Archive For: Wellness

Exercise Is Good Medicine

Get Up and Join the Movement

As we emerge from the doldrums of winter hibernation and COVID-19-related inertia, it’s important to remember that exercise is good medicine and there’s no better time than now, to get moving again.

“There isn’t a chronic condition that can’t be better managed with an appropriate dose of exercise,” asserts Dr. Cedric Bryant*, President and Chief Science Officer at the American Council on Exercise. “This requires good interaction with your physician, an ability to listen smartly to your body and the realization that some exercise is always better than none.”

He recommends fostering good muscular fitness and enhancing strength, flexibility and balance with the exercise routine shown below. The 15-minute investment of time needed to complete one set of 8 to 15 repetitions for each exercise provides beginners with “the minimum effective dose needed to elicit a very positive response,” says Dr. Bryant.

Add regular rounds of exercise that build endurance, helping improve the health of your heart, lungs and circulatory system. To achieve the best results, you should have enough breath to talk but not enough to sing during aerobic activities such as brisk walking or jogging, dancing, biking, swimming, climbing stairs, or playing basketball, tennis or the uber-popular pickleball. (Learn more about today’s fastest-growing sport in an upcoming newsletter.) Be sure and check with your healthcare provider before beginning an exercise program.

Dr. Bryant’s Essential Seven

1. Pushups

Benefits: Develop the large muscles of the chest and the back of arms
The basic incline pushup is done using a sturdy table or other solid surface about 3 feet high. Stand facing the table and place your hands on the edge (shoulder width apart) arms straight and elbows not locked. Walk your feet backward until your arms and body are in a straight line. Bend elbows and slowly lower chest to the edge of the table while inhaling. Keep body straight and rigid throughout the movement. Push body away from the table until elbows are extended but not locked. Exhale as you push up.

 


 

2. Bodyweight Squat (we need a little green guy for this one)

Benefits: Strengthens and tones the lower body

Stand with your feet slightly more than hip width apart, toes turned slightly outward, hands at sides with palms facing in. Pull shoulders down and back. Stiffen your core and abdominal muscles. Hold chest up and out, tilt head slightly up, shift weight back onto your heels while pushing hips toward the wall behind you.

Downward phase: Shift hips back then down to create a hinge-like movement at hips and knees. Try to control the amount of forward movement of the shinbones. Maintain tension in the core muscles and keep your back straight. Lower yourself until thighs are parallel or almost parallel with the floor. DO NOT go deep enough to cause pain. Make sure your feet don’t move, ankles don’t collapse in or out, knees remain aligned over the second toe, and body weight is evenly distributed between balls and heels of the feet.

Upward phase: Extend the hips and knees by pushing your feet into the floor. Hips and torso should rise together while heels are flat on floor and knees are aligned over the second toe. Continue extending until you reach the starting position.

Remember to inhale on the way down and exhale on the way back up.


3. Bent-Over Row

Benefits: Targets muscles in the upper and middle back and improves stability of the spine

Holding a small weight in each hand and standing with feet hip-distance apart, bend at the waist. Your back should be parallel to the floor with a neutral, not rounded, spine. Extend arms toward floor, keeping knees slightly bent. Engage abs and squeeze shoulder blades together as you bend elbows back and bring weights to your torso. Keep arms close to your torso. Slowly lower the weights back to the starting position.


4. Modified Single-Leg Deadlift

Benefits: Strengthens and tones gluteals and helps improve balance

Position yourself by a wall or chair. Stand straight, with feet aligned with hips, and shift weight to right leg. Slowly bend forward at the waist while raising your left leg behind you until your torso and leg are both parallel to the floor. Keep your head up and arms straight, perpendicular to the floor. Lower your leg as you return to an upright position. Keep your leg straight at all times. Repeat all reps on one side, then switch legs.


5. Overhead Front Press

Benefits: Increases shoulder strength and engages the core for stability

Stand upright and keep the back straight. Note: Beginners or those with back issues can perform this exercise seated. Hold a small weight in each hand at the shoulders, with an overhand grip. Thumbs are on the inside and knuckles face up. Exhale as you raise the weights above the head in a controlled motion. Pause briefly at the top of the motion. Inhale and return the weights to your shoulders.


6. Calf Raises

Benefits: Strengthen lower leg muscles, increase stability, balance and agility

Start by standing 6 to 12 inches away from a wall, facing it, with feet hip width apart. Extend arms to place your palms on the wall, level with chest or shoulders. Exhale and slowly lift heels off the floor, keeping knees extended without rotating your feet. Use your hands on the wall to support your body. Hold raised position briefly. Inhale and slowly lower heels back to the floor.


7. Plank Pose

Benefits: Strengthens the core and abdominals while increasing stability and balance

Modified version: Start in tabletop position with hands and knees on the floor. Walk your hands so your forearms and palms are facing down, keep shoulders and elbows aligned. Walk your knees away from your body until you feel your core and abdominals engaged. Keep torso straight and rigid, your body in a straight line from ears to knees with no sagging or bending, and with shoulders down, not creeping up toward your ears. You may keep your toes on the floor for extra support. Hold position for 10 seconds. Walk your knees back in, repeat. Over time, work up to 30, 45 or 60 seconds.


*As President and Chief Science Officer at the American Council on Exercise, Cedric X. Bryant, PH.D and Fellow of the American College of Sports Medicine, stewards the organization’s exercise-science and behavior-change education. He earned both his doctorate in physiology and master’s degree in exercise science from Pennsylvania State University, where he received the Penn State Alumni Fellow Award, the school’s highest alumni honor.

Sources/refer to these websites for more detailed descriptions on the exercises: American Council on Exercise, Verywell Fit, Women’s Health

The post Exercise Is Good Medicine appeared first on Specialdocs Consultants.

What’s Keeping You Up at Night?

Breaking the Cycle of Anxiety, Insomnia and Sleep Anxiety

A good night’s sleep does more than refresh and revitalize. It’s essential to your health, so make it a priority to understand what’s keeping you up at night.

“Healthy sleep is as important as proper nutrition and regular exercise for our physical and mental well-being,” says Kannan Ramar, MD, sleep medicine physician at the Mayo Clinic’s Center for Sleep Medicine and immediate past president of the American Academy of Sleep Medicine. “Lack of sufficient sleep is associated with increased risks of type 2 diabetes, high blood pressure, cardiovascular disease, depression and anxiety.”

The sleepless nights and drowsy days previously experienced by one out of three Americans with insomnia rose to pandemic highs of almost 60% in 2021, sounding a wake-up call to address this treatable condition which profoundly impacts both mental and physical well-being.

Sleep disturbance is intricately interconnected with the presence of issues such as anxiety and depression, each influencing the others, so it’s not always possible to determine which came first. Behavioral changes that result from chronic insomnia include feelings of being overwhelmed, inability to concentrate, irritability, nervousness, restlessness, and a sense of impending danger or doom.

Of adults diagnosed with depression, 75% experience insomnia and 20% have obstructive sleep apnea. Similarly, anxiety can make it harder for the body to relax and fall asleep.

Research suggests that anxiety can also affect rapid eye movement (REM) during slumber and trigger vivid, disturbing dreams that wake the sleeper.

Completing the loop is sleep anxiety — apprehension or fear about going to sleep — which is commonly seen in those with insomnia, narcolepsy, sleep apnea or restless legs syndrome.

While insomnia can seem never-ending, a number of strategies can effectively break the cycle.

The Basics:

  • Set boundaries for blue light exposure by turning off tv, tablets and phones at least 30 minutes before bedtime.
  • Limit large meals, caffeine and alcohol within 3 to 4 hours of bedtime, which can disrupt sleep. Alcohol allows you to fall asleep quickly but not stay asleep throughout the night.
  • Establish a consistent wake-up time seven days a week.
  • Ensure your bedroom is a designated place of sleep by keeping it dark, cool and quiet. And turn around your clock so you can’t see the time if you’re tossing and turning in the middle of the night.
  • Pursue support if you are experiencing chronic insomnia, defined as difficulty sleeping three or more times per week for at least three months. “We know that the longer insomnia lasts, the more difficult it is to treat,” says Dr. Ramar.

Support can include:

  • Cognitive behavioral therapy for insomnia (CBTI), a form of talk therapy focused on learning how to create an optimal sleep environment with positive bedtime routines and avoidance of factors that trigger anxiety and negative thinking. Requiring up to 12 weeks to see results, the key is shifting from “trying hard to sleep” to “allowing sleep to happen,” according to Stanford Health.
  • Prescription sleep hypnotics, such as Ambien or Lunesta. Hypnotics can be considered in conjunction with CBTI, but patients must be closely monitored for adverse effects and a buildup of tolerance to the medication’s effects. Low doses of Trazodone, an antidepressant, are sometimes used, as it causes drowsiness.
  • Light therapy, which is especially helpful for those who need to reset their circadian rhythms; e.g., a night owl who wants to function better with an early morning rising time.

If you are experiencing too many wakeful nights, please let your healthcare provider know. It may be helpful to keep a sleep diary for several weeks to help pinpoint the habits affecting your ability to fall and stay asleep. In some cases, we may recommend a polysomnography (sleep study), where you’ll be monitored for blood oxygen levels, body position, breathing, electrical activity in the brain, eye and leg movements, heart rates and rhythms, sleep stages and snoring during an overnight stay in a sleep lab.

Finally, keep in mind that the amount of sleep needed per night – typically 7 or 8 hours on average – varies by individual. “If you function well and are fully alert during the day, you can be confident your sleep needs are being met,” says Dr. Ramar.

The post What’s Keeping You Up at Night? appeared first on Specialdocs Consultants.

What Does BMI Really Tell Us?

Definitive Diagnostic Tool or Part of a Greater Health Matrix?

It’s an easily understood calculation: Body Mass Index, popularly known as BMI, computes an individual’s measure of body fat as weight in kilograms divided by height in meters squared. Levels are defined as Underweight if less than 18.5, Normal weight if between 18.5 and 24.9, Overweight if between 25.0 and 29.9, and Obese if above 30. But what does BMI really tell us?

This simple formula has nonetheless sparked controversy and continued questioning: Is BMI a quick, easy and efficient way to identify weight problems and associated risk of disease in adults? Or is it an inaccurate measure because it doesn’t consider body composition, age, sex or ethnicity?

Years of debate, research and analysis now point to using BMI in a more nuanced way, suggesting that it is best employed as just one part of an initial health screening for individuals, and not as a diagnostic tool. Much more meaningful is how BMI fits with other essential measures of an individual’s health — blood pressure, blood sugar, cholesterol levels, heart rate, inflammation, physical activity, diet, cigarette smoking and family history.

Looking at BMI alone can be misleading when you consider that:

  • Women tend to have more body fat than men.
  • Older adults have more body fat than younger ones. Aging is associated with an unhealthy increase in body fat and an associated increased risk for prediabetes and type 2 diabetes.
  • At the same BMI, the metabolic risks for people of Asian descent are higher than for Caucasians.
  • People who engage in strength training two or more times per week have higher lean muscle mass than nonathletes, which can result in a higher BMI but not necessarily a higher risk of disease.

Additionally, knowing where the fat is distributed is essential in determining disease risk. The pear shape associated with women means subcutaneous fat around the hips, thighs and buttocks; more dangerous is the apple shape, which indicates visceral fat in the abdomen (waist circumference of more than 40 inches for men or more than 35 inches for nonpregnant women), which is linked to higher risk of heart disease and type 2 diabetes.

An influential study published in Nature further revealed the flaws in categorizing people as “unhealthy” or “healthy” based on BMI alone. The authors found that more than 74 million American adults were miscategorized. Nearly half of people considered overweight and 29% of those categorized as obese were actually metabolically healthy, with normal blood pressure, cholesterol and blood glucose levels. Meanwhile, 30% of those considered “normal weight” had metabolic or heart issues.

The origins of BMI help explain its limitations. In the 1830s Belgian mathematician Lambert Adolphe Jacques Quetelet developed a test intended to identify the “l’homme moyen,” or the “average man,” by taking the measurements of thousands of Western European men and comparing them to find the ideal weight. More than a century later, American physiologist and dietician Ancel Keys promoted Quetelet’s Index as the best available way to quickly screen for obesity, identifying certain BMI ranges as associated with greater risk of disease and poor health outcomes. However, like Quetelet, Keys didn’t account for different body types or ethnicities.

One other point to consider: While more intrusive and not as commonly available, methods such as measuring skinfold thicknesses, bioelectrical impedance, underwater weighing, abdominal CT scans (for visceral fat) and dual-energy X-ray absorption are more accurate than BMI for estimating body fat.

So is BMI still meaningful?
As a discussion point, or as one tool used in combination with other assessments of metabolic and skeletal health, it can be useful.

Most importantly, body fat is just one of many factors considered when evaluating individual health and risk of disease.

We encourage you to call your healthcare provider to discuss your personal wellness profile.

The post What Does BMI Really Tell Us? appeared first on Specialdocs Consultants.

Pandemic Stress Likely Compounded by Seasonal Affective Disorder

 

Coping With Sad This Winter

As we continue to weather the storm of COVID-19, seasonal affective disorder, or SAD, is once again on our radar. More subtle than an arctic blast, SAD is just as real, with just as much potential to have a chilling effect on our mood, productivity and wellness. Similar to last winter, the emotional stress and ongoing uncertainty that come with a global pandemic is unfortunately creating an ideal climate for SAD. Not surprisingly, mental health experts are expecting to diagnose and treat an increased number of people with SAD in 2022.

First discovered in the 1840s, SAD was not officially recognized as a disorder until the early 1980s, when Dr. Norman Rosenthal coined the term and categorized it as a form of clinical depression. We now know that SAD affects at least 5% of Americans; is more likely to affect women than men, those with other forms of depression or family members with the condition; and is far more common in northern regions, due to reduced natural sunlight. New research has advanced several theories as to why some people develop SAD, including: sluggish transmission of serotonin (which helps regulate mood and the body’s circadian rhythms; reduced sensitivity of the eyes to environmental light; a combination of these factors; or other reasons yet to be uncovered).

A deeper understanding of what triggers SAD and its impact on mental health has inspired a growing number of clinical treatments that can effectively neutralize its effects.

Chief among them:
Healing light.
Sitting in front of a bright light box for 30 to 45 minutes daily has been a treatment of choice for more than three decades, helping SAD patients with either 10,000 lux of white fluorescent or full spectrum light that shines 20 times brighter than ordinary indoor illumination. Dawn simulation, another form of light therapy, begins in early morning before patients awake by emitting a low level of light that gradually increases over 30 to 90 minutes to recommended room light level (approximately 250 lux). Enhancing indoor lighting with regular lamps and fixtures is also recommended).

Talk therapy.
Newer studies from the University of Vermont suggest that cognitive behavioral therapy (CBT), a psychological treatment aimed at providing patients with tools to change negative thoughts and behaviors, may be as effective as light therapy for treating SAD. According to the National Institute for Mental Health (NIMH), CBT adapted for SAD focuses on behavioral activation, helping SAD sufferers identify and engage in enjoyable seasonal activities to combat the ennui and fatigue they typically experience in winter.

Sleep hygiene.
Creating a consistent light-dark, sleep-wake cycle is important for SAD patients, who often experience hypersomnia (excessive daytime sleepiness) and insomnia (trouble falling or staying asleep).
Antidepressant medications. Because SAD is associated with disturbances in serotonin activity, antidepressant medications have been effectively used to treat symptoms.
Active days. Keep moving with daily walks outside, even on cloudy days, and aerobic exercise. Both can help alleviate symptoms of SAD.

Winterize your mental health
Be proactive in safeguarding your mental wellness over the coming months. Most importantly, know the symptoms of SAD and call our office for help if you’re experiencing:

  • Diminished interest in things that were once enjoyable
  • Low energy or overwhelming fatigue
  • Difficulty with concentration or focus
  • Worthless or helpless feeling
  • Sleep issues: too much sleep, or not enough
  • Changes in appetite or weight; increases in carbohydrate and sugar cravings
  • Agitation

Experts advise those who’ve previously experienced episodes of seasonal depression to try to get in front of it this year. Call our office for guidance regarding medications or CBT sessions. For many, reprogramming their mindset can help restore proper circadian rhythms and eliminate the psychological dread of winter. Try enrolling in an online class, taking up a new hobby or creating a new routine to optimize daylight exposure. Or keep it even simpler. As Dr. Rosenthal told the New York Times, “A 20-minute early morning walk in the sun can be as good as commercial light therapy.”

The post Pandemic Stress Likely Compounded by Seasonal Affective Disorder appeared first on Specialdocs Consultants.

A Novel Approach to Behavior Change

How to Replace Bad Habits with Healthy, Sustainable Behaviors

For entrepreneur physician Kyra Bobinet, MD, the typical reasons behind a failed diet served as the impetus for developing a novel approach to behavior change.

“I was doing so well. I knew what to eat, when to eat, how to eat, and then I just stopped doing it…and I don’t know why.”

Her answer to a patient’s familiar lament above, called the Iterative MindsetTM, is now used by the U.S. Centers for Disease Control and Prevention (CDC) to enhance its diabetes prevention program.

Drawing on her neuroscience and medical training at the UCSF School of Medicine and Harvard T.H. Chan School of Public Health, Bobinet conducted years of field research aimed at eliminating the inevitable gap between intention and action. What she discovered was a way to change even the most intractable bad habits and permanently replace them with healthy, sustainable ones.

The Iterative Mindset, Bobinet asserts, is the key to people who succeed despite seemingly insurmountable odds. In her early work helping frontline Walmart employees manage conditions such as obesity, cardiac disease and diabetes, she observed that only a small percentage of people were able to achieve the necessary lifestyle changes. Notably, they faced every possible headwind of financial and social stress – single parenting, senior caregiving, food insecurity and lack of healthcare access.

“Nonetheless, they somehow were able to lose weight, get off their medications, and dramatically improve their health,” she recounts. “We looked and looked, but the only common link between them was the Iterative Mindset, a resilient way of approaching behavior change like an experiment – with curiosity, innovation and no failure or blame if it doesn’t work out as planned.”

It’s a stark contrast with the way most people view their failure to change longstanding habits. Bobinet describes why: “The habenula, a recently characterized area of the thalamus, has two functions – detecting failure and then, if you think you failed, suppressing your motivation to keep trying. By activating whenever you believe you’ve failed to reach a goal, the habenula places you in a state of learned helplessness, associated with higher depression and low self-efficacy. This is when most people give up and bad choices ensue.”

She posits that those who form new habits by continually trying again in different ways, or iterating, are able to bypass that switch in the brain. An iterative mindset can succeed where the performance mindset, used for SMART (specific, measurable, achievable, relevant, time-based) goals or tracking steps with wearable devices, sometimes cannot.

“Performance mindset works well to motivate for tasks that are short-lived, and for optimization, such as athletes who have already experienced a substantial success and want to strive for the next level,” says Bobinet. “However, it can be detrimental when used to modify behaviors in more vulnerable people, setting them up for an eventual win or lose situation that triggers feelings of failure and causes loss of motivation to keep trying.”

True change only happens when a new behavior turns into a habit, repeated so frequently it grows to be automatic, and by definition becomes part of your lifestyle, says Bobinet. The process can take up to two years, with multiple relapses an expected part of the process.

“It’s completely natural to relapse when you’re stressed or distracted; it’s how fast you get back in motion that counts. And you cannot fail as long as you iterate,” emphasizes Bobinet. “Don’t blame yourself, blame what you tried—it wasn’t the right thing right now. Think of it as an experiment that needs tweaking and continue to version until you find the right fit for you.”

If you’re interested in trying this mindset approach to behavior change, Dr. Bobinet offers a free basic Fresh Tri app through the Apple App Store and Google Play.

The post A Novel Approach to Behavior Change appeared first on Specialdocs Consultants.

Staying Well in the New Year A Proactive Guide

In the spirit of starting 2022 with healthy intention, we’ve taken a page from the U.S. Preventive Services Task Force (USPSTF) latest recommendations, long considered the gold standard for clinical preventive services, and prepared the following proactive guide to staying well in the new year.

Back in 1903, Thomas Edison predicted where we were headed: “The doctor of the future will give no medicine but will instruct his patient in the care of the human frame, in diet, and the cause and prevention of disease.”

While we have yet to reach the future envisioned by Edison, preventive care, relegated to the back seat during the pandemic, is in full gear once again.

Since 1984, the USPSTF team of volunteer, independent experts in internal medicine, family medicine, pediatrics, behavioral health, obstetrics/gynecology and nursing has conducted rigorous assessments of the scientific evidence for the effectiveness of a broad range of preventive screening, counseling and medications. Their findings, published in the Journal of the American Medical Association, laid the foundation for preventive medicine in primary care, from when to get your first colonoscopy to whether an aspirin a day is really the best way to keep a heart attack at bay.

A number of USPSTF recommendations have changed significantly over the years, guided by evolving science and clinical experience. In 2021, these changes included lowering the screening age for diabetes from age 40 to 35, lowering the age for colorectal cancer screening from age 50 to 45, and strongly discouraging people over 60 from taking a low-dose aspirin each day to prevent a first cardiovascular (CV) event. As recently noted by the advisory board, this doesn’t represent a flip-flop or misfire, but rather necessary updates based on new research. So, for example, when the latest evidence showed the increased risk of gastrointestinal or brain bleeds in certain populations from taking a daily aspirin to prevent CV disease, the panel reviewed, reconsidered and drafted a revision to its 2016 recommendation. Similarly, when data pointed to the incidence of diabetes increasing at age 35 and the benefits of lifestyle interventions for reducing progression from prediabetes to the more serious type 2, the USPSTF revised accordingly.

What’s on the radar for the USPSTF? Recommendations being studied now for potential updates include statin use for the prevention of CV disease; vitamin, mineral and multivitamin supplementation to prevent CV disease and cancer; behavioral counseling interventions for prevention of CV disease in low-risk adults; hormone therapy to prevent chronic conditions in postmenopausal women; effectiveness of screening for depression, eating disorders, obstructive sleep apnea, skin cancer, osteoporosis, glaucoma and atrial fibrillation; and a comparison of breast cancer screening methods. Stay tuned for new developments.

An Ounce of Prevention

Following are the latest USPSTF preventive medicine recommendations, intended for people without symptoms of the disease. As always, please consult with your healthcare provider for guidance based on your personal health situation.

The post Staying Well in the New Year A Proactive Guide appeared first on Specialdocs Consultants.

Color Your World with Every Hue of Fruit and Vegetable

Eating Your Fruits and Veggies May Help Reduce the Risk of Chronic Disease

Fill your plate with a vibrant, colorful array of fruits and vegetables for a naturally delicious way to meet your daily requirement of vitamins, minerals and nutrients. Plant foods contain thousands of natural compounds called phytonutrients, which may have anti-inflammatory benefits that can help reduce the risk of chronic diseases. Every color has a contribution to make – aim for a few different ones each day, and enjoy the entire spectrum.

Red and pink:

These fruits and vegetables are an abundant source of the carotenoid lycopene, which may help balance free radical activity in the body, offering protection against prostate cancer and heart and lung disease. Additional picks: red onions, persimmons and raspberries.

  • beets
  • cherries
  • cranberries
  • pink grapefruit
  • pomegranates
  • radicchio
  • red radishes
  • red apples
  • red grapes
  • red peppers
  • red potatoes
  • rhubarbs
  • strawberries
  • tomatoes
  • watermelons

Orange and yellow:

Enjoy an extra boost of beta cryptoxanthin, which supports intracellular communication and may help prevent heart disease. Orange and yellow fruits and vegetables also contain vitamin C and carotenoids, including beta-carotene, which is associated with promoting healthy vision and cell growth. Additional picks: pomelos, turmeric root and star fruit.

  • acorn squash
  • butternut squash
  • apricots
  • cantaloupes
  • carrots
  • corn
  • grapefruit
  • lemons
  • mangoes
  • nectarines
  • oranges
  • orange peppers
  • papayas
  • peaches
  • pineapples
  • pumpkins
  • summer squash
  • sweet potatoes
  • tangerines
  • yams
  • yellow apples
  • yellow peppers
  • yellow squash

Green:

These are some of the healthiest fruits and vegetables, rich in chemicals like sulforaphane, isocyanate and indoles, which may inhibit the action of carcinogens. Dark green and leafy vegetables have the highest concentration of both antioxidants and fiber. They’re also packed with potassium, lutein, isothiocyanates, isoflavones and vitamin K, which can be important for vision, bone and blood health. Greens like kale have as much calcium as milk. Additional picks: Swiss chard, arugula, zucchini, edamame, alfalfa sprouts and green herbs (mint, rosemary, sage, thyme and basil).

  • artichokes
  • asparagus
  • avocados
  • bok choy
  • broccoli
  • Brussels sprouts
  • celery
  • collard greens
  • cucumbers
  • green beans
  • green cabbage
  • green grapes
  • green onions
  • green peppers
  • kale
  • kiwis
  • leeks
  • limes
  • mustard greens
  • okra
  • pears
  • peas
  • romaine lettuce
  • snow peas
  • spinach
  • sugar snap peas
  • watercress
  • zucchini

Blue and purple:

Anthocyanins – powerful antioxidants that may help delay cellular aging, block the formation of blood clots and boost urinary tract health – abound in these fruits and veggies. Additional picks: beetroot, radishes and purple cabbage.

  • blackberries
  • blueberries
  • black currants
  • dates
  • eggplants
  • grapes
  • plums
  • prunes
  • purple figs
  • raisins

White:

These foods may not be as brightly hued as the others, but they shine with valuable phytonutrients. These include the potentially anti-tumor properties of allicin and quercetin, found in garlic and onions; the healthy compound sulforaphane in the cruciferous cauliflower; and immune-supporting selenium in mushrooms. Additional picks: leeks, white beans (cannellini, navy beans, lima beans, soybeans), lychees, white peaches and daikon radish.

  • bananas
  • cauliflower
  • garlic
  • Jerusalem artichokes
  • mushrooms
  • onions
  • potatoes
  • parsnips
  • shallots

Sources: American Heart Association, Rush.edu, Harvard Health

The post Color Your World with Every Hue of Fruit and Vegetable appeared first on Specialdocs Consultants.

COVID-19 and The Road Ahead

From Boosters & Breakthroughs to Vaccines & Variants: Where Do We Go From Here?

The following reflects an 8/24/2021 discussion; please check the CDC website for real-time updates as the situation continues to evolve.

Their answers may not land lightly, but epidemiologist Jodie Guest, PhD, and drug development expert Michael Kinch, PhD, have been immersed in examining COVID-19 since its first stirrings in early 2020. They share an informed look at the road ahead for us all.

State of Concern

Noting more than 39 million COVID-19 cases nationwide, (as of 9/2/21) Guest projects this will continue to rise rapidly and eclipse one million a week. While “hot spots” for outbreaks clearly correspond to the country’s most lightly vaccinated locales, the impact of the delta variant is being felt in virtually every state. “There’s almost nowhere you can go in the U.S. that you don’t need to be masked indoors, even if vaccinated,” she says. The progressive increase in vaccinated patients with COVID-19 in European hospitals is also troubling, says Kinch, a potential harbinger of what is to come for the U.S.

However, what’s driving the surge is not cases among the vaccinated, known as “breakthroughs.” It’s a term Guest would like to eliminate permanently, given its negative connotation regarding vaccine efficacy. “These type of infections are still rare. More than 90% of those hospitalized with COVID-19 are unvaccinated.” She points out that while viral loads in patients with COVID-19 are the same for vaccinated and unvaccinated patients in the first few days of illness, they drop much faster and further in the vaccinated.

The vaccine, contends Kinch, was never intended to eliminate all possibility of getting COVID-19. “It’s not a suit of armor,” he says, “because no vaccine ever provides 100% protection. But we know they work incredibly well to prevent you from getting very sick or dying.”

The FDA’s recent approval of the Pfizer mRNA vaccine, with Moderna approval expected to follow soon, is pivotal, says Guest, in helping launch vaccination requirements at businesses, schools and other locations. “Don’t underestimate the importance of this approval in providing support for mandates that will protect all of us,” she says. “Recognize that in the entire history of vaccines, there has never been a set more studied than the ones we have now.”
Adds Kinch, “With the enormous amount of data gathered on the vaccines’ efficacy and safety, those who think of themselves as vaccine hesitant may more accurately be described as vaccine resistant.”

Third Doses and Boosters

The recent approval of a third dose of Pfizer or Moderna for immunosuppressed patients who didn’t build sufficient immunity from the first two doses applies to just 3% of the adult population. For everyone else (with the exception of pregnant women), a booster shot six to eight months after the initial series is being considered for approval.

“Right now, that’s how long we believe we can go without significantly diminished immunity,” says Guest. Antibody tests are not proven to be an accurate measure of protection from COVID-19, says Kinch, because the antibody levels vary by individual.

If you received Pfizer or Moderna initially, choose the same for a booster. Notes Kinch: “There’s no difference between these two vaccines—one is not better than the other.” In fact, some studies show no impact on efficacy from switching brands, he says; Johnson & Johnson data is yet to come.

And where does the flu shot fit in this fall? Absolutely essential, both agree, with the only caution that a two-week separation between the two vaccines may be recommended by some healthcare providers to avoid triggering a hyperactive immune response.

Protecting our Children

The best way to keep youngsters under 12 safe is ensuring that everyone around them is vaccinated, says Guest.
“Teachers, caregivers, babysitters and others should be vaccinated, or fully masked whenever they’re with children,” she advises. A different dose is being tested for 5- to 12-year-olds, with approval possible later this year.

The Next Wave of Variants?

While not identified by the Centers for Disease Control (CDC) as a “high concern,” Kinch admits that the lambda variant worries him primarily because not enough is known about its ability to resist vaccines. “One view is that the COVID-19 spike protein can only mutate to a certain point, and if that’s true, lambda could be the end of the virus. The other view is that we don’t know if it stopped mutating,” he says.
“We’re not defenseless, though,” counters Guest, “because we can keep it from getting here by having COVID-19 not circulating in communities. Greater numbers of vaccinated people will prevent us from getting whatever variant might follow delta.”

Stay Safe and Well

One of last year’s most popular signoff lines takes on new resonance as our experts advise on what that now means for the vaccinated in fall 2021.

Mask Up, Indoors and Out.

Masks are increasingly needed outside in crowded areas. Indoors, remember that while a soft, comfortable cloth mask protects others from you, if you need extra protection in certain settings, use a KN95 or N95 mask.

Pass on Indoor Dining, Movies, Concerts and Sporting Events.

Also reconsider full-capacity outdoor events with no masking/distancing/vaccine requirements. (As an alternative, order take-out and support virtual events offered by local venues). And avoid getting together in person with those who are not vaccinated.

Reach out to Every Unvaccinated Person you Know.

“The best action we can take is to keep encouraging every unvaccinated person we know to get the shot, now,” advises Guest. “We’re all in the race against variants and need to work together to defeat them as quickly as possible.” Adds Kinch, “It’s unfortunate that the motivations behind much of the messaging has messed up the message itself. Be completely honest about what is known and not known about the vaccine.”

The Swiss Cheese Respiratory Pandemic Defense.

“Layering prevention messages is crucial because the delta variant has made the holes in the Swiss cheese slice of the vaccine just a bit bigger,” says Guest. “Now masks are more crucial than ever before.”

Dr. Jodie Guest is professor and vice chair of the Department of Epidemiology, Emory University, Atlanta, and award-winning leader of Emory’s Outbreak Response Team for COVID-19.

Dr. Michael Kinch is associate vice chancellor and founder/director of the Center for Research Innovation in Biotechnology and the Center for Drug Discovery at Washington University, St. Louis.

The post COVID-19 and The Road Ahead appeared first on Specialdocs Consultants.

Healthier Eating

Fish skewers, baked potatoes, vegetables and yogurt greens sauce on dark background, top view

How to Pare Down Protein & Cut Back Carbs

Inspired by a belief that our diets can be redefined to integrate both healthier eatting and environmental responsibility , Menus of Change encourages a meaningful “flip” in the emphasis on animal proteins and highly processed carbohydrates to an emphasis on highly appealing alternatives.

Menus of Change, a collaboration of the Harvard T.H. Chan School of Public Health and the Culinary Institute of America (CIA), authors a creative approach to enjoying delicious, nutritional and sustainable foods: “The Protein Flip” and its companion, the
“Carbohydrate Flip.”

The Protein Flip, introduced in 2016, laid the groundwork for the Menus of Change health- oriented methodology, stating, “Higher intake of red meat, irrespective of its total fat content, increases risk of heart disease, stroke and diabetes when compared to poultry, fish, eggs, nuts, or legumes.”

The Menus of Change solution was to challenge chefs in every setting to place meat, poultry and seafood in a supporting role or as a side and make vegetables and plant proteins the stars – for example, burger blends composed of primarily mushrooms, other vegetables, grains or legumes; surf and turf reimagined as seafood with bountiful vegetables and only a bite or two of meat; use of tapas, mezze and other plant-forward small plate replacements for entrees. The public response was immensely gratifying, spurring further innovation and the mainstreaming of vegan options, such as lentil, barley and black bean burgers or wild rice polenta burgers made with mushrooms, carrots and leeks.

Building on their successful work with proteins, the collaborative is now developing a complementary program centered on advancing carbohydrate quality on the American plate. “From fluffy pancakes to soft hamburger buns, refined, fast-metabolizing carbohydrates are still found in many a diet and are contributing to the rise in diet-linked chronic conditions such as
diabetes and heart disease,” according to a recent Menus of Change summit panel discussion headed by Sarah Schutzberger, RD, CSO (certified in oncology nutrition). “In large part because of our food choices, scientists project that 75 percent of chronic diseases are attributable to diet and lifestyle.”

A substantial emphasis on whole, minimally processed carbohydrates can help change the trajectory, beginning with these flips described by the panel:

  • Take on the Three Pleasures challenge: Create a delicious dessert using dark chocolate, nuts, and fresh-cut or dried fruit. “Instead of forcing a choice between a whole slice of cheesecake with a single strawberry as garnish or a plain bowl of berries, enjoy a dessert made from a healthy market basket that includes dark chocolate, fruit, whole grains, nuts and yogurt,” advised Greg Drescher, Culinary Institute of America.
  • Look to world food cultures for inspiration:
    • Mediterranean region: “This type of cooking features a healthy fat versus a low fat approach to diet, with olive oil as the foundation of flavor,” said Drescher. Try tabouli, made of cracked bulgur wheat, chopped parsley and olive oil, or a salad made with hydrated, whole-grain barley rusks, topped with chopped tomatoes and fresh feta cheese and tossed with olive oil. Also important: improve the health profile of pasta by using a whole-grain type and cooking al dente to make it a source of slower-releasing carbohydrates.
    • France: The niçoise salad suggests ways to include potatoes in limited amounts by pairing with green beans and other vegetables, hard-boiled egg, and a light vinaigrette for a slow-metabolizing lunch.
    • Asia and India: Try a salad featuring soba noodles made from buckwheat flour; a Buddha bowl with foundational ingredients that include legumes, fresh vegetables and plant proteins, paired with small amounts of salmon or roasted tofu; and whole-grain flatbreads.

The post Healthier Eating appeared first on Specialdocs Consultants.

New Lung Cancer Screening Recommendations

Illustration of a toxic smoke in Lung

Spotlighting Both Challenges and Progress

This winter the U.S. Preventive Services Task Force (USPSTF) released its new Lung Cancer screening recommendations, lowering both the starting age and pack-per-year criteria. Previously, low-dose computed tomography screening was advised for adults age 55 to 80 years with a 30-pack-per-year history of smoking who are current smokers or have quit within the past 15 years; now the USPSTF recommends extending the screening to adults starting at age 50 who have a 20-pack-per-year smoking history.

For most, the announcement may have gone under the radar due to the intense focus on the COVID-19 vaccine rollout in early 2021. But as the first change in lung cancer screening eligibility criteria since 2013, its significance was quickly recognized and is still being broadly debated across the medical community.

Notably, previous recommendations missed female patients who tended to be lighter smokers than men, and despite Black smokers’ higher risk of developing lung cancer, included only 17% of Black people who smoke compared to 31% of White smokers. The question is, by doubling the number of people eligible for screening, do the guidelines indicate a significant shift that will improve gender and racial disparities in testing and outcomes, or are they simply a small, overdue step in the right direction?

“It’s excellent news because expanded screening eligibility can reduce lung cancer mortality and may reduce all-cause mortality,” acknowledges Ella Kazerooni, MD, professor of radiology and internal medicine at the University of Michigan Medical School, who’s devoted much of her career to creating lung cancer survivors through her work as chair of the National Lung Cancer Roundtable.

The downside: “This may also cause false-positive results, leading to unnecessary tests and invasive procedures, because we’re still not incorporating other known risk factors. These encompass more than just smoking, but include air pollution, exposure to radon and other carcinogens, family history and social determinants of health,” says Dr. Kazerooni.

In March 2021, the American Academy of Family Physicians (AAFP) weighed in with support for the measure while also noting the need for additional research to determine potential harms from annual screening.

“More studies are needed to achieve our goal of increasing survivorship and lowering mortality without enhancing risk along the way,” agrees Dr. Kazerooni. “Compared to cardiac disease, research for lung cancer screening and risk assessment is relatively new and evolving. Tools, like an individualized lung cancer risk calculator, will take time to develop because of the complexity of the disease.”

Lung cancer survivor Jill Feldman views the new recommendations with the same unflinching honesty that’s fueled her remarkable 20-year crusade for others with the disease. She is the former president of LUNGevity and a founding member of the EGFR Resisters, both leading nonprofit patient support and advocacy organizations.

“We took too long to get here,” she says, “and it’s still not being viewed with a nearly wide enough lens. By focusing solely on age and smoking habits, we’re not considering the critical intersection of environmental factors and personal and family history that impact an individual’s risk of lung cancer.”
Having lost two grandparents, an aunt and both her parents to lung cancer before being diagnosed in 2009 with non-small cell lung cancer at age 39, Jill is painfully aware of the barriers that still surround screening and treatment.

“Despite its prevalence, lung cancer carries a real stigma,” says Jill. “The unintended consequence of successfully educating the public about the heightened risk of lung cancer among people who smoke, is that it’s considered preventable, making people reluctant to seek screening, and if diagnosed, ashamed to admit they have it.”

“It’s a significant problem that impacts people along the entire cancer care continuum,” says Dr. Kazerooni. “And it affects funding and research dollars as well. Although lung cancer is the leading cause of cancer death in the U.S., only 6% of federal dollars dedicated to cancer research are allocated to lung cancer.”

The stigma issue is particularly harmful for the rising numbers of younger women in their 20s to 40s with no smoking history who are diagnosed with lung cancer. “When someone is forced to
emphasize that they never smoked, the message being sent to the 85% of patients with lung cancer who have a smoking history is ‘you are the ones who deserve this.’ No one deserves lung cancer,” says Jill.

Epidemiology studies centered on nonsmokers with lung cancer have begun, but actionable findings may not be reported for at least another decade or two, according to Dr. Kazerooni. The GO2 Foundation for Lung Cancer is currently studying genomic, environmental and behavioral risk factors to identify the common link among nonsmokers in order to run trials.

“We know the disease seems to be increasing among nonsmokers, especially younger women, but we don’t know enough to effectively screen for it now,” says Dr. Kazerooni.

While screening challenges remain, advances in treatment show incredible promise, especially targeted biomarker therapy, which is allowing Jill to treat her incurable lung cancer as a chronic condition.

“I never used to use the word ‘hope’ in the same sentence with lung cancer. But there is real hope now,” she says.

The following are traditional signs of non-small cell and small cell lung cancer, which can also be present as a result of many other conditions. Keep in mind, however, that the hope of expanded lung cancer screening is to find the disease before these symptoms appear.

  • A cough that gets worse or does not go away
  • Coughing up blood
  • Breathing trouble, such as shortness of breath
  • New wheezing when you breathe
  • Ache or pain in your chest, upper back or shoulder that doesn’t go away and may get worse with deep breathing
  • Hoarseness
  • Frequent respiratory tract infections, such as pneumonia or bronchitis
  • Feeling unusually tired all the time
  • Weight loss with no known cause
  • Trouble swallowing
  • Swelling in the face and/or veins in the neck

Source: LUNGevity Foundation

The post New Lung Cancer Screening Recommendations appeared first on Specialdocs Consultants.