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.

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.

How and Why to Steer Clear of Ultra-Processed Foods

, , Health Basics, Healthy Living, Lifestyle, Nutrition

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

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

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

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

What the Studies Say

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

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

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

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

How are Foods Classified?

Researchers classify foods into roughly three categories:

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

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

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

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

What’s Wrong with Processing?

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

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

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

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

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

How to Break the Addiction

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

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

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

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

Take it Easy

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

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

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

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

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

sleep-disorders

Health Risks Associated with Lack of Sleep

Health Basics, Healthy Living, Lifestyle

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

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

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

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

Consequences to Health

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

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

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

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

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

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

The Study

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

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

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

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

Long-term Damage

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

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

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

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

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

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

Prioritizing Sleep

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

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

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

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

And to help you sleep better, you should:

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

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

running

Does Running Really Ruin Your Knees?

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

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

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

Counterintuitive Findings

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

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

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

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

What Other Research Says

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

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

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

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

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

Overall Health Benefits

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

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

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

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

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

Some Cautions

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

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

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

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

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

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

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

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

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

belly fat

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

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

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

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

Read more
vit d

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

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

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

Dueling Conclusions

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

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

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

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

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

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

More Confusion

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

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

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

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

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

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

The Last Word?

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

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

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

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

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

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

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

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

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

Vitamin D Overdose?

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

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

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

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

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

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

Latest on COVID-19 Omicron Boosters

, , , , COVID, Disease, Lifestyle, Preventative Health, Vaccinations

The Centers for Disease Control and Prevention (CDC) earlier this month approved two new booster vaccines specifically formulated to target the BA.4 and BA.5 omicron subvariants of the SARS-CoV-2 coronavirus, so our primary care concierge doctors in Jupiter want to bring you up to date on the latest information.

What’s different about this vaccine?

The COVID-19 vaccines that have been in use since they were first rolled out in 2021 were all designed to target the original strain. They also effectively reduced hospitalizations and deaths against the different variants that emerged in the following months, including the widespread delta variant.

As the newest omicron subvariants emerged and are now responsible for 90 percent of COVID-19 infections, vaccine makers Pfizer-BioNTech and Moderna developed new, more tailored versions to specifically target them.

The new formula is defined as “bivalent,” meaning it protects against both the original strain as well as the highly contagious BA.4 and BA.5 subvariants. They are the first updated COVID-19 vaccines to be cleared by the U.S. Food and Drug Administration (FDA).

“The updated COVID-19 boosters are formulated to better protect against the most recently circulating COVID-19 variant,” said CDC director Rochelle Walensky.

“They can help restore protection that has waned since previous vaccination and were designed to provide broader protection against newer variants,” she added. “This recommendation followed a comprehensive scientific evaluation and robust scientific discussion.”

Tests in mice have shown they produce a good immune system response to omicron’s BA.4 and BA.5 subvariants.

Are they safe?

Some have questioned the safety of the new versions of the shots because they haven’t been tested in humans, only in mice. But the new vaccines have merely been “tweaked” to “change the recipe,” as the University of Colorado’s UCHealth website explains.

The original Pfizer and Moderna vaccines have been fully tested in humans, and more than 600 million doses in the U.S. and millions more around the world have been given safely. The advisors and experts at both the FDA and the CDC have determined that the newly formulated booster shots are safe.

UCHealth infectious disease and COVID-19 expert Dr. Michelle Barron compared the new boosters to the flu shot, which is updated every fall as vaccine makers guess which strains of the flu will be circulating, and change the recipe to match. But the vaccine itself is not entirely new, she explained.

“We don’t test the flu shot each year. We just change it slightly,” Barron said.

“This new COVID-19 booster just tweaks the formula. The technology is the same. The safety of the vaccines will be exactly the same because it’s not a new vaccine,” she explained.

Who can get them?

The Pfizer vaccine is authorized for anyone ages 12 and older; the Moderna vaccine is authorized for adults 18 and older.

Like the previous coronavirus vaccines, the new boosters are free to the public. They will be available to anyone who has already had their primary vaccine series from any authorized U.S.-approved company regardless of how many boosters they’ve already received.

Public health officials recommend that those who are pregnant or have been pregnant recently should also get the updated boosters because they are at a slightly increased risk of more severe illness and death from COVID-19.

For those who recently received a booster of the previous vaccines, the FDA has set a minimum waiting period at two months, but advisers to the CDC recommend waiting longer: at least three months for those at high risk, or as long as six months for everyone else.

It’s also recommended that anyone who has recently recovered from a COVID-19 infection should wait at least three months to be vaccinated, not only to boost the effects of the vaccine but also to avoid the possibility of a rare side effect, heart inflammation, that sometimes affects teen boys and young men.

“If you wait a little more time, you get a better immunologic response,” CDC adviser Dr. Sarah Long of Drexel University told CBS News.

According to the CDC, side effects are expected to be similar to those associated with the current vaccine, including headache and muscle soreness, occasional fatigue, and redness and swelling at the injection site.

What about other vaccines?

As we head into the fall flu season, several of our clients have asked whether they can get a coronavirus vaccine along with a flu vaccine. The answer is yes, one in each arm.

In fact, health officials have recommended this protocol, and the government is preparing to launch a campaign that will urge Americans to do just this, due to the possibility of the high spread of flu and COVID-19 this season.

As for the Jynneos monkeypox vaccine, the CDC suggests that adolescent and young adult men consider waiting four weeks after receiving the monkeypox vaccine before receiving a Moderna, Novavax, or Pfizer COVID-19 vaccine, because of the risk of inflammation of the heart muscle (myocarditis) or inflammation of the tissue surrounding the heart (pericarditis).

However, the agency adds that the monkeypox vaccination “should not be delayed” due to recently receiving a coronavirus vaccine.

If you have any questions about whether or not to get the new booster, don’t hesitate to contact us for advice.

organic

Some Common Questions About Organic Foods

Environment, Healthy Living, Lifestyle, Nutrition

Our concierge primary care doctors in Jupiter of course want our patients to eat healthy foods as much as possible.

This typically means a diet low in processed foods and high in fresh fruits, vegetables, nuts, and seeds, along with lean meats and fish.

Does it also mean eating organic foods as well? Many people hear the word “organic” and automatically think it equals “healthy,” but that may not always be the case. So let’s try to clear up the confusion around this widely available—and usually much more expensive—food.

What does the term “organic” mean?

The word “organic” refers to the way the food is grown and processed. The U.S. Department of Agriculture (USDA) has created a set of standards that describe the specific requirements that must be verified by a USDA-accredited certifying agent before products can be labeled organic.

The National Organic Program (NOP), an advisory committee that includes members of the public, develops these rules and regulations for the USDA.

They include several restrictions on farming practices and raising livestock and poultry, as well as on handling and labeling.

In general, the regulations restrict the types of pesticides, fertilizers, and seeds that can be used, and ensure healthy farming practices to protect the environment.

To receive the USDA Organic seal, a product must:

Improve soil and water quality.
Enable farm animals’ natural behaviors.
Cut pollution.
Promote a self-sustaining cycle of resources on a farm.

Certified organic products cannot use:

artificial fertilizers or sewage sludge as fertilizer
radiation to preserve food or get rid of pests or diseases
genetically modified or engineered materials to improve crop harvests or improve pest or disease resistance
antibiotics or growth hormones for livestock
most synthetic pesticides (except in special, USDA-approved circumstances)

Is organic food healthier?

You can find all kinds of persuasive arguments and testimonials online about how organic food is so much healthier for you to eat.

It’s certainly healthier for the environment, because of the sustainable practices organic farmers use.

It’s also undeniably better to avoid products from animals that have been fed antibiotics throughout their lifecycle to promote unnatural growth and suppress diseases that occur from overcrowded conditions. This is one of the things that contribute to antibiotic resistance in humans.

Other than that, though, science has so far not been able to prove that organic foods contain more substantial nutrients than conventionally grown foods.

As reported by Harvard Health, one meta-study by Stanford researchers, for example, found little difference in nutritional content, except for slightly higher phosphorus levels and a higher omega-3 fatty acid content in organic milk and chicken. And the bacteria that can cause food poisoning were equally present in both organic and non-organic foods.

And according to the Mayo Clinic, studies have shown much lower cadmium levels in organically grown grains, but not fruits and vegetables. Cadmium is a toxic chemical found naturally in the soil and absorbed by plants as they grow.

Is the label ‘organic’ a guarantee?

If the food contains the USDA Certified Organic label, that means it was grown and processed according to federal guidelines.

According to the USDA, “Produce can be called organic if it’s certified to have grown on soil that had no prohibited substances applied for three years prior to harvest. Prohibited substances include most synthetic fertilizers and pesticides.

“As for organic meat, regulations require that animals are raised in living conditions accommodating their natural behavior (like the ability to graze on pasture), fed 100 percent organic feed and forage, and not administered antibiotics or hormones.”

The agency performs more than 45,000 onsite inspections per year to ensure compliance with regulations. If foods are labeled “100 percent organic,” that means all ingredients are certified organic. Foods labeled “organic” contain at least 95 percent certified organic ingredients.

On the other hand, labels that say “made with organic” or “organic ingredients” can’t carry a USDA seal, because they contain less than 95 percent organic ingredients.

More confusion in labels

In addition, there is a difference between “organic” and “natural” on a product’s label. The term “natural” may simply refer to products or animals that have been minimally processed and contain no artificial ingredients, but that doesn’t mean they’re organic.

Another confusing term is “grass-fed,” which means animals receive a majority of their nutrients from grass throughout their entire life and have continuous access to pasture during the growing season. It does not mean they have been raised without the use of antibiotics, hormones, or pesticides on their feed.

Likewise, “cage-free” birds are able to freely roam a building, room, or enclosed area with unlimited access to food and fresh water during their production cycle. “Free-range” birds are provided shelter in a building, room, or area with unlimited access to food and fresh water, as well as continuous access to the outdoors during their production cycle. But neither of these terms reveals whether they have been raised without antibiotics or hormones.

So is organic better for you? In some of the ways we’ve listed above, yes. But only you can decide whether the extra expense is worth the small gains in nutritional value, as well as the larger impact on the environment and the animal’s welfare.

Coronavirus Pandemic

New Guidance on COVID-19 Can Be Confusing

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

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

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

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

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

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

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

A new approach

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

According to The Washington Post:

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

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

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

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

Isolation changes

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

Additional CDC guidance on isolation includes the following:

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

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

What about boosters?

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

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

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

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

The mask question

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

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

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

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

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

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

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