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

Health Basics, Healthy Living, Preventative Health

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.

How and Why to Steer Clear of Ultra-Processed Foods

, , Health Basics, Healthy Living, Lifestyle, Nutrition

Our concierge primary care doctors in Jupiter often suggest you consume healthy foods and avoid processed and ultra-processed foods. In the real world, of course, we know how difficult that is to do.

The question is, why? Why have ultra-processed foods come to dominate 60 percent of the American diet?

Ultra-processed foods are quick and convenient, for one thing, and for another, there’s no denying that, for the most part, these foods taste good. From frozen dinners, cookies, and cakes, to fast-food burgers and chicken, fried foods, deli meats, and sodas, many of us not only can’t quit them, but we also don’t want to.

And we convince ourselves that processed foods aren’t really all that bad for us. On that last point, we have to disagree. The one thing we know for sure is that processed and ultra-processed foods can trigger numerous health concerns.

What the Studies Say

For example, one study of more than 22,000 adults published this year in the journal BMJ found that subjects who consumed more ultra-processed foods had a 19 percent higher likelihood of early death and a 32 percent higher risk of dying from heart disease than those who ate fewer ultra-processed foods.

Another 2019 study published in BMJ followed more than 100,000 adults in France for five years. They found that those who ate the most processed foods were 23 percent more likely to experience a heart condition or stroke than those who consumed the lowest amounts.

A third study, also published in BMJ, tracked 20,000 Spanish adults over 20 years. Those who ate the most processed foods were 62 percent more likely to die during the study period than those who ate the lowest.

Other studies have linked processed and ultra-processed foods to a higher risk for colon cancer, type 2 diabetes, obesity, and heart disease.

How are Foods Classified?

Researchers classify foods into roughly three categories:

“Unprocessed or minimally processed” foods include fruits, vegetables, milk, eggs, legumes, meats, poultry, fish and seafood, yogurt, white rice and pasta, and natural juices (some classification systems divide these into two categories).

“Processed” foods include cheeses, bread, beer, wine, ham, and bacon.

“Ultra-processed” foods include potato chips, pizza, cookies, chorizo, sausages, mayonnaise, chocolates and candies, and artificially sweetened beverages.

They also created a separate category called “processed ingredients,” which includes salt, sugar, honey, olive oil, butter, and lard.

What’s Wrong with Processing?

The big mystery is why foods that are so convenient and taste so good are so bad for us. The problem seems to come from the processing itself, which changes foods from their natural state.

These tend to be high in poor-quality fats, additional sugar, salt, and chemical preservatives, and low in vitamins and fiber. The common factor can be summed up in the phrase “convenience foods”; that is, foods that are quick and easy to prepare at home or grab at a drive-through.

Some researchers believe that changing foods from their natural state leads to inflammation throughout the body, which puts us at risk for a host of diseases.

“Some of the foods that have been associated with an increased risk for chronic diseases such as type 2 diabetes and heart disease are also associated with excess inflammation,” Dr. Frank Hu, professor of nutrition and epidemiology in the Department of Nutrition at the Harvard School of Public Health, told Harvard Health Publishing.

“It’s not surprising, since inflammation is an important underlying mechanism for the development of these diseases,” he said.

How to Break the Addiction

Asking you to give up all these delicious foods might seem as if we’re condemning you to a life of bland, tasteless meals. But that’s because Big Food has spent billions of dollars getting you addicted to all its additives.

In addition, these ultra-processed foods leave our bodies so depleted of nutrients that we keep eating more and more to try to make up the shortfall, not unlike Star Trek’s famous tribbles, which “starved to death in a storage compartment full of grain.”

The fact is, humans have been eating non- or minimally processed food for millennia. When your taste buds reacclimate themselves to the real thing, you’ll be surprised how sweet a carrot can be, or how a locally grown tomato is bursting with tangy flavor.

Finally, when you begin eating better, you’ll likely begin sleeping better, looking younger, have more energy, and many of the aches and pains you thought you’d just have to live with may begin to decrease or disappear altogether.

Take it Easy

All this will make you want to keep on this new path, and eventually, you’ll lose your taste for processed and ultra-processed foods. When you’ve been eating lower- or no-salt foods for a while, for example, then dip into a package of potato chips, you’ll think the contents are half potatoes and half salt.

The key is to withdraw from these addictive substances gradually. Substitute french fries for sweet potato chips you’ve baked yourself, for instance, or swap out soda for water occasionally.

Shop the store’s perimeter as much as possible, where they keep the fruits and vegetables and fresh meat and seafood.

If you must visit a fast-food restaurant, opt for salads or baked chicken sandwiches if they offer them.

Finally, don’t agonize over everything you eat. Stress is bad for you, too. Simply prefer fresh food over processed as often as possible.

sleep-disorders

Health Risks Associated with Lack of Sleep

Health Basics, Healthy Living, Lifestyle

If you have a hectic family life, a busy career, or both, it’s easy to push sleep to the back burner, telling yourself you’ll catch up “later.”

But that hour of sleep you gained last weekend as we switched from daylight saving time to standard time doesn’t begin to make up for the shortfall. For optimal health, you need a good night’s sleep every night.

If you sleep fewer than the recommended seven to eight hours every night, should you lie awake worrying about it? Our primary care concierge doctors in Jupiter certainly hope not.

But we think it’s important to remind our patients that adequate sleep on a regular basis is essential to good health, and now a new study seems to show why.

Consequences to Health

The health issues associated with lack of sufficient sleep affect every part of the body and can trigger numerous diseases: obesity, type 2 diabetes, cancer, cardiovascular disease, dementia, depression . . . even a shorter lifespan overall.

For years, science has known that insufficient sleep leads to these and other diseases, but no one was sure why.

Now a study published in September in the Journal of Experimental Medicine has linked lack of sleep to inflammation, a condition that can result in long-term damage throughout the body.

The study by researchers at the Icahn School of Medicine at Mount Sinai in New York City showed that chronic sleep deprivation in healthy adults increased the production of immune cells linked to inflammation, while at the same time changing the immune cells’ DNA to impair their protective abilities.

“Not only were the number of immune cells elevated but they may be wired and programmed in a different way at the end of the six weeks of sleep deprivation,” said study co-author Cameron McAlpine, an assistant professor of cardiology and neuroscience at Mount Sinai.

“Together, these two factors could potentially predispose someone for diseases like cardiovascular disease,” he said.

The Study

Although small, the study was carefully crafted to measure the effects of restricted sleep on a group of 14 healthy men and women, of average age 35, who normally sleep eight hours a night. The researchers checked the immune cell content of the volunteers’ blood over the course of six weeks, as their sleep time was reduced from their normal eight hours to 90 minutes less during the study.

They found that during the period of sleep restriction, the volunteers’ immune cells increased, suggesting an increase in inflammation as a result. Furthermore, the stem cells which create new immune cells appeared to be permanently damaged over the study period.

“The key message from this study is that sleep lessens inflammation and loss of sleep increases inflammation,” said study co-author Filip Swirski, director of the Cardiovascular Research Institute at Icahn Mount Sinai.

“In subjects who had undergone sleep restriction, the number of immune cells circulating in the blood was higher. These cells are key players in inflammation,” he added.

Long-term Damage

One researcher who was not involved in the study, Kristen Knutson, an associate professor at the Center for Circadian and Sleep Medicine at the Northwestern Feinberg School of Medicine, called this new study’s design “elegant.” 

While many studies of this type are restricted to one or two nights of sleep deprivation, this one lasted much longer. Moreover, it was conducted on healthy adults, who were monitored in a clinical setting, rather than relying on self-reporting of sleep duration.

“They emphasized the long-term effects of sleep impairment that we don’t quickly recover from and they showed this in both animal and human studies,” Knutson told NBC News.

Another doctor who also was not involved in the study agreed. Stephen Chan, director of the Vascular Medicine Institute at the University of Pittsburgh School of Medicine, told NBC News that this new study explains how chronic lack of sleep could weaken the immune system.

“We fundamentally did not understand why at the cellular level, sleep was so important in the control of the immune system [prior to this study],” he said.

“It’s really important to understand how sleep might impact inflammatory diseases like sepsis, cardiovascular disease, Alzheimer’s, and dementia,” he explained.

Prioritizing Sleep

Although we need a certain amount of inflammation in the body to recover from injuries or illness, too much over a long period of time causes damage throughout the body and can lead to chronic disease.

And Swirski explained that, although the increase in immune cells may return to normal after a few weeks of adequate sleep, their study showed that the damage to the stem cells may be more permanent, impairing their ability over time to perform well.

As we said earlier, we don’t want to make you so nervous about missing a bit of sleep that you lie there staring at the clock every night and worrying.

But we do want to emphasize the importance of making sleep a priority in your schedule.

And to help you sleep better, you should:

  • Go to bed at the same time every night.
  • Don’t try to sleep on a full stomach.
  • Refrain from using caffeine or alcohol after dinner.
  • Turn off “blue-light” devices (TVs, computers, smartphones) at least an hour before bedtime.
  • Restrict activity in the bed to sex and sleep (i.e., no working, reading, TV, etc.).

Let us know if you have any difficulty falling asleep or staying asleep. We can help uncover the causes and provide solutions.

running

Does Running Really Ruin Your Knees?

Health Basics, Healthy Living, Lifestyle, Preventative Health, Sports

Our primary care concierge doctors in Jupiter have heard it for years: “I don’t run because I don’t want to wreck my knees.” Intuitively, that makes sense. The argument goes something like this: When you run, each time the foot hits the ground, the body experiences a force equal to eight times body weight, and that will eventually cause osteoarthritis.

The good news is that study after study confirms that’s not the case; in fact, the opposite appears to be true: regular running actually strengthens cartilage, according to experts.

Counterintuitive Findings

One 2020 Stanford University study on the effect of running on knees found that for young, healthy individuals, such exercise appears to trigger an anti-inflammatory reaction in the joints.

“In fact, a normally functioning joint can withstand and actually flourish under a lot of wear,” the study’s lead researcher, James Fries, told Time magazine. Fries is a professor emeritus of medicine at Stanford.

He explained that cartilage—the soft connective tissue that surrounds the bones in joints—doesn’t contain arteries that deliver blood along with its rejuvenating dose of oxygen and nutrients. As a result, cartilage depends on movement to obtain needed nourishment.

“When you bear weight,” he said, “[the joint] squishes out fluid, and when you release weight, it sucks in fluid,” thereby delivering the nutrients necessary to build new cartilage.

What Other Research Says

Studies on this issue go back decades. For example, in 1971, researchers began to look at the children and spouses of the famous Framingham, Mass., Heart Study. Called the Framingham Offspring Cohort, 1,279 volunteers enrolled in a study of exercise and arthritis. The results of the study showed no link between jogging and arthritis.

The results of other studies went even further, appearing to actually show improvement in runners’ knees from their avocation, as the Stanford study found.

A 2008 Australian study found that subjects who engaged in vigorous exercise had knee cartilage that was thicker and healthier than those who didn’t exercise routinely.

In another study, published in the Journal of Orthopedic and Sports Physical Therapy in 2017, 10 percent of those who weren’t runners developed osteoarthritis in their knees or hips over the course of the study, while only 3.5 percent of runners did so.

Again echoing the Stanford results, another 2017 study, published in the European Journal of Applied Physiology, found that running decreased inflammation in the knees of study subjects, suggesting that running was a kind of medicine for those who were experiencing knee pain.

Overall Health Benefits

And running, along with other vigorous aerobic activities, provides whole-body benefits not confined just to the knees.

One study published in JAMA in 2008 followed members of a running club, comparing them with healthy non-runners, all of whom were over 50 at the beginning of the study. After 21 years, the researchers found that more of the runners than non-runners were still alive, as well as reported much less disability than those in the non-running group.

Another study confirming the health benefits of aerobic exercise such as running was published last month in the journal JAMA Network Open, conducted by the Division of Nutrition, Physical Activity, and Obesity at the Centers for Disease Control and Prevention (CDC).

Researchers found that doing between 10 and 300 minutes of aerobic exercise a week was associated with a 24 percent lower risk of death from any cause than exercising less than 10 minutes a week.

Another 2018 study, published in JAMA, produced similar results. Researchers investigated 122,007 former patients at Cleveland Clinic who were tested on a treadmill between January 1, 1991 and December 31, 2014. They found that those with the lowest level of fitness, i.e., a sedentary lifestyle, had a risk of death almost 500 percent higher than those who were the most physically fit.

Some Cautions

Does this mean everyone should lace up their sneakers and head for the trails? Not necessarily.

Mark Harrast, medical director of the Sports Medicine Center at the University of Washington, told HuffPost that running could cause damage in the knees of people who have already experienced trauma to knee cartilage.

“If you have cartilage damage from an injury, such as skiing, a torn meniscus, or a blown-out ACL, and if you run regularly and overuse it, that’s a set-up for arthritis,” he said.

Other reasons you might not want to take up running include having a family history of arthritis, or being overweight or over the age of 50.

Running, even for young, healthy people, though, is not without some risks, including the possibility of stress fractures and soft-tissue injuries. But with sensible safeguards, these issues can generally be prevented. 

Precautions include wearing a proper pair of running shoes, matched to your gait and foot size.

In addition, before you begin each run, always warm up with long, slow stretches to get the blood flowing. 

As with any form of exercise, you need to build up to full speed gradually. And have any pain you experience evaluated early to prevent further injury.

As long as you pace yourself and take it easy, there’s no reason you can’t enjoy the proven health benefits and euphoria of the “runner’s high.” Just be sure to check with us if you’re just starting out.

flu season

Experts Predict a Severe Flu Season, So Get Vaccinated Now

, Health Basics, News, Preventative Health, Vaccinations

If you hear the word “vaccine” and automatically think of COVID-19, our concierge primary care doctors in Jupiter don’t blame you. But there’s another virus lurking on our shores: the annual influenza outbreak, which deserves our attention now.

You can be forgiven for thinking we no longer had to worry about the flu because, for the last two years, it all but disappeared. This is largely due to all the hand washing, social distancing, and mask-wearing we practiced during the pandemic.

But unfortunately, those sensible health precautions are pretty much behind us now, and all signs point to a worse-than-normal flu season. In fact, we’ve already seen scattered reports of cases around the country. And remember that many cases go unreported because people typically recover at home without being officially tested and recorded.

Ominous Signs

The reason experts are expecting a more severe 2022-23 flu season is that they’re looking to Australia, which undergoes its flu season before ours. 

That country is just concluding its worst season in five years, with cases reported to be three times higher than normal. Their season also began two months sooner than it typically does, meaning it is expected to arrive sooner than usual here, as well.

“The Southern Hemisphere has had a pretty bad flu season, and it came on early,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Bloomberg News late last month.

“Influenza, as we all have experienced over many years, can be a serious disease,” he added, “particularly when you have a bad season.”

Dr. Frank Esper, a pediatric infectious disease specialist at the Cleveland Clinic, echoed those warnings.

“This year we expect it to be a very big flu season and that the flu season [will be] even worse in the younger groups [than] it was in years past,” he told Cleveland’s Fox8. 

We’re Not Prepared

For the last two years, we have rightly been focused on avoiding COVID-19, which has killed well over one million Americans to date. But influenza also presents a danger, especially to very young, pregnant women, those with chronic conditions, and the elderly.

In 2019, the last year that we actually had a notable flu season, nearly 61,000 Americans died from the flu, including 129 children. There were approximately 42.9 million cases of the flu, with 647,000 of those requiring hospitalizations. And that was considered a mild season (although it was the longest season in a decade, beginning in October and ending in May).

In addition, because of the demise of COVID-19 restrictions in general, we could get hit even harder.

“The thought is when the COVID pandemic hit, we started masking up and everyone started socially distancing, schools were closed for a whole year,” Esper said.

“Flu just nose-dived. It almost got to the point where there was no flu.” 

But because we haven’t been exposed to it lately, we are even more vulnerable to its effects, making it harder to fight off.

“Usually, we see the flu every year. Our immune systems are ready for it. When you haven’t seen the flu in two or three years, that means our immune systems may be a little slower,” he explained.

Double Whammy?

Then there’s the possibility of a “twindemic,” or a severe flu season that strikes at the same time as an uptick in coronavirus activity. This is a distinct possibility because both viruses tend to increase circulation when people spend more time indoors in the colder months, and immunity from earlier vaccinations or infections is beginning to wane, especially in those who haven’t had a recent coronavirus booster.

In fact, we’ve already seen an increase in COVID-19 cases across the country in the last two weeks, according to data provided by the Mayo Clinic.

So the Centers for Disease Control and Prevention (CDC) reports that getting a flu shot this year is recommended as “the first and most important step in protecting against flu viruses,” while at the same time reducing the burden of flu hospitalizations and deaths.

“An influx of hospitalizations from COVID-19 and the flu could stress the healthcare system and impact staffing if any healthcare workers are out sick,” Soniya Gandhi, associate chief medical officer at Cedars-Sinai, told Cedars-Sinai Newsroom.

The Time is Now

Because of all the signs that the flu season here could start early, it’s important to receive your vaccine as soon as possible, since it takes at least two weeks to achieve full immunity.

“The bottom line is that you don’t want to wait until you’re already going to be at risk of getting influenza to get vaccinated,” Dr. Albert Ko, an infectious disease physician and professor of public health, epidemiology, and medicine at Yale School of Public Health, told NBC’s TODAY.

And we’ve seen with COVID-19 that vaccines work to reduce the severity of such illnesses, not only in individuals but also in those around them who either can’t receive the vaccine or who don’t respond well to it.

Remember that if you haven’t yet received your omicron booster, you can get both shots at the same time, one in each arm.

“The flu and COVID-19 vaccinations are important on a personal level, and they’re critical from a public health standpoint,” Gandhi said.

belly fat

From Fat Belly to Flat Belly: 3 Effective Ways to Slim Down

Health Basics, Healthy Living, Lifestyle, Nutrition, Preventative Health

You think you’re doing all the right things: exercising, eating healthy, and keeping your weight in check. So why do you look down and see that bulge hanging over your belt line?

Our concierge primary care doctors in Jupiter can’t promise that the following tips will give you a washboard abdomen, but we do know that you can at least reduce the problem area if you know what causes it and, therefore, how to combat it.

Read more
vit d

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

Health Basics, Healthy Living, Lifestyle, Medications, Nutrition, Preventative Health

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

Dueling Conclusions

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

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

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

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

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

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

More Confusion

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

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

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

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

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

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

The Last Word?

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

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

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

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

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

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

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

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

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

Vitamin D Overdose?

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

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

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

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

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

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

Coronavirus Pandemic

New Guidance on COVID-19 Can Be Confusing

, , , , , , COVID, Disease, Health Basics, Healthy Living, Lifestyle, News, Preventative Health, Vaccinations

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

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

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

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

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

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

A new approach

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

According to The Washington Post:

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

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

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

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

Isolation changes

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

Additional CDC guidance on isolation includes the following:

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

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

What about boosters?

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

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

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

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

The mask question

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

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

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

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

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

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

pfas

How to Combat the Lingering Danger of ‘Forever Chemicals’

Disease, Environment, Health Basics, Healthy Living, Lifestyle, Nutrition, Preventative Health

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

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

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

The Problems with PFAS

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

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

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

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

They’re Everywhere

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

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

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

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

Lingering Threat

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

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

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

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

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

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

What You Can Do

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

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

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

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

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

The NAS committee also offered these tips:

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

Coffee Scores Another Win for Improving Health

, , , , , , Health Basics, Healthy Living, Lifestyle, Nutrition, Preventative Health

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

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

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

Evidence piles up

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

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

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

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

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

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

Latest findings

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

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

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

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

Some coffee caveats

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

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

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

Other possible negative effects of too much coffee include:

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

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

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

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

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

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

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