Nature Can Heal in More Ways Than One

Humans evolved in the natural world. We may have retreated to caves or huts to protect ourselves from the elements, but we spent much of our time outdoors, hunting, gathering, cooking, telling stories, and so on. Our lives these days, though, are largely spent cut off from nature.

This way of life has sparked a wealth of studies showing that our loss of contact with nature—dubbed “nature deficit disorder”—has a real impact on our physical and mental health.

So our primary care concierge doctors in Jupiter weren’t too surprised to learn of a new study published this month in the journal Occupational & Environmental Medicine, which found that enjoying nature up to four times a week reduced the odds of needing mental health medications by 33 percent.

It also reduced the odds of using blood pressure pills by 36 percent and asthma medications by 26 percent.

The Study

Researchers interviewed about 6,000 people who live in large cities in Finland, asking about their access to and use of green and blue spaces, including parks, zoos, rivers, lakes, or the sea. 

They also asked subjects whether they could see views of nature from their homes, how often they spent time outdoors as well as how much they exercised while outdoors.

The study also accounted for other possible factors such as traffic-related outdoor air pollution and noise, which have been proven to have an adverse effect on health.

Respondents were then asked about their use of medications for depression, anxiety, high blood pressure, asthma, or insomnia, and correlated these with time spent in nature.

As noted above, the results were markedly better for those who were regularly exposed to green or blue spaces. Notably, those who lived in areas with a lot of green spaces or who simply looked at nature from their windows showed no improvement in any of these categories.

“Frequent green space visits, but not the amounts of residential green or blue spaces, or green and blue views from home, were associated with less frequent use of psychotropic, antihypertensive, and asthma medication in urban environments,” the study authors wrote.

Confirming Prior Research

Numerous earlier studies have found significant benefits from spending time in nature.

One meta-review of 143 other studies published in the journal Environmental Research, for example, found that people with access to green space generally had a slower heart rate, lower blood pressure, and fewer blood levels of the stress hormone cortisol. Researchers also found significantly fewer cases of diabetes and lower rates of mortality from heart disease in the group regularly exposed to nature.

An American Institutes for Research (AIR) study in 2005 found that sixth-grade students who attended three outdoor education programs showed marked improvement in conflict resolution skills.

Another study in China in 2013 involved 60,000 children between the ages of two and 17. It showed that regular exposure to nature, or “greenness” around their schools, reduced the incidence of attention deficit/hyperactivity disorder (ADHD). A more recent study at the University of Illinois produced similar results.

And a 2016 study of nearly 100,000 women conducted over eight years found that having access to the greenest space not only improved the subjects’ mental health but also reduced their death rate by 12 percent.

Nature Deprivation Hurts

Author Richard Louv coined the phrase Nature Deficit Disorder (NDD) in his 2005 book “Last Child in the Woods: Saving Our Children from Nature Deficit Disorder.” In it, he argued that elements of our urbanized lifestyle, including few natural spaces, a car-focused culture, more screen time, changes in the perception of risk (e.g., fear of “stranger danger”), less leisure time, and increased time pressure from work or school, combine to decrease or even eliminate contact with nature for both adults and children, according to the National Institutes for Health (NIH).

“The average young American now spends practically every minute—except for the time in school—using a smartphone, computer, television, or electronic device,” Tamar Lewin reported in a Kaiser Family Foundation study on the subject.

According to the Children and Nature Network (C-NN), which was co-founded by Louv, an expanding body of scientific evidence suggests that nature-deficit disorder contributes to:

  • diminished use of the senses
  • attention difficulties
  • conditions of obesity, and
  • higher rates of emotional and physical illnesses

Make the Connection

Unfortunately, to get back to nature, you may need to make a specific effort, because in our harried lives trapped indoors, focused on our screens, we have very little time for real relaxation.

Therefore, it’s often necessary to add nature breaks to our schedules the same way we schedule everything else.

One way is to undertake the Japanese practice known as “forest bathing,” or shinrin-yoku. As Kaiser Permanente’s’ online Thrive explains, “Heading out to a heavily wooded area isn’t required. You could take a trip to a nearby park, your favorite local trail, the beach, or any natural setting. Just be sure to turn off or silence your phone or other devices.”

Psychology Today explains, “Forest bathing is an antidote to pinging distractions, impending deadlines, and never-ending obligations . . . . The idea is to immerse yourself in a natural environment and soak up the many health benefits of being in the green woods.”

However, you manage it, for the sake of your overall health we recommend you take the time to reconnect with the natural world as often as possible.

Damar Hamlin Brings CPR Into the Spotlight

It was a terrifying moment on the field at the Buffalo Bills-Cincinnati Bengals game earlier this month when Bills safety Damar Hamlin stood up following a hit to the chest and then collapsed on the field.

But the good news is that he seems to be well on his way to a remarkable recovery. So our concierge primary care doctors in Jupiter want to join with so many others who are using the incident to urge everyone to learn the lifesaving cardiopulmonary resuscitation (CPR) technique that helped save his life.

What happened to Hamlin?

First, let’s discuss how a routine hit in a football game drove a man to the brink of death.

While full details are not yet available, it appears he was the victim of a rare phenomenon called “commotio cordis,” or ventricular fibrillation. It occurs when an impact directly to the heart occurs at the precise millisecond of the heartbeat when it becomes susceptible to such a blow, interrupting the rhythm.

In such cases, “there is nothing wrong with the heart,” Dr. Hari Tandri, director of the cardiac arrhythmia program at Vanderbilt University Medical Center in Nashville, Tennessee, told NBC News.

Dr. Comilla Sasson, an emergency medicine physician in Denver and a spokesperson for the American Heart Association (AHA), told NBC: “It’s not about how hard a hit it was. It’s actually about the timing of when the blow happens.”

CBS News medical contributor Dr. David Argus told “CBS Mornings” that he believed Hamlin sustained blunt force trauma to his chest “in the exact right spot, at the exact right moment during his heartbeat,” causing his heart to go into arrhythmia, or “not beat effectively to push blood to the brain,” he explained.

“It happens in Little League baseball,” he added. “A ball is thrown by a pitcher and hits the person in the chest. It happens in soccer where there’s something that causes that blunt force trauma. So, remarkably rare.” So rare, in fact, that he estimated that only about 30 of these cases occur in the U.S. every year.

Hamlin was Lucky

As Hamlin continued to rapidly recover in the days following his collapse, observers credited his survival to the immediate response of medical personnel on the field.

“When someone is having a sudden cardiac arrest emergency for any reason . . . time is absolutely critical,” Matthew Levy, an associate professor of emergency medicine at Johns Hopkins University School of Medicine, told The Washington Post.

“For every minute that someone is in sudden cardiac arrest—every minute where their heart is not beating normally and their body tissue is not getting the oxygen it needs—their [chances of] survival goes down by like seven to 10 percent,” he said. “So time is absolutely of the essence.”

“The key in any cardiac arrest is how quickly and effectively CPR is done,” Aaron Baggish, a Mass General Brigham sports medicine cardiologist and founder of the Cardiovascular Performance Program at Massachusetts General Hospital, told The Post.

“So it has to start soon, and it has to be done well enough to get blood to the brain and the other vital organs for as long as it takes to start the heart again with defibrillation,” he said.

Rapid Response

Which is what happened with Hamlin.

Within seconds of Hamlin’s collapse, assistant athletic trainer Denny Kellington began administering CPR to Hamlin, according to a tweet from Bills offensive lineman Dion Dawkins. Others followed the CPR with use of an automated external defibrillator (AED) before Hamlin was rushed to the hospital.

Observers credited the immediate CPR and AED with saving his life. But only about half of Americans report having received CPR training.

And unfortunately, many people who witness a cardiac arrest are reluctant to perform CPR, either because they don’t know how or are afraid of causing further harm. But Good Samaritan laws in all 50 states protect bystanders who step in to help during an emergency from legal liability.

Florida’s statute provides that “Any person . . . who . . . in good faith renders emergency care or treatment . . . shall not be held liable” for damages. Read the whole law here.

But too few Americans have CPR training, the AHA reports.

A Simple Technique

Formal training, which typically involves practicing on a dummy, is preferable to reading about the technique, doctors say.

“You can certainly learn a lot by reading it online, and you can certainly watch videos and understand and learn the technique, but, ultimately, the best thing is to actually get into a class so you can actually practice,” Dr. Jayne Morgan, a cardiologist at Piedmont Healthcare in Atlanta, told NBC News.

The Cleveland Clinic’s Dr. Michael Emery, a sports cardiologist there, told USA Today that CPR is “the most profound, life-changing thing you could potentially learn and do for someone.”

If you’re interested in someday possibly saving a life, you can find CPR classes near you here.

And if you find yourself in a situation where you need to perform CPR, the AHA recommends doing chest compressions at a rate of 100 to 120 per minute, but in the throes of trying to save a life, it can be difficult to count the precise beats needed to keep up the correct rhythm.

So the AHA created a playlist of over 50 familiar songs on Spotify to help bystanders maintain the beat. Click here to listen!

What to Know About the New COVID-19 Variant

As our concierge primary care doctors in Jupiter have said more than once over the past couple of years, we may be done with COVID-19, but the coronavirus isn’t done with us.

It’s still spreading, it’s still sickening and killing people, and it’s still learning how to survive. That’s why the latest report from the Centers for Disease Control and Prevention (CDC) didn’t surprise many health experts.

Late last month the CDC estimated that about 40 percent of current cases of COVID-19 are caused by the latest omicron relative, known as XBB.1.5. In December, XBB.1.5 more than doubled its share of COVID-19 cases each week, rising from about four percent of new infections in the first week to about 41 percent by the end of the month.

“For a few months now, we haven’t seen a variant that’s taken off at that speed,” Pavitra Roychoudhury, director of COVID-19 sequencing at the University of Washington School of Medicine’s virology lab, told CNN.

Latest Mutation

Mehul Suthar, who studies emerging viral infections at the Emory University School of Medicine in Atlanta, told USA Today that XBB.1.5 appears to be about five times more contagious than earlier omicron variants, which were five times more contagious than the original virus.

“The numbers start adding up,” he told the paper.

For you who are trying to keep up with the “scrabble variants,” (so-named because these letters tend to produce higher scores in Scrabble) the XBB.1.5 is related to the XBB variant, which is a recombinant of the BA.2.10.1 and the BA.2.75 sublineages.

While scientists still aren’t sure whether the XBB.1.5 causes more serious illness than its predecessors, NBC News reports that studies performed in the lab have found that XBB appears to be more contagious.

“It’s clear that there are immune evasive properties of XBB,” Isaach Bogoch, an infectious disease physician and epidemiologist at the University of Toronto, told NBC News.

In other words, the virus is evolving to get around the antibodies we’ve built up from vaccines and infections with previous strains.

Improving its Abilities

CBS News reports that the XBB.1.5 variant also contains an additional mutation called S486P, which Chinese scientists say appears to offer a “greatly enhanced” ability to bind to cells. In addition, XBB is resistant to various monoclonal antibody drugs used to treat infections.

“The mutation is clearly letting XBB.1.5 spread better,” Jesse Bloom, a computational virologist at the Fred Hutchinson Cancer Center, told CNN.

“It’s got a better ability to get into cells,” Roychoudhury added.

“We’re projecting that it’s going to be the dominant variant in the Northeast region of the country and that it’s going to increase in all regions of the country,” Dr. Barbara Mahon, director of the CDC’s proposed Coronavirus and Other Respiratory Viruses Division, told CBS News.

The question is how much of this spread is due to XBB.1.5’s enhanced abilities and how much can be attributed to the increased travel and social gatherings over the holidays.

To Worry or Not?

Another looming question is whether it will make people sicker. The data so far are unclear.

While XBB.1.5 shows an ability to evade immunity, Bogoch told NBC News that even if cases begin to rise significantly, he doubts there’ll be the dramatic spike in hospitalizations or deaths we saw in previous waves.

In addition, other parts of the immune system can work to protect against the virus, and vaccines along with prior infections should offer some protection from severe disease.

“We might certainly have a wave, but it’s just much less likely to be as deadly or overwhelming to healthcare systems compared to earlier waves before we had this degree of hybrid immunity,” he said.

Still, experts worry that the falloff in vaccination boosters could create problems.

“We aren’t in 2020, but people still do need to take this seriously and protect themselves,” the CDC’s Mahon told NBC.

Get Protection

One way to protect yourself, which most people are resisting, is to wear masks in public because it’s safer to avoid getting infected at all, Suthar told USA Today.

“The ‘it’s OK if I get infected’ attitude is not the most viable,” he said, adding that he still wears a mask when in public indoor spaces.

And all of the experts are concerned that less than 15 percent of the population has received the latest boosters against the coronavirus. Although they aren’t designed for the XBB.1.5 variant, they will offer some degree of protection.

Michael Osterholm, who directs the University of Minnesota’s Center for Infectious Disease Research and Policy, told CNN he sees reason for hope from the updated bivalent boosters, which target the original coronavirus as well as the omicron strains BA.4 and BA.5.

“They still provide a level of immunity that may not prevent you from getting infected but may have a significant impact on whether you become seriously ill and die,” he said.

“I mean, right now, the most recent data we have shows that for those who have the bivalent vaccine, they have a three-fold lower risk of dying than those who don’t,” he added.

Could You Have Hidden Thyroid Problems?

Has your sex drive decreased recently? Have you been constipated lately? Do you have brain fog or unusual fatigue? Are you unusually sensitive to heat or cold?

You could have a thyroid problem and not even know it. The World Health Organization (WHO) estimates that 750 million people in the world have some form of thyroid disease, and as many as 60 percent of those are undiagnosed.

Because January is Thyroid Awareness Month, our concierge primary care doctors in Jupiter want to take this opportunity to share some facts you may not know about this critical gland in your body.

About Thyroid Disease

Many people go through their lives feeling “blah” or “not right” or putting up with symptoms they think is just a part of life, when in fact a malfunctioning thyroid is the real issue.

This gland, shaped like a butterfly, is located at the front of the neck, just below the Adam’s apple. It produces a hormone (thyroid stimulating hormone, or TSH) that influences nearly all the metabolic processes in the body. So when something goes wrong, this little gland can produce big problems.

The U.S. Department of Health and Human Services (HHS) reports that women are more likely than men to have thyroid disease. One in eight women will develop thyroid problems during their lifetime. Anyone over age 60, especially women, is at higher risk of developing thyroid disease, along with anyone who has diabetes.

In women, thyroid disease can cause several issues specific to their sex, including problems with the menstrual period, problems with getting pregnant, and problems during pregnancy.

In general, the two main types of thyroid disorders result from either underproduction or overproduction of TSH, and the symptoms of each are generally opposites of each other, although thyroid dysfunction can have hundreds of possible symptoms.

These two main disorders, hyperthyroidism, and hypothyroidism can result from many different causes, and can also be inherited.

Symptoms of Each Type

Hyperthyroidism results from the overproduction of thyroid hormones, thereby speeding up every process in the body. The heart beats faster, food is digested more rapidly, the kidneys process urine more quickly, etc.

Some of the symptoms of hyperthyroidism can include:

-increased perspiration
-insomnia
-increased appetite
-weight loss
-nervousness/anxiety
-irritability
-hand tremors
-muscle weakness, especially in the upper arms or thighs
-hair loss/fine brittle hair
-heart palpitations/irregular heartbeat/racing heart
-sensitivity to heat
-carpal tunnel syndrome
-more frequent bowel movements
-light or less frequent menstrual cycles

Hypothyroidism is the more common type of thyroid disease, in which the thyroid doesn’t release enough thyroid hormone. As you might expect, with this type of thyroid problem every process in the body slows down.

Some of the symptoms of hypothyroidism can include:

-fatigue
-sensitivity to cold, especially cold hands and feet
-constipation and gas
-pain, stiffness, or swelling in joints
-brain fog/memory problems
-weight gain
-irregular or heavy menstrual periods
-hoarseness
-dry skin
-poor appetite
-lowered libido
-puffy/swollen face
-fluid retention/bloating
-thinning hair or hair loss
-muscle weakness
-depression

There can also be other symptoms, and they vary from person to person. Often they are dismissed as stressed, feeling “run down,” or simply aging. So you can see why so many people have undiagnosed thyroid dysfunction.

Simple Treatments

Another type of thyroid issue that frequently has no symptoms is thyroid cancer. According to the American Society of Clinical Oncology (ASCO), thyroid cancer is the most common form of cancer in women between the ages of 20 and 34, and the only symptoms may be difficulty swallowing, or sometimes throat pain accompanied by a persistent cough.

Approximately one percent of Americans are diagnosed with thyroid cancer in their lifetimes, representing about two percent of all cancer cases in the U.S. The good news is that this cancer is highly treatable, even in advanced stages.

And treatment for an over- or underactive thyroid is simple, safe, and effective. This includes anti-thyroid drugs, radioactive iodine, and beta-blockers to help control symptoms.

If you are experiencing any of these symptoms, it’s important that you let us know so you can get treatment. Untreated thyroid disease can damage many organs of the body, including the heart and kidneys.

Keeping it Healthy

Here are some steps you can take to keep your thyroid healthy.

  1. Be sure the salt you use is iodized. Many of the specialty salts do not contain iodine. The thyroid requires iodine to function properly, but the recent popularity of such specialty salts as sea salt and Himalayan salt has reduced the amount of iodine in some diets. Too little iodine can result in hypothyroidism.
  2. Avoid uncooked cruciferous vegetables, including broccoli, cauliflower, cabbage, Brussels sprouts kale, watercress, and kohlrabi. These particular vegetables contain substances called goitrogens that interfere with the efficient synthesis of thyroid hormones. Cooking inactivates these substances, making them safer to eat.
  3. Opt for more seafood in your diet, especially crab, shrimp, lobster, clams, and mussels. All of these are rich sources of iodine.
  4. Avoid processed foods. Although high in sodium, processed and packaged foods do not contain iodized salt.

These guidelines can help maintain the health of your thyroid. But do not try to self-treat a suspected thyroid problem, especially with iodine supplements, which can make symptoms worse.

Doctor’s Best Diets for the New Year

At the beginning of every new year, it’s customary to make resolutions to improve our lives in some way. Usually near the top of the list of New Year’s resolutions the goal of losing weight. Our primary care concierge doctors in Jupiter certainly applaud that one, because obesity negatively impacts our health in so many areas, from the possibility of type 2 diabetes to heart disease. 

But there are other reasons to adhere to a particular type of diet, which don’t necessarily relate to weight loss. Diet in this sense means a way of eating, whether it’s cultural or just for overall health.

Forbes 2023 Rankings

Forbes Health recently consulted a team of seven nutrition experts to rate 19 diets considering a range of factors, from weight loss to heart health. 

Which one is best for you depends on your reason for trying a new diet. Of the 19 diets reviewed, these made the top 10:

  • Best for overall health: Mediterranean diet, emphasizing fresh fruits, olive oil, nuts, and fish
  • Best non-meat diet: vegetarian, which generally doesn’t allow meat, poultry, or fish
  • Best for heart health: dietary approaches to stop hypertension (DASH) diet, which focuses on fruits, vegetables, whole grains, lean proteins, and low-fat dairy
  • Best commercial diet: Weight Watchers (now known as WW), emphasizing lower calories, with coaching and group support
  • Best commercial diet runner-up: Noom, an app that ranks food according to calories, with coaching and group support
  • Best non-meat diet runner-up: vegan, which allows no animal products of any kind
  • Best diet for flexibility: pescatarian, a type of vegetarianism that also allows fish and other seafood
  • Best diet for holistic health: Ornish diet, low-fat emphasis allowing no meat, fish, or poultry
  • Best diet for a brain boost: MIND diet, a combination of the Mediterranean and DASH diets
  • Best diet for a nutrient boost: Nordic diet, consisting primarily of fish, berries, and winter vegetables, with a small amount of meat and sweets allowed

Other Views

The annual US News listing of best diets includes most of the above diets, in addition to Jenny Craig, Dr. Weil’s anti-inflammatory diet, the Mayo Clinic diet, volumetrics, the nutritarian diet, the South Beach diet, and the Plantstrong diet.

Everyone, it seems, has an opinion on what makes a great diet.

For instance, Dr. Michael Greger told NBC’s TODAY that the worst diet is what he terms the CRAP diet: “calorie-rich and processed foods” that make health problems worse and weight loss impossible.

Instead, he recommends consuming a whole-food, plant-based diet, which is naturally high in fiber and low in calorie density and allows people to eat as much as they want—no calorie counting or portion control needed.

“It’s a diet that minimizes the intake of meat, eggs, dairy, and processed junk, and maximizes the intake of fruits, vegetables, legumes like beans, whole grains, nuts and seeds, mushrooms—basically, real food that grows out of the ground. Those are our healthiest choices,” he told TODAY.

“The strategy is to improve the quality of food rather than restricting the quantity of food,” he added, “so it doesn’t leave you hungry. That’s a diet you can stick with. You get a boost of energy, better digestion, better sleep.”

Skip the Gimmicks

His approach is simple. And in contrast, notice what kinds of diets don’t show up on any of these lists.

The hugely popular keto diet is one example. Studies show that 80 percent of those who try it struggle to stick with it. Why, when it often results in huge and rapid amounts of weight loss?

Because it not only can it cause numerous side effects—body aches, headaches, light-headedness, nausea, fatigue and lethargy, constipation, and brain fog—but because everyone else is eating garlic bread and mashed potatoes (not cauliflower) with gravy and pasta. 

Because, in short, the keto diet is restrictive. It has a long list of very tasty foods that either aren’t allowed or are allowed only in small portions after a certain time.

“When you are on the keto diet, you drastically cut your carbs to only 20 per day. That’s less than one apple!” nutritionist Lisa Drayer, a CNN contributor, told the network.

Bottom Line

Above all, research shows that the most successful diet is the one that you yourself designed because it gives you a sense of control, rather than being at the mercy of a set of restrictive rules.

“You have to have joy and pleasure in food,” Stanford University professor of medicine Christopher Gardner told The Washington Post. He has conducted numerous randomized trials to test the success rate of various diets and found they are essentially the same.

“They agree more than they disagree,” he said. Instead, he counsels, “Limit added sugars and refined grains, and eat more non-starchy vegetables. [I]f you do those two things, you get 90 percent of the benefits.” 

If you enjoy what you eat, you’ll have a much better chance of sticking with it for the rest of your life, he added.

Study Finds Another Possible Benefit from Intermittent Fasting

Diet fads come and go, especially on today’s social media. Our primary care concierge doctors in Jupiter cringe whenever a new weight loss gimmick surfaces, because nearly all of them are unsupported by science, and—while they may achieve temporary weight loss—are nutritionally unsound.

One atypical approach to eating that seems to be generally accepted in the medical literature is the technique of intermittent fasting (IF). This is an eating pattern that includes hours or days of no or minimal food consumption without deprivation of essential nutrients.

The first approach, known as 16:8, is the most popular, which involves fasting for 16 hours a day and consuming all your meals within an eight-hour period.

Other popular types of Intermittent Fasting involve either fasting on alternate days, or 5:2 fasting, which involves eating normally five days a week and fasting for two non-consecutive days a week, consuming 500-600 calories on fasting days.

Benefits of Intermittent Fasting

Evidence from decades of animal and human research suggests wide-ranging health benefits from IF, according to a 2020 review of the research published in the New England Journal of Medicine (NEJM).

Researchers found that “eating in a six-hour period and fasting for 18 hours can trigger a metabolic switch from glucose-based to ketone-based energy, with increased stress resistance, increased longevity, and a decreased incidence of diseases, including cancer and obesity.”

And researchers at Johns Hopkins Medicine also found numerous health benefits that result from Intermittent Fasting:

-improved working memory and verbal memory
-improved blood pressure and resting heart rates, as well as other heart-related measurements
-reduced tissue damage during and after surgery
-loss of fat while maintaining muscle mass

In addition, the Mayo Clinic reports: “Some research suggests that intermittent fasting may be more beneficial than other diets for reducing inflammation and improving conditions associated with inflammation, such as Alzheimer’s disease, arthritis, asthma, multiple sclerosis, [and] stroke.”

And the American Heart Association recently reported in its journal Heart that “[r]egular fasting is associated with lower rates of heart failure and a longer life span, according to two new studies.”

Latest Finding

Finally, a new study published this month in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism showed that after an IF diet intervention, patients achieved complete diabetes remission, defined as an HbA1c (average blood sugar) level of less than 6.5 percent at least one year after stopping diabetes medication.

In this small study of 36 participants, researchers at Hunan Agricultural University in Changsha, China, placed participants who had type 2 diabetes from one year to 11 years on the more restrictive IF plan of five fasting days followed by 10 days of reintroducing everyday food items such as wheat, barley, rice, rye, and oats. Subjects ranged between 38 and 72 years of age and were using anti-diabetic drugs and/or insulin injections.

Known as the Chinese Medical Nutrition Therapy (CMNT) diet, the approach resulted in 47.2 percent of participants achieving diabetes remission, compared with 2.8 percent in the control group.

The study showed that “type 2 diabetes is not necessarily a permanent, lifelong disease,” Dongbo Liu, the study’s corresponding author and a professor at the University, said in a news release.

Dr. Robert Gabbay, chief scientific and medical officer for the American Diabetes Association (ADA), told UPI he found the study’s findings encouraging.

“This study, though small, adds to the emerging literature on the potential benefits of intermittent fasting for the diabetes community,” he told the news organization.

Some Caution Warranted

If you plan to follow an IF diet, we strongly suggest that you check with us first, because this type of eating plan isn’t for everyone.

For example, one small 2020 study published in the journal JAMA Internal Medicine found that those following the 16:8 IF diet over 12 weeks lost little weight but most of what they did lose was “lean mass” which includes muscle tissue, possibly because they were consuming less protein.

And Harvard Health Publishing notes several other potential side effects from IF:

  1. Depending on the length of the fasting period, you may experience headaches, lethargy, crankiness, or constipation.
  2. It may cause you to overeat “because your appetite hormones and hunger center in your brain go into overdrive when you are deprived of food.”
  3. It may be dangerous if you’re taking certain medications, including anti-diabetes drugs and medications for blood pressure or heart disease.

How to Intermittent Fast Safely

Registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women’s Hospital, recommends easing into an IF plan to help your body adjust more easily.

“Slowly reduce the time window for eating, over a period of several months,” she advises.

She recommends you should also:

Continue your medication regimen as recommended by your doctor.
Stay hydrated with calorie-free beverages, such as water and black coffee.
Choose a modified fasting plan approved by your doctor if you need to take the medication with food.

Also, if you’re thinking, “If some fasting is good, more will be even better,” don’t. Longer periods without food can encourage your body to store more fat because it slips into starvation mode.

Finally, eating normally during the off-fast portion of the day or week doesn’t mean binging on junk food. Whether fasting or not, your body needs healthy, nutritious food to maintain health and a normal weight.

Protect Yourself from the Common Cancer That Killed Kirstie Alley

Like many fans of Kirstie Alley, our primary care concierge doctors in Jupiter were sorry to learn of her death at age 71. We were even more troubled to learn of its cause: colon cancer because many of these deaths can be prevented with early screening.

The National Cancer Institute (NCI) estimates that 151,000 cases of colorectal cancer will be diagnosed this year. Colon cancer is the second-most deadly cancer in the U.S., behind only lung cancer, and is the third most common type of cancer.

Alley’s family reported that her cancer was “only recently discovered.” While we don’t know details beyond her family’s brief statement, her longtime friend Taylor Dayne told The Daily Beast she hopes to raise awareness about how common colon cancer is. The singer, who went public this summer with her own colon cancer diagnosis, urged people to get regular screening tests.

“I say stay on top of your health, get your mammograms, get a colonoscopy at 40. I don’t think you have to wait until 50,” she said.

How Screening Helps

Colon cancer begins in the large intestine (i.e., the colon), the final part of the digestive tract. It typically affects older adults, although it can occur at any age. Award-winning actor Chadwick Boseman died of colon cancer in 2016 at age 43. Jay Monahan, husband of former “Today” show host Katie Couric, died of colon cancer in 1998 at age 42.

More recently, actors Ryan Reynolds and Rob McElhenney videotaped parts of their colonoscopies to raise public awareness of the disease. Doctors found both actors had polyps that were removed.

One 2017 study from the American Cancer Society (ACS) published in the journal JAMA showed that colon cancer deaths are not only rising among younger white people but that the cancers diagnosed in this population are more advanced and more deadly. Researchers found that new cases of colorectal rose more than two percent each year among those under 50.

The Mayo Clinic reports that colon cancer usually begins as small, noncancerous (i.e., benign) polyps (tiny bumps or mushroom-like stalks) that form in the lining of the colon. Over time, some of these polyps can become cancerous although they produce few if any, symptoms.

But with regular colonoscopies, these polyps can be found and removed before they become cancerous.

According to the American Cancer Society (ACS), treatment can depend on the cancer stage. For example, stage II colon cancer can grow through the wall of the colon, and patients may need surgery to remove part of the colon, which is what Dayne had done following a routine colonoscopy.

“I was prone to developing polyps, so I was more on top of it, but five months after my last colonoscopy I had another one done in July, and that’s when I found out,” she told The Daily Beast.

Symptoms and Risk Factors

Although there may be a few symptoms, they can often be mistaken for other conditions such as hemorrhoids or irritable bowel syndrome (IBS).

Some of the earliest symptoms may include rectal bleeding or changes in bowel movements such as diarrhea or constipation, or a feeling that your bowel doesn’t empty completely.

Other symptoms can include abdominal cramps, gas, or other pain, fatigue, anemia, decreased appetite, and weight loss.

Besides being over the age of 50, risk factors that may increase your risk of colon cancer include:

  • a personal history of colorectal cancer or polyps
  • inflammatory intestinal conditions such as ulcerative colitis or Crohn’s disease
  • a family history of colon cancer
  • a low-fiber/high-fat diet
  • sedentary lifestyle
  • diabetes or insulin resistance
  • obesity
  • smoking
  • heavy use of alcohol

Screening Tests Matter

Because anyone can get colon cancer, doctors recommend screening tests every 10 years beginning at age 45, but those with increased risk should consider screening sooner.

“Unfortunately, colon cancer doesn’t have a lot of symptoms until it’s advanced, which is why screening is so important,” Paula Denoya, director of the Colorectal Surgery Residency Program at Stony Brook Medicine, told NBC News.

Meanwhile, Joel Levine, co-director of the Colon Cancer Prevention Program at UConn Health told NBC News that the rising rates of the disease among younger Americans show no signs of abating.

“There’s an expectation there will be 15 percent of [all] colorectal cancers in people under 50 not too long from now,” he said, which is why he strongly recommends early screening.

“One of the reasons I’m so fussy about not waiting for symptoms is because it leads to, ‘Well, I feel all right, everything’s OK.’ And by the time you have a symptom, the horse is a little bit out of the barn.”

ACS guidelines emphasize individual preference and choice in testing options.

These are basically broken into two categories: stool-based tests, which are recommended every one to three years, and visual exams, including colonoscopy, every five to ten years, depending on risk factors. 

The ACS stresses that these screening tests must be repeated regularly to be effective and that any abnormal stool-based test result should be followed up with a colonoscopy, which it considers to be the gold standard in colorectal cancer screening.

And the best ways to avoid many types of cancer, according to the ACS, are to limit red and processed meats, consume a diet high in vegetables, fruits, and whole grains, avoid tobacco, maintain a healthy weight, get regular physical exercise, and limit alcohol consumption.

There’s a Reason Why You’re Feeling SAD

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

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

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

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

Symptoms

The APA lists the following symptoms associated with SAD:

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

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

Likely Causes

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

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

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

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

Treatment

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

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

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

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

Self-care

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

1. Stay active outdoors

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

2. Let in the light

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

3. Eat right

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

4. Take it easy

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

5. Stay connected

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

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

Are You Sick? How to Tell Which Virus You Have

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

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

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

The ‘Tripledemic’

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

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

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

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

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

Similar Symptoms

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

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

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

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

Ways to Tell

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

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

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

Common cold:

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

Flu:

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

COVID-19:

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

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

RSV:

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

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

What To Do

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

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

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

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

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

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

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

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

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

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

What are Anxiety Disorders?

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

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

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

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

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

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

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

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

Drug-Free help

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

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

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

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

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

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

The Time Issue

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

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

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

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

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

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

Drug vs. Drug-free?

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

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

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

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

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

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

Even Arpaia agreed in principle.

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

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