My new book

My new book, The End is Nigh: An Insider's Guide to Old Age is available on Amazon.

Supplements (again)

Over half of American adults take supplements. Some take prodigious amounts. This can be a bad idea. One paper in The New England Journal of Medicine estimated that supplements are responsible for 23,000 emergency room visits a year, often because of liver damage.

A few supplements have their place. Women who are trying to have a baby benefit from folic acid. People who have been shown to be deficient in vitamin D, vitamin B12, and omega-3s may also benefit from these supplements. This may be particularly true for old people who are not getting enough sunlight and/or their diets are lacking in such foods as fatty fish, plant oils, or certain seeds and nuts.

As to boosting longevity, no large clinical trials have shown that supplements extend human life span.

The supplements market has been described as having a “wild west” nature. Unlike medicines, supplements do not require FDA approval before they can be sold. Also, what’s on the bottle’s label might not match what’s inside the pill. One study of supplements found that, for the majority, the amount of the ingredient shown on the label differed from the actual amount—in some instances by as much as 100 percent.

Some supplements have been found to include lead, arsenic and mercury. Researchers at the University of Michigan estimated that 15 million American adults take a supplement, such as turmeric or red yeast rice, that could potentially cause liver toxicity.

 I’ve taken supplements in the past. I don’t anymore.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Allergy advice—too late

I don’t have seasonal allergies (knock on wood), but many of those around me do. They’ve started suffering from itchy, watery eyes and other symptoms. A recent article in The New York Times offers advice that centers on taking action prior to allergy seasons. But, as far as I can tell, the first allergy season has already started—at least here in California and in Arizona. Anyhow, maybe this advice, which comes from allergists, could be helpful next year.

First, you must figure out your personal allergy season when your symptoms are most intense: tree pollen from late winter to spring; grass pollen from late spring through summer; and weed pollen from late summer through fall. This helps you determine when your medications might be most effective. Internet sites such as Pollen.com might help to find allergy forecasts.

After you’ve determined your season, the experts say to start taking your medication—such as Claritin, Zyrtec, and Allegra—about two to four weeks before your pollen season begins. This helps to block the histamines in your body from triggering itching, sneezing, and congestion.

To prevent pollen from wafting into your home, keep your windows closed starting a week or two before allergy season. Maybe even clean or replace filters on your air conditioner or air purifier and keep outdoor clothing and shoes away from areas where you spend a lot of time.

The docs also suggest using your inhaler before you go outside and keeping your skin moisturized to create a protective barrier.

Good luck!

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Rx to OTC switch

I’ve read that the FDA is considering broadening the types of dugs that can be sold without a prescription—that is, making them available “over the counter.”  FDA commissioner Martin Makary told CNBC that “everything should be over the counter” except drugs that are deemed unsafe or addictive or that require clinical monitoring.

Over the years, plenty of drugs have migrated from Rx to OTC, including those that treat allergies, joint pain, heartburn, overactive bladder, and acne, as well as those used for birth control. Examples include:

Nasonex—a steroid nasal spray.
Lastacaft, Pataday—eye drops to relieve itchy eyes.
Astepro—an antihistamine nasal spray.
Voltaren Gel—a nonsteroidal anti-inflammatory topical gel.
Plan B—a form of emergency contraception.
Opill—a once-daily birth control pill.
Xyzal, Claritin and Zyrtec—antihistamines.
Differin Gel—acne treatment.
Prilosec and Nexium—for heartburn.
Oxytrol—for overactive bladder.
Narcan—to reverse an opioid overdose.

Note that OTC versions aren’t always the same as their Rx versions.

It will be interesting to see what, if any, previously prescribed medications will soon be available over the counter.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

A doctor’s advice on consulting AI

Over a third of Americans use AI for health advice. In 2025, 66 percent of physicians also used it.

Dr. Adam Rodman, director of AI programs at Beth Israel Deaconess Medical Center in Boston says, “I believe that when used appropriately, these large language models [AI chatbots] are the greatest tool for empowering patients since the invention of the internet.”

He recommends using chatbots, such as ChatGPT, to enhance, not replace, your medical appointments. To do this, he suggests first pulling up your doctor’s medical notes (they should be available online). After removing all your identifiable information, copy those notes into a chatbot. Next, give the chatbot an update of your condition, then ask it to concisely summarize all this information. Finally, ask the chatbot: “Given this context about my health, please give me three questions I should ask my doctor about [insert health concern here] during my upcoming visit.”

Because chatbots depend on having a full picture of your health and medical conditions, Dr. Rodman says you can learn how to describe your symptoms by asking the chatbot to “interview me as if you’re a doctor.” Such a question-and-answer session can lead to a clearer explanation of your condition and help to exclude other conditions that might cause unnecessary alarm.

Chatbots try to please their users by adding layers of information. For this reason, you need to be aware they may lead you down a rabbit hole of scary possibilities. To avoid this, you need to tell the chatbot explicitly why you are asking a question. For example, “I am having a bad headache today. Here is my last note from my primary care doctor. What are some strategies to make it better?”

Diagnostic errors cause almost 800,000 deaths or permanent disabilities in the United States each year. For this reason, Dr. Rodman believes that AI can be one of our best tools for saving patients’ lives. At the same time, he advises that you need to be cautious about seeking second opinions from chatbots or rely on it for advice on treatment plans. Just use what you’ve learned as a conversation starter with your doctor.

I've never tried any of these suggestions.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Tests for aging well: Fourth test

This post is the last of the tests described in The New York Times article, “Are You Aging Well? Try These Simple Tests to Find Out.” Here’s the fourth test:

Single-leg stand

Stand on one leg for a minimum of 10 seconds on at least one side. As an added challenge, the article says, try it with your eyes closed.

I found that I could stand on my left leg for significantly more than 10 seconds (I stopped after 20) but couldn’t make it to 10 on my right leg. What’s with that? Maybe if I practiced.

Like everything else, balance declines with age, raising the risk of falls—a major cause of injury and death for old people. One study found that 20 percent of people aged 51 to 75 were unable to make it to 10 seconds. Experts say that those individuals had an 84 percent higher chance of dying in the next seven years, possibly because they were unhealthier at the start of the study.

I didn’t try standing on one leg with my eyes closed. I’m not going to push my luck.

Update: I have trained myself to get up off the floor using just one knee instead of two (plus both hands), which gives me another point, as described in an earlier blog. I used the technique suggested by alert reader, Jocelyn. You can see it on this video she sent to me.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Tests for aging well: Third test

This post is the third installment of the four tests described in The New York Times article, “Are You Aging Well? Try These Simple Tests to Find Out.” Here’s the third test:

Grip strength test

Doctors use a gadget called a dynamometer to test grip strength. Assuming you don’t have a dynamometer, you can test yourself at home by walking for 60 seconds while holding heavy weights, such as dumbbells, in each hand. A 45-year-old-man should aim to carry two 60-pound dumbbells, a 65-year-old two 40-pound dumbbells, and an 85-year-old two 25-pounders. For a woman at those ages the weights are 40 pounds, 25 pounds and 15 pounds, respectively, in each hand.

Walking with weights in each hand is called a “farmer's carry.” Assuming you also don’t have dumbbells of appropriate weight, I got to thinking about what a farmer might carry and came up with the idea of filling two buckets with as much water required to get the amount of weight you want, weighing them on a bathroom scale. Or maybe just fill two totes with appropriately heavy items.

Luckily, I don’t have to do that, although I might try it. As I wrote in an earlier post, I had my grip strength measured a year or so ago by a doctor using a dynamometer. My reading was 50, which I discovered was rated between normal and strong for my age group.

Like the other tests, grip strength is related to mortality, serving as an indicator for how active you are in your daily life. As one physical therapist noted, “When you’re using your hands more, it’s probably because you’re doing things more.”

I wonder what I might have kicking around the house that weighs 15 pounds, the proper weight for my sex and age.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Tests for aging well: Second test

This post is the second installment of the four tests described in The New York Times article, “Are You Aging Well? Try These Simple Tests to Find Out.” Here’s the second test:

Walking speed assessment.

To take the test, measure about 13 feet on a straight flat surface. Walk that distance at your normal speed, not as fast as you can. The article says that “people of all ages should aim for a gait of at least 1.2 meters per second, a little over three seconds total.”

I tried walking that distance at what I think might be my normal pace. (It’s hard trying not to rush to get a good score.) Using my Apple watch stopwatch function, my score was between 4 and 5 seconds.

Jennifer Brach, a professor of health and rehabilitation sciences at the University of Pittsburgh says that your walking speed is “predictive of future decline, it’s predictive of mortality, nursing home placement, disability, a whole host of different things.” She says you should retest yourself every few months to see if you’re slowing down—a warning sign of possible problems with your cardiovascular, musculoskeletal, vestibular (balance), or sensory nervous systems.

Maybe I should up my normal walking speed—once I figure out what it is.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Tests for aging well: First test

If you read The New York Times, you may have already seen this article: “Are You Aging Well? Try These Simple Tests to Find Out.” A challenge!

To keep my posts short (and provide material for four posts), I’m going to describe one of these tests per post, along with my test results. Here is the first test:

Go from standing to sitting on the floor, and back up again, using the least amount of support as possible.

Here’s a link to a video showing a man (in his 20s?) doing the test. CLINIMEX: Sitting-rising test (SRT) - an updated 2025 video . On the first try he uses one hand. On the second try he doesn't.  (It’s in Portuguese or something, but there are captions.)

The test is scored on a 10-point scale—5 points for sitting down and 5 points for getting up. You lose a point for every hand, knee or other body part you use to help yourself.  The article says that if you’re in your 30s and 40s, you should score a perfect 10. If you’re over 60 and get an 8, you’re in “very good shape.” 

My result: I used both hands and both knees to get down to the floor and the same for getting up, so I lost 8 points, giving me a score of 2. (First, I got down to my hands and knees to sit down, then I got back onto my hands and knees to stand up.) Pitiful score, but hey, I got down and up!

Supposedly this test is a predictor of mortality. A study that looked at more than 4,000 people, aged 46 to 75, found that, over the course of 12 years, the people who scored 4 or below had death rates nearly four times higher than those who scored a 10. Apparently, that’s because people with low scores were at a higher risk for falls.

 What if, like me, you’re 89? Isn’t my 2 worth something? Evidence of life?

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Should cancer be treated or not?

This is tricky business. Since 1992, the diagnoses of eight cancers in people under 50 has doubled in the U.S. Those cancers include thyroid, anus, kidney, small intestine, colorectum, endometrium (uterus), pancreas and myeloma (blood cancer). Breast cancer is also on the rise.

But here’s the thing: some cancer specialists say this surge is the result of an “epidemic of detection”—finding cancers that wouldn’t have killed patients. One doctor notes, “The epidemic narrative not only exaggerates the problem, but may also exacerbate it. While more testing is often seen as the solution to an epidemic, it can just as easily be the cause.” As another doctor noted, “We are a very imaging-happy society.”

Not every cancer is dangerous. Some go away on their own; others stop growing or pose no risk. Autopsy studies repeatedly find that many people die with small cancers they were unaware of. Prostate cancer is one of these; so is thyroid cancer. The problem is that it’s impossible to know if someone’s cancer will be deadly or not, and if the cancer is gone after treatment, there’s no way to know if it needed to be treated.

Other doctors believe the surge in cancer diagnoses is real and serious. While the death rates for six of the cancers mentioned in the first paragraph are flat or declining, the death rates of colorectal and endometrial cancers have increased. Some scientists attribute this increase to the obesity epidemic, or something amiss in people’s microbiomes, or toxins in the environment. They’re trying to figure it out.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Saturated fat (again)

 I’m not afraid of eating saturated fat. In fact, I eat plenty of it.

“Saturated” refers to fats, such as butter and animal fats, that are firm when refrigerated. Unfortunately, the term, “saturated,” makes it sound like the fat is somehow loaded with goop. In fact, it simply describes the composition of the fat molecule: each carbon atom in the molecule is linked to two hydrogen atoms such that the carbon is “saturated” with hydrogen atoms.

Saturated fats do not clog arteries. They are either burned for fuel or stored in your fat cells. Your cells need saturated fat to help your body perform important chemical processes and make use of vitamins and minerals. For example, saturated fat makes it possible for calcium to be incorporated into your bones.

Scientists have conducted trial after trial comparing the health effects of saturated fats to unsaturated fats, such as vegetable oils. The National Institutes of Health spent several hundred million dollars trying to demonstrate a connection between eating saturated fat and getting heart disease but never did find the connection.

In reviewing the data from the numerous trials, scientists had plenty to say. For example, “…after 50 years of research, there was no evidence that a diet low in saturated fat prolongs life.…if saturated fatty acids were of no value or were harmful to humans, evolution would probably not have established within the mammary gland the means to produce saturated fatty acids…that provide a source of nourishment to ensure the growth, development, and survival or mammalian offspring.”

By the way, most fats are a mixture of saturated, monounsaturated, and polyunsaturated fatty acids. Lard is only 40 percent saturated fat. Olive oil is 13.7 percent saturated fat, which is why it turns cloudy when refrigerated.

So go ahead and slather your toast with butter. That's what I do.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Those food pyramids!

The 1994 food pyramid had you eating mostly starchy food: 6 to 11 servings of “bread, cereal, rice and pasta.” 

In adhering to the high-carbohydrate, low-fat recommendations, we increased our yearly consumption of grain by almost sixty pounds per person and our consumption of sweeteners, such as high-fructose corn syrup, by thirty pounds per person. The number of young people under the age of 20 with Type 2 diabetes grew by 95% from 2001 to 2017. A third of all people over 65 are diabetic. (Carbohydrates spike blood sugar.)

The 2011 food guide, below, reduced the grains to 30 percent of our diets, but also included the phrase "switch to 1% or skim milk."

Rigorous research has concluded that saturated fats, such as the butter fat in milk, have no effect on “major cardiovascular outcomes,” including heart attacks, strokes or mortality. As the American College of Cardiology states, "The recommendation to limit dietary saturated fatty acid intake has persisted despite mounting evidence to the contrary." (I don't believe in limiting saturated fats.)

I’m no fan of JFK, Jr., but the new pyramid (below) makes more sense to me, although it still limits saturated fat to about 20-22 grams for a 2,000-calorie diet. This limit is nearly impossible to achieve, especially if you’re eating red meat. 

Looking at these vacillating recommendations over the years, you might be thinking, what the heck?! Like me, you can just ignore them, especially considering that members of the guidelines panels have ties to food industries. The problem is that schools, military personnel, and others who receive food through federal programs are required by law to follow the guidelines. Poor them.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Exercise benefits

For the new year, here are some quotes from scientists about the benefits of exercise:

Euan Ashley, a professor of cardiovascular medicine, genetics, and data science at Stanford, says, “Exercise is just the single most important intervention you can think of for your health.” In analyzing data of more than half a million people over the course of ten years, he found that exercise reduces our chances of having atrial fibrillation, diabetes, hip fractures, and colon cancer by at least 50 percent. Unlike other interventions that might target one aspect of health, exercise affects nearly every system in your body.

According to neuroscientist Justin Rhodes, exercise can reverse the effects of a genetic bad hand by lowering the risk of a variety of ailments, including heart disease. Exercise also slows aging in several ways: by promoting the growth of stem cells in muscle, expressing genes linked to longevity, and lengthening telomeres. Rhodes contends that we can introduce exercise at any point in our lives and that, for every hour we exercise, we tack two hours onto our life span. 

I read in a recent JAMA article (2025) that “individuals with the highest levels of physical activity at midlife and late life had 41% and 45% lower risk of all-cause dementia, respectively, compared with those with the lowest levels of physical activity.” The study used data collected since 1971 from 5,124 participants.

For my exercise regimen, at age 89, I load Jazzercise on Demand onto my iPad and perform one of their 30-minute dance cardio routines followed by 10 minutes of upper body strength training using two five-pound weights. After that, I do a series of yoga stretches. I follow this routine on Mondays, Wednesdays, and Saturdays. (I’d rather just sit.) Lots of people walk for their exercise, but the road we live on is too steep. I do my walking on our weekly golf outings.

Plenty of old people live long lives without exercising, but I’ve decided not to chance it. Besides, I’m trying to stave off further deterioration.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Your brain on AI

The other day, my iPad quit downloading emails. My husband took a picture of the error message and uploaded it to ChatGPT. ChatGPT provided clear step-by-step instructions for fixing it. The instructions worked!

An Article in The Atlantic magazine tells of a man who uses AI (Anthropic’s Claude) for up to eight hours a day, sometimes running as many as six sessions simultaneously. At the market, he takes pictures of fruit to ask if it’s ripe; he consults Claude for marriage and parenting advice; he asks Claude if a particular tree needs to be removed from his yard, and so forth.

Apparently, like the man described above, some people rely on AI to navigate basic aspects of daily life. For these compulsive users, AI has become a primary interface through which they interact with the world. The article calls this “outsourcing your thinking.” One man found himself turning to AI when a woman sitting next to him dropped her AirPod between the seats on the train. His first instinct was to ask ChatGPT for a solution rather than figure it out for himself.

Researchers are now getting a picture of how AI use might affect your mind. One researcher believes that AI tools “exploit cracks in the architecture of human cognition. The human brain likes to conserve energy and will take available shortcuts to do so. It takes a lot of energy to do certain kinds of thought processes. Meanwhile, a bot is sitting there offering to take over cognitive work for you.” In this researcher’s view, using AI to write your emails, for example, isn’t laziness so much as it is a naturally adaptive behavior.

Wow! Naturally adaptive behavior! That strikes me as kind of scary. What will become of our brains?

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.