Carvings                    May 1, 2021

In the news

Flu who?

            Have you noticed that no one you know has seemed to have gotten the flu this year? There have been remarkably few cases of influenza this season, the CDC noting that the number of hospitalizations has been the lowest since 2005. One of the blessings of this lull is that only one child has died of influenza this year, a tragedy to be sure for that family but thankfully less than the hundred or more kids who die in most flu seasons.

            It seems that hunkering down at home, social distancing and mask wearing keep us from infecting each other with various germs. The CDC doesn’t keep up with simple colds but they do watch the incidence of Respiratory Syncytial Virus (RSV) infections, a serious lung disease among infants, and they are down too.

            Some pundits propose that we simply aren’t testing as much for influenza because of our focus on COVID-19 or that the flu virus, with fewer victims, has mutated so little this year that the current vaccine is still working.

            Does all this portend a worse than usual flu season next winter? Based on what happened following a similar drop in the 2011-2012 flu season, that’s not likely – but it’s no reason to skip your flu vaccine next October or November!

            Advances in vaccine development have been so dramatic that we may have a combined influenza/coronavirus vaccine before the end of the year. Wouldn’t that be a great outcome of this crummy epidemic?

Lifestyle

Sensible snacking

Snacks can make or break a diet. The kind that you find while you’re standing in line at the checkout counter is probably the worst, even the trail mix or beef jerky. Some trail mixes have well over 100 calories per ounce and a piece of beef jerky that weighs a little more than a half-ounce can contain as much as 440 milligrams of sodium – about 20 percent of what you should allow yourself in a whole day.

            The ideal snack should contain enough fiber or protein to satisfy your appetite. A piece of fruit averages only 50 to 75 calories but the fiber leaves you feeling full. A single handful of nuts, especially almonds or walnuts (for the engineers and accountants in the audience that’s about 12 pieces or about ½ ounce) will provide about 80 or 90 calories. That will also give you some protein and some omega-3 fats, both of which will give you a feeling of fullness – especially if you eat them slowly!

            Diet gurus sometimes recommend a tablespoon of peanut butter on a stalk of celery. Nice theory but who has the time to make it – and not find something else in the refrigerator to nibble on while searching for the celery?

            Dried fruit? Not such a good choice because it’s high in sugar. After all, 6 apricot halves are the equivalent of 3 whole apricots, and four prunes are the equivalent of four plums. Do you usually eat that many pieces of fresh fruit at one time?

Carvings             April 15, 2021

In the News

Another COVID surprise!

* Caveat: any numbers in this post should be considered temporary estimates. The input from government and academic institutions changes by the hour.

          The good news: we have two effective vaccines against the virus that has taken the lives of millions of people and disrupted the lives of almost everyone else.

            The bad news: two other vaccines by Johnson and Johnson and Astra-Zeneca that have the advantage of requiring only one dose have been associated with about a dozen deaths from a rare blood clotting disorder. Those deaths have mostly occurred in women of early middle age who should have had decades more of life with their families.

            It’s called Vaccine-Induced Thrombotic Thrombocytopenia (VITT). Thrombocytes, known as “platelets” because they resemble small dinner plates, are sharply reduced, partly because they are taken up in the formation of blood clots in various organs. This results in thrombocytopenia, meaning scarcity of platelets and some patients have simultaneous hemorrhages when there aren’t enough platelets remaining to control bleeding.

            The condition typically arises during the second week after vaccination. Clots in the brain cause headaches; those in the blood vessels that supply the intestines produce abdominal pain; clots in the legs result in leg pain and those in the lungs cause shortness of breath. Anyone with these symptoms following receipt of the Johnson and Johnson or Astra- Zeneca vaccine should seek medical attention without delay in order to present stroke or even death.

            We have a long way to go before we can unravel the cause, provide lifesaving treatment and perhaps modify the vaccines. Fatalities have so far occurred only in about once for every million doses of vaccine in the U.S. To put this in perspective, the loss of life among a million persons with COVID-19 would be about twenty thousand! A report from the University of Oxford states that this clotting disorder is about forty times as likely from COVID-19 infection as it is from the vaccine.

            A further perspective: the CDC estimates that deep vein thrombosis (DVT), sometimes associated with air travel, causes death in from 60,000 to 100,000 persons every year.      

            Why have most of the deaths occurred in women? One reason might be that they have higher levels of estrogen, somehow making them more susceptible to the condition. Another reason is that women are more often affected by autoimmune diseases such as lupus, rheumatoid arthritis and multiple sclerosis, all of which are autoimmune diseases, which VITT appears to be.

            Some reassuring thoughts: the disease is rare, especially in males. More than 600 million doses of the current vaccines have been administered so far and this clotting disorder has been reported in fewer than 300 persons with about a dozen deaths. We have two vaccines that are known to be safe – to my knowledge there have been no deaths attributed to either the Pfizer or the Moderna vaccines — and effective, more than 90 percent at the six-month mark.

            It would seem prudent that women of childbearing age should not receive either of the one-dose vaccines. They should opt for either the Pfizer or the Moderna vaccine, neither of which has been linked to deaths from VITT. The risk to men appears to be vanishingly small.

            There are several more vaccines in the pipeline and some of these employ new technology. You can be sure that there are more surprises among them.

Lifestyle

Some Stone Age humans were probably aware of plant products that gave them a caffeine-like jolt but they never started the day with a good old cup of coffee. It was just a few years ago though, that America’s favorite beverage caught the blame for causing a variety of ills, including cancer of the pancreas. Fortunately for Starbucks devotees, coffee now has a clean rap sheet and is taking credit for some genuine health benefits.

The pancreatic cancer issue has been put completely to rest and there is convincing research showing that coffee lowers the risk of several types of cancer, including liver, brain, prostate, uterus, mouth and throat. Except for a link to bladder cancer in men who drink several cups a day, there is no evidence that it causes cancer.

Coffee is a plant product and like red wine and dark chocolate it contains thousands of chemicals that have beneficial health effects. These include antioxidants that protect blood vessels from damage by harmful free radicals and substances known as antimutagens that keep cells from becoming malignant. There are chemicals in coffee that rein in inflammation, a contributor to heart disease, stroke and rheumatoid arthritis.

In spite of coffee’s growing list of advantages, drinking more than three eight-ounce cups a day can cause nausea, irritability and insomnia. Even decaffeinated versions are not entirely free of caffeine and may lead to poor sleep in caffeine-sensitive individuals. Excess caffeine can increase heart rate and raise blood pressure.

Adding milk to coffee appears to diminish at least some of its benefits in the same way that converting dark chocolate to milk chocolate does. Of course, when the addition of lots of cream and sugar transforms a large cup of black coffee into a 500-calorie “specialty of the house” you can kiss the heart-health benefits goodbye. Moderation, as usual, is a good thing.

Pandemic Perspective #41  April 3, 2021

Why vaccines don’t always work

            Vaccines have never been without controversy since the first one appeared at the end of the 18th century. The permutations of that first smallpox vaccine led to the total eradication in the 1970s of one of the most terrifying of human afflictions, one that sometimes killed half of its victims and left many of the rest with characteristic pitted facial scars.

            The COVID-19 vaccines that have now been given to more than half a billion (!) people appear to have a protective effect in as many as 95 percent of vaccinees. Why not 100 percent? There are multiple reasons and they apply to all vaccines in one way or another.

            Reason #1. After more than half a century we still don’t have an influenza vaccine that is completely effective or whose protection lasts more than a few months. That virus undergoes mutations in those structures that are the targets of the vaccine so that a new preparation needs to be produced nearly every flu season. The SARS-CoV-2 virus that has upended the global economy mutates too but those changes – at least for the moment – are not of the type that negate the effectiveness of the vaccine.

            [Note: as of this writing there have been no deaths attributed to the current vaccines and no COVID-19 deaths among persons who are at least one month post-vaccination. That too might change by the time you read this but the numbers showing its safety remain overwhelming.]

            Reason #2. The human immune system is enormously complex and some persons are genetically missing a key component. An example is that some persons are incapable of forming antibodies against the diphtheria vaccine. However the redundancy of the immune system probably covers for that defect.

            Reason #3. Obesity and diabetes (type 1 and type 2) reduce the effectiveness of the immune system. The high incidence of obesity (nearly 40 percent) and type 2 diabetes (more than 12 percent) undoubtedly limit the protection afforded by the vaccine in these groups.

            Reason #4. Using a standard needle in an obese person can put the vaccine into fat, not muscle. This not only can make the vaccine ineffective it can lead to complications such as abscess formation. Some health facilities now use needles in obese persons that are twice as long as those used for those who appear to be of normal weight.

            Reason #5. Improper storage. Some COVID-19 vaccines require ultra-cold freezers to maintain potency.

            After the measles vaccine became available in the 1960s some children developed the disease in spite of having been vaccinated. Some medical offices had stored the vaccine in the door shelves of the refrigerator, where the temperature was too high, severely reducing the potency of the vaccine.

            Reason #6. Aging reduces the strength of the immune system. That’s why there exists a high-potency influenza vaccine for seniors. We don’t yet know if this will be a problem among our oldest old in this pandemic but it will require monitoring.

            Reason #7. Timing. The measles vaccine is not given to children until the age of  12 to 15 months. Prior to about 1985 most women had had natural measles infection and they transferred protective antibody to their infant that persisted for several months. A measles vaccine given too early might be ineffective, hence the delay. None of today’s mothers born in the U.S. have experienced natural measles and vaccine antibodies do not last as long as those induced by wild measles virus. For that reason, infants above the age of six months that are exposed during an outbreak should receive the vaccine.

            Coronavirus infections are common during the preschool years, less so afterwards. Existing natural antibody may help to explain why children rarely become seriously ill from the COVID-19 virus but it could reduce the effectiveness of the vaccine. Vaccine trials in children are only now being done and the vaccination of children will probably begin this summer. How they will respond won’t be known for at least another year.

            Vaccine failure is common, it is not unexpected and it should not be a reason for not accepting the vaccine. If you are willing to take a chance on being killed while driving your car you should be willing to take a chance on the vaccine. I’ll bet on the vaccine every time.

Pandemic Perspective #41  March 27, 2021

Vaccine reluctance by healthcare workers. Why? Do they know something?

            The media reports are unsettling.  A Medscape article just a few days ago noted that fully 30 percent of those who care for patients stated that they were still undecided (12%) or did not plan to receive the vaccine (18%).

            Consider four different elements of this issue:

1. Are manufacturers using experimental, i.e., untested methods to develop these vaccines?

2. Do the vaccines work?

3. Are the current vaccines effective against the rapidly-emerging variants, (mutations)?

4. Are vaccinated persons subject to a paradoxical response to later infection by the wild virus?

            This short blog can’t possibly adequately address each of these issues but here are some comments that might help those who are still agonizing over this decision.

1. Some methods of manufacturing vaccines have not been used on a large scale but they are not really new. mRNA technology was developed more than thirty years ago and was effective in helping to control the Ebola virus. Carrier adenoviruses have been used in several veterinary vaccines. We have less experience with these innovative vaccines because there has not been a need for such new variants until now.

2. The three vaccines released to date do produce an appropriate immune response and appear to prevent infection. For example, in one trial there were 30 subjects who required hospitalization for COVID-19 infection but all 30 were in the placebo arm of the trial. It’s true that some vaccine recipients have become infected but almost all of these were exposed within a month of receiving the second dose and at least in some reports, shed non-infectious virus particles.

3. Will these vaccines work against newly-emerging variants such as the B.1.1.7 strain that is rapidly spreading in the U.S.? That appears to be the case at the moment but this wild and woolly virus has been full of surprises and it’s quite likely that some of today’s vaccines (there are 73 vaccines in clinical trials and a total of 308 in various stages of development) will have to be tweaked or replaced by the end of this year.

4. The problem that many healthcare workers – including myself – fear most is a paradoxical immune response in which later exposure to a naturally-occurring SARS-CoV-2 virus will cause even worse disease. This happened a few decades ago with a vaccine that was designed to prevent Respiratory Syncytial Virus lung disease in very young children. If that does occur we’ll probably see it by the end of this summer. I’m keeping my fingers crossed.

            Perhaps a publication in Medscape.com on March 24th will put this concern to rest. In San Diego and Los Angeles a pooled study among hospital staff showed that positive tests fell to 0.2% in the second week after the second dose of either the Moderna or the Pfizer vaccine. In Dallas’ Southwestern Medical Center there was a 90% decrease in the number of employees who were in isolation or quarantine. In spite of a surge in cases in Texas the number of infections was only 0.05% among fully vaccinated employees and 2.61% of those who were unvaccinated – a whopping 50-fold difference!

            The old cliché, the perfect is the enemy of the good, applies in this case. As of this week more than a half-billion doses of the vaccine have been administered and there have been very few serious side effects. Of course, some might show up later – perhaps even a year or more from now but the initial results are reassuring. I will receive my second dose of the Moderna vaccine in a couple of days; the first was a nothingburger. I hope I can report the same next week.

            In case you wonder why vaccines don’t always work, remember that prescription drugs don’t always work either and neither do surgical procedures. I’ll explain why in the post for April 1.

Carvings                March 15, 2021

In the news

            Is red meat bad? Is red meat good? What a sticky mess!

            This controversy has been going on for more than a half-century and it’s just as confusing as ever. The reason? GIGO, the acronym that we are now all familiar with: Garbage In, Garbage Out.

            One of the more recent analyses is a good example. In a comparison of five reviews the authors concluded that we don’t need to change our meat-eating  habits and that even eating processed meats has little effect on the risk of heart disease. Although the study was highlighted by the media it was castigated by medical professionals. Here are some issues that were not addressed.

            Although the authors separated unprocessed meats (muscle meat from the cow or the pig) with processed meats (hot dogs, sausage, cold cuts, etc.) their classification ended there. Healthy diets can include unprocessed meat but there is a difference between prime beef (lots of saturated fat), select beef and wild game (venison for instance). The fat content of the first is often greater than 30 percent; wild game contains about 7 percent; select beef usually has even less. Think that matters?

            A serving of unprocessed meat is 3 ½ ounces, what many Americans would consider a child’s portion. Your favorite restaurant probably starts with an 8-ounce steak – one famous steak house call this a petite filet — 16 ounces is common and one place in Texas – where else – serves a 64-ouncer! Think that matters?

            Some steaks and chops are broiled, some are fried. Think that matters?

            Is beef, lamb or pork typically the only thing on your plate? Would you miss the fried onion rings or the baked potato with butter or sour cream? Think that matters?

            Then there’s processed meat with added salt, nitrites and saturated fat, all of which have been associated consistently with diseases such as heart disease and cancer.

            So is red meat good for you?  Of course it is! As long as it’s a realistic serving, broiled not fried, and comes with a side or two of veggies – including a baked potato with salsa in place of butter or sour cream. An occasional splurge (those onion rings and sour cream) won’t shorten your life, and neither will having bacon or sausage with your eggs now and then.

            Keep things in perspective. Overindulgence shortens lifespan; moderation makes life worth living.

Lifestyle

          Maintaining muscle strength and tone is one of the most important aspects of healthy living but it is a very low priority for most Americans. Several surveys reveal that approximately 80 percent* of us fail to spend even the minimum of two to three hours a week in resistance training (using barbells, dumbbells, machines, elastic bands) or any activity that requires lifting, pushing or pulling with enough intensity to break a sweat or even to raise our heart rate. Walking is good exercise and great for the heart and lungs but it has almost no effect on helping us to reach our later years with strong bones, good balance and enough strength to open a jar of pickles.

            * – 80 percent of Americans are overweight or obese, probably the same 80 percent.

            At the other extreme are those who overdo weight training, some because of lack of instruction, others in a quest to maintain youthful vigor. Christian Finn of the United Kingdom is a fitness expert with a graduate degree in exercise science and recently provided some guidelines that would benefit both groups. These are a few that I found most helpful, with some observations of my own.

            Avoid squats, bench presses and overhead lifts. The first are unnecessary for all but bodybuilders. Overhead lifts are especially likely to cause injury to the shoulder, the most complex joint in the body. As we get older we’re more likely to tear the rotator cuff, which takes about a year to heal.

            You don’t need heavy weights to build or maintain muscle. You should be able to do 10 or 12 repetitions of an exercise. The last one should be difficult but not impossible.

            There is no magic interval between sets of exercises. Take the time you need to rest if you’re not in the running for Mr. Olympia.

            It’s OK to exercise almost every day but not if it’s the same group of resistance exercises every time. Your muscles need about 48 hours to recover. Enjoy a walk on the beach or in the park on those other days. (Hint: that should be about an hour.)

            Make sure that you’re getting enough protein if you exercise regularly. And don’t treat yourself with a Krispy Kreme donut as a reward!

Pandemic Perspective #40   March 6, 2021

So far nearly 300 million doses of the several new COVID-19 vaccines (including Russian and Chinese) have been administered and the earlier-feared complications and possible deaths from the vaccines have just not materialized. Earlier this week the CDC reported that deaths among vaccine recipients occurred in 0.0015 percent and analysis of each has concluded that the vaccine did not cause any of those deaths.

Is that information trustworthy? It’s unlikely that the media and anti-vaxxers could have missed casualties on even a modest scale. Their silence tells the story: this is a safe vaccine and has resulted in reactions mainly among persons with known allergies. From the reports I have seen these unfortunate persons were treated promptly and successfully.

The hesitancy to receive the vaccine because of risk of side effects is no longer justified but there are still many persons, including healthcare workers, who claim that we don’t know if the vaccine will prevent disease. That fear is also being diminished but obviously at a slower rate because not enough time has passed to evaluate that with certainty.

What about mutations, of which there are now several hundred, a number that was not unexpected even from the beginning of the outbreak? Coronaviruses mutate a lot. There are some now circulating around the globe that are able to spread more easily and may cause more serious disease. This virus has been so full of surprises that no one can predict accurately but the technology of the age is not only able to identify such mutants quickly but manufacturers of the vaccine now have the ability to tweak their product to maintain vaccine efficacy – or so we hope!  Specifically, the just-released single-dose J&J vaccine is effective when tested in an environment where there is significant occurrence of some of the new variants.

In light of these facts and the recognition that the fatality rate of this virus is lower in the United States (1.8%) than in the rest of the world (2.2%) the hand-wringers have become less vocal. Yet the fact remains that the death toll will continue to rise, certainly at a slower rate as we are now seeing. By mid-summer the adverse effects of a lockdown will exceed the dangers of the virus. For our children that is already certainly the case. Perhaps life will again return to something that we will recognize as normal. Texas has just opened all businesses and in a couple of months we’ll learn if that is a wise move.

NOTE: To those who have an interest in the history of the U.S. West – Wild West magazine has just published my article, No prescription for gold fever in the April 2021 issue. It describes the health challenges faced by the forty-niners and how physicians treated them in the generation prior to the explosion of science-based medicine. To the credit of the editor, the illustrations are remarkable and add a great deal to the text.

Carvings             March 1, 2021

In the news

            A pandemic within a pandemic: can we put a stop to both? COVID-19 is the worst infectious pandemic in the last century. To date it has taken the lives of more than a half-million Americans, a tragic number. Could that loss have been avoided?  To the frustration of many of the nation’s leading health authorities, the answer is yes. But the solution is to end another pandemic, diabesity, the combination of obesity and type 2 diabetes.

            In a study published in the Journal of the American Heart Association on February 25th. 2021, “the risk of coronavirus disease 2019 (COVID-19) hospitalization is robustly linked to cardiometabolic health.” By now most Americans are aware that comorbidities such as obesity, heart disease, type 2 diabetes, hypertension, and diseases of the lungs and kidneys are found in nearly every instance where death occurred as a result of infection with this new coronavirus. But the study from Tufts University
School of medicine puts it in quantitative terms: sixty-three percent of hospitalizations are due to four factors – obesity, diabetes, hypertension and heart failure.

            As one of the authors put it, “If individuals exercised a little more and ate a bit more healthily, we would see improvements in diabetes and hypertension in just a few weeks. (Emphasis mine.) We should be shouting this from the rooftops.” Is that realistic? Of course, but the current mindset of our population makes that impossible.

            Obesity is the driver of the other comorbidities and together with diabetes it lowers the effectiveness of the immune system, a fact that most persons are unaware of. Another unrecognized fact is that losing only about 15 or 20 pounds significantly lowers blood pressure and blood sugar and might possibly restore the effectiveness of the immune system.

            Exercise alone won’t do the trick; meaningful weight loss only comes with reduction of calories although exercise does prevent the unnecessary loss of muscle tissue when calorie intake is reduced.

            Here’s a sobering thought: persons who have received the second dose of the COVID-19 vaccine might be somewhat complacent about being safe from the disease. However, we know from our experience with the influenza vaccine that obese persons do not reach the same level of protection from influenza as persons of normal weight after vaccination. Could that be the reason that the current two vaccines are only about 95 percent effective instead of 100 percent?  Is anyone looking at that?

Lifestyle

Exercise Tips

            There are some exercises that you should avoid. Arguably, running is one of them, primarily because running on pavement is hard on the body and is much more likely to result in stress fractures than walking does. If you like it, enjoy it but be aware of the risks. 

            If you use weights or machines, go easy on shoulder exercises. That is a complex joint, easily injured, and takes months to heal. The other upper body exercises that you do bring shoulder muscles into play without the risk of injury.

            You don’t need to do dead lifts or exercises that cause you to extend your back. Those are for athletes and bodybuilders and just are not necessary for you to develop good muscle tone and add to bone strength.

 Carvings                February 1, 2021

In the news

            Does it seem logical to wear a mask after you have received the COVID-19 vaccine?

            “I honestly don’t think I’ll ever go without a mask at work again,” says Dr. Eugenia South, emergency physician. At first glance this doesn’t seem to make sense but we need to look at her statement in context, especially the words “at work”. Healthcare workers are at extremely high risk for several reasons. They spend many hours a week in the presence of the sickest COVID-19 patients, those that are shedding large amounts of virus as they cough and breathe rapidly. Physicians have known for decades that a large dose (called an inoculum) may cause more rapid and more grave illness. E.g., a small amount of a poison will make you sick but a large dose will do you in. The protective gear that caregivers wear for many hours at a time is uncomfortable and unless it is donned properly and adjusted frequently it causes exposure to infection. That especially applies to medical-grade face masks. Caregivers have been under the kind of stress that few of us can appreciate and they have been doing this for nearly a year. Chronic stress can lower the immune system; in a high-risk setting it can be fatal, as the large number of healthcare workers who have died has shown. Dr. South has undoubtedly received a vaccine but there are other considerations that she is surely aware of.

             First, very few vaccines are 100 % effective. Persons who are immune-compromised have a poor response to vaccines and so do persons who are obese – currently 42 percent of U.S. adults. That’s a lot of poor-responders. Sometimes the specific sample of the vaccine is ineffective because of improper storage. This occurred a couple of decades ago when the measles vaccine was kept in refrigerators whose door shelves were not cold enough to preserve the vaccine. The first two coronavirus vaccines released so far have extremely low temperature requirements for storage. Some facilities and some personnel may not be as competent as they should be. The risk of vaccine failure for this reason is probably small but it is real.

            There is considerable fear among healthcare workers and the general public that these are unproven – some use the word “experimental” — vaccines. We have enough evidence that the vaccines now being distributed provide a strong protective response and serious side effects have been uncommon and treatable but there’s more to the story. Will we see serious side effects in the months or years to come? We don’t know. If vaccine recipients are exposed to the natural virus next year will they be protected or will they have even worse disease? We don’t know. How long will protection last? We don’t know.

            Dr. Tom Friedman, former director of the CDC, is concerned that vaccine recipients might be free of disease after later exposure but if they are reinfected they might still be able to transmit the virus to others. Again, we don’t know, but my personal feeling is that the risk of that is very low.

            All viruses mutate but so far it seems that the current mutations do not negate the protective effects of today’s vaccines. Could that change? Of course, but vaccine developers are watching that closely and may have to modify their product. We do that every year with the influenza vaccine.

            Let’s assume the best-case scenario: the vaccine that you received caused nothing more than a sore arm and feeling punk for about a day. The vaccine will prevent you from becoming ill with this virus for at least a year. Studies later will show that you cannot transmit the virus to others. The virus is stable and you don’t need another variant of the vaccine.

            You won’t get complete protection even in this best-case scenario for at least a month after your second dose and you could be infected – and infectious – until then. It is this fact that has prompted the warning that we need to keep wearing a mask after vaccination. Less worrisome reasons are those that I mentioned above: faulty vaccine and mutations.

            If you are in a vulnerable group, i.e., over 60 years and/or with a comorbidity such as obesity (I include overweight), diabetes, heart disease, hypertension or kidney disease, get the vaccine as soon as you are able. If you are young and healthy I suggest waiting until those who are not have been protected, which will probably take until about April 2021. By then we should have answers to most of the questions that are of concern to those who have been refusing the vaccine until now.

            That is, of course, unless this rascal of a virus unleashes another surprise!

Lifestyle

            Snacks can make or break a diet. The kind that you find while you’re standing in line at the checkout counter are probably the worst, even the trail mix or beef jerky. Some trail mixes have well over 100 calories per ounce and a piece of beef jerky that weighs a little more than a half-ounce can contain as much as 440 milligrams of sodium – about 20 percent of what you should allow yourself in a whole day.

            The ideal snack should contain enough fiber or protein to satisfy your appetite. A piece of fruit averages only 50 to 75 calories but the fiber leaves you feeling full. A single handful of nuts, especially almonds or walnuts (for the engineers and accountants in the audience that’s about 12 pieces or about ½ ounce) will provide about 80 or 90 calories. That will also give you some protein and some omega-3 fats, both of which will give you a feeling of fullness – especially if you eat them slowly!

            Diet gurus sometimes recommend a tablespoon of peanut butter on a stalk of celery. Nice theory but who has the time to make it – and not find something else that’s more appealing and convenient in the refrigerator to nibble on, like ice cream?

            Dried fruit? Not such a good choice because it’s high in sugar. After all, 6 apricot halves are the equivalent of 3 whole apricots, and four prunes are the equivalent of four plums. Do you usually eat that many pieces of fresh fruit at one time?

Carvings                      January 15, 2021

The risk of COVID-19: it’s not just being old

            The pandemic has taken a dreadful toll among the senior population. The vast majority of deaths have occurred among persons over the age of 65. One estimate is that about ten percent of persons living in senior facilities have died, at least indirectly, from COVID-19. San Diego County is an example; 88 percent of deaths have occurred in persons over the age of 60. Those below the age of 40 account for only 1.1% of the fatalities.

            If age were the most important factor those over the age of 100 would surely have zero chance of survival. Yet as of the middle of January there have been at least two hundred people over the age of 105 (!!!!) who have tested positive for the virus and remain alive. The oldest confirmed survivor is a 113-year-old woman in Spain, a country that has suffered severely during the pandemic. Maria Morera is not obese or even overweight and thus has none of the diseases that are the consequences of having excess body fat and that play a major role in a morbid outcome. The oldest woman in Spain, she is bright-eyed and alert, noting that “I am old, very old, but not an idiot.” What an inspiration!

            Maria is fortunate in having an immune system that is strong enough to have overcome COVID-19. Not all seniors are so lucky; aging itself does take a toll on the immune system. However the stark truth is that most older persons are overweight or obese, triggering other comorbidities. Some have lost weight as they have aged but not the burden of their past: type 2 diabetes, heart disease, coronary artery disease and poor kidney function. These are the classic comorbidities of COVID-19. Another is chronic obstructive pulmonary disease (COPD) because nearly half of today’s seniors were smokers; smoking history accounts for nearly 90 percent of that lifestyle-destroying affliction.

            At the time of the last great pandemic, the influenza scourge of 1918-1919, about five percent of Americans were obese; that number is now an appalling 42.4 percent. In addition to contributing to the comorbidities mentioned, excess body fat adds fuel to the pandemic fire in two other ways. Fat tissue contains cells of the immune system and the more fat the more of these cells. During infection with SARS-CoV-2 these cells produce an overreaction, the cytokine storm that is almost always fatal.

            As noted in earlier blogs, COVID-19 victims who are deficient in vitamin D are several times more likely to be infected with the coronavirus, to require ICU care and to die. Vitamin D is critical for normal immune function but fat tissue acts as a vitamin D sink, preventing this hormone-like chemical from exerting its protective effect.

            Finally, what if the rate of obesity were the same today as it was during The Great Influenza of a century ago? Think about it.

Lifestyle

            Taking in less sodium isn’t going to do much for weight loss but it will certainly improve your overall health.  Americans take in about 5 times (!) as much sodium as they need, contributing to the current epidemics of high blood pressure, heart disease and osteoporosis.

            The sodium intake of hunter-gatherers in Africa is about 600 milligrams per day and the incidence of hypertension (high blood pressure) in that group is almost zero. The diet of their genetically identical cousins in the United States contains about 3500 milligrams of sodium each day, a major factor in the very high incidence of hypertension among blacks in this country.

            Most of our daily sodium intake comes from packaged, processed food. That’s why it’s so important to read the Nutrition Facts label on every package. If the sodium content is over 500 mg. (milligrams) per serving, take a pass.

            There are plenty of tasty substitutes for salt but potassium chloride isn’t one of them. Most users complain about the taste. However, there are plenty of spices that you can use to brighten up your menu. Just start experimenting.

            When you cut back on salt you’ll notice that you start losing your taste for salty foods in just a few weeks. If you are one of the 20 percent of Americans that are salt-sensitive you’ll also find that your blood pressure is coming down as well. That lowers your risk of heart attack and stroke, which together are the leading cause of death.

Pandemic Perspective #39     January 9, 2021

COVID-19 – Still a mess!

            SARS-CoV-2 is providing humanity with more twists and turns than any novelist could dream up. Among a myriad of different kinds of tests none is reliably accurate. We don’t even know how many Americans have been infected. The official number cited by the Johns Hopkins Coronavirus Resource Center on January 8th was nearly 22 million, more than six percent of the population, but some epidemiologists state that the actual number may be ten times as high. (BTW: when you see a number that ends in zero you can bet that it is a guesstimate, not an estimate.) We don’t know if persons who have recovered from the infection will have permanent immunity or whether the vaccine will provide that either. Of course, with the number of vaccine candidates now more than 200 it will be a very long time before we know which one is best and how much protection each one will provide. Can a person be infected more than once? Yes, but the number is reassuringly low, at least at the moment!

            So is there any good news? Yes, namely that the first two vaccines that have been released have an effectiveness of about 95 percent – better than many vaccines, especially the one for influenza. In one trial thirty persons developed severe infection but they were all in the placebo group; none of those who received the actual vaccine became seriously ill.

            More good news is that by the end of 2021 most of the U.S. population will have received a vaccine. There has been a lot of criticism of state and federal authorities for their seeming sluggishness but in the larger picture the delay of a month or two in the face of the worst pandemic in a century is (in my humble opinion) acceptable. My reason for giving them some slack is not just the enormity of the task but that these vaccines require storage and transport at extremely low temperatures that most of the medical facilities in the country have never needed to consider.

            One final confounding issue: if you have had a documented infection with this coronavirus, should you still receive the vaccine? The prevailing opinion among virologists, immunologists and epidemiologists is yes. They note that some persons do not develop lasting immunity in the course of infection. Some scientists feel that the immunity produced by the vaccine is stronger and more consistent than that formed by natural infection. That is counter to what we know of most viral infections, a reminder that this virus is not like any other.

            The controversies and confusion that marked 2020 are not going to go away soon. We might shed our masks this year but not our wariness. Most of us will probably continue to limit interaction with persons beyond our circle of family and close friends. But we will do that in our our favorite restaurant!