Here’s to Your Heart Health

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

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

Surprising Heart Facts

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

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

About Heart Disease

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

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

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

Common Symptoms of Heart Disease Include:

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

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

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

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

Increasing Risk

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

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

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

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

diabetes
overweight and obesity
unhealthy diet
physical inactivity
excessive alcohol use

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

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

Lowering Risk

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

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

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

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

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

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

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

Is a Neti Pot Right for You?

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

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

What is a neti pot?

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

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

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

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

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

How do they work?

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

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

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

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

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

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

Some Cautions

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

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

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

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

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

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

Safe Use

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

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

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

To safely use and care for your device:

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

Does it Work?

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

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

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

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

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

Nature Can Heal in More Ways Than One

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

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

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

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

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

The Study

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

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

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

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

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

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

Confirming Prior Research

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

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

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

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

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

Nature Deprivation Hurts

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

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

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

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

Make the Connection

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

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

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

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

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

The Risk of Salmonella in Backyard Chickens

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

If you’ve been buying cage-free eggs, or eggs from your local farmer, or even raising your own chickens to lower your risk of salmonella, our concierge doctors in Jupiter have some unhappy news for you: Most chickens, ducks, and turkeys carry some form of the more than 2,000 types of salmonella, according to Craig Coufal, Texas A&M AgriLife Extension Service poultry specialist.

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is kratom safe

Use Caution with Kratom

, , , , , , Healthy Living, Medications

Our concierge primary care doctors in Jupiter know that many of our patients are interested in over-the-counter (OTC) alternative treatments for their ailments.

One of the more popular of these is kratom, an herb that has been used for centuries in Asian countries as a way to reduce fatigue and ease various aches and pains. In this country, it is sold in drinks or as supplements and is said to treat such common conditions as anxiety, depression, and opioid withdrawal.

One report estimated that as many as 16 million Americans also use kratom for pain relief in such chronic diseases as lupus, multiple sclerosis, fibromyalgia, rheumatoid arthritis, and other similar conditions.

Testimonials from users include such claims as, “Kratom gave me my life back after being addicted to pain pills;” “It has helped me enormously with chronic back pain;” and, “It got me off a 20-plus-year addiction to narcotics and opioids.”

On the other side are statements like these from a former user who told The Washington Post that “kratom was fun—it was like having morphine and cocaine at the same time”—until he got addicted. Withdrawal, he reported, was like “getting ripped apart by fishhooks.”

Agencies fighting it

Various agencies including the U.S. Food and Drug Administration (FDA), the World Health Organization (WHO), and even the U.S. Drug Enforcement Agency (DEA) have spent the last several years trying to ban it. Six states have already done so, with several others considering it. It is still legal in Florida, but may be banned or controlled in some localities here.

In April, the FDA released a statement warning consumers not to use the herb, Mitragyna speciosa, commonly known as kratom:

“FDA is concerned that kratom, which affects the same opioid brain receptors as morphine, appears to have properties that expose users to the risks of addiction, abuse, and dependence.”

FDA

Opponents have been buoyed in their arguments by several studies linking kratom to serious side effects.

One such study in 2019 reported that the number of phone calls to U.S. poison control centers regarding adverse effects from kratom have soared, from 13 calls in 2011 to 682 in 2017. Reported effects of kratom overdose included rapid heartbeat, agitation, high blood pressure, seizures, coma, kidney failure, and 11 deaths during the study period. Two of those deaths were attributed to kratom alone, while the other nine occurred in people who combined kratom with other drugs.

Another study on kratom use disorder (KUD) by the National Institute on Drug Abuse (NIDA), published in the Journal of Addiction Medicine in March, found that over half of 129 past and current kratom users showed no signs of addiction. But 29.5 percent met the diagnostic criteria for KUD, which includes increased use, tolerance, withdrawal, unsuccessful attempts to quit, and cravings.

Counter-arguments

Proponents attribute these adverse reports to a profit motive on the part of drug companies, overly restrictive U.S. drug policies, and poor research. They say it has been used successfully for thousands of years in Southeast Asia without a problem.

Advocates also maintain that, in these times of widespread and deadly opioid addiction, kratom is an acceptable alternative and that its dangers have been wildly overblown.

In a recent editorial published in the Scientific American, Maia Szalavitz, an author and journalist who focuses on science, public policy, and addiction treatment, writes that kratom “does appear to be far safer than all illegal and most prescription opioids.” She referred to a Centers for Disease Control and Prevention (CDC) study in 2016 and 2017 of some 27,000 kratom-related overdoses. Of those, kratom was implicated in less than one percent of overdose deaths.

“Moreover, in nearly all overdose deaths associated with kratom, it was accompanied by stronger drugs that kill more often, so it is not clear that it actually played a major role or even any at all,” she wrote.

“For example, around two-thirds of the 152 deaths the CDC studied also involved illicit fentanyl and its analogues, which are thousands of times more potent. In only seven cases was kratom the only only substance identified—and even here, researchers cannot rule out the possibility of undetected drugs,” she added.

Caution warranted

Nevertheless, most medical experts warn that kratom use can have adverse consequences. According to the Cleveland Clinic, “kratom’s potential for serious side effects outweigh its potential benefits.”

It lists the following most common side effects of kratom:

  • aggression
  • altered mental status
  • anxiety and irritability
  • constipation
  • delusion and hallucination
  • drowsiness and sedation
  • dry mouth
  • frequent urination
  • itching
  • nausea and vomiting
  • tongue numbness

More serious side effects can include:

  • cardiac issues, such as heart attack, abnormal heart rhythms, and high blood pressure
  • encephalopathy (brain disease)
  • hypothyroidism (underactive thyroid)
  • insomnia
  • liver damage and liver failure
  • loss of appetite
  • psychosis
  • respiratory depression (difficulty breathing)
  • seizure
  • tremor
  • weight loss

In addition, people going through kratom withdrawal may experience:

  • muscle spasms
  • pain
  • rhabdomyolysis (a condition leading to kidney damage when muscles disintegrate and release a protein into the blood)
  • rigidity
  • seizures
  • tremors

Think twice about kratom

While proponents hope more research will eventually vindicate kratom as a useful supplement, the medical community generally holds that its side effects more than outweigh any potential benefits. It can be especially dangerous when combined with other legal and illegal drugs.

While it’s up to you, we would suggest that our patients not take the risk of using this substance. If you’re thinking of using kratom for any reason, please discuss it with us first. We may be able to help you find other safer treatment options.

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