benefits of supplements

Supplement Benefits: All In the Mind?

It sounds so easy: Pop a pill (or pills) every day and enjoy radiant health. Unfortunately, our concierge doctors have to caution you that it may not be not that simple. And, according to a new study, the claimed benefits of taking supplements might not even be true.

The study, published this month in the journal BMJ, suggests that the perceived benefits of over-the-counter (OTC) vitamin and mineral supplements may largely be due to the power of the mind.

“The effect of positive expectations in those who take multivitamin or mineral supplements is made even stronger when one considers that the majority of them are sold to the so-called worried well,” lead study author Dr. Manish Paranjpe said in a statement. “The multibillion-dollar nature of the nutritional supplement industry means that understanding the determinants of widespread multivitamin or mineral use has significant medical and financial consequences,” he added.

The financial aspect is obvious. Dietary supplements are a $40-billion-a-year business in this country. And if the products don’t work as expected, that’s a huge waste of money.

The medical impact is less well known. Between 2007 and 2012, the U.S. Food and Drug Administration (FDA) received reports of more than 6,300 reports of serious adverse events linked to dietary supplements. These included 115 deaths and more than 2,100 hospitalizations.

What’s the harm in taking supplements?

This may surprise people who think that because these substances are sold over the counter they can’t do you harm. Others believe that the government wouldn’t allow their sale unless they were safe and effective. However, a 1994 law, the Dietary Health and Education Supplement Act, actually prevents the FDA from regulating dietary supplements or removing them from sale unless it can prove a supplement is unsafe.

But indiscriminate use of supplements can produce serious side effects. For example, Vitamin E and beta-carotene supplements can actually increase the chances of developing lung cancer in smokers.

St. John’s Wort is sold over the counter for mild depression. Some of its potential side effects include dizziness, sun sensitivity, insomnia, anxiety and headaches. It can also reduce the effectiveness of birth control pills and some heart medications.

Fish oil can cause nausea and diarrhea and increase the levels of LDL (bad) cholesterol. It can also increase the risk of bleeding. Some people have suffered such severe liver damage with green tea extract that they required a liver transplant.

Niacin, another popular supplement, has been shown to slightly increase the risk of death from any cause. So have calcium supplements, which one study suggested increased the risk of death from cancer when taken in amounts greater than 1,000 milligrams per day.

Little evidence for real benefits

Then there’s the question of whether these products are effective for the reasons we take them. Various studies have been performed on the efficacy of supplements in the prevention of many diseases. All have shown little-to-no benefits of dietary supplements and vitamins.

Those marketed for the prevention of cardiovascular disease (CVD) have, for example, been studied extensively. In 1996, the Physicians Health Study assigned 22,071 men to take either beta-carotene or a placebo for 12 years. They assessed the effect of the vitamin on the prevention or progression of the disease. The results showed no difference in either CVD occurrence or overall mortality.

A Women’s Health Study found a similar result when it looked at the effect of beta-carotene on 40,000 women. It found no differences in the incidence of heart disease between those taking the vitamin and those receiving the placebo.

Another study published in the Journal of the American College of Cardiology that examined multivitamins, calcium supplements, and vitamins C and D, found no measurable advantage in terms of preventing CVD, heart attack, stroke, or early death. A similar study found no CVD-associated benefits for vitamin D.

Yet the belief persists

Despite these findings, many people still swear they notice a difference in their health after taking supplements. The study this month attributes this to the power of belief. Consumers also point to studies that support their faith in these substances.

An article in Harvard Women’s Health Watch, however, explained that the benefits of supplements that often appear in some studies are based on observational research vs. clinical trials. That is, researchers ask study participants to self-report on their daily habits, vs. performing randomized controlled trials. Because observational studies don’t control for diet, exercise, and other variables, they can only suggest an association with better health benefits from particular supplements.

“People who take supplements tend to be more health conscious, exercise more, eat healthier diets, and have a whole host of lifestyle factors that can be difficult to control for fully in the statistical models,” Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School, told the journal.

So whether you’re trying to improve your health or ward off illness, your best bet is to follow the time-honored advice: Consume a balanced diet, including fruits and vegetables, get plenty of exercise, don’t smoke, use alcohol in moderation, and avoid recreational drugs. It really is that simple.

smoking and covid-19

Smoking and COVID-19: What You Need to Know

The annual Great American Smokeout is set for this week, November 19. So our concierge doctors thought this would be a good time to look into what we know about the combined effects of smoking and COVID-19.

This is especially important because there has been some confusing information on the effects of cigarette smoking on the disease, with some early reports even suggesting that cigarette smokers who contract COVID-19 actually fare better than non-smokers. Subsequent studies have found the opposite: that smoking increases the risk that the virus causes more damage in smokers.

Tobacco’s extensive effects

One study, reported in The Guardian, analyzed more than 11,000 COVID-19 patients. It found that about 30 percent of those with a history of smoking saw their conditions progress to a more severe or critical state, versus 17.6 percent of non-smokers. Researchers concluded that “smoking is a risk factor for progression of COVID-19,” with smokers nearly twice as likely to develop severe symptoms.

In addition to the well-known damage to the lungs and cardiovascular system—both of which are compromised by COVID-19—smoking has also been shown to suppress the immune system’s ability to fight infection in the body.

“Tobacco products cause inflammation in the airways and affect lung immunity, which makes people more susceptible to infection in general,” Dr. David Christiani, a professor at the Harvard TH Chan School of Public Health, told the paper.

In a scientific brief released this summer, the World Health Organization (W.H.O.) concluded that “the available evidence suggests that smoking is associated with increased severity of disease and death in hospitalized COVID-19 patients.”

The brief also reiterated that, in addition to the findings on the coronavirus, “Tobacco causes eight million deaths every year from cardiovascular diseases, lung disorders, cancers, diabetes, and hypertension.”

We believe it’s safe to add COVID-19 complications to that list.

Benefits of quitting

If you smoke, you’re not alone. More than 32.4 million people in the U.S. still smoke cigarettes, according the American Cancer Society (ACS). Unfortunately, as a result more than 16 million Americans live with a smoking-related disease.

But it’s never to late to quit.

Here’s a timeline from the ACS showing what happens when you stop smoking:

  • Twenty minutes after quitting your heart rate and blood pressure drop.
  • Twelve hours after quitting the carbon monoxide level in your blood drops to normal.
  • Two weeks to three months after quitting your circulation improves and your lung function increases.
  • One to nine months after quitting, coughing and shortness of breath decrease. Tiny hair-like structures (called cilia) that move mucus out of the lungs start to regain normal function in your lungs. This increases their ability to handle mucus, clean the lungs, and reduce the risk of infection.
  • One year after quitting the excess risk of coronary heart disease is half that of someone who still smokes. Your heart attack risk drops dramatically.
  • Five years after quitting your risk of cancers of the mouth, throat, esophagus, and bladder is cut in half. Cervical cancer risk falls to that of a non-smoker. Your stroke risk can fall to that of a non-smoker in two to five years.
  • Ten years after quitting your risk of dying from lung cancer is about half that of a person who is still smoking. Your risk of cancer of the larynx and pancreas decreases.
  • Fifteen years after quitting your risk of coronary heart disease becomes that of a non-smoker’s.

Ready to quit?

There are myriad ways to successfully stop smoking. What works for one person might not work for another. And studies show that the average smoker tries several times before giving up the addiction entirely.

“No matter your age or how long you’ve been smoking, quitting improves health, both immediately and over the long term,” the ACS says. “Giving up smoking is a journey, and it can be hard, but you can increase your chances of success with a good plan and support. Getting help through counseling and medications doubles or even triples your chances of quitting successfully.”

You can also download numerous quit-smoking apps to help, or find tools and tips at Smokefree.gov. The site also offers live chat help for those trying to quit. In addition, each state has a quit line, which you can access by dialing 1-800-QUIT-NOW (1-800-784-8669).

Of course there are various medications also available, so if you’re trying to stop smoking, please talk with us. We can help find the best path for you.

The coronavirus pandemic has had everyone on edge for months, and smoking may be one way you’ve used to cope. But, as with increasing alcohol or drug consumption, it’s unhealthy and ultimately unhelpful.

safely celebrate holidays

How to Celebrate the Holidays Safely

As we head into the holidays, our concierge doctors are concerned that pandemic fatigue might tempt people to throw caution to the winds and just celebrate, starting with Thanksgiving.

The fact is, we’re all fed up with the “new normal.” People want more than anything to return to the way our lives were before this scourge attacked the world early this year. Pandemic fatigue is not only real, it’s totally understandable.

“In the spring, it was fear and a sense of, ‘We’re all in it together,’” Vaile Wright, a psychologist at the American Psychological Association (APA) told The New York Times. “Things are different now,” she said. “Fear has really been replaced with fatigue.”

This led to a sense of complacency and carelessness. While understandable, this caused a wave of increased cases and deaths in the U.S. and around the world.

“Citizens have made huge sacrifices,” Dr. Hans Kluge, the World Health Organization’s (W.H.O.’s) regional director for Europe, told the Times. “It has come at an extraordinary cost, which has exhausted all of us, regardless of where we live, or what we do.”

The high cost of carelessness

A recent report in The Washington Post serves as a cautionary tale for our country. Canada celebrates their own Thanksgiving on the second Monday of October. Despite warnings from public health officials there to limit celebrations to members of the immediate household, apparently that advice went unheeded by many Canadians.

In the weeks after, Canada saw rising case numbers as a result. Ontario, for example, reported a record-high number of daily cases within two weeks of the holiday. A single gathering of 12 extended family members in Toronto resulted in a cluster of coronavirus cases.

“People did not mean to spread COVID-19,” Deena Hinshaw, Alberta’s chief medical officer of health, told The Post. “But it is a reminder that social gatherings where social distancing and masking are not used consistently are a significant risk for spread.”

We can understand the longing to get together for the traditional holidays, beginning with with Thanksgiving. But that is, unfortunately, a recipe for disaster.

“We are set up for just a perfect storm—a conflagration,” Megan Ranney, an emergency medicine professor at Brown University, told The Post recently. “Right now, you can talk about there being lots of little burning fires across the country. And then Thanksgiving will be the wind that will whip this fire up into an absolute human disaster for our country.”

This country’s leading infectious disease expert, Dr. Anthony Fauci, likewise warned that Thanksgiving celebrations could lead to even more cases.

“That is, unfortunately, a risk, when you have people coming from out of town, gathering together in an indoor setting,” he told CBS News recently. “It is unfortunate, because that’s such a sacred part of American tradition.”

Yes it is. But we’d like to suggest some ways to minimize that risk and safely celebrate the holidays.

A few COVID-19 reminders

First, let’s review a few facts.

The SARS-CoV-2 coronavirus is one of the most contagious viruses known to man. It spreads readily through the air and by surface contact, from those who have symptoms as well as those who don’t.

Because of this, areas with high air circulation, such as the outdoors on a windy day, tend to be safer than crowded indoor spaces with poor ventilation.

Far deadlier than the flu, the coronavirus travels through the bloodstream to every part of the body. This is why it’s so difficult to treat, and why many of its victims appear to suffer months-long aftereffects.

How to safely celebrate the holidays

With that in mind, if you’re preparing to celebrate the holidays, here are a few tips.

The Centers for Disease Control and Prevention (CDC) recommends limiting gatherings to those in your immediate household. If you’re going to host a Thanksgiving dinner, the CDC suggests holding it outdoors. It also says to only invite family and friends from your immediate neighborhood.

“Gatherings with more preventive measures, such as mask wearing, social distancing, and hand washing . . . pose less risk than gatherings where fewer or no preventive measures are being implemented,” the CDC says.

Other ways to judge risk, according to the CDC:

  • Indoors is riskier than outdoors.
  • Poor ventilation is riskier than good ventilation (e.g., places with open windows and doors).
  • Longer gatherings are riskier than shorter gatherings.
  • More attendees pose a greater risk than fewer attendees.
  • Local attendees pose less of a risk than those traveling from other areas who may have been exposed at home or during their travels but aren’t yet showing symptoms.

If you can’t control the environment, the attendees, or their behavior, you need to ask yourself whether one holiday is worth the risk.

“Staying home is the best way to protect yourself and others,” the CDC says.

As we noted above, we’re all tired of the precautions necessary to reduce the spread of the novel coronavirus. But parents, for instance, remain on high alert to ensure the safety of their children for eighteen-plus years. If you think of it in these terms, a year or two of vigilance might seem more acceptable.

Remember, the fastest way for this thing to be “over” is to deny it new hosts. This includes the bodies of you and your loved ones. Please follow these tips in order to safely celebrate the holidays.

kids bone health

Help Your Kids Have a ‘Goldilocks Day’ for Bone Health

One of the many drawbacks of the pandemic our concierge doctors have noted is that children aren’t getting as much exercise these days. Limited in their ability to run and play freely with friends, along with the increased prevalence of virtual learning, kids are not getting the exercise they need to stay healthy.

One place this lack of activity is impacting them is in their bone health. The National Osteoporosis Foundation (NOF) recommends that osteoporosis prevention begin in childhood. Studies have shown stronger bones in youth result in better bone health later in life. And it’s possible to help develop your kids’ bone health.

Preventing osteoporosis starts early

According to the National Institutes of Health (NIH), more than 53 million Americans have either been diagnosed with osteoporosis or are at risk of developing it. But one myth about osteoporosis is that it is a normal part of aging. Osteoporosis and the broken bones that result from it can be prevented.

Osteoporosis is a bone disease in which the body loses too much bone, makes too little bone, or both. This causes bones to become weak and brittle.

The NIH calls osteoporosis “a childhood disease with old-age consequences.” Bone is living tissue that changes constantly. The bone mass formed in childhood has significant impact on the health of bones later in life.

The Centers for Disease Control and Prevention (CDC) reported more than 300,000 Americans ages 65 and older are hospitalized each year for hip fractures. More than half of those never fully recover from the break. Many die as a direct result of the fracture.

For most people, the amount of bone tissue in the skeleton peaks by their late twenties. Up to 90 percent of peak bone mass is acquired by age 18 in girls and age 20 in boys, according to the NIH.

The ‘Goldilocks Day’

Does this mean you need to have your children lifting weights at the gym for hours on end? Not according to a new study released last month in the Journal of Bone and Mineral Research.

It turns out there’s a “just right” balance of activities that will maximize bone health in children. Researchers at the University of South Australia (UniSA) evaluated 804 Australian children between the ages of 11 and 13 years. They found children require more moderate-to-vigorous physical activity, more sleep, and less time spent in sedentary activates to achieve optimal kids’ bone health.

They found the ideal balance of a child’s activities across a 24-hour-period comprises:

  • 1.5 hours of moderate-to-vigorous physical activity (e.g., from sports and running and playing);
  • 3.4 hours of light physical activity (e.g., from walking and doing chores);
  • 8.2 hours of sedentary time (e.g., studying, reading, sitting at school); and,
  • 10.9 hours of sleep.

“Children’s activities throughout the whole 24-hour day are important for their bone health, but until now, we haven’t known the perfect combination of exercise, sleep, and sedentary time,” Dr. Dot Dumuid, lead researcher of the UniSA study, said in a statement. “The ‘Goldilocks Day’ tells us the durations of physical activity, sleep, and sitting that are ‘just right’ for children’s optimal bone health.”

Participants wore accelerometers 24 hours a day for eight days to track their mobility. They kept supplemental self-recorded logs for sleep and wake times. They recorded bone density measures at the start and end of the study. These findings led to the recommendations shown above. The most surprising factor appeared to be the role sufficient sleep plays in healthy bone development.

“We always talk about getting enough exercise to help build bones, but for children, it’s vital that they also get enough sleep,” Dumuid said. “By knowing the best balances and interrelations of sleep, exercise, and rest, parents and caregivers can guide their child’s daily activities to put them in good stead for future bone health.”

Don’t forget nutrition

In addition to the “Goldilocks” balance of activity and sleep, it’s important to also factor in proper nutrition for bone health. For children, the NIH says that means a diet rich in calcium and vitamin D. It notes most children don’t get enough of either nutrient.

Calcium is found in many foods, including salmon, green beans, and kale. But the most common source is milk and other dairy products. Drinking one eight-ounce glass of milk provides 300 mg. of calcium. This is about a third of the recommended intake for younger children and a quarter of the recommended intake for teens.

Fortified milk also contains vitamin D. One eight-ounce glass contains 2.5 mg. of vitamin D3, or about 10 percent of the recommended intake. Other good sources include liver, egg yolks, and oily seafood such as salmon, tuna, herring, and sardines.

We realize it’s difficult to get them moving as much lately with the various pandemic restrictions. But try nevertheless to encourage as much exercise as you can, whether indoors or outdoors.

If you have any questions about developing kids’ bone health or any other health issue, be sure to let us know.

Halloween Safety

Is Trick-or-Treating Safe This Year?

From a small Celtic festival in the British isles around 2,000 years ago, Halloween has morphed into an annual tradition of costumes, parties, haunted houses, and, above all, door-to-door trick-or-treating. According to a recent Harris Poll, 80 percent of those surveyed said handing out treats on Halloween is their favorite way to celebrate the holiday.

Because Halloween has become such a huge fall celebration, our concierge doctors want to provide the best information on Halloween safety and whether you should let the little ones partake this year.

A risky business

Knowing they’ll rain on everyone’s parade, the Centers for Disease Control and Prevention (CDC) nevertheless suggests people find another way to celebrate Halloween.

“Many traditional Halloween activities can be high-risk for spreading viruses,” the CDC says. “There are several safer ways to participate in Halloween.”

While children represent only 10.6 percent of COVID-19 cases to date, the American Academy of Pediatrics (AAP) reports, as of October 1, over 657,000 children have tested positive since the onset of the pandemic, and more than 100 have died. Now that schools across the nation have largely reopened, in part or in full, that number is likely to increase dramatically.

And even though children are at relatively low risk of dying from COVID-19, they can still spread the disease to at-risk adults in their household.

So what should you do to celebrate Halloween safely?

The CDC has broken down traditional activities into lower-, moderate-, and higher-risk activities as follows.

Lower risk

  • Carve/decorate and display pumpkins with members of your household
  • Carve or decorate pumpkins outside, at a safe distance, with neighbors or friends
  • Decorate your house, apartment, or living space
  • Participate in a Halloween scavenger hunt. Give kids lists of Halloween-themed things to look for while they walk outdoors from house to house admiring Halloween decorations at a distance
  • Have a virtual Halloween costume contest
  • Hold a Halloween movie night with people you live with
  • Have a scavenger hunt-style search with your household members in or around your home, rather than going house to house

Moderate risk

  • Participate in one-way trick-or-treating. Line up individually-wrapped goodie bags for families to grab-and-go while continuing to social distance (such as at the end of a driveway or at the edge of a yard).
    • If you are preparing goodie bags, wash your hands with soap and water for at least 20 seconds before and after preparing bags
  • Have a small group, outdoor, open-air costume parade where people are distanced more than six feet apart
  • Attend a costume party held outdoors where protective masks are used and people can remain more than six feet apart
  • Go to an open-air, one-way, walk-through haunted forest where appropriate mask use and social distancing is enforced.
    • If screaming will likely occur, greater distancing is advised. The greater the distance, the lower the risk of spreading a respiratory virus.
  • Visit pumpkin patches or orchards
    • Use hand sanitizer before touching pumpkins or picking apples, wear masks, and maintain social distancing
  • Hold an outdoor Halloween movie night with local family friends, with people spaced at least six feet apart.

Higher risk

  • Participate in traditional trick-or-treating where treats are handed to children who go door to door
  • Hold “trunk”-or-treat where treats are handed out from trunks of cars lined up in large parking lots
  • Attend crowded costume parties held indoors
  • Go to an indoor haunted house where people may be crowded together and screaming
  • Go on hayrides or tractor rides with people who are not in your household
  • Use alcohol or drugs, which can cloud judgment and increase risky behaviors
  • Travel to a rural fall festival that is not in your community if you live in an area with community spread of COVID-19.

The CDC recommends avoiding all these higher-risk activities.

In addition, it cautions that a costume mask is not a substitute for a cloth or disposable mask. Any costume mask should not be used unless it is made of two or more layers of breathable fabric. It must cover the mouth and nose and doesn’t leave gaps around the face.

Finally, it warns that people not wear a costume mask over a protective cloth mask. This can be dangerous if the costume mask makes it difficult to breathe. Consider using a Halloween-themed cloth mask, instead.

If you have questions about Halloween safety or the safety of any activity, please let us help you evaluate your and your family’s risk.

flu shot twindemic

Flu Shots Can Help Avert a ‘Twindemic’

The U.S. Centers for Disease Control and Prevention (CDC) recommends all adults and children older than six months receive a flu shot by the end of this month. The CDC says it takes at least two weeks for the vaccine to become effective. Then it won’t reach its peak effectiveness until another week after that. And children who are being vaccinated for the first time need two vaccines spaced a month apart to become fully protected.

Therefore, our concierge doctors suggest you get your flu shot for the 2020-21 influenza season as soon as possible. While there have been scattered reports of shortages around the country, The Washington Post recently reported a record number of flu vaccine doses—between 194 million and 198 million—have been ordered. Because the vaccine is shipped in stages, more is on the way.

“This year I think everyone is wanting to get their vaccine and maybe wanting it earlier than usual. If you’re not able to get your vaccination now, don’t get frustrated. Just keep trying.”

The CDC’s Dr. Daniel Jernigan, to the Associated Press (AP).

COVID-19 and flu overlap: a ‘twindemic’

We were fortunate the 2019-20 flu season was winding down this spring as the coronavirus crisis began to hit the country. This year, however, we’ll be looking at the possibility of a “twindemic”—both waves hitting at once.

So it’s especially important that as many people as possible get vaccinated for the flu this year. The flu shot won’t prevent COVID-19, but it can help reduce the strain on our already overburdened health care system.

“Since hospitals and doctors’ offices are going to be very busy caring for COVID-19 patients, a flu vaccine can help decrease burdens on the health care system and make sure that those who need medical care are able to get it.”

Dr. Susan Bailey, president of the American Medical Association (AMA) and an immunologist in Fort Worth, Texas, told CNN.

Last year, the CDC estimated that the flu killed 22,000 Americans, and resulted in hospitalization of an additional 400,000. By contrast, at least 215,000 Americans have died of COVID-19 since March.

Hopeful signs

Health experts are hopeful the precautions we’ve been taking to avert COVID-19—hand washing, social distancing, and wearing masks—will mean this season’s flu won’t take as severe a toll as in previous years. But they all insist that widespread vaccinations are necessary.

Even if the flu vaccine isn’t 100 percent effective in preventing influenza, it has been shown to reduce the length and severity of the illness in those who contract it. In addition, if you’re unlucky enough to contract COVID-19, you won’t want your body’s defenses to be weakened by a prior bout with the flu.

This is already present in the Southern Hemisphere, where each season’s flu strikes over the summer. From South Africa to Australia, public health experts reported remarkably low levels of influenza among their populations. They attributed this partly to coronavirus lockdowns and to extremely high participation in influenza vaccinations.

One pharmacy in Cape Town, South Africa, for example, reported that the demand for flu shots was four times higher than in previous years. People were trying to avoid the co-morbidity (simultaneous presence of two or more diseases) of contracting the flu in addition to COVID-19.

“People were lined up outside the pharmacy down to the corner of the street waiting to get their injections. We had to prevent people from coming into the store.”

Ellis Henen, owner of Sunset Pharmacy, told The Post.

Additional benefits of the flu shot

We hope Americans will have the same attitude to this year’s flu shot.

Some people think they’re still protected from the one they received last year. But having received a flu shot last year won’t protect you from this season’s strains of the virus. This is because your immunity from a year ago has deteriorated by now. In addition, manufacturers create a new vaccine each year based on which strains the World Health Organization (WHO) expects to be predominate. This is based on which strains were seen over the summer in the Southern Hemisphere. So this year’s shot will include strains different from those in last year’s inoculation.

It’s important to remember, even if you contract influenza after receiving the shot, it’s likely to be less serious than if you’d skipped being inoculated. And the flu vaccine offers additional benefits, especially among the elderly. For older people and those with chronic health conditions, recent studies show the extra benefits of a flu shot. It’s as effective in preventing a heart attack as quitting smoking, using cholesterol-lowering drugs, or taking blood pressure medications.

So be sure to let us know if you’re interested in getting a flu shot. If you encounter a shortage, we may be able to help you locate a supply nearby.

help insomnia

Weighted Blankets May Help with Insomnia

Our concierge doctors note the stress resulting from the coronavirus pandemic affects large portions of our population. This has manifested in many ways, including a sharp increase in insomnia.

Even without the pandemic, the National Institutes of Health (NIH) estimates that between 30 and 40 percent of the population experiences insomnia regularly. A 2005 National Sleep Foundation (NSF) poll showed more than half of respondents reported experiencing insomnia at least a few nights a week in the past year. Thirty-three percent said they had insomnia every night or nearly every night for the past year.

And since the advent of the pandemic, prescriptions for sleep medications are up 15 percent, according to pharmacy benefit manager Express Scripts. The UCLA Sleep Disorders Center reports insomnia complaints have soared 20-30 percent.

An occasional sleepless night is not technically categorized as insomnia. It’s when it becomes a longer-term occurrence that it is officially called insomnia. Ironically, though, the occasional sleepless night can quickly turn into insomnia when the sufferer begins worrying that it will happen again. The worry feeds the arousal state in the brain, thus leading to night after night of wakefulness.

How to beat insomnia

You’ve probably heard the typical suggestions for how to help your insomnia:

  • Maintain a regular bedtime
  • Increase exercise
  • Turn off blue light-producing electronic devices (smartphone, computer, TV) at least one hour before bedtime
  • Don’t eat or drink alcohol within three hours of bedtime
  • Stop drinking caffeine no later than 2 p.m.
  • Avoid naps
  • Restrict the bedroom to sleep and sexual activity
  • Try to stay awake, instead of trying to fall asleep (known as paradoxical intention, which takes the pressure off trying to sleep)
  • Get up and leave the room if you haven’t fallen asleep within 20 minutes

These tips may work for those with occasional insomnia. If your difficulty is chronic or worrisome, talk to us. We can perform a physical examination to ensure your insomnia isn’t caused by a correctable physical condition, such as sleep apnea or thyroid problems.

We can also suggest other measures that have proven useful. Cognitive behavioral therapy, various relaxation and breathing techniques, light therapy to reset the body’s circadian clock, and even short-term medication, if necessary, can all help.

Weighted blankets seem to help

In addition to these suggestions, consider trying is a weighted blanket. They have been around for several years, and many users have given them rave reviews. They help you to fall asleep more easily, sleep more soundly and sleep longer.

Until now, however, such testimonials had little science to back them up. That was until a new study was published last month in the Journal of Clinical Sleep Medicine. It found those who slept with weighted blankets experienced better sleep. They also reported fewer symptoms associated with depression and anxiety during the day.

The 120 adult participants had all been clinically diagnosed with insomnia for at least two months. Also, each had been diagnosed with either major depressive disorder, bipolar disorder, generalized anxiety disorder (GAD), or ADHD. Half were given weighted blankets and half were given blankets that appeared the same as the weighted type.

After four weeks, those in the weighted-blanket group were almost 26 times more likely to have seen at least a 50 percent reduction in the severity of their insomnia. And they were nearly 20 times more likely to achieve full remission of their insomnia.

Researchers suggested that the results were due to the pressure the blanket applies to different parts of the body. This stimulates the sensation of touch similar to acupressure and massage.

“I was surprised by the large effect size on insomnia by the weighted blanket and pleased by the reduction of levels of both anxiety and depression.”

Lead researcher Dr. Mats Alder, consultant psychiatrist at the Karolinska Institute in Stockholm, Sweden, said in a statement.

Some cautions

If you’d like to try using a weighted blanket to help insomnia, be sure to purchase it at a place that allows for returns. Weighted blankets come in different weights, and weight preferences are highly individual. You may find you prefer a heavier or a lighter weight. Also be sure it’s washable. Opt for one without plastic beads, which could end up in the ocean.

Finally, if you have a tendency toward claustrophobia, you might not like the sensation of feeling trapped under a heavy object, so proceed with caution. You can try to simulate the effect of a weighted blanket by folding a large quilt in half and sleeping under that for a few nights. If you have no problem with that, then you may want to purchase a commercial weighted blanket.

In addition, never put a weighted blanket on a child under the age of three or one weighing less than 50 pounds, because there’s a danger of suffocation.

overcome chronic conditions

Healthy Habits Can Conquer Chronic Medical Conditions

We’ve heard a great deal lately about how those with chronic conditions—diabetes, high blood pressure, and obesity—are more likely to become sicker when exposed to the SARS-CoV-2 virus that causes COVID-19. Even leaving aside the coronavirus, many individuals have thought that having multiple chronic medical conditions such as those or others (cancer, asthma, coronary artery disease, and so forth) doomed them to a premature death.

But our concierge doctors have recently come across some good news for those people. It turns out that healthy lifestyle habits can overcome multiple types of chronic conditions and help extend your life.

Lifestyle impacts on chronic conditions

A new study reported last month in the journal PLOS One followed nearly 481,000 middle-aged adults in the U.K. for up to nine years. Of those, 93,746 had two or more chronic medical illnesses (known as multimorbidity) such as those mentioned above.

The researchers focused on four lifestyle factors: smoking, diet, physical activity, and alcohol consumption. They then weighted each of these factors (some healthy foods vs. a great deal, moderate physical activity vs. a great deal vs. none, and so forth) and broke them into four categories:

  • healthy
  • very healthy
  • unhealthy
  • very unhealthy

Then they assigned each study participant to a category.

Their results show that those who practiced the healthiest habits lived longer than those who did not, regardless of their current medical challenges.

In particular, men with a very healthy lifestyle were found on average to live 6.3 years longer than those with a very unhealthy lifestyle, while women in these same categories were found to live an average 7.6 years longer.

Even those in the third category, unhealthy, saw some benefit over those with a “very unhealthy” lifestyle.

Healthiest habits

Not smoking had the largest impact on life expectancy, according to the researchers. Smokers at age 45 were found to live five to six years less than non-smokers, regardless of other disease complications. Because the screening question asked only if participants were current smokers, it is fair to assume that the large study cohort included many former smokers. This proves quitting smoking at any age does confer health advantages.

Regular physical exercise also showed a significant benefit. Those who engaged in some type of regular physical activity lived longer than those who did not. Even if the exercisers had serious medical conditions. Researchers defined regular physical activity as that which met the global health recommendations: 150 minutes a week of moderate physical activity or 75 minutes of weekly vigorous activity.

Men who engaged in regular physical exercise gained an additional 2.5 years of life on average. The benefit for women was slightly lower; they gained 1.9 additional years of life.

Surprisingly, a healthy diet– defined as consuming at least five different fruits and vegetables daily– and moderate or no alcohol intake demonstrated little benefit in increasing life expectancy.

Never too late

We hope our patients find these results encouraging. They show that—even with multiple chronic illnesses—you can not only influence your life expectancy with healthier habits. And they show you can improve your quality of life by following standard guidance for a healthy lifestyle.

These include:

1. Diet

Avoid processed foods, and consume a diet high in seafood and fresh produce. Include fruits and vegetables, nuts, olive oil, and beans. and low in red meat, dairy, sugar, salt, and saturated fat.

2. Exercise

A daily minimum of a half-hour of any kind of mild-to-moderate exercise is crucial to overall health. If necessary, it can be broken into 10-minute increments throughout the day. Even a daily brisk walk will help.

But for optimal health, we recommend any kind of regular, vigorous movement. Try to add up to 150 minutes (2 ½ hours) per week.

3. Stress relief

When your body thinks it is constantly under attack, studies have shown such chronic stress puts you at greater risk for serious health problems, including cardiovascular disease, cancer, digestive disorders, impaired memory and concentration, anxiety, and depression.Reducing stress is crucial to maintaining good health, so:

  • take time for hobbies
  • practice relaxation techniques
  • exercise regularly
  • eat a healthy diet
  • stay in touch with friends

At the same time, avoid unhealthy stress relievers like smoking, excess alcohol consumption, and illicit drug intake. These practices merely mask stress triggers temporarily. They can cause damage to the body, as well as to your mental health, in the long run.

e. coli

Take Care with Leafy Greens

Our concierge doctors absolutely recommend a diet high in vegetables, especially leafy greens, for optimal health. But a new study released this month highlights a problem with this otherwise beneficial food: E. coli.

The report, published in the journal Emerging Infectious Diseases, found leafy greens are a common source of food-borne illnesses. It notes that they’ve been implicated in 40 outbreaks of a serious strain of E. coli between 2009 and 2018. These outbreaks resulted in 1,212 illnesses, 420 hospitalizations, and eight deaths.

Products to look out for

As you might suspect from the frequent reports in the news, romaine lettuce was involved most often. In of the outbreaks related to leafy greens studied for E. coli contamination, romaine lettuce was responsible for 54 percent of cases. Spinach and iceberg lettuce caused 17 percent each. Kale, cabbage, and green leaf lettuce were linked for four percent of the outbreaks.

The study also found outbreaks linked to mixed greens. This included three romaine and iceberg mixes, a butter lettuce and radicchio mix, and a spinach and spring mix.

Researchers were uncertain why romaine lettuce was so often involved in E. coli contamination. They speculated the green’s growing popularity over the study period accounted for some of the increase. Also the shape of the leaf itself contributed to contamination. Because romaine’s crinkled leaves grow in an elongated rosette shape, it’s difficult to wash it sufficiently to remove all of the surface contamination.

What’s causing the bacteria growth

Agricultural practices in this country have also been implicated in contamination outbreaks in leafy greens, but especially romaine lettuce.

Nearly all romaine lettuce grown in the U.S. originates from two main areas: the Salinas Valley in California and the Imperial and Coachella valleys in Southern California and around Yuma, Arizona.

E. coli is common in animals, including goats, deer, feral pigs, and especially cattle. One recent widespread outbreak in 2018 was attributed to contamination of surface water possibly used to irrigate and harvest the crop (with high-pressure water knives, which are used to cut the vegetables, as opposed by slicing them from the roots by hand).

Perhaps not surprisingly, many of the outbreaks have occurred within weeks of the time when nearby farming operations fertilize their fields.

“We know from earlier outbreaks that a little bit of contamination in the field can lead to cross-contamination,” Benjamin Chapman, a professor and food safety specialist at North Carolina State University, told NBC News. Chapman was not involved in the current study.

Once the plant is contaminated, it’s “very difficult to remove,” he explained. Even though produce is triple-washed in processing plants and once at home, the consumer maybe be able to rinse off 90 to 99 percent of what remains. That may not be enough to ensure complete safety, he added.

Symptoms of an infection

Symptoms of E. coli bacterial infection include stomach pain or non-bloody diarrhea that worsens over several days. It can take up to 10 days to begin feeling symptoms after consuming affected food. This makes outbreaks so difficult to track down.

An E. coli infection is normally self-limiting, meaning the body fights it off with no complications other than feeling fairly miserable for a few days. But it can also lead to more severe complications, especially for infants and children under five, older adults, and those with compromised immune systems.

Reducing the risk

As we said earlier, we still encourage consumption of leafy greens. They’re an excellent source of fiber, vitamins, minerals, and phytonutrients. They’ve also been linked to a reduced risk of heart disease, some cancers, macular degeneration and type 2 diabetes.

So how can you keep your family safe? First, always assume leafy greens are contaminated, and rinse them thoroughly if you plan to eat them raw.

The Center for Disease Control and Prevention (CDC) provides the following advice to minimize the chances of contamination.

Check to see if your prepackaged leafy greens are labeled “ready to eat,” “triple washed” or “no washing necessary.” These leafy greens do not need to be washed again. Thoroughly wash all other leafy greens before eating, cutting or cooking.

Consumers should follow these simple steps:

  • Wash your hands for 20 seconds with soap and water before preparing leafy greens.
  • Discard outer leaves and any torn or bruised ones.
  • Rinse the leafy greens under running water and use your hands to gently rub the surface of the leaves.
  • Don’t soak leafy greens in a sink filled with water. They can become contaminated with germs in the sink.
  • Don’t soak leafy greens in a bowl filled with water, which can spread contamination through the water to other leaves.
  • Dry leafy greens with a clean cloth or paper towel.
  • Do not wash vegetables with soap, detergent, or produce washes.
  • Do not use bleach solution or other disinfectants to wash produce.

If you think you have become ill from eating contaminated foods, be sure to talk to us. While food poisoning may result in nothing more than a few days of misery, it can also be dangerous. We can advise you on the best ways to recover.

cholesterol

What You Should Know About Cholesterol

Since September is National Cholesterol Education Month, our concierge doctors want to review the often-confusing facts about this vital blood component.

What is cholesterol?

Cholesterol is a type of waxy, fat-like substance found in every cell in your body. Made by your liver and also present in some foods, it allows your cells to function properly. It helps synthesize Vitamin D in the body as well as some necessary hormones. These include cortisol and cortisone, and the sex hormones estrogen, testosterone and progesterone, among others. It also helps create the bile you need for digestion.

Cholesterol gets transported through the body on proteins called “lipoproteins.” There are two types of lipoproteins: high-density lipoproteins (HDL) and low-density lipoproteins (LDL). The LDL type makes up most of the cholesterol in the body (between two-thirds to three-quarters). The HDL type absorbs excess LDL cholesterol and returns it to the liver, where it gets flushed from the body.

Why is high cholesterol bad for you?

Despite the role cholesterol plays in keeping the body healthy, only a small amount is needed to maintain critical functions. When your body has too much of the LDL-type of cholesterol, it can build up on the walls of your blood vessels. This causes them to become narrow. This in turn begins to block the free flow of blood to and from your heart and other organs in the body. When blood flow to the heart is blocked, it can cause chest pain (angina), a heart attack or a stroke, among other cardiovascular problems. Therefore, too much LDL is “bad” for your body when it isn’t balanced by higher HDL levels.

The confusion surrounding “high” and “low” cholesterol no doubt arises from their names. If we say your cholesterol levels are too high, you might think, “But isn’t ‘high’ cholesterol the good kind?” High-density lipoproteins (HDL) are good, and the higher that number, the better. But when we say you have “high” cholesterol, we’re talking about the “bad” type, meaning the low-density lipoproteins.

To confuse matters even more, triglycerides that are too high further contribute to fatty buildup in the arteries. Triglycerides are the most common type of fat in the body. High levels of triglycerides combine with high levels of LDLs to raise the risk of cardiovascular disease even further.

How to lower bad cholesterol

The optimal mix is low triglycerides, low LDL levels and high HDL levels in the blood.

According to the National Heart, Lung, and Blood Institute (NHLBI), the leading cause of high LDL cholesterol and triglycerides are unhealthy lifestyle choices. Certain medical conditions and medications, as well as genetics, also play a role.

There are a number of LDL lowering drugs available, including the very successful statins. But, as always, it is preferable to try to lower LDL levels naturally first. There are a number of ways to go about this:

  • lose weight
  • avoid trans fats (most commonly found in fried foods and pastries as well as margarine)
  • avoid red meat and dairy products
  • cut sugar consumption
  • keep alcohol consumption no greater than one drink daily
  • keep stress levels low

These steps, combined with increasing HDL levels in the blood, are often sufficient for many people to remain healthy.

How to raise good cholesterol

Medications to raise HDL cholesterol have not proved effective in lowering the risk of heart attacks and strokes. The best way to increase your supply is through lifestyle changes:

  • quit smoking
  • increase aerobic exercise to a total of at least one hour a week
  • consume more monounsaturated fats, e.g., nuts, seeds, avocados
  • increase intake of polyunsaturated fats, e.g., salmon, tuna, trout, and walnuts
  • consume more soluble fiber, e.g., fruits, vegetables, whole grains, beans, and legumes

In addition, avoid drugs that contain testosterone or other anabolic steroids, which have been shown to lower HDL levels.

Because there are no symptoms of high cholesterol, the only way to know for sure if your levels are within acceptable levels is through a simple blood test. This is especially important if you have a family history of heart disease, are a smoker, are regularly exposed to cigarette smoke or have high blood pressure or diabetes. The National Institutes of Health recommends that all adults have their cholesterol levels checked beginning at age 20.

It’s not difficult to keep “bad” cholesterol levels in check, unless you have a genetic predisposition toward high LDLs. Let us help you sort out the confusion surrounding cholesterol and heart health.

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