothie or eaten separately from berries in the same meal.
For your consideration, these are the fruits and vegetables with high polyphenol oxidase activity, expressed as KiloUnits per 100 grams of the edible portion:
Banana: 3258
Beet greens: 1594
Apple (red delicious): 570
Pear: 147
Beets: 94
Peach: 41
I was dismayed by the news, since bananas and berries have had a regular place in my breakfast cereal. A day without bananas would almost feel like a day without sunshine. Yet, because bananas make great snacks all by themselves, I don’t need to eat them along with flavonoid-rich foods in a smoothie or bowl of oatmeal. I can simply take a “banana break” later in the day. For those who have trouble falling asleep on an empty stomach, a banana at bedtime is recommended.
If by now you think I’m going bananas for bananas, let me refer you to a definitive source of information about the subject: Harvard University’s T.H. Chan School of Public Health. Check out what the nutrition scientists have to say about bananas.
Too Much of a Good Thing
As if the banana study wasn’t enough to make me rethink my favorite breakfast fruit, there is research casting cinnamon in an unfavorable light. Coumarins are chemical class of unsaturated lactones found in a number of plants. In high enough concentrations they have the potential to cause liver damage in humans. Coumarins are present in high concentrations in Cinnamomum aromaticum (cassia), grown in China and Vietnam and typically used in baked goods, but not in the less common and more expensive Cinnamomum zeylanicum (true cinnamon) grown in Sri Lanka.
Coumarin research led to a short-lived attempt to ban cinnamon buns by the E.U., sparking a bakers’ rebellion. While more research is needed to clarify the risk of cassia’s hepatotoxicity, to be on the safe side it is currently recommended that no more than a teaspoon a day be eaten by people with a healthy liver, and it should probably be avoided by those with elevated liver enzymes on blood tests.
How Low Can Some Docs Go?
A doctor has formulated and promoted a line of so-called “Natural Medicines” for blood sugar control, obesity, and neuropathy, among other ailments. These products have recently come under scrutiny by safety regulators, prompting the FDA to issue an immediate recall order for one of the supplements because it contains two undeclared prescription medications that could pose a health risk.
Adulteration of natural substances with prescription drugs is not a rare occurrence in the nutraceutical and herbal medicine industries. The FDA regularly encounters companies that boost the effectiveness of their products with undeclared drugs. Examples range from “Natural Male Enhancement” products containing generic Viagra to a “Natural Pain Relief” tea laced with both a steroid and an NSAID.
Supplements are generally a waste of money, especially if you eat a healthy diet. However, if you still need a vitamin or mineral supplement because of poor absorption, make sure that the products you buy are USP certified for purity and potency. Otherwise, it’s like buying snake oil to “cure whatever ails you,” and you’ll never know what you’re really getting.
As a general rule, it is best to view with considerable skepticism any supplement recommendations made by anyone who makes money selling them, even if they sport impressive credentials. It’s deemed an unethical “conflict of interest” when physicians try to sell products to patients. They are licensed to provide health care in the best interest of their patients, not make self-serving sales pitches.
Standard Time for Better Health
Now that we’re waking up to more sunlight on standard time, you’ll be happy to know that it is actually better for your health, a claim that’s supported by an abundance of scientific evidence. That’s because the circadian rhythms set by our internal clock work better when we are exposed to daylight upon awakening. Deep, restorative sleep suffers when we are required to wake up while it is still dark outside.
Severe circadian rhythm disruption occurs when we are commanded to change the clocks twice a year. Interestingly, people living in Arizona and Hawaii, where daylight saving time is not observed, appear to be generally healthier than those who live elsewhere in America. Clock changes have a harmful impact on sleep and the functioning of the neuroendocrine and immune systems. There are also more heart attacks and strokes, as well as a temporary cognitive impairment causing motor vehicle accidents and other injuries in the weeks following each time change.
Nonetheless, Republican Senator Marco Rubio from Florida reintroduced the “Sunshine Protection Act” in March, 2023, that would make daylight saving time permanent. The bill has been stalled in the Committee on Commerce, Science and Transportation. Last year, the bill received unanimous approval in the Senate, but languished in the House.
The legislative push for permanent daylight saving time is another glaring example of corporate wealth versus people’s health. The political influence of lobbying and campaign contributions financed by corporations have helped them push their argument for permanent daylight savings: Having more daylight in the evenings encourages people to go out and do things that involve spending money. Please let your elected officials know that your health is more important.
Daylight and Mood Disorders
Seasonal Affective Disorder (SAD) affects seven percent of those living at higher latitudes (between the 45th Parallel and the Pole), and 20 percent will experience the less severe “winter blues.” Some relief is provided by early morning exposure to daylight and spending more time outdoors, without using sunglasses. A stronger preventive measure for SAD is daily morning use of a 10,000 lux indoor light box or “dawn simulator” during the months of November through February in the Northern Hemisphere. Severe cases of SAD may require specific antidepressant medications.
Increasing amounts of daylight following the Winter Solstice have been celebrated by people for thousands of years. Druid priests in the Celtic British Isles are said to have observed the so-called “Death of the Old Sun and Birth of the New Sun” at Stonehenge, celebrating the triumph of light over darkness. In an effort to attract others to their faith, early Christians created their own celebration coinciding with the season’s earliest recognition that the amount of daylight was increasing.
Conversely, exposure to too much light in the summertime, or during the evening hours any time of year, can have an adverse effect on mental health. The largest study of light exposure found that having more light at night-time increases the risk for a number of mood disorders. A recent study suggests that light therapy can lead to significant improvement in sleep and psycho-behavioral symptoms in patients with Alzheimer’s disease. The take-away: Never underestimate the power of light!
November 7, 2023
Do You Need to Lose Weight?
Even if your bodyweight in relation to your height is calculated to be a healthy Body Mass Index (BMI), if your waist circumference is close to or greater than your hip circumference (waist-to-hip ratio), your risk is high and you’ll need to lose weight if you want to optimize your health.
Permanent weight loss can often be accomplished with lifestyle changes alone, but genetic and hormonal factors can make it difficult to achieve for many people. With a diagnosis of obesity, losing weight quickly may be necessary to reduce associated disease risks, such as type 2 diabetes, hypertension, heart disease, certain cancers, and liver disease. In the previous issue I went into detail about the drugs currently being used to assist people with weight loss. Their effect can be enhanced by concomitant lifestyle changes, described below.
Chrono-Nutrition
Timing of meals may play a role in people’s metabolism. Eating the first meal of the day shortly after sunrise may improve metabolic health, while skipping breakfast can increase the risk of obesity. The ideal situation is when our eating pattern aligns with our circadian rhythm, the internal clock that governs our body temperature, hormonal fluctuations, and sleep-wake cycle.
According to a meta-analysis of nine clinical trials, we digest and metabolize our food most efficiently early in the day. People who consumed most of their calories earlier in the day lost more weight and showed improvements in blood sugar, insulin sensitivity, and cholesterol levels.
Rather than counting and limiting calories, restricting mealtimes to an eight-hour period appears to be equally effective, and a lot easier to accomplish. With time-restricted eating, your biggest meal of the day should be the first one, and your smallest meal the last. A hearty breakfast, a modest lunch (that doesn’t come with a built-in siesta), and a light dinner, with no snacking afterward, is ideal. When it comes to reducing diabetes risk, the earlier you begin an overnight fast, and the earlier you have breakfast, the better.
Don’t Lose Muscle Mass
Preserving lean muscle mass is important when reducing caloric intake, so strength exercises plus an adequate intake of high-quality protein are necessary. Frailty is a huge contributor to morbidity and mortality among the elderly. For the sake of health and longevity, people need to minimize their loss of muscle mass (known as sarcopenia) and avoid the frailty that accompanies it. With the new GLP-1 receptor agonist drugs that people are taking for weight loss, a significant amount of that loss comes from reduced muscle mass, creating an undesirable condition known as “sarcopenic obesity.”
The U.S. Recommended Dietary Allowance (RDA) for protein is about 0.4 grams per pound per day. This is the minimum intake to prevent malnutrition, and is based on studies of sedentary individuals. The more active a person is, the more protein they will need. The RDA is not enough to prevent age-related sarcopenia.
The minimum protein intake to prevent the loss of skeletal muscle in healthy older people is 0.5 grams per pound of lean body mass per day. Unless they have impaired renal function, active younger adults may require 0.6 grams of protein per pound of lean body mass per day, depending upon their age, sex, activity level, and physiological state. There are diminishing returns from consuming too much protein, usually more than 0.7 grams per pound of lean body mass per day, because surplus protein will be converted to fat stores. However, for athletes who are training for a triathlon, a maximum intake could be as high as 0.9 grams per pound of lean body mass per day.
There are nine essential amino acids that should be eaten on a daily basis. Because neither beans nor grains by themselves contain complete proteins, entirely plant-based diets can present nutritional challenges. Complete proteins that are plant-based are found in soybeans, peanuts, spelt, quinoa, buckwheat, amaranth, chia seeds, hemp seeds, and nutritional yeast.
Animal sources of protein contain abundant amounts of all the essential amino acids, but tend to be much higher in saturated fats. Consequently, eating too much meat can adversely impact people’s cardiovascular health. Another caveat: A high-protein diet can come at the expense of plant-based fiber and essential micronutrients.
The precise calculation of lean body mass usually takes into account age, sex, height, weight, and body fat percentage. The latter can be determined using skin-fold calipers or a bioelectrical impedance analysis performed in a medical office, weight-loss clinic, or fitness center. To get a rough estimate of your lean body mass, use this simple calculator.
As an example, if an Olympic athlete needs 150 grams of protein a day, that’s the amount found in 10 cups of beans, 8 cups of lentils, or 30 cups of brown rice. In order for them to get all the essential amino acids, they would need to eat 5 cups of beans plus 15 cups of brown rice each day, if that was their only source of protein. That seems rather impractical, doesn’t it?
My point is that wisely-chosen, animal-based food sources can make up for the protein (and vitamin B12) shortcomings of a strictly vegan diet. It’s no surprise that evolution has shaped humans into natural-born omnivores. An added bonus for those wanting to lose weight is that the digestion of proteins burns calories. Here’s the protein content of some common foods:
Greek yogurt, plain, non-fat, 1 cup: 27 grams
Chicken breast, 3 ounces: 26 grams
Tuna, canned, 3 ounces: 22 grams
Salmon filet, 3 ounces: 21 grams
Tofu, 3 ounces: 13 grams
Lentils, cooked, 1 cup: 18 grams
Black or pinto beans, cooked, 1 cup: 15 grams
Spelt, cooked, 1 cup: 11 grams
Quinoa, cooked, 1 cup: 8 grams
Oats, cooked, 1 cup: 6 grams
Brown rice, long-grain, cooked, 1 cup: 5.5 grams
Corn, cooked, 1 cup: 5 grams
Peanuts, 1 ounce: 7 grams
Almonds, 1 ounce: 6 grams
Cashews, 1 ounce: 5 grams
Walnuts or hazelnuts, 1 ounce: 4 grams
Pecans, 1 ounce: 3 grams
Egg, large: 6 grams
Don’t Avoid Fats
While paying attention to your sources of calories, don’t skimp on healthy fats. Essential polyunsaturated fatty acids (PUFAs) need to be eaten on a daily basis, just like vitamin C, which can’t be stored by the body. Essential PUFAs are found in foods containing omega-3 fatty acids, such as fatty fish (salmon, mackerel, sardines, anchovies, herring), seeds (flax, chia, hemp), and walnuts (which have 10 times more ALA than pecans).
The human body is more efficient at converting alpha-linolenic acid (ALA), the omega-3 fatty acid found in plant sources, into eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the omega-3 fatty acids found in fish, when it is accompanied by enough omega-6 fatty acids. That’s why it’s important to eat an omnivorous diet that includes omega-3 fatty acids, with no more than four times the amount of omega-6 fatty acids, according to a review. Good sources of omega-6 polyunsaturated fatty acids are olive oil (which contains lots of monounsaturated fatty acids), nuts and seeds (walnuts, pine nuts, Brazil nuts), legumes (soybeans, lentils, peanuts), and whole grains.
Good and Bad Carbs
While calories are calories, calories that come from fructose are accompanied by metabolic havoc caused by the five-carbon sugar. Fructose stimulates the deposition of body fat, and increases hunger and a craving for sweets. Excessive amounts of fructose are found in table sugar, honey, maple syrup, corn syrup, fruit juices (as drinks or concentrated as sweeteners), dried fruits, and processed foods containing high-fructose corn syrup. If you want to lose weight, they should all be shunned.
Eating enough fiber has the opposite effect on metabolism, especially plant-based sources containing soluble fiber known as beta-glucans. They increase the expression of the gut hormones GLP-1 and PYY, which help to reduce appetite and in turn, manage body weight, according to a recent review. The best dietary sources of beta-glucans are whole grains such as barley, rye, oats, corn, and rice, as well as nutritional yeast, mushrooms, and seaweed.
The Ultra-Processed Elephant in the Room
Ultra-processed foods (UPFs) have been implicated in the development of obesity, according to a landmark randomized controlled trial (RCT), the “gold standard” for medical research. Highly profitable UPFs are manufactured by the “Big Food” industry and typically contain things not found in nature, such as chemical additives, preservatives, and substances that enhance color, texture, and flavor. When you read food labels (as you should) and see ingredients that wouldn’t be found in your grandmother’s kitchen, don’t buy it.
In the U.S. and other developed nations, obesity has reached epidemic proportions for both adults and children. Parents, please pay careful attention to what your children are eating, not only at home. The disgraceful National School Lunch Program allows schools to serve Domino’s pizza, Lunchables, Cheez-Its, and other ultra-processed foods that aren’t good for growing bodies and developing minds.
The Ultra-processed Foods in Obesity Project has been investigating the ways in which UPFs are contributing to childhood obesity. A number of other countries have recently issued dietary guidelines urging people to cut back on their consumption of ultra-processed foods. Let’s push for the same kind of sanity in America.
Eat At Home
The last bit of advice I have to offer about losing weight is that the best way to control what you eat is to make it yourself. When you dine out, you are typically presented with food choices containing ingredients that will hook your tastebuds and keep you coming back for more, all in the interest of making a profit. Healthy eating begins, and ends, at home. I wrote Rx for Healthy Eating to show people that healthy home cooking can be easy, and if they get creative, lots of fun.
October 31, 2023
During this traditionally spooky time of year, it’s appropriate for me to explore some particularly scary topics. Sorry, there’s no “trick-or-treat” option here, but I do hope the information I present will encourage your most thoughtful consideration.
Dangerous Wild Animal Encounters
No, I’m not talking about man-eating tigers, grizzly bears, poisonous snakes, or great white sharks. I’m referring to an animal that kills 700,000 to a million people world wide every year, and it is probably coming to a neighborhood near you, thanks to global warming. It’s the mosquito, a prolific vector for tropical diseases, including locally transmitted malaria in Florida, Texas, and Maryland, dengue in southern California, Florida, Hawaii, Texas, and Arizona, and chikungunya in Florida and Texas. West Nile virus is the most common mosquito-borne illness in the continental U.S., with 1,035 cases and 79 deaths reported in 2022.
If the risk of mosquito-borne illnesses are not enough for you to take precautions when venturing outdoors, consider that the U.S. has also seen a steep rise in diseases transmitted by ticks over the past 50 years. In a recent report, the surge in tick-borne diseases has been deemed a significant public health threat. Ticks can transmit Lyme disease bacteria, the Powassan virus, and rickettsial diseases such as Rocky Mountain spotted fever, as well as a number of other infections.
Contagion
Let’s not forget the dangers of contagion with members of our own species, with over 200 viruses that can cause the common cold. As the winter season approaches, respiratory illnesses are ramping up in frequency, including flu, RSV infections, and COVID-19, all of which can be fatal for vulnerable individuals. The U.S. Code of Federal Regulations specifies four Class A Communicable Diseases of Public Health Significance for which immigrants are screened: tuberculosis, syphilis, gonorrhea, and leprosy.
American children average six respiratory infections a year, while adults typically have two to four episodes, with more illnesses if they have school-age children. When out in public, I involuntarily cringe whenever I hear someone coughing, but with many respiratory viruses, infected people can be contagious before developing symptoms. Have it your way, but even one yearly bout with an infectious disease is one too many for me.
Relentless Viral Evolution
The novel coronavirus known as SARS-CoV-2 continues to evolve in unpredictable ways that are being shaped by immunity pressures from the human population. Random mutations that enhance the virus’ ability to escape immune defenses enable it to become more common with each successive infection. Since the current vaccines cannot completely prevent infections, breakthroughs will inevitably occur. That’s why I continue to remain a strong advocate for wearing N95 or equivalent masks in indoor public spaces, and testing people before they gather in indoor private spaces.
The latest variant that has shown an impressive ability to evade people’s immune defenses is JN.1, a descendant of BA.2.86, which traces its lineage back to BA.2. This is a different evolutionary path than the XBB family of variants, and that’s why it is a concern. The current vaccines target the XBB.1.5 variant, so our humoral immunity (ie. antibody response) from previous vaccinations and/or infections is expected to be rather weak. The good news is that the cellular immunity of those who are “up to date” will likely be adequate to prevent severe illness from JN.1, unless they are immunodeficient or immunocompromised.
Different Strokes for Different Folks
In case you missed the World Stroke Day announcements on October 29, strokes are the fifth leading cause of death in the U.S. and account for about 5 percent of all adult deaths. The good news is that most strokes, which doctors refer to as cerebral vascular accidents (CVAs), are preventable. Although stroke deaths dramatically declined during the period 2000 to 2013, they have since risen and then plateaued in many parts of the country.
There are basically two types of CVAs; hemorrhagic and ischemic. The former refers to brain damage caused by bleeding from an artery within the brain, while the latter is usually due to a blood clot or arterial wall plaque blocking off the brain’s blood supply. It is important to recognize the signs of stroke and receive emergency treatment as soon as possible.
Stroke prevention includes lifestyle modifications such as not smoking or vaping tobacco and cannabis, avoiding second-hand smoke and air pollution, abstaining from alcohol, increasing physical activity, reducing one’s intake of sugar and salt, eating less red and processed meat, protecting your head from injuries, and maintaining a healthy weight. Those with high blood pressure, high cholesterol, diabetes, or obesity will usually need to take medications to bring those conditions under control in order to reduce their stroke risk.
People with untreated atrial fibrillation (A-Fib) have a five-fold increase in their risk of stroke. A recent study found that people who sit for 13 or more hours a day had a 44 percent higher risk of stroke. Even a short-term exposure to air pollution can increase stroke risk, as can stressful life events. Learning how to ameliorate one’s physiological responses to stress can help with stroke prevention.
Brain Fog in Long-COVID
By the end of 2022, one in seven people in the U.S. reported having had Long-COVID symptoms, according to a large-scale investigation. Patients who became bed-ridden for several days as a result of a COVID-19 infection are more likely to develop Long-COVID, as are those who have had repeated infections. Although Paxlovid has been shown to significantly reduce the risk for severe complications and death from COVID-19 infections in vulnerable individuals, there is no evidence that it can lessen the chance of developing Long-COVID.
A new lab study offers evidence that the SARS-CoV-2 virus can directly infect brain cells. Questions regarding the ability of the virus to persist in the human brain beyond the acute phase of the infection, and if the presence of the virus in the brain can produce chronic inflammation and the neurological symptoms associated with Long-COVID, remain unanswered.
Another lab study suggests that low blood levels of the neurotransmitter serotonin might lead to the most common neurological symptoms of Long-COVID. The authors propose a mechanism involving the gut microbiome: Intestinal bacteria are the major source of serotonin production from the amino acid, tryptophan. Persistence of the coronavirus in the gut and subsequent inflammation can cause serotonin depletion by reducing the absorption of tryptophan. The vagus nerve connecting the brain and the gut is presumed to be the pathway affected by low serotonin.
There is still much research that needs to be done in the search for effective Long-COVID treatments. One interesting modality with a positive impact on cognitive performance and psychological parameters is biofeedback-enhanced meditation combined with multi-modal sensory stimulation. As a non-pharmacological intervention with cognitive benefits, this approach deserves further study.
Paxlovid Sticker Shock
Unfortunately, there is widespread misunderstanding within the medical community about the appropriate use of Paxlovid. The federal government and state medical boards need to do a better job providing up-to-date guidance for health-care providers. In the meantime, patients must take a proactive approach and advocate for their coronavirus treatment.
Getting Paxlovid shouldn’t hinge on the severity of one’s symptoms. Rather, treatment should be based upon the likelihood of an individual becoming severely ill. Because Paxlovid works by stopping viral replication, it is most effective when given early in the course of the illness.
It is important to be aware of potential interactions with other medicines you are using, and steps should be taken to avoid risky combinations. Paxlovid carries a boxed warning from the FDA about significant drug interactions, and treatment guidelines from the National Institutes of Health urge clinicians to carefully review patients’ medications. Many commonly used drugs can still be safely administered, despite their interaction potential. The CDC provides guidancefor prescribers.
As if coming down with COVID-19 isn’t enough of a pain, consider how much Paxlovid is likely to cost once it is no longer subsidized by the U.S. government. Pfizer has announced that it will set the U.S. retail price for Paxlovid at $1,390 per five-day course when government stocks run out. That’s more than twice what the federal government currently pays for it. The drug will continue to be free for patients with Medicare and Medicaid through 2024, and to uninsured and underinsured patients through 2028.
If you do contract COVID-19 and qualify for Paxlovid, don’t take Molnupiravir, a less effective oral antiviral drug. New research shows that Molnupiravir can induce numerous mutations in the virus and has accelerated viral evolution, with the production of new, more transmissible variants that might also become more dangerous.
Two Drinks a Day Won’t Keep the Doctor Away
Observational studies of low to moderate alcohol consumption have found statistical associations with physiological benefits such as improved cholesterol profiles, enhanced platelet activity and blood-clotting function, and increased insulin sensitivity. However, the health burden of regular alcohol consumption can easily outweigh any potential benefits.
The FDA defines moderate alcohol consumption as up to one drink per day for women and up to two drinks per day for men. One drink is equivalent to 12 fluid ounces of regular beer, five fluid ounces of wine with 12 percent alcohol, or 1.5 fluid ounces of distilled spirits.
The global average for drinking alcohol is a total of about six liters of pure ethanol per drinker per year. That translates to about one bottle of wine per week. In wine-producing regions, people tend to consume twice that amount. World-wide, four percent of all cancers can be attributed to alcohol.
Over the last two decades, multiple studies have strongly established that consuming alcohol increases the risk of several cancers, including breast, colorectal, liver cancer. Other sites impacted by drinking alcohol include the oral cavity, esophagus, pharynx and larynx. A meta-analysis indicated a linear dose-response relationship for bladder cancer in those who consume alcohol as liquor or spirits. Emerging evidence suggests that stomach and pancreatic cancers may also be alcohol-related.
Moderate drinking is thought to account for about 14 percent of all cancer cases in which alcohol is implicated. According to a 2020 population-based study, the greater the consumption, the higher the cancer rate, with heavy drinking accounting for almost 47 percent of the alcohol-attributable cancers.
Heavy Metal Dangers
As if the heavy metal musical assault on people’s eardrums wasn’t bad enough, a new Consumer Report announcement warned that chocolate products containing excessive levels of heavy metals, such as lead and cadmium, were found in dark chocolate bars and hot chocolate mix from Walmart, cocoa powder from Hershey’s and Droste, semi-sweet chocolate chips from Target, and hot chocolate mixes from Trader Joe’s, Nestle and Starbucks.
Long-term exposure to heavy metals can damage the nervous system, immune system, and kidneys. Pregnant women and young children are at higher risk. I doubt that there will be anything healthy found among the Halloween treats your kids bring home today.
Fighting Fake Foods
There is a major problem with industrially produced concoctions that people eat at the expense of their health, while enriching food corporations’ investors. The ultra-processed food (UPF) epidemic begins with infant formulas and school lunches, and ends up with adults having a 50 percent higher cardiovascular mortality risk, according to a recent analysis. It would not be far-fetched to think of UPFs as the instruments of installment-plan suicide. There is also a growing body of evidence linking obesity to the consumption of UPFs. Unfortunately, in this fight against the merchants of death, we, the people, are pretty much on our own, but being forewarned is forearmed.
UPFs are not necessarily the same thing as junk foods, which are real foods that contain too much sugar, salt, and saturated fat, while lacking adequate amounts of fiber. A widely used scientific definition of ultra-processed food is: “Food that has undergone intense industrial physical, chemical, or biological processes, such as hydrogenation, molding, extruding, and pre-processing by frying; contains industrial substances not usually found in domestic kitchens, such as maltodextrin, hydrogenated oils, and modified starches; has cosmetic additives, such as dyes, emulsifiers, and texture-enhancers; or contains non-nutritive sweeteners and flavor-enhancing agents.”
Examples of industrially manipulated foods are: sweetened beverages, including diet sodas and sports drinks; packaged snacks, such as chips, cookies, crackers, candy, and energy bars; dehydrated foods, such as instant noodles and soups; processed meats, such as hot dogs, sausages, ham, and bacon; pre-made meals, such as frozen pizza, microwavable entrees, and TV dinners; fried fast-foods, such as french fries and chicken nuggets; many kinds of breakfast cereals; most spreads, sauces, and dips; cake mixes; and vegan meat substitutes made from soy protein isolates.
What UPFs tend to have in common is that they hack people’s taste buds, leading to overeating. Passing legislation that would mandate the inclusion of warning labels on UPFs is going to require the same kind of public pressure as it did with government consumer protections versus the lobbying power and misinformation campaigns of the tobacco industry. Perhaps food industry reforms need to begin with class-action lawsuits brought by people who have been harmed by eating UPFs.
Why Fiber Is Your Friend
If you haven’t yet made friends with fiber, now is the time to start. The recommended daily intake of fiber for adults is an average of 25 grams for women and 38 grams for men, but most Americans consume only about 15 grams of fiber per day. High-fiber whole grains and legumes (beans, peas, lentils, and peanuts), along with seeds and nuts, promote a beneficial gut microbiome and enhance gastrointestinal health. Soluble fiber can also help lower LDL (“bad”) cholesterol levels, and regulate blood sugar by increasing insulin sensitivity.
When a particular type of soluble fiber known as beta-glucans reaches the large intestine, microbes digest it into smaller molecules that trigger the release of GLP-1 and Peptide-YY hormones, which suppress appetite. People who feel full longer after eating are less inclined to snack between meals and don’t eat as much at meal times. The best dietary sources of beta-glucans are whole grains such as barley, rye, oats, corn, and rice, as well as nutritional yeast, mushrooms, and seaweed.
Bioactive compounds found in insoluble dietary fiber are associated with a reduced risk of heart disease, stroke, type 2 diabetes, and some types of cancer. A new study has identified 64 bioactive compounds from a variety of insoluble fiber sources. Of particular interest are the phenolics, which include flavonoids and polyphenols, because these are the most abundant natural antioxidants found in the human diet. A good way to get enough phenolics and other beneficial phytochemicals is to eat the skins of fruits and vegetables whenever possible.
Just because processed foods claim to have added fiber doesn’t mean that they are good for you. Food manufacturers are always looking for new ways to cash in on the latest nutritional health trends. Cellulose is an indigestible plant fiber that can be added to foods to improve texture, mouth-feel, and stability, but it does not have the nutritional benefits of dietary fiber. As always, whole, natural, plant-based foods are your best bet when it comes to healthy eating.
Never Underestimate Chicken Soup
Here’s an article explaining how homemade chicken soup can help you feel better when you’re sick. When it comes to treating symptoms of the common cold, there may not be anything that’s much better.
Many of the remedies found on drugstore shelves for symptoms of the common cold were grandfathered in by the FDA more than 50 years ago. Today’s requirements regarding the safety and efficacy of drugs are much more stringent. Over-the-counter (OTC) drug manufacturers have been pushing a plethora of products using the old ingredients without having to prove their claims.
In 2020, new regulations were enacted for reviewing previously approved OTC drugs. In September, 2023, the FDA’s advisors declared the common nasal decongestant, phenylephrine, to be ineffective. There are lots of similar products on the market that are also likely to fail today’s requirements.
Nutrition’s Holy Grail
Unhealthy diets are one of the leading causes of death and chronic disease, yet the healthcare system has mostly taken a one-size-fits-all approach to nutrition. While there are well-known general recommendations regarding healthy eating, and several evidence-based nutrition programs aimed at prevention, such as the Mediterranean, DASH, and MIND diets, figuring out what’s best for people with specific chronic health conditions remains an ongoing challenge for primary care providers.
There is a lot that has already been written about the science and politics of nutrition. Now, some experts are anticipating an algorithm that can offer every individual a custom-tailored diet based upon their unique needs and physiology, calling it the “holy grail” of nutrition. It will take a lot of information about a person; blood tests, microbiome analysis, genomic analysis, lifestyle evaluation, including sleep, exercise and stress levels, and a knowledge of preexisting conditions, before specific recommendations will be accurate enough.
A large National Institutes of Health (NIH) research program called “All of Us” was created in 2015 to advance the science of precision medicine. In order to tailor health care to the specific needs of individuals, the program has been collecting health and genetic data from a million volunteers around the nation. The NIH is now enrolling people in a “Nutrition for Precision Health” study to find out how different individuals metabolize food and respond to various diets.
People who enroll in the new study will be contributing to landmark research. They will also be given free analyses of their gut microbiomes, monitoring of daily blood sugar fluctuations, insulin levels, gut and satiety hormones, and other intricacies of their metabolic health. There will also be a financial incentive. It would be wonderful if, at some time in the not too distant future, people will be able to get a precise and reliable answer to the question, “What’s the best diet for me?”
Weight Loss Drugs
Obesity is a life-threatening chronic disease that has reached epidemic proportions in many developed nations. A recent randomized clinical trial showed that people with type 2 diabetes can lose weight and manage blood sugar by restricting their eating to an 8-hour window each day.
When dietary interventions such as caloric restriction and fasting 12 to 16 hours a day do not adequately address an obesity problem, surgical and pharmacological treatments can be considered. Bariatric surgical techniques, such as gastric bypass and sleeve gastrectomy, carry a much higher risk than weight-loss drugs, and should be reserved for patients who are not candidates for medical treatment.
Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) are a class of drugs developed for the treatment of type 2 diabetes mellitus. Semaglutide is sold under two brand names, Ozempic and Wegovy. While Ozempic is only FDA-approved as a treatment for diabetes, physicians have been prescribing it off-label to help people lose weight. Wegovy has been approved for the treatment of obesity, but is in short supply because of the demand.
Tirzepatide, sold as Mounjaro, is also prescribed off-label for weight loss, while Zepbound has recently been approved as a treatment for obesity among those without a diagnosis of type 2 diabetes. A systematic review and meta-analysis showed that tirzepatide is the most efficacious GLP-1 RA for weight loss, and can be used at the lower 10 mg weekly dose for optimal effect. This class of drugs is discussed in depth in this article.
One downside is the potential for significant weight gain when treatment is stopped if lifestyle changes have not also been made, so patients may need to take these drugs for extended periods of time. With billions of dollars in sales, drug companies are not inclined to fund further research that might raise questions about long-term efficacy and safety.
Another downside is the potential for accidental overdoses. Poison control centers across the country have seen a 15-fold increase in calls related to semaglutide overdoses. Some required hospitalization for severe nausea, vomiting and stomach pain. Symptoms resolved after patients were given intravenous fluids and medications to control their nausea.
GLP-1 RAs also appear to reduce cravings for sweets, alcohol, and addictive drugs. They improve insulin sensitivity in people with pre-diabetes, and may also reduce the risk for colorectal cancer. Although that makes them sound like miracle drugs, they are not risk-free. Semaglutide and tirzepatide have FDA boxed warnings. As always, any medication’s anticipated benefits need to be weighed against its potential risks. Ongoing monitoring by healthcare providers while taking these drugs is essential.
For now, the companies making GLP-1 RAs have settled into a pattern of high cost and limited access to ensure profitability. Most insurance won’t cover the $1,300 per month cost when these injectable diabetes drugs are prescribed off-label for weight loss. The good news is that more than 70 weight-loss drugs are now in clinical trials, including an oral version of semaglutide.
Don’t Trust Your Health to Social Media
When it comes to online sources of accurate medical information, inadequate fact-checking by social media companies can make those sources dangerous places for people to go for help. With the exception of bonafide medical experts who post to their social media accounts, healthcare misinformation runs rampant on YouTube, X(Twitter), Facebook, TikTok, Instagram, and the like. So, how can you distinguish the bonafide medical experts from the charlatans, frauds, and hucksters?
The first clue is whether the information presented comes across as being certain. Science-based medicine is not about certainties. Science can only give us percentages, and help doctors make informed guesses about the most probable diagnosis and what’s likely to be the best course of treatment. That will depend upon the totality of the information available at any given time, and new information is constantly becoming available. If this sounds like doctors need to hedge their bets when diagnosing and prescribing, they do, because that’s what the science of medicine requires.
Psychologically, people are generally uncomfortable with uncertainty, especially when they are dealing with troubling symptoms or facing the prospect of a diagnosis with a grim prognosis. We’d rather know for sure, than be left still wondering if what the doctor is telling us is right. That’s why the most popular doctors project a comforting sense of confidence when interacting with their patients. However, if they are being honest with themselves, they recognize that what they tell a patient is in actuality only their best guess.
It may be troubling for you to read this, but it is important to understand the limitations of medical science. Appreciating the honesty of uncertainty is how you can avoid becoming enthralled by alternative practitioners whose stock in trade is holding out false hopes and making impossible claims. People want to believe the promise of a cure, and sad to say, there are unethical medical doctors who stand apart from the mainstream and enrich themselves by taking advantage of people’s psychological vulnerability.
It never ceases to amaze me how many people fall for false claims and promises, and how easily they can be manipulated and exploited by con artists in a variety of guises, be they political, religious, financial, or medical. I’m not just talking about “crystal energy” healers or “aura balancing” practitioners who have no legitimate scientific evidence supporting their methods.
The bulk of the vitamin, supplement, and herbal medicine industries, and their prescribers, are also complicit in scams to separate people from their money. The pharmaceutical industry is not beyond reproach on this account, either.
Back to the pitfalls of social media: I’m not saying that you can’t learn how to properly fix a leaking toilet by watching YouTube videos, but obviously the stakes are a lot higher when it comes to your health. There are respected physicians on the faculties of medical schools whose lectures are posted on YouTube. There are also shady doctors who recruit patients with their YouTube videos.
However, it is not that hard to do your own online fact-checking and find out who they are. Your intuition can also be a guide, and if something like Prevagen’s claims sound too good to be true, that’s because they are. They were even more egregious before the FDA intervened.
The unfounded claims involve a protein that gets digested just like any other protein, and a so-called “clinical trial” that doesn’t meet the criteria for trustworthy science. The only thing that the barrage of TV testimonials suggests is the impressive power of the placebo effect.
Willful Ignorance
“Indeed, one can be deceived in many ways; one can be deceived in believing what is untrue, but on the other hand, one is also deceived in not believing what is true;” ~ Søren Kierkegaard, Works of Love (1847).
Paul Simon put it this way in his 1969 hit song, The Boxer: “A man hears what he wants to hear, and disregards the rest.” Putting it another way, we are all born ignorant, but it requires some serious effort to make ourselves stay that way.
A new meta-analysis of 22 research studies, involving a total of 6,531 participants, found that when faced with a choice, about 40 percent of people choose to remain ignorant about how their decisions will impact others. This typically allows them to act more selfishly, while maintaining a positive self-image that is at odds with reality.
Willful ignorance goes far beyond a failure to anticipate the far-reaching consequences of our actions. Being a one-issue voter, or having blind loyalty to a political party or leader, can have enormous implications for our democracy.
Ignoring food packaging labels can not only affect your personal health, it can financially enable companies that produce ultra-processed and junk foods, resulting in huge social and economic costs. While you might no longer grab a quick lunch at Arby’s, have you checked to see if your mutual funds include shares in food corporations and restaurant chains?
Being a socially responsible citizen doesn’t have to be at odds with our self-interest. It’s okay to be self-serving, but let’s try to do it with a greater awareness of the potential consequences of our beliefs, choices, and behaviors. Self-reflection affords us an opportunity to increase the likelihood that what we do for ourselves won’t be at the expense of others.
I encourage the development of “enlightened self-interest” and a preference for win-win interactions. In our relationship with this planet, it can be mutually beneficial to reflect upon our carbon footprint, and our habitual patterns of consumption and waste. By not choosing ignorance, we can create a positive sense of self that we truly deserve.
October 15, 2023
Let’s start off with some good news: The risk of developing Long-COVID has been decreasing as the coronavirus evolved from the original wild-type, to Alpha, Delta, and Omicron, according to new research. Let’s hope that trend continues, but it may not be entirely due to changes in the virus. There have also been increasing numbers of people who’ve received multiple vaccinations.
A meta-analysis of 24 studies focusing on COVID-19 vaccine effectiveness (VE) against Long-COVID, from December, 2019 to June, 2023, showed a 69 percent VE for people who received three doses of the COVID-19 vaccine, and a 37 percent VE for those with two doses.
A Phase-1 clinical trial of an attenuated-virus vaccine administered through the nose produced strong humoral and cellular immunity in adults who had received it. Several intranasal vaccines are currently under development. They are expected to be the next generation of broader and longer lasting vaccines effective against emerging strains of the SARS-CoV-2 virus.
Striking Healthcare Workers
Healthcare workers employed by hospitals and large medical clinics are generally overworked and underpaid, especially when for-profit corporations exploit their desire to help people. When being of service becomes detrimental to a worker’s physical and mental wellbeing, they are entitled to demand better working conditions. If they aren’t earning a salary that at the very least keeps up with inflation, then they also need to insist upon higher wages.
The public is unaware of how stressful their jobs can be. Patients don’t realize that the suicide rate among ancillary healthcare workers, such as nursing assistants and aides, along with nurses and medical technicians, greatly exceeds that of the general population, according to a recent analysis. The pandemic has taken an additional toll, and there are now fewer doctors, nurses, and other healthcare professionals because they have taken early retirement or found another, less stressful and more financially rewarding occupation. Those who’ve remained are now being forced to take up the slack.
The Kaiser strike is over for now, and the union seems to have negotiated a satisfactory agreement, but this won’t be the last time that healthcare workers have to strike in order to get what they deserve. Patients need to stop expecting those who care for their health to jeopardize their own in order to be of service. Please lend your support to striking healthcare workers, regardless of the short-term inconveniences you might experience. You’ll be much better off for it in the long run.
It is unlikely that U.S. physicians will go on strike for better working conditions, but I wish they would. The way corporate medicine is practiced, whether it is for profit or under a not-for-profit system such as the Kaiser Foundation, primary care providers are generally expected to see at least six patients an hour. This is simply inadequate for the establishment of a good doctor-patient relationship, and not enough face-to-face time for the delivery of the highest quality care. Overworked doctors typically feel like they are simply cogs in the medical machine, and unsatisfied patients often feel like they are being processed on an assembly line.
Doctors are now laborers under a system that is managed by people with no medical training. When “managed care” became the norm, I was no longer able to survive as a sole proprietor in private practice, so I chose an early retirement rather than going to work for a soulless corporation. By running my own office, I didn’t overbook, so I could see patients within a few minutes of their arrival. Then, I’d spend at least 15 minutes with each patient. I was also able to give them my undivided attention, because I wasn’t required to make computer entries into patients’ electronic health records.
I hope that patients will let their doctors know that they will be supportive if they demand changes that will be more satisfying for doctors, and provide better care for patients. As long as the bean-counters keep their stranglehold on the healthcare system, this is a battle that can only be won if both doctors and their patients collaborate in the strategic application of economic pressure.
Patients should avoid getting locked-in to a specific healthcare delivery corporation or insurance plan that limits their freedom to go elsewhere if they are not satisfied with the service. For example, Kaiser generally won’t pay when subscribers to their plan obtain medical care elsewhere, unless it is a bonafide emergency or pre-authorized. Medicare Advantage plans put patients at a disadvantage by restricting where they can go for covered services. Patient power comes from being able to freely choose the best medical care at any given time.
Lifestyle Medicine
Unhealthy lifestyle behaviors are a contributing factor in up to 80 percent of chronic illnesses. The clinical practice guidelines for many chronic diseases now recommend lifestyle interventions as a first-line treatment. An increasing number of studies recommend behavior changes for treating and potentially reversing conditions such as cardiovascular disease, obesity, and type 2 diabetes. There is strong evidence that lifestyle modifications can also be effective in the prevention of those diseases.
Since 2017, almost 2,500 U.S. physicians and 1,000 ancillary healthcare professionals have received certifications in Lifestyle Medicine. Yet, many patients are unable to obtain coverage for lifestyle treatment programs from their insurance providers. Comprehensive lifestyle programs are often so poorly reimbursed that clinicians and healthcare systems refuse to offer them. It is incomprehensible that insurance companies fail to recognize the wisdom of “an ounce of prevention being worth a pound of cure.”
Making matters worse, Medicare and Medicaid have reimbursement schedules that incentivize ongoing treatment with medications, and penalize lifestyle interventions that result in disease reversal. It’s as if physicians are financially rewarded if their patients remain sick, and have their income reduced if their patients’ health improves to the point where they no longer need expensive medications. For this to change, interventions involving optimal nutrition, physical activity, restorative sleep, better social connections, stress management, and avoidance of harmful substances must become the foundation for healthcare quality assessments.
The High Risk of Inactivity
Sitting is currently taking a lot of heat for its deleterious health impact, including an increased risk for heart disease, diabetes, cancer, dementia, and early death. Unfortunately, about 85 percent of U.S. workers have jobs that involve prolonged sitting. Humans did not evolve in an environment that had chairs. Squatting or sitting on the ground was the only alternative to standing in one place. The oldest known chair, found in an Egyptian tomb, is only about 5,000 years old. Chairs did not become common as household furniture until the 16th century.
According to a recent lab study, standing immobile does not offset the harm done by sitting, so a standing desk for your computer is not, by itself, the solution. What is necessary is to stand and move for five minutes after every half-hour of sitting. Think of taking a break from inactivity as a “movement snack.” If you have a standing desk, all you need to do is shuffle from side to side for five minutes to experience the health benefits of activity.
Diet, Exercise, and Dementia
There is a new randomized controlled trial (RCT) underway in Australia to study the influence of the Mediterranean diet and walking on the risk of cognitive decline and dementia. Called the MedWalk trial, preliminary results should be available by the end of this year.
Exercise is likely the most important factor when it comes to increasing the odds for a long and healthy life. However, more than 60 percent of Americans do not get enough exercise. Couple that with a diet that includes lots of frozen, ready-to-eat foods, ultra-processed snacks, sugar-laden cereals, desserts, and beverages, alcohol and tobacco, and what you have is a recipe for a public health disaster.
Numerous studies have shown an inverse relationship between physical activity and all-cause mortality. Exercise prescriptions are now considered to be the main therapy for cardiac patients, according to a recent review. Only 90 minutes of exercise a week can lower the risk of death by 15 percent, something that no medication can achieve. That’s mind-blowing! How can anyone say that they don’t have enough time to exercise? If you’re too busy to spare 90 minutes for something that can save your life, then you’re way too busy, and you need to rethink your priorities.
Walking Speed Matters
A new study (systematic review and meta-analysis) has found a relationship between people’s walking pace and a reduction in their risk of type 2 diabetes. Walking at 2 miles per hour was associated with a 15 percent lower risk, while a 3 mph pace resulted in a 24 percent reduction. A pace of 4 mph lowered the risk by 39 percent, with an additional 9 percent decreased risk for every 0.6 mph above 4 mph. Jogging and running were not studied.
I recommend that most people walk a couple of miles a day at the fastest pace they can safely achieve. For those of you who say you are “too busy to walk every day,” I say unto thee: If you’re too busy to spend an hour walking, then you’re too darn busy, and you need to rearrange your priorities. When it all comes down to dust, it is the health benefits of daily walking that will enable you to continue doing all the other stuff that you think is much more important than some “preventive medicine.”
As for the “if it doesn’t kill you, it will make you stronger” philosophy, when it comes to transitioning from a sedentary to an active lifestyle it is prudent to make small changes over time, rather than trying to become a “weekend warrior” in one fell swoop. This is especially true when it comes to pushing the limits of one’s cardiovascular fitness. If you have any doubts, please check with your physician to determine what those limits are, and how safe it would be to push them.
Consider Food Combinations
Flavonoids and polyphenols belong to a large group of plant compounds that have been linked to a number of health benefits, including reduced risk of heart disease, stroke, cancer, and type 2 diabetes; improved cognitive function and protection against age-related cognitive decline; reduced inflammation; and improved gut health by promoting the growth of beneficial bacteria and suppressing the growth of harmful bacteria.
Good sources of flavonoids and polyphenols include berries, citrus fruits, grapes, unpeeled apples and pears, onions, garlic, broccoli, spinach, kale, whole grains, legumes, nuts, seeds, green and black tea, coffee, and cocoa (dark chocolate). Overcooking can destroy flavonoids and polyphenols. According to the results of a recent meta-analysis, vegetarian diets correlated with a reduced risk of gastric and colorectal cancers, but more studies will be needed before doctors can recommend giving up meat entirely.
While plant-based diets are beneficial, some plants just don’t play nicely with others. New research at U.C. Davis revealed that the specific combination of bananas and berries can substantially reduce the absorption of flavonoids. Consuming a smoothie containing bananas and berries resulted in an approximately 84 percent lower absorption of flavonoids, compared to smoothies containing only berries.
Bananas are rich in potassium and offer a host of other nutrients, including vitamins C and B6, dietary fiber, antioxidants, magnesium, and niacin. So, I’m not suggesting that they be excluded from your diet, but the next time you decide to make a fruit smoothie, you might want to leave them out and eat them later, by themselves.
You may also want to pay attention to the sequence in which your foods are eaten. Studies suggest that eating fiber-rich vegetables and protein at the beginning of a meal, and eating refined carbohydrates such as bread and pasta last, can improve blood sugar levels, stimulate higher levels of hormones that signal satiety, and help with weight loss.
For breakfast, maybe eat a handful of nuts before grabbing that bagel. One study found that people who did so lowered their body fat, including dangerous visceral fat that surrounds internal organs. Another study found that people with pre-diabetes who ate about 12 almonds before meals improved their blood sugar response on glucose tolerance tests.
Vegetarian Junk Food
People on plant-based diets might offset the benefits if they eat plant-based junk food. According to a 2021 study, vegans and vegetarians tended to eat more ultra-processed foods than omnivores. These unhealthy ingestibles include sodas, many juices, chips, candies, ready-to-eat meals, fast foods, high-end lattes, protein bars, protein powders and shakes, specialty iced teas, sweetened breakfast cereals (including granola and muesli), energy drinks, vegan meat substitutes, instant mashed potatoes, white bread, margarine, and many plant-based milks.
What I’ve been promoting is a diet that is mainly plant-based, but not exclusively so, but I must admit to having a personal bias. Someone’s ability to thrive on a totally plant-based diet may come down to their DNA, according to a recent study. It seems that three genes are closely associated with lipid metabolism and how that affects the brain in ways that could influence the ability to be a healthy vegetarian.
As a devout omnivore myself, I can attest to the difficulty of subsisting on a strict vegetarian diet, something that I tried for a couple of years as a medical student. I totally ran out of energy during my strenuous post-graduate year in what I hoped would be a surgical residency. Fortunately, I resuscitated myself with a beef burger, and concluded that I was not well suited to dietary asceticism, nor the brutal hours demanded by on-call surgery.
Avoiding Non-Alcoholic Fatty Liver Disease (NAFLD)
NAFLD is the most common type of liver disease in the United States. It is estimated that 25 to 30 percent of American adults have the disease, regardless if they are or are not obese. Data from 2017 to 2021 shows a large increase in the incidence of NAFLD, with the greatest increase being in children. Liver transplants have correspondingly increased among adolescents and young adults, with a 25 percent increase during the past decade in children 11 to 17 years old.
There is new research suggesting that adults who develop NAFLD before age 45 have nearly an 18 percent increased risk of developing cancer. Study limitations include diagnosis based on ultrasound rather than liver biopsy, potentially missing the less severe cases. As with any observational study, data can only reveal associations, not causality.
While more research is needed, there is suspicion that the disease is related to the excessive consumption of ultra-processed foods (which now make up more than 67 percent of children’s diets, according to one study), along with inadequate levels of physical activity. Fructose in processed foods and beverages, such as those that contain added sugar or high-fructose corn syrup, has been implicated in the development of NAFLD.
Fructose is metabolized differently than glucose. When fructose is consumed, it is transported directly to the liver. If it arrives there at a faster rate than the liver can detoxify it, it is converted to fat. Continued fructose intake keeps the fat from being broken down, resulting in liver inflammation. One trend that’s alarming pediatricians is the inclusion of corn syrup in infant formulas. Just one more reason to always read ingredients labels and choose foods wisely.
Declaring War on Junk Foods
Ethoxylated mono- and diglycerides (EMGs and EDGs) are non-ionic emulsifiers used in the baking industry to enhance the volume of breads and cakes by increasing aeration during the mixing of batters. EMG is commonly known as Polyglycerate-60. Mono- and diglycerides contain small amounts of trans fats, but there’s no way to know how much because the FDA doesn’t require its disclosure. When mono- and diglycerides enter the bloodstream they are converted into triglycerides.
California is now leading the nation with legislation that will ban the manufacture, sale, and distribution of four food additives found in thousands of products, including candies, baked goods, frozen desserts, fruit bars, and toaster pastries, among others. The Environmental Working Group and Consumer Reports had pushed for the measure, which is expected to affect as many as 12,000 products, starting in 2027.
The additives, suspected of causing cancer and hyperactivity in children, are erythrosine (red dye #3), brominated vegetable oil, potassium bromate, and propyl paraben. They are currently prohibited or restricted in European countries. As I have said before, industrially manufactured eatables containing chemicals that have no nutritional value don’t deserve to be called foods. Please read ingredient labels, and don’t let yourself be poisoned.
Hacking Taste Buds for Profit
An even darker side of the food industry may be coming in the form of a newly developed technology. An “electronic tongue” and an artificial intelligence (AI) program allows the testing of chemicals to see how they will influence peoples sense of taste and their desire to eat.
Presumably, the AI will mimic the physiological and psychological factors that determine people’s food preferences and eating behaviors. Fake foods can then be engineered to more effectively manipulate people’s tendency to eat for pleasure. That will mean even bigger profits for food manufacturers, at the expense of people’s health.
If you don’t think that your tongue-brain circuitry can be hacked, think again. Have you ever experienced feeling so full that you thought you couldn’t eat another bite, until you were offered a sweet dessert? “Just one wafer-thin mint, Mr. Creosote….”
Wondering how to protect yourself from taste-hacks? Keep in mind that dietary fiber is your friend. A new randomized controlled trial suggests that dietary fiber can exert a significant influence on both the composition of gut bacteria and reward signals in the brain associated with food choices. Consumption of high-fiber prebiotics leads to a reduction in reward-related brain activation responses to high-calorie foods. This was shown to be of particular benefit for overweight adults. Yes, you can learn to love the things that are truly good for you.
October 15, 2023
COVID-19 and Heart Disease
New research has found that the SARS-CoV-2 virus can infect coronary artery plaques, including macrophages and foam cells, causing inflammation that could trigger acute cardiovascular complications and increase the risk of heart attacks and strokes, for up to a year following an infection. The coronavirus RNA was detectable and capable of replicating in coronary artery lesions, regardless of the degree of plaque formation. Although previous studies have shown that COVID-19 directly impacts the brain and lungs, the relationship between an infection and cardiovascular heart disease was not understood until now.
When to Test
As the SARS-CoV-2 virus evolves to better evade the human immune system, the relationship between symptom onset and maximum viral shedding has changed. Coronavirus strains seen early in the pandemic had their highest virus loads soon after symptom onset, much like the seasonal influenza virus. However, the virus loads of the latest variant now peak on the fourth day of symptoms, on average. That means home rapid antigen tests could produce more false negatives early in the course of the illness, according to a new study. Consequently, the FDA has updated testing instructions, and recommends that tests be repeated 48 hours after an initial negative result.
Get the New COVID-19 Booster
Regardless of your insurance status, you should be able to obtain the XBB monovalent vaccine for free, once supply-chain issues and misinformed providers are sorted out. Here’s a detailed guide for navigating the vaccine delivery system and overcoming its obstacles.
The CDC strongly encourages adults aged 50 years and older to get the updated vaccine, because they are more likely than younger people to become severely ill from COVID-19, and the risks increase with age. Currently, most COVID-19 deaths occur in people older than 65. Chronic medical conditions further increase the risk of hospitalization and death.
Let’s Talk About Needles
Hopefully, you don’t have a needle phobia, but if you do, please skip this article. Vaccines must reach the intended tissue to provide an optimal immune response and reduce the likelihood of injection-site reactions. If you weigh more than 152 pounds, you may need a longer needle, and will likely have to ask for it.
The covid vaccines need to be injected into muscle, not skin or fat. If you have more fat over the muscle, the typical one-inch needle may not be long enough to reach the deltoid muscle of your upper arm. That’s why the CDC guidelines recommend body weight be taken into account by those administering vaccines.
While body weight can give a rough estimate of arm fat, body shape and size are more important. Vaccinators are charged with making the determination while consulting with the patient prior to giving them the vaccine. Longer needles are not more painful, so there’s no reason not to follow the CDC guidelines:
Adults, up to 152 lbs: 1″ needle
Women, 200 lbs up: 1.5″ needle
Men, 260 lbs up: 1.5″ needle
Those in-between: decision based on arm subcutaneous fat
The Demographics of COVID-19 Deaths
From January through August, 2023, adults aged 65 and older accounted for about 63 percent of all COVID-19 hospitalizations, 61 percent of intensive care unit admissions, and 88 percent of in-hospital deaths associated with COVID-19, according to the latest CDC report. Most of the hospitalized seniors had chronic health conditions such as diabetes or kidney disorders. Less than a quarter of them had received the bivalent vaccine.
In addition to age, biological sex, race/ethnicity, and socioeconomic status, political party affiliation has also been linked to disparities in COVID-19 death rates. Research suggests that during the first 22 months of the pandemic the age-adjusted excess death rate of Republican voters was significantly higher than that of Democrats. After COVID-19 vaccines became available, Republicans had a 43 percent higher excess death rate than Democrats. The takeaway: Older Republican men are the demographic most likely to die from COVID-19, especially if they aren’t White.
According to the Kaiser Family Foundation COVID-19 Vaccine Monitor for September, 2023, almost one in four U.S. adults have never received a COVID-19 vaccine, and they do not intend to get the new vaccine. Of the Democrats surveyed, 58 percent said that they’ve recently modified their behavior to be more covid-conscious, compared to only 16 percent of Republicans. As in past winters, it is expected that once again there will be a Republican strain placed upon our nation’s already faltering healthcare system.
Anti-Vax Canines
A new study found that the anti-vaccine mentality has also infected pet owners, placing both their animals and other humans at risk. Overall, 53 percent of dog owners believe that dog vaccines are unsafe, or are ineffective, or are unnecessary. While canine rabies in the U.S. has essentially been eliminated by the widespread adoption of dog licensing and vaccination requirements, unvaccinated pets are still at risk for contracting rabies from contact with wild animals such as bats, raccoons, skunks, and foxes. The more unvaccinated dogs there are out there, the more the risk of rabies transmission grows.
Too Much of a Good Thing
Water is essential for human life, and dehydration can be deadly, but so can drinking too much water. Water intoxication can result from healthy people consuming large amounts of water during heat spells or prolonged periods of exercise when concomitant electrolyte intake has been inadequate. This causes water to move into brain cells causing them to swell, leading to increased intracranial pressure.
Symptoms can include headache, confusion, irritability, and drowsiness, followed by difficulty breathing, and muscle weakness, twitching, or cramping. Cerebral edema can eventually produce seizures, coma, and death. The principle of too much of a good thing becoming a bad thing applies to many other substances beside water. How many examples can you think of?
Your Brain on Smog
New research suggests that even a short exposure to urban air pollution raises a person’s risk of suffering a stroke. Over 18 million stroke cases were analyzed to see whether there was a correlation between strokes and exposure to polluted air for as little as five days. The meta-analysis showed higher levels of nitrogen dioxide, carbon monoxide, sulphur dioxide, and particulate matter were associated with an increased stroke risk. Perhaps you might want to consider that when making your travel plans.
There is also an association between exposure to particulate air pollution and dementia that is independent of stroke and hypertension. A study included 27,857 American adults with a mean age of 61 years, who were without dementia at baseline. The study used the 10-year average PM2.5 exposure based upon residential history. As is typical for observational studies, causality cannot be established. The value of the study lies in pointing out the need for investigating other pathways and potential mediators of dementia risk.
Smoking is considered a risk factor for Alzheimer’s Disease, and research also suggests that the more exposure to second-hand tobacco smoke a person has, the higher their dementia risk. It stands to reason that smoking or vaping any substance that produces aerosols with particulate matter in the fine and ultrafine size range will be detrimental to your brain. So, if you’re using cannabis “medicinally” my advice would be to eat it, rather than inhale it.
The Health Risks of Central Adiposity
Once your waistline circumference exceeds that of your hips, it doesn’t matter how skinny the rest of you may be; you are at increased risk of premature death. In a new study, observational exposure-outcome associations were run through a Mendelian randomization cohort analysis involving 387,672 adults in the U.K. Biobank datasets. The waist-hip ratio (WHR) had the strongest and most consistent correlation with all-cause mortality, and was the only metric unaffected by changes in a person’s body mass index (BMI).
Previously, a U.K. Biobank study found an association between waist-to-hip ratio and brain structure; a bigger belly meant a smaller brain due to gray matter atrophy. More recently, a U.K. Biobank study using Mendelian-randomization identified a causal relationship between obesity and brain structure. Another study of visceral adipose tissue found it to be associated with an increased risk of pancreatic cancer and lung squamous-cell carcinoma. The take-away is that a big belly is bad news for your health in so many ways.
Unfortunately, there is no one-size-fits-all prescription for treating central adiposity. The best treatment plan will depend upon your individual circumstances, genetics, and health history. What we do know is that studies show that the overconsumption of fructose leads to inflammation in fat cells, resulting in more fat storage in visceral adipose tissue. Smoking and drinking alcohol can also increase visceral fat. So, is it a beer belly, or a sugar belly, which so many people are sporting these days?
Stress and inadequate sleep raise cortisol levels, further contributing to the belly-fat problem. To reduce central adiposity, it is important to avoid highly processed foods, sugary foods and drinks, and saturated fats, and to make sure that you eat enough high-quality protein, providing an adequate intake of all the essential amino acids. Moderate-intensity core muscle exercises such as planks, when part of your daily exercise routine, may also help reduce belly fat.
Exercising for Health
First, consult with your primary care provider to make sure that you can tolerate the recommended exercises. If you are cleared to participate in an exercise program, the latest medical recommendations are:
1) Increase your endurance and improve cardiovascular and respiratory system fitness by breaking a sweat as often as you can during the week with vigorous physical activity such as jogging or biking.
2) Also do some strength-building exercises at least a couple of times a week that involve your arm, leg, and core muscles, preferably using weights or resistance bands.
But what if you’re too busy (not a good excuse), or too sickly (a better excuse) to exercise, yet you don’t want to miss out on its advantages? Well, the “exercise pill” of science fiction, one that helps people gain the benefits of exercise while sleeping, has just moved closer to becoming a reality. A new drug, SLU-PP-332, was injected into mice, where it tricked their metabolic pathways into reacting as if they were exercising, leading to weight loss, increased endurance, and greater muscle mass, without affecting their appetite or physical activity levels.
It is hoped that this new class of drugs will maintain muscle mass during weight loss and when aging makes metabolism less responsive to exercise. However, it is going to take years before human clinical trials of a related drug in pill form could provide sufficient evidence of safety and efficacy to warrant FDA approval, so don’t hold your breath while waiting. Instead, keep in mind that any exercise is better than none at all, and that it is also possible to overdo exercise and negate some of its benefits.
As for the best time of day to exercise, the most pragmatic advice is to do it whenever you can. However, according to a new study, exercising before breakfast will likely bestow the most health benefits in return for the time and effort invested, provided you’ve had a good night’s sleep. On the other hand, exercising shortly before bedtime should be avoided if you want to sleep well.
Complementary and Alternative Medicine (CAM)
“Complementary medicine” involves using treatments that lack a convincing evidentiary basis as accompaniments to standard medical care. For example, using guided imagery and yoga for patients undergoing cancer chemotherapy. The argument goes that as long as there is no harm done, using a complementary treatment can potentially have a beneficial effect, along with a placebo effect.
That argument may have been valid a half-century ago when I was just starting out in medicine. Back then, with limited diagnostic and treatment options at our disposal, the practice of medicine was at least as much of an art as it was a science. I therefore had no qualms about accepting a faculty position at a naturopathic college, where nutrition was an important part of the curriculum, in stark contrast to medical schools at that time. Today, the default position for modern medicine is: “Show me the evidence.” If a treatment has to be accepted just on someone’s say-so, I can’t in good conscience recommend it.
“Integrative medicine” in its best expression combines conventional medical treatments with only those complementary practices that are supported by sufficient evidence for being both safe and effective, and there aren’t a great many of those. At worst, it is a hodge-podge of pseudoscience and questionable medical practices, despite its having acquired the status of being a medical specialty in the U.S. As always, “caveat emptor” applies when receiving medical advice from your friendly neighborhood naturopath, chiropractor, or shaman.
There are good reasons for upholding the highest standards of medical practice, especially when the primary dictum of ethical medicine is, “First, do no harm.” It therefore makes good sense to view the practice of integrative medicine with some skepticism, and perhaps relegate it to the treatment of psychosomatic illnesses, where a little woo-woo can go a long way. As for long-standing healing practices such as traditional Chinese and Ayurvedic medicine, how good can they be if they haven’t changed in a thousand years, while our scientific understanding of how things work has been continually evolving?
“Alternative medicine” isn’t really medicine at all, at least insofar as the term “medicine” is used by modern western physicians. Alternative treatments are used instead of conventional medicine. The ethical practice of modern medicine involves standards supported by scientific evidence. While some alternative practices may give clients an emotional boost, claiming specific health benefits is fraudulent. The Quackwatch website provides a search engine that will help consumers identify health frauds and medical practitioners involved in shady practices, such as claiming they have a cure for Alzheimer’s disease.
Alternative practitioners will frequently use unusual diagnostic methods such as dowsing and aura-reading, apply energy healing and chakra-balancing techniques, and prescribe vitamins, minerals, herbs, and nutritional supplements (misleadingly called “nutraceuticals”). Because it has become quite challenging to find reliable sources of medical information and evidence-based healthcare on the internet, the National Institutes of Health (NIH) has created a guide for navigating online resources.
The Medical Hoax That Just Won’t Die
A recent U.S. study found that five percent of patients who contracted COVID-19 used treatments that lacked scientific evidence for effectiveness, such as ivermectin and hydroxychloroquine. This was due to people believing vaccine-related misinformation disseminated on social media. Predisposing factors included mistrust of physicians and scientists, and being conspiracy minded.
I’m all for letting natural selection favor those with genes for greater intelligence. Still, when considering the harm that such misinformation creates, I must speak out against those who continue perpetrating this wicked medical hoax. The public health risk is significant: Only 17 percent of the U.S. population received last year’s COVID-19 vaccine. Among those who were not fully vaccinated were 57 percent of seniors, despite being a high-risk group.
A recent U.S. study found that five percent of patients who contracted COVID-19 used treatments that lacked scientific evidence for effectiveness, such as ivermectin and hydroxychloroquine. This was due to people believing vaccine-related misinformation disseminated on social media. Predisposing factors included mistrust of physicians and scientists, and being conspiracy minded.
It saddens me to say that some members of the medical profession are unscrupulous, unethical, and downright dangerous when they promote bogus treatments. Schemes and scams, amplified by conspiracy theories, have proliferated during the coronavirus pandemic. I know of doctors who still prescribe ivermectin for patients with COVID-19, despite a number of well-conducted, peer-reviewed, randomized clinical trials showing ivermectin to be ineffective against the coronavirus. There really aren’t “two sides to an issue” when the science clearly shows that one side is wrong.
Contrary to social media hype, the FDA has not approved ivermectin for human use, other than for the treatment of some parasitic worms and head lice. It remains primarily a veterinary medicine. However, the FDA does not have regulatory authority over the prescribing practices of physicians, and recognizes that “off-label use” of FDA-approved drugs occurs. The FDA does in fact advise patients not to use ivermectin to treat or prevent COVID-19.
It is up to the individual state licensing boards to discipline doctors who deviate from medical standards of practice. This usually doesn’t happen unless patients file complaints with the board and an investigation is instigated. The California Medical Board issued a blanket warning in 2022 stating that doctors who prescribe ivermectin for COVID-19 may be subject to disciplinary action. Unfortunately, many other states are apparently less protective of patients.
If a patient suffers complications from a bout of COVID-19, such as having to be hospitalized, or developing post-acute sequelae (aka Long-COVID), because their doctor prescribed ivermectin instead of Paxlovid, the doctor can be sued for malpractice. Deviation from the accepted “standard of care” in the doctor’s medical community is the epitome of malpractice. It is then up to the patient’s attorney to prove damages and seek recompense.
Vaccine Honesty
Physicians have a duty to communicate honestly with their patients. We don’t want vulnerable people to mistakenly think that they will be protected against a COVID-19 infection by vaccination alone. The most important reason to get the new XBB booster (and the flu vaccine as well) is to reduce the risk of hospitalization and death.
If you’re not masking in public indoor spaces with an N95 or equivalent, you’re still at risk for getting infected even if you are fully vaccinated. You might even contract an asymptomatic infection. That’s why, if you will be in contact with a high-risk individual, you should mask for at least five days before visiting them and forego indoor dining and other activities where you might encounter the virus.
Regardless of your vaccination status, if you develop symptoms of an upper respiratory infection, do a home rapid antigen test. Kits are still free from the USPS. If you test negative, test again 48 hours later. If you test positive for COVID-19, you should begin taking Paxlovid right away if eligible (see checklist) and take precautions to avoid infecting others until you test negative.
Just to be clear, if you are vaccinated and test positive for COVID-19, you should start taking Paxlovid within five days of symptom onset if you are at risk for developing severe disease. According to a recent study of patients aged 65 and older, Paxlovid reduced the incidence of death nearly 10-fold. That is truly impressive.
If you have been taking a statin, you may need to stop while taking Paxlovid. I advise against taking Lagevrio if you are eligible for Paxlovid, because it is less effective and has been linked to the development of resistance to anti-viral medication.
The “Food Is Medicine” Movement
This preventive approach is not considered alternative medicine, since it does not prescribe specific foods for specific ailments as a substitute for medical treatment. Studies of the potential impact of medically tailored meals and general nutritional support have elucidated the health effects of good and bad nutrition. The data suggests that public spending on nutritional programs such as healthy school lunches will save more money than they cost.
The economic impact due to healthcare spending and lost productivity as a result of suboptimal diets in America are estimated at over a trillion dollars a year, an amount equal to all the money Americans currently pay for food. A study on the true cost of food suggests that if patients on Medicare, Medicaid, and private insurance with diet-related conditions were treated with food prescriptions to help their recovery, an estimated 1.6 million hospitalizations annually could be avoided, along with an estimated net savings of $13.6 billion in healthcare costs.
“Unhealthy diets are a major impediment to achieving a healthier population in the United States. Although there is a relatively clear sense of what constitutes a healthy diet, most of the US population does not eat healthy food at rates consistent with the recommended clinical guidelines. An abundance of barriers, including food and nutrition insecurity, how food is marketed and advertised, access to and affordability of healthy foods, and behavioral challenges such as a focus on immediate versus delayed gratification, stand in the way of healthier dietary patterns for many Americans.” ~ American Heart Association Presidential Advisory.
A half-million U.S. deaths a year are caused by poor diets. An epidemic of obesity impacts 42 percent of American adults, increasing their risk of heart disease, stroke, and type 2 diabetes. My latest eBook, “Good Food is Good Medicine,” supports this movement. I invite you to share it with those you love.
Avoiding Ultraprocessed Foods
While the Food Is Medicine movement encourages people to increase their consumption of healthy foods, it is also important to limit foods that have been shown to adversely affect people’s health. There is plenty of evidence linking the consumption of ultraprocessed foods with adverse health outcomes and all-cause mortality. To avoid highly processed foods, with ingredients such as high-fructose corn syrup, modified corn starch, hydrogenated oils, emulsifiers, and added colors, flavors, and preservatives, you will need to carefully read food package labels. I suggest that you also cut back on foods that are high in added sugars and sodium.
In a prospective cohort study of 72,083 U.K. Biobank subjects 55 years of age or older, who were free from dementia at baseline, those who had reduced their intake of highly processed foods by 10 percent during the 10-year study period were 19 percent less likely to have developed dementia. Despite the limitations of observational studies, finding an association between ultraprocessed foods and cognitive impairment should make the case for healthy eating a no-brainer.
The Perils of Eating for Pleasure, Part Deux
There are many pleasurable experiences to be had in life, and some of them are accompanied by measurable risks. Eating for pleasure has a fairly high risk-to-reward ratio, but we usually ignore the price we pay for that pleasure until we step on a scale in the doctor’s office and discover we’re obese, or we get food poisoning from dining at a restaurant, or are diagnosed with diabetes, or suffer a heart attack or stroke, all of which can come as rude awakenings.
What I’d like to suggest here is that it is worth making an effort to override our taste buds’ affinity for the pleasurable sensations associated with sugars, salt, and saturated fats. We can actually live quite happily without sweet-treats, pretzels, salted nuts, butter, and bacon. We can defy the psychologically manipulative marketing strategies of the giant food corporations, supermarkets, and restaurant chains, and focus strictly on our food’s nutritional value, rather than its taste.
The reality is that with just a little effort you can prepare your own meals, ones that are far healthier and tastier than anything you could find in any restaurant, for just a fraction of the cost. Why let yourself be simultaneously ripped-off and poisoned for the sake of convenience?
By cutting back on your intake of sugar, salt, and fats, you will soon learn to enjoy the wonderful subtle tastes of nutritious foods that are actually good for you, instead of over-stimulating your taste buds. There are many other healthy pleasures we can experience, such as going for a walk in the woods, listening to music, or spending time with people whose company we enjoy.
Think of eating as being like fueling or charging your motor vehicle. It’s something you need to do from time to time, but you don’t get excited about it. You put nutrients into your body to keep it running, and just as you wouldn’t put sugar in your car’s gas tank, you won’t want to consume anything that interferes with your body running well. Once you’ve shifted your perspective on eating, you will be pleasantly surprised when your high-octane meals, devoid of unhealthy ingredients, taste pretty darn good after all.
And, while you’re being good to your body by eating only what’s healthy, remember to enhance the quality and quantity of your gut microbiome. Include some yogurt, kefir, sauerkraut, kimchi, or miso in your diet, but make sure that it has no added sugars, contains live, active cultures, and is not cooked or pasteurized. Then, give those microbes enough fiber to keep them well nourished. Increase the variety and amount of plant foods you eat, and your microbiome will repay your kindness by producing healthful metabolites. That’s a win-win relationship.
Under Pressure
A lack of standardized blood pressure (BP) training among doctors, physician assistants, nurses, and other healthcare professionals is preventing the medical community from adequately addressing hypertension. In a 2021 survey of 571 clinicians, most of whom were cardiologists, only 23 percent performed accurate BP measurements, despite the majority saying they trusted the BP readings taken in their clinic. I must admit that I, too, was ignorant about the updated protocol.
The elements of proper BP measurement include patients relaxing for five minutes before the measurement, with an empty bladder, legs uncrossed, both feet on the floor, and their arm supported at chest height. No talking, reading, or using a cell phone. Don’t smoke, drink caffeinated beverages, or exercise within 30 minutes of measuring your blood pressure.
Blood pressure must initially be measured in both arms using a correctly sized cuff placed over a bare arm. The practitioner should identify the BP from the arm with the higher reading as being clinically more important. It should then be the one to use for all future readings.
Manual readings using a sphygmomanometer and stethoscope tend to be higher than automated digital readings. The latter method may more closely reflect the patient’s baseline BP, provided the cuff is placed on the arm correctly. The next time you visit your primary care provider, if they’re not following the correct protocol you may want to provide them with the link to this guide via your patient portal.
Too Much of a Good Thing Examples
Eating too many cherries can cause diarrhea and stomach cramps.
Eating too many radishes can result in developing calcium oxalate kidney stones.
Too much exercise can produce stress fractures and overuse injuries.
Working too much can lead to stress, depression, burnout, and health problems.
Sleeping too much increases the risk of heart disease, stroke and diabetes.
Taking too much acetaminophen (Tylenol) can cause liver damage and death.
Drinking too much alcohol can lead to addiction, liver disease, and social problems.
Spending too much time looking down at a smartphone can cause neck problems.
Binge-watching TV shows can negatively impact physical health and cognitive abilities.
September 22, 2023
The COVID-19 Surge
COVID-19 is still the fifth leading cause of death in the U.S., and we have seen an increasing the number of hospitalizations and deaths over the past eight weeks. If it has been more than two months since your last COVID-19 vaccination (or infection), and you are 6 months or older, it is now time to get the new XBB monovalent booster, but please don’t rely on vaccination as your only means of protection. One-way masking, avoiding crowded indoor spaces, and good hand hygiene add additional layers of protection. Go to vaccines.gov to find a source near you.
If you develop symptoms of an upper respiratory infection, please get tested. Your home rapid antigen test should still work, but if you have symptoms and test negative, test again 24 hours later. Free at-home COVID-19 tests, distributed by the U.S. Postal Service, will again be made available. Orders will be accepted beginning September 25, 2023. The FDA has an updated list of expiration dates for previously distributed kits.
If you do test positive, begin taking Paxlovid ASAP, and institute measures against infecting others. If you are taking a statin, you may have to temporarily stop taking it while on Paxlovid. Yale Medicine has a helpful Q&A website about Paxlovid.
The oral antiviral is currently undergoing clinical trials to see if it might be an effective treatment for Long-COVID. The hypothesis under investigation is that lingering post-acute symptoms may be due to the persistence of viral reservoirs within the body. It is hoped that Paxlovid will be effective in eliminating the remaining virus and that the inflammatory reaction the infection produces will eventually subside.
Vaccination not only reduces the risk of infection for several months, it provides longer term protection against the serious complications that can result from an infection. Although further studies are needed, a recent Mayo Clinic study of about 500 patients found that vaccination against SARS-CoV-2 lowered the risk for developing Long-COVID, and also reduced its severity if it did occur, resulting in better post-acute functioning.
Sedentary Lifestyle Risks
A new observational study suggests that the less time older adults spend being physically active, the higher their risk for developing hypertension, cardiovascular disease, obesity, diabetes, and all-cause dementia. In the study, the risk of dementia progressively increased with each hour after 10 hours a day spent sitting. These findings imply that as long as people keep their sedentary time under 10 hours, they won’t be subject to an increased risk of dementia.
Researchers gathered data from the U.K. Biobank on 49,841 adults ages 60 years or older who were not diagnosed with dementia when they began wearing an accelerometer to document their activity levels. Sitting still appears to have a cumulative negative effect, and it’s the total time we spend sitting during a 24-hour period that we need to reduce. While a causal connection between being a couch potato and getting dementia has not been established, there is still enough evidence to “hedge our bets” and become more physically active, even if it’s in a seated position.
Doing toe-raises while sitting is reported to have a beneficial effect on lipid and glucose metabolism. According to his recent studies on health and human performance, professor Marc Hamilton at the University of Houston has concluded that “sitting too much is not the same as exercising too little,” leading to his development of the “soleus muscle push-ups.” As I write this, I am standing in front of my keyboard, and doing toe-raises whenever I pause typing.
The Benefits of Napping
In my previous newsletter, I mentioned that afternoon naps were part of the Mediterranean Lifestyle, with evidence that they confer health benefits. A Mendelian randomization study using the U.K. Biobank found an association between daytime napping, cognitive function, and brain volume.
According to current research, too little sleep appears to impact our hunger and dietary choices, and too much sleep can result in fewer calories being burned. The optimum amount of high-quality (restorative) sleep for most adults is seven to nine hours a day. If you don’t get your quota at night, then try to work in a siesta after lunch.
It is worth noting that ambient temperature plays an important role in sleep quality. Although there is a lot of individual variability, for most older people the optimum temperature range for restorative sleep is 68 to 77 degrees Fahrenheit.
The “Blue Zone” Longevity Hype
Netflix has a new hit show called “Live to 100: Secrets of the Blue Zones.” It presents an inspiring story of happy and healthy elders who work hard in the morning, walk and dance a lot, and make their own food from scratch. Unfortunately, the film appears to be more of an infomercial for the diet books and “longevity” foods and beverages that are sold on the Blue Zones website.
Blue Zones are locations around the world where populations are alleged to have significantly greater longevity. However, this is more of a myth than a scientific reality, and some of the so-called “secrets” aren’t really secrets, but rather well-known, evidence-based components of a healthy lifestyle. Some of the other touted “secrets” have no evidentiary basis at all.
Many of the conclusions drawn about longevity are based on cherry-picked anecdotes and motivated reasoning, rather than scientific studies. As you surely know by now, oxymoronic “anecdotal evidence” does not pass scientific muster as being reliable data. When scientific methods are applied to observational studies, the known confounding variables are identified and statistically accounted for, the study’s limitations are acknowledged, and the authors’ conflicts of interest are fully disclosed. As far as I know, the “Blue Zone Diet” has never been subjected to any scientifically rigorous research.
According to an independent analysis of the Blue Zone data set regarding longevity, the remarkable age records exhibit patterns indicative of clerical errors and pension fraud. One of the alleged Blue Zones is Okinawa, Japan. Data from Japan’s Ministry of Health shows the average life expectancy for Okinawa’s men is 81 years, and for women 87 years, which is not all that impressive when compared to the rest of Japan’s population. Only a third of Okinawa’s centenarians were functionally independent, while two-thirds needed major assistance or were very disabled. So, even in Okinawa, the most fortunate thing about getting really old is that it doesn’t last too long.
What the “Blue Zone Diet” does have going for it is a passing similarity to the Mediterranean Diet, with its emphasis on whole, natural, plant-based foods. The MEDLIFE study (and DASH and MIND diets) do have strong scientific evidence that eating lots of fruits, vegetables, and whole grains, reducing one’s intake of salt and sugar, and lifestyle habits that include sufficient rest, physical activity, and positive social interactions, can result in a lower risk of all-cause mortality.
According to an American Council on Science and Health report, the “Blue Zone Diet” is replete with fictional superfoods, contains generous servings of half-truths, and is well-seasoned with blatant misinformation about longevity. When it comes to describing a healthy lifestyle, it has nothing new to offer. As far as I’m concerned, the overall quality of my life is far more important than its quantity. Consequently, one’s “healthspan,” the number of years of relatively good health, has greater value than a long lifespan with many years of illness and infirmity near its end.
What About Multivitamins and Longevity?
It might be true that people who take a daily multivitamin live longer, but concluding that multivitamins produce a longer lifespan would be incorrect. There are myriad other things about people who are inclined to take multivitamins that could result in a healthier and longer life. For example, people who have more disposable income can afford not only multivitamins, but many other things that contribute to better health, including easier access to medical care. Wealthy people seem to live longer, according to a landmark study.
Healthy Lifestyles and Mental Health
Not only does a healthy lifestyle reduce morbidity and mortality risks, there are also concomitant mental health benefits. During a nine-year period, researchers examined 287,282 individuals from the UK Biobank, 13,000 of whom experienced depression. Using Mendelian randomization, the study provides evidence for a causal relationship between seven lifestyle habits and a reduced risk of depression. Those with the healthiest lifestyle were 57 percent less likely to develop depression than those with the least healthy.
Researchers were able to determine what percentage of each lifestyle habit decreased the risk of depression:
A healthy diet decreased the risk of depression by 6 percent.
Minimal alcohol consumption decreased the risk of depression by 11 percent.
Lower sedentary behavior decreased the risk of depression by 13 percent.
Exercise decreased the risk of depression by 14 percent.
Frequent social connections decreased the risk of depression by 18 percent.
Lack of smoking decreased the risk of depression by 20 percent.
Good sleep decreased the risk of depression by 22 percent.
Once again, sleep is shown to play an essential role in people’s health.
Trouble Sleeping?
Reduction in blood oxygen levels due to obstructive sleep apnea is associated with increased cardiovascular morbidity and mortality risks according to a recent study. About 54 million people in the U.S. have obstructive sleep apnea. CPAP devices, although they can be a game-changer for many people, are not the only solution. Sometimes, a simple modification in sleeping position, such as going from back-sleeping to side-sleeping, or elevating your head more, can make a significant difference. So can losing weight and avoiding an alcoholic nightcap.
The Looming Dementia Epidemic
As America’s population ages, the demographic with the highest prevalence of dementia becomes proportionately larger, presaging a dementia epidemic. An estimated 6.7 million Americans are now living with Alzheimer’s disease (AD), a figure that’s expected to double by 2050. Caring for those with AD cost an estimated $321 billion nationwide last year alone, much of which came from Medicare and Medicaid. Compared with older White Americans, Black Americans are twice as likely to have AD, and Hispanic Americans are 1.5 times as likely to develop AD, possibly due to being disadvantaged by overall health disparities.
The FDA has recently approved two anti-amyloid, monoclonal antibodies; aducanumab (Aduhelm) and lecanemab (Leqembi), which can remove amyloid plaques and slow cognitive and functional decline for patients with early, symptomatic Alzheimer’s disease.
A third, even more promising drug, donanemab, should receive FDA approval before the end of the year. In its phase-3 trial, donanemab was administered intravenously every four weeks for up to 72 weeks, and showed a 36 percent slowing in the rate of cognitive decline over an 18-month period. As with the other monoclonal antibodies, donanemab comes with safety concerns, such as brain swelling, bleeding, and death.
Medicare beneficiaries who are living with the disease would like to have drug coverage for these very expensive treatments. Tracking the longitudinal performance of these new monoclonal antibodies outside of their clinical trials is going to be essential before the CMS approves coverage. So far, the real-world benefit of anti-amyloid monoclonal antibody treatments seems to be a slowing of disease progression by 4.4 or 7.5 months, depending upon the scale used to measure cognitive performance. One is then left wondering whether the expense, inconvenience, and risks will actually be worth it.
The MIND Diet for Dementia
The MIND diet combines elements of the Mediterranean diet and the heart-healthy DASH diet, and has produced evidence suggesting that it may delay cognitive decline. The MIND diet relies on eating mostly plant-based foods such as berries, leafy, dark green vegetables, whole grains, beans, and nuts. It is somewhat more permissive of saturated fats, sugar, and alcohol than I would recommend for optimum health.
Studies show that people who most closely follow these diets have a reduced risk of dementia, compared with those who don’t. The original MIND diet research found that older adults who adhered most closely to the diet had a 53 percent lower risk of developing Alzheimer’s disease, and those who followed it moderately well had a 35 percent lower risk.
The “MICK Diet” goes even further than the MED, DASH, and MIND diets. As anyone who has read my books about healthy eating will know, it is essential to create a healthy food environment by having almost all of your meals at home, and stocking your kitchen with only healthy foods. Desserts, snacks, sweet treats, and “comfort foods” are not invited, if one wants to avoid developing (or worsening) cardiovascular disease, cancer, diabetes, obesity, and dementia. Having lots of fiber in your diet is not only an antidote to the toxic effects of fructose, it also helps maintain a health-promoting gut microbiome.
Can You Hear Me Now?
In observational studies, hearing loss has been associated with cognitive decline and dementia in older adults. A comprehensive 2020 report on dementia by The Lancet suggests that age-related hearing loss nearly doubles the risk. In the ACHIEVE study, participants aged 70–84 years were randomly assigned to a hearing intervention (audiological counselling and dispensing hearing aids) or to a control intervention of health education. The findings indicated that hearing aids might reduce cognitive decline in older populations with known risk factors and lower cognitive baseline scores by 48 percent at three years, but not for those who were cognitively intact and without the risk factors for cognitive decline.
The risk factors for dementia considered by the ACHIEVE study included hypertension, diabetes, lower education level, lower income, and living alone. The causal chain between hearing loss and dementia, and whether hearing aids can reduce the long-term risk of cognitive decline, is still unknown. Unfortunately, the media, always in search of attention-grabbing headlines and clickbait, summarized the results as: “Hearing aids cut your risk of dementia by half.”
While we await further studies, if you are older and have any of those risk factors, you might want to get your hearing checked. If you do have hearing loss, but are not at risk for dementia, you still might want to hear things better, although I once had a nearly deaf patient who refused hearing aids because he didn’t want to have to listen to his wife.
Listen to Your Gut
There are an increasing number of studies that point to a gut-brain connection. The latest study to be published suggests that manipulating the intestinal microbiome through the use of probiotics might improve symptoms of mild cognitive impairment (MCI). Analyzing MCI participants’ stool samples, researchers found high levels of Prevotella ruminicola, Bacteroides thetaiotaomicron, and Bacteroides xylanisolvens. Administration of Lactobacillus rhamnosus GG in a double-blind, placebo-controlled, randomized clinical trial was statistically correlated with an improved cognitive score.
Although such studies make for good headlines, and can push the sales of probiotics, we must not jump to conclusions. Even well-done RCTs have both strengths and weaknesses, so further studies are almost always warranted. If correctly performed and truthfully reported (aye, there’s the rub), RCTs can help to elucidate causal relationships between a drug or risk factor (known as the “exposure”) and a measurable result (the “outcome”). For example, a vaccination that results in the reduction of a disease’s impact (morbidity), or even better, a decreased risk of death (mortality), such as the COVID-19 vaccines.
Beware of Health Advice from Social Media and the Popular Press
The food industry has been paying influencer dietitians to steer people’s eating habits toward diet sodas, sugar-laden foods such as candy and ice cream, and certain supplements, using videos posted on Instagram and TikTok. What these dietitians don’t reveal is that they are being funded by American Beverage, a trade and lobbying group representing Coca-Cola, PepsiCo, and other food companies.
The campaign employs a little-known tactic to manipulate consumers. An analysis of thousands of online posts found that food companies downplayed the health risks of highly processed foods and unproven supplements. Among 68 dietitians with 10,000 or more social media followers on TikTok or Instagram, about half had promoted foods, beverages, or supplements to their combined 11 million followers within the last year.
Something Else Is Fishy
Many labels on fish oil supplements make unsubstantiated health claims, according to a recent analysis of more than 2,800 different supplements. Overall, about 74 percent of them made at least one unsubstantiated health claim. For example, one in five older adults take fish oil supplements “for heart health,” despite the fact that multiple randomized trials showed no cardiovascular benefits.
The FDA does have a loophole called “qualified health claims” (QHCs), which are statements regarding a supplement or food’s potential to treat or prevent disease. Such claims must undergo an evidence review by the FDA, and they typically are required to include qualifying language that reflects a lack of scientific consensus or uncertainty. Only 19 percent of the fish oil supplements studied had QHCs.
The Perils of Eating for Pleasure
In previous issues, I’ve written about hyper-palatable foods (HPFs), which are super-tasty junk foods, and are related to ultra-processed foods (UPFs) that have poor nutritional value and contain many ingredients that have no good reason for being in your body. Eating for pleasure or stress relief is a slippery slope that leads to junk-food addiction. Not only are the health consequences tremendously harmful for individuals, but also for society as a whole. Unhealthy foods can cancel out benefits gained from a healthy diet.
I can speak from personal experience about how easy it is to become hooked on pleasurable tastes, and how we tend to overeat when the taste of food is especially delicious. I have also seen many of my patients learn the hard way how easy it is to gain weight, and how hard it is to lose it, and have experienced that struggle myself. Like any addiction, eating for pleasure presents a challenge to overcome. The good news is that it can be accomplished less painfully and less dangerously by going “cold turkey” compared to alcohol, tobacco, and opioid addictions.
Watch any of the cooking competitions featured on TV and you’ll see that the contestants’ dishes are judged mostly on taste, with appearance and presentation secondary. There is absolutely no mention of the nutritional value of the dish, or lack thereof, and there is no incentive for the competing chefs to use healthy ingredients. The message is loud and clear: When it comes to eating, it’s your pleasure that counts (and forget about health consequences).
Because of this pervasive mentality, it falls entirely upon us to stop eating for pleasure while learning to love the subtle tastes of food that’s actually good for us. We really can train our brains to prefer healthy foods, and rehabilitate our taste buds so we can enjoy them. Weaning ourselves off commercially prepared foods, regardless of their source, and using seasonings sparingly in our home cooking, will eventually reveal the delicious subtle flavors of whole, natural foods.
Researchers at the Tufts University Friedman School of Nutrition Science and Policy are using a nutrient profiling algorithm called “Food Compass” that scores food choices on their estimated health impact. Still a work in progress, Food Compass is the first major nutrient profiling system to use a consistent scoring system across diverse food groups, including mixed dishes.
The Food Compass Score (FCS) ranges from 100 (best) to 1 (worst). It provides a metric for food quality, but does not take the quantity consumed into account. I recommend that the FCS be used in conjunction with Glycemic Load (GL) data. Although dried fruits were given a high FCS, they have a high glycemic load and should be avoided by people at risk for developing type 2 diabetes.
Foods and beverages scoring 31-69 should be consumed in moderation. Anything scoring 30 or lower should be consumed minimally, if not avoided entirely. The highest scoring categories were vegetables (an average FCS 69.1), fruits (an average of FCS 73.9, with nearly all raw fruits receiving a FCS of 100), and legumes, nuts, and seeds (an average FCS 78.6). Starchy vegetables scored an average FCS of 43.2.
Interestingly, the average FCS for beef was 24.9; for poultry, 42.67; and for seafood, 67.0. Among beverages, the average FCS ranged from 27.6 for sugar-sweetened sodas and energy drinks, to 67 for unsweetened fruit or vegetable juices. The lowest scoring category was snacks and sweet desserts (an average FCS 16.4).
I encourage you to check out the Food Compass Score comparisons within food categories to guide your future food choices. The study compiled a complete database for 8,032 unique foods and beverages. It can be found in the study’s Supplementary Information section. Open the link and scroll down until you reach Table 7.
September 12, 2023
Bye-Bye Bivalents!
Both Pfizer and Moderna will begin shipping their monovalent XBB.1.5 mRNA vaccines later this week, replacing their current bivalent vaccines. The FDA has approved the updated vaccines for Americans as young as 6 months old. The CDC’s independent Advisory Committee on Immunization Practices (ACIP) met today, and voted 13 to 1 in favor of recommending the new vaccines.
Currently, the most prevalent coronavirus strain in the U.S. is EG.5, accounting for about 22 percent of tested cases; 90 percent of the circulating strains belong to the XBB lineage. The new monovalent vaccine is expected to provide a good level of protection for several months, but breakthrough infections can still occur. Vulnerable individuals should continue masking in high-risk settings, even if recently vaccinated. Use this online search tool to find available vaccines near you.
Moderna has announced that its XBB vaccine “will likely be effective” against the highly mutated BA.2.86 subvariant, according to their clinical trial data. Pfizer has said that their XBB vaccine “elicited a strong antibody response” against BA.2.86 in a preclinical study in mice. Let’s hope that the new vaccines will help to mitigate the impact of a back-to-school surge.
A third COVID-19 vaccine option from Novavax is expected to be available later this year. The XBB-specific vaccine has been delayed by the FDA, pending further review. According to Novavax, their protein-based vaccine “induces broadly neutralizing responses against XBB subvariants, including EG.5.1 and XBB.1.16.6. Non-clinical data previously showed functional immune responses for XBB.1.5, XBB.1.16 and XBB.2.3 variants.” With a different mode of action than mRNA vaccines, it could offer the advantage of a broader immunity against future variants.
One-Way Masking Works!
A CDC study published last year showed that the use of surgical masks in indoor public settings by individuals reduces their risk of contracting COVID-19 by at least 66 percent. High-quality N95 (and equivalent KN95 or KF94) masks could decrease the risk of infection by more than 83 percent. Those estimates were based on ordinary people in real-world community settings, in which it was likely that most of the study subjects were not masking at all times. Consistent use of well-fitting masks would result in even greater protection than the study results indicate.
Mask nay-sayers point to studies showing that mask mandates haven’t had much of an impact when it comes to halting the pandemic. That’s because of rampant non-compliance, with people masking in some settings but not in others, and because of pseudo-compliance, where people are using poorly-fitting face coverings with ineffective filtration. I’ve seen women wearing see-through lace veils in grocery stores while mask mandates were in effect. If masks didn’t help on a population level, that’s because inadequate masking still allows airborne infectious diseases to spread. Duh!
Let’s remember that the coronavirus is not the only airborne pathogen that we want to avoid, and that virus particles landing on surfaces can be transmitted from hands to face. Hand hygiene remains an important defense against RSV, the influenza virus, and the common cold, so keep on using hand sanitizer when out in public, and wash your hands well when you get home.
The Fight for Lower Prescription Drug Costs
According to data compiled in a recent study, pharmacy prices can be competitive, especially for generic medications. In many cases, a pharmacy’s standard charge may be lower than the out-of-pocket (OOP) costs determined by your insurer’s drug plan. So, shop around before filling your prescriptions. As I’ve suggested in a previous newsletter, a discount card program, such as GoodRx, can further lower your OOP costs.
If you’ve already filled a prescription, and then discover a lower price at another pharmacy, before getting it refilled just ask the pharmacy with the better price to transfer your prescription to them. They’ll be glad to do it, and it will send a message to the first pharmacy that they have been overcharging.
More Protein May Prevent Obesity
Humans, like many species, have a pressing need to sustain their protein intake, compared to other dietary components. Consequently, if we don’t get enough protein in our diet, there can be a compensatory increase in our consumption of protein-poor, high-calorie foods. Modern diets, consisting of fat- and carbohydrate-rich processed foods and deficient in protein, result in people consuming unnecessary calories. According to current research, unmet protein requirements are a driving factor in the obesity epidemic and its associated complications.
But wait! Before you fill your shopping cart with streaks, ground beef, and pork chops, pause to remember all the health benefits associated with a primarily plant-based diet. You can easily meet your protein requirements by combining whole grains with legumes, and you’ll also be eating lots of healthy fiber. Then, just add some seeds and nuts for their essential fatty acids, and fruits and vegetables for their vitamins and minerals.
A benevolent gut microbiome thrives on lots of fiber, which you can’t get from animal-based protein. To round out an omnivorous diet, consider poultry, eggs, dairy, and seafood as accompaniments to your meal, rather than being the main course. If you’re going to eat red meat, treat it like a condiment used for seasoning.
Poisoned for Profit
Poorly regulated supplement manufacturers sell vitamins, minerals, nutraceuticals, and herbal remedies to an unsophisticated public. This $40 billion a year industry is known for making wildly untrue health claims about the purported benefits of their products, fleecing people and sometimes harming their health. Unlike drugs, supplements do not require an FDA approval based on safety and efficacy, demonstrated by rigorous clinical trials. Consequently, there are numerous violations of consumer safety.
Let’s take, for example, Nut Diet Max brand Nuez de la India capsules that were found to contain toxic amounts of cardiac glycosides such as those found in the poisonous yellow oleander plant. Adding insult to injury, this product contained no candlenuts, as it had claimed. You can be certain that this is not an isolated incident.
Laboratory analyses have repeatedly found supplements that don’t contain what they claim, or have been contaminated with heavy metals, mold, and bacteria, or contain other substances that should not be unknowingly ingested by humans, such as potent allergens, prescription medications, and other drugs. Selling an herbal “pain reliever” that contains aspirin, at many times the price of aspirin, is one such scam.
The latest in a long list of so-called “nutritional supplements” that have been adulterated with prescription drugs is the “testosterone support supplement” marketed as “WeFun” which was found to contain generic Viagra. According to the FDA, “The presence of sildenafil in this product renders it an unapproved drug for which the safety and efficacy has not been established and, therefore, subject to recall.” Natural products adulterated with pharmaceuticals are especially common with herbal medicines imported from China and India.
Global Vitality Inc. of Chandler, Arizona, is recalling their Food Research International brand of ‘Serious Brain Enhancer Capsules’ because of potential fecal contamination. A brain enhancer? Seriously? It sounds more like the supplement industry is counting on people having poop for brains if they’re suckers for this kind of hype.
What about Prevagen? The FTC charged the company in 2017 for making false and deceptive representations about Prevagen that were actually contradicted by the results of their referred to “clinical trial.” When their much-touted ingredient (apoaequorin) is digested, it changes into common amino acids that are no different from any other dietary protein. There is no way for proteins to reach the brain or affect its functioning.
Under the Dietary Supplement Health and Education Act of 1994, supplement manufacturers are legally allowed to make claims that are totally lacking in scientific integrity, as long as they don’t unreservedly claim to treat specific diseases or conditions. They can get away with making claims that their product relieves symptoms, without being required to demonstrate actual efficacy.
The act was co-sponsored by Senator Orrin Hatch (R-Utah), who received considerable financial support from supplement manufacturers, including multi-level marketing firms XanGo and Herbalife. Today, although Prevagen isn’t sold as a treatment for dementia, it is still allowed to make bogus claims about the product improving people’s memory and clarity of thinking. This is tantamount to legalized fraud. Please don’t be fooled by their slick TV ads.
With supplements, there is also the risk of getting too much of a good thing. Taking vitamins or dietary supplements could accelerate the growth of tumors. Common antioxidants, such as vitamins A and C, and minerals such as selenium and zinc, stimulated the growth of blood vessels in lung cancer tumors when taken in excess, according to a recent Swedish study. The study’s authors warned that this finding could be applicable to the growth of all cancers, and increase their rate of spread.
There are ways to protect yourself from supplement scams:
1) Meet your nutritional needs through a varied, whole-foods diet.
2) Don’t take herbal remedies unless their safety and efficacy are backed by reliable research, rather than some “natural healing” tradition.
3) If a reputable medical doctor determines that you are deficient in one or more micronutrients, purchase only those that have the USP seal guaranteeing the product’s purity and potency.
4) Remember that if any product is heavily advertised, you will have to pay far more for it than it is actually worth, because a company’s advertising costs are typically passed on to consumers. So, shop for a similar product that is not a “name brand.”
A final caveat: The American Medical Association advises patients that physicians who distribute health products should provide them for free or at their own cost, because a profit motive can interfere with objective clinical judgments. If your doctor both prescribes and tries to sell you supplements, that’s an unethical conflict of interest. Report them to the medical board, and find another doctor.
How Safe Is Our Food Supply?
Every year, an estimated 46 million Americans experience a food-borne illness; about 128,000 are hospitalized as a result, and 3,000 die. That’s because we are being failed by federal regulators at the poorly run and poorly funded Food and Drug Administration’s Center for Food Safety and Applied Nutrition. An independent investigation found that there are inherent structural problems that greatly contribute to the problem
It took four months and two deaths before the dysfunctional food division of the FDA inspected the processing plant where Abbott’s infant formula was produced, after workers raised concerns about bacterial contamination. When the FDA shut down the plant, it precipitated a severe shortage of infant formula. This is but one of many egregious examples of the FDA’s failure to adequately ensure our food safety.
The FDA’s rules and procedures appear to have been heavily influenced by the food industries they are charged with regulating. The FDA is supposed to monitor almost all of the fish and seafood we eat, except for catfish. That species requires mandatory federal inspection by the U.S. Department of Agriculture’s Food Safety and Inspection Service. Adding to the confusion, the FDA inspects whole eggs, while the USDA monitors egg products, which aren’t clearly defined.
Due to the FDA’s inadequate oversight of produce farms, leafy green vegetables have become a major source of food-borne illnesses. Irrigation with water that has been contaminated with farm animal feces occurs far too often, and is not usually recognized until there’s a widespread outbreak of food-borne illness. Unlike beef, which is frequently inspected by the USDA, the riskiest part of a fast-food burger today is the lettuce, tomato, and onion, due to rare FDA farm inspections.
The FDA Food Safety Modernization Act of 2011 mandates an inspection frequency of at least once every three years for domestic high-risk facilities, and at least once every five years for non-high-risk facilities. The FDA seeks to achieve comparable coverage of imported foods using an array of regulatory tools, including U.S. importer verification, field examination, sampling, and foreign inspections.
Consequently, consumers have ample justifications for their concerns about the quality and safety of our commercial food supply. Here are some notable food safety violations:
The USDA’s Food Safety and Inspection Service (FSIS) issued a public health alert due to concerns that specific ready-to-eat salads and wraps may contain lettuce contaminated with deer feces. The FSIS has issued a public health alert to help consumers become aware that this product should not be consumed. Deer feces can transmit enteropathic E.coli bacteria.
Deer can also carry a fatal, prion-caused brain disease known as chronic wasting disease, which is related to “mad cow” disease. It is not yet known if humans can be infected, although the prion has experimentally infected monkeys. Because of the long time it takes before any symptoms of a prion disease appear, scientists expect the study will require many years before determining if there is a risk for people.
The Los Angeles County Department of Public Health is working with Panda Express in Lancaster, California to alert customers of a possible hepatitis A exposure. Hepatitis A infection was identified in a food handler who worked at that location. The virus is very contagious, and is typically spread by food or drink contaminated by human feces. The disease is vaccine-preventable.
Three people have died, and three others have been hospitalized, after drinking milkshakes contaminated with Listeria bacteria at a restaurant in Tacoma, Washington. The state’s Department of Health investigators found that the outbreak was linked to ice cream machines that were not cleaned properly. Symptoms of Listeria infections may not appear for up to 70 days after exposure.
Lowering the Risk of Food-Borne Illnesses
In the July issue I talked about an outbreak of hepatitis A caused by fecal contamination of organic frozen strawberries grown in Mexico and sold at many U.S. outlets, including Trader Joe’s and Costco. Since then, I have been asked how people can protect themselves against infections caused by contaminated food. This is a strategy that I use:
For fresh produce, if I don’t grow my own, the best defense is to purchase foods from reputable sources and wash items thoroughly under cold, running water. I also buy canned and frozen produce to supplement the fresh fruits and vegetables. They tend to be less prone to contamination than fresh produce, which is handled by many more people before it gets to you.
I usually store canned and frozen produce for a few weeks before consuming them. In the meantime, I’m checking Food Safety News and the FDA’s email alerts and RSS feed about food safety recalls. If there has been no report of a food-borne illness outbreak associated with the products I’ve purchased and put aside, it’s fairly safe to assume they are okay to eat. What I’m doing is waiting for other people to become the guinea pigs for food safety testing.
When it comes to dining (or ordering) out, putting myself at the mercy of the for-profit restaurant industry means that my health threats are multiplied. Risks come from the ingredients (or prepared dishes) supplied to the restaurant, the conditions under which food items are stored, and the hygiene of the employees. Why this matters to me, and why it should matter to you, can be summed up by one of many similar examples: “Although the CDC has not named the restaurant involved, a food handler who was not wearing gloves was determined to have been the cause of a norovirus outbreak that sickened more than 300 people.”
The norovirus is transmitted by the fecal-oral route. Outbreaks typically involve many more sick people than those included in official counts, because most infected people spend the acute phase of their illness hugging the toilet, rather than seeking medical attention. If you’ve ever had a norovirus infection, you surely won’t want to get one again. It’s a rough ride, with nausea, projectile vomiting, explosive diarrhea, aches and pains, abdominal cramps, and fever and chills. Symptoms begin 12 to 48 hours after infection and can last for up to three days.
The risk of norovirus infections can be reduced by thoroughly washing your hands with soap and water (hand sanitizer is ineffective against this virus), and by not dining out. You can learn more about this tenacious organism and its debilitating effects from this article about an outbreak along the Pacific Crest Trail.
What We Learn from Food Labels
Unfortunately, the ingredient labels on packaged foods don’t tell the whole story. For example, if a product contains less than half a gram of deadly trans fat per serving, the Nutrition Facts section of the label can list it as 0g of trans fat, so look for the word “hydrogenated” in the Ingredients part of the label. If a food product contains “natural flavors,” you still don’t know if those flavors came from plants, animals, or synthetic chemical sources. You won’t know about potential allergens, carcinogens, and the health impact of the product.
The ingredients are listed in descending order, by weight. This means that the ingredient listed first is the most abundant. If sugar is the first, or second, or third ingredient, beware! The last few ingredients are usually the preservatives used to retard spoilage. Some preservatives, such as sodium benzoate, have been linked to health problems.
Consider an ingredient label as just being a starting point for understanding the nutritional value and potential health risks of a packaged food item. To obtain in-depth information before your next grocery shopping trip, check out Healthline’s “Eat It or Leave It” website.
The Connection Between Poor Nutrition and Poor Health
Health conditions that are caused or exacerbated by poor nutrition include heart diseases, stroke, diabetes, and cancer. Coronary artery disease is the nation’s number one killer, and is responsible for a quarter of all deaths in the United States. According to the American Cancer Society, one in five cancers can be linked to a combination of an unhealthy diet, physical inactivity, alcohol and tobacco use, and excess body weight. That’s a lot of cancers, and 20 percent of them could have been prevented by lifestyle changes.
Worldwide, the number of people under the age of 50 being diagnosed with cancer has risen by nearly 80 percent over the past three decades, according to the largest study of its kind. Alarmingly, a new study shows that cancer rates have been increasing faster among people in their twenties and thirties, with colon cancer showing the greatest increase.
If you’re tired of being manipulated into eating unhealthy products by agribusiness, the food processing industry, supermarket chains, and the vast majority of restaurants, it is time to just say “No!” Stop thinking of dining out as a treat, when it’s actually another opportunity for you to be poisoned for profit. If you want to be healthy, you need to be fully in charge of the ingredients that go into your meals. That means you’ll need to shop smart, and then eat even smarter.
According to a study by the Center for Science in the Public Interest, processed foods occupy about three-quarters of grocery store shelf space, and that amount is increasing. To find the healthiest ingredients, do most of your shopping around the perimeter of the grocery store. That’s where the fresh fruits, vegetables, and other unprocessed foods are typically located. If you are going to buy something that comes in a package, please read the ingredients label carefully, and avoid those with lots of ingredients and those that are high in calories, sugars, salt, and/or unhealthy fats.
Addictive “Foods” Pushed by Big Tobacco
Known as hyper-palatable foods (HPF), addictive, super-tasty junk foods were developed by tobacco-owned food companies, resulting in a substantial adverse effect upon the quality of the U.S. diet, according to a recent analysis of Department of Agriculture data sets. If you let your taste buds determine your food choices, it will be nearly impossible to maintain a healthy diet, because we are surrounded by pseudo-foods that are engineered to induce sustained eating.
The only way to fight back against this kind of manipulation is to consciously make deliberate, rational food choices based upon their ingredients’ nutritional qualities, not their taste. We can learn to love the taste of foods that are actually good for us. It doesn’t take long, so just do it.
The Mediterranean Lifestyle
A new observational study (with all its attendant limitations) suggests that middle-aged adults following a “Mediterranean Lifestyle” (MEDLIFE) have a 29 percent lower risk of all-cause mortality and a 28 percent lower risk of cancer mortality, in a dose-response manner. The study followed 110,799 individuals, 40 to 75 years of age, from the U.K. Biobank cohort, with a median 9.4-year follow-up period. The lifestyle, which includes factors such as diet, eating habits, rest and physical activity, and social habits, can be effectively replicated outside the Mediterranean region.
The Mediterranean diet is characterized by high consumption of fruits and vegetables, whole grains, healthy fats such as extra virgin olive oil (EVOO), and lean protein, predominantly from fish. Eating habits include limiting salt and sugar consumption, reduced intake of processed foods, and drinking red wine in moderation. Social factors include socializing with friends, especially at mealtimes, and engaging in collective sports. Being physically active during the day (when not taking daily naps) is also part of the MEDLIFE system.
The American Heart Association’s Dietary Approaches to Stop Hypertension (DASH) diet is similar to the Mediterranean Diet, but limits alcohol and salt (sodium) intake. Emphasizing whole food sources such as fruits, vegetables, legumes, nuts, whole grains, low-fat dairy products, skinless poultry and fish, and non-tropical vegetable oils, it cautions against the consumption of red meat, saturated fats, and sweets, added sugars, and sugar-containing beverages.
Note that the American Cancer Society’s Diet and Physical Activity Guidelines for Cancer Prevention recommend avoiding alcohol consumption. The less sugar and more fiber you consume, and the more your diet includes whole, natural foods instead of processed and refined foods, the better off you’ll be. Aim for daily walks outdoors with a companion (human or canine), and take a short siesta after eating a healthy lunch, and it will feel as if you’re living in the south of France. A new study has shown that napping is good for the brain.
Choosing Healthy Cooking Oils
By now, you should know that highly saturated oils, such as coconut oil and those derived from animal fats, are a big no-no. Oils that are hydrogenated (even “partially”) will contain extremely harmful trans-fats. Because partially hydrogenated oils are inexpensive and less likely to become rancid, foods that are made with them will have a longer shelf life. Unfortunately, those who consume them will have a shorter shelf life. With what science now knows, the days of cooking with lard and margarine should be over, but sadly, they are not.
The politically powerful American food industry, in its relentless pursuit of profits, has figured out that human beings will put just about anything in their mouth if it looks good, smells good, and tastes good. So what if it harms people’s health? It is not by accident that most of the shelf space in grocery stores is occupied by nutrient-poor, ingestible products that don’t deserve to be called foods.
I’ve said it before, and I’ll say it again: Extra virgin olive oil (EVOO) should be your go-to oil for cooking and making dressings, if you want to optimize your health. Now, let’s take a closer look at some of the less healthy oils commonly found in people’s kitchens:
Canola Oil
In a previous issue of this newsletter, I warned against eating foods that contain the ubiquitous canola oil. Conventional canola oil is usually produced from GMO seeds, with the oil extracted by using a chemical solvent called hexane, or sometimes hot-pressed. In contrast, organic canola oil comes from non-GMO seeds and is cold-expeller-pressed, a mechanical process with a lower yield, higher cost, but a much healthier product than its conventional counterpart.
The problem with GMO products is not their genetics per se, but the fact that the plants have been genetically engineered to withstand heavy applications of herbicides, such as Monsanto’s Roundup. Thus, you can count on GMO plant products containing traces of herbicides. Look for labels that say “Non-GMO,” or even better, “Certified Organic.”
Soy Oil
Soybean oil is among the world’s most widely used cooking oils, but it is hard to find a non-GMO or organic version in the U.S. The oil contains a high ratio of omega-6 to omega-3 fatty acids, so it is not a good source of the essential fatty acids EPA and DHA. Too much omega-6 fatty acids in the diet has been associated with chronic inflammation and blood clots. If you can’t avoid soy oil entirely, at least try to limit your intake.
Other Oils to Avoid
It should go without saying that cottonseed oil is dangerous. Because it is inexpensive and heat-stable, it is often the go-to oil for frying foods in restaurants and fast-food joints. It can also be found in mayonnaise, salad dressings, crackers, cookies, margarine, shortening, and potato chips. If the ingredients label says, “may contain one or more of these oils” and lists cottonseed, you can pretty much count on it mostly containing the cheapest (and least healthy) oils available.
Cottonseed oil sold as an edible product is chemically processed and refined to eliminate compounds such as gossypol that are considered toxic to humans. Cotton plants are heavily sprayed with pesticides, the residues of which will show up in the oil. Also on my no-no list are palm oil and coconut oil, due to a high proportion of saturated fatty acids and the disastrous ecological impact due to their cultivation.
Please do your health and the environment a big favor and stick to extra virgin olive oil (EVOO), especially if it is organic and first cold-pressed. Avocado oil comes in second, with organic canola oil in a distant third place. Forget all the others, including sunflower, safflower, and sesame oil. When you can have the best (EVOO), why settle for less? Organic, first cold-pressed, EVOO may be expensive, but how much is good health worth?
August 30, 2023
The insurance, pharmaceutical, and hospital industries wield enormous political power that they use to their own advantage, at the expense of the American public. The solutions are obvious: Universal, government-sponsored healthcare akin to “Medicare for All” would compete with private insurance, driving costs down. There also need to be controls on drug prices and hospital charges. An important step in that direction is requiring hospitals to provide price transparency, allowing consumers to comparison shop for elective care. The CMS website has more information on hospital charges.
The High Cost of American Healthcare
If you have any doubts about it being due to unrestrained capitalism in a for-profit healthcare system, please read on: According to a new investigation, an insurance industry lobbying campaign has recently persuaded federal officials to allow insurers to charge physicians for paying them electronically. Although it costs insurance companies a lot more to mail paper checks, snail-mail enables them to delay pay-outs, while earning interest on the money that they owe.
The high cost of U.S. prescription medications isn’t due to the pharmaceutical industry’s costs for research and development (R&D) as they falsely claim, but rather to their enormous marketing and lobbying expenditures. Big Pharma spends about $1.8 billion a year trying to persuade physicians to prescribe their drugs, $350 million lobbying Congress (which is many times more than any other industry), and nearly $8.1 billion on direct-to-consumer advertising of brand-name prescription drugs, according to the latest figures.
According to Evaluate Pharma, the top pharmaceutical companies spend, on average, only 15 percent of their total revenue on R&D. A Pharmacy Checker report shows how drug companies consistently spend more on marketing and sales than they do on R&D. Obviously, you are paying far more for your medications than you need to because of those slick drug company ads on TV.
In a bold move, the Biden administration named ten prescription drugs for Medicare price negotiations with pharmaceutical manufacturers, seeking to reduce the financial burden on older and medically challenged Americans. The unprecedented move is part of the Democrats’ long political battle against this country’s exorbitant drug costs.
Predictably, the move has been challenged in various courts by six drug manufacturers, the Chamber of Commerce, and the pharmaceutical industry’s main trade group. Even if the government prevails, resulting lower prices won’t be available until at least 2026.
Consumers need to become activists and challenge the high and sometimes prohibitive costs of prescription drugs. The best way to do that is to pressure your representatives in Congress. The only thing they like less than losing their campaign contributions from drug companies is losing their jobs. Demand that they support legislation authorizing the federal government to negotiate even more drug prices, as well as limiting the duration and extent of drug patent protections and prohibiting expensive direct-to-consumer drug advertising like almost every other country does.
Are Bean-Counters in Charge of Medicine?
Health insurance companies are allowed to require “prior authorization” as a cost-cutting tool. The way it works is that patients and/or their doctors will need to secure the insurer’s approval before moving forward with many tests, procedures, and prescription medications. Insurers’ decisions are not necessarily made by qualified medical personnel. Insurers claim that the process helps them control costs by preventing medically unnecessary care, but their rules often create hurdles that can delay or deny necessary treatments. In some cases, delays and denials have resulted in patients’ deaths.
The 2010 Patient Protection and Affordable Care Act (aka “Obamacare”) prohibits health insurance plans from denying or canceling coverage to patients due to their preexisting conditions. However, patient advocates and health policy experts say that some insurers are using prior authorization as a loophole to deny care to those patients with the highest healthcare costs. According to one whistleblower, “They just delay and delay and delay until you die. And you’re absolutely helpless as a patient.”
If we’re not going to storm the barricades, then this pervasive problem needs to be addressed through legislation. So, once again, please pressure your representatives in Congress and your state legislature. You can also fight insurer’s denials by filing a “bad faith business practice” lawsuit, but that can take time.
When I was in private practice, I had an attorney on retainer who would write threatening letters to insurance companies that tried to deny treatments I had ordered. It only took a couple of lawsuits to be filed (and quickly settled) on behalf of my patients before insurers learned not to mess with this doctor’s orders. The leverage is that insurers don’t want the bad publicity and expense of going to court.
Three Questions to Ask Your Doctor
There are three very important questions you should be asking your doctor. The first one has to do with any diagnosis that you might be given. Unless the answer is obvious to you, ask your doctor if there is anything else that might account for your symptoms. “What else could this be?” is perhaps the most important question in medicine, because it invites what is known as a “differential diagnosis,” a range of possibilities that needs to be narrowed down to the most probable one through subsequent testing and evaluation. This question is the very best antidote for medical tunnel vision.
The second question relates to almost any treatment that you might be prescribed. Ask your doctor if there is anything else you can do that might help you with your recovery. Since the time of the Greek physician Hippocrates, doctors have prescribed lifestyle changes along with medication. Today, with the for-profit corporatization of healthcare delivery, a doctor can see many more patients in a day if they only prescribe drugs, rather than discuss lifestyles. Even if your doctor is ignorant about this important area of adjunctive healthcare, asking the question might encourage them to take a more holistic approach to patient care.
The third question has to do with the medications that your doctor wants to prescribe. It is certainly worth asking if there is a less expensive (ie. more “cost effective”) alternative. The cost of the drugs they prescribe is something that most physicians don’t investigate or concern themselves with, so it would behoove you to do some investigating yourself. Even if you have a health insurance plan with drug coverage, it may not get you the best price compared to GoodRx and other free pharmacy discount programs. Also be aware that your out-of-pocket cost can vary widely with your choice of pharmacy, so shop around.
COVID-19 Reinfection Risks
As new cases continue to rise, with hospitalizations up 21 percent compared to the previous week, it seems that for most people getting COVID-19 a second, third, or fourth time may be inevitable. The longer the coronavirus is with us, the more common repeat infections become, especially with the SARS-CoV-2 virus continually evolving to become more transmissible and better able to evade our immune system’s defenses.
There is no such thing as a risk-free COVID-19 infection, and it is still unclear as to whether symptoms tend to become more or less severe from one bout of the illness to the next, or if one’s risk of developing Long-COVID increases with multiple infections. The data suggests that people who have had a severe first infection are more likely to end up hospitalized for a reinfection, especially if they are older or immunocompromised.
However, for many younger and healthier people who get infected multiple times, subsequent infections typically are as mild or less severe than their first, according to a recent report (not peer reviewed). This is likely due to partial immunity from previous infections and/or vaccinations, plus the fact that the latest circulating variants seem to be causing less severe illnesses for most people than the earlier strains of the coronavirus did.
Still, there’s no escaping the fact that every time you get infected, no matter the severity, there is always a chance that you can develop longer-term symptoms. People with two or more bouts of COVID-19 were more than three times as likely to develop lung and heart issues, and more than one-and-a-half times as likely to experience a neurological disorder, than those who were infected only once, as detailed in a new report.
According to the CDC’s Variant Tracker, the EG.5 subvariant (nicknamed Eris) is estimated to cause more than a fifth of U.S. cases, and is gaining ground against its competitors. However, there’s a new player in town that’s causing concern among epidemiologists. It is designated as BA.2.86, and it has 35 new mutations compared to the XBB.1.5 variant, more than 30 of which affect its spike protein, the key that allows entry into your cells.
Moderna has announced that its preliminary clinical trial data for its new vaccine formulation, which should be available at the end of September, showed a significant boost in neutralizing antibodies against the EG.5 variant. However, the new vaccines could face a setback if BA.2.86 spreads more widely. Because surveillance efforts have been drastically reduced since the pandemic emergency was declared over, it is not yet known how widespread this highly mutated variant is, and how much ground it has been gaining.
An even more pressing question is how effective the upcoming XBB-targeted vaccines will be against BA.2.86, because they are not a good match for its spike protein. There is likely to be “immune escape” that makes it more difficult for our front-line, antibody-mediated immune response to recognize this new variant, even after prior vaccinations, boosters, and infections. According to a current report, there’s no reason for alarm right now. We’ll just have to keep monitoring the situation as new data becomes available. You can follow the CDC’s current risk assessment as it is periodically updated.
As you would expect, I’ll be getting the XBB booster as soon as it becomes available, and I will continue to mask with an N95 whenever I’m indoors around other people with unknown infectious status. As I’ve said many times before, vaccination is only one layer of protection. For me, the minor inconvenience of masking pales in comparison to the major inconvenience of becoming ill. You may feel differently, but don’t say I didn’t warn you, because…
Long-COVID Is No Joke
According to a just-published study, almost a third of adult patients who had COVID-19 in 2020, but did not require hospitalization, had one or more post-acute symptoms of the infection two years later. Of those with severe enough illness to be hospitalized, 65 percent still had significant problems after two years, including cardiovascular disease, blood clots, diabetes, gastrointestinal issues, and kidney disorders. Considering the sheer number of people affected, this represents a substantial cumulative burden of health loss due to SARS-CoV-2 infections.
Another study revealed the limitations of commercially available diagnostic tests early in the pandemic. The researchers estimate that approximately 10 million people in the U.S. during the first year of the pandemic had COVID-19, developed Long-COVID, yet tested negative. These findings suggest that a positive diagnosis for COVID-19 should not be a requirement for treating people whose symptoms correspond to the syndrome, which is now considered to be “a pandemic within the pandemic.”
There is some good news: According to at least one study (not peer-reviewed), people who took the antiviral drug Paxlovid within a few days after being infected with the coronavirus were 26 percent less likely to have Long-COVID symptoms 90 days later. Still, it’s going to take many more years of careful follow-up studies to fully understand the ways and the extent to which this novel coronavirus has harmed us.
Health Fraud Watch
The FDA maintains a database of health-related products that have been involved in violations. These products have been subject to warning letters, online advisory letters, recalls, public notifications, and press releases. Although the FDA’s database includes only a small fraction of the potentially hazardous products marketed to consumers online and in retail establishments, it is still worth perusing before purchasing any nutritional supplements. For example, the latest products to be added to the recall list are six different “energy supplements” that contain undeclared drugs.
Bad News for Vegans
In a new study, scientists found that two-ounce-equivalents (“2-oz-eq”) of animal-based, protein-containing foods provide greater assimilation of essential amino acids than the same quantity of plant-based, protein-containing foods. This study refutes the 2020–2025 U.S. Department of Agriculture and U.S. Department of Health and Human Services Dietary Guidelines for Americans. Those guidelines suggest that plant and animal protein sources are nutritionally equivalent. Vegetarians, take note: If you want to build muscle, you probably should add a slice of cheese to that veggie-burger.
What Are Superfoods?
The CDC has defined “powerhouse” fruits and vegetables by using a nutrient density approach. On the basis of the qualifying nutrients, 41 nutritional powerhouses were identified. At the top of the list, in descending order, are: Watercress, Chinese (Napa) cabbage, Swiss chard, beet greens, spinach, leaf lettuce (red, green, oak), and Romaine (cos) lettuce.
August 6, 2023
Our Plastic Fantastic Planet
A new study from the University of Nebraska has found that microwaving polypropylene-based plastic containers and polyethylene-based reusable food pouches releases microplastics, nanoplastics, and toxic chemicals into the food. The study found that some containers released as much as 4.22 million microplastics and 2.11 billion nanoplastic particles from only one square centimeter of plastic during three minutes of microwaving.
Even storing refrigerated food in plastic containers for over six months resulted in the release of millions to billions of these particles. While scientists aren’t sure what the health hazards are, limiting one’s exposure to these particles makes sense. Is it time to stop storing your meal’s leftovers in plastic baggies?
Shots for the Fall
The CDC recommends that medically vulnerable older adults (60 years plus) should consult with their primary care provider about getting the RSV vaccine. Its protection against symptomatic infection is expected to last for at least eight months. Both Pfizer and GSK will be offering fairly comparable RSV vaccines. Although quite expensive, they could be covered by Medicare Part D and other carriers, but be sure to verify this with your insurance company.
It is recommended that people get their annual flu vaccine before the end of October. Those who are older and medically vulnerable to developing severe illness or complications should receive the high-dose, quadrivalent flu vaccine no earlier than mid-September, to afford the best protection throughout the winter.
Because the COVID-19 vaccine’s maximum effectiveness against symptomatic infection starts to wane after two months, its timing becomes more challenging. Depending upon your risk profile, you might want to wait for the updated XBB booster until two weeks before an anticipated high-exposure event, such as travel or holiday gatherings. Although it is an acceptable practice, I suggest you don’t get all your vaccinations at the same time, in order to reduce the risk of a systemic vaccination reaction such as a fever or fatigue.
Boosted or not, sharing air with infected people is always risky. Your N95 mask (or equivalent) is your first line of defense. My one-way protection in all indoor public spaces continues to be a high-quality, industrial grade, 3M 8511 N95 mask with an exhaust valve, covered by an elastic neck gaiter to help it seal and keep it clean. The mask can be worn multiple times. It is also effective in blocking particulates from wildfire smoke.
Now that the vast majority of people are no longer masking when indoors in public spaces, such as stores, theaters, on public transportation, and healthcare settings, I feel no obligation to protect others from my exhalations. I therefore focus entirely on protecting my own health and enhancing my comfort. The one-way exhaust valve of my N95 keeps my glasses from fogging up, and protects me from inhaling virus-laden aerosols in the shared air.
Direct-to-Consumer Drug Ads
It’s no wonder that U.S. drug prices are the highest in the world. Drug manufacturers are spending a fortune on slick TV ads that typically end with, “Ask your doctor if such-and-such is right for you.” In reality, if a drug has a good track record for being both safe and effective, patients don’t need to ask their doctor about it. Doctors are continually being “educated” about new drugs by in-person visits from pharmaceutical companies’ representatives who are part of an extensive sales force.
Direct to consumer advertising is designed to put additional pressure on doctors to prescribe certain drugs. This kind of tactic is something we’d expect in a country where unrestrained capitalism and corporate influence shapes healthcare policies. What I don’t understand is how New Zealand, the only other country that allows this kind of advertising, lets Big Pharma get away with it, albeit with stringent regulations in place.
The “dirty little secret” of the pharmaceutical industry is that the results of their clinical trials are presented in terms of Relative Risk Reduction for the drug’s efficacy, which over-estimates how effective it is, and Absolute Risk Reduction for its adverse events, which over-estimates the drug’s safety profile.
That’s why an independent analysis of the trial’s data is so important, and so hard to obtain by the FDA due to “trade secrets” protections. This lack of transparency creates a considerable risk for people’s health, as well as their basic human rights to benefit from scientific progress and its applications, as detailed in an overview of the problem.
So, how do we, as consumers, protect ourselves from the predatory practices of Big Pharma? By insisting on generic drugs, unless there is a very compelling reason to take a relatively new medication seen on TV. Such drugs are still under patent, and typically do not yet have a well-established history of safety and efficacy, or verification of the manufacturer’s claims by independent studies.
I also recommend that you keep moving your prescriptions to pharmacies that charge less, as drug costs seem to change nearly monthly. An easy way to comparison shop is to use the GoodRx drug locator and discount coupons. Speaking from personal experience, the savings can be huge. When asked for your preferred pharmacy, the correct answer is, “It depends on what they are currently charging.” Ask your provider for written prescriptions, then shop around. Mail-order pharmacies may have even lower prices than retail pharmacies.
Science-Based Medicine
It may come as a surprise that the vast majority of medical doctors aren’t scientists. It takes special training in research methods to become a scientist, and that kind of training is not part of a medical education. Before I chose a career in medicine, I earned a graduate degree in marine biology. Part of my education involved doing informal “peer-reviews” of published scientific studies, and figuring out what the authors might have gotten wrong. What I learned was that there is no such thing as a “perfect” study. While major flaws typically result in the rejection of manuscripts by reputable journals, and minor flaws are met with demands for revisions, there are still errors that can get through. A well-done study will acknowledge its own limitations.
A key to understanding the value of any study lies in knowing the statistical significance of its results. Researchers have to ask themselves, how likely is it that these findings are not due to chance alone? Assuming that a study is not fraudulent and has no confounding variables that weren’t accounted for, no biases, and no inappropriate methods, random chance can still play a role and must be factored into an analysis of the results. In reality, there are always potential sources of error, so a good statistical analysis can get rather complicated. Consequently, bio-statisticians are key players when conducting high-quality medical research.
When experimentally testing a treatment in a clinical trial, the results are considered to be “statistically significant” if at least 95 percent of the time the outcome with treatment, when compared with no treatment, is more pronounced than what would be predicted if the treatment was ineffective. There must be enough participants in the study, and the dropout rates between the test group and control group must be similar. That may seem like a lot of room for error, but the wonderful thing about science is that it continually corrects itself along the way.
Rather than being a collection of unchanging “truths,” science is an unending process of progressively improving our understanding of how things work, based upon independently verifiable evidence gathered by competent researchers. Because there is never 100 percent certainty, the results of legitimate scientific studies must be expressed in terms of probabilities and levels of confidence, rather than absolutes.
When trying to determine if a particular treatment or exposure to a risk factor has a causal connection to a specific outcome, science-based medicine requires both randomization of the participants and replication of the studies. Randomized, controlled trials (RCTs), when powered by enough participants and independently replicated, build upon each other, providing ever greater confidence if the results are consistent. After a number of high-powered RCTs have been published, there is still a need for systematic reviews and meta-analyses of the trials before clinical practice guidelines are changed.
A Life Extension Formula?
Americans have a shorter life expectancy compared with residents of almost all other high-income countries. According to CDC statistics for 2021, heart disease and cancer were the leading causes of death. Studies have found that approximately 90 percent of diabetes, 80 percent of heart disease, and 70 percent of cardiovascular mortality can be attributed to unhealthy lifestyles.
A new, not yet published observational study identified eight lifestyle habits that, when adopted by age 40, could possibly extend an individual’s lifespan by as much as 24 years, at least according to its headlines. These “commonsense” habits were:
● Not smoking.
● Not drinking excessive amounts of alcohol.
● Not developing an opioid addiction.
● Being physically active.
● Managing stress.
● Maintaining a good diet.
● Maintaining good sleep hygiene.
● Maintaining positive social relationships.
Although observational studies can discover interesting associations between different variables, and will sometimes find a high degree of correlation, they cannot determine cause-and-effect relationships. Other factors linked to both a treatment (exposure) and its presumed benefit (outcome) are what researchers call “confounding variables.” All observational studies are plagued by them. The only way to account for all the known and unknown confounders is through randomly assigning a trial’s participants to either the experimental or the control group. That’s why the randomized, controlled trial (RCT) is considered the “Gold Standard” for medical research.
The Dangers of Medical Fraud
What used to be called quackery has been rebranded by unscrupulous practitioners as “Alternative Medicine.” It comes with claims of being able to achieve the same healing results as orthodox medicine, despite lacking biological plausibility, testability, repeatability, or convincing evidence of effectiveness. As Carl Sagan remarked, “extraordinary claims require extraordinary evidence.” Be very skeptical of claims made for treatments that are not a part of standard medical practice.
Alternative Medicine is sold as a substitute for mainstream medical treatment. People who go down that path will usually fare worse than those who receive no treatment at all, and the typical out-of-pocket costs add further insult to the injury. An example is getting coffee enemas and infusions of Chinese herbs as a treatment for colon cancer, instead of receiving care from board-certified surgeons and oncologists.
I have had patients who would have gone into remission with standard cancer care, but died much sooner as a result of seeking alternative treatments in Mexico. According to a recent article, this kind of medical quackery continues unchecked. Just remember that anecdotal “evidence” is not scientific evidence, and therefore should be totally ignored.
No amount of glowing testimonials can take the place of a well-done RCT.
Stem cell clinics in the U.S. are raking in fortunes by administering unproven treatments, according to a 2019 report. Such clinics may provide misleading information, or advertise that they are running clinical trials. However, these clinics almost always work without FDA regulatory approval and oversight, and do not follow legitimate clinical trial methodology. Treatment at these unregulated stem cell clinics also carries significant risks, according to a report by NIH Science, Health, and Public Trust.
Even standard medical treatments and procedures can be over-prescribed and over-used. For example, when a doctor prescribes an antibiotic for a viral infection, because that’s what the patient wants or expects, it not only doesn’t help, but creates a risk for developing resistant strains of bacteria. Unfortunately, in this era of rating everything, physicians who appropriately use antibiotics tend to get lower patient ratings.
Avoiding Medical Misinformation
With so much garbage on the Internet, it can be hard to find trustworthy sources of medical information. Look at the websites of the NIH and CDC, as well as those of the Mayo Clinic and Cleveland Clinic. National advocacy organizations, such as the American Diabetes Association, American Lung Association, American Heart Association, and Alzheimer’s Association, often have patient guides, but their information might not be up-to-date. What you don’t want to do is rely on information sent to you by your “Facebook Friend,” since it is likely to be wrong.
Social media algorithms are designed to promote emotionally laden controversies and addictively lead viewers down “rabbit holes” in which they become increasingly engaged with content that is similar to what they have already consumed. Confirmation bias then leads users into “echo chambers,” where they are only exposed to information that supports their existing beliefs. As users become more engaged, they are more likely to be exposed to false or misleading information and abandon their critical thinking skills. Social media employs a number of “brain hacks” to exploit people’s inherent cognitive biases.
While I strive for accuracy on my own website, I don’t have the benefit of peer review, so I welcome and appreciate any challenges regarding its information. Please be skeptical, and seek independent verification of facts and conclusions. YouTube videos are a great source of information on how to fix common plumbing problems, but they are NOT a good place to find medical advice, unless it comes from a highly reputable source, such as a video from Yale Medicine.
Medical Misinformation Kills
American Samoa experienced a measles outbreak that began in September, 2019, the worst in the country’s history. In October, 2019, Robert F. Kennedy Jr., an outspoken anti-vaccine activist and conspiracy theorist, visited American Samoa and gave a speech in which he criticized the government’s measles vaccination program and promoted the false claim that vaccines cause autism. The measles outbreak lasted until February, 2020. By the time it was over, more than 5,000 people had been infected, and 73 had needlessly died.
It is clear that Kennedy’s speech sowed doubts about the safety of vaccines. These doubts likely led a significant number of Samoans to delay or refuse vaccination, which contributed to the spread of the disease. American Samoa’s recent measles catastrophe is a grim reminder of the dangers of medical misinformation.
Kennedy is currently a candidate for the Democratic Party nomination in the 2024 presidential election, counting on his family name and history of environmental activism to build support. His campaign is being financed by conservatives who would like him to take voters away from Biden, thereby weakening the Democratic base.
Ultra-Processed Foods
A recent assessment conducted by the Access to Nutrition Initiative found that about 70 percent of food products sold in the United States are unhealthy. New research from the Network Science Institute suggests that 73 percent of the U.S. food supply can be considered ultra-processed. The inclusion of ultra-processed foods (UPFs) along with a healthy Mediterranean or DASH diet can have adverse health consequences, according to a new study.
Ultra-processed foods undergo intensive manipulation and contain substances not found in people’s kitchens, such as hydrolyzed proteins, maltodextrins, and hydrogenated fats, as well as additives such as colorings, preservatives, flavor enhancers, and chemical sweeteners.
The aim of UPF manufacturers is to increase their products’ taste-appeal, appearance, and shelf life, while ignoring people’s health and nutritional requirements. The main problem with UPFs, however, is not so much due to the chemicals they contain, but because they’re super-delicious, yet leave us feeling hungry, so we end up eating far too much of them.
UPFs include packaged snacks, sodas, ready-to-eat meals, and fast foods, which have been chemically engineered to hook people’s taste buds. Their excessive consumption is fueling the current obesity and diabetes epidemics. Ultra-processed foods such as hot dogs, donuts, cookies, candy, and fruit-flavored beverages are some of the unhealthiest items we can consume. Most UPFs don’t even deserve to be called foods. The moniker “industrial chemical concoctions” would be more appropriate.
UPFs are linked to a plethora of medical problems, ranging from heart disease to cancer. Yet, according to a new analysis, the U.S. has woefully few federal and state regulatory policies addressing the health impact of UPFs. U.S. consumer protections lag far behind those of many other countries, including a number of less wealthy nations. Food packaging should be required to include information about the degree of processing. The dietary recommendations of government agencies should urge people to limit their consumption of ultra-processed foods.
The dominance of UPFs in the food market is yet another example of America’s conscienceless capitalism at its worst. With a for-profit healthcare industry and a political system corrupted by corporate campaign contributions via dark money and super-PACs, the best way for consumers to protect themselves is by insisting upon whole, natural foods, and by boycotting UPFs. You can also help to educate others about what happens when the food industry places their pursuit of profits ahead of the welfare of their customers.
If you doubt the corporate influence in politics, simply follow the money. Corporations shape election outcomes through campaign contributions, media advertising, and political action committees, and influence legislation through lobbying and grassroots organizing efforts. Corporate influence can have a significant impact on public policies. Until we have campaign finance reform, limits on lobbying, and transparency laws, public policies are susceptible to being hijacked by the monied interests.
My own scrutiny of the U.S. food and agricultural industries, and the health issues related to what people eat, has led me to conclude that in addition to avoiding UPFs, I need to monitor my consumption of sugar, salt, and saturated fats, in order to optimize my health. I therefore make an effort to:
1) Avoid restaurant food, because I have no control over their ingredients and sanitation.
2) Carefully read all ingredients labels when grocery shopping, and avoid the sweet taste-traps.
3) Limit my consumption of mammalian meats, especially red and processed meats.
4) Eat poultry and eggs that are preferably organic and/or free-range.
4) Eat seafood that is lower on the food chain, and is preferably wild-caught and sustainable.
5) Choose organic produce when it can help to reduce my ingestion of pesticides.
6) Choose whole grains over refined or polished grains, and preferably unmilled.
7) Include legumes, berries, nuts, and lots of different vegetables in my daily diet.
8) Use only extra-virgin olive oil as my cooking and salad oil.
9) Avoid taking herbal remedies, supplements, and most vitamins, since they are unregulated.
10) Follow the advice found in my book, Good Food Is Good Medicine (shameless plug).
I’m not saying that this is what you should be doing. Considering my family history (genetic susceptibility) and my health data (lab tests, blood pressure, BMI, etc.), this is how I want to hedge my bets when it comes to eating for health. YMMV, and diet is not a one-size-fits-all prescription. The best advice I can offer on the subject is to pay attention to what you eat. In any case, be wary of claims that a single food can bestow long-term health benefits. Sorry, cinnamon. I still love you, but I can’t claim you’re a cure for anything.
Life Without Sweets
The long-term consumption of artificial sweeteners such as aspartame and saccharin, as well as diet beverages, has been linked to increased fat stores in the abdomen and within muscle tissue, anda greater risk of obesity, independent of diet quality or caloric intake, according to a study conducted by the University of Minnesota Medical School and School of Public Health. These findings raise concerns about the recommendations of the American Diabetes Association and the American Heart Association that promote the replacement of added sugars with artificial sweeteners.
In the past, I have recommended natural, low- or no-calorie sweeteners such as erythritol, Stevia extract, and monk fruit extract, as sugar substitutes for those who have or are at risk for diabetes, and have a sweet tooth that demands satisfaction. Long-term safety profiles and acceptable daily intakes for these substances do not exist.
My current recommendation is for people to get over their craving for intense sweetness by eliminating both sugar and sweeteners, along with dried fruits, thereby “resetting” their sense of taste. One “taste bud rehab” hack is to eat a few apple slices along with some dry roasted, unsalted peanuts or pecans as your dessert (if you’re not allergic).
If you simply must have a taste treat to finish off an otherwise healthy meal, you might try eating a small piece of dark chocolate (at least 85% cocoa). A recent RCT involving 48 healthy young adults showed that 85% cocoa had prebiotic effects, resulting in a restructuring of the diversity and abundance of intestinal bacteria.
Cocoa may also act as a mood elevator, possibly acting via the gut-brain axis, since there was a statistically significant improvement among those who ate 10 grams, three times a day, of the 85% dark chocolate for three weeks, but not in the control group or those who ate 70% cocoa chocolate. Although this study had some limitations, my motivated reasoning makes me want it to be true that, at least for my microbiome, 85% dark chocolate is a healthy food.
A Book Recommendation
If you want to gain a better understanding of how scientific research is conducted and how evidence-based medicine is practiced by ethical physicians, I can highly recommend a book by one of the best teachers I know, F. Perry Wilson, MD. Dr. Wilson is a professor and researcher at the Yale School of Medicine, and has written How Medicine Works and When It Doesn’t for lay people. The book gives readers the knowledge they need to determine the validity of medical information and make informed decisions about their healthcare.
July 5, 2023
Organic Hepatitis A
I’ve been paying attention to the FDA’s warnings and recalls regarding food-borne illnesses. What may come as a rude awakening is that the “Organic” designation on commercially produced foods doesn’t necessarily mean healthy. Case in point: “FDA Outbreak Investigation of Hepatitis A Virus Infections: Organic Frozen Strawberries from Trader Joe’s and Costco.“
Following an investigation begun in February, 2023, recalls have been initiated based upon traceback data regarding hepatitis A infections linked to frozen organic strawberries imported from Mexico. The FDA has identified additional firms that may have received potentially contaminated products. Check out the link above for a list of affected brands.
Covid: Is It Over?
Most Americans now seem to think so. According to an Axios-Ipsos poll in May, 2023, 62 percent said that COVID-19 is over, compared with 47 percent who felt that way in February. More than half said they never mask in public. The proportion of respondents who said they always or sometimes mask dropped from 30 percent in February to 23 percent in May.
Since the CDC stopped tracking data, it is harder to get a handle on COVID-19’s prevalence. The coronavirus remains among the most common respiratory pathogens out there, and it is still infecting tens of thousands people. It has already killed 40,000 this year alone, and hundreds still die daily. Devastating complications of an infection continue afflicting otherwise healthy people, and symptoms of Long-COVID linger in about one out of ten people who get the disease.
Many of my subscribers had remained covid-free until recently, when they let their guard down and became infected in the usual high-risk places; in a restaurant, at a gym, during airline travel. It is too soon to know what the long-term consequences of those recent infections will be, but even a mild case increases the risk of developing diabetes, heart disease, and dementia down the road.
Don’t get me wrong. I’d love for the pandemic to be over, but that’s just not the reality yet. The coronavirus continues taking its toll on the most vulnerable; the immunocompromised, the elderly, and those with chronic illnesses such diabetes and obesity.
Although people are less likely to die or require hospitalization during the acute phase, COVID-19 can still wreak havoc with various organ systems each time someone gets an infection. The last remaining metric for assessing the pandemic’s impact in your community is the CDC’s county-level map of hospital admissions. Please check it out.
While socializing is good for our physical and mental health, vulnerable people should continue to be selective about who they socialize with, and in what kinds of environments. Summertime is a great time for socializing outdoors. When entertaining indoors, it is not unreasonable to ask guests about their current state of health, immunization status, potential exposures, and if in doubt, to take a rapid antigen test before arriving.
If you’re going to travel, wear an N95 or equivalent mask at the airport and on the plane, skip dining at indoor restaurants, and continue testing for COVID-19 if you develop symptoms of a respiratory infection. If you can persuade your physician to provide you with a prescription, it would be a good idea to travel with some Paxlovid in your suitcase, in case you test positive during your trip. Trying to get medical help while away from home can prove quite challenging.
Unfortunately, access to affordable testing can be problematic, now that the federal government has stopped mailing free kits, and Medicare and private insurers are no longer required to pay for them. Public health experts are concerned that higher rates of transmission will occur as more people stop testing and their stockpiled test kits expire. People will be more likely to dismiss their respiratory symptoms as “just a cold,” and not refrain from attending gatherings.
Uptake of the bivalent booster dose remains low. Only 17 percent of eligible Americans have received it, according to the most recent CDC data (May 10, 2023). For those aged 65 and older, only 43 percent are up-to-date on their boosters.
Masking in Healthcare Settings
It pains me to see that masking requirements have been dropped for most healthcare facilities. It seems obvious that those are indoor settings where people with contagious respiratory infections, and those who are most medically vulnerable, are likely to encounter one another. For what it’s worth, I still mask to the max at my doctor’s office, and don’t understand why other people consider it to be such an inconvenience. If I need to remove my mask for part of the exam, I expect my healthcare provider to be wearing one.
The Department of Veterans Affairs announced a new masking policy: Masks are no longer required in most clinical settings, but are still mandated in areas that serve high-risk patients, such as dialysis clinics, transplant centers, chemotherapy units, and urgent-care and emergency departments. The VA guidance is also clear that patients with COVID-19 should still mask, and that patients can request healthcare personnel to mask up. This compromise is based on the fact that veterans and their families did not want continued universal masking in all healthcare settings.
While most Americans do not support mask mandates, healthcare settings have a responsibility to safeguard their most vulnerable patients. They need to have policies that allow patients, along with their family members and caregivers, to request that providers wear masks while seeing them. A recent article in the New England Journal of Medicine makes a strong case for masking in healthcare settings to protect patients from all respiratory viral infections, not just COVID-19.
Paxlovid and Statins
Paxlovid is not recommended for people who are taking statins, which is a very large percentage of the older population. Consequently, Molnupiravir is prescribed for them instead, although it is significantly less effective as an oral antiviral agent. The FDA’s Checklist Tool for Prescribers says that patients who are taking atorvastatin and rosuvastatin should temporarily discontinue taking it during their five-day Paxlovid course. Those on lovastatin and simvastatin should discontinue use 12 hours before starting Paxlovid, then restart it five days after finishing their course of Paxlovid. Unless there’s another reason not to take Paxlovid, those who are on statins should insist on it, and follow the FDA’s guidelines.
America’s Herd Immunity
The CDC recently reported that more than 96 percent of the American blood donors sampled had antibodies against SARS-CoV-2 from previous infection, vaccination, or both. Of those tested, about 48 percent had hybrid immunity (from infection plus vaccination). Unfortunately, breakthrough infections still frequently occur with the highly infectious Omicron XBB variants that are currently circulating. Bivalent booster protection against infection declines after about two months, although protection against severe disease remains strong.
New Boosters Are Coming
An additional bivalent booster four months after the last one is recommended for people aged 65 and older, as well as those who are immunocompromised. XBB-specific boosters will be coming this Fall, and should provide longer protection against infection. They were designed to target the XBB.1.5 variant, which has been replaced by two even more infectious XBB derivatives; XBB.1.16 and XBB.2.3. It is still expected that a vaccine targeting XBB.1.5 will be much more effective against all XBB strains than is the current bivalent booster.
The most recent CDC data shows that the bivalent vaccine is 62 percent effective in protecting against hospitalization for up to two months, but this protection drops to only 24 percent by four to six months. Protection against critical illness, defined as admission to an intensive-care unit or the morgue drops from 69 percent to 50 percent over a similar time frame. A recent CDC analysis found that nursing home residents who were up-to-date with their coronavirus vaccinations were 31 percent less likely to contract the virus than those who were not.
Although eligibility guidelines have not yet been determined, it is expected that people who have received a bivalent booster at least four months previously, along with anyone who did not receive a second bivalent booster, will be eligible.
The CDC says people who have had COVID-19 can receive their next booster if it has been three months since their recovery. Those people could probably wait longer if they have hybrid immunity, which appears to be stronger than vaccination alone. That still begs the question: “If I am eligible for a second bivalent booster, should I get one now, or wait until the Fall for an XBB booster?”
I’m inclined to recommend waiting at this point if you are not immunocompromised. For those who are elderly and/or chronically ill, continue effectively masking in all high-risk settings. People who are moderately or severely immunocompromised can receive boosters as often as every two months, with the approval of their healthcare provider.
In any case, whoever you are, don’t rely upon the bivalent booster as your sole protection. A recent report from the CDC showed that the bivalent booster’s effectiveness against a symptomatic XBB infection was just 43 percent among those age 65 and older. That’s still better than nothing, and the bivalent booster is generally good at keeping people out of the hospital.
Covid Clouds on the Horizon
As the coronavirus continues to evolve, it appears to be getting more infectious but less lethal. Its incubation period, the time between exposure and the onset of symptoms, seems to be getting shorter. The mean virus incubation period during the time that the SARS-CoV-2 Omicron BA.5 variant was dominant was 2.6 days (95% CI: 2.5–2.8 days). For the XBB variants, it may be even shorter. The original strain had an incubation period of 5-10 days.
In India, the BF.7 (short for BA.5.2.1.7) subvariant is showing very high transmissibility because of its capability in eluding the immune system, its short incubation period, and its marked ability to cause reinfection. BF.7 has a very large growth value (R0 = 10-18), making it two to three times more contagious than the parent Omicron (R0 = 5-6). This has resulted in a big surge of infections. So, there it is, déjà vu, all over again.
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