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Carvings October 1, 2025

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In the news

Prescription drugs and fatal falls

            In the blog posted on June 15th I noted that some prescription drugs caused dizziness, resulting in falls. There is more to the story as noted in a recent publication in the Journal of the American Medical Association (JAMA).

          About 40,000 people over the age of 65 die from falls every year, and many of these are directly related to four groups of drugs: benzodiazepines (e.g., Valium), opioids (e.g., hydrocodone, codeine), gabapentinoids (e.g., Gabapentin) and antidepressants, of which there is a wide variety.  They all have numerous side effects and all of them are associated with drowsiness, impaired balance and loss of coordination, conditions that lead directly to falls. 

          The authors of the study note that overprescribing of these drugs is a serious problem, that long-term use is to be avoided and that safer alternatives are available. In their opinion, more than 25,000 lives could be saved each year if these medications were used appropriately, i.e., that with rare exceptions they should not be used at all in persons over the age of 65.

          Persons taking these medications should consult with their physician to determine if their use justifies the risk.

Lifestyle

          I wrote about this topic three years ago but I’m repeating it here because I have recently talked with two persons in their 80s who have not yet had the shingles vaccine – Shingrix. That’s a serious mistake!

          Elderly persons are particularly at risk of shingles, a painful condition whose complications include severe chronic pain in affected areas, and even blindness when it involves the face. About 20 percent of persons over the age of 60 are going to get shingles. That number jumps to 50 percent at age 85

          The vaccine that was released in 2017 is 97 percent effective in preventing shingles and it probably will be protective for about ten years. (That is my personal opinion based on data to date but we’ll have to wait another few years to be certain.) Two doses are required and most recipients can expect some side effects such as a sore arm, headache, mild fever and feeling crummy for a day or two. These are insignificant when compared with blindness or pain that lasts for years. Those complications are not rare. They occur in about 15-20 percent of persons over the age of 80.

          It is strongly recommended for persons over the age of fifty, even those who have had shingles in the past or who have received the old vaccine (Zostrix).

Carvings September 1, 2025

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Omega-3s and Alzheimer’s Disease

            Omega-3 fats are critical nutrients for every cell in the body, especially those in the brain and eyes. The main natural sources, fish and leafy green vegetables, are lacking in the diets of most people. Now there’s another reason to ensure that you get what you need. A study of more than 800 Alzheimer’s Disease (AD) patients in the UK revealed that women with AD had fewer omega 3s and more saturated fat in their blood than normal individuals. The authors caution that “this still warrants further research” a CYA phrase that seems to be included in so many scientific publications, but it is consistent with hundreds of peer-reviewed articles that show how important omega-3 fats are. A study that I included in my lecture on avoiding dementia about two decades ago revealed that patients with AD had less omega-3 fats in brain tissue than normal persons.

          Alzheimer’s Disease is enormously complex, beginning with the fact that there are several types of this disorder, that at least one form is strongly hereditary, and that not a single drug has been shown to significantly reverse it or to stop it. All the more reason to do what we can with proper nutrition and lifestyle (see the article below) to slow it down.

Lifestyle

What do knitting and playing the piano have in common?

            Neuroscientists have known for decades that mind-engaging activities can stimulate the formation and connectivity of brain cells, thus developing a “cognitive reserve” that delays the progression of age-related brain shrinkage and Alzheimer’s Disease. Two new studies reveal why activities such as knitting and playing the piano are particularly valuable. They both require the use of two hands, advance planning and fine motor movement. (Note that similar activities such as woodworking, painting and model building are similarly beneficial.) The result of the aforementioned nerve cell connectivity is improved memory, better motor skills and a reduction in stress. Specifically, a study of seniors engaged in piano playing showed improvement in areas of the brain that are associated with memory and language. Brain-associated hormones also showed improvement in the knitters. The stress hormone cortisol was reduced while serotonin and dopamine – the latter associated with Parkinson’s Disease – were increased.

          It’s important to emphasize that you can build a cognitive reserve at any age, and the benefits of these activities have been observed even in persons who are already showing symptoms of dementia or Parkinson’s Disease.

          The adage “It’s never too late” takes on new meaning.

Carvings August 15, 2025

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Pickle juice to relieve muscle cramps? Really?

            Muscle cramps are a universal annoyance but their cause and cure are largely mysteries. They are more common among athletes, pregnant women and older persons. Electrolyte solutions like Pedialyte have been recommended to prevent them but few medications or measures such as stretching provide quick relief. Pickle juice is a recent entry, and it has some scientific backing.

          I was a sceptic when one of my sons urged me to try it when I developed a severe leg cramp during a visit to his home. “Baloney” was my first response but I took two swallows – the stuff is awful – and about three seconds – yes, seconds — later the pain was entirely gone. “Coincidence” was my second response.

          A few nights later I had another cramp, this one deep-to-the-bone painful. I ignored the container of pickle juice in my refrigerator that was foisted on me by my son. “Baloney” I muttered during the ten or so minutes of agonizing walking that it took to resolve most – not all – of the pain.

          The next time a similar, severe cramp hit me I thought “What can I lose? But it probably won’t work.” But it did, within a few seconds – and all the pain was gone this time.

          It didn’t take long to find a couple of dozen articles at the National Library of Medicine site (PubMed) that discussed the merits of pickle juice and the mechanism by which it works. It’s not the electrolytes; it’s the stimulation of the lining of the throat by acetic acid (vinegar) that causes a reflex to inhibit the firing of nerve cells that are causing the muscle fibers to contract.

          Thank you, Steven.

Carvings   August 1, 2025

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Walking is great – but it’s not enough.

            I commend all those who walk several times a week. Besides improving heart and lung fitness, it strengthens the core muscles (back and abdomen) and adds to the bone strength of the legs, which includes the hips. But if you fall while walking (!) and land on your outstretched hands, it could result in a fracture of one or both wrists or elbows or collarbones. We need resistance-type exercises that provide numerous health benefits, including stronger bones for the upper body.

            When you exercise your biceps, for example, it puts stress on the bones of the arm where the muscle is attached. The bone reacts by becoming thicker and stronger, thus resistant to breakage. But there’s more.  A beneficial by-product of using barbells, dumbbells, elastic bands and exercise machines is maintaining the health of specialized nerve endings attached to each muscle cell that help us to retain balance. One reason why seniors are prone to falls is that when they lose muscle cells because of inactivity they also lose those nerve structures that maintain balance.

            Although a fitness center is ideal, a home exercise program is a good start. Any household item that fits comfortably in your hand, e.g., a can or jug that holds food or juice, will do. Gym memberships are often available for less than $25 a month and some senior insurance programs will cover the cost.

            For persons with a chronic illness such as arthritis or heart disease, a physical therapist can provide a suitable, safe program. Four or five hours a week of regular, moderately intense physical activity, at any age, results in greater energy and a feeling of well-being. You’ll never go back to being a couch potato!

Lifestyle

“Don’t be a spectator, don’t let life pass you by.” Lou Holtz

            Lou Holtz, the famous Notre Dame football coach, is an outstanding motivational speaker. I have modified one of the elements of his repertoire as follows:

            For a meaningful life, have:

                        Someone to love

                        Something to believe in

                        Something to hope for

                        Something to give

                        Something that brings you daily joy

Carvings July 15, 2025

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U.S. children’s health going downhill

            A very significant paper was published this month in JAMA, the Journal of the American Medical Association. It is the loudest wake-up call that I have heard yet, warning us of a deadly trend: American children from birth to age 19 years are nearly twice as likely to die as a cohort from 18 other high-income nations. Nearly half (!) – 45.7 percent — have a chronic health condition such as autism, sleep apnea, behavioral disorders and depression, among others. Nearly 21 percent of children are obese. (The figure was 5.2 percent in 1974.) The type 2 diabetes epidemic among children shows no slowing trend.

            It’s frightening to think what this scenario will be like two or three generations from now, knowing that the several causes of these conditions are unlikely to be reversed without severe, draconian regulations that no politician dares to propose. The multiple causes have been staring us in the face for decades but there is no national will to eliminate them.

            A major cause of the decline in our children’s health is the lack of outdoor exercise. Kid power is no longer needed for bicycles, skateboards or scooters. Team sports are over-organized, so that the kids expend minimal energy. A study of PE classes in schools revealed that the students were actually moving for only ten minutes out of an allotted hour.

            Processed foods high in salt and sugar have replaced vegetables. More than half of children are deficient in omega-3 fats that are crucial for brain development and function.

            The recent decision to remove artificial dyes from candy and other forms of junk food will have only a minuscule effect on children’s health. It is junk food, not just its coloring, that should disappear from grocery shelves. That is unlikely and so is the prospect that the nation’s children’s health issues will be reversed in this generation. The only hope is that individuals and their families will follow a healthy lifestyle.

Carvings July 1, 2025

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Eat more, weigh less? Are you kidding me??

            It appears that weight loss surgery is more effective over the long term than Ozempic, that new kid on the block, and similar prescription drugs. But no matter how effective these two elements may be in the short term, this is simply not the way to solve the multiple problems – now epidemics — of obesity, type 2 diabetes, cardiovascular disease and osteoporosis. Those who promote these solutions are apparently oblivious to the fact that a century ago, those four chronic, non-infectious conditions were almost non-existent. They don’t have anything to do with aging, nor does osteoporosis, the fact of which I’ll cover in a future post. Ditto cancer, the second leading cause of death, 85 percent of which is due to lifestyle factors and has nothing to do with growing older, according to the M.D. Anderson Cancer Center.

            So if these diseases, which together account for more than one million deaths per year in the United States, are almost entirely due to lifestyle factors, the solution appears to be astonishingly simple: change the lifestyle.

            Obesity is at the root of the other diseases, via multiple mechanisms. The rate of obesity in 1900 was five percent. It is now 42 percent. Although health experts advise us to drastically reduce our sugar intake, that’s only part of the picture. The real solution is to eat foods that fill you up, not fill you out. 

            Our great-grandparents were not obese mainly because their diet was largely based on plant foods and whole grains that had a lot of bulk, giving them full bellies but few calories. The Standard American Diet does the opposite: refined sugar, refined flour and only one or two servings of plant foods per day. (If you’re a teenager you typically eat less than one serving per day of fruits and vegetables.) We take in lots of calories before our appetite is satisfied, especially if those calories come in the form of soft drinks, so we eat more.

            Sugary desserts and soft drinks should be the first to go. Next, add a small salad to one meal a day, later two meals a day when you get used to it. Instead of having a starch (pasta, potatoes, rice) at dinner, substitute a cooked vegetable for more fiber and fewer calories. You’ll be eating more food – and will weigh less.

            Now – how hard was that?

Lifestyle

How dry I am!

            Now that summer heat is here in full force it’s time for a reminder that dehydration is a risk at all ages, but especially as we get older. One reason is that our thirst mechanism is unreliable; our body may require a greater fluid intake but it fails to let us know. Especially in areas of low humidity – e.g., the American Southwest – overt sweating is minimized and thus we are not aware of the fluid loss. When we’re engaged in some activity such as gardening or athletics, we just might not be paying attention to early signs of dehydration, such as fatigue.

            Statistics regarding deaths from dehydration are hard to ascertain since heat stroke is often part of the picture. During a severe heat wave dozens of deaths may be reported in the United States. Infants and the elderly comprise most of the victims. Contributing factors include the inability of the former to express their symptoms. The latter often live alone or are visited infrequently by caretakers. Persons over the age of 65 are especially at risk. Many are taking blood pressure medications that increase the loss of water as well as the loss of electrolytes (sodium and potassium).

            Monitoring a person’s state of hydration, whether an infant in diapers, a healthy adult or an elderly person who needs to be checked at least once daily, the indicators of dehydration are the same. If urine is cloudy, orange-brown and pungent, dehydration is already in progress. Urine should always be clear, slightly yellow and with only a mild odor.

 Repeated bouts of dehydration increase the risk of kidney stones, a malady whose intensity of pain is only matched by the pangs of childbirth – so I’m told!

            You can avoid dehydration even on the hottest, driest days by keeping a glass or bottle of water everywhere – family room, bedroom, car, office. Fruit juices are fine but they all have sugar, so diluting them by about a third will give you the fluid you need with fewer calories. Fruit is mostly water; three or four pieces a day are healthy as well. If you sweat a lot during a hard workout don’t forget to replenish sodium and potassium with an electrolyte drink. Avoid sugary carbonated drinks and alcohol.

Carvings June 15, 2025

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Wither goest Ozempic?

            Ozempic and Wegovy, made by the same company, are the trade names of the GLP-1 drugs known as semaglutides. Although they are chemically identical, the dosage, the packaging and their intended uses are different. Such is the way of marketing!

            These medications are intended to improve the health of obese, diabetic persons. They have several actions, including decreasing the appetite, providing a feeling of fullness, slowing digestion, decreasing glucose production in the liver and increasing the release of insulin. Ozempic is intended to slow the progress of type 2 diabetes while Wegovy is designed to aid in weight management, i.e., weight loss. 

            In clinical trials they were helpful in managing both problems, although the regimen used also included reducing calories and increasing physical activity, fundamental measures in any weight loss program.

            Patients taking Wegovy lost 15 percent of their body weight in a 16-month trial period. Those taking Ozempic lost 7 percent. If we can assume that the average weight of the participants was approximately 225 pounds, both groups would still have been overweight or obese at the end of the trial. To be sure, even such modest weight loss is beneficial in managing type 2 diabetes and in lowering the risk of cardiovascular disease. In fact, among study subjects, those taking these drugs showed a significant decrease in cardiovascular disease, and in slowing of the progression of kidney disease.

            Is this the best solution to the national epidemics of obesity (42 percent) and type 2 diabetes (12 percent). Consider the following challenges.

            The cost of Ozempic is nearly $1000 per month; Wegovy costs about $1350. Few patients will pay that much because of insurance, or pricing plans offered by the company.

            This is a weekly injection, not a pill. Side effects are not common, most being in the range of ten percent or less, including nausea, vomiting, diarrhea and constipation. Infrequent but serious side effects include inflammation of the pancreas and gallbladder; allergies, temporary hair loss, vision problems and mood changes have been reported.

            Losing weight is frustratingly difficult, as most overweight persons are aware. Drugs are convenient; lifestyle changes are not. Some of the current generation of weight-challenged persons may find some success with prescription drugs. The long-term hope is that coming generations will be encouraged to avoid excess weight gain in the first place, but that will probably require draconian governmental intervention. The combined cost of obesity and diabetes is more than a half-trillion dollars annually. I’ll discuss what might be a real solution in a coming post.

Lifestyle

Preventing falls: things we overlook

            Falls, especially among the older generation, are a serious problem, often resulting in death. The frailty that accompanies aging is only part of the problem and one that can be postponed for decades if we are committed to a lifetime of regular, moderately intense physical activity. In addition, there are some steps, especially as we get older, that will lower our risk.

            How safe is your flooring? Secure or remove loose rugs.

            Some shoes don’t belong in your wardrobe. Get rid of those that are too slippery (smooth leather soles) or too clingy (crepe soles).

            Bare feet and socks increase the risk of falls.

            Improve lighting with night lights and lighting strips. They are cheap insurance.

            Move frequently used kitchen items to a lower shelf. And never stand on a chair!

            If you wear bifocals or transitional lenses you just might have to move more deliberately.

            Face it! You can’t hold your liquor like you did at 20. Adjust.

            On a new medication? Be extra careful. Some cause dizziness.

            It’s worth getting a consultation on fall prevention from an occupational therapist. Discuss this with your physician. Things like grab bars in the shower can be literal lifesavers. And they increase resale value!

Carvings June 1, 2025

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Kiddie canaries in the coal mine

            For those of you who have come to believe that vitamin D is my favorite vitamin, you are correct. Month after month, there is more data showing that this micronutrient has more functions within the body than had been thought only a few years ago. One reason for my constant referral to vitamin D in my blogs is that deficiency is a serious problem. This is highlighted by a study from the University of Florida.

          The crux of the article is that fractures in children who are deficient in vitamin D take much longer to heal. But there is another very serious implication that is not addressed by the authors of the article: those whose bone health is poor and who are significantly deficient in vitamin D as children face the strong likelihood that they will develop osteoporosis at a relatively young age.

          For several reasons, osteoporosis will be Third Epidemic of this century; obesity and type two diabetes are the first and second, respectively. Although figures vary depending on the demographic group and research population studied, approximately one-half of Americans are deficient in vitamin D. But there is more to bone health, including adequate amounts of omega-3 fats, vitamins A, C and K, and exercise. In regard to the last, physical activity continues to decline among youngsters, and the recent surge in electric bikes, scooters and skateboards can only make things worse.

          The Florida study attributes the slow healing of bone fractures in children to low levels of vitamin D. I believe that the problem is far more complex. A thorough analysis of these children’s lifestyle would probably uncover other nutritional deficiencies, and a lack of exercise as well.

Lifestyle

“I’m doing everything right! Why do I have osteoporosis?”

          I have heard this lament several times during my nearly twenty-years’ speaking on matters of health and fitness, mostly to senior organizations. The complaints have usually come from slender women who state that they exercise regularly, eat a healthy diet, take vitamins regularly and ensure an adequate calcium intake, often with the help of a supplement.

          My answer is not a comforting one for them. After assuring them that they are now following the proper course to maintain good bone health, I point out that building a strong skeleton depends on regular, moderately intense physical activity during the “bone-building window” from ages roughly 5 to 25, and that they were probably not aware of that during those years. A good diet, as noted above, also matters, but the prime determinant of bone health is moderately intense exercise throughout life, even past retirement age.

          Approximately 20 percent of women over the age of fifty have osteoporosis, compared to 4 percent of men. That figure for men is misleading and it is going to rise significantly in the coming decades. Generally speaking, boys are physically more active during the critical bone-building window, and a man’s occupation involves greater physical activity – until recently. Today a man’s thumb is more likely to be injured by repetitive stress from using a keyboard than from pounding a hammer; construction workers’ cordless power tools have replaced manual screwdrivers, handsaws and drills. Modern males make little use of their muscles and they will pay the price when they reach middle age.

          Although it’s possible to regain some bone mass at any age, it takes more effort than most persons are aware. Persons of every age (nonagenarians included) should engage in resistance exercise (barbells, dumbbells, machines, elastic bands) at least three times weekly. The Standard American Diet (S.A.D.) is poor in bone-building nutrients. Those are the hard facts.

         

Carvings May 1, 2025

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Your brain on eggs. What does it mean for Alzheimer’s Disease?

            Alzheimer’s Disease (AD) has become a severe burden in the U.S., both financially and emotionally. Six million Americans already suffer from the condition and it is projected to more than double by 2050. It is not only because our population is aging. In my opinion, our diet plays a major role in the development of this debilitating disease. 

            Caveat: this blog addresses only a single nutrient. Many other factors, nutritional, inflammatory, toxicological and social are part of the picture. However, the one discussed here is entirely under our control.

            According to the Framingham Study, a research program that was instituted more than 75 years ago by Harvard Medical School and that carries a stellar reputation in tracking the dietary and lifestyle habits of generations of participants, a low intake of dietary choline is associated with an increased risk of dementia, including Alzheimer’s Disease. It is one of many recent studies that have noted that inverse association. Further, it is becoming evident that the current DRI (Dietary Reference Intake) for choline “may not be optimal for proper brain health and cognition”. (Ref.: Velaquez R et al., Choline as a prevention for Alzheimer’s Disease, Aging 2020 Vol. 12, No 3, p. 2026-270).

            In July 2024 the Rush Memory and Aging Project, involving more than 1,000 subjects, reported that a modest intake of two eggs per week was associated with a decreased risk of Alzheimer’s Disease, and at autopsy, AD patients with a higher egg intake showed fewer changes in the brain than are typical of that disease.

            Although choline is present in many common foods, especially poultry, fish, red meat, eggs, liver, cruciferous vegetables (such as broccoli, kale, Brussels sprouts, etc.), nuts and seeds, the Standard American Diet (S.A.D.) is lacking in almost all of these foods except for red meat. Taking a vitamin supplement won’t help; among several whose labels I examined, none lists choline in the list of ingredients. A solution appears to be the Mediterranean Diet, which includes the best sources of choline and many other nutrients.

            Eggs to the rescue! As noted in recent posts, eggs are among the healthiest foods and contain a generous amount of choline. Cholesterol is a non-issue. Eating two or three eggs every day will not raise your blood cholesterol by a single milligram, unless you eat them with “egg helpers” such as bacon, sausage, ham, hash browns, etc., all of which contain saturated fat, the real cholesterol-drivers. Eggs are excellent sources of protein and vitamins A, B complex, D and E, and several important but lesser-known nutrients.

            The recommendation of the month: Include a veggie omelet in your meal plan at least twice a week. Frozen mixed vegetables make it really easy. Be sure to add a tablespoon of olive oil to the mix. And leave those egg-helpers on the supermarket shelf!

Carvings April 17, 2025

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In the news

Synergistic supplements

            I have long argued that a high dose of a single supplement – vitamin, mineral or other – is not a solution to any health problem. Most if not all nutrients interact with each other like the instruments in a symphony orchestra and taking a large amount of any nutrient causes imbalance which can be harmful. On the other hand, we must ensure that our diet includes optimal amounts of vitamins, minerals and other nutrients.

            Omega-3 fatty acids are absolutely essential for virtually every cell in the body. They are vital for normal development and function of the heart, brain, eye and skeleton. Numerous studies link omega-3 deficiency with behavior disorders, schizophrenia, bipolar disorder and attention deficit disorder, and other neuropsychiatric problems.

            Vitamin D also has numerous roles, especially in maintaining a vigorous immune system. The deficiency of this vitamin in childhood results in rickets, a softening of the bones, often accompanied by serious brain damage. It is one of the many nutrients that are essential in preventing osteoporosis in older persons.

            Both of these nutrients are lacking in most Americans. An astonishing 95 percent of children and more than 65 percent of adults have an inadequate dietary intake of omega-3s. More than half of adolescents and adults have inadequate levels of vitamin D, especially in the northern latitudes. These two nutrients together act in the synthesis of serotonin, a brain chemical that regulates executive function and social behavior.

            Psychiatric disorders in our young population have reached levels that threaten to overwhelm our healthcare system. Children’s hospitals throughout the country find themselves unable to cope with what is clearly an epidemic. Nutrition alone will not stem the tide but it clearly is one factor that is within our ability to improve. Perhaps we should start with some strategy to get our kids to bolster their diet with these synergistic supplements. 

Lifestyle

            We are about to see an assault on highly processed foods, which now account for 60 to 90 (!) percent of the Standard American Diet (SAD – a perfect acronym) There is more to this picture than the addition of dozens of chemicals that make non-nutritious foods so attractive and addictive. In the course of altering the basic ingredients, the manufacture of these products results in the loss of important vitamins, minerals and fiber. Sometimes these are added back in, of course. That may not be enough, as reported in data from the UK’s National Health Service, showing a surge in hospital admissions due to vitamin deficiencies.

            All three leading causes of death, heart disease, cancer and type 2 diabetes, are unequivocally associated with (a) a high intake of highly processed foods and (b) the lack of whole foods, such as whole grains, legumes, fruits and vegetables. Highly processed foods include our favorite processed meats: cold cuts, hot dogs, bacon and sausage. We might add a warning from a 2009 article in the British Journal of Psychiatry: Persons who ate whole foods had a 26% lower risk of depression; those who ate processed food had a 58% higher risk. (Akbaraly TN et al., Dietary pattern and depressive symptoms in middle age, Br J Psychiatry 2009 Nov;195(5):408-13)