Dara K. Lee Lewis, MD – Harvard Health Blog

Vaccines To Prevent Severe Diseases

Fri, 08 Aug 2025 15:13:22 GMT

By Dr. Joel T. Katz, MD

Primary care physician & Fellow of the Infectious Diseases Society of America

Lown Group

Where did it all start?

A thousand years ago, practitioners in China, and thereafter in Africa, India, and Turkey, noted that exposing healthy individuals to dried scab material from recovering smallpox patients could prevent a subsequent smallpox infection – a process called “variolation.” This practice eventually spread to Europe and the Americas in the early 1700’s – one hundred eighty years before Louis Pasteur proposed the “germ theory” of contagion. In the winter of 1764, as smallpox descended on Boston, John Adams and other colonists were inoculated against it through variolation . However, while beneficial to most, some of those exposed got very sick or died from the practice itself.

In 1798, British zoologist and surgeon Edward Jenner tested the frameshifting hypothesis of his colleagues that milkmaids had fair skin because they were protected from smallpox by their occupational acquisition of a milder agent – cowpox, confirmed as pustules spread from cows to their hands. Jenner inoculated the 8-year old son of his gardener with liquid from a cowpox pustule recovered from milkmaid’s hand and thereby protected him from an intentional smallpox exposure 2 weeks later. Jenner was not the first to use this technique, but he proved the effectiveness through subsequent challenges and made the effort to track and self-publish his findings in a case series, which secured his fame. The term “vaccine” is derived from vacca (Latin for “cow”) reflecting the historical origin this first modern vaccine, a term now applied broadly to all immunizations.

What has been the impact of vaccines?

GONE: The is no smallpox in the world now, thanks to vaccines. The same is nearly true for diphtheria, polio, tetanus, and rubella. Important veterinary diseases have also been completely eliminated.

GREATLY REDUCED: Measles, rabies, Neisseria and Hemophilus bacteria, chicken pox and shingles have become rare conditions thanks to effective vaccinations. Cervical cancer and liver cancer are now prevented by vaccines against the viruses that cause these conditions. Measles vaccine campaigns have reduced measles-specific mortality by 91% and all-cause mortality by 30% in resource-poor countries; even if one survives measles patients are at high risk for succumbing to malnutrition and other long term sequella of this infection. While rare for the past 3 decades, in 2025 there have been 1,333 confirmed measles cases (certainly an underestimate) and a hand full of confirmed deaths in the US – exclusively in communities of high vaccine hesitancy. This number is the highest since 1991.

MORE SURVIVABLE: Further, previously devastating infections such as pneumococcal pneumonia is rendered less severe by vaccination. In addition, we know that older unvaccinated adults are more likely to die from heart attacks when they get pneumonia or shingles, compared to similarly health people who are vaccinated to those agents.

Scientists estimate that in the past 50 years, 154 million lives have been saved by vaccines. Advanced vaccine methodologies are now being applied successfully to treating cancer .

What are the so-called “Seasonal Vaccine” options?

Certain respiratory infections are caused by viruses that predictably peak in the winter in the US – 3 of these are vaccine preventable with fall inoculation, including:

Influenza (“flu”) vaccine
Severe cases of influenza are on the rise – the 2024-25 season resulted in the highest number of hospitalizations in the US since 2010-11, according to the CDC. The 2025-2026 flu shot will build immunity to some of the most severe strains detected by epidemiologists. All adults should receive a flu shot in the fall. Those who are pregnant or likely be become pregnant in the winter are at especially high risk for the disease and should seek out flu shots. Those over 65 should receive the “high dose” vaccine.

COVID-19 vaccine
Before the pandemic, coronaviruses were known to cause the “common cold,” and thereby largely ignored by scientists. From the first reports of novel coronavirus SARS-CoV-2, miraculously less than 12 months elapsed until new and novel mRNA vaccines were safety-tested and available to the public! This fall there will be 4 new and improved (targeted to circulating strains) FDA-approved COVID-19 vaccines available.

RSV vaccine
Respiratory syncytial virus most frequently causes mild to severe respiratory illness in young kids and their grandparents can inadvertently be at risk. All previously unvaccinated adults 75 years and older, and those 50-74 who have chronic lung or heart disease or a weaken immune systems should receive this vaccine. This vaccine was first available during the 2023-24 season.

These seasonal vaccines are safe and effective , based on many well-designed scientific trials. The Advisory Committee on Immunization Practices of the CDC has comprehensive, reliable and balanced information about all available vaccines. Everyone is different, and I urge you to discuss any concerns about these vaccines or others (e.g., pneumonia, shingles, measles) with your own healthcare team.

Menopause & Your Heart: What Every Woman Needs to Know

Fri, 23 May 2025 14:34:03 GMT

Whether you’re in the middle of menopause or well past it, your heart health matters more than ever. Hormonal changes during and after menopause can raise your risk for cardiovascular disease – but the good news is, you can take action to protect yourself.

Watch this webinar to learn:

- How menopause impacts your heart, both now and later

- The raising risk of heart disease after menopause

- Practical steps you can take to strengthen your heart at any stage

Dr. Simin Lee, a board-certified cardiologist and founder of Systole Health, will lead this important conversation on how menopause affects your heart and what you can do to protect it. Dr. Lee also leads the Lown x Systole Heart Health Program, a six-week virtual program.

Learn more and sign up for the program here: https://7blj7mhtu88.typeform.com/to/Rfq8C7vK

For any questions, feel free to reach out to us at hello@systolehealth.com .

6 Mental Health Hacks for Navigating Life with POTS with Evolvinn Therapy & Consulting

Mon, 24 Jun 2024 12:39:13 GMT

Living with Postural Orthostatic Tachycardia Syndrome (POTS) can be incredibly taxing and overwhelming, often depleting resources we didn't even know we had. Amidst the constant management of symptoms, or mental health and overall well-being can sometimes take a back seat. However, nurturing our mental and emotional health is just as crucial as caring for our physical health.

Join three chronic health psychologists for an engaging and supportive discussion where we will explore practical strategies to cope with the daily challenges of POTS. Learn how to manage your symptoms while prioritizing your mental well-being effectively.

Follow along with the worksheet:

https://drive.google.com/file/d/1DMhCvjhUcXQ08zG2OYu2Uo5r_ahG1bst/view?usp=sharing

Evolvinn Contact information:

Website: https://evolvinn.com/

Facebook: https://www.facebook.com/Evolvinn

Linked in: https://www.linkedin.com/company/evolvinn

Instagram: https://www.instagram.com/evolvinntherapy/

Pinterest: https://www.pinterest.com/evolvinntherapy/

Office phone: (703) 520-7878

Email: info@evolvinn.com

Eating for a Healthier Heart and Gut

Tue, 05 Mar 2024 20:38:48 GMT

Join us as we welcome Skylar Griggs, MS, RD, LDN of Newbury Street Nutrition. We will be discussing 5 simple diet changes you can make to optimize your heart health and how your food choices directly affect your blood pressure, cholesterol levels and gut health.

GLP-1 Medications Demystified: Heart Health in the "Ozempic Era"

Tue, 06 Feb 2024 13:25:53 GMT

Dive into the heart health breakthrough of the moment with our expert-led webinar on GLP-1 medications. We'll dissect how these drugs work, their impact on your heart health, common concerns, and what the future holds. This session is tailored for patients who seek a deeper understanding of their treatment options in a rapidly evolving medical landscape.

Exercise in Coronary Artery Disease, Atrial Fibrillation, and Heart Failure

Mon, 04 Dec 2023 21:53:00 GMT

Please join us as we continue our discussion on the benefits of exercise in cardiovascular health. This webinar will be devoted to understanding the role of exercise in patients with cardiac diseases including coronary artery disease, atrial fibrillation, and heart failure.

Study on Coronary Artery Disease: https://www.jacc.org/doi/10.1016/j.jacep.2022.12.002

Study on Atrial Fibrillation: https://www.jacc.org/doi/10.1016/j.jacep.2022.12.002

Study on Heart Failure with Preserved EF: https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.117.030617

Study on Heart Failure with Reduced EF: https://jamanetwork.com/journals/jama/fullarticle/183708

Overview study of all cardiac diseases: https://www.jacc.org/doi/10.1016/j.jacc.2022.07.004

Pranayama-Breath-Work: The Art and Science of Slow Breathing

Mon, 06 Nov 2023 21:53:35 GMT

Please join us as we welcome Dr. Amit Anand for his talk on Pranayama-Breath Work. The talk will focus on the role of Pranayama-breath-work practices for the cultivation of health and well-being. Breath-work has its roots in the wisdom tradition of Yoga. The accumulated science on breath-work and its effects on pulmonary and cardiovascular physiology, emotional wellbeing and sleep will be highlighted. The participants will also learn simple breathing exercises that they can incorporate into their lives on a daily basis.

Dr. Anand's Website:

https://www.pranayamarx.com/

Raynaud’s and Beyond: Why are my fingers and toes cold and discolored?

Tue, 17 Oct 2023 18:33:54 GMT

Join us as we welcome Dr. Marie Gerhard-Herman to discuss “Raynaud’s and Beyond: why are my fingers and toes cold and discolored?”

Dr. Gerhard-Herman is an internationally renowned Cardiologist and Vascular Specialist at Brigham and Women’s Hospital, where her clinical expertise includes peripheral arterial disease, venous disease, Raynaud’s phenomenon, and the impact of aging on the blood vessels. She has extensive experience as a lecturer, mentor, and teacher, and is beloved by her many patients and trainees.

Resources:

Follow Up Info Sheet
Stress Response Sheet

How to Improve Sleep with Dr. Karen Lee

Mon, 11 Sep 2023 20:31:16 GMT

Getting a good night's sleep every night is vital to cardiovascular health. Please join us for an in-depth discussion on optimal sleep. We welcome Dr. Karen Lee, a sleep-medicine-trained neurologist, with a busy practice at Mass Eye and Ear and appointment at Harvard Medical School. Dr. Lee will review sleep recommendations, tactics to optimize sleep, treatments for insomnia, and when to see a sleep-medicine physician.

Follow up questions answered by Dr. Karen Lee

Q: Is there a specific brand of melatonin that you recommend?

A: Per my talk, a prescription would be optimal to control what is in the melatonin. But if you would still like to purchase over the counter, some recommended over the counter brands are: Natrol, Nature's Made, and Puritan's Pride. If you try a different brand ensure it is USP or NSF certified on the label.

Q:Is it normal to wake up about twice a night to go to the bathroom?

A: There is not a straight forward answer to this, as there could be several reasons why this occurs, that could range from normal to abnormal, based on what is leading to the night time urination. It is known that sleep apnea leads to sympathetic surges at night, that lead to the need to urinate. So often, I have patients that urinate once, twice, or more per night, and when their sleep apnea is treated, this completely resolves or improves, regardless of patient age. If you would like to better understand of your fluid intake could be contributing, you can do a trial of cutting off fluids a few hours before bedtime several nights and see if that has an impact.

Q: What can be done if the need for frequent urination interrupts sleep? Other then holding fluids after a certain time of night.

A: See above, as it is always important to ensure sleep apnea is not contributing. This is a frequent referral to sleep specialists from Urologists, as if there is a Urology work up and they cannot find a reason for night time urination (there are several such as over active bladder, or insufficient emptying, or prostate issues etc.,), then they refer to sleep medicine to ensure sleep apnea is not leading to this. You should also evaluate if there is an issue with just as frequent urination during the day, this can help be clue if this is just related to sleep, or a consistent issue during the day.

Q: What do you think about Trazodone?

A: I prefer FDA approved sleep aids, as these medication are formulated directly to help with sleep, and trazodone is not. It is an antidepressant that has a side effect of drowsiness. But it has some positive and negatives. Some negative besides using this medication for its side effects, is that it impacts serotonin, and they may be good or bad, depending on the patient and other medications they take and how they feel. It also tends to have a very long half life, so it very commonly leads to morning and/or daytime sedation or cognitive complaints. Another negative is that it can lead to an EKG abnormal finding of QT prolongation, so this needs to be initially checked and potentially monitored moving forward based on the patient. Pros are that it is less habit forming than some other sleep aids like Ambien. Another pro is that often it can help individuals fall asleep or stay asleep.

Q:Can you discuss how to improve sleep during menopause, with frequent hot flashes during the night? For women who cannot take hormones.

A: This is still an active field of research. Off label medication used for this from a sleep medicine perspective is Gabapentin at night. On the other hand, Ob-gyn often uses serotonin acting medications to help with hot flashes in general. The CBTI that I spoke about in my talk is usually felt to be the most helpful. Below is a nice article that summarizes some aspect of this topic:
https://womensmentalhealth.org/posts/managing-sleep-problems-in-menopausal-women-what-options-do-we-have/

Foundations of an Optimized Diet

Tue, 18 Jul 2023 17:37:38 GMT

What is the Mediterranean Diet and is it really so great for me?
Why should I care about potassium?
Am I getting enough protein?
We are delighted to welcome back Erin DeMille, formerly Erin Murray, to answer all these questions and more! Join us for our next webinar as Erin shares strategies for optimizing our diet to maximize heart health.

Erin's website: https://erindemillewellness.com/

Email: erin@erinmurraywellness.com

LinkedIn: https://www.linkedin.com/in/erin-murray

A New Era for Diabetes and Weight Loss Drugs

Thu, 13 Jul 2023 13:49:37 GMT

Source: GoodRx, American Diabetes Association

A New Era for Diabetes and Weight Loss Drugs

For patients seeking new solutions to managing type 2 diabetes and obesity, the introduction of a class of drugs called GLP-1 receptor agonists (RA) has simultaneously inspired hope and excitement along with misuse and confusion. We developed the following Q&A to go beyond the headlines and explore how Ozempic and similar drugs work, who may benefit most from them, and why they may ultimately represent a true breakthrough in the way these chronic conditions are classified, considered and treated.

What defines type 2 diabetes?

More than 37 million Americans have type 2 diabetes, a chronic disease that affects the ability of the body to regulate glucose (blood sugar) levels. This leads to an increase of glucose over time which significantly increases the risk for complications to vital organs such as the heart, kidneys, eyes and nerves. Diagnosis is made when testing shows: fasting glucose of 126 mg/dl or higher; or non-fasting glucose of 200 mg/dl or higher; or A1C (average of glucose over the past 3 months) of 6.5% or higher.

How was type 2 diabetes previously treated?

Approved by the FDA in 1994, Metformin is well established as the first line therapy for management of type 2 diabetes if lifestyle changes (low-carbohydrate diet, weight loss and exercise activity) are not enough to bring blood sugar levels down near the normal range. Metformin works by decreasing the amount of blood sugar produced by the liver in a fasting state, decreasing the absorption of food through the intestines, and restoring the body’s response to insulin.

What is different about the GLP-1 RA drugs?

Among the major benefits this class of drugs brings to patients with type 2 diabetes is lowering their risk for heart disease and stroke, and providing a significant boost to weight loss, in addition to helping reduce glucose levels to a near-normal range. As a result of the positive outcome reported in trials, the American Diabetes Association changed its longstanding guidelines for first-line treatment of type 2 diabetes to include recommendations for GLP-1 RA drugs in patients at high risk for cardiovascular disease or with risk factors such as high blood pressure, high cholesterol, or chronic kidney disease.

How do GLP-1 RA drugs work?

Known as incretin mimetics, this class of drugs mimics the effect of a hormone, glucagon-like peptide-1, or GLP-1, which is normally produced naturally to stimulate the release of insulin secretion after eating a meal. Receptors to GLP-1 are found in the pancreas, the brain and elsewhere in the body. The drug enhances these receptors, which help the pancreas release more insulin and help reduce blood sugar levels without raising the risk for hypoglycemia (too- low blood sugar levels). By limiting the amount of sugar the liver releases into the bloodstream in a fasting state, and slowing down how long food stays in the stomach, the drug promotes a feeling of satiety, leading people to be satisfied with eating smaller portions. In addition, some patients have reported a marked decrease in cravings for carbohydrate-rich and fatty foods.

What are GLP-1 RA drugs intended to treat – diabetes, obesity, or both?

Under certain names, GLP-1 RA drugs are FDA-approved only for treatment of type 2 diabetes while offering added benefits of weight loss and cardiovascular protection; under other names, the drugs are indicated only for weight loss, but not for treatment of diabetes. While the ingredients can be identical, the difference is in dosage amounts and whether the trials focused on the drug’s impact on blood sugar or weight changes. For example, semaglutide, a GLP-1 drug, is approved to treat diabetes under the name Ozempic; a higher-dose version of semaglutide, Wegovy, is only FDA approved for weight loss. The same is true for liragutide, approved for type 2 diabetes as Victoza, and for weight loss as Saxenda.

Are there side effects?

Most side effects for these types on drugs are gastrointestinal, including nausea, diarrhea or constipation, abdominal pain.

How effective are GLP-1 RA drugs like Saxenda and Wegovy for weight loss?

Trials to date have shown excellent results, with patients able to lose between 5 to 20% of their total body weight. However, these drugs are not meant for people wanting to lose 10 or 15 pounds. They are indicated for those who are obese, as measured by a body mass index (BMI) of 30 or higher; or for people with a BMI of 27 or greater with at least one weight-related

coexisting condition such as high blood pressure, elevated cholesterol levels. It’s important to note that obesity is a chronic disease, and these drugs may be needed as a long-term treatment to help lose pounds and maintain weight loss, along with lifestyle changes that include a healthy diet and 150 minutes a week of moderate-intensity aerobic and muscle-strengthening activities.

How do SGLT2 inhibitors fit into the mix of drugs for diabetes?

This is a newer class of drugs that lowers blood sugar levels by preventing the kidneys from reabsorbing glucose back into the bloodstream but instead releasing it through urine. Originally intended only for lowering blood sugar, later research data showed the drugs offered significant benefits for type 2 diabetes patients with coexisting conditions. Now some SGLT2 drugs- Invokana (canaglifozin), Farxiga (dapaglifozin), and Jardiance (empagliflozin) - have also been approved for use by non-diabetic patients with a history of chronic kidney disease or congestive heart failure.

Are other drugs in the wings?

Mounjaro, a GLP-1 RA drug that also promotes a second gut hormone (glucose-dependent insulinotropic polypeptide, or GIP) is currently approved for treatment of type 2 diabetes, and on a fast track approval by the FDA to be used as a weight loss medication.

How will I know which drug is right for me?

This is a decision best made on an individual basis with your physician, who will consider factors such as your overall health status, drug intolerances, risk factors for developing diabetes-related complications, benefits versus possible harm from side effects, and preferred formulation (oral or injection).

Drugs with Benefits: A Guide to GLP-1 RA Therapies

NOTE: Non-GLP-1 RA drugs used for weight loss are not listed here… Please consult with your healthcare provider regarding your best option.

Ticked Off: How to Recognize, Relieve and Resist Lyme Disease

Thu, 13 Jul 2023 13:49:35 GMT

Source: NIH, National Geographic

Ticked Off: How to Recognize, Relieve and Resist Lyme Disease

Summertime is prime time for ticks, which are becoming more prevalent each year. A combination of changing land use and warmer winters has greatly expanded the ticks’ habitat and they’re now found in more than half of U.S. counties. As a result, tick-borne Lyme disease has doubled over the last two decades to nearly 500,000 cases annually, earning it the

unfortunate distinction of being the most common vector-borne illness in the Northern hemisphere. Read on for details on how to protect yourself this season, and in the summers to come.

Identifying Lyme

In its acute phase (one to two weeks after the bite), Lyme can cause fevers and chills, joint

pain, headache, muscle aches and is frequently accompanied by a salmon-colored rash at the site of the tick bite. It may have a “bulls-eye” appearance, often considered a sign of infection, but the rash can manifest differently, or not at all. Diagnosis is based on symptoms, physical findings (e.g., rash), the possibility of exposure to infected ticks, and antibody tests. A high

number of false negative tests occur in the early phase, however, because it takes time for the immune system to respond to the infection and create antibodies. As the infection progresses, virtually everyone with Lyme disease has a positive test result.

Treating early, late and long Lyme

Most people recover from Lyme disease rapidly and completely if diagnosed early and treated with a short course of oral antibiotics. More serious symptoms, including joint pain and

swelling, nerve problems and neurological issues, may develop if Lyme disease is left untreated. Known as late Lyme disease, it can occur months to years after a tick bite, and requires a longer course of antibiotics, administered intravenously. Post-Treatment Lyme disease, sometimes called chronic or long Lyme disease, is experienced by 5% to 15% of

patients who have lingering symptoms such as headache, fatigue, joint pain and “brain fog.” While the condition is not yet well understood, experts have found additional antibiotic treatments are not usually helpful, and the symptoms gradually resolve over time.

Preventing Lyme

The best way to avert the complications of Lyme disease is to vigilantly avoid ticks. These tips can help you prevent Lyme disease:

Wear shoes, long pants tucked into socks, a long-sleeved shirt, hat and gloves in wooded or grassy areas.
Stick to trails, stay clear of low bushes and long grass.
Use insect repellants such as DEET, picardin, permethrin (apply to clothing).
Do tick checks on your body after outside activities. Be sure to check your dogs for ticks too!
Remove any ticks promptly with clean, fine-tipped tweezers. Be reassured that just finding a tick on your skin doesn’t mean you’ll get Lyme disease; a tick needs to be attached for at least 48 hours before it can transmit the bacteria.
Look for advanced protection in the next few years from two well-known names in vaccines – Pfizer and Moderna. An earlier vaccine, LYMERix, was discontinued in 2002 due to lack of interest at a time of lower Lyme disease cases, as well as concerns over side effects. Pfizer’s VLA15 is intended to block the bacteria from leaving the tick. Moderna is applying mRNA technology used in its COVID vaccine to target the Borrelia bacteria species at the root of most U.S. Lyme disease cases. Also of note is
MassBiologics’ shot that delivers a single, human anti-Lyme antibody directly to a person to provide immediate immunity…now in trials.

QUICK BITES: Fast Facts About Lyme Disease

Most Lyme disease infections in the U.S. occur May through September.
Cases of Lyme disease are most commonly seen in the northeast and mid-Atlantic states (from Maine to Virginia), the Midwest (Minnesota, Wisconsin, and Michigan), and the West Coast (California).
The disease was first recognized in Old Lyme, Connecticut in 1975 when a cluster of children developed unexplained, rheumatoid arthritis-like symptoms. Not until the next decade was the cause discovered: the spiral bacteria Borrelia burdorferi in deer ticks prevalent in the forests near where the infections occurred. Testing confirmed the Lyme disease bacterium was passed to humans via the bite of a deer tick.

Staying Hydrated This Summer: Water Infused with Fruits, Vegetables, and Herbs

Thu, 13 Jul 2023 13:49:33 GMT

Source: Have a Plant, Kathryn Long, RDN, LDN

Author: Kathryn Long

Staying Hydrated This Summer:

Water Infused with Fruits, Vegetables, and Herbs

Stay hydrated and energized this summer by refreshing yourself with generous amounts of water, nature’s best elixir. Inspire yourself to keep reaching for another sip by infusing water with fresh fruits, vegetables and herbs…no sugar or artificial flavoring needed. Have a Plant shares how:

Wash all produce and herbs before slicing and dicing.
Start with a large glass bottle or jar with a lid, add your desired ingredients and fill with cold or room temperature water.
Refrigerate for at least one hour. For a more intense flavor, refrigerate overnight. Some fruits and herbs will infuse more quickly than others. The longer it soaks, the more the flavors are released into the water.
Foster even more concentrated flavor by muddling – the process of mashing ingredients to draw out essential oils in herbs, rinds and fruits.
Extract multiple uses from the ingredients by adding more water and letting it infuse again. Make sure to drink within one day.
Experiment with sparkling, seltzer or unsweetened coconut water as the base.

Try making infused water ice cubes for your beverages with this simple technique: Half fill each section of an ice cube tray with water; add small pieces or slices of desired fruits, vegetables to each section; fill remaining space with water and freeze.

What Is the Always Hungry Solution Plan?

Tue, 11 Jul 2023 14:55:06 GMT

Source: The Always Hungry Solution Plan | U.S. News (usnews.com)

Published: July 7th, 2023

Author: Vanessa Caceres

This article is based on reporting that features expert sources.

What Is the Always Hungry Solution Plan?

Based on the 2016 book "Always Hungry" written by Dr. David Ludwig, an endocrinologist at Boston Children’s Hospital , the Always Hungry Solution plan is an approach to eating that focuses on eating high-quality proteins , healthy fats and fewer processed carbs. Calorie counting isn’t part of the Always Hungry Solution plan. Instead, you eat until you feel full.

The concept is that, by focusing on high-quality food choices and filling up more on protein and fats instead of highly processed carbs, you'll feel fuller, longer. When you feel full, you'll eat less. You also reset the body to lose weight and give it the right fuel for better health.

“Although many people come to (the Always Hungry Solution plan) for weight loss , our not-so-secret agenda is improving metabolic health, reducing risk for chronic diseases like diabetes and enhancing well-being. We consider weight loss a pleasant side effect,” says Ludwig, who also serves as professor of pediatrics at Harvard Medical School and professor of nutrition at Harvard School of Public Health in Boston.

Why Conventional Weight Loss Diets May Not Work

Ludwig says the conventional approach to weight loss focuses on overeating as the cause of obesity and a low-calorie diet as the solution for it. Yet, after a short time, you might feel tired from following a low-calorie diet . As willpower goes down, you risk giving up on your diet and eating more, leading you to maintain your pre-diet weight or put on even more weight.

“Our approach can seem a bit of a shock at first,” Ludwig says, referring to the lack of calorie counting.

What Causes Weight Gain, According to Ludwig

In “Always Hungry?”, Ludwig says that overeating isn’t what causes us to gain weight or become obese. Instead, it's the process of eating too many low-quality carbs that can lead to weight gain.

By eating too many low-quality carbs – like pastries, white bread, pasta and potato chips – it interrupts the body's normal release of insulin , a hormone that controls blood sugar and leads fat cells to store more calories. This is also called the carbohydrate-insulin model.

To help get out of the weight-gain rut and improve health, the Always Hungry Solution plan focuses on:

Ignoring calories.
Eating until you feel satisfied.
Choosing proteins, healthy fats and quality carbohydrates as primary nutrition sources.
Following a meal plan that helps lower insulin and support metabolism to keep the body from storing too many calories, which can make weight loss tougher to achieve.

By doing these things, it becomes easier for the body to lose weight, Ludwig says.

How Does It Work?

The Always Hungry Solution plan has three phases. In Phase 1, the goal is to focus on lower carb intake and moderate protein intake. The mix: 25% carbs, 25% protein and 50% fat. Phase 1 takes about two weeks and helps to lower insulin without more extreme restriction, such as that associated with low-carb or keto diets, Ludwig says. Phase 1 lowers insulin by restricting sugar and carbs that can spike insulin levels.

Foods that are part of Phase 1 include:

Legumes .
Greens and non-starchy vegetables .
Fruits, such as whole apples or oranges.
Proteins, such as eggs, meat and Greek yogurt.
Dairy, like milk and cheese.
Healthy-fat foods like nut butters, olive oil and avocado.

Phases 2 and 3 involve adding quality carbs and fine-tuning the diet. These phases of the diet emphasize:

A limited number of grains , like oats, quinoa, rice and wheat.
Legumes.
Vegetables .
Fruits, but limiting tropical fruits and dried fruits in Phase 2 because they’re higher in sugar, which can cause a spike in insulin.
High-protein foods .
Dairy.
Healthy high-fat foods.

A limited amount of sugar and high-carb sweets and snack foods are allowed by Phase 3, with some specific guidance given for each phase. There's more guidance within the book, on Ludwig's website and in the following document that outlines foods by each phase of the Always Hungry Solution plan.

Over time, you'll fine-tune the Always Hungry Solution plan to meet your metabolic needs and personal preferences, Ludwig says.

Some meal examples that are part of Always Hungry Solution plan include:

Chicken salad with grapes and walnuts.
Pesto baked fish.
Bacon cheddar quiche.
Spinach feta quiche.
Moroccan lamb stew.
Red lentil soup.
Beef stroganoff salad.
Yogurt parfait.

The book contains recipes and meal prep tips, planning and grocery lists to help people get started.

The diet plan also addresses getting quality sleep , doing physical activities that you enjoy and finding ways to reduce stress. All of these can help improve metabolic health and make weight loss easier.

Can I Lose Weight With the Always Hungry Solution Plan?

You might lose weight with the Always Hungry Solution plan. In a 6-week national pilot study with 237 participants, people lost weight at a rate of ½ pound to 2 pounds a week. In addition to weight loss, the participants had:

More satisfaction with food.
Lowered hunger.
More energy.
Feeling full for a longer time period after eating.

However, Ludwig acknowledges this study was not formal scientific research and that a greater investment into nutrition research from the government is needed to support definitive, long-term trials.

Pros and Cons of the Always Hungry Solution Plan

Here are some potential pros of the Always Hungry Solution plan as shared by Roxana Ehsani, a Miami-based registered dietitian nutritionist and a board-certified specialist in sports dietetics; and Mary Sabat, a nutritionist and ACE certified trainer in Milton, Georgia:

Pros

Certain advantages of the Always Hungry Solution plan include:

Emphasizes whole foods over supplements and processed foods. The main staples include fruits, vegetables, whole grains, proteins and healthy fats.
Encourages mindfulness and checking in with how certain foods make you feel.
No calorie counting or restrictive eating, which can be hard to do long term and may lead to unhealthy eating behaviors.
Reduces processed carbs and increases healthy fats.
Emphasizes getting a good night’s sleep , which can help with weight loss and insulin regulation.

Cons

On the other hand, the diet always has its disadvantages, such as:

Requires a good deal of food prep . Sabat recommends choosing simple dishes to make and repeating them or using leftovers throughout the week rather than having to make many different dishes.
Could become pricey with the number of animal proteins on the menu, including eggs.
May be hard for a vegan or vegetarian to follow due to the number of animal proteins. However, the diet does suggest alternatives to these.
Doesn’t restrict foods that are high in saturated fats , such as animal proteins and full-fat dairy. A diet high in saturated fat can increase your “bad” cholesterol levels and your risk for heart disease and stroke.
Could be hard to follow for someone who travels frequently or isn’t used to preparing a lot of food for themselves.

How to Save Money Following the Always Hungry Solution Plan

With most of us being cost-conscious nowadays, it helps to have a few tips on how to save money if you’re going to try a diet approach like the Always Hungry Solution plan. Here are a few suggestions:

Purchase frozen fruits and vegetables instead of fresh . These usually cost less and will have the same nutritional value.
Look for sales on kitchen staples like oils, nuts, seeds and canned fish.
Buy store-brand products instead of brand-name ones.
Purchase items like whole grains, beans, lentils and seeds in bulk.
Focus on seasonal and local produce, which is often cheaper than imported varieties.

Those who try the Always Hungry Solution plan may find that they have an initial investment in stocking up their kitchen and buying basic cookware if they aren’t accustomed to cooking. Yet that is offset by not having to buy special products or supplements associated with some diet plans or overspending on take-out meals, Ludwig says.

Who Should Not Try the Always Hungry Solution Plan?

If you have any special medical conditions, speak with a health care provider before starting the Always Hungry Solution plan, Ludwig recommends.

Both Ehsani and Sabat say that if you have an eating disorder, the Always Hungry Solution plan should be avoided due to the number of rules associated with it. For someone with a binge eating disorder , it may be easy to overdo portions and gain weight instead of losing it, Sabat says.

Getting Started With the Always Hungry Solution Plan

If you want to get started with the Always Hungry Solution plan, follow these suggestions:

Connect with others following the approach via the Facebook group for the Always Hungry Solution plan. You can share ideas, advice and support.
Realize the Always Hungry Solution plan may be hard to follow at first if you’re used to calorie counting and fat restriction.
Prepare as many meals or meal-prep tasks in advance so you aren’t overwhelmed by meal prep every day.
Reduce meal prep time by choosing simple recipes and doubling them for a future meal, Sabat advises.
Don’t confuse the sauces and higher-fat meals in restaurants as substitutes for cooking at home, as these are not quality controlled, and eating poor-quality foods will cause inflammation and weight gain, Sabat says.

A Final Word

Losing weight and eating healthier can be a challenge for anyone. While following a specific diet approach helps some people, keep in mind that you want to find something that can sustain you and improve your health in the long term.

If you’d like to lose weight or improve your nutrition, Ehsani advises speaking with a r egistered dietitian nutritionist who can help you find an eating regimen that best fits your needs and considers your medical history, food preferences, dietary restrictions and budget.

SOURCES The U.S. News Health team delivers accurate information about health, nutrition and fitness, as well as in-depth medical condition guides. All of our stories rely on multiple, independent sources and experts in the field, such as medical doctors and licensed nutritionists. To learn more about how we keep our content accurate and trustworthy, read our editorial guidelines .

Roxana Ehsani MS, RD, CSSD, LDN

Ehsani is a board-certified dietitian and national media spokesperson for the Academy of Nutrition and Dietetics. She is based in Miami, Florida.

David Ludwig, MD, PhD

Mary Sabat, MS, RDN, LD

Sabat is an ACE-certified personal trainer, nutritionist and owner of BodyDesigns in Alpharetta, Georgia.

The Emotional Heart: How What You Feel Impacts Heart Health

Tue, 11 Jul 2023 14:50:02 GMT

Source: The Emotional Heart: Feelings Matter | Food Revolution Network

Published: February 22, 2023

Author: Ocean Robbins

SUMMARY

Science has discovered that the heart is so much more than a mechanical pump. It has its own brain and a nervous system, and constantly changes what it’s doing based on its perception of your internal state. It turns out that love doesn’t just feel good — it can actually protect your heart from damage and disease, too.

EDITOR'S NOTE:

The following article includes quotes from cardiologist Dr. Mimi Guarneri that were pulled directly from the Healthy Heart Masterclass and Course she produced with FRN. For more information, sign up for the free Masterclass .

An exhaustive Google search confirmed what I had long suspected: There are no popular songs about livers or kidneys. Celine Dion never penned the immortal lyric, “My gallbladder will go on.” The Bee Gees and Al Green chose not to wonder, “How can you mend a broken appendix?” And Neil Young didn’t lament about his search for a spleen of gold.

When it comes to love songs, it’s the heart, the whole heart, and nothing but the heart. (I said love, not lust.)

So why is that? What’s the link between the bright red emoji and the complicated four-chambered organ in the middle of your chest? Why have millennia of poets and musicians from around the globe associated that little blood pump with intense feelings of connection and desire?

Could there be actual scientific truth, and cardiovascular significance, to the metaphors?

From Physical to Emotional Hearts

This viewpoint of the heart as a purely physical organ has determined the shape of modern cardiology. Medical professionals measure heart health via blood pressure , cholesterol and triglycerides, and heart rhythm via EKGs. And when there are problems, they’re described and treated in material terms via medications and physical interventions like surgeries.

I’m not saying there’s no merit to this approach. On the contrary, modern cardiac medicine saves lives on a daily basis. Improvements in cardiac care, including new drugs and innovations in heart implant technology , have lowered the mortality rate from heart disease in the industrialized world — saving millions of lives.

At the same time, modern science is rediscovering what many traditional cultures have known since time immemorial: that the heart is much more than a physical pump. While we know that lifestyle, especially diet , has a major impact on the physical aspects of heart health, there’s another factor related to heart health that’s not talked about as often as it deserves to be: your emotions.

However, in 2004, researchers conducted the first large-scale trial looking at emotions and the heart. The INTERHEART study enrolled over 25,000 participants in 52 countries and clearly identified several emotional stressors as key risk factors for heart disease. And continuing research is filling in the picture, as well as creating protocols for healing “broken hearts” on both the emotional and physical levels.

In this article, we’re going to look at the emotional side of the heart, how your feelings (both pleasant and unpleasant) can impact your heart, and how to take care of your emotional heart.

Can Your Heart Think or Feel?

For a long time, Western science assumed that the brain was the only part of the body that “thinks.” All the other organs and systems were, in this view, mindless automata just carrying out instructions from the brain. This theory was turned on its head by the discovery that the gut also has something of a “brain,” in the form of what’s known as the enteric nervous system .

And more recently, researchers are coming to recognize another kind of “brain” within the heart as well — a discovery that helped spawn the field of neurocardiology .

Wait a second, though. What does it mean to say there’s a “brain” in the gut or the heart? Are we literally talking about a cauliflower-shaped lump of gray squishy stuff in there?

No, “brain” here is a metaphor, referring to particular functions: the ability to sense the environment, make decisions based on that information, and communicate those decisions throughout the body. And by those criteria, the heart does indeed have a brain, which trades information back and forth with the head brain.

The Heart’s “Little Brain”

Renowned cardiologist and FRN’s Healthy Heart Course partner, Dr. Mimi Guarneri, calls it the body’s “ little brain ,” since it has, in her words, “its own intelligence, emotions, nervous system, and decision-making power.”

We now know that the heart includes the hardware to run all this brain-like software. In fact, the heart has its own nervous system, called the intrinsic cardiac nervous system (ICNS). The ICNS can manufacture and secrete hormones and operates similarly to the brain’s nervous system via an intricate network of nerve clusters, neurotransmitters, proteins, and other cells.

All this circuitry enables the heart to act independently of the brain. The heart can feel and sense your internal world (and aspects of the external world) directly and can learn, store memories, and make decisions. And what the heart feels turns out to have a direct impact on how well it functions and how long it lasts.

In short, as Dr. Guarneri puts it, your heart is a “mental, emotional, and spiritual organ with many complex connections that go well beyond pumping blood.”

How Pleasant Feelings Impact the Heart

In healing traditions throughout the world, the heart is seen as the emotional center of the body. In Indian Ayurvedic texts as well as Greek and Roman literature, the emotion most closely associated with the heart is love. In Traditional Chinese Medicine, it’s joy.

Many people report feeling the sensations of love, caring, and joy emanating from the heart or chest area. And it’s not just cultural mythology; the heart actually is a sensory organ, capable of feelings. In fact, one of the hormones that the heart manufactures is oxytocin , the so-called “cuddle” or “love” hormone that activates when we feel close to another person, a companion animal, or something greater than ourselves.

Pleasant emotions make you feel good, which is reason enough to want to feel them on a regular basis. But here’s another reason: they also provide protection for your heart.

Loving Touch

Love is a potent cardioprotective emotion. Hugging and other forms of loving touch can lower blood pressure and heart rate. Oxytocin triggers vasodilation or the widening of the arteries. When that happens, more blood can flow through the arteries, lowering blood pressure and reducing the risk of heart attacks and strokes.

Laughter and Heart Health

Laughter also puts a smile on your heart as well as your face. The act of laughing releases chemicals called beta-endorphins, part of that feel-good family of endorphins. These beta-endorphins coax receptors on the vascular endothelium to release nitric oxide, a molecule that protects the cardiovascular system in many ways. When you laugh on a regular basis, you’re at lower risk of heart attack and stroke than your more dour counterparts. And laughter reduces stiffness and damage to blood vessels as you age.

Gratitude and Heart Health

Gratitude also helps your heart function at its healthiest. In Dr. Guarneri’s words:

“An attitude of gratitude is not just a mental tool, it can also be good for your physical health — especially your heart… Research has shown that individuals who practice gratitude are healthier, exercise more, have fewer physical ailments, and feel better overall . Clinical trials have proven that ritual gratitude can even lower your blood pressure and increase your immune function — having dramatic, and lasting effects on your health.”

Gratitude can begin to heal your heart even after significant damage. A 2016 study looked at the benefits of keeping a gratitude journal for older patients (average age was mid-60s) with Stage B heart failure. The participants who journaled regularly for eight weeks saw their inflammatory biomarkers go down significantly compared to non-journaling controls. While journaling, their heart rate variability (HRV) improved as well.

And in other studies , regular expressions of gratitude and optimism have been correlated with both lower heart rate and blood pressure.

An Aside on Heart Rate Variability

Neurocardiac researchers are extremely interested in HRV , as it appears to be an extremely important biomarker for overall health and cardiovascular health, in particular. Physicians used to believe that a normal heart rhythm was a steady, even beat, like a metronome.

But we now know that there’s a difference in interval length between beats depending on whether the person is inhaling or exhaling. And the bigger the difference (and the smoother the “sine wave” of the variance), the healthier the individual and the more resilient to stressors. Since the opposing branches of the autonomic nervous system, the excitatory sympathetic and the calming parasympathetic, work in tandem to create the heart rate variations between beats, a smooth and large HRV is believed to represent a healthy dynamic balance between the two.

How Unpleasant Feelings Impact the Heart

While agreeable emotions like love, gratitude, and hopefulness can protect the heart, unpleasant emotions can have the opposite effect. Four well-studied (and for most of us, very familiar) “negative” emotions include depression, grief, stress, and anger. Let’s take a look at each of these now — and then we’ll look at what can help you (and your heart) feel better.

Depression and Heart Disease

Someone with depression now is at increased risk of heart disease in the future. (And the relationship goes in both directions, as many cardiac patients develop depression in response to their diagnosis.)

In Dr. Guarneri’s words:

“While about one in twenty American adults experience major depression in a given year, that number jumps to about one in three for people who have survived a heart attack. And, the risk of having a heart attack is four times greater in people with heart disease who also suffer from depression when compared to those who are not depressed.”

The American Heart Association reported in a 2015 scientific statement that even teens with depressive disorder were at greater subsequent risk for heart disease. While the exact mechanisms aren’t yet known, one promising theory links depression to heart disease via lower HRV. That’s because, the theory goes, depression disturbs the balance between the sympathetic and parasympathetic nervous systems.

That could explain why coexisting anxiety can also increase cardiac risk; anxiety represents a constant drain on the autonomic nervous system, which can further depress HRV.

Grief’s Impact on the Heart

When people say they have a “broken heart,” they aren’t just speaking in metaphor. It turns out the phrase has a sound physiological basis. Grief — an intense emotional response to loss — can damage the heart and leave it vulnerable to acute and chronic injury.

Takotsubo cardiomyopathy , also called broken heart syndrome, can cause heart attacks without the presence of an arterial blockage. The disease gets its name from the shape the affected heart takes, which resembles Japanese ceramic vases used as pots to catch octopi (“tako tsubo”).

A person who has recently lost a spouse is at a significantly elevated risk of developing and dying from heart disease. While part of this may be due to changes in lifestyle (eating poorly or not getting out as much, for example), there are also direct biochemical pathways.

Bereavement can lead to elevated catecholamines , which are stress hormones, and higher blood pressure. Both of these are effects of great sympathetic nervous system activity.

But it’s not just the loss of a spouse that can trigger such heartrending grief. Those who lose a parent or a child also face an increased risk of a cardiac event.

Stress and the Heart

Psychosocial stress (a fancy way of saying that there’s a gap between the demands of your life and your capacity to meet those demands) may be as bad for your heart as an unhealthy diet or even smoking, according to recent research .

And while eating poorly or smoking may be within an individual’s control, the “social” in psychosocial indicates that external stressors may be difficult or impossible to avoid or mitigate. Things like job stress, racism , poverty , and chronic stress conditions like PTSD are all associated with a higher risk of hypertension.

While stress can damage the cardiovascular system at any age, it’s most strongly associated with early onset (prior to age 50) cardiovascular disease (CVD). Think of an engine that’s constantly revving too fast and too hot. The sustained sympathetic nervous system activity characterized by chronic stress has been shown to do a number on the cardiovascular system.

Mechanisms of damage include arrhythmias, platelet aggregation, acute coronary syndromes, and heart failure.

Anger and Heart Health

If depression is about shutting down, then anger is about lashing out. Those prone to angry outbursts have been found to be at greater risk of CVD, stroke, and heart failure.

In Dr. Guarneri’s words:

“Emerging research on how anger can affect your body is quite disturbing: being angry can increase your risk of a heart attack by as much as 230% ! Stress and anger can trigger more than 1,400 chemical reactions in your body. These oftentimes lead to measurable physical changes in your cardiovascular system.”

Anger doesn’t occur in a vacuum but rather in an existing environment, and it may be the case that the more stressful that environment, the more corrosive the effects of an individual’s anger on their heart health. One study found a positive association between anger expression and the risk of CVD among urban residents but not rural residents. Researchers hypothesized that the more stressful city atmosphere enhanced the association between anger and CVD.

Another study found anger may contribute to the development of specific cardiovascular diseases and CVD mortality, especially heart failure in men and in those with diabetes.

How to Take Care of Your Emotional Heart

Just as depression, grief, stress, and anger can have a negative impact on your heart health, it turns out that cultivating positive and pleasant emotions can protect and even heal your heart.

Experience Love

Social connection and love are powerful antidotes to loneliness, which, as we’ve seen, can lead to the development of CVD. Spending time with loved ones, even over the phone or via video call, can stimulate the production of oxytocin and other pro-social and heart-friendly neurotransmitters.

Socializing at any age provides long-term health benefits to your heart. A fascinating 2018 study found that teen boys whose parents reported them spending more time with friends grew — 20 years later! — into men with lower blood pressure and healthier body mass index — both of which are predictors of heart health.

An action step here is to work on increasing the expression and experience of love in your life. The more quality time you spend with friends and loved ones, the greater your production of oxytocin.

Cultivate Inner Peace

Inner peace is an antidote to rampant and overwhelming stress, and can also moderate your angry responses. Activities like yoga, prayer, meditation, and other spiritual or contemplative practices have all been shown to improve biomarkers of cardiovascular risk.

Mindfulness helps you practice nonjudgmental awareness of your feelings and surroundings, which gives you the space to choose your response rather than just reacting with emotions and expressions that can compound your stress.

And tai chi, a gentle martial art based on principles of Traditional Chinese Medicine, has been shown to help suppress inflammation and lift depression.

Relaxing lifestyle activities can all improve your parasympathetic tone, strengthening your ability to maintain a healthy blood pressure and heart rate in the face of life’s inevitable stressors.

Editor’s Note:

HeartMath is a world leader in the science of improving heart rate variability for increased health and happiness. Their work is backed up by more than 400 independent peer-reviewed studies. The HeartMath Experience is a 90-minute video program that shares 5 of their top techniques to regulate emotions and activate the power and intelligence of the heart. Join in for free, here .

Cultivate Positivity

When it comes to heart health, thinking positively can become a self-fulfilling prophecy. A 2019 meta-analysis of studies of almost 230,000 people found that those who were more optimistic had a lower risk of CVD.

Positive well-being, which refers to having positive feelings and a sense of optimism, is also associated with less mental stress and more resilience. Making an effort to experience positive emotions daily can counteract the influence of negative emotions on systolic blood pressure.

I’m not suggesting that you try to banish all unpleasant emotions or aggressively recite positive affirmations every time you feel sad or angry or afraid. These so-called “negative” emotions can serve a valuable purpose. Grief when confronted with loss is totally natural, and not something that I’d recommend you try to bypass or “get over” just to lower your blood pressure.

Instead, I’m talking about seeking balance. The world that most of us live in doesn’t actively afford us multiple daily opportunities to relax, slow down enough to appreciate our lives, or connect with friends, neighbors, and loved ones. That means we need to be deliberate and proactive about making sure we build these heart-healthy — and life-affirming — practices into our days.

Curious about gratitude? Discover the neuroscience of gratitude, and specific practices that have been proven to improve health as well as happiness .

What You Feel Impacts Your Heart

The heart is not just a physical organ. It’s also an emotional one with its own nervous system. What you feel can have a direct impact on the health of your heart. When you cultivate more love, peace, and gratitude, things don’t just feel better. They also support your health, which makes them get better, too.

And here’s a really cool resource:

FRN teamed up with the prominent cardiologist and author, Dr. Mimi Guarneri, to create the hugely popular Healthy Heart Masterclass. If you want to find out more about how your heart works, and about some simple practices you can use to cultivate better cardiovascular health and a more satisfying life, you can join the Masterclass for free .

Tell us in the comments:

Have you ever experienced the effects of emotions — pleasant or unpleasant — on your health?
What are your favorite strategies and practices for cultivating positive emotions?
What’s one thing you could build into your day that would afford you greater joy and resilience?

Strength and Stability Assessment

Mon, 26 Jun 2023 20:45:10 GMT

Are you or a loved one at increased risk for falls or fractures? How can you maintain your independence and functionality as you age? Join us for our next webinar as we explore these topics.

Intuitively, we know that both strength and stability are important when it comes to health and longevity. In older adults, conditions such as osteoporosis, sarcopenia (loss of muscle mass), and decreased strength are significant risk factors for falls and fractures, cardiovascular disease, and overall mortality.

Many studies have shown that regular strength training at appropriate levels of intensity, carried out in a supervised manner, can significantly improve markers of health, including bone mineral density. We will discuss the importance of obtaining an accurate, reliable, and actionable baseline of strength and stability to serve as an objective baseline, and the best strategies to prevent bone and muscle loss with age.

Website: www.Divergenceptandwellness.com

Instagram: @divergenceptandwellness

3 SIMPLE SWAPS FOR HEART HEALTH: Busy people may find it hard to take heart-healthy steps. These simple swaps can help.

Fri, 16 Jun 2023 14:01:25 GMT

Source: 3 simple swaps for better heart health - Harvard Health

Date: September 26th. 2022

Busy days make it hard to put heart health on the front burner. It just feels like you don't have time for habits that keep the ticker in top shape — like exercising regularly, getting enough sleep , and eating a healthy diet. So maybe you take the stairs when you can, or you park farther away from a store to rack up a few extra steps each day. But what else can you do? Here are three things that might fit in your schedule.

Swap electronic communication for an in-person meeting

It's fine if texting, emailing, social media, or Zoom calls are your primary means of communicating with others. But it's not okay if those methods leave you feeling lonely or isolated — two problems linked to higher risks for heart disease, heart attack, or stroke , according to a scientific statement from the American Heart Association in the Journal of the American Heart Association.

To combat loneliness and isolation, try to replace some of your electronic back-and-forth with people with in-person meetings. Maybe you can find room in your schedule for a quick walk, cup of coffee, or brief lunch with a friend or colleague.

"Time spent face-to-face helps connect you to others and may make you feel less isolated," explains Matthew Lee, a sociologist and research associate at Harvard University's Human Flourishing Program. "Being physically co-present can help you feel more engaged with others, more valued, and more likely to feel a sense of shared identity — all things that may help ease loneliness. This is why some doctors are starting to engage in 'social prescribing,' including suggesting that people get involved in volunteering and other activities that build in-person social relationships."

A recent study published in the International Journal of Public Health by Lee and a team of Harvard-led researchers suggests that better social connectedness may reduce the risk of being diagnosed with depression or anxiety . Both are associated with heart disease or making existing heart conditions worse.

Swap an unhealthy breakfast for a healthier one

Is your typical breakfast something quick and full of refined (not whole) grains, processed meat, saturated fat, or added sugar? Eating that kind of food regularly may drive up calories, weight, blood sugar, or cholesterol levels — and that's not good for your heart.

Instead, chose breakfast foods rich in fiber, a type of carbohydrate that either passes through the body undigested (insoluble fiber) or dissolves into a gel (soluble fiber) that coats the gut.

Not only does fiber help digestion, it also

traps, mops up, and lowers bad [LDL] cholesterol that can lead to clogged arteries
controls blood sugar and lowers the risk for diabetes, which is strongly associated with heart attacks and strokes
may help fight chronic inflammation, which plays a role in clogging arteries and causing heart attacks.

Fruits, nuts, seeds, whole grains (oats, barley, quinoa) and many other foods are rich in fiber. Try these fiber-rich breakfast ideas:

microwaved oatmeal (heat a 1/2 cup of oatmeal with almost a cup of low-fat milk for about two minutes)
a serving of cooked quinoa (cold, if you have it in your fridge) with a dollop of nonfat Greek yogurt, berries, and granola
whole-grain cereal with milk (go for cereals with the highest amounts of whole grains and lowest amounts of added sugars)
a slice of whole-grain toast with two tablespoons of nut butter (like almond or peanut butter)
one or two handfuls of homemade trail mix (use your favorite unsalted nuts, sunflower seeds, and dried fruit such as raisins or apricots).

Swap a few minutes of scroll time for meditation time

If you ever take a break from your busy day to scroll through news on your phone or computer, chances are you can also find a little time to meditate, which is important for heart health. Research indicates that people who meditate have lower rates of high cholesterol, diabetes, high blood pressure, stroke, and coronary artery disease compared with people who don't meditate.

What's the connection? Meditating triggers the body's relaxation response, a well-studied physiological change that appears to help lower your blood pressure, heart rate, breathing rate, oxygen consumption, adrenaline levels, and levels of the stress hormone cortisol.

The great news: it doesn't take much time to reap the heart-healthy benefits of meditating — just about 10 to 20 minutes per day.

Ideas for quick ways to meditate in a busy day include sitting quietly, closing your eyes, and

focusing on your breathing, without judging sounds you hear or thoughts that pop into your head
listening to a guided meditation, which uses mental images to help you relax
listening to a recording of calming sounds such as waves, a bubbling brook, or gentle rain.

Just try to calm your brain for a few minutes a day. Soon, you may find you've become better at meditating and better at practicing other heart-healthy habits, no matter how busy you are.

Cardiorespiratory Fitness and Cardiopulmonary Testing (CPET) with Lown Staff

Tue, 09 May 2023 12:10:39 GMT

Please join your team at the Lown Group for a webinar focusing on exercise. We will begin by reviewing the benefits of exercise. Our team will then jump into how we measure your cardiorespiratory fitness, reviewing the details of stress testing and cardiopulmonary testing. Then we will then share some clinical cases and save time for Q&A. This will be packed with lots of great information for all our patients.

Talk Therapy Is Good For Your Heart Health, Study Finds

Mon, 08 May 2023 12:12:06 GMT

Published: 5/4/2023

Use the link here to view the original article: Talk Therapy Is Good for Your Heart Health, Study Finds

Fast Facts:

New study found that managing depression using talk therapy can reduce an individual’s risk of heart disease.[1]
Past research has shown that people with depression have a 72% greater chance of developing cardiovascular disease in their lifetime.
Experts point to exercise as another means of managing depression and heart health, in addition to therapy resources.

Managing depression could play a huge role in reducing the risk of cardiovascular disease, a new study found.1

Past research has shown that people with depression are up to 72% more at risk to develop cardiovascular disease in their lifetime. Depression also puts people at higher risk for other chronic diseases, such as diabetes .[2]

The new research, which was conducted by a team in the United Kingdom, people with depression who responded positively to a type of psychotherapy called talk therapy (including cognitive behavioral therapy), had reduced risk of heart disease and stroke.[1]

“That would suggest that the benefits of therapy may go beyond mental health and also benefit physical health,” Céline El Baou , research assistant, PhD candidate at University College London, and study leader told Health.

The study’s findings emphasize the importance of making therapy more accessible to everyone, she added.

Mental Health and Heart Disease

To measure the effect relief from depression had on peoples’ heart health, El Baou and her team used health records from nearly 637,000 adults who had completed one course of talk therapy between 2012 and 2019. The researchers followed up after 3 years to determine each patient’s risk of cardiovascular disease, coronary heart disease , stroke, and death from any cause.

The study authors did not measure other ways people may be reducing depression other than talk therapy, but they did adjust for some of the other risk factors that increase the risk of cardiovascular disease, including diabetes. The team found that people whose depression reliably improved were 12% less likely to have cardiovascular disease at any point in the future.[1]

The effect appeared to be stronger in people under age 60 compared to those 60 and over. Those under age 60 saw a 15% risk reduction in incidents of cardiovascular disease and a 22% decrease in risk of dying from any cause during the study time. That’s compared to a 6% and 15% decrease for people over age 60.

According to Ahmed Tawakol, MD , a cardiologist at Massachusetts General Hospital and associate professor of medicine at Harvard Medical School, depression may have an outsized impact on heart disease in younger people.

Because older people have multiple risk factors for heart disease, many different issues would need to be addressed to have a big impact on the overall risk for a cardiovascular event such as coronary artery disease or stroke

But younger people typically have fewer risk factors for heart disease. For some, depression may be the only one, meaning if they target that, they would have a bigger benefit than someone with multiple risk factors.

“It could be that people who are younger are deriving a bigger net risk from depression,” explained Dr. Tawakol, who was not involved in the new study.

The new findings add to a growing body of research showing that depression can have a particularly big effect on heart health in younger adults. A separate study published earlier this year included nearly 600,000 U.S. adults ages 18 to 49. About 20% had depression, and the researchers found that the more depressive days a person reported in a month, the more likely they were to develop cardiovascular disease.[3]

Compared to those who didn’t have any poor mental health days, people who had up to 13 poor mental health days in a month had almost 1.5 times greater risk for cardiovascular disease. Those with more than 13 days were more than twice as likely to develop cardiovascular disease.

How Depression Affects the Heart

The study authors had little information on lifestyle factors such as whether or not a person smoked, what they ate, and how often they exercised.

But while depression can make it harder for people to stick to certain lifestyle habits that promote heart health, such as not smoking, exercising, and eating a healthy diet, habits aren’t the only factor at play.

“Lifestyle choices are definitely linked with both heart and mental health, but they do not explain in themselves why certain people experience depression, heart problems, or both,” El Baou told Health, adding that if lifestyle factors are an issue, getting these on track could be a focus of therapy.

But there are also known biological connections between depression and heart disease.

“Independent of lifestyle aspects, depression also has physiological consequences that lead to diabetes, adiposity, and hypertension ,” Dr. Tawakol added. “It’s a dual pathway.”

He continued, adding, “When we used to think of it as simply only the result of lifestyle changes, we would mistakenly assume that if the patient could only improve their lifestyle, their cardiovascular risk would be improved.”

Depression actually changes the parts of the brain associated with stress and releases chemicals that ramp up inflammation, one of the main drivers of disease, including heart disease.[4]

Relieving depression, whether it be through therapy or other means, can quell this inflammation. And while not exercising enough because a person is depressed may not have as big of an effect on the link between mental health and heart disease as experts once thought, exercise is one proven way people can reduce depression—especially when therapy is not accessible.

In a study presented last year at the American College of Cardiology’s Annual Scientific Session, Dr. Tawakol and a team of researchers set out to determine how exercise, depression and anxiety, and cardiovascular disease were linked.[5]

After analyzing health records from more than 50,000 adults, they found that exercise had an outsized effect in improving cardiovascular health in people who have anxiety and depression compared to those who do not.

While the heart benefits people got from exercise plateaued after a certain amount of weekly exercise in people who did not have depression and anxiety, the benefit kept steadily increasing in people who did.

And according to Dr. Tawakol, it’s not just endorphins. “There is a change in the function of the brain,” he noted.

Exercise changes the wiring of the brain, creating more dendrites, or ‘branches,’ that facilitate complex communication. Since the brains of people who have depression are impacted by the condition, this stimulation may have an outsized effect that settles the sense of stress and depression in the brain. Exercise also curbs inflammation.

There are many ways to treat depression, therapy is just one. But what the new research highlights is the important link between mental and physical health.

Dr. Tawakol concluded, “This reminds us that you’re never too young to benefit substantially from treatment of depression.”

Sources:

[1] El Baou C, Desai R, Cooper C, et al. Psychological therapies for depression and cardiovascular risk: evidence from national healthcare records in England . Eur Heart J. Published online April 18, 2023. doi:10.1093/eurheartj/ehad188

[2] Herrera PA, Campos-Romero S, Szabo W, Martínez P, Guajardo V, Rojas G. Understanding the relationship between depression and chronic diseases such as diabetes and hypertension: a grounded theory study . Int J Environ Res Public Health. 2021;18(22):12130. doi:10.3390/ijerph182212130

[3] Kwapong YA, Boakye E, Khan SS, et al. Association of depression and poor mental health with cardiovascular disease and suboptimal cardiovascular health among young adults in the United States . J Am Heart Assoc. 2023;12(3):e028332. doi:10.1161/JAHA.122.028332

[4] Shao M, Lin X, Jiang D, et al. Depression and cardiovascular disease: shared molecular mechanisms and clinical implications . Psychiatry Res. 2020;285:112802. doi:10.1016/j.psychres.2020.112802

[5] Zureigat H, Abohashem S, Grewal S, et al. Cardiovascular benefit of exercise is greater in those with anxiety and depression . J Am Coll Cardiol. 2022;79(9 Suppl A):1436. doi:10.1016/S0735-1097(22)02427-5

Vision meets reality: Why concierge medicine offers an optimal environment for treating chronic disease

Mon, 24 Apr 2023 14:55:43 GMT

Source: Vision meets reality: Why concierge medicine offers an optimal environment for treating chronic disease (medicaleconomics.com)

As most physicians will attest, treating patients with chronic disease in a traditional fee-for-service practice model can be a challenging experience, leaving all involved frustrated and unsatisfied. The culprit as always is lack of time - unsurprising in an environment where providing patients with even a bare minimum of preventive, chronic disease and acute care would require an impossible 26.7 hour workday for primary care physicians.1

For concierge doctors, practicing in a model that completely reverses the traditional paradigm, the difference in care can be profound. From initial diagnosis, a concierge physician has time to listen, advise and shepherd patients through years of highly variable individual trajectories of disease flare-up and progression. We share some notable success stories from Specialdocs-affiliated concierge physicians below.

At Lown Cardiology Group , a Boston-based concierge medicine practice, Alyson Kelley-Hedegepeth, MD treats patients with afib, ischemic heart disease and congestive heart failure. As with many chronic conditions, ideal care begins with an in-depth evaluation to understand risk factors and root causes, and continues with frequent check-ins, direct contact between visits, and ongoing treatment and support.

“Once the diagnosis is made, patients need to recognize the condition is permanent and will never be resolved or go away,” she says. “However, the more we understand both the driving factors and address triggers for recurrence, the better opportunity we have to reverse symptoms and stabilize disease so that patients experience long periods of feeling great.”

Educating her patients on lifestyle changes that can greatly impact their disease course requires time and dedicated attention, according to Kelley-Hedgepeth. “Obesity, inactivity, sleep disorders, diabetes, alcohol consumption and unhealthy eating patterns are all modifiable factors that are key to managing conditions like afib,” she says, “but can’t even begin to be thoroughly discussed in a standard 15-minute visit. We can spend an hour or more – whatever is necessary to explore and effect real change.”

For example, a plan of lifestyle changes for a 77-year-old obese man who experienced afib symptoms daily proved highly effective. He lost weight by following a healthy diet, took short walks every day, started CPAP treatment for obstructive sleep apnea and eliminated regular alcohol consumption. “He is now feeling great and has not experienced any afib symptoms in months,” reports Kelley-Hedgepeth.

Preventive testing for patients at high risk of heart failure due to family history, hypertension, diabetes or coronary artery disease is another best practice at Lown Group. “Early intervention can have a significant impact on symptoms and progression,” she says.

For example, when a 52-year-old patient with mild heart dysfunction who had previously experienced a heart attack was treated with blood pressure and cholesterol medications and followed a tailored exercise routine that included daily walks, the results were outstanding. “He lost 20 pounds, considerably increased his exercise tolerance, and says he feels younger than he did 10 years ago!” exults Kelley-Hedgepeth.

Arguably the most compelling case for taking time to focus on preventive screening can be made for managing coronary artery disease, the number one cause of death worldwide. “We look for subclinical disease in asymptomatic patients to find this chronic condition before symptoms develop,” emphasizes Kelley-Hedgepeth. “When patients question why they need medication if they’re feeling fine, we explain that a combination of treating lifestyle factors and medications can significantly minimize their risk and enable them to live for years without a cardiac event.”

She describes a 74-year-old patient referred to Lown with an abnormal calcium score who benefited greatly from a candid discussion and personalized plan. “She was pre-diabetic and needed cholesterol-lowering treatment, but because she was an avid exerciser who eschewed medication, no one encouraged her to take it. By working with me and a nutritionist she has reversed her pre-diabetes, agreed to take cholesterol medication, and added muscle mass with an enhanced workout routine,” says Kelley-Hedgepeth. “Our goal is for her to pass away at an old age - with coronary disease - and not from it.”

Mayes DuBose, MD, a geriatric specialist who founded Carolina Concierge Care in 2019, routinely helps his elderly patients manage multiple chronic conditions, but there’s nothing routine about his approach. The care he provides is deeply empathetic and personal, built on rock-solid relationships with patients and families nurtured assiduously over years.

For example, the recent referral of a patient with lymphoma to an oncologist for a biopsy was just the beginning of a complex, time-intensive journey compassionately navigated by Dr. DuBose. Speed bumps were smoothed and detours avoided with lengthy phone calls and visits to help manage everything from alternate transportation arrangements to and from the procedure, evaluation of how the patient’s other chronic conditions including diabetes and hypotension would impact outcomes, and extensive discussion to overcome the patient’s reluctance to receive needed radiation treatment.

“If you deal with this kind of situation in a traditional practice, you either gloss over some essential parts or realize you’ll be hours behind,” says DuBose. “With concierge medicine, you don’t have to make that choice.”

He’s also thankful for the time to evaluate and counsel patients for mental health issues like depression, a condition that has become far more prevalent since the pandemic. “Most primary care physicians have at least some training in this, and the ability to counsel patients you know so intimately is invaluable,” he explains. “However, consultative counseling is poorly reimbursed, so a referral is often made to a psychologist or therapist as a way to better manage time, which is always in short supply with a traditionally-sized patient panel (1500 or more). Now I only make a mental health referral when it’s really needed, not because I didn’t have the time to handle it well.”

Advance care planning is another area where Dr. DuBose’s guidance is frequently sought, especially by patients in early stages of dementia or other illness that places them at higher risk of losing their decision-making ability. “These are conversations best had with both the patient and a close family member, and they shouldn’t be rushed to conform to a pre-determined time allotment,” he says.

A recent encounter provided fresh evidence of the genuine value of the smaller, more personalized practice model fundamental to concierge medicine. “My patient was exhibiting signs of dementia and wanted to make his family aware of his ultimate desire for a natural death,” relates DuBose. “Together we reviewed his dementia evaluations, MRIs, and current memory issues, and with his daughter present, discussed in detail an advance care plan that would ensure his wishes would be accommodated. His daughter was exceedingly grateful for the guidance, and my patient was so appreciative that he was able to advocate for himself. I can’t imagine a better or more rewarding way to practice medicine.”

REGISTER HERE to learn more about treating chronic conditions in concierge medicine from Dr. Alyson Kelley-Hedgepeth and Dr. Mayes DuBose at the Medical Economics/Specialdocs webinar on April 20th at 8 pm ET.

Terry Bauer is the CEO of Specialdocs , and Mindy Kolof is the public relations specialist for Specialdocs . Since 2002 Specialdocs has worked to transform physicians’ professional lives with a change to its industry-leading, sustainable concierge medicine model. The company provides all the essentials and support for a successful concierge medicine practice throughout the transition process and well beyond

The Good Life

Tue, 04 Apr 2023 15:37:23 GMT

The webinar will focus on lessons from the Harvard Study of Adult Development (HSAD) and from The Good Life: Lessons from the World’s Longest Scientific Study of Happiness, co-authored by our guest and Robert Waldinger. For 85 years, HSAD has closely followed individuals from over 700 families from adolescence until the end of their lives and is now working with more than 1,300 children of original participants. The findings from HSAD and those of other studies point to the critical role of relationships in shaping our happiness and health. We will discuss these findings and steps that audience members can take to improve their relationship health and happiness.

The Good Life website: https://the-good-life-book.com/
Dr. Schulz’s Academic Website: https://www.brynmawr.edu/inside/people/marc-schulz

TED Talk: What makes a good life? Lessons from the longest study on happiness
https://www.ted.com/talks/robert_waldinger_what_makes_a_good_life_lessons_from_the_longest_study_on_happiness/c

Understanding Heart Disease with Alyson Kelley-Hedgepeth, MD and Dara Lee Lewis, MD

Wed, 22 Feb 2023 20:43:31 GMT

Heart disease is the leading cause of death for both women and men. Join Drs. Kelley-Hedgepeth and Lewis as they present a brief overview of common cardiac conditions, including coronary atherosclerosis, heart failure and atrial fibrillation. They will review the treatments for these chronic heart diseases, the impact of lifestyle, and other strategies to stabilize disease. After their talk, they’ll welcome your questions.

So You Have a Cold: A timely discussion about upper respiratory infections (including RSV, flu and COVID)

Mon, 06 Feb 2023 21:36:09 GMT

Please join us for a discussion on different types of URI's (upper respiratory infections), including the trifecta that is plaguing us this year (RSV, Flu, COVID), how they are spread, practical tips on caring for yourself, when antibiotics/antivirals are warranted, dispelling myths, and a quick and dirty rundown of the dizzying array of over the counter cold meds - when to use what and what actually works.

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Dr. Lee Lewis Recommended Yoga Poses:
The first three poses are best while you are recuperating. The others may feel too challenging until you are back to normal.
https://drive.google.com/file/d/1RS-gE3z5K7vGitagCFBAb9D7-5Mvr4da/view?usp=sharing

3 Steps to Age Exuberantly

Mon, 30 Jan 2023 15:43:32 GMT

An 86-year-old Author has a few rules to live by even when the trials of getting older make it easy to complain.

Source: 3 Steps to Age Exuberantly - The New York Times (nytimes.com)

Date: January 19, 2023

A new book came across my desk recently, with an irresistible title: “The Swedish Art of Aging Exuberantly: Life Wisdom from Someone Who Will (Probably) Die Before You.” I was already familiar with the astringent humor of the author, Margareta Magnusson, having read her previous book, “The Gentle Art of Swedish Death Cleaning” — a surprise international best seller and a call to, as she put it, “not leave a mountain of crap behind for our loved ones to clean up after we die.”

I phoned Magnusson, who was an artist before becoming a published author and is now 86 years old, in Stockholm, to get some of her best advice on how to make life worth living, no matter your age.

Magnusson acknowledged that aging is hard. “You cannot stop the passing of time and how it affects your body, but you can work to keep a clear and positive mind,” she said. “You can be young upstairs in your head even if your joints creak.” Here are her top three tips.

Embrace kärt besvär

This Swedish phrase blends kärt, meaning “dear or cherished,” and besvär, which means “pain.” So, one kärt besvär might be paying your bills — an annoying obligation, but you’re still grateful that you have the money to pay. Or, it could be taking care of someone who is sick, which I’ve been doing this week with my flu-addled daughter. When I’m frazzled by her endless requests for streaming service passwords and mugs of tea, delivered via text message, I remind myself that I’m glad I’m strong enough to take care of her.

As you get older, it’s easy to be frustrated and complain, Magnusson said. But kärt besvär helps her to live with joy. “There seems to be no other choice than to see every nuisance as something that I must find a way to cherish,” she said.

What I think Magnusson’s getting at is the idea that it’s OK to lean into your emotions — whatever they might be. Laura Carstensen, a psychologist at the Stanford Center on Longevity, who has studied the emotional changes that occur with age, said, “We find that older people are more likely to report a kind of mosaic of emotions than younger people do.” While younger people tend to be “all positive or all negative,” she said, older people are more able to experience joy “with a tear in the eye,” she added.

Surround yourself with the young

This is Magnussen’s simple definition of happiness: being around young people. Not only do they supply fresh ideas and perspectives, she said, but hearing about their plans and prospects “is a way to stay in tune with the young person you yourself were at some point.”

Spending time with younger people can also benefit your brain, said Vonetta Dotson, a professor of psychology and gerontology at Georgia State University and author of “Keep Your Wits About You: The Science of Brain Maintenance as You Age.”

There is research to suggest that as you age, especially if you’re starting to experience some cognitive decline, socializing with younger people who are mentally sharp can provide the type of stimulation that helps boost cognitive functioning, she explained.

Yet this blending of generations often doesn’t happen, Becca Levy, professor of epidemiology at the Yale School of Public Health and author of “Breaking The Age Code,” said. “Because, unfortunately, there’s quite a bit of age segregation in our culture.”

Break that barrier by keeping your door (and fridge) open for grandchildren, if you have them nearby. Make an 8-minute phone call to a younger relative. Volunteer to read to children at your library, or sign up for an organization like Big Brothers Big Sisters.

And, to keep young people around you, Magnusson writes, “Just ask them questions. Listen to them. Give them food. Don’t tell them about your bad knee again.”

Say “yes” whenever possible

One of the misconceptions about older people, according to Regina Koepp, clinical psychologist and founder of the Center for Mental Health and Aging in Burlington, Vt., is that “they’re rigid and they’ll never change,” she said. “That’s not true. Older people are not more rigid than younger people. Those are personality traits, not age traits.” Yet even older adults have internalized this narrative, Dr. Koepp said, “because they’ve heard it their whole life.”

To age exuberantly, you must actively recognize your “internalized ageism” and fight against it, Dr. Koepp said. Saying “yes” as often as you can, she added, “is in effect saying ‘yes’ to life — being curious and exploratory, being part of community.”

Magnusson told me that the older she gets, the more she can vividly recall the things she has said “yes” to, just when she was on the verge of saying no, and how those experiences have made her life richer. “I’ve found that having a closed mind ages me more quickly than anything else,” she said. Before she refuses something — a dinner, an art show, buying a leather jacket — she asks herself: “Is it that I can’t do it, or I won’t?”

“Give it a try, whatever it is,” she said. “Maybe you’ll go to a party and be the last to leave because you’re having such a good time.” I asked Magnusson when she last shut down a party. “A week ago,” she said.

8 Best Snacks for active Older Adults

Mon, 30 Jan 2023 13:06:03 GMT

An active body needs protein. An active person needs more convenient ways to get that protein. Problem solved.

Source: 8 Best Snacks for Active Older Adults (silversneakers.com)

Date: January 25th, 2023

You know a granola bar isn’t the most nutritious snack, but it’s a lot easier to eat on the go than an egg white omelet.

Which begs the question: Can a packed schedule and a high-protein diet coexist? Yes, says Elizabeth Adler, R.D., a dietitian with Laura Cipullo Whole Nutrition Services in New York City.

“Whole and minimally processed foods that are naturally high in protein are your best bets,” she says, adding that snacks with at least 10 to 15 grams of protein will keep your stomach content and your muscles fueled between meals.

Another reason to reach for protein-filled snacks: Research published in the American Journal of Clinical Nutrition shows that older adults who spread their protein intake throughout the day (not just at mealtimes) have stronger, healthier muscles.

Here are eight convenient snacks to help solve your active-body, active-life diet dilemma.

High-Protein Snack #1: Hard-Boiled Eggs

Eggs contain the most bioavailable form of protein there is. That means your body absorbs and uses the protein from eggs better than it does protein from any other food, says Atlanta-based sports dietitian Marie Spano, R.D.

Each egg contains between 6 and 7 grams of protein, so a snack of two or three hard-boiled eggs is an easy way to meet your goals—and stay satisfied between meals.

To eliminate the need to peel on the go, Spano recommends preparing your hard-boiled eggs in batches: Boil, peel, and then store in an airtight container filled with water. Keeping the eggs covered in water will prevent them from drying out. They’ll be ready whenever you are.

High-Protein Snack #2: Ready-to-Eat Tuna

“If you’re a fish fan, adding tuna to a snack adds about 17 grams of protein, plus vitamin D and omega-3 fats,” Adler says. All three support overall health and weight loss efforts.

Consider purchasing tuna in pouch form. Many brands now sell no-drain, easy-to-open pouches with flavors like lemon dill or chipotle. Some even come with a tiny fork, making it easier than ever to enjoy on the go.

High-Protein Snack #3: Edamame

One cup of these little bright green pods delivers 15 grams of plant-based protein, making them ideal for anyone who follows a vegan or vegetarian diet. What’s more, edamame is a complete protein source, meaning it provides all nine essential amino acids your body needs.

Buy them fresh and steam, or use the precooked frozen variety and briefly microwave to defrost before chowing down.

High-Protein Snack #4: Jerky

Not all jerky is created equal. Fortunately, many health-conscious brands now offer minimally processed jerkies (think: beef, pork, and turkey) that are free of nitrates and added sugars, and low in sodium, Adler says.

She recommends opting for jerkies that contain less than 400 milligrams of sodium per serving — and remember to pay attention to the serving size.

Jerky provides between 10 and 12 grams of protein per ounce, Adler says. So it’s hard to beat in terms of convenience. Plus, this chewy snack stays fresh for months when packed properly.

High-Protein Snack #5: String Cheese and Turkey Sticks

The classic snack that kids love to pull and peel is also one of the best for adults. One string cheese packs about 7 grams of protein and 20 percent of your daily recommended intake of calcium. That’s important since calcium is one of the most common nutrients older adults aren’t getting enough of .

You can enjoy a plain string cheese on the go, or to hit your protein goals even quicker, Spano recommends wrapping it in two slices of deli turkey and setting the combo with toothpicks. You’ll add extra flavor along with 10 more grams of filling protein.

High-Protein Snack #6: Roasted Chickpeas

There’s so much more to chickpeas than hummus, and one of the tastiest ways to enjoy these protein-packed beans is also the simplest.

What to do: Toss 1 cup of chickpeas (12 grams of protein) with 1 tablespoon of olive oil, a pinch of salt, and cayenne pepper to taste. Roast for 20 to 30 minutes. You’ll have a crunchy snack you can take with you to pop a handful whenever you feel hunger coming on.

High-Protein Snack #7: Greek Yogurt

A single serving of this tangy goodness contains a whopping 23 grams of protein. But what truly sets it apart from other high-protein snacks are the probiotics , Spano says.

Also called “good bacteria,” probiotics help improve digestion and immune health. And according to emerging research, they may promote a healthy weight. To ensure your supermarket buy is rich in probiotics, look for a brand with “live and active cultures” on the label.

You can buy your yogurt in single-serve sizes to make snacking simple. Or buy it in larger quantities, and then divvy it up into your own single-serve airtight containers.

High-Protein Snack #8: Protein Powder

While getting your protein from whole food sources is ideal, an occasional dip into the protein powder canister is an incredibly convenient way to hit your daily protein goals. You can add one scoop to a smoothie, glass of milk, or even to a bottle of water.

“Adding protein powder to a delicious smoothie is a superb way to create a balanced snack when you’re on the go,” Adler says.

“And it can deliver around 20 grams of protein per scoop.”

She recommends whey protein as a first choice. It contains an ideal array of amino acids, which is one reason why a 2015

Journal of Food Science review found it to be the most effective form of protein powder for promoting muscle growth and health.

Other solid options include casein (a milk-based protein that contains less lactose), and soy and pea protein for vegans.

The Future of Aging

info@digitallm.com (digitalLM Staff) — Sun, 29 Jan 2023 05:44:01 GMT

The First Hundred Years: Healthy Longevity May Ultimately Define the Future

Humankind has eternally searched for the fabled fountain of youth. While we suspect that a magical elixir to turn back time may never be discovered, in 2023 we are coming ever closer to a more achievable goal: using scientific breakthroughs to slow the process of aging and therefore prolong our healthspan. As the number of Americans celebrating their 90th, 95th and even 100th birthdays continues to rise, aging research has radically shifted from efforts to extend the lifespan to enhancing function and years lived independently. Countless studies, encompassing everything from launching stem cells into space to investigating the genetics of “super agers”, are underway. Below we explore some of the newest thinking and exciting breakthroughs to come with nationally recognized expert George Kuchel, MD, whose decades of successful research both at the bench and in clinical settings have contributed to shaping a new vision of how we age.

“We can't reach old age by another man's road. My habits protect my life but they would assassinate you.” – Mark Twain, 1905

Individuality in Aging

“We used to look at older adults as if they were all the same, with everyone becoming old the day they retired at 65,” says Dr. Kuchel, director of the UConn Center on Aging , which was established in 1985, making it one of the first multidisciplinary centers focused on improving the lives of older adults through research, education and clinical care. “While aging is inevitable and a normal part of the lifespan process, there’s tremendous heterogeneity, or variability, in how each of us ages. When we study the rate at which individuals age in terms of physical and cognitive function, frailty, disability, and disease development, we find increasing heterogeneity with age. Therefore, rather than focusing on averages typically culled from observational studies of older people compared to younger people, we are focusing on the differences within those averages.”

Geroscience and Aging Adults

Better understanding the uniqueness of each individual as they age has inspired Dr Kuchel and his colleagues to spearhead the burgeoning new field of Precision Gerontology. The overarching goal is to develop treatments for older patients that are more effective in promoting health and independence by being more precise and targeted. Adding exponentially to this knowledge base is the field of Geroscience, which seeks to delay the onset and progression of different chronic diseases by targeting the shared biological mechanisms that make aging a major risk factor and driver of common chronic conditions and diseases of older people.

“Many older people have multiple ongoing chronic conditions, and see different physicians for each,” says Kuchel. “ However, as geriatricians and concierge medicine physicians were among the first to recognize, looking at the whole patient is essential. Geroscience transforms the ‘one disease at a time’ approach by studying the role of biological aging in enabling all these conditions.”

The 2021 launch of the NIA Older Americans Independence “Pepper” Center at UConn , one of only 15 National Institutes of Health ( NIH )-funded centers across the country dedicated to enhancing function and independence in older adults through research, has significantly advanced the scope of studies at the university. According to Kuchel, “We are combining evidence-based geriatric care with more individualized treatments involving emerging interventions designed to delay the onset of chronic diseases by targeting biological aging. Our work moves us closer to the mission of extending the healthspan of greater numbers of individuals.”

Studies Related to Healthy Aging and Longevity

Promising studies under the microscope at UConn and other prominent research institutions include:

Can chronic diseases be delayed by targeting aging?

A geroscience-based trial to test the effectiveness of diabetes drug metformin in slowing the onset of chronic diseases in older adults is slated to be announced in 2023. The randomized, six-year TAME (Targeting Aging with Metformin) trial , led by the American Federation for Aging Research, will engage over 3,000 individuals nationwide between the ages of 65 and 79 to test if those taking metformin experience decreased or delayed onset or progression of age-related diseases such as cardiovascular disease, cancer and dementia.

Dr. Kuchel believes that conducting the trial will prove revolutionary. “Metformin has an excellent safety profile, proven over more than six decades,” he says, “and uniquely among other oral hypoglycemics, it appears to have a broad effect on many aspects of aging.” By collecting and analyzing trial participants’ serum, plasma, blood, urine and stool for varied biomarkers, the study will also provide information about a person’s risk of developing a disease, and lay a solid foundation for future biomarker discovery and validation as well as accelerating the pace of geroscience research.

Worth noting: In earlier stages is the study of rapamycin, an immunosuppressant currently used in high doses in transplant patients. However, when used in much lower doses the drug promotes longevity and reduces age-related disease in animal models, while it improves influenza vaccine responses in community-dwelling older adults.

Senolytics

This entirely new class of drugs may one day be used to halt cellular senescence, a hallmark of aging. As cells age and lose their ability to divide, they secrete molecules that trigger inflammation and cause much of the damage seen in osteoporosis, arthritis, diabetes, sarcopenia, cardiovascular disease and cancers. In numerous animal trials, use of senolytic

drugs such as fisetin to selectively eliminate and clear senescent cells from the body were shown to significantly improve function. Multiple placebo-controlled, double-blind studies with older patients are planned or underway through the National Institute of Aging Translational Geroscience Network and elsewhere.

Inside the microbiome

This topic of intense interest continues to build an impressive body of research, including a recently completed collaboration between UConn Center on Aging and Julia Oh, PhD, at the Jackson Laboratory for Genomic Medicine on the same campus. This study showed the presence of an altered microbiome (the millions of microbes living in our gut, mouth, skin and elsewhere) in nursing home residents. Importantly, the changes were specific to frailty rather than biological age, and linked to bacteria associated with severe infections and antibiotic resistance. Going forward, in keeping with a focus on Precision Gerontology, clinical approaches may be used to identify individuals with high risk for severe infections and to explore treatments for restoring the microbiome to a state characteristic of younger or less frail individuals.

Personalized influenza vaccines

Another example of Precision Gerontology research is underway with Duyu Ucar, PhD, at the Jackson Laboratory and the Icahn School of Medicine at Mount Sinai , studying adults aged 65 and older over the next three influenza seasons to pinpoint the age-related immune alterations that reduce influenza vaccine effectiveness. “We know the body’s ability to produce a robust immune response after receiving the flu shot decreases with age, and we’ll be testing whether next-generation influenza vaccines, including mRNA-based ones, can help boost these immune responses. Understanding the factors that predict good responses to each vaccine will allow us to ultimately personalize our recommendations,” explains Kuchel.

“This is truly a time of meaningful change and ongoing advances in the field of aging,” says Kuchel. “Each day we uncover new answers to the question that has inspired our research from the start: ‘ How can we add life to our years? ’”

Studying the Secrets of Super Agers

info@digitallm.com (digitalLM Staff) — Sun, 29 Jan 2023 05:43:57 GMT

The growing group of people able to enjoy 100 years of life may well be one of the most remarkable achievements of the 21st century. A generation ago, the number of centenarians worldwide was just 110,000; today they are 600,000 strong. Notably, a sizable segment of this long-lived group, aptly called Super Agers, reach 100 in good health with no age-related disease or disability. Are they the fortunate recipients of outstanding genes, followers of a particularly healthy lifestyle, or a combination of both?

Definitive answers may start to emerge sooner than we had imagined possible, thanks to the SuperAgers Family Study , called one of the most ambitious ever conducted, with the goal to uncover and understand the genetic and biological mysteries of exceptional longevity and healthy aging. The initiative, spearheaded by the American Federation for Aging Research (AFAR) and Albert Einstein College of Medicine , in collaboration with https://www.bumc.bu.edu/busm/ Boston University School of Medicine, will recruit 10,000 people over age 95 to collect their DNA samples and health histories, as well as their children’s.

“Super Agers show us that chronic disease is not an inevitable part of aging, and that an extended period of good health can accompany a long lifespan,” says Sofiya Milman, MD, principal investigator of the study and director of Human Longevity Studies at Einstein’s Institute for Aging Research .

While previous research has attempted to pinpoint the distinctive characteristics of people living well in their ninth and tenth decades, the enrollment of 10,000 participants in SuperAgers will represent the largest cohort ever studied. The extensive numbers are essential to obtaining meaningful data that can benefit many in the future, according to Milman.

“We believe longevity may be linked to rare genetic variants found in less than five percent of the population, making it a challenge to amass ample genetic evidence,” explains Milman. “The enormous data bank being built in our SuperAgers study will enable us to identify these genes, understand their biological pathways and explore how to duplicate their functions.”

Milman aims to achieve full enrollment over the next two to three years, with results from the first phase available in 2024. “SuperAgers will significantly accelerate our research by providing us with a treasure trove of data on not just genetics, but biological and behavioral factors that affect aging and its related diseases. Ultimately, this will help us develop, trial and fast-track new therapies to extend a healthy old age,” she says.

In the meantime, adhering to a nutritionally balanced diet, exercising, getting sufficient sleep, managing stress and eliminating tobacco are all well advised. “A healthy lifestyle alone may not be enough to guarantee you reach 100,” admits Milman, “but all evidence points to the fact that it will extend your healthy lifespan.”

SuperAgers Sign-Up

Interested in being part of the SuperAgers family study?

Individuals who have passed their 95th birthday, as well as children of those individuals, are invited to enroll online at http://www.superagersstudy.org and complete a health history, family history and demographic profile. Those eligible will receive a biospecimen collection kit in the mail and are asked to return it in a postpaid envelope to the Albert Einstein College of Medicine, which will store and process each participant’s DNA. Please note that participants may choose to receive results regarding their ancestry or family origins. The SuperAgers biobank holding the DNA records, and all the related data, will be protected and maintained at Einstein in compliance with federal medical privacy law (HIPAA).

What Older Americans Need to Know About Taking Paxlovid

Tue, 24 Jan 2023 14:34:42 GMT

Source: What Older Americans Need to Know About Taking Paxlovid (medscape.com)

Date: January 19th, 2023

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

A new coronavirus variant is circulating, the most transmissible one yet. Hospitalizations of infected patients are rising. And older adults represent nearly 90% of U.S. deaths from covid-19 in recent months, the largest portion since the start of the pandemic.

What does that mean for people 65 and older catching covid for the first time or those experiencing a repeat infection?

The message from infectious disease experts and geriatricians is clear: Seek treatment with antiviral therapy, which remains effective against new covid variants.

The therapy of first choice, experts said, is Paxlovid, an antiviral treatment for people with mild to moderate covid at high risk of becoming seriously ill from the virus. All adults 65 and up fall in that category. If people can't tolerate the medication — potential complications with other drugs need to be carefully evaluated by a medical provider — two alternatives are available.

"There's lots of evidence that Paxlovid can reduce the risk of catastrophic events that can follow infection with covid in older individuals," said Dr. Harlan Krumholz , a professor of medicine at Yale University.

Meanwhile, develop a plan for what you'll do if you get covid. Where will you seek care? What if you can't get in quickly to see your doctor, a common problem? You need to act fast since Paxlovid must be started no later than five days after the onset of symptoms. Will you need to adjust your medication regimen to guard against potentially dangerous drug interactions?

"The time to be figuring all this out is before you get covid," said Dr. Allison Weinmann , an infectious-disease expert at Henry Ford Hospital in Detroit.

Being prepared proved essential when I caught covid in mid-December and went to urgent care for a prescription. Because I'm 67, with blood cancer and autoimmune illness, I'm at elevated risk of getting severely ill from the virus. But I take a blood thinner that can have life-threatening interactions with Paxlovid.

Fortunately, the urgent care center could see my electronic medical record, and a physician's note there said it was safe for me to stop the blood thinner and get the treatment. (I'd consulted with my oncologist in advance.) So, I walked away with a Paxlovid prescription, and within a day my headaches and chills had disappeared.

Just before getting covid, I'd read an important study of nearly 45,000 patients 50 and older treated for covid between January and July 2022 at Mass General Brigham, a large Massachusetts health system. Twenty-eight percent of the patients were prescribed Paxlovid, which had received an emergency use authorization for mild to moderate covid from the FDA in December 2021; 72% were not. All were outpatients.

Unlike in other studies, most of the patients in this one had been vaccinated. Still, Paxlovid conferred a notable advantage: Those who took it were 44% less likely to be hospitalized with severe covid-related illnesses or die. Among those who'd gotten fewer than three vaccine doses, those risks were reduced by 81%.

A few months earlier, a study out of Israel had confirmed the efficacy of Paxlovid — the brand name for a combination of nirmatrelvir and ritonavir — in seniors infected with covid's omicron strain, which arose in late 2021. (The original study establishing Paxlovid's effectiveness had been conducted while the delta strain was prevalent and included only unvaccinated patients.) In patients 65 and older , most of whom had been vaccinated or previously had covid, hospitalizations were reduced by 73% and deaths by 79%.

Still, several factors have obstructed Paxlovid's use among older adults, including doctors' concerns about drug interactions and patients' concerns about possible "rebound" infections and side effects.

Dr. Christina Mangurian , vice dean for faculty and academic affairs at the University of California-San Francisco School of Medicine, encountered several of these issues when both her parents caught covid in July, an episode she chronicled in a recent JAMA article .

First, her father, 84, was told in a virtual medical appointment by a doctor he didn't know that he couldn't take Paxlovid because he's on a blood thinner — a decision later reversed by his primary care physician. Then, her mother, 78, was told, in a separate virtual appointment, to take an antibiotic, steroids, and over-the-counter medications instead of Paxlovid. Once again, her primary care doctor intervened and offered a prescription.

In both cases, Mangurian said, the doctors her parents first saw appeared to misunderstand who should get Paxlovid, and under what conditions. "This points to a major deficit in terms of how information about this therapy is being disseminated to front-line medical providers," she told me in a phone conversation.

Michael Osterholm , director of the Center for Infectious Disease Research and Policy at the University of Minnesota, agrees. "Every day, I hear from people who are misinformed by their physicians or call-in nurse lines. Generally, they're being told you can't get Paxlovid until you're seriously ill — which is just the opposite of what's recommended. Why are we not doing more to educate the medical community?"

The potential for drug interactions with Paxlovid is a significant concern, especially in older patients with multiple medical conditions. More than 120 medications have been flagged for interactions, and each case needs to be evaluated, taking into account an individual's conditions, as well as kidney and liver function.

The good news, experts say, is that most potential interactions can be managed, either by temporarily stopping a medication while taking Paxlovid or reducing the dose.

"It takes a little extra work, but there are resources and systems in place that can help practitioners figure out what they should do," said Brian Isetts , a professor at the University of Minnesota College of Pharmacy.

In nursing homes, patients and families should ask to speak to consultant pharmacists if they're told antiviral therapy isn't recommended, Isetts suggested.

About 10% of patients can't take Paxlovid because of potential drug interactions, according to Dr. Scott Dryden-Peterson , medical director of covid outpatient therapy for Mass General Brigham. For them, Veklury (remdesivir), an antiviral infusion therapy delivered on three consecutive days, is a good option, although sometimes difficult to arrange.

Also, Lagevrio (molnupiravir), another antiviral pill, can help shorten the duration of symptoms.

Many older adults fear that after taking Paxlovid they'll get a rebound infection — a sudden resurgence of symptoms after the virus seems to have run its course. But in the vast majority of cases "rebound is very mild and symptoms — usually runny nose, nasal congestion, and sore throat — go away in a few days," said Dr. Rajesh Gandhi , an infectious-disease physician and professor of medicine at Harvard Medical School.

Gandhi and other physicians I spoke with said the risk of not treating covid in older adults is far greater than the risk of rebound illness.

Side effects from Paxlovid include a metallic taste in the mouth, diarrhea, nausea, and muscle aches, among others, but serious complications are uncommon. "Consistently, people are tolerating the drug really well," said Dr. Caroline Harada , associate professor of geriatrics at the University of Alabama-Birmingham Heersink School of Medicine, "and feeling better very quickly."

Understanding our Mind, Improving our Health

Mon, 09 Jan 2023 21:58:29 GMT

Join us for a conversation with Dr. Natasha Beauvais, award-winning Family Practice physician from Northern Virginia. Dr. Beauvais will discuss a novel approach to optimizing healthy behaviors through understanding our motivations and psychological barriers to change. Dr. Beauvais regularly employs this technique with her patients and employees to great effect. We will discuss ways that we can each improve our own health by taking a deeper dive into what lies beneath our daily choices.

Here is a simplified version of Dr. Beauvais’ talk.
Start with the following 4 columns:

Name something you would like to get better at.

State the goal in the affirmative. It should be something that is your goal, not relying on others. Choose a goal that is important and meaningful to you.

What are you doing or not doing that is getting in the way of this goal?
What are you worried might happen if you change this behavior?
In other words, if you reversed those things that are getting in the way, what might that feel like?

3b. What do we then see as our competing commitment? What’s the outside motivator for the action?

What is your “big assumption” about what might happen if you change this behavior?

Once you make it through the 4 columns, design a “tiny experiment” for yourself. Make sure it is a small change that feels reasonable to try for a few days. Take notes. What did you notice, what did you realize during this experiment?

After the few day experiment, re-evaluate your 4 columns. Do you want to change anything?

Recommended Books:

An Everyone Culture: Becoming a Deliberately Developmental Organization By Dr. Robert Kegan, Dr. Lisa Laskow Lahey, Dr. Matthew L Miller, Dr. Andy Fleming, and Dr. Deborah Helsing.

Immunity to Change: How to Overcome It and Unlock the Potential in Yourself and Your Organization By Dr. Robert Kegan and Dr. Lisa Laskow Lahey

Right Weight, Right mind: the ITC Approach to Permanent Weight Loss By: Dr. Robert Kegan, Dr. Lisa Laskow Lahey, and Dr. Deborah Helsing.

Websites:
https://mindsatwork.com/
https://developmentalsprint.com/

Eat to Survive and Thrive This Holiday Season!

Tue, 13 Dec 2022 21:37:39 GMT

Ready to go into the holidays feeling stronger, full of energy, and confidently able to manage whatever comes your way? Sue Levy, the founder of Savory Living, will show you how to activate healthy eating to power up and THRIVE during this demanding time of year!

In this live webinar you’ll learn:

How to eat to support your health, reduce inflammation, gain energy, improve focus, and feel calm & better able to manage stress

Practical tips to enjoy eating the foods you love AND avoid the common holiday food traps!

About a FREE trial for an online healthy eating & cooking lifestyle program to help you discover how to eat right for YOU and turn it into a delicious lifestyle that you love!

Happiness, Well-being, and The Heart

Mon, 07 Nov 2022 21:37:24 GMT

Please join us for our next health and wellness webinar with guest speaker Dr. Jona Ludmir. A critical care cardiologist from Mass General Hospital and an Assistant Professor of Medicine at Harvard Medical School. This webinar will explore the power of well-being and how it impacts our overall cardiovascular health. We will discuss the role of happiness and optimism in helping us stay healthy and achieve success.

Book recommendation: Springboard: Launching Your Personal Search for Success by G. Richard Shell

Book recommendation: Flourish by Martin E.P. Seligman

Website referenced: Positive Psychology Center (upenn.edu)
Exercise option recommendations: Couch to 5K and Burnalong

Trying to lower stubbornly high LDL cholestrol?

Mon, 07 Nov 2022 15:02:41 GMT

Expert consensus focuses on individual planning to bring down elevated LDL.

Recently I met with Nancy, a 72-year-old woman with coronary artery disease, to review her latest cholesterol results. Despite taking a statin, following a healthy diet, and exercising regularly, her low-density lipoprotein (LDL) cholesterol remained above our target. "What else can I do?" she asked. "When I increase my statin dose I get terrible leg pains. But I don’t want to have another heart attack!"

When elevated, LDL contributes to cardiovascular disease, which can cause a heart attack or stroke. Taking statin drugs can drop LDL levels in most people by about 30%, substantially lowering this risk. Usually, these commonly prescribed drugs work effectively with tolerable side effects. But what if a person’s LDL level remains too high on their maximally tolerated dose? An expert consensus report issued by the American College of Cardiology lays out a clear path for next steps.

What is a healthy target for LDL cholesterol?

Target LDL depends on many factors, including your age, family history, and personal history of cardiovascular disease. For people at intermediate risk, LDL should be lowered by 30% to 50%. For those who have already had a heart attack, target LDL is no more than 70 mg/dl (note: automatic download).

Which non-statin therapies are recommended first?

Five non-statin therapies described in this post aim to help people achieve target LDL goals while minimizing side effects. They may be combined with a statin or given instead of statins.

Each helps lower LDL cholesterol when diet and statins are not sufficient, such as when there is a family history of high cholesterol (familial hypercholesterolemia). But so far, only two options are proven to reduce cardiovascular risk — the risk for heart attack, stroke, heart failure, and other issues affecting the heart and blood vessels.

Follow me on Twitter @daraleelewismd .

The post Trying to lower stubbornly high LDL cholestrol? appeared first on Harvard Health Blog .

NVFP Presents: Understanding POTS: Postural Orthostatic Tachycardia Syndrome

Mon, 31 Oct 2022 16:10:08 GMT

Join Dr. Cecily Havert and Dr. Maria Castillo-Catoni as they sit down with Dr. Dara Lee Lewis from Lown Cardiology Group for a conversation regarding Postural Orthostatic Tachycardia Syndrome (POTS) and Dysautonomia.

Dementia and Alzheimer’s: Updates from a Leading Geriatrician

info@digitallm.com (digitalLM Staff) — Tue, 18 Oct 2022 04:53:35 GMT

Senior Moments Or Something More?

As Baby Boomers continue the inexorable journey deep into their senior years, preserving cognitive function understandably tops the list of worries. While Alzheimer’s Disease and related dementias are seen in just 5% of people over 65, that number jumps to 30% for people age 85 and over. Questions abound: is forgetting a name a sign of normal aging or an indicator of a more serious memory disorder? Are any nutritional supplements or pharmaceutical treatments available that are proven to stave off memory loss? Most importantly, what steps can be taken to modify individual risk?

To better understand how to identify and manage dementia and Alzheimer’s disease, we asked one of the country’s leading experts, R. Sean Morrison, MD , for his informed perspective on this growing concern for seniors, their families and caregivers. A practicing geriatrician, palliative medicine physician and health researcher for almost three decades, Dr. Morrison has earned numerous awards and recognition for his work, and currently serves as the Chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai and as Director of the Hertzberg Palliative Care Institute .

Is memory loss an inevitable, natural sign of aging?

Dr. Morrison: The good news is that not all cognitive functions decline with age. The ability to maintain attention, language comprehension, usage, and vocabulary does not decrease. Knowledge learned years ago like how to ride a bike, or brush your teeth, also stays intact. Additionally, when you learn something new and can remember it, you won’t forget it any more rapidly than when you were younger.

The not so good news is that it will take greater effort to learn those new things; more attention, repetition and use of memory-enhancing strategies will be needed. The ability to multitask is also diminished, as processing information takes longer and reaction times are slower. People may experience poorer performance when working under time pressure, and find it more difficult to manipulate information in the brain, such as calculating a tip in a restaurant or figuring out a route to travel from one place to another.

How do you distinguish between a “senior moment” lapse in memory and a sign of Alzheimer’s disease?

Dr. Morrison: So many people experience that temporary inability to remember a name. But if you are able to recall things with a cue or can pick it out from a list of possibilities, that’s evidence of a problem with retrieval but not with storage. You can be reassured that it doesn’t indicate Alzheimer’s disease but a “senior moment” because the information has been successfully stored in your memory.

Is routine screening for dementia recommended in older adults?

Dr. Morrison: The U.S. Preventive Services Task Force does not recommend for or against routine screening, saying no interventions are proven to have a significant effect in people with earlier detected cognitive impairment. However, it is required as part of Medicare’s yearly assessments, and most primary care physicians consider dementia screenings an essential part of their annual wellness exam.

What types of screening tests do you recommend?

Dr. Morrison: At least a dozen tests are available, each with their own benefits and drawbacks. I recommend the following for their ease of use and proven sensitivity and specificity in diagnosing cognitive impairment:

Mini-Cog is a quick, three-minute evaluation. Patients are asked to repeat three words, draw a clock with hands at a specific time, and then recall the initial three words.
Memory Impairment Screen assesses free and cued word recall. Patients are read four unrelated words from four categories (e.g. Red Cross, saucer, checkers, telegram) and after a few minutes of diversion, asked to recall the words in 20 seconds, either with no prompting or cued by category.
Animal Fluency Test. Patients are asked to name as many animals as possible in a 60-second period.

Are there any risk factors for dementia and Alzheimer’s disease that can be controlled by patients?

Dr. Morrison: Quite a few risk factors are modifiable with lifestyle changes and non-pharmaceutical treatments. These include:

Address hearing and visual impairments, with eyeglasses, hearing aids and other assistance
Prevent and manage hypertension and diabetes
Maintain a healthy weight
Stop smoking
Seek treatment for depression
Prioritize regular exercise and physical activity
Avoid social isolation
Explore cognitive training

The best advice I can give to people in their 50s to 70s looking to prevent or delay progression of dementia and Alzheimer’s disease: exercise, exercise, exercise and rigorously control your blood pressure.

How are the symptoms frequently experienced by people with dementia - sleep disturbance, mood disorders, agitation - best addressed?

Dr. Morrison: There are a number of non-pharmaceutical interventions that have proven effective. Use adaptive clothing and assistive devices to help eliminate distress around bathing and dressing. Create a reassuring familiar structure to the day with a regular routine and activities. Optimize the sleep environment with a comfortable temperature, the right amount of light, a warm milky drink and a bath or shower before bed; avoid stimulating medications, drinks containing caffeine and alcohol, and exercise too close to bedtime. Pharmaceutical treatments can also be considered, including antidepressants to improve cognition and ameliorate agitation and aggression, and melatonin and melatonin antagonists to help with sleep disorders. Of note: medications such as benzodiazepines (BZD), non-BZD hypnotics, mood stabilizers and antipsychotics are no longer routinely recommended as side effects can outweigh possible benefits.

Are there any benefits to nutritional supplements or appetite stimulants?

Dr. Morrison: Nutritional supplements can help with weight gain in patients with anorexia or cachexia (‘wasting’ syndrome) but have no meaningful impact on survival. And while appetite stimulants such as cannabinoids and steroids are often given to help patients with dementia, there is no consistent data regarding their safety and efficacy.

What medications are available to treat or stop the progression of dementia?

Dr. Morrison: Until last year, only four medications were approved for treatment of dementia and Alzheimer’s disease, showing only a minimal to modest improvement in cognition. In 2021 a fifth drug was launched – aducanumab - a monoclonal antibody designed to reduce amyloid protein in the brain. Its fast-track approval was quite controversial as the clinical benefits of the drug were not proven during trials, which were stopped early as a result, and some severe side effects were observed. Interestingly, some researchers are now rethinking the idea that targeting amyloid protein plaques will eliminate Alzheimer’s disease, and instead exploring Alzheimer’s as a disease of inflammation. This could be the next fascinating line of research.

How a Memory is Made

Memory begins to form by giving attention to the information received through your senses. Anything that interferes with your ability to pay attention, such as hearing impairment, will affect the formation of a sensory memory. Successful integration of sensory memories into your working memory enables you to temporarily store, organize and manipulate information. These memories are then encoded into long-term memory and finally put into permanent storage.

Nourish Body, Brain and Heart with the MIND Diet

info@digitallm.com (digitalLM Staff) — Tue, 18 Oct 2022 04:53:32 GMT

Mindful Eating for Your Brain

Harkening back to ancient civilizations, the concept of food as medicine represents one of today’s most cutting-edge approaches to prevention and disease management. Inspired by the intricate connection of mind and body wellness, a small, special group of diets have made their way into the mainstream offering benefits far beyond short-term weight loss. Among them are DASH (Dietary Approaches to Stop Hypertension), a low-sodium diet that encourages consumption of foods rich in nutrients such as potassium and calcium and magnesium; the Mediterranean diet for heart health, emphasizing fish, fruits, and vegetables, with olive oil as the main source of fat; and combining both, the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet, which shows real promise in helping its adherents preserve cognition and reduce the risk of dementia.

Launched in 2015 by researchers at Rush University Medical Center , the MIND diet encourages selecting foods from categories that include leafy greens and vegetables, legumes, fish and seafood, poultry, nuts and berries, while limiting high fat, high sugar and processed foods. Longitudinal observational studies showed the rewards of shifting to this healthier way of eating, with a 53% reduction in the risk of dementia for seniors who rigorously followed the diet, and somewhat surprisingly, a 35% risk reduction even for those who followed it only moderately well.

“This is my favorite feature,” says Jennifer Ventrelle, MS, RD, lead dietitian for the MIND Diet Intervention to Prevent Alzheimer’s Disease at Rush, “you don’t have to be perfect! It’s not necessary to eat from every preferred category to achieve your goals.”

Although it’s not intended as a reducing diet, Ventrelle says people who follow it naturally lose weight by focusing on the preferred categories of foods. “It’s too difficult for many people to consider banishing all sweets or giving up red meat forever, so we haven’t eliminated these foods but allow them with limited frequency and close attention to portion sizes,” she explains.

Additional research pointed to a host of other benefits associated with eating MINDfully for older adults: slower cognitive decline and progression of Parkinsonian signs in aging, and reduced risk of functional disability, depressive symptoms, metabolic syndrome, cardiovascular disease and all-cause mortality. “The literature continues to grow, with new studies that point to the key role diet plays in preventing cognitive decline,” says Puja Agarwal, PhD, nutritional epidemiologist and assistant professor of internal medicine at Rush.

But it is the gold-standard randomized controlled trial begun several years ago by Rush and Harvard School of Public Health that may ultimately establish a causal relationship between diet and dementia. More than 600 participants at higher risk for Alzheimer’s disease – overweight, suboptimal diets and a history of dementia in the family – were enrolled in the study designed to directly measure whether following the MIND diet versus a low-fat diet can prevent neurodegenerative ills. Results are expected by the end of 2022, according to Agarwal, who is fully aware of its significance at a time when more than 6 million people in the U.S. are living with Alzheimer’s disease, a number expected to double in the coming decades. “We don’t have a cure for these diseases, so prevention strategies are essential. We’re hoping for intervention trial results for the effects of MIND diet in protecting the brain to further establish the role of diet in healthy aging.”

What a day of meals on the MIND diet might include:

BREAKFAST

Greek Yogurt Parfait: ½ cup whole grain, high fiber cereal, ½ cup berries, ½ cup low-fat Greek yogurt, 2 tbsps (raw, unsalted) walnuts, almonds or pecans.

LUNCH

Whole Wheat Turkey Wrap: 1 tortilla wrap + 3-5 oz turkey breast lunchmeat or carved white meat + 1 slice reduced fat cheese + lettuce, tomato and veggies of choice.

3-Bean Salad: Mixture of kidney beans, black beans, chickpeas, red onions + 1 tbsp extra-virgin olive oil + 1 tsp balsamic vinegar + Italian seasoning mix such as oregano, parsley, basil, etc.

SNACK

Mediterranean Rice Cake: 1 whole grain rice cake spread with 2 tbsps hummus topped with cucumber slices, tomato slices + fresh lemon juice.

DINNER

Baked Salmon over Spinach and Grains with Asparagus

• 3-5 oz salmon filet topped with fresh or dried dill or parsley + a squeeze of fresh lemon juice baked on top of 1 cup baby spinach leaves

• 8 asparagus spears topped with ½ tbsp extra-virgin olive oil + fresh lemon juice + zest

• 1 cup cooked whole grain such as brown rice, quinoa, or bulgur mixed with ½ tbsp. extra-virgin olive oil

DESSERT

1 oz of dark chocolate (at least 75% cocoa) and ½ cup frozen berries

Working Toward a Healthy Body, Peaceful Mind, and Joyful Heart

Mon, 17 Oct 2022 19:57:23 GMT

Please join us as we welcome Dr. Beth Frates for a discussion on the mind body relationship and overall wellness. Dr. Frates is the President-Elect of the American College of Lifestyle Medicine, Director of Lifestyle Medicine at Massachusetts General Hospital Surgery Department, and the faculty advisor and founder of the Lifestyle Medicine Interest Group at Harvard Medical School.

Resources:

Paving Wheel PDF

Paving the Path to Wellness Workbook

https://healthylearning.com/paving-the-path-to-wellness-workbook/

Paving A Women's Guide Through Menopause and Beyond

https://healthylearning.com/paving-a-womans-path-through-menopause-and-beyond/

flow by Mihaly Csikszentmihalyi

https://www.amazon.com/Flow-Psychology-Experience-Perennial-Classics/dp/0061339202

Please use the link below to browse other publications by: Dr. Frates current publications through her website.

https://www.bethfratesmd.com/books

Website

www.bethFratesMD.com

Twitter

@BethFratesMD

Osteoporosis and Bone Health

Tue, 27 Sep 2022 17:14:30 GMT

Join us in welcoming Dr. Sharon H. Chou, an endocrinologist at Brigham and Women's Hospital and a leading expert in osteoporosis. Dr. Chou will lead a discussion on osteoporosis, why it’s important, how it’s diagnosed, and how we can reduce our risk of fractures.

FRAX Score:
www.shef.ac.uk/FRAX
See the calculation tab and select your region to get started.

Exercise recommendations:
https://onero.academy/osteoporosis-exercises/
https://americanbonehealth.org/exercises

Evoking Positive Memories Is a Powerful Resource

Tue, 30 Aug 2022 12:28:36 GMT

Why what you remember matters.

Read the article here: https://www.psychologytoday.com/gb/blog/helping-humanity-thrive/202208/evoking-positive-memories-is-powerful-resource

KEY POINTS

When we are mentally stressed or highly emotional, we lose perspective.
Positive reminiscence activates the brain regions that can help calm us down and enable us to think straight.
It is a simple, powerful tool that anyone can use for reducing stress and distress.

In a Pickle and Looking for a New Summer Activity?

info@digitallm.com (digitalLM Staff) — Tue, 19 Jul 2022 18:15:56 GMT

Try Pickleball, the Country’s Fastest-Growing Sport

Tired of the same ‘ole routine every summer but find yourself in a pickle and looking for a new summer activity? Well, according to American Council on Exercise (ACE), you might want to consider pickleball.

As everyone from your next-door neighbor to ACE will attest, pickleball is extraordinarily popular. Its rapid rise to ubiquity can be attributed to a number of factors, ranging from easily learned rules and minimal equipment needs to intergenerational appeal and abundant opportunities for socializing.

This blend of badminton, tennis and table tennis can be adjusted to suit the intensity and competitiveness of the players, making it simple enough for beginners but fast-paced enough for more fit or skilled participants.

All of which is to say that if you haven’t yet considered picking up a pickleball paddle and the light, whiffle-like plastic ball, summer 2022 might be the perfect time to do so.

“Pickleball doesn’t require the skill of tennis, so it is easily adapted by most, and provides all the benefits of movement, including calorie burning and enhanced functional capabilities,” says Dr. Cedric Bryant, ACE president and chief science officer.

Already a favorite sport in retirement communities, pickleball has swelled to include more than 4.8 million players in the U.S. – almost double the number from five years ago – earning it the title of fastest-growing sport in 2021 and 2022. According to the Sports and Fitness Industry Association, the spike has been fueled by people ages 54 and younger looking for a friendly yet competitive and lively sport.

“People who play are generally having so much fun they don’t realize how much exercise they’re actually getting,” says Laura Gainor, spokesperson for the USA Pickleball Association .

At 44 x 20 feet, the pickleball court is one quarter the size of a tennis court, so it’s easier to keep the ball in play and achieve a brisk workout. According to ACE, pickleball may provide just what many middle-aged and senior adults are seeking – a safe and effective workout that yields long-term benefits and encourages lifelong participation.

A small research study recently conducted by the organization among people ages 40 to 85 showed that playing four 15-minute pickleball matches three days each week meets exercise intensity guidelines for improving and maintaining cardiorespiratory fitness. Study authors reported the positive impact on cardiometabolic risk factors, with participants experiencing favorable changes in cholesterol levels, systolic and diastolic blood pressure, and peak oxygen uptake after six weeks.

The smaller court also benefits older people or those who have problems with their joints, because less running is needed, resulting in less wear and tear on the joints. One cautionary note: Experts advise learning proper technique to prevent falls. As always, be sure to check with your healthcare provider before beginning any new physical activity.

“Take a few lessons to get started, and you’ll quickly ramp up,” assures Gainor. “After three to five games, you’ll have a very good understanding of how to play, and will become addicted to it shortly after!”

Take It Outside: Keep Moving This Summer:

There’s no one-sport-fits-all approach, so if pickleball doesn’t appeal, find your inspiration in one of these activities, spanning the spectrum from low exertion to highly energetic:

Stroll through farmers’ markets or art fairs
Go produce picking at a local orchard
Forest bathe – immerse yourself in nature at a forest preserve
Gardening – remember to bend from your knees and waist rather than your back
Swim – use a variety of strokes to limber up your whole body
Disc golf – a low-impact way to challenge your coordination
Yard yoga – take your mat and routine outdoors
Hike, jog, run or cycle on an outdoor trail
Kayaking – for a vigorous upper body workout
Stand-up paddleboarding or Boga – challenging, board-based water workouts

Sources: American Council on Exercise , American Heart Association , USA Pickleball Association

Tips for Safe Summer Fun

info@digitallm.com (digitalLM Staff) — Tue, 19 Jul 2022 18:15:53 GMT

Stay Safe with Sunscreen, Sunglasses and Plenty of Water

The longer, sunshine filled days of summer are upon us and without a doubt, they are one of life’s unrivaled joys, especially when you protect yourself from the powerful impact of ultraviolet rays. With that in mind, we share our tips for safe summer fun; from choosing and using the right sunscreen to staying hydrated.

The debate around sunscreen safety heated up with last year’s recall of some popular consumer products containing chemicals such as benzene, which is absorbed through the skin and into the bloodstream. Yet according to the FDA , the American Academy of Dermatology and other experts, there is minimal evidence that systemic absorption of these ingredients is toxic or harmful to health. There is, however, a mountain of proof regarding the harmful effects of sunburn – most notably its significant contribution to the risk of melanoma.

“Use of a broad-spectrum, SPF 30 sunscreen effectively blocks UVB and UVA rays to prevent sunburn,” says Dr. Andrea Murina, MD , associate professor of dermatology at Tulane University School of Medicine and director of the University Medical Center’s dermatology clinics. “This not only reduces the risk of developing skin cancer but also decreases signs of early aging on your skin (such as wrinkles, age spots, sagging skin) and stops existing melasma from darkening and new patches from appearing.”

According to Dr. Murina, while we know some ingredients in sunscreen do cross over into the bloodstream, most are rated by the FDA as GRASE, meaning generally recognized as safe and effective.

A bit of background: Earlier studies conducted by the FDA showed that common chemical ingredients used in sunscreen, including oxybenzone are absorbed into the bloodstream.

Further research on whether systemic absorption of oxybenzone was an actual concern was suggested. However, no clear links to any health problems in humans were identified.

Nevertheless, the ingredient has been eliminated from most sunscreens currently being manufactured, making it easy to find an oxybenzone-free product.

When applied correctly, a water-resistant, SPF 30 sunscreen is optimal, blocking 97% of UVB rays. “A higher SPF is fine, but only incrementally blocks more rays, and the time and duration of effectiveness is the same,” says Murina.

The best way to protect yourself is by using a combination of measures:

Wear sun-protective clothing, including a lightweight, loose-fitting, long-sleeved shirt, pants, a wide-brimmed hat and sunglasses. Darker colors, densely woven cloth, unbleached cotton and shiny polyesters are recommended by the Skin Cancer Foundation .
Judiciously apply broad-spectrum sunscreen every two hours on uncovered body parts, such as top of hands, face, neck and ears.
Swap out regular SPF 15 foundation for a tinted sunscreen. “There are so many cosmetically elegant ones available today that mimic the look of makeup but offer much more protection,” says Murina. Tinted sunscreens with an SPF of 30 or higher provide protection that blends well with all types of natural skin tones, and help prevent exposure to both UV rays and visible light from the sun.
Seek shade when the sun’s rays are strongest, between 10:00 a.m. and 2:00 p.m.

Like sunscreen, sunglasses are vital in blocking the harmful effects of UV radiation. UVA and UVB rays can cause increased risk of conditions such as cataracts, eye cancers and growths on the eye, as well as premature aging of the delicate skin around your eye. Choose sunglasses that block 99% or 100% of all UV light or are listed as having UV absorption up to 400nm. Wear them even when it’s hazy or cloudy, as UV light can pass right through clouds. And although you’ve undoubtedly heard this piece of advice before, it bears repeating: To protect your retina, never look directly at the sun.

Finally, drink up when you’re out in the sun. Water is the elixir of choice, helping to lower your body temperature and replace the fluids you lose through sweating. This is particularly important for older adults whose body’s fluid reserve becomes smaller and thirst sense decreases as they age. Be aware of the most common signs of dehydration – lightheadedness, fatigue, dizziness, less frequent urination, dark-colored urine – and rehydrate promptly with cool water.

Safe Travels:

If your summer vacation includes international travel, we recommend some healthy pre-planning that includes the following:

COVID-19: Make sure you are up to date with your vaccines and boosters. Get tested for COVID-19 as close to the time of your departure as possible (no more than three days before travel). Do not travel if you have COVID-19 symptoms, if you tested positive or if you are in quarantine due to possible exposure.
Check the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) websites for the most up-to-date travel alerts, advisories and recommendations. Immunizations needed will vary based on your health condition, immunization history, countries and regions on your itinerary, and duration of your visit.
Update your routine immunizations to protect against increased risk of exposure to illnesses such as seasonal flu, diphtheria, varicella (chickenpox), measles, mumps and rubella. For quick guidance on additional immunizations you may need, try the online tool at GlobalTravEpiNet.
To protect yourself from the serious diseases spread by mosquitos, such as dengue fever and malaria, bring an EPA-registered insect repellent with an active ingredient like DEET or picaridin.
Pack your prescription medications and consider bringing over-the-counter medicines, including anti-diarrheal medicine, antacid, antihistamine, hydrocortisone cream, motion sickness medicine, cough medicine, pain and fever medicine, and mild laxative.
Also, pack supplies to prevent illness or injury, such as hand sanitizer, water purification tablets, insect repellent and sunscreen; and first aid items such as antibacterial ointment, antiseptic wound cleanser, aloe gel, insect bite cream, a digital thermometer and bandages.

We encourage you to contact your health care provider four to six weeks prior to your trip for personalized guidance … and we wish you a safe and memorable journey!

Sources: FDA , American Academy of Dermatology , Mayo Clinic , American Academy of Ophthalmology , U.S. Centers for Disease Control and Prevention , Skin Cancer Foundation

Summer Fruits and Veggies

info@digitallm.com (digitalLM Staff) — Tue, 19 Jul 2022 18:15:51 GMT

Picking the Season’s Prime Produce

A seasonal bounty of fruits and vegetables is in bloom everywhere from your grocery’s fresh foods section to local farmers’ markets, and in your own backyard garden. The following is advice from experts on how to purchase summer fruits and veggies at its peak, and store them safely, until ready to enjoy.

Berries and Cherries. Look for plump, unblemished fruits with no dark spots or fuzzy white mold; raspberries, blackberries and strawberries should be fragrant. All are shiny when ripe – except for blueberries, which will have a dull matte finish. While most berries can be refrigerated for up to a week, raspberries can start fading more quickly; when that occurs, The Spruce Eats recommends freezing them for use in smoothies and other recipes. To extend their life, do not wash fruit when you unpack your groceries; wait until right before you eat them.

Corn. Choose uncut silks coming out of tightly closed, bright green husks that smell slightly grassy, advises Martha Stewart; and peel back a tad to make sure the kernels look plump and healthy. Refrigerate corn with husks on and use as soon as possible.

Cucumbers and Peppers. Look for firm, shiny vegetables without blemishes, wrinkles or soft spots. According to Have a Plant, cucumbers and peppers can be refrigerated in a plastic bag for up to one week.

Grapes. Choose firm, plump grapes with green healthy stems. They can last up to two weeks when refrigerated. Or try an easy frozen treat: Place on a baking sheet; freeze until firm, and enjoy. Store leftovers in a freezer-safe bag for up to 12 months.

Lettuces. Eliminate those with wilted or broken leaves. Lettuce can be stored for up to four days when refrigerated; darker lettuces tend to last longer than pale, tender varieties. Wash all lettuces just before using.

Melons. Select watermelons without flat sides or dents, and choose ones with a heavy weight for optimal juiciness. Cantaloupe and honeydew melons are best when they have a pale yellow rind and flowery smell at the stem. Harvest to Table recommends storing whole ripe melons in the refrigerator for up to a week to avoid spoiling; cut melons will keep for up to three days.

Plums, Nectarines, Peaches. Opt for vibrant colors, a firm feel, and beautifully fragrant aroma for nectarines and peaches. Store unripe plums, nectarines and peaches in a paper bag until ripe. When ripe, peaches and nectarines can be stored at room temperature for use within a few days; plums can be kept fresh for up to five days in the refrigerator.

Tomatoes. Pick vividly colored, medium-firm tomatoes with smooth, shiny skin. To preserve the freshness and natural flavor of unripe tomatoes, Master Class recommends storing them on a countertop away from direct sunlight. They will last a week on countertops and up to two weeks if stored in the refrigerator.

Zucchini and Summer Squash. Look for smooth-skinned, small to medium size vegetables. Eating Well advises storing zucchini in the crisper drawer of your refrigerator, in either a plastic or paper bag with one end open to ensure good ventilation.

Mouthwatering Bites

Rightly renowned as abundant sources of vitamins, minerals and fiber, much of summer produce is water-rich as well, helping you stay hydrated in the heat, including these:

Contain 90–96% water

Broccoli
Cantaloupe
Celery
Cucumber
Eggplant
Green bell pepper
Honeydew
Lettuces (iceberg, spinach)
Radish
Strawberries
Tomato
Watermelon
Zucchini

Contain 83–90% water

Apple
Apricot
Blackberries
Cherries
Grapes
Mango
Orange
Papaya
Peach
Pineapple
Plum

Source: USDA

Reframing Nutrition, Part II

Mon, 11 Jul 2022 20:47:33 GMT

Erin Murray is back for her much anticipated part II of her previous webinar with on Reframing Nutrition. Most nutrition problems aren’t just an issue of willpower. The way we often think about food, diets, and our bodies is actually the wrong framework. To successfully get healthy, and stay healthy, we must rethink the way we think about food and the role it plays in our life. This workshop will introduce viewers to a new framework for their nutrition and behavior and offer them insight into how they can completely renew their love for food and their bodies by cultivating a nourishing lifestyle. Additionally, Erin will explore the ways that various nutrients and lifestyle practices can promote “deep health” — a more profound level of wellness that promotes longevity, biological optimization, and physiological wellbeing. Please join Erin Murray and our LCG doctors for part II.

Exercise - Prove It To Me

Mon, 06 Jun 2022 20:17:19 GMT

Our own nurse practitioner Jonathan Gerbode-Grant brings his years of experience as an endurance athlete, coach, mentor and healthcare provider to describe an overview of the multisystem benefits of exercise and how it can improve your quality of life.

Want to set up an exercise consult or testing with the Lown Cardiology Group? Reach out to us by phone (617) 732-1318

See Jonathan's sources HERE

The Aging Brain

Thu, 14 Apr 2022 20:20:30 GMT

Changes in memory and thinking? “It’s no more than you’d expect when you get old…” You have probably heard similar words. Perhaps you have said them about yourself or a family member or a friend. Perhaps somebody has said them about you. The truth is that there are many misconceptions about the effects of age on the brain. What is normal and what is not? Are there things we can do to keep our brains functioning well in old age? What should you do if you are concerned about yourself or somebody else? Join us for the answers to these questions and more.

HealthinAging.org – for practical advice on health and aging from the American Geriatrics Society’s Health in Aging Foundation.
Alz.org – for lots of information about various types of cognitive impairment, including mild impairment and dementia, especially but not exclusively related to Alzheimer’s Disease.
https://www.nia.nih.gov/health/cognitive-health - for more information on understanding normal aging related changes in memory, compared to abnormal changes.

What’s Keeping You Up at Night?

info@digitallm.com (digitalLM Staff) — Thu, 07 Apr 2022 04:37:49 GMT

Breaking the Cycle of Anxiety, Insomnia and Sleep Anxiety

A good night’s sleep does more than refresh and revitalize. It’s essential to your health, so make it a priority to understand what’s keeping you up at night.

“Healthy sleep is as important as proper nutrition and regular exercise for our physical and mental well-being,” says Kannan Ramar, MD , sleep medicine physician at the Mayo Clinic’s Center for Sleep Medicine and immediate past president of the American Academy of Sleep Medicine . “Lack of sufficient sleep is associated with increased risks of type 2 diabetes, high blood pressure, cardiovascular disease, depression and anxiety.”

The sleepless nights and drowsy days previously experienced by one out of three Americans with insomnia rose to pandemic highs of almost 60% in 2021, sounding a wake-up call to address this treatable condition which profoundly impacts both mental and physical well-being.

Sleep disturbance is intricately interconnected with the presence of issues such as anxiety and depression, each influencing the others, so it’s not always possible to determine which came first. Behavioral changes that result from chronic insomnia include feelings of being overwhelmed, inability to concentrate, irritability, nervousness, restlessness, and a sense of impending danger or doom.

Of adults diagnosed with depression, 75% experience insomnia and 20% have obstructive sleep apnea. Similarly, anxiety can make it harder for the body to relax and fall asleep.

Research suggests that anxiety can also affect rapid eye movement (REM) during slumber and trigger vivid, disturbing dreams that wake the sleeper.

Completing the loop is sleep anxiety — apprehension or fear about going to sleep — which is commonly seen in those with insomnia, narcolepsy, sleep apnea or restless legs syndrome.

While insomnia can seem never-ending, a number of strategies can effectively break the cycle.

The Basics:

Set boundaries for blue light exposure by turning off tv, tablets and phones at least 30 minutes before bedtime.
Limit large meals, caffeine and alcohol within 3 to 4 hours of bedtime, which can disrupt sleep. Alcohol allows you to fall asleep quickly but not stay asleep throughout the night.
Establish a consistent wake-up time seven days a week.
Ensure your bedroom is a designated place of sleep by keeping it dark, cool and quiet. And turn around your clock so you can’t see the time if you’re tossing and turning in the middle of the night.
Pursue support if you are experiencing chronic insomnia, defined as difficulty sleeping three or more times per week for at least three months. “We know that the longer insomnia lasts, the more difficult it is to treat,” says Dr. Ramar.

Support can include:

Cognitive behavioral therapy for insomnia (CBTI), a form of talk therapy focused on learning how to create an optimal sleep environment with positive bedtime routines and avoidance of factors that trigger anxiety and negative thinking. Requiring up to 12 weeks to see results, the key is shifting from “trying hard to sleep” to “allowing sleep to happen,” according to Stanford Health .
Prescription sleep hypnotics, such as Ambien or Lunesta. Hypnotics can be considered in conjunction with CBTI, but patients must be closely monitored for adverse effects and a buildup of tolerance to the medication’s effects. Low doses of Trazodone, an antidepressant, are sometimes used, as it causes drowsiness.
Light therapy, which is especially helpful for those who need to reset their circadian rhythms; e.g., a night owl who wants to function better with an early morning rising time.

If you are experiencing too many wakeful nights, please let your healthcare provider know. It may be helpful to keep a sleep diary for several weeks to help pinpoint the habits affecting your ability to fall and stay asleep. In some cases, we may recommend a polysomnography (sleep study), where you’ll be monitored for blood oxygen levels, body position, breathing, electrical activity in the brain, eye and leg movements, heart rates and rhythms, sleep stages and snoring during an overnight stay in a sleep lab.

Finally, keep in mind that the amount of sleep needed per night – typically 7 or 8 hours on average - varies by individual. “If you function well and are fully alert during the day, you can be confident your sleep needs are being met,” says Dr. Ramar.

What Does BMI Really Tell Us?

info@digitallm.com (digitalLM Staff) — Thu, 07 Apr 2022 04:37:45 GMT

Definitive Diagnostic Tool or Part of a Greater Health Matrix?

It’s an easily understood calculation: Body Mass Index , popularly known as BMI, computes an individual’s measure of body fat as weight in kilograms divided by height in meters squared. Levels are defined as Underweight if less than 18.5, Normal weight if between 18.5 and 24.9, Overweight if between 25.0 and 29.9, and Obese if above 30. But what does BMI really tell us?

This simple formula has nonetheless sparked controversy and continued questioning: Is BMI a quick, easy and efficient way to identify weight problems and associated risk of disease in adults? Or is it an inaccurate measure because it doesn’t consider body composition, age, sex or ethnicity?

Years of debate, research and analysis now point to using BMI in a more nuanced way, suggesting that it is best employed as just one part of an initial health screening for individuals, and not as a diagnostic tool. Much more meaningful is how BMI fits with other essential measures of an individual’s health — blood pressure, blood sugar, cholesterol levels, heart rate, inflammation, physical activity, diet, cigarette smoking and family history.

Looking at BMI alone can be misleading when you consider that:

Women tend to have more body fat than men.
Older adults have more body fat than younger ones. Aging is associated with an unhealthy increase in body fat and an associated increased risk for prediabetes and type 2 diabetes.
At the same BMI, the metabolic risks for people of Asian descent are higher than for Caucasians.
People who engage in strength training two or more times per week have higher lean muscle mass than nonathletes, which can result in a higher BMI but not necessarily a higher risk of disease.

Additionally, knowing where the fat is distributed is essential in determining disease risk. The pear shape associated with women means subcutaneous fat around the hips, thighs and buttocks; more dangerous is the apple shape, which indicates visceral fat in the abdomen (waist circumference of more than 40 inches for men or more than 35 inches for nonpregnant women), which is linked to higher risk of heart disease and type 2 diabetes.

An influential study published in Nature further revealed the flaws in categorizing people as “unhealthy” or “healthy” based on BMI alone. The authors found that more than 74 million American adults were miscategorized. Nearly half of people considered overweight and 29% of those categorized as obese were actually metabolically healthy, with normal blood pressure, cholesterol and blood glucose levels. Meanwhile, 30% of those considered “normal weight” had metabolic or heart issues.

The origins of BMI help explain its limitations. In the 1830s Belgian mathematician Lambert Adolphe Jacques Quetelet developed a test intended to identify the “l'homme moyen,” or the “average man,” by taking the measurements of thousands of Western European men and comparing them to find the ideal weight. More than a century later, American physiologist and dietician Ancel Keys promoted Quetelet’s Index as the best available way to quickly screen for obesity, identifying certain BMI ranges as associated with greater risk of disease and poor health outcomes. However, like Quetelet, Keys didn’t account for different body types or ethnicities.

One other point to consider: While more intrusive and not as commonly available, methods such as measuring skinfold thicknesses, bioelectrical impedance, underwater weighing, abdominal CT scans (for visceral fat) and dual-energy X-ray absorption are more accurate than BMI for estimating body fat.

So is BMI still meaningful?

As a discussion point, or as one tool used in combination with other assessments of metabolic and skeletal health, it can be useful.

Most importantly, body fat is just one of many factors considered when evaluating individual health and risk of disease.

We encourage you to call your healthcare provider to discuss your personal wellness profile.

Exercise Is Good Medicine

info@digitallm.com (digitalLM Staff) — Thu, 07 Apr 2022 04:37:43 GMT

Get Up and Join the Movement

As we emerge from the doldrums of winter hibernation and COVID-19-related inertia, it’s important to remember that exercise is good medicine and there’s no better time than now, to get moving again.

“There isn’t a chronic condition that can’t be better managed with an appropriate dose of exercise,” asserts Dr. Cedric Bryant* , President and Chief Science Officer at the American Council on Exercise . “This requires good interaction with your physician, an ability to listen smartly to your body and the realization that some exercise is always better than none.”

He recommends fostering good muscular fitness and enhancing strength, flexibility and balance with the exercise routine shown below. The 15-minute investment of time needed to complete one set of 8 to 15 repetitions for each exercise provides beginners with “the minimum effective dose needed to elicit a very positive response,” says Dr. Bryant.

Add regular rounds of exercise that build endurance, helping improve the health of your heart, lungs and circulatory system. To achieve the best results, you should have enough breath to talk but not enough to sing during aerobic activities such as brisk walking or jogging, dancing, biking, swimming, climbing stairs, or playing basketball, tennis or the uber-popular pickleball. (Learn more about today’s fastest-growing sport in an upcoming newsletter.) Be sure and check with your healthcare provider before beginning an exercise program.

Dr. Bryant’s Essential Seven

1. Pushups

Benefits: Develop the large muscles of the chest and the back of arms

The basic incline pushup is done using a sturdy table or other solid surface about 3 feet high. Stand facing the table and place your hands on the edge (shoulder width apart) arms straight and elbows not locked. Walk your feet backward until your arms and body are in a straight line. Bend elbows and slowly lower chest to the edge of the table while inhaling. Keep body straight and rigid throughout the movement. Push body away from the table until elbows are extended but not locked. Exhale as you push up.

2. Bodyweight Squat

Benefits: Strengthens and tones the lower body

Stand with your feet slightly more than hip width apart, toes turned slightly outward, hands at sides with palms facing in. Pull shoulders down and back. Stiffen your core and abdominal muscles. Hold chest up and out, tilt head slightly up, shift weight back onto your heels while pushing hips toward the wall behind you.

Downward phase: Shift hips back then down to create a hinge-like movement at hips and knees. Try to control the amount of forward movement of the shinbones. Maintain tension in the core muscles and keep your back straight. Lower yourself until thighs are parallel or almost parallel with the floor. DO NOT go deep enough to cause pain. Make sure your feet don’t move, ankles don’t collapse in or out, knees remain aligned over the second toe, and body weight is evenly distributed between balls and heels of the feet.

Upward phase: Extend the hips and knees by pushing your feet into the floor. Hips and torso should rise together while heels are flat on floor and knees are aligned over the second toe. Continue extending until you reach the starting position.

Remember to inhale on the way down and exhale on the way back up.

3. Bent-Over Row

Benefits: Targets muscles in the upper and middle back and improves stability of the spine

Holding a small weight in each hand and standing with feet hip-distance apart, bend at the waist. Your back should be parallel to the floor with a neutral, not rounded, spine. Extend arms toward floor, keeping knees slightly bent. Engage abs and squeeze shoulder blades together as you bend elbows back and bring weights to your torso. Keep arms close to your torso. Slowly lower the weights back to the starting position.

4. Modified Single-Leg Deadlift

Benefits: Strengthens and tones gluteals and helps improve balance

Position yourself by a wall or chair. Stand straight, with feet aligned with hips, and shift weight to right leg. Slowly bend forward at the waist while raising your left leg behind you until your torso and leg are both parallel to the floor. Keep your head up and arms straight, perpendicular to the floor. Lower your leg as you return to an upright position. Keep your leg straight at all times. Repeat all reps on one side, then switch legs.

5. Overhead Front Press

Benefits: Increases shoulder strength and engages the core for stability

Stand upright and keep the back straight. Note: Beginners or those with back issues can perform this exercise seated. Hold a small weight in each hand at the shoulders, with an overhand grip. Thumbs are on the inside and knuckles face up. Exhale as you raise the

weights above the head in a controlled motion. Pause briefly at the top of the motion. Inhale and return the weights to your shoulders.

6. Calf Raises

Benefits: Strengthen lower leg muscles, increase stability, balance and agility

Start by standing 6 to 12 inches away from a wall, facing it, with feet hip width apart. Extend arms to place your palms on the wall, level with chest or shoulders. Exhale and slowly lift heels off the floor, keeping knees extended without rotating your feet. Use your hands on the wall to support your body. Hold raised position briefly. Inhale and slowly lower heels back to the floor.

7. Plank Pose

Benefits: Strengthens the core and abdominals while increasing stability and balance

Modified version: Start in tabletop position with hands and knees on the floor. Walk your hands so your forearms and palms are facing down, keep shoulders and elbows aligned. Walk your knees away from your body until you feel your core and abdominals engaged. Keep torso straight and rigid, your body in a straight line from ears to knees with no sagging or bending, and with shoulders down, not creeping up toward your ears. You may keep your toes on the floor for extra support. Hold position for 10 seconds. Walk your knees back in, repeat. Over time, work up to 30, 45 or 60 seconds.

*As President and Chief Science Officer at the American Council on Exercise, Cedric X. Bryant, PH.D and Fellow of the American College of Sports Medicine, stewards the organization’s exercise-science and behavior-change education. He earned both his doctorate in physiology and master's degree in exercise science from Pennsylvania State University, where he received the Penn State Alumni Fellow Award, the school's highest alumni honor.

Sources/refer to these websites for more detailed descriptions on the exercises : American Council on Exercise , Verywell Fit , Women’s Health

Reframing Nutrition, Part I

Wed, 02 Feb 2022 21:43:27 GMT

Most nutrition problems aren’t just an issue of willpower. The way we often think about food, diets, and our bodies is actually the wrong framework. To successfully get healthy, and stay healthy, we must rethink the way we think about food and the role it plays in our life. This workshop will introduce viewers to a new framework for their nutrition and behavior, and offer them insight into how they can completely renew their love for food and their bodies. Please join Erin Murray and our LCG doctors for this talk.

Want to learn more?

Check out Erin's Podcast "Uncommon Living" on
Apple Podcasts: https://podcasts.apple.com/us/podcast/uncommon-living/id1603907345

or on
Spotify: https://open.spotify.com/show/1YmX3uxHBjbUMVnWBOAcT

See the links below for Erin's Contact information and social media

Email: erin@erinmurraywellness.com

Website: erinmurraywellness.com

Instagram: @erinsuncommoneats

A Novel Approach to Behavior Change

info@digitallm.com (digitalLM Staff) — Mon, 31 Jan 2022 10:38:50 GMT

How to Replace Bad Habits with Healthy, Sustainable Behaviors

For entrepreneur physician Kyra Bobinet, MD, the typical reasons behind a failed diet served as the impetus for developing a novel approach to behavior change.

“I was doing so well. I knew what to eat, when to eat, how to eat, and then I just stopped doing it…and I don’t know why.”

Her answer to a patient’s familiar lament above, called the Iterative Mindset ^TM , is now used by the U.S. Centers for Disease Control and Prevention ( CDC ) to enhance its diabetes prevention program.

Drawing on her neuroscience and medical training at the UCSF School of Medicine and Harvard T.H. Chan School of Public Health , Bobinet conducted years of field research aimed at eliminating the inevitable gap between intention and action. What she discovered was a way to change even the most intractable bad habits and permanently replace them with healthy, sustainable ones.

The Iterative Mindset, Bobinet asserts, is the key to people who succeed despite seemingly insurmountable odds. In her early work helping frontline Walmart employees manage conditions such as obesity, cardiac disease and diabetes, she observed that only a small percentage of people were able to achieve the necessary lifestyle changes. Notably, they faced every possible headwind of financial and social stress – single parenting, senior caregiving, food insecurity and lack of healthcare access.

“Nonetheless, they somehow were able to lose weight, get off their medications, and dramatically improve their health,” she recounts. “We looked and looked, but the only common link between them was the Iterative Mindset, a resilient way of approaching behavior change like an experiment - with curiosity, innovation and no failure or blame if it doesn’t work out as planned.”

It's a stark contrast with the way most people view their failure to change longstanding habits. Bobinet describes why: “The habenula, a recently characterized area of the thalamus, has two functions – detecting failure and then, if you think you failed, suppressing your motivation to keep trying. By activating whenever you believe you’ve failed to reach a goal, the habenula places you in a state of learned helplessness, associated with higher depression and low self-efficacy. This is when most people give up and bad choices ensue.”

She posits that those who form new habits by continually trying again in different ways, or iterating, are able to bypass that switch in the brain. An iterative mindset can succeed where the performance mindset, used for SMART (specific, measurable, achievable, relevant, time-based) goals or tracking steps with wearable devices, sometimes cannot.

“Performance mindset works well to motivate for tasks that are short-lived, and for optimization, such as athletes who have already experienced a substantial success and want to strive for the next level,” says Bobinet. “However, it can be detrimental when used to modify behaviors in more vulnerable people, setting them up for an eventual win or lose situation that triggers feelings of failure and causes loss of motivation to keep trying.”

True change only happens when a new behavior turns into a habit, repeated so frequently it grows to be automatic, and by definition becomes part of your lifestyle, says Bobinet. The process can take up to two years, with multiple relapses an expected part of the process.

“It’s completely natural to relapse when you’re stressed or distracted; it's how fast you get back in motion that counts. And you cannot fail as long as you iterate,” emphasizes Bobinet. “Don’t blame yourself, blame what you tried—it wasn’t the right thing right now. Think of it as an experiment that needs tweaking and continue to version until you find the right fit for you.”

If you’re interested in trying this mindset approach to behavior change, Dr. Bobinet offers a free basic Fresh Tri app through the Apple App Store and Google Play.

Staying Well in the New Year

info@digitallm.com (digitalLM Staff) — Mon, 31 Jan 2022 10:38:47 GMT

A Proactive Guide

In the spirit of starting 2022 with [MK1] [MM2] healthy intention, we’ve taken a page from the U.S. Preventive Services Task Force ( USPSTF ) latest recommendations, long considered the gold standard for clinical preventive services, and prepared the following proactive guide to staying well in the new year.

Back in 1903, Thomas Edison predicted where we were headed: “The doctor of the future will give no medicine but will instruct his patient in the care of the human frame, in diet, and the cause and prevention of disease.”

While we have yet to reach the future envisioned by Edison, preventive care, relegated to the back seat during the pandemic, is in full gear once again.

Since 1984, the USPSTF team of volunteer, independent experts in internal medicine, family medicine, pediatrics, behavioral health, obstetrics/gynecology and nursing has conducted rigorous assessments of the scientific evidence for the effectiveness of a broad range of preventive screening, counseling and medications. Their findings, published in the Journal of the American Medical Association , laid the foundation for preventive medicine in primary care, from when to get your first colonoscopy to whether an aspirin a day is really the best way to keep a heart attack at bay.

A number of USPSTF recommendations have changed significantly over the years, guided by evolving science and clinical experience. In 2021, these changes included lowering the screening age for diabetes from age 40 to 35, lowering the age for colorectal cancer screening from age 50 to 45, and strongly discouraging people over 60 from taking a low-dose aspirin each day to prevent a first cardiovascular (CV) event. As recently noted by the advisory board, this doesn’t represent a flip-flop or misfire, but rather necessary updates based on new research. So, for example, when the latest evidence showed the increased risk of gastrointestinal or brain bleeds in certain populations from taking a daily aspirin to prevent CV disease, the panel reviewed, reconsidered and drafted a revision to its 2016 recommendation. Similarly, when data pointed to the incidence of diabetes increasing at age 35 and the benefits of lifestyle interventions for reducing progression from prediabetes to the more serious type 2, the USPSTF revised accordingly.

What’s on the radar for the USPSTF? Recommendations being studied now for potential updates include statin use for the prevention of CV disease; vitamin, mineral and multivitamin supplementation to prevent CV disease and cancer; behavioral counseling interventions for prevention of CV disease in low-risk adults; hormone therapy to prevent chronic conditions in postmenopausal women; effectiveness of screening for depression, eating disorders, obstructive sleep apnea, skin cancer, osteoporosis, glaucoma and atrial fibrillation; and a comparison of breast cancer screening methods. Stay tuned for new developments.

An Ounce of Prevention

Following are the latest USPSTF preventive medicine recommendations, intended for people without symptoms of the disease. As always, please consult with our office for guidance based on your personal health situation.

Eating Your Fruits and Veggies May Help Reduce the Risk of Chronic Disease

info@digitallm.com (digitalLM Staff) — Mon, 31 Jan 2022 10:38:45 GMT

Color Your World with Every Hue of Fruit and Vegetable

Fill your plate with a vibrant, colorful array of fruits and vegetables for a naturally delicious way to meet your daily requirement of vitamins, minerals and nutrients. Plant foods contain thousands of natural compounds called phytonutrients, which may have anti-inflammatory benefits that can help reduce the risk of chronic diseases. Every color has a contribution to make – aim for a few different ones each day, and enjoy the entire spectrum.

Red and pink:

These fruits and vegetables are an abundant source of the carotenoid lycopene, which may help balance free radical activity in the body, offering protection against prostate cancer and heart and lung disease. Additional picks: red onions, persimmons and raspberries.

Orange and yellow:

Enjoy an extra boost of beta cryptoxanthin, which supports intracellular communication and may help prevent heart disease. Orange and yellow fruits and vegetables also contain vitamin C and carotenoids, including beta-carotene, which is associated with promoting healthy vision and cell growth. Additional picks: pomelos, turmeric root and star fruit.

Green:

These are some of the healthiest fruits and vegetables, rich in chemicals like sulforaphane, isocyanate and indoles, which may inhibit the action of carcinogens. Dark green and leafy vegetables have the highest concentration of both antioxidants and fiber. They’re also packed with potassium, lutein , isothiocyanates, isoflavones and vitamin K, which can be important for vision, bone and blood health. Greens like kale have as much calcium as milk. Additional picks: Swiss chard, arugula, zucchini, edamame, alfalfa sprouts and green herbs (mint, rosemary, sage, thyme and basil).

Blue and purple:

Anthocyanins – powerful antioxidants that may help delay cellular aging, block the formation of blood clots and boost urinary tract health – abound in these fruits and veggies. Additional picks: beetroot, radishes and purple cabbage.

White:

These foods may not be as brightly hued as the others, but they shine with valuable phytonutrients. These include the potentially anti-tumor properties of allicin and quercetin, found in garlic and onions; the healthy compound sulforaphane in the cruciferous cauliflower; and immune-supporting selenium in mushrooms. Additional picks: leeks, white beans (cannellini, navy beans, lima beans, soybeans), lychees, white peaches and daikon radish.

Sources: American Heart Association , Rush.edu , Harvard Health

Migraine, Headache and Brain Health

Thu, 27 Jan 2022 16:11:49 GMT

Dr. Bernstein, a neurologist and headache specialist, will review migraine, explain what causes it, and discuss how a migraine is different than a typical headache. She will review acute and preventive treatments for migraine including explaining the newer biologic targeted medications.

She'll discuss non-pharmacologic treatments and then will explain how you can help to keep your brain healthy and will demonstrate techniques for falling asleep and for decreasing stress. Anyone who gets migraines, knows someone with migraine or is interested in brain health and wellness will find this talk helpful.

Better Sleep: Understanding Insomnia and Treatment options with Dr. Eric Zhou

Wed, 12 Jan 2022 21:47:24 GMT

Sleep disorders are common among adults in the US, but often overlooked as a major factor contributing to a patient’s overall health and well-being. We discuss the reasons why it is critical to think about your sleep health and evidence-based approaches for insomnia disorder.

Resources

https://behavioralsleep.org/

AASM Behavioral and Psychological Treatments for Chronic Insomnia Disorder in Adults

Books that Dr. Zhou mentioned:
- Cognitive Behavioral Treatment of Insomnia A Session-By-Session Guide
- The Insomnia Workbook: A Comprehensive Guide to Getting the Sleep You Need by Stephanie Silberman

Below are some questions we didn’t get to today that Dr. Zhou has generously answered after the webinar for us.

Q: both my husband and my son have always had an extremely difficult time falling asleep. (hours or lying awake) Is there hope for them.
A: Absolutely. This is a common struggle for patients with insomnia.

Q: Does pure zzz or zquil work and is it safe to take on a regular basis
A: Consult with your medical providers. The active ingredient in ZZZQuil is diphenhydramine, which is an antihistamine. This is generally not an advised long-term solution for insomnia.

Q: How do you go about addressing polypharmacy in older adults that have been taking sleep meds for a long time, but now may cause harmful effects, for example, overnight fall risk?
A: Consult with your prescriber, ideally a geriatric psychiatrist.

Q: A question about the chart—the light blue at the top and the bottom are ok if you are feeling ok if you are not sleepy during the day?
A: Correct. If you feel good, sleep is consistent, then the light blue shows what is possible (and less common) for sleep need by age.

Q: Is it helpful to reset a sleep schedule? If exhaustion forces you to go to bed at 9 pm which results in waking up at 2 am, will forcing yourself to remain awake later in the evening, perhaps 11 pm, will that help in realizing a longer, better quality sleep period?
A: Needing to reset frequently is an issue. It should be something done once, perhaps, during CBT-I.

Q: Within CBT-I, are there different approaches for trouble falling asleep right away vs trouble waking in the middle of the night and not being able to get back to sleep?
A: Yes, the approach would depend on your individual challenges.

Demystifying Medical Cannabis (ie. Marijuana) with Dr. Ben Caplan

Tue, 21 Dec 2021 21:42:39 GMT

This discussion will be an introduction to the modern world of medical cannabis (ie marijuana.)

Why might someone benefit from the use of cannabis?
What is the difference between “medical” and “adult use” or “recreational” cannabis?
Who is eligible to have a medical card?
What are the advantages?
What choices are available to those who want to explore cannabis therapies?
Is it expensive?

Join the discussion of these, and any other questions people have in this open-forum webinar, and come meet Dr. Caplan, who was recently voted one of the 100 most influential people in Cannabis - and the only practicing physician on the list!

Resources Dr. Caplan has provided:

CED Clinic
Your First Visit: Your First Visit at Our MA Medical Cannabis Clinic - CED Clinic - CED Clinic
Accepting New Patients (telemedicine): Book an appointment
Contact: 617-500-3595 hello@CEDclinic.com

CED clinic YouTube

Dr. Ben Caplan on Twitter

Dr. Ben Caplan on LinkedIn

***Click for more information, links, resources, articles from Dr. Caplan ***

Find Your Motivation and Use It with Dr. Lisa Lewis

Wed, 01 Dec 2021 22:21:48 GMT

Do you want to exercise more, eat better, and improve your healthy habits, but feel a lack of motivation to get going, or to keep momentum? If so, this webinar is for you! Motivation comes in many forms, and you can identify and leverage the types of motivation that you have, in order to get yourself on track, and more importantly, to keep yourself going over time. In this webinar, we'll review the nature of motivation, help you understand what motivates you, personally, and how to leverage those motives so that you can pursue and achieve your health and wellness goals.

Want to reach Dr. Lisa Lewis?
lisa@drlewisconsulting.com
617-903-8403
1368 Beacon St. Ste 108
Brookline, MA 02446

Check out her website

Follow her on Instagram

Resources and other related articles:
Pez Cycling News Blog: Use the Motivation That Moves You, Right Now
Hit Play Not Pause Podcast: Stoke Your Motivation with Dr. Lisa Lewis
Strength Radio Podcast: Dr. Lisa Lewis on the Mechanics of Motivation
Netflix recommendation: The Mind Explained "Mindfulness"

POTS: Diagnosing and treating this dizzying syndrome - Harvard Health

Tue, 02 Nov 2021 17:00:06 GMT

Part II: POTS: Diagnosing and treating this dizzying syndrome - Harvard Health

POTS: Diagnosing and treating this dizzying syndrome - Harvard Health

In Part II of this two-part series, Dr. Lee Lewis discusses the diagnosis and management of POTS”

Get Outside: How Environment Influences Your Cognition

Wed, 20 Oct 2021 21:02:26 GMT

In this webinar, Rachel Hopman-Droste, PhD will discuss the science underlying cognitive fatigue, mental distraction, and attention restoration from time spent in nature. Recent evidence suggests that short breaks in natural environments can significantly improve mood and decrease stress. Dr. Hopman-Droste's work has delved into neural signals of attention during multi-day trips in wild, outdoor environments to better understand the effects of time in nature. This ongoing research has also explored the relationship between physical activity and the outdoors to differentiate the environmental effects on attention and cognitive functioning. Dr. Hopman-Droste will provide key insights into the field of psychology research and recommendations to ensure you are getting the most out of your time outside.

Resources

Books:
- The Nature Fix by Florence Williams
-The Comfort Crisis by Michael Easter
-National Geographic: Power of the Parks 2016

Articles:
- Time Magazine: Just 15 minutes of Nature Can Make You Happier
- Outside Online: The New Science of the Creative Brain on Nature
- NPR: Ah, Wilderness! Nature Hike Could Unlock Your Imagination
- New York Times: Your Brain on Computers; Outdoors and Out of Reach, Studying the Brain

Want to participate or support the research?
Please call 617-373-8060 or email theignitestudy@gmail.com to participate

Healthier Eating

info@digitallm.com (digitalLM Staff) — Tue, 05 Oct 2021 07:52:10 GMT

How to Pare Down Protein & Cut Back Carbs

Inspired by a belief that our diets can be redefined to integrate both healthier eating and environmental responsibility, Menus of Change encourages a meaningful “flip” in the emphasis on animal proteins and highly processed carbohydrates to an emphasis on highly appealing alternatives.

Menus of Change, a collaboration of the Harvard T.H. Chan School of Public Health and the Culinary Institute of America (CIA), authors a creative approach to enjoying delicious, nutritional and sustainable foods: “ The Protein Flip ” and its companion, the

“Carbohydrate Flip.”

The Protein Flip, introduced in 2016, laid the groundwork for the Menus of Change health- oriented methodology, stating, “Higher intake of red meat, irrespective of its total fat content, increases risk of heart disease, stroke and diabetes when compared to poultry, fish, eggs, nuts, or legumes.”

The Menus of Change solution was to challenge chefs in every setting to place meat, poultry and seafood in a supporting role or as a side and make vegetables and plant proteins the stars – for example, burger blends composed of primarily mushrooms, other vegetables, grains or legumes; surf and turf reimagined as seafood with bountiful vegetables and only a bite or two of meat; use of tapas, mezze and other plant-forward small plate replacements for entrees. The public response was immensely gratifying, spurring further innovation and the mainstreaming of vegan options, such as lentil, barley and black bean burgers or wild rice polenta burgers made with mushrooms, carrots and leeks.

Building on their successful work with proteins, the collaborative is now developing a complementary program centered on advancing carbohydrate quality on the American plate. “From fluffy pancakes to soft hamburger buns, refined, fast-metabolizing carbohydrates are still found in many a diet and are contributing to the rise in diet-linked chronic conditions such as

diabetes and heart disease,” according to a recent Menus of Change summit panel discussion headed by Sarah Schutzberger, RD, CSO (certified in oncology nutrition). “In large part because of our food choices, scientists project that 75 percent of chronic diseases are attributable to diet and lifestyle.”

A substantial emphasis on whole, minimally processed carbohydrates can help change the trajectory, beginning with these flips described by the panel:

Take on the Three Pleasures challenge: Create a delicious dessert using dark chocolate, nuts, and fresh-cut or dried fruit. “Instead of forcing a choice between a whole slice of cheesecake with a single strawberry as garnish or a plain bowl of berries, enjoy a dessert made from a healthy market basket that includes dark chocolate, fruit, whole grains, nuts and yogurt,” advised Greg Drescher, Culinary Institute of America.
Look to world food cultures for inspiration:

o Mediterranean region: “This type of cooking features a healthy fat versus a low fat approach to diet, with olive oil as the foundation of flavor,” said Drescher. Try tabouli, made of cracked bulgur wheat, chopped parsley and olive oil, or a salad made with hydrated, whole-grain barley rusks, topped with chopped tomatoes and fresh feta cheese and tossed with olive oil. Also important: improve the health profile of pasta by using a whole-grain type and cooking al dente to make it a source of slower-releasing carbohydrates.

o France: The niçoise salad suggests ways to include potatoes in limited amounts by pairing with green beans and other vegetables, hard-boiled egg, and a light vinaigrette for a slow-metabolizing lunch.

o Asia and India: Try a salad featuring soba noodles made from buckwheat flour; a Buddha bowl with foundational ingredients that include legumes, fresh vegetables and plant proteins, paired with small amounts of salmon or roasted tofu; and whole-grain flatbreads.

Pandemic Inspires and Challenges Medical Innovation

info@digitallm.com (digitalLM Staff) — Tue, 05 Oct 2021 07:36:36 GMT

Pandemic Sparks Promising Future for Clinical Trial Speed and Flexibility

Like wartime medicine, the pandemic inspires and challenges medical innovation.

The silver lining of the pandemic is the reinvigorated sense of urgency breaking down cumbersome and expensive barriers to the FDA’s phased approval process . While the research- lab-to-patient-arm trials for the highly successful COVID-19 vaccines famously moved the traditional pace to warp speed, other critical and life-altering medicines, devices and therapies also broke through during this period.

To be clear, the current surge of medical innovation through clinical trials in immunology, cardiology, multiple sclerosis, oncology and more, is not the result of a rush-to-market panic. All necessary and appropriate testing protocols to ensure quality are still being achieved, but at a more expedient pace in many cases. This is the good news.

“In times of crisis, we can accelerate the development and review process,” explains Andrew Badley, MD, infectious disease specialist, Mayo Clinic. “Throughout the pandemic, many of these steps were accelerated. No steps were skipped. It was just the amount of effort that went into the development and the review that was increased.”

Of course, there is also some not-so-good news about clinical trials today. During the pandemic, the number of new studies launched dropped by as much as 57 percent, according to Trials Journal, and the overall completion rate of clinical trials decreased between 13 and 23 percent globally. Shifting research priorities (11 percent of studies shifted to pandemic-related trials in 2020) and initial challenges in recruiting and following up with volunteer patients during the global lockdown contributed to this decrease. Often, a clinical trial is tethered to an academic medical center with participants centered in one geographical area, limiting volunteer pools and access.

However, the future speed and flexibility of clinical trial protocols is very promising, reflecting the long-term viability of alterations made to the fabric of patient care and research during the pandemic. Some of the new flexibility that is being assessed and considered for permanent use includes:

Telemedicine. While telemedicine has been available for years, the lockdown most certainly fast-tracked adoption among researchers, regulators, physicians and patients. Clinical trial investigators can now use telemedicine for many patient check-ins, saving time and broadening the geography of volunteer pools. Dr. Ray Dorsey, a neurologist at the University of Rochester, noted in a recent article that his virtual clinical study of genetic predisposition to Parkinson’s disease moved forward more quickly amid the pandemic, spurred by a rising number of online enrollments.
Delivery. Like specialty pharmacies and physicians during lockdown, clinical trial investigators are now allowed to deliver trial medicine to volunteers.
Remote Access. Volunteer participants are able to use online platforms for completing consent forms, and they can often visit their local physician for basic assessments. Some trials also require less frequent check-ins, which can be important in recruiting volunteer patients. The growing number of smartphone-enabled applications that provide measurement of critical physiologic variables means patients don’t need to continually return to the hospital or clinic for tests during the trial. For instance, an entirely remote study testing vitamin D for treating COVID-19 and preventing transmission is being conducted by Brigham and Women’s Hospital; participants obtain their own blood samples with a finger prick, dot the blood drop onto filter paper supplied to them and mail it back.

The Clinical Trial Explainer

In the United States, the Food and Drug Administration (FDA) directs and approves all prescribed medicines, diets, diagnostics, devices and therapies. Clinical trials are the part of research that determines whether a medical intervention should be moved, or “translated,” from the lab to routine patient care. At each phase along the way, the team must answer different questions about safety, efficacy (whether the intervention works as intended) and whether there might be better options available. The current clinical trial journey to FDA approval, shown below, can take years, a mountain of paperwork and millions of dollars – there is room for improvement.

Preclinical phase establishes the pharmacological profile and determines toxicity on at least two animal species.
Phase I, a short study of 20 to 80 healthy people to determine safe treatment and dosing.
Phase II, a larger-scale study of targeted patients to determine treatment effectiveness and identify side effects; can take months to years to complete.
Phase III compares the trial intervention with existing therapies; requires several years of multiple data collection check-ins and comparisons. About 1 in 15 won’t make it past phase III.
FDA Review and Approval
Phase IV follows patients after therapy approval to ensure the intervention is working and prove the long-term benefits outweigh any risks or side effects.

Keep it Moving! But Is 10,000 Steps A Day The Right Goal?

info@digitallm.com (digitalLM Staff) — Tue, 05 Oct 2021 07:26:39 GMT

Are 12,000 steps better, or will 6,000 work equally well?

In the last decade, we’ve all been watching our step. From casual strollers in the park to purposeful striders in the mall, armed with phones, watches, wearables or pedometers, walkers are everywhere, tracking their daily tallies to reach the magical 10,000 step mark. However, as recently reported in Nature, few people are actually reaching it. The average number of steps achieved daily is approximately 5,000 worldwide and slightly lower in the U.S. at 4,800.

Do we all need to step up our efforts?

Or maybe we can all take a step back and consider how 10,000 steps a day became the holy grail of fitness walking - and why optimal outcomes may well be possible at lower numbers.

You may be surprised to learn that the number originated at the Tokyo Olympics in the 1960s with manpo-kei, Japanese pedometers, which were then marketed to the country’s walking enthusiasts. The term, which translates to ‘10,000 steps meter’ in English, gradually became the accepted standard for optimal fitness in the U.S. and was adopted by the American Heart Association. Identifying an achievable target number, posits Catrine Tudor-Locke, PhD, behavior researcher at the University of Massachusetts, was key to spreading the word about the health benefits of walking.

Dr. Michael Roizen , chief wellness officer at the Cleveland Clinic in Ohio, was an early booster of the 10,000 step goal, saying: “That specific number of steps seems to help break down insulin resistance, an underlying cause of Type 2 diabetes.”

Years of research followed building a solid case for the role of walking in lowering blood pressure, reducing risk of cardiovascular diseases and diabetes, improving cholesterol, enhancing mood and easing mental stress – with some finding that these could occur well below the 10,000-step threshold. Some of the most noteworthy studies:

A 2019 study published in the Journal of American Medical Association found that women in their 70s who walked only 4,400 steps a day reduced their risk of premature death by about 40 percent, compared to women completing 2,700 or fewer steps a day. The risks for early death continued to drop among the women walking more than 5,000 steps a day, but benefits plateaued at about 7,500 daily steps. Study leader Dr. I-Min Lee agrees that taking 10,000 steps a day can sound daunting. “But we found that even a modest increase in steps taken is tied to significantly lower mortality in older women,” she said. “Our study adds to a growing understanding of the importance of physical activity for health and amplifies the message: Step more—even a little more is helpful.”

Brigham and Women’s Hospital research showed that a brisk walking program nearly cut in half the risk of early death in breast cancer patients.

An American College of Cardiology study of 89,000 post-menopausal women over a 10-year period showed that walking for at least 40 minutes several times per week at an average to fast pace is associated with a near 25% drop in the risk of heart failure. "The benefit appears to be consistent regardless of a woman's body weight or whether she engages in other forms of exercise besides walking,” said Somwail Rasla, MD, study leader. “There may be a misconception that simply walking isn't enough, but our analysis shows we can reach a comparable energetic expenditure through walking that we gain from other types of physical activity."

A Harvard Health retrospective study including more than half a million participants found that those who walked regularly over the course of 11 years had a 30% reduction in risk of angina, heart attack or bypass surgery, as well as an overall 30% reduction in risk of death.

So is more better when it comes to stepping out? That depends on your health and wellness goals. Consider these options:

New to exercise or returning from injury

Start slowly to avoid burnout or further injury. Determine your baseline by measuring number of steps you take each day over the course of a week. The Mayo Clinic recommends adding 1,000 daily steps each week.

Weight management

While calorie reduction is the proven path to weight loss, completing 10,000 steps each day will burn additional calories, and is most effective at helping you stay at your desired weight.

Health maintenance

As a general goal, aim for at least 30 minutes of walking or other physical activity each day, either at one time or spread out in several short sessions. Keep in mind that any amount of activity is better than none, and accumulated activity throughout the day adds up to a health benefit. Try this method used by a popular wearable: take at least 250 steps each hour, and you may be able to add 1,000 to 2,000 steps per day to your total.

Walk with purpose because cadence matters. A walking pace around 100 steps a minute that leaves you slightly out of breath is recommended by experts. Not surprisingly, intensity counts too, so try a faster pace for short intervals, or walk up hills rather than on a flat surface.

There’s no age when walking is not essential, so whatever your goal, we urge you to get started. As ancient philosopher Lao Tzu wisely said: “The journey of a thousand miles begins with one step.” Need more inspiration? Consider this thought from philosopher Friedrich Nietzsche: “All truly great thoughts are conceived while walking.”

Sources: Nature, JAMA, Harvard Health, American College of Cardiology, Mayo Clinic

Hot to Age Gracefully

Mon, 04 Oct 2021 12:24:10 GMT

How to Age Gracefully

Check out this article From the New York Times: How to Age Gracefully - The New York Times

Inspired by a new book, “Stupid Things I Won’t Do When I Get Old,” I’m taking stock of my life and deciding what I need to reconsider.

POTS: Lightheadedness and a racing heart- Harvard Health

Mon, 04 Oct 2021 12:11:29 GMT

Part I: POTS: Lightheadedness and a racing heart- Harvard Health

POTS: Lightheadedness and a racing heart - Harvard Health

In this article Dr. Lee Lewis will explain what’s known so far about the triggers and hallmark symptoms of POTS. In a later post, She will discuss diagnosis and treatment.

Let’s talk about it – communicating with your medical team and loved ones about serious illness

Thu, 23 Sep 2021 12:22:17 GMT

Drs. Alyson Kelley-Hedgepeth and Dara Lee Lewis welcome two outstanding BWH colleagues Natasha Leven, NP and Eliza Curtis LICSW to discuss the challenges of talking about advanced illness. We have all faced these difficult conversations and we will face them again. How can we do it better?

Resources:

QPL Baseline- https://drive.google.com/file/d/1CcqoY6Bq11PeEbdbnJF0yhsNW2YsWx4S/view

Conversation Starter Guide- https://drive.google.com/file/d/1qWjzZ59OtPz-9pQ0CKOr7OzSYK649wNT/view

Five Wishes- https://drive.google.com/file/d/14j43D2699vLovAF502DmWoVpFDFLVC1H/view?usp=sharing

https://theconversationproject.org/

https://www.joincake.com/

Supplements and Heart Health: Updates on the Latest Research

Thu, 15 Jul 2021 12:43:37 GMT

Should you take supplements to improve your heart health? Join Drs. Kelley-Hedgepeth and Lee Lewis as they review recent research on commonly used supplements including fish oil, vitamins, calcium, coenzyme Q10, and more.

What to learn more about the supplements you take every day? Try these links below:

- www.Drugs.com search for “interaction checkers” to check drug interactions
- https://www.webmd.com/drugs/2/index for general information on supplements
- www.ods.od.nih.gov Office of Dietary Supplements of the NIH
- Health.harvard.edu/blog Free online health newsletter

New Lung Cancer Screening Recommendations

info@digitallm.com (digitalLM Staff) — Fri, 02 Jul 2021 07:09:04 GMT

Spotlighting Both Challenges and Progress

This winter the U.S. Preventive Services Task Force ( USPSTF ) released its new Lung Cancer screening recommendations ,

lowering both the starting age and pack-year criteria. Previously, low-dose computed tomography screening was advised for adults age 55 to 80 years with a 30 pack-year history of smoking who are current smokers or have quit within the past 15 years; now the USPSTF recommends extending the screening to adults starting at age 50 who have a 20 pack-year smoking history.

For most, the announcement may have gone under the radar due to the intense focus on the COVID-19 vaccine rollout in early 2021. But as the first change in lung cancer screening eligibility criteria since 2013, its significance was quickly recognized and is still being broadly debated across the medical community.

Notably, previous recommendations missed female patients who tended to be lighter smokers than men, and despite Black smokers’ higher risk of developing lung cancer, included only 17% of Black people who smoke compared to 31% of White smokers. The question is, by doubling the number of people eligible for screening, do the guidelines indicate a significant shift that will improve gender and racial disparities in testing and outcomes, or are they simply a small, overdue step in the right direction?

“It’s excellent news because expanded screening eligibility can reduce lung cancer mortality and may reduce all-cause mortality,” acknowledges Ella Kazerooni, MD , professor of radiology and internal medicine at the University of Michigan Medical School, who’s devoted much of her career to creating lung cancer survivors through her work as chair of the National Lung Cancer Roundtable .

The downside: “This may also cause false-positive results, leading to unnecessary tests and invasive procedures, because we’re still not incorporating other known risk factors. These encompass more than just smoking, but include air pollution, exposure to radon and other carcinogens, family history and social determinants of health,” says Dr. Kazerooni.

In March 2021, the American Academy of Family Physicians ( AAFP ) weighed in with support for the measure while also noting the need for additional research to determine potential harms from annual screening.

“More studies are needed to achieve our goal of increasing survivorship and lowering mortality without enhancing risk along the way,” agrees Dr. Kazerooni. “Compared to cardiac disease, research for lung cancer screening and risk assessment is relatively new and evolving. Tools, like an individualized lung cancer risk calculator, will take time to develop because of the complexity of the disease.”

Lung cancer survivor Jill Feldman views the new recommendations with the same unflinching honesty that’s fueled her remarkable 20-year crusade for others with the disease. She is the former president of LUNGevity and a founding member of the EGFR Resisters , both leading nonprofit patient support and advocacy organizations.

“We took too long to get here,” she says, “and it’s still not being viewed with a nearly wide enough lens. By focusing solely on age and smoking habits, we’re not considering the critical intersection of environmental factors and personal and family history that impact an individual’s risk of lung cancer.”

Having lost two grandparents, an aunt and both her parents to lung cancer before being diagnosed in 2009 with non-small cell lung cancer at age 39, Jill is painfully aware of the barriers that still surround screening and treatment.

“Despite its prevalence, lung cancer carries a real stigma,” says Jill. “The unintended consequence of successfully educating the public about the heightened risk of lung cancer among people who smoke, is that it’s considered preventable, making people reluctant to seek screening, and if diagnosed, ashamed to admit they have it.”

“It’s a significant problem that impacts people along the entire cancer care continuum,” says Dr. Kazerooni. “And it affects funding and research dollars as well. Although lung cancer is the leading cause of cancer death in the U.S., only 6% of federal dollars dedicated to cancer research are allocated to lung cancer.”

The stigma issue is particularly harmful for the rising numbers of younger women in their 20s to 40s with no smoking history who are diagnosed with lung cancer. “When someone is forced to emphasize that they never smoked, the message being sent to the 85% of patients with lung cancer who have a smoking history is ‘you are the ones who deserve this.’ No one deserves lung cancer,” says Jill.

Epidemiology studies centered on nonsmokers with lung cancer have begun, but actionable findings may not be reported for at least another decade or two, according to Dr. Kazerooni. The GO2 Foundation for Lung Cancer is currently studying genomic, environmental and behavioral risk factors to identify the common link among nonsmokers in order to run trials.

“We know the disease seems to be increasing among nonsmokers, especially younger women, but we don’t know enough to effectively screen for it now,” says Dr. Kazerooni.

While screening challenges remain, advances in treatment show incredible promise, especially targeted biomarker therapy, which is allowing Jill to treat her incurable lung cancer as a chronic condition.

“I never used to use the word ‘hope’ in the same sentence with lung cancer. But there is real hope now,” she says.

The following are traditional signs of non-small cell and small cell lung cancer, which can also be present as a result of many other conditions. Keep in mind, however, that the hope of expanded lung cancer screening is to find the disease before these symptoms appear.

• A cough that gets worse or does not go away

• Coughing up blood

• Breathing trouble, such as shortness of breath

• New wheezing when you breathe

• Ache or pain in your chest, upper back or shoulder that doesn’t go away and may get worse with deep breathing

• Hoarseness

• Frequent respiratory tract infections, such as pneumonia or bronchitis

• Feeling unusually tired all the time

• Weight loss with no known cause

• Trouble swallowing

• Swelling in the face and/or veins in the neck

Source: LUNGevity Foundation

A Quick Guide to Seasonal Allergies

info@digitallm.com (digitalLM Staff) — Fri, 02 Jul 2021 07:09:03 GMT

Pollen, Grass, Ragweed and Mold spores

For more than 24 million Americans, the flowering trees and mild weather of spring and summer, signals another allergy season in full bloom. The cause: substances such as pollen, grass, ragweed and mold spores enter the body and are mistakenly identified as a threat by the immune system, triggering a variety of symptoms. We hope you find some comfort in this quick guide to seasonal allergies.

Reduce the effects of seasonal allergies

Pollen and spores can be carried into the home on your clothes or enter through windows during allergy season.

Know which pollens you are sensitive to and then check pollen counts. Weather reports often include this information during allergy seasons. In spring and summer, during tree and grass pollen season, levels are highest in the evening. In late summer and early fall, during ragweed pollen season, levels are highest in the morning. For an interactive map to view allergy levels and pollen count forecasts, visit pollen.com .

If your allergy symptoms are very bothersome:

1. Take a shower, wash your hair and change your clothes after you’ve been working or playing outdoors, and keep windows and doors shut at home and in your car.

2. Wear sunglasses and a hat outside to keep pollen out of eyes and hair. Your COVID-19 mask could provide a protective barrier against pollen.

3. Indoors, get an air purifier with a HEPA filter, and vacuum regularly.

Treatment

Seasonal allergies are treated with over-the-counter or prescription antihistamines (non-drowsy types are available), nasal steroid spray, decongestants and immunotherapy (allergy shots that expose you over time to gradual increments of the allergen), as well as alternative methods. Please check with your healthcare provider to discuss what’s right for you.

Symptom Checker: Is It Allergies, a Cold or COVID-19?

Not Your Imagination: Pollen Season May Be Getting Worse

According to the American College of Allergy, Asthma and Immunology ( ACAAI ), climate change has made pollen season longer and more severe throughout North America. A recent study showed that pollen seasons for plants like trees, grasses, and weeds showed a 20-day increase in length and a 21% increase in pollen concentration from 1990 to 2018. Notably the researchers also found that the pollen produced is more allergenic - more likely to trigger an allergic reaction with fewer grains of pollen in the air.

Sources: Mayo Clinic , ACAAI

The Art of Cooking without Sugar

info@digitallm.com (digitalLM Staff) — Fri, 02 Jul 2021 07:08:59 GMT

A Chef’s Tasteful Look at Taking Sugar Off the Table

In part two of our series with professional chef Stan Hodes , he shares some artful substitutes, both natural and man-made, to sweeten up recipes without dipping into the sugar bowl. The art of cooking without sugar.

“It’s almost impossible to eliminate sugar completely because it appears, sometimes stealthily, in just about all foods,” says Chef Stan, “but there are many alternatives available that won’t substantially raise your blood sugar level and leave you craving even more sweetness.”

Cutting back can produce a number of important benefits, as evidence links added sugar to poor oral health, obesity, diabetes, heart disease and cancer.

“Keep your primary goal in mind – reduced insulin levels, decreased caloric intake, weight loss or disease prevention - when considering substitutions and tailor accordingly,” he urges.

When Cooking, Chef Stan Recommends:

Minimize use of salt and you’ll bring out the natural sugars in your ingredients by at least half.
Focus on lower-sugar ingredients that coax out sweetness: dark chocolate, coconut or coconut oil, prunes and berries. Carrots and dates are terrific for sweetening stews.
Try robust spices that enhance sweetness: cinnamon (whole or powdered), fennel, star anise, licorice root, vanilla.
Make dehydrated fruit: Thinly slice fruit, cook in a convection oven at 160o to 180o for 2to 4 hours, depending on the firmness and chewiness you prefer. Dehydrated fruit contains more calories than fresh fruit (because the sugar content becomes concentrated) so cut portion size in half.

Choose your Fruits Carefully

Some naturally contain substantially more fruit sugar, or fructose, making it best to limit: mangos (the highest), grapes, cherries, pears, pineapple, watermelon, dried figs, dates and bananas. Lower-sugar choices include: blackberries, cranberries, strawberries, grapefruit, starfruit, rhubarb, casaba melon, cantaloupe, papaya and guava.

Natural Sweeteners

Most natural sweeteners contain more nutrients and antioxidants than refined sugar, but beware, a calorie is still a calorie, and these contain approximately the same amount as sugar. Look for:

Date sugar , a powder made by pulverizing dried dates, is high in potassium.
Maple syrup , in its pure form, is one of the most natural forms of sugar, processed simply by boiling the sap of maple trees.
Honey , one of the oldest replacements for sugar around the world, made by bees from flower nectar and then mechanically filtered and strained. The complex range of flavors is ideal for baked goods and easily incorporated into desserts requiring a smooth texture such as custards and puddings.
Blackstrap molasses , made by boiling down sugar cane or sugar beet juice for a syrup-like consistency, is high in iron, potassium and calcium.
Organic coconut sugar , naturally processed from coconut palm sap, offers a rich brown sugar-like flavor, nutrients such as zinc and iron, and some inulin (fiber), but has a high fructose content.

Sugar Substitutes Offer Reduced or No-calorie Alternatives to Table Sugar:

Monk fruit , extracted from the Asian luo hang guo fruit, has been used for centuries in Chinese medicine. It contains no carbohydrates or calories, drawing its sweetness (up to200 times sweeter than table sugar) from antioxidants called mogrosides.
Sugar alcohols such as xylitol and erythritol, processed from plant fibers like birch and cornhusks, have a sweetness similar to sugar. Most of it is not broken down by enzymes in the body, but excreted in urine. In large doses, these sweeteners can cause digestive issues such as gas and diarrhea in some people.
Stevia , made from the leaves of a South American shrub, has been considered by some as the most natural sugar substitute, but it is highly refined and often blended with additives.

Avoid completely:

Agave Syrup contains 75-90% fructose, which rapidly raises blood sugar levels.
High Fructose Corn Syrup contributes to diabetes, inflammation, high triglycerides and non-alcoholic fatty liver disease. It’s not typically used as an individual ingredient at home, but is commonly found in store-bought sauces, salad dressings and other condiments – check the labels before you buy.

Stan Hodes served as Executive Chef and Manager of Dining Services Operations at Baptist Hospital of Miami for 27 years, and worked as chef for the Marriott Hotels, Cancun’s Casa Magna Resort, and Royal Caribbean and Norwegian cruise lines. He was recognized by Health Leaders Magazine as one of the top 20 Most Innovative Foodservice Executives in America.

Concierge Medicine: Is It for You?

info@digitallm.com (digitalLM Staff) — Fri, 11 Jun 2021 12:23:56 GMT

Dr. Alyson Kelley-Hedgepeth and a Lown Cardiology Group patient offer insights on the benefits of concierge medicine in this article from the Summer 2021 issue of Wellesley Weston Magazine

Article by Keri Bancroft

Writer, Wellesley Weston Magazine

It happened a couple of times. Cheryl* noticed her heart “fluttering,” which she chalked up to stress. Then one Friday evening, when she and her partner were on their way to see their grandson, she experienced it again. At her partner’s insistence, Cheryl checked the heart monitor on his phone, and it showed her heart rate was about three times as fast as it should be. Concerned, the Wellesley resident called Dr. Rachel Haims, her concierge doctor, on Dr. Haims’ personal cell phone. She answered immediately and asked Cheryl a number of questions to rule out the most serious reasons this could be happening, and then she said something surprising, “Cough as hard as you can.” Cheryl did and her heart rate came down to normal. Dr. Haims had suspected that Cheryl was experiencing Supraventricular Tachycardia (SVT), and this appeared to be confirmed when Cheryl’s cough broke the SVT. Dr. Haims cautioned that Cheryl should call back immediately if there were any other symptoms, such as another episode of a fast heart rate, shortness of breath, or lightheadedness. As a result, Cheryl was able to avoid a trip to the emergency room during the COVID-19 pandemic. The next week, extensive tests confirmed the SVT diagnosis, which is now being treated effectively.

With concierge doctors, like Dr. Haims of PersonalMDs in Chestnut Hill, patients pay an annual fee or retainer to ensure direct availability to a doctor who limits his or her practice to far fewer patients than a traditional doctor.

Concierge doctors have been around since the late ’90s. At first, having one was considered an option only for the super-rich, since these practices had retainers that were astronomical, but over the years that has changed as concierge medicine has become more mainstream. Demand has also increased during the past year as people look for more personalized care during the COVID-19 pandemic.

While this type of medical practice is still most popular with high income clients — with one in five wealthy people choosing “to pay an extra fee for direct access to their doctors” according to NPR’s All Things Considered — it has now become much more available to a larger segment of patients. Dr. Alyson Kelley-Hedgepeth, a concierge cardiologist in the Lown Cardiovascular Group in Chestnut Hill, notes that the cost of concierge medicine has gone down so much that it is now equivalent to going out to eat a couple times a month.

In fact, according to Terry Bauer, CEO of Specialdocs Consultants, a nationwide company that helps physicians set up concierge practices, the average cost for a patient to join a concierge practice — which is usually a primary care practice — across the U.S. is $2,000 annually, or approximately $166 a month. That’s about the same as a cable or cell phone bill, says Bauer. As would be expected, the cost of concierge medicine is higher in the more pricey Boston area than in other parts

of the country, with local costs ranging roughly between $2,000 and $4,500 annually.

Michael* of Weston, who is a patient of the Lown Cardiovascular Group and has congestive heart failure, says, the way he sees it is, “If you’re out of health, you’re out of business. I look at my health care expenses as basic to everything in life.”

So, what do these fees cover? You still have to use your insurance to pay for covered medical expenses. A concierge agreement pays for “noncovered services,” which means you pay for your concierge physician to dramatically limit his or her number of patients to “ensure direct availability and adequate time for each patient,” says Bauer.

This means same-day appointments, significantly longer and comprehensive appointments, and having your physician’s personal cell phone number. Bauer says this model lets doctors “focus on the art of medicine, not cranking patients through. In other words, concierge doctors don’t have one hand on the keyboard and one hand on the door.”

Dr. Geoffrey Burns of Renaissance Family Medicine of Wellesley, who has practiced concierge family medicine for seven years, says there’s no comparison between a concierge and traditional practice. Dr. Burns, who still goes on house calls, says now on an average day he sees six patients as opposed to 15 when he had a traditional practice. He went from having a patient “panel” of 4,000 patients to 300, not uncommon numbers. He notes that seeing fewer patients has allowed him to think instead of acting reflexively and to provide more precision test ordering, instead of cookie-cutter care. “Everything is for the patient’s benefit, not the doctor’s,” Dr. Burns says.

This is also true of Dr. Alan Glaser of Wellesley Primary Care Medicine, who moved from a traditional medical practice to a concierge practice in 2019 and went from 5,000 to 300 patients. Dr. Glaser, who says he researched changing his large practice for seven years, says, “This is not about a yearly fee: It’s about being the best possible primary care doctor. ... It’s the whole reason I went to medical school.”

John,* who has been a patient of Dr. Alan Glaser of Wellesley for 22 years and is now part of his concierge practice, says Dr. Glaser’s availability and responsiveness probably saved his life. A scientist himself, John describes himself as healthy. He doesn’t smoke, he runs, and he is thin. But his dad had strokes in his 60s, the age John was, so he and Dr. Glaser had prepared for a crisis. It hit on an August Sunday morning at 8:30 a.m., when John was experiencing arm and hand weakness, early signs of a stroke. John attributed the weakness to sleeping funny on his arm and said the symptoms had begun hours before. John called Dr. Glaser, who advised John to call 911 immediately. John was rushed to the emergency room. When he arrived, John

started having difficulties with speech and comprehension. The hospital physicians connected with Dr. Glaser on this personal cell phone to discuss the situation. According to Dr. Glaser, they were near the end of the window of treatment for a stroke. Dr. Glaser and the ER doctors decided to give John a powerful drug that ultimately saved his life. “If I hadn’t been able to reach Dr. Glaser directly and get instant attention, I probably would have died.” Dr. Glaser also confirmed that, saying there would “have likely been a different outcome.” Now John says he talks to Dr. Glaser twice a day to constantly monitor his blood pressure.

So what happens to the patients from the traditional practices who no longer have a doctor? Both Dr. Glaser and Dr. Burns made certain that their traditional primary care patients were well cared for by other doctors or existing physicians in their traditional practices.

A Place in The Room

Fri, 04 Jun 2021 14:56:01 GMT

A Place in The Room: Women are advocating for advances in women's health

In this article from Harvard Medicine, Dr. Dara Lee Lewis discusses the crucial role that women physicians play in advocating the growing field of Women's Health.

Harvard Medicine Magazine published the article A Place in the Room: Women are advocating for advances in women's health by: Elizabeth Gehrman

Enjoy this quick 15 minute read on the advocacy being done buy our female leaders in healthcare including our own Dr. Dara Lee Lewis.

Click here to read more.

Heart Palpitations in Menopause

Thu, 13 May 2021 20:00:56 GMT

Dr. Dara Lee Lewis was a guest Speaker on Dr. Heather Hirsch's webinar titled Heart Palpitations in Menopause. Listen along while Drs. Lee Lewis and Hirsch discuss the how, when, and why of palpitations.

Heart Smart Cooking Demo

Thu, 13 May 2021 16:58:19 GMT

Join us on a field trip to the beautiful Jarvis Kitchen Showroom for a cooking demonstration with Culinary Coach Dr. Shalu “Shirly” Ramchandani. We invite you to cook along with us, or just watch, as Dr. Ramchandani prepares three delicious heart healthy Mediterranean style dishes.

Now more than ever, we should be using food to boost our immune systems, prevent chronic disease, and manage weight. However, preparing healthful and tasty meals can feel challenging for a variety of reasons these days, including lack of time and reluctance to go to the grocery store. As a result we turn to take-out or processed food options that are less healthy and more expensive. Join us as we discuss strategies to bring joy back into the kitchen, while adding years to your life. During this Heart Smart cooking demonstration, you will find easy to follow culinary instructions to create three simple Mediterranean recipes, the ingredients of which can be repurposed to make additional meals throughout the week.

Check out her website: SmartlifestylesMD.com

Intrested in more healthy cooking? Check the links below.

https://www.forksoverknives.com/

https://www.instituteoflifestylemedicine.org/wp-content/uploads/2020/12/Resources_Culinary-Tips-and-Tools-2020.pdf

h ttps://www.savorylotus.com/how-to-make-vegetable-broth/#tasty-recipes-19594-jump-target

https://joybauer.com/

https://www.diabetesfoodhub.org/

minimalistbaker.com
Dr. Lee Lewis loves the almond meal cookies with chocolate chips and coconut!

Dr. Shalu Ramchandani' s Easy Peanut Sauce Recipe:
Easy Peanut Sauce
1⁄2 cup (120 ml) unsalted, natural creamy peanut butter
1 1⁄2 (22.5 ml) tbsp low-sodium soy sauce or tamari
2 tbsp (30 ml) brown sugar or date paste
1⁄2 lime, juiced
1 tsp (5 ml) chili garlic sauce (can substitute
1/8 teaspoon ground cayenne pepper plus
1 clove minced garlic)
1⁄2 tsp (2.5 ml) freshly grated ginger
Approximately 4 tbsp (60 ml) hot water
1⁄4 cup (10 g) chopped cilantro, optional
1⁄4 cup (25 g) thinly sliced scallion, optional.

Atrial Fibrillation and Hypertension

Wed, 21 Apr 2021 23:05:14 GMT

Join us for a discussion of two common and important cardiac conditions. Hypertension (high blood pressure) has been called “the silent killer” because it can increase the risk of heart attack, congestive heart failure, stroke, and kidney disease – yet most people with high blood pressure have no symptoms. Atrial fibrillation is the most common rhythm disturbance in the world, affecting up to 20% of older people. Atrial fibrillation can increase your risk of stroke but with proper treatment, it can be managed safely.

For those of you interested in just learning about hypertension, skip forward to minute 38 of the video.

COVID-19 Vaccine Update: Experts Weigh In With Reassuring Outlook

info@digitallm.com (digitalLM Staff) — Sat, 10 Apr 2021 16:28:40 GMT

The latest answers from nationally recognized vaccine experts, Dr. Paul Sax and Dr. Michael Kinch.

J&J Vaccine Update

April 23rd, 2021

CDC and FDA Recommend Use of J&J's Janssen COVID-19 Vaccine Resume

On April 23rd, the pause on using J&J's COVID-19 vaccine in the U.S. was lifted. Click HERE to see the CDC/FDA official statement.

Please continue to check the CDC website for the latest vaccine information

___________________________________________________________________________________________________________

J&J Vaccine Update

April 13, 2021

As news regarding the J&J vaccine has changed significantly since our COVID-19 Vaccine Update posted on 3.24.21, we offer the following link to today’s Joint CDC and FDA Statement on Johnson & Johnson COVID-19 Vaccine .

____________________________________________________________________________________________________________

The information below is from a webinar delivered March 24 2021.

Please be sure to check CDC and other reputed websites for the latest updates.

The COVID-19 vaccine rollout is in full swing around the country but many questions remain. We reveal the latest answers (as of February 2021) from nationally recognized vaccine experts Dr. Paul Sax , Professor of Medicine, Harvard Medical School and Clinical Director of Infectious Disease, Brigham and Women’s Hospital; and Michael Kinch, PhD , Director of Washington University’s Center for Drug Discovery.

How will the new variants impact the effectiveness of the vaccines?

Sax: Data is emerging daily. The UK variant has a higher level of contagiousness but is mediated just as well with the vaccine; other variants’ stories are still unfolding. Vaccine manufacturers are retooling the antigens to make them effective against a broader group of viruses. Boosters may be provided in the future.

Kinch: The variants show us that the coronavirus is very efficient at mutation, and we’ll likely need to adapt our vaccines every two to five years to provide the right protection.

Is it safe to get vaccinated at large outdoor stadiums?

Sax: Yes, absolutely. People are not being crowded into poorly ventilated indoor spaces at these events.

Which vaccine is best?

Sax: The one that’s offered to you! Don’t wait for a specific vaccine because in the interim, you’re at higher risk for getting a more severe case of COVID-19. Pfizer and Moderna, both mRNA vaccines, are 95% effective after two doses. The J&J vaccine works differently, using a virus that doesn’t reproduce in humans and stimulating an immune response after just one dose. While J&J’s 70-80% rate may not be as high as the others, it’s very effective in preventing severe disease, so you can feel confident about getting it. We are also likely to have a fourth vaccine, Novavax, available soon.

Kinch: We may not have a definitive answer to this question until later this year. But these are incredible vaccine breakthroughs, with exceptionally high rates of effectiveness.

Is delaying the second dose problematic?

Sax: Getting it too early is actually more concerning. The first dose primes the immune system and the second dose gives it a huge boost. Waiting six weeks won’t matter.

Are side effects worse after the second dose?

Sax: Yes, there are more side effects reported but this indicates your body is responding to the vaccine. I experienced headache, fatigue and trouble concentrating immediately afterwards, and then felt totally fine the next day. That’s a trade-off I’d take anytime versus the potentially life-threatening consequences of COVID-19.

What if I don’t experience side effects?

Sax: No need for concern, as the vaccines were shown to be highly effective in trials with thousands of people, including a significant number over age 55. However, older, frailer people weren’t tested, and it’s possible they may not respond as well to the vaccine.

Can I take pain relievers before or after getting the vaccine?

Sax: Don’t take any beforehand as it can blunt the immune response; afterwards, it’s fine.

What is still unknown about COVID-19 and vaccines?

Sax: We don’t know the risk of immunized people transmitting COVID-19, but we’re seeing promising evidence from Israel that vaccinated individuals carry lower amounts of virus. This will significantly reduce but not completely eliminate transmission. Also unknown is whether natural or vaccine-induced immunity is better.

Kinch: The long-term durability of the vaccine’s immune protection isn’t known, but we’ll discover that over time. Preliminary data seems to indicate that recovery from minor cases of coronavirus provides three to nine months of protection.

Is it important to vaccinate younger people?

Sax: Elementary age kids only get mildly sick from COVID-19 and they’re not very contagious, but teenagers are at higher risk for severe disease and are more contagious. The most important group to vaccinate is people in their 20s, who’ve been primary spreaders of the virus.

Should immunosuppressed patients get the vaccine?

Kinch: Yes, and in fact, patients with autoimmune conditions will be prioritized as a higher-risk group. One of the most promising and least discussed aspects of the Moderna and Pfizer trials is that while many patients became infected with the virus, not one was hospitalized, needed intubation or died. This is particularly significant for immunosuppressed patients, because if infection can’t be prevented altogether, the vaccine will lessen disease severity and result in much better outcomes.

Should pregnant women get the vaccine?

Sax: Pregnancy is a severe risk factor for COVID. While theoretically the vaccine is safe, we don’t have all the data yet. I’d recommend it, but also understand if a woman chooses to wait.

What needs to happen to resume normal life?

Sax: We have to be laser focused on mobilizing vaccinations nationally and not expect the states to just figure it out. I feel optimistic that enough vaccine will be available by summer, possibly even by late spring, for everyone to be immunized.

(sidebar)

After vaccination, is it safe* to…

Visit family and friends? Wearing masks and social distancing is still necessary in large, public settings, but we can relax a bit in small group settings. Although the risk of interacting without masks is not zero, it is low, so go ahead and hug your grandchildren! And if you’re dining indoors with family, simply open the windows for good ventilation.

Exercise? Yes, and no need to wear a mask if outdoors and you’re a decent distance away from people. At indoor gyms, wear a mask, keep your distance and avoid areas that are not well-ventilated.

Eat at restaurants? Yes, if outdoors; no if indoors.

Travel by air? Yes, with precautions. Surprisingly few transmission events have occurred aboard planes; however, the boarding process and airport experience are not well controlled, so stay masked and distanced.

Additional post-vaccination guidelines are available from the CDC.

*Dr. Paul Sax, Guest Speaker, Lown Cardiology Group Health & Wellness Webinar (2.16.2021)

A Guide to the Power Players in Pain Relief Which Pain Relievers Work Best?

info@digitallm.com (digitalLM Staff) — Sat, 10 Apr 2021 16:08:58 GMT

When you reach for a pain reliever, what are you most likely to find in your medicine cabinet? And does it matter?

When you reach for a pain reliever, what are you most likely to find in your medicine cabinet? And does it matter? While aspirin, Tylenol and Aleve may appear similar and aim for the same results, their effects can vary. Below is a quick guide to today’s most recognizable over-the-counter (OTC) pain relief products.

The effectiveness of nonsteroidal anti-inflammatory drugs ( NSAIDs ) in alleviating pain and reducing inflammation is well documented. They work by blocking the effects of specific enzymes to decrease the number of prostaglandins made in the body, which cause tissue to swell and increase the pain you experience. While widely used, it’s important to be aware of the limitations of these medications, most notably that all NSAIDs except aspirin carry an FDA warning for increased risk of heart attack, stroke or high blood pressure when used at high doses for long periods of time. They can also cause stomach upset, heartburn, and ulcers which may bleed; because they are blood thinners, should not be taken with medications such as Coumadin . Additionally, NSAIDs provide rapid pain relief for most, but may require a two-to-three week regimen to realize anti-inflammatory effects.

NSAIDs include:

Acetylsalicylic acid/aspirin (Bayer, Bufferin)

Aspirin, the first OTC pain reliever to be mass produced in the early 1900s, is still the most commonly used for headaches, minor aches and pains and inflammation. Unlike other NSAIDs, it is not associated with a higher risk of heart attack.

Ibuprofen (Advil, Motrin) Ibuprofen is commonly used to treat pain and bring down fever, and alleviates symptoms of migraine, menstrual cramps, toothache, and inflammation with better results than aspirin. Some studies point to a lower risk of ibuprofen causing ulcers and gastrointestinal bleeding than other NSAIDs.

Naproxen sodium (Aleve, Midol)

This NSAID is most effective for alleviating backaches, arthritis, sprains and other types of inflammatory-based pain. In comparable doses, naproxen has a longer-lasting effect than other pain relievers, lasting 8 to 12 hours versus 4 to 8.

The non-NSAID solution:

Acetaminophen (Tylenol, Anacin)

Tylenol, the most well-known brand of acetaminophen, is used to treat pain and reduce fever and is safe for both heart and gut. However, this non-NSAID can’t be used to relieve inflammation-related conditions. Also different from NSAIDs, acetaminophen is broken down and removed by the liver, and taking too much in a 24-hour period can cause liver damage. Be sure to read product labels carefully because acetaminophen, ibuprofen and aspirin are often combined in products to treat cough, flu or sinus infection.

Which pain reliever should you take?

There are no easy answers because individual responses to the same type and dose of medication can be considerably different. It’s sometimes necessary to try one drug and then another to determine optimal treatment; or consider prescription medications. Please call your healthcare provider to discuss your best options.

New Perspectives on Aspirin

The long-accepted use of a daily low-dose aspirin to treat or prevent heart attacks or strokes was re-examined in light of recent studies showing the therapy’s heightened risk of gastrointestinal bleeding or hemorrhagic stroke outweighed its benefits for people who are healthy with no history of cardiovascular disease. Some experts now recommend daily aspirin therapy only for those who’ve already had a heart attack or stroke, a coronary artery stent or coronary bypass surgery, or are at a higher risk for coronary artery disease.

Always using pain relievers to bring down a fever has been challenged, somewhat controversially, by researchers including Dr. Paul Offit , Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, Professor of Pediatrics at the Perelman School of Medicine and author of Overkill: When Modern Medicine Goes Too Far . “Fever is a symptom that occurs for a reason,” he says. “The immune system actually works better at a high temperature, so treating a fever with aspirin can prolong or worsen illness.”

Cooking without Sodium or Sugar Executive Chef Stan Hodes Shares Secrets of the Spice Rack

info@digitallm.com (digitalLM Staff) — Sat, 10 Apr 2021 15:50:16 GMT

"...we’re predisposed to enjoy the sweet and the salty, the yin and the yang”

- Chef Hodes

The benefits of reducing sodium and sugar in the diet are compelling, backed by well documented studies. The flip side is an equally powerful human craving for enhanced flavor, compounded by years of exposure to products boosted with salt and sugar and the ongoing quest for umami (the fifth taste, defined by experts as the essence of deliciousness).

“Salt and sugar were once basic to preserving foods, and we’re predisposed to enjoy the sweet and the salty, the yin and the yang, such as salted caramel,” explains executive chef Stan Hodes, who has spent three decades bringing the “wow” factor to hospital and senior living meals with strict nutritional requirements. In this two-part series, he shares how to coax out natural flavors with no shakers of salt or spoonfuls of sugar.

Hodes encourages a holistic approach to meeting recommended limits for calories, sodium, sugar and fat.

“All too frequently, reducing sodium in a particular product or recipe can mean amping up the sugar instead, so it’s best to consider the overall nutritional value rather than a single component,” he explains. “Then, be inspired by natural substitutes from other cultures that don’t use salt to create their remarkable flavor profiles with real punch from the very first bite, such as Cajun spice mixes or Indian garam masala (a coriander, cumin, cardamom, cloves, black pepper, cinnamon and nutmeg blend).”

Hodes’ spicy recommendations:

Bagel seasoning. Low-sodium versions of this blend of poppy seeds, toasted sesame seeds, dried garlic, dehydrated onions and other spices provide a welcome bit of crunch and texture as well as flavor.

Black pepper, cayenne pepper or red pepper flakes. Eliminate the need for salt with a light dusting of these pungent peppers.

Cinnamon . A peppery and semi-sweet spice ideal for tomato sauces, curries and marinades. Hodes uses a potent mix of cinnamon and coffee as the closely held keys to flavor in his popular chili.

Citrus juices. Drizzle over cooked vegetables, tenderize meats and fish, and transform vinaigrettes with an acidic zing from the juice of a lemon, lime, orange, grapefruit or yuzu (a small Japanese citrus fruit). Additionally, try grating (zesting) the peel of a lemon and mix it into soups, marinades and beverages to bring out the flavors.

Coffee . A rich source of flavor sometimes found in Mexican moles, brewed coffee can be reduced by half in a saucepan and used in sauces, stews and gravies, or try a sprinkle of instant coffee instead.

Ginger. Chop and mix fresh ginger root into stir-fries, sauces, soups and beverages; this pungent and sweet spice is also known for its possible anti-inflammatory effects.

Infused oils. Place stalks of fresh garlic, rosemary and oregano, each in a separate bottle of olive oil, for freshly flavored dressings.

Mushrooms and beets. These naturally occurring sources of umami can easily be added to recipes for a burst of flavor: Dehydrate mushrooms by roasting until crisp and store them in a jar for future use; oven-roast beets, slice, and add to salads, soups or root vegetable platters.

Nutritional yeast. This deactivated yeast, available as flakes or powder, provides a cheesy, salty flavor without using either. Ideal on roasted vegetables or baked taco chips; when blended with carrots, potatoes, lemon juice, garlic and onion powder, “It tastes exactly like Velveeta cheese,” promises Hodes. Pour it over cooked elbow noodles for a lower-sodium, non-dairy mac ’n’ cheese.

Olives. Known for their salty taste and high sodium content, olives can be used more healthily if you soak the sodium out. Cut them in half, immerse overnight in a bowl of tap water and drain the next day.

Paprika. Warm up any recipe with fresh or smoked varieties of this vibrant red spice made from a variety of red peppers.

Sage. Strongly aromatic, with an earthy taste of citrus and pine, this herb can be used fresh or dried to flavor sauces, roasted vegetables and bean dishes.

Salsa. Store-bought salsas can bring too much sodium into the mix, so make your own fruit salsa with finely diced melons and a dash of orange juice as a colorful, phytonutrient-rich topping for grilled fish, chicken or salads.

Vinegars. Another way to use the power of acidity is with rice wine vinegars for seasoning; the sweetly sharp tang of balsamic vinegar to wake up dressings, stews and marinades; and the strong kick of apple cider vinegar.

Wines. Cook red or white wine until reduced by half, let it thicken and cool, and store in a squeeze bottle to use as a glaze for proteins.

Stan Hodes served as Executive Chef and Manager of Dining Services Operations at Baptist Hospital of Miami for 27 years, and worked as chef for the Marriott Hotels, Cancun’s Casa Magna Resort, and Royal Caribbean and Norwegian cruise lines. He was recognized by HealthLeaders magazine as one of the top 20 Most Innovative Foodservice Executives in America.

Omega-3 fatty acids and the heart: New evidence, more questions

Mon, 05 Apr 2021 19:16:15 GMT

Omega-3 fatty acids and the heart: New evidence, more questions

My patients commonly ask me whether they should try one supplement or another. Often my answer is equivocal, because for most supplements we just don’t have enough evidence to give a definite answer. This doesn’t mean that a particular patient couldn’t benefit from a specific supplement; it just means I don’t have standardized research to guide my recommendations. Sadly, this remains true of omega-3 fatty acid supplements. The results of studies looking at omega-3 supplements have been inconsistent, and have left both physicians and patients wondering what to do.

Omega-3 fatty acids show benefit in REDUCE-IT trial and win FDA approval

Two main omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are found mainly in fish and fish oil. Omega-3s from fish and fish oil have been recommended by the American Heart Association (AHA) for the past 20 years to reduce cardiovascular events, like heart attack or stroke, in people who already have cardiovascular disease (CVD). I have written about and been a strong advocate of getting omega-3s through diet, and sometimes through the use of supplements.

Over the past year I have prescribed an omega-3, sold under the brand name Vascepa, to my patients who are at high risk for CVD, based on evidence of cardiovascular benefits. Vascepa contains purified EPA, and its use is based on good clinical data from the REDUCE-IT trial . This study enrolled over 8,000 patients with elevated cardiovascular risk and high blood triglyceride levels. They assigned half of the study participants to receive 2 grams of Vascepa twice a day, and assigned the other participants a placebo (a pill filled with mineral oil). The results showed a significant benefit of Vascepa over the placebo. Vascepa reduced blood triglyceride levels, but more importantly, it reduced the number of heart attacks and strokes, the need for a heart stenting procedure to open clogged arteries, and death.

A subsequent meta-analysis , which included data from over 10 studies, found fish oil omega‐3 supplements lowered risk for heart attack and death from coronary heart disease.

In December 2020, the FDA approved the use of Vascepa to reduce the risk of cardiovascular events in certain patients with, or at high risk for, CVD.

STRENGTH trial casts some doubt on omega-3 benefits

But a recent study has raised some questions. The STRENGTH trial , published in JAMA, looked at a different formulation of omega-3 fish oil — a combination of EPA and DHA — to see if it would also reduce cardiovascular risk. This study enrolled over 13,000 patients who were randomized to receive either the EPA/DHA combination pill or the placebo (a pill filled with corn oil). The trial was terminated early due to an interim analysis revealing no difference between the two treatment groups.

We don’t know for certain why the REDUCE-IT trial showed a benefit from omega-3s while the STRENGTH trial did not. One possibility is that the different results are due to the different drugs studied. REDUCE-IT studied a purified formulation of high-dose EPA, which resulted in higher EPA levels. This was similar to the results of another trial , which also found that pure EPA reduced the risk of cardiac events. The STRENGTH trial tested a combination of EPA and DHA. No large study has ever evaluated the effects on cardiovascular outcomes of purified DHA alone, leaving us to wonder whether DHA might counteract the benefits of EPA.

Where do we stand?

Back to my patients who want to know if they should be taking an omega-3 supplement. With the availability of today’s data, I would recommend a pure EPA supplement, or one that contains more EPA than DHA. But don’t stop there. Eat a heart-healthy diet, get regular exercise, and pursue other lifestyle changes that have proven benefits for cardiovascular health. In the meantime, my colleagues and I wait for more definitive data on the utility of omega-3 fish oil, and who might benefit the most.

Your Heart is in Your Hands Part II

Wed, 31 Mar 2021 17:50:44 GMT

Join us as we continue our conversation, addressing topics raised at our Prevention Roundtable Part I.
Harnessing exercise, nutrition, and sleep to lower your risk of cardiovascular disease, with the Lown Group Cardiologists.

Apps for help with sleep: Headspace , Calm , CBT-i coach
NY times article on stretches: click here
Tips:
Magnesium and Sleepy Tea, Snooz Machine , 10% Happier
Youtube: Body Scan Mediation

The benefits of the Transcendental Meditation

Thu, 18 Mar 2021 18:23:08 GMT

Dr. Baruti KMT-Sisouvong and his wife Mina serve as Directors of the Transcendental Meditation® Program (TM) for Cambridge and the larger Metropolitan area of Boston, MA. Dr. Baruti holds degrees in History, Sociology, and Consciousness & Human Potential Studies and is currently completing his Doctoral dissertation research on Mystical Experiences Among Freemasons and Rosicrucians.

Dr. Baruti regularly writes and delivers talks on Meditation, Consciousness, Cognition, and Creativity. Through his teachings on Transcendental Meditation, he enjoys the privilege of aiding people in tapping into the deep well of silence present within each for the betterment of their personal and professional lives and in service to their communities.

Website: https://www.tm.org/transcendental-meditation-cambridge

Twitter: https://twitter.com/baruti?lang=en

Facebook: https://www.facebook.com/baruti

Instagram: https://www.instagram.com/baruti/?hl=en

Linked in: https://www.linkedin.com/in/baruti

YouTube: https://www.youtube.com/c/Baruti/featured

Your Heart is In Your Hands: Part I

Wed, 17 Mar 2021 08:56:01 GMT

The power to change your heart’s destiny is in your hands. Over 80% of heart disease and stroke is directly related to lifestyle. Join Lown cardiologists Drs. Brian Bilchik, Alyson Kelley-Hedegepth and Dara Lee-Lewis and learn how to optimize your cardiac health with the pillars of Lifestyle Medicine: nutrition, exercise, sleep and stress management. The emphasis shifts from treating symptoms with increased medications and procedures to identifying and eradicating the root cause of disease with simple but powerful, evidence-based lifestyle changes.

Moderated by former CNN producer, speaker and author Nadia Bilchik.

Check out part II:

https://www.lowngroup.org/prevention-roundtable-ii

Introduction to P.O.T.S. Part II: Exercising with P.O.T.S. Live Facebook event

Sat, 20 Feb 2021 01:22:28 GMT

Please join us as we jump in for Part II of our Introduction to P.O.T.S. (Postural Orthostatic Tachycardia Syndrome). Where we will discuss exercising with P.O.T.S. The benefits of exercise and how to tackle starting and maintaining an exercise routine.

If You missed Part I view it here with the link below:

https://www.lowngroup.org/pots-webinar-session-1

Introduction to P.O.T.S. Part I: Live Facebook event

Sat, 20 Feb 2021 01:21:22 GMT

Please join us as we jump in for Part I of our Introduction to P.O.T.S. (Postural Orthostatic Tachycardia Syndrome) Live Facebook session. Where we will discuss what is POTS, How do you know if you have it, and possible treatment options.

Make sure you tune in for part II linked below!

https://www.lowngroup.org/pots-webinar-session-2

A Personal Tribute to Dr. Bernard Lown

Fri, 19 Feb 2021 23:57:17 GMT

Dr. Bernard Lown passed away at age 99 on February 16, 2021. He was a giant in medicine, and my teacher and mentor. He founded the Lown Cardiovascular Group in 1974. At 99 years old he remained active and engaged. We mourn his passing but celebrate his legacy and life.

I first met Dr./Professor Lown in 1994 and after my fellowship in cardiovascular medicine, he hired me as a Lown cardiologist in 1997. Initially he was my teacher and mentor, and subsequently a colleague, but always my mentor.

A brilliant, self-deprecating man, I clearly remember that when Dr. Lown retired from clinical medicine at age 87, he lamented to me he was “just learning how to be a doctor.”

Throughout his life he received countless honors and awards, and in his later years, after receiving yet another accolade, he said: “As I grow older, the words you have just heard sound more and more like finely etched eulogies, and they promise to make death a non-event.” While I always smiled when I heard this, this is certainly not the case now.

Dr. Lown had unfathomable impact on many, on a personal level, nationally and globally. He has written much, and much will be written about his life. He trained countless cardiologists and clinicians around the world. After his passing on Tuesday, I was flooded with vivid memories of the dynamic, lively conversations, discussions, and even heated arguments all of us at Lown Cardiovascular Group had while sitting at a board room table in a room enshrined with his many accolades and awards.

I am struggling to find the words to express my grief, sadness and profound gratitude to Dr. Lown. Very few people are gifted with his eloquence, however, so instead, I’d like to share a few of his words that provide insight into his remarkable life. They resonate even more meaningfully now and will always inspire and define my vision of medicine, patient care and a life well-lived.

From his 1996 book “The Lost Art of Healing”:

A three-thousand-year tradition, which bonded doctor and patient in a special affinity of trust, is being traded for a new type of relationship. Healing is replaced with treating, caring is supplanted by managing, and the art of listening is taken over by technological procedures. Healing is best accomplished when art and science are conjoined, when body and spirit are probed together. Only when doctors can brood for the fate of a fellow human afflicted with fear and pain do they engage the unique individuality of a particular human being. Patients and doctor then enter in a partnership as equals. As the patient is empowered, the doctors curing power is enhanced. A doctor establishes credentials as a caring practitioner during the very first visit by listening attentively. This, requiring engagement of all sensibilities, is the most powerful diagnostic device in the doctor’s armamentarium.

From his 80th birthday speech in 2001:

Central to my life over these many decades has been the work of the Lown Cardiology Group. Against great odds, we have tried to demonstrate that a few physicians, in a micro enterprise, can uphold in clinical practice an old and hallowed tradition as well as adhere to the cutting edge of scientific practice. We have refused to pigeonhole patients by their disease and become "health vendors.” We have desisted being traffic cops shuttling patients to numerous consultants, or being triage officers for differing technologic options. We aspired to provide first-rate health care with a human face.

One of the most uplifting experiences of my life involved the launching of the International Physicians for the Prevention of Nuclear War (IPPNW), together with that extraordinary Soviet physician Dr. Eugene Chazov. The advent of the nuclear age posed an unprecedented question: not whether war would exact yet more lives but whether human beings had a future on planet earth. Our destination of nuclear abolition is not yet reached, but we helped provide a breathing spell, to permit reason to prevail.

1997 we launched ProCOR (for the heart) an e-mail and web based electronic conference on the Internet addressing the menace of cardiovascular disease in developing countries. We aim to stimulate community practices and health policies that promote cost-effective prevention. The Lown Group in cooperation with the Brigham and Women's Hospital then created a developing world fellowship. Promised is expansion of the global outreach of our philosophy and hopefully diminution of the scourge of heart disease.

I came to appreciate the impact that physicians can exert when involved socially. I have learned to let imagination roam into the gossamer terrain of the weave of great dreams. Above all I have come to appreciate that there are humans out there who stand proud and principled and are ever ready to challenge injustice whatever the odds, whatever the costs.

At the close of a long life the British philosopher, essayist and peace activist Bertrand Russell wrote: “This has been my life. I have found it worth living and would gladly live it again if the chance were offered to me."

I too would accept the chance of living my life again, but only on condition that I could have the very same family, the very same friends, the very same colleagues and the very same patients.

We will miss you Dr. Lown. We are grateful for your mentorship, your time, and the gift of social conscience.

Everything You Need to Know About COVID-19: Vaccines, Treatments, and Prevention

Wed, 17 Feb 2021 01:29:37 GMT

Join us for a special webinar event open to the public.
Dr. Paul Sax is Professor of Medicine at Harvard Medical School and the Clinical Director of Infectious Disease at Brigham and Women’s Hospital. He is a nationally recognized expert on COVID-19 and recently published the widely read “Frequently Asked Questions about COVID-19” in the New England Journal of Medicine, available for your review HERE.

Feel-Good Ways to Lower Your Blood Pressure

Fri, 12 Feb 2021 18:29:47 GMT

Dr. Dara Lee Lewis is quoted in this AARP article about creative ways to keep your heart healthy during a pandemic.

How just stretching, taking baths or enjoying your coffee could lower your risk of heart attack and stroke

You know the drill: Exercise, eat a Mediterranean-style diet, get a good night's sleep and tame your stress to optimize the health of your heart.

"You can't really get on a path to wellness without addressing all four of these,” says cardiologist Dara Lee Lewis, M.D., codirector of the Women's Program at the Lown Cardiovascular Group in Boston.

But recent research suggests some unexpected ways to further protect your heart's health. Try these tactics also to lower your risk for both heart attacks and strokes:

Take a hot bath daily

There's nothing wrong with having a nice long soak in the tub while winter weather and the ongoing COVID-19 pandemic have you spending more time at home. In fact, doing so may give you an extra heart boost. High temperatures cause the blood vessels to dilate, which lowers blood pressure. Plus a hot bath helps with lowering stress, one of the four pillars of heart health.

A new study in the journal Heart confirms these benefits. Researchers tracked the bathing habits and health records of some 30,000 people ages 40 to 59 in Japan for more than 20 years. Compared with people who took baths less than twice a week, those who soaked in a tub almost every day had a 28 percent lower risk of heart problems overall and a 26 percent lower risk of stroke. The findings held up even when researchers took into account other factors that can affect heart health, such as exercise, a smoking habit and diet.

Just stretch

It doesn't replace a vigorous bike ride or brisk walk, but according to a recent study from Europe, mere stretching may reduce the risk of heart attack and stroke by improving blood flow, which in turn is believed to decrease stiffness and damage to the walls of your arteries.

To test the idea, researchers at the University of Milan divided 39 men and women into three groups. One group did leg, ankle and foot stretches five times a week for 40 minutes, while another group stretched just one side of the body. The third group didn't stretch at all. When the study ended 12 weeks later, those in the stretching groups had significantly improved the health of their blood vessels compared to those who didn't stretch.

Stretching doesn't quite meet the American Heart Association's recommendation of at least 150 minutes of moderate-intensity aerobic activity a week (30 minutes, 5 times a week). But it could “have a practical implication in maintaining or even improving vascular function in people with a limited aerobic capacity or with a limited motor capacity,” says study author, Emiliano Cè, associate professor of biomedical science for health at the University of Milan.

Filter your coffee

Improving heart health is one of coffee's nifty perks — but it turns out that's true only if you brew it the right way. A study of more than a half million people in Norway recently showed that those who drank filtered coffee were 15 percent less likely to die during the 20-year follow-up due to any cause, including heart disease.

People who drank one to four cups a day of filtered coffee had the lowest risk of death from heart woes. The findings held even after researchers accounted for participants’ weight, blood pressure and cholesterol — factors that could skew the results. Norwegians who regularly drank unfiltered joe (that includes espresso drinks or brews from methods like a French press or moka pot) had a higher risk of dying from heart disease.

Why the difference? The study authors believe unfiltered coffee retains high levels of oils in coffee that can raise cholesterol levels.

Practice tai chi

The heart-related benefits of tai chi , the ancient Chinese practice of slow, meditative movement, are multifold. According to a study of more than 200 people with somewhat elevated blood pressure, those who practiced tai chi for three months significantly decreased it, compared to those who didn't. In research involving obese patients with diabetes, tai chi lowered cholesterol, body mass index (BMI) — a measure of weight and height used to define obesity — and C-reactive protein (CRP), a marker of inflammation in the body that's linked to poorer heart health.

These effects may be due to tai chi's effect on harmful stress, something a recent review study from the University of Arizona saw among older adults with cardiovascular disease in particular.

However, tai chi is just one way to find calm and boost your heart's health. “It's not necessarily sitting in the lotus position, with your legs crossed, chanting,” Lewis says. “It can be baking bread, walking in nature, gardening, knitting — anything that takes you into the quiet part of your brain and allows you to shut the world out for a little bit.”

To read similar articles, please click here .

COVID-19 and Heart Health

Fri, 05 Feb 2021 01:27:25 GMT

Please join us for a round table Facebook live event recorded in July of 2020. As we discuss the latest updates on COVID-19 and the current medical knowledge of COVID-19, with a focus on heart disease with Drs. Dara Lee Lewis and Alyson Kelley-Hedgepeth of the Lown Cardiovascular Group.

Health Through Resilience: A Modern Approach to Rehab

Thu, 04 Feb 2021 01:43:29 GMT

We all know that a consistent exercise program is essential to cardiovascular, orthopedic, and even emotional health and well being. Benefits include, improving cholesterol and blood pressure, avoiding hip and knee replacements, remaining active as you age, just to name a few. However, exercise can be confusing and intimidating, do you ever feel like you always start and stop an exercise program, searching for a consistent routine that works for you? At Pure Performance Training our Physical Therapists and Personal Trainers work to understand your injuries and past medical history, making exercising safe, fun, and enjoyable!

Website for Mike Demille’s clinic: https://divergenceptandwellness.com/

What We’re Not Telling the Public When They Get the Vaccine

Thu, 21 Jan 2021 19:20:17 GMT

Once the size of the COVID-19 crisis was clear, and the obvious measures we could take to stop it politicized, I became convinced that vaccines alone were our best path out of this hellscape. The obligatory selfies posted by my fellow frontline health-care providers getting their shots were a good start. While most of my physician colleagues were clamoring to be vaccinated, many of our other colleagues were less enthusiastic .

All of this, I figured, could be addressed with better messaging and a little educational outreach. That is, until I heard about a physician who got her vaccine and the coronavirus itself in the span of a few days. Now, with access to vaccines expanding to the general public, we will need to go to greater lengths to make sure that benign coincidences like this don’t get interpreted and repackaged as something more nefarious than they are.

Consider this timeline and how easily things could have been derailed for members of her community if the wrong narrative had emerged from it. Shortly after receiving her first dose of the vaccine, she experienced some arm soreness. But then, a couple of days later, headache, body aches, and fatigue set in. Then came the fever. These symptoms were not entirely unexpected: All the data suggest that a majority of vaccine recipients can expect at least one of these, and that around one in six younger adults will develop a fever. Still, the effects were stronger than she expected. A few hours later, she started coughing and lost her sense of taste and smell. Growing suspicious, she decided to get tested for the coronavirus the next day. She was positive. (She gave me permission to tell her story.)

As a practicing emergency physician in South Dakota treating many COVID-19 cases, she had gone to work the previous week and saw her usual complement of patients. A few days later, with vaccines first arriving at hospitals around the country, she was among the lucky few to get their first dose in mid-December. The onset timing of her COVID-19 symptoms could only mean one thing: She had been infected with the virus a few days before receiving her vaccine.

My heart sank. Not for her — she’s fine — but for our country. A person with adequate health-care literacy can piece this all together relatively easily. But most Americans, and sadly even some health-care workers with some degree of research literacy, probably cannot. Currently, around 200,000 Americans are testing positive daily. Most people develop symptoms within three to seven days, though it can take up to ten days or more to develop in some instances. In other words, hundreds of thousands of Americans are becoming symptomatic with COVID-19 on any given day. That means a small but noticeable fraction of people will get vaccinated right around the time they notice that they’ve developed COVID-19. As a result, there is a genuine risk that false narratives could take root that “the vaccine gave me the coronavirus” start to spread in our communities as vaccination opens to a wider population. In fact, something similar plays out every year. When I ask patients if they have received their annual flu shot, I sometimes hear, “I don’t get vaccinated ever since the time the flu shot gave me the flu.” No matter how much I try to explain that this is literally impossible , once that belief sets in, it’s very difficult to talk someone out of it.

Worse yet, clickbait headlines about a small number of elderly individuals dying after receiving the vaccine fail to mention that hundreds of similar patients die of natural causes each and every week. It’s likely that many of these people also died after eating Jell-O. All of them died after brushing their teeth. Semantics take on great meaning in times like these. That is why we have epidemiology: to separate anecdotes from genuine data. We — and by we, I mean journalists and public-health commentators — have got to be a bit more rigorous about how we frame reports like these in this most crucial of moments.

A closer look at the data from the large clinical trials reveals another potential problem in how people will understand the protection that the vaccines offer. Both the Pfizer -BioNtech and the Moderna vaccines demonstrated impressive efficacy in preventing COVID-19, but that protection does not begin to become apparent in the data sets until around two weeks after the first dose. Even then, the full effect is not realized until weeks later. Data from the period between the first and second dose of the Pfizer vaccine shows that the incidence of COVID-19 is around 50 percent among those who received the vaccine compared to those who received the placebo. Only weeks later does that number approach 95 percent. So, in the first two weeks after vaccination, many people will still get COVID-19, though the figures fall with every passing day. And we still remain uncertain as to whether the vaccines prevent asymptomatic disease and contagion, though early hopeful signs that they do are starting to emerge.

Now that I have received both doses of the Pfizer vaccine, I have my own field report to file. Each time I went to get my shot, I was quizzed by the friendly provider as to whether I had any history of allergy to vaccines, medications, or foods. The singular focus of the brief inquisition was to identify whether or not I had any risks of an allergic reaction. There was no hint at an attempt to provide me with any education — and, no, I don’t think it’s because I happen to do a lot of work on COVID-19. If I had any questions about the vaccine, everything I needed to know, I was told, could be found in the glossy 12-page information packet I had just been handed. On page four I found a three-line item stating that, no, the vaccine can’t give me the coronavirus.

This is a huge missed opportunity. If we do not tell our patients about how the vaccine works and when the protective effects are expected to kick in, some people are going to feel betrayed when they get sick following vaccination. That’s preventable. Vaccinations are both a public-health and messaging opportunity. At the moment, we’re letting it slip away.

Another major concern I have about vaccine uptake is not around what the vaccine fails to do (i.e., provide immediate protection), but what it frequently does do, which is cause a pretty unpleasant constellation of side effects. The reason the South Dakota physician initially shrugged off the symptoms of what was ultimately diagnosed as COVID-19 was that she figured that the vaccine and not a coincident infection was the most likely culprit. (Mathematically speaking, she had the right idea.) But having myself experienced some fairly disruptive symptoms after each dose of the vaccine — arm soreness, followed by body aches, chills, a low-grade fever, and some pretty substantial fatigue, all of which I affectionately referred to as a mild to moderate case of “manaphylaxis” — I’ve become worried that some people may not go back for their second dose. Others may delay or even refuse vaccination after seeing it knock a few of their friends and families out for a couple of days.

We have to tell people to expect this and accept this. These symptoms, I told myself, were a sign that “the vaccine is working.” That knowledge helped me get through my symptoms in good spirits. I also now tell my friends, family, and patients not to worry if they happen not to have any of these symptoms; there’s no indication in any of the data sets to suggest that a lack of side effects implies an inadequate immune response to the vaccine.

Messaging about all of this needs to occur at the time of vaccination. A person whose sleeve is about to be rolled up is about as captive an audience as you’ll find. We need to pounce on that educational window of opportunity. More than that, there should be paid sick leave for people who experience the level of symptoms I felt. That alone would lower the bar for many essential workers who, unlike me, do not have the flexibility to rejigger their schedules around getting vaccinated.

The two most important things we need to emphasize are that the vaccine can’t give anyone the coronavirus and that protection is not immediate. But beyond that, we need to emphasize that for those of us who had symptoms substantial enough to disrupt our normal activities, contracting COVID-19 itself would likely have been far worse. Even in what are considered “mild cases” of COVID-19, fever and cough can last for days and weeks, causing missed work and prolonged suffering. In moderate and severe cases, the need for oxygen, intensive care, and intubation can cause disability for months, and maybe longer. As we all know, critical cases can be fatal. The upshot is that if you didn’t like some of the symptoms caused by the coronavirus vaccine, be very glad you never had to experience the virus itself.

The post What We’re Not Telling the Public When They Get the Vaccine appeared first on Intelligencer .

Colorectal Cancer Prevention: Do Diet and Lifestyle Really Matter?

Thu, 21 Jan 2021 01:47:14 GMT

Colorectal cancer is the third most common cause of cancer in the U.S., but it is also a highly preventable disease. During this talk, Dr. Kimmie Ng will review the epidemiology of colorectal cancer and the basics of colorectal cancer screening. She will also discuss the diet and lifestyle factors that may help to decrease the risk of developing this disease.

Dr. Kimmie Ng is an Associate Professor of Medicine at Harvard Medical School. She serves as the Founding Director of the Young-Onset Colorectal Cancer Center, Co-Director of the Colon and Rectal Cancer Center, and Director of Translational Research in the Center for Gastrointestinal Oncology at Dana-Farber Cancer Institute in Boston, MA. Her research focuses on identifying dietary, plasma, and molecular predictors of improved survival in patients with colorectal cancer, with a special interest in the vitamin D pathway and the microbiome.

News and TV articles/videos featuring Dr. Ng:
https://www.today.com/video/colon-cancer-screening-should-start-at-45-task-force-recommends-94839877658
h t tps://www.nytimes.com/2020/10/27/health/colon-cancer-screening-age-45.html
https://www.washingtonpost.com/lifestyle/wellness/colon-cancer-chadwick-boseman-tips/2020/09/03/13d224f2-ed29-11ea-99a1-71343d03bc29_story.html
https://www.today.com/video/new-colon-cancer-screening-guidelines-what-you-need-to-know-80057925690

Information about Dr. Ng's Young-Onset Colorectal Cancer Center:
https://www.dana-farber.org/young-onset-colorectal-cancer-center/

Stress and Your Heart

Thu, 07 Jan 2021 01:51:17 GMT

“Stress” permeates our lives in so many ways - visibly and invisibly. Whether it’s stress associated with work, finances, relationships, a transition or simply making everyday decisions - the effects of stress can be cumulative and impact the heart, health and overall well-being.

In this se ssion Dr. Charles Blatt will discuss what mediates the stress response, the biophysiological signs and symptoms, what is known about the impact of stress on the heart and why he believes it’s an important topic and one he addresses in clinical encounters. He will also highlight practical techniques that may help you to minimize and manage your stress levels in the New Year.

COVID-19 and the heart: What have we learned?

info@digitallm.com (digitalLM Staff) — Wed, 06 Jan 2021 15:30:00 GMT

Early in the pandemic, epidemiologists made a striking observation. Compared to the general population, people with cardiovascular disease (CVD) were more than twice as likely to contract severe forms of COVID-19. In the last six months, death rates from COVID-19 have dropped significantly, but CVD remains a major predictor of poor outcome. What have we learned about heart disease and COVID-19 in that time?

Pre-existing heart conditions and poor metabolic health increase risk of severe COVID-19

As I described in a blog post back in April, some health conditions, like diabetes, increase risk of severe COVID-19 by suppressing the immune system; others, like asthma, increase risk by weakening the lungs. However, in the early months of the pandemic it was not entirely clear how CVD increased the risk of severe COVID-19. We now have two explanations.

The first is that pre-existing heart conditions, such as damaged heart muscle or blocked heart arteries, weaken the body’s ability to survive the stress of the illness. A person with a vulnerable heart is more likely to succumb to the effects of fever, low oxygen levels, unstable blood pressures, and blood clotting disorders — all possible consequences of COVID-19 — than someone previously healthy.

A second explanation relates to poor underlying metabolic health, which is more common in those with heart disease. Poor metabolic health refers to diseases such as type 2 diabetes or prediabetes and obesity, which themselves cause inflammation and risk of blood clots, compounding the effects of COVID-19 and increasing the likelihood of devastating complications of COVID-19.

How does COVID-19 cause heart damage?

The SARS-CoV-2 virus can damage the heart in several ways. For example, the virus may directly invade or inflame the heart muscle, and it may indirectly harm the heart by disrupting the balance between oxygen supply and demand. Heart injury, which may be measured by elevated levels of the enzyme troponin in the bloodstream, has been detected in about one-quarter of patients hospitalized with severe COVID-19 illness. Of these patients, about one-third have pre-existing CVD.

Inflammation of the heart muscle

The majority of people with COVID-19 will have mild symptoms and recover fully. However, about 20% will develop pneumonia, and about 5% will develop severe disease. In the severe form of COVID-19, the body’s immune system overreacts to the infection, releasing inflammatory molecules called cytokines into the bloodstream. This so-called “cytokine storm” can damage multiple organs, including the heart.

Inflammation of the heart muscle, called myocarditis, typically occurs only in patients with advanced COVID-19 disease. Myocarditis can result from direct heart invasion by the virus itself, or more commonly by inflammation caused by cytokine storm. When this occurs, the heart may become enlarged and weakened, leading to low blood pressure and fluid in the lungs. While this severe form of myocarditis is rare, recent studies have suggested that a milder form of heart muscle inflammation may be much more common than previously recognized. A recent study showed that asymptomatic heart inflammation was seen on magnetic resonance imaging in up to three-quarters of patients who had recovered from severe COVID-19.

Increased oxygen demand and decreased oxygen supply lead to heart damage

Fever and infection cause the heart rate to speed up, increasing the work of the heart in COVID-19 patients who develop pneumonia. Blood pressure may drop or spike, causing further stress on the heart, and the resulting increase in oxygen demand can lead to heart damage, especially if the heart arteries or muscle were unhealthy to begin with.

Heart damage is most often caused by heart attacks, which result from the formation of a blood clot in a vulnerable heart artery, blocking delivery of oxygen to the heart muscle. COVID-19-related inflammation raises the risk of this type of heart attack by activating the body’s clotting system and disrupting the blood vessel lining. When inflamed, this lining loses its ability to resist clot formation. These blood clots in the large and small arteries of the heart cut off its supply of oxygen. The increased clotting tendency can also lead to blood clots in the lungs, which can cause a drop in blood oxygen levels. Severe pneumonia drops blood oxygen further. When the oxygen demand exceeds the supply, the heart muscle is damaged.

Finding a silver lining and lowering risk through healthy lifestyle

People with CVD who adopt healthy behaviors can strengthen their defenses against COVID-19 while also reducing the long-term risk from cardiovascular disease itself. This means plenty of physical activity and following a healthy diet like the Mediterranean diet . Cook at home when you can, and walk outdoors with friends if your gym is temporarily closed. Purchase an inexpensive and easy-to-use monitor to measure your blood pressure at home. And continue to follow the CDC’s safety guidelines to wear masks, physically distance, and avoid large gatherings.

Follow me on Twitter @daraleelewismd .

The post COVID-19 and the heart: What have we learned? appeared first on Harvard Health Blog .

New Year’s Resolutions Are So 2020!

Fri, 01 Jan 2021 06:10:00 GMT

What are your 2021 Anti-Resolutions?

Year after year, the pattern rarely varies. Resolutions made, promptly followed by resolutions broken. The odds of sticking to New Year’s resolutions are, in fact, completely stacked against us, as research shows a paltry success rate of between 10 and 20%. But since the challenges of 2020 have reconfigured every aspect of daily living, 2021 may be the ideal time to reset this ritual as well. Perhaps it’s time we consider this upcoming new year, the year of the anti-resolution for dieting, exercising, eating healthier and managing stress.

We’ve asked therapists steeped in mindful eating, body positivity and resilient thinking to help reframe this perennial wish list. There are no checklists to mark off or milestones to meet, just inspiration to view yourself and the world around you through a new lens.

Instead of Dieting in 2021… Consider being more mindful about what you eat.

Replace the resolve to lose weight on a diet with a shift to mindful eating. “Keep in mind that while all diets work in the short run, there’s not a single plan that has long-term results for the majority of participants, and that’s why people make the same resolution every year,” says Judith Matz , nationally recognized speaker, therapist and co-author of The Diet Survivor’s Handbook and Beyond a Shadow of a Diet . “The deprivation that comes from dieting often leads to overeating or bingeing, setting into motion an endless cycle of frustration.”

Instead, learn to eat when you’re hungry and stop when you’re full, and choose from a wide variety of foods, including healthful ones.

Matz describes the essence of the process. “First, learn to recognize when you are just beginning to feel hungry. If you have a headache, are crabby, irritable, fatigued and low on energy, you’ve waited too long and are much more likely to overeat as a result.”

Next, think about what food would make you feel satisfied. “Sometimes a fresh apple or a raw carrot is exactly what you want, and at other times you might want ice cream or a bowl of pasta. Depriving yourself of foods you love can be counterproductive – there’s room for all types of food,” she says.
For patients with specific medical issues, such as high cholesterol, Matz notes that adjustments can easily be made while still respecting the process: a craving for ice cream can be met with a sorbet instead.

Finally, trust your body to let you know when to stop eating. While that may sound simple, Matz counsels patience, especially for chronic dieters. “It can take time to tune in to your natural cues for both hunger and satiety.”

The key is to stop having rules around food and to really listen to your body. “Ultimately it’s about having a healthy relationship with food rather than focusing solely on eating so-called healthful foods,” she says.

Moving from body image to body appreciation.

An equally important shift is changing the desire for a new body size to a genuine appreciation of the body you have. Matz defines this as “body positivity, relating to your body with acceptance and respect rather than self-criticism and shame.” It means rejecting ingrained cultural messages related to body embarrassment and weight stigma and replacing them with ones that reflect inclusiveness and self-compassion. It encourages taking pleasure in natural body changes throughout your life cycle and not putting off anything you might enjoy doing because you’re not the “perfect” size or shape.

Body positivity also empowers you to view exercise positively rather than as punishment for having the wrong body. “Unhook exercise from weight, and focus on choosing exercise for endurance, strength, flexibility, stress reduction, health, social connection or just the simple pleasure of moving your body,” advises Matz.

Finally, refrain from focusing on weight loss praise, which reinforces the mistaken belief that you can’t be happy, healthy and successful unless you’re a certain body size, says Matz.
“Consider that body positivity is a gift we can give to support family, friends and, most notably, the next generation.”

Find joy in what you do and who you surround yourself with to reduce stress.

Resolving to manage stress effectively is an oft-expressed but infrequently realized New Year’s wish. But it can be triggered by one pivotal question, says influential family therapist Debbie Gross, who asks it at every session with a new client: “What brings you joy?”

She explains, “It’s transformational in terms of moving out of the survival mode many experienced last year, and into thriving mode. When people are in crisis, they become overwhelmed by the thought that no one will meet their needs. Their only goal is to focus on how to get through this moment; their attitude is ‘If I don’t take care of me, who will?’”

To stop the “anxiety spiral” in the brain, Gross recommends the “5, 4, 3” grounding exercise for staying in the present: “Focus on five things you can see, four things you can hear and three things you can feel, either physically or emotionally.”

And while it’s all too easy to devolve into perpetual doom and gloom against a backdrop of unceasing anxiety, Gross says we have a choice – Eeyore or Tigger?
“We can wake up each day just waiting for the next problem to come our way, or we can look at the world with more of a ‘beginner mind’ that recognizes small, everyday miracles,” she says. “It takes real work for some to switch the channel in their brain to that mindset, but the difference it makes is astounding.”

The post New Year’s Resolutions Are So 2020! appeared first on Specialdocs Consultants .

Pandemic Stress Likely Compounded by Seasonal Affective Disorder

Fri, 01 Jan 2021 06:07:00 GMT

Experts Expect Record Numbers of Seasonal Affective Disorder Diagnoses in 2021

As we continue to weather the storm of COVID-19, seasonal affective disorder, or SAD , is also on our radar. More subtle than an arctic blast, SAD is just as real, with just as much potential to have a chilling effect on our mood, productivity and wellness. Unfortunately, the emotional stress and fear that come with a global pandemic create an ideal climate for SAD this winter. Not surprisingly, mental health experts are expecting to diagnose and treat more cases of SAD in 2021 than ever before.

First discovered in the 1840s, SAD was not officially recognized as a disorder until the early 1980s, when Dr. Norman Rosenthal coined the term and categorized it as a form of clinical depression. We now know that SAD affects at least 5% of Americans; is more likely to affect women than men, those with other forms of depression or family members with the condition; and is far more common in northern regions, due to reduced natural sunlight. New research has advanced several theories as to why some people develop SAD, including: sluggish transmission of serotonin (which helps regulate mood and the body’s circadian rhythms; reduced sensitivity of the eyes to environmental light; a combination of these factors; or other reasons yet to be uncovered).

Increased understanding of what triggers SAD and its impact on mental health has inspired a growing number of clinical treatments that can effectively neutralize its effects.

Chief among them:

Healing light.

Sitting in front of a bright light box for 30 to 45 minutes daily has been a treatment of choice for more than three decades, helping SAD patients with either 10,000 lux of white fluorescent or full spectrum light that shines 20 times brighter than ordinary indoor illumination. Dawn simulation, another form of light therapy, begins in early morning before patients awake by emitting a low level of light that gradually increases over 30 to 90 minutes to recommended room light level (approximately 250 lux). Enhancing indoor lighting with regular lamps and fixtures is also recommended).

Talk therapy.

Newer studies from the University of Vermont suggest that cognitive behavioral therapy (CBT), a psychological treatment aimed at providing patients with tools to change negative thoughts and behaviors, may be as effective as light therapy for treating SAD. According to the National Institute for Mental Health (NIMH), CBT adapted for SAD focuses on behavioral activation, helping SAD sufferers identify and engage in enjoyable seasonal activities to combat the ennui and fatigue they typically experience in winter.

Sleep hygiene.

Creating a consistent light-dark, sleep-wake cycle is important for SAD patients, who often experience hypersomnia (excessive daytime sleepiness) and insomnia (trouble falling or staying asleep).
Antidepressant medications. Because SAD is associated with disturbances in serotonin activity, antidepressant medications have been effectively used to treat symptoms.
Active days. Keep moving with daily walks outside, even on cloudy days, and aerobic exercise. Both can help alleviate symptoms of SAD.

Winterize your mental health

Be proactive in safeguarding your mental wellness over the coming months. Most importantly, know the symptoms of SAD and call our office for help if you’re experiencing:

Experts advise those who’ve previously experienced episodes of seasonal depression to try to get in front of it this year. Call our office for guidance regarding medications or CBT sessions. For many, reprogramming their mindset can help restore proper circadian rhythms and eliminate the psychological dread of winter. Try enrolling in an online class, taking up a new hobby or creating a new routine to optimize daylight exposure. Or keep it even simpler. As Dr. Rosenthal recently told the New York Times , “A 20-minute early morning walk in the sun can be as good as commercial light therapy.”

The post Pandemic Stress Likely Compounded by Seasonal Affective Disorder appeared first on Specialdocs Consultants .

Start 2021 off Right by Sticking to your Winter Exercise Plan

Fri, 01 Jan 2021 06:01:00 GMT

A Winter Workout Routine Will Prepare You For Life After COVID

Exercise will reduce pain, improve function and mobility, lower blood pressure and blood sugar, decrease risk of chronic illness and death from heart disease and many forms of cancer, enhance mood and focus, and may even help reduce your risk of contracting COVID-19.

Despite those compelling benefits, only 5% of us stick to an exercise regimen. With months of staying close to home base ahead, we asked national exercise expert Dr. Josh D’Angelo, PT, of MovementX to help us beat the odds and emerge from our winter cocoons fitter, stronger and more limber than before.

“Recent research has shown that even a little bit of exercise and movement is beneficial in improving your movement, health and life,” says Dr. D’Angelo. “We start with a focus on functional strength training exercises because it provides the best protection against future injury and helps with everything from mobility to balance. To maximize your gains, we encourage supplementing with 15-20 minutes of aerobic exercise, such as walking briskly, riding a stationary bike, dancing … or anything that gets you moving and you enjoy! And remember, every little bit of movement helps.”

Following are some ways to get started, from MovementX’s “ AgeProof Your Body ” program:

Work toward repeating three complete sets of these fundamental exercises: squats, pushups and abdominal strengthening for your core. Start with 5-8 repetitions each, and build weekly. Rest, repeat.

The post Start 2021 off Right by Sticking to your Winter Exercise Plan appeared first on Specialdocs Consultants .

Palpitations

Thu, 17 Dec 2020 01:50:17 GMT

Please join us as we chat with Dr. Shmuel Ravid, who is a former director of the Lown Cardiovascular Group with a special training and interest in heart rhythm abnormalities. Today we will be discussing palpitations. What they are, why we feel them, what causes them to begin with and what to do about them.

Tough Conversations: Talking With Your Loved Ones About Death and Dying

Thu, 03 Dec 2020 01:42:21 GMT

Please join us in conversation with nationally known physician / author and expert in palliative care, Dr. Jessica Zitter. Dr. Zitter will lead us through one of the most difficult yet important topics we should all be talking about with our physicians and our loved ones – how to be pro-active and planful as we approach the end of life.

Many of us have completed Advance Directives indicating our preferences around life-support machinery if our organs start to fail. But there is much more to “Advance Care Planning” than simply whether or not to use a ventilator. How can “life support” help, and how can it hurt? Isn’t it best to “give it a try?” What alternatives are there? What is the role of hospice, and what are its limitations?

Join us as we explore the many ways that we can maintain control over how we live our lives, all the way until the end.

- Advance Directives: https://www.nhpco.org/advancedirective/
- P OLST forms: https://polst.org/form-patients/
- Go Wish: http://gowish.org/
- Ethical Wills: https://www.nextavenue.org/what-heirs-want-even-more-money/
- Palliative care: https://getpalliativecare.org/
- Extreme Measures: https://jessicazitter.com/extreme-measures/
- Extremis: https://jessicazitter.com/extremis/
- Caregiver: A Love Story - caregiveralovestory.com
Watch the trailer here: https://www.youtube.com/watch?v=jtKTngulaI4
- Article by Dr. Zitter: Treated To Death- Pacific Standard

Aggressive hypertension treatment does not lead to dangerous drops in blood pressure

Wed, 02 Dec 2020 15:30:00 GMT

Hypertension (high blood pressure) is a leading cause of death and disability worldwide. It is a primary risk factor for numerous medical conditions, including heart attacks, strokes, heart failure, kidney disease, atrial fibrillation, and dementia.

Blood pressure (BP) control is so critical that when the American Heart Association and the American College of Cardiology updated their treatment guidelines in 2017, they called for more aggressive blood pressure treatment. They lowered the definition of normal, or optimal, blood pressure to less than 120/80 mm Hg, and they recommended treatment for blood pressure higher than 130/80 mm Hg.

Doctors worry about treating high blood pressure too aggressively

Physicians have historically worked to optimize blood pressure, yet many doctors have been reluctant to be overly aggressive . This is likely based on our Hippocratic Oath of “first, do no harm.” There is concern that lowering blood pressure too aggressively might result in symptoms of weakness and fatigue, or lightheadedness and dizziness. These symptoms, especially in older patients, could result in a fall with the potential for injury or disability.

A reduction in blood pressure with a change in position is called orthostatic hypotension. It typically occurs when someone goes from sitting to standing. Most of us have experienced momentary symptoms, noting dark vision after getting up too quickly. This is typically a short-lived event, lasting only seconds and resolving quickly. But what if these symptoms were severe enough or lasted long enough to be dangerous?

Study finds intensive hypertension treatment does not cause dangerous drops in blood pressure

A recent meta-analysis published in Annals of Internal Medicine reviewed five trials to examine the effect of intensive blood pressure-lowering treatment, and to answer the question: does intensive blood pressure treatment cause a dangerous drop in blood pressure? The analysis included over 18,000 participants, and study quality was noted to be good, with minimal variation between trials.

This meta-analysis analyzed randomized studies in which patients were assigned to either intensive blood pressure control, less intensive blood pressure control, or a placebo, for at least six months. The studies documented both seated and standing blood pressure readings, and the standing blood pressure readings were taken after standing for at least one minute. Orthostatic hypotension was defined as a drop in seated to standing blood pressure of at least 20 mm Hg systolic blood pressure (the top number in a BP reading) and at least 10 or more mm Hg diastolic blood pressure (the bottom number).

The study results provide an important take-home message for both patients and their physicians: intensive blood pressure lowering was not associated with orthostatic hypotension, and in fact intensive treatment decreased the risk of orthostatic hypotension. These results should give physicians peace of mind when aiming for lower blood pressure goals.

One less worry when selecting blood pressure treatment

Given that Americans have a greater than 80% lifetime risk of hypertension, most individuals with a normal blood pressure are likely to eventually develop elevated blood pressure. Regular blood pressure measurements are essential to ensure prompt treatment.

Treatment should usually start with lifestyle changes such as weight loss, regular exercise, and a healthy diet, which means limiting processed foods and sodium, working on portion control, and limiting alcohol. These changes can have a significant impact on blood pressure, but they’re not always enough. If you do need medications, you and your doctor can select a treatment without worrying about orthostatic hypotension.

The post Aggressive hypertension treatment does not lead to dangerous drops in blood pressure appeared first on Harvard Health Blog .

Intuitive Eating

Thu, 19 Nov 2020 01:01:24 GMT

Have you ever been on a diet and felt hungry, frustrated and dissatisfied? Not sure what to eat? If you're ready to stop the cycle of rules, deprivation and overeating, then it's time to learn about Intuitive Eating.

Intuitive Eating is a non-diet approach to eating that emphasizes internal cues over external diet rules. The focus isn’t on the scale or calories, but instead on promoting health-enhancing behaviors, better body image, and a healthier relationship with food. Intuitive Eating helps you get back in touch with internal cues, like hunger and fullness, cravings, and how food makes you feel. This approach also helps unravel diet rules so you’re better able to respond to your internal cues.

This interactive webinar will briefly review the 10 Principles of Intuitive Eating designed to help you overcome the diet mentality and set the stage for a satisfying relationship with food.

10 Principles of Intuitive Eating: https://www.intuitiveeating.org/10-principles-of-intuitive-eating/

Intuitive Eating 4 ^th edition: https://www.amazon.com/Intuitive-Eating-4th-Anti-Diet-Revolutionary/dp/1250255198/

The Intuitive Eating Workbook: https://www.amazon.com/Intuitive-Eating-Workbook-Principles-Relationship/dp/1626256225

Tara’s cookbook- Real FIT Kitchen: https://www.amazon.com/Real-Fit-Kitchen-Increase-Strength/dp/1592336906

Ergonomics Strategies to Support a Healthy Lifestyle

Thu, 05 Nov 2020 01:40:27 GMT

With COVID-19, many of us pivoted to work, school, and physically distance in our homes. This new stay-at-home lifestyle included relying on a non-ergonomic arrangement for computer work, prolonged sitting, increased screen time for video conferencing, and binge watching our favorite television shows. Join this webinar to learn ergonomic strategies to proactively protect your physical and mental health while working from home.

Source 1: https://drive.google.com/file/d/1jW9PdseIZwVItlz8mOQfjUYPfLmED8Fh/view

Source 2: https://drive.google.com/file/d/1tAMjso3q4E99BgIodEfy6p0is8f7YApK/view

Source 3: https://drive.google.com/file/d/1GPl6hYJCQ1dl7ieGQPaT-18ajs1OYz0h/view

Reconsidering Statins After 75

Thu, 29 Oct 2020 18:26:51 GMT

When she was 74, Barbara Rivers, a former schoolteacher and administrator in Charlotte, North Carolina, was prescribed a statin — one in the popular class of drugs that lower cholesterol. This was after tests had shown that her LDL (bad) cholesterol was creeping up above the normal range.

Now 89, Rivers has been on the drug ever since. “It seems to be doing its job, and it hasn't created any side effects ,” she says. “My doctor says my cholesterol is amazingly low."

Rivers is one of millions of Americans who take these lipid-lowering medications, which work by slowing down the liver's production of cholesterol overall while increasing its ability to remove LDL cholesterol in particular from the blood. By doing this, they also appear to help prevent heart attacks and strokes by keeping plaques from breaking apart and forming clots that can move to the heart or brain.

While all those benefits sound good, doctors may hesitate to prescribe this type of drug for people over 75 in the absence of clear-cut guidelines from the American College of Cardiology and the American Heart Association . Those state that you should take a statin if:

You've had a heart attack or stroke or you have peripheral artery disease.
Your LDL cholesterol level is 190 mg/dL or higher.
You are 40 to 75 years old with diabetes.
You are 40 to 75 years old with a high risk of developing heart disease or stroke and have an LDL cholesterol level of 70 mg/dL or higher.

According to the guidelines, after age 75 you should have a workup with your doctor and a discussion of risks and benefits. That's due to a lack of studies assessing the safety and effectiveness of statins for people in this age group.

"There are no clear guidelines after 75,” says cardiologist Dara Lee Lewis, M.D., an associate physician and instructor in medicine at Brigham and Women's Hospital in Boston. “And it has been difficult as a provider, because this is who our patients are.” In fact, the older you are, the greater your risk for a variety of heart ills. “About 1 in 3 Americans will ultimately die from cardiovascular disease,” Lewis says. “So everyone over 75 is at high risk.”

On the other hand, older patients are more likely to be on multiple medications that can interact with statins. And there's some evidence that this age group may be more prone to statin side effects, such as muscle pain, an increased risk of diabetes, and liver problems.

New drug data show benefits

But the picture is becoming clearer. A slew of recent studies have shown that statins may have significant benefits in older age groups. “Your physiology doesn't suddenly change when you turn 75 years of age,” says Steven Nissen, M.D., chair of cardiovascular medicine at the Cleveland Clinic.

In data released in July, researchers followed more than 320,000 veterans age 75 and older for about seven years. “There was a 25 percent lower risk of dying from any cause among those who were taking a statin, compared to those who never did — and a 20 percent lower risk of dying from a cardiovascular event, such as a heart attack or stroke , among those who started taking a statin after age 75,” says the study's lead author, Ariela Orkaby, M.D., MPH, a physician scientist at the VA Boston Healthcare System and assistant professor of medicine at Brigham and Women's Hospital.

What's more, in a 2019 French study, people ages 75 to 79 experienced a health issue after going off these cholesterol-lowering medications. Over a follow-up period of up to four years, 10 percent of those who discontinued their statins were later admitted to the hospital for cardiovascular problems, compared with only 8 percent of those who stayed on the drugs.

Similarly, an Israeli study, also published in 2019, in the Journal of the American Geriatrics Society, found that older people who adhered to their statin prescription had a 34 percent lower chance of an early death from any cause than those who stopped taking the drug.

Cardiologists are quick to point out that such research, showing correlations, isn't the strongest type of data. Still, the studies are compelling. “They've been so consistent,” says Lewis. “Across the board, statins appear to [lower risk] about 20 to 30 percent, compared to placebo, no matter how old you are and no matter your baseline level of risk."

A new NIH/Duke University study is expected to resolve the age question. Called “Pragmatic Evaluation of Events and Benefits of Lipid-Lowering in Older Adults (PREVENTABLE),” the study will enroll 20,000 adults age 75 and older to investigate the overall benefits and risks of statins — not just for their heart health but for their neurological function. The results won't be available for several years, but in the meantime, the American College of Cardiology and the American Heart Association call statins a reasonable choice for older people when other measures have not worked to bring down their cholesterol levels. With one caveat: It depends on the patient.

"When I see a patient over 75 who I believe has a relatively long life expectancy and who has elevated cholesterol and maybe some other risk factors, like diabetes or hypertension, I discuss with them the pros and cons of statins and suggest we try one,” says Nissen. “If they tolerate it well, without any adverse effects, then I think I've done them a lot of good.”

It's a different story if a patient is very frail or is not expected to live for more than a few years because of advanced illnesses. In that case, a statin may or may not be the right choice.

"I do try to twist people's arms to get them on one, especially if they're diabetic or have a lot of other risk factors,” Lewis agrees. “But I watch them much more closely, and I worry about them more."

If statin side effects become an issue, the prescription can often be tweaked. “For most people who say that they're statin intolerant, there's usually an option,” says Orkaby, who adds that there are some that are considered lower or moderate intensity. “It's finding the sweet spot of what works for every patient."

While statins aren't for everybody, Nissen says, there's a role for them — at any age. “I am doing the best scientific work of my life and will probably be doing this for 10 more years,” he says. “I'm taking a statin, and when I turn 75 I have no intention of stopping the stuff.”

The post Reconsidering Statins After 75 appeared first on AARP .

What You Need to Know About Sleep Apnea

Thu, 29 Oct 2020 00:32:12 GMT

Join Dr. D 'Ambrosio as she discusses sleep apnea with a focus on the patient experience. This seminar will be centered around teaching the signs and symptoms of sleep apnea, the different treatments available and most importantly, the health benefits from treatment. Dr. D 'Ambrosio will also review some common problems patients have with sleep apnea treatment and ways to address those issues.

When the Doctor Is a Covid ‘Long Hauler’

Wed, 21 Oct 2020 18:36:52 GMT

Coronavirus may leave patients with a condition called POTS that makes the heart rate soar after even the mildest activities.

I am a physician who contracted what was initially a fairly mild case of Covid-19 in early March. Seven months later, I remain substantially debilitated, with profound exhaustion and a heart rate that goes into the stratosphere with even the tiniest bits of exertion, such as pouring a bowl of cereal or making a bed. I may never get better, despite receiving the best care available. And there are likely to be thousands more like me .

My early symptoms were fairly typical, with a sore throat, headache, body aches and fatigue. When I developed shortness of breath and chest pain, an emergency department physician I was seeing via telemedicine recommended I go to the E.R. My chest X-ray and oxygen saturation were normal, so I was sent home with an inhaler and was on the mend within two weeks.

But then the sequelae — the medical word for longer-term consequences — set in. My ongoing symptoms are familiar to many of the so-called Covid “long-haulers”: in addition to the exhaustion and careening heartbeat, I have headaches, shortness of breath, tremulousness, and numb and tingling extremities. Sounds are too loud, light is too bright, nine hours is too little sleep at night. I am fortunate to have been spared some of the other symptoms that plague long-haulers , such as “brain fog,” memory problems and PTSD-like anxiety.

Like many long-haulers, I was young — 37 — and healthy when I got Covid-19. I was working full-time in private practice and teaching at an academic medical center. I was doing pro bono work, raising my daughter, exercising most days, going out to museums and shows, serving on multiple nonprofit boards, and getting ready to host 20 kindergartners for an at-home birthday party the week I got sick (we canceled it).

Post-Covid, I can still do some of these things, which is more than many long-haulers can say, but only because they are virtual and therefore sedentary: pandemic life allows for visiting museums and viewing the performing arts virtually and attending work and board meetings online. So I can do it all from a seated position. I read endlessly on the couch to my daughter, and we play pretend games with me in a supine pose, while my husband does the vertical parenting that I can no longer do. He cooks for the family, he does the bike rides with our daughter. He would replace me as the chaperone to swimming lessons and ballet class, but for the pandemic.

Thanks to my medical background, good referrals from friends and an online forum called Body Politic, which includes a discussion group for Covid long-haulers, I have been diagnosed with dysautonomia, a disorder of the autonomic nervous system that is commonly triggered by viral infections. The autonomic nervous system controls involuntary functions in our bodies such as heart rate, blood pressure and digestion. When it is damaged by an infection or other cause, these functions go out of whack.

My specific form of dysautonomia, called postural orthostatic tachycardia syndrome, or POTS, was coined in 1993 by Dr. Phillip Low and his team at the Mayo Clinic, though it went by other names throughout history . POTS precludes standing for more than a few minutes at a time, because autonomic damage prevents blood vessels in the lower extremities from properly returning blood to the heart and brain against gravity. Heart rate can double or triple on standing, and lack of oxygen to the brain and upper body lead to many of the symptoms seen in POTS patients: dizziness, headaches, shortness of breath, chest pain, “brain fog.”

If a POTS patient does stay vertical for a prolonged period, he or she can be left with massive fatigue, light and sound sensitivity, tingling extremities, temperature intolerance and gastrointestinal problems (again, all the bodily functions of the autonomic nervous system gone awry).

POTS is not life-threatening, unless a patient faints and suffers a serious head injury, but the degree of disability that it causes is equated to that of congestive heart failure or chronic obstructive pulmonary disease . Data from the Mayo Clinic shows that about half of POTS patients have some improvement in symptoms over an average of five years . It’s too soon to know how the course of Covid-induced POTS might unfold.

Increasingly, doctors are recognizing that POTS appears to account for many of the Covid long-haul symptoms being reported around the world. It’s a condition with no known cure, but the symptoms can be managed with medications, a physical rehabilitation program and dietary interventions. To even have a diagnosis and a management plan makes me one of the lucky ones.

Here’s why else I am lucky: My medical specialty is psychiatry. I can work from home using a telemedicine platform to see my patients and Zoom to do my teaching. My job is sedentary, so I can continue to work full time in my physically debilitated state. If I were a surgeon, or a gynecologist, or an ophthalmologist, let alone a construction worker or hair stylist or other professional in a physically demanding field, I would be unable to continue to work and would be a candidate for formal disability benefits.

What of other Covid long-haulers who have more physically demanding jobs than I do? What about those who are single parents? How and when will they return to work and normal parenting? What if they never can?

On good days, when my heart rate is controlled and I’m not shaky or short of breath, I go outdoors. I wear a mask (or two), keep my distance from others and avoid even outdoor restaurants. As reports about genetically confirmed repeat Covid-19 infections surface, I worry about getting infected again. If I had a repeat Covid infection, would it be more severe, or more mild, than my first? Any kind of infection tends to exacerbate POTS symptoms and could undo all the hard work I am putting into illness management.

Unlike the more than a million people lost to Covid worldwide, I am alive. That said, in addition to a disease’s mortality rate, it’s also important to consider its morbidity rate — the long-term consequences for those who do not die. How much disability will we accumulate by the end of this pandemic? How much hopelessness? Knowledge about POTS and how to manage it gives me hope. Many long-haulers, mired in morbidity, aren’t so lucky.

The post When the Doctor Is a Covid ‘Long Hauler’ appeared first on The New York Times .

Stress and the heart: Lessons from the pandemic

Wed, 14 Oct 2020 14:30:00 GMT

The effects of COVID-19 have been extensive, with more than seven million confirmed cases and more than 200,000 deaths in the US alone. COVID-19 has caused additional impacts on healthcare; for example, patients have delayed seeking care for serious symptoms over fears of exposure to COVID-19. But the consequences of COVID-19 have reached beyond healthcare alone, with daily impacts on our financial, social, and emotional well-being.

As we attempt to cope and settle into this new normal, we will learn about the long-term effects of these hardships. Doctors have already begun to study the effects of COVID-related stress and anxiety on people around the world.

Physical effects of stress

Stress can have real physical effects on the body, and it has been linked to a wide range of health issues. Stress directly activates our sympathetic nervous system, initiating a fight-or-flight response that can elevate blood pressure and blood sugar. Though potentially useful in the short term from an evolutionary standpoint, stress can worsen hypertension and diabetes when it occurs chronically. Stress can disrupt our sleep, and can lead us to make unhealthy food choices, as we seek comfort foods or abandon portion control.

A recent study suggests that stress due to the pandemic may already be affecting our heart health.

The link between stress and heart health

Stress cardiomyopathy, also called Takotsubo cardiomyopathy and broken-heart syndrome, is a cardiac disorder characterized by a sudden onset of chest pain and heart dysfunction that mimics a heart attack. But, in contrast with what is seen during a heart attack, doctors are unable to find evidence of a blood clot or abnormalities with cardiac blood flow.

Typical stress cardiomyopathy patients are postmenopausal women experiencing sudden onset of chest pain and shortness of breath. The link between stress and stress cardiomyopathy is well documented; patients with stress cardiomyopathy often experience emotional or physical stress in the week preceding their illness. The exact mechanism of this reaction is not clearly understood, but researchers have found changes in blood flow to the brain and in signaling of stress-related hormones.

Emotional triggers of stress cardiomyopathy include death of a spouse or family member, divorce or interpersonal conflict, and natural disasters such as earthquakes and floods. It stands to reason that living with the chronic stress of a global pandemic could also trigger this syndrome.

Pandemic-related stress is already affecting heart health

A recent study published in JAMA Network Open attempted to measure the effect of COVID-19-related stress on our health by looking at the prevalence of stress cardiomyopathy during the pandemic. The researchers compared the incidence of stress cardiomyopathy during the COVID-19 pandemic (March 1 to April 30, 2020) to the incidence of stress cardiomyopathy during three prior periods (in 2018, 2019, and earlier in 2020). Importantly, all patients included in the study tested negative for COVID-19.

Researchers found that there was a significant rise in stress cardiomyopathy during the COVID-19 period, with stress cardiomyopathy occurring more than four times as often as usual during March and April 2020.

Fortunately, heart function typically recovers over one to two weeks in people with stress cardiomyopathy, and prognosis is generally good. However, affected patients do have an increased risk of recurrence.

Take steps to manage stress

This study is a cautionary tale regarding the impact of stress. It serves as a good reminder that we should all strive to minimize stress, even in these trying times, and improve how we handle it. Some practical tips for managing stress including choosing healthy foods, exercising regularly, getting enough sleep, and staying connected with friends and family.

The post Stress and the heart: Lessons from the pandemic appeared first on Harvard Health Blog .

Can We Co-Exist with COVID-19?

Mon, 12 Oct 2020 19:36:00 GMT

An Epidemiologist Separates Fact from Fiction and Offers Hope for the Future

Epidemiologists seek to learn why, how and when some people contract diseases when others don’t. Their findings are used to help monitor public health status, develop new medical treatments and disease prevention efforts, and provide an evidence base to healthcare and policy leaders.

Whether you feel the coronavirus is receding or set to surge, that testing is plentiful or inadequate, or that cases are reported as too high or too low may vary considerably based on where you live and your political leanings.

For an objective, no-spin perspective, we checked in with Jodie Guest, PhD , an epidemiologist at Emory University in Atlanta. Dr. Guest’s life’s work is studying the distribution, causes, prevention and control of diseases in populations.

Her answers to some of today’s most important questions about COVID-19 are below. Please note these reflect the situation mid-September…check our website for further updates.

Q: Are we seeing a slowdown in the number of new COVID-19 cases in the U.S.?

Dr. Guest: The number of new cases has, fortunately, plateaued or slowed down, but in many places the plateaus reflect substantially higher numbers than were reported in April, when everyone was still staying home. My concern is with schools and businesses reopening and less willingness to follow safety guidelines, the numbers may creep back up.

Q: What sites do you trust for accurate reporting on COVID-19?

Dr. Guest: I compare numbers from Johns Hopkins , Centers for Disease Control (CDC) and Worldometer to see if they match.

Q: What is the significance of the latest report from the CDC that just 6% of coronavirus deaths to date have COVID-19 as the only cause of death?

Dr. Guest: It’s not at all surprising for two reasons. One is that more than 60% of Americans have an underlying condition, such as obesity or diabetes. The risk of complications and hospitalization for people with two to three underlying conditions who contracted the virus is up to five times greater than for people with no [underlying] conditions. Second, death certificates list everything that may have contributed to mortality, including comorbid conditions and conditions caused by COVID-19 such as pneumonia. This does NOT mean that any of the more than 200,000 people who had heart disease or diabetes as an underlying condition didn’t actually die of COVID-19.

Q: Why are people of color and Latinos at greater risk of death from COVID-19?

Dr. Guest: This is not about a genetic risk of death. It’s driven by multiple factors, including a higher incidence of underlying conditions, less access to proper healthcare, greater risk of infection at the workplace and crowded living conditions that preclude social distancing.

Q: What is your take on the revised CDC guidelines that say testing for people who have been exposed to COVID-19 should be limited to those with symptoms?

Dr. Guest: Many of us in the public health community feel very strongly that we need to be testing asymptomatic people. From a public health perspective, more testing of asymptomatic people, not less, must be done to control the virus. NOTE: As of 9.18.20, CDC guidelines were revised again to state: “if you have been in close contact, such as within 6 feet of a person with documented SARS-CoV-2 infection for at least 15 minutes, and do not have symptoms, you need a test.”

Q: What are the relative risks of activity as we move forward?

Dr. Guest: There’s so much variation based on how carefully an activity is done, but there are four good rules that apply to all: Outside is safer than inside, shorter time is safer than longer, small groups are safer than bigger, and distance is safer than closeness.

Q: How might COVID-19 affect the epidemic of flu we see annually?

Dr. Guest: If we take COVID-19 prevention measures seriously – masking, social distancing, handwashing – we could have a light flu season. If we don’t, COVID-19 will make it worse. The good news is that this has already spurred many people to get their flu shots.

Q: Any other silver linings you’re seeing?

Dr. Guest: For the first time, we are having a national conversation around health disparities and inequalities. We might actually come to a reckoning and take corrective action, and that would be spectacular.

Q: What is most important for people to know about getting back to normal?

Dr. Guest: Eventually we’ll have a vaccine but we’re not going to eliminate COVID-19 completely. However, there needn’t be this level of impact on our society. I can’t emphasize enough that we have control over how this virus spreads. We need strict guidelines and most importantly, a social contract with everyone in your community. This may be the first time many of us are asking “What are we willing to do for each other?” I hope we can all rise to the challenge.

When considering whether it is safe to resume an activity, there is much variation based on how carefully an activity is done. Additional details are provided in the infographic below, courtesy of www.covid19reopen.com

The post Can We Co-Exist with COVID-19? appeared first on Specialdocs Consultants .

Let It Go: The Ancient Art of Meditation

Mon, 12 Oct 2020 19:27:00 GMT

Finding Peace Through Mindfulness and Meditation

Mindful, compassionate, serene, happy: emotions that have been in short supply during the pandemic but can be beautifully restored to those who embrace the chance to learn the time- honored practice and art of meditation. For many, it is as easy as downloading the Headspace app on their smartphone, receiving a seamless introduction to a technique the company describes as “rooted both in ancient history and modern science.”

There’s an App For That

Meditation has been practiced for over 3,000 years, and its benefits, improving well-being, helping eliminate insomnia, enhancing focus, decreasing stress, and reducing blood pressure, among many others, have been studied for decades.

But the real democratization of meditation may have been ushered in by the proliferation of apps like Calm , Buddhify , Insight Timer and Simple Habit . Since its 2010 debut, global leader Headspace has been downloaded more than 65 million times, a number that has steadily risen during the coronavirus crisis.

Dr. Megan Jones Bell , the company’s chief science officer, reports a tenfold increase in those starting the “ stressed ” meditation and a twelvefold increase in “ reframing anxiety at home ” users from mid-March to mid-May of 2020.

Getting Started

First, choose a time to meditate, and consistently make it part of your daily routine. Find an uncluttered, quiet spot where you won’t be disturbed. Make yourself comfortable in a chair or on the floor with a pillow behind you, close your eyes and allow yourself to let go. It’s natural to wonder, “Am I doing this right?” The experts at Headspace offer some gentle guidance:

More Than One Way to Meditate

More than a dozen different types of meditation are taught, including:

The post Let It Go: The Ancient Art of Meditation appeared first on Specialdocs Consultants .

How Red Meat Went from Taboo to Acceptable and Back Again

Mon, 12 Oct 2020 19:22:00 GMT

What’s the Beef With Red Meat?

It’s long been the case that provocative headlines, unexpected findings and misinformation travel far faster than conventional wisdom, especially in the internet age. Even respected medical journals like the Annals of Internal Medicine can become caught in a crossfire of disagreement, as occurred last year when a controversial nutritional study by the NutriRECS Consortium concluded that three servings of red and/or processed meat weekly resulted in a very small increased risk of cancer or heart disease.

NutriRECS further suggested that the evidence surrounding potential harm from regular consumption of red meat was weak, and therefore people needn’t abstain from eating it for health reasons.

So misleading was the journal’s press release headline, “New guidelines: No need to reduce red or processed meat consumption for good health”, that the entire study was offered as a cautionary tale at the most recent Menus of Change conference , an influential initiative on plant-forward eating from the Harvard T.H. Chan School of Public Health and the Culinary Institute of America .

A panel headed by Walter Willett, MD , professor and past chairman of the department of nutrition at the Harvard School of Public Health, dissected why a message that flew in the face of decades of research and established guidelines from the American Heart Association and the World Cancer Research Fund, made its way into the mainstream.

According to Dr. Willett, the major flaw was the authors’ decision to disregard numerous studies done over the years regarding red meat and health as “weak evidence” because they weren’t based solely on randomized clinical trials. While these are the gold standard of scientific research, the reality for nutrition studies can be different.

“There are no double-blinded, placebo-controlled trials of red meat and its links to cardiovascular disease or cancer,” explained Dr. Willett. “It’s not really possible to get this kind of study because people won’t stay on specific diets for years to track and compare.”

The result was elimination of influential studies and meta-analyses clearly pointing to increased risk of disease for meat eaters. This included a pivotal 2015 Harvard School of Public Health study of more than 121,000 individuals followed for an average of 26 years that showed every daily serving of processed meat was associated with a 13% higher risk of death from all causes; processed red meat increased the risk to 20%. A 2019 meta-analysis in the Annals itself showed that reducing processed red meat by three servings per week decreased the incidence of diabetes by 22%; lowered mortality from cardiovascular disease by 10% and from cancer by 7%; and decreased overall mortality by 7%.

“These statistics alone could have been the basis for a blockbuster drug,” asserted Dr. Willett.

Additionally, as came to light after the study was published, the authors’ ties to food industry groups were not accurately disclosed. In January, the journal issued a correction detailing those connections, but the panel’s experts were concerned that the damage had been done, and the study’s misleading headlines had negatively affected public acceptance of traditional nutritional guidance.

“The global consensus remains unchanged: largely replacing red meat with plant protein sources and (optionally) modest amounts of fish, poultry and dairy foods will reduce the risk of coronary heart disease, diabetes and premature death,” said Dr. Willett.

Beyond the Burger: What’s Next in Plant-Based Alternatives

Also featured at Menus of Change was a look at the growing American appetite for alternative proteins. The trend, kick-started by the popularity of plant-based burgers, intensified during the pandemic as consumers sought what they perceived as healthier foods produced in safer, sterile environments. Note: plant-based items are not always nutritionally sound, so please check the labels carefully when these products become available .

Coming soon:

“Plant proteins are becoming the growth story of the decade, on the cusp of replacing fish and seafood as the fourth-most-popular protein in America.”

— Zak Weston, The Good Food Institute

The post How Red Meat Went from Taboo to Acceptable and Back Again appeared first on Specialdocs Consultants .

In Rare Step, Esteemed Medical Journal Urges Voters To Oust Trump

Thu, 08 Oct 2020 19:03:28 GMT

The Trump administration has "taken a crisis and turned it into a tragedy" in its response to the COVID-19 pandemic, The New England Journal of Medicine says in a scathing editorial that essentially calls on American voters to throw the president out of office.

It is the first time the prestigious medical journal has taken a stance on a U.S. presidential election since it was founded in 1812.

"When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent," reads the editorial signed by nearly three dozen of the journal's editors. "We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs."

The editors accuse Trump's government of a massive public health failure — and of worsening the pandemic's effects by prioritizing politics over sound medical guidance.

The piece, titled "Dying in a Leadership Vacuum" and published Wednesday, does not mention President Trump or his Democratic rival, Joe Biden, by name. But it refers to the Trump administration repeatedly, and its footnotes cite news articles about Trump insisting that coronavirus risks are overblown, pressuring federal scientists, and politicizing the search for treatments.

"Instead of relying on expertise, the administration has turned to uninformed 'opinion leaders' and charlatans who obscure the truth and facilitate the promulgation of outright lies," the editorial states.

The New England Journal of Medicine is at least the third widely respected medical or science journal to call for a change in U.S. leadership. Editor-in-Chief Dr. Eric Rubin says the editorial is rare for two main reasons: It's one of the handful of times an editorial has been signed by all the editors, and it takes an unprecedented political stand.

"There have been many mistakes made that were not only foolish but reckless," Rubin tells CNN , "and I think we want people to realize that there are truths here, not just opinions."

Even though the U.S. has distinct advantages in biomedical research, manufacturing capacity and public health expertise compared with many other countries, the U.S. has recorded more than 212,000 deaths from the coronavirus — the most in the world. Along the way, U.S. leaders have denigrated experts and ceded disease control to the states, the journal's editors say.

"Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences," the editorial states. "Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment."

The editorial acknowledges the difficulties that all countries face in coping with the coronavirus. And it notes that some deaths are unavoidable in a pandemic. But in the U.S., the authors say, "we have failed at almost every step," from having adequate protective gear to a problematic approach to testing and contact tracing to a failure to follow basic precautions such as wearing face masks.

"In much of the country, people simply don't wear masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures," the editorial states.

Many of the sentiments echo concerns raised in other venerable journals this year.

Scientific American broke with 175 years of tradition by endorsing Biden last month – a decision that was both unanimous and quick, Editor-in-Chief Laura Helmuth told NPR . And The Lancet called on Americans to make Trump a one-term president back in May.

All three journals took stands against Trump without referring to political parties; Helmuth says the Scientific American editorial purposefully avoided doing so in an attempt to be inclusive for its readers.

In a similar vein, the New England Journal of Medicine editorial states, "Truth is neither liberal nor conservative."

The opinion piece notes that the U.S. has performed worse than many other developed nations, such as South Korea that had much higher rates of travel to and from China when the coronavirus initially emerged.

The journal's editors write: "The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000."

The post In Rare Step, Esteemed Medical Journal Urges Voters To Oust Trump appeared first on NPR .

Risk of COVID-19 During Air Travel

Thu, 01 Oct 2020 19:08:32 GMT

The risk of contracting coronavirus disease 2019 (COVID-19) during air travel is lower than from an office building, classroom, supermarket, or commuter train.

How Is COVID-19 Transmitted?

The virus that causes COVID-19 is emitted when someone talks, coughs, sneezes, or sings, mainly in droplets that can be propelled a short distance, and sometimes in smaller aerosol particles that can remain suspended and travel further. Another person can be infected if these particles reach their mouth or nose, directly or via hands. Transmission via surface contact is also important in some cases.

How Clean Is the Air in Passenger Aircraft?

Air enters the cabin from overhead inlets and flows downwards toward floor-level outlets. Air enters and leaves the cabin at the same seat row or nearby rows. There is relatively little airflow forward and backward between rows, making it less likely to spread respiratory particles between rows.

The airflow in current jet airliners is much faster than normal indoor buildings. Half of it is fresh air from outside, the other half is recycled through HEPA filters of the same type used in operating rooms. Any remaining risk to be managed is from contact with other passengers who might be infectious. Seat backs provide a partial physical barrier, and most people remain relatively still, with little face-to-face contact.

Despite substantial numbers of travelers, the number of suspected and confirmed cases of in-flight COVID-19 transmission between passengers around the world appears small (approximately 42 in total). In comparison, a study of COVID-19 transmission aboard high-speed trains in China among contacts of more than 2300 known cases showed an overall rate of 0.3% among all passengers. Onboard risk can be further reduced with face coverings, as in other settings where physical distancing cannot be maintained.

Risk Reduction Steps by Airports and Airlines

Steps being taken at airports and on board can include temperature testing and/or asking about symptoms (fever, loss of sense of smell, chills, cough, shortness of breath); enhanced cleaning and disinfection; contactless boarding/baggage processing; use of physical barriers and sanitization in airports; physical distancing in airports and during boarding; use of face coverings or masks; separation between passengers on board when feasible; adjustment of food and beverage service to reduce contact; control of access to aisles and bathrooms to minimize contact; limiting exposure of crew members to infection; and facilitation of contact tracing in the event that a passenger develops infection.

Additional steps being studied are preflight testing for COVID-19 and adjustments to quarantine requirements.

Steps Passengers Can Take

Wear a mask, don’t travel if you feel unwell, and limit carry-on baggage. Keep distance from others wherever possible; report to staff if someone is clearly unwell. If there is an overhead air nozzle, adjust it to point straight at your head and keep it on full. Stay seated if possible, and follow crew instructions. Wash or sanitize hands frequently and avoid touching your face.

The post Risk of COVID-19 During Air Travel appeared first on JAMA Network .

Building Personal Resilience

Thu, 01 Oct 2020 00:39:20 GMT

Resilience is about far more than “bouncing back”. Resilience is about strengthening your ability to navigate future challenges—a skill that is arguably one of the most critical for both personal and professional success. Strength in this area positions you to adapt in the face of change, think more objectively under pressure, creatively problem solve, identify unexpected opportunities, and maintain hope and focus on the future. Fortunately, resilience isn’t a static personality trait, but rather something you can develop with awareness and practice. In this session, you will learn strategies for bolstering your resilience, discover why mindset matters and how to adjust your thinking when navigating difficult situations, and learn how to approach future challenges with realistic optimism.

A Potential Downside of Intermittent Fasting

Mon, 28 Sep 2020 18:46:53 GMT

A rigorous three-month study found that people lost little weight, and much of that may have been from muscle.

Intermittent fasting is a trendy weight loss strategy. But a new study found that a popular form of intermittent fasting called time-restricted eating produced minimal weight loss and one potential downside: muscle loss.

The new research, published in JAMA Internal Medicine , is one of the most rigorous studies to examine time-restricted eating, which involves fasting for 12 or more hours a day. Many followers of the diet, which has been popularized in best-selling diet books and touted by celebrities, routinely skip breakfast and eat all their meals between roughly noon and 8 p.m., resulting in a daily 16-hour fast.

Research over the years has suggested that the practice spurs weight loss and improves metabolic health, although much of the data has come from animal experiments or small studies of relatively short duration in humans. Experts say the diet works because it allows people the freedom to eat what they want so long as they do it in a narrow window of time, which leads them to consume fewer calories over all.

But the new research found that overweight adults who were assigned to routinely fast for 16 hours daily, eating all their meals between noon and 8 p.m., popularly known as the 16:8 diet, gained almost no benefit from it. Over the course of the three-month study, they lost an average of just two to three and a half pounds — only slightly more than a control group — and most of the weight they shed was not body fat but “lean mass,” which includes muscle.

While it is normal to lose some muscle during weight loss, the fasting group lost more than expected. That is concerning because muscle provides many health benefits: It protects against falls and disability as people age, and it is linked to lower mortality . It also increases metabolism and can help prevent weight that is lost during dieting from returning later on. The researchers speculated that one reason for the muscle loss may have been that the fasting diet led people to consume less protein.

The new findings were surprising to the study’s senior author, Dr. Ethan Weiss, a cardiologist at the University of California, San Francisco. Dr. Weiss had been practicing time-restricted eating since 2014, eating all of his meals between noon and 8 p.m. on a daily basis. But when he analyzed the data and saw the results of his study, he stopped his daily fasts and began eating breakfast again.

“My bias was that this works and I’m doing it myself, and so I was shocked by the results,” he said.

But some experts cautioned that the study was too short for a weight loss trial. They said it was likely that the fasting group would have showed greater weight loss had the study been longer and included more participants. They also pointed out that previous research has shown that people do better when they consume the bulk of their calories relatively early in the day, which is when our bodies are better able to metabolize food, rather than skipping breakfast and eating most of your food in the afternoon and evening, which goes against our biological clocks.

Studies have found , for example, that overweight adults lose more weight and have greater improvements in their cardiovascular risk factors when they eat a large breakfast, a modest lunch and a light dinner, compared to when they eat a small breakfast and a big dinner.

“It could be that the benefits of time-restricted eating are smaller than we thought, or that you just get better results when you eat earlier in the day,” said Courtney Peterson, a researcher at the University of Alabama at Birmingham who studies intermittent fasting and who was not involved in the new study. “The jury is still out.”

Many cultures around the world practice fasting for religious or spiritual reasons. But fasting became popular for health reasons after small studies suggested it promotes longevity and a wide range of metabolic benefits, such as improved cholesterol profiles and reductions in insulin resistance. Some of the other common forms of intermittent fasting are alternate day fasting, in which followers eat no more than 500 calories every other day, and the 5:2 diet, which entails eating normally for five days a week and fasting for two.

Many people, however, have trouble going an entire day with little or no food. Krista Varady, a professor of nutrition at the University of Illinois, Chicago, has found in her research that people lose weight more slowly with time-restricted eating than other forms of fasting but that it is generally the easiest form of fasting to adopt. People tend to eat 300 to 500 calories fewer per day when they restrict themselves to an eight-hour window, said Dr. Varady, who was not involved in the new research.

“The best part is there are no limitations during the window,” she said. “There is no carb or calorie counting, and people don’t have to switch out all the food in their pantries.”

Dr. Varady said she is planning to start a yearlong study of time-restricted eating in the near future. “I find it fascinating that this diet has become so popular and there are so few studies,” she said.

Dr. Weiss got interested in time-restricted eating after learning about research that showed that mice provided round-the-clock access to high-fat, high-sugar foods got fat and sick, while mice that ate the same foods in an eight-hour daily window were protected against obesity and metabolic disease. In his own experience, Dr. Weiss found that skipping breakfast and eating between noon and 8 p.m. was not very difficult.

He wanted to see whether the diet could be a simple prescription for people to lose weight, so for the current study, he and a colleague, Dylan Lowe, designed an experiment: They recruited 116 overweight and obese adults and split them into groups. One group, which served as controls, was told to eat three structured meals daily. The other group was assigned to eat all their food between noon and 8 p.m., with only noncaloric beverages like tea and black coffee permitted outside that window.

The researchers chose noon to 8 p.m. because it would be more socially acceptable for participants to skip a meal in the morning rather than in the evening, when they might be sitting down to dinner with family or friends. “We wanted to make this something that was simple enough that people could actually do,” Dr. Weiss said.

The researchers gave the participants digital scales and tracked their weight for 12 weeks. They also had 50 of the participants, from both the fasting and three-meals-a-day groups, visit their lab four times during the study so they could measure things like their fat and muscle mass, blood sugar levels and energy expenditure.

In the end, the fasting group lost an average of two pounds, only half a pound more than the controls. When the researchers looked at participants who had visited their lab for extensive testing, they found that the fasting group had little or no improvement in most of their metabolic markers, though they did tend to lose more weight, a little over three and a half pounds. That was roughly two and a half pounds more than the control group, a difference that fell narrowly short of being statistically significant. But 65 percent of the weight that the fasting group lost was from lean mass — more than double what is considered normal for weight loss.

Dr. Weiss said it is possible that the fasting group lost an unusual amount of muscle because skipping breakfast each day caused their overall protein intake to fall. But that could potentially be avoided: Other studies have found that people can maintain muscle while fasting by doing resistance training and consuming more protein during their eating windows. Dr. Weiss said the findings need to be explored further, but for now he remains skeptical of time-restricted eating.

“This was a short study, but it was enough of a study that to me it calls into question whether this works — and if it does work, then the magnitude of the benefit is very small,” he said.

The post A Potential Downside of Intermittent Fasting appeared first on The New York Times .

Herbs for the Heart and Metabolic Health

Thu, 24 Sep 2020 00:00:17 GMT

Join Sarah Byrne, MD as she discusses the power of herbal medicine, and how all of us can easily and safely incorporate herbs into our daily lives for increased vitality and resilience. She will highlight herbs that are used specifically to support cardiovascular and metabolic health (high blood pressure, high cholesterol, diabetes, etc) and give you specific examples of products and brands she uses with her own patients at Root Family Medicine. You will leave this webinar with a better understanding of herbal medicine and plants that you can utilize at home to strengthen your heart health. Dr. Byrne practices holistic Primary Care in Norwood and has trained in herbalism under Tieraona Low Dog, MD for the past three years; you can find her practice at rootfamilymedicine.com .

Instagram:

Root Family Medicine: https://www.instagram.com/rootfamilymedicine/?hl=en

Dr. Byrne's: https://www.instagram.com/root.dr.sarah/?hl=en

For Older People, Reassuring News in the Statin Debate

Mon, 21 Sep 2020 19:14:14 GMT

There is accumulating evidence that the benefits of statins far outweigh possible risks, and nearly all statins on the market are now available as inexpensive generics.

Cholesterol-lowering statin drugs, already one of the most popular medications worldwide, may become even more widely used as evidence grows of their safety and value to the elderly and their potential benefits beyond the heart and blood vessels.

Among the latest are reports of the ability of several leading statins to reduce deaths from common cancers and blunt the decline of memory with age. Perhaps such reports will persuade a reluctant 65-year-old friend who has diabetes, and others like him, that taking the statin his doctor strongly advised is a smart choice.

In addition to accumulating evidence that the benefits of statins far outweigh possible risks for the vast majority of people for whom they are now recommended, nearly all statins on the market are now available as inexpensive generics.

Full disclosure: I have a strong family history of heart disease and have been taking a statin — atorvastatin, originally marketed as Lipitor — for many years after dietary changes failed to control a steadily rising blood level of artery-damaging LDL-cholesterol. My prescription is now fully covered by my Medicare Part D insurance with no co-pay.

But cost of a medication is not the only consideration for a drug that can be lifesaving for many people. The primary indication for taking a statin is to reduce the risk of a heart attack or stroke by lowering serum LDL-cholesterol and, in some cases, also triglycerides, both of which can damage coronary arteries when levels rise above normal.

Statins offer further cardiovascular protection by stabilizing the fatty deposits in arteries called plaque that can break loose, block a major artery and cause a heart attack or stroke.

Current guidelines typically recommend statin therapy for:

People with a history of heart disease, stroke or peripheral artery disease or risk factors that give them a 10 percent or greater chance of a heart attack within 10 years;
People over 40 with diabetes and an LDL-cholesterol level above 70 milligrams per deciliter;
People over 21 with an LDL-cholesterol level of 190 or higher (despite dietary changes to minimize saturated fats and achieve a normal body weight).

Currently, more than 60 percent of older people in the United States who, like me, have high cholesterol take a statin to help prevent a heart attack or stroke.

Still, there’s been a long-simmering debate as to whether statins are advisable for people over 75, even though the risk of suffering life-threatening cardiovascular disease rises precipitously with age. Concerns have been raised about side effects associated with statins, potential adverse effects of the drugs on other ailments common in the elderly and possible harmful interactions with the many other medications they often take.

Writing in the Harvard Health Blog last October, Dr. Dara K. Lee Lewis noted, “The paradox that we face is that as our patients age, they are at increased risk for heart attacks and strokes, and yet they also become more sensitive to medication side effects, so it is a tricky balance.”

Statins can sometimes cause blood sugar abnormalities, resulting in a diagnosis of pre-diabetes or diabetes, and possible toxic effects on the liver that necessitate periodic blood tests for liver enzymes. A very small percentage of people prescribed a statin develop debilitating muscle pain. An elderly friend developed statin-induced nightmares. There have also been reports suggesting statin-associated memory problems and cognitive decline, already a common concern as people age.

But likely the biggest deterrent was the existence of meager evidence for the role statins might play for older people at risk of cardiovascular disease. As is true in most drug trials on new medications, relatively few people over 75 were included in early studies that assessed the benefits and risks of statins.

The latest reports, however, are highly reassuring. One followed more than 120,000 French men and women ages 75 to 79 who had been taking statins for up to four years. Among the 10 percent who stopped taking the drug, the risk of being admitted to a hospital for a cardiovascular event was 25 to 30 percent greater than for those who continued taking a statin.

Another study in Israel, published last year in the Journal of the American Geriatrics Society , involved nearly 20,000 older adults followed for 10 years. Among those who stayed on statin therapy, the chance of dying from any cause was 34 percent lower than among those who failed to adhere to a prescribed statin. The benefits were not reduced for those older than 75 and applied to women and men alike.

This year a study published in JAMA by a team headed by Dr. Ariela R. Orkaby of the VA Boston Healthcare System found that among 326,981 United States veterans whose average age was 81, the initiation of statin use was associated with 25 percent fewer deaths over all and 20 percent fewer cardiovascular deaths during a follow-up of nearly seven years.

However, none of these studies represent “gold standard” research. The results of two such studies, the Staree trial and the Preventable trial, both randomized controlled clinical trials of statin therapy to prevent cardiovascular events in the elderly, have not yet been published. Both will also assess effects on cognition.

Meanwhile, a report last year from Australia published in the Journal of the American College of Cardiology found no difference over a six-year period in the rate of decline in memory or cognitive status between statin users and those who had never taken the drugs. In fact, among those who started a statin during the study, the rate of memory decline was blunted. Another observational study by a Swedish team published in Nature found beneficial effects on reaction time and fluid intelligence among statin takers over 65.

Finally, there are several reports that a major class of statins called lipophilic (including atorvastatin, simvastatin, lovastatin and fluvastatin) may have anticancer effects . One study of nearly 2,000 survivors of early-stage breast cancer found a decreased five-year recurrence rate in women who started a statin within three years of diagnosis.

In a report presented in June to a virtual meeting of the American Association for Cancer Research, Dr. Kala Visvanathan of Johns Hopkins Medicine in Baltimore described a 40 percent reduction in deaths from ovarian cancer among more than 10,000 patients who had used statins either before or after their diagnosis. The patients who benefited in this observational study had the most common and aggressive form of ovarian cancer.

Dr. Visvanathan explained that statins inhibit an enzyme in a chemical pathway involved in the growth and proliferation of tumors. At a press briefing, Dr. Antoni Ribas, president of the association, said that if the finding is confirmed in a randomized clinical trial, “this would be a great outcome.”

The post For Older People, Reassuring News in the Statin Debate appeared first on The New York Times .

Gut Health and Motility

Thu, 17 Sep 2020 00:46:07 GMT

Join Dr. Supriya Rao as she discusses gut health with a focus on the gut microbiome. This seminar will explain gut motility, irritable bowel syndrome and lifestyle habits that are essential for optimal gut health.

Supriya Rao, MD is a board certified physician in internal medicine, gastroenterology and obesity medicine. She is a graduate of the Massachusetts Institute of Technology and Duke University School of Medicine. She completed her residency in internal medicine at the University of Pennsylvania and gastroenterology fellowship at Boston Medical Center. She is a managing partner of her GI practice, Integrated Gastroenterology Consultants , located in Chelmsford, MA. She is also the Director of Medical Weight Loss at Lowell General Hospital. Her clinical interests include gut health and motility, inflammatory bowel disease, women's health, and nutrition & weight management.

Supriya Rao’s Resources:

Facebook: https://www.facebook.com/gutsygirlMD/

Instagram: https://www.instagram.com/gutsygirlmd/

Twitter: https://twitter.com/gutsygirlmd

Link Tree: https://linktr.ee/gutsygirlmd

Tai Chi and Healthy Aging

Thu, 10 Sep 2020 00:38:18 GMT

A growing body of medical research—including dozens of studies based at the Harvard Medical School—supports that Tai Chi mind-body exercise effectively improves balance and musculoskeletal strength, heart health, cognitive function, and psychological well being. During this online session, participants will learn about the background and philosophy of Tai Chi. They will be introduced to what Dr. Wayne has coined the ‘Eight Active Ingredients of Tai Chi’ that underlie its therapeutic effects, and summaries of clinical and physiological research on the health benefits of Tai Chi. The session will include an experiential component during which participants will have an opportunity to learn some practical and easy-to-learn Tai Chi exercises. At the close of the session, interested attendees will be advised on how to develop and integrate a regular practice of Tai Chi into their daily routines.

Tai Chi Handout: https://drive.google.com/file/d/1LTl5xep5RcwKuml6zXycqBHx3EiG4V4b/view

Osher Center for Integrative Medicine: www.oshercenter.org

Tree of Life Tai Chi Center: www.treeoflifetaichi.com

Did COVID-19 Mess Up My Heart?

Fri, 04 Sep 2020 19:22:04 GMT

I got sick six months ago. Now I can barely make it up the stairs.

The stairs have become my daily Everest. Just six months ago, the steep climb to my fourth-floor walk-up in Brooklyn was a nuisance only when I was carrying bags of groceries. Now, every time I mount those 53 steps, no matter how slowly, even if I’m empty-handed, my heart rate shoots up to marathon-level. I can actually feel the thud-thud in my throat. Sometimes I have to pause between landings to lie on the floor and stick my feet up in the air to avoid passing out.

This unusually rapid beating can also be triggered seemingly by nothing––sitting up in bed, standing up from the toilet. I first noticed it in March, when I came down with COVID-19. Or at least, it seems clear that I came down with COVID-19. My whole household got sick just before the peak of New York City’s outbreak. Like most Americans in the early weeks of the pandemic, we were unable to get tested, so my primary-care physician diagnosed my illness based on symptoms: endless days of fever, loss of taste and smell, sore throat, nausea, exhaustion, body aches, a hacking dry cough , and an intense struggle to breathe.

Most of these symptoms subsided in mid-April, but some have lingered. For months, I needed a twice-daily dose of a steroid inhaler to breathe normally. I’m more tired and brain-fogged than usual. And I’m still dealing with my racing heart. I’ve always been a bit of a fainter: Years ago, I was diagnosed with orthostatic hypotension, a sudden, rapid decrease in blood pressure that sometimes strikes when I stand up too quickly. But now, instead of fainting once or twice a year, I feel that woozy fade from light to dark daily, sometimes even hourly. A few weeks ago, I stood up to make a smoothie and my heart rate zoomed from lying-in-a-hammock to booming-bass-drum.

The official name for my new heart troubles, as I’ve recently been diagnosed, is postural orthostatic tachycardia syndrome, or POTS. The condition , a puzzling dysfunction of both the heart and the nervous system, messes with how the body regulates involuntary functions, including pulse. POTS is known to affect approximately 500,000 people in the U.S., typically young women in their late teens or early 20s. But now, several cardiologists with whom I’ve spoken say they’re noticing an unsettling trend. Previously fit and healthy women of all ages who have had COVID-19 are showing up at their offices, complaining of inexplicably racing hearts.

The more we learn about COVID-19, the stranger its effects appear to be. Beyond its telltale fever and cough, troubling early evidence has been mounting that the disease can damage many organs in the body, including the lungs, the brain, and—yes, you guessed it—the heart. An array of cardiac dysfunctions has cropped up, confounding researchers and revealing that COVID-19 is a far more complicated and potentially long-lasting disease than people initially expected. These heart ailments have especially gained attention from sports: Some college football players who have had COVID-19 are sitting out this season with myocarditis, a rare condition that can be fatal if untreated. The Red Sox pitcher Eduardo Rodriguez is doing the same.

In a strange way, I feel lucky. POTS is not life-threatening—at least, aside from the risk of head trauma from blacking out. But it is destabilizing, both physically and mentally, to wander around not knowing what my body has in store for me from one minute to the next. Like so many other aspects of this pandemic, this latest syndrome in my parade of illness is mysterious, disruptive, and scarily indefinite.

After my smoothie incident, I called my cousin Emily Wessler, a pediatric cardiologist at Stanford, and asked her what was going on in my body whenever I felt like I was going to pass out. “You’re not getting enough blood to the brain,” she told me, “so the brain says, ‘Shut down! Shut down! Emergency!’” She’d been reading more and more professional chatter about cases of POTS and other cardiovascular disorders post-COVID, so she urged me to make an appointment with a cardiologist. She added that I also might want to speak with a neurologist. There are a lot of doctors to call if your whole body feels like it’s malfunctioning, which is not ideal at a time when millions of Americans are losing their health insurance.

I started with a cardiologist. At NYU Langone, Seol Young Han Hwang hooked me up to an EKG that immediately spit out bad news. “Sinus tachycardia,” it read. “Abnormal ECG.” In other words, my heart was beating much faster than it should have been, given that I was reclining on an exam table. Han asked me to wear a Holter monitor for a week to trace my heart’s vagaries. It showed abrupt daily spikes, during which my heart rate would jump from as low as 51 beats per minute, while at rest, to as high as 163.

I returned to the hospital for a cardiac ultrasound and a test of my heart’s ability to deal with exercise. The echocardiogram was normal. The stress test was not. Susan Polizzi, another Langone cardiologist, had me slowly build up my heart rate to 161 beats per minute on a gradually steepening treadmill. The test confirmed that I’m in good shape for my age (54) and gender, but when Polizzi then had me sit down and rest, my heart rate remained elevated well above 100 bpm for the next four minutes, instead of quickly slowing down as it should have. When it was finally within the normal range, Polizzi told me to stand. My heart rate immediately shot back up, and I felt on the verge of fainting.

“Yup, that’s POTS,” Polizzi said. In layperson’s terms, having POTS means that blood pools too rapidly in your pelvis and legs when you stand up, and your heart goes nuts to compensate. This bodily response is actually an exaggerated version of the system that allows us to walk on two feet. But knowing that doesn’t make the condition any more tolerable. It just makes me jealous of dogs.

POTS has been recognized under different names by doctors for more than 160 years, but the syndrome’s root cause is still poorly understood. Its apparent link to COVID-19 is even more of a mystery, in the most nascent stage of research. “We know much more about POTS in general than we do about post-COVID POTS,” says Matthew Tomey , the director of the cardiac intensive-care unit at Mount Sinai Morningside and one of a growing number of cardiologists who have begun studying the lingering effects of COVID-19 on the heart. “In a series of patients who do have POTS, over 40 percent describe symptoms of a preceding viral illness. And so while we’re still learning more and more about COVID-19 specifically, we have good reason to believe that it is yet another viral illness that could precede the onset of POTS.”

Tomey is in the middle of gathering data on COVID-19 survivors stricken with all manner of symptoms, so he wasn’t able to share any specific numbers on those with POTS that might hint at exactly how widespread the overlapping conditions are. For now, the evidence is anecdotal. But Tomey and the other cardiologists with whom I spoke all are alarmed by the uptick in POTS and other forms of dysautonomia—the dysfunction of the nerves regulating involuntary body functions—in their practices. This is frustrating for everyone involved. POTS’s unclear origins and wide range of symptoms vex doctors. And they make it easy for patients to be dismissed.

Many teens and young women who develop POTS grow out of the condition. But the apparent surge in cases across a wider age range has made it harder for cardiologists to speculate about how long these symptoms might persist or what the lasting consequences could be. POTS’s greatest danger, according to Tomey, is not a heart attack today, but a downward spiral in physical activity that could eventually lead to heart failure in the future. If cases linked to COVID-19 are not an urgent crisis, in other words, they could perhaps be more subtly pernicious. The most significant health damages could be difficult to trace and could arrive far down the road, well after the pandemic ends.

Before leaving my stress test, I asked Polizzi how best to manage POTS. She suggested I buy a pair of compression socks and pants to keep the blood from pooling in my lower half, eat more salt and drink more liquids with electrolytes, and follow a recumbent exercise regime developed for POTS patients. Swimming, rowing machine, recumbent bike—none of which I have access to during a pandemic. (Notably, POTS can overlap with myalgic encephalomyelitis/chronic fatigue syndrome, in which case patients need to be very cautious about how they approach exercise.)

I walked out of Polizzi’s office more confused than ever. Although a POTS diagnosis was a helpful validation, it mostly raised more questions. When would I be able to walk up stairs again? Was this the new normal for the rest of my life? After months of anxieties and baffling ailments, how could it be that two of the best solutions available to me were merely … Gatorade and Spanx? “Some of my POTS patients take frequent shots of pickle juice,” Han later told me at a follow-up visit. Yeah, no thanks.

I was not surprised by the dearth of either cures or data. Like so many others, I’ve come to rely on confusion as the one constant I can expect in this pandemic. Studies have found that most COVID-19 patients produce antibodies that stick around in the body for months, if not longer. Yet when I was finally able to get an antibody test two months after I got sick, I tested negative—twice. Testing can’t confirm that I even had COVID-19 in the first place. But nothing about this disease is simple. As Ed Yong has pointed out in The Atlantic, “most existing antibody studies have focused on either hospitalized patients or those with mild symptoms and swift recoveries.” David Putrino, a physical therapist at Mount Sinai Hospital who has surveyed more than 1,000 people with long-lasting symptoms consistent with COVID-19, has found that about two-thirds of these “long-haulers” who’ve had antibody tests received negative results. (Putrino hasn’t tracked when in the course of their illness they were tested.)

It feels important to note here that I’m not prone to hypochondria. In fact, I’m used to ignoring and pushing through illness and recovery. I once hiked the foothills of the Himalayas two weeks after emergency surgery. I put the finishing touches on a TV news story while in active labor with my daughter. This time, however, I feel both annoyed and limited. I’m stuck in post-COVID limbo, waiting until I can magically walk up the stairs again without feeling like I swallowed Dave Grohl ’s drum. Last month, on a long-anticipated family trip to rural Maine, instead of hiking Acadia with my kids, as planned, I had to wave them off into the wild while I stayed back at our Airbnb, reading.

It’s probably going to be a while until research has any new solutions for me. “Right now the emphasis is almost entirely on coming up with a vaccine and testing and mechanisms of the viral disease, and these are obviously all key,” says David S. Goldstein, the chief of autonomic medicine at the National Institutes of Health and the discoverer of the chemical imbalance that leads to fainting. But Goldstein does believe that this focus will shift toward the virus’s lasting effects once we can tame its global rampage. “My guess is that it won’t be long before the main public-health threat from this pandemic won’t be acute critical illness or death,” he told me. “Instead, it will be a post-COVID syndrome, like chronic fatigue syndrome but drastically amplified.”

That future already seems to be arriving. COVID-19 long-haulers have launched their own online support groups and research projects to call attention to lasting symptoms that were at first widely dismissed. Survivor Corps , one of the largest of these groups, has identified 98 different symptoms self-reported by long-haulers, such as brain fog, chronic shortness of breath, digestive issues, dry eyes, fatigue, and depression, along with diagnoses of lupus, diabetes, and tachycardia. Goldstein himself caught COVID-19 and now has mild post-COVID symptoms, such as shortness of breath and fatigue, which he referred to as a “sense that if I don’t have anything else to do, I’m going to go to sleep.”

With POTS, at least, I do have some hope for a less heart-wrenching future. Both Goldstein and Tomey were quick to point out that many astronauts—including, they said, every female astronaut who has ever blasted off into space and spent extended time in zero gravity––have come home with cases of POTS-like orthostatic intolerance. All recovered relatively quickly. As strange as it sounds, a link between space travel and COVID-19 might actually exist: The physical deconditioning that occurs both during prolonged time in zero gravity and while lying in bed battling a virus may play a key role in triggering the syndrome.

As for why women are disproportionately affected, Goldstein has what he calls a “pet theory”: Women’s larger pelvises, where blood pools too rapidly in POTS, need to be more vascularly “stretchy” than men’s to grow a baby, so “some women might simply be too stretchy,” he said. No one, to his knowledge, has been given a grant to study this. “It’s a women’s-health issue,” he said, clearly pained by the lack of scientific resources appropriated to half the human species.

For the sake of furthering post-COVID science, I’ve volunteered my own female body to join Tomey’s study sometime this fall. This will require extra trips up and down my stairs. I asked Tomey if I should change apartments. “No,” he said. “As difficult as those stairs are for you right now, they may be the salvation to the problem.” Such is the damning catch-22 of POTS. A racing heart limits physical activity. But to recuperate, I must be active.

The point, however, may be moot. Less than a week after my conversation with Tomey, a process server showed up at the bottom of my Everest stairs with a letter announcing that my landlord would not be renewing our lease once it ends on November 30. “Is this a joke?” I asked when I walked down to receive it. “Nope,” the process server said, then left.

We’ve since gotten permission to stay through the end of the school year. Still, because no one will tell us why we can’t stay even longer, it’s all just more confusion. The answers to seemingly basic questions––Why are you kicking out a family from their home during a pandemic? Why am I still sick? When will I get better?––are somehow maddeningly elusive. Clutching the letter in one hand and the banister in the other, I climbed the 53 stairs, one by one, pausing on each landing to lie down and catch my breath between ascents.

The post Did COVID-19 Mess Up My Heart? appeared first on The Atlantic.

Heart Failure Resistance Band Circuit

Thu, 27 Aug 2020 00:08:43 GMT

Exercise for the Couch Potato

Thu, 27 Aug 2020 00:07:10 GMT

Lynne will be sharing exercises that work for everyone, with a goal to get more movement in each day. She will discuss the benefits of regular exercise and tips on how to keep moving even when life gets complicated.

Lynne offers workouts and health coaching from her gym in Weston, MA. She offers individual or small group sessions. She is passionate about making fitness accessible and enjoyable for everyone. She has worked with a variety of clients from young children to grandparents!

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Balancing Your Plate

Wed, 19 Aug 2020 23:59:11 GMT

Please join Dr. Ramchandani as she reviews evidence based recommendations for healthy dieting and clarifies common misconceptions about nutrition.

Intermittent Fasting Part II

Wed, 05 Aug 2020 23:57:41 GMT

Back by popular demand! Join Beth Reardon as she summarizes highlights from her outstanding May 27th presentation, "Intermittent Fasting: Hype or Hope?" and introduces new information about intermittent fasting and time restricted eating practices. There will be plenty of time allotted for interactive Q&A at the end of the seminar.

Please use the following link to view Beth’s resources: https://mailchi.mp/partners/beth-reardon-resources

Lifestyle changes are important for managing atrial fibrillation

Fri, 31 Jul 2020 10:30:00 GMT

Atrial fibrillation (afib) is a common heart rhythm disorder in which the upper chambers of the heart (the atria) beat fast and irregularly. Afib commonly causes recurrent symptoms, usually palpitations and shortness of breath, and can negatively affect quality of life. Afib also substantially increases the risk of stroke, and is also associated with heart failure, high blood pressure, and diabetes. People with afib routinely require lifelong treatment with blood thinners, to prevent blood clots that can lead to strokes.

Doctors are only recently understanding the importance of lifestyle factors in treating afib. Modifiable lifestyle factors are so important and under-recognized that the American Heart Association (AHA) recently released a scientific statement summarizing the latest research on this topic. The AHA wants both doctors and patients to understand the relationship between lifestyle and afib, and to work as a team to put these lifestyle factors into practice. Following is a discussion of important lifestyle factors, how they may impact afib, and what you can do.

Obesity

One of the strongest factors associated with afib is body weight. Obesity (defined as body mass index [BMI] > 30) has been shown in multiple studies to be linked to the development of afib. Obesity is associated with changes to electrical signaling within the atria, as well as structural changes to the heart’s upper chambers. Overeating can also cause inflammation via changes in hormone and cell-signaling pathways in the atria. Several studies have shown that as we gain weight, fat is deposited in the heart (as well as other places throughout the body), and this can trigger arrhythmias, most commonly afib.

Obesity can also be a cause of new or worsening hypertension (high blood pressure), which promotes further structural changes in the heart. Obesity also can cause obstructive sleep apnea and diabetes, both of which independently increase risk of afib.

The good news is that for people who are overweight or obese, just a 10% reduction in weight seems to improve symptoms related to afib.

Exercise

For decades cardiologists have encouraged people to exercise, because exercise reduces the risk of dying from cardiovascular causes. Not only is exercise good, but physical inactivity is actually detrimental; a sedentary lifestyle contributes to afib and may actually be an independent predictor of this condition. The AHA recommends 150 minutes per week of moderate-intensity aerobic exercise, or 75 minutes per week of vigorous-intensity aerobic exercise, to improve cardiovascular health. Regular exercise helps to prevent atrial fibrillation and, if you already have afib, reduces symptoms and improves afib-related quality of life.

If you are not already exercising, talk to your physician about starting a low-intensity exercise program. Brisk walking is a great form of moderate exercise and allows for physical distancing. Start with 20 minutes a day and gradually increase your pace and duration to achieve at least 150 minutes per week of moderate-intensity activity.

Sleep disorders

Obstructive sleep apnea (OSA) is a sleep disorder in which people stop breathing for short periods while they are sleeping. It is the most common form of sleep-disordered breathing and is strongly associated with cardiovascular disease. There is also a very high prevalence of OSA in people with afib, and recurrence of afib symptoms is higher in people with more severe OSA.

Cardiologists now routinely screen people with recurrent afib symptoms for OSA. Treating OSA with continuous positive airway pressure (CPAP) appears to improve afib symptoms.

If you experience afib symptoms, ask your doctors if you should have a sleep study to check for OSA.

Alcohol

Alcohol is a known risk factor for atrial fibrillation, and there is mounting evidence that the old adage “less is more” may be true for drinking if you have afib. A recent study in the New England Journal of Medicine found less afib when patients decreased or abstained from alcohol .

If you have afib, try cutting back on alcohol, or even not drinking at all. Talk to your doctor if you are having trouble reducing your alcohol consumption.

Diabetes

The risk of afib is higher in patients with type 2 diabetes. While the mechanism is not well understood, it’s likely that elevated blood sugars directly damage the heart and promote structural, electrical, and autonomic changes within the heart tissue.

The good news is that better blood sugar control improves both the severity and frequency of afib symptoms. Lifestyle changes that promote exercise and limit inactivity can also help with weight loss and blood sugar control.

Diet

Dietary changes can translate into weight loss, and also help to control blood sugar if you have diabetes. Changing your diet can be challenging, but eating less processed foods and more fresh vegetables and fruit is a good starting place. Target bad habits, like snacking or eating out of boredom. And consider transitioning to a Mediterranean diet , which helps control weight, blood sugar, and blood pressure.

The post Lifestyle changes are important for managing atrial fibrillation appeared first on Harvard Health Blog .

Nutrition Fact vs Fiction: How to Keep Yourself Healthy Based on Science and Experience

Wed, 29 Jul 2020 23:55:43 GMT

This presentation will discuss common diet myths and demystify the food label. She will also discuss health halos and fads, and she will provide a quick update on what you can do to boost your immune system in this new age.

Skylar’s expert opinion has been featured in media groups such as the Boston Globe, MedPage Today, Boston Magazine, WBGH, FOX 25 and The Manual of Pediatric Nutrition. Most recently, Skylar has launched a Video Subscription Series where she shares her science-backed tools and tips to boost metabolism, improve nutritional status, and effectively lose weight. Additionally, Skylar’s blog and Instagram page provide helpful insight into the world of nutrition for heart health and weight management.

Common Musculoskeletal Injuries and Prevention Strategies for the Active Adult

Thu, 23 Jul 2020 00:05:51 GMT

Please join Dr. Rebecca Breslow as she discusses Common Musculoskeletal Injuries. Dr. Breslow is a Sports Medicine Physician in the Orthopedics Department at BWH. She will provide us with a definition of fitness and give an overview of her perspective of fitness, as a sports medicine physician. She will also review overuse injuries and focus on common injuries involving knees, shoulders, and hips. The discussion will conclude with preventative measures for everyone, leaving time for a short Q & A.

Dr. Breslow's website: https://rebeccabreslowmd.com/

Exercise During a Pandemic

Thu, 16 Jul 2020 00:02:45 GMT

Dr. Brian Bilchik, Director of the Lown Cardiovascular Group and Director of Sports Cardiology will give a talk titled: Exercise in a Pandemic.

This pandemic has created extraordinary challenges. Addressing vulnerabilities is imperative. Dr. Bilchik will explain the how and the why of exercise and discuss practical recommendations to stay healthy and active during this time.

COVID-19 and the Heart

Fri, 10 Jul 2020 00:24:37 GMT

Please join us for a round table webinar on Thursday, July 9 ^th from 3-4 pm as we discuss the latest updates on COVID-19 and the Heart. Drs. Lee Lewis, Bilchik, and Kelley-Hedgepeth will discuss the current medical knowledge of COVID-19, with a focus on heart disease.

Sleep and Health: What You Need to Know

Thu, 09 Jul 2020 00:30:52 GMT

In a society that tries to accomplish as much as possible in 24 hours, sleep often the first thing to be compromised. Come to this interactive seminar and learn about why sleep is important, the effects of sleep deprivation on health, and how to improve your sleep. Presented by Dr. Suzanne Bertisch, Division of Sleep and Circadian Disorders.

Harvard Health Blog: https://www.health.harvard.edu/blog/strategies-to-promote-better-sleep-in-these-uncertain-times-2020032719333

Info on Sleep Apnea: https://www.apneapartners.org/

Coronavirus Vaccine: Expert Says, ‘We Need Time to Get This Right’

Tue, 07 Jul 2020 18:00:00 GMT

Expert Calls for Slow & Steady Approach in Vaccine Development

While the race to develop a coronavirus vaccine may seem as if it’s being run in slow motion, with most experts predicting a 2021 launch at earliest, by historical standards it’s unfolding with incredible swiftness. Looking back at timelines for other vaccines, it becomes evident that there are numerous reasons for a slow and steady approach, according to Michael Kinch , director of Washington University’s Centers for Research Innovation in Biotechnology and Drug Discovery . Kinch, who authored the authoritative book, Between Hope and Fear: A History of Vaccines and Human Immunity , cautions that vaccine development is a long, complex process requiring gathering of laboratory and real-world evidence and extensive evaluation.

“Testing for safety and efficacy requires considerable time, even with improved technology. We need to get this absolutely right, because if we panic and rush, there may be a price to be paid in terms of toxicity,” explains Kinch. “For example, in 1976, fear of a swine flu epidemic led to rapid development of a vaccine which caused Guillain-Barre syndrome [a paralyzing neurological disorder] in a small percentage of patients. That doesn’t normally happen if you take the time to check at each step.”

Lessons Learned from Past Vaccine Development

A salient lesson can be learned by going further back to the polio vaccine of the 1950s, according to Kinch. Long heralded as one of the 20th century’s landmark immunizations, it nevertheless encountered a problem when initially released. In a situation eerily similar to today’s coronavirus pandemic, the poliovirus’s paralyzing and often deadly effects were terrifying the nation, and the threat of prolonged quarantines as the only real mode of prevention had people desperate for a solution. In 1952, Dr. Jonas Salk began his clinical investigation of a polio vaccine, and the development and distribution schedule was significantly expedited to allow for release in 1955. Unfortunately, in the rush to launch, improper manufacturing of some of the early batches led to unnecessary outcomes.

The logistical challenges of rolling out a coronavirus vaccine will be significant, predicts Kinch.

“We need to manufacture enough of the vaccine to immunize 350 million Americans, but this will also require 350 million vials, syringes, stoppers and any other parts yet to be determined,” says Kinch. “This is fundamental to success, but we’re not fully looking it in the eye. And extending it to a world population of 7.5 billion makes it even more essential to address now.”

The stakes are enormous, as Kinch believes a successful coronavirus vaccine may have the power to change medicine for a generation.

“We’re going to rethink our approach just as we did with other epidemics which defined the 20th century from a scientific standpoint. Smallpox led to awareness of the importance of sanitation, and the vaccine which was developed eliminated the disease worldwide. Spanish flu gave us the structure of DNA and the foundations of biotechnology, and HIV-AIDS led us to focus on evidence-based science and government-sponsored clinical trials,” he says.

What can be learned through development of a safe, effective and scalable vaccine for the novel coronavirus may well parallel these important breakthroughs. As Kinch recently wrote: “Vaccines come with serious medical, social and political implications. If we anticipate and address them accordingly, the coming months and perhaps years could be among the finest hours for the United States and its people.”

The post Coronavirus Vaccine: Expert Says, ‘We Need Time to Get This Right’ appeared first on Specialdocs Consultants .

Superfoods and Your Immune System

Tue, 07 Jul 2020 17:00:00 GMT

Food for Thought: Nourishing the Immune System

As football coaches and nutritionists know, the best offense is a good defense. In the fight against COVID-19, the promise of boosting the immune system with specific ‘superfoods’ is an enticing one. However, registered dietitian Linda Gigliotti , who is a fellow of the Academy of Nutrition and Dietetics and has been in practice for more than three decades, cautions that the concept is somewhat misleading. Here is what you should consider regarding superfoods and your immune system.

Balance Leads to Immune System Harmony

She explains, “We may wish there were specific foods that could make us less susceptible to illness by building up our immune system, but it doesn’t work that way. The immune system is not a single entity, and requires harmony and balance between its different components to function well.”

According to experts, although the body continually generates immune cells, with extra ones dying off in a process called apoptosis, scientists don’t yet know how many cells are needed for optimal functioning of the immune system or what the best mix of cells may be. A better approach, according to Gigliotti, is using a mix of foods that are the building blocks of a nutritionally balanced diet (e.g., the Mediterranean diet) to support or protect the immune system, not boost it.

Foods to Support & Protect the Immune System

“There’s no one ‘superfood’ or category that should be singled out to the exclusion of others,” says Gigliotti. “The typical American diet can certainly benefit from more of an emphasis on fruits and vegetables, but eat the whole rainbow of colors – red peppers, yellow corn, orange carrots, green broccoli, brown mushrooms. Chickpeas, often touted as a superfood, are excellent, but so are other legumes, such as kidney and pinto beans. Be sure to include a variety of probiotic-rich and fiber-packed foods to promote healthy gut bacteria, which also enhances your ability to maintain health and resist disease.”

Immune System of Older Adults

For older adults the picture may be a little hazier, due to “micronutrient malnutrition,” a deficiency in essential vitamins and trace minerals obtained from the diet, which is frequently seen in seniors even in affluent countries. According to Harvard Health, some lab studies have linked deficiencies in zinc; selenium; iron; folic acid; and vitamins A, B, C and D to an altered immune response in animals.

Can Vitamin Megadoses boost your Immune System?

However, it’s important to know that megadoses of vitamins and minerals are not recommended as a preventive measure for anyone. For example, studies over the years show that vitamin C supplements do not appear to lessen the possibility of getting a cold, although they may help recover from one faster and lessen the symptoms. Taking extra-large doses is not advised, because vitamin C is water soluble and excess amounts aren’t stored in the body, but excreted. The optimal way to naturally absorb vitamin C and other vitamins is by eating a variety of fruits and vegetables. If you are concerned that you may not be getting sufficient micronutrients in your diet, you may want to consider a multi-vitamin.

Flu Season and your Immune System

How can you best support your immune system as the new flu season waits in the wings? Focus on healthy lifestyle habits, advises Gigliotti, including a balanced diet rich in fruits, vegetables, high-protein foods and whole grains; adequate sleep; regular exercise; no smoking or vaping; and managing anxiety.

And … keep washing your hands!

The post Superfoods and Your Immune System appeared first on Specialdocs Consultants .

Navigating Uncertain Times with Hope and Optimism

Tue, 07 Jul 2020 17:00:00 GMT

How to Adjust, Adapt and Embrace the New Normal

As we emerge cautiously from the safety of home into a world that seems comfortingly familiar yet irrefutably altered, a swirl of conflicting emotions is certain to be triggered. Relief and thankfulness may mingle uneasily with fear, anxiety and uncertainty, making it difficult to cope at times. Concierge psychologist Dr. Rebecca Johnson Osei , MA, PsyD, ABPP, shares her thoughtful perspective on navigating uncertain times with hope and optimism.

Q: What are some of the short- and long-term effects of the COVID-19 crisis on our mental health?

Dr. Johnson Osei: We’re seeing increases in anxiety and depression. Loneliness has also been a concern, due to social distancing, especially for older populations who may be more isolated from family and friends. Some are feeling grief, particularly those who weren’t able to say goodbye to a loved one, and survivor’s guilt, a common reaction to traumatic events. And most of us keenly miss the sense of control over our daily lives.

Q: How can we best manage these feelings?

Dr. Johnson Osei: Most importantly, allow yourself to experience all these emotions without guilt or judgment. They’re simply part of being human. While much of what we’re feeling may be remedied with time, be mindful and address your feelings now so they don’t become long-term issues. Also realize that you can regain control of your narrative by “reframing” your decisions. For example, instead of feeling forced to stay inside, frame it as a decision you made to protect your family. It changes your mindset when you realize that, ultimately, your behavior is your choice.

Q: Are there positive behaviors you’re seeing as a result of people learning to cope with unprecedented circumstances?

Dr. Johnson Osei: A number of really significant ones. People are gaining a renewed appreciation for the people and things they love. One-on-one time and simple human touch are valued so much more now. I imagine when friends and families reunite, there will be some really great long hugs! Being more aware of our mortality is also helping people cherish life, realizing it truly is a gift that can disappear in a second.

Being solitary and alone with our thoughts is a struggle for some, but it’s emotionally healthy to be able to entertain yourself and meet your own needs. For most Americans, coping with the discomfort of not being able to do what they want, when they want to do it, is a tough lesson, but it’s a good one to learn.

The need to connect has driven a much greater acceptance of technology than existed just a few months ago. There’s a growing willingness to think outside the box for new, ingenious ways to stay connected, and I believe this will carry on in our society well beyond the current crisis.

Q: What lessons learned from previous world crises can help guide us?

Dr. Johnson Osei: Think about how 9/11 fundamentally changed the way we travel. At first, it seemed untenable – the security lines were long and slow-moving, no one had the right size toiletries. It all feels completely normal now, and we know how to navigate the lines, pack our toiletries correctly, and wear shoes that slip on and off easily. Humans are incredibly resilient, and it’s why we’ve survived as a species. We don’t know what the new normal will look like, nor can we predict if this will go on for months or maybe years. But we do know we will adapt, and it will get easier.

Q: Any recommended strategies as we move to the next phase?

Dr. Johnson Osei: Go at the pace that’s right for you as an individual, even if it may not align with your city or state’s approach. Just because you can do something doesn’t mean you should. Be an outlier if wearing a mask or working from home makes you feel more comfortable.

Finally, it’s so important to remember: Life may be different, but this is not the end of the world we knew – it’s literally a new beginning.

The post Navigating Uncertain Times with Hope and Optimism appeared first on Specialdocs Consultants .

Thriving in Menopause Part II

Thu, 02 Jul 2020 00:57:53 GMT

Please join us this afternoon as we host nationally known expert on Women’s Health Dr. Heather Hirsch as she presents “Thriving in Menopause and Midlife in 2020”. Dr. Hirsch presented Part I of this 2-part series on June 17, to rave reviews from our patients. Today she will dive deeper into topics including hormone replacement therapy, wellness in midlife, and women’s sexual health during and after menopause. Dr. Hirsch is the Director of the Midlife and Menopause Clinic at the Brigham and Women’s Hospital. Women and men of all ages are welcome to join!

Dr. Rebecca Hirsch's Resources:

Website: https://heatherhirschmd.com/

Instagram: https://www.instagram.com/heatherhirschmd/?hl=en

Twitter: https://twitter.com/heatherhirschmd?lang=en

YouTube: https://www.youtube.com/channel/UCrAeWep_qZiP7QeR7ogcCPA

Podcast: https://podcasts.apple.com/us/podcast/health-by-heather-hirsch/id1423965506

Life Design: The Way to Stress Free Living

Thu, 25 Jun 2020 00:36:59 GMT

Life Design is a program that guides people through a structured process to intentionally design their lives to be in alignment with who and what they want to be while eliminating stress, managing challenging situations, experiencing calm and being fully engaged in life. This workshop is an introduction to this program and lays out the benefits and rewards that can be enjoyed by living life by design.

Thriving in Menopause Part I

Thu, 18 Jun 2020 00:56:11 GMT

Dr. Hirsch is Board certified in Internal Medicine and completed advanced fellowship training in Women’s Health at the Cleveland Clinic. Her consultative specialty practice focuses on the intersection of internal medicine and office gynecology with a focus on menopausal hormone therapy, and family planning, breast health, sexual dysfunction, and urinary incontinence, and more. Her Fellowship training included an emphasis on scholarly activity, the development of women’s health curriculum, clinical research and leadership. Her clinical work and research centers on inequalities or unanswered questions in the field of women’s health, specifically in menopause and its role in chronic disease development. Her academic work centers on enhancing women’s health curriculum for the fellow, resident, and medical student. She currently practices at the Brigham and Women’s Hospital in Boston MA.

Dr. Health Hirsch's resources

Website: https://heatherhirschmd.com/

Instagram: https://www.instagram.com/heatherhirschmd/?hl=en

Twitter: https://twitter.com/heatherhirschmd?lang=en

YouTube: https://www.youtube.com/channel/UCrAeWep_qZiP7QeR7ogcCPA

Podcast: https://podcasts.apple.com/us/podcast/health-by-heather-hirsch/id1423965506

Nutrition Myths: A Guide to Fact vs Fiction

Wed, 10 Jun 2020 23:54:43 GMT

With so much nutrition information constantly around us, you'd think it would be easier to learn about balanced eating. Unfortunately, the internet and social media is loaded with misinformation, making it more difficult to tell what is evidence-based science from what is sensationalized, misinterpreted, or opinionated nutrition information. In this presentation, Jillian will discuss some of the myths she hears most commonly among patients and get to the bottom of the facts versus fiction behind them. Join us in this discussion to approach nutrition with a more critical eye to optimize your unique whole body nourishment

Jillian’s Website: https://www.wholebalancednutrition.com/

Are statins enough? When to consider PCSK9 inhibitors

Mon, 08 Jun 2020 14:30:00 GMT

For well over 30 years, physicians have understood the role of LDL (low-density lipoprotein, or “bad”) cholesterol in the development of cardiovascular disease (CVD). LDL cholesterol levels are directly correlated with increasing CVD risk and, as summarized in a recent blog post , lowering LDL cholesterol levels, through both lifestyle changes and medications, has been shown to reduce this risk.

Statins are the first-line choice of medications for lowering LDL cholesterol. They are widely prescribed for both primary prevention (reducing CVD risk in patients without known CVD) and secondary prevention (preventing subsequent heart attacks, strokes, and other CVD events in patients with established CVD).

How do PCSK9 inhibitors work?

In 2003, researchers found a genetic mutation that caused some people to develop very high LDL cholesterol levels and CVD at a young age. This laid the groundwork for understanding the PCSK9 pathway, and ultimately the medications now known as PCSK9 inhibitors.

Our liver makes PCSK9 protein, and this protein breaks down LDL receptors, which remove LDL cholesterol from our bloodstream. So the more PCSK9 protein in our bodies, the fewer LDL receptors in our liver, and the higher our LDL cholesterol levels. PCSK9 inhibitors are monoclonal antibodies that block the PCSK9 protein from working. As a result, levels of LDL receptors increase, and LDL cholesterol levels fall. PCSK9 inhibitors work via a pathway different from statin medications, and may be used together.

The FDA approved two PCSK9 inhibitors in 2015: alirocumab (Praluent) and evolocumab (Repatha). These drugs must be given by injection, typically every two to four weeks.

Who could benefit from PCSK9 inhibitors?

The most recent cholesterol treatment guidelines , a collaborative effort from multiple professional organizations including the American Heart Association and the American College of Cardiology, were updated in 2018. These guidelines were broadened from the previous version to include LDL treatment targets, which has prompted doctors to think about adding PCSK9 inhibitors to treat select patients. In the 2018 guidelines, high-risk patients are defined as those with known CVD or with elevated cholesterol levels and diabetes. For high-risk individuals, the guidelines recommend an LDL cholesterol target of less than 70 mg/dl. This cholesterol goal can usually be achieved on a high-dose statin. But what happens if your LDL cholesterol level remains elevated?

Initial studies ( FOURIER using evolocumab and ODYSSEY using alirocumab) compared these medications against placebo in patients with known atherosclerotic disease; an LDL cholesterol level above goal; and some, but not all, patients on a statin. In both trials, PCSK9 inhibitors compared against placebo demonstrated average LDL cholesterol reduction of 60%, with a favorable safety profile and robust reductions in CVD events.

A 2019 study published in JAMA Cardiology asked the question: does adding a PCSK9 inhibitor to a statin, in patients with stable CVD and LDL cholesterol levels above goal (greater than 70 mg/dl), prevent future CVD events? For this study, patients fitting this profile were randomized to receive either the PCSK9 inhibitor evolocumab or a placebo. All patients in the study continued to take their statin medication. Researchers looked at the occurrence of CVD events (heart attack, stroke, or hospitalization for heart-related reasons) during the average two-year follow-up period. They found a significant reduction in cardiac events in patients receiving the PCSK9 inhibitor plus a statin, compared to study subjects taking statin plus a placebo.

Side effects and cost of PCSK9 inhibitors

PCSK9 inhibitors are usually well tolerated. Some people experience flulike symptoms with fatigue, feeling cold, and back pain. Muscle aches and pains have also been reported. The most common side effect is pain at the injection site.

The cost of PCSK9 inhibitors has dramatically decreased from their initial pricing of around $14,000 per year. Prescription coverage has also broadened to include these medications, but restrictions still apply based on individual plans.

In summary

Over the past few years, the FDA has expanded its approval of PCSK9 inhibitors to include a larger group of people with elevated LDL cholesterol levels who are at high risk for CVD events. If your LDL cholesterol remains elevated, talk to your doctor about available treatment options.

The post Are statins enough? When to consider PCSK9 inhibitors appeared first on Harvard Health Blog .

Fueling and Exercising For A Strong Heart

Wed, 03 Jun 2020 23:50:21 GMT

This presentation will cover how to balance a plate and why certain nutrients are important for a strong heart, the consequences of under-fueling the body, and the benefits of exercise.

For more information on the Laura Moretti Nutrition Group, please visit their website or Instagram linked below. Amanda is currently accepting new patients. If you would like to continue to work with her, please contact her directly using the email below.

Email: info@lauramorettird.com

Instagram: https://www.instagram.com/lmorettinutrition/

Website: https://www.lauramorettird.com/

Fighting the Colonoscopy Fear Factor

Mon, 01 Jun 2020 15:39:00 GMT

Colorectal Cancer awareness could save your life.

As one of the country’s most preventable illnesses, with a readily available test that is both diagnostic and therapeutic, why does colorectal cancer (CRC) stubbornly remain the second-leading cause of cancer-related deaths in the US? The key to reducing deaths is in the colonoscopy, a direct visualization test of the entire colon that enables a physician who specializes in gastroenterology to screen for abnormal growths (polyps) and remove them before they turn cancerous. Fighting the colonoscopy fear factor through knowledge is critical.

Don’t let colonoscopy prep scare you away. Fighting the Colonoscopy Fear Factor is important to your health

For many people, the rigorous prep required to thoroughly clean out the colon the night before the test has overshadowed the colonoscopy’s lifesaving impact, resulting in a third of adults 50 or older, the group most at risk of developing colorectal cancer, to not be screened. The colonoscopy reputation deserves a major turnaround, because in 2020 the colonoscopy experience is highly manageable, with more palatable prep options, a pain-free procedure and swift reporting of results … so there’s no need to dread your colonoscopy or anxiously avoid a 10-year follow-up. You can fight the colonoscopy fear factor.

Previous prep involved drinking up to 128 ounces of salty-tasting fluid over a short time, but several new colon cleansing preparations are now available that require less fluid, according to Mayo Clinic. Products such as Prepopik, Suprep and Plenvu can be mixed with a liquid of choice, and some patients might be offered a nonprescription prep of polyethylene glycol (such as MiraLAX) followed by an electrolyte-containing drink (such as Gatorade) – but note that these lower-volume prep solutions may not be appropriate for people with heart, kidney or liver disease. If higher-volume fluid solutions are needed, a split dose makes it easier and more tolerable, with half of the laxative taken in one sitting and the other half on the morning of the procedure. Even newer possibilities are on the horizon: Keep an eye out for an edible colonoscopy prep kit that incorporates active laxative ingredients into better-tasting food bars and drinks, with final phase of trials scheduled in mid-2020.

Whatever type of solution you choose, adjust your diet a few days before your colonoscopy to include smaller portions and low-fiber foods to ensure a smoother prep. On the day before your procedure, when you’ll be on a liquid diet, treat yourself to good-tasting items like organic low-sodium broth, white grape juice, flavored sparkling waters and full-bodied coffee (without creamer). Make the prep solution more palatable by refrigerating and drinking it chilled; suck on a lemon wedge or chew a piece of gum between glasses to help mask the flavor. When the solution starts to work emptying your bowels, be prepared for your time in the bathroom with wet wipes or double ply toilet paper, a fully charged phone, and some light reading.

During the 30- to 60-minute procedure, most people will be given a mild sedative drug or an anesthetic to put them in a “twilight” sleep, while a few will require general anesthesia. A thin, flexible, lighted tube is inserted into the colon, and air, CO2, sterilized water or saline is gently pumped in to inflate the colon and allow the entire lining to be viewed. Polyps are removed if present, and biopsies are taken of any abnormal areas. After the test, you’ll recover from the sedative for about an hour before you go home and consider this mission accomplished.

Still feeling uneasy about a colonoscopy?

Noninvasive, stool-based screening tests may offer an alternative if you’re considered at average risk – that is, no family or personal history of CRC, no previous polyps, no long-standing inflammatory bowel disease or the presence of certain genetic syndromes. The most well-known is FDA-approved Cologuard, which detects DNA markers for cancer and uses fecal immunochemical testing (FIT) to find blood in the stool, with less reliable results: 92% accuracy for cancer and only 69% for advanced colon polyps, plus a 13% rate of false positives. Other options include a “virtual colonoscopy” that uses CT imaging for a detailed view of the inside of the colon and rectum or a flexible sigmoidoscopy to view the lower part of the colon, which requires the colon prep described above. However, a positive result on any of these tests will result in the need for a colonoscopy, which remains the gold standard for colon cancer testing as the most accurate way to find and remove polyps and determine the right follow-up intervals.

Under 50: Are Screenings Necessary?

For people with a family history of genetic conditions that put them at increased risk, screenings may be recommended at a younger age. Additionally, in 2018, a controversial decision was made by the American Cancer Society to lower its threshold to age 45, in response to a steady rise in the cancer’s prevalence each year since the mid-1990s among ages 20 to 54. A new 2020 study appeared to provide more evidence, showing a 46% spike in colorectal cancer incidence between ages 49 and 50 – attributed to cancer that had gone undetected in younger patients until routine screening at age 50.

Research is in progress to resolve the conflicting guidelines, but current best practices * keep 50 as the age to begin colorectal cancer screening for average-risk adults; with FIT or guaiac-based fecal occult blood testing every two years or a colonoscopy every 10 years; and no testing after age 75.

Did You Know?

More than 15 million colonoscopies are performed in the United States annually. Speaking with your doctor and being armed with the right information can make fighting the colonoscopy fear factor a little easier.

Recommendation:

We recommend all adults over the age of 40, with anemia, have a gastroenterology evaluation including colonoscopy. Please call our office for more information.

* American College of Physicians

The post Fighting the Colonoscopy Fear Factor appeared first on Specialdocs Consultants .

Intermittent Fasting, Hype or Hope

Wed, 27 May 2020 23:47:33 GMT

Fasting has been relegated to the status of Rock Star in certain circles, but just what does the science tells us and who is most likely to benefit? What is the hype about and is it really something that can as is claimed, increase our lifespan as well as our health span? In this presentation Beth will discuss some of the benefits and myth understandings of fasting. Join us as we step into the fascinating science behind this popular trend.

Does Vitamin D Protect Against COVID-19?

Mon, 11 May 2020 19:28:32 GMT

Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital.

I'd like to talk with you about vitamin D and COVID-19. Is there potentially a protective role?

We've known for a long time that it's important to avoid vitamin D deficiency for bone health, cardiometabolic health, and other purposes. But it may be even more important now than ever. There's emerging and growing evidence that vitamin D status may be relevant to the risk of developing COVID-19 infection and to the severity of the disease.

Vitamin D is important to innate immunity and boosts immune function against viral diseases. We also know that vitamin D has an immune-modulating effect and can lower inflammation, and this may be relevant to the respiratory response during COVID-19 and the cytokine storm that's been demonstrated.

There are laboratory (cell-culture) studies of respiratory cells that document some of these effects of vitamin D. There's also evidence that patients with respiratory infections tend to have lower blood levels of 25-hydroxy-vitamin D.

There's now some evidence from COVID-19 patients as well. In an observational study from three South Asian hospitals , the prevalence of vitamin D deficiency was much higher among those with severe COVID illness compared with those with mild illness. In fact, there was about an eightfold higher risk of having severe illness among those who entered with vitamin D deficiency compared with those who had sufficient vitamin D levels.

There's also evidence from a meta-analysis of randomized clinical trials of vitamin D supplementation looking at acute respiratory tract infections (upper and lower). This was published in the British Medical Journal 2 years ago, showing that vitamin D supplementation was associated with a significant reduction in these respiratory tract infections. Overall, it was only a 12% reduction, but among the participants who had profound vitamin D deficiency at baseline (such as a blood level of 25-hydroxy-vitamin D of less than 10 ng/mL), there was a 70% lower risk of respiratory infection with vitamin D supplementation.

So the evidence is becoming quite compelling. It's important that we encourage our patients to be outdoors and physically active, while maintaining social distancing. This will lead to increased synthesis of vitamin D in the skin, just from the incidental sun exposure.

Diet is also important. Everyone should be reading food labels which list the vitamin D content. Food sources that are higher in vitamin D include fortified dairy products, fortified cereals, fatty fish, and sun-dried mushrooms .

For patients who are unable to be outdoors and also have low dietary intake of vitamin D, it's quite reasonable to consider a vitamin D supplement. The recommended dietary allowance of vitamin D is 600-800 IU/daily, but during this period, a multivitamin or supplement containing 1000-2000 IU/daily of vitamin D would be reasonable.

We are in the process of planning a randomized clinical trial of vitamin D supplementation in moderate to high doses to see whether it has a role in the risk of developing COVID-19 infections and also in reducing the severity of disease and improving clinical outcomes.

In the meantime, it's important to encourage measures that will, on a population-wide basis, reduce the risk for vitamin D deficiency.

Thank you so much for your attention. This is JoAnn Manson. Stay safe.

The post Does Vitamin D Protect Against COVID-19? appeared first on Medscape .

Kombucha, Kimchi and More

Fri, 01 May 2020 15:35:00 GMT

Nutrition Health Spotlight: Kombucha, Kimchi and More

Researchers continue to examine the trillions of bacterial species residing in our gut microbiome to better understand their potential to help maintain health and prevent disease. Some of the most studied are probiotics, microorganisms found in yogurt and other fermented items. Probiotic foods are much in demand as a tasty, trendy way to improve “good” bacteria and enhance digestive health…but can they? We’ll find out in this Nutrition Health Spotlight.

The landscape is a confusing one, spawning a multimillion-dollar industry of probiotic-rich foods and supplements and a growing fascination with fermentation. But keep these facts in mind: No health claims for probiotics have yet been approved by the Food and Drug Administration, and, overall, data is still emerging regarding the potential health benefits of fermented foods. We checked in with Robert Hutkins, Ph.D. , professor of food science at the University of Nebraska, who literally wrote the book on the topic with the second edition of Microbiology and Technology of Fermented Foods .

Q: What sparked the newfound popularity of centuries-old fermented foods?

A: When I wrote the first edition of the textbook in the early 2000s, fermentation was considered an old science with not much new to be learned. But a perfect storm occurred in the last 10 years, with rising interest in nutrition and health; artisanal, organic and ethnic foods; and bold, unique flavors. All are found in fermented foods. In addition, advances in genome sciences provided researchers with tools to study relevant microbes and microbial communities in nearly every category.

Q: How are fermented foods made?

A: The traditional way is to rely on the microbes already present in that food, as in sauerkraut or kimchi. The other way is to use a starter culture, a concentrated collection of microbes designed to provide consistent flavor and quality, which is how yogurt, cheeses and yeast breads are made. Ultimately, the microbes feed on the starch and sugars in the food to produce lactic acid or ethanol, which have natural antimicrobial activities to protect from spoilage microbes. Nearly every civilization has at least one fermented food as part of its heritage, such as Japanese natto, Hawaiian poi and the Indian yogurt drink lassi.

Q: Why are fermented foods considered healthier?

A: Many fermented foods are rich in live microorganisms, and yogurt, kefir and other products often contain added probiotic microbes known to support a healthy microbiome. But despite a great deal of information that appears to point toward including fermented foods as part of a good diet, we need more clinical human studies to show specifically how they can improve health.

Q: Do all fermented foods contain probiotics?

A: Although overlap exists, fermented foods don’t always contain probiotics. Only specific live microbes that have been identified as having potential health benefits can be considered probiotics, and there are dozens in foods yet to be studied. Another important distinction is that while fermented foods are always made with microorganisms, when processed by baking, smoking or pasteurization, those live microbes are killed. For example, live cultures are present in sourdough bread, but they don’t survive the baking process; likewise for products that are processed, like canned sauerkraut. Also note there are foods that may seem fermented but are not, such as California olives and most pickles, which are simply put into a brine.

Q: I’d like to try adding some fermented foods to my diet. What would you recommend?

A: You’re likely already familiar with yogurt or plant milks that contain live strains of bacteria. Other fermented foods include kefir (a tangy dairy drink), kimchi (a spicy Korean dish of cabbage, radish and scallions), miso (a Japanese fermented soybean paste used in soups and sauces), kombucha (a sweet tea beverage fermented with a symbiotic colony of bacteria and yeast), and cheddar and most other hard cheeses. Many contain healthy omega-3 fatty acids and B vitamins as well as live microbes.

Note: If you are immune compromised, check with our office first about eating unpasteurized fermented foods, like raw milk cheese or dry fermented sausage.

The post Kombucha, Kimchi and More: Nutrition Spotlight appeared first on Specialdocs Consultants .

The post Kombucha, Kimchi and More appeared first on Specialdocs Consultants .

Physical Activity Change and CV Health in Older Adults

Thu, 30 Apr 2020 19:34:24 GMT

Quick Takes

Decrease in frequency of moderate to vigorous physical activity (MVPA) was associated with a significantly elevated risk of CVD events as compared to consistently engaging in >5 times of MVPA per week in older adults.
Increase in frequency of MVPA per week regardless of disabilities and chronic conditions was associated with a significant risk reduction of CVD among those who were physically inactive.
Clinicians should encourage all patients and especially older adults to increase or maintain frequency of MVPA regardless of disabilities or chronic conditions.

Study Questions:

What is the association of changes in moderate to vigorous physical activity (MVPA) level and cardiovascular disease (CVD) in older adults?

Methods:

The investigators identified >1.1 million subjects in a nationwide cohort study of older adults aged ≥60 years, without previous history of CVD at baseline, who underwent two consecutive national health screenings from 2009 to 2012. The authors prospectively assessed the risk of CVD that occurred between 2013 and 2016, according to changes in frequency of MVPA by initial MVPA status. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD outcomes were calculated from adjusting the following variables in the Cox regression model: age, sex, place of residence, insurance premium, insurance type, body mass index, systolic blood pressure, total cholesterol, fasting serum glucose, cigarette smoking, alcohol consumption, medication use (aspirin, antihypertensive medication, antidiabetic medication, statin, nonsteroidal anti-inflammatory drugs), Charlson comorbidity index, and family history of CVD.

Results:

Compared to those who were continuously physically inactive, those who increased their frequency of MVPA from physically inactive to 1–2 times per week (0.7/1,000 person-years decrease in incidence rate [IR]; aHR, 0.95; 95% CI, 0.92–0.99), 3–4 times per week (1.5/1,000 person-years decrease in IR; aHR, 0.89; 95% CI, 0.84–0.94), and ≥5 times per week (0.4/1,000 person-years decrease in IR; aHR, 0.91; 95% CI, 0.85–0.97) had a significantly reduced risk for total CVD (p for trend < 0.001). Older adults who became physically inactive from engaging in more than 1–2 times of MVPA per week had a higher CVD risk compared to those who maintained their frequency of MVPA.

Conclusions:

Among older adults, engaging in higher frequency of MVPA or maintaining MVPA level was associated with reduced risk of CVD.

Perspective:

This population-based cohort study from the Republic of Korea reports that the older adults with insufficient physical activity who increased frequency of MVPA to >3–4 times per week had a significantly lower risk of CVD events as compared to those who were continuously physically inactive, and this association was consistent among those with disabilities and chronic conditions. Furthermore, decrease in frequency of MVPA was associated with a significantly elevated risk of CVD events as compared to consistently engaging in >5 times of MVPA per week in older adults. These data suggest a need to encourage higher frequency of MVPA among physically inactive older adults and maintaining frequency of MVPA among those who are already physically active for substantial and tangible CVD risk reduction.

The post Physical Activity Change and CV Health in Older Adults appeared first on American College of Cardiology .

Will a good night’s sleep help my heart?

Fri, 17 Apr 2020 10:30:00 GMT

It is estimated that over 50 million Americans report difficulty sleeping. With our busy American lifestyle, where we are overcommitted in both our work schedules and personal lives, it may seem that sleep is indeed a luxury. But a good night’s sleep is increasingly recognized as an important factor in maintaining good health overall, and good cardiovascular health in particular.

Sleep disturbances and heart health

Disrupted sleep has been implicated in cardiac disease risk in multiple ways. Insomnia and obstructive sleep apnea (OSA) are the most common sleep disturbances and affect sleep duration and sleep quality, which in turn impact cardiometabolic health. OSA is a serious sleep disturbance in which breathing stops or becomes shallower multiple times each night because the tongue or throat tissues block the airway. It is estimated to affect somewhere from 10% to 25% of adults. Insomnia is also a common sleep disturbance, estimated to affect up to 25% of adults, but is frequently undiagnosed. The American Heart Association (AHA) recommends screening for OSA in everyone with heart failure and atrial fibrillation .

Poor sleep leads to poor food choices

In a recent study published in the Journal of the American Heart Association , researchers analyzed the relationship between sleep and eating patterns — which also affect cardiovascular health — in almost 500 women. The women reported on their sleep quality, the amount of time it took to fall asleep, and whether or not they had insomnia. They also reported on their dietary habits.

The study found that those who had the worst sleep quality consumed more added sugars than women with better sleep quality. Women who took longer to fall asleep consumed more calories and more food overall. And women with poor-quality sleep were more likely to overeat and to make unhealthy food choices. Poor diet is known to increase risk of cardiovascular disease (CVD).

Since this study is observational, we cannot draw conclusions of causality. We can surmise that the sensation of being satisfied or full is affected by sleep deprivation, likely via complex hormonal signaling. We can also consider that poor diet (too much of the wrong kinds of food) may affect our ability to fall asleep and stay asleep. In addition, poor diet and overeating are associated with obesity, an important risk factor for CVD.

Consistent sleep duration, regular bedtime are good for the heart

Another recent study , published in the Journal of the American College of Cardiology , linked sleep irregularity to the development of CVD. This study followed nearly 2,000 adult men and women without CVD for five years. Participants wore wrist trackers to track sleep and activity. Study participants also completed a comprehensive sleep study and answered questions about their lives, including diet.

Researchers found that irregular sleep duration increased the risk of heart disease. Those with the most irregular sleep duration and variable bedtimes had more than double the risk of developing heart disease, compared to those with less variability in sleep duration and more consistent bedtimes. Researchers think that multiple factors could link irregular sleep patterns with harmful metabolic changes, such as obesity, diabetes, and elevated cholesterol, all of which impact CVD risk. And since our metabolic health may be affected by sleep, our dietary choices may be even more important when we are sleep deprived.

Prioritize good sleep for better heart health

There is growing evidence that sleep is important to optimal health. These two recent studies raise the important question of how sleep affects our diet and cardiovascular health.

Pay attention to how long and how well you sleep at night. If you have insomnia or poor-quality sleep, talk to your doctor about having a formal sleep study and about factors that could help to improve your sleep.

The post Will a good night’s sleep help my heart? appeared first on Harvard Health Blog .

How does cardiovascular disease increase the risk of severe illness and death from COVID-19?

Thu, 02 Apr 2020 18:30:00 GMT

Based on reports from China , we know that most COVID-19 patients (about 80%) will develop mild flulike symptoms, including fever, dry cough, and body aches that can be managed at home. 20% will develop more serious symptoms, such as pneumonia requiring hospitalization, with about a quarter of these requiring ICU-level care.

Initial reports focused on the respiratory effects of COVID-19, such as pneumonia and difficulty breathing. But more recent literature has described serious cardiovascular complications occurring in about 10% to 20% of hospitalized patients.

Someone with pre-existing heart disease who becomes ill with COVID-19 may suffer a heart attack or develop congestive heart failure. This rapid worsening of cardiovascular health is likely due to a combination of the severe viral illness and its increased demands on the heart (fever causes rapid heart rate, for example), compounded by low oxygen levels due to pneumonia and increased propensity for blood clot formation. In addition to the increase in these heart problems, a more unusual condition called myocarditis has also been observed in COVID-19 patients.

COVID-19 triggers inflammation of the heart muscle

Some COVID-19 patients who appear to be having a heart attack are instead suffering from marked inflammation of the heart muscle, called myocarditis. The electrocardiograms in these patients show changes suggestive of a major heart attack, and blood tests reveal elevated levels of troponin, a cardiac enzyme that is released when heart muscle is damaged. The heart muscle becomes weak, and dangerous heart rhythms may develop. Severe injury to the heart muscle, as measured by troponin levels, has been strongly associated with increased risk of death in people with COVID-19, according to a review published in JAMA Cardiology .

It is not clear whether myocarditis is due to a direct effect of the virus on the heart muscle, or whether it is due to an overactive immune response to the virus, so doctors do not yet know how best to treat these patients.

Increased risk of severe illness and death in heart patients with COVID-19

About 10% of patients with pre-existing cardiovascular disease (CVD) who contract COVID-19 will die, compared with only 1% of patients who are otherwise healthy. Increased risk has also been seen in people with high blood pressure (hypertension) and coronary artery disease (CAD), though it is not clear why. Some experts have suggested that the missing link may be the use of certain blood pressure medications called angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs).

ACE inhibitors and ARBs — harm or help?

ACE inhibitors and ARBs are among the most commonly prescribed medications for the treatment of high blood pressure. These medications have been proposed as a possible factor in the increased incidence of COVID-19 in people with high blood pressure. That’s because of the observation that the coronavirus attaches to the ACE2 receptor, which is found in lung and heart tissue. People who take ACE inhibitors and ARBs produce increased numbers of these receptors, raising the question of increased susceptibility to infection.

However, ACE2 has been found to protect against viral lung injury in mice. And a study is ongoing to test whether losartan, an ARB, may protect patients infected with COVID-19.

As of today, there is insufficient evidence of either harm or benefit. The American College of Cardiology, American Heart Association, and Heart Failure Society of America therefore recommend that we neither stop the use of ACE inhibitors and ARBs in patients already taking them, nor prescribe them anew.

Do all you can to prevent infection

There are no special protocols for higher-risk cardiac patients to prevent COVID-19 exposure, but these individuals should be especially careful to follow the CDC recommendations , including frequent handwashing and physical distancing.

It is also important to stay up to date on the flu and pneumonia vaccines, because any illness can weaken the body’s ability to fight off COVID-19. Heart patients should avoid close contact with children 18 and under, because although children rarely develop serious illness from COVID-19, they may be asymptomatic carriers who can transmit disease to vulnerable family members.

In addition to these recommendations, it remains vitally important to exercise (outdoors when possible, keeping safe distance from others), get enough sleep , manage stress, and eat a balanced diet. These healthy habits will not only bolster the immune system to help ward off COVID-19, but will help prevent CVD progression in the longer term. After all, once the pandemic has subsided, we will still have heart disease to contend with.

Follow me on Twitter @daraleelewismd.

For more information, listen to our podcasts and see our Coronavirus Resource Center .

The post How does cardiovascular disease increase the risk of severe illness and death from COVID-19? appeared first on Harvard Health Blog .

Recognizing and treating depression may help improve heart health

Thu, 02 Apr 2020 14:30:00 GMT

Depression affects about 20% of Americans in their lifetime, and is one of the leading causes of disability. The rates of depression are even higher in those with cardiovascular disease (CVD). Depression affects 38% of patients undergoing coronary artery bypass graft surgery, and the risk of depression is three times as high in patients who have experienced a heart attack compared with the general population. Depression also makes it much more likely that CVD patients will be readmitted to the hospital and report heart-related symptoms.

Yet much of the time, symptoms of depression in those with CVD go unrecognized. And as we all know, if we don’t identify a problem it’s very difficult to find a solution.

Depression makes adherence to healthy behaviors less likely

Depression matters to cardiologists because patients with both depression and CVD have increased mortality rates, and significant reductions in their quality of life. Depression can often stem from feeling increased stress and lack of control regarding a chronic health condition like heart disease. In other cases, depression may already exist, and continue or worsen in response to CVD.

By affecting mood, sleep, and energy, among other things, depression can greatly impact a person’s ability to optimally manage their CVD. For example, depression makes it less likely that someone will take their medications as prescribed. And depression can make it very difficult to adhere to lifestyle recommendations such as eating a healthy diet or getting regular exercise.

The brain-heart connection

In addition to affecting behaviors, depression is also associated with physiologic mechanisms that help to explain the poor prognosis in patients with CVD. These mechanisms highlight the connection between the brain and the heart.

For example, depression can cause autonomic dysfunction, which negatively impacts resting heart rate, heart rate variability, and blood pressure. Depression can affect underlying inflammation, leading to elevated levels of potentially harmful circulating inflammatory molecules. Depression can also worsen insulin resistance, leading to further inflammation and diabetes. And depression can affect platelet reactivity, making blood stickier and, in turn, making a recurrent or new heart attack more likely.

Screening for depression

In April 2019, the Journal of the American College of Cardiology published a review in which they discussed a practical approach to the screening and management of depression in patients with CVD.

The review is a practical resource for cardiologists, which can help with early identification and improved management of patients with depression and CVD. By implementing screening practices, doctors can start a conversation about symptoms and their impact on health outcomes.

A multidisciplinary approach to symptom assessment is likely most effective, and involves the patient, the cardiologist, and the primary care physician (PCP). In some cases, mental health professionals, pharmacists, and care coordinators might also be involved.

The American College of Cardiology recommends that screening take place at routine office appointments with both cardiologists and PCPs. Screening questions you may be asked include:

Your doctors are looking for symptoms of a depressed mood, diminished pleasure in activities, low self-esteem, sleep disturbances, changes in appetite, loss of energy, and difficulty with concentration.

If your cardiologist or PCP does not ask you about symptoms of depression, you should feel comfortable volunteering this information.

Path to treatment

Thankfully, multiple proven treatment options exist for depression, and doctors and patients should discuss a personalized treatment plan. Exercise is an effective antidepressant therapy for those with mild or moderate depression. Exercise has been shown in multiple studies to have a significant impact on depression and cardiovascular outcomes.

With my cardiology patients who are experiencing depression, I typically recommend participating in an organized exercise program. If patients have had a recent heart attack they are eligible to enroll in a cardiac rehabilitation program . For all other patients, I recommend joining a program at their local gym.

Cognitive behavioral therapy (CBT) is another great nondrug way to treat depression. CBT is a form of therapy designed to change ingrained patterns of negative thoughts or behaviors. Medications can also be used, either alone or in combination with exercise and CBT.

The post Recognizing and treating depression may help improve heart health appeared first on Harvard Health Blog .

Pet Therapy: The Healing Power of Dogs

Wed, 01 Apr 2020 15:35:00 GMT

Unleashed: The Healing Power of Dogs

“Who rescued whom?”
They’re already considered best friends, trusty companions and beloved members of the family. Now add to the dog’s list of accomplishments, heart healer, exercise coach, and mood enhancer, and the answer to the question above, often used by rescue organizations, becomes even more meaningful. There is new a body of research that goes beyond the anecdotal charms of dog ownership to provide some increased evidence around the health benefits of pet therapy.

Studies show the dog ownership can have healing powers

Late in 2019, a meta-analysis of studies, including data from 3.8 million patients, further bolstered the concept that dog ownership can play a significant role in reducing CVD risk factors by alleviating social isolation, improving physical activity and lowering blood pressure. According to the study, compared to non-owners, dog owners experienced a 24% reduced risk in all-cause mortality, 31% reduction in mortality due to cardiovascular-related issues and 65% reduced risk of mortality after a heart attack.

The AHA noted that while the non-randomized studies can’t conclusively “prove” that owning a dog leads directly to reduced mortality among heart attack and stroke survivors, “the robust findings are certainly suggestive of this” and set the stage for additional exploration.
“The results were very positive,” affirmed researcher Caroline Kramer, MD. “The next step would be an interventional study to evaluate cardiovascular outcomes after adopting a dog and the social and psychological benefits of dog ownership.”

A dog owner herself, she added, “Adopting Romeo [her miniature Schnauzer] has increased my steps and physical activity each day, and filled my daily routine with joy and unconditional love.”

Pet ownership is a long term commitment

As compelling as the statistics are, researchers emphasize that dog adoption should never be done for the primary purpose of reducing CVD risk. The long-term commitment and lifestyle changes involved in dog ownership must be fully understood and accepted.

Consider these questions:
• Do I have time to care for and clean up after the dog?
• What type of environment does the dog need to thrive?
• How large will the dog get and how much exercise will it need?
• What is the dog’s life span, and can I commit to caring for it throughout its life?
• How much will veterinary care cost?

Animal-assisted therapy

The healing power of dogs extends well beyond the home as their value in helping decrease pain, stress and anxiety and aid recovery in people coping with a range of health problems is increasingly recognized. Therapy dogs provide comfort to nursing home residents, hospice patients, prisoners, children coping with trauma, and veterans suffering from post-traumatic stress disorder (PTSD), among others. The field of animal-assisted therapy is growing rapidly, as seen in the success of Mayo Clinic’s Caring Canines program , now in its 10th year. More than a dozen registered therapy dogs make their daily “rounds” of hospital rooms and clinic waiting areas.

“If someone is struggling with something, dogs know how to sit there and be loving,” researcher Dr. Ann Berger explained in the National Institute of Health News . “Their attention is focused on the person all the time.”

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Are Plant Based Burgers Really Healthier?

Sun, 01 Mar 2020 19:25:00 GMT

Examining Plant Based Burgers as Meat Alternatives

They’re 2019’s most sizzling success story, found everywhere from grocery freezer to fast food counter. Impossible Foods and Beyond Meat have brought plant based burgers from fringe to mainstream with remarkable rapidity. So quickly, in fact, that despite their ubiquity, questions abound regarding the burgers’ benefits. What exactly are they made of? Are they flavorful? How do they compare nutritionally with a turkey patty or an all-beef quarter pounder? Are they meant for a healthy planet and a healthy body?

Both feature a lengthy list of ingredients that may seem far from natural, but both plant based burgers were formulated to recreate the meaty, juicy mouthfeel of a hamburger. That being said, hundreds of meat alternative taste tests and rave reviews have demonstrated that expectations have indeed, been exceeded.

Ironically, many vegans haven’t embraced these plant-based burgers precisely because their taste, smell and texture evokes a beefy authenticity they’ve long eschewed.

What Goes Into Plant Based Burgers?

Impossible Burger is made primarily of soy protein concentrate, coconut and sunflower oil, binders, vitamins, minerals and the key ingredient – soy leghemoglobin, or “heme” – which makes the burger “bleed” and brown like meat. Beyond Burger, recently reconfigured to promise an even meatier flavor and chew, features an elaborate combination of plant proteins including pea and mung bean; fats for cooking sizzle, such as coconut oil and cocoa butter; minerals like calcium and iron; potato starch to bind; and beet juice extract for a beef-like red color in their plant based burgers.

Just the (nutritional) Facts!

Nutritional info for plant based burgers, paints a somewhat mixed picture. The good news is, the burgers contain approximately 20 grams of protein (equivalent to ground beef); a healthy mix of vitamins and minerals, including B vitamin, zinc and iron; and no cholesterol.

Interestingly, the plant based burgers may not be the best choice for people following a heart-healthy diet, as they are higher in saturated fat than turkey burgers and contain substantially more sodium than lean beef burgers. Moreover, you might consider creating your own vegetarian burger with beans, whole grains, herbs, seeds and nuts as a healthier option.

“These burgers offer good amounts of antioxidants and certain vitamins and minerals, but they aren’t quite the same as a whole-foods veggie burger made from beans,” explains Registered Dietitian Ginger Hultin, spokesperson for the Academy of Nutrition and Dietetics. “In order to mimic meat well, they use a blend of ingredients that includes saturated fat, similar to a beef burger, but from coconut oil.”

So, what’s the verdict?

“They’re interesting, delicious products that can fit into a balanced diet, and have benefits in the form of supporting the environment and saving the lives of animals,” she says.

To sum up, supporting the environment and saving the lives of Animals is, in fact, the real fuel driving these companies, both of which are on a mission to reduce meat consumption and ensure a sustainable global food supply by giving people what they enjoy most – big, juicy (plant based) burgers.

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Good news for those with type 2 diabetes: Healthy lifestyle matters

Mon, 17 Feb 2020 15:30:00 GMT

Type 2 diabetes (T2D) is a metabolic disorder of insulin resistance — a reduced sensitivity to the action of insulin — which leads to high blood sugar, or hyperglycemia. Approximately 12% of American adults have T2D, and more than one-third of Americans have prediabetes, a precursor to T2D. This is a major public health concern, as T2D dramatically increases risk for heart disease, including heart attacks, atrial fibrillation, and heart failure.

The development and progression of T2D is affected by many factors. Some, such as a person’s race/ethnicity, age, and gender cannot be modified. Others, including body weight, exercise, and diet can be changed.

Can lifestyle changes help reduce heart disease risk if you have diabetes?

In 2010, the American Heart Association (AHA) published “ Life’s Simple 7 ,” which they defined as “seven risk factors that people can improve through lifestyle changes to help achieve ideal cardiovascular health.” The Simple 7 touched on smoking status, physical activity, ideal body weight, intake of fresh fruits and vegetables, blood sugar, cholesterol levels, and blood pressure.

Subsequent studies found that people in optimal ranges for each of these factors had lower risks of heart disease compared to people in poor ranges. But given the significant increase in heart disease risk in those with T2D, it was not clear if the impact of these modifiable factors would hold true for the T2D population.

Recent study suggests lifestyle changes do benefit T2D and prediabetes

A recent study published in JAMA Cardiology looked at whether the ideal cardiovascular (CV) metrics covered in Life’s Simple 7 translate into improved CV health for those with T2D or prediabetes. The results were exciting, and consistent with other large population-based studies. Patients who had five or more ideal CV measures had no excess of CV events compared with people with normal blood sugar levels. CV events measured in the study included death, heart attack, stroke, and heart failure. Each additional ideal health metric was associated with an additional 18% drop in CV event risk for people with T2D, and an additional 15% drop for those with prediabetes.

This was a prospective, observational study, examining the association of risk factors only. It was not a randomized trial looking at an intervention. As a result, we cannot draw conclusions about cause and effect. Nonetheless, this is the first study to show a positive association between ideal lifestyle factors and CV health in people who are at high risk for CVD due to T2D. These results showcase the importance of our lifestyle choices, suggesting that meeting ideal health metrics can help reduce risk of CV events.

Life’s Simple 7

So what are the lifestyle and metabolic health goals should you strive for, whether or not you have diabetes?

The post Good news for those with type 2 diabetes: Healthy lifestyle matters appeared first on Harvard Health Blog .

Headaches – Types and Remedies

Sat, 01 Feb 2020 19:24:00 GMT

Oh, My Aching Head

A dull pressure, a sharp pain, an uncomfortable pounding, a vise-like sensation – all can signal the start of a headache. A painful part of the human condition since the beginning of time, more than 150 different types of headaches have been identified, categorized and treated in increasingly effective ways. We take a look at how to cope with the most common headaches, as well as when your symptoms indicate immediate attention is needed in this great reference guide to headache types and remedies.

It’s the rare person who hasn’t experienced the tight feeling or band-like grip around the head that characterizes a tension headache. Stress is frequently the trigger, so staving them off with recognized stress management strategies such as deep breathing exercises, yoga, meditation, and progressive muscle relaxation may help. For immediate relief, gentle massage and use of warmth or heat to ease tense neck and shoulder muscles often work well. Over-the-counter medicine such as aspirin, ibuprofen or acetaminophen may also be used judiciously.

Cluster Headache

Seen more often in men, these headaches cause intense pain on one side of the head or around one eye; are often accompanied by nasal discharge or teary eyes; and occur in bouts of frequent attacks over weeks or months, followed by long periods of remission. Treatments include inhaling pure oxygen through a face mask, which often relieves pain within 15 minutes, and injectable triptan medications used to treat migraines.

Exertional Headache

Headaches experienced after strenuous exercise may result from being dehydrated or overheated or simply from overexertion, and are usually resolved quickly with rest and adequate hydration.

Sinus Headache

The pain, pressure and fullness in cheeks, brow or forehead, often accompanied by stuffy nose, fatigue and an upper toothache, can indicate a headache from sinusitis or seasonal allergies, but be aware that in many cases it is actually a migraine. Rest, fluids, decongestants and over-the-counter pain medications help alleviate headaches caused by sinusitis; those caused by an allergy will usually be treated with a nasal spray.

Each headache has its own “flavor,” but if they occur more frequently or more severely, seem to worsen with the use of over-the-counter drugs, and interfere with your normal activities, please contact us…and consider starting a headache journal that you can bring to your appointment. Track if they are occurring at certain times of day, or after specific activities or foods; e.g., after a workout, a sleepless night or a change in diet. Also note the duration of each headache; where the pain is located; the intensity and type of pain; other accompanying symptoms, such as gastrointestinal distress; and medications you used. Pre-formatted trackers can be accessed online at sites such as headaches.org .

When to seek help promptly: If your headache can be described as one of the worst you’ve ever experienced and is accompanied by trouble seeing, speaking or walking; fainting; high fever; numbness, weakness or paralysis on one side of your body; stiff neck; or nausea or vomiting.

Inside the ‘Migraine Brain’

Despite the prevalence of migraine headaches, which affect 39 million people in the U.S. alone, their complex and multifactorial causes have made it difficult to pinpoint the most effective management of often debilitating symptoms that can include severe, pulsating pain; nausea; and visual auras. But years of research into the “migraine brain” are revealing a deeper understanding and new treatments, discussed in our Q&A with a headache expert, below.

Q: What is a migraine brain?

A: We have found it’s wired somewhat differently than the average brain, highly sensitive to light, sound and movement.

Q: Does genetics play a role?

A: Absolutely, as more than 70% of migraine sufferers have at least one close relative with the problem.

Q: What triggers a migraine?

A: Among the multiple factors are stress, hormonal shifts, time and travel changes, certain foods, inadequate nutrition, alcohol, and too much or too little caffeine. Anyone of these, or more likely, a combination, can trigger an episode. But the number one cause is the overuse of migraine medications, which triggers rebound headaches and starts a cycle of needing increasing quantities for relief.

Q: What medications are used to manage or prevent symptoms?

A: In addition to over-the-counter medications such as acetaminophen, a class of drugs called triptans that block pain signals in the brain have been used effectively for years. There are many other options, such as new biologic drugs to prevent or minimize the pain of migraines, including calcitonin gene-related peptide (CGRP) inhibitors and serotonin-receptor agonists.

Q: Will lifestyle adjustments make a difference?

A: There is no question that migraine patients benefit most from a set routine of healthy eating (avoiding alcohol and foods with nitrites or preservatives) and regular exercise; getting adequate sleep each night; and learning to manage stress with techniques such as biofeedback training, relaxation training and cognitive-behavioral therapy.

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LDL cholesterol: How low can you (safely) go?

Mon, 20 Jan 2020 15:30:00 GMT

Elevated low-density lipoprotein (LDL, or “bad”) cholesterol is a clearly established risk factor for the development of cardiovascular disease (CVD). Lowering LDL with medications and/or lifestyle changes has been shown to lower CVD risk. Just how far to lower LDL, however, has remained controversial.

Current guidelines developed by the American Heart Association, American College of Cardiology, and several other professional organizations recommend lowering elevated LDL levels to 70 milligrams per deciliter (mg/dL) in people with high-risk CVD. However, recent studies have suggested that CVD risk may continue to drop as LDL is lowered beyond these targets, leading some cardiologists to believe that our current guidelines are not aggressive enough. Others are concerned that lowering LDL too much may lead to harm.

No apparent danger of very low LDL cholesterol

LDL is a key component of many hormones and all cell membranes, which allow cells to communicate with each other. Earlier studies had raised concerns that lowering LDL too far might interfere with normal cellular functions, especially in organs that have higher lipid concentrations, such as the brain and reproductive organs. And there have been reports of a slightly increased risk of osteoporosis and brain bleeding in patients treated with high doses of statin medications.

Well-known side effects in people who use statin medications include muscle aches and a slightly increased risk of diabetes, especially when high doses of medication are used. Whether these risks are due to the statin medications themselves or the lowering of LDL is not entirely clear.

However, people with rare inherited disorders in which LDL levels are extremely low (often less than 30 mg/dL) from birth appear to have normal fertility and no major organ dysfunction. Therefore, an extremely low LDL by itself does not appear to be dangerous in these unusual cases.

Study suggests lower LDL cholesterol is better

A recent meta-analysis published in JAMA Cardiology suggests that it is both safe and effective to lower LDL below 70 mg/dL. The authors reviewed a large database of CVD patients with LDL levels averaging 70 mg/dL or less at the start of the studies. On average, there was a 20% drop in CVD risk seen for every 39 mg/dL drop in LDL cholesterol. In other words, a drop in LDL from 70 mg/dL down to 31 mg/dL was associated with 20% fewer CVD events such as heart attack or stroke.

The benefit was consistent regardless of the medications used to lower cholesterol. The JAMA Cardiology meta-analysis looked at studies in which LDL was lowered with a statin drug, which works by lowering LDL production in the liver, or with a different type of medication, including ezetimibe (Zetia), which interferes with absorption of LDL from the intestine, or PCSK9 inhibitors, newer injectable medicines that increase uptake of LDL from the bloodstream into the liver. The drop in CVD risk was in line with previous studies of patients who started with LDL levels around 130 mg/dL, and saw a drop in CVD events of about 22% for every 39 mg/dL drop in LDL.

In this study, there was no increased risk of adverse outcomes (including muscle aches, liver dysfunction, new onset of diabetes, cancer, and bleeding strokes), even when LDL was lowered to as low as 20 mg/dL. Although statin medications themselves have been linked to side effects, especially at high doses, it appears that extremely low LDL concentrations are not responsible for side effects.

In other words, lowering LDL beyond our previous target of 70 mg/dL appears to be not only safe but beneficial, in patients with CVD.

The post LDL cholesterol: How low can you (safely) go? appeared first on Harvard Health Blog .

Antibiotics Awareness is Good for Your Health

Thu, 16 Jan 2020 17:02:00 GMT

Antibiotics Awareness

Spurred by Alexander Fleming’s serendipitous discovery of penicillin in 1928, antibiotics have rightfully become wonder drugs, often able to change the course of deadly bacterial infections in a matter of days. But in recent years, their unmatched healing power has become overprescribed and over utilized, leading to concerning findings like these: Nearly 23% of antibiotic prescriptions filled in 2016 were unnecessary, and an additional 36% were prescribed for conditions for which an antibiotic is only sometimes recommended, according to a recent study from the Agency for Healthcare Research and Quality . Antibiotics awareness is good for your health

Unintended consequences far from benign

Patients may needlessly experience the drug’s side effects, such as rash, dizziness, nausea, diarrhea or Clostridium difficile infection (C. diff), which can cause severe diarrhea and may be life-threatening. On a larger, global scale, overuse leads to antibiotic-resistant bacteria, a growing danger that occurs when bacteria that have been exposed to an antibiotic mutate, rendering the drug ineffective against them. The Centers for Disease Control estimates that at least 2 million people are infected with antibiotic-resistant bacteria each year in the US, resulting in approximately 23,000 deaths. In fact, Fleming himself predicted the possibility in his 1945 Nobel Prize acceptance speech, saying: “It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body.”

Antibiotics: Handle With Care

That’s why the World Health Organization’s annual “ Antibiotics: Handle With Care ” campaign, launched in 2015, and the United States’ “ Be Antibiotics Aware ” program, launched the following year, are more important than ever in raising awareness as to why antibiotics aren’t always the answer. Becoming knowledgeable about the difference between bacterial and viral infections, and why an observational (“watch and wait”) approach to antibiotic treatment may be considered for conditions like sinusitis or ear infections, is critical to stemming the tide of overuse.

Below is a look at when antibiotics should be the treatment of choice, when they should be considered only after watching and waiting, or when they are not called for at all. Note that antibiotic drugs effectively kill bacteria but not viruses, which is why they are never recommended for viral infections such as colds or flu. However, not all bacterial infections require the use of antibiotics. As always, check-in with our office regarding what’s best for your individual health.

Sources: Up to Date, CDC

About that penicillin allergy

Most people who believe they’re allergic to penicillin can take it without a problem, either because of the rash, they experienced as part of a virus or because the allergy resolved over time. You may want to get tested by an allergist to be certain, as research shows that patients identified as penicillin-allergic are more likely to receive very powerful antibiotics with greater side effects, and are also at higher risk of developing resistant infections that require longer stays in the hospital. It’s interesting to note that when skin tested, approximately 90% of people will test negative for a penicillin allergy.

Did You Know?

Reactions from antibiotics cause 1 out of 5 medication-related visits to the emergency department.
Source: Centers for Disease Control

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No More Excuses Not to Exercise

Wed, 01 Jan 2020 20:43:44 GMT

Many people say they don’t have the time to work out. But most of us spend hours each day viewing screens.

If, like many of us, your New Year’s resolution is to find more time to exercise, you may be in luck. According to a recent study of how Americans typically spend their waking hours, almost all of us have far more leisure time available than we think we do.

But the study shows that few of us use even a portion of that free time for physical activity, raising thought-provoking questions about what really keeps us from exercising and how we might better shape our days to get ourselves moving.

At the moment, about two-thirds of Americans do not meet the standard exercise guidelines of about 30 minutes a day of moderate exercise, such as walking. In past studies of exercise behavior, when researchers have asked people why they rarely work out, the almost-invariable response has been that time is too tight. Work, family, school, travel and other obligations seem to gobble up the hours, they said, leaving them feeling unable to sneak in a daily walk or a workout.

But whether we are actually too busy has not been clear. Other research has teased the idea that we may underestimate how many hours we spend each day seated in a chair or how much time we devote to watching television.

So, for the new study, which was published recently in Preventing Chronic Disease: Public Health Research, Practice, and Policy, researchers from the RAND Corporation in Santa Monica, Calif., decided to look more closely at what we do with our days and, in particular, how we spend our free time.

They began by turning to a large database of information gathered by the U.S. Census Bureau. For years, the bureau has conducted an ongoing telephone survey of Americans’ lifestyles, called the American Time Use Survey. For this survey, tens of thousands of men and women ages 15 or older are asked about their days and how they spent their time, almost minute by minute, during the preceding 24 hours. The participants in the survey represent a range of ages, socioeconomic demographics and ethnicities.

The RAND researchers then gathered responses from more than 32,000 of the survey participants between 2014 and 2016 and compared their days, looking at how much of their time was their own.

“We defined leisure time as involving activities that were not in some way required or compulsory,” said Dr. Deborah Cohen, a physician and senior scientist at the RAND Corporation who oversaw the new study.

Time devoted to work, commuting, education, sleeping, cleaning, caring for children or other household members, cooking, food shopping, showering or dressing was not free time. But minutes or hours spent exercising, socializing, relaxing, playing, watching television, volunteering, taking classes for fun, chatting with friends, traveling for pleasure or otherwise not working constituted leisure time.

The researchers then calculated the average free time for the 32,000 men and women.

And they found plenty. Almost all of the respondents — whatever their income, age, gender or ethnicity — reported about five hours a day of leisure time. Men tended to have more free time than women, older people more than the young, and African-American women the least of all. But no group reported less than about four and a half hours a day of free time.

For almost everyone, physical activity was uncommon during those hours. Most people instead spent the overwhelming majority of their free time watching television or in front of a phone or a computer.

“I was frankly surprised at how many leisure hours people spend every day in front of screens,” Dr. Cohen said.

These findings might suggest that, if we adjusted our schedules and turned off the TV, phone or computer, most of us would have plenty of time to work out.

But the data also underscore other lingering barriers to exercise, Dr. Cohen said.

“For many people, especially women, almost all of their free time is clustered in the evening, after a day of work and chores and caring for children,” she said. “They may be tired. They have no child care. There is no gym nearby or it’s expensive and the parks and recreational centers are closed or do not have programming,” such as evening exercise classes or sports leagues.

So, getting more people moving in 2020 and beyond will require both individual and social initiatives, she said.

“We need to make it easier” for people to devote some portion of their free time to physical activity, Dr. Cohen said.

Of course, this study was based on people’s recollections of how they spent their time, which can be greatly inaccurate. But, in general, people overestimate rather than underreport their exercise time (and they reported very little exercise time here).

The overarching lesson of the study, then, is that many of us, if we choose to use it, have enough free time to exercise, Dr. Cohen said, and that dialing back screen viewing might be a simple way to start.

The post No More Excuses Not to Exercise appeared first on The New York Times .

Medications as effective as stents for most with coronary artery disease

Mon, 09 Dec 2019 15:30:00 GMT

How best to treat a patient with stable coronary artery disease (CAD)? The cardiology community has debated this question for decades, arguing whether it’s best to take a conservative or invasive approach.

The ISCHEMIA trial (ischemia means not enough oxygen is getting to the heart muscle), a new study reported at November’s American Heart Association meeting, provides some answers. This study suggests that for most, managing CAD with medications alone (the conservative approach) is as safe and effective as the more invasive strategy of cardiac catheterization and opening of the blocked artery.

Findings of the ISCHEMIA trial

ISCHEMIA followed over 5,000 patients with significant narrowing in one or more coronary arteries. Half of the patients were randomly selected to receive conservative treatment with optimal medical therapy (OMT) and lifestyle changes to treat risk factors such as high blood pressure and high cholesterol. The other half were given OMT and also sent for cardiac catheterization (threading of a flexible catheter into the heart arteries to look for narrowed or blocked coronary blood vessels). When blockages were found, these patients underwent placement of a small mesh tube, called a stent, to prop open the affected area. When blockages were too complex for stent placement, open-heart surgery was performed.

The findings were surprising. Many cardiologists would have predicted that the invasive strategy would be superior to the conservative strategy. The group that received stents did report greater relief of angina , or chest pain. But there was no significant difference between the two groups in terms of rates of heart attack, death, or hospitalization for worsening heart pain.

Proponents of the conservative approach argue that OMT makes more sense than stenting because it addresses all the arteries in the heart, not just the small section of narrowing addressed by a stent that may be causing angina but may not represent a risk to health.

Stents still a good choice for unstable angina

Since their introduction in the 1980s, stents have been widely used in the treatment of CAD. Stents are effective at relieving angina in patients who continue to experience symptoms despite being on appropriate medicines. Angina refers to the symptoms — typically pressure or tightness across the chest — that occur when the heart muscle does not get enough oxygen-rich blood.

Angina is a symptom of advanced atherosclerosis, a process of inflammation and plaque formation that leads to blood vessel narrowing. If an atherosclerotic plaque ruptures, this can trigger the formation of a blood clot, severely and suddenly obstructing blood flow. Depending on the degree of obstruction and which artery is involved, this may cause abrupt worsening of angina, called unstable angina, or death of the heart muscle, called a heart attack. Unstable angina occurs at rest, or with increasingly little exertion.

Patients experiencing unstable angina or heart attack almost always require urgent cardiac catheterization, and often stent placement.

Medications as effective as stents for stable angina

Unlike unstable angina, patients with stable angina have more predictable, chronic symptoms that can be managed with medications. Stable angina worsens with exertion or sometimes with emotional stress, and improves with rest. Reduction of stable angina involves improving the mismatch between oxygen supply and demand. This can be accomplished either by lowering demand or improving supply.

Demand can be reduced with OMT, which may include beta blockers, which slow down the heart rate, or nitroglycerin, which decreases the work of the heart by relaxing blood vessels. Statins and aspirin are another important component of OMT, because they help to stem the progression of heart disease, reducing the risk of unstable angina or heart attack. When medication fails, blood supply to the heart muscle can be increased by removing the blockage with a stent or bypassing the blockage with open-heart surgery.

Many cardiologists have assumed that stents are effective, not only at relieving symptoms but also at preventing future heart attacks, leading many to pursue early cardiac catheterizations for their patients with stable angina. However, the ISCHEMIA trial suggests that medications are just as good at preventing heart attacks and death in stable patients.

This is welcome news for patients who previously would have been urged to have a cardiac catheterization and stent placement for stable angina. It now seems clear that these patients can be safely managed with medications alone, avoiding the risk and discomfort of the procedure, not to mention reducing healthcare costs.

Optimal medical therapy safe and effective for most with coronary artery disease

ISCHEMIA is not the first study to demonstrate that OMT is a safe and effective alternative to stent placement. But it is the most influential because of its careful design, large number of patients, and comparison of the newest stents and most current medical treatments.

So, how best to manage patients with stable coronary artery disease? A safe and effective long-term strategy for most is to start with medications and healthy lifestyle. For those who continue to be limited by angina, an invasive procedure is appropriate for symptom control. Stents relieve angina, but they do not prevent heart attacks or death.

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The complicated relationship between fish oil and heart health

Wed, 04 Dec 2019 15:30:00 GMT

For nearly two decades, the American Heart Association (AHA) has recommended that people with coronary heart disease (CHD) consume omega-3-fatty acids (the kinds of fatty acids found in fish and fish oil) to prevent another heart attack. This recommendation was based on early randomized, controlled trials, which found that fish oil supplementation was associated with lower rates of stroke, heart attack, and death in people who already had heart disease. On the other hand, the impact of fish oil supplements on preventing a first heart attack or stroke (primary prevention) was never clearly demonstrated.

Recently there have been large trials examining the complex relationship between fish oil and heart health. The results have been mixed and somewhat confusing, leaving both patients and physicians to wonder: will fish oil supplements reduce my risk of heart disease?

What’s the connection between fish oil and heart health?

How might omega-3-fatty acids found in fish oil provide heart health? Multiple possibilities have been proposed and are supported by animal research. These protective mechanisms include

Research examining each of these is ongoing.

Many studies, varied results

Despite these animal data, clinical studies in humans have not consistently supported the protective benefits of fish oil supplementation.

A meta‐analysis published in JAMA Cardiology found no clear benefit to fish oil supplements in preventing heart disease or major cardiovascular disease (CVD) events such as heart attack or stroke, in people who were at increased risk for CVD.

This was followed by the publication of the ASCEND and VITAL trials, both with mixed results. In ASCEND , which examined diabetic patients without known CHD, fish oil supplements did not reduce heart attacks or strokes, but did significantly lower risk of death from heart attack and stroke. VITAL examined the effects of fish oil on primary prevention in people with regular risk of heart disease, and also failed to find a significant reduction in all major CVD events. However, there were fewer heart attacks in study subjects who took fish oil supplements, particularly in those who did not eat fish.

The REDUCE‐IT trial was published next. This trial looked at the effect of high-dose fish oil supplements on people with high blood triglyceride levels who were at elevated CVD risk. In contrast to previous studies, REDUCE-IT found a significant reduction in cardiovascular events among study subjects who took the high-dose fish oil supplements. While most studies have tested 1 gram or less of fish oil with a combination of eicosapentaenoic acid (EPA) and docosahexaenoic (DHA), REDUCE-IT used a dose of 4 grams of EPA alone. (Vascepa, a prescription version of the EPA fish oil supplement used in REDUCE-IT, is FDA-approved to treat very high triglyceride levels of 500 mg/dl or higher. In November, an FDA advisory panel unanimously voted in favor of expanding approved use of Vascepa. If the FDA follows the advisory panel’s recommendation, Vascepa will be able to be prescribed to reduce the risk of cardiovascular events like heart attack and stroke. The FDA decision is expected in late December.)

In October 2019, a repeat of the JAMA Cardiology meta-analysis, but now including 13 trials instead of the original 10, was published in the Journal of the American Heart Association . The addition of these three trials increased the sample size by almost 65%, from 77,917 study participants to 127,477 participants. In reanalyzing the expanded data, researchers found that fish oil omega‐3 supplements lowered risk for heart attack and CHD death. There was no effect on stroke. Interestingly, risk reductions appeared to be linearly related to omega‐3 dose. In other words, the higher the dose, the greater the risk reduction.

What does this mean for you?

Omega-3 supplements from fish oil appear to be heart-healthy and have a protective effect on CHD. But before we all start reaching for supplements, it may be worth following a heart-healthy diet full of fresh fruits and vegetables, with lean protein such as fish, as recommended by the AHA. For those of us at highest risk, especially those with elevated triglyceride levels, it is worth speaking with your physician about high dose EPA fish oil supplements.

The post The complicated relationship between fish oil and heart health appeared first on Harvard Health Blog .

Alcohol Affects Women Differently than Men

Mon, 02 Dec 2019 18:03:00 GMT

The Female Factor: Alcohol is Not Gender-Neutral

Given the growing popularity of the cocktail culture and wine time, it’s important to know that alcohol affects women differently than men – physiologically, psychologically and socially. It’s worth asking: For women, is the wine glass half full or half empty when considering the risk-versus-benefit ratio?

First, there is the difference in women’s body composition. Women have more total body fat and less total body water than men. As a result, alcohol is less dispersed, resulting in a higher blood alcohol level, drink for drink, than in men.

Metabolism also plays a role

Women produce less of the alcohol dehydrogenase (ADH) enzyme that controls the rate at which alcohol is broken down in the body. This means a blood alcohol level that rises more quickly in women and stays elevated longer. Women are more vulnerable than men to alcohol’s effects on other levels too: more likely to black out from drinking, to suffer from mood and behavioral changes and to more rapidly develop an addiction. Women may also experience higher rates of depression and anxiety, often drinking in response to negative emotions and problems with loved ones versus men’s tendency to drink for positive reinforcement and pleasure.

High Drinking Rates in Women: A Cause for Concern

All these factors make the record high drinking rates for women a real cause for concern. Problem drinking rose by 83% among women from 2002 to 2013, rapidly closing – in a most unfortunate way – a gender gap that has existed for decades. Current statistics show that 5.4 million women over 18 may be considered as having alcohol use disorder (AUD) and need treatment. However, gender plays a role here too, as women who consistently seek treatment for almost every other physical and mental health problem at higher rates than men are far less likely to do so for alcohol-related problems. Less than 1 in 10 women get formal help, hindered by the stigma of addiction and feelings of guilt or shame in not being able to function as caregiver for their family.

Alcohol’s impact on other disease is mixed. There is evidence that one drink a day may reduce women’s risk of heart attack, cardiovascular disease and the most common type of stroke. The risk of breast cancer, however, increases by 5 – 9% and rises with each additional drink per day. It’s worth noting that taking a multivitamin fortified with 400 mcg of folic acid daily may lower some of women’s elevated risk from alcohol, according to recent studies.

Alcohol in Moderation is Key

The best advice, as with most of life’s issues, is moderation. Avoid alcohol if pregnant or if you have a personal or family history of breast cancer, liver disease or alcohol abuse. Otherwise, consuming one drink a day is generally healthy, so be knowledgeable about how to measure that (see below) and enjoy a glass with friends or at special events. Don’t try to match the pace of male celebrants, especially if they’re over-imbibing. In fact, gently steering them away from the bar and onto the dance floor may be the healthiest move for all.

Heavy drinking for women = more than one drink per day or seven-plus drinks per week

Did You Know?

Alcohol use disorder is characterized by symptoms such as:
· excessive time spent drinking
· needing to drink more to get the same effect
· wanting a drink so badly you can’t think of anything else
· inability to stop drinking despite the impact on work and family
*Source: National Institute on Alcohol Abuse and Alcoholism

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When Are the Best Years of Our Lives?

Tue, 26 Nov 2019 19:23:00 GMT

Life’s Happiness Continuum

Is there a predetermined peak age for happiness, before which our normal outlook is gloomy and melancholy and after which we slump back into these non-euphoric ways? When Are the Best Years of Our Lives?

Studies Show Two Stages of Life Happiness

Like trying to define why some people are born to be joyful and others to play the role of curmudgeon, this issue has long intrigued psychological and social science researchers. While no singular conclusion has been reached, there are a number of compelling hypotheses…and you may be pleasantly surprised to learn that a number of studies suggest a U-shaped happiness curve with peaks for young and old, giving us not one but two stages of life to savor. Mid-life can be stressful, full of the challenges and demands of raising a family and sustaining a career, but according to some experts, there is indeed a light at the end of the tunnel.

The Economist’s international survey of happiness gathered data from America’s General Social Survey, Eurobarometer and Gallup finding an upward trajectory of happiness until age 30, a downward trend into midlife, with the lowest point reached at age 46, and up to higher levels again after the 50’s. Jonathan Rauch, a senior fellow at the Brookings Institution and author of the 2018 book, The Happiness Curve , says although its effects vary between individuals, there appears to be a subtle but insistent tug that makes happiness more difficult to achieve in midlife and then reverses direction when we least expect it.

Other research supports this finding, including a University of Chicago retrospective study of 28,000 Americans over a 32-year period which showed older age groups were consistently the happiest. Interestingly, Dr. Dilip Jeste, director of the UC San Diego Center for Healthy Aging , describes it not as a curve, but more of a linear improvement in mental health that occurs even as physical and cognitive function declines.

Might Happiness in Women Peak Between the Ages of 50-70?

In particular, today’s women may find some of their sweetest times between ages 50 and 70, according to an in-depth lifestyle study spanning three decades conducted by the TrendSight Group. The take-away for younger generations: “Aging isn’t a dirty word, with it can come incredible confidence, strength and freedom,” says study author Marti Barletta. Even better, a full 59% of women ages 50 to 70 felt their greatest achievements were still ahead of them.

Happiness may Increase with Age

Experts theorize a number of reasons that happiness may increase with age, including increased wisdom or psychological intelligence in handling challenges, fewer aspirations and expectations of self, greater appreciation for life, living in the moment with less worry about the future, greater ability to regulate emotions and less worry about pleasing everyone all the time. Stanford psychologist Laura Carstensen’s Socioemotional Selectivity Theory , which is grounded in the unique human ability to monitor time, suggests that relative to younger people, older adults focus more on positive than negative information and prioritize emotionally meaningful activities – notably, deepening close relationships – over those related to individual achievement and exploration.

Recent findings from the Harvard Study of Adult Development , one of the world’s longest studies of adult life, begun in 1938, also point to the vital role of relationships in happiness at older ages. According to the research, these ties protect people from life’s discontents, help to delay mental and physical decline, and are better predictors of long and happy lives than social class, IQ or genes. Dr. Robert Waldinger, study director and psychiatrist at Massachusetts General Hospital, acknowledges that the research shows correlation, not necessarily causation. However, after following the subjects (including both Harvard graduates and inner-city residents) for many decades and comparing the state of their health and their relationships early on, he is confident that strong social bonds play a causal role in long-term well-being.

Perhaps 19th century journalist David Grayson had the best advice of all: “The other day a man asked me what I thought was the best time of life. ‘Why,’ I answered without a thought, ‘now.’”

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Manage Prescription Drugs Effectively

Tue, 26 Nov 2019 19:20:00 GMT

Managing Prescription Drugs: From Pickup to Take Back

If you are not taking your prescription medications as directed (or at all), you’re far from alone. Compliance is estimated at just 50% among U.S. patients. Unfortunately, adherence is a direct impact on quality and length of life, and overall healthcare costs, accounting for up to 50% of treatment failures and up to 25% of hospitalizations each year. The reasons for noncompliance vary, from patients not being convinced of the medication’s effectiveness, fear of side effects, the cost of certain medications to difficulty using tools (such as inhalers) or an aversion to injections. What can be done to manage prescription drugs more effectively?

For most, non-compliance is simply an unintentional consequence of forgetfulness or lack of organization. When faced with the need to keep track of a growing lineup of daily doses – and 77% of older adults manage two or more chronic conditions according to the National Council on Aging – it can become challenging to keep up. Fortunately, many solutions are available, from old school pen and paper to high-tech smartphone apps, that make it easy to reap the benefits of and manage your prescription medications.

Pick up

Organize

Smartphone Reminders

Free smartphone apps can serve multiple functions. A few of the best:

Properly Store your Prescription Drugs

Discard with care: Toss, flush or Take Back

Most prescription and OTC medicines can be thrown away in the household trash, with these important procedures:

Even more convenient and environmentally sound are programs such as National Prescription Drug Take Back Day , sponsored by the U.S. Drug Enforcement Administration (DEA) in communities nationwide. The next one is scheduled for October 26, 2019: Find a collection site near you at https://takebackday.dea.gov , dispose of your unused or expired drugs safely and easily.

Did You Know?

Approximately 50% of medications for chronic disease are not taken as prescribed.
*Source: Annals of Internal Medicine

11.8 million pounds of prescription drugs collected since Take Back Day began in 2010.
*Source: Drug Enforcement Administration

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In defense of the salt shaker

Wed, 06 Nov 2019 15:30:00 GMT

Sherry B, a healthy and active 61-year-old woman, came to my office several months ago. She had noted an unusually fast heart rate during exercise, and felt lightheaded when standing in line at the grocery store or after finishing her five-mile run. She carried a water bottle with her and drank from it throughout our meeting. “I don’t understand!” she said, “I’m always thirsty, even though I drink water constantly.” Most of her symptoms had started the previous year when she decided to “clean up” her lifestyle, began to exercise more regularly, and stopped eating out. She added proudly that she had thrown away her salt shaker.

After ruling out diabetes, weak heart, anemia, and other medical conditions, I suspected that Sherry was one of the few Americans who may actually not consume enough salt in their daily diet.

The dangers of insufficient sodium

Those at higher risk for getting insufficient salt (sodium) in their diet include people who sweat heavily with exercise or at work, have normal or low blood pressure, have normal heart and kidney function, and consume a very-low-sodium diet. In addition to an inappropriately fast heart rate and lightheadedness with standing, other symptoms can include constipation, fatigue, headaches, and even fainting. In extreme cases, excessive sodium restriction can cause brain swelling. There is no simple way to diagnose this problem; routine blood tests, including measurement of sodium levels in the blood, are typically normal.

We all know that too much salt is bad for our health. Excess sodium intake causes elevated blood pressure and increases the risk of cardiovascular disease (CVD). But consuming too little salt can also be harmful.

When we do not replace the salt we lose every day in our urine and feces, exhaled breath, and sweat, we cannot retain sufficient water to properly regulate our blood volume. This is because our kidneys precisely regulate the sodium concentration in our blood so that it matches the concentration in our cells. If we drink too much water without consuming enough sodium, our blood becomes more diluted than our cells. This forces the kidneys to eliminate the excess water as dilute urine. As a result, we can become “dehydrated,” no matter how much water we drink.

How much sodium do we need?

Individual sodium needs vary, but most people require at least 1,500 milligrams (mg) of sodium every day (roughly 2/3 of a teaspoon of table salt), with an additional 300 mg added per hour of exercise. When sodium intake is extremely restricted, the body compensates by increasing production of hormones called renin and aldosterone, which signal the blood vessels to narrow, and tell the kidneys to retain salt and water in an attempt to maintain balance. When sodium intake is so low that blood pressure drops when we stand ( orthostatic hypotension ), the body produces more norepinephrine, a “fight or flight” hormone that tells the heart to beat more quickly and forcefully.

Many studies have shown that consuming more than 5,000 mg of sodium per day is associated with increased risk for CVD. The PURE study , the largest international study to examine the relationship between sodium intake and health, looked at the relationship between sodium consumption and CVD risk in over 95,000 people from the general population. The authors reported a J-shaped association, with the lowest risk of CVD events in those with moderate sodium consumption (about 4,500 mg per day). Both higher and lower consumption (less than 3,000 mg per day) was associated with increased risk. (The study accounted for those who consume very little salt due to other illnesses.)

Moderation is key

The great majority of Americans consume excessive amounts of sodium, mostly in the form of commercially processed foods. Approximately 80% of our sodium intake comes from processed and restaurant foods, another 15% from foods that contain sodium such as olives and pickles, and only about 5% from salt added in the home.

From a CVD standpoint, the ideal diet would mainly consist of home-cooked, plant-based foods, but with a modest amount of added salt. With this strategy it is almost impossible to exceed the (somewhat arbitrary) 2,300 mg upper limit recommended by the American Heart Association.

Without a doubt, the typical Western diet, heavy in processed foods and extremely high in sodium, is contributing to excess CVD risk in the majority of Americans. However, we also need to keep in mind that a modest amount of sodium is essential for proper regulation of blood volume and nervous system function. In otherwise healthy people, there is no proven benefit, and possible harm, from overly restricting salt intake.

The post In defense of the salt shaker appeared first on Harvard Health Blog .

Study supports benefit of statin use for older adults

Wed, 02 Oct 2019 14:30:00 GMT

Statin drugs have been shown to reduce the risk of cardiovascular disease (CVD) in young and middle-aged adults. With older adults (those 75 and over), the benefits are less clear. But a recent study published in the European Heart Journal suggests that there is in fact a benefit to statin use in this older population.

Current guidelines are unclear on statin use in older adults

Elevated levels of cholesterol, specifically low-density lipoprotein (LDL) cholesterol, cause plaque buildup in the arteries, leading to an increased risk of heart attacks and strokes. Lowering LDL, through either medications or healthy lifestyle, has been shown to reduce cardiovascular events. The most commonly used medicines to lower LDL are the statins, including atorvastatin (Lipitor) and rosuvastatin (Crestor), among many others. Statins work by preventing the liver from making excess cholesterol.

However, most studies showing that statins lower CVD risk have excluded older study participants. As a result, current European and American guidelines do not make clear recommendations for statin use in older adults who do not have a history of pre-existing CVD. (For older individuals who already have CVD, including those with a history of angina, heart attacks, stroke, or peripheral artery disease involving the aorta or major leg arteries, there are clear guidelines recommending statin use to prevent subsequent events.)

Recent study shows significant benefit of statins in older adults

The EHJ study carefully analyzed a large healthcare database, following over 120,000 French men and women ages 75 to 79 who had been taking statins for at least two years, but who had no previous history of CVD. They were observed for up to four years to see if those who discontinued their statins were more likely to be admitted to the hospital for a CVD event (heart attack, stroke, or other arterial problem).

At the end of the study period, the researchers found that approximately 10% of patients who had stopped taking statins required a hospital admission due to a CVD event, compared to about 7.5% of those who had continued taking statins. In other words, stopping statins was associated with a statistically significant increased risk of roughly 25% to 30%.

Major illness, side effects can affect statin use

In this study, the most common reason that patients or their doctors stopped statins was the development of advanced cancer or other major illness.

In my practice, I have also cared for many patients who have stopped taking statins or who express reluctance to take statins due to side effects. The most common side effect is muscle ache (typically tenderness or soreness of the large muscle groups, such as the biceps and thighs), which affects about 20% of statin takers and reverses when the statin is discontinued. There is also a slightly increased risk of diabetes with long-term statin use and, very rarely, liver problems.

Other potential (but uncommon) side effects include cognitive problems, such as short-term memory loss and confusion, although statins actually decrease the long-term risk of dementia due to stroke or Alzheimer’s disease.

Study tips the scale in favor of continued statin use in older adults

Most primary care doctors and cardiologists prescribe statins according to the current guidelines. However, because these guidelines are vague when it comes to treating those over 75, there is variability when it comes to prescribing to this population.

Several factors weigh into the decision. For example, many doctors (and patients) are not convinced that statins will provide any benefit in older patients, because most of our knowledge comes from studying middle-aged subjects.

In addition, in older patients who may have more medical illnesses and take more medication than younger patients, doctors worry about interactions among statins and other medications. As the liver and kidneys age, we also worry about slower drug breakdown and the increased potential for drug side effects.

Unfortunately, the paradox that we face is that as our patients age, they are at increased risk for heart attacks and strokes, and yet they also become more sensitive to medication side effects, so it is a tricky balance.

As with everything we do in medicine, we must weigh the risks of statins against the benefits. In older patients, the risk of side effects may be somewhat higher, but so is the benefit. This new study tips the balance in favor of continuing statins in our older patients, to lower the risk of strokes and heart attacks. However, we must stay on the lookout for side effects and interactions, to ensure that we do not overtreat this often-vulnerable population.

The post Study supports benefit of statin use for older adults appeared first on Harvard Health Blog .

Kidney Stones: Treatment & Prevention

Wed, 04 Sep 2019 19:35:00 GMT

This Too Shall Pass: Treating and Preventing Kidney Stones

More common, frequently less painful and far more preventable than reputed, kidney stones have, entered a new era of highly effective, noninvasive procedures. We bring you up to date on kidney stone treatment & prevention

Q: Why do kidney stones happen?

A: They form when substances such as calcium, oxalate, cystine or uric acid are present at high levels in urine, becoming crystals that gradually increase in size to a stone. According to the Urology Care Foundation , Calcium stones are the most common (80%), with Uric Acid and Struvite / Infection stones making up the other 20%.

Q: How likely am I to experience kidney stones?

A: One in 10 people deal with kidney stones in their lifetime, more frequently men, but in recent years, women are rapidly closing the gap. Genetic factors also play a role: if kidney stones are prevalent among your family members, you are at higher risk of developing them.

Q: Are kidney stones very painful?

A: Over the years, the pain associated with kidney stones has taken on an almost mystical aura, sometimes described as “worse than childbirth.” However, the truth is that not every kidney stone causes intense pain. Some are small enough to pass unnoticed, and many are asymptomatic and only discovered when blood is found in the urine during routine testing. Others are large but can stay in the kidney forever without incident. It is only the stones that become “stuck” on their way out of the body that cause renal colic, or waves of severe pain, which can be promptly treated with pain medication.

Q: Does back pain mean I have kidney stones?

A: This is frequently asked by patients concerned about pain felt in the flank area near the kidney. A careful history will be taken to help determine the location of the pain, but a fairly simple way to distinguish the cause is to change positions. If the pain worsens, it is more likely to be a musculoskeletal type of strain. Kidney stone pain is less likely to be positional.

Q: How do you determine if treatment is needed?

A: A noninvasive, less expensive ultrasound is used for screening, but a spiral computed tomography (CT) scan provides superior imagery used to more accurately pinpoint the stone’s location. If only a partial obstruction is seen and not much pain is involved, time is on your side and we can wait to see if the stone passes naturally. At that point, many patients can rest comfortably at home and may be given antispasmodics (such as Flomax) to relax the ureter, pain medications to manage pain and instructed to drink plenty of water to aid the stone’s passage.

Q: What if it doesn’t pass on its own?

A: It’s reassuring to realize there is no urgency to remove the stone unless the kidney is obstructed or infected or the patient is experiencing intractable pain. And when removal is indicated, urologists (specialists in diseases of the urinary tract) have a number of options available, many of them noninvasive or minimally invasive. Open surgical procedures are a rare event. Instead, an outpatient ureteroscopy can be done, using an endoscope to break up or remove the stone. Even less invasive is lithotripsy, good for small stones, which directs high-energy shock waves toward the stone and breaks it into fragments to more easily pass out of the body. For extremely large or resistant stones, a minimally invasive percutaneous nephrolithotomy is conducted to remove the stone via an endoscope inserted through a small incision in the skin.

Q: What is the best way to prevent kidney stones from forming again?

A: We can take the time to develop an individualized approach, based on your stone’s composition. First, your stone will be tested and categorized as calcium oxalate (the most common type), calcium phosphate, a mix or a non-calcium type. Also recommended is a 24-hour urine collection to form a clear picture of how the crystals form in your body, as well as blood tests for further analysis. While those who have formed stones before are at higher risk for forming a subsequent one, we know that dietary modifications tailored to stone type and – if needed – drug therapy can substantially reduce that risk. If you form calcium oxalate stones, we’ll work on a plan to avoid foods high in oxalate, such as spinach, beets and rhubarb, and keep sodium consumption at a minimum. Also important to know is that despite its role in the stone’s composition, there is no need to restrict calcium. In fact, increasing your calcium intake with higher-calcium foods such as milk, yogurt and cheese can help lower oxalate levels in the urine. Finally, keep in mind that the single best preventive measure is to simply fill a bottle with water and drink often.

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Keto Diet: Right for You?

Thu, 01 Aug 2019 14:50:00 GMT

Considering Keto: Is It the Right Diet for You?

The truth is that a silver bullet for weight loss likely does not exist, but Americans’ perpetual search continues unabated. Low-carb diets such as Paleo, Whole30, and most prominently, Ketogenics, or “keto” may be the latest contenders, yet Academy of Nutrition and Dietetics spokesperson Ginger Hultin , RD, reveals she’s never seen a more popular – or more misunderstood – trend, the Keto Diet…..

Keto’s guidelines dramatically change typical eating patterns, with an emphasis on high fats (accounting for 80% of daily calories); moderate proteins (10 to 20% of daily calories); restricted carbs (5 to 10% of daily calories – ideally 20 to 30 grams a day, or the equivalent of a medium apple); and elimination of all grains, starchy vegetables and high-carb fruits. This means a diet replete with meats, butter, seeds, avocado and oily fish, but little or no bread, potatoes, corn, beans, legumes, milk, beer, sugar or fruits like bananas and pears.

The concept, according to Hultin, is that getting most of your calories from fat forces the body to enter ketosis and burn stored fats. Here’s how: In the absence of circulating blood sugar, which comes from carbohydrates, the body starts breaking down stored fat into molecules called ketones via a process called ketosis. Once ketosis is reached, usually within three to four days of eating less than 20 to 50 grams of carbohydrates daily, ketones are used to generate energy in the body until carbohydrates are eaten again.

Earlier research showed ketosis has benefits for blood sugar control among people with diabetes, and its efficacy has been proven in controlling seizures in some patients with epilepsy. Most people are attracted to keto based on the promise of shedding pounds quickly, which is when the diet’s drawbacks become glaringly evident.

“When followed consistently for the short term, the keto diet can lead to rapid weight loss,” says Hultin. “However, when people stop following it, as is inevitable on a highly restrictive diet, the weight is just as quickly regained, plus more.”

Side effects of a keto diet range from constipation due to lack of fiber to a potential negative impact on liver and kidney function, and limiting vitamin- and mineral-rich fruits, vegetables and grains is a concern for sustaining heart health. Hultin believes keto’s limited choices can also be socially isolating to dieters.

“The keto diet may be a quick fix but is not a sustainable solution,” she says.

There is no debate around the life-changing aspects of the keto diet for young patients with epilepsy, but experts agree that the long-term effects on others warrant further research before recommendations can be made. For those still interested in trying keto, a focus on healthier fats is essential, rather than options such as bacon and cheese. Additionally, be sure to test and monitor your blood cholesterol levels, as studies show many keto dieters experience an unwanted increase in these numbers.

Other trendy diets may fare no better in terms of sustainability. Whole30 takes a deliberately short-term approach with a 30-day plan that eliminates all sugar, alcohol, grains, legumes and dairy and focuses on moderate amounts of meat, seafood and eggs; plenty of vegetables; some fruit; and natural fats. Most people return to their previous eating habits after the monthlong experiment, according to Mayo Clinic. A paleo diet focuses on foods that were hunted and gathered during the Paleolithic era, and typically includes lean meats, fruits, vegetables and nuts, but eliminates whole grains, legumes and dairy products, making it challenging to adopt long-term.

The ideal diet? One that places the greatest emphasis on nature’s bounty of fruits and vegetables; encourages whole foods, whole grains, healthy oils, moderate amounts of protein, and does not eliminate entire categories of food.

“Find a diet that’s flexible enough to let you feel good about your relationship with food … and enjoy your life!” advises Hultin.

Did You Know?

Because fasting can put a person into ketosis, intermittent fasting can also be considered a type of ketogenic diet.

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Fighting Fatigue

Wed, 10 Jul 2019 01:22:00 GMT

Wake-up Call: Fighting Fatigue at Its Roots

Feel like you are fighting fatigue throughout the day, the joy in life slowly diminishing and your active lifestyle becoming a distant memory? Are these ordinary signs of aging?

No, no and no!

Feeling tired all the time is not a normal part of the aging process. Instead, it can point to the need for a better night’s sleep, stress or an underlying illness, or be the result of a mix of common medications. Or it may be a combination of all these things. Identifying the possible sources of your fatigue is the most important step in reenergizing your lifestyle.

Medical: Visit your physician to rule out these frequently seen causes of tiredness.

Emotional health: Low-grade depression, anxiety or chronic stress can sap energy.

Anemia: This condition occurs when your blood has too few red blood cells or those cells have too little hemoglobin, a protein that transports oxygen through the bloodstream. If untreated, anemia results in a drop in energy levels.

Heart disease: When the heart pumps blood less efficiently, it can lead to fluid in the lungs, causing shortness of breath and reducing the oxygen supply to heart and lungs.

Hypothyroidism : An underactive thyroid gland can cause fatigue – along with other symptoms, such as weight gain, weakness, dry skin, feeling cold and constipation.

Medications : Many medicines can cause fatigue, including blood pressure drugs, antidepressants, anti-anxiety drugs and antihistamines.

Lifestyle Habits

Sleep: Quality, quantity and environment matter greatly in ensuring a healthy sleep, but these factors are surprisingly misconstrued. According to NYU School of Medicine, dispelling these widely held beliefs is key:

Under- or over-activity : Sedentary days and nights can cause loss of muscle mass and flexibility and make even moderately intense activities seem exhausting. However, exercising at a very high intensity can also cause fatigue.

An Infusion of Energy for Chronic Fatigue Research

Far beyond ordinary tiredness is the profound fatigue known as myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS), which has puzzled and frustrated medical professionals for decades. No cure or approved treatment is available to its 2.5 million sufferers, only a management of symptoms worsened by any type of physical, cognitive or emotional effort. But a sea change is underway. It began in 2015 with a new name recommendation by the Institute of Medicine (IOM): Systemic Exertion Intolerance Disease (SEID) . Noting that the term chronic fatigue syndrome can trivialize the seriousness of the condition and that “ME” is inappropriate because neither muscle pain nor brain inflammation has proven to be a symptom, the IOM panel stated: “SEID captures a central characteristic of this disease – that exertion of any sort can adversely affect patients in many organ systems and in many aspects of their lives.”

Even more promising is the significant investment in research announced by the National Institutes of Health (NIH). Up to $36 million over five years has been granted to shine a brighter light on the origins and progression of chronic fatigue and ultimately to help develop diagnostic markers and effective treatments for fighting fatigue.

Did You Know?

58% of older adults sleep less than seven hours a night.

80% of people age 55 and over report unintentionally falling asleep at least once during the day within the last month.

Source: Centers for Disease Control and Prevention

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Spring Fitness

Tue, 02 Apr 2019 19:50:00 GMT

Ramping Up your Sprint Fitness after a Long, Sedentary Winter

Whether you went into hibernation as the result of a record cold winter season, or took time off from your usual exercise routine because of a busy schedule or illness, spring is an ideal time to get back in action. When done with care, starting or rebooting your fitness regimen this spring will set you up for a vibrant, energetic summer. After being cleared for exercise by our office, consider these issues to ensure you’re not sidelined by injury, fatigue or boredom and get the most out of your spring fitness efforts

Aerobic or strengthening exercise?

Both. According to the 2018 Physical Activity Guidelines for Americans , any amount is helpful but the recommendations to help prevent chronic diseases is 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity, aerobic activity is recommended each week, and muscle-strengthening activities (free weights or resistance bands) two or more days a week. It would be ideal for older adults to add balance training to the mix. If it’s challenging to find long periods of time to exercise, note that three 10-minute bouts or one 30-minute bout will deliver equal improvements in fitness.

Stretch before or after exercise?

Before, after or both can all work well, if done properly. Do not attempt long stretches beforehand when your muscles are cold and you’re likely to pull a tendon, cautions Christine Butz , Doctor of Physical Therapy at Athletico . Instead, take 10 minutes to pedal on a stationary bike, march in place or walk around. Post exercise is the time for long, 30-second stretches that help you slowly increase muscle length (see below for examples). Most importantly, don’t push through pain, says Butz. “If you experience sharp, persistent pain, or have difficulty moving through a full range of motion, stop and see a physician to determine if it’s a strain, tear or fracture.”

Steady state or interval training?

Once the bastion of elite athletes, interval training can be used at any level, according to Mayo Clinic. Simply alternate short bursts (approximately 30 seconds) of intense activity with longer intervals (three to four minutes) of less intense activity. For instance, if your exercise is walking, try incorporating a brief surge of jogging into your regular walks or alternate leisurely strolling with periods of brisker walking. As your cardiovascular fitness improves, you’ll be able to exercise longer or with more intensity during your spring fitness routine.

What are the best activities to try?

Tap into one of these fitness trends to reinvigorate your workouts:

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Medical Marijuana Myths

Tue, 02 Apr 2019 19:48:00 GMT

Smoking Out the Myths: Medical Marijuana

Does medical marijuana offer a solution to treating epilepsy, chronic pain, anxiety and neurogenerative diseases? Or is it an untested, potentially unsafe treatment that will eventually turn out to be more of a pipe dream? As with so many of today’s biggest questions, the truth is somewhere in between. We bring you a down-to-earth view of this much-discussed and yet oft-misunderstood topic to separate the hype from the hope and dispel some Medical Marijuana Myths.

While the marijuana or hemp plant has been used for more than 3,000 years, research and treatment today is primarily focused on the extract known as CBD, a cannabinoid. Unlike one of the other chemicals in the plant, THC (tetrahydrocannabinol,) CBD has no psychogenic effects and does not produce the “high” commonly associated with marijuana. Hundreds of CBD-related tests are now in progress, and CBD products are available at dispensaries, online and are making their way into everything from coffee and yogurt to pet treats.

Last June, a major milestone was reached when the U.S. Food and Drug Administration (FDA) approved the CBD drug Epidiolex for two rare, severe forms of treatment-resistant epilepsy. Epidiolex, along with dronabinol and nabilone (which are synthetic cannabinoids previously approved to treat nausea from chemotherapy that has not responded to standard therapy), are now the only FDA-approved cannabis-based drugs.

The FDA was careful to note about Epidiolex: “This approval serves as a reminder that advancing sound development programs that properly evaluate active ingredients contained in marijuana can lead to important medical therapies. Controlled clinical trials testing the safety and efficacy of a drug, along with careful review through the FDA’s drug approval process, is the most appropriate way to bring marijuana-derived treatments to patients. Because of the adequate and well-controlled clinical studies that supported this approval, prescribers can have confidence in the drug’s uniform strength and consistent delivery.”

High hopes

The FDA’s cautionary tone was necessary because of the many well-publicized clinical and preclinical trials underway to test marijuana and its extracts. Interest continues to grow, as evidenced by the numerous research projects in progress. The most prominent studies are focused on chronic pain, trying to evaluate whether marijuana is a safer and less addictive alternative to opioids.Other research is aimed at testing if cannabinoids improve the symptoms of multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, anxiety and insomnia, as well as its potential role in a nti-inflammatory and antiviral activity, blocking cell growth and preventing the growth of blood vessels that supply tumors . ¹

As promising as the research appears, it’s important to realize that at this time, not enough large, clinical trials have been conducted to show that the benefits of marijuana outweigh the potential risks. Research is still preliminary and much remains unknown about CBD and other cannabinoids’ optimal dosing range and the best route of administration (by mouth, inhaled, topically or sprayed under the tongue). Importantly, because they are not FDA-approved, the levels of THC or CBD can differ greatly from one dispensary to another or one batch to another.

Side effects are also hard to predict because potential impurities and variations in dosage are not addressed as they are in all FDA-regulated products. We are only starting to evaluate side effects which may range from minor dry mouth and dizziness, to death. It is also unclear if the products interact with other medications. An added concern is that older and sicker people may be more vulnerable to the drug’s side effects.

Our bottom line: although CBD is readily obtainable in most parts of the United States, and laws legalizing its use for medicinal purposes continue to pass, we need to take a step back and realize the process is far from complete. The fact is the scientific evidence does not yet support many of the claims to ease symptoms of certain diseases, improve quality of life and relieve pain, nor has it been approved for use as a cancer treatment. As Cleveland Clinic’s head of Employee Health Services recently pointed out, medical marijuana has not yet undergone extensive clinical trials, public hearings and approval by the FDA, or been thoroughly tested for safety and efficacy. His recommendation is one we can all support – focus on research that isolates specific compounds found in marijuana, produces a dose-specific medication, and submit it to testing and regulatory processes.

1 National Cancer Institute, 2019

Did You Know?

330

Number of cannabinoid research projects supported by the National Institutes of Health in 2017

Number of states (including the District of Columbia) that have approved the medical use of cannabis as of 2018

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Adult ADD

Tue, 02 Apr 2019 19:46:00 GMT

Attention Please: ADD/ADHD is Not Just a Childhood Condition

In the 21 ^st century, it’s standard procedure to test unfocused, impulsive and restless children who struggle to achieve in school for Attention Deficit Disorder ( ADD ) and Attention Deficit Hyperactivity Disorder (ADHD), and provide support and treatment well into adulthood. But for those who came of age prior to the 1970s, that diagnosis was rarely made, leading to a lifetime of challenges. Only now, as ADHD and ADD are recognized as conditions that often do not disappear with maturity, are some seniors finally finding the answer to problems that have haunted them for years in Adult ADD.

ADD is a condition of varying degrees, and in cases of milder severity, whether in the young or older patient, can be difficult to diagnose; especially in older adults, because the symptoms are different than in children. Hyperactivity is rarely the primary indicator, although remnants are felt such as restlessness and talking too much. Most frequently experienced by adults is a tendency to be easily distracted, a decline in working memory and a lack of focused attention. As we get older, the challenge may lie in distinguishing these issues from the normal aging process, mild cognitive impairment or early dementia. Forgetting names, misplacing things, or having problems with organization and planning can be hallmark traits of ADD or an aging brain. The key to identifying the difference is longevity of symptoms. ADD doesn’t suddenly appear full-blown in an adult, but leaves a years-long trail of distraction in its wake.

What are Symptoms of Adult ADD?

Experts advise that symptoms can shift with age, but these are found fairly consistently in older adults with ADD*:

According to the organization ADDitude , a leading source of information, support and advocacy for people living with ADHD, asking this simple question – “Would you have been talking about these symptoms 20 years ago?” – can be one of the most accurate of all indicators. Patients who answer in the affirmative, remembering constantly being chided for a messy room, branded as a daydreamer or underachiever, and finding it difficult to keep organized and on time at a first job, are more likely to have previously undiagnosed ADHD. In fact, the majority would say “I can’t remember a time that I wasn’t this way.”

Gratifyingly, adults who are diagnosed with ADHD or ADD in their older years find it can be revelatory to finally identify the cause of their ongoing challenges, and receive the support they need at a particularly vulnerable life stage. Coping with ADD as a senior actually parallels the issues faced by young people with ADHD when they leave home. The loss of structure for both groups can strain their ability to adequately care for themselves, and poor sleeping or eating habits can result, which exacerbate ADHD symptoms. However, treatment which may include appropriate doses of stimulant medication and cognitive behavioral therapy, has been shown to work as well for adults as children, and provide a newfound satisfaction with life.

As Dr. David W. Goodman, assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and director of the Adult Attention Deficit Disorder Center of Maryland, explains: “People may ask, ‘if you’ve had this problem for so long, why bother treating it now?’ Imagine you believed yourself to be as others labeled you throughout your life – careless, irrational, a daydreamer, dumb or just plain odd. Then, you realize a treatable disorder caused these symptoms, and they aren’t a reflection of who you are. It’s liberating to understand the difference between what you have – a disorder – and who you are – a person.”

*Source: Kathleen Nadeau, Ph.D. presentation at the 2018 Annual Meeting of the American Professional Society of ADHD and Related Disorders

Did You Know?

Although ADHD and ADD is a commonly seen psychiatric condition in the US, second only to generalized depression, adults in their 50s, 60s and 70s often go undiagnosed and untreated.

Fewer than half of adults with ADHD ages 45+ have ever sought any kind of treatment and only 25% have tried medication.

Source: www.additudemag.com

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The Age of Anxiety

Fri, 11 Jan 2019 17:10:00 GMT

Higher Anxiety? Our ‘age of anxiety’ began four centuries ago

It can come on suddenly and intensely, causing shaking, confusion and difficulty breathing for no apparent reason…trigger an irrational avoidance of elevators or public transportation…or become a steady drumbeat of worry always in the background. All are known as anxiety disorders, one of the country’s most commonly experienced yet largely untreated mental health issues. Is our era of 24/7 disturbing news, packed schedules and often unrealistic expectations spurring a rise in these disorders, or does it just seem that way? Are we in the midst of the Age of Anxiety?

Modern life can be disquieting, but the truth is that anxiety disorders have always impacted large numbers of people around the world. Consider this description of Hippocrates’ patient in 1621’s The Anatomy of Melancholy: “He dare not come into company for fear he should be misused, disgraced, overshoot himself in gestures or speeches, or be sick; he thinks every man observeth him” – a classic case of what would now be diagnosed as social anxiety disorder. Recent research notes that anxiety disorders may be under-recognized and under-treated, but there is no evidence that its prevalence has increased. While the incidence rose from 9 to 15 percent in college students since 2009, according to the Journal of American College Health, the authors attribute the finding to a greater willingness to admit having a mental health issue and increased acceptance of it as a bona fide health problem.

Constant anxiety undeniably takes a toll on health, potentially increasing levels of the stress hormone cortisol and raising blood pressure and may drive inflammation and plaque formation that leads to heart attack and strokes. A reaction to stress that occurs in a region of the brain called the amygdala, anxiety prepares people to confront a crisis by putting the body on alert. The ‘fight or flight’ response serves us well when faced with actual danger but is counter-productive when dealing with worries around work, money, family life or health. However, it’s only when daily function is affected that a disorder is diagnosed, as shown below:

Everyday Anxiety: Worry about finances, health, family or other important life issues
Anxiety Disorder: Constant and unsubstantiated worry that causes significant distress and interferes with daily life

Everyday Anxiety: Embarrassment or self-consciousness in an uncomfortable or awkward social situation
Anxiety Disorder: Avoiding social situations for fear of being judged, embarrassed or humiliated

Everyday Anxiety: A case of nerves or sweating before a big test, business presentation, stage performance or other significant event
Anxiety Disorder: Seemingly out-of-the-blue panic attacks and preoccupation with the fear of having another one

Everyday Anxiety: Realistic fear of a dangerous object, place or situation
Anxiety Disorder: lrrational fear or avoidance of an object, place or situation that poses little or no threat of danger

Everyday Anxiety: Anxiety, sadness or difficulty sleeping immediately after a traumatic event
Anxiety Disorder: Recurring nightmares, flashbacks or emotional numbing related to a traumatic event that occurred several months or years before

The American Psychology Association defines these types of anxiety disorders (obsessive-compulsive disorder and post-traumatic stress disorder are now categorized separately):

Additionally, anxiety disorders may play a role in exacerbating other conditions such as irritable bowel syndrome (IBS), chronic respiratory disease and heart disease.

Reassuringly, the number of treatment options, both pharmaceutical and non, has grown. Most effective is a combination approach of psychotherapy (cognitive-behavioral therapy, focused talk therapy or exposure therapy), stress management (deep breathing, meditation and yoga) and antidepressant and/or anti-anxiety medications.

Finally, considerable benefits are seen from a healthy lifestyle – reduced intake of caffeine, tea, cola and chocolate, avoidance of recreational drugs and excessive alcohol, and emphasizing exercise, a nutritious diet, and most importantly, a good night’s sleep. According to a recent University of California at Berkley study, the amygdala was particularly stimulated when sleep deprived, mirroring that of anxiety disorders, suggesting that sleep therapy could reduce anxiety in people suffering from panic attacks, GAD and other conditions.

Did You Know?

40 million

People in the U.S. affected by anxiety disorders
Source: NIMH.gov

37%

Percentage of Americans with an anxiety disorder who receive treatment
Source: ADAA.org

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Whole Grain Superfood

Fri, 11 Jan 2019 16:58:00 GMT

Going with the (Whole) Grain

Whole Grains may be the culinary trendsetters of the 21st century, but the ancient wonders of the grain world have remain unchanged for the last several hundred years. From chia to kamut, sorghum to spelt, like many whole grains, they are significant sources of protein, fiber and other important nutrients, such as B vitamins, iron, folate, selenium, potassium and magnesium.

You may already be familiar with quinoa, which became one of the first ancient grains to trend in U.S. kitchens earlier in the decade. You’ll find more below, each a story to tell and a taste to be discovered:

Amaranth,* native to Peru and a major food crop of the ancient Incas, has a peppery taste and a versatile cooking profile – bake it with bananas, use it to coat chicken or fish or toss with vegetables for a fresh salad.

Farro goes back 10,000 years to the time of the Fertile Crescent, and is thought to have sustained the Roman army. Key to Mediterranean diets, this grain is higher in dietary fiber than quinoa and brown rice and lower in calories. Its dense, chewy texture works well in soups, risottos and is thought by some aficionados to make the best pasta.

Freekeh, frequently found in Middle Eastern and North African cuisine, has roots in ancient Egypt. A form of wheat known for its chewy texture and nutty flavor, it’s often sold cracked into smaller, quicker cooking pieces. Use in pilafs and salads, or cook into a delicious porridge.

Kamut, also known as Pharaoh grain in a nod to its discovery in ancient Egyptian tombs, is rich and buttery-tasting, ideal in breads, pancakes and salads, or in a breakfast bowl with avocado and other whole grains, such as quinoa.

Millet,* a staple of the long-lived Himalayan Hunzas, is likely to be more familiar to Americans as a birdseed ingredient, but this grain has a delicious, nutty like flavor. Cook as a hot cereal, steam and use in salads or bake in breads and cookies.

Quinoa,* cultivated by the Inca in the Andes, has become even more popular on the American table in recent years. Dozens of varieties exist, from mild-flavored white and yellow to earthier tasting red and black. Prepare as a breakfast cereal, substitute it for rice and pasta, add to soups and salads, or pop and eat like popcorn.

Sorghum,* from Asia and West Africa, is a source of protein, and can be substituted for wheat in baked goods, eaten like popcorn or cooked into porridge.

Teff,* from Ethiopia and Eritrea, is a smaller-sized, quick-cooking grain high in iron and calcium, with a sweet molasses-like flavor that can be cooked into a polenta or ground into flour to make gluten-free breads and baked goods.

*Gluten-free
Sources: Harvard Health & Whole Grains Council

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Health Studies: Expert Insight

Fri, 11 Jan 2019 16:46:00 GMT

Why Today’s Health News Often Becomes Tomorrow’s Retractions

We’ve all seen it played out hundreds of times, as a drug, food or habit is trumpeted as the way to lower the risk of cancer or heart disease only to be walked back the next month in another study. The reasons can be diverse, including a flawed hypothesis, bad data or misleading conclusions, but at the center is the study design itself. A longitudinal trial may yield very different findings from an observational one, while the gold standard – a randomized controlled trial (RCT) – can be extremely costly and difficult to design. The resulting patchwork of research requires professional analysis and a wait-and-see approach until confirmation is received via follow-up studies. We share some expert insights to help you view new health studies with both a healthy skepticism and the realization that some of the most important medical breakthroughs of recent years have been discovered in just this way.

Fast Facts on Health Studies

1,400

Number of scientific papers retracted each year
Sources: Vaccine Journal August 2018, Centers for Disease Control, Harvard Health

50%

Percentage of scientific studies confirmed in follow-up studies
Source: Healthy Aging Project, University of Colorado, Boulder

Researchers agree that a randomized, controlled trial is the best way to learn about the world. In a drug study, for instance, a population is randomly divided into groups who receive the drug and those who don’t. If properly controlled and designed, any difference in outcomes between the groups can be measured and credibly attributed to the effects of the treatment. The methodology is highly valued in evidence-based medicine, proving that associations are causal, and not just by chance. The approach has powerful real-world applications, as seen in the Women’s Health Initiative (WHI), one of the nation’s largest-ever health projects.

Begun in 1993, with more than 161,000 women enrolled, the randomized, controlled clinical trial was designed to test the efficacy of long-term hormone therapy in preventing heart disease, hip fractures and other diseases in post-menopausal women over 60 years old on average. Previous observational studies had strongly suggested the preventive benefits of hormone therapy, and it was routinely recommended for women years after menopause. What happened next was stunning.

In 2002, the trial was halted three years earlier than planned as evidence mounted that the estrogen plus progestin therapy significantly raised a woman’s chances of developing cardiovascular disease, stroke and breast cancer. Millions of women stopped taking hormone therapy, and the trial has since been credited with reducing the incidence of breast cancer by 15,000-20,000 cases each year since the results were made public. Numerous follow-up studies were conducted to dig deeper into the surprising data, and while they showed that hormone therapy may still be reasonable short-term to manage menopausal symptoms in younger women, it is no longer routinely recommended years after menopause to prevent chronic disease in women.

Similarly, Vitamin E supplements, once thought to reduce risk of heart disease, were found to not have beneficial properties and actually may increase the risk of heart disease in higher doses. Consequently, the American Heart Association now advises that the best source of Vitamin E is foods, not supplements.

The biggest takeaway from both initiatives: the critical need for randomized, controlled trials to prove that associations between an intervention and a disease are causally related.

Nutrition health studies have also come under increased scrutiny, especially with the recent revelation of erroneous data published by high-profile researcher Dr. Brian Wansink, founder of the Food and Brand Lab at Cornell University. Numerous papers have been retracted as the lab’s propensity for data dredging – running exhaustive analyses on data sets to cherry pick interesting and media-friendly findings – came to light. This practice, seen somewhat frequently in food and nutrition research, may be part of why contradictory headlines seem to be the norm.

As the adage goes, data can be tortured until it says what the researcher wants to hear. That’s why your physician will always be the best source for making sense of the tremendous amount of health data released each day…so please ask!

Testing by Design

The most commonly used research models include:

Randomized controlled trial (RCT): carefully planned experiments like the WHI that introduce a treatment or exposure to study its effect on real patients; includes methodologies that reduce the potential for bias and allow for comparison between intervention groups and control groups.

Observational studies: researchers observe the effect of a risk factor, diagnostic test, treatment or other intervention without trying to change who is or isn’t exposed to it. Includes cohort studies, which compare any group of people linked in some way (e.g. by birth year); and longitudinal studies in which data is gathered for the same subjects repeatedly over years or even decades. An example is the Framingham Heart Study , now in its third generation, which has provided most of our current consensus regarding the effects of diet, exercise and medications on heart disease.

Case control study: compares exposure of people with an existing health problem to a control group without the issue, seeking to identify factors or exposures associated with the illness. This is less reliable than RCTs or observational studies because causality is not proven by a statistical relationship.

Meta-analysis:  a thorough examination of numerous valid studies on a topic, which uses statistical methodology to combine and report the results of multiple studies as one large study. This is cost-effective but not as accurate as RCTs as the individual studies were not designed identically.

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Decoding Diets

Tue, 25 Sep 2018 20:11:00 GMT

Finding the Path to Better Health Through Your Diet

In the quest for a healthier lifestyle, even inveterate beef eaters may be considering a more vegetable-centric diet. If you’re on a journey to vegetarianism or simply curious about the side roads surrounding it, follow our road map to nutritious eating and decoding diets with the expert direction of Jen Bruning, RDN, Academy of Nutrition and Dietetics .

What Kind of Eater are You?

Flexitarian is a term recently coined to describe those who eat a mostly vegetarian diet with occasional forays into meat. “Flexitarian is probably the most relatable, allowing people to take a stepwise approach to less meat,” says Bruning. “Instead of building a meal around beef, it becomes a side dish, ingredient, or is eliminated altogether.” The flexibility is key to real life applications. “If you’re at a barbecue you can enjoy without guilt.”

Dietary notes: No real challenges in terms of meeting dietary needs – follow the traditional healthy ‘plate’ but place more emphasis on vegetables, and substitute beans and legumes for meat when possible.

Pescatarian refers to those who abstain from eating all meat and animal flesh with the exception of fish. It’s becoming increasingly popular as a healthier way to eat or as a stepping stone to a fully vegetarian diet. “This can be a very balanced way of eating,” confirms Bruning, “as fish are rich in protein and Omega-3 fatty acids.” Some pescatarian diets include eggs and dairy.

Dietary notes: Avoid fish that contain higher amounts of mercury e.g. marlin, orange roughy, swordfish. Instead, opt for cod, tilapia, trout, canned light tuna, whitefish, salmon and sardines, among other choices.

Lacto-Ovo-Vegetarian is the more traditional vegetarian diet, eliminating beef, pork, poultry, fish, shellfish or animal flesh of any kind, but including eggs and dairy. It can be a nutritionally complete way of eating. Good sources of protein include legumes (lentils, beans, peas), soy-foods (tofu, tempeh, edamame), seitan, meat alternatives (veggie burgers, plant-based crumbles), milk, nuts, seeds, and grains (farro, millet, quinoa). Incorporate foods high in iron: dark leafy greens, beans, tofu, tempeh, black strap molasses, quinoa and tahini. Calcium requirements can be met with leafy green vegetables, tofu, and calcium-fortified products.

Dietary notes: Add vitamin C-rich food, such as tomatoes, bell peppers or citrus fruit, to increase iron absorption, such as beans in tomato sauce.

Vegans do not eat meat of any kind, or eggs, dairy products, honey or processed foods containing these or other animal-derived ingredients.

Dietary notes: To ensure adequate nutrition, incorporate the following foods or take a vitamin:

Avoid the Raw Vegan/Raw Food diet, which is based on a nutritionally incorrect premise that cooking foods above 118 degrees F is harmful to the body.

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Pain Management: The New Approach

Tue, 25 Sep 2018 20:00:00 GMT

The New Approach to Pain Management: Fewer Pills, Lower Doses, More Vigilance

It’s hard to imagine a medical crisis more widely discussed, dissected and debated in the last two years than opioid abuse. As a result, clear action steps have been taken, including retooling of the 2016 guidelines for opioid-prescribing protocols – dosage recommendations, follow up assessments and ongoing monitoring were reconsidered and adjusted. In short, for patients with chronic pain not from cancer, non-pharmacological treatment and non-opioid medications should be evaluated first, and opioids used for pain management only when:

Following are details on the newest developments, and how they may impact the way you’re treated for pain, from hospital bed to physician office.

Minimize and customize dosage. Not surprisingly, the dosage recommendations for exercising caution are lower than in earlier guidelines, beginning with even relatively low doses (20-50 morphine milligram equivalents (MME) per day). The lowest effective dose, for the shortest period needed, will be used to treat acute pain. In most cases, even pain following surgery does not require opioids for more than three days. Several high-profile institutions have changed their opioid prescribing guidelines following surgery.

At Johns Hopkins , a panel of health care providers developed recommendations for the number of five-milligram oxycodone pills needed after almost two dozen common procedures, finding that some required none, while the maximum of 20 pills was appropriate for others. The prescribing limits were designed to help prevent patients from receiving unnecessary opioid pills after surgery and ultimately face a one-in-16 risk of becoming a long-term user.

“Prescriptions for pain meds after surgery should be custom tailored to the operation and a patient’s needs and goals, but the hope is that these guidelines will help reset ‘defaults’ that have been dangerously high for too long,” the study’s author reported in a recent Journal of the American College of Surgeons .

An open discussion. It is now acknowledged that opioids present a risk to all patients, and risks must be clearly presented when starting therapy. These range from common (constipation, nausea) to serious (respiratory problems, opioid use disorder, overdose).

Establish realistic treatment goals. It’s essential to realize there’s no cure for chronic pain, but work toward pain relief to improve function and quality of life. “SMART” goals – specific, measurable, attainable, relevant and time-limited – should be set at the start to determine end points and be continually reassessed.

Continual monitoring. Opioids should only be continued after confirming that clinically meaningful improvements in pain and function were realized without significant risks or harm. In regular checks, patients will be asked to rank their pain, and level of interference with their enjoyment of life and general activity. A 30 percent improvement from baseline scores would be needed to continue the therapy. Reassessments are recommended within a few weeks after starting, and at least every three months throughout the course of treatment.

Not recommended for elderly patients. A body of evidence shows possible harm from long-term opioid use in older patients, who metabolize medications more slowly and so may be prone to side effects such as respiratory and cognitive impairment. UCLA Comprehensive Pain Center experts advise a multidisciplinary approach using psychological support, physical therapy and other complementary therapies.

Proper disposal of unused opioids. Noting that a large part of the opioid abuse crisis was spurred by people taking medications not prescribed to them, new guidelines emphasize not leaving unused pills in the medicine cabinet “just in case.” Patients are advised to dispose of them as quickly and appropriately as possible.

New approaches to addiction. According to a recent editorial in Mayo Clinic Proceedings, looking beyond the “supply side” issue to target the “demand” side of opioid use is critical to addressing why patients were initially drawn to using opioids. The authors recommend screening for depression and other psychiatric disorders which are often the impetus for patients to over-use opioids. Other studies posit that as many as 65 percent of overdoses reported at poison control centers were actually suicide attempts, underscoring the need for comprehensive psychological evaluation and treatment.

Optimize use of non-opioid therapies. A growing list of options includes:

Fast Facts; Did You Know?

70–80% – 70-80% Percentage of opioid pills prescribed for pain management after surgery not used by patients

Source: Johns Hopkins

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Staying Healthy During the Flu Season

Tue, 25 Sep 2018 19:49:00 GMT

Your Best Shot at a Flu-Free Winter

Last year’s flu season was severe in most parts of the country and left many wondering why the flu vaccine hadn’t performed more effectively. However, it remains our best line of defense for averting and lessening the severity of this common but potentially deadly illness. Below we clear up some of the most common misconceptions about the flu vaccine…and continue to strongly recommend that you make sure to get your shot of prevention this fall.

Myth: I can get the flu from a flu shot.

A flu shot will not give you the flu. The viral strains in injectable influenza vaccine are inactive and biologically unable to cause illness. The one exception is the vaccine administered in nose spray form.

Myth: The vaccine didn’t work last year, so it must be losing potency.

The amount of protection provided by flu vaccines varies by influenza virus type, and how well matched vaccine viruses are to the circulating flu viruses. Last year’s results, while lower than average, still meant that the risk of getting sick from flu was reduced by a third. This year, both types of vaccines, trivalent (protection against influenza A H1N1 and H3N2 viruses and one type of influenza B virus) and quadrivalent (four component protection to protect against two types of B viruses), have been modified to better anticipate the season’s circulating flu viruses.

Myth: The flu vaccine will also prevent other viruses.

Flu vaccines do not protect against infection and illness caused by other viruses, such as rhinovirus (one cause of the common cold) and respiratory syncytial virus (RSV), despite their flu-like symptoms.

Myth: Flu vaccines are not appropriate for people over 65, who have weaker immune systems than younger people.

Although immune responses may be lower in the elderly, flu vaccine effectiveness has been similar in most flu seasons among older adults and those with chronic health conditions compared to younger, healthy adults. It’s also important to remember that people 65 and older are at increased risk of serious illness, hospitalization and death from the flu, making the flu vaccination especially important for this age group.

Myth: There are no flu vaccines just for people over 65.

There are two vaccines designed specifically to help enhance the effectiveness in adults older than 65. A high dose vaccine, containing four times the amount of antigen as the regular flu shot, and the adjuvanted flu vaccine, which creates a stronger immune response in the elderly.

Myth: The vaccine is less effective if received every year.

Multiple studies have shown that while immune responses to vaccination may be higher among people not previously vaccinated, those who are repeatedly vaccinated still have increased immune responses and are provided protection against the flu.

Myth: I should wait as late as possible to get immunized so it lasts throughout the season.

The CDC and Advisory Committee on Immunization Practices (ACIP) recommends that you get a flu vaccination in early fall to ensure you’re protected before flu season begins. However, as long as flu viruses are circulating, it’s not too late. Receiving a vaccination in December or January can still protect you because flu season often peaks after January and can last as late as May.

Myth: Getting sick with the flu is not all that serious.

In the U.S., 36,000 people die and more than 200,000 are hospitalized each year because of the flu. Children, the elderly and people with certain chronic conditions (heart disease, lung disease, asthma or diabetes) are at higher risk for complications such as pneumonia. For everyone, flu symptoms, including fever, headaches, cough, sore throat, nasal congestion, extreme tiredness and body aches, can disrupt work and social life for up to two weeks. The flu vaccine has proven effective in both preventing flu and in lessening the severity of symptoms if flu should occur, thereby reducing the risk of hospitalization and admission to the intensive care unit.

Did You Know?

Up to 60% – Decrease in the risk of flu during seasons when most circulating flu viruses are well matched to the flu vaccine. Put another way, in 2016-17, the vaccine prevented an estimated 5.29 million illnesses, 2.64 million medical visits and 84,700 hospitalizations associated with flu.

79% / 52% – Reduction in hospitalization for people with diabetes (79%) or chronic lung disease (52%) as a result of receiving the flu vaccine.

Sources: Vaccine Journal August 2018, Centers for Disease Control , Harvard Health

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Autoimmune Disease on the Rise

Tue, 16 Jan 2018 17:22:00 GMT

The Enemy Within

Autoimmune Disease, a condition that is thought to have tripled in prevalence over the last 50 years, impacting over 23 million people, could justifiably be seen as an epidemic, or at least, a growing health concern. Autoimmune diseases are not often thought of in that way because they manifest as 80+ different illnesses that nevertheless share the same root cause: a malfunctioning immune system that mistakenly attacks its own tissues. Virtually every human organ system can be impacted: the brain and spinal cord in multiple sclerosis, the skin in psoriasis, the joints in rheumatoid arthritis, the intestines in Crohn’s disease and ulcerative colitis, the insulin-producing cells in the pancreas in Type 1 diabetes, the thyroid in Hashimoto’s disease, among others.

Ironically, 100 years ago, Nobel Prize-winning immunologist Paul Ehrlich, MD , was openly skeptical of a concept in which the body turns on itself, calling it “horror autotoxicus” (literally, the horror of self-toxicity). That set back acceptance of autoimmunity another half century, according to today’s leading neuro-immunologists. Now we are beginning to recognize the pervasiveness of autoimmune disease and develop therapies based on new research into its complex causes.

Notably, the gut, which houses 80 percent of the immune system, has come under increased scrutiny for the role it can play in causing disease. One theory posits that a ‘leaky gut’ may allow undigested food particles, microbes and toxins to enter the blood stream, and trigger inflammation that goes on to disrupt the proper functioning of the immune system.

There is also a growing consensus that these diseases result from complex interactions between genetic and environmental factors. Autoimmune disease is commonly clustered in families, but may affect different organs. For example, a mother may develop rheumatoid arthritis while her daughter copes with juvenile diabetes, her sister has Hashimoto’s thyroiditis, and her grandmother deals with Graves’ disease. Environment and lifestyle may contribute to the increased incidence of these diseases, including chronic stress.

For the many living with an autoimmune condition, there is hope in the form of new medications, advanced treatments and genuine breakthroughs in the precision medicine approach. Experts predict substantial advances in the next decade, fueled by more than 310 medicines and vaccines for autoimmune diseases already in clinical trials or awaiting review by the Food and Drug Administration (FDA) . Options go well beyond simply relieving symptoms or replacing substances destroyed by the disease, including:

Running on a parallel and complementary path are natural methods, which continue to gain traction. Areas under investigation include: reducing foods high in sugar and saturated fat, practicing de-stressing techniques, lowering the toxic burden caused by constant exposure to environmental factors and restoring intestinal health with a diet that includes prebiotic and probiotic foods.

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Plant-Based Diet

Tue, 09 Jan 2018 21:02:00 GMT

Plant the Seeds of Healthy Eating

Plant-based diet proponents are growing at a rapid clip in the US, buoyed by ongoing reports that following the regimen faithfully can result in a multitude of health benefits, ranging from increased energy and elevated mood to lower risks of diabetes, high blood pressure and heart disease. The abundance of antioxidants in whole plant foods may also help prevent or slow certain cancers. In addition, plant-based diets are more environmentally sustainable than diets rich in animal products because they use fewer natural resources.

“Plant-based nutrition is superior when it comes to most diseases.”
– Dr. Kim Williams, former president of the American College of Cardiology

Multiple studies point to the preponderance of refined, processed foods, loaded with added sugars and salts that comprise the standard American diet, and the link to disease. Choosing whole foods instead of refined grains and sugary fruit juices is key, and the Physicians Committee for Responsible Medicine illustrates the concept with these four ‘new’ food groups on the nutritional plate:

How to adopt a plant-based diet

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Genetic Testing and Your Health

Tue, 09 Jan 2018 20:59:00 GMT

20,000 and You: Unlocking the Genetic Code

In just the past few years, there has been a significant shift in the practical uses of genetic testing, which examines changes, or variants, in your genes that may lead to illness or disease. Once considered more of an investment in the future and less applicable to individual patient care, opportunities to guide health and lifestyle decisions in the here and now may be tantalizingly close at hand.

“Genetic testing is progressing from an occasionally deployed diagnostic tool to becoming the new founding architecture of a personal health record, and may ultimately become a vital addition to a patient’s clinical portfolio,” explains Calum MacRae, MD, geneticist, Chief of Cardiovascular Medicine at Brigham and Women’s Hospital and in private practice at Boston’s AllCare Medical, whose decades-long focus has been on how to systematically implement genomics discoveries into clinical care.

In broad strokes, three areas are identified through genetic testing: disease carrier states for genes, important to the patient’s immediate family; inherited diseases such as heart disease or cancer; and an emerging predictive utility for drug responses and risk of common diseases. This information forms the foundation of personalized medicine, targeted to a patient’s specific genetic profile. According to Dr. MacRae, a holistic approach will optimize the enormous potential of genetic testing, allowing physicians to engage all their patients to understand their own genomes and build collaborative plans for lifestyle modification, nutritional choices and medications that may prevent or delay disease.

Direct-to-consumer (DTC) testing such as 23andMe has become ever more mainstream and is predicted to grow to a $340 million industry in the next five years. In fact, earlier this year, the FDA began allowing 23andMe to provide DTC testing for increased risk of 10 conditions, including celiac disease, hereditary hemochromatosis, Parkinson’s, alpha-1 antitrypsin deficiency and late-onset Alzheimer’s disease.

However, experts cast a wary eye on DTC testing for a number of reasons. Genetic testing is highly technical and complex and it is still hard to predict who will actually develop common diseases such as diabetes, hypertension, and many cancers from genes alone. For many conditions, a negative DTC test result does not necessarily guarantee low risk because it is believed to be the interaction of complex environmental factors with genes that cause disease. That means all information must be considered in the context of a patient’s environment, lifestyle and family medical history, ideally explored during a one-to-one consultation with a primary care physician.

While there is still much to be uncovered, there is no denying the desire to incorporate personalized medicine in clinical practice is increasing. Scientists are beginning to understand the interplay of genes and environment on disease for about one third of the roughly 20,000 genes we all possess, and the portfolio of knowledge continues to grow rapidly. Even more comprehensive tests that examine numerous genes and variants in an individual’s exome (the protein-making part of the gene), known as next generationgeneration sequencing, will gradually become accessible as the costs associated with them continue to fall. Technologies that enable scientists to alter an organism’s DNA (see below) are being refined. With every advance, we may come closer to realizing the vision of Dr. J. Craig Venter, one of the primary forces behind the original Human Genome project, who said in 2015: “I’m hoping that these next 20 years will show what we did 20 years ago in sequencing the first human genome was the beginning of the health revolution that will have more positive impact in people’s lives than any other health event in history.”

Coming to Terms with Genetic Testing

Source: Up to Date

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Healthy Eating: From Food Pyramid to MyPlate

Mon, 20 Nov 2017 20:36:00 GMT

Nutritionists Weigh in on Healthy Eating

Picturing a healthy meal has never been more accessible, thanks to the ubiquity of visual aids such as MyPlate , successor to the well-known Food Pyramid of the ‘90s. A quick scan of the plate’s quadrants enables users to see at a glance proportions of vegetables, proteins and other foods recommended for a nutritionally balanced day of healthy eating. Hailed as a significant breakthrough when it debuted in 2010, for many dietitians and health experts, MyPlate did not go far enough in revamping the American diet.

For instance, Harvard’s Healthy Eating Plate limited red meats but not healthy oils, while the American Institute of Cancer Research’s New American Plate relied even more heavily on vegetables and fruits, accounting for fully two thirds of the plate. The most recent federal guidelines, just issued for 2015-2020, now emphasize shifts needed to choose nutrient-dense foods and beverages in place of less healthy options, and the interconnected relationships between each dietary component. Illustrated at right are what a healthy, and even healthier meal, can look like at your table this year.

MyPlate breaks it down:

The American Institute of Cancer Research (AICR) offers a portion-controlled diet based on fruits, vegetables, whole grains and other plant-based foods that provide an array of cancer-protective compounds while serving as powerful weight-management tool. According to the AICR, the fiber and water in plant foods gives a feeling of satiety with a minimum of calories. Their main message: maintaining a healthy weight is one of the most important steps you can take to reduce your risk of cancer.

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Got Milk? Or Calcium Supplements? Or Neither?

Mon, 20 Nov 2017 20:35:00 GMT

Calcium, so essential to strong bones and teeth, as well as nerve transmission, muscle contraction and blood clotting, can be in short supply as we age. Exactly how much is needed of this important mineral, and Vitamin D, its companion to ensure optimal absorption, has been the subject of intense scrutiny over several decades. However, a clear cut consensus has yet to be reached from data that is by turns contradictory, reassuring or confusing. A cluster of respected studies have cast doubt on the efficacy of calcium – either in supplements or from dietary sources – in reducing the risk of osteoporosis or bone fractures. Some reports cast supplements in an even more negative light, pointing to potential side effects that range from gastrointestinal issues to increased risk of cardiovascular disease.

A quick look at research highlights, beginning with the study that arguably set the stage for use of calcium supplements in seniors, illustrates why there is still a considerable amount of debate:

Confusing, to be sure. While the optimal dose has yet to be determined, today’s best guidelines call for calcium intake below 1,600 mg a day for women over 50 and men over 70, and 1,000 mg a day of calcium for those under 50, along with appropriate amounts of vitamin D to enhance absorption. However, experts agree, more is not necessarily better, and supplements should be considered only if the daily goal cannot be met through food sources. In addition, strength training, for arms and upper spine, and weight-bearing exercise such as walking or stair climbing, for legs, hips and lower spine, are essential to build and maintain bone density. Remember: every patient has different needs, and these can change over time.

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Aging Well, Aging Healthy…a continuing series

Mon, 20 Nov 2017 20:33:00 GMT

As almost 10,000 Baby Boomers officially become senior citizens each day, the focus on preventing and treating age-related ailments becomes distinctly more urgent. HealthWise presents an ongoing look at research that provides valuable insights to help today’s seniors – and the generations set to follow – create a vibrant next chapter. We began with strategies to keep the aging brain healthy, and continue in this issue with a look at how your senses, specifically taste and smell, are affected by the aging process. Look for the latest on safeguarding your sight and sound in future editions.

A Taste of the Future

Savoring the sweetness of a rich chocolate, breathing in the scent of a fresh burger on the grill…taste and smell trigger the delights of eating by matching odorous molecules in the air with memories stored in your brain.

Taste buds have helped humans since the beginning of time identify foods as sweet, salty, sour, bitter or savory, and provide a warning not to ingest toxic substances. Forever intertwined with smell, food molecules travel through the rear of the nasal cavity to olfactory receptors in the roof of the nose – that is why if you hold your nose and put chocolate in your mouth, you will not taste the chocolate.

An effortless process for most, recognizing tastes and odors is actually cognitively demanding, and for older people, can be extremely challenging, as these capabilities greatly diminish as we age. Although new neurons continue to form in the olfactory region of the brain into adulthood, by age 50, the sense of smell starts to deteriorate rapidly as the number of sensor cells that detect aroma decrease…by age 80, smell detection is reduced by almost 50 percent. There is also a weakening of the nerves that carry the signals to the brain, and in the olfactory bulb, which processes them. In addition, the sense of smell may be diminished by reduced production of mucous, thinning of the nose lining and hormonal changes.
At the same time, the tongue’s taste buds are on the wane, dwindling from a high of 10,000 to just 5,000 in older adults. Dry mouth, caused by a reduced flow of saliva that is commonly seen in the elderly, or from medications such as antihistamines or antidepressants, also cause a loss of taste perception.
Why this matters: The ability to detect odors from spoiled foods, gas leaks and smoke is critical to safety. Taste issues means food becomes less appealing, and unhealthy amounts of sugar or salt may be added to food to make it more palatable, or less food is eaten, potentially leading to nutrition problems.

Preserve, protect and adapt

While there may not yet be a way to completely halt the decline, experts recommend a number of strategies to sharpen your senses of smell and taste and keep them working longer and better:*
Take brisk walks daily…exercise heightens the smell sense.

Finally, buy safety products, such as a gas detector that sounds an alarm you can hear.

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Salt Shake Down: Sodium Reduction is on the Table

Mon, 20 Nov 2017 20:32:00 GMT

Turkey sandwiches…soups…deli meats. Are these the building blocks of a healthy meal or stealthy contributors of excess sodium? Both, according to experts, but improved versions are in the works, thanks to June 2016 Food and Drug Administration (FDA) recommended guidelines and commitments from food manufacturers and restaurant operators to shake down the salt.

Implicated in a litany of ills from increased risk of heart disease and stroke to higher blood pressure, sodium is one of today’s major targets for elimination in the quest for a healthy diet. According to the Institute of Medicine, reducing sodium intake to 2,300 mg daily can significantly reduce blood pressure, ultimately preventing hundreds of thousands of premature illnesses and deaths. Currently, Americans consume on average, about 3,400 mg a day (a teaspoon and a half), most of it involuntarily.

“While a majority of Americans reports watching or trying to reduce added salt in their diets, the deck has been stacked against them,” the FDA stated. “The majority of sodium intake comes from processed and prepared foods, not the saltshaker.”

The guidelines set targets for reducing sodium over the next decade in the majority of processed and prepared foods, including pizza, deli meats, canned soup, snacks, breads and rolls. Already Nestle has reduced the salt in its pizzas, General Mills reduced sodium in more than 350 products, and Mars Food, Unilever and PepsiCo have pledged to follow suit.

Experts at the Harvard School of Public Health and the American Heart Association urge even further downward pressure on sodium in the diet, recommending a limit of 1,500 mg per day. Dr. Frank Sacks, the Principal Investigator in the groundbreaking Dietary Approaches to Stop Hypertension (DASH) Sodium-Trial, concurs, saying the effect of sodium intake on blood pressure is strong and causal, and called the new guidelines “a tremendous step forward to lower heart attacks and strokes in the US.”

Start shrinking the sodium in your diet with these simple, tasty strategies:

On vegetables:

On meats:

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Bring It Down: Healthy Blood Pressure Numbers May Go Even Lower

Mon, 20 Nov 2017 20:30:00 GMT

If you’ve ever wondered why a blood pressure check is part of almost every visit to a doctor’s office, consider what is communicated through the familiar black cuff in just a few seconds. The force of blood pushing against the walls of the arteries as the heart pumps is a critical measure of how well your heart muscle works – systolic blood pressure (SBP, or the top number of a reading) measures the pressure in the arteries when the heart beats; diastolic blood pressure (DBP, or the bottom number) refers to the pressure in the arteries when the heart muscle is resting between beats and refilling with blood.

Readings that exceed the norm, hypertension or high blood pressure, indicate an increased risk of heart attack, stroke and kidney failure. However, exactly what constitutes ‘normal’ blood pressure for optimal health has been debated and tested for decades, and recommendations have fluctuated over time. While the gold standard is under 120 mm Hg/80 mm Hg, the targets for treating hypertension have varied over the years – less than 140/90 in the 1990s, down to 130/80 in 2003, raised to a controversial 150 or less in 2014, and retreating to less than 140 in 2015.

At the end of 2015, a landmark study of more than 9,300 patients, the Systolic Blood Pressure Intervention Trial (SPRINT), moved the needle down even further. Those who were treated most aggressively to drive down blood pressure to 120/80 experienced a significantly lower risk of cardiovascular events, chronic kidney disease, and death. In fact, the outcomes were so convincing that the trial was actually halted after just three years, much sooner than planned, leading the American Society of Hypertension to state: “The early termination of this trial represents an exciting moment in the history of hypertension treatment.” Still, notes of caution were sounded because multiple medications were required, sometimes causing adverse side effects, and experts
agreed more study was needed to justify changes in clinical practice. Additional evidence followed this year, with an analysis of adults aged 75 years and older who participated in the SPRINT study. The benefits of lowering blood pressure to 120 were even more pronounced, resulting in a one third reduction in risk of cardiovascular events and death, even among the frailest older patients. This finding could benefit almost six million seniors over 75 with elevated blood pressure, according to the Journal of the American College of Cardiology.

While the outcomes are promising, and point in an even more downward direction, experts have not yet reached a consensus on optimal blood pressure targets. For now, hypertension patients should consult with their doctor to determine whether this lower goal is best for their individual care.

Who’s at risk? Virtually everyone

Even those who don’t have high blood pressure by age 55 face a 90 percent chance of developing it during their lifetime, so learning how to identify, prevent and control hypertension can benefit us all. Consider these best practices:

Identify.

Prevent.

Control.

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The Painful New Reality of Opioid Prescriptions

Mon, 20 Nov 2017 20:29:00 GMT

Nothing erodes the quality of life faster than pain and unfortunately more than half of American adults report they live with it on a chronic, recurring basis. That makes it easy to understand why, when seemingly safe, effective opioid drugs became widely available in the 1990s, they were quickly embraced by physicians and patients. Considered one of the most promising developments in pain management in decades, opioids such as oxycodone (OxyContin, for example), hydrocodone (Vicodin) or meperidine (Demerol) had already proved highly effective on a short-term basis to treat acute pain. The mechanisms were clear: opioid molecules travel through the bloodstream into the brain, attach to receptors on the surface of certain brain cells and trigger the release of dopamine in the brain’s reward and pleasure center.

However, what was not known was how patients reacted to these medications when taken daily for weeks, months and years to treat chronic conditions ranging from headaches and stubborn lower back pain to neuropathy, fibromyalgia and severe degenerative joint disease. As use of opioids for chronic pain (defined as lasting longer than three months) became widespread, reports of unwanted side effects emerged, along with doubts about long-term efficacy and optimal outcomes. Most alarmingly, the potential for abuse and addiction materialized into a full-blown crisis, evidenced by stark statistics like these:

Clearly, sweeping changes were needed, and in response, new recommended guidelines for safer pain management were issued by the Centers for Disease Control (CDC) last spring, and received
strong endorsement from well-respected organizations including the American Academy of Pain Medicine and the American College of Physicians (ACP). According to ACP, the recommendations are “reasonable, based on the best available evidence, and find the right balance between educating about the hazards of opioids while recognizing special circumstances where such medications may be an important part of a treatment plan.” The recommendations specify best practices for dosage levels and usage, and raise awareness of the risks posed to all patients by the drugs. Please note that these are recommendations only and may be altered at the discretion of the physician treating you to fit your unique needs. These include:

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Is What You’re Reading What You’re Eating?

Mon, 20 Nov 2017 20:27:00 GMT

While the evidence is not yet in on the enhanced nutritional value of organic or natural foods, consumers appear to have made their own decision. The latest research shows more than 62 percent of Americans now regularly shop for these types of products and pay premium prices for ‘farm to table’ dishes when dining out. Many questions remain, however, chief among them: what exactly is promised by these terms…and do they deliver?

The lack of official guidelines can make it difficult to identify the difference between ‘organic’ and ‘natural’ or ‘cage-free’ versus ‘free-range.’ The Food and Drug Administration (FDA) does not formally define ‘natural,’ but refers to a longstanding policy that interprets it to mean nothing artificial or synthetic has been added to a food that wouldn’t normally be expected, without addressing production, processing or manufacturing methods. Realizing the term is vague, even misleading, the FDA is solicitingpublic input until May and plans to issue more meaningful standards later this year.

For now, “’all-natural’ is more of a marketing ploy,” according to Mick Bessire, agricultural educator at Cornell Cooperative Extension. “Antibiotics can be used in production, or chickens can be raised in battery cages and have their beaks trimmed and still be called natural.”

Other frequently used terms:

Organic: A USDA Organic seal signifies that the product is made without synthetic fertilizers, irradiation, and has not been genetically modified in any way; no antibiotics or growth hormones are used in meats; 100 percent organic feed is used for livestock. The use of food additives and fortifying agents such as preservatives, artificial sweeteners and colors is severely restricted. Usually pesticide-free, too.

Hormone-Free: The best choice for hormone-free meat is products with the USDA Organic label. Hormones are already banned in egg-laying hens.

Grass-Fed : Look for an American Grass-fed Association or Animal Welfare Approved stamp, which guarantee the animal was raised on a family-owned pasture or range. Beyond the humane
benefits, some studies have found that grass-fed beef contains higher levels of healthy fatty acids and antioxidants.

Cage-Free: A voluntary label recognized by the USDA’s Agricultural Marketing Service (AMS) as birds permitted to roam, but generally without access to the outdoors.

Free-Range or Free-Roaming : Another voluntary label that indicates animals have access to the outdoors but type and duration is undefined.

Pasture-raised: Means animals roam freely and eat vegetation in their natural environment.

Certified Humane: Offers more specific guidelines for cage-free, free-range and pasture-raised labels.

White/brown eggs: Does not indicate quality or nutrition levels, but is based on the breed of the egg-laying hen.

Farm-raised fish: Frequently bred to be heavier, grow faster and can contain chemicals versus wild-caught fish. Diner beware though: according to advocacy organization Oceana’s recent study, restaurant customers were misled about salmon 43 percent of the time – ordering sustainable wild salmon as labeled on the menu, but receiving farmed salmon on their plates.

Is it worth the effort? Probably. For example, wild salmon contains far more healthy omega 3 fatty acids than farm-raised salmon. While a recent study from Mayo Clinic showed that many organically and conventionally produced foodstuffs were similar nutritionally, organic foods are inarguably less processed and more sustainable choices – good for our bodies and the environment.

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Joint Assets

Mon, 20 Nov 2017 20:25:00 GMT

The aching, swollen, stiff joints associated with osteoarthritis (OA) have long been considered an inexorable result of aging. According to conventional wisdom, cartilage, the smooth connective tissue on the end of bones that cushion the joints, simply breaks down over a lifetime of walking, exercising and moving, allowing the bones to rub together. When medications and physical therapy no longer provide relief, a costly and time-intensive mechanical joint replacement may be the only solution. However, advances in research and a focus on prevention are providing
a new outlook on an ageold problem…we bring you the latest insights, below.

Prevention

The connection between overweight and OA is even stronger than previously thought. Recent studies show that up to 65 percent of cases of OA of the knee could be avoided if weight was reduced. Consider that your knees bear a force equivalent to three to six times your body weight with each step, so a lighter weight relieves the burden considerably. For women, extra weight is even more of a risk factor than men. In addition, fat tissue produces proteins called cytokines that cause inflammation, and in the joints, this can alter the function of cartilage cells. Gaining weight results in your body releasing more of these harmful proteins. However, losing even a few pounds can reduce joint stress and inflammation and decrease by half the risk of OA.

Avoid practicing a sport in an intensive and prolonged way. An injured joint is nearly seven times more likely to develop arthritis than one that was never injured. The condition is now seen more frequently among 30 to 50-year-olds than previously because young athletes or middle-aged ‘weekend warriors’ who tear their anterior cruciate ligament (ACL) or menisci of the knee have a much higher risk of osteoarthritis 10 to 20 years after their injury. Take steps to manage or prevent diabetes, which may be a significant risk factor for OA. Some studies suggest high glucose levels trigger the formation of molecules that make cartilage stiffer and less resistant to stress, and cause inflammation that leads to cartilage loss.

Management

Low impact exercise is key to living well with osteoarthritis . While resting aching joints can bring temporary relief, lack of movement will ultimately lead to more discomfort.
Exercise strengthens the muscles around the joint, acting like a shock absorber, helping to reduce pain. In addition, exercise helps with weight control and is a natural mood elevator. Experts recommend low-impact activities like swimming, walking, biking, and moderate weight lifting. The Arthritis Foundation developed a form of tai chi specifically for people with arthritis,
featuring agile steps and a high stance, that helps increase flexibility and improve muscle strength inthe lower body.

Some new approaches to pain management show promise, but beware of unsubstantiated claims. Platelet-rich plasma (PRP) injections, which involve withdrawing blood, spinning
it to separate the platelets and then injecting the concentrated platelets into a joint, are being studied for long-term effectiveness. Experts advise against costly supplements such as glucosamine, chondroitin and shark cartilage, all of which have proven of little benefit for people with OA. Some elements of Chinese medicine, including herbs and acupuncture, may help control OA symptoms in some people, but these therapies have not yet been confirmed in large, well-designed clinical studies. Also unproven are low-power laser light, copper bracelets or magnets, chiropractic manipulation and acupressure. The most effective over the counter medication are NSAIDs (non-steroidal anti-inflammatory drugs such as Advil). While Tylenol helps reduce pain and is the safest medicine for older people or those with kidney disease, it does not lower inflammation.

Finally, if you do need an orthopedic implant in the future, take comfort in the fact that development of the next generation of devices is well underway. They will likely be biologic, composed of protein and cells instead of metal and plastic,…functioning as well as a normal joint and created to last a lifetime.

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Aging Well, Aging Healthy…a continuing series

Mon, 20 Nov 2017 20:24:00 GMT

HealthWise presents an ongoing look at research that provides valuable insights to help today’s seniors – and the generations set to follow – create a vibrant next chapter. We have looked at strategies to keep the aging brain healthy and to protect the aging senses. In this issue, we get under your skin to learn how to keep it supple and resilient over the years. Wrinkles. Dry skin. Crow’s feet. Undereye circles. Sagging. Is there a way to stave off these very natural signs of aging? The answer is yes…and no. The thickening of the stratum corneum (the outer layer of the epidermis) which causes drier and flakier skin, is inevitable, as is the thinning of the dermis (underneath the epidermis), resulting in loss of elasticity. Genetics plays a pivotal role in determining when this starts to occur. However, there are a number of preventive steps you can take – some well-known and a few unexpected – which may help mature skin keep its youthful glow at 50, 60 and beyond.

Experts advise:

If you want to explore other remedies, consider peels that exfoliate, and fractional resurfacing, a laser process that increases collagen production.

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Find Your Roots with Winter’s Best Veggies

Mon, 20 Nov 2017 20:21:00 GMT

While they may not have the crisp appeal of sugar snap peas or the sleek appearance of a summer tomato, winter’s bounty of root vegetables and greens brings some of the year’s most nutrient-rich dishes to the table. Serve up as chips or gratins, roasted or braised, mashed or raw, in soups or salads…see our recommendations for a taste of the season below.

If you like kale, try collard greens, a super-green that can be thinly sliced and used in salads, or braised with mushrooms for satisfying flavor without meat. Anti-inflammatory, antioxidant (cancer preventive) and cholesterol-lowing nutrients are on the long list of benefits.

Looking for low-carb substitutes for mashed or fried potatoes? Pureed cauliflower makes a delightful stand-in for mashed potatoes, especially when blended with Greek yogurt. Less common are Romanesco, an excellent source of vitamins C and K, fiber and carotenoids; Kohlrabi, with edible roots, leaves and stems packed with potassium and Vitamin C; and Celeriac, also known as root-celery, containing antioxidants, Vitamin K and phosphorus. For a healthy alternative to French fries, consider Jerusalem artichokes, or sunchokes, with a mellow taste and flaky texture, and plenty of energy-boosting iron and cholesterol-lowering soluble fiber. Slice matchstick-thin, mix in a sprinkle of vegetable oil, rosemary, cayenne, salt and pepper and bake for 15 minutes. Or enjoy a baked sweet potato, skin and all, for a winter treat that’s high in Vitamin A and fiber, with a minimum of calories.

Beets, high in folic acids, offer crunch, color and taste. Sautee with garlic and some olive oil or use in soups for a nutritional boost.

Change up onions with leeks, which have a milder, sweeter flavor, and compounds such as allicin that fight free radicals in your body and flavonols that may help fight cancer and lower the risk of heart disease.

Carrots are always a sturdy choice, rich in beta carotene, a compound that may reduce heart disease and certain types of cancer (although supplements are not recommended, especially for smokers), and Vitamin A, which bolsters vision and bone growth. Parsnips offer a change of pace, with a sweet flavor, double the fiber of carrots, potassium and folate for cardiovascular benefits, and almost 40 percent of the daily requirement of Vitamin K, a nutrient associated with bone health.

Winter squash, in a variety of shapes, colors and flavors, are rich in Vitamins C and A, and can be boiled, baked, roasted, simmered, steamed, microwaved or sautéed. For a low-calorie alternative to pasta, try spaghetti squash which yields long yellow strands when cooked. Sweet potato fans will enjoy butternut squash, with a similar sweet nuttiness and an even silkier texture.

Broccoli contains calcium, folate, iron, protein, Vitamins A and C and fiber, and is versatile enough to steam, roast, stir fry, puree for soups or eat raw.

Give winter salads a spin with a bowl of curly endive, radicchio, beets, fennel, kohlrabi and turnip greens. Roast or boil until tender and dress while still warm to allow the flavors to be completely absorbed.

There are many more choices in the produce aisle…go browse your local grocery store and try something new this winter!

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In Our Sights: Sharper Focus on Macular Degeneration Offers New Hope

Mon, 20 Nov 2017 20:20:00 GMT

In the not so distant past, age-related macular degeneration (AMD), characterized by a loss of central vision, was deemed just another unfortunate consequence of growing older. The gradual breakdown of light-sensing retinal tissue that results in a blind spot directly ahead has caused each generation to struggle with driving a car, reading a printed page or recognizing a friend’s face. As the population ages, the sheer number of people affected grows rapidly. Another case of AMD is diagnosed every three minutes in the U.S. More than 2.1 million Americans with advanced AMD now will grow to 3.7 million by the year 2030, according to the National Eye Institute, who warns the condition will soon take on aspects of an epidemic. A surge of clinical trials and investigative research aims to prevent that from happening, with sights set firmly on restorative, curative solutions.

Scientists exploring the possible causes have made much progress isolating a group of genes that increases the likelihood of an individual developing AMD. Other studies point to inflammation as the trigger. The macula needs a constant, rich blood supply to work correctly, and any interference such as narrowing of the blood vessels, fatty plaque deposits, or a shortage of antioxidants, can cause the macula to malfunction and become diseased.

Treatments have likewise advanced. Last fall, a decades-old drug used to treat HIV/AIDS was reported in Science as unexpectedly exhibiting the capability to halt retinal degeneration. Nucleoside reverse transcriptase inhibitors, known as NRTIs, are already FDA-approved and can be rapidly and inexpensively translated into therapies for both dry and wet AMD (see sidebar), say the study’s authors. At the same time, a nanosecond laser treatment was successfully used to reduce drusen (small fatty deposits beneath the retina) and the thickening of Bruch’s membrane, both hallmark features of early AMD. Importantly, the structure of the retina remained intact, suggesting “this treatment has the potential to reduce AMD progression,” according to Medical News Today . Stem cell transplantation shows enormous promise, as reported in Lancet , with sight restored long-term to a group of patients with severe vision loss. Additionally, injectible drugs and pills that target inflammation associated with AMD are in nationwide trials.

Technological innovations to help AMD patients include the 2013 introduction of a miniature telescope implanted behind the iris to magnify images. Google is moving into the space with a patent for a contact lens containing a built-in camera that will enable audible warnings via a remote device, detect and describe faces, and act as a text reader.

Today’s AMD patients have no shortage of low-vison aids to help them adapt and live well. Google is developing a patent for a contact lens containing a built-in camera that will enable audible warnings via a remote device, detect and describe faces, and act as a text reader. Additional solutions range from ‘smart’ thermostats, watches and remote controls to talking devices.

Finally, understanding who is at risk for developing AMD can be key to prevention. These include: white, female, smoker, family member with AMD, high blood pressure, lighter eye color, obesity, and possibly, over-exposure to sunlight. To minimize risk, follow a healthy diet with plenty of leafy green vegetables and fish high in omega-3 fatty acids, exercise to keep weight and blood pressure under control, eliminate tobacco use, and wear sunglasses to protect from UV rays and high-energy visible (HEV) radiation.

When Dry Becomes Wet

Diagnosis of AMD is first confirmed with a visual acuity exam and testing with an Amsler grid. Those with AMD see the grid’s straight lines as wavy or blurred with dark areas at the center. Additional tests help determine the type of AMD — the dry form affects about 85 percent of AMD patients, and in about 10 to 15 percent of cases, progresses to wet. The difference is significant. The wet form usually leads to more serious vision loss, caused by new blood vessels that leak fluid and blood beneath the retina, resulting in permanent damage. While no treatment currently exists for dry AMD, in the last decade, a number of effective therapies have been implemented for wet AMD. These include monthly, intraocular injections (anti-VEGF) to inhibit a protein that stimulates formulation of new blood vessels, photodynamic or ‘cold’ laser treatment, thermal (heat) laser photocoagulation…and on the horizon are topical eyedrops that may someday replace injections. Nutritional supplements containing antioxidant vitamins, lutein and zeaxanthin are also effective in reducing the chances of dry AMD worsening to wet.

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How Much Vitamin D Do We Really Need?

Mon, 20 Nov 2017 20:17:00 GMT

In the multi-lettered world of vitamins and minerals, why did Vitamin D move to the top of the list…and should it be there? Following is a look at the paradox of the “sunshine vitamin,” critical to the body’s healthy function in numerous ways, but may not be important enough to warrant regular screenings, according to the latest national recommendations.

The undisputed connection between Vitamin D, the sun and bone strength was established early in the 20th century, when doctors discovered that sunlight triggers the production of Vitamin D and helped cure rickets in children. Essential for strong bones, Vitamin D helps the body absorb calcium. Unlike other vitamins, however, it is naturally present in very few foods (fish like salmon and mackerel, eggs, mushrooms and commercially fortified milk). Dr. John Cannell, who founded the Vitamin D Council to better advocate for its use, cautions: “It’s nearly impossible to get what you need from food.”

For many Americans, lack of sunshine except during the short summer season poses a concern because exposure to the sun is necessary to turn a chemical in the skin into Vitamin D. Even in sunny climates, people who spend most of their day indoors or faithfully apply sunscreen are at risk of Vitamin D deficiency, according to research that emerged in the 2000s. Low levels of the vitamin were increasingly linked to a litany of the world’s ills—cancer, heart disease, diabetes, arthritis, even depression. By 2012, researchers had discovered that Vitamin D receptors were found not only in the intestines, but in many other organs. “We know that basically every cell in your body has a Vitamin D receptor; it has been found in the brain, skeletal muscle, colon, breast, prostate, and the list goes on,” Dr. Michael F. Holick, a prominent expert at Boston University Medical Center, told Endocrine News .

Additional research bolstered the importance of Vitamin D, such as a recent British Medical Journal study that tracked more than 95,000 participants for nearly 40 years to find that genes associated with permanent low levels of Vitamin D raised the risk of early death by up to 40 percent. However, the study’s author cautioned that the relationship was not proven to be causal and therefore, no recommendations for supplements can be made.

The chicken-egg conundrum is explained by Dr. JoAnn Manson, Professor of Medicine at Harvard Medical School: “We’re at a crossroads because we really don’t know if there’s a cause and effect relationship between Vitamin D status and outcomes such as heart disease and cancer.” Obesity and lack of exercise contribute to higher rates of cancer and heart disease, so those factors could explain the illnesses, rather than a low Vitamin D level, she said.

In fact, despite the mountains of research, the U.S. Preventive Services Task Force (USPSTF) stated late in 2014 there is insufficient evidence to justify taking mega-doses of Vitamin D to prevent chronic diseases, and did not recommend regular testing of blood levels. All eyes are now on the national, 26,000-participant VITAL trial, which will conclusively report in 2017 the effects of Vitamin D or fish oil on reducing the risk of cancer, heart disease and stroke.

Different medical experts suggest different guidelines for Vitamin D supplementation. The Institute of Medicine’s guidelines state 600 IU (International Units) for ages 14 to 70, and 800 IU for age 71 and above; the Endocrine Society recommends 1,500-2,000 IU per day, and the Vitamin D Council advises “safe, sensible sun exposure, and if that’s not possible, 5,000 IU a day.” Please call my office for recommendations on the right amount of Vitamin D for you.

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Thinking on Your Feet: The Latest on Warning Signs from Below

Mon, 20 Nov 2017 20:15:00 GMT

Every step you take is a physiological marvel, made possible by the 26 bones, 33 joints and over 100 ligaments of the foot working together to ensure maximum movement. The intricate sequence begins as your heel hits the ground, and ends with a push off the big toe at the same time the Achilles tendon lifts the heel, requiring a force that is about 50 percent greater than your body weight. Now consider that during a typical day, people spend about four hours on their feet and take 8,000 to 10,000 steps – that means the feet support a combined force equivalent to several hundred tons every day.

While feet were designed to propel you through life with powerful ease, many factors can affect function. Age, obesity, long periods of standing, certain diseases such as diabetes, some types of exercise, faulty foot mechanics, overuse or misuse of muscles, even ill-fitting shoes, result in pain that can sideline even the most determined walker. However, today’s treatment of choice – a combination of non-invasive measures and time – will get most people back on their feet without the complications of surgery.

Plantar Fasciitis, the most common cause of foot pain. Although it is known as jogger’s heel, there are multiple causes of plantar fasciitis, responsible for one million visits to the physician each year. Exercise such as dance and aerobics can contribute to plantar fasciitis, as can being flatfooted or having a high arch, carrying extra weight, or working in an occupation that requires frequent standing or walking on hard surfaces. The plantar fascia is a band of tissue from the heel to the ball of your foot that supports your arch like a bowstring; too much tension on it creates small tears. Repetitive stretching and tearing causes the fascia to become inflamed and irritated, and results in a stabbing pain felt most acutely in the morning or after any period of inactivity.

Physical therapy can help relieve the pain, which is often aggravated by tight muscles in your feet and calves. Exercises to stretch the plantar fascia and Achilles tendon and strengthen lower leg muscles are often prescribed initially. Notably, one of the most effective treatments for plantar fasciitis may also be the simplest. Patients who tried slowly raising and lowering the affected heel while standing barefoot on a stair or a box, 12 times every other day, reported a vast improvement in pain and disability in three months, compared with those who adhered to a standard regimen of pulling toes toward the shins several times daily. When performing that exercise, it is best to roll a hand towel and place it under the toes to increase the amount of flexion.

In addition to therapy, other conservative measures are recommended initially, including:

Plantar fasciitis can persist, however, and additional treatment may include:

Fancy Footwork: Expert Advice to Keep You on Your Toes
Preventive stretching . Add conditioning exercises to your daily routine, such as rolling your foot over a golf ball for a few minutes to work the plantar fascia ligament, or tracing the letters of the alphabet with your feet. Wrap a TheraBand (a resistance tool) around the sole of your foot while sitting on the floor with your legs straight out in front, and flex and point.

Size check. The size of your foot can change over time, especially in women whose feet become longer and wider after pregnancy. Ask for a professional measurement the next time you shoe shop.

Find the right fit. Too-tight shoes weaken the muscles in the ball of the foot and the ligaments that hold the toes straight, causing corns, ingrown nails and bunions. Make sure your shoe is roomy enough to provide a finger’s breadth between its tip and your big toe.

Stand tall, naturally . High heels are the most common cause of foot pain among women, leading to corns, calluses, bunions and neuromas (pinched nerve or nerve tumor). Choose shoes broad in the toes, with a low wedge and shock absorbent sole.

The good news: almost 90 percent of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods, say experts.

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The Healthy Aging Brain…a Continuing Series

Mon, 20 Nov 2017 20:13:00 GMT

While exercise has an undisputed key role in maintaining brain health throughout our lives, promising new research points to a number of other factors that can spell the difference between thriving or just surviving the senior years. We checked in with Eric Terman, MD, personal physician and Assistant Professor of Internal Medicine and Geriatrics at Northwestern University for an informed view of the latest thinking on this topic…important not just for current seniors, but also for aging Baby Boomers and for younger 40-somethings just beginning the “aging” process.

What are some of the key findings of current studies into how the mind ages?

Research shows that the brain continues to form new connections throughout life. This process, called adult neurogenesis, shows how plastic or structurally adaptable the brain is, even as we age. A combination of exercise, diet and stimulating environments can increase adult neurogenesis and improve cognitive functioning in young and old individuals. This has been documented in animals and we are seeing increasing evidence this occurs with humans too.

What role does exercise play?

We know exercise appears to increase the neurogenerative properties. While the cause is not clearly proven yet, there is little doubt that exercise benefits both body and mind in many ways. It is associated with reduced risk of dementia, and may actually be preventive. For these reasons, I almost always recommend a form of regular activity to my patients.

Do you advise your older patients to consider retirement for reduced stress, more time for leisure activities, etc?

It’s critical to stay engaged in something you care about, whether or not you’re earning a significant salary. The brain stays sharp if you continually grapple with problems, find solutions and achieve positive outcomes.

Wouldn’t lifelong learning classes and lectures fill that void?

Sometimes listening to a lecturer can be barely better than watching TV in terms of passive versus active involvement of your brain. Unless you’re reading textbooks and writing papers, you’re better off with the type of engagement you receive from working. It’s the same reason the benefits of brain training games are unclear – problem solving for real world issues results in better cognitive capacity.

Can you explain mindfulness-based interventions and how these work to reduce the severity or risk of diseases such as Parkinson’s and Alzheimer’s?

High levels of stress are associated with increased risk of these diseases, and with mild cognitive impairment. Mindfulness-based interventions such as meditation and yoga are non-invasive stress reducers, and proven effective complements to treatments for anxiety, hypertension, chronic pain and insomnia too. Preliminary research is also showing that mindfulness-based interventions reduce atrophy of the hippocampus (a critical site of episodic memory), increase gray matter and improve functional connectivity in the neural networks of the brain most affected by the disease process of Parkinson’s and Alzheimer’s.

What is the best way to get started with this kind of program?

There are formal meditation programs and yoga training activities, as well as some excellent apps that take you through the process, such as Headspace.

What advice would you give seniors looking for ways to keep their brain and spirit vigorous as they age?

Find something to pursue that keeps you actively engaged and that you love to do if you formally stop working. Definitely, keep moving – I have patients who have started exercise programs in their 70s and they see significant differences in the way they feel. Modify your sleep behaviors if needed to ensure a good refreshing sleep, every night. And while the effect of a strong social network may be somewhat of a chicken-egg conundrum, there is increasing evidence that social and mental stimulation strengthen connections between nerve cells in the brain.

Breakthrough research sheds new light on Alzheimer’s disease

Numerous studies of Alzheimer’s disease, the leading cause of dementia that gradually erodes a person’s memory, thinking and ability to perform everyday tasks, are beginning to provide answers as to causes and possible targets for treatment. For instance, the link with cardiovascular disease has become increasingly evident. Several conditions known to raise the risk of cardiovascular disease, including high blood pressure, diabetes and high cholesterol, also increase the risk of developing Alzheimer’s – as many as 80 percent of individuals with Alzheimer’s disease also have cardiovascular disease, according to the Alzheimer’s Association. Experts have noted that while some people develop brain plaques and tangles seen in the disease, they do not suffer from the symptoms of Alzheimer’s unless vascular disease is also present.

Other new research is focused on the blood-brain barrier (BBB), a protective filter of the brain that becomes more damaged in patients with Alzheimer’s disease. At University of Southern California, neuroscientist Berislav Zlokovic and team found that the BBB becomes leaky with age, starting in the hippocampus, an area that is affected before the symptoms of Alzheimer’s disease are seen. He noted that specialized brain scans might help doctors diagnose the condition earlier. “Dr. Zlokovic’s advances bring us that much closer to a cure,” reports the chairman of the Cure Alzheimer’s Fund.

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MIND Your Diet

Mon, 20 Nov 2017 20:10:00 GMT

Let food be thy medicine and medicine be thy food. – Hippocrates
Food’s healing properties is a concept that stems back to the earliest days of medicine, but has taken on new significance as a natural way to prevent or manage today’s most devastating illnesses, from dementia to heart disease. The regimens presented below are not ‘diets’ in the traditional sense, but rather represent a shift to eating habits that preserve wellness.

DASH (Dietary Approaches to Stop Hypertension), a low-sodium diet that encourages consumption of foods rich in nutrients such as potassium and calcium magnesium that help lower blood pressure, prevent diabetes and support heart health.

The Mediterranean diet emphasizes fish, fruits, and vegetables, with olive oil as the main source of fat, has gained prominence for its link to stronger bones, a healthier heart and reduced blood pressure.
Combining both of the above, the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet, from Rush University Medical Center, shows real promise in helping patients maintain cognition and reduce the risk of dementia. Seniors who rigorously adhered to the recommended foods lowered their risk for Alzheimer’s disease by 53 percent, but even those who followed it only moderately well experienced a 35 percent reduction, according to newly published research from the Health and Retirement Study. The focus is on eating ‘brain-healthy’ foods, including:
Green leafy vegetables, such as spinach or kale – at least six servings weekly

Excluded: red meat, butter, margarine, cheese, pastries, sweets, refined sugar or flour, and fried or fast food. Eggs and dairy are included but in small portions.
Additional research points to the role of a high quality diet in preserving brain health and maintaining cognition. However, MIND study lead author and nutritional epidemiologist Claire McEvoy, Phd, cautions that to conclusively prove the connection between diet and dementia risk, the next step is to conduct clinical trials. In the meantime, experts say there’s no harm in incorporating these foods into your daily diet, as they provide antioxidants, assist with maintenance of normal blood pressure levels and help keep chronic inflammation in check.

Other plans worth considering:

Weight Watchers: still a smart, effective diet after 54 years. It’s rated high by dietitians for ease of adherence, nutritional soundness, emphasis on group support, abundance of fruits and vegetables, and allowance for occasional indulgences.
Mayo Clinic Diet: consisting of a two-week jump start for weight loss, followed by a lifelong approach to diet and health, with information on food choices, portion sizes, menu planning and physical activity. The emphasis is on generous amounts of low-energy-dense foods that help you lose weight by feeling full on fewer calories, and includes whole-grain carbohydrates, lean sources of protein and unsaturated fats. At least 30 minutes of exercise is recommended daily. A typical 1200-calorie-a-day menu includes:

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Unlocking the Genetic Code: Spotlighting Pharmacogenomics

Mon, 20 Nov 2017 20:03:00 GMT

This is the first in a series exploring some of the most promising advances inspired by the Human Genome project. From the burgeoning field of pharmacogenomics to consumer genetic testing such as 23 and Me, the time from discovery to application is progressing rapidly. We’ll look at some of the latest thinking and its impact on personalizing medicine in the future.

To boil down a complex subject to its very human goal, pharmacogenomics means using genomics to get the right dose of the right drug to the right patient at the right time. There is tremendous variability in individual response to drugs, and a large percentage of adverse drug reactions may be due to genetic variables that are just beginning to be really understood.

It’s important to note that while significant progress has been made, the actual use of pharmacogenomics in primary care may be many years away and unlikely to impact the way in which your physician currently prescribes medications for you. However, as research continues to accumulate, the medical community is hopeful that this information will someday help guide prescription decision-making in a much more precise and personalized way.

Did You Know?

1957 – Dr. Arno Motulsky suggests that individual differences in drug efficacy and adverse drug reactions are at least partially attributable to genetic variations

2008 – The Food and Drug Administration releases a table listing genomic biomarkers with established roles in determining drug response

Sources: The National Human Genome Research Project, UptoDate, FDA.gov , JAMA

What we know now

Slightly different, but normal, variations in the human genetic code can yield proteins that work better or worse when they are metabolizing different types of drugs and other substances. Even small differences can have a major effect on a drug’s safety or effectiveness for an individual patient. Your drug-metabolizing enzymes may be set to act in a completely different way than a friend of similar height and weight because phenotypes range from ultrarapid and rapid metabolizers to normal, intermediate and poor metabolizers.
Consider this example from the National Institutes of Health: The liver enzyme known as CYP2D6 acts on 25 percent of all prescription drugs, including the pain reliever codeine. There are more than 160 versions of the CYP2D6 gene, and many of these vary by only a single difference in their DNA sequence. People who manufacture an overabundance of CYP2D6 enzyme molecules metabolize the drug very rapidly, and as a result, even a standard dose can be too much. Conversely, those who carry a CYP2D6 gene that results in a slowly metabolizing enzyme may not experience any pain relief. Armed with this kind of information, a physician may be able to prescribe different types of pain relievers for both of these patients.
The Food and Drug Administration now includes pharmacogenomic information on the labels of some medications, with details on risk for adverse events and side effects, effectiveness for people with specific genome variations, genotype-specific dosing and mechanisms of drug action (the specific biochemical interaction through which a drug substance produces its pharmacological effect). This may eventually help physicians make the right individual patient choices for drugs that include pain relievers, antidepressants, antivirals, statins and blood thinners.
A number of barriers, which includes the lack of clear, evidence-based guidelines, need to be overcome before personalized drug therapy becomes a routine component of mainstream medicine. For now, pharmacogenetics testing is successfully being used in treatment of specific genetically influenced tumors, and for certain medications for cystic fibrosis, inflammatory bowel disease and HIV…important first steps in this promising field.

Defining Terms

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Forget Me Not: Normal Aging, Mild Cognitive Impairment or Dementia?

Mon, 20 Nov 2017 19:56:00 GMT

We’ve all had the experience of frantically searching for car keys in the morning or walking purposefully into another room only to forget why we were going there, and as we age, it seems to occur with increasing frequency. Are these just signs of normal aging, or harbingers of a more serious condition? It’s a question more seniors and their families are asking, as awareness of progressive memory disorders such as Alzheimer’s disease grows.

The answers can be more reassuring than yo• may imagine. Many symptoms of memory loss are benign,or due to the aging process, and no further evaluation is needed (see the signs of normal aging, at right). Experts agree that most people who are aware of—and nervous about—their own declining memory, most likely do not have mild cognitive impairment or dementia.

However, it’s vital to know that if you do have symptoms of mild cognitive impairment (MCI), this may be due to underlying medical conditions that can be treated, such as thyroid dysfunction, vitamin deficiency, anxiety/depression, sleep disorders and uncontrolled chronic conditions such as diabetes.

You may want to consider seeking an evaluation if you experience increasing difficulty, compared to your past ability, over a range of everyday activities that include: remembering important details of things you’ve done in the past few weeks; completing complex tasks at work or home, such as keeping track of monthly bills; requiring personal assistance to remember family occasions or holidays; or having trouble finding your way around familiar environments.

Cognitive abilities are also affected by depression, so if you have experienced these feelings during the last month, further evaluation is recommended:

Felt that I cannot stop feeling “down” or “blue,” even with help from family or friends.

150 minutes a week

Amount of exercise time needed to improve memory and reduce the risk of dementia. Source: Harvard Health

“Having memory loss does not necessarily mean yo• have Alzheimer’s disease (AD),” says neurologist William Rodman Shankle, MD, chair of California’s Memory and Cognitive Disorders Program at Hoag Neurosciences Institute. “In fact, there is a treatable cause in the majority of patients with cognitive impairment, provided it is detected early.”

Additionally, a rigorous combination of physical exercise, healthy diet, strict control of hypertension and diabetes, medication and ongoing social and intellectual stimulation, has proven highly effective in stopping or slowing down progression of all types of dementia, including Alzheimer’s.

Sources: Medical Care Corporation ( www.mccare.com ), Alz.org

Did You Know?

Learn, then sleep

While we sleep, memories are shifted to more permanent brain regions; studies have shown that sleeping shortly after learning new information can help retention in the long term. Source: The National Sleep Foundation

Signs of Normal Aging

Sources: mccare.com , Alz.org

Making Memories

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Sweet Surrender: Is Sugar Off the Table for Healthy Eaters?

Mon, 20 Nov 2017 19:47:00 GMT

As we become more aware of what comprises healthy eating, sugar is increasingly viewed with a wary eye. Evidence is mounting that a sugar-filled diet – and the resulting weight gain – can lead to increased cholesterol, blood pressure and inflammation, and to a higher risk of obesity and obesity-related conditions such as diabetes, pre-diabetes, cancer and cardiovascular disease (CVD). The key to prevention is understanding exactly what sugars you’re eating.
Naturally occurring sugars are found in foods such as fruit (fructose) and milk (lactose). Any product that contains milk, such as yogurt or cream, or fresh or dried fruit contains some natural sugars. These can be eaten freely.
Added sugars hide in 74 percent of packaged foods, even those that many consider healthy, such as energy bars. They also lurk in savory foods, including ketchup, breads, salad dressing and pasta sauce. The top five sources are sugar-sweetened beverages (soda, specialty coffees, sports drinks); grain-based sweets (cookies, cakes, pies); fruit drinks (juice cocktails, punch); dairy-based desserts (ice cream, frozen yogurt); and candy (lollipops, jelly beans). These should be limited.
“Consider the company the sugar keeps. If it’s accompanied by a nutritional element, it is not a contributor to disease,” advises Jennifer McDaniel, Academy of Nutrition and Dietetics spokesperson. For example, fruit contains fructose, but also fiber, which ensures the natural sugar is absorbed in a slow and controlled manner; the same applies to the protein in plain yogurt.

Guidelines for maximum daily amount of added sugars vary as follows:

While a complete sugar detox is not recommended – there is little evidence that it improves health or spurs weight loss – cutting back on added sugars to make room for healthier calories is strongly advised. McDaniel suggests:

Can sugar be part of a healthy diet? Thankfully, yes. “It’s all about balance. The majority of our diet should be foods that nourish us, but there’s certainly a place for the sweet treats in life,” says McDaniel.

Sweet Disguise

It can be difficult to discern if a product contains both added and natural sugars, because the nutrition fact panels of food products don’t distinguish between them. That’s set to change in 2018 when federal regulations mandate the break out of added sugars. For now, be on the lookout for sugar in one of its many guises:

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Hepatitis C Testing Recommended for All Baby Boomers

Mon, 20 Nov 2017 19:44:00 GMT

It’s called ‘the forgotten virus,’ but after a sustained advertising campaign and years of strong recommendations for testing by the Centers for Disease Control it’s almost certain that the liver-damaging Hepatitis C will be remembered…and for good reason. All people born between 1945 and 1965 – the Baby Boomer years – are now advised to take a screening test for Hepatitis C virus, the most common bloodborne infection in the United States. The reason? Boomers, born in a time before universal precautions and infection control guidelines were fully established, are five times more likely to have Hepatitis C than other adults, but not likely to be aware of it, as symptoms lay dormant for years. Testing was first recommended for all Boomers in 2013, but less than 15 percent of this at-risk generation have heeded the advice, which means many who are infected remain unaware they carry a potentially fatal but very curable virus.
Below we dispel some of the misperceptions and the breakthrough treatments available today. Most importantly, we explain why scheduling a blood screening is a vital act of prevention, and one we encourage every Baby Boomer to take.

What is hepatitis C?

The common, chronic bloodborne infection known as hepatitis C is caused by the hepatitis C virus, and is a major cause of liver disease.

How does it happen?

The virus causes an inflammation that triggers a slow cascade of damage in the liver, with hard strands of scar tissue replacing healthy liver cells. The liver is no longer able to effectively filter toxins or make the proteins the body needs to repair itself.

Why is testing critical?

Hepatitis C can hide in the body for decades without causing symptoms, while it attacks the liver. Since most people don’t have warning signs of hepatitis C, they don’t seek treatment until many years later, when the damage often is well underway. Left untreated, hepatitis C can result in cirrhosis or liver cancer, and is the leading indication for liver transplant in the U.S. If treated, however, the vast majority of patients can be cured within a few months.

Did You Know?

80% – Of the 3.2 million people affected by chronic hepatitis C, almost 80% were born during the baby boomer generation

10.5 million – Out of 76.2 million Baby Boomers, the number who have been tested for hepatitis C

Sources: American Journal of Preventive Medicine, Centers for Disease Control

Why are Baby Boomers at particularly high risk for hepatitis C?

Once thought of as a disease primarily of drug users, contracted from sharing of needles, hepatitis C can also be contracted through inadequate sterilization of medical equipment and the transfusion of unscreened blood. Boomers grew up before the hepatitis C virus was identified in 1979, so it’s likely that many became infected through medical equipment or procedures before universal precautions and improved infection control techniques were adopted. Others may have been infected from contaminated blood before widespread screening nearly eliminated the virus from the blood supply by 1992.

What is the test for Hepatitis C?

A simple blood test for hepatitis C antibodies will indicate if you’ve been exposed to the virus at some point in your life. If you test positive, further testing will be done to determine if the virus remains in your body, how much is circulating and what specific strain or genotype you have. At least six strains of hepatitis C exist and treatment is based on the specific genotype. Other tests, including ultrasound, magnetic resonance imaging (MRI) and a liver biopsy can be performed to identify inflammation and see if any permanent scarring has taken place in the liver.

What treatments are available?

Today’s regimens of direct acting oral antivirals stop the virus from reproducing and clear hepatitis C from the body in a matter of weeks. These breakthrough drugs, first made available in 2013, represent a tremendous step forward in treatment, with a success rate upwards of 95% in those infected with the hepatitis C virus. Medication is targeted to the specific genotype of the virus, and most patients experience few side effects – a vast improvement over previous options of pegylated interferon and ribavirin which caused uncomfortable side effects and were effective less than half the time.

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Stressed Out? A Guide to Signs, Symptoms

Mon, 20 Nov 2017 19:40:00 GMT

“I think that you will all agree that we are living in most interesting times. I never remember myself a time in which our history was so full, in which day by day brought us new objects of interest, and, let me say also, new objects for anxiety.”

Was the above heard: 1. At a recent town hall meeting in Florida? 2. On the 2016 campaign trail? 3. During an 1898 address by a British statesman?

It may surprise you to learn that number 3 is the correct answer, and provides a welcome bit of perspective on the stress felt by every generation. While current times are considered stressful by a majority of adults, we also have better ways to identify, manage and prevent it than before.

Did You Know?

60-80% Percentage of visits to primary care physicians for stress-related conditions. Sources: APA, Mayo Clinic, Benson Henry Institute

Causes of stress

While stressors of American adults have remained fairly stable over the years, some are specific to the decade. As the American Psychological Association’s “2017 Stress in America” survey shows, the political climate and technology-centric world has caused an uptick in stress:

One nation, over stressed. 57% of Americans report the political climate is a significant source of stress; 66% say the same about the nation’s future. Stress about acts of terrorism was high at 59%, while worries over personal safety rose to 34%, the highest since the question was first asked in 2008.

Money, money, money. Other top causes of stress include money (61%), work (58%) and the economy (50%).

Media overload. Although nearly all adults own at least one electronic device, and more than 86% check emails, text or social media accounts daily, those who do so constantly report higher stress levels.

How to cope: For decades, stress-related issues have been recognized as the leading cause of visits to a primary care physician. Stress-relieving techniques continue to evolve:

Eat, pray, love. Exercise and going online are frequently used to manage stress. Women, how- ever, also reported spending time with friends or family, reading, engaging in prayer or eating as their primary methods of relieving stress.

Unplug. Interestingly, while 65% of Americans agree that periodically disconnecting is important for mental health, only 21% actually report doing so. Some techniques that work include no cell phones at the dinner table or while with friends, periodic digital detoxes, watching less tv, and turning off notifications for social media apps.

Trigger your relaxation response. Based on Dr. Herbert Benson’s 1974 discovery of an opposite state to the fight-or-flight response, the relaxation response puts the body in a state of deep rest. Techniques include mindful meditation, repetitive prayer, focused breathing, progressive muscle relaxation, tai chi and yoga. Studies have shown significant short-term impact on stress symptoms, as well as profound long-term improvements. Immediate reductions in blood pressure, heart and breathing rate helps manage periods of acute stress. If practiced regularly, the relaxation response can also help decrease inflammation and stress hormone levels and improve insulin activity and gastrointestinal issues.

Types of stress

Acute stress , the most common form, is experienced by virtually everyone at some point. Arising from the pressures of current conditions, and anticipated ones in the near future, acute stress can be exciting, even motivating, but too much is simply exhausting.

Symptoms : Emotional distress, such as anger, irritability, anxiety or depression; muscular problems including tension headache, back or jaw pain; stomach and bowel problems; temporary elevation in blood pressure; rapid heartbeat; sweaty palms, heart palpitations; dizziness; shortness of breath.

Solutions: This stress is short-term and highly manageable. Techniques to slow your breathing and focus your attention, as well as walking outdoors or participating in sports, can all help dispel it.

Episodic acute stress is a fact of life for those people who are always rushed, late and dealing with a plethora of self-inflicted demands and pressures. This category includes “Type A” personalities – aggressive, impatient, short-tempered. Another type of person who feels episodic acute stress is the worrier – those with a pessimistic world view and a tendency to catastrophize every situation; likely to also feel anxious and depressed.

Symptoms: Persistent tension headaches, insomnia, migraines, hypertension, chest pain and heart disease.

Solutions: Lifestyle changes, such as daily physical exercise, meditation and mindful prayer, as well as expanding social support, can help. Additionally, consider consulting with a psychologist or other mental health professional, who can offer a range of treatment, from pharmaceutical to biofeedback. For example, insomnia, a considerable source of stress in adults, can be remedied with cognitive behavioral therapy, CBT-I, a structured program to help replace negative or obsessive thoughts that keep you up at night with habits that promote sound sleep. Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems.

Chronic stress wears people down on a daily basis, often for years. Whether the cause is a dysfunctional family situation a bad career fit, people suffering from chronic stress often can’t see a way out.

Symptoms: Anxiety, insomnia, muscle pain, high blood pressure, weakened immune system; can contribute to the development of heart disease, depression and obesity.

Solutions: The most effective strategy is to seek help from professionals who can help you develop and implement lifestyle and behavior changes, recommend therapy, and prescribe medication when needed.

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The Healthy Aging Brain: Making Strides by Taking Strides

Mon, 20 Nov 2017 19:36:00 GMT

“Walking is man’s best medicine.” Hippocrates
Put away the handheld brain games and turn your focus from lifelong learning to lifelong walking. The road to sustaining brain health is an active one and taking that first step, followed by thousands more on a daily basis, can make an enormous difference in quality of life in your later years. Arthur Kramer, PhD, director of the Beckman Institute for Advanced Science and Technology at the University of Illinois, has amassed decades of research that clearly points to the prescience of Hippocrates’s ancient wisdom. His studies have become a focus of public health policy as well, sparked by 10,000 Baby Boomers crossing the over-65 threshold each day for the next 15 years, each hoping to age with vigor and dignity intact. We checked in with Dr. Kramer for an update on how physical activity keeps the brain healthy over the lifespan.

What are the most striking results seen in your research?
Our 2006 study was one of the first to report actual increases in brain volume in the prefrontal and temporal cortices of seniors who participated in aerobic exercise. These areas of the brain normally decline with age, but in our group, significant improvements in cognitive performance and memory were noted. We subsequently explored the impact of exercise on white matter, which allows information to be transferred within the brain, and found that connectivity is markedly improved, which is linked to more efficient memory, attention and decision making capabilities. All this points to the fact that age-related cognitive and brain changes are not inevitable, and can actually be reversed.

Why does exercise trigger these changes?
Several theories: increased blood flow, which improves cerebrovascular health; the release of proteins in the brain that stimulate the growth of new neurons; and the benefits of glucose and lipid metabolism which bring nourishment to the brain.

What type of exercise is most effective?
Only modest increases in physical activity are needed. Walking 40 minutes three times a week for a year, at up to 70 percent of maximum heart rate, resulted in increased volume of the hippocampus, a part of the brain responsible for memory. You don’t have to run marathons – just walk, bike or swim at moderate intensity.

Tell us why you joined an international group of leading scientists who posted a strongly worded statement on the Stanford Center on Longevity website as to the unproven efficacy of ‘brain games.’
We felt that the scientific literature does not support claims made by the manufacturers of software-based brain games…that these can make people smarter, more alert, able to learn faster, and even prevent or reverse Alzheimer’s disease. What we discerned from the research was that when people practice a task repeatedly, they will get better at that task, but it is not necessarily applicable to real-world functions. The relationship between brain training games and real-world performance and cognition needs to be explicitly tested. Unfortunately, this is rarely done. Further, time spent on brain training can be better used for activities we know improve cognitive functioning – aerobic exercise, learning a new sport or a new language, staying socially connected. Our consensus was that the promise of a magic bullet detracts from the best evidence to date…cognitive health in old age reflects the long-term effects of healthy, engaged lifestyles.

As a contributor to the recent Institute of Medicine report on cognitive aging, what lifestyle modifications do you suggest?
Being physically active is unquestionably a top recommendation for enhancing cognition and longevity. We also noted the critical importance of reducing and managing cardiovascular disease risk factors; staying socially and intellectually engaged; getting adequate sleep and receiving treatment for sleep disorders as needed; and regularly reviewing health conditions and medications
that might influence cognitive health with a physician. What’s on your radar for future research? We are looking at what types of exercise lead to the largest cognitive and brain benefits. Dance is
particularly interesting because it’s physical, social and intellectually complex. Defining the optimal doses of exercise, and how these might differ with age, health and other factors are also a focus. We are working with children, who increasingly suffer from adult diseases like diabetes, due to obesity and inactivity. And we want to determine whether a combination of nutrition and exercise provides greater benefits than either of these factors alone. The definitive answers have not yet been found. We’ll continue to seek them out, to ensure we don’t just live long, but live well.

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A Quick Spin on Dizziness, Vertigo and Other Balance Disorders

Mon, 20 Nov 2017 19:33:00 GMT

Common, rarely life-threatening, but very unsettling, an attack of dizziness or vertigo can send your world into a spin with simple acts like turning around to back up a car, bending down to tie a shoe or looking up at the sky.

A range of sensations may keep you off balance, from tilting, swaying, whirling and floating, to feeling lightheaded, or conversely, heavy-headed. The swirl of symptoms may seem similar, but there are important differences that define these conditions:

While dizziness or vertigo represent some of the most frequent reasons people visit their doctors – an estimated one out of four adults has sought treatment for the condition at some point – getting to the root cause can sometimes be a frustrating experience, say experts at the Vestibular Disorders Association. That is because numerous issues can trigger dizziness/ lightheadedness, from cardiovascular concerns such as arrhythmia, atherosclerosis and low blood pressure or conditions such as dehydration, low blood sugar or anemia. Vertigo is caused by head injuries/trauma, disorders of the vestibular system (parts of the inner ear and nervous system that control balance) or rarely, the cerebellum. In addition, aging itself can affect the vestibular system’s function by decreasing the number of nerve cells, and diminishing blood flow to the inner ear.

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The Connected Patient: Keeping Up with Apps

Tue, 14 Mar 2017 15:37:00 GMT

The ubiquitous smart phone has boosted its useful- ness tenfold in the past decade with a mushrooming library of health and wellness apps. Some aim to help you monitor your condition day-to-day, understand and stay on track with medications, or diagnose your symptoms, while others prepare you for an unforeseen emergency, allow you to share information electronically with your physician or receive education and encouragement between doctor’s appointments. With almost 200,000 apps already on the market, the real challenge is identifying the treasures that are credible, accurate and can guide you toward a healthier lifestyle. Some notable apps are listed below; all are available for iPhone (in iTunes store) and Android (Google Play).

Condition-specific information

Diabetes Tracker and One Drop offer comprehensive logging of glucose, food, medication and activity; GluCoMo works as an electronic diary to store data for blood sugar levels, weight, insulin intake, pulse rate, blood pressure and other information.

AsthmaSense and AsthmaMD provide tools to manage the disease with a digital record of triggers, medications and testing.

The National Comprehensive Cancer Network Patient Guides for Cancer covers 25 different types of cancer, with medical illustrations, information on screening, treatment and follow-up, and questions for patients to ask their physician.

A healthier lifestyle

MyFitnessPal Calorie Counter & Diet Tracker remains one of the best diet trackers, allowing you to log meals and weight data for an at-a-glance view of your intake on the dashboard.

Nike+ Running and Garmin Connect lets you log distance, time and intensity of jogs and runs; Endomondo enables logging and sharing of information from walks, hikes and cycles; Trails, known as the ‘ultimate walker’s app,’ provides topographical tracking of your strolls; and 7 Minute Workout provides exercise timers, instructional videos and a personalized exercise plan.

Buddhify and Omvana offer guided meditation tracks, ranging from three minutes to an hour.

Deep Sleep with Andrew Johnson features step- by-step instructions to guide yourself into meditation and a restful sleep and Sleep Cycle provides easy- to-read graphs to help you make sense of your sleep patterns and wakes you when you will feel the least groggy.

Medication tracking

Drugs.com is an easy way to look up drug informa- tion, identify pills, check interactions with different drugs and foods and set up your own personal medication records. A symptom checker powered by Harvard Health Publications is included with the app. CareZone will curate a list of medications, dosages, and schedules directly from your photo library, enable you to share symptoms with your doctor, store insurance information and schedule reminders for upcoming appointments.

GoodRx shows current pricing for your prescrip- tions at nearby pharmacies.

Round Health and Medisafe make it easier to follow a medication regimen with reminders on timing and dosage for each prescription, customized to your schedule.

Healthcare news

For information you can trust, check out Medscape MedPulse, a robust news aggregator for the world of medicine and UptoDate’s patient information section, featuring evidence-based, peer-reviewed information on hundreds of medical topics.

First aid

Download First Aid by American Red Cross to receive simple step-by-step instructions to guide you through everyday first aid scenarios, from asthma attacks to broken bones; there’s a Pet First Aid app as well; and Resuscitate! CPR AED & Choking, developed by doctors and educators at the University of Washington, features short videos on how to perform CPR, operate commonly available Automated External Defibrillators (AEDs) and aid a choking victim.

New parents

BabyBump helps parents-to-be keep track of the stages of pregnancy, doctor’s appointments, and share their news on social networks when baby arrives; Sprout offers 3D images of baby’s growth by the week and advice on essential items needed for the newborn.

KidsDoc from the American Academy of Pediat- rics offers expert advice to help parents make smart decisions on level of care needed for their child’s illness or injury.

Please remember: an app, no matter how sophisticated or technologically advanced, cannot replace a phone call or visit to your personal physician.

Sources: Digitaltrends.com, Harvard Health, imedicalapps.com

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Gut Instincts: Can More Bacteria Mean Better Health?

Tue, 14 Mar 2017 15:20:00 GMT

Healthy bacteria may seem like a contradiction in terms, but years of research and real world experience point toward an unexpectedly promising finding: the microorganisms continually forming in your intestine may confer health benefits that we are only just beginning to understand.

Here is what we know: each of us has an individual set of microbes, collectively known as the microbiome, from the moment we are born, starting with our mother’s bacteria and then continuing to gather new microbes throughout our life as a result of environmental influences. Among these are probiotics, needed and beneficial bacteria which support the bacteria that live within us. Their numbers can become challenged by factors that include antibiotics, poor diet or travel. Scientific investigators are finding their impact on overall health can be significant. The chemicals they emit may interfere with the way food is digested, medicine is deployed, and even how a disease progresses, according to experts.

Research in the last decade on manipulating the microbes within has been varied and extensive, involving antibiotics, probiotics and prebiotics (dietary fibers that promote the growth and met- abolic activity of beneficial bacteria, including probiotics). The results of numerous studies suggest that certain types of probiotics may play a potential role in reducing gastrointestinal illnesses, including inflammatory bowel diseases, antibiotic-related and infectious diarrhea and irritable bowel syndrome. Additionally, the benefits of probiotics may extend into enhancing immune function. The idea that probiotics can improve the ability to fight off colds, promote a healthy urinary tract, reduce the risk of eczema, allergies and possibly Parkinson’s disease, in preliminary studies, has gained traction with nutritionists and gastrointestinal physicians alike.

As with all touted healthcare advancements, however, a note of caution should be sounded.

According to the American Gastroenterological Association (AGA) Institute, adding probiotics to your diet, especially in the form of a supplement, should only be done in consultation with your physician. Some probiotics may not be appropriate for seniors, others may interfere with or interact with medication. Not all strains are the same, and while a specific kind of Lactobacillus may help prevent an illness, that doesn’t necessarily mean that another kind of Lactobacillus would have the same effect or that Bifidobacterium probiotics would work. The same advice applies to adding prebiotic supple- ments to your diet. Although a great deal of research has been done, much remains to be learned. The encouraging news: gaining a comprehensive picture of the microbiome is a matter of intense interest to the medical community, and will be further advanced in 2017 by programs such as the government-funded $121 million National Microbiome initiative.

The best approach now? To promote intestinal health, make sure your diet includes foods that are good sources of fiber, probiotics and probiotics:

Did you know?

100 trillion
Number of bacterial cells in the human digestive tract
Source: International Scientific Association for Probiotics and Prebiotics

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Try a New Approach to Food in the New Year: Stop Dieting and Focus on Mindful Eating

Mon, 13 Mar 2017 21:05:00 GMT

The dieting-overeating-weight regain cycle is almost inevitable, not because people fail diets but because diets fail people. It is important to understand that rebound overeating happens to almost everybody, and should not be viewed as an individual weakness or fault. The main reason diets do not work over the long term is they create deprivation and promote a loss of the internal signals for hunger and fullness that are necessary for normal eating. In fact, dieting sets in motion physiological and psychological factors that actually trigger overeating.

How does mindful eating address the dieter’s dilemma?

Mindful eating begins when you ask: Do you know when you are hungry? Do you eat when you are hungry? Do you eat what you are hungry for? Do you stop when you are full? If you answered “yes,” you’re in tune with your body’s natural hunger signals. If you replied “no,” you may be out of touch with your true hunger needs.

How do you teach people to change their eating habits of a lifetime and adopt mindful eating?

It begins with learning how to identify your physical hunger. If you experience symptoms such as headaches, weakness, shakiness, irritability and lightheadedness, you may have waited too long to eat, and unfortunately, are now at high risk for overeating. Instead, look for an empty or gnawing feeling. The Hunger Scale above is a tool to help you evaluate your internal state. Ideally, you would stay in the range of ‘hungry’ to ‘full’ so you don’t become ravenous or stuffed. As you consistently ask yourself, “Am I hungry?” you will become better able to recognize your body’s needs.

The next step is deciding what to eat when you are physically hungry. When people eliminate categories of food in pursuit of weight loss, they frequently experience deprivation that ultimately leads to overeating the very foods they tried to avoid. Instead, think of what will truly satisfy you and supports your body as you make the match. Also take into consideration what will best support your body’s needs. For instance, those with high cholesterol might choose sorbet instead of ice cream if they are craving a cold, sweet snack. Consider not just taste, but feel – do you crave hot, cold, crunchy, smooth, salty, sweet, spicy, etc? If you eat what you are hungry for when you are hungry, you will find a moment when your stomach feels satisfied.

Is this process effective for most people?

Absolutely. The key is to be consistent and keep accumulating attuned eating experiences day in and day out.

Will I lose weight by becoming a mindful eater?

If weight loss occurs, it will be a side effect. However, I urge people to not use weight as a measure of success or failure. Health is so much more than just numbers on the scale, and a positive relationship with food along with a focus on physical activity, good sleep habits and regular medical care are much more important.

Did You Know?

33 – 66 Percentage of dieters that regain more weight than they lost on their diets

What is ‘mindful’ or ‘attuned’ eating?

Attuned eating teaches people to reconnect with their natural, inner signals that guide them as to when, what and how much to eat…literally bringing harmony into their relationship with food and allowing them to experience the real joy of eating. Mindfulness means bringing awareness to the experience without judgment or distraction. It is a transformative process that takes some time before people are able to honor their natural cues for hunger and satiety.

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The Mindful Diet: Words From Our Own Registered Dietician

Sun, 01 Jan 2017 20:59:08 GMT

Knowing the nutritional make-up of your diet is one thing, but have you ever thought about the psychology of what you eat? A new book combines both to help you lose weight and keep it off for life.

If you’ve ever overeaten, rushed your meal, eaten comfort or junk food, you’re not alone, but knowing each of these things isn’t good for you and figuring our why you do them could be the key to weight loss and a healthy life. Authors Ruth Wolever and Beth Reardon, both leading experts from Duke Integrative Medicine, spent 14 years researching The Mindful Diet, an innovative book that combines health psychology and nutrition.

While most of us have a fairly good idea of what we shouldn’t eat, it’s the ingrained unhealthy eating habits that hold us back from succeeding when it comes to making the right nutritional choices. As my co-author, Dr. Ruth Wolever reminds us; our culture is very externally focused. We respond to external cues to eat and look for external advice. Diets become a set of rules to follow with someone else telling us what to do. That can work for a short period of time, but we are likely to return to old eating habits unless we acknowledge the real reasons why we eat/overeat. That’s why many people will initially lose weight but then gradually regain or increase their weight over the long-term.

It’s a challenge that many yo-yo dieters experience repeatedly, but weight-loss success is far more likely to come from within than from others, believes Wolever. “Lots of people ignore their own bodies and internal wisdom,” she says. “It’s counterintuitive and leads to a disconnect between our mind and body. If we access the incredible power of our mind and appreciate what we have internally we improve both our mind and self-esteem.”

As the book’s title suggests, mindfulness is a powerful tool in changing our approach to food and affecting our behavior. Stress, unhappiness and unconscious beliefs are all likely contributors to unhealthy eating and so being in the moment and thinking about what and how we eat can make huge inroads to change.

Are Hotshots the End to Muscle Cramping?

Sun, 01 Jan 2017 20:55:20 GMT

Many athletes suffer from chronic muscle cramping. It affects people during exercise, rest, or even sleep and can have debilitating and painful effects on an athlete’s performance. In 2004, women’s marathon world record holder Paula Radcliffe of Great Britain was unable to complete the Olympic Marathon due to muscle cramping midway through the race. So if even elite athletes suffer from this common problem, how do we fix it?

The first step is to make sure that electrolyte and hydration levels are sufficient. The easiest way to cramp is by dehydrating a muscle or upsetting the electrolyte balance (ex. magnesium, sodium, potassium). The first remedy most people use for cramps is an electrolyte sports drink (Skratch) or potassium rich food (banana). But if the problem persists beyond that, there may be another solution. Acclaimed neuroscientist and Nobel Prize winner Dr. Rod MacKinnon claims to have discovered the key to preventing and curing cramps within the neuromuscular pathway. His research indicates that cramps are due to over excitation of nerves. These excited nerves signal the muscle to contract at a higher than normal rate, resulting in a cramp. This in mind, he and his research partner Bruce Bean developed a new product called Hotshots to prevent the nervous system from over firing. The active ingredients in the drink activate specific nerve channels to prevent neurons from becoming overexcited. MacKinnon claims that while using his product, cramps will never be an issue because they have been stopped at the neural source rather than the muscle.

The results of MacKinnon’s study are significant and the list of athlete testimonials is impressive. Many athletes have come forward as satisfied customers, ranging from casual weekend warriors suffering from cramps during races to five time Ironman World Champion Craig Alexander. If you find yourself struggling with muscle cramps, we recommend that you first work to balance your hydration and electrolyte intake as the temperatures continue to rise through the summer. If the problem persists, experimenting with Hotshots could benefit your daily exercise or performance in races.

The Zika Virus: Prevention is the First Line of Defense

Mon, 22 Aug 2016 19:48:00 GMT

As the Zika virus continues to make headlines daily, it is essential to know who is at risk, how it is transmitted and most importantly, to understand strategies for prevention. Following are the latest findings on Zika, according to experts at the Centers for Disease Control and the World Health Organization.

How does Zika spread?

Most people get Zika from a mosquito bite, but it can also be passed through sexual contact, blood transfusion or during pregnancy to a fetus. Zika is spread primarily by Aedes aegypti mosquitoes, which breed in areas with small pools of water, even as small as a coffee cup. When a mosquito bites a person with Zika, the virus travels from its gut to its salivary glands and is then injected into the next human it bites.

Who is at risk?

Almost no one is immune to the virus.

How serious is the Zika virus?

If Zika is transmitted to a fetus during pregnancy, it can cause microcephaly, a birth defect that is a sign of incomplete brain development. Babies with microcephaly have extremely small heads, and the nerves connecting the eyes and ears to the brain may be permanently damaged. Therefore, pregnant women should avoid traveling to destinations with outbreaks of the virus, and should take extra precautions to protect themselves from mosquito bites. In addition, current research links Guillain-Barre syndrome (GBS), an uncommon sickness of the nervous system in which a person’s own immune system damages the nerve cells, to Zika; however, only a small proportion of people with recent Zika virus infection get GBS.

What parts of the US is Zika most likely to reach?

The Aedes aegypti mosquito is most common in Florida and along the Gulf Coast, but can travel much farther north in summer. In July, the first cases of Zika caused by mosquitoes in the U.S. (versus those cases acquired by people who traveled outside the country) were reported in the Miami area; in August several more were reported in Miami Beach. However, the CDC indicates clusters of cases are to be expected and does not signal the virus is spreading throughout the state. Experts say Zika is not as likely to spread in the U.S. as it did in Central and South America, because our living conditions are very different (air conditioning, closed windows in the summer and use of window screens) and tracking and treatment of infections is more effective.

What are the symptoms of Zika virus?

The illness is usually mild, lasting about a week with symptoms that include fever, rash, joint pain and red eyes. Only one in five people infected with the virus exhibits symptoms.

What can I do to protect myself?

First, decrease your risk of being bitten by a mosquito:

Additionally:

How is it treated? Is there a vaccine?

Considerable progress is being made in the development of a vaccine, but none is available yet, and health experts warn that it may take years before one is commercially available. Treatment today focuses on relieving symptoms and includes rest, rehydration, and acetaminophen for fever and pain.

For more information, check our website for updates and/or visit http://www.cdc.gov/zika/whats-new.html

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Death of Former Patriot Ron Brace due to Preexisting Cardiac Condition

Sun, 24 Apr 2016 19:51:30 GMT

In April, former Patriot and long time Bostonian Ron Brace died due to heart failure at the age of 29. After autopsy, medical examiners listed Brace’s cause of death as an irregular heartbeat combined with a heart condition caused by high blood pressure. Examiners ruled out the possibility of heart attack, as was assumed before the autopsy. Brace, six foot six and 330 pounds, was drafted in 2009 to the Patriots as a defensive lineman after a successful career at Boston College. He played 39 games over four seasons with the Patriots before retiring.

We at the Lown Group are deeply saddened by Brace’s story. Heart failure should not be a problem at age 29, and it represents a core issue in athletics. Many athletes are not given the testing and protection that they need to maintain their health because the focus and priority is performance. Coaches and physicians often assume that the athlete’s heart is healthy and functional because they are such active people. However, the body and heart respond to physical and neurological stress with the same response, and the repeated and constant workload of professional athletics can push a weakened heart past its boundaries. This is an area of opportunity for protection in athletics in the form of ECG Stress Exercise and Echocardiogram tests for athletes. With baseline testing, coaches and athletes would be aware of preexisting conditions and possible risk associated with high volume training. With our new Sports cardiology program, we hope to protect athletes with noninvasive testing and careful guidance from one of our cardiologists to prevent injury and cardiac events.