About stoneagedoc

Pediatric infectious diseases specialist, author and public speaker. After 35 years in clinical practice including 40 years in academic pediatrics I now share that experience in helping others to enjoy a long, healthy life without the burden of chronic disease.

Upcoming presentation

Tuesday, December 10, 12:30, Mission Valley Library. Immunizations: The good, the bad and the future. Vaccines have been around for centuries and they are responsible for the eradication of several deadly diseases. They are not entirely benign, however. Immunization is no longer only for children. There are at least two adult vaccines that can save your life. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

In the news

We underestimate the need for exercise.

Humans have evolved to require moderately intense physical activity every day, a concept that we discussed in this blog nearly a year ago. Now we have more compelling reasons to be active, in other words, to exercise.

A research team in Norway looked at the lifestyles of more than 23,000 young people and monitored their activity periodically for 22 years. They found that those who were inactive were twice as likely to die during the study and nearly three times as likely to die from heart attack or stroke compared to their fellow Norwegians who were physically active.

What does “physically active” mean? It’s not really intense – 150 minutes per week (2 ½ hours) of moderately intense exercise, being able to just about break a sweat, or 75 minutes (1 ¼ hours) per week of vigorous, intense, aerobic activity. Those who got religion, that is to say that they began to exercise more often and with greater intensity during the study, had survival rates between the figures noted above.

The 150-minute figure is interesting for two other reasons, just coincidentally. Another study showed that persons with prediabetes who walked for about 2 ½ hours per week were much less likely to cross the line to type 2 diabetes in the following several years. In still another study, women with osteopenia, the stage of bone loss that precedes osteoporosis, gained bone mass during the course of about one year with 2 ½ hours per week of vigorous walking.

Does it help to exercise even more than 2 1/2 hours a week? Yes, as we learn from senior athletes, especially those            who compete in various sports. But it’s nice to know that even moderate activity has real benefits.

 

Lifestyle

Another annoyance of aging: alcohol intolerance.

          About the time we approach the end of middle age we notice that we feel the effects of alcohol after fewer drinks than in the past. It bruises our ego a little but there’s more to it. We’ve known for a century or so that driving under the influence of alcohol is responsible for tens of thousands of deaths each year. Alcohol-related falls are also a major problem, especially when so many seniors are on blood-thinning medications and even a relatively minor bump on the head can lead to fatal bleeding within the brain.

So why are we more sensitive to the effects of alcohol? The major reason is that we have a smaller percentage of body water in which the alcohol can be diluted, so our blood levels – and hence brain levels – are higher than they would have been a few decades ago.

The obesity epidemic is having an effect. Most Americans have lost muscle mass by the time they reach middle age and it has been replaced by fat. As with lower percentages of body water, lower muscle mass also results in less volume in which to dissolve the alcohol.

To a lesser extent we have lower concentrations of the enzymes in the stomach and liver that help us to break down alcohol.

The lesson is clear: two glasses of wine or the equivalent should be the limit for most mature adults. You might even have noticed that you’re not quite the same after only one glass of wine. My solution is simple: stop at two glasses and switch to water. It’s good bet that no one will even notice – because they’re still drinking alcohol.

 

 

 

 

 

 

 

 

 

 

Variety is the price, not the spice, of life

Tens of thousands of years ago, when our body chemistry was evolving, humans had a choice of hundreds of different kinds of plant and animal foods. That is what nature has designed for us so why are we squandering such abundant variety? A more important question: can we afford to ignore the cornucopia that our bodies require for good health?

Our lack of nutritional diversity is obvious in the produce section of any supermarket. Count the vegetables. You’ll find between 30 and 40 – but not really. There are three or four varieties of carrots, lettuce and cabbage and perhaps four or five varieties of tomatoes. The differences between them are really pretty small compared to what our Stone Age ancestors enjoyed thousands of years ago.

Nothing illustrates this better than birds and their eggs. How many species of birds (and their eggs) would you have encountered back in the Stone Age? Certainly more than the only two in our modern markets: chickens and turkeys and only the former provide us with eggs. How boring!

Ninety percent of the worlds’ food supply comes from only 17 plant species. When we discarded the rest we also lost the diversity of protein, vitamins, minerals and antioxidants that a varied diet produces, to say nothing of scores of different flavors. When the first farmers limited their food supply mostly to cereal grains that are easy to cultivate, harvest and store, they became more prone to disease, had smaller stature and shorter lifespans.

A first step in regaining diversity might be to explore genuine ethnic foods – Chinese, Indian, South American and Vietnamese. Take your time to explore your favorite produce department. I’ll bet that you’ll find at least three or four vegetables and fruits that you’ve never tried. It’s a start.

Continuing the Annoyances of Aging: loss of appetite.

          If you’ve noticed that your interest in food has decreased or that you feel full earlier than a few years ago, the most likely reason is that you have become less active and your body just doesn’t need as many calories. Of course if your appetite has not changed in spite of your being less active, you’re likely to gain weight, something that is quite typical in the modern age.

Along with gray hair and wrinkles we begin to lose our sense of taste and smell, so food just doesn’t seem as appetizing. I consider that a plus; nature is accommodating our decreased need for calories.

Several different prescription medications can depress the appetite, including pain relievers such as acetaminophen (Tylenol), opiates, blood pressure medications, antibiotics and chemotherapy.

Sometimes the loss of appetite is a sign of a medical problem and there are two that are rather subtle and have few other symptoms: thyroid disease and depression.

When there are other symptoms such as weight loss, increasing fatigue, a change in urinary pattern or persistent cough it’s time for a doctor’s visit. With early treatment conditions such as diabetes, heart disease and even cancer are likely to have a favorable outcome.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Upcoming presentations

Monday, November 4, 11:30 a.m. Hidden Crises, creative Cures. What is happening to the healthcare system and how we can improve it. We’ll examine the root cause of the impending meltdown of the healthcare system and what we as individuals can do about it. Escondido Senior Center, 210 E. Park Ave., Escondido. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org

Wednesday, November 13, 1:00 p.m. The True Mediterranean diet. It’s not what you’ll find at your local pizza parlor but it’s a key to a long and healthy life. Point Loma Library, 3701 Voltaire St., San Diego. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org

In the news

From the San Diego Union-Tribune: Can a single pill keep you healthy to 100?

He was no scientist but Ponce de Leon was the poster child for the Fountain of Youth and that’s still a goal for much of humanity. The latest entry is a pill called RTB101 and it works by boosting the immune system. In the few trials on humans so far it improved the response to the flu vaccine and reduced the incidence of colds, bronchitis, influenza and pneumonia.

Unfortunately, infections are far less common as causes of death than heart disease and cancer. A major driver of heart disease, stroke and type 2 diabetes is obesity, which also is a major factor in cancer, osteoporosis and numerous other lifestyle-destroying conditions. The latest survey on obesity shows that it affects more than 35 percent of the population and in some regions it is more than 40 percent!

Don’t hold your breath until RTB101 comes to your local pharmacy. While you’re waiting, you can boost your immune system by shedding a few pounds, adding more protein to your diet and getting more vitamin D. And be sure to protect yourself from infection by keeping your immunizations up to date: influenza, shingles and pneumonia.

 

Lifestyle

Avoid the annoyances of aging; another cause of decreased energy

          Poor circulation contributes to decreased energy for a couple of reasons. When muscles lie dormant for more than a few days the blood vessels that supply them lie dormant too. After all, they have nothing to do. When we become active, increasing the rate and the intensity of the heartbeat, the increase in blood flow causes those vessels to open up to provide more oxygen and thus more energy to muscles. That also removes accumulated waste products. It all adds up to more energy.

Regular physical activity that pushes the heart to send more blood flowing has a long-range affect too: it keeps blood vessels flexible so that in times of stress, those vessels can accommodate increased blood delivery, more nutrients and more oxygen. Your heart and brain will really appreciate that! The result is a greatly reduced risk of heart attack and stroke.

When you begin an exercise program you’ll notice an increased energy level in just a few days, certainly by the end of the second week. Be careful, however, to start slowly if you haven’t been active for a long while. Your first walk should be no more than 15 or 20 minutes; gradually work up to a brisk pace for at least an hour.  At the gym, begin with the lowest weights on the machines or free weights in order to avoid the next day’s muscle soreness.

         

 

 

 

 

 

 

 

 

In the news

Influenza vaccine by the numbers

The flu season is here and the first deaths have already been reported in San Diego. Some unsettling news is that there have been twice the usual number of cases here compared to last year.

“The flu vaccine doesn’t always work.” That’s true but it’s clear from studies over several years that if you get influenza in spite of having received the vaccine your illness will be milder, which means that you are less likely to be hospitalized.

Remember! Most deaths are due to secondary bacterial infection, not the virus, and hospitals are incubators for bacteria, some of which are resistant to most antibiotics.

From the CDC (Centers for Disease Control and Prevention): in a five-year study, vaccination reduced the risk of severe outcomes by 36%; for those over the age of 65 vaccination reduced the risk of admission to the intensive care unit by 28% and reduced the risk for mechanical ventilation by 46%!

“I’m going to wait to get the flu vaccine because it doesn’t last for the whole season.” Although there is a measurable drop-off in effectiveness of the vaccine by the end of the flu season the decline is not worth waiting. You might be one of the early victims. For those over the age of 65 and persons with an underlying condition, especially asthma or heart disease, the wise decision is to get the vaccine in October.

Lifestyle

A new series: Avoid the annoyances of aging.

      This is taken from my newest PowerPoint presentation, which has received a very enthusiastic response. So much of what we encounter as we get older is often dismissed as the price we pay for lasting long enough to collect that first Social Security check. Maybe. But some of the conditions in the blogs that follow are symptoms of diseases that can be treated successfully.

There are some things that are inevitable but benign: gray hair, wrinkles, stiff joints and some that will go unmentioned. Sometimes we need a little help from our dermatologist. Some things take a little effort to overcome; some things take lots of effort to overcome. I have identified eighteen of these. It ain’t the Fountain of Youth but you’re bound to find something that will enhance your Golden Years!

  1. Decreased energy. A major reason for feeling pooped much of the time is simply that we have cut back on physical activity – what some people call “exercise.” Put simply, exercise is energizing and there are several reasons for that. Most of us are carrying around more weight than we did in our twenties, largely because we have cut back on physical activity. Seventy-five (the most recent estimate) percent of us are overweight or obese. The average American weighs 29 pounds more than he or she did in 1970. Imagine carrying a 29-pound backpack all day. Of course you’d feel tired much of the time. And if you weigh fifty or sixty pounds more than you did in high school – the current state of nearly forty percent of Americans — the effect is obviously worse.

When we don’t move our muscles vigorously every single day the smallest blood vessels in those muscles lie dormant, meaning that they are are closed, not supplying those muscles with energizing oxygen and nutrients and failing to remove accumulated waste products. Both factors are fatigue-inducing.

The remedy for almost all (!) age-related fatigue is simply to engage in some sort of physical activity most days of the week. I know – that’s easy for me to say. But I can guarantee that within as little as two weeks of about one hour most days of the week of moderately intense physical activity, both aerobic (walking, swimming, etc.) and resistance (exercise machines and weights) activity you are going to feel more energetic and less fatigued.

A couple of caveats: start slowly if you have not been very active. And get some advice from a trainer at the gym if you are going to use weights and machines.

Important! In spite of the above comments, fatigue can be a symptom of underlying disease, especially heart disease, high blood pressure, anemia, diabetes and thyroid disease. It’s a good idea to get a checkup before starting any exercise program.

There are several other reasons why we feel tired a lot and I’ll discuss these in subsequent blog posts.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Upcoming presentations

Saturday, October 5th, 10.00 a.m. at the Coronado Library, The new shingles vaccine and other immunizations for adults. What you learn may save your life.

Tuesday, October 8, 1:00, OASIS Center, Grossmont Center. Avoid the annoyances of aging. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org. What you think is part of the aging process may be a sign of underlying disease.

Wednesday, October 16th, 10:30 a.m. Escondido Senior Center. Body fat: all that jiggles is not the same. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org

Monday, October 28th 9:30 a.m. Cal State San Marcos campus, Rm. ELB 372, Avoid the annoyances of aging. Sponsored by Osher Lifelong Learning Center. To register see their web site at http://www.csusm.edu/el/olli or call 800-500-9377.

Wednesday, October 30th, 10:00 a.m., OASIS Center, Grossmont Center. Hidden Crises, creative Cures. What is happening to the healthcare system and how we can improve it. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org

In the news

Burgers – the Impossible Burger and the Beyond Burger. Are they ready for prime time?

Meat substitutes have been around for decades but they have never taken hold with the public, perhaps because they really don’t taste like real meat. That may be changing with the arrival of The Impossible Burger and the Beyond Burger. Are they safe? Are they nutritious? Are they better than real beef? That last question might depend on how you feel about the beef industry and GMOs (which are included in the Impossible Burger but not the Beyond Burger).

They are both OK with vegans, so how do they ooze that beef-like juice? In the Impossible Burger it comes from heme that is produced in genetically modified yeast; Beyond Burger’s juice comes from beet extract. No problem with either. In spite of stuff you’ll find in the Internet, GMO foods are entirely safe.

Differences between their nutrient content and beef is not a big issue even though the Beyond Burger has no vitamins – at least at the moment. Both faux meats have more sodium and calcium than beef patties but the former is not excessive and we can get the latter from a variety of sources. Each has about 20 grams of protein in a 4-ounce patty, a little less than beef.

Expect lots of new developments in this area, including meat that is grown in the laboratory. New products are already creeping into the market and the two discussed here are likely to be modified as the market matures.

Red meat is associated with some forms of heart disease and cancer while chicken and fish are not. The angst over energy resources, pollution and cow farts has already led to a decline in the demand for beef. If someone comes up with a really tasty and nutritious burger from something other than a cow you may see a real change in the coming decade.

But will we still call it a hamburger?

Lifestyle

Me? A Neanderthal??!!

           I got quite a surprise the other day when 23andMe reported that I have Neanderthal genes.  Not just a trace, which is not uncommon among persons of European ancestry.  It turns out that I have more Neanderthal “variants” than 96 percent of 23andMe customers! Considering that I am tall, thin and have almost no body hair that didn’t seem quite right until I read a little further: those “variants” account for less than 4 percent of my overall DNA.

The Neanderthals disappeared from the planet about 35,000 years ago and anthropologists can’t entirely agree on why. Homo sapiens (that’s the other 96 percent of me) appeared to have better tools and communication skills than the Neanderthals. Some of them probably had enough communication skills to sire offspring whose DNA can still be identified in a cheek swab.

Neanderthals were not the brutes that anthropologists of a century ago described and that you probably recognize if you still remember the comic strip character, Alley Oop. It’s clear from fossil studies that they cared for their crippled and their dead. Even their brains were bigger than ours, although probably not as complex.

I took the title of The Stone Age Doc about 25 years ago when I began writing and lecturing about how far we have drifted from our pre-Agricultural Revolution lifestyle. Little did I know where that interest came from – those genetic “variants.”

 

 

 

 

 

 

 

 

 

 

In the news

Vaccine benefits that most people are unaware of.

          The United States may soon lose its measles-free status as we are close to a record number of measles cases. Almost all the victims have not been immunized at all. Outbreaks are occurring because of the arrival of infected persons from other countries. Besides saving lives through the near-universal immunization of our population we ought to consider some unexpected benefits of vaccines.

As we age we are vulnerable to heart attack and stroke but persons who receive the influenza vaccine lower their risk of these killers in the months that follow vaccination. On the other hand, persons who develop influenza have an increased risk of heart attack and stroke in the six months or so following infection. The flu season has begun. The current vaccine’s effectiveness is unproven but if it follows the pattern of the past, even though it is not completely protective it does lower the risk of hospitalization – and a hospital, with all those superbugs, is NOT the place to be for us seniors.

Rotavirus infection causes diarrhea in children and it is a major cause of death in developing countries. America’s kids are safer because of the quality of our medical care but those who receive the rotavirus vaccine get another benefit: a lower risk of type 1 diabetes. Formerly known as juvenile diabetes because most of its victims are below the age of 20 years, it is often triggered by an infection. Before the development of the mumps vaccine that infection was often the prelude to type 1 diabetes. It looks like rotavirus may also predispose to type 1 diabetes in persons with a familial tendency for that disease. Victims of type 1 diabetes require daily insulin for the rest of their lives. It’s great to know that some people can be spared that burden by preventing one of its causes .

Lifestyle

Is the Keto Diet worth trying?

When you drastically reduce carbohydrates in your diet your body will begin to burn fat for energy, making you lose weight. That makes sense and most people will lose weight on the keto diet in the first few weeks. After that, not so much.

Pediatricians began putting kids on the ketogenic diet about a century ago to control epileptic seizures, as they were known back then. It often worked but it drove the parents crazy! Trying to keep a child on a diet that consisted largely of cream, bacon and similar foods while eliminating bread, cookies, fruit and sweets, etc., while the rest of the family enjoyed these things resulted in the kind of battle you could predict.

Dr. Robert Atkins’ low-carbohydrate diet was immensely popular a couple of decades ago but it was really hard to maintain for long, and controlled studies showed that after a year or so it was no better than other fad diets. The typical adherent lost an average of twelve pounds in twelve months. As my kids would say: “Big whoopee!”

The ketogenic diet is back, but this time in so many forms that confusion is rampant. There is no official definition and “low-carb” can range from 20 to 60 grams a day of carbohydrate. Hardly anyone can stay on that kind of diet for long and if they do they are likely to encounter the classic symptoms of ketosis: fatigue, bad breath, constipation or diarrhea, nausea, vomiting, muscle cramps, headaches and difficulty falling asleep.

One slice of whole wheat bread and a glass of milk will put you over the limit of carbs for the day, so will a single banana. One apple plus a serving of Trader Joe’s low-fat Greek yogurt will too.

Now we’re learning that those who maintain a ketogenic diet – which includes some not-so-healthy stuff like red meat, processed meats, salty foods, cheese, processed oils, etc. and few healthy items like most fruits and vegetables — have a lower life expectancy. A recently associated risk is atrial fibrillation, which can lead to stroke.

My choice of diets is the true Mediterranean diet, which includes fruits, vegetables, a little pasta, fish, chicken and of course, a glass of red wine!

 

 

Upcoming presentation

Friday September 13th at 1:00 p.m. at the Temecula Learning Center.  Avoid the annoyances of aging. Growing older is inevitable but many of the physical and mental challenges that seniors face are not. More than twenty such topics that range from decreased energy to liver spots, irregular sleep to poor memory can be postponed or even avoided completely. Sponsored by Osher Lifelong Learning Center. To register see their web site at http://www.csusm.edu/el/olli or call 800-500-9377.

In the news

A recent study involving more than 23,000 people from Norway who were followed for two decades confirmed what we have been preaching for many years: folks who exercise live a lot longer than those who don’t. Couch potatoes had an overall death rate more than twice as high as exercisers and nearly THREE times the risk of dying from heart disease.

Two particularly interesting points came out of this study. First the amount of exercise: 2 and ½ hours of moderate exercise a week, that’s enough to break out a sweat, did the trick. Those who had really intense aerobic exercise (running, biking, swimming, etc.) for only an hour and a quarter a week saw the same good results. (Note – that’s what the statisticians found but such infrequent, intense exercise is not very practical and hard to maintain on a regular basis.)

A really interesting finding was that persons who were inactive but got religion and got the optimal amount of exercise on a regular basis got real results – a life expectancy increase between that of non-exercisers and moderate exercisers.

The take-home message? All exercise matters even if you are a late starter and it doesn’t take a long daily workout to become healthier

What this study didn’t address but others have – exercisers simply have more comfortable lives, with less shortness of breath, fatigue, loss of energy, arthritis, depression and stronger immune systems. What’s that worth?

Lifestyle

Your mother was right! Eating slowly is better for you but not for the reasons I heard when I was a kid: “Don’t eat so fast! You’ll choke on your food.” “It’ll make you sick.” Well, that second part was right but the sickness would take years, even decades to develop.

When we eat fast we eat more. That’s because it takes about 15 or 20 minutes for our hard-wired appetite-control mechanism to let us know that we’ve eaten enough. It was once thought that this was a simple mechanism brought into play by a hormone called cholecystokinin that was released when the stomach was full. We should have known! Nothing is really that simple in matters of biology. Scientists now know that there are several mechanisms, some regulated by hormone-like chemicals that control appetite.

Some of this came to light after lots of people had a portion of the stomach removed to lose weight. They didn’t get as hungry as they should have when portion sizes were limited to something about the size of a golf ball. The part of the stomach that had been removed contained cells that produced one of the hunger-causing hormones.

The bottom line: follow Mom’s advice and eat slowly. You’ll end up eating less, especially if your meals consist largely of fiber-rich vegetables.