Tag Archives: wellness

Carvings August 1, 2026

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In the news

Moving by e-movers: What it means for the future

            It’s impossible not to notice them – e-bikes, e-skateboards, e-scooters, e-one-wheeled something or other. Has anyone seen e-roller skates yet? Yes, they’re here.

            Among military-age Americans barely one-fourth can pass recruiting physical standards. What kind of physical shape will the younger e-travel generation be in? What are the implications for the nation’s health, healthcare facilities and economy as these youngsters enter middle age?

            Diabesity, the combination of type two diabetes and obesity, is already costing the United State healthcare system more than one-half trillion dollars a year. Diet is a major factor in its development but so is the lack of exercise. Among children aged six to eleven years, 20.7 percent are obese as of 2020. Type two (formerly adult onset) diabetes is now being diagnosed with increasing frequency among sub-teens, and its complications, such as kidney disease, are emerging in twenty-somethings.

            There is a hidden hazard that is soon to emerge: osteoporosis. The human skeleton becomes fully developed between the ages of about five and twenty-five – the bone-building window. The childhood play activities that we knew as children, climbing jungle gyms, riding bikes, pushing scooters, skating that actually involved using our leg muscles, contributed to normal skeletal development. Even before the current change in children’s activities, orthopedists observed a striking increase in bone weakness among pre-adolescent and early adolescent children. Between 1970 and 2000, forearm fractures increased by more than thirty percent. A similar study from the years 2014-2016 revealed that the incidence had more than doubled.

            Can you guess where this is going? Are we likely to reverse the e-transport trend?

Lifestyle

Tinned fish, anyone?

            “Tinned fish” sounds like something you’d find in a London grocery store, but American nutritionists are encouraging everyone on this side of the pond to take advantage of their concentrated nutrients. Sardines are rated highest but salmon, tuna, herring, mackerel and anchovies are also healthy choices.

            Unfortunately, most people turn their noses up at them. That’s too bad, because they are rich in the very nutrients that many of us lack, starting with omega-3 fats. Omega-3 fatty acids are abundant in most fish, including shellfish as well as leafy green vegetables. They are necessary for a vigorous immune system, strong bones, healthy heart function and especially for brain and eye development in children.

            About half the senior population lacks adequate levels of vitamin D, a necessary nutrient for a strong skeleton and immune function. Tinned fish are a good source of vitamin D.

            Speaking of bones, these tinned fish species are excellent sources of calcium, protein and vitamin K2.

            The smallest of these fish have minimal levels of mercury but pregnant women should limit their intake of tuna to about one or two servings a month. Olive oil is the best packing medium for tinned fish. If they are packed in water or sauce, check the labels for their sodium content, and limit anchovies, which tend to have lots.

            Thanks to Google there is no shortage of recipes that feature these nutrient-rich fish. In fact, you’ll find some tasty-looking ones that will add some variety to your diet.

Carvings July 15, 2026

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In the news

Is cyclosporiasis something to worry about?

            In the past couple of months a parasitic disease, cyclosporiasis, has emerged in many states, with a few thousand cases to date. The symptoms can be severe but they are rarely fatal. One of the hallmarks of the disease is the explosive watery diarrhea that can last for weeks, or even longer. No deaths have been reported to date but persons whose immune system is compromised should take special precautions to prevent this and other microbial diseases.

            Scary headlines notwithstanding, cyclosporiasis will not become an epidemic, but it gives me the opportunity to remind readers to minimize infection by properly cleansing ALL fruits and vegetables as soon as you return from the market. Remove the outer leaves of lettuce and cabbage. Use soap and warm water, rinse thoroughly and refrigerate most items. Blackberries, raspberries and strawberries, because of their irregular surfaces, are well known for harboring germs even after washing. The last should have the green tops removed to make cleaning more effective. Bagged salads are occasionally the source of infection and should be rinsed in plain water — no soap — after careful inspection for dirt, bugs and spoiled leaves.

            Pesticide residues are not the threat that many people think but washing produce does remove the very small amount that has not dissipated during storage and transport. Organic foods are not necessarily free of pesticide residues or microbes and should be cleaned thoroughly.

Lifestyle

Polio – not quite gone yet

            Those of us who are old enough to remember polio epidemics are grateful for the vaccine that spared our children and grandchildren from that frightening disease. During my medical school years I worked among patients who spent their lives in an “iron lung”. The last of these patients passed away just recently at the age of 78. There have been no cases of natural polio in the United States since 1979 but dozens of people have developed a polio-like illness when the oral (Sabin) vaccine virus underwent mutation and acted like its wild cousin. The oral vaccine is no longer administered in this country.

            Polio has almost been eradicated from the globe except for continuing activity in Pakistan and Afghanistan. It exists there only because the savages who control those nations do not allow their children to be vaccinated and have repeatedly assassinated healthcare workers sent by the World Health Organization. To date more than one hundred members of vaccination teams have been killed.

            But polio has left its scars among many of those who suffered from paralytic disease in their youth. Post-polio syndrome develops years or decades after the original attack, averaging about 30 years. Pain, weakness and fatigue are the hallmarks of this condition and it has a marked effect on the quality of life of its victims.

            Only a small percentage of persons infected with the poliovirus, perhaps one in a hundred, will be struck with paralysis. However, even those with non-paralytic polio will sometimes develop post-polio syndrome. The diagnosis is often elusive, but anyone who develops abnormal weakness or fatigue with no obvious cause deserves thorough evaluation for post-polio syndrome.

            The mechanism by which post-polio syndrome occurs has eluded physicians but a recent study suggests that a persistent low-grade infection by a mutated virus might be the cause. The finding of poliovirus proteins in the spinal fluid and white blood cells of past polio victims but not in healthy persons may help to unravel the mystery. It is possible that a non-infectious form of the virus can persist in the nervous system for decades, continuing the ravages of the initial illness. This leads to the speculation that antiviral drugs can halt the process. I hope so.

Carvings July 1, 2026

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The exercise-cancer connection

            Physicians have recognized for decades that persons who engage in regular, moderately intense exercise have lower rates of cancer than non-exercisers. There are two reasons for this. First, exercise strengthens the immune system that can snuff out abnormal cells before they can multiply and produce cancer.

            Another reason is that exercisers do not become overweight or obese, whereas fat deposits produce two cancer-promoting factors, estrogen and inflammatory chemicals. Obesity, in fact, is associated with at least fourteen different types of cancer.

            In recent years, cancer specialists have become aware that exercise keeps cancer from returning in those who have received treatment. In 2024 the International Society of Exercise Oncology was formed to help organize the more than 2100 cancer exercise programs in the United States and to further their expansion.

            As I have noted numerous times in these posts, regular, moderately intense exercise is a fundamental requirement for good health. Yet, only about twenty percent of Americans exercise at least four or five times a week. The majority do not exercise at all. If those 80-20 numbers could be reversed cancer would no longer be the second leading cause of death, and deaths from heart disease and stroke would plummet as well.

Lifestyle

            In the early decades of my pediatric career I treated children for diseases that are virtually absent today. They ranged from common ear infections to infrequent but devastating meningitis, from uncomfortable mumps to sometimes fatal measles. Vaccines deservedly get the credit for the near elimination of those heartbreaking illnesses. Unfortunately the anti-vaccination movement is tragically undoing some of these advances, as shown by the surge in measles and whooping cough in recent years.

            One group of vaccines that is available for adults as well as children is the pneumococcal vaccine. A major cause of ear infections (otitis media) in children and pneumonia in adults and children is a bacterium called Streptococcus pneumoniae, commonly called the pneumococcus.

            The first attempts at creating a pneumococcal vaccine began over a hundred years ago but it wasn’t until the 1980s that a truly effective vaccine became available. Methodological advances and the vagaries of the bacterium itself have led to numerous formulations, each one capable of thwarting more and more strains.

            Use of the vaccine in children has led to a significant decline in the incidence of ear infections and a marked reduction in pneumonia, meningitis and blood stream infections. The adult vaccine has sharply reduced the incidence of pneumonia in adults. Widespread use of the pneumococcal disease in children has led to the emergence of herd immunity among adults. 

            The effectiveness of the pneumococcal vaccine and the absence of significant side effects should encourage every adult over the age of 65 to receive it but only about seventy percent of seniors have done so. Universal acceptance would almost completely eliminate pneumonia in the elderly population, a condition once described by Sir William Osler as “the old man’s friend”. Before the availability of antibiotics, pneumonia, often caused by the pneumococcus, quickly and relatively gently ended the lives of older persons who would otherwise have suffered through weeks or months from diseases such as cancer, stroke or heart failure.

            Because the vaccine has undergone so many changes since 2000, persons who received the vaccine several years ago should consult with their physician regarding the need for another dose. We no longer need the old man’s friend

Carvings March 15, 2026

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Revamping our dietary patterns

                It’s painfully clear that the Standard American Diet (SAD) is killing us by the millions and crippling us with conditions such as osteoporosis. Whatever your feelings are about the current administration, they are clearly on the right track to encourage Americans to begin eating normal food. The new food pyramid is not perfect but it’s an improvement over the old one, now with its emphasis on plant-based foods. I know, I know – I’d rather see the salmon above the steak but the latter does have an appropriately small space compared to the broccoli, carrots, and tomato. Let’s not quibble. Almost one-half of the new pyramid consists of veggies, fruit, berries and nuts.

                The place to start is breakfast, which for many persons consists of a sugary cereal. If you can’t give up breakfast cereal you can at least switch to the kind without added sugar or other processed ingredients. Eggs are fine but start cutting back on “egg helpers” such as bacon, sausage, ham, hash browns. Those are the foods that raise cholesterol, not the eggs, which are entirely innocent of that crime.

                If you need something sweet, how about one or two pieces of fruit, say half a grapefruit and a banana. Fruit juice is okay but why bother when whole fruit has less sugar, more fiber and much more satisfying “mouth feel” and is probably less expensive.

                Many Americans, especially seniors, don’t get enough protein. A morning breakfast shake that includes a scoop of powdered protein, some frozen berries, a little (!) fruit juice and some plain yogurt (more protein, as well as calcium, is tasty and filling and will get you through the morning without having to have a Danish or a donut with your coffee break.

Lifestyle

Continuing ethnoid: the salt issue

                Sodium, in the form of table salt, is a critical nutrient but taken in excess it contributes to high blood pressure. Two centuries ago it was almost the only means of preserving food and the result of a very high intake was a correspondingly high incidence of stomach cancer. In Japan, where the intake of sodium is nearly twice that in the United State – itself a higher intake than nature prefers – the incidence of stomach cancer is considerably higher than in other countries.

                In spite of the high sodium content in soy sauce and miso soup, most of the Japanese cuisine, with its emphasis on seafood and vegetables, is quite healthy. Considering that the Japanese people are the longest living on the planet, we should learn from their example. One caveat however: the youngest generation in Japan is destined to live shorter lives than its elders because of its adoption of the Western diet.

                Four items on the Chinese American menu that are particularly high in sodium are General Tso’s chicken, wonton soup, egg drop soup and vegetable stir-fry. White rice is a common staple in southern China but not in most of the country, where the folks enjoy a wide variety of vegetables that are only rarely found on Chinese restaurant menus in the United States.

 

Carvings January 1, 2026

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Happy New Year!

In the news

Is a pill the answer?

                The new year is going to see a surge in the oral forms of Ozempic and similar drugs for control of type 2 diabetes and for weight loss. The injectable forms of GLP-1, in spite of their inconvenience compared to oral medications, have been very popular because they are effective and they have relatively few serious side effects.

                The availability of a new class of drugs for the control of type 2 diabetes is welcome. That disease, which is entirely lifestyle related with very few exceptions, is a threat to the financial stability of the healthcare system. If the CDC projection is correct, more than half the U.S. population will be burdened with this disease by 2050 and the cost will reach over one trillion dollars per year.

                What are the practical aspects of the new pills in regard to weight loss? Some studies show a weight reduction of 10-15 percent; the best that I have seen in one trial was 27 pounds. That degree of fat loss does matter. It lowers the risk of coronary artery disease, stroke and the complications of type 2 diabetes.  That’s not the end of the story. A 250-pound person who loses 27 or 30 pound is still obese. They have lowered their risk but they have not eliminated it. The benefits are not permanent. Approximately two-thirds of users will regain their weight within only one year after stopping medication.

                There is nothing easy about trying to lose weight. The new pill has not changed that.

                The hardest “pill” for Americans to swallow is a change in lifestyle. Prescription drugs will help along the way, but only a reduction in caloric intake will eventually eliminate a decades-old accumulation of fat. Nor is exercise the answer. To exercise without cutting food intake is folly. However, it is extremely important to exercise regularly when on a calorie-reduction diet in order to prevent the loss of muscle mass that would otherwise result.

                The holidays are a lousy time to cut back on calories, but the holidays are over. Consider just throwing away all the goodies that were foisted upon you by loving friends and relatives. (A confession: I will not throw away my daughter’s fruit cake! Everything else goes.)

Carvings December 15th, 2025

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In the news

Another win for chocolate

            Well, not exactly. A recent study from Birmingham, England among a small group of volunteers showed that the harmful effects on blood vessels that occur during prolonged sitting can be offset by drinking cocoa. The researchers didn’t use dark chocolate, but a specially formulated cocoa drink that had a high level of flavonoids, the micronutrients that help to maintain the health and flexibility of blood vessels. In short, it was not the kind of hot chocolate mix that is so popular at this holiday time.

            Excellent sources of flavonoids include fruit, berries, nuts and tea, including green tea and herbal teas such as chamomile. These are all far superior to the sugar-laden hot chocolate mix that you’ll find at your local grocery store.

            Sitting, even for short periods – two hours in the study noted – has adverse effects on the flexibility of blood vessels and blood pressure. Decades of such inactivity inevitably lead to the kinds of cardiovascular diseases (heart attack and stroke) that are two of the three leading causes of death in Western society. Unfortunately, many occupations necessarily require long sessions at a desk. Wouldn’t it be nice to know that we can possibly offset at least a little of sedentary living’s hazards by some healthy snacking and sipping?

Lifestyle

            In the previous blog I promised to address the “I don’t have time to exercise” issue. Pardon my being blunt, if not outright crass, by pointing out that those making that argument will have plenty of time – but later – while in rehab, recovering from a heart attack or stroke, or getting around in a wheelchair while waiting for a prosthetic leg to arrive. Gross! I know, but it’s a fact.

            The most obvious lifestyle change is to substitute some TV-watching time for at least one hour of physical activity about four or five times a week. Even that relatively small input of time has been shown to significantly improve your chances of avoiding a cardiac catastrophe. And anyway, the news never changes – only the places where it’s freezing/flooding/quaking/erupting or how many people have been shot/stabbed/arrested.

            Then there are the many other ways of activating your muscles and improving your heart and lungs: stealth exercise. Take the stairs instead of the elevator – up and down. Do you find yourself driving around the parking lot to find the closest one to the entrance to the gym? The gym?!? If you park at the farthest corner of the lot you’ll get a warmup and a cooldown, you’ll never “lose” your car and your car door is less likely to get dinged. Stand up when you’re on the phone. Let your dog take you for a walk three times a day instead of twice on weekends.

            Exercise as if your life depends on it. It does!

Carvings, December 1, 2025

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In the news

I hope that I’m preaching to the choir

        As you know from recent blog posts, the influenza vaccine, though it does not always prevent the flu, is important because it decreases the severity of an infection, likely avoiding hospitalization. You may also recall that an episode of influenza significantly increases the risk of a heart attack or stroke, while the vaccine has just the opposite effect. Another point to emphasize: influenza weakens the immune system, which is the reason why deaths from the flu are almost always due to secondary infection, not viral infection.

                Infectious disease experts warn that this year’s flu season will probably be more severe than most because the current strain is more potent. This is already evident in Australia and the UK. That makes getting the vaccine especially important this winter.

Lifestyle

What hardly anyone knows about exercise.

                The title of this blog might seem somewhat pretentious but the evidence is all around us. Surveys over the years are pretty consistent: about eighty percent of Americans simply do not engage in any form of exercise. An interesting coincidence: eighty present of Americans are overweight or obese. Are they the same eighty percent. Ya think?

                The human body has evolved to require several hours a day of moderately intense physical activity. Before the Industrial Age there was no way around it. Getting to or from anywhere required walking. (Lest you think that riding horseback didn’t require physical activity, be assured that a ride of any distance is a pretty good workout.) Craftsmen used only hand tools; the most mundane household chore required lifting, carrying, chopping, etc..

                Moderately intense physical activity has two major effects: it burns calories and it opens dormant blood vessels. If we use up all the calories we take in there aren’t any left to be turned into fat. That’s obvious but what is not so obvious is that those fat stores are factories (fattories?) for churning out inflammatory chemicals that are the drivers of coronary heart disease, ischemic stroke, type 2 diabetes, cancer and osteoporosis. Another interesting coincidence: none of those conditions exist in pre-industrial societies – not one, except for some cancers!

                When your heart pumps vigorously in the course of intense physical activity, every blood vessel in the body, even those that are “resting”, opens up to accommodate the flow. That ensures that every cell receives oxygen and nutrients and gets rid of accumulated waste products. The ebb and flow of blood also keeps those blood vessels flexible so that they can handle the sudden stress of the kind that might precipitate a heart attack or stroke. 

                Twenty-five percent of the blood that exits the left side of the heart goes to the head, nearly all of it to the brain. Simply put, well-fed brain cells last longer.

                The excuse that I hear most often is “I don’t have time”. I’ll address that issue in the next post.

Carvings October 15, 2025

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In the news

What are we doing to our children’s brains – and ours?

            In the course of doing some research for a PowerPoint presentation titled How the computer affects your brain and your health, I learned some disturbing facts about the effects of screen time and social media. Numerous studies have observed that heavy use of both – and note that the average adolescent spends 8.5 hours a day looking at one kind of screen or another – leads to memory problems, short attention span, decreased self-control and more negative behaviors.

            A Canadian study of pre- and barely-adolescents, 9 to 13 years of age, evaluated six measures of cognitive performance, including reading recognition, picture vocabulary, explicit memory and overall cognitive skills. In every category but one (pattern comparison processing speed) the more time spent on social media the greater the decline in these skills. Even the group with the lowest level of social media exposure showed poor cognitive performance. The authors of the study consider this a “pressing public health concern” and believe that the time has come for public policy action to address the issue.

            I believe that there is more for us to consider. First, the age range studied here is younger than the mid-teens, where social media activity is far greater than the 0.3 to 3.0 hours per day of these younger children. It is not a stretch to say that a similarly designed study among older children would reveal even worse outcomes.

            Second, the detrimental effect of many hours of screen time and social media participation is not limited to the young. The aging process does not shield us from harm. I would argue that we could all benefit from finding better ways to engage our brains.

            A couple of years ago I weaned myself from reading the daily newspaper, having asked if reading it really increased my font of knowledge, and if I felt uplifted by the time I put the paper down. I’m sure you know the answer. I no longer own a television for the same reason. Unfortunately, I still have a “smart” phone – is that an oxymoron? —  on which I had felt compelled to learn what’s going on in the world at least once a day. I recently decided to check the news on Sunday morning – period. I feel more calm already, and my book queue is getting shorter.  

Lifestyle

Exercise, the heart, the brain and the immune system

            It has been known for decades that regular exercise is necessary to maintain muscle mass. What is not known as widely is that persons who do not exercise lose heart muscle, not just the muscle that powers your arms and legs. This has two significant consequences. The first is that as we get older the heart cannot keep up with demand. The result is that fatigue comes quickly; the larger problem is that when the blockage of a coronary artery occurs there is less heart muscle reserve, so when a heart attack occurs there is less chance of recovery. The second is that the loss of muscle can eventually lead to chronic heart failure, a serious and common problem among the elderly.

            In regard to the brain, regular exercise keeps its blood vessel supple, better able to deliver nutrients and to remove accumulated waste products. But regular aerobic exercise such as walking, cycling, swimming, etc., also increases the volume of both gray and white matter in the brains of older persons.

            A third benefit of exercise is that it improves the responsiveness of the immune system to vaccines and to infectious agents, counteracting the gradual decline that most elderly persons experience.

            If you think that you don’t have time to exercise, consider these facts.

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.