There’s a Reason Why You’re Feeling SAD

, , , , , , , , , Environment, Health Basics, Healthy Living, Lifestyle, News, Preventative Health

If you’ve been feeling down, sleepy, or hopeless, even with all the holiday merriment going on around you, our primary care concierge doctors in Jupiter want you to know you’re not alone. Health experts estimate that seasonal affective disorder (SAD), or the “winter blues,” affects about five percent of the U.S. population.

SAD is more than just the “winter blues,” according to the American Psychiatric Association (APA). The symptoms can be distressing and overwhelming, and can interfere with daily functioning, the APA reports. 

Affecting more than 10 million Americans, symptoms of the condition usually begin in October or November and begin to subside in March or April. However, some patients don’t feel fully back to normal until early May.

SAD may begin at any age, but it typically starts when a person is between the ages of 18 and 30 and seems to affect women more than men.

Symptoms

The APA lists the following symptoms associated with SAD:

  • fatigue, even with excessive amounts of sleep
  • weight gain associated with overeating and carbohydrate cravings
  • feelings of sadness or depressed mood
  • marked loss of interest or pleasure in activities once enjoyed
  • loss of energy
  • an increase in restless activity (e.g., hand-wringing or pacing)
  • slowed movements and speech
  • feeling worthless or guilty
  • trouble concentrating or making decisions
  • thoughts of death or suicide or attempts at suicide.

The severity of such symptoms can vary from person to person, and not everyone will experience all these symptoms.

Likely Causes

While no one is certain what causes SAD, the lower amounts of sunlight in fall and winter are believed to lead to a biochemical imbalance in the brain, impacting the body’s circadian clock, which triggers sleep and wake cycles.

This process affects the output of serotonin, the so-called “mood” hormone. Studies have shown that the circadian-related output of serotonin drops markedly with the decrease in light during the winter. It also increases the level of melatonin, a hormone secreted by the pineal gland that regulates the sleep cycle.

The cause of SAD may have an ancient survival connection, as humans learned to restrict activity when food sources were scarce. The tendency may still be hardwired into our biology, and people can experience symptoms on a sliding scale from barely noticeable to full-blown clinical depression.

Risk factors include a family history of SAD or another form of depression, having major depression or bipolar disorder, and having lower levels of vitamin D. Vitamin D is believed to promote serotonin production.

Treatment

SAD can be effectively treated in a number of ways, including through the use of light-box therapy, which employs specially built full-spectrum lamps to alleviate symptoms. The NIMH reports that this type of therapy has been a mainstay for treating SAD since the 1980s.

In this treatment, a person sits in front of a very bright lightbox (10,000 lux) every day for about 30 to 45 minutes, usually first thing in the morning, from fall to spring. The light boxes, which are about 20 times brighter than ordinary indoor light, filter out the potentially damaging UV light, making this treatment safe for most people.

However, those with certain eye diseases or people taking certain medications that increase their sensitivity to sunlight might need other treatment types.

Other approaches include the use of antidepressants such as Paxil and Prozac, or cognitive behavioral therapy (CBT), a type of talk therapy aimed at helping individuals learn how to cope with difficult situations. In addition, the U.S. Food and Drug Administration (FDA) has also approved another type of antidepressant specifically for SAD: bupropion. In extended-release form, it is taken daily from fall to spring to prevent major depressive episodes.

Self-care

Meanwhile, there are steps you can take to help mitigate milder cases.

1. Stay active outdoors

Exposure to early morning light has been shown to be the most effective at reducing symptoms, as has regular exercise. An early morning walk or run might be all you need to help alleviate your symptoms.

2. Let in the light

If you can’t get outside, at least let the sunshine in as much as possible. Open blinds and drapes first thing in the morning, and keep them open all day. If you can, arrange your home or office so you’re exposed to as much sunlight as possible during the day (but remember that the sun’s harmful UV rays can penetrate glass, so use sunscreen if you’re actually sitting in the sun all day).

3. Eat right

Simple carbs and sugars wreak havoc with your blood sugar, thereby affecting your mood. Lean meats, fruits, vegetables, nuts, and complex carbohydrates will help to keep your brain functioning properly.

4. Take it easy

Don’t try to do too much, which can add to feelings of being overwhelmed. Do what you can, and postpone the rest, or ask friends and family for help with your to-do list.

5. Stay connected

Studies have shown that connecting with others helps improve mood: volunteering, getting together with friends and family, and participating in group activities, are some possibilities.

If your symptoms are interfering with your daily life, let us know. We can help evaluate your symptoms and recommend the right therapy.

Are You Sick? How to Tell Which Virus You Have

, , , , , , COVID, Disease, Health Basics, Preventative Health, Vaccinations

As most of us have shed our pandemic masks in favor of returning to less restricted socializing, some of the viruses we didn’t have to deal with for the last two winters have resurfaced—with a vengeance.

According to the Centers for Disease Control and Prevention (CDC), seasonal flu activity is “elevated across the country.” The respiratory virus RSV is 10 times higher than normal, and more than 40,000 new cases of COVID-19 are being reported daily.

So if you’re sick, our concierge primary care doctors in Jupiter want to help you figure out which of these highly contagious viruses may be causing your symptoms, and what to do about them.

The ‘Tripledemic’

The flu season began six weeks earlier than normal this year, with at least 880,000 reported cases as of the end of October, including 6,900 hospitalizations and 360 flu-related deaths. This is the highest number recorded since the 2009 H1N1 swine flu pandemic.

“The Southern Hemisphere has had a pretty bad flu season, and it came on early [there],” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Bloomberg News. So officials weren’t especially surprised when it hit early and hard here, too.

At the same time, the respiratory syncytial virus, or RSV, has been flooding children’s hospitals with cases. And while the media’s attention has largely been focused on children, RSV can also hit older adults and those who are immunocompromised.

Meanwhile, COVID-19 cases have leveled off, but as of the end of November, the CDC was reporting 281,000 new cases and 2,222 deaths a week, with cases expected to rise this winter.

And, of course, without universal masking, colds are also making a comeback. To make matters worse, it is possible to be infected with more than one virus at the same time.

Similar Symptoms

With all these viruses hitting at once, it’s doubly difficult to know which one you have, because all of them have overlapping symptoms.

“At this stage of the pandemic, it’s really difficult to differentiate between the flu, COVID, common colds, and even seasonal allergies,” Céline Gounder, an infectious disease specialist, epidemiologist, and senior fellow at the Kaiser Family Foundation, told CNBC’s Make It.

“I, even as an infectious disease specialist who’s been practicing for a couple of decades now, cannot differentiate just on an exam,” she said. “You really need to do a test.”

Early on, it was easier to tell the difference at least at least with COVID-19, because of such distinctive symptoms as loss of smell and taste and red eyes or toes. But Gounder explained that because most people now have some degree of immunity, either through vaccination or infection or both, our bodies aren’t reacting the same way. Second, the newer variants are behaving differently than the original strain.

Ways to Tell

It helps to know which virus you have because they are not treated the same. With COVID-19, you can receive antiviral therapies, which can short-circuit the severity of the illness. But the antiviral treatments you can get for the flu are different.

As for RSV, Vandana Madhavan, clinical director of Pediatric Infectious Disease at Mass General for Children, told HuffPost that doctor’s offices are overrun right now, and if you bring your child in for mild symptoms that might otherwise get better at home, there’s a risk they could pick up something else while they’re there.

So how do you tell? As Gounder pointed out, there’s no way to know for sure, but here are some typical symptoms of each.

Common cold:

  • sore throat
  • runny or stuffy nose
  • coughing
  • sneezing
  • headaches
  • body aches

Flu:

  • sore throat
  • runny or stuffy nose
  • muscle/body aches
  • cough
  • fever or chills
  • headache
  • fatigue

COVID-19:

  • sore throat
  • runny or stuffy nose
  • muscle/body aches
  • cough
  • fever or chills
  • headache
  • fatigue
  • diarrhea
  • nausea/vomiting
  • difficulty breathing or shortness of breath

The CDC notes that this list does not include all possible symptoms. Symptoms may change with new COVID-19 variants and can vary depending on vaccination status.

RSV:

  • runny nose
  • decrease in appetite
  • coughing
  • sneezing
  • fever
  • wheezing

The CDC reports that these symptoms usually appear in stages and not all at once. In very young children with RSV, the only symptoms may be irritability, decreased activity, and breathing difficulties. Almost all children will have had an RSV infection by their second birthday.

What To Do

With any type of respiratory virus, it’s important to keep from spreading the virus to others, especially those who may be immunocompromised or are otherwise at higher risk. There are tests for COVID-19 and the flu, but not for the common cold or RSV.

Stay home if you are sick and get in touch with us if you have any questions.

Call 911 if you see any signs of an emergency, especially with COVID-19, including:

  • trouble breathing
  • persistent pain or pressure in the chest
  • new confusion
  • inability to wake or stay awake
  • pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone
  • if you think it may be an emergency

As the number of cases of all these viruses rise, it’s smart to take precautions. Wear a mask in crowded, poorly ventilated places, wash your hands frequently, eat well, and get plenty of sleep. 

And get your flu vaccine and a COVID-19 booster if you haven’t had one recently (there is no vaccine for RSV or the common cold).

Study Finds Reliable—and Drug-Free—Treatment for Anxiety

Health Basics, Healthy Living, Preventative Health

There’s no doubt that the last three or so years have raised anxiety levels among all of us. But anxiety disorders are more than just the normal reaction to stress. They are persistent feelings of fear or anxiety that regularly interfere with a person’s life.

According to the National Institutes of Mental Health (NIMH), nearly 40 million Americans—or about 18 percent of us—are currently living with a diagnosable anxiety disorder.

That’s why our primary care concierge doctors in Jupiter were so pleased to learn about a study released this month, which found that mindfulness is just as effective at treating anxiety disorders as commonly prescribed medication.

What are Anxiety Disorders?

According to NIMH, anxiety disorders fall into five primary types:

Generalized Anxiety Disorder (GAD) is characterized by chronic anxiety, and exaggerated worry and tension, even when there is little or nothing to provoke it.

Obsessive-Compulsive Disorder (OCD) is characterized by recurrent, unwanted thoughts (i.e., obsessions) and/or repetitive behaviors (compulsions) such as hand washing, counting, checking, or cleaning.

Panic Disorder is characterized by unexpected and repeated episodes of intense fear when there is no obvious reason for it, accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened.

Social Phobia (or Social Anxiety Disorder) is characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. 

It is also possible to have more than one anxiety disorder at the same time.

Anxiety disorders are so common that this month the U.S. Preventive Services Task Force (USPSTF) recommended that doctors screen all adults under the age of 65 for such issues. The task force estimates that anxiety disorders affect as many as 40 percent of women and 25 percent of men at some point in their lives.

Drug-Free help

Those who suffer from anxiety disorders are often desperate for relief. The standard treatment involves the use of anti-anxiety drugs such as Lexapro and cognitive behavioral therapy.

Now, a study published this month in the journal JAMA Psychiatry found that eight weeks of intensive instruction in the practice of mindfulness meditation worked as well as Lexapro at reducing anxiety. That is, both groups showed about a 20 percent reduction in the severity of their anxiety.

Mindfulness is a type of meditation popularized more than 40 years ago by Jon Kabat-Zinn, in which practitioners learn to focus fully on what’s happening at the moment, as opposed to ruminating over the past or worrying about what might happen in the future.

The practice typically begins with breathing exercises, and full-body scans for relaxation, then learning how to let go of intrusive thoughts.

Instead of stressing over a particular thought, “you say, ‘I’m having this thought, let that go for now,’ ” lead study author Elizabeth Hoge, director of Georgetown University’s Anxiety Disorders Research Program, told Consumer Reports (CR).

“It changes the relationship people have with their own thoughts when not meditating,” she said.

The Time Issue

Critics have raised concerns with the length of time it takes not only to learn the new skill, but also the time commitment it requires.

“Telling people who are that overworked they should spend 45 minutes a day meditating is the ‘Let them eat cake’ of psychotherapy,” Joseph Arpaia, an Oregon-based psychiatrist specializing in mindfulness and meditation, wrote in an op-ed in JAMA accompanying the new study.

He says he’s found less lengthy approaches to using mindfulness to treat anxiety, including a technique he calls the “one-breath reset” to help patients become less anxious.

But Hoge told CNN that she hopes her study prods insurance companies to pay for mindfulness training.

“Usually, insurance companies are willing to pay for something when there’s research supporting its use,” she said.

“If they know it’s just as effective as the drug which they do pay for, why don’t they pay for this, too?”

Drug vs. Drug-free?

Another issue raised by Joy Harden Bradford, a psychologist in Atlanta who hosts the podcast Therapy for Black Girls, is the question of medication vs. meditation.

“The thing I would hate to have to happen is for people to pit medication against the mindfulness-based resources,” she told NPR, adding that someone with panic attacks might have a quicker reduction in symptoms with Lexapro than with waiting weeks before they fully absorb the mindfulness practices.

It’s worth noting, however, that Lexapro, like other anti-depressant drugs such as Paxil and Prozac, can take several weeks before serotonin levels in the brain begin to normalize. There’s also the issue of side effects, which are associated with any medication.

CR reports that 10 patients in the 200-participant study who were taking Lexapro dropped out due to the side effects they experienced, including insomnia, nausea, and fatigue. None of those in the mindfulness group dropped out because of side effects, although 13 patients reported increased anxiety.

Hoge told CNN that her study showed that meditation could be prescribed as an alternative for those who experience severe side effects from medication.

“Lexapro is a great drug,” she said. “I prescribe it a lot. But it’s not for everyone.”

Even Arpaia agreed in principle.

“It’s always interesting to see meditation work, and it works as well as medication,” he said.

How and Why to Steer Clear of Ultra-Processed Foods

, , Health Basics, Healthy Living, Lifestyle, Nutrition

Our concierge primary care doctors in Jupiter often suggest you consume healthy foods and avoid processed and ultra-processed foods. In the real world, of course, we know how difficult that is to do.

The question is, why? Why have ultra-processed foods come to dominate 60 percent of the American diet?

Ultra-processed foods are quick and convenient, for one thing, and for another, there’s no denying that, for the most part, these foods taste good. From frozen dinners, cookies, and cakes, to fast-food burgers and chicken, fried foods, deli meats, and sodas, many of us not only can’t quit them, but we also don’t want to.

And we convince ourselves that processed foods aren’t really all that bad for us. On that last point, we have to disagree. The one thing we know for sure is that processed and ultra-processed foods can trigger numerous health concerns.

What the Studies Say

For example, one study of more than 22,000 adults published this year in the journal BMJ found that subjects who consumed more ultra-processed foods had a 19 percent higher likelihood of early death and a 32 percent higher risk of dying from heart disease than those who ate fewer ultra-processed foods.

Another 2019 study published in BMJ followed more than 100,000 adults in France for five years. They found that those who ate the most processed foods were 23 percent more likely to experience a heart condition or stroke than those who consumed the lowest amounts.

A third study, also published in BMJ, tracked 20,000 Spanish adults over 20 years. Those who ate the most processed foods were 62 percent more likely to die during the study period than those who ate the lowest.

Other studies have linked processed and ultra-processed foods to a higher risk for colon cancer, type 2 diabetes, obesity, and heart disease.

How are Foods Classified?

Researchers classify foods into roughly three categories:

“Unprocessed or minimally processed” foods include fruits, vegetables, milk, eggs, legumes, meats, poultry, fish and seafood, yogurt, white rice and pasta, and natural juices (some classification systems divide these into two categories).

“Processed” foods include cheeses, bread, beer, wine, ham, and bacon.

“Ultra-processed” foods include potato chips, pizza, cookies, chorizo, sausages, mayonnaise, chocolates and candies, and artificially sweetened beverages.

They also created a separate category called “processed ingredients,” which includes salt, sugar, honey, olive oil, butter, and lard.

What’s Wrong with Processing?

The big mystery is why foods that are so convenient and taste so good are so bad for us. The problem seems to come from the processing itself, which changes foods from their natural state.

These tend to be high in poor-quality fats, additional sugar, salt, and chemical preservatives, and low in vitamins and fiber. The common factor can be summed up in the phrase “convenience foods”; that is, foods that are quick and easy to prepare at home or grab at a drive-through.

Some researchers believe that changing foods from their natural state leads to inflammation throughout the body, which puts us at risk for a host of diseases.

“Some of the foods that have been associated with an increased risk for chronic diseases such as type 2 diabetes and heart disease are also associated with excess inflammation,” Dr. Frank Hu, professor of nutrition and epidemiology in the Department of Nutrition at the Harvard School of Public Health, told Harvard Health Publishing.

“It’s not surprising, since inflammation is an important underlying mechanism for the development of these diseases,” he said.

How to Break the Addiction

Asking you to give up all these delicious foods might seem as if we’re condemning you to a life of bland, tasteless meals. But that’s because Big Food has spent billions of dollars getting you addicted to all its additives.

In addition, these ultra-processed foods leave our bodies so depleted of nutrients that we keep eating more and more to try to make up the shortfall, not unlike Star Trek’s famous tribbles, which “starved to death in a storage compartment full of grain.”

The fact is, humans have been eating non- or minimally processed food for millennia. When your taste buds reacclimate themselves to the real thing, you’ll be surprised how sweet a carrot can be, or how a locally grown tomato is bursting with tangy flavor.

Finally, when you begin eating better, you’ll likely begin sleeping better, looking younger, have more energy, and many of the aches and pains you thought you’d just have to live with may begin to decrease or disappear altogether.

Take it Easy

All this will make you want to keep on this new path, and eventually, you’ll lose your taste for processed and ultra-processed foods. When you’ve been eating lower- or no-salt foods for a while, for example, then dip into a package of potato chips, you’ll think the contents are half potatoes and half salt.

The key is to withdraw from these addictive substances gradually. Substitute french fries for sweet potato chips you’ve baked yourself, for instance, or swap out soda for water occasionally.

Shop the store’s perimeter as much as possible, where they keep the fruits and vegetables and fresh meat and seafood.

If you must visit a fast-food restaurant, opt for salads or baked chicken sandwiches if they offer them.

Finally, don’t agonize over everything you eat. Stress is bad for you, too. Simply prefer fresh food over processed as often as possible.

One Way to Boost COVID-19 Vaccine Effectiveness: Exercise

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If you need another excuse to slip on your running shoes and head outdoors, our concierge primary care doctors in Jupiter have a good one for you: Exercise can increase the effectiveness of coronavirus vaccines.

That’s according to a large study published last month in the British Journal of Sports Medicine. Researchers found that fully vaccinated study participants who logged high levels of physical activity were nearly three times less likely to be admitted to the hospital than those who were vaccinated but had lower levels of physical activity.

Even those with lower levels of physical activity saw a benefit.

This confirms an earlier study conducted last winter, showing that even a single 90-minute session of aerobic exercise could increase antibodies in those who had just been vaccinated.

The New Study

Researchers in Johannesburg, South Africa reviewed anonymous medical records, gym visits, and wearable activity-tracker data for nearly 200,000 fully vaccinated healthcare workers between February and October of 2021. (The Johnson & Johnson vaccine was the only one available to the population at the time.)

Participants were categorized according to their average recorded activity levels over the previous two years. Those with the highest weekly levels of physical activity (150 minutes or more per week) were 86 percent less likely to be admitted to the hospital after testing positive for COVID-19 than participants with a low level of physical activity (less than 60 minutes per week).

But even those in the medium and low categories of physical activity saw some benefit, compared to the sedentary group. The medium-level exercisers (60 to 149 minutes per week) were 72 percent less likely to be hospitalized, while with the low-level exercisers (less than 60 minutes per week) the risk of needing hospitalization fell by 60 percent as opposed to those who never exercised.

“The findings suggest a possible dose-response where high levels of physical activity were associated with higher vaccine effectiveness,” the researchers said in a press release.

“This substantiates the [World Health Organization] recommendations for regular physical activity—namely, that 150-300 minutes of moderate-intensity physical activity per week have meaningful health benefits in preventing severe disease, in this context against a communicable viral infection,” they wrote.

Prior Research

This large study confirms an earlier one published last February in the journal Brain, Behavior, and Immunity, which found that even a single 90-minute session of exercise could boost the immune response in those who had just received the flu or COVID-19 vaccine.

The study also found that 45 minutes of exercise did not increase antibodies, making 90 minutes the preferred target to see results.

“As far as we know, our findings are the first of their kind for evaluating exercise response on the COVID-19 vaccine,” Marian Kohut, Ph.D., a professor of kinesiology at Iowa lead researcher, told Medical News Today at the time.

“[They are] the first to show that light [to moderate] intensity, long-duration exercise enhances antibody response for the COVID-19 vaccine,” she said.

The Exercise Dividend

Even before vaccines became available, however, numerous studies showed that being physically active substantially lowered the risk of becoming seriously ill or needing hospitalization following infection with the coronavirus.

Robert Sallis, a family, and sports medicine doctor at the Kaiser Permanente Fontana Medical Center in California and former president of the American College of Sports Medicine, led a 2021 study of 48,440 adults before vaccines became available.

This research found that physical inactivity was associated with a higher risk for severe COVID-19 outcomes, including hospitalization rates, intensive care unit (ICU) admissions, and death. Those who were engaging in some activity, or regularly meeting physical activity guidelines, were about half as likely to need hospitalization as patients who were mainly inactive.

An earlier review of 16 prior studies involving nearly two million people likewise found that those who were physically active were far less likely to experience adverse outcomes from the virus.

Sallis told The Washington Post that these findings make sense because we know “that immune function improves with regular physical activity,” as do lung health and inflammation levels, which have been proven to protect against the worst effects of COVID-19.

Free Medicine

No one is sure of the reasons for these results. One theory suggests that exercise boosts blood and lymph flow, promoting the circulation of immune cells. The researchers involved in the South African study wrote that it “may be a combination of enhanced antibody levels, improved T-cell immunosurveillance, and psychosocial factors.” 

The Centers for Disease Control and Prevention (CDC) maintains that physical activity can improve overall mental and physical health, and reduce the risk of many chronic diseases such as heart disease, cancer, and type 2 diabetes. One 2008 study found that physical inactivity is responsible for more than five million premature deaths every year.

So it makes sense that regular physical activity would confer benefits to our immune system.

And it’s never too late to get moving, even with just a 10-minute walk, according to Jon Patricios, a professor of clinical medicine and health sciences at the University of Witwatersrand in Johannesburg-Braamfontein, who oversaw the new study.

“Doing something mattered, even if people weren’t meeting the full guidelines,” he told The Post.

“It’s an idea we call ‘small steps, strong shield,’ ” he said. “Plus, you don’t need a prescription, and it’s free.”

sleep-disorders

Health Risks Associated with Lack of Sleep

Health Basics, Healthy Living, Lifestyle

If you have a hectic family life, a busy career, or both, it’s easy to push sleep to the back burner, telling yourself you’ll catch up “later.”

But that hour of sleep you gained last weekend as we switched from daylight saving time to standard time doesn’t begin to make up for the shortfall. For optimal health, you need a good night’s sleep every night.

If you sleep fewer than the recommended seven to eight hours every night, should you lie awake worrying about it? Our primary care concierge doctors in Jupiter certainly hope not.

But we think it’s important to remind our patients that adequate sleep on a regular basis is essential to good health, and now a new study seems to show why.

Consequences to Health

The health issues associated with lack of sufficient sleep affect every part of the body and can trigger numerous diseases: obesity, type 2 diabetes, cancer, cardiovascular disease, dementia, depression . . . even a shorter lifespan overall.

For years, science has known that insufficient sleep leads to these and other diseases, but no one was sure why.

Now a study published in September in the Journal of Experimental Medicine has linked lack of sleep to inflammation, a condition that can result in long-term damage throughout the body.

The study by researchers at the Icahn School of Medicine at Mount Sinai in New York City showed that chronic sleep deprivation in healthy adults increased the production of immune cells linked to inflammation, while at the same time changing the immune cells’ DNA to impair their protective abilities.

“Not only were the number of immune cells elevated but they may be wired and programmed in a different way at the end of the six weeks of sleep deprivation,” said study co-author Cameron McAlpine, an assistant professor of cardiology and neuroscience at Mount Sinai.

“Together, these two factors could potentially predispose someone for diseases like cardiovascular disease,” he said.

The Study

Although small, the study was carefully crafted to measure the effects of restricted sleep on a group of 14 healthy men and women, of average age 35, who normally sleep eight hours a night. The researchers checked the immune cell content of the volunteers’ blood over the course of six weeks, as their sleep time was reduced from their normal eight hours to 90 minutes less during the study.

They found that during the period of sleep restriction, the volunteers’ immune cells increased, suggesting an increase in inflammation as a result. Furthermore, the stem cells which create new immune cells appeared to be permanently damaged over the study period.

“The key message from this study is that sleep lessens inflammation and loss of sleep increases inflammation,” said study co-author Filip Swirski, director of the Cardiovascular Research Institute at Icahn Mount Sinai.

“In subjects who had undergone sleep restriction, the number of immune cells circulating in the blood was higher. These cells are key players in inflammation,” he added.

Long-term Damage

One researcher who was not involved in the study, Kristen Knutson, an associate professor at the Center for Circadian and Sleep Medicine at the Northwestern Feinberg School of Medicine, called this new study’s design “elegant.” 

While many studies of this type are restricted to one or two nights of sleep deprivation, this one lasted much longer. Moreover, it was conducted on healthy adults, who were monitored in a clinical setting, rather than relying on self-reporting of sleep duration.

“They emphasized the long-term effects of sleep impairment that we don’t quickly recover from and they showed this in both animal and human studies,” Knutson told NBC News.

Another doctor who also was not involved in the study agreed. Stephen Chan, director of the Vascular Medicine Institute at the University of Pittsburgh School of Medicine, told NBC News that this new study explains how chronic lack of sleep could weaken the immune system.

“We fundamentally did not understand why at the cellular level, sleep was so important in the control of the immune system [prior to this study],” he said.

“It’s really important to understand how sleep might impact inflammatory diseases like sepsis, cardiovascular disease, Alzheimer’s, and dementia,” he explained.

Prioritizing Sleep

Although we need a certain amount of inflammation in the body to recover from injuries or illness, too much over a long period of time causes damage throughout the body and can lead to chronic disease.

And Swirski explained that, although the increase in immune cells may return to normal after a few weeks of adequate sleep, their study showed that the damage to the stem cells may be more permanent, impairing their ability over time to perform well.

As we said earlier, we don’t want to make you so nervous about missing a bit of sleep that you lie there staring at the clock every night and worrying.

But we do want to emphasize the importance of making sleep a priority in your schedule.

And to help you sleep better, you should:

  • Go to bed at the same time every night.
  • Don’t try to sleep on a full stomach.
  • Refrain from using caffeine or alcohol after dinner.
  • Turn off “blue-light” devices (TVs, computers, smartphones) at least an hour before bedtime.
  • Restrict activity in the bed to sex and sleep (i.e., no working, reading, TV, etc.).

Let us know if you have any difficulty falling asleep or staying asleep. We can help uncover the causes and provide solutions.

running

Does Running Really Ruin Your Knees?

Health Basics, Healthy Living, Lifestyle, Preventative Health, Sports

Our primary care concierge doctors in Jupiter have heard it for years: “I don’t run because I don’t want to wreck my knees.” Intuitively, that makes sense. The argument goes something like this: When you run, each time the foot hits the ground, the body experiences a force equal to eight times body weight, and that will eventually cause osteoarthritis.

The good news is that study after study confirms that’s not the case; in fact, the opposite appears to be true: regular running actually strengthens cartilage, according to experts.

Counterintuitive Findings

One 2020 Stanford University study on the effect of running on knees found that for young, healthy individuals, such exercise appears to trigger an anti-inflammatory reaction in the joints.

“In fact, a normally functioning joint can withstand and actually flourish under a lot of wear,” the study’s lead researcher, James Fries, told Time magazine. Fries is a professor emeritus of medicine at Stanford.

He explained that cartilage—the soft connective tissue that surrounds the bones in joints—doesn’t contain arteries that deliver blood along with its rejuvenating dose of oxygen and nutrients. As a result, cartilage depends on movement to obtain needed nourishment.

“When you bear weight,” he said, “[the joint] squishes out fluid, and when you release weight, it sucks in fluid,” thereby delivering the nutrients necessary to build new cartilage.

What Other Research Says

Studies on this issue go back decades. For example, in 1971, researchers began to look at the children and spouses of the famous Framingham, Mass., Heart Study. Called the Framingham Offspring Cohort, 1,279 volunteers enrolled in a study of exercise and arthritis. The results of the study showed no link between jogging and arthritis.

The results of other studies went even further, appearing to actually show improvement in runners’ knees from their avocation, as the Stanford study found.

A 2008 Australian study found that subjects who engaged in vigorous exercise had knee cartilage that was thicker and healthier than those who didn’t exercise routinely.

In another study, published in the Journal of Orthopedic and Sports Physical Therapy in 2017, 10 percent of those who weren’t runners developed osteoarthritis in their knees or hips over the course of the study, while only 3.5 percent of runners did so.

Again echoing the Stanford results, another 2017 study, published in the European Journal of Applied Physiology, found that running decreased inflammation in the knees of study subjects, suggesting that running was a kind of medicine for those who were experiencing knee pain.

Overall Health Benefits

And running, along with other vigorous aerobic activities, provides whole-body benefits not confined just to the knees.

One study published in JAMA in 2008 followed members of a running club, comparing them with healthy non-runners, all of whom were over 50 at the beginning of the study. After 21 years, the researchers found that more of the runners than non-runners were still alive, as well as reported much less disability than those in the non-running group.

Another study confirming the health benefits of aerobic exercise such as running was published last month in the journal JAMA Network Open, conducted by the Division of Nutrition, Physical Activity, and Obesity at the Centers for Disease Control and Prevention (CDC).

Researchers found that doing between 10 and 300 minutes of aerobic exercise a week was associated with a 24 percent lower risk of death from any cause than exercising less than 10 minutes a week.

Another 2018 study, published in JAMA, produced similar results. Researchers investigated 122,007 former patients at Cleveland Clinic who were tested on a treadmill between January 1, 1991 and December 31, 2014. They found that those with the lowest level of fitness, i.e., a sedentary lifestyle, had a risk of death almost 500 percent higher than those who were the most physically fit.

Some Cautions

Does this mean everyone should lace up their sneakers and head for the trails? Not necessarily.

Mark Harrast, medical director of the Sports Medicine Center at the University of Washington, told HuffPost that running could cause damage in the knees of people who have already experienced trauma to knee cartilage.

“If you have cartilage damage from an injury, such as skiing, a torn meniscus, or a blown-out ACL, and if you run regularly and overuse it, that’s a set-up for arthritis,” he said.

Other reasons you might not want to take up running include having a family history of arthritis, or being overweight or over the age of 50.

Running, even for young, healthy people, though, is not without some risks, including the possibility of stress fractures and soft-tissue injuries. But with sensible safeguards, these issues can generally be prevented. 

Precautions include wearing a proper pair of running shoes, matched to your gait and foot size.

In addition, before you begin each run, always warm up with long, slow stretches to get the blood flowing. 

As with any form of exercise, you need to build up to full speed gradually. And have any pain you experience evaluated early to prevent further injury.

As long as you pace yourself and take it easy, there’s no reason you can’t enjoy the proven health benefits and euphoria of the “runner’s high.” Just be sure to check with us if you’re just starting out.

BREAST CANCER

What to Know During Breast Cancer Awareness Month

Breast Cancer, Cancer, Disease, Preventative Health

Long-time cancer-screening activist Katie Couric, 65, announced last month that she’d been treated for breast cancer. Within days came the news that WNBA star Tiffany Jackson had died of the disease at age 37.

These two stories help to highlight Breast Cancer Awareness Month in October, both the importance of screening and the fact that even young women can this deadly disease.

So our primary care concierge doctors in Jupiter want to offer you some facts you may not have known about breast cancer and what to look out for.

Some Little-known Facts

  • Breast cancer is the most common form of cancer in women in the U.S., except for skin cancers, according to the American Cancer Society (ACS). And contrary to common belief, 85 percent of American women who are diagnosed have no family history of the disease.
  • This year, about 287,850 new cases of invasive breast cancer will be diagnosed in women, with about 51,400 of those being ductal carcinoma in situ (DCIS). Nearly all women with this early stage of breast cancer can be cured.
  • About 43,250 women will die from breast cancer.
  • But it’s not just women. The ACS reports that in 2022, about 2,710 new cases of invasive breast cancer will be diagnosed in men, and about 530 of them will die from it.
  • And Yale Medicine reports that breast cancer is the most common form of cancer in women ages 15-39.

Screening Guidelines Vary

Although different organizations offer different guidelines for cancer screening, in general, regular cancer screening can catch cancer before someone has symptoms. This allows a small, localized area to be removed, hopefully before it can spread.

The U.S. Preventive Services Task Force (USPSTF), for example, recommends mammography screenings every two years (biennial) for women ages 50 to 74 years, while the ACS recommends such screenings annually for women ages 50 to 54 and every other year after that.

As for the standard clinical breast exam, the International Agency for Research on Cancer (IARC) states: “There is inadequate evidence that clinical breast examination reduces breast cancer mortality.” The American College of Physicians agrees. Even the ACS doesn’t recommend clinical examination to screen for breast cancer, preferring to emphasize mammography as the preferred method of detection.

The American College of Obstetricians and Gynecologists (ACOG) says, “Decisions between screening with mammography once a year or once every two years should be made through shared decision-making after appropriate counseling.” In other words, the benefits of annual mammography for those with average risk haven’t been firmly established, so it’s up to the woman and her doctor to decide on the frequency.

Different Outcomes

Katie Couric co-founded the organization Stand Up to Cancer after the death of her first husband, Jay Monahan, from colon cancer, so she was an advocate for regular cancer screenings. Still, her diagnosis stunned her.

Couric told CNN that she went for a mammogram in the summer, which found her breast cancer.

“I think those words, ‘It’s cancerous or you have cancer’ do stop you in your tracks,” she said. But her doctor told her it was treatable, so she underwent a lumpectomy in July, followed by radiation.

Unfortunately, as in the case of Tiffany Jackson, breast cancer is more likely to be found at a later stage among women under the age of 45, and is often more aggressive and difficult to treat.

She was originally diagnosed with stage three breast cancer in 2015 and thought her treatment had been successful.

But studies show that women who are first diagnosed before age 35 have between a 13-38 percent risk of recurrence that spreads to other parts of the body, while in women ages 50 and over, that risk is between 4-29 percent.

What To Do

Besides having the recommended mammographies, for both men and women of all ages, it’s important to know the risk factors for the disease as well as the early signs.

Risk factors include:

  • getting older
  • having dense breasts
  • a family history
  • hormonal changes
  • excess alcohol consumption
  • environmental factors, including exposure to radiation
  • obesity and overweight
  • beginning periods before age 12 and menopause after age 55
  • becoming pregnant at an older age or never being pregnant
  • taking hormones, including birth control pills and hormone replacement therapy
  • physical inactivity
  • night-shift work
  • smoking

It’s important to become familiar with your breasts, so you’ll know what symptoms to look for.

Warning signs include:

  • new lump in the breast or underarm (armpit)
  • thickening or swelling of part of the breast
  • irritation or dimpling of breast skin
  • redness or flaky skin in the nipple area or the breast
  • pulling in of the nipple or pain in the nipple area
  • nipple discharge other than breast milk, including blood
  • any change in the size or shape of the breast
  • pain in any area of the breast

The CDC cautions, “Keep in mind that these symptoms can happen with other conditions that are not cancer,” so don’t panic if you see any of them. But do contact us right away if you do see such changes.

Remember, the sooner breast cancer is caught, the easier it is to treat.

flu season

Experts Predict a Severe Flu Season, So Get Vaccinated Now

, Health Basics, News, Preventative Health, Vaccinations

If you hear the word “vaccine” and automatically think of COVID-19, our concierge primary care doctors in Jupiter don’t blame you. But there’s another virus lurking on our shores: the annual influenza outbreak, which deserves our attention now.

You can be forgiven for thinking we no longer had to worry about the flu because, for the last two years, it all but disappeared. This is largely due to all the hand washing, social distancing, and mask-wearing we practiced during the pandemic.

But unfortunately, those sensible health precautions are pretty much behind us now, and all signs point to a worse-than-normal flu season. In fact, we’ve already seen scattered reports of cases around the country. And remember that many cases go unreported because people typically recover at home without being officially tested and recorded.

Ominous Signs

The reason experts are expecting a more severe 2022-23 flu season is that they’re looking to Australia, which undergoes its flu season before ours. 

That country is just concluding its worst season in five years, with cases reported to be three times higher than normal. Their season also began two months sooner than it typically does, meaning it is expected to arrive sooner than usual here, as well.

“The Southern Hemisphere has had a pretty bad flu season, and it came on early,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Bloomberg News late last month.

“Influenza, as we all have experienced over many years, can be a serious disease,” he added, “particularly when you have a bad season.”

Dr. Frank Esper, a pediatric infectious disease specialist at the Cleveland Clinic, echoed those warnings.

“This year we expect it to be a very big flu season and that the flu season [will be] even worse in the younger groups [than] it was in years past,” he told Cleveland’s Fox8. 

We’re Not Prepared

For the last two years, we have rightly been focused on avoiding COVID-19, which has killed well over one million Americans to date. But influenza also presents a danger, especially to very young, pregnant women, those with chronic conditions, and the elderly.

In 2019, the last year that we actually had a notable flu season, nearly 61,000 Americans died from the flu, including 129 children. There were approximately 42.9 million cases of the flu, with 647,000 of those requiring hospitalizations. And that was considered a mild season (although it was the longest season in a decade, beginning in October and ending in May).

In addition, because of the demise of COVID-19 restrictions in general, we could get hit even harder.

“The thought is when the COVID pandemic hit, we started masking up and everyone started socially distancing, schools were closed for a whole year,” Esper said.

“Flu just nose-dived. It almost got to the point where there was no flu.” 

But because we haven’t been exposed to it lately, we are even more vulnerable to its effects, making it harder to fight off.

“Usually, we see the flu every year. Our immune systems are ready for it. When you haven’t seen the flu in two or three years, that means our immune systems may be a little slower,” he explained.

Double Whammy?

Then there’s the possibility of a “twindemic,” or a severe flu season that strikes at the same time as an uptick in coronavirus activity. This is a distinct possibility because both viruses tend to increase circulation when people spend more time indoors in the colder months, and immunity from earlier vaccinations or infections is beginning to wane, especially in those who haven’t had a recent coronavirus booster.

In fact, we’ve already seen an increase in COVID-19 cases across the country in the last two weeks, according to data provided by the Mayo Clinic.

So the Centers for Disease Control and Prevention (CDC) reports that getting a flu shot this year is recommended as “the first and most important step in protecting against flu viruses,” while at the same time reducing the burden of flu hospitalizations and deaths.

“An influx of hospitalizations from COVID-19 and the flu could stress the healthcare system and impact staffing if any healthcare workers are out sick,” Soniya Gandhi, associate chief medical officer at Cedars-Sinai, told Cedars-Sinai Newsroom.

The Time is Now

Because of all the signs that the flu season here could start early, it’s important to receive your vaccine as soon as possible, since it takes at least two weeks to achieve full immunity.

“The bottom line is that you don’t want to wait until you’re already going to be at risk of getting influenza to get vaccinated,” Dr. Albert Ko, an infectious disease physician and professor of public health, epidemiology, and medicine at Yale School of Public Health, told NBC’s TODAY.

And we’ve seen with COVID-19 that vaccines work to reduce the severity of such illnesses, not only in individuals but also in those around them who either can’t receive the vaccine or who don’t respond well to it.

Remember that if you haven’t yet received your omicron booster, you can get both shots at the same time, one in each arm.

“The flu and COVID-19 vaccinations are important on a personal level, and they’re critical from a public health standpoint,” Gandhi said.

belly fat

From Fat Belly to Flat Belly: 3 Effective Ways to Slim Down

Health Basics, Healthy Living, Lifestyle, Nutrition, Preventative Health

You think you’re doing all the right things: exercising, eating healthy, and keeping your weight in check. So why do you look down and see that bulge hanging over your belt line?

Our concierge primary care doctors in Jupiter can’t promise that the following tips will give you a washboard abdomen, but we do know that you can at least reduce the problem area if you know what causes it and, therefore, how to combat it.

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