In the news

The fiber factor: more good news.

          A study published a few days ago in the journal Lancet supports what we have been preaching for years: a high-fiber diet lowers the risk of several diseases and it has no side effects.

            This is a meta-analysis that reaches back four decades and includes more than 200 research studies. Eating 25 to 29 or more grams per day of fiber-containing foods (whole grain bread and cereals, legumes, fruit) significantly increases lifespan by lowering the risk of heart disease, type 2 diabetes and colorectal cancer.

When you consider that it was only about a century ago that the average American ate 50 to 100 grams of fiber a day, the researchers’ idea of 29 grams being “high fiber” seems a little incongruous. Still, even that small (in my opinion) amount makes a difference.

Soluble fiber or insoluble – it really doesn’t matter. A diet that is high in plant foods and whole grains provides both. Yet there’s more to the fiber story. It helps to lower cholesterol, perhaps by binding to bile acids. By absorbing water fiber increases the bulk of the intestinal contents and it’s more than just keeping you regular and avoiding constipation, the bane of senior citizens. Regularity lowers the chances that you will develop diverticulosis, tiny outpouchings of the large intestine that sometimes progress to diverticulitis, inflammation that is always painful and that sometimes leads to perforation. If that’s not enough to motivate you to getting more fiber in your diet, consider that constipation leads to hemorrhoids. As I once heard a golfing buddy say, “Happiness is never having to use Preparation H.”

Lifestyle

Avoiding dementia: cholesterol

The arguments over cholesterol never seem to end. There are at least nine different forms of cholesterol and even taken together they are only part of the heart disease/stroke picture. However, there is a clear and consistent association of a high LDL (Low-Density Lipoprotein) cholesterol – the bad kind – and both Alzheimer’s disease and vascular (involving damage to blood vessels) dementia. HDL (High Density Lipoprotein) cholesterol – the good kind – protects us from both forms of dementia.

Too bad it’s not really that simple! Persons with high LDL cholesterol are more likely to be obese and diabetic, two conditions that are also related to Alzheimer’s disease and dementia. Those who exercise regularly and with moderate intensity – that means working up a sweat – not only have a higher HDL but are much less likely to be obese and diabetic.

Although statin drugs do lower cholesterol and the risk of heart disease they are not tolerated well by many people.

It’s important to recognize that eating cholesterol does not raise your blood cholesterol level. Your liver, where cholesterol is manufactured, has a feedback system that reduces cholesterol when more is present in the diet. So go ahead and enjoy an egg or two most days of the week!  BUT!!! It’s those egg-helpers like bacon, ham, sausage, butter, hash browns, etc. with their saturated fat that raise cholesterol. Try a veggie omelet instead but it’s OK to have some of that other stuff now and then.

What you can do before taking a prescription drug:

Eat more oats, barley, legumes, avocados, olive oil, fish (or an omega-3 supplement).

Take Metamucil several times a week.

Lose weight.

Exercise (I’ll be that you knew I would say that!) That means about one hour four days a week, hard enough to sweat, including both aerobic (brisk walking or something similar) and resistance (weights, machines, elastic bands).

 

 

Upcoming presentations

Friday, January 18, 2:30 LIFE program at Mira Costa College, Oceanside. How to regain your youthful memory. Details at http://www.miracosta.edu/life.

Thursday, January 24, 1:00, OASIS Center, Grossmont Center. Keeping your wits; ten ways to prevent Alzheimer’s disease and dementia. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

In the news

Get in line for the new shingles vaccine

Shingles (herpes zoster) is an unpleasant experience but as more older persons are taking advantage of the available vaccines, fewer of them are having to suffer through it. The decline in incidence began with the first shingles vaccine known as Zostavax but it’s likely to accelerate with Shingrix, a completely new product that offers more than 90% effectiveness and whose protection lasts for at least four years.

There is new evidence that adds urgency to getting the vaccine: there is a significantly higher incidence of heart attack and stroke in persons who have had an attack of shingles in the preceding year.

The demand for Shingrix has been so high that it is now in short supply. Many pharmacies have waiting lists and the manufacturer states that it will be several months before they can catch up.

Although the new vaccine requires two doses (the second is given two to six months after the first) and the incidence of side effects such as arm soreness and malaise is more common, there is no doubt that it’s worth the inconvenience. Just a few days ago I encountered another person who has had recurrent pain in the area that was affected by shingles years ago. That’s a lot worse than a couple of needle jabs.

Here’s a suggestion for this year New Year’s Resolution: get the shingles vaccine before shingles gets you. The sooner you get on your local pharmacist’s waiting list the sooner you’ll be protected.

Lifestyle

Another step to prevent dementia and Alzheimer’s disease

       All prescription drugs have side effects; there are no exceptions. Several types of medications have been associated with an increased risk of dementia. Although the risk is very small, it is real. Drugs that are used for allergies, insomnia, bladder problems and depression are valuable and they should be used when indicated but they should be taken in the smallest effective doses and for the shortest possible duration.

Sleep medications are often prescribed for insomnia but they should be taken for no more than two weeks, not for years. There are several steps that might resolve sleep problems without drugs.

Occasional use of medications like Benadryl or Tylenol PM may be justified but years-long use does increase the risk of Alzheimer’s disease and dementia.

 

 

 

 

 

 

 

In the news

Romaine lettuce and E. coli – again!

The hazards of mega-farming became apparent again with the recent outbreak of E. coli that contaminated romaine lettuce. The outbreak is apparently over but it might be a good idea to avoid romaine lettuce, whether packed separately or in a mixed salad, at least until the end of December.

Most strains of E. coli are benign and they comprise much of the probiotics, the bacteria that thrive in our large intestine but some cause diseases that range from diarrhea to kidney failure. There have been many instances of contamination of leafy green vegetables, an especially serious one back in 2012. Sanitary facilities for farmworkers are rudimentary (have you ever seen a porta-sink alongside a porta-potty?) and one infected worker among scores can affect produce that is shipped to half the states in the country.

What can you do about it besides not eating leafy greens? Unfortunately, not much. Vigorous rinsing can still leave some bacteria but it’s worth doing. Also, discard the outermost leaves of lettuce but wash your hands thoroughly after doing this.

The industry is taking steps to reduce contamination but one measure that would eliminate most of the problem is not being taken advantage of: irradiation. Irradiating foods has been known to be effective and safe for more than half a century. Zapping a salad doesn’t make it radioactive any more than a chest x-ray makes you radioactive! There is a slight but inconsequential loss of some vitamins. Emotional public perception and opposition by misguided activists are the deal-killers. So E. coli continues to make thousands of persons ill every year.

 

Lifestyle

Avoiding dementia – a BIG step

       High blood pressure is a major factor in developing dementia of the type that involves blood vessels. Its role in Alzheimer’s disease, the other major form of dementia, is not as obvious.

Nearly half of adult Americans have at least mild hypertension (abnormally high blood pressure) and the number went up when the definition of hypertension was revised a few months ago. That happened because it has been found that even small increases in blood pressure cause measurable changes in thinking ability and problem-solving. Treating high blood pressure lowers the risk of dementia as well as reducing the risk of heart disease and stroke. Here’s a link to the new guidelines published by Harvard Health: http://www.health.harvard.edu/heart-health/reading-the-new-blood-pressure-guidelines.

There are three simple and safe ways to lower blood pressure without prescription medication. Considering that certain prescription blood pressure medications have just been shown to be associated with a higher risk of cancer, these make sense.

Decrease weight.

Eat more fruits and vegetables.

Increase physical activity.

      

 

 

 

 

 

 

 

 

 

 

Upcoming presentations

Wednesday, December 5, 11:00 a.m. How wars changed the world of medicine. Escondido Senior Center. Since the time of the pharaohs of Egypt and right up to the present day, tragedy on the battlefield has inspired dramatic changes in medical practice. From cautery to cataracts, ultrasound to infection control, innovative discoveries during wartime have benefitted the general public. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

Wednesday December 12, 1:00 p.m.  Tuberculosis, a colorful history of the White Plague. Escondido Senior Center Tuberculosis was a leading cause of death for millennia. Its victims included famous artists, writers, actors, composers and politicians. Learn what made it so devastating and why the medical community is worried about its resurgence. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

 

 

In the news

Don’t take a chance on ground beef!

Just a few days ago the Centers for Disease Control and Prevention (CDC) reported another nearly-nationwide outbreak of Salmonella infection from ground beef. Undercooked hamburgers and meat loaf have been leading causes of disease outbreaks for decades. It might be a good time to review how to keep you and your family safe from this kind of threat.

So far at least 22 states have reported cases of ground beef-associated disease, which usually takes the form of abdominal cramps, diarrhea and fever. The illness may begin as early as 12 hours or as late as 3 days. Most persons recover in a few days but there are occasional deaths among very young infants, older people and anyone whose immune system is compromised by other diseases or chemotherapy.

NOTE: It isn’t possible to guess if ground beef has reached a safe temperature (160 degrees F.). A food thermometer is is a pretty inexpensive kitchen gadget and it takes only seconds to get a reading. Make it a habit to wash your hands, countertops and utensils that have touched ground beef.

You can find out which states are involved and a list of stores that sold the tainted meat at http://www.cdc.gov/salmonella/outbreaks.html.

 

 

Lifestyle

Preventing Alzheimer’s disease and dementia – another step: avoid foul fats

Back in the Stone Age folks had almost no trans fat or saturated fat in their diet and what they did have was chemically different from what is in ours. Trans fats, which are present in baked goods in order to lengthen their shelf life, damage the heart and blood vessels (including those in the brain, of course). The government has mandated that they are to be gradually eliminated from foods beginning this year but you can avoid processed foods that may still contain them by reading the nutrition label: the term “partially hydrogenated” means “trans fat” even though the label might state that the amount of trans fat is ZERO. In its wisdom, the government allows up to 0.5 grams of trans fat in each serving to be equal to zero.

Saturated fat is the “marbling” in cuts of meat that gives it such a delicious flavor but it raises cholesterol levels. A recent (2018) study of more than 9,000 persons showed that a high intake of saturated fat increased Alzheimer’s disease risk by nearly 40 percent and more than doubled the risk of vascular dementia.

 

 

 

 

 

 

 

Upcoming presentation

Monday, November 5, 1:30 Tuberculosis, a colorful history of the White Plague. Carlsbad-by-the-Sea Retirement Community, 2855 Carlsbad Blvd., Carlsbad. Tuberculosis was a leading cause of death for millennia. Its victims included famous artists, writers, actors, composers and politicians. Learn what made it so devastating and why the medical community is worried about its resurgence. Sponsored by Osher – to register see their website http://www.csusm.edu/el/olli.

 

In the news

Second hand smoke: the picture worsens.

A recent study by a group of Canadian pediatricians reported that children that are exposed to second hand smoke are more likely to have symptoms of depression. That prompted me to review the medical literature on second hand smoke and the results are – well, depressing!

It has been known for decades that non-smokers who are exposed to tobacco smoke in their homes or workplaces are much more likely to develop lung cancer. More recently it has been found that they are more likely to develop COPD (Chronic Obstructive Pulmonary Disease), heart disease, stroke and hearing loss.

Sudden Infant Death Syndrome (SIDS), a heart-wrenching tragedy, is more common in the households of smokers. The risks to children whose parents smoke are especially concerning because they only appear later in life: asthma, obesity, COPD and heart disease. Before they get to high school the children that are exposed to second hand smoke experience more infections, including meningitis, and are more likely to experience complications of influenza. They also have slower language development and poorer cognitive development.

Fewer than half as many Americans smoke today than a generation ago but one in five – the current estimate – is still too many, especially when that figure includes pregnant women and teenagers. Besides encouraging ditching the habit, we should ensure that persons who do smoke should not do so when children are in the home or the car.

 

Lifestyle

Preventing Alzheimer’s disease and dementia – another step

Keep your blood vessels healthy. After all, brain cells need a steady supply of nutrients and a way to whisk away waste products. Regular exercise sends pulses of blood into every part of the body and that keeps blood vessels open and flexible.

Trans fats and saturated fats damage the lining of blood vessels and so does cooking oil that has been heated over and over. (Like those French fry vats at your local fast food place.) Blood vessels whose lining is damaged form scars and deposits of fat and calcium, limiting blood flow and resulting in the death of brain cells.

Blood vessels undergo constant renovation so the replacement materials need to be perfect. However if blood sugar levels are repeatedly elevated those excess sugar molecules attach themselves to and distort the protein building blocks of blood vessels. The result? Blood vessels that are narrow, distorted and leaky. Organs that are rich in blood vessels, the eye, the kidney – and the brain, become unable to function properly. That’s why blindness, kidney failure, stroke and dementia are so common among persons with diabetes. As the brain shrinks, so does memory. The solution is simple: keep blood sugar low and physical activity high.

 

 

 

 

 

 

In the news

Typhus in L.A.

Typhus, usually associated with deplorable living conditions, is in the news. Nearly 100 cases have been reported in and around Los Angeles so far this year. Is it something for us to worry about?

The disease – not to be confused with typhoid – produces fever, chills, rash and stupor, and is sometimes fatal. In the past it has been associated with wars and severe crowding. It decimated the army of Napoleon during his futile campaign against Russia. It tragically caused the death of Anne Frank just weeks before World War Two ended.

Historically, typhus was spread from one person to another by body lice. The L.A. outbreak is different in that it is being spread by fleas, and especially among the homeless. Fleas breed among rats and both critters thrive in garbage-strewn neighborhoods. Feral cats carry infected fleas that can spread to household pets and then to humans.

Those who own cats and dogs usually monitor and treat their animals for fleas but that is especially important if you live in suburban areas where feral cats, rats and opossums are present. Getting close to any wild animal risks diseases that are even worse than typhus.

Some pet owners have found that sprinkling brewer’s yeast on dog and cat food helps to prevent flea infestation but others claim that it doesn’t work. It might be worth trying it for about a month. Maybe it depends on the breed. The upside is that yeast contains nutrient vitamins and won’t harm your pet.  (Note – the preparation that contains yeast plus garlic should not be given to cats.)

Lifestyle

Another step to avoid Alzheimer’s disease and dementia – omega-3 fats.

Omega-3 fats are the healthy fats – physicians refer to them as “essential fats” – that are especially important for normal brain and eye development in infants but we never outgrow the need for them. They are most abundant in fish, including shellfish, and in some plant foods such as walnuts, peas, Brussels sprouts, chia seeds and flaxseeds.

The brain-healthy effect of omega-3 fats has been determined from large population groups, from studies in animals and from their beneficial effect in a variety of neuropsychiatric problems that range from depression to behavior disorders.

A Dutch study showed that fish eaters had less cognitive decline than fish-avoiders. Persons living in Framingham, Massachusetts with the highest levels of DHA, an omega 3-fat found in fish, had a 47 percent (!) lower likelihood of dementia compared with those with the lowest levels. Finally, Alzheimer’s patients have low levels of omega-3 fat in their brains.

These findings should encourage you to include fish in your diet three to four times a week. (Sorry – fish sticks won’t do.) Fish oil is a perfectly good substitute but it doesn’t have the extra benefit of protein, a nutrient that many seniors lack in their diet.

Your mother was right: fish is brain food.

 

 

 

 

 

 

 

 

 

Upcoming presentations

A day in the life of a Gold Rush physician. Saturday, October 6, 10:00 a.m., OASIS Grossmont Learning Center, La Mesa. Go to http://www.oasisnet.org/sandiego for registration details and class description.

Regain your youthful memory. Monday October 8, 12:00 a.m. OASIS Escondido Senior Center. 210 E. Park Ave. Go to http://www.oasisnet.org/sandiego for registration details and class description.

How to lose weight after 40. Tuesday, October 23, 12:30. Carlsbad Dove Library. Go to http://www.oasisnet.org/sandiego for registration details and class description.

All about salt. Saturday October 27, 1:00 p.m. San Diego Archaeological Center, San Pasqual Valley Road (same as Hwy. 78, just past Safari Park) $30, non –member, $20 members. Local wine and inspired foods will be served after the lecture. See https://sandiegoarchaeology.org for further information.

 

In the news

Influenza vaccine – there’s more to the story.

There are few topics in medicine that are more controversial than the influenza vaccine. The media focus on its failure to prevent disease. Depending on the year the effectiveness ranges from about 20 to 60 percent. That sounds like a reason not to bother, doesn’t it? In those disparaging articles there is usually acknowledgment near the last paragraph that even if the vaccine does not prevent infection, those who receive it have a significantly lower risk of requiring hospitalization. That fact has been documented repeatedly.

The last place you want to be at any time is in a hospital, where infections, often from antibiotic-resistant bacteria, kill nearly 100,000 persons every year. The influenza virus has long been known to weaken the immune system. Most people who die during an attack of influenza are brought down by secondary infection to which they have become more susceptible, not the virus. When you put together the age-related decline in immunity, the further weakening incurred by the influenza virus and the high risk of hospital exposure to several species of dangerous bacteria, a perfect storm emerges.

But wait – there’s more! Physicians have known for decades that the risk of dying from a heart attack is greater during and in the weeks after infection with the influenza virus. We now know why: release of inflammatory chemicals, disruption of plaques within the walls of blood vessels and increased tendency to form artery-plugging blood clots. Another perfect storm.

One more thing: you cannot get influenza from the influenza vaccine. The virus is dead – period! And the intense scrutiny of the vaccine production process, driven by attorneys who dread a vaccine-induced infection, makes it highly unlikely that any live virus particles will make it to you.

The flu season has begun. ‘Nuf said.

Preventing Alzheimer’s disease and dementia: antioxidants.

The human body evolved to require many kinds of nutrients and about 4,000 of these are antioxidants. Nature provides them to plants and animals in order to counteract the damage inflicted by free radicals, chemicals that result from exposure to radiation, sunlight, infection, exercise or even normal digestive processes. Animals can manufacture only a handful of antioxidants, that’s why we need a high intake of fruits and vegetables.

Plant products that are high in antioxidants have three characteristics: they are highly colored, highly aromatic and highly flavored. Think carrots, beets, garlic, coffee, red wine and dark chocolate.

Antioxidants don’t act alone. That’s why, as in the case of vitamins, studies on single chemicals such as curcumin are not convincingly conclusive. What we do know is that persons who have a diet high in natural antioxidant-containing fruits and vegetables have a lower risk of dementia. In part that’s because they are less likely to eat refined grains and sugars or to get their protein from red meat. Antioxidants reduce inflammation, which plays a large role in Alzheimer’s disease and dementia.

There is plenty of evidence that a high intake of antioxidants has many health benefits. This is confirmed by studies of the Mediterranean Diet revealing that those who adhere to this diet have a thicker layer of gray matter in the brain, preventing or postponing cognitive decline, especially memory.