How and Why to Steer Clear of Ultra-Processed Foods

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

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.”


Health Risks Associated with Lack of Sleep

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.


Does Running Really Ruin Your Knees?

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.


What to Know During Breast Cancer Awareness Month

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

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

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.

Read more

Psychological Distress May Increase Risk of Long COVID

A new study suggests that certain types of common psychological distress may make people more likely to experience the debilitating effects of long COVID.

While our primary care concierge doctors in Jupiter don’t want to add to anyone’s stress, it’s important to know why everyone should continue to try to protect themselves as much as possible from contracting COVID-19, especially if they fall into one of the higher-risk groups.

The mystery of long COVID

By now, everyone is familiar with the constellation of symptoms that linger long past recovery from COVID-19, which can include:

  • extreme fatigue
  • chest pain
  • muscle pain
  • brain fog
  • dizziness
  • heart palpitations
  • headache
  • fever
  • chronic cough
  • shortness of breath
  • insomnia
  • stomach pain
  • gastroenteritis
  • loss of smell and taste

Frustrating condition

Complaints vary by individual and can include as many as 200 different debilitating symptoms.

The Washington Post reports that data from the U.S. Census Bureau collected in June, which was analyzed by the National Center for Health Statistics, found that nearly one in every five Americans who developed COVID-19 still have long COVID symptoms.

And there are no tests to help definitively diagnose the syndrome, or reliable treatments to help people recover.

“Globally, no one understands what’s going on,” Laurent Uzan, a French sports cardiologist who treats younger people with long COVID, told The Post.

“We don’t give people a miracle cure. It’s a real war for them, daily,” he said.

Latest findings

Nevertheless, researchers continue to pin down a cause for long COVID.

Last month, a study by released by researchers at Harvard T.H. Chan School of Public Health, found that psychological distress, including depression, anxiety, worry, perceived stress, and loneliness before COVID-19 infection was associated with an increased risk of long COVID.

The study, published in the journal JAMA Psychiatry, showed that the increased risk was independent of other factors such as smoking, asthma, or other health behaviors or physical health conditions.

The team looked at survey responses from nearly 3,000 Americans and Canadians from April 2020 to November 2021. Of that group, around 1,400 participants said they had long COVID, defined as symptoms lasting four weeks or longer.

They found that those who reported some type of psychological distress before infection had a 32-46 percent increased risk of developing long COVID, compared to those who did not report any such distress. Those with two or more types of psychological distress had a 50 percent increase in risk.

“We were surprised by how strongly psychological distress before a COVID-19 infection was associated with an increased risk of long COVID,” study leader Siwen Wang, a researcher in the Department of Nutrition at Harvard Chan School, said in a statement.

“Distress was more strongly associated with developing long COVID than physical health risk factors such as obesity, asthma, and hypertension,” she said.

Senior study author, Andrea Roberts, a senior research scientist in the Department of Environmental Health at Harvard Chan School, added, “The factors that we identified are more strongly associated with risk of long COVID than pretty much anything else anyone’s found.”

‘All in their head?’

Does this mean these reports of long COVID are imaginary? Quite the contrary. Scientists have known for decades that psychological stress makes people more susceptible to physical illness.

“The results shouldn’t be misinterpreted as supporting post-COVID conditions as psychosomatic,” Jacqueline Becker, a clinical neuropsychologist at the Icahn School of Medicine at Mount Sinai who wasn’t involved in the research, told NBC News.

“Having a mental health issue is always going to be more likely to predispose you to health problems later on, whether it’s COVID, long COVID, or a different post-viral illness,” she said.

Wang and her team surmised that two different factors are involved in the increased risk.

First, stress has been proven to activate molecules that produce inflammation in the body, leading to cell damage throughout the body.

Second, stress has been shown to suppress the immune response, making it harder to fight off viruses and other illnesses. Even obesity, type 2 diabetes, and heart disease have been linked to emotional distress.

Mind-body connection

“Your brain and your immune system are very tightly interconnected,” Roberts explained.

“Studies have shown when you’re depressed or anxious, your immune system doesn’t work as well against targets like viruses and bacteria,” she said.

Furthermore, the study’s results only underscore the critical need for better availability of mental health services in this country.

“These results also reinforce the need to increase public awareness of the importance of mental health and to get mental health care for people who need it, including increasing the supply of mental health clinicians and improving access to care,” Roberts added.

We would also stress the importance of taking precautions to avoid COVID-19, such as masking in indoor settings and being up to date on vaccines and boosters.

Despite recent statements—including from President Biden—that the pandemic is “over,” approximately 400 Americans are still dying every day from the disease.

In the words of Tedros Adhalom Ghebreyesus, director general of the World Health Organization (WHO), “We can see the finish line [of the pandemic], but now is not the time to stop running.”

vit d

Vitamin D: Is It the ‘Cure-All’ Vitamin?

Studies surrounding vitamin D can be conflicting, often leading to confusion on the part of our patients. So our concierge primary care doctors in Jupiter thought we’d take a look at some of the newest findings about this essential vitamin.

Dueling Conclusions

As an example of how different researchers can draw opposite conclusions even from the same study, one doctor recently wrote in The Washington Post that a study she led “found no statistically significant reduction in cardiovascular disease or cancer” in a nationwide randomized trial of 26,000 adults over five years.

Furthermore, she wrote, “My colleagues and I have conducted further studies from VITAL [the study’s title] showing that vitamin D supplements do not decrease the risk of cognitive decline, depression, macular degeneration, atrial fibrillation or several other health conditions. The most recent report showed no reduction in the rate of bone fractures—once the vitamin’s most commonly touted benefit.”

She concluded that the vast majority of Americans are already getting all the vitamin D they need from brief sun exposure and a normal diet.

“Is it necessary for you to spend money on the supplement? For most healthy adults, the answer is no,” JoAnn Manson wrote in The Post.

However, this same researcher told the Harvard Gazette in January of this year that the VITAL study showed subjects who took vitamin D, or vitamin D and omega-3 fatty acids, had a significantly lower rate of autoimmune diseases such as rheumatoid arthritis and psoriasis than those who took a placebo.

“Given the benefits of vitamin D and omega-3s for reducing inflammation, we were particularly in whether they could protect against autoimmune diseases,” she said.

More Confusion

So maybe the vitamin has some value after all, at least for some.

Yet in 2018, another study published in the National Institutes of Health’s (NIH) National Library of Medicine looked at the prevalence of vitamin D deficiency in the U.S. population. In the introduction, the study’s authors wrote that, “Since foods containing natural vitamin D are rare, the primary source of the compound remains . . . exposure to ultraviolet rays in sunlight.”

It went on to assert that “subclinical vitamin D deficiency . . . plays a role in downstream clinical consequences, including cardiovascular disease, cancer, diabetes, osteoporosis, and fractures.”

Why the frequent discrepancy among various studies? One 2020 clinical study published in the journal BMJ sought to answer that question. 

“Our analysis of pooled raw data from each of the 10,933 trial participants allowed us to address the question of why vitamin D ‘worked’ in some trials, but not in others,” Adrian Martineau, a professor at Queen Mary University of London (QMUL) and a lead researcher on the study, wrote in a release.

Those who have the lowest levels of vitamin D in their blood seem to show the largest benefit, he said, along with those who took it daily or weekly, as opposed to intermittently.

The Last Word?

A fact sheet on vitamin D produced by the NIH’s Office of Dietary Supplements (ODS) updated last month summarized numerous studies, including the VITAL study.

For each of the most common health claims connected to vitamin D it reached the following conclusions:

Bone health – All adults should consume recommended amounts of vitamin D and calcium from foods and supplements.

Cancer – Taken together, studies to date do not indicate that vitamin D with or without calcium supplementation reduces the incidence of cancer, but adequate or higher levels might reduce cancer mortality rates.

Cardiovascular disease (CVD) – Overall, clinical trials show that vitamin D supplementation does not reduce CVD risk, even for people with low levels as measured in their blood.

Depression – Overall, clinical trials did not find that vitamin D supplements helped prevent or treat depressive symptoms or mild depression, especially in middle-aged to older adults who were not taking antidepressants.

Type 2 diabetes – Clinical trials provide little support for the benefits of vitamin D supplementation for glucose homeostasis.

Weight loss – Overall, the available research suggests that consuming higher amounts of vitamin D or taking vitamin D supplements does not promote weight loss.

And although the COVID-19 pandemic sparked hope that vitamin D could help prevent or reduce the severity of the illness, two new clinical studies released this month found that it didn’t help with the coronavirus or any other type of respiratory virus.

Vitamin D Overdose?

According to the NIH, the recommended daily allowances for vitamin D are:

  • 0-12 months: 10 mcg (400 IU)
  • 1-70 years: 15 mcg (600 IU)
  • >70 years: 20 mcg (800 IU)

And while many people who supplement with vitamin D take much higher doses than that, too much can be dangerous. Vitamin D is a fat-soluble vitamin, which means it tends to be stored in the body’s fat and can lead to accidental overdoses. 

The upper limit of safety appears to be 100 mcg (4,000 IU) daily.

Those who take more than that could experience side effects from supplementing with vitamin D, including nausea and vomiting, constipation, weakness, and kidney damage, among others.

Overall, most studies seem to show that supplementing with vitamin D doesn’t have much effect on various conditions. On the other hand, moderate doses from a reputable manufacturer are generally considered safe. So if you think you could benefit from vitamin D supplements, the decision is up to you.


Latest on COVID-19 Omicron Boosters

The Centers for Disease Control and Prevention (CDC) earlier this month approved two new booster vaccines specifically formulated to target the BA.4 and BA.5 omicron subvariants of the SARS-CoV-2 coronavirus, so our primary care concierge doctors in Jupiter want to bring you up to date on the latest information.

What’s different about this vaccine?

The COVID-19 vaccines that have been in use since they were first rolled out in 2021 were all designed to target the original strain. They also effectively reduced hospitalizations and deaths against the different variants that emerged in the following months, including the widespread delta variant.

As the newest omicron subvariants emerged and are now responsible for 90 percent of COVID-19 infections, vaccine makers Pfizer-BioNTech and Moderna developed new, more tailored versions to specifically target them.

The new formula is defined as “bivalent,” meaning it protects against both the original strain as well as the highly contagious BA.4 and BA.5 subvariants. They are the first updated COVID-19 vaccines to be cleared by the U.S. Food and Drug Administration (FDA).

“The updated COVID-19 boosters are formulated to better protect against the most recently circulating COVID-19 variant,” said CDC director Rochelle Walensky.

“They can help restore protection that has waned since previous vaccination and were designed to provide broader protection against newer variants,” she added. “This recommendation followed a comprehensive scientific evaluation and robust scientific discussion.”

Tests in mice have shown they produce a good immune system response to omicron’s BA.4 and BA.5 subvariants.

Are they safe?

Some have questioned the safety of the new versions of the shots because they haven’t been tested in humans, only in mice. But the new vaccines have merely been “tweaked” to “change the recipe,” as the University of Colorado’s UCHealth website explains.

The original Pfizer and Moderna vaccines have been fully tested in humans, and more than 600 million doses in the U.S. and millions more around the world have been given safely. The advisors and experts at both the FDA and the CDC have determined that the newly formulated booster shots are safe.

UCHealth infectious disease and COVID-19 expert Dr. Michelle Barron compared the new boosters to the flu shot, which is updated every fall as vaccine makers guess which strains of the flu will be circulating, and change the recipe to match. But the vaccine itself is not entirely new, she explained.

“We don’t test the flu shot each year. We just change it slightly,” Barron said.

“This new COVID-19 booster just tweaks the formula. The technology is the same. The safety of the vaccines will be exactly the same because it’s not a new vaccine,” she explained.

Who can get them?

The Pfizer vaccine is authorized for anyone ages 12 and older; the Moderna vaccine is authorized for adults 18 and older.

Like the previous coronavirus vaccines, the new boosters are free to the public. They will be available to anyone who has already had their primary vaccine series from any authorized U.S.-approved company regardless of how many boosters they’ve already received.

Public health officials recommend that those who are pregnant or have been pregnant recently should also get the updated boosters because they are at a slightly increased risk of more severe illness and death from COVID-19.

For those who recently received a booster of the previous vaccines, the FDA has set a minimum waiting period at two months, but advisers to the CDC recommend waiting longer: at least three months for those at high risk, or as long as six months for everyone else.

It’s also recommended that anyone who has recently recovered from a COVID-19 infection should wait at least three months to be vaccinated, not only to boost the effects of the vaccine but also to avoid the possibility of a rare side effect, heart inflammation, that sometimes affects teen boys and young men.

“If you wait a little more time, you get a better immunologic response,” CDC adviser Dr. Sarah Long of Drexel University told CBS News.

According to the CDC, side effects are expected to be similar to those associated with the current vaccine, including headache and muscle soreness, occasional fatigue, and redness and swelling at the injection site.

What about other vaccines?

As we head into the fall flu season, several of our clients have asked whether they can get a coronavirus vaccine along with a flu vaccine. The answer is yes, one in each arm.

In fact, health officials have recommended this protocol, and the government is preparing to launch a campaign that will urge Americans to do just this, due to the possibility of the high spread of flu and COVID-19 this season.

As for the Jynneos monkeypox vaccine, the CDC suggests that adolescent and young adult men consider waiting four weeks after receiving the monkeypox vaccine before receiving a Moderna, Novavax, or Pfizer COVID-19 vaccine, because of the risk of inflammation of the heart muscle (myocarditis) or inflammation of the tissue surrounding the heart (pericarditis).

However, the agency adds that the monkeypox vaccination “should not be delayed” due to recently receiving a coronavirus vaccine.

If you have any questions about whether or not to get the new booster, don’t hesitate to contact us for advice.

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