best diet

The Best Diet for You

The start of a new year is traditionally the time to turn the page on the bad habits and disappointments of the previous year.

Usually near the top of the list of New Year’s resolutions that people make is the decision to lose weight. And from a health perspective, our concierge doctors certainly applaud that one.

Overweight or obesity is responsible for a host of chronic diseases, from type 2 diabetes to backaches to joint pain. So you want to achieve and maintain a healthy body weight, right? But which diet is best?

The problem with keto

What about the popular keto diet? 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?

First, it can it cause numerous side effects—body aches, headaches, light-headedness, nausea, fatigue and lethargy, constipation, and brain fog. Plus, all their friends are eating garlic bread and mashed potatoes (not cauliflower) with gravy and pasta. Or because they lost their job and need a regular intake of brownies to help them feel better. Or because they’re stressed about the pandemic—possible job loss, not being able to see friends and family, worried about catching the coronavirus. And that chocolate cream pie dulls the loneliness and anxiety, at least for a little while.

Because, in short, the keto diet restrictive. It has a long list of quite tasty foods that either aren’t allowed, or 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.

The common problem

And this is the problem with all diets. Nearly all of them work as promised, but are difficult to adhere to over time. So you “cheat.” Then you cheat some more. Then you figure, why bother? You then start eating normally again and regain all the weight you lost. And you likely gain back even more.

But here’s the thing: It’s not you, it’s them. In other words, it’s the whole concept of dieting to begin with. Someone once pointed out that diet begins with the word “die,” so even if only subconsciously, the concept has a negative connotation.

In addition, our bodies were built to store calories. That’s because our ancient ancestors never knew when they’d be facing lean times, or even starvation if the mastodons they hunted migrated elsewhere. Even in more recent times, before there was such a thing as a food industry, mankind learned to store food over the winter. But it still wasn’t as abundant as during the summer months.

So we’re biologically built to store up calories to last through the lean times.

And speaking of the food industry, their entire reason for being is to get us to buy more of their product. Stores are laid out with enticing displays of sugary, fat-laden foods. Advertising constantly tempts us with photos and videos of delicious, fattening foods.

We succumb, we gain weight, and then it’s up to us to find a way to lose it. And we try a long list of diets, only to be disappointed with the results. So which one do we recommend?

The only real solution

The best diet is one that works for you, that helps you gradually lose weight, but doesn’t leave you feeling deprived or hungry all the time.

“For any given person, it’s really a matter of what they can stick with,” Michael Jensen of the Mayo Clinic told Psychology Today.

Keto might be the right choice for some people. For others, the Paleo diet, moderation, veganism, intermittent fasting, or simply cutting back on sugar and flour.

Above all, research shows the most successful diet is the one that you yourself designed. This 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.

“[The most successful way of dieting] will be different from one person to the next, and there will never be a randomized trial of it.”

We would add that for the most wholesome way to eat, consider the Mediterranean diet. It rates number one in surveys of diets, not only for long-term weight loss, but also for ease of adherence and the healthiest outcomes.

If you have any questions about weight loss, please talk with us. We can suggest the best approach specifically for you.

running knees

Studies Say Running May Actually Be Good for Your Knees

Of course running is bad for your knees, right? Everybody knows this. After all, it only makes sense. You’re bringing the full weight of your body down on these joints with every step, so you’re wearing out the cartilage from overuse.

But our concierge doctors have often found that what seems like “common sense” is anything but, which is why we look to science for answers.

Studies say otherwise

Rather than the widespread notion that running wears out the cartilage in the knees, it appears the opposite is true. The old adage “use it or lose it” apparently applies here.

Over the last fifty years, researchers have been looking at the question of whether running is bad for the knees.

One of the oldest studies dates to 1971. Here researchers began studying the children and spouses of the Framingham, Massachusetts Heart Study. Called the Framingham Offspring Cohort, 1,279 volunteers participated in a study of exercise and arthritis, which ultimately found no link between jogging and arthritis.

A 2008 study at Stanford University not only confirmed the Framingham findings, but in a 21-year-long follow-up, the runners “experienced significantly less musculoskeletal disability than did their less-active peers,” according to a Harvard University report on the study. They also found that runners experienced less disability and lived 39 percent longer than those who weren’t as physically active.

An Australian study that same year found 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 Orthpaedic 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. Only 3.5 percent of runners did so.

Movement is medicine

What about the frequent reports of runners experiencing knee problems? Experts believe that they would have happened whether subjects were runners or not. Researchers attribute the onset of osteoarthritis to obesity or genes, rather than overuse of the joints.

And one recent study published in the European Journal of Applied Physiology seems to bear this out.

Researchers asked six recreational runners, ages 18-35, to spend 30 minutes running, and then extracted the cushioning synovial fluid from their knees. They found that two cytokine markers for inflammation were lower in the runners than in a control group of non-runners.

“What we now know is that for young, healthy individuals, exercise creates an anti-inflammatory environment that may be beneficial in terms of long-term joint health,” the study’s lead author, Robert Hyldahl, BYU assistant professor of exercise science, said in a statement. He further wrote that the study results indicate exercise may help delay the onset of such joint degenerative diseases as osteoarthritis.

“In fact, a normally functioning joint can withstand and actually flourish under a lot of wear,” James Fries told Time magazine. Fries was the lead researcher on the Stanford study, and is 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. Therefore, 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,” thus delivering the necessary nutrients to build new cartilage.

Protect yourself regardless

Running, however, does carry some element of risk, including the possibility of stress fractures and soft-tissue injuries. But with proper precautions, these can generally be prevented.

Here are some tips to prevent running injuries:

1. Wear the right shoes

You need to be fitted with a proper pair of running shoes, matched to your gait and foot size. Don’t try to run in regular footwear.

2. Strengthen supporting muscles

To ensure good support for your knees as you run, be sure to exercise all your leg muscles, especially the quads and glutes. 

3. Start slowly

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. Pace yourself as you start out or if you’re returning to running after a long time away from it.

4. Run correctly

If your strides are too long, you’ll land on your heels, a prime cause of shin splints and joint pain. Shorter strides will allow you to land on mid-foot, minimizing the chances of injury. In addition, a 2018 study found that leaning forward slightly while running can help reduce the stress on your knees. Ensuring proper form will optimize your run.

5. Cross-train

Alternate days of running and days of other forms of exercise to allow muscles and tendons time to heal.

If you have any questions about your body’s ability to withstand any type of exercise, be sure and talk with us.

effects of sitting

Sitting Is the New Smoking

If you’ve been one of those fortunate enough to be able to work at home during the pandemic, you’ve probably been glued to your chair for eight or more hours a day. At least at the office you might have been able to walk around from desk to desk, or take the stairs, or take a walk at lunch.

Whereas at home, our concierge doctors are guessing that you get very little chance to move at all. And that could be detrimental to your health.

Scientists have been researching the effects of sitting…

Researchers have known for several years that sitting for long periods is hazardous to your health. But newer studies have revealed that lack of frequent movement is even more dangerous than previously known.

Some of the results that attributed to prolonged periods of sitting include:

  • organ damage, including heart disease
  • an over-productive pancreas
  • a greater risk for colon, breast, and endometrial cancers
  • muscle degeneration
  • leg disorders, including osteoporosis
  • slower brain function

One 2011 study examined more than 800,000 people’s sitting habits. Those who sat the most during the day found they had:

  • a 112 percent increased risk of diabetes
  • a 147 percent increased risk of heart attacks and strokes
  • a 90 percent increased risk of death from CVD
  • a 49 percent risk of death from any cause

… And they continue to see similar results

Newer studies have confirmed those who spend more time sitting than moving have higher rates of cardiovascular disease (CVD) and certain cancers than people who don’t sit as long. They are also more likely to die early than their less sedentary counterparts.

One study, for example, found that adults who sat for 11 hours or more a day had a 40 percent higher risk of dying in the next three years than those who sat for less than four hours daily.

Another study published in the Annals of Internal Medicine, tracked the daily movements of 7,985 adults. Participants used hip-mounted accelerometers to actually record their activity, rather than rely on self-reported data. As the total time spent sitting increased, so did the risk of death from any cause, regardless of age, sex, race, body-mass index (BMI), or exercise habits.

Those who sat for less than 30 minutes at a time had a 55 percent lower risk of death compared with those who sat longer than that.

So, yes, sitting really is as bad for your health as smoking.

Some good news

But it is possible to counteract the effects of sitting just by getting out of your chair from time to time.

The World Health Organization (WHO) released new guidelines last month to help counteract the effects of prolonged sitting, based on a new study published in a special issue of the British Journal of Sports Medicine (BJSM).

The WHO now says that all physical activity counts toward better long-term health. This could include anything from climbing stairs instead of taking the elevator, gardening or doing housework, taking a walk around the block, participating in a team sport, going for a run or a bike ride, or participating in a high-intensity interval training workout.

The BJSM researchers followed more than 44,000 people from four countries. They fitted each participant with activity trackers. They found that moderate to vigorous physical activity for 30-40 minutes daily brought the risk from prolonged periods of sitting down to levels associated with very low amounts of sedentary time.

What to do for your health

So, while the higher intensity workouts were better, it appears that any movement is better than nothing.

“These guidelines are very timely, given that we are in the middle of a global pandemic, which has confined people indoors for long periods and encouraged an increase in sedentary behavior,” Emmanuel Stamatakis, BJSM co-editor and professor at the University of Sydney, wrote in the journal.

“But people can still protect their health and offset the harmful effects of physical inactivity,” he said. “As these guidelines emphasize, all physical activity counts and any amount of it is better than none. There are plenty of indoor options that don’t need a lot of space or equipment, such as climbing the stairs, active play with children or pets, dancing, or online yoga or Pilates classes.”

There’s one more benefit from any type of exercise that we’d like to point out: stress relief. The pandemic has put us all on edge, and a brisk walk outdoors or a brief period of play with the kids or the dog can go a long way to helping alleviate tension.

So, for better health all around, set a kitchen timer, your watch, or your phone to remind you to get up and move every few minutes throughout the day.

chocolate good for you

Check Out Chocolate for Your Health

Let’s face it—this has been a lousy year. We’ve either lost or postponed so many of our normal pleasures, it’s no wonder that we’re feeling deprived. But our concierge doctors have a prescription that can help cheer you up: chocolate.

And ‘tis the season for it, after all. Not to mention that, as we’ll explain below, it can be healthier than eggnog, frosted cookies and cakes, and all the other sugarplums we’re inclined to consume this time of year.

The good news

Many recent studies have found the right kind of chocolate consumed in moderation might benefit everything from the cardiovascular system to cognitive improvement. Some have even attributed consumption to a reduced risk of cancer and a lower risk of diabetes.

One study at Johns Hopkins University School of Medicine, for example, found that blood platelets clotted more slowly in subjects who had consumed chocolate. This can help prevent clots—and thus, heart attacks and strokes—from occurring.

Another study published in the journal BMJ suggested that consumption could lower the risk of developing heart disease by as much as a third.

“Based on observational evidence, levels of chocolate consumption seem to be associated with a substantial reduction in the risk of cardiometabolic disorders,” the authors wrote in a paper presented at the European Society of Cardiology Congress in Paris.

Several studies have looked at this claim

In a 2017 study, researchers found that consuming raw almonds, dark chocolate, and cocoa helped lower “bad” cholesterol in overweight or obese subjects.

A 2008 study found those who ate a small amount of dark chocolate each day had lower blood levels of a protein associated with inflammation.

A Canadian study of 44,489 subjects found those who regularly consumed chocolate were 22% less likely to suffer a stroke than those who abstained. That those who suffered a stroke saw a 46% decline in likelihood of death.

Other benefits attributed to this sweet include improved cognitive function, enhanced athletic performance, benefits to fetal growth and development, and lower cholesterol. (These tend to come from small studies that have not been confirmed.)

“(Chocolate) is a good antioxidant,” Dr. Owais Khawaja, a cardiology fellow at St. Vincent Mercy Medical Center in Toledo, Ohio, told CNN. “We think most of the beneficial effects are because of this.” Antioxidants are known to reduce the amount of free radicals in the body, those compounds known to cause cellular damage.

“More and more research is showing that [eating chocolate] is really more beneficial than we ever imagined,” said Katherine Tallmadge, a registered dietician and spokesperson for the American Dietetic Association told Live Science.

The bad news

But it’s not permission to gorge on the stuff. As with other indulgences, moderation is key, and the right kind of chocolate makes all the difference. Experts recommend limiting intake to no more than one ounce a day.

Compounds called flavonoids exist in chocolate as well as wine, beer, tea, berries, fruits, and vegetables. They may be responsible for chocolate’s healthful benefits. Flavonoids are antioxidants believed to reduce inflammation throughout the body.

One reason chocolate has received its bad reputation is because of all the sugar it typically contains. This leads to heart disease, obesity, tooth decay, and myriad health problems.

The more nonfat cocoa solids chocolate consists of, the more antioxidants it contains. Steer clear of chocolate products with added fats such as “milk fats,” or “partially hydrogenated vegetable oil.” These will tend to cancel out the beneficial effects of chocolate, in addition to causing weight gain.

The closer you can get to the original cocoa, the better. So natural cocoa powder is best (though it tends to be bitter); dark chocolate and semi-sweet chocolate chips are better. Milk chocolate is the least desirable. Milk proteins may bind to the flavonoids and make them unavailable to the body. White “chocolate” contains no cocoa solids at all.

The American Heart Association (AHA) says that chocolate can be part of an overall healthy diet, but the key phrase is “part of.”

Alice H. Lichtenstein, the Gershoff professor of nutrition science and policy at Tufts University in Boston, says, “If you enjoy chocolate, the important thing to do is choose the type you enjoy the most and eat it in moderation because you like it, not because you think it’s good for you.”

wearing a mask

CDC: Masks Protect Wearer, Too

As Florida closes in on the unenviable milestone of nearly a million confirmed cases of COVID-19, our concierge doctors wanted to share a bit of good news. We’ve mentioned before how critical it is to wear face masks in public to help keep others from becoming infected. People can be contagious for up to two weeks before they begin to show symptoms, which accounts for the rapid spread of the disease.

Now a new scientific briefing from the Centers for Disease Control and Prevention (CDC) confirms what researchers had long suspected: Masks protect the wearer as much as those around them. The revised guidance, released late last month, cites several studies. These show masks reduce the risk of contracting the virus by up to 79 percent.

In one case, for example, a study examined 124 households in Beijing with a single case each of COVID-19. It found mask wearing by the infected individual as well as others in the household reduced secondary transmission by 79 percent. Another case followed two hair stylists who were infected and showing symptoms. They wore masks while interacting with 139 clients over eight days. The clients also wore masks. Subsequent testing showed that not a single client contracted the disease as a result.

An added bonus

In addition to protecting both the wearer and the public, universal mask-wearing can also help the economy, the CDC notes.

“Adopting universal masking policies can help avert future lockdowns, especially if combined with other non-pharmaceutical interventions such as social distancing, hand hygiene, and adequate ventilation,” the CDC said.

Besides pandemic fatigue, another reason people have begun to rebel against stay-at-home guidance is because of the dire effect the early lockdowns had on the economy. Most people need to work, and economic stress is as unhealthy as any other kind of stress.

But the agency cites one recent economic analysis from Goldman Sachs. It found a 15 percent increase in universal masking could prevent losses of up to $1 trillion. This equals about five percent of gross domestic product (GDP).

So it turns out that wearing a mask is a win-win-win proposition.

But which mask is best?

The type of mask worn by health-care workers is the N95 respirator. This is the best at filtering out infected particles, which is precisely why you shouldn’t wear them.

“The CDC does not recommend that the general public wear N95 respirators to protect themselves from respiratory diseases, including coronavirus (COVID-19),” according to the U.S. Food and Drug Administration (FDA). “Those are critical supplies that must continue to be reserved for health care workers and other medical first responders.”

There is a still a severe shortage of such masks, even after all this time. The CDC recommends the public wear others types of face coverings, many of which have been shown to be quite effective.

“Multiple layers of cloth with higher thread counts have demonstrated superior performance compared to single layers of cloth with lower thread counts, in some cases filtering [out] nearly 50 percent of fine particles,” the CDC said.

“Try to get at least a two-ply cloth mask and make sure it’s tightly woven,” Dr. John O’Horo, an infectious disease specialist at the Mayo Clinic in Rochester, Minnesota, told NBC News.

One test of effectiveness is to hold the mask up to the light. If you can see the outline of individual fibers in the cloth, it’s too thin to offer enough protection.

Dr. Scott Segal, chair of anesthesiology at Wake Forest Baptist Health in Winston-Salem, North Carolina, recently partnered with the Wake Forest Institute for Regenerative Medicine to test a variety of cloth materials. They looked not only for breathability and comfort, but also for the ability to filter small particles. They concluded the best masks were constructed of two layers of heavyweight “quilter’s cotton,” with a thread count of at least 180.

What doesn’t work

Now we consider what doesn’t work.

The most ineffective mask is one that doesn’t cover the nose. In fact, there’s little point in wearing one at all if the nose isn’t covered. The resulting nasal exhalations will spread the virus, and also allow the wearer to inhale infected particles. So will face masks with valves. They make for easier breathing, but they also allow the breath to leave the mask without any filtering.

Plastic face shields fall into this category as well. One recent study confirmed that plastic face visors allow nearly 100 percent of tiny airborne droplets such as those emitted by talking or breathing to escape into the surrounding air. Yes, doctors wear them . . . along with N95 masks.

Remember, it’s safest to always assume that everyone you meet outside your immediate household is infected. We now have the promise of two new effective vaccines on the horizon. But until they can be widely distributed, we’ll need to hang on just a little longer. And wearing a mask can help us control the spread of the virus sooner.

smoking and covid-19

Smoking and COVID-19: What You Need to Know

The annual Great American Smokeout is set for this week, November 19. So our concierge doctors thought this would be a good time to look into what we know about the combined effects of smoking and COVID-19.

This is especially important because there has been some confusing information on the effects of cigarette smoking on the disease, with some early reports even suggesting that cigarette smokers who contract COVID-19 actually fare better than non-smokers. Subsequent studies have found the opposite: that smoking increases the risk that the virus causes more damage in smokers.

Tobacco’s extensive effects

One study, reported in The Guardian, analyzed more than 11,000 COVID-19 patients. It found that about 30 percent of those with a history of smoking saw their conditions progress to a more severe or critical state, versus 17.6 percent of non-smokers. Researchers concluded that “smoking is a risk factor for progression of COVID-19,” with smokers nearly twice as likely to develop severe symptoms.

In addition to the well-known damage to the lungs and cardiovascular system—both of which are compromised by COVID-19—smoking has also been shown to suppress the immune system’s ability to fight infection in the body.

“Tobacco products cause inflammation in the airways and affect lung immunity, which makes people more susceptible to infection in general,” Dr. David Christiani, a professor at the Harvard TH Chan School of Public Health, told the paper.

In a scientific brief released this summer, the World Health Organization (W.H.O.) concluded that “the available evidence suggests that smoking is associated with increased severity of disease and death in hospitalized COVID-19 patients.”

The brief also reiterated that, in addition to the findings on the coronavirus, “Tobacco causes eight million deaths every year from cardiovascular diseases, lung disorders, cancers, diabetes, and hypertension.”

We believe it’s safe to add COVID-19 complications to that list.

Benefits of quitting

If you smoke, you’re not alone. More than 32.4 million people in the U.S. still smoke cigarettes, according the American Cancer Society (ACS). Unfortunately, as a result more than 16 million Americans live with a smoking-related disease.

But it’s never to late to quit.

Here’s a timeline from the ACS showing what happens when you stop smoking:

  • Twenty minutes after quitting your heart rate and blood pressure drop.
  • Twelve hours after quitting the carbon monoxide level in your blood drops to normal.
  • Two weeks to three months after quitting your circulation improves and your lung function increases.
  • One to nine months after quitting, coughing and shortness of breath decrease. Tiny hair-like structures (called cilia) that move mucus out of the lungs start to regain normal function in your lungs. This increases their ability to handle mucus, clean the lungs, and reduce the risk of infection.
  • One year after quitting the excess risk of coronary heart disease is half that of someone who still smokes. Your heart attack risk drops dramatically.
  • Five years after quitting your risk of cancers of the mouth, throat, esophagus, and bladder is cut in half. Cervical cancer risk falls to that of a non-smoker. Your stroke risk can fall to that of a non-smoker in two to five years.
  • Ten years after quitting your risk of dying from lung cancer is about half that of a person who is still smoking. Your risk of cancer of the larynx and pancreas decreases.
  • Fifteen years after quitting your risk of coronary heart disease becomes that of a non-smoker’s.

Ready to quit?

There are myriad ways to successfully stop smoking. What works for one person might not work for another. And studies show that the average smoker tries several times before giving up the addiction entirely.

“No matter your age or how long you’ve been smoking, quitting improves health, both immediately and over the long term,” the ACS says. “Giving up smoking is a journey, and it can be hard, but you can increase your chances of success with a good plan and support. Getting help through counseling and medications doubles or even triples your chances of quitting successfully.”

You can also download numerous quit-smoking apps to help, or find tools and tips at Smokefree.gov. The site also offers live chat help for those trying to quit. In addition, each state has a quit line, which you can access by dialing 1-800-QUIT-NOW (1-800-784-8669).

Of course there are various medications also available, so if you’re trying to stop smoking, please talk with us. We can help find the best path for you.

The coronavirus pandemic has had everyone on edge for months, and smoking may be one way you’ve used to cope. But, as with increasing alcohol or drug consumption, it’s unhealthy and ultimately unhelpful.

safely celebrate holidays

How to Celebrate the Holidays Safely

As we head into the holidays, our concierge doctors are concerned that pandemic fatigue might tempt people to throw caution to the winds and just celebrate, starting with Thanksgiving.

The fact is, we’re all fed up with the “new normal.” People want more than anything to return to the way our lives were before this scourge attacked the world early this year. Pandemic fatigue is not only real, it’s totally understandable.

“In the spring, it was fear and a sense of, ‘We’re all in it together,’” Vaile Wright, a psychologist at the American Psychological Association (APA) told The New York Times. “Things are different now,” she said. “Fear has really been replaced with fatigue.”

This led to a sense of complacency and carelessness. While understandable, this caused a wave of increased cases and deaths in the U.S. and around the world.

“Citizens have made huge sacrifices,” Dr. Hans Kluge, the World Health Organization’s (W.H.O.’s) regional director for Europe, told the Times. “It has come at an extraordinary cost, which has exhausted all of us, regardless of where we live, or what we do.”

The high cost of carelessness

A recent report in The Washington Post serves as a cautionary tale for our country. Canada celebrates their own Thanksgiving on the second Monday of October. Despite warnings from public health officials there to limit celebrations to members of the immediate household, apparently that advice went unheeded by many Canadians.

In the weeks after, Canada saw rising case numbers as a result. Ontario, for example, reported a record-high number of daily cases within two weeks of the holiday. A single gathering of 12 extended family members in Toronto resulted in a cluster of coronavirus cases.

“People did not mean to spread COVID-19,” Deena Hinshaw, Alberta’s chief medical officer of health, told The Post. “But it is a reminder that social gatherings where social distancing and masking are not used consistently are a significant risk for spread.”

We can understand the longing to get together for the traditional holidays, beginning with with Thanksgiving. But that is, unfortunately, a recipe for disaster.

“We are set up for just a perfect storm—a conflagration,” Megan Ranney, an emergency medicine professor at Brown University, told The Post recently. “Right now, you can talk about there being lots of little burning fires across the country. And then Thanksgiving will be the wind that will whip this fire up into an absolute human disaster for our country.”

This country’s leading infectious disease expert, Dr. Anthony Fauci, likewise warned that Thanksgiving celebrations could lead to even more cases.

“That is, unfortunately, a risk, when you have people coming from out of town, gathering together in an indoor setting,” he told CBS News recently. “It is unfortunate, because that’s such a sacred part of American tradition.”

Yes it is. But we’d like to suggest some ways to minimize that risk and safely celebrate the holidays.

A few COVID-19 reminders

First, let’s review a few facts.

The SARS-CoV-2 coronavirus is one of the most contagious viruses known to man. It spreads readily through the air and by surface contact, from those who have symptoms as well as those who don’t.

Because of this, areas with high air circulation, such as the outdoors on a windy day, tend to be safer than crowded indoor spaces with poor ventilation.

Far deadlier than the flu, the coronavirus travels through the bloodstream to every part of the body. This is why it’s so difficult to treat, and why many of its victims appear to suffer months-long aftereffects.

How to safely celebrate the holidays

With that in mind, if you’re preparing to celebrate the holidays, here are a few tips.

The Centers for Disease Control and Prevention (CDC) recommends limiting gatherings to those in your immediate household. If you’re going to host a Thanksgiving dinner, the CDC suggests holding it outdoors. It also says to only invite family and friends from your immediate neighborhood.

“Gatherings with more preventive measures, such as mask wearing, social distancing, and hand washing . . . pose less risk than gatherings where fewer or no preventive measures are being implemented,” the CDC says.

Other ways to judge risk, according to the CDC:

  • Indoors is riskier than outdoors.
  • Poor ventilation is riskier than good ventilation (e.g., places with open windows and doors).
  • Longer gatherings are riskier than shorter gatherings.
  • More attendees pose a greater risk than fewer attendees.
  • Local attendees pose less of a risk than those traveling from other areas who may have been exposed at home or during their travels but aren’t yet showing symptoms.

If you can’t control the environment, the attendees, or their behavior, you need to ask yourself whether one holiday is worth the risk.

“Staying home is the best way to protect yourself and others,” the CDC says.

As we noted above, we’re all tired of the precautions necessary to reduce the spread of the novel coronavirus. But parents, for instance, remain on high alert to ensure the safety of their children for eighteen-plus years. If you think of it in these terms, a year or two of vigilance might seem more acceptable.

Remember, the fastest way for this thing to be “over” is to deny it new hosts. This includes the bodies of you and your loved ones. Please follow these tips in order to safely celebrate the holidays.

flu shot twindemic

Flu Shots Can Help Avert a ‘Twindemic’

The U.S. Centers for Disease Control and Prevention (CDC) recommends all adults and children older than six months receive a flu shot by the end of this month. The CDC says it takes at least two weeks for the vaccine to become effective. Then it won’t reach its peak effectiveness until another week after that. And children who are being vaccinated for the first time need two vaccines spaced a month apart to become fully protected.

Therefore, our concierge doctors suggest you get your flu shot for the 2020-21 influenza season as soon as possible. While there have been scattered reports of shortages around the country, The Washington Post recently reported a record number of flu vaccine doses—between 194 million and 198 million—have been ordered. Because the vaccine is shipped in stages, more is on the way.

“This year I think everyone is wanting to get their vaccine and maybe wanting it earlier than usual. If you’re not able to get your vaccination now, don’t get frustrated. Just keep trying.”

The CDC’s Dr. Daniel Jernigan, to the Associated Press (AP).

COVID-19 and flu overlap: a ‘twindemic’

We were fortunate the 2019-20 flu season was winding down this spring as the coronavirus crisis began to hit the country. This year, however, we’ll be looking at the possibility of a “twindemic”—both waves hitting at once.

So it’s especially important that as many people as possible get vaccinated for the flu this year. The flu shot won’t prevent COVID-19, but it can help reduce the strain on our already overburdened health care system.

“Since hospitals and doctors’ offices are going to be very busy caring for COVID-19 patients, a flu vaccine can help decrease burdens on the health care system and make sure that those who need medical care are able to get it.”

Dr. Susan Bailey, president of the American Medical Association (AMA) and an immunologist in Fort Worth, Texas, told CNN.

Last year, the CDC estimated that the flu killed 22,000 Americans, and resulted in hospitalization of an additional 400,000. By contrast, at least 215,000 Americans have died of COVID-19 since March.

Hopeful signs

Health experts are hopeful the precautions we’ve been taking to avert COVID-19—hand washing, social distancing, and wearing masks—will mean this season’s flu won’t take as severe a toll as in previous years. But they all insist that widespread vaccinations are necessary.

Even if the flu vaccine isn’t 100 percent effective in preventing influenza, it has been shown to reduce the length and severity of the illness in those who contract it. In addition, if you’re unlucky enough to contract COVID-19, you won’t want your body’s defenses to be weakened by a prior bout with the flu.

This is already present in the Southern Hemisphere, where each season’s flu strikes over the summer. From South Africa to Australia, public health experts reported remarkably low levels of influenza among their populations. They attributed this partly to coronavirus lockdowns and to extremely high participation in influenza vaccinations.

One pharmacy in Cape Town, South Africa, for example, reported that the demand for flu shots was four times higher than in previous years. People were trying to avoid the co-morbidity (simultaneous presence of two or more diseases) of contracting the flu in addition to COVID-19.

“People were lined up outside the pharmacy down to the corner of the street waiting to get their injections. We had to prevent people from coming into the store.”

Ellis Henen, owner of Sunset Pharmacy, told The Post.

Additional benefits of the flu shot

We hope Americans will have the same attitude to this year’s flu shot.

Some people think they’re still protected from the one they received last year. But having received a flu shot last year won’t protect you from this season’s strains of the virus. This is because your immunity from a year ago has deteriorated by now. In addition, manufacturers create a new vaccine each year based on which strains the World Health Organization (WHO) expects to be predominate. This is based on which strains were seen over the summer in the Southern Hemisphere. So this year’s shot will include strains different from those in last year’s inoculation.

It’s important to remember, even if you contract influenza after receiving the shot, it’s likely to be less serious than if you’d skipped being inoculated. And the flu vaccine offers additional benefits, especially among the elderly. For older people and those with chronic health conditions, recent studies show the extra benefits of a flu shot. It’s as effective in preventing a heart attack as quitting smoking, using cholesterol-lowering drugs, or taking blood pressure medications.

So be sure to let us know if you’re interested in getting a flu shot. If you encounter a shortage, we may be able to help you locate a supply nearby.

help insomnia

Weighted Blankets May Help with Insomnia

Our concierge doctors note the stress resulting from the coronavirus pandemic affects large portions of our population. This has manifested in many ways, including a sharp increase in insomnia.

Even without the pandemic, the National Institutes of Health (NIH) estimates that between 30 and 40 percent of the population experiences insomnia regularly. A 2005 National Sleep Foundation (NSF) poll showed more than half of respondents reported experiencing insomnia at least a few nights a week in the past year. Thirty-three percent said they had insomnia every night or nearly every night for the past year.

And since the advent of the pandemic, prescriptions for sleep medications are up 15 percent, according to pharmacy benefit manager Express Scripts. The UCLA Sleep Disorders Center reports insomnia complaints have soared 20-30 percent.

An occasional sleepless night is not technically categorized as insomnia. It’s when it becomes a longer-term occurrence that it is officially called insomnia. Ironically, though, the occasional sleepless night can quickly turn into insomnia when the sufferer begins worrying that it will happen again. The worry feeds the arousal state in the brain, thus leading to night after night of wakefulness.

How to beat insomnia

You’ve probably heard the typical suggestions for how to help your insomnia:

  • Maintain a regular bedtime
  • Increase exercise
  • Turn off blue light-producing electronic devices (smartphone, computer, TV) at least one hour before bedtime
  • Don’t eat or drink alcohol within three hours of bedtime
  • Stop drinking caffeine no later than 2 p.m.
  • Avoid naps
  • Restrict the bedroom to sleep and sexual activity
  • Try to stay awake, instead of trying to fall asleep (known as paradoxical intention, which takes the pressure off trying to sleep)
  • Get up and leave the room if you haven’t fallen asleep within 20 minutes

These tips may work for those with occasional insomnia. If your difficulty is chronic or worrisome, talk to us. We can perform a physical examination to ensure your insomnia isn’t caused by a correctable physical condition, such as sleep apnea or thyroid problems.

We can also suggest other measures that have proven useful. Cognitive behavioral therapy, various relaxation and breathing techniques, light therapy to reset the body’s circadian clock, and even short-term medication, if necessary, can all help.

Weighted blankets seem to help

In addition to these suggestions, consider trying is a weighted blanket. They have been around for several years, and many users have given them rave reviews. They help you to fall asleep more easily, sleep more soundly and sleep longer.

Until now, however, such testimonials had little science to back them up. That was until a new study was published last month in the Journal of Clinical Sleep Medicine. It found those who slept with weighted blankets experienced better sleep. They also reported fewer symptoms associated with depression and anxiety during the day.

The 120 adult participants had all been clinically diagnosed with insomnia for at least two months. Also, each had been diagnosed with either major depressive disorder, bipolar disorder, generalized anxiety disorder (GAD), or ADHD. Half were given weighted blankets and half were given blankets that appeared the same as the weighted type.

After four weeks, those in the weighted-blanket group were almost 26 times more likely to have seen at least a 50 percent reduction in the severity of their insomnia. And they were nearly 20 times more likely to achieve full remission of their insomnia.

Researchers suggested that the results were due to the pressure the blanket applies to different parts of the body. This stimulates the sensation of touch similar to acupressure and massage.

“I was surprised by the large effect size on insomnia by the weighted blanket and pleased by the reduction of levels of both anxiety and depression.”

Lead researcher Dr. Mats Alder, consultant psychiatrist at the Karolinska Institute in Stockholm, Sweden, said in a statement.

Some cautions

If you’d like to try using a weighted blanket to help insomnia, be sure to purchase it at a place that allows for returns. Weighted blankets come in different weights, and weight preferences are highly individual. You may find you prefer a heavier or a lighter weight. Also be sure it’s washable. Opt for one without plastic beads, which could end up in the ocean.

Finally, if you have a tendency toward claustrophobia, you might not like the sensation of feeling trapped under a heavy object, so proceed with caution. You can try to simulate the effect of a weighted blanket by folding a large quilt in half and sleeping under that for a few nights. If you have no problem with that, then you may want to purchase a commercial weighted blanket.

In addition, never put a weighted blanket on a child under the age of three or one weighing less than 50 pounds, because there’s a danger of suffocation.

overcome chronic conditions

Healthy Habits Can Conquer Chronic Medical Conditions

We’ve heard a great deal lately about how those with chronic conditions—diabetes, high blood pressure, and obesity—are more likely to become sicker when exposed to the SARS-CoV-2 virus that causes COVID-19. Even leaving aside the coronavirus, many individuals have thought that having multiple chronic medical conditions such as those or others (cancer, asthma, coronary artery disease, and so forth) doomed them to a premature death.

But our concierge doctors have recently come across some good news for those people. It turns out that healthy lifestyle habits can overcome multiple types of chronic conditions and help extend your life.

Lifestyle impacts on chronic conditions

A new study reported last month in the journal PLOS One followed nearly 481,000 middle-aged adults in the U.K. for up to nine years. Of those, 93,746 had two or more chronic medical illnesses (known as multimorbidity) such as those mentioned above.

The researchers focused on four lifestyle factors: smoking, diet, physical activity, and alcohol consumption. They then weighted each of these factors (some healthy foods vs. a great deal, moderate physical activity vs. a great deal vs. none, and so forth) and broke them into four categories:

  • healthy
  • very healthy
  • unhealthy
  • very unhealthy

Then they assigned each study participant to a category.

Their results show that those who practiced the healthiest habits lived longer than those who did not, regardless of their current medical challenges.

In particular, men with a very healthy lifestyle were found on average to live 6.3 years longer than those with a very unhealthy lifestyle, while women in these same categories were found to live an average 7.6 years longer.

Even those in the third category, unhealthy, saw some benefit over those with a “very unhealthy” lifestyle.

Healthiest habits

Not smoking had the largest impact on life expectancy, according to the researchers. Smokers at age 45 were found to live five to six years less than non-smokers, regardless of other disease complications. Because the screening question asked only if participants were current smokers, it is fair to assume that the large study cohort included many former smokers. This proves quitting smoking at any age does confer health advantages.

Regular physical exercise also showed a significant benefit. Those who engaged in some type of regular physical activity lived longer than those who did not. Even if the exercisers had serious medical conditions. Researchers defined regular physical activity as that which met the global health recommendations: 150 minutes a week of moderate physical activity or 75 minutes of weekly vigorous activity.

Men who engaged in regular physical exercise gained an additional 2.5 years of life on average. The benefit for women was slightly lower; they gained 1.9 additional years of life.

Surprisingly, a healthy diet– defined as consuming at least five different fruits and vegetables daily– and moderate or no alcohol intake demonstrated little benefit in increasing life expectancy.

Never too late

We hope our patients find these results encouraging. They show that—even with multiple chronic illnesses—you can not only influence your life expectancy with healthier habits. And they show you can improve your quality of life by following standard guidance for a healthy lifestyle.

These include:

1. Diet

Avoid processed foods, and consume a diet high in seafood and fresh produce. Include fruits and vegetables, nuts, olive oil, and beans. and low in red meat, dairy, sugar, salt, and saturated fat.

2. Exercise

A daily minimum of a half-hour of any kind of mild-to-moderate exercise is crucial to overall health. If necessary, it can be broken into 10-minute increments throughout the day. Even a daily brisk walk will help.

But for optimal health, we recommend any kind of regular, vigorous movement. Try to add up to 150 minutes (2 ½ hours) per week.

3. Stress relief

When your body thinks it is constantly under attack, studies have shown such chronic stress puts you at greater risk for serious health problems, including cardiovascular disease, cancer, digestive disorders, impaired memory and concentration, anxiety, and depression.Reducing stress is crucial to maintaining good health, so:

  • take time for hobbies
  • practice relaxation techniques
  • exercise regularly
  • eat a healthy diet
  • stay in touch with friends

At the same time, avoid unhealthy stress relievers like smoking, excess alcohol consumption, and illicit drug intake. These practices merely mask stress triggers temporarily. They can cause damage to the body, as well as to your mental health, in the long run.

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