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.

In the news

Is COVID-19 finally winding down?

          After more than three years of living through a pandemic we are seemingly on our way to adjusting our lifestyle to the endemic form of the disease. Roughly eighty percent of Americans have either had the natural infection or have received one or more doses of a vaccine, or both. Sadly, it still kills a few hundred people every day and that will only decline very slowly.

            The COVID vaccines have been a disappointment in one sense: they do not prevent infection. The protection that they provide is short-lived, perhaps only about three months. There are two very significant benefits, however. The risk of dying among vaccinees is greatly reduced; a recent observation indicates a 90 percent reduction in mortality compared with those who have not been vaccinated. To the relief of those of us in the health field, the frightening side effects, such as enhancement of mortality among those who received the vaccine and who were later exposed to the natural virus, never materialized. Myocarditis (inflammation of the heart muscle) and Guillian-Barré Syndrome (nerve inflammation that is sometimes fatal but often temporary) are more likely with the vaccine that is the least utilized in this country.

            In the endemic form, this coronavirus is here to stay, for a couple of reasons. Dozens of species of animals, both wild and domestic, now have been infected and will be a reservoir for outbreaks forever. Americans living in sparsely populated parts of the country have been somewhat protected, but will suffer occasional clusters of infection. And then there is the upcoming generation of susceptibles, children who are infants now or only a gleam in their parents’ eyes. If a COVID vaccine does not become part of the usual slew of vaccines that kids must endure by the time they reach kindergarten – a very unlikely situation – they will form a virgin population that will eventually become infected, and will spread it to adults whose immunity is waning.

            By the Fall of 2023 we can expect a vaccine that includes both coronavirus and influenza and because both have such a prominent inclination toward mutation, you will need that vaccine every year. However I’m quite confident that by the end of this decade things will change; we will have a combined vaccine that will only have to be  given once, maybe twice and whose protection will last a lifetime.

Lifestyle

From a physiologic point of view, there really isn’t a “best” time of day to exercise. Although there may be small differences when exercise is conducted early or late in the day, what matters most is when it’s most convenient for you. You need to pick a time that you can make part of your regular lifestyle routine – forever!

            For working folks who have to get up early for a long commute, a 4 or 5 a.m. start isn’t very appealing. If you’re fortunate enough to have a reasonably long lunch hour, a mid-day workout or walk might be ideal. You might seem to have the most free time at the end of the day but dinner, time with the spouse and kids or other responsibilities cut into that. Studies show that exercising two hours before bedtime really won’t interfere with your sleep but simple fatigue is often the stopper.

            If you work from home, use the time that used to be your commute time and walk, jog or work out. The average commute is slightly less than 30 minutes and that can give you an hour five days a week. What a bonus!

            If you go to a place of business, park about 15 minutes away from the workplace. Voila! Thirty minutes a day for five days equals 150 minutes, just what the health experts tell us to shoot for.

            The hard reality: you might have to alter your routine to fit in an hour or so of exercise at least four days a week. What few people realize is how important exercise is for good health. For those who complain that they simply can’t find the time, my admittedly callous response is that there will be plenty of time in stroke rehab, cardiac rehab or the waiting room of the prosthetics clinic where they fit artificial legs to replace those lost to diabetes. An awful thought, but true. Just look around at your most senior friends and family members.

In the news

Hooray for eggs!

            The nutritional value of eggs is considerable. Besides being an excellent source of complete protein (that which contains all nine of the amino acids that the body cannot manufacture) eggs are rich  sources of vitamins, minerals and eye-healthy lutein and zeaxanthin.

Eggs have been maligned for decades in the (false) belief that their cholesterol content leads to heart attack and stroke. Your dietary intake of cholesterol  — within limits – has no effect on your blood cholesterol because of a feedback mechanism in the liver which reduces its production of cholesterol when dietary cholesterol increases. Eggs do not raise blood cholesterol but EGG HELPERS do.

An international study has confirmed these facts. Asians who usually eat their eggs boiled, poached, scrambled, in an omelette or sunny side up with no extras had lower rates of cardiovascular disease even though their per capita egg consumption is higher than Americans’. The latter, who usually accompany their butter-fried eggs with ham, bacon, sausage or hash browns had higher rates of cardiovascular disease. Frying also converts cholesterol to cholesterol oxidation products, which are associated with arterial plaque formation.

Having said that, I admit that our traditional Sunday brunch for more than sixty years has consisted of bacon and eggs. On other days when we eat eggs for breakfast they are soft-boiled, scrambled or in an omelette – no other saturated fat-containing stuff. In fact, probably the healthiest egg dish that you can enjoy is a veggie omelette made with frozen chopped vegetables. And  instead of using butter we add a tablespoon of olive oil to the eggs before pouring them over the formerly frozen veggies in a non-stick pan. And yes, the olive oil is a healthy bonus.

(Sigh!) Timing is everything. As I write this the price of eggs has skyrocketed because chicken flocks are being destroyed because of the presence of avian flu in nearly every state. We now pay about $6.00 a dozen – some stores are charging as much as $15.00!

Be reassured that avian influenza, the dreaded bird flu, has not affected humans in the U.S. The only reported case is a chicken handler who was asymptomatic but was tested because the avian influenza virus was found in his flock.

Lifestyle

            Sister André, a French nun, recently passed away at the age of 118. She experienced an asymptomatic COVID infection one year ago. At the age of 108 she finally stopped working, saying that “working …makes you live…” Sister André also admitted to enjoying a glass of wine and a little chocolate every day. That’s my kind of girl!

In the news

The COVID variant stew: the latest ingredient.

            When this pandemic was recognized three years ago it didn’t take long for the first mutations to make themselves known. To the lay public this came as a surprise but to infectious diseases specialists it did not. Coronaviruses, like influenza viruses but even more so, undergo frequent mutations. Most of these cause the virus to self-destruct but they are extremely numerous and some have characteristics that make them more contagious or more lethal. When these two features occur simultaneously the results can be devastating. For the moment, at least, COVID-19 has not seen such a frightening combination.

            The new kid on the block is the Omicron subvariant known as XBB. Its incidence has nearly doubled since mid-December and it now accounts for more than half the cases of COVID in the northeastern United States, about 20 percent for the country as a whole. The recent massive storm frustrated many people whose travel plans were aborted but it may have blunted or at least delayed the spike in cases that has followed holiday travel in the past.

            It appears that XBB is no more dangerous than its parent, BA.2 and we still don’t know if the latest vaccine booster will protect us from it. (Saint Anthony has stated that it will provide “some protection but not the optimal protection.”) Nonetheless, if you have not yet gotten the fourth dose of the vaccine – and more than 85 percent of Americans have not – you should seriously consider it. In spite of the fact that the coronavirus vaccine does not always prevent infection, its track record of preventing death by a factor of about sixteen (!) compared with no vaccine, along with the fact that it has very few side effects, makes this a no-brainer.

Note: The COVID saga is a fascinating one that is the subject of an excellent book by Dr. David Quammen: Breathless. The scientific race to defeat a deadly virus. The audio version is very well done. He is also the author of Spillover, which describes (and predicts) how animal diseases make their way into our lives and why pandemics like COVID-19 are inevitable unless we develop entirely new strategies to intercept them.

Lifestyle

            For a better night’s sleep – from Why we sleep, by Matthew Walker – with a few personal edits.

1. Have a regular bedtime both at night and in the morning. This will stabilize your sleep pattern and provide consistently better sleep.
2. Exercise is a great sleep inducer but don’t exercise within two hours of bedtime. It will have the opposite effect.
3. Avoid caffeine after about noon. Some persons are caffeine sensitive so that even decaf (a misnomer) coffee or an ounce of chocolate will interfere with sleep.
4. Avoid that alcohol nightcap. It interferes with the all-important REM (Rapid Eye Movement) sleep that nature intended to refresh the brain.
5. A large meal (solid or liquid) before bedtime will interfere with sleep.
6. Numerous medicines, both OTC and prescription, can interfere with sleep. Of the former, cold medications are especially problematic. Blood pressure and heart medications might be better taken earlier in the day. Discuss these with your physician.
7. Daytime naps are healthy, especially for seniors, but don’t nap late in the day.
8. Unwind before bedtime with reading (not the scary stuff) or music.
9. An evening warm bath helps by causing after-bath cooling, which helps to induce sleep.
10. The ideal bedroom is cool, dark and free of gadgets such as a TV or cell phone. And don’t check your e-mail just before getting into bed!
11. Do you really need that telephone extension on the nightstand? We removed ours after months of getting 7 a.m. telemarketing calls. What took us so long?
12. Get as much daytime light exposure as is practical. Daylight helps to stabilize your circadian rhythm and that includes getting sunlight when you wake up. So open those blinds before you go to pee.
13. If you don’t fall asleep in about 20 or 30 minutes, get up and do something relaxing. But keep the lights low and don’t indulge in a nighttime snack. Walk around, listen to soothing music.

In the news

When scientists wear blinders.

            Two recent articles reveal why scientific information is rendered less valuable by a narrow view of the subject by investigators. Some researchers simply are unable to see factors beyond their field of study that would affect, perhaps negate, their conclusions.

            In Obesity tied to worse brain health in children, the authors report that a study of nearly 12,000 children revealed that obesity is linked to “pervasive loss of white matter integrity and neurite density, cortical gray matter thinning, and decreased connectivity within and between networks that have been associated with impulse control and reward-based decision making.” (Note: This is an article in Medscape based on an abstract presented at a meeting of the Radiological Society of North America, therefore there was no original paper that I could access for more details.)

            Obesity is a form of dysnutrition, that is, the body receives excess calories but too few nutrients such as vitamins, minerals and antioxidants. Obese persons, especially adolescents, consume almost no plant foods (except for french fries). In actual surveys, the average teenager takes in only 0.9 servings of fruits and vegetables per day – less than 10 percent of the recommended number. They eat nearly zero omega-3 fats that are essential for normal brain and eye development. It’s not the presence of fat that hinders brain development but the absence of brain-building nutrients.

            I think that those scientists are simply looking in the wrong direction.

            On the same day that I saw that article another appeared: The surprising failure of vitamin D in deficient kids. In that study, 4400 Mongolian children who received vitamin D for three years didn’t become taller or gain weight faster than 4400 given a placebo. Note: 95 percent of these kids had vitamin D deficiency; more than 30 percent were severely deficient. Isn’t it possible that pretty much everything else in  their diet was also inadequate for normal growth? The  physician who wrote the column for Medscape offered some possible reasons: “Perhaps the dose wasn’t given correctly, or three  years isn’t long enough to see a real difference (C’mon, man !!!), or the growth metrics were wrong, or vitamin D needs to be given alongside something else to really work and so on”.

            That last part might have hit the nail on the head – many somethings! All the studies that compare a group given a supplement with a group given a placebo suffer from the same defect: adding a single vitamin or other supplement to one’s diet and expecting significant results makes no sense. Vitamins, as well as other nutrients, never act alone. A normal diet for humans consists of several thousand nutrients, most of which are found in plant foods. Expecting to see a difference when adding more of only one out of thousands is not what I would expect from nutrition experts.

            BTW – if  you’re wondering how nearly 100 percent of Mongolian kids could be vitamin-D deficient, consider that Ulan Bator is at about the same latitude as Winnipeg, Canada. If you draw a line from Los Angeles to Atlanta, residents above that line get almost no vitamin D from sun exposure for about six months of the year – and Ulan Bator is waaaay farther north than Atlanta. And do you think that those kids are getting vitamin D-fortified milk like our kids?

Lifestyle

Most seniors (sorry – that means about 55) don’t sleep through the night, mostly for bathroom visits, sometimes because of medical issues. In a drowsy state, falls are more likely, so there are some safety tips that are recommended in the book Why we sleep by Matthew Walker – an excellent read for people of all ages because sleep disorders of one type or another affect more than half the population.  

Some tips to avoid falls:

Don’t get out of bed quickly. As we get older it takes a few seconds of sitting on the side of the bed to allow blood vessels to adjust so that we don’t get light-headed. This is known as postural hypotension. (Don’t let it bother you. It’s very common in adolescents too, whose bodies are going through a lot of adjustments.)

Have a light and a phone on the nightstand.

Consider motion-sensitive night lights. We have two from Amazon (of course) for only about $10 for both. They plug in, fit the décor just fine, intensity is adjustable.

Get rid of loose carpeting.

Check with your physician if you are taking a new medication. Some of them are associated with a risk of falls, especially antidepressants and sleep aids.

A new (to me) kind of scam

            I received a notice of a possibly unauthorized payment allegedly from PayPal. There was an 888 number to call to delete this payment from my account.This is part of the scam. A professional sounding man with an Indian accent started to walk me though the process of deleting the payment but I smelled a rat and ended the call. Indeed, when I went to my PayPal account there was a list of ways in which this scam is perpetrated and the unauthorized payment appeared on my account. I was able to refuse payment. Sure enough, a Google search gave all the details of how it works. ☹

In the news

To mask or not to  mask.

It has been three years since an unusual virus emerged from Wuhan, China to cause the most serious pandemic in a century. The turmoil that it has caused is not just medical but has spawned economic ruin for many businesses, disruption of children’s education from kindergarten to college and public distrust and disgust for politicians and medical authorities. One of the most contentious issues is the effectiveness of masking. Has near-universal wearing of face masks made a difference?

Like many medical issues, “It depends.” It depends on the type of mask, how long it is worn, the circumstances in which it is worn, and how it is worn. The last issue is the most maddening to those of us in the world of infectious diseases.

Persons who wear a mask that covers the mouth but not the nose, and who might be shedding the virus from their upper airway, not only contaminate the space around them but are depositing virus particles on the mask itself with every downward nasal exhalation. When they touch the mask they contaminate their hands and everything that they touch. It should be noted that contaminated surfaces such as doorknobs, light switches, computer keyboards and money are seldom sources of infection, but hands are another matter. Hands are usually warm and slightly moist, conditions that prolong the survivability of the virus.

Making cloth masks became a cottage industry in the early months of the pandemic. A cloth mask, especially one that consists of only one layer, is pretty – but it’s pretty useless. Infected persons who wear such a facial ornament can actually increase spread of the virus, thinking that they are safe to be around when they are not. One can also become infected while wearing a cloth mask, since those little buggers can easily pass through such an ineffective barrier. To quote one researcher: “If you can smell smoke through a mask you are also inhaling viruses into your respiratory tract.”

The N95 mask is the gold standard, but only if your standards are very low. It was not designed for medical purposes; the so-called “medical N95” mask gives a false sense of security. It does work, however, to lower the risk of transmission provided that it is fitted properly, that the fit is verified by another person, that it is not worn for more than a few hours– nobody knows how much is a “few” – and the wearer does not touch the mask – ever! The WHO recommends changing the masks every time they are touched!

In a study of several types of masks by the National Institute for Occupational Safety and Health it was found that a medical mask – the blue-on-the-outside-and-white-on-the-inside one that is worn by most people, 48 percent of cough aerosols and 58 percent of exhaled aerosols got through the  mask. This was improved significantly (but not reassuring to me) by wearing a second cloth mask. Fifteen percent of cough aerosols and 9 percent of exhaled aerosols still got through.

So is masking worthwhile? It is as long as it’s the right type of mask, is fitted properly, is not touched, and is not worn for more than about six hours. Just don’t expect it to be completely protective. After all, Saint Anthony (Fauci) wears two at a time, has received four vaccines and tested positive twice in about one month.

In the news

One more reason

                The influenza vaccines that have been developed over the last half-century are far from perfect, but to quote an old saw: “The perfect is the enemy of the good.” Some vaccines have low efficiency, perhaps about 25 percent, but some are much better – and this year’s vaccine might be one of those. As I have noted numerous times over the past several decades, the flu vaccine might not keep you from getting that disease but the evidence has been consistent that it will keep you out of the hospital, and from dying. Remember that influenza weakens the immune system, which is why nearly all influenza-related deaths are not due to the virus itself but to secondary bacterial invaders, many of which are now resistant to almost all antibiotics.

            A recent report from Canada offers even more evidence that getting the flu vaccine is a prudent move. A  nine-year study involving more than four million adults showed that the vaccine reduced the incidence of all forms of stroke by about 25 percent. Previous research indicated that there is a similar reduction in heart attacks in vaccinees. Conversely, there is a significantly greater risk of heart attack and stroke following natural influenza virus infection.

            Flu season is well under way. Don’t spoil your holiday season by putting off such a minor procedure that is free for almost everyone and that has a very low incidence of side effects. And for heaven’s sake, stop reading all that negative crap on the Internet!

Lifestyle

            Pretty much everyone knows that cancer chemotherapy has some really nasty side effects: nausea, vomiting, feeling lousy, among others. A couple of recent studies encourage maintaining an exercise schedule during chemotherapy, at least as much of a workout that can be tolerated. An ideal regimen includes 30 minutes of cardio exercises such as the stationary bike or treadmill three days a week and 20 to 30 minutes of weight training two times a week. For persons who have not been exercising much, a physical therapist can provide the best guidance to maximize benefits and avoid injury.

            Objective measurements of participants in the Netherlands revealed improvement in muscle strength and oxygen uptake. These patients not only felt better but they lived longer by as much as 25 percent compared to controls (persons who did no exercise during the study period).

In the news

I love raw oysters but…

            The first human who ate a raw oyster must have been really hungry! Although they are a modern delicacy those who enjoy them probably have had to watch someone else slurp and swallow that slimy, viscous mass, although a good hot sauce really does help. I am one of those who love raw oysters but unfortunately, my background in infectious diseases has put the brakes on that culinary delight.

            To be honest, acquiring a serious infection from raw oysters is pretty uncommon but when it does occur it can be a serious, life-threatening illness. This problem made the news in the aftermath of Ian, the recent hurricane in Florida. An organism called Vibrio vulnificus is common in brackish water and in sewage, especially in summer months, so it’s no surprise that a number of Vibrio infections occurred recently in Florida. Since the hurricane’s exit nearly 30 persons have been diagnosed with the infection and four have died. That is not an inconsequential mortality rate. Some of these persons were infected because they were wading in contaminated floodwaters and had open wounds that provided an easy entry for the Vibrio organism.

            Vibrio vulnificus is the most common cause of death from eating shellfish. Most persons who become infected by eating raw shellfish, especially oysters, suffer little more than gastroenteritis, a nasty inflammation of the stomach that usually causes vomiting, diarrhea and abdominal pain. For persons with a compromised immune system and  those with liver disease the results can be dire. Such persons are at high risk from a bloodstream infection that has a mortality rate of about fifty percent.

            Persons in good health don’t have to worry about eating raw oysters but there is an enlarging population of persons who should probably have their oysters fried or prepared a la Rockefeller. Those who are undergoing cancer treatment or who are infected with HIV are most at risk, as are persons with type 2 diabetes, which now affects more than twelve percent of Americans of all ages and a whopping thirty percent of those over the age of 60.

            If you don’t fit into one of those categories, go ahead and enjoy them. I might even  join you.

Lifestyle

            Is your BMI (Body Mass Index) worth measuring? Only if you’re a subject in a study of the demographics of obesity or related matters. The BMI was developed in the middle of the 19^th century and it was never intended to apply to individuals, but to populations. Unfortunately, even physicians and nutritionists have fallen under its spell.

            The BMI is calculated by dividing your weight in kilograms by the square of your height in meters. Those units of measurement, instead of pounds and inches, are a clue to the fact that it was developed by a scientist in Europe – Belgium, to be precise. If you are muscular your BMI will be unrealistically high. If you are not highly muscled, the higher the BMI, the greater the risk of heart disease – but keep in mind that the BMI is not the only predictor of health risk.

            The best measure of fitness vs. fatness is your waist circumference. Anything over 35 inches for women and 40 for men is an indicator of heart disease risk. Those are NOT your targets! Normal for men is about 35 inches and for women 31 inches. That’s because fat around the middle is the best predictor of cardiovascular risk – and that includes both heart attack and stroke.

            Even body fat measurement is not the perfect answer because all fat is not the same. The fat around the hips and thighs – which really makes women unhappy – is not associated with heart disease risk

            I’ll bet that in spite of my disclaimer you probably want to know your BMI, so just Google BMI calculator.

In the news

Influenza – don’t become complacent

            The flu season of 2021-2022 was the mildest since reporting began in 1997 due to several factors emanating from the rise in COVID-19. Among other things, we traveled less, kept our distance, worked and shopped from home and avoided crowds. Wearing masks probably helped but that issue is a can of worms in which each worm is different from every other, i.e., some masks are effective but even the best begin to fail after a few hours, and cloth masks, in the opinion of one scientist, are no more than facial ornamentation. In the last influenza season there was a dramatic reduction in deaths due to influenza – estimated at less than 10,000 when 40,000-80,000 is the norm – as well as deaths from other common respiratory illnesses.

            This should not make us complacent. It’s likely that influenza will come back with a vengeance this season and next. Unlike the coronavirus epidemic, seasonal influenza is devastating for children.

            Influenza vaccines are far from perfect but those who have received the vaccine, if otherwise in good health, almost never die from the disease. There is no doubt that the influenza vaccine significantly reduces the risk of hospitalization or death but there is another advantage that most people are not aware of. If you are unvaccinated and develop influenza, even if you survive you are at greater risk of a heart attack or stroke in the following six months. Conversely, vaccine recipients are statistically less likely to suffer a heart attack or stroke in subsequent months.

            Unlike the “dirty”influenza vaccines of half a century ago, modern vaccines are almost free of side effects and the injection itself is almost painless. In short, there is no reasonable argument for not getting the vaccine.

On the COVID-19 front

            The fat lady is still in the wings and she isn’t likely to sing for quite a while. Although cases and deaths continue to decline in the U.S. they are beginning to rise elsewhere in the world. The latest version of the Omicron strain has spawned many variants – estimated at more then 200 so far this year – and it’s quite possible that an invasive one is lurking among them.

            As I have noted repeatedly, this virus is remarkably unpredictable. We are fortunate in that the latest vaccine is protective against the latest variants and as more persons throughout the world are vaccinated, and thus are likely to excrete the virus for a shorter duration and in smaller concentrations, the emergence of vaccine-resistant strains will become less likely. But still….

            Little things mean a lot – so keep up your immune system and overall resistance by taking some simple steps:

            Keep your weight down. Every pound of excess fat raises your risk because fat stores generate cytokines that can overreact if you are infected, leading to cytokine storm – a killer. Fat tissue also is a “vitamin D sink”, making that valuable nutrient less available to the body. And more – being overweight raises the risk of acquiring type 2 diabetes, a condition that weakens the immune system.

            Get enough protein in your diet. That’s what you need to make antibodies and immune cells.

            Exercise more. For reasons that are not entirely clear, persons who exercise regularly – that means at least four days a week for at least one hour, and with enough intensity to make you sweat – have stronger immune systems than those who do not.

            Get more omega-3 fatty acids in your diet, from fish or from supplements. These nutrients reduce inflammation and boost the immune response.