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.

 

In the news

Should we worry about monkeypox?

The answer is “No.” So why discuss it? Monkeypox has popped up in the news again after two persons were diagnosed with the disease in the U.K.  In an era when biological warfare is a potential threat, a virus that is related to smallpox has some people worried.

Monkeypox was first identified in laboratory monkeys, hence the name, though it is found in a variety of other animals especially in Africa. There was an outbreak in the American Midwest in 2003 that originated in a pet shop that sold prairie dogs that acquired the disease from African rodents. Prairie dogs seem to be popular pets in our heartland; they infected 71 persons. No one died and neither did the two unlucky people in England. (Both had recently come from Nigeria.)

Smallpox has a frighteningly high mortality rate, about 50 percent – no wonder that authorities worry about its use in a biological warfare attack. Although the death rate from monkeypox is reportedly only about 10 percent it is probably even lower in a healthy population. Both diseases cause a blistering rash that somewhat resembles chickenpox, a relatively benign disease that most adults have experienced but that has disappeared since the release of the chickenpox (varicella) vaccine.

 

Lifestyle

Ten ways to prevent dementia and Alzheimer’s disease: step 4 – vitamins.

          Persons who eat a “normal” diet don’t need to take a vitamin supplement. That is correct but only about 20 percent of us eat a “normal” diet and for women in the childbearing age that number drops to 10 percent.  As we have drifted from eating fresh plant foods to packaged foods that are high in fat and sugar and our fruits and vegetables are rarely fresh, our nutrition is lacking.

Dementia and Alzheimer’s disease have multiple causes but persons with the highest intake of vitamins B3, B12, C, E and folic acid had significantly lower rates of these conditions than those who intake was deficient. It should be noted however that the best results were found when those vitamins came from natural foods.

Vitamin D is not only important for healthy bones and a strong immune system, it helps to maintain connections between brain cells. In a couple of months we’ll be entering the part of the year when those who live in the northern half of the United States won’t get enough sunlight to manufacture sufficient vitamin D. If you live in the far north or Canada you could run around naked all winter and still not get enough sun exposure because of the slant of the sun’s rays.

A quality multivitamin/multimineral is good insurance against Alzheimer’s disease and dementia. Next time we’ll talk about antioxidants.

Upcoming presentations

Keeping your wits. Ten steps to prevent dementia and Alzheimer’s disease. Tuesday, September 18th, 6:00 p.m., Solana Beach Library.

Health benefits of wine and chocolate. Wednesday, September 19th 2:15 p.m. Rancho Penasquitos Library

In the news

Overdose on vitamin D? Not likely.

It’s rare to find an article about vitamin D that doesn’t mention the possibility of toxicity but that is extremely rare and should not be of concern to anyone taking a daily supplement. Even if one were to take ten times the recommended amount of 800 units per day it would take more than six months to show any signs of toxicity such as kidney damage.

A study of more than 70,000 patients at the University of Iowa Hospitals and Clinics revealed only four persons with symptoms, including abnormal calcium deposits and kidney injury that resulted from high doses of vitamin D. Two of these patients were children whose parents gave them a dropperful of liquid vitamin D instead of one drop.  The third patient was taking 50,000 units per day; the history of the fourth patient was not complete.

Of the more than 780 persons whose blood levels of vitamin D were above normal none had any symptoms and the blood levels of calcium were within the normal range among all but seven.

Some supplement manufacturers recommend 2,000 to 3,000 units of vitamin D per day, a dosage that is entirely safe.  For persons over the age of about 60 some experts recommend an intake of 1,000 units per day. Older persons who fear skin cancer tend to avoid sun exposure. That helps to explain why more than half of the senior population, especially in the northern half of the United States have abnormally low blood levels of this important vitamin.  In addition to its bone-building benefits vitamin D is necessary for a healthy immune system and appears to play a role in the prevention of heart disease and cancer.

 

Lifestyle

Ten ways to prevent dementia and Preventing dementia and Alzheimer’s disease: step 2.

#2 – Keep your blood sugar normal

Type 2 diabetes is a lifestyle-destroying disease that now affects about eleven percent of the U.S. population.  It is characterized by frequent and prolonged high levels of blood sugar that cause distortion of blood vessels. The inevitable result is damage to those parts of the body that have a rich network of blood vessels: the kidneys, the eyes, the heart and the feet. Type 2 diabetes is the main cause of kidney failure and will soon become the major cause of blindness among seniors. Diabetics have high rates of heart disease and stroke. Defective blood vessels fail to bring nutrients to the brain and cannot remove waste products. Brain cells die, the brain shrinks and the result is dementia, deteriorating memory, loss of cognitive skills and the inability to care for oneself.

A high intake of refined (white) flour and refined sugar including high-fructose corn syrup produces elevated levels of sugar in the blood. Sugar molecules attach themselves to protein molecules that are the building blocks of blood vessels. Just as one cannot build a decent-looking wall with bricks of varying shapes and sizes, one cannot form healthy blood vessels with distorted protein molecules.

The solution: stay away from refined grains and sugars. Replace them with whole grain foods along with plenty of fruits and vegetables.

In the news

Is the price of legalized marijuana getting too high?         By the end of this decade it’s likely that nearly half of the states will have legalized the medical and/or recreational use of marijuana. It’s clear that it does have some medical benefits. What is also becoming clear is that frequent use of marijuana carries more risks than its supporters acknowledge, or may even be aware of. Three disturbing findings should make us pause for a moment.

We know that marijuana affects the brain. Otherwise, why bother? Colorado pediatricians, concerned about the future mental health of babies whose mothers smoke marijuana during pregnancy, monitor all newborn babies for the presence of the drug. Ten to fifteen percent of newborns in Colorado have marijuana in their systems. In one recent month in the city of Pueblo that figure was an astounding ninety percent!

In a study of more than 3600 children there was a more than 30 percent increased risk of “psychotic-like experiences” in the offspring of cannabis (marijuana) users when the children were evaluated at age ten years.

Canadian physicians are also concerned, and no wonder. The Canadian Psychiatric Association notes that “22 percent of youth aged 15 to 19 reported using cannabis during the past year.”  In a 2017 article they note that marijuana use in teenagers is “strongly linked” to other substance use disorders, depression, anxiety, psychosis, impaired neurological development, cognitive decline and diminished school performance.

Marijuana, like tobacco and alcohol, is here to stay.  If we could keep it from young people and pregnant women we could limit the ultimate damage.

Lifestyle

Ten ways to prevent dementia and Alzheimer’s disease

       “Alzheimer’s disease is no longer considered an inevitable consequence of the aging process.” M. Folstein, M.D.

          This should be not only a reassurance but an incentive to take advantage of the several means of avoiding or at least postponing the onset of one of the most feared illnesses of our generation. In the biweekly blogs that follow we will present each of the steps – there are actually more than ten – that anyone can do without a massive change in lifestyle.

Alzheimer’s disease is only one type of dementia and is not actually a single condition. However all the steps described here will not only help to prevent these dementias, they will also lower your risk of heart disease, stroke, cancer, osteoporosis and type 2 diabetes.

#1 – Busy body, better brain

Regular, moderately intense exercise is the single most important factor in preventing not only dementia but the major chronic diseases that are (incorrectly) blamed on aging.

Exercise helps to grow new brains cells, makes existing cells last longer and forms more connections between brain cells. Thus with an extra reserve of brain cells and the connections between them, loss of some of these structures due to the accumulation of abnormal protein such as that which occurs in Alzheimer’s disease is less crippling.

Persons who exercise regularly (that means at least 4 times a week and for about one hour) are found to have faster thinking speed and better memory. Exercise almost entirely eliminates one form of dementia, that caused by damage to blood vessels.

 

 

 

 

 

 

 

 

Upcoming presentations

Friday, August 3, 2:30 LIFE program at Mira Costa College, Oceanside. Baby Boomer blindness. Details at  http://www.miracosta.edu/life.

Tuesday, August 28, 1:00 Mission Valley library, A day in the life of a Renaissance physician. Learn how it impacts what your physician is doing today.

In the news

Exercise more, feel better

Physical activity – another term for exercise – has lots of benefits that go beyond helping you to keep from gaining weight. Besides making your heart and lungs perform better, moderately intense physical activity can completely prevent type 2 diabetes (which now affects 12 percent of the adult population!) and lowers the risk of osteoporosis and Alzheimer’s disease.

Research from Finland shows that it also improves psychological well-being.  A group of couch potatoes was instructed in the use of weights and resistance bands and they were observed for nine months. Compared to non-exercisers the gym rats reported improved quality of life and fewer depressive symptoms.

Those of you who exercise regularly probably could have predicted that. Better circulation, especially to the brain, improved appetite, more flexibility, more restful sleep and greater physical endurance are all benefits of regular exercise.

Although even those who (by study design) exercised only once a week showed significant improvement those who exercised three days a week showed the most improvement.

Try it. You’ll like it!

 

Lifestyle

Shingles vaccine update

About side effects – I received the second (and final) dose of the new shingles vaccine, called Shingrix a couple of weeks ago. There was some soreness at the injection site, which is typical for most vaccines and it wasn’t very bothersome. However, I felt crummy for two days. That was it! It didn’t keep me from my usual activities except that I took a holiday from the gym for about five days because of the sore arm.

About a quarter of Americans will have had at least one episode of shingles – known as herpes zoster – and if you’re lucky enough to live past 85 the risk is about 50 percent.

Even an “ordinary” case of shingles will include a painful rash that lasts about three weeks. In some cases the pain lasts forever! The worst side effects of the Shingrix vaccine aren’t nearly as bad as that.

Older age carries an even greater risk, that of depressed immune function resulting from leukemia or chemotherapy, in which case the disease can be really severe.

The bottom line: everyone over the age of 50 should have the vaccine, even those who have had shingles in the past or have had the older vaccine (Zostavax). Are the side effects a problem? Nah!

 

 

 

 

 

 

In the news

Thanks for (Ouch!) saving my life

Perhaps you saw the recent news article about how Senator Joe Manchin saved the life of another senator – Claire McCaskill – by performing the Heimlich maneuver/abdominal thrust. The story didn’t describe the details of what caused the airway obstruction but the big news was that Rescuer Joe cracked one of Ms. McCaskill’s ribs. Bad form but a good outcome.

There’s a teaching point here: if the abdominal thrust – the Washington Post called it the Heimlich maneuver – is performed correctly you shouldn’t crack a rib. The good senator obviously placed his hands too high on Ms. McCaskill’s abdomen. The best place is just above the bellybutton. Not only will that avoid vulnerable ribs, it will also avoid the xiphoid process, the arrowhead-shaped bone that points downward (and right at the liver!).

I’m willing to bet that by now Senator Manchin has received dozens of e-mails and tweets to let him know how to improve his technique.

 

Lifestyle

Dieting Guidelines

Spot reducing sounds like a great idea. Too bad it doesn’t work for thighs, chins or upper arms. Categorically, using a vibrating “fat-reduction” tool on any part of your body or exercising one area (like your thighs) will have little effect on the fat there.

Having said that, all fat is not the same. The stuff around a woman’s hips and thighs is hard to get rid of because nature has programmed it to be one of the last stores to melt away during food scarcity in case the owner of the fat happens to be pregnant. Fat around the middle – which is usually an indicator that there is too much heart-damaging fat around the abdominal organs, intestines, etc. – usually starts coming off first when you lower calorie intake and exercise more. Be aware, however, that doing lots of abdominal exercises won’t make that fat go away any faster, it will just give you stronger abs underneath the fat.

That dangling fat at the back part of the upper arms won’t go away any faster if you do lots of arm exercises but the muscles there will get bigger and more firm. Eventually you’ll lose those “angel’s wings” along with the excess fat everywhere else.