Surviving Spring Allergies Without Gaining Weight

, , , , , Health Basics, Healthy Living, Medications

With the fresh air of the ocean and year-round warmth, you might be surprised to find that Florida is one of the top hot spots in the country for spring allergies. You might also be surprised to learn that some of the over-the-counter (OTC) allergy medications you automatically reach for to stop the resulting sneezing and sniffling can cause you to gain weight.

So our concierge primary care doctors in Jupiter want to tell you the differences between the various types of antihistamines and suggest other ways of battling spring allergies.

‘Pollen Storm’

As NBC News reported last month, a growing number of adults in their 30s, 40s, and 50s who’ve never had allergies before are experiencing them now.

“What I see is people coming in for the first time, especially over the last five, seven years or so,” Dr. Clifford Bassett, an allergist at NYU Langone Health in New York City, told NBC.

“They will always say, ‘I don’t understand how this is happening to me,’ ” he added.

The culprit appears to be climate change, the network reported. As CO2 levels rise, plants and trees produce more pollen, coupled with earlier spring blooms from trees. This is driving a longer season, with more severe reactions from sufferers.

“The pollen season right now is about three weeks longer than it was 30 years ago, and there’s about 20 percent more pollen in the air,” Dr. Neelu Tummala, an ear, nose, and throat specialist and co-director of the Climate Health Institute at George Washington University, told the network.

Dr. Stanley Fineman, an allergist at Atlanta Allergy and Asthma and a spokesperson for the American College of Allergy, Asthma & Immunology, calls the phenomenon a “pollen storm.”

“The pollen counts, particularly this season, have been much, much higher than we’ve seen in the past,” he told NBC.

COVID, Cold, or Allergies?

And since the dawn of the SARS-CoV-2 pandemic, now people are wondering whether their stuffy or runny nose, loss of taste or smell, and itchy, watery eyes are symptoms of COVID-19.

For instance, the loss of the senses of taste and smell can also happen with allergies and colds when the nasal passages become blocked.

In the past, doctors would say that if you’ve never had allergies before, your symptoms are likely something else, such as a cold or other type of virus. But because more people are now experiencing allergies, that’s not necessarily a reliable indicator.

Experts generally agree, however, that fever, chills, and body aches typically indicate viruses, while the telltale symptom of allergies is itching.

“The biggest symptom I would suggest is the itchiness of the eyes, nose, and throat,” Bassett said. “You don’t get itchiness if you have a cold or if you’re having a sinus infection.”

Nevertheless, it’s best to get tested if you’re experiencing new symptoms.

“We’ve definitely had patients come to our clinic who thought they were having allergies, but they had COVID instead,” Dr. Michelle Pham, an allergist, and immunologist at USCF Health in San Francisco, told NBC.

The Risk of Weight Gain

Depending on the severity of your symptoms, there are several ways to treat allergies.  One of these is oral antihistamines.

But a 2010 Yale University Study that found those who regularly took antihistamines weighed more than those who didn’t gave some allergy sufferers pause. The researchers cautioned that it wasn’t clear whether those who were already overweight were more prone to allergies, and thus more likely to take antihistamines.

According to the non-profit Obesity Medicine Association, however, “Histamine decreases our hunger by in part affecting the appetite control center in our brains, and it makes sense [that] an anti-histamine would have the opposite effect. These drugs can interfere with the ‘I’m full’ signal coming from the rest of our bodies and lead to overeating.”

In fact, some antihistamines—particularly cyproheptadine—are prescribed for children and pets to increase appetite.

But not all antihistamines have this effect. The Cleveland Clinic explains that so-called first-generation antihistamines were approved in the 1930s, but had more serious side effects, including drowsiness, dry mouth, and rapid heart rate. The second-generation antihistamines, approved in the 1980s, carry far fewer side effects. They also don’t relieve nasal congestion the way many first-generation antihistamines do.

What To Do Instead

If you want to try to do without antihistamines, first, avoid exposing yourself as much as possible to pollen.

  • Avoid outdoor activity in the early morning when pollen counts are highest.
  • Keep windows closed, in the home and car.
  • Wear a mask, hat, and sunglasses if you need to be outdoors.
  • Use a vacuum equipped with a HEPA filter.

Next, rinse frequently with a saline nasal spray or a neti pot to clean out pollen in your sinuses.

Finally, try switching to second-generation antihistamines. These include:

  • azelastine (Astelin)
  • loratadine (Claritin, Alavert)
  • cetirizine (Zyrtec)
  • desloratadine (Clarinex)
  • fexofenadine (Allegra)

If OTC medications aren’t working, be sure to let us know. There are prescription approaches that may help.

Keep in mind that, even if your allergies have been manageable in the past, with the stepped-up pollen levels accompanying global warming, you may need more intensive therapy.

“Before, you could get away with just using an intranasal steroid,” Tummala told NBC, “and now you have to do a neti pot rinse and then the steroid,” she said.

Yes, COVID-19 Remains a Threat

, , COVID, Health Basics, Healthy Living

Our primary care concierge doctors in Jupiter dislike being the bearers of bad news, but it’s important to know that the COVID-19 virus is still active, still mutating, and still killing people: as many as 250 Americans a day, primarily those who are immunocompromised and older adults.

That equals roughly 90,000 of us every year. This figure is well below the height of the pandemic when 4,000 Americans a day were dying. But the number isn’t insignificant if it impacts you or someone you love.

It’s also important to remember that, even if an infection doesn’t result in death, the long-term consequences even for younger, healthy people can be severe and/or debilitating.

Newest Variant

The latest omicron subvariant, XBB.1.5, now accounts for nearly 80 percent of COVID-19 cases being diagnosed in the U.S., according to the Centers for Disease Control and Prevention (CDC).

In addition, the World Health Organization has identified a new subvariant, XBB.1.16, known as Arcturus. The CDC reported last month that it is now responsible for about seven percent of coronavirus infections, up from about four percent the previous week.

The good news is that Arcturus doesn’t appear to be any more deadly than previous omicron variants. While a change in the spike protein might mean it could spread more rapidly, there’s no indication that cases will be more severe.

“We’ve seen this in the past,” Paul Hunter, a professor of medicine at the University of East Anglia in Britain, told The Washington Post.

“You look at the virus and it’s got mutations that should make it more virulent, but then, in reality, you don’t see that,” he said.

“It will probably become the dominant variant for a while in the U.S. and Europe and most countries around the world, but I don’t see it driving up severe infections more than we’ve seen in recent waves,” he added.

Still Dangerous

That doesn’t mean Arcturus or the currently dominant XBB.1.5 are benign, however.

COVID-19 remains the third leading cause of death in the U.S. Florida is currently seeing 17 new cases every day per 100,000 population, the highest in the nation (Kentucky is second, at 13 new cases per day per 100,000).

These numbers are likely undercounted because so many people have abandoned getting officially tested for COVID-19, are testing at home and not reporting positive cases, or not getting tested at all.

And it’s not just older Americans who are impacted. The CDC reported last month that the 18-29-year-old age group “has accounted for the largest cumulative number of COVID-19 cases compared to other age groups.”

NBC’s Today Show recently reported on a new study by Cedars Sinai Hospital in Los Angeles, which found that the age group hit hardest by post-COVID-19 heart attack deaths was people between 25 and 44. This cohort saw a 29.9 percent relative increase in heart attack deaths over the first two years of the pandemic.

“Young people are obviously not really supposed to die of heart attack,” Susan Cheng, a cardiologist at Cedars Sinai and co-author of the study, told Today in February.

“They’re not really supposed to have heart attacks at all,” she said.

In addition, a National Center for Health Statistics survey showed that nearly 20 percent of adults who had a COVID-19 infection continue to have the debilitating symptoms of long COVID.

Remember the Vulnerable

Unfortunately, most of America seems to have moved on from the pandemic. People are going about their lives as if SARS-CoV-2 was just a bad dream they’re happy to have awakened from.

“Get all the shots you wish, take all the precautions you wish, but the health of us out there are done sacrificing for the weakest of health or brain,” wrote one anonymous commenter last month on The Post website.

This attitude of “stay home forever” rankles journalist Jeanine Santucci, as she recently wrote in USA Today.

A young mother with type 1 diabetes, she is at higher risk from COVID-19. She is fully vaccinated and has loosened her self-quarantine over the past three years, now seeing friends outdoors unmasked if they have a negative COVID-19 test. She ventures out in public with an N95 mask and a portable air purifier but resents the general lack of masking in indoor public spaces.

But she called the “stay home if you’re at risk” approach “cruel” and unfair.

“The main reason I am still taking this seriously, and I hope you will, is that our country’s most vulnerable people deserve to be part of society,” she said.

Protect Yourself and Others

“With the removal of mask mandates in health care settings and essential places such as pharmacies, public transit, and grocery stores, immunocompromised people are made outcasts,” Santucci added.

“But simply putting on an N95 when you go out makes us safer. It shows us you care that we’re alive.”

Given the prevailing attitudes from both government and the general public that if you want to avoid getting COVID-19 you’re pretty much on your own, we recommend continuing to take precautions when you’re in public spaces.

This means any place that is not well-ventilated, including your own home if you have visitors whose infection status is unknown. Wear a mask in crowded settings, and stay up to date on your vaccinations.

As Santucci wrote, “I hope you’ll take into consideration just how much is at stake for you, and the fact that you’re also making a risk calculation for vulnerable people like me when you do.”

Is Exercise Better Than Drugs for Mental Health?

, , , , , Concierge Medicine, Health Basics, Healthy Living, Lifestyle, Preventative Health, Uncategorized

If our primary care concierge doctors in Jupiter could prescribe a single treatment for a host of different health concerns, it would be exercise.

For example, one study published in the journal BMJ compared exercise alone versus drug therapy alone and found that for heart disease, diabetes control or prevention, stroke rehabilitation, and treatment of heart failure, regular physical exercise was just as effective as prescription medications in treating many of these conditions.

And according to the Mayo Clinic, some of the disorders that benefit from regular exercise include:

  • Heart disease – In addition to strengthening the heart muscle and lowering blood pressure, exercise can help you be more active without experiencing chest pain or other symptoms.
  • Diabetes – Regular exercise can not only help insulin more effectively lower your blood sugar level, but also help control weight and boost energy.
  • Asthma – Exercise has been shown to control the frequency and severity of asthma attacks.
  • Back pain – Regular low-impact aerobic exercise can help increase the strength of your back muscles and improve endurance and muscle function.
  • Arthritis – Exercise is the primary approach to reduce pain, help maintain muscle strength in affected joints and reduce joint stiffness.

What About the Brain?

It makes sense, then, that the benefits of exercise would also impact the brain.

And that’s just what a new study, published in February in the British Journal of Sports Medicine, revealed. Researchers from the University of South Australia correlated data from 1,039 studies involving more than 128,000 volunteers.

They found that physical activity was 1.5 times more effective for managing depression than either counseling or the leading medications typically prescribed for the disease.

The review showed that exercise interventions that were 12 weeks or shorter were the most effective at reducing mental health symptoms, showing how quickly physical activity can make a difference, Science Daily reported.

“Our review shows that physical activity interventions can significantly reduce symptoms of depression and anxiety in all clinical populations,” lead researcher Dr. Ben Singh said in a statement.

“We also found that all types of physical activity and exercise were beneficial, including aerobic exercises such as walking, resistance, training, Pilates, and yoga,” he said. 

“Importantly, the research shows that it doesn’t take much for exercise to make a positive change to your mental health.”

Even a Little Bit Helps

This last finding is important because one of the hallmarks of depression is a lack of energy. So asking them to engage in the Centers for Disease Control and Prevention’s (CDC) recommendation of 150 minutes of moderate physical activity every week is akin to asking them to climb a mountain with a broken leg.

Another study, published this month in the journal JAMA Psychiatry, offers similar reassurance that any regular movement can make a difference.

For this study, the researchers looked at 15 studies involving more than 190,000 subjects.

They found that people who engaged in brisk walking for a total of 2.5 hours a week had a lower risk of depression than those who didn’t exercise at all. 

“Most benefits are realized when moving from no activity to at least some,” the study authors wrote. 

“Our findings, therefore, have important new implications for health practitioners making lifestyle recommendations, especially to inactive individuals who may perceive the currently recommended target [of 2.5 hours a week] as unrealistic,” they added.

How Does it Work?

There are several reasons exercise has such a positive effect on depression and anxiety, according to Dr. Antonia Baum, an assistant clinical professor of psychiatry and behavioral sciences at George Washington University, who was not involved in these studies.

It can improve blood circulation to the brain and have a positive impact on inflammation and the body’s immune response, she told U.S. News, noting the connection between heart health and depression. There may also be intangible benefits such as getting stronger or feeling empowered or gaining a sense of well-being.

Yet another recent meta-review of 41 studies involving 2,265 people with depression found that almost any type of exercise substantially reduces symptoms of depression, The Washington Post reported.

“We found large, significant results,” said study leader Andreas Heissel, an exercise scientist at the University of Potsdam in Germany.

Although more exercise produced greater results, “Something is better than nothing,” Heissel noted.

Small Moves

Jennifer Heisz, a neuroscientist and an associate professor in the Department of Kinesiology at McMaster University in Ontario, Canada, who was not involved in these studies, was even more encouraging.

“Any movement, every movement, every step counts,” she told U.S. News.

“It doesn’t have to be as much as you need for physical health,” she added. “You can get by with half of that, and this is very consistent with the literature.”

Heisz suggested that people try to move a little every day, even if it’s just a five- or 10-minute walk, or a two-minute movement break every half hour for those who sit all day.

“That’s how simple we need to get, especially for people who are not moving at all, and to acknowledge that there is this additional barrier of motivation for people who are suffering from depression,” she said.

One final word: It’s important not to try to treat depression yourself. We can help guide you through different approaches or even recommend other professionals that can help.

If you have thoughts of harming yourself, dial or text the new national suicide hotline number 988 for immediate help.

Celebrate Earth Day With a Climate-Friendly Diet

, , Environment, Health Basics

As we prepare to celebrate the 51st Earth Day this week, our primary care concierge doctors in Jupiter know that many people are looking for ways to be kinder to the Earth without radically altering their entire lifestyle.

One way is to be more mindful of the carbon impact of the foods we eat. As an added bonus, eating more sustainably provides great health benefits, as well.

But you don’t have to make drastic changes to make a difference.

First, Some Facts

The World Economic Forum reports that, in a business-as-usual scenario, emissions from food production alone could use up all of the earth’s 1.5°C to 2°C carbon budget.

The World Health Organization (WHO) says that food production accounts for 20-30 percent of global greenhouse gas (GHG) emissions and as much as 66 percent of water usage.

According to Scientific American (SA), the Environmental Working Group (EWG) found that red meat such as beef and lamb is responsible for 10 to 40 times as many GHG emissions as grains and vegetables.

Livestock farming from cattle alone is estimated to generate about 20 percent of the GHG methane produced in the U.S.

In addition, a 2009 study found that cattle ranching is responsible for 80 percent of the deforestation of the Amazon rainforest.

Finally, SA reports that concentrated animal feeding operations (CAFOs or “factory farms”) can produce as much sewage waste as a small city.

The Wellness Advantage

In addition to the benefits for the planet, this way of eating provides another bonus: From a health perspective, plant-based diets are unquestionably better for the body than a diet high in meat, especially red meat.

According to Harvard Health, “an accumulated body of evidence shows a clear link between high intake of red and processed meats and a higher risk for heart disease, cancer, diabetes, and premature death.”

“The evidence is consistent across different studies,” says Dr. Frank Hu, chair of Harvard’s Department of Nutrition.

On the flip side, plant-forward diets have been shown to support the immune system, reduce inflammation in the body, reduce the plaques associated with Alzheimer’s disease, and improve the gut microbiome.

And, of course, incorporating more plants into your diet reduces the number of antibiotics you’re exposed to.

As SA reports, the widespread use of antibiotics to keep livestock healthy in the unnatural confines of those overcrowded CAFOs has led to the development of dangerous antibiotic-resistant strains of bacteria that can make some common infections impossible to treat.

Different Approaches

As we said, you don’t have to go totally vegan to help the planet or your health. There is an array of climate-friendly (or at least friendlier) diets to choose from.

Vegans, of course, don’t consume any animal products at all.

Vegetarians don’t eat meat but may eat some animal products such as eggs and dairy.

Flexitarians are, as their name suggests, more flexible in what they eat. Closest to vegetarians, they do occasionally consume meat.

Sustainarians eat a mostly plant-based diet but will eat meat if it is locally and humanely raised.

Reducetarians try to eat less meat for a variety of reasons, including their own health, the welfare of animals, and the environmental impact of their food. They’re also concerned with the concepts of biodiversity loss, and their food’s impact on water supplies and food workers.

Climatarians, also known as “climavores,” eat less meat and only a moderate amount of sustainable fish, avoid food waste and “air-flown” food, and choose high-welfare, organic meat.

Regenivores’ diets are similar to those above, especially reducetarians, but focus even more on whether it’s ethically produced. HuffPost reports they take into consideration soil health, workers’ rights, the impact of chemicals on the humans involved in food production, and the treatment of animals throughout the supply chain.

Other Ideas

Kind of confusing, isn’t it? If you don’t want to label your efforts to reduce your carbon footprint but just want to eat more sustainably, Canadian Living offers a simpler approach:

  1. Eat less meat. “A 2016 systematic review shows that following a diet low in animal products has the biggest impact on the environment of any dietary change, reducing GHG emissions and land use up to 70-80 percent, and water uses up to 50 percent,” the magazine reports. Keep in mind that beef has the largest carbon footprint of all animal products.
  2. Eat more plants. For your health and that of the planet, focus on vegetables, fruits, whole grains, legumes, nuts, and unsaturated oils, moderate amounts of seafood and poultry, and little red or processed meat, added sugar, or refined grains.
  3. Reduce food waste. Food waste ends up in landfills, where it generates about 25 percent of Canada’s methane gas. (The U.S. total is approximately 16 percent). Buy only what you need, and make a plan to use up leftovers as much as possible.
  4. Buy local food. This supports local farmers, reduces the need for transporting food long distances, and is more nutritious because fewer nutrients are lost during transit.
  5. Reduce kitchen garbage:
    • Buy/use reusable grocery and produce bags.
    • Carry a reusable water bottle.
    • Use beeswax wraps instead of plastic wrap.
    • Replace washable silicone bags instead of plastic bags.

This Earth Day, you can do your health and the planet a favor just by making a few simple changes to your diet.

For a suggested Earth Day menu, Earthday.org offers a sample here.

Progestin-Only Birth Control Slightly Increases Breast Cancer Risk

, , , , , Uncategorized

Our family practice concierge doctors in Jupiter have heard from some of our patients that they’re concerned about a new study regarding the safety of certain contraceptives.

In fact, many observers think this study’s findings are reassuring, and should not unduly alarm women.

According to the Centers for Disease Control and Prevention (CDC), among women ages 15 to 49 in the U.S., about 14 percent of those using contraception use oral contraception, and around 10 percent use long-acting devices like IUDs.

Contraceptive Risks and Benefits

Since their inception, birth control pills have been associated with various risks to the women who take them.

In 1960, the U.S. Food and Drug Administration (FDA) approved the first birth control pill, Enovid. It combined two types of hormones designed to prevent ovulation: estrogen and progestin. According to Planned Parenthood, it contained far more hormones than were needed to prevent pregnancy, which is why it was also responsible for occasional severe side effects and increased the risk of heart attacks and strokes.

Later forms of the pill, as it came to be called, used much lower formulations, but they are still implicated in a slightly increased risk of breast cancer, heart attack, strokes, blood clots, and liver tumors.

Many see these risks as being outweighed by the benefit of preventing unwanted pregnancies. In addition, studies have found a decreased risk of ovarian, endometrial, and colorectal cancers in long-term users of the pill, as compared with non-users.

Birth control pills are also prescribed for women with excessive bleeding and/or painful periods, apart from their use in pregnancy prevention.

Another UK study of more than 46,000 women who were followed for up to 39 years showed that their use of the pill not only didn’t increase their risk of mortality but also appeared to have increased longevity.

The New Study

Progestin-only formulations in various forms of birth control were thought to lower the risks of complications because estrogen is known to increase the incidence of the most common side effects.

Progestin-only pills thicken the mucus in the cervix, preventing sperm from reaching an egg. One form of the progestin-only pill can also stop ovulation.

“We’ve known for a while that estrogen and progestin birth control pills, oral contraceptives, have a slightly increased risk of breast cancer,” Dr. Jennifer Ashton, a board-certified OB-GYN, and ABC News chief medical correspondent said on “Good Morning America” when the new study was released.

“What we didn’t know is the newer forms of progestin-only pills, IUDs, injectable implants, what their associated risk, if any, was in comparison,” she explained.

The study that made the news last month was published in the journal PLOS One. Researchers in the U.K. analyzed data on nearly 10,000 women who had been diagnosed with invasive breast cancer between 1996 and 2017.

They then compared these subjects’ profiles with more than 18,000 women who did not have breast cancer.

“On average, 44 percent of women with breast cancer and 39 percent of matched controls had a hormonal contraceptive prescription, with about half the prescriptions being for progestagen-only [i.e., progestin-only] preparations,” the study authors wrote.

Explaining the Results

The findings “suggest that the 15-year absolute excess risk of breast cancer associated with the use of oral contraceptives ranges from eight per 100,000 users (an increase in incidence from 0.084 percent to 0.093 percent) for use from age 16 to 20 to about 265 per 100,000 users (from 2.0 percent to 2.2 percent) for use from age 35 to 39.”

In other words, those who use the progestin-only forms of contraceptives have about the same slight risk of breast cancer as women who use the combination pill.

They also found that the longer a woman is off hormonal birth control, the lower the risk.

Claire Knight, a senior health information manager at Cancer Research UK, which provided core funding for the study, told CNN that hormonal contraception is a personal choice, as “there are lots of possible benefits to using contraception, as well as other risks not related to cancer.

“Women who are most likely to be using contraception are under the age of 50, where the risk of breast cancer is even lower,” she explained.

Reassuring Users

Gill Reeves, a co-author of the study and professor of statistical epidemiology at the University of Oxford, told The Washington Post that “it may be reassuring to know that these newer contraceptives that women are using in increasing numbers do not have any untoward effects that might be unexpected. 

“They do seem to behave pretty much like traditional contraceptives,” she added.

Ashton, who was not involved in the study, stressed that it’s important to recognize how slightly the use of hormonal contraceptives raises the risk of breast cancer.

“It’s about individualizing the risk-benefit and option risk for the woman,” she told GMA.

“If you talk to any OB-GYN, they will say, we have a line: ‘Pregnancy is much higher risk than any associated risk with birth control pills or hormonal contraception.’ ”

“For anyone looking to lower their cancer risk, not smoking, eating a healthy balanced diet, drinking less alcohol, and keeping a healthy weight will have the most impact,” Knight told CNN.

All the experts suggest that women discuss the risks and benefits with their doctors.

We’re Still Consuming Too Much Salt, WHO Warns

Nutrition, Preventative Health

Our concierge primary care doctors in Jupiter often caution our patients about their salt intake, but now a new report from the World Health Organization (WHO) appears to lend new weight to that advice.

Unless governments act to restrict the salt content in our food, seven million people will die unnecessarily from diseases linked to excessive salt consumption, the WHO warned last month.

“Unhealthy diets are a leading cause of death and disease globally, and excessive sodium intake is one of the main culprits,” WHO Director-General Dr. Tedros Adhanom Ghebreysesus said in a statement.

“This report shows that most countries are yet to adopt any mandatory sodium reduction policies, leaving their people at risk of heart attack, stroke, and other health problems,” he added.

The Damage Salt Does

“Excessive sodium intake is the top risk factor for an unhealthy diet, and it is responsible for 1.8 million deaths each year,” Francesco Branca, director of the WHO’s Department of Nutrition for Health and Development, explained.

“This is really something that doesn’t cost money to anybody,” he said. “It’s a simple intervention, but it’s incredibly effective.”

Science has known for decades that too much salt is harmful.

The American Heart Association (AHA) says, “[T]he science behind sodium reduction is clear. Significant evidence links excess sodium intake with high blood pressure, which increases the risk of heart attack, stroke, and heart failure.”

“Sodium,” by the way, is not the same as salt. Salt, or sodium chloride, is a crystal-like compound that is abundant in nature. Sodium is a mineral, and one of the chemical elements found in salt. Nevertheless, most people tend to use the two words interchangeably.

“If you retain more salt in the body, it slowly puts up the blood pressure,” Graham MacGregor, a professor of cardiovascular medicine at the Queen Mary University of London, told The Washington Post.

“That raised blood pressure then causes strokes, heart attacks, or heart failure,” he explained. MacGregor was not involved in the study, but campaigns in favor of reducing salt intake.

History of Salt

Humans have used salt since ancient times, to preserve food as well as to flavor it. Cities around the world sprang up near sources of salt, according to Wikipedia.

But we’re getting too much of a good thing. The average American today consumes 55 percent more salt than in 1980, large thanks to the proliferation of processed foods.

When food began to be mass-produced, manufacturers quickly discovered that salt not only preserved their products longer and enhanced the flavor of less-flavorful foods, but also caused consumers to crave more of it.

At least one 2016 study on mice by Australian researchers appeared to identify the opioid system in the central amygdala region of the brain as the mechanism linked to our addiction to salt, the same pathway responsible for our addiction to drugs.

“It wasn’t until now known that our natural opioids working in this emotional hotspot drove salt cravings,” neuroscientist Craig Smith of the Florey and Deakin University, told the Sydney Morning Herald.

So salt begets a desire for more salt, and manufacturers are happy to comply. It’s far cheaper to add loads of salt to a product than to use more expensive herbs and spices. 

The Scoop on Salt

There’s no denying that we need a certain amount of salt to live. To maintain bodily functions, we require approximately 500 milligrams per day.

Moderate amounts of sodium also help maintain the extracellular fluid necessary for the cells’ function. Without adequate sodium, the body’s fluids would dehydrate, resulting in low blood pressure and death.

The current dietary guidelines recommend 2,300 milligrams of sodium per day. The AHA recommends even less (about 1,500 milligrams) for those at risk of heart disease. This includes adults ages 51 and older, Blacks, and those with high blood pressure, diabetes, or chronic kidney disease.

Most Americans, however, consume an average of 3,400 milligrams of sodium per day.

According to the U.S. Food and Drug Administration (FDA), sodium attracts water, and a high-sodium diet draws water into the bloodstream, thus increasing the volume of blood and subsequently your blood pressure.

Over time, high blood pressure (hypertension) injures blood pressure walls, leading to the build-up of plaque that blocks blood flow. Because hypertension causes the heart to work too hard, the high force of blood flow can harm arteries and organs throughout the body (heart, kidneys, brain, and eyes).

How to Cut Back

According to the AHA, more than 70 percent of the sodium we consume comes from packaged and restaurant foods.

“That can make it hard to control how much sodium you eat because it’s added to your food before you buy it,” the organization says.

Nevertheless, there are things you can do:

  • Compare labels, looking for the lowest amount of sodium you can find.
  • Pick fresh and frozen poultry that hasn’t been injected with a sodium solution.
  • Opt for canned vegetables labeled “no salt added” and frozen vegetables without salty sauces.
  • Drain and rinse canned beans and vegetables.
  • Cook pasta, rice, and hot cereal without salt.
  • At restaurants, ask for your dish to be made without extra salt.

One final tip: Incorporate foods with potassium like sweet potatoes, potatoes, greens, tomatoes and lower-sodium tomato sauce, white beans, kidney beans, nonfat yogurt, oranges, bananas, and cantaloupe. Potassium helps counter the effects of sodium and may help lower your blood pressure.

What to Know About the Newest Migraine Drug

, , Health Basics, Medications, Uncategorized

Our primary care concierge doctors in Jupiter have a great deal of sympathy for our patients who suffer from migraines. It can be a debilitating condition and is often difficult to treat. So we welcome any new drug that can help relieve the pain. 

The latest such treatment is a new nasal spray that the U.S. Food and Drug Administration (FDA) approved earlier this month. In a clinical trial, the drug was found to provide relief from migraine pain in as little as 15 minutes.

According to health experts, nearly 40 million Americans suffer from migraines.

“They often interfere with daily functioning, keeping patients away from their work and unable to enjoy time with their loved ones,” neurologist Leah Croll at the Lewis Katz School of Medicine at Temple University, told ABC News.

“The faster we can bring relief to people suffering from a migraine attack, the sooner we can give them back that lost time,” she said.

What is a Migraine?

A migraine is not technically a headache, but a neurological disorder that includes a constellation of symptoms, with a painful, long-lasting headache at the center. Its main symptom is a severe throbbing pain or pulsing sensation in the head, which feels like a very bad headache, usually on one side of the head, but in a third of migraine attacks, both sides are affected.

It is often—but not always—preceded by what is known as an “aura,” strange tricks of vision that can encompass anything from a blind spot in the vision to flashing or shimmering lights to wavy or zigzagging lines.

Migraines are also usually, but not always, associated with such symptoms as nausea, vomiting, and extreme sensitivity to lights and noises, and can also include a pins-and-needles sensation in the arms and legs or a weakness or numbness on one side of the face or body.

One or two days before the onset of a migraine, patients often experience subtle body signals (called “prodrome”) that can alert them to an upcoming migraine. These changes can include neck stiffness, constipation, increased thirst and urination, food cravings, frequent yawning, and mood swings from depression to euphoria.

It is also possible to have many migraine symptoms, especially the aura, without a headache. The primary signs of a migraine, however, are the extreme incapacitation associated with the headache pain involved.

The Nasal Spray Advantage

According to the National Institute of Neurological Disorders and Stroke, migraines are caused by the activation of nerve fibers in the wall of brain blood vessels. 

Calcitonin gene-related peptide (CGRP) is a chemical messenger in the brain that controls pain and inflammation. The newly approved drug, Zavzpret, works by blocking CGRP’s pain signals, according to its maker Pfizer.

Pfizer says Zavzpret (generic name “zavegepant”) is the “first and only” CGRP nasal spray for treating migraines with or without an aura. A March study published in the journal Lancet found the drug began working to treat symptoms in as little as 15 minutes, offer normal functioning in 30 minutes, and provided some relief for up to 48 hours for 24 percent of migraine sufferers.

The rapid relief Zavzpret provides offers an advantage over existing oral treatments, Dr. Emad Estemalik, a headache specialist at the Cleveland Clinic, told NBC News.

“A lot of patients, when they have migraines, they’re throwing up, for instance, so they may not be able to hold oral medication,” he said. “That’s where an intranasal comes as an advantage.”

Kate Mullin, a board-certified neurologist at the New England Institute for Neurology and Headache who helped conduct the trial for Pfizer, explained to ABC News that at least 60 percent of migraine sufferers also experience nausea, making it difficult to swallow pills.

“You can’t absorb oral medications when you’ve got what’s called gastroparesis of migraine,” she said.

“Your gut pretty much falls asleep and is not in a place to absorb mediations effectively for many migraine sufferers,” she added. “A nasal spray helps bypass the gut altogether to optimize absorption.”

Some Reservations

As with all drugs, of course, there are side effects to Zavzpret.

The FDA listed the following side effects reported by participants during the clinical trial:

  • taste disorders (18 percent)
  • nausea (four percent)
  • nasal discomfort (three percent)
  • vomiting (two percent)

Still, those who treat migraines welcomed the addition of the new drug to the migraine arsenal. 

Elizabeth Kraus, Phar.D., Neurology Clinical Pharmacy Specialist at Corewell Health, told Prevention that while she’s not overly impressed with the 24 percent success rate, Zavzpret may be better for those whose migraines tend to progress rapidly, those who don’t do well with oral medications, and individuals who struggle with severe nausea.

Amit Sachdev, M.D. M.S. medical director in the Department of Neurology at Michigan State University told Prevention that he, too, wasn’t happy with the 24 percent success rate.

“I would like to see a more broad effect, but the current trial results wouldn’t keep me from thinking of this medication [for patients],” he said.

Kraus concurred.

“If I can give someone something that will act fast and have a more lasting effect . . . That’s what I care about,” Kraus said.

The new drug is expected to be released in July of this year.

Zero-Calorie Sweetener Linked to Heart Attacks, Strokes

Concierge Medicine, Health Basics, Medications, Nutrition, Preventative Health

You may have heard the expression, “There ain’t no such thing as a free lunch.” It means that few things are actually free; there’s often a hidden cost to “freebies.”

Our concierge primary care doctors in Jupiter were reminded of that saying when we heard the results of a new study on the sugar substitute erythritol, popular in keto diets, which suggested it can cause an increase in strokes and heart attacks.

The Study

Researchers from the Cleveland Clinic evaluated more than 4,000 Americans and Europeans who were being evaluated for heart disease. The results, published last month in the journal Nature Medicine, showed that those with the highest blood concentration of the artificial sweetener erythritol were at an increased risk of heart attack or stroke in the following three years.

The researchers examined the subjects’ blood platelets—the type of blood cell that sticks together to form blood clots—and found those with the highest level of erythritol showed increased platelet activity, thereby encouraging the greater formation of clots. Clots in the bloodstream have the potential to cause heart attacks or strokes when they block the normal flow of blood.

The researchers also injected mice with erythritol and found that clots formed more quickly after an injury than those who had been injected with saline.

Finally, they took blood samples from subjects who had consumed an erythritol-sweetened drink and found levels of the sweetener remained high for two days.

“Every way we looked at it, it kept showing the same signal,” Stanley Hazen, a cardiologist at the Cleveland Clinic, who also directs the Cleveland Clinic’s Center for Microbiome and Human Health, told The New York Times.

“People are trying to do something healthy for themselves but inadvertently may be doing harm,” he told the paper.

About Erythritol

Erythritol is a sugar alcohol like xylitol and sorbitol and is found naturally in many fruits, vegetables, and fermented foods. It is also manufactured artificially for use in food products.

It has become more popular than earlier types of artificial sweeteners because it has no lingering aftertaste, doesn’t spike blood sugar, and doesn’t cause the laxative effect common with other such additives.

USA Today reports that it is added to many processed foods and beverages and is commonly found in products aimed at those on the keto diet because it does not affect blood glucose. It is also an ingredient in the sweetener Truvia.

“Erythritol looks like sugar, it tastes like sugar, and you can bake with it,” Hazen told CNN.

“It’s become the sweetheart of the food industry, an extremely popular additive to keto and other low-carb products and foods marketed to people with diabetes,” he added.

The U.S. Food and Drug Administration (FDA) lists erythritol as generally recognized as safe or GRAS. Therefore, it is not required to be listed on a product’s ingredient list, according to Hazen. The label might simply say, “artificially sweetened with natural products,” or “zero sugar.”

Other Research

Robert Rankin, executive director of the Calorie Control Council, an association representing the low- and reduced-calorie food and beverage industry, told USA Today that the people in the study were at higher risk for cardiovascular disease (CVD), so the results shouldn’t be applied to the general population.

“The results of this study are contrary to decades of scientific research showing reduced-calorie sweeteners like erythritol are safe,” he said.

But other studies have raised the question about the safety of erythritol.

For example, Karsten Hiller, a biochemist, and specialist in human metabolism at the Braunschweig Institute of Technology in Germany published a paper in 2017 showing that Cornell University freshmen whose blood contained high levels of erythritol gained more weight than students with low levels, the USA Today reported. Which kind of defeats the purpose of using an artificial sweetener.

“Science needs to take a deeper dive into erythritol and in a hurry, because this substance is widely available right now,” Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health, a hospital in Denver, told CNN. Freeman was not involved in Hazen’s research.

Hazen agreed.

“I normally don’t get up on a pedestal and sound the alarm,” he told CNN.

“But this is something that I think we need to be looking at carefully,” he added.

Eating Healthier

Artificial sweeteners in general have been called into question by numerous studies. For example, a 2020 study by a group of Yale researchers found that those who used the artificial sweetener sucralose (found in the brand names Splenda, Zerocal, and others) can result in high blood sugar levels in the blood. The Washington Post reports that sucralose is found in thousands of consumer-packaged goods such as baked goods, yogurt, canned soups, condiments, and syrups.

Another study at the Weizmann Institute of Science last year looked at what happened to subjects who consumed aspartame, saccharine, stevia, or sucralose in amounts well below the FDA’s daily allowances. The researchers found that these sweeteners caused changes in both the function and composition of the participants’ gut microbiomes, the communities of bacteria, viruses, and fungi that live in the intestines, The Post reported.

There’s no question that artificial sweeteners are hard to avoid these days. And we keep trying to have our sugar without paying the price.

But for the sake of your long-term health, we recommend sticking as closely as possible to fresh, natural, unprocessed foods and beverages.

Best Ways to Treat Lower Back Pain

, Health Basics, Healthy Living, Lifestyle, Preventative Health

Whatever the cause of your low back pain—lifting your child, the wrong tennis move, or (often) no reason you can recall—what you want is relief: now!

Our concierge primary care doctors in Jupiter understand because we’ve been there. In fact, it’s estimated that at some point in our lives, 80 percent of us will seek medical attention for that searing pain that flares every time we move.

So we were pleased to learn of a new study that looked at the best medications for treating lower back pain. And there are other ways to treat the pain without drugs, which we’ll explore below.

The Latest Research

The study, published last month in the Journal of Orthopaedic Research, found that the best medications for acute lower back pain was a combination of a non-steroidal anti-inflammatory NSAID) drug and a prescription muscle relaxant. Acute lower back pain is defined as pain that lasts no longer than 12 weeks; chronic back pain lasts longer.

Researchers reviewed 18 randomized clinical trials that looked at various analgesics, including aspirin, acetaminophen, and NSAIDs (ibuprofen, naproxen, and celecoxib). The NSAID/muscle relaxer combination relieved pain and disability the fastest, often within one week.

The main drawback, of course, is that muscle relaxants—which actually tend to relax the whole body rather than just muscles—cause sleepiness, meaning they can’t be taken while driving or trying to function normally throughout the day.

And—as with all drugs, whether over-the-counter (OTC) or prescription—each drug comes with the possibility of side effects, including indigestion, dizziness, liver damage, and internal bleeding, among other risks.

Harvard Health Publishing notes that other drug treatments are also available for those whose pain isn’t helped by analgesics, or becomes more severe.

This includes opioids as a last resort, which are generally safe when taken for a short period and monitored by a doctor.

Certain antidepressants can also be prescribed off-label to treat pain, even if the person is not depressed.

Non-drug Approaches

Because of the risks associated with drug therapy, many people look to alternative methods to help relieve their pain.

Matthew Solan, the executive editor of Harvard Men’s Health Watch, mentions several options.

Cold and heat therapies can work by starting with ice packs immediately following the onset of pain to reduce swelling, followed by a heating pad or a hot-water bottle to relax muscles and increase blood flow.

Limited bed rest, although recently fallen out of favor as the preferred treatment for back pain, can still be helpful if the pain is so severe that it hurts to sit or stand. Try to limit it to a few hours at a time, however, and for no more than one or two days. 

Physical activity can not only help build strong muscles that are less prone to injury but can also help the healing process.

Complementary therapies, often thought of as “woo-woo nonsense,” have been shown to offer relief in many cases. They include:

  • acupuncture, in which needles inserted in precise points on the body are said to release blocked energy suspected of causing pain
  • spinal manipulation, in which chiropractors apply pressure to the body to correct spinal alignment
  • therapeutic massage to relax aching muscles
  • movement therapies such as yoga and tai chi

Another Non-traditional Approach

Nearly 40 years ago, the late back pain physician John Sarno proposed an entirely different approach to treating chronic lower back pain, and eventually pain of all sorts. He claimed that much of the pain was caused by the brain trying to repress unwanted or frightening emotions and that once this was acknowledged, the pain would resolve on its own.

This is a vast oversimplification of his theory, of course, and over the years has been vehemently rejected by pain sufferers who thought he was saying their pain was “all in the head,” which was not his message. Anyone who is familiar with the concept of mind-body medicine will understand the connection between the brain and what happens in the body.

Although the medical community has been slow to warm up to Sarno’s approach, two recent studies tend to lend credence to his theory.

One, published in the journal JAMA Psychiatry in 2021, was a randomized, controlled trial of 151 patients using an approach based on Sarno’s work: “pain reprocessing therapy,” or PRT, which taught patients to reinterpret their pain as a neutral signal from the brain. Researchers found that 98 percent of participants had at least some relief from their pain; 66 percent were nearly or fully pain-free, compared with 10 percent of the control group.

Another study, published the same year, found similar results to Sarno’s approach.

If you’re interested in pursuing this form of treatment, Sarno’s books are readily available online. Although he offered in-person counseling when he was alive, he also claimed that simply reading his books, which explained the theories behind his treatment, worked for many. 

A Final Word

Finally, if you have persistent or severe lower back pain, it’s important that you let us know because it could be a symptom of something serious.

Dr. Akhil Chhtre, who specializes in back pain at the Johns Hopkins Department of Physical Medicine and Rehabilitation, cautions that “in some cases, pain is your body’s way of telling you that something isn’t right.”

He says it could be sciatica, kidney pain, or even cancer (especially prostate cancer). So it’s important to have persistent lower back pain checked. 

Should You Worry About Catching Bird Flu?

Disease

Since the outbreak of the novel coronavirus, SARS-CoV-2, we’ve all learned a lot more than we ever wanted to know about viruses and how they work, including how they mutate and how they can spread from animals to humans.

So the recent widespread outbreaks of bird flu have made some people a bit anxious, mainly because it has been reported in a number of mammals.

Our concierge primary care doctors in Jupiter want to explain why you shouldn’t be overly concerned, although there is an element of risk. Here’s what scientists are saying.

Background

According to the Centers for Disease Control and Prevention (CDC), although avian influenza A, popularly known as “bird flu,” viruses usually do not infect people, “there have been some rare cases of human infection with these viruses.”

Infected birds shed the virus through their saliva, mucus, and feces. Bird flu can transmit to humans when a virus from one of these sources gets into a person’s eyes, nose, or mouth, or is inhaled, either from unprotected contact with infected birds or with surfaces contaminated with these viruses.

Some infections in humans, however, haven’t been traced directly to this type of transmission—in other words, no one knows how these “very rare” cases happened. That means some cases may have passed from human to human.

But historically, other types of bird flu have been responsible for several flu pandemics in America’s history, including the devastating H1N1 flu pandemic in 1918-1919, which killed 50 million people worldwide. (The current strain is Type A H5N1, which is not related.)

Recent Outbreaks

The current H5N1 flu virus was first identified in 1959 and can be found in wild birds in all 50 states, along with backyard flocks in most states, including one in a backyard flock in Florida last month, according to the CDC.

In the last year, 58 million birds were slaughtered because of the H5N1 bird flu. In addition, it began transmitting to mammals, including hundreds of wild sea lions in Peru and a farm of minks in Europe. The U.S. Department of Agriculture (USDA) also reported last month that the virus has been detected in skunks, bears, a raccoon, and red foxes.

Most of these mammal infections were probably stand-alone cases in which the mammal ate an infected bird, Jürgen Richt, professor, and director of the Center on Emerging and Zoonotic Infectious Diseases at Kansas State University, told USA Today.

The exception could be the October mink outbreak, he said, in which the virus transmitted from mammal to mammal. And because humans have never been exposed to H5N1, we don’t have any immunity to it—just as we didn’t to the SARS-CoV-2 coronavirus.

“If this virus has mammalian adaption and can transmit between mammals, humans are immunologically naive . . . and humans are mammals,” Richt said.

Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO), said last month that avian influenza’s spillover to mammal species must be monitored closely, but that the risk to humans remained low for the moment.

“But we cannot assume that will remain the case, and we must prepare for any change in the status quo,” he said.

Low Chance

Still, most virologists aren’t yet alarmed, because the virus would need to mutate in a certain way in order to spread to humans.

“It’s a series of events, each of which is fairly improbable,” Anice Lowen, a virologist and associate professor at Emory University School of Medicine, told NBC News.

“This is why I say the risk to humans is presently low,” she said. “The evolutionary barriers are high. It’s a numbers game,” she added, meaning the large numbers of outbreaks around the world are in the virus’s favor, but it would need to undergo a complicated string of mutations to be able to pass to humans.

Nevertheless, the mink farm infestation caught scientists’ attention, even though none of the workers at the farm became ill.

CNN reports that researchers found multiple mutations of the virus in the minks, including one that made it better at replicating in mammals.

“But it’s when it starts to spread from one mammal to the next mammal to the next mammal, it’s in those environments where we think it’s most likely that it will pick up these changes that allow us to switch hosts, and that’s why we get concerned,” Richard Webby, an infectious disease researcher at St. Jude Children’s Research Hospital in Memphis, Tennessee, told CNN. Webby is also the director of WHO’s Collaborating Centre for Studies on the Ecology of Influenza in Animals and Birds.

Staying Safe

Of course, we can’t predict the future, and as we saw with COVID-19, viruses have a way of getting out of hand.

So the CDC recommends a few precautions, such as never handling a dead bird without gloves and a mask.

Songbirds don’t (yet) appear affected, nor do such wild birds as crows or pigeons, so backyard birders don’t need to worry. And the CDC says it’s safe to eat poultry and eggs that are properly handled and cooked.

“The chances are not zero that you could get this, and anything you can do to further reduce that risk is a good thing,” Webby told CNN.

“But you probably really have to work hard to be infected with this virus,” he said.

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