Is a Neti Pot Right for You?

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

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.

Could You Have Hidden Thyroid Problems?

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

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

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

About Thyroid Disease

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

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

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

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

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

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

Symptoms of Each Type

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

Some of the symptoms of hyperthyroidism can include:

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

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

Some of the symptoms of hypothyroidism can include:

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

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

Simple Treatments

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

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

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

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

Keeping it Healthy

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

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

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

Doctor’s Best Diets for the New Year

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

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

Forbes 2023 Rankings

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

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

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

Other Views

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

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

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

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

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

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

Skip the Gimmicks

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

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

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

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

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

Bottom Line

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

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

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

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

There’s a Reason Why You’re Feeling SAD

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

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

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

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

Symptoms

The APA lists the following symptoms associated with SAD:

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

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

Likely Causes

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

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

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

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

Treatment

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

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

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

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

Self-care

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

1. Stay active outdoors

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

2. Let in the light

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

3. Eat right

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

4. Take it easy

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

5. Stay connected

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

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

How and Why to Steer Clear of Ultra-Processed Foods

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

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

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

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

What the Studies Say

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

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

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

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

How are Foods Classified?

Researchers classify foods into roughly three categories:

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

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

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

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

What’s Wrong with Processing?

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

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

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

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

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

How to Break the Addiction

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

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

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

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

Take it Easy

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

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

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

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

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

sleep-disorders

Health Risks Associated with Lack of Sleep

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

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

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

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

Consequences to Health

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

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

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

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

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

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

The Study

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

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

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

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

Long-term Damage

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

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

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

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

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

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

Prioritizing Sleep

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

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

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

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

And to help you sleep better, you should:

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

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

running

Does Running Really Ruin Your Knees?

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

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

Counterintuitive Findings

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

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

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

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

What Other Research Says

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

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

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

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

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

Overall Health Benefits

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

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

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

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

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

Some Cautions

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

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

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

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

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

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

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

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

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

belly fat

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

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

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

Read more
vit d

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

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

Dueling Conclusions

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

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

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

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

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

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

More Confusion

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

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

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

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

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

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

The Last Word?

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

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

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

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

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

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

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

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

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

Vitamin D Overdose?

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

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

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

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

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

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

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