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!

In the news

            Several studies over the past few years have shown that persons who receive the recommended adult vaccines – influenza, pneumonia, shingles – seem to be less likely to develop Alzheimer’s Disease. Now a large study involving more than 900,000 persons over a ten-year period has revealed that the reduction is significant: persons who received one or more influenza vaccinations were 40 percent less likely to develop Alzheimer’s disease during the ten-year study period.

            Influenza is not the only vaccine that provides such protection but the number of persons who receive the other adult vaccines is considerably smaller and the protective effect is harder to prove. Those who have received the adult versions of tetanus-pertussis-diphtheria vaccines also derive a protective effect. The tuberculosis vaccine known as BCG, seldom used in this country because of the very low incidence of tuberculosis in our population, is among those. In fact, a lower likelihood of Alzheimer’s Disease has even been observed in patients with bladder cancer who have received intra-bladder infusions of BCG.

            The mechanisms involved are not yet clear but researchers are closing in. We have known that some viral diseases such as influenza have effects on the brain, even if there are no symptoms that would suggest such involvement (unless we include the sometimes severe headache that occurs in some patients). One possibility is that the vaccine prevents the virus from exerting influence among brain cells. Another possibility is that the resemblance of an influenza virus protein to the beta-amyloid protein that appears to be the culprit in Alzheimer’s disease may be involved.

            It will probably be several years before scientists will tease out all the details but this is yet another reason for receiving ALL the vaccines that are recommended for persons beyond middle age, in whom influenza, pneumonia and shingles have a much greater incidence and fatality rate. It’s true that some persons experience significant, sometimes painful or debilitating side effects but you should keep in mind this salient fact: if you have a serious reaction to a mild version of one of these diseases, what do you think would happen if you were hit with the real thing?

Lifestyle

It’s hard to avoid partaking of the usual Christmas treats like cookies, candies and eggnog, and of course the inevitable increased intake of alcohol. They all have concentrated calories and it’s no wonder that many people find that slacks and skirts don’t fit the way they did in mid-November. The good news: there are some strategies that you can employ that will help you to enjoy holiday feasting without feeling like a martyr.

It starts with limiting your “downfall foods.” (Mine are those mini cream puffs from Costco.) Decide how many you will have at the party. It helps to save them for last, when your appetite has been fairly well satisfied.

Limiting alcohol at parties helps. After two drinks I switch to water or ginger ale. Nobody seems to notice, maybe because they haven’t made the switch.

Move across the room from the buffet table. The closer you are the easier it is to step over and pick up a little more to put on your plate.

It’s not politically correct for me to say this, but hang around with the skinniest folks in the room. They are less likely to grab those treats being passed around by the hostess, and that will make it easier for you to pass them up as well. (I know I’ll get mail for that one!)

Don’t be the first person in the buffet line. The hostess has taken great pains to make everything look pretty and appealing. It won’t look as tempting after a few other folks have helped themselves.

One more thing – your exercise routine is likely to take a hit with all the hustle and bustle of the holiday season. Make it a priority on your calendar, not something that gets squeezed in when time permits.

In the news

More evidence that vaccines save lives – and it’s not the COVID vaccine

            Sickle cell disease occurs when the hemoglobin  molecule that carries oxygen in the blood undergoes a mutation that distorts the shape of red blood cells into a curve that resembles a sickle – hence the obvious name. Unable to swish smoothy through small blood vessels, the cells pile up and lead to obstructions that cause pain in various parts of the body and can lead to stroke when those blood vessels happen to be in the brain. The condition is highly prevalent among those of African descent and often causes death in early childhood.

            These children are susceptible to infection by the pneumococcus, a bacterium that is a common cause of pneumonia – another obvious designation – and that causes overwhelming infection in sickle cell patients. The development of highly effective vaccines against the pneumococcus in the 1980s dramatically reduced the prevalence of these infections in the entire population but especially among persons with sickle cell disease.

            According to a study from Europe the relative frequency of disease caused by the pneumococcal strains contained in the current vaccines has diminished, so that another nasty germ, salmonella, has taken its place as the leading cause of infection among children with sickle cell disease. There is no widely available vaccine against salmonella.

            Only about 60 percent of affected children in Europe in this study had received the pneumococcal vaccine although it also reduces the risk of ear infection, pneumonia and meningitis caused by vaccine-associated strains. It’s clear that this vaccine, like almost all others, is effective. It’s also clear that too few children are receiving optimal medical care even in the developed world.

Lifestyle

Exercise doesn’t do much to help you lose weight, but do it anyway.

            It’s painful to watch them, severely overweight individuals slowly pedaling away on a stationary bike at the fitness center, or languidly performing exercises on a machine. Most of them have probably been told that they need to exercise in order to lose weight, but even sweat-producing exercise has little to do with weight loss. I have noticed that I seldom see those folks again after only about one week!

            Having said that, it is vitally important to engage in moderately intense physical activities while cutting calories – the most important step in getting rid of excess fat – but not for the reason that most people think. People who seriously cut back on food intake, a.k.a. calories, will lose weight, but as much as half of that lost weight comes from muscle tissue, not from fat. Exercising not only preserves muscle, but it may add some, so that you might (frustratingly) see little change on the bathroom scale but you will see your belly begin to shrink. Remember that your goal is to lose fat, not weight.

In the news

One less thing to worry about.

            You might have heard about a disease that has affected the deer population in most states – especially if you are a hunter – called Chronic Wasting Disease (CWD). Elk, caribou and moose are also affected. First described in the late 1960s, it has been found in 30 states and some areas of Canada; a few diseased animals have been found in Scandinavia.  Affected animals show gradual weight loss (hence the name), abnormal gait and behavior. The disease is caused by prions (pree-ons), unusual proteins that are not alive but yet are capable of being transmitted from one animal to another.

            If the term prion sounds familiar it harkens back to the 1980s when Mad Cow Disease (the medical term is Bovine Spongiform Encephalopathy, or BSE) terrorized the United Kingdom. About 200 Britons succumbed to a disease that was very similar to a very rare but fatal brain disease in humans. Only four cases of human CWD-related illness have been reported in the United states but all appear to have acquired the disease in other countries.

            My reason for writing about a disease to which humans do not appear to be susceptible is the growing awareness that many, perhaps most, infectious diseases of humans ultimately come from animals. COVID-19 is an example and has stimulated intense interest in zoonoses, diseases transmitted from animals to humans. There is speculation – irresponsible in my opinion – that CWD will mutate as viruses are known to do and will initiate a pandemic for which there is no known treatment.

            On the other hand, there is no need to tempt fate. BSE spread in the United Kingdom because farmers there fed their animals meat scraps from infected cows. That practice does not exist in this country. The worry is that deer or elk hunters may feast on their kill and thus acquire the deadly brain disease. After nearly half a century that hasn’t happened but hunters have been put on notice by health officials that they should not eat meat from animals that appear ill. There is, of course, no way that contaminated meat will find its way into your local supermarket.

            So there! You can stop worrying about prion diseases the next time you see a dramatic headline on the Internet warning us of the next animal-related pandemic.

Lifestyle

Which is healthier, white potatoes or sweet potatoes?

            During my lectures I discourage some kinds of potatoes. For instance, I define french fries as nutritional pornography. Unlike the other kind of pornography, it’s OK to enjoy french fries now and then. We all love baked potatoes but the stuff we put on them, like butter and sour cream, isn’t exactly health food. Further, those Idaho baking potatoes as well as the ones used to make French fries are bred to produce starch that is quickly broken down into sugar – which is why they taste sweet even while you’re still chewing them – a clever marketing ploy.

            According to Dr. Katrina Nguyen, a pediatric gastroenterologist, both white potatoes and sweet potatoes are considered healthy. White potatoes have more calories but sweet potatoes have lots more vitamin A – perhaps 1,000 times as much depending on the variety.

            What most laboratory-centered nutritionists seem to ignore is the eating habits of the average American. Most people eat the starchy stuff on the inside and leave the skin – where most of the vitamins, minerals and fiber are – in the garbage disposal. (I know – some of you are saying “Not me! I always eat the skin.” Forgive me, but that’s not what I see when I dine with family or friends.)

            The bottom line: except for the generous amount of vitamin A in the form of beta carotene in sweet potatoes, it’s pretty much a draw. But eat the skin!!

In the news

West Nile virus season is here

            West Nile virus appeared in the United States in 1999 and several hundred to several thousand cases have been reported each year since then. Since this is a mosquito-borne disease you can avoid it by avoiding mosquitoes and I’ll give you some tips on that below. Mosquitoes transmit other viral diseases that are much less common but that can be serious, even fatal.

            The good news is that the vast majority of cases of West Nile disease have few or no symptoms and when these occur they are usually limited to fever, headache and vomiting. The bad news is that about one percent of individuals usually the elderly, especially those with an underlying condition such as diabetes or cancer, will develop inflammation of the brain and/or nervous system. The mortality rate is low, roughly about 5 percent among reported cases.

            Although July and August are typically the worst  months for West Nile disease, there are already several hundred cases in the U.S. and more than two dozen deaths. If news reports in your area are reporting cases, be sure to take some basic steps to avoid mosquito bites.

            Although the type of mosquito that transmits this virus typically feeds after sunset, some strains don’t follow that schedule. Consider using a mosquito repellent when you have to be outdoors for a long period. These insects love the kinds of fragrances that we have become accustomed to using, such as perfume, hair spray, aftershave, etc., so it might be a good idea to take a break from fragrant products until autumn comes.

            Summertime is short-sleeve time but a long-sleeved shirt makes sense, especially if you are in a high-risk group.

            West Nile virus primarily targets birds, so don’t don’t pick up a dead bird, not even if you are wearing gloves.

Lifestyle

Is taking a multivitamin worth it?

            Some controversies never end and the vitamin supplement question is a classic. There is no question that a healthy diet is the best source of vitamins but most Americans don’t follow one. For example, only about one person in five eats the recommended number of servings of fruits and vegetables. Two studies of women of childbearing age showed that ninety percent (!) were lacking in one or more essential vitamins or minerals. Further, analyses of plant foods since the mid-twentieth century reveal losses of nutrient content in fruits and vegetables that range as high as 78 percent.

            Among more than 3500 participants over the age of 60 in a study done by Harvard professor Dr. JoAnn Manson and her colleagues at Brigham and Women’s Hospital and Columbia University, persons taking a multivitamin had an estimated 3.1 fewer years of memory loss compared with those taking a placebo. Three years might not sound like much but I’ll take whatever I can get!

In the news

Score another one for physical activity

            Most people are aware that regular physical activity – a euphemism for the E-word – goes a long way to prevent heart disease, obesity and type 2 diabetes as well as a host of other bodily ills but fewer are aware that the mind can benefit, and to a very significant degree.

          A report from the University of South Australia has revealed some surprising facts, including: “Physical activity was found to be 1.5 times more effective than counseling or the leading medications in managing depression and is being recommended as a mainstay of treatment.” And to think that it  doesn’t cost anything!

          The timing is important in view of the fact that depression, especially among teenagers, has increased dramatically since the onset of the COVID-19 pandemic.

          The benefits accrue to other populations: pregnant and postpartum women, persons with HIV and those with kidney disease.

          A particularly interesting finding is that it needn’t take lots of time. The researchers found that bursts of short and mid-duration proved more beneficial than exercise of longer duration.

          Nor does it matter how you exercise. Anything that gets your body moving and your heart rate up will be of benefit, including yoga, walking, swimming, resistance training (weights and  machines) and Pilates. Biking is also a great exercise but PLEASE – not an electric bike!

Don’t like fish? How about walnuts?

            Most persons who get the omega-3 fats that they need obtain them from fish or fish oil supplements. Fish is the better choice because it tastes better and doesn’t give you “fish burps” and because it is an excellent source of protein.

          If you’re not a fan of fish and don’t like taking those rather large fish oil capsules, walnuts might be a good substitute. They are rich in omega-3 fats, protein, magnesium, vitamins B1 and B6, zinc, and antioxidants.

          And according to a recent study from Spain, they are a great addition to the adolescent diet. Teenagers who ate about one ounce of walnuts at least three times a week showed a reduction in ADHD and a boost in their attention span and cognitive function. The research team also measured their risky-decision-making score using the Roulettes Task (!) but walnuts didn’t seem to help. Darn!

In the News

Why is there a rise in “strep” infections?

            Nearly everyone has experienced a “strep throat” during childhood, although that infection, caused by a common bacterium, can occur at any age. The throat is the most likely target but it can invade the skin through a thorn or splinter. Before the availability of penicillin it was not unusual for a local skin infection to march up the arm or leg and then to invade the bloodstream, so-called “blood poisoning” that was almost always fatal.

            This germ is quite sensitive to penicillin and similar antibiotics. It’s a relief to know that after more than 75 years, strains resistant to penicillin have not emerged, in contrast to many other bacterial invaders. In the pre-antibiotic era vast numbers of children developed the late complications of a strep infection, heart-damaging rheumatic fever, and kidney inflammation that eventually resulted in kidney failure.

            In rare instances some strains of this bacterium, Streptococcus pyogenes, are highly invasive, leading to the terrible-sounding flesh-eating condition that invariably leads to loss of limbs or death. Unfortunately there has been a dramatic rise in these invasive infections in several countries, including the United States. Compared to prior years the numbers have doubled or tripled; scores of children have died.

            There are two factors that may be contributing to the rise in strep throat as well as deep infections. Several viruses, including influenza, measles and chickenpox weaken the immune system, making a child more susceptible to bacterial infections, such as strep. We have seen that children are falling behind in receiving recommended vaccines since the onset of the COVID-19 pandemic. A deeper concern is the refusal of parents to immunize their children, a trend that has already resulted in outbreaks of preventable diseases such as pertussis (whooping cough) and measles. It’s critical for parents to ensure that  their children have received the vaccines that are indicated for their age, including the influenza vaccine.

            There is another possible reason for the recent increase in streptococcal infection: natural periodicity. Before childhood vaccines came into general use, epidemiologists observed that some disease-causing organisms occur in cycles. For instance, measles had a periodicity of two years, rubella (German measles) came in nine-year cycles. For the streptococcus that cycle appears to be about 75 years. As a consequence, the incidence of rheumatic fever began to decline in the early twentieth century, decades before penicillin became available. That lull has not persisted. A few years ago more cases of rheumatic fever began to appear, especially in developing countries. To be sure, other factors such as nutrition and sanitation may play a role, but if we are indeed in a rising cycle of strep infections, it behooves us to be more vigilant, to seek treatment early for a sore throat and to maintain an appropriate immunization schedule for both children and adults.

Lifestyle

Running is not exercise, it’s a sport. For all you runners, I do not suggest that you stop if you enjoy it. It’s a great calorie-burner but it really isn’t all that much better than brisk walking.

            One issue is that a person can be injured in a sport but not in exercise that is being performed properly – with a few exceptions. Humans are evolutionarily designed for running so that it is a very efficient means of locomotion. Brisk walking is actually not as efficient so that we end up burning even more calories over a given distance.

            The pace for walking should be fast enough so that you are breathing rapidly but not so hard that you can’t keep up a conversation. After you have been walking regularly for a few weeks consider taking a route that includes some hills. That will increase your fat burn and it will also improve your heart and lung reserve.

            Aerobic activity such as running, walking, biking, swimming, etc. are important for good health and we should partake of them several times a week. However, resistance exercises, using weights and machines, are equally important because they strengthen the entire body, not just the legs, and because they stress bones, making them thicker and stronger.

            In other words, there is no “best” exercise. All activity matters and we are programmed to enjoy a variety of them.

In the news

Finally – It’s official! The WHO admits that healthy children below the age of 18 do not need the COVID-19 vaccine!

            I have argued since the first few months of the pandemic that children handle the coronavirus so well that they don’t need the vaccine. It has taken nearly three years for the WHO to come to that conclusion.

            As of February 1, 2023 fewer than 1500 American children below the age of 18 have died from this virus. The reasons include the fact that many if not most have experienced a coronavirus cold and have some cross-immunity. Compared with adults, children have significantly fewer comorbidities that are associated with mortality: obesity, type 2 diabetes, kidney disease, hypertension, chronic obstructive lung disease or drug-induced immunodeficiency.

            Some children SHOULD receive the vaccine. Those who are immunodeficient, have heart disease or who are obese or diabetic, or who have lung diseases such as cystic fibrosis fall into that category. About 35 percent of children who died from COVID-19 were apparently healthy but it’s likely that some of them had an unrecognized immune deficiency.

            N.B.: This information does not apply to the influenza vaccine. The influenza season usually results in about 40,000 deaths in an average year, and many of these involve children. ALL children and adults should receive the flu vaccine every year.

Lifestyle

Red wine as health food?? Sure it is, and the mainstream medical community has awakened to that fact. After all, it comes from plants, is highly colored – like all foods that are rich in antioxidants – and has numerous documented health benefits. The obvious caveat is that it should be consumed in small amounts, i.e., no more than two 5-ounce glasses a day for men and one glass for women. (Sorry, ladies – I’m just the messenger.)

The health benefits of wine were touted by none other than Louis Pasteur, the father of modern microbiology: “Wine can be considered with good reason as the most healthful and most hygienic of all beverages.”

Some of the advantages of red wine include its ability to relax blood vessels, inhibit the clotting mechanism and add to our antioxidant supply. All these factors reduce the likelihood of heart attack and stroke.

Resveratrol is one of the much-promoted constituents of wine but you need to know that almost all the studies on that constituent have been done on animals and in test tubes, not in humans. Categorically, resveratrol tablets have not been shown to be of value.

One 5-ounce glass of wine contains 100 calories. If you are a calorie-counter, keep that in mind.

In the news

Does lots of exercise harden your arteries?

            There have been a couple of studies using imaging techniques among endurance athletes —  for example, marathon runners — that reveal high rates of calcium accumulation in their coronary arteries. Is that a problem for persons who exercise a lot?

            For decades we have known that persons who exercise frequently with moderate intensity* have lower risks of obesity, type 2 diabetes, hypertension, stroke and coronary artery disease. The recent report does not change that. Nor do the recent studies show that these endurance athletes have a greater risk of dying of heart attacks. The more so then that moderate exercise confers all the benefits and none of the risks. * Frequently means about 4 times a week for at least sixty minutes; moderate means breaking a sweat  during most of that hour.

            It’s possible that when the body calcifies arterial plaques it makes them less likely to rupture, which is what causes a heart attack or stroke.

            The old saw, “Moderation in  everything” becomes the Goldilocks Principle: too little exercise is bad; too much exercise (when extreme) might be bad; moderate (see above) exercise is just right.

            Lowering the risk of stroke or heart attack is only part of the exercise picture. A “Goldilocks” routine will provide more energy, a feeling of well-being, a stronger immune system, less likelihood of diabetes, cancer or gallbladder disease, and looking really good on the beach this summer!

Lifestyle

            This might be a good time to confirm why you’re dieting, if you are. Or if you’ve given up, why you ought to reconsider that decision.

Dieting improves the quality of life. Here are some examples, not necessarily in order of importance, and this list is far from an exhaustive one:

            You will have more self-confidence. After all, if you have hung on and especially if you reached your targets, either short- or long-term, you know that you have accomplished something that most people have not.

            You look better. If you haven’t had to change your wardrobe yet you probably fit better in the current one. Buttonholes don’t stretch, zippers zip and other people only see what you want them to see.

            You feel better. If you’ve ever been hiking and finally got to take off your backpack at the end of the day – that’s what it feels like to lose a few pounds. All the time.

            Pain is going away. Back pain, hip pain and knee pain are often due simply to the extra weight that is pressed down on them.

            Hunger pangs are fewer. That’s because you have been eating smaller meals and your stomach has gotten a little smaller. It takes less to fill it up. And you’re getting used to fewer calories.

            You don’t feel tired as often. Besides having less weight to carry, you have been building up muscle strength with resistance exercise. (Well, you have been doing those exercises, haven’t you?)

In  the news

So did SARS-CoV-2 come from a lab “accident”? The United States Department of Energy reported that “the COVID-19 pandemic likely originated from an accidental lab leak in China.” Several months ago I noted in Carvings that a lab leak was possible and that it could have happened in several ways, including a lab worker who purloined animals that he or she sold at the local wet market to augment their salary.

N.B.: You may not be aware of this issue depending your source of news. In my commitment to remain non-political I will not list those networks in which there is no mention of the information that comes from the U.S. Department of Energy, the FBI or the Lancet medical journal.

It’s distressing to recall that the government and the media tried so hard to dismiss that possibility. Even with this newest revelation, it remains unlikely that we will ever know what really happened. But there is an important fact that we should keep in mind: we will always be under threat of a pandemic from the enormous reservoir of viruses and bacteria in the animal population, and it doesn’t take a lab leak to set that in motion. Although we can’t avoid them we can take steps that will increase our ability to survive them.

Have you ever wondered why kids in the same family can have different degrees of illness from the same infection, such as chickenpox or measles (both of which have almost completely disappeared because of vaccines)? Sometimes it’s a matter of genetic roulette – every individual has a unique immunologic profile and some, even within the same family, are more resistant to certain infections than others. In the great majority of instances, however, having a mild or asymptomatic disease is the result of having an immune system that is not compromised by self-inflicted conditions such as obesity, diabetes or dysnutrition. That was painfully evident in the first few weeks of the pandemic, when older, obese, diabetic and heart-compromised individuals were noted to have the poorest outcomes, including those with very low levels of vitamin D. Dysnutrition refers to the all-American practice of ingesting highly processed foods laden with sugar, salt, fat and an astonishingly large amount of chemicals that are designed to improve the bottom line of producers by improving flavor and shelf life.

Persons who are obese or diabetic don’t handle infections well and don’t respond as vigorously to vaccines as persons who are of  normal weight and in good health. Those with heart disease, high blood pressure or who have lung or kidney disease have less reserve when the body is assaulted by a virus. 

Your best strategy: maintain normal weight, get plenty of exercise, have enough protein in your diet to support your immune system, take a multivitamin/multimineral supplement and get at least eight hours of sleep every night.

Lifestyle

If you are a carb-reducer, don’t overdo carb reduction. Carbohydrates are a major source of energy whether you are dieting or not. You can drop several hundred calories a day by simply eliminating refined carbohydrates such as bread products, cereals, pasta and potatoes and replacing them with vegetables. The latter will provide you with the carbohydrates that you need but will release their starch more slowly in order to keep blood glucose levels within the normal range.

Most low-carb diets limit fruits and vegetables, especially in the early “induction” phase. That’s usually the hardest part for new dieters. Concentrate on fruits and vegetables that have the lowest glycemic index, the number that indicates how high and how rapidly your blood glucose will climb after eating them. You can find a list of these on Google.

For dieters, the great advantage of eating large quantities of plant foods is that you will never be hungry. Their bulk is mostly fiber and water; most Americans don’t get enough of the former and lots of seniors not enough of the latter.