Best Ways to Treat Lower Back Pain

, Health Basics, Healthy Living, Lifestyle, Preventative Health

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

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

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

The Latest Research

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

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

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

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

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

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

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

Non-drug Approaches

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

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

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

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

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

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

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

Another Non-traditional Approach

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

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

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

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

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

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

A Final Word

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

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

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

Live Longer with Blue Zone Foods

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

Of all the diet trends available today, one our primary care concierge doctors in Jupiter can highly recommend is the Blue Zone way of eating: fresh, healthy, unprocessed food, from as close to its source as possible, in meals shared with family and friends.

The term “Blue Zone” was coined nearly 20 years ago by journalist and researcher Dan Buettner in a 2005 National Geographic cover story titled, “Secrets of Living Longer.”

His team of anthropologists, demographers, and scientists had traveled the world to find the world’s longest-living people, and to discover the secrets to their longevity.

Buettner’s team found five seemingly disparate places where the people live exceptionally long, healthy lives: on average, around 100. (The term “blue zone” came from the blue circles the researchers drew on a map during their quest.)

The five places are:

Okinawa, Japan
the Nicoyan Peninsula in Costa Rica
the Seventh Day Adventists in Loma Linda, California
Sardinia, Italy
Ikaria, Greece

More than Diet

Of course, healthy eating is key to a healthy body, but the Blue Zone residents had more than good food on their side. Genetics, as always, plays a big role in how long anyone will live no matter where they are.

Other factors the team found the Blue Zones had in common were:

Natural movement: no marathons or gym visits, just long walks, hiking, gardening, etc.
Hara Hachi Bu: an Okinawan term for eating until they’re about 80 percent full
Plant slant: a preference for plant foods over meat
Grapes of Life: one to two servings of red wine daily (except for the Seventh Day Adventists, who eschew alcohol)
Plan de Vida: or “why I wake up in the morning,” i.e., a sense of purpose
Downshift: controlling stress, a sense of serenity
Belong: participation in a spiritual community
Loved ones first: making family a priority
Close tribe: social connectedness

Blue Zone Meals

The Blue Zone diet, which Buettner details in his latest book, “The Blue Zones American Kitchen: 100 Recipes to Live to 100,” is a cornerstone of the Blue Zone program, and closely resembles the Mediterranean diet, but with even less emphasis on fish and meat.

“The five pillars of every longevity diet, including the Blue Zones, are whole grains, vegetables in season, tubers, nuts, and beans. In fact, I argue the cornerstone of a longevity diet is beans,” he told CNN.

Legumes, in fact, are key, he told The Washington Post. They are rich in fiber, which is key to improving cholesterol and blood sugar levels.

“Figure out how to get a cup of beans into your diet every day,” he told the paper. “Just one cup gives you half of all the daily fiber you need.”

What Not to Eat

And even though the Mediterranean diet includes a certain amount of meat and fish, Blue Zone diets contain little, if any.

“People in Blue Zones don’t eat nearly as much fish as the Mediterranean diet prescribes, only three times a week and only three ounces,” he told CNN. “Meat is eaten only five times a month. There’s no cow’s milk in any Blue Zone.”

Instead, people eat goat and sheep’s milk cheeses such as feta and pecorino, he said.

In addition, “no more than three eggs are consumed per week,” he told NBC’s Today show.

“The Blue Zone eating pattern is 98 percent plant-based foods—whole food-based and high carbohydrate,” Buettner told CNN.

“But only complex carbs, not the simple carbs like salty snacks and candy bars and soda pop. You say carbohydrates and people are horrified, but the healthiest foods in our food system are complex carbohydrates,” he added.

Time and Place Count, too

In keeping with the other factors that affect longevity, sharing meals—especially with family—is another component. While our busy schedules might not often permit this, Buettner says it’s worth doing as often as possible.

“Families that eat together tend to each much more nutritiously, they eat slower, and there’s good research that children have fewer issues with disordered eating if they’re eating socially,” he told The Post.

And it turns out the recent trend toward intermittent fasting appears to have some validity. Buettner reports that people in Blue Zones tend to eat earlier in the day.

Okinawans, for instance, traditionally eat a big breakfast and a moderate lunch.

“They don’t even have dinner,” he told the paper.

And the Seventh Day Adventists in Loma Linda would eat a big breakfast at 10 a.m. and a moderate lunch at 4 p.m. “And then they’re done for the day,” he said.

Small Moves

Of course, there’s more to the Blue Zone lifestyle than just food, as we mentioned earlier. Three of the five Blue Zones are isolated, which forces tight social connections and a lot of walking.

“Walking is one of the best forms of exercise and you can do it without thinking about it,” Buettner told Today, suggesting that people think about adopting a dog as a strategy to encourage regular walks.

“We’re all looking for magic dietary pills or serums or supplements, but you see none of that in the Blue Zones,” he said. “It’s mostly small things driven by the right environment,” he said.

That includes social connections.

“We’re genetically hardwired to crave social interaction, and when you don’t have it, there’s a level of subconscious stress that grates away at you,” he added.

Here’s to Your Heart Health

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

In recognition of American Heart Month in February, our primary care concierge doctors in Jupiter thought we’d share some facts with you about your heart, and what you can do to keep it healthy.

Surprising Heart Facts

First, from the Cleveland Clinic, here are a few interesting things you may not know about your heart.

Your heart is about the size of your two hands clasped together.
It beats 100,000 times a day.
The beating sound is the clap of valve leaflets opening and closing.
A woman’s average heartbeat is faster than a man’s by almost eight beats a minute.
Every cell in your body gets blood from your heart, except for your corneas.
The heart pumps blood through 60,000 miles of blood vessels.
A normal heart pumps approximately four tablespoons of blood with each beat.
Each minute, your heart pumps 1.5 gallons of blood.
Your heart has its own electrical supply and will continue to beat when separated from your body.
Heart cancer is very rare because heart cells stop dividing early in life.

About Heart Disease

Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the U.S. About 697,000 people in the U.S. died from heart disease in 2020 (the most recent figures available). And every year about 805,000 people in the U.S. have a heart attack; over 600,000 of those are first heart attacks.

According to the Centers for Disease Control and Prevention (CDC), the term “heart disease” refers to several types of heart conditions.

The most common type of heart disease in the U.S. is coronary artery disease (CAD), which affects blood flow to the heart. Decreased blood flow can cause a heart attack. In 2020, about 20 percent of deaths from CAD occurred in adults below the age of 65, known as an “early cardiac event.”

Common Symptoms of Heart Disease Include:

Heart attack: chest pain or discomfort, upper back or neck pain, pain in the jaw or throat, indigestion, heartburn, nausea or vomiting, extreme fatigue, upper body discomfort, dizziness, a cold sweat, and shortness of breath
Arrhythmia: fluttering feelings in the chest (palpitations)
Heart failure: shortness of breath, fatigue, or swelling of the feet, ankles, legs, abdomen, or neck veins

The Cleveland Clinic’s Dr. Curtis Rimmerman, a cardiologist, emphasizes that symptoms of a heart attack can vary widely, but adds that the discomfort is usually unrelenting, typically lasting five minutes or more.

“Regardless of where the pain is, people typically can’t find a position that relieves the pain,” he says. “Nor do they find relief by taking a drink of water, popping antacids or taking deep breaths.”

That means it’s time to call 911, he adds.

Increasing Risk

Unfortunately, about one in every five heart attacks are “silent”—that is, the damage is done, but the person is not aware of it.

That’s why it’s important to know your risk factors and what you can do about them.

About half of all Americans (47 percent) have at least one of the three key risk factors for heart disease: high blood pressure, high cholesterol, and smoking.

In addition, several other medical conditions and lifestyle choices also put people at a higher risk for heart disease, the CDC reports, including:

diabetes
overweight and obesity
unhealthy diet
physical inactivity
excessive alcohol use

In addition, a 2021 study published in the journal Heart found that those who used illicit substances, including amphetamines, cocaine, and cannabis, were far more likely to experience an early cardiac event than those who didn’t.

And another study, published in the Journal of the American Heart Association (AHA) in 2020, found that the chances of developing cardiovascular disease (CVD) were 19 times higher in women who consumed one or more sugary drinks a day. This included everything from fruit juices to soft drinks (not diet) to coffee with sugar.

Lowering Risk

Some risk factors cannot be controlled, such as age or family history of heart disease, but you can take steps to lower your risk by changing the factors you can control.

Have your blood pressure, cholesterol, and triglycerides checked regularly.
Ask us whether you should be tested for diabetes.
Quit smoking.
Limit the alcohol you consume to one drink a day.
Learn how to manage stress levels by finding healthy ways to cope with stressful events.

In addition, there are two other ways that have been shown to dramatically reduce your risk for heart disease.

The first is exercise. According to the Cleveland Clinic, regular moderate-intensity exercise for at least 150 minutes is the single most important—and free—key to heart health.

The second is diet, specifically a plant-based diet. This doesn’t necessarily mean going totally vegetarian, just making plant foods vs. animal foods the main component of your diet.

“I’ve seen people whose diabetes, angina, or blood pressure goes into remission [on a plant-based diet],” Andrew Freeman, a cardiologist and the co-founder of the Nutrition and Lifestyle Work Group at the American College of Cardiology, told The Washington Post.

“I’ve seen autoimmune diseases go away when you cut inflammation,” he said. “The best way to do that is with a plant-based diet, and people get better.”

Is a Neti Pot Right for You?

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

Because our concierge primary care doctors in Jupiter have been receiving more questions about the effectiveness of Neti pots for various sinus conditions, we thought we’d take some time to explore their usefulness—and to reiterate a special warning about their use.

What is a neti pot?

Neti pots are one type of nasal irrigation device that use a saline or saltwater solution to treat congested sinuses, colds, allergies, and congestion from flu and COVID-19.

These devices include the teapot-looking container that originated with Ayurvedic medicine in India, along with bulb syringes, squeeze bottles, and more expensive motorized pulsed water devices.

In general, these devices all introduce salt water (saline) into the nostrils to flush out mucus, allergens, and bacteria. The saline helps thin the mucus, making it easier to expel.

The U.S. Food and Drug Administration (FDA) says that such saline rinsing “can remove dust, pollen, and other debris, as well as help to loosen thick mucus. It can also help relieve nasal symptoms of sinus infections, allergies, colds, and flu.

“Plain water can irritate your nose,” the agency says. “The saline allows the water to pass through delicate nasal membranes with little or no burning or irritation.”

How do they work?

 “There are various ways to deliver saline to the nose,” says Eric A. Mann, M.D., and Ph.D., a doctor at the FDA.

“Nasal spray bottles deliver a fine mist and might be useful for moisturizing dry nasal passages. But irrigation devices are better at flushing the nose and clearing out mucus, allergens, and bacteria,” he says.

Information that comes with each device can give more specific instructions, but in general, the FDA says they all work basically the same way:

  • Leaning over a sink, tilt your head sideways with your forehead and chin roughly level to avoid liquid flowing into your mouth.
  • Breathing through your open mouth, insert the spout of the saline-filled container into your upper nostril so that the liquid drains through the lower nostril.
  • Clear your nostrils. Then repeat the procedure, tilting your head sideways to the other side.

While some people experience immediate relief from their symptoms, for others it may take a few days to begin breathing more freely.

And experts caution that—like oral decongestants—nasal irrigation devices are simply a treatment for a symptom, not a cure for the underlying cause.

Some Cautions

Although the FDA says that neti pots and other similar nasal irrigation devices are generally safe, they may not be right for everyone. If your immune system isn’t working properly, the agency advises checking with your healthcare provider before using any nasal irrigation system.

A few users report ear discomfort, nasal irritation, a burning or stinging sensation, and even nosebleeds. But in general, the FDA considers them safe to use, even for children aged two and up.

The most significant warning, however, concerns the type of water used in them. 

“Tap water isn’t safe for use as a nasal rinse because it’s not adequately filtered or treated,” the FDA cautions.

“Some tap water contains low levels of organisms—such as bacteria and protozoa, including amoebas—that may be safe to swallow because stomach acid kills them. But in your nose, these organisms can stay alive in nasal passages and cause potentially serious infections.”

They can even be deadly, the Centers for Disease Control and Prevention (CDC) reports. Since 1993, there have been at least 70 cases of “brain-eating” amoeba infections in the U.S., which are “almost uniformly fatal,” the agency reports.

Safe Use

The safety of neti pots and other such nasal irrigation devices—including the motorized versions—depends on the type of water used and how meticulously the containers are cleaned after each use.

The FDA lists the following types of water as safe to use for neti pots and similar devices:

  • Distilled or sterile water, which you can buy in stores. The label will state “distilled” or “sterile.”
  • Boiled and cooled tap water—boiled for three to five minutes, then cooled until it is lukewarm. Previously boiled water can be stored in a clean, closed container for use within 24 hours.
  • Water passes through a filter designed to trap potentially infectious organisms. The CDC has information on these filters here. 

To safely use and care for your device:

  • Wash and dry your hands.
  • Check that the device is clean and completely dry.
  • Prepare the saline rinse, either with the prepared mixture supplied with the device, or one you make yourself.
  • Follow the manufacturer’s directions for use.
  • Wash the device, and dry the inside with a paper towel or let it air dry between uses.

Does it Work?

Most people who use neti pots to relieve nasal congestion and allergies swear by them, especially if they want to avoid using over-the-counter decongestants. 

“Just about any condition that causes irritants and mucus to build up inside the nose will benefit from saltwater rinsing with a net pot or similar device,” Richard Orlandi, a nasal and sinus specialist and professor of surgery at the University of Utah Health in Salt Lake City, told Consumer Reports (CR).

“These include allergies, nonallergic nose irritation, colds, and sinus inflammation and infections,” he said.

The World Health Organization (WHO) reports that rinsing your nose with saline does not prevent COVID-19, by the way.

If saline rinsing doesn’t relieve your symptoms, or if you have a fever, nosebleeds, or headaches while using the devices, let us know.

Nature Can Heal in More Ways Than One

, , , , , , , , Environment, Health Basics, Healthy Living, Lifestyle, Motivation, News, Preventative Health, Uncategorized

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

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

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

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

The Study

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

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

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

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

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

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

Confirming Prior Research

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

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

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

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

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

Nature Deprivation Hurts

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

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

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

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

Make the Connection

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

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

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

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

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

Doctor’s Best Diets for the New Year

, , , , Health Basics, Healthy Living, Holiday Safety, Lifestyle, Motivation, Nutrition

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

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

Forbes 2023 Rankings

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

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

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

Other Views

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

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

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

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

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

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

Skip the Gimmicks

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

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

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

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

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

Bottom Line

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

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

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

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

Study Finds Another Possible Benefit from Intermittent Fasting

Healthy Living, Nutrition

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

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

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

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

Benefits of Intermittent Fasting

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

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

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

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

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

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

Latest Finding

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

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

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

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

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

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

Some Caution Warranted

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

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

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

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

How to Intermittent Fast Safely

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

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

She recommends you should also:

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

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

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

There’s a Reason Why You’re Feeling SAD

, , , , , , , , , Environment, Health Basics, Healthy Living, Lifestyle, News, Preventative Health

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

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

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

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

Symptoms

The APA lists the following symptoms associated with SAD:

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

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

Likely Causes

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

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

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

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

Treatment

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

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

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

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

Self-care

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

1. Stay active outdoors

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

2. Let in the light

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

3. Eat right

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

4. Take it easy

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

5. Stay connected

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

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

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.

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