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.

Some Common Questions About Organic Foods

Our concierge primary care doctors in Jupiter of course want our patients to eat healthy foods as much as possible.

This typically means a diet low in processed foods and high in fresh fruits, vegetables, nuts, and seeds, along with lean meats and fish.

Does it also mean eating organic foods as well? Many people hear the word “organic” and automatically think it equals “healthy,” but that may not always be the case. So let’s try to clear up the confusion around this widely available—and usually much more expensive—food.

What does the term “organic” mean?

The word “organic” refers to the way the food is grown and processed. The U.S. Department of Agriculture (USDA) has created a set of standards that describe the specific requirements that must be verified by a USDA-accredited certifying agent before products can be labeled organic.

The National Organic Program (NOP), an advisory committee that includes members of the public, develops these rules and regulations for the USDA.

They include several restrictions on farming practices and raising livestock and poultry, as well as on handling and labeling.

In general, the regulations restrict the types of pesticides, fertilizers, and seeds that can be used, and ensure healthy farming practices to protect the environment.

To receive the USDA Organic seal, a product must:

Improve soil and water quality.
Enable farm animals’ natural behaviors.
Cut pollution.
Promote a self-sustaining cycle of resources on a farm.

Certified organic products cannot use:

artificial fertilizers or sewage sludge as fertilizer
radiation to preserve food or get rid of pests or diseases
genetically modified or engineered materials to improve crop harvests or improve pest or disease resistance
antibiotics or growth hormones for livestock
most synthetic pesticides (except in special, USDA-approved circumstances)

Is organic food healthier?

You can find all kinds of persuasive arguments and testimonials online about how organic food is so much healthier for you to eat.

It’s certainly healthier for the environment, because of the sustainable practices organic farmers use.

It’s also undeniably better to avoid products from animals that have been fed antibiotics throughout their lifecycle to promote unnatural growth and suppress diseases that occur from overcrowded conditions. This is one of the things that contribute to antibiotic resistance in humans.

Other than that, though, science has so far not been able to prove that organic foods contain more substantial nutrients than conventionally grown foods.

As reported by Harvard Health, one meta-study by Stanford researchers, for example, found little difference in nutritional content, except for slightly higher phosphorus levels and a higher omega-3 fatty acid content in organic milk and chicken. And the bacteria that can cause food poisoning were equally present in both organic and non-organic foods.

And according to the Mayo Clinic, studies have shown much lower cadmium levels in organically grown grains, but not fruits and vegetables. Cadmium is a toxic chemical found naturally in the soil and absorbed by plants as they grow.

Is the label ‘organic’ a guarantee?

If the food contains the USDA Certified Organic label, that means it was grown and processed according to federal guidelines.

According to the USDA, “Produce can be called organic if it’s certified to have grown on soil that had no prohibited substances applied for three years prior to harvest. Prohibited substances include most synthetic fertilizers and pesticides.

“As for organic meat, regulations require that animals are raised in living conditions accommodating their natural behavior (like the ability to graze on pasture), fed 100 percent organic feed and forage, and not administered antibiotics or hormones.”

The agency performs more than 45,000 onsite inspections per year to ensure compliance with regulations. If foods are labeled “100 percent organic,” that means all ingredients are certified organic. Foods labeled “organic” contain at least 95 percent certified organic ingredients.

On the other hand, labels that say “made with organic” or “organic ingredients” can’t carry a USDA seal, because they contain less than 95 percent organic ingredients.

More confusion in labels

In addition, there is a difference between “organic” and “natural” on a product’s label. The term “natural” may simply refer to products or animals that have been minimally processed and contain no artificial ingredients, but that doesn’t mean they’re organic.

Another confusing term is “grass-fed,” which means animals receive a majority of their nutrients from grass throughout their entire life and have continuous access to pasture during the growing season. It does not mean they have been raised without the use of antibiotics, hormones, or pesticides on their feed.

Likewise, “cage-free” birds are able to freely roam a building, room, or enclosed area with unlimited access to food and fresh water during their production cycle. “Free-range” birds are provided shelter in a building, room, or area with unlimited access to food and fresh water, as well as continuous access to the outdoors during their production cycle. But neither of these terms reveals whether they have been raised without antibiotics or hormones.

So is organic better for you? In some of the ways we’ve listed above, yes. But only you can decide whether the extra expense is worth the small gains in nutritional value, as well as the larger impact on the environment and the animal’s welfare.

Why We’re Careful About Using Antibiotics

Among the many problems that resulted from the COVID-19 pandemic, one of the more serious was an increase in antibiotic resistance (AR), according to a new report from the Centers for Disease Control and Prevention (CDC). The agency estimates that in 2020, the first year of the pandemic, AR infections and deaths in hospitals increased at least 15 percent over 2019.

Our concierge primary care doctors in Jupiter were discouraged to hear this because concerted efforts by the medical community in the last ten years had succeeded in reducing these resistant infections by nearly 30 percent.

It’s worrisome news, because bacteria and other pathogens evolve, just as the coronavirus does to better ensure its survival. As bacteria mutate, they are able to resist the commonly used antibiotics used to treat them, meaning eventually our best weapons become useless and people die unnecessarily.

According to the CDC, at least two million people get an AR infection every year, and at least 23,000 die as a result.

What happened?

What was it about the pandemic that caused this jump in numbers?

For one thing, lack of knowledge; for another, sheer numbers. Medical staff facing patients with fevers and shortness of breath turned to antibiotics as one weapon in their frantic attempts to treat people with an illness they’d never encountered.

Second, whenever such invasive procedures as ventilators and catheters are used, they provide an opportunity for infections, which must then be treated by antibiotics, and the hundreds of thousands of hospitalized COVID-19 patients thus drove higher antibiotic use.

The CDC report says that from March 2020 to October 2020, nearly 80 percent of those hospitalized for COVID-19 received an antibiotic.

Finally, overwhelmed staff—desperately fighting to save lives—had less time to follow protocols normally used to prevent infections, the report says.

The problem with antibiotics

What’s wrong with using antibiotics if they might help?

According to the CDC, “If even one bacterium becomes resistant to antibiotics, it can then multiply and replace all the bacteria that were killed off. That means that exposure to antibiotics provides selective pressure, making the surviving bacteria more likely to be resistant.”

In addition, the CDC says, “When a patient (human or animal) receives an antibiotic they do not need, not only does the patient get no benefits, but they are also put at risk for side effects (e.g., allergic reactions, toxicity that affects organ function, C. diff). Evidence suggests that one in five hospitalized patients who receive an antibiotic has an adverse drug event.”

Antibiotics can cause such side effects as diarrhea when they destroy friendly bacteria, along with the invaders. Other possible side effects include stomach pain, rash, respiratory difficulties, nausea and vomiting, and joint swelling.

Other factors involved

But antibiotic overuse didn’t just happen during the pandemic and doesn’t just happen in hospitals.

One study by the CDC and the Pew Charitable Trust found that nearly a third of the antibiotics prescribed every year—whether in doctor’s offices, hospital-based clinics, or emergency rooms—are not needed and are ineffective for the illness they’re prescribed for.

This report found that at least a third of prescriptions were for conditions that didn’t warrant antibiotics. “An estimated half of antibiotic prescriptions given during pediatric ambulatory care visits are inappropriate,” the report found.

A large number of these prescriptions were provided at the request of patients, who demand their doctors “do something” for conditions that cannot be cured by antibiotics. These include the flu, colds, coughs, and sore throats not caused by strep. Other conditions for which antibiotics are not indicated include bronchitis, asthma, and allergies.

And not just doctors

Patients also play a role in the spread of AR by:

  • insisting on an antibiotic when the doctor has said it won’t help
  • sharing their leftover or unused antibiotics with friends or family members
  • not taking the full course of an antibiotic when one is prescribed

This last behavior, in fact, is a major contributor to the problem of antibiotic resistance. When a patient begins to feel better after a few days and stops taking the antibiotic, the bacteria may be weakened but not killed; their remaining numbers survive to mutate into a strain that can no longer be killed by the antibiotic.

Finally, animal agriculture also contributes to the problem. Antibiotics are used to feed livestock to accelerate growth and prevent disease in otherwise healthy animals that are kept in unnaturally confined conditions during their lifecycle.

A 2017 study by the Pew Charitable Trust confirmed that antibiotic use on farms and feedlots leads to the emergence of resistant bacteria and that these resistant bacteria are infecting humans, either through direct contact with the bacteria, with food produced from the animals, or through the environment.

How to help

These are the reasons why we’re very careful about when we prescribe antibiotics to our patients. You can do your part, as well, by:

  • not skipping doses of an antibiotic we have prescribed for you
  • not saving doses for the next time you get sick (different infections require different antibiotics)
  • never take an antibiotic prescribed for someone else
  • avoiding meat and animal products that have been treated with antibiotics during their lifecycle

Finally, it’s important to take steps in your daily life to prevent infections from taking hold in the first place. This includes frequent hand washing, getting all the vaccinations we recommend, and using safe sanitation practices when handling food.

New Guidance on COVID-19 Can Be Confusing

Sometimes it seems as though we need a spreadsheet to keep track of all the changing information and recommendations on COVID-19.

  • Masks/no masks?
  • Boosters? Maybe not, maybe now, maybe later.
  • Quarantine? Yes, no, who, and how long?

Our primary care concierge doctors in Jupiter don’t mean to criticize the researchers and public officials who are responsible for keeping us healthy. The SARS-CoV-2 coronavirus is, after all, a disease we’d never seen until early in 2019. No one knew how to deal with it.

And thanks to the combined efforts of scientists around the world, we’ve made tremendous strides in the effort to combat it.

But one thing few counted on was “pandemic fatigue,” which meant many people rapidly grew tired of taking precautions and radically altering their lifestyles to help stem the spread of COVID-19.

Which may be what’s behind the latest guidance from the Centers for Disease Control and Prevention (CDC). (https://www.cdc.gov/media/releases/2022/p0811-covid-guidance.html

A new approach

This month the CDC relaxed many of its coronavirus recommendations, leaving measures to battle to limit viral spread largely up to individuals.

According to The Washington Post:

  • “No longer do schools and other institutions need to screen apparently healthy students and employees as a matter of course.
  • “The agency is putting less emphasis on social distancing—and the new guidance has dropped the ‘six-foot’ standard.
  • “The agency’s focus now is on highly vulnerable populations and how to protect them—not on the vast majority of people who at this point have some immunity against the virus and are unlikely to become severely ill.”

In releasing the new guidance, the CDC cited improved tools like vaccination, boosters, and treatments to better protect ourselves from the virus.

“We also have a better understanding of how to protect people from being exposed to the virus, like wearing high-quality masks, testing, and improved ventilation,” Greta Massetti, a CDC epidemiologist, said in a statement.

“This guidance acknowledges that the pandemic is not over, but also helps us move to a point where COVID-19 no longer severely disrupts our daily lives,” she added.

Isolation changes

In one fairly substantial shift, for example, the CDC no longer recommends quarantine if you’re up to date with your vaccines and have been exposed to COVID-19. Instead, you should mask for 10 days and get tested on Day Five.

Additional CDC guidance on isolation includes the following:

  • If you’ve tested positive and have a healthy immune system, regardless of your vaccination status, you should isolate yourself for five days. On Day Six, you can end isolation if you no longer have symptoms or have not had a fever for 24 hours and your symptoms have improved.
  • Once isolation has ended, you should wear a high-quality mask through Day 10. If you test negative on two rapid antigen tests, however, you can stop wearing your mask sooner.
  • Until Day 11 at least, you should avoid visiting or being around anyone who is more likely to have severe outcomes from COVID-19, including the elderly and people with weakened immune systems.

These changes stem from a new statistic, according to Massetti: 95 percent of the U.S. population has at least some level of immunity against the virus, either from vaccination or previous infection.

What about boosters?

As for booster shots, the U.S. Food and Drug Administration (FDA) finally decided last month against allowing adults younger than 50 to become eligible for a second booster vaccine (for a total of four mRNA shots).

Currently, only those age 50 and older and children at least 12 years old with impaired immune systems can get a second booster.

This is because the agency expects to have reformulated mRNA boosters available by next month that will contain components from both the original virus and its variants, as well as from the currently circulating (and highly contagious) omicron subvariants BA.4 and BA.5.

Meanwhile, the FDA still recommends that anyone under age 50 receive a single booster shot, and people older than 50 or those with weakened immune systems receive a second mRNA booster.

The mask question

No one likes wearing masks, especially in the heat. However, our primary care concierge doctors believe it’s better to err on the side of caution, especially if you’re immunocompromised or older than 65.

Especially given the new CDC guidance revisions, there’s no harm in wearing a mask in crowded indoor situations with poor ventilation.

It’s true that we now have effective treatments for COVID-19, but given the risk of long COVID—one recent study found that as many as one in every eight people who contracted it had lingering symptoms—what’s the point in taking unnecessary chances?

It’s up to you, of course, but in a recent interview with The Post, Ziyad Al-Aly, an epidemiologist at Washington University in St. Louis, compared the current state of the country to “the Wild West.”

“There are no public health measures at all,” he told the paper.

“We’re in a very peculiar spot, where the risk is vivid and it’s out there, but we’ve let our guard down and we’ve chosen, deliberately, to expose ourselves and make ourselves vulnerable.”

Lightning: Deadly But Avoidable

Labor Day is coming up, signaling the unofficial end of summer. Kids will be heading back to school and families will be trying to get as much outdoor fun into the waning days of the season as possible.

But as you go about your last-minute recreation, there’s a rare but deadly danger that our concierge primary care doctors in Jupiter want to warn you about: lightning.

Our state is known as the “Lightning Capital of the U.S.” More people die from lightning strikes in Florida every year than in any other state, and the southeastern coast of the state is second only to the Tampa area in reported fatalities.

That’s why we want to remind you that these tragic deaths can be prevented, as long as you know how to avoid them.

Recent deaths

Lightning kills an average of 23 people every year. So far this year, 12 people have been killed by lightning, including a 27-year-old man doing lawn maintenance in New Smyrna Beach, Florida, and a soldier on a training exercise at Fort Gordon, Georgia, both in July.

The most recent deaths occurred this month in Washington, D.C., in Lafayette Park just north of the the White House, as the victims huddled under a tree for protection from a sudden severe thunderstorm.

One was a 29-year-old bank vice president in town on business. The others were a Wisconsin couple celebrating their 56th wedding anniversary. All three were killed, while another woman who was also struck remains in critical condition.

They were struck by an unusual six-prong bolt that hit the same place within half a second, creating a ground current.

According to the National Weather Service (NWS), “When lightning strikes a tree or other object, much of the energy travels outward from the strike in and along the ground surface.”

“This is known as ground current. Anyone outside near a lightning strike is potentially a victim of ground current,” the agency adds.

Five potential paths 

A ground current discharge is one of five ways people can by struck by lightning.

The five are:

Direct strike – These most often occur to victims who are in open areas. While the most deadly type, it’s not as common as the other four.

Side flash – Also called a “side splash,” these occur when lightning strikes a taller object near the victim and a portion of the current jumps from the taller object to the victim.

Ground current – This type, mentioned above, causes the most lightning deaths and injuries, including to farm animals. 

Conduction – Lightning can travel long distances in wires or other metal surfaces, because the metal provides a path for the lightning to follow. This type is the way most people are killed indoors during a lightning storm, including when they’re taking showers, washing dishes, or talking on corded phones. 

Streamers – While uncommon, streamers can injure or kill when a side bolt separates or rebounds from the main or leader bolt and discharges.

Lightning safety rules

To stay safe from lightning, the NWS offers these guidelines to avoid being struck by lightning.

  • Appoint someone to watch the skies during your outdoor work or recreation. Check the latest thunderstorm forecast and monitor the NOAA Weather Radio.
  • When lightning is in your vicinity, go quickly inside a completely closed building. Do not consider carports, open garages, covered patios, or pavilions adequate shelter.
  • If no closed building is convenient, get inside a hard-topped, all-metal vehicle and be sure the windows are completely closed.
  • Do not take shelter under a tree, especially if it is tall and isolated.
  • Get out of the water. This includes pools, lakes, rivers, oceans, water rides, and even puddles. And leave the beach immediately if you see or hear a thunderstorm approaching.
  • Put down metal objects such as fishing poles, golf clubs, tennis rackets, tools, etc.
  • Dismount from tractors and heavy construction equipment. Do not seek shelter under the equipment.
  • Move away from metal objects such as metal fences, metal sheds, telephone and power lines, pipelines, etc.

Indoor safety

  • Avoid contact with corded phones.
  • Avoid contact with electrical equipment or cords. If you plan to unplug any electrical equipment, do so before the storm arrives.
  • Avoid contact with plumbing. When thunderstorms are occurring, do not take a shower or bath, wash dishes, or do the laundry.
  • Move away from windows and doors. Do not stay on the porch.

If someone is struck

Call 911 immediately.

  • Determine whether the victim is unconscious. Check to see if they are breathing, and gently roll the victim onto their back.
  • If the victim is not breathing, perform CPR until the paramedics arrive. (A reminder: Mouth-to-mouth breathing is no longer recommended to revive someone; regular chest compressions—between 100 and 120 a minute—are more effective.)
  • Always keep in mind the NWS directive: When thunder roars, go indoors.
pfas

How to Combat the Lingering Danger of ‘Forever Chemicals’

They’re called “forever chemicals” because they don’t break down fully in the environment, and this summer the Environmental Protection Agency (EPA) warned that they are more dangerous to human health than regulators knew.

Within weeks, the National Academies of Sciences, Engineering, and Medicine (NAS) weighed in with its own 300-page report on these chemicals, known as perfluoroalkyl and poly-fluoroalkyl (PFAS) substances, urging doctors to test high-risk patients for PFAS contamination.

Because of the heightened attention on these chemicals, our primary care concierge doctors in Jupiter want to summarize for you what we’ve learned about them, and offer tips on how to reduce your exposure.

The Problems with PFAS

In 1946, DuPont introduced its revolutionary non-stick product, Teflon. By 1950, studies by DuPont and 3M showed that PFAS could build up in the blood, but chose to keep these results secret, according to the non-profit Environmental Working Group (EWG).

Since 1998, when a class-action lawsuit against a West Virginia DuPont factory revealed the extent of the pollution from the factory, researchers have found probable links to such diseases as:

  • thyroid disease
  • high blood pressure
  • kidney cancer
  • testicular cancer
  • breast cancer
  • higher cholesterol levels
  • ulcerative colitis
  • weakened immune system 
  • vaccine interference
  • weight gain
  • changes in liver enzymes
  • decreased fertility
  • growth and learning delays in infants and children

The NAS report encourages doctors to conduct blood tests for these chemicals on patients who are worried about exposure or who are at high risk for exposure or who are in “vulnerable life stages”: during pregnancy, early childhood, and old age. 

They’re Everywhere

As we’ve seen with microplastics, PFAS can begin innocently enough and end up in unexpected places, including our water.

Recently, for example, Consumer Reports (CR) tested more than 100 food-packaging products from U.S. restaurants and supermarkets. They found dangerous PFAS chemicals in many of the products, including paper bags for french fries, hamburger wrappers, pizza boxes, molded fiber salad bowls, and single-use paper plates.

These chemicals are used in a wide variety of products, including waterproof and sweatproof makeup, nonstick cookware, cellphones, waterproof clothing, carpets, and—especially—fast-food containers, where their ability to make products grease-proof has led to their widespread use.

They are also used to make products water-repellent and resistant to high temperatures, as well as in fire-fighting foams used at military installations, floor wax, upholstery, and clothing. The qualities that make items containing PFAS so desirable, however, also make them long-lasting in the environment.

Lingering Threat

“These chemicals are ubiquitous in the American environment,” Ned Calonge, an associate professor of epidemiology at the Colorado School of Public Health and chair of the NAS committee that wrote the report, told CNN.

“More than 2,800 communities in the U.S., including all 50 states and two territories, have documented PFAS contamination,” he said.

Researchers have even detected them in the snows of Mt. Everest, apparently shed from climbers’ waterproof tents and parkas. 

“You are not just exposed in one place or one source,” toxicologist Linda Birnbaum, former director of the National Institute of Environmental Health Sciences and the National Toxicology Program, told The Washington Post. “They are everywhere.”

The problem is that these chemicals build up (or “bioaccumulate”) in the body over time. 

And according to the Centers for Disease Control and Prevention (CDC), which has been conducting studies of the U.S. population, PFAS has been found in the blood of nearly all people they’ve tested. Since the risk appears to rise with the amount of exposure, it’s important to try to limit the amount we come in contact with.

What You Can Do

Because PFAS chemicals are found in so many consumer products, they’re next to impossible to avoid. But there are ways to reduce the amount you’re exposed to.

“The most dangerous way that people are exposed to PFAS is through drinking water,” says Don Huber, director of product safety at CR.

That’s why the NAS report recommended filtering tap water as a major step consumers could take to protect themselves.

“The water filters that are most effective for PFAS are reverse osmosis filters,” David Andrews, a senior scientist for the EWG, told CNN, adding that some carbon-based filters can also reduce some levels.

“The important part is that you have to keep changing those filters,” he said. “If you don’t change that filter, and it becomes saturated, the levels of PFAS in the filtered water can actually be above levels in the tap water.”

The NAS committee also offered these tips:

  • Stay away from stain-resistant carpets and upholstery, and don’t use waterproofing sprays.
  • Look for the ingredient PTFE or other “floro” ingredients on product labels.
  • Avoid nonstick cookware. Instead, use cast-iron, stainless steel, glass, or enamel products.
  • Boycott takeout containers and other food packaging. Instead, cook at home and eat more fresh foods.
  • Don’t eat microwave popcorn or greasy foods wrapped in paper.
  • Choose uncoated nylon or silk dental floss or one that is coated in natural wax.

Why Monkeypox Is Not Like COVID-19

Last month, the World Health Organization (WHO) declared the newly spreading monkeypox virus a global health emergency.

This has prompted many to fear we’re heading into another coronavirus situation, as our concierge primary care doctors in Jupiter have found from talking with our patients.

While this is a debilitating, painful, and—occasionally—deadly virus, there are many reasons why it’s very dissimilar to the SARS-CoV-2 virus, the virus that causes COVID-19.

The history is different

Although both originated as “zoonotic” diseases—that it, they began in animals and spread to humans—we have a far longer history with monkeypox, meaning we know more about it than we did when the coronavirus first appeared.

According to the Centers for Disease Control and Prevention (CDC), monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, thereby giving the disease the name “monkeypox.” Its typical animal hosts, however, are rodents and other small mammals.

The first human case of monkeypox was recorded in 1970 in the Democratic Republic of Congo during a period of intensified effort to eliminate smallpox. Since then, monkeypox has been reported in humans in other central and western African countries.

Although relatively new to the U.S., a large monkeypox outbreak occurred here in 2003 as a result of imported rodents.

Transmission is different

Next, the ways the two viruses are transmitted are completely different.

Unlike the largely airborne transmission of SARS-CoV-2 through aerosols that linger in the air, the monkeypox virus can only be spread through close contact with an infected person or animal, or materials such as bedding or towels that are contaminated with the virus.

In addition, monkeypox appears to be far less transmissible than COVID-19. One study found that just three percent of those in close contact with an infected person would develop monkeypox.

It appears at this time to be spreading primarily among gay and bisexual men following sexual encounters, but anyone who comes into close and prolonged, direct contact with the pox sores can become infected.

Even women, and at least two children, have been reported to have contracted monkeypox, as a result of being in close proximity to men who have sex with other men.

The symptoms are different

Unlike the stealth infections of the coronavirus, it’s very apparent when a person is infected with monkeypox. As with COVID-19 and other viruses, they develop fever, headache or body aches, chills, muscle aches, and exhaustion.

These symptoms are also similar to those of smallpox, a cousin of monkeypox, with one difference:

“A feature that distinguishes infection with monkeypox from that of smallpox is the development of swollen lymph nodes,” the CDC says.

Otherwise, however, both smallpox and monkeypox exhibit the same signature fluid-filled lesions (the so-called “pox”), which the coronavirus doesn’t produce. Some individuals have these sores all over the body, while others may have only a single lesion. This rash can be extremely painful.

The vaccines are different

When COVID-19 first appeared two-and-a-half years ago, it was a brand new virus (i.e., “novel” coronavirus).

We knew nothing about it, and at the time had no way to combat it in the form of either effective treatments or vaccines.

Because of our long history with monkeypox, however, we do have vaccines and antiviral treatments. Monkeypox and smallpox come from the same family of viruses (although monkeypox is not as severe as smallpox). That has allowed us to utilize the stockpile of smallpox vaccines and antivirals to fight monkeypox.

And, unlike the coronavirus vaccines, the vaccines for monkeypox are effective even after infection, if given within four days of exposure. Even if the vaccine is given as late as two weeks after exposure, it can still lessen the likelihood of severe illness.

Not to worry?

Does all this mean we don’t have to panic about monkeypox? Panic is never a good idea because it prevents thoughtful responses in a crisis. But at this time the monkeypox outbreak still appears to be confined largely to men who have sex with men and those who are closest to them and who may come in contact with the open sore or infected linens.

If you fall into one of those categories, it’s important to take precautions until the supply of vaccines and antivirals becomes sufficient to cover everyone at high risk of exposure, because cases are spreading rapidly in the U.S. At the end of July, the Centers for Disease Control and Prevention (CDC) reported more than 3,500 confirmed cases but noted that is probably a significant undercount.

Experts advise that, if you’re at risk, you temporarily reduce your number of sexual partners, reconsider sex with new partners, and exchange contact details with any new partners to enable follow-up, if necessary.

Infected people are encouraged to self-isolate from other humans as well as pets, and to wear a mask and long clothing over any sores.

Although there is currently a limited supply of vaccines in the U.S., the government has purchased 2.5 million doses, which should be available in the coming weeks. This means it isn’t yet enough available to offer shots to all high-risk individuals.

So until there is, take precautions, and let us know if you think your symptoms might be those of monkeypox. It’s a painful, debilitating, and sometimes deadly disease, but we can treat it if it’s caught in time.

health benefits of coffee

Coffee Scores Another Win for Improving Health

Besides water, our primary care concierge doctors in Jupiter are hard-pressed to think of another beverage that offers such a wide range of health benefits as coffee.

For example, research has found that regular coffee consumption has been linked to a lower risk of: 

  • heart disease and strokes
  • heart failure
  • melanoma
  • diabetes
  • liver and prostate cancer
  • Parkinson’s disease

Evidence piles up

Studies have also found that the caffeine in two cups of coffee a day provides significant protection against Alzheimer’s disease, as well as other types of dementia. A study released last year, for example, found that individuals who drank four to six cups of coffee or tea a day reduced their risk of stroke and dementia by 28 percent compared to those who did not drink either beverage.

Another study, published last year in the journal BMC Public Health, found that those who drink three to four cups of coffee a day (whether ground, instant, caffeinated or decaf) reduced their risk of chronic liver disease by 21 percent, compared with those who didn’t drink coffee at all.

A third study, also published last year in the American Heart Association (AHA) journal Circulation, found that drinking one or more cups of plain, caffeinated coffee a day was associated with a long-term reduced risk of heart failure.

The AHA researchers found that the risk of heart failure dropped between five percent and 12 percent for each cup of black coffee the subjects drank. The risk declined even more, to 30 percent, when subjects drank two or more cups daily in one of the studies. The study found, however, that decaffeinated coffee did not offer the same benefit. 

“The association between caffeine and heart failure risk reduction was surprising,” senior author Dr. David Kao, medical director of the Colorado Center for personalized Medicine at the University of Colorado School of Medicine in Aurora, said in a statement.

“Coffee and caffeine are often considered by the general population to be ‘bad’ for the heart because people associate them with palpitations, high blood pressure, etc. The consistent relationship between increasing caffeine consumption and decreasing heart failure risk turns that assumption on its head,” he said.

Latest findings

The most recent research, published last month in the Annals of Internal Medicine, found that people who drink a moderate amount of coffee, defined as up to 3 1/2 cups a day, were up to 36 percent less likely to die from any cause over the seven-year period of the study than those who did not drink coffee.

It didn’t matter what type of coffee the subjects drank—ground, instant, caffeinated, or decaf—or even if they added a modest amount of sugar: The results were the same.

According to Johns Hopkins, there are also many other benefits from daily coffee consumption. For example:

  • Coffee may help your body process glucose better, meaning you may be less likely to develop type 2 diabetes.
  • Coffee may lower the risk of developing Parkinson’s disease, and help those who have it control their movements better.
  • Coffee can help lower your risk of colon cancer.
  • Drinking dark-roast coffee has even been shown to decrease breakage in DNA strands, which helps protect against various cancers.

Some coffee caveats

It’s typical with humans, however, to think that if something is good for you, more of it is better. That’s rarely the case, including with coffee.

The U.S. Department of Agriculture’s (U.S.D.A.) Dietary Guidelines for Americans recommend no more than 400 milligrams of caffeine a day. An average eight-ounce cup contains 95 milligrams of caffeine.

Several studies—including those outlined above—have found that five cups of coffee a day appears to be the upper limit of safety. In fact, a 2009 study found a 17-21 percent increased risk of death among those who drank four or more cups a day.

Other possible negative effects of too much coffee include:

  • increased blood pressure
  • headache
  • heartburn
  • dehydration
  • increased heart rate
  • abnormal heart rhythm
  • anxiety
  • dizziness
  • insomnia

In addition, a 2017 study found that pregnant women who drink more than four cups of coffee a day were more likely to experience low birth rate babies, preterm births, and stillbirths.

Another study linked coffee consumption with the possibility of increased bone loss in postmenopausal women if their diets lack sufficient calcium intake.

Finally, those who are sensitive to caffeine may experience many of these side effects with even small amounts of coffee. Older adults also may not be able to metabolize caffeine as well they did when they were younger.

And anyone who is taking certain drugs (like ephedrine, used in decongestants) can experience increased blood pressure, along with a higher stroke risk, when they consume coffee as well. 

But if you’re not caffeine-sensitive, and you don’t overdo it, our primary care doctors urge you to feel free to enjoy that third or fourth cup of the day without guilt.

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