In the news

Don’t follow the crowd.

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

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

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

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

Lifestyle

Learn a language to postpone Alzheimer’s disease.

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

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

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

In the news

The 2024 measles outbreak.

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

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

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

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

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

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

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

Lifestyle

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

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

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

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

The changing world of diabetes

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

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

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

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

The Internet Trap

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

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

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

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

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