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 presentations

Upcoming presentations in the San Diego area are scheduled for the Osher Lifelong Learning Center, Cal State San Marcos (www.csusm.edu/olli) and the OASIS Adult Learning Center (www.oasisnet.org). Dates, times and locations are posted on their websites.

Avoiding modern diseases –  Osher Lifelong Learning Center at the Temecula Higher Education Center,  February 19 and 26, March 5 and Mission San Luis Rey, March 22 and 29, April 5. Topics include Ten steps to avoid cancer, Baby Boomer blindness and Ten ways to avoid dementia and Alzheimer’s disease.

Sleep, light and health, Mission Valley Library (OASIS) February 20, 1:00 p.m.

Dieting Guidelines

Cravings occur because sheer survival is built into our behavior. Survival is an overriding instinct, so don’t feel guilty when you have cravings, even when they make you do irrational things like raiding the refrigerator when everyone else is asleep.

You can avoid cravings by snacking on foods that are high in fiber and low in calories, such as most fruit. Don’t be concerned about fruit sugar; a normal piece of fresh fruit usually has only about 70-80 calories but the fiber will satisfy your appetite. Protein snacks, such as protein food bars, will also help to prevent cravings but they should contain only small amounts of carbohydrate and fat.

A hint: eat snacks slowly. That’s especially true of nuts, a small handful of which will usually contain a little more than 100 calories but that is very filling – if you eat them slowly!

In the news

Tiny turtles – cute but dangerous.

Many of us had little turtles as kids, usually from the local Five-and-Dime with an American flag painted on the shell. But for decades those pets have been responsible for thousands of cases of illness due to various strains of Salmonella. The germ usually only causes diarrhea but in the very young and the very young it can cause serious bloodstream infection and even death.

The Centers for Disease Control has banned the interstate sale of small (carapace less than four inches in diameter) turtles since 1975 because of the high risk. Salmonella bacteria are common in turtles and the water of the tanks in which they are kept – and kids love to pet and kiss those cute critters.

Banned or not, tiny turtles continue to cause outbreaks, the latest in November of 2017 that spread to fourteen states. More than a third of the victims were below the age of five years.

 

Area presentations

Area Presentations

Upcoming presentations in the San Diego area are scheduled for the Osher Lifelong Learning Center, Cal State San Marcos (www.csusm.edu/olli) and the OASIS Adult Learning Center (www.oasisnet.org). Dates, times and locations are posted on their websites.

Avoiding modern diseases –  Osher Lifelong Learning Center at the Temecula Higher Education Center,  February 19 and 26, March 5 and Mission San Luis Rey, March 22 and 29, April 5. Topics include Ten steps to avoid cancer, Baby Boomer blindness and Ten ways to avoid dementia and Alzheimer’s disease.

Sleep, light and health, Mission Valley Library (OASIS) February 20, 1:00 p.m.

In the news

After a few decades of being warned of the danger of cholesterol in eggs Americans are now being told that hen’s fruit is not the risk that we thought that it was. First, not all cholesterol is bad. “High cholesterol” is a meaningless term. It usually refers to the total cholesterol level but there are several different forms of cholesterol. High-density lipoprotein (HDL) is a beneficial marker of heart health while low-density and very low density lipoproteins (LDL and VLDL) should be the targets of treatment. It is these latter two forms of cholesterol that are clearly linked to the risk of coronary artery disease and heart attack but that is not the whole story. Persons whose blood cholesterol levels are normal often are victims of heart attack. Several other factors, especially high blood pressure, are part of the picture. Inflammation, largely due to excess body fat, plays an important role in heart attack and stroke.

Second, unless the intake is very high, cholesterol in the diet does not raise the level of cholesterol in the blood. The more cholesterol we eat the less the liver manufactures. This feedback mechanism ensures that we will maintain enough cholesterol to produce hormones, vitamin D, bile (needed for digestion) and other vital components. It also keeps blood levels from going too low, a condition that is associated with significant neurological problems, including depression and aggressive behavior.

Eggs have been part of the human diet since the Stone Age and our ancestors had a huge variety of birds’ eggs compared to chicken eggs, our only one. Even so, chicken eggs are a valuable source of protein, vitamins, calcium and iron.

When we eat eggs they are almost always part of a meal that includes saturated fat, the real cause of elevated cholesterol. Bacon, sausage, ham and other “egg helpers” that include butter and hash brown potatoes are hardly heart-healthy. On the other hand, an omelet made with assorted vegetables eliminates the saturated fat and includes healthy fiber, more vitamins and antioxidants.

Is there a limit to the number of eggs that we can safely eat in a week? One or two eggs most days of the week will have zero effect on your blood cholesterol. The exception might be persons with a genetic trait that keeps their cholesterol levels abnormally high. For the rest of the population, enjoy those veggie omelets – without the saturated fat!

Lifestyle

Hypertension, type 2 diabetes and colon cancer share some important characteristics. They affect large numbers of people, they are silent for long periods, they are difficult if not impossible to cure when they become established and they can be identified in their earliest stages with non-invasive screening tests. To be sure, there are other conditions such as coronary artery disease that kill more Americans but in that specific example there is no simple, reliable, non-invasive test that can identify its victims. In fact, among the 1,000 persons who die each day of sudden cardiac arrest, death is the first symptom of heart disease.

Yet, many heart disease victims’ lives could have been extended, perhaps for decades, if they had been screened for high blood pressure. Hypertension usually develops gradually over several years and it causes almost no symptoms. It is the single most important treatable cause of heart disease and stroke and it often begins in early adolescence. Everyone should have an annual blood pressure check starting in childhood, especially those who have a family history of heart disease or stroke, or who are overweight or obese.

Blood pressure devices are so inexpensive, reliable and easy to use that every family should have one. Since a single blood pressure reading is not diagnostic, especially in the stressful atmosphere of a physician’s office, measuring it a couple of times a day over several days is worth the time and effort. The upper number (systolic) should be less than 125 and the lower (diastolic) less than 80. It’s true that blood pressure increases with age but that is not normal; it is simply common.

We are in the midst of an epidemic of type 2 diabetes. Everyone should be screened with an annual fasting blood sugar starting at age 40. For those with a family history of the disease, obese individuals or any non-Caucasian, screening should start in adolescence. More than half of those who have type 2 diabetes have at least one complication at the time of diagnosis. The blood test can identify persons with pre-diabetes, half of whom will develop full-blown disease within a decade.

Colon cancer screening begins with a test for blood in the stool, done once yearly from age 50. A colonoscopy should be done at that time and repeated at 60. Yes, the preparation is uncomfortable but sedation makes the procedure itself quite tolerable. It can be a lifesaver.

 

 

 

In the news

Ignore those life expectancy numbers

Life expectancy is a number that is useful to actuaries who deal with population statistics, to healthcare planners and to the journalists who write about it. It has nothing to do with how long you will live. Life expectancy in the United States is more than eighty for women and somewhat less (seventy-six) for men. The not-so-good news is that life expectancy has decreased for two years in a row, the fall attributed to the rampant abuse of opioids. If drug-related deaths do not decrease this year and the flu season is worse than most years we can expect another decline, shattering a record that will provide much hand-wringing at all levels of government, in the halls of academia and in the media. The steady increase in drug-related deaths does demand our attention because it mostly affects those in mid-life, destroying families and ending productive careers. Perhaps the most frustrating aspect of the opioid problem is that these deaths are entirely preventable. Influenza deaths are also largely preventable. Although the influenza vaccine is far from perfect it does reduce mortality at both extremes of life, the very young and the very old, whose deaths are almost always due to secondary bacterial infection, not to the virus itself.

Although heart disease is still the leading cause of death in the United States, improvements in diagnosis and treatment have slowed its climb. Diabetes reportedly accounted for fewer than 80,000 deaths in 2015 but that is a misleading statistic. Type 2 diabetes now affects nearly ten percent of the population and contributes to heart disease and stroke, a fact that is not usually reflected in death certificates. Obesity is not listed as a cause of death in official records but it is a very important contributor to coronary artery disease and it is linked to more than a dozen cancers. Chronic lower respiratory disease, third on the list, is almost entirely the result of smoking.

As individuals it is within our power to postpone if not to avoid six of the seven leading causes of death: heart disease, cancer, lower respiratory disease, accidents (nearly half of which include drug/opioid victims), stroke and type 2 diabetes. Persons who maintain normal weight and do not smoke or use drugs don’t have to pay attention to life expectancy figures. Good habits will help you to exceed those numbers by a couple of decades.

 

In the news

 

Avoid false blood pressure readings

High blood pressure is the single most important factor in heart disease and it is a major factor in stroke. Another consequence is a significantly greater risk of dementia.  In the past a reading below 130/80 (systolic/diastolic) was considered normal; a reading above 140/90 was diagnostic of abnormally high blood pressure (hypertension).  The new guidelines lower those numbers so that nearly one-half (forty-six percent) of Americans are now considered to be hypertensive. According to the newest guidelines from the American College of Cardiology and the American Heart Association, persons whose blood pressure is 130/80 or more (either number) are considered to have high blood pressure. A blood pressure less than 120/80 is the new normal.

Taking one’s blood pressure is not as easy as it looks, even with the latest automatic devices, and falsely high readings are common. White coat hypertension results from anxiety and even physicians are not immune from this distortion. A few minutes of rest, both physical and and mental, are helpful. The check-in routine in most medical offices thwarts the process. Minor factors that each push the numbers up can lead to a false diagnosis of hypertension and unnecessary treatment. A cuff that is too small gives erroneously high readings; the arm should be on the same level as the heart and resting on a table, desk or the armrest of a chair; the legs should be uncrossed and both feet flat on the floor. The cuff should be placed on the bare arm, not over clothing. It helps to avoid caffeine and alcohol in the hours prior to the visit to the doctor’s office. Even when the measurement is done correctly the diagnosis of hypertension, unless other factors dictate otherwise, should await a second measurement on a different day.

There are numerous prescription medications that lower blood pressure but all of them have side effects and of course, are expensive. Persons with mild hypertension can almost always bring it back to normal with a few simple measures: losing a few pounds, lowering salt intake and increasing potassium intake by adding several servings of fruits and vegetables to the daily menu. For most people, taking the time for moderately intense exercise at least four days a week for about one hour is the most difficult step but it is perhaps the most effective.

Digital devices for home monitoring are inexpensive and are recommended in the new guidelines.

Exercise Tips

If you are not already exercising, consider that until the development of mechanized transportation and labor-saving devices, the average human burned 4 or 5 thousand calories a day in finding food and getting the chores done.

Some basic facts about exercise:

Your body is designed to be moderately active almost every day.

“Exercise” doesn’t only mean the things we do at the fitness center.

It is absolutely impossible to become musclebound.

The benefits of exercise include much more than losing weight or                                        avoiding a heart attack.

No one is too old to exercise.

Almost no one is too sick to exercise.

Using about 500 calories per week is not an ordeal and it will result in the loss of about one pound per week if they are not replaced with food.

 

Area Presentations

Upcoming presentations in the San Diego area this winter are scheduled for the Osher Lifelong Learning Center at Cal State San Marcos (www.csusm.edu/olli) and at the OASIS Adult Learning Center (www.oasisnet.org). Dates, times and locations are posted on their websites.

Scheduled presentations include: Being a kid in the Stone Age, Ten ways to prevent dementia and Alzheimer’s disease, Ten ways to prevent cancer, How to prevent blindness as you age, Health benefits of wine and chocolate, and more. We’ll keep you posted.

If you are looking for a speaker for your organization there are more than sixty-five PowerPoint presentations listed at http://www.stoneagedoc.com.

In the news

A better shingles vaccine

Herpes zoster, known as shingles, is a very late complication of chickenpox, a disease that was common when today’s seniors were kids but that is now almost nonexistent because of the chickenpox vaccine. Shingles begins when the chickenpox virus that has lain dormant within nerves of the spinal cord emerges because of an aging or compromised immune system. It begins with an itchy or tingling sensation, usually on one side of the chest or abdomen. Over several hours the pain increases and a rash appears in the form of small blisters that may form an angry red cluster. After about a week the rash begins to disappear but some patients have pain in the area that can last for years. When the rash involves the face it may result in eye damage, even loss of vision.

If an antiviral drug is taken during the first twenty-four hours the attack may be halted but vaccines are now available that can prevent the disease or at least modify it considerably. The first of these was released in 2006. Although it prevented the disease in only a little more than fifty percent of patients it did make the disease milder in most recipients.  A new vaccine, Shingrix, was approved in October 2017. It is almost twice as effective as the older vaccine but it requires two doses, two to six months apart. Side effects such as pain, redness and swelling at the injection site may occur and some persons experience headache, fatigue and generalized muscle pain. These short-lived and generally mild symptoms must be counterbalanced against the risk of severe, long-lasting pain and occasional blindness that occur with shingles. It’s estimated that about one out of three people over the age of sixty will develop shingles; for those over the age of eighty-five the risk is more than fifty percent.

Persons over the age of sixty should be vaccinated even if they received the earlier vaccine and even if they have had shingles in the past. The new vaccine, in addition to being ninety percent effective, provides protection for at least nine years.

Some pharmacies expect to start receiving the new vaccine in December but it will probably not be available until January or February in most areas.  Most private insurance plans cover the cost of the vaccine and so does Medicare Part D. Some plans may require payment by the patient.

Only about thirty percent of eligible persons received the old vaccine. Shingles is a debilitating illness that no one should endure, especially in the golden years.

The Osteoporosis Cocktail – bottoms up!

Calcium is important for strong bones and the prevention of osteoporosis but it’s only a start. Important bone-building nutrients include protein, magnesium, boron, omega-3 fats, vitamins A, C, K and D as well as trace minerals such as copper, manganese, zinc and others.

The good news is that almost all these nutrients are present in a diet that includes whole grains, fruits, vegetables and fish. The bad news is that only four percent (!) of Americans get the recommended amount of all these nutrients every single day AND also get a moderate amount of bone-building exercise at least four times a week. That’s why  a daily multivitamin/multimineral is good insurance, especially for older persons.

Osteoporosis is not inevitable just because we get older but it seems that way because it’s so common. It simply doesn’t happen even among the oldest modern-day hunter-gatherers.

 

 

October 27, 2017

Area Presentations

Keeping your wits: how to avoid dementia and Alzheimer’s disease, Wednesday November 15, 3:00 p.m. Encinitas Library.

Bone: not so boring, Friday November 17, 10:00 a.m. at Escondido Senior Center. Register at OASIS Adult Learning Center (www.oasisnet.org)

In the news

            Have you had your flu shot yet? If you think that you might get the flu anyway you may be right! The vaccine is rarely 100 percent effective but that’s not the point. What we do know is that persons who receive the influenza vaccine, especially seniors, are much less likely to be hospitalized with a complication.

Most people who die during an influenza epidemic don’t succumb to the virus but to secondary infection, such as that caused by Staphylococcus bacteria, many strains of which are now resistant to several antibiotics. And the last place you want to be is in the hospital where antibiotic-resistant bacteria are most likely to occur.

And you can’t get the flu from the vaccine! It’s made from a killed virus. But you might get the flu in the couple of weeks that it takes for the vaccine to protect you. So don’t wait!

Lifestyle

Dieting Guidelines

You’ve probably heard that by using a smaller dinner plate it will appear that there is more food there and you will eat less. The reverse is also true. If a plate is bigger and you fill it yourself you’ll put more on it – and you’ll probably clean your plate!

Some ingenious researchers with a sense of humor went a little further. They offered Philadelphia moviegoers fresh popcorn in either a medium-sized bowl or a large one. (There is no such thing as a “small” popcorn bowl in a movie theater.) The large-bowl folks ate 45.3 percent more popcorn than those who had a medium-sized bowl. But the sadistic researchers went a step further. They did the same thing with stale popcorn – and the people with large bowls ate 33.6 percent more than the medium-bowl subjects.

Even persons who should know better can fall into the trap. When a group of 85 nutrition experts were invited to an ice cream social, they were given either a small bowl or a small scoop or a large bowl or a large scoop, and were told to serve themselves. If they had a large bowl they took (and ate) 31 percent more ice cream. Those who used a large scoop gave themselves 14.5 percent more, whether they had a small or large bowl.

Take a look at your mealtime habits and ask yourself if you can make a few changes to take advantage of this nutritional illusion!

 

 

October 9, 2017

Area Presentations

Upcoming presentations in the San Diego area are scheduled for the Osher Lifelong Learning Center at Cal State San Marcos (www.csusm.edu/olli) and at the OASIS Adult Learning Center (www.oasisnet.org). Dates, times and locations are posted on their websites. Titles include Health benefits of wine and chocolate, Keeping your wits: 10 ways to prevent dementia and Alzheimer’s disease, Probiotics: feeding the germs that keep us well, Bone: anything but boring, Being a kid in the Stone Age.

In the news

            Hepatitis A: everyone should get the vaccine because you can never know when you will be exposed to the virus. It could be at the beach, at a fancy restaurant or when having dinner at the home of a friend or relative. Salt water, even lots of it, won’t kill or dilute the virus if there is a sewage spill and the authorities might not even know about it the day you go for a swim. Persons who are infected can spread the disease before they have obvious symptoms and not everyone is a scrupulous hand-washer.

The hepatitis A vaccine is extremely effective, protection lasts for a lifestyle and side effects are rare. It’s not cheap but neither is a hospital stay.

Lifestyle

Dieting Guidelines

Consider the first three letters of the word diet. That should serve as a reminder that purposeful starvation or even marked calorie restriction are not normal human behaviors. Before the modern era such events did occur and humans developed the capacity to tolerate prolonged hunger. True famine was extremely rare.

In order to avoid the body’s reaction to starvation, such as slowing of the metabolism, cravings or the urge to become inactive, don’t cut back too much on calories. By lowering portion sizes to about 75% of what you usually eat and by having small, calorie-sparse snacks between meals, you can easily cut about 500 calories from your daily intake. If you do that consistently you will lose about one pound per week. Another pound should melt away if you exercise at least one hour about 4 times a week.