In the news

Don’t follow the crowd.

            It’s painfully obvious that the vast majority of Americans are heavier than ever. Forty-two percent are obese, i.e., 30 pounds more than standard weight for height and about 40 percent are overweight, i.e. 10 pounds more than standard weight for height. In other words, fewer than 20 percent of us are of normal weight.

            As a nation we are spending approximately one-half TRILLION dollars a year on healthcare for problems that shouldn’t exist. A century ago almost no one died of a heart attack or type 2 diabetes, which together account for more than one million deaths per year. This is not an “American” problem; it is occurring in every modern economy, with Germany and the UK not far behind us.

            The bad news: this is an unstoppable juggernaut. No politician has the courage to restrict highly processed foods that are at the heart of the problem, or to impose punishing taxes upon them.

            The good news: every one of us can avoid the non-infectious chronic diseases that afflict the masses. It’s not rocket science! Persons who exercise with moderate intensity for 4 or 5 days a week, who totally avoid refined grains and sugar, who eat several servings of fruits and vegetables every day – especially leafy greens – are much more likely than the other 80 percent to enjoy their golden years.

Lifestyle

Learn a language to postpone Alzheimer’s disease.

            Did you know that being bilingual can delay the onset of Alzheimer’s Disease by six years, on average? It’s probably because when we learn a new language we increase the number of connections between brain cells. When the abnormal proteins (amyloid and tau) of Alzheimer’s Disease clog up some of those connections, you will still have a reserve of undamaged links that will maintain memory and cognition.

            Learning a new language can get really boring when it’s taught the way it is in most high schools and colleges, long hours trying to memorize vocabulary and grammar. Attaining fluency takes a great deal of effort but it isn’t necessary for the goal of delaying the onset of dementia.

            Enter Duolingo. This is an innovative app that you can use on your computer or cell phone and it injects a lot of fun into an otherwise boring process. There is a free version but you’ll have to put up with commercials every few minutes. The paid version is about $75 a year – about a buck and a half per week. Duolingo offers more than 40 languages, uses several different formats and starts you off with a proficiency test so that you don’t have to slog through all the basics if you already have a head start on your chosen language. If you have a competitive nature, it’s even more fun. Every week you’ll be competing against about 25 or 30 other learners as you earn points for every short lesson. You can even share your progress with friends or family who are also Duolingo participants.

In the news

The 2024 measles outbreak.

            There is a rising fear, especially in the media, about several cases of measles, primarily in Florida but also noted recently in several other states.

As someone who has seen scores of children with measles, I’m very much aware of the seriousness of this disease. Before we had a vaccine, we lost about one child for every one thousand who were infected and about one in 500 suffered from measles encephalitis that left them seriously impaired. Those children who seemed to be unscathed by the disease were not. About one half of children with measles had abnormal cells in the spinal fluid that revealed a low-grade inflammation of the brain. As evidence of this, it was common for teachers to note that their kids were just not performing as well as usual in the months following a measles outbreak.

In the recent outbreak more than 90 percent of the victims had not received the measles vaccine, a tragedy considering that the vaccine has an effectiveness rate of more than 95 percent and almost no side effects – and no serious ones in my experience nor in published studies involving tens of thousands of vaccine recipients.   

The media are reluctant to report the incidence of measles among recent immigrants, especially considering that the number of measles cases number in the hundreds of thousands in developing countries, and that measles is a leading cause of death and childhood blindness in those parts of the world.

If you wonder why the vaccine is “only” 95 percent effective, there are several reasons. We delay giving the MMR (Measles-Mumps-Rubella) vaccine until 12 to 15 months because women who have been naturally infected by these viruses can transmit antibody during pregnancy to the fetus that will interfere with the performance of the vaccine. Note, however, that infants over six months of age should receive the vaccine if they are exposed to a case of measles. The reason: a woman who has never had natural measles, but has only received the weaker vaccine virus, will not have enough of the transplacental antibody to protect her infant.

Some vaccine failures are due to improper storage of the vaccine, and there are some children whose immune system simply does not respond adequately to the vaccine.

The worst tragedy of all: vaccine resistance among parents. This was sparked by the totally discredited Andrew Wakefield in the early 1990s who blamed the MMR vaccine for autism. He bears the blame for hundreds, perhaps thousands, of children who have suffered from diseases that could have been prevented by childhood immunization.

Lifestyle

Ow! That hurts! But it doesn’t have to.

            We’re very fortunate that having a tooth pulled, getting a crown or even a simple filling isn’t the ordeal that it was before the advent of dental anesthesia. But WOW! – the pain of the lidocaine injection into the gum – or even worse, the palate – is the worst part of the procedure.

Did you know that you can reduce or even eliminate the pain of the needle? Thanks to Dr. Geoff Bell of Carlsbad, I learned a simple technique that really works. As the dentist asks you to open wide so that he or she can inject the anesthetic, raise one leg a few inches and rotate your foot in a circle until the medication has been administered. I know – it sounds like voodoo, but there’s a reason why it works. When you rotate your foot it sends an impulse to your brain that interferes with the pain pathway. Don’t ask me for the details. I’m a pediatrician, after all, not a neurologist.

You can use the same method to reduce the pain of a venipuncture the next time you give a blood sample at the laboratory or donate at the blood bank.

The changing world of diabetes

            In barely a century the disease known as diabetes has undergone seismic changes relative to its incidence, its treatment and quite recently, its very nature. The ancient Greeks knew only type 1 diabetes, a condition marked by a large outpouring of urine, so they gave it the Greek word for siphon. It occurs when the insulin-producing cells of the pancreas are wiped out by an aberrant immune response, and it usually occurs in persons below the age of thirty. Without insulin, victims rarely survived more than a few weeks until the Nobel Prize-winning discovery of insulin in the 1920s. Type 2 diabetes has a very different mechanism but that wasn’t recognized until the post-World War Two era, at which time it began its spectacular rise. Known at that time as adult-onset diabetes, it is caused by an excess intake of refined carbohydrates and a simultaneous marked reduction in physical activity. Diabetologists refer to it as an exercise-deficiency disease. The incidence has skyrocketed to the current figure of thirteen percent of Americans; it affects more than thirty percent among those over the age of sixty years. The CDC predicts that more than half of all Americans will have type 2 diabetes by 2050.

            Now we have another major shift in our understanding of type 2 diabetes. Some type 2 patients have an immune response similar to those with the juvenile (type 1) form, namely that they also have an altered immune response and produce antibodies to insulin, though at lower levels than type 1 patients.  

            Some persons with apparent type 2 diabetes have difficulty maintaining normal blood sugar levels. The patient usually gets the blame for this but in at least some cases, it’s because they have Latent Immune Diabetes of Adults (LADA), a relatively new entity that some refer to as type 1.5 diabetes, a label that is itself in some dispute. Adding to the confusion is that LADA is a variable condition, sometimes occurring in persons who do not have the usual risk factors for type 2 diabetes, such as being overweight or obese.

Although most physicians are probably aware of this previously unrecognized form of diabetes, which may affect roughly ten percent of patients that have been diagnosed with the type 2 form, there are numerous examples of individuals who did not receive appropriate, timely treatment for several years. Thus, my reason for posting this blog is to alert patients who have difficulty in managing their disease to discuss this issue with their physician. Considering that there are now more than forty million Americans who have been diagnosed with type 2 diabetes, it is certain that some are suffering from and struggling with LADA. I encourage readers to forward this message to anyone who has or is at risk of developing type 2 diabetes.

The Internet Trap

            The Internet can be a marvelous source of information on almost any subject, but it is also the source of a great deal of misinformation. But you already knew that. Things will only get worse as Artificial Intelligence becomes a major tool for the bad guys whose goal is to alarm, mislead or entrap us.

            A recent example of seeming ignorance of the subject matter is a photo calling attention to the recent outbreak of measles that showed a child not with the rash of measles, but of chickenpox. A simple error, probably not intentional.

            An article that raised alarm about bubonic plague as if it portended the return of the Black Death failed to point out that there are, on average, about seven cases per year of this illness in the United States and that a myriad of small animals, especially in the Southwest, carry the bacterium known as Yersinia pestis. A risk, to be sure, for persons hiking or camping in places such as our local Palomar Mountain area. Fortunately, the conditions that led to one of the most deadly pandemics in history simply do not exist in the First World. Even in Madagascar, an economic and political basket case if there ever was one, which has been experiencing a smoldering outbreak of bubonic plague since 2015, the cases are in the hundreds, not thousands.

            Since the first months of the COVID pandemic we have heard reports of the dangers of the recently developed vaccines, one strongly suggesting that “white clots” caused by the vaccines are killing people. It has been thoroughly debunked but like the aspartame hoax of thirty years ago (the Nancy Markle hoax) it continues to linger.

            A rule of thumb regarding health-related matters on the Internet: limit your searches to web sites associated with medical centers, universities or the CDC, using suffixes such as edu or gov. Regarding the CDC, whose reputation has been severely tarnished, keep in mind that mundane articles regarding the symptoms and signs of diseases, statistical information, treatment, etc., are produced by rank and file scientists, not the politically or financially motivated people at the top. These days it’s easy to verify almost anything by going to other trusted sites.

Help for migraineurs.

            Migraine headaches affect millions of persons but there has been a steady accumulation of evidence that nutritional factors, especially vitamins, can help to decrease their frequency and intensity. Considering that supplemental vitamins and minerals have minimal side effects if not taken in excess amounts and that all prescription medications have annoying, if not serious, side effects, promulgating this information is worth the effort.

            Certain B vitamins (B2, B6, B12 and folate – known as B9), reduce the formation of homocysteine, a well-studied trigger of migraine and a contributor to cardiovascular disease. Because the production of homocysteine has a genetic basis the results of prophylaxis with these vitamins have been spotty, and some persons may require high amounts of certain vitamins (Vitamin B2 for example) that are not usually recommended.

            Vitamin D is important for normal bone health and for a strong immune system but about half the U.S. population is deficient in this vitamin for at least part of the year. In an analysis of several studies, persons who took 50 micrograms (2,000 units) of vitamin D per day had fewer attacks and fewer “migraine days” per month than did control participants. Vitamin D supplements have no significant side effects, and you can ignore the pointless warnings in some lay publications that high doses of this vitamin can cause kidney disease. That is correct but “high” means more than 10,000 units per day for at least six months!

            Vitamin E is a kind of orphan vitamin, little studied compared to the others and deficiency of this vitamin is rare, or at least rarely recognized. However, it has been found to be an effective supplement for women who have menstrual migraine and menopausal migraine.

            Magnesium is another nutrient that is lacking in the diet of roughly half the population. It shouldn’t be. Leafy green vegetables, nuts and whole grains have an abundance of this mineral, but it is almost absent in the processed foods that have become so prevalent in the American diet. Along with the vitamins mentioned above, magnesium is a component of any quality multivitamin/multimineral supplement.

The bottom line.

            Migraine headaches will continue to vex millions of people and it’s not likely that there will be a breakthrough soon in this very complicated condition. However, sufferers should consider improving their diet to contain more leafy green vegetables, whole grains, nuts and fresh fruit, in addition to drastically lowering their intake of processed foods – that means just about everything at the grocery store that comes in a box or bag – and adding a quality multivitamin/multimineral to their daily diet. It ain’t rocket science!

In the News

It ain’t rocket science!

            For several years there has been a steady stream of articles that have unequivocally demonstrated that the dozen or so chronic diseases that shorten our lives have almost nothing to do with aging but are the result of poor dietary habits and the near-universal lack of sufficient physical activity. We have dealt with the latter in the last couple of posts but a recent article, Dietary nutrient intake and cognitive function in the Age-Related Eye Disease Studies 1 and 2, in the journal Alzheimer’s and Dementia, confirms what we have been promoting for decades: a diet that includes vitamins, minerals and omega-3 fats slows the loss of cognitive function while a diet high in processed foods and refined carbohydrates does the opposite. The studies of Dr. Dean Ornish clearly show that a mostly vegan diet not only prevents coronary artery disease and stroke, but if vigorously maintained can actually reverse those diseases.

            Is it really so complicated??

            The above-cited article refers to the value of the true Mediterranean diet, which includes little red meat, an abundance of fruits and vegetables, no refined flour or sugars – well, OK, maybe an occasional tiramisu – a daily dose of olive oil and perhaps a single glass of red wine! Not exactly a Spartan regimen.

            Why have the most advanced, knowledgeable and sophisticated countries of the world not adopted these simple lifestyle programs. Perhaps because we are inundated with highly processed foods that are just too tempting to resist. In a recent rip through two chain supermarkets, I was struck by seeing large displays at the entrance of the stores with dozens of counters filled with junk food, beautifully decorated and packaged and surrounded by tempting aromas.

            What will it take to turn things around? 42% of Americans are obese, 40% are overweight, 13 percent have type 2 diabetes and fewer than 25 percent of young Americans can pass the entrance physical for the armed forces. What will our population look like in 2050?

In the news

Get ready for the next big (medical) thing.

            Gene-editing treatment is here, and it’s more meaningful than most people can imagine. For the first time the FDA has approved two methods for the treatment of sickle cell disease, a genetic defect that affects primarily dark-skinned people and that leads to years of pain episodes, strokes and other complications, including early death.

            The Nobel Prize-winning discovery of the structure of DNA was reported in 1953, just five years before I entered medical school. Multiple advances in the science of genetics have finally led to the manipulation of genes that can reverse the abnormality that causes sickle cell disease. We now have the basic framework that will eventually lead to the cure of brain-destroying conditions like Tay-Sachs disease and Huntington disease, as well as common diseases such as cystic fibrosis and neurofibromatosis. There are scores more such diseases that are relatively rare but that are devastating for the families in which they occur.

            There are – and will be – challenges, of course. The cost is staggering — more than two million dollars per patient. Side effects are inevitable, and some may be fatal. It will always be thus with brand-new technologies.

            Early in my career I watched the explosion in the field of antibiotics. Penicillin got off to a slow start, in which producing it was so difficult that the urine of patients that were being treated was collected so that the precious substance could be recovered and re-administered. Within about fifteen years diseases such scarlet fever, pneumonia and meningitis were no longer highly fatal. We are going to see the same surge of advances in the treatment, cure and elimination of many more diseases.

Lifestyle

The value and the psychology of the push-up

            The simple push-up, with its few variations, is IMHO (In My Humble Opinion) the most valuable exercise that one can do without equipment. It involves every major muscle group: back, abdomen, shoulders, chest, arms and legs. It even helps to strengthen the muscles of the neck, and if you are eventually able to rest on your fingertips and not your palms – yes, Virginia, you will be able to do that someday – some of the smallest muscles in your body will become stronger.

            Most people (53 percent), according to a study reported last September, cannot do TEN push-ups. A third cannot do five! Considering how important those major muscle groups are in daily living, that is a dismal situation.

            But here’s the good news: if you start doing push-ups every day or even every other day, you will be amazed at how quickly your numbers will rise. Begin by doing only five on the first day, then add only one more at each session. I guarantee that by the end of the second week you’ll be doing ten with ease. From then on it’s a matter of how hard you want to push yourself and whether you’ll get satisfaction from doing 30, 50 or even 100 push-ups at a time. Remember that because so many muscles are involved no single group has to handle a large load.

            Some tips:

            If you are not exercising regularly, begin with modified push-ups by resting on your knees and not your toes.

            Instead of resting your hands on the floor, rest them on a small platform or cushion. It can be three feet high in the beginning, gradually making that platform/cushion lower until you are hands-on-the-floor.

            After the first session you might want to rest for a couple of days, for two reasons. One is that if you work any muscle hard after a long period of inactivity you will experience DOMS (Delayed Onset Muscle Soreness). It’s the pain that often sabotages the desire to get in shape. The second reason is that dormant muscles are filled with dormant blood vessels. When you begin to activate a muscle those small vessels need to be awakened so that they will adequately supply muscle fibers with nutrients and carry away waste products.

            Bragging rights

            How do you think you’ll feel the day that you have done 50 or 100 push-ups? (Don’t get too cocky. When I told my brother how many push-ups I was doing he said “Of course! You don’t have much to push up!”)

            A New Year’s resolution

            I hope that this column will motivate you to take advantage of the psychological phenomenon called A New Year’s Resolution – most of which have been discarded by Valentine’s Day. But I know that when you have been able to do more push-ups than half the population you’ll find psychological as well as physiological energy to make 2024 your healthiest year ever!