Cartoon for holiday I

 

"You'll be kept awake throughout the operation."

Protecting your knees

Researchers are re-thinking long-held doctrines about the cartilage that cushions the bones of your knees and other joints. The breakdown of cartilage is the primary cause of arthritis. As one of the researchers states, “Since cartilage doesn’t have a blood or nerve supply, we used to think it couldn’t adapt or repair itself.” Apparently, that’s not true. Weight bearing activities such as walking and running squeeze the cartilage in the knee joint, expelling waste and drawing in a fresh supply of nutrient- and oxygen-rich fluid with each step. Cartilage is a living tissue that thrives with regular use.

Because people worry about damaging their knees, they often turn from running or walking to low-impact activities such as swimming and cycling, believing it will protect their joints. But, as another researcher notes, “what they’re doing is starving the cartilage.” You need to keep up your exercise, but, if you have knee pain, do it more frequently and for shorter periods. A physiologist who studies the molecular properties of cartilage and other connective tissues says that the cells in cartilage respond positively to exercise for about ten minutes. After that, you’re just accumulating more stress and damage in the tissue.

Another important principle is strengthening the muscles that support your knees. Keeping those muscles strong stabilizes your knees and stiffens the tendons and ligaments around the joints. The experts recommend squats and lunges. If you’re like me and can’t do those exercises anymore, look on the internet for alternatives that suit you. You can also focus your attention on how you get up from chairs and the toilet: don’t use your hands; keep your knees and hips aligned over your feet. If you can’t keep the joints aligned, it’s a sign you need to strengthen your leg and butt muscles.

Experts have debunked the notion that you should stop being active as soon as you notice knee pain. What you need to do is stay active, strengthen the muscles around the joint, and develop good movement patterns.

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How to stand correctly

 Today’s blog post is verbatim from a New York Times article with the same title. I’m a big believer in the idea that posture—and related matters such as gait—have a huge impact on the development of aches and pains as we age. The following advice comes from James Murphy, the director of the Iyengar Yoga Institute of New York. 

Here’s what to do:

Plant your feet about hip distance apart; the weight on each foot should feel the same. Establish equilibrium by spreading the pinkie toe as far away from the big toe as possible. You can feel how weight might shift a little bit from the inside of your foot to the outside, the front to the back.

Next, bring your feet together so your big toes and heels touch. This action forces your muscles to engage in balancing you.

Press your heels against the floor, and work your way up, tightening the muscles. Get some grip coming up to your knees and thighs and buttocks to have a firmness take place in our legs.

Once the legs are engaged, align the upper half of the body by lifting spine, rib cage and chest. Take a deep breath as you straighten your backbone. Use the whole circumference of your chest and around your heart and your lungs—use that whole rib cage to lift up, so that you’re creating space in your trunk, including the spine and also the organs.

I know. It seems kind of complicated. Give it a try anyway. I’m going to.

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

Energy: the work of mitochondria

Some people have more energy than others. That’s probably because their mitochondria are doing a good job. Mitochondria are the powerhouses of our cells. They are organelles (little organs) that convert glucose and oxygen into cellular fuel. They also help produce essential hormones including estrogen, testosterone, and cortisol, and they transform chemical energy into electrical energy, making it possible for organs and cells to communicate.

Our mitochondria started out as bacteria. One and a half billion years ago, the planet’s only life forms were single-celled. Over time, multicellular life-forms evolved into bacteria, and the bacteria evolved into mitochondria, the organelles that fuel living creatures (vast oversimplification). As Nick Paumgarten writes in The New Yorker, “It’s not inconceivable that the rest of the body…is merely an elaborate and sometimes clumsy apparatus for the nourishment of the mitochondria.” In this way of thinking, our cardiovascular systems are essentially a delivery system for the oxygen required by the mitochondria.

Martin Picard, a professor of behavioral medicine at Columbia University Irving Medical Center specializes in the connection between the mind and mitochondria. He sees the human body as a social network and views mitochondria as “cellular antenna, or little brains that receive, process, and integrate information.”  He has found that “Cells age faster if you expose them to stress. They consume more oxygen. They’re wasting energy, and we don’t know why.” He has also found that mood has a direct effect on mitochondria and that one in five thousand humans have mitochondria disease—genetic defects that cause them to be tired all the time. Other scientists have determined that antibiotics, environmental chemicals, over-used pharmaceutical, fructose, bad light, and electromagnetic fields are energy disrupters. I don’t know about that.

Much remains to be learned about mitochondria. As Paumgarten says, “The precise workings of the metabolic system, its nuances and contingencies, are, in many respects, an enduring mystery.”

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

Chronic pain: a new discovery validates sufferers’ complaints

People who suffer from chronic pain are often not taken seriously by health care providers. That’s because medical people can’t find an injury or other source of the pain. Recent discoveries have found a hard-science explanation for the pain: glial cells have run amok. Glia are scattered throughout the nervous system and take up nearly half its space. Scientists have determined that glia play a role in supporting neurons, cleaning up their waste and helping them communicate. Now, they have discovered that, instead of just supporting and responding to neuronal activity, glia often direct it. With chronic pain, glia send false and destructive pain signals that never end. In such cases, pain is not just a symptom of something gone wrong, it becomes its own disease.

Sensation of pain works in three stages. First, pain-sensitive neurons send a message to your spinal cord that triggers a reflex—say jerking your hand back from a hot surface. Next, the signal is handed off to neurons in the spinal cord (stage two), which then take the message to your brain (stage three). It’s at stage two—the handoff in the spinal cord—that things can go wrong. At this stage, a profusion of glia regulate the pain signals by amplifying or decreasing their intensity or duration. Chronic pain develops because the glia accelerate the pain system into an endless inflammatory loop that provokes the nerves into generating a perpetual pain alarm, generated in the brain.

Scientists don’t know how or why glial mismanagement develops. It can emerge after an injury or out of nowhere. Apparently, even after an injury has healed, pain signals can spread to other areas, causing more pain. (They can transmit information through dozens of communication pathways.) So far, solutions to this terrible condition have not been found. You can’t knock glia out, and current painkillers don’t help because they target neurons, not glia. Plus glia have a built-in redundancy. Even if a treatment blocks one pain signal, glia promptly find another.

At least sufferers of chronic pain now have validation that their suffering is real.

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

Small bends

I get an emailed newsletter from Esther Gokhale, “the posture lady.” The latest one focused on “small bends,” the small degree of rounding you do to pick things up. If you round at the upper back instead of bending at the hip joint you produce, she says, “counter-tension in the lower back and/or pelvis to hold you there. Rather than compromise our backs, it is far healthier to keep our necks tall and bend at the hip joint. The start of a bend usually sets its trajectory. If you have a problematic start to your bend, it will likely continue that way.” 

The images below illustrate small bends--the right way on the left and the wrong way on the right.

In the image on the left, the “bend” occurs at the hips rather than at the waist. The spine remains elongated and the hip joints rotate. The spine follows the pelvis, and the back muscles and core work gently to keep the entire torso in one piece.

In the image on the right, the pelvis is fixed in a tucked position and the spine is rounded to bend forward, a movement that loads and compresses the discs. As Gokhale describes it, “With frequent repetition the microaggressions of even small bends take their toll on the discs. Rounding also overstretches the spinal ligaments, allowing for increasingly hunched posture. Even a small bend done in this way may be perceived by the brain as a threat and send the muscles into spasm, trying to prevent movement and protect against such misuse and damage.”

Easier said than done. Must pay attention!

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

Ivermectin to treat Covid-19: bad idea

 You’ve probably seen news articles about people demanding Ivermectin to prevent or treat Covid-19. I didn’t pay much attention to it because I wasn’t interested. Ivermectin is approved by the FDA to treat certain intestinal parasites and lice in people. It’s also used by veterinarians as a treatment for parasites in pets and livestock—deworming, in other words. It got touted as a treatment for Covid-19 after some Australian researchers discovered that large quantities of it killed the virus in a laboratory setting—in a petri dish, that is. The scientists made it clear that the amount of the drug required to affect the virus was much higher than the amount approved for use in humans. Nevertheless, the news went viral, as they say, and people began demanding the drug.

What did interest me was a letter published in The New England Journal of Medicine submitted by three doctors associated with Oregon Health and Science University in Portland, Oregon. The letter gives real-world examples of the effects Ivermectin on some people who tried it. The Oregon Poison Center received 21 calls in August 2021, all were from people who had used Ivermectin. Eleven used the drug to prevent Covid and 10 used it to treat symptoms. Three had received their prescriptions from physicians or veterinarians; 17 purchased veterinary formulations elsewhere. The source for one wasn’t known. Six were hospitalized for the toxic effects; four were in intensive care. None died. Their ailments included gastrointestinal distress, confusion, dizziness, weakness, low blood pressure, seizure, vision problems, and rash. Note that these are just the cases called into the poison control center. Perhaps the tip of an iceberg.

I guess they were afraid to get vaccinated.

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

Maryland: where health care prices are regulated

 Elisabeth Rosenthal, a former emergency room physician, now editor in chief of Kaiser Health News, was treated at Johns Hopkins Hospital for a “complicated head injury.” As she explained in the New York Times, Johns Hopkins is in Maryland, the only state in the nation that controls what hospitals can charge for services. At Johns Hopkins, her visits with top neurologists were billed at $350 to $400. Her spinal tap at Johns Hopkins was performed in an exam room by a neurology fellow. It was billed as an office visit ($300 to $400). In seeking a second opinion at a “prestigious” New York hospital, she also had a spinal tap. This one was performed in a special suite “under ultrasound guidance by neuroradiologists. It was billed as ‘surgery,’ for a price of $6,244.38. The physician charge was $3,782.”

The online version of the article allows readers to make comments. Here’s what Canadian reader (and anesthesiologist) wrote: “To address the differential costing that the author experienced, let’s get something clear. A ‘spinal tap’ or lumbar puncture is a five-minute procedure routinely done (as in Johns Hopkins) without fancy imaging. I am a pediatric anesthesiologist and for our oncology kids who need repeated LPs for monitoring and delivery of chemotherapy it takes 15 minutes per case including the anesthetic with the oncologist doing the test. The costs quoted for New York are obscene—and since we know this was not a difficult LP as done easily previously by a trainee—and unjustifiable. The doctors may not set the prices, but I would argue that they are part of the problem by colluding in such a system and collecting the dosh.”

Oh, Canada!

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

The salt "sweet spot"

  Sometimes I crave salt, as I imagine most people do. I don’t know whether the craving means my sodium level is down. Maybe it does. Salt (sodium) is one of the most important nutrients in your body. It maintains normal blood pressure, supports the work of nerves and muscles, and regulates your body's fluid balance. Your body strives to maintain a constant sodium level. If you have normal kidney function and blood pressure, your kidneys can deal with wide variations in sodium intake without increasing your blood pressure. To maintain the sodium level, if you drink too much, your body excretes the excess water it doesn’t need.

Most Americans eat between 3.0 and 4.4 grams of salt per day, with women consuming less and men consuming more. (A teaspoon contains six grams of salt.) According to the USDA’s Dietary Guidelines for Americans, that’s too much. They recommend less than 2.3 grams a day, an amount that would supposedly lower blood pressure and, in turn, result in a lower incidence of cardiovascular disease.  However, scientists reporting in the September 2021 issue of Nutrients found that current evidence indicates that “the risk of adverse health outcomes increases when sodium intake exceeds 5 g/day or is below 3 g/day [my italics].” In other words, the “sweet spot” for sodium intake is three to five grams a day, with “both lower and higher levels of intake associated with higher risk of cardiovascular disease or death.” (The increased risk associated with five grams per day was largely confined to those with hypertension.) In studying populations worldwide, the scientists involved in this study found that, in fact, most people around the world consume this moderate range of salt (three to five grams a day)—a level “associated with the lowest risk of cardiovascular disease and mortality.” 

You can ignore the Dietary Guidelines of 2.3 grams of salt per day. It’s not enough

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

For good health, eat a low carb, high fat diet

 In one of the largest and most rigorous trials to date, a new study, published in the American Journal of Clinical Nutrition, found that eating a diet low in carbohydrates and higher in fats is good for you. As you probably know, I, and many others, have been saying this for years. In commenting about the new study, Dr. Dariush Mozaffarian, a cardiologist and dean of the Friedman School of Nutrition Science and Policy at Tufts University, said “It’s a well-controlled trial that shows that eating lower carb and more saturated fat is actually good for you…Most Americans still believe that low-fat foods are healthier for them, and this trial shows that at least for these outcomes, the high-fat, low-carb group did better.”

The study participants were divided into groups in which 20 percent, 40 percent or 60 percent of their calories came from carbohydrates. (The low carb diet largely eliminated highly processed and sugary foods and emphasized carbs from whole fruits and vegetables, beans and legumes. I can’t argue with that.) Protein was kept at 20 percent for all groups. The remaining calories came from fat.

The low carb group got 21 percent of their daily calories from saturated fat, an amount double that recommended by the federal government’s dietary guidelines. Nevertheless, they experienced no detrimental changes in their cholesterol levels. Their LDL cholesterol—the so-called “bad” kind—stayed about the same as those who got just 7 percent of their daily calories from saturated fat. What’s more the low-carb, high-fat group had a roughly 15 percent reduction in their levels of lipoprotein(a), a fatty particle in the blood that is strongly linked to the development of heart disease and strokes.

The low carb/high fat group also showed a 15 percent drop in their lipoprotein insulin resistance scores, which indicates a reduction in the risk of diabetes. Those on the high carbohydrate diet saw their scores rise by 10 percent. What’s more, the low carb group had a drop in their blood triglyceride levels—a good thing because high levels are linked to heart attacks and strokes. They also had increases in their levels of adiponectin, a hormone that helps lower inflammation and makes cells more sensitive to insulin, another good thing.

So what's not to like? 

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

Problems with generic drugs

 When a drug goes off patent, competing companies can make generic versions of the drug. Initially, there’s a fortune to be made, but then brutal competition causes prices to drop. Even though generic medications represent 90 percent of prescriptions that are filled in this country, they’re often so cheap that companies stop making them or cut corners to turn a profit. Now, most generics are produced overseas. In fact, a recent study found that of the top 100 generic drugs that Americans consume, 83 had no American source for the drugs' ingredients. The study also revealed that there's no American source for 97 percent of the most prescribed antivirals, and no American source for 92 percent of the most prescribed antibiotics. Chinese companies flooded the US market with penicillin so cheap that American companies couldn’t compete. The last American factory making key ingredients for penicillin closed in 2004.

One problem with this arrangement is that we have no idea where our drugs are manufactured, or the names of the companies contracted to make it. This information is considered trade secrets in the pharmaceutical industry. Another problem is lack of quality control. With drugs being manufactured overseas (mostly China and India), it’s harder for the FDA to inspect factories. They don’t drop in unannounced like they do here. During the pandemic in 2020, the FDA managed to perform just three foreign inspections. More than a thousand inspections had to be postponed. In 2008 at least 81 people died from a poisoned blood thinner traced back to a Chinese supplier. In another case, Valsartan, a generic drug used to treat high blood pressure was found to contain a probable carcinogen. Another blood-pressure medicine, Lisinopril, was found to vary widely from one batch to the next. An inspection of Ben Venue Laboratories in Ohio revealed that poorly maintained equipment shed particles into the drugs. Major companies have been caught faking and manipulating the data that is supposed to prove that drugs are effective and safe. And so on.

Quality control issues are a leading cause of drug shortages both at American plants and overseas. Sometimes the FDA shuts down a plant after discovering violations. Other times companies with quality control issues stop making a drug rather than investing in expensive upgrades to their facilities. 

So we don't know who makes our generic drugs or whether we can trust them for safety and efficacy. Maybe shortages aren't such a bad thing.

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

A thirty-year study of old people

 I recently found the transcript of a May 4, 2014, edition of 60 Minutes that discussed a study of  people who are 90-plus. The study was sparked by a discovery, in 2003, of a survey that had been completed in 1981 by 14,000 residents of Leisure World, a retirement community in California. Residents had provided data about their diet, exercise, vitamins, activities, and other health-related matters. In poring over the records from 1981, the researchers discovered that 1,900 of these people were still alive and enrolled 1,600 of them in a follow-up study. Here is what they learned about the still-healthy “oldest old”:

• Exercise: “People who exercised definitely lived longer than people who didn’t exercise. As little as 15 minutes a day on average made a difference.” Forty-five minutes was best and it didn’t have to be every intense.
• Socializing: "For every hour you spent doing activities in 1981, you increased your longevity and the benefit of those things never leveled off."
• Vitamins: “People who took Vitamin E didn’t live any longer than people who didn’t take Vitamin E…The short answer is none of ‘em [vitamins] made any difference."
• Alcohol: “Moderate alcohol was associated with living longer…Up to two drinks a day led to a 10-15 percent reduced risk of death compared to non-drinkers."
• Caffeine: "Caffeine intake equivalent to 1-3 cups of coffee a day was better than more, or none."
• Weight: “It turns out that the best thing to do as you age is to at least maintain or even gain weight." People who were overweight or average weight outlived people who were underweight.
• Blood pressure: “If you have high blood pressure it looks like your risk of dementia is lower. “

 I find most of these findings heartening.

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

Costa Rica’s health care beats ours

 Costa Rica spends less on health care as a percentage of income than we do. Its per-capita income is a sixth that of ours, and its per-capita health care costs are a fraction of ours. Nevertheless, their life expectancy is nearly 81 years, while ours peaked at just under 79 years in 2014 and has declined since then. For people between ages 15 and 60, the mortality rate in Costa Rica is 8.7 percent. Here, it’s 11.2 percent—a 30 percent difference. In Costa Rica, the average sixty-year-old survives another 24.2 years compared to 23.6 years in the U.S. Here’s why: Costa Rica has made public health central to the delivery of medical care. Individual health and public health are inseparable. Even in countries that have good universal health care, public health is an add-on, not central to health care. In Costa Rica, it’s been a priority for decades.

Here's how they do it: They set up community health care teams throughout the entire country. The teams consist of a physician, nurse, and community health worker. Every Costa Rican is assigned to one of the teams. The health care worker visits every household at least once a year. Children have regular pediatric visits starting from the first day of life. People with diabetes are enrolled in classes to learn about controlling their blood sugar. Everyone gets contacted about vaccination appointments. And so forth. It’s all free. The Ministry of Health also deals with community-wide concerns and undertook programs to deal with malnutrition, toxic hazards, running water, and other health-related issues.

In the U.S., according to Dr. Atul Gawande, our medical systems “seldom focus on any overarching outcome for the communities they serve. We doctors are reactive. We wait to see who arrives at our office and try to help out with their ‘chief complaint.’” We’ve got plenty to complain about.

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

The benefits of fermented food

 Some new research out of Stanford has shown that eating fermented food, such as yogurt, sauerkraut, kombucha, and kefir may alter our gut biome (bacteria, viruses and fungi) in a beneficial way. Fermented foods are often teeming with live microorganisms as well as byproducts of the fermentation process that include various vitamins and lactic and citric acids. In the study, the group of subjects that ate such foods were found to have far more microbial species in their guts than the control group. What’s more, those who ate the fermented foods showed marked reductions in 19 inflammatory compounds, such as interleukin-6, an inflammatory protein that tends to be elevated in diseases such as Type 2 diabetes and rheumatoid arthritis.

Interestingly, just five percent of the new microbes came directly from the fermented foods. As one researcher said, “The vast majority came from somewhere else, and we don’t know where.” The researchers guessed that the species were either low-level microbes below the level of detection that bloomed, or the fermented foods did something that allowed for the rapid recruitment of other microbes into the gut environment.

The more fermented foods the test subjects ate, the greater the number of microbial species they acquired—a good thing. Studies have linked high levels of microbial diversity to lower rates of obesity, Type 2 diabetes, and other ills. Researchers also discovered that those with a higher levels of diversity had reductions in inflammation when eating a high fiber diet, while those with less diversity had slight increases in inflammation when they ate more fiber. The researchers suspect that people with low microbiome diversity lack the right microbes to digest all the fiber they consume. Perhaps that’s why some people experience uncomfortable gastrointestinal issues when they eat a lot of fiber.

I like fermented foods, such as sauerkraut and yogurt. I eat yogurt several times a week. I’ve been eyeing bottles of kimchi at my market for months. Now I’m motivated to buy it.  

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

Hospital billing secrets revealed (sort of)

 This year the federal government ordered hospitals to publish a complete list of the prices they have negotiated with insurers. Some hospitals have complied; many have not (they just ignore it and pay a fine). Even when the prices are published, the data is nearly impenetrable. In one case, a hospital posted information about one treatment that spread its prices across 269 web pages.

At any rate, what the data has shown so far is that, depending on the insurers, hospitals are charging patients wildly different amounts for the same services and a single insurer can have half-dozen different prices within the same facility. What’s more, major health insurers are often negotiating unfavorable rates for their customers. In many cases, insured patients are getting prices that are higher than if they pretended to have no coverage at all. As to Medicare, it generally covers 87 percent of the cost of care. Often major health plans pay more than four times the Medicare rate for a routine colonoscopy and more than ten times for an MRI scan.

Examples of ranges for insurance prices:

• Basic knee MRI at Massachusetts General: From $877 to $4,140.
• Emergency room foot X-ray at Baylor Medical Center: $832 (no insurance) to $1,727.
• Colonoscopy at Beaumont Hospital in Royal Oak, Michigan: $732 to $1,801.
• Pregnancy test at University of Pennsylvania hospital: $10 (no insurance) to $93.
• Rabies shot at Layton hospital in Utah: $16,953 to $37,214

It matters. If your insurer negotiates a bad deal and you have a high-deductible plan, you’re responsible for thousands of dollars in costs before coverage kicks in. Sixteen percent of insured families currently have a medical debt with a median amount of $2000. When choosing a plan, you have no way of knowing how this is going to turn out—what you’ll end up paying when the time comes. Neither do employers or the government. What a mess.

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

Problems with eye drops

 Here’s something that users of eye drops might find helpful—or at least interesting. I read about a woman who had lots of problems with her eyes—an abnormal membrane on her retina; glaucoma; cataracts. She used pressure-reducing eye drops for her glaucoma, and ocular antibiotic and steroid drops as well as artificial tears for her other ailments. After her cataract surgery, she found she was intensely sensitive to light. Also, when she used her glaucoma drops her eyes began to burn, and her eyes were dry and gritty feeling. She stopped all the drops and the problems went away.

It turns out that eye drops contain a preservative called benzoalkonium chloride (BAK). BAK, a soap-like compound, prevents the growth of bacteria in bottles of medications that contain more than a single dose. It is the most commonly used preservative in both over-the-counter and prescription eye drops. BAK kills bacteria by dissolving their protective outer coat. The problem is that our tears are covered by a similar protective coat. The BAK in eye drops breaks down the protective coat in our tears, exposing the salty fluid to the air. The unprotected fluid evaporates and our eyes become even dryer. If you make enough tears, the drops won’t bother you. But aging reduces this protective layer, which puts older users of medications containing BAK at higher risk of drying eyes. The dryness can eventually lead to permanent damage to the cornea, the clear outermost layer of the eye. (As to the woman I described above, she switched to single-dose bottles of drops, which don’t need preservatives.)

When the optometrist puts drops in my eyes to dilate them, the drops really burn. She says it’s because I have dry eyes and that I should use lubricant drops. So I bought some Systane. It contains a preservative called Polyquad, which is similar to BAK, but it’s a larger molecule and is “not internalized by the epithelial cells on the eye, so it doesn’t cause the kind of toxicity that BAK causes,” according to the Review of Opthalmology. But I hate putting drops in my eyes so I never use it anyway.

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

Mouth breathers: Listen up!

 I was alerted by my sister and daughter to a new book called Breath: The New Science of a Lost Art by James Nestor. One key point is the importance of breathing through your nose and not your mouth. I had no idea that mouth-breathing was so commonplace and so bad for you. I’ve always breathed through my nose, I so never thought much about it.

Your nose is designed for breathing and for maintaining your health. Trillions of air molecules pass through your nose in a single breath. Specialized bones and cilia filter out pollutants and keep the air moving. By heating, cleaning, and pressurizing air, the structures in your nose can extract more oxygen with each breath. Mouth breathing does not do these things,

“Mouthbreathing transforms airways for the worse. Inhaling air through the mouth decreases pressure, which causes the soft tissues in the back of the mouth to become loose and flex inward, creating less space and making breathing more difficult. Mouthbreathing begets more mouthbreathing. Inhaling from the nose has the opposite effect. It forces air against all those flabby tissues at the back of the throat, making the airways wider and breathing easier. After a while, these tissues and muscles get ‘toned’ to stay in this opened and wide position. Nasal breathing begets more nasal breathing.”

Mouth-breathing causes snoring and sleep apnea. It also causes your body to lose 40 percent more water than nose breathing. Rats who had their nostrils obstructed developed fewer brain cells and took twice as long to make their way through a maze than the nasal-breathing control group. And so on. The author learned that after 240 hours of having his nostrils plugged by a researcher, his stress-related hormones spiked, he developed a bacterial infection in his nose, and his blood pressure increased.

The author and other experts recommend taping your lips together at night to train yourself to breathe through your nose (just a little square will do it). My sister, who is 86, has been working on eliminating mouth breathing. Here’s what she wrote to me: “I taped my mouth for two or three naps, and then it seemed to catch on. Now I just try to remember all day. At night I try to sleep with nose breathing and it’s only partially successful, but I wake up without the awful congestion with lots of phlegm. I’m more comfortable both night and day. When I must do something that takes concentration, I forget to nose-breathe. An interesting experiment.” At another point she writes, “It’s so nice to be able to go on an errand, eat out, and visit friends without having to rest constantly.” My daughter reports that she’s sleeping better and her blood pressure has gone down. Wow! I urge all you mouth breathers to buy the book and get going!

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

New information about metabolism

Using data collected over 40 years from half a dozen labs and 6,500 test subjects ages 8 days to 95 years, researchers (80 of them!) have upended some conventional assumptions about metabolism, most notably that our metabolisms slow down around middle age and that women have slower metabolisms than men. It turns out that neither is true. (Metabolism, by the way, is the sum of all chemical reactions in our bodies, but more easily understood as the breakdown of food and its transformation into energy—aka calorie burning.) As one scientist remarked: “We will have to revise some of our ideas. It will be in textbooks.”

Specifically, the researchers learned that metabolism differs for all people across four distinct stages of life:

• Infancy up until age 1: Calorie burning is at its peak, accelerating until it is 50 percent above the adult rate.
• Ages 1 to 20: Metabolism gradually slows by about 3 percent a year.
• Ages 20 to 60: Metabolism holds steady.
• After age 60: metabolism declines by about 0.7 percent a year.

As you can see, your metabolism rate depends on your age, and the slowdown doesn’t start at 40. Thus, if you started gaining weight after 40, you can’t blame it on metabolism. You’ll have to wait until you’re over 60 to do that. As you can see also, if you just graduated from college, you’re burning fewer calories than you did when you were a freshman.

While the above results were true for the general population, a few people had metabolic rates 25 percent below the average for their age and others have rates 25 percent higher than expected. These outliers will open a number of research questions, such as understanding the characteristics of such people and whether there is a relationship with obesity.

I started gaining weight in my 50s, as do many women in that age bracket. I blamed it on menopause (I still do). But I can’t blame it on a slower metabolism.

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

GMO food (redux)

 GMO stands for genetically modified organism. Example: A purple tomato created by inserting a snapdragon gene into it, making the tomato high in antioxidants and anti-inflammatory compounds. (Cancer-prone mice lived longer than mice fed the same quantity of ordinary tomatoes.)

I have no problem with GMO food, but plenty of people do. Even though a 2016 report by the National Academy of Sciences declared that GMOs were safe, the market for products certified to be non-GMO has increased more than 70-fold since 2010. Because of fear of the unknown, consumers are willing to pay 20 percent more to avoid them. Of course, through crossbreeding, almost everything we eat has had its DNA altered extensively. But it takes much longer to alter foodstuffs this way—150 years in some cases.

Monsanto introduced the first GMO in 1996. It was an herbicide-resistant soybean. Clever. Now farmers could slather their soybean fields with Monsanto’s herbicide Roundup without harming their crop. Monsanto became the largest producer of genetically engineered seeds, including corn, sugar beets, and canola. By the way, farmers are not allowed to save seeds from these crops. At one time, Monsanto had a 75-person team dedicated to investigating seed-saving farmers in order to prosecute them on charges of intellectual-property infringement. 

Unfortunately, this sleazy beginning tarnished the whole GMO technology, which has the potential to improve food production where it’s most needed. For example, Golden Rice was created by a pair of university researchers hoping to combat vitamin A deficiency, a devastating ailment that causes blindness in millions of people in Africa and Asia annually. In the Philippines, anti-GMO groups destroyed the crop. Nevertheless, a few crops, such as disease-resistant papayas, have been successfully introduced. (See my earlier post on GMOs for more information on this.)

Because of FDA and USDA regulations, only big conglomerates have the means to go through the GMO approval process—a process costing millions of dollars. Lately, because the USDA has updated its regulations, some universities have managed to get through the process, and seeds for the purple tomatoes will be on the market next spring. I’m going to get some.

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Omega-3 fats: a cure for migraines?

I’ve never had a migraine headache, but some members of my family have them, as do twelve percent of all Americans. Migraine sufferers don’t get much help from meds. A few years ago, the National Institutes of Health conducted a clinical trial with test subjects who suffered five to 20 days of migraines a month. The trial, which lasted only 16 weeks, examined whether increasing the amount of omega-3 fatty acids in the test subjects’ diets would reduce their headaches. Some of the test subjects also reduced their intake of omega-6 fatty acids.

The diet emphasized eating more fish and, for some, eating less foods, such as potato chips, that are fried in vegetable oil. The diet worked best for those who both increased their consumption of fish and decreased their consumption of vegetable oils. Those people who ate the diet high in omega-3 fats and low in omega-6 fats had 30 to 40 percent reduction in “headache hours” each day. One participant, who stayed on the diet, said, “I haven’t had a migraine, not even a mild one, in over two years. Going from having one a week to not have any was just amazing to me.”

Researchers discovered that those who increased their consumption of fish had greater blood levels of oxylipins, compounds that are involved in soothing pain. They had particularly high levels of 17-HDHA, an oxylipin that has been shown to reduce pain in people with arthritis.

If you want to experiment with increasing your omega-3 intake and decreasing your omega-6 intake—

• Eat more—fish, especially fatty fish such as salmon, mackerel, sardines, (also caviar and oysters!); cod liver oil and flaxseed oil; flaxseed, walnuts, chia seeds.
• Eat less—omega-6 oils such as safflower oil, sunflower oil, corn oil, soybean oil, and foods fried in these oils.

If you’re a migraine sufferer, it seems like this diet is worth a try.

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OTC pain relievers

 I take Advil about four times a week for the pain I get in my legs from sustained exercise (golf, house cleaning, yardwork.) Advil definitely helps, but I’ve discovered that it’s probably implicated in my occasional bouts of acid reflux—a new thing for me. So I’m looking at alternative over-the-counter pain relievers. Here are the common ones:

Non-steroidal anti-inflammatory drugs (NSAIDS): Because these drugs work by blocking certain enzymes (COX-1 and COX-2) that are involved in the inflammatory process, they impede inflammation and the pain it can cause. They work outside the central nervous system and at the site of tissue damage. All are better than Tylenol (acetaminophen) for inflammatory injury or disease.

•  Advil, Midol (ibuprofen): best for quick action; better than Aleve for acute pain; because it is short acting, it must be taken more often than Aleve; it can cause damage to the stomach and intestines and can cause heartburn.
•  Aleve (naproxen): lasts longer than Advil; better than Tylenol for pain involving inflammation; associated with fewer side effects than Advil, although has a higher risk of stomach ulcers.
• Aspirin: as good as other NSAIDs for pain relief (and is cheaper). However, it’s more of an irritant to the stomach and can cause bleeding.

With the exception of aspirin, the risks of overdoing NSAIDS include an increased risk of heart attack or stroke. This risk is actually quite small, but increases with chronic usage, higher doses, and for people with known cardiovascular disease.

 Tylenol (acetaminophen): This drug works inside the central nervous system, has fewer side effects than other OTC pain medications and doesn’t interact negatively with most common drugs. However, it doesn’t reduce inflammation. Scientists don’t know exactly how it works. One theory is that it uses the same communication systems in the brain as those used by opioids such as morphine. When over-used Tylenol can damage the liver, especially if combined with alcohol.

The last time I walked the golf course, I tried taking Aleve instead of Advil. It didn't do much good (I have a torn meniscus, sciatica, and bursitis). I'll try aspirin next, but am not very hopeful. I'll probably have to stick with Advil, but will use it only twice a week instead of four times. I'll just suffer through house cleaning and yard work. Or maybe aspirin will work.

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About those 10,000 steps

 We’re told we're supposed to take 10,000 steps a day for the sake of health and longevity. As I write this, it’s 2:00 in the afternoon. I spent the morning cleaning house. According to my Apple watch, I have taken 3,673 steps and walked 1.65 miles so far. I’ll be walking some more before bedtime, but of course I won’t come close to 10,000 steps. Must I walk more?

 Actually, that 10,000-step goal (about five miles) was not based on science. It began as a pedometer maker’s marketing ploy but has managed to stick in our consciousness as scientific truth. We now know that 10,000 is more than you need—but not a whole lot more. It looks like 7,500 steps is the new “sweet spot,” which still seems like a lot to me.  

 In one study, researchers found that women in their 70s who managed as few as 4,400 steps a day reduced their risk of premature death by 40 percent, compared to women completing 2,700 or fewer steps a day. For those women who took more than 5,000 steps a day, the risks for early death continued to drop, but plateaued at about 7,500 daily steps. In an experiment with 5000 middle-aged test subjects, researchers found that the people who took about 8,000 steps a day were half as likely to die prematurely from heart disease or other illness than those who accumulated only 4,000 steps a day.

 So, you only need to take 7,500 steps, not 10,000. If I want to hit that goal today, I’ll need to take another 3,500 steps before bedtime. It’s not going to happen. Besides, I’m a few weeks away from turning 85. What do they mean by longevity? How old am I supposed to get?

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

Choking (pulmonary aspiration)

Now that I’m old, I choke way more than I used to—mostly when drinking something and swallowing incorrectly. The liquid starts to head toward my lungs (via my trachea), instead of toward my stomach (via my esophagus). Because breathing and swallowing occur in the same space, swallowing requires extremely precise coordination with breathing. Failure to coordinate results in choking.

Swallowing involves over 20 muscles of your mouth, throat and esophagus, and all are controlled by nerves in your head. Your tongue pushes the food toward the back of your throat and also prevents food going back into your mouth; your soft palate blocks the food from going into your nasal cavity; vocal folds close to protect the airway to your lungs; your larynx (voice box) is pulled up and the epiglottis (a leaf-shaped lid) covers the entry to the trachea (windpipe). This last part is the most important step: the epiglottis keeps food from going into your lungs.

Choking is a common effect of aging. Like everything else, the muscles in your mouth get flabby, including your epiglottis, the flap that keeps food from going down your trachea. We also have less saliva, which adds to the problem. In young people, the normal time for a single swallow, is about one second; it can be twenty percent longer in older people, so the airway has to be protected longer. 

One solution is to tuck your chin down when drinking, rather than raising your chin up. Tucking tilts the epiglottis backward to help prevent food going down your windpipe. I can never remember to do that.

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

Embodied cognition

Embodied cognition is the theory that our entire body—not just our brains—shape our knowledge and understanding of the world. From the standpoint of evolution, abstract thought is less than 100 thousand years old, whereas the sensory and motor portions of our brains—those necessary for survival—have been at work for a billion years. As one researcher said, “the deliberate process we call reasoning is, I believe, the thinnest veneer of human thought, effective only because it is supported by this much older and much powerful, though usually unconscious, sensorimotor knowledge.”

Researchers have performed lots of experiments to demonstrate this theory. For example, if you're holding a warm cup of coffee, you're more likely to judge a person as trustworthy than you would if you're holding a cold cup of coffee. If you squeeze a soft ball while looking at a gender-neutral face, you are more likely to perceive the face as female than you would while squeezing a hard ball, in which case you would perceive the face as male. When you think about the future, you're more likely to lean forward, but if you think about the past, you'll probably lean back.

One interesting aspect of embedded cognition is that we think and talk in metaphors because metaphors are based on the physiology of emotion. When we’re angry our skin temperatures and heartbeats rise. Thus, we describe someone as being “boiling mad” or doing a “slow burn.” Some of the metaphoric language comes from physical interactions during our first several years of life. We equate up with control (“I have control over him”) and down with being controlled. We equate affection with warmth (“I’m warming up to her”). 

Engineers who work with artificial intelligence are trying to figure out how to construct robots so that they, like us, can learn from their environment. As Alan Turing wrote in 1950, “ …it is best to provide the machine with the best sense organs that money can buy.” Good luck with that.

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

Why we’re living longer

 In 1880, average life expectancy in rich countries was 40 years. In 2018, in the U.S., it was 78.5 years. (Life expectancy is the average number of years a newborn would live if prevailing mortality rates remained unchanged.) In a sense, we have been granted an extra life: an added 40 years.

Because of the Covid pandemic, we’ve been made acutely aware of the ways in which pathogens can sicken and kill us. But it has been ever thus. We fail to appreciate the fact that we’ve been living longer because feats of human ingenuity followed by public health measures have been protecting us from these microscopic invaders.

For example, in London, a physician by the name of John Snow traced cholera deaths to a neighborhood water pump, proving that contaminated water, not foul air (“miasma”), caused the illness. Although Snow wasn’t able to identify the specific contamination agent—later identified as a bacterium—he was the first to study the pattern of deaths in the neighborhoods and thus to pinpoint the culprit. In other words, he was the first epidemiologist. His discovery led to improved sanitation facilities in London.

Discoveries by Pasteur and other scientists continued our forward progress. Antibiotics, blood transfusions, and similar medical interventions have saved millions of lives. But we owe the lion’s share of our extra life not to individualized medicine but to public health measures such as sewers and clean water, pasteurization, chlorination, and vaccines. We should be more grateful.

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The hospital business

 At least a fifth of America’s hospitals are now run for profit. Private-equity investment in health care has tripled since 2015. Nevertheless, hospitals are closing at the rate of about thirty a year. What's wrong with this picture?

The idea of hospitals turning profits is somewhat recent. The oldest hospital—co-founded by Benjamin Franklin—opened in Philadelphia in 1795. Care was free (costs were covered by philanthropy and taxes). The cost of hospital care rose significantly after the second World War, partly because of the development of expensive procedures and partly because the government began to offer tax breaks for employers who paid for their workers’ health benefits. In 1965, after Medicare and Medicaid came into being, the number of insured Americans grew to more than sixty percent of the population. To capitalize on the boom, for-profit hospitals sprang up and more than seven hundred for-profit insurance companies were offering medical coverage. 

Since 2008 American hospitals have been involved in more than a thousand mergers and acquisitions, resulting in large, powerful health systems that influence both the price of hospital care and the reimbursement rates paid by private insurers. Last year sixty-six billion dollars was spent on acquisitions, a situation that has led to increased price hikes and unnecessary procedures. 

For hospitals, the most lucrative business comes from privately insured patients seeking specialized care. If your hospital is in an area where relatively few privately insured patients reside, it may be doomed. Where I live, the conglomerates have taken over. My hospital is currently undergoing a $360 million dollar renovation. Looks like business is good.

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A picture of snot

 This photo appeared in the New England Journal of Medicine. Yes! It’s snot! Of course, the NEJM calls it “nasal mucus.” To get a photo like this, you must let the mucus dry then use “phase-contrast microscopy at high magnification” to take the picture. The pattern is called “ferning,” which simply means that the design is fern-like.

Mucus is mostly water, plus electrolytes, “mucin glycoproteins,” fats, and some other proteins. Apparently, if you’ve got allergies or a cold or similar nasal problem, the ferning doesn’t look so nice. Our nasal mucus is an important part of the defense mechanism in our airways, so be glad you have it, even if isn’t so pretty.

I think the photo is rather comforting. It makes it seem like we live in an ordered universe, right down to our snot.

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

Learn to live with microbes

 As one who doesn’t believe in sanitizing everything—or, really, anything—I was heartened to read about an international project in which over 900 scientists and volunteers collected samples of microorganisms from subways in 60 cities and on six continents. They swabbed turnstiles, railings, ticket kiosks, benches and subway cars. (One researcher was thanked by a bystander for cleaning the subway.)

They found 4,246 known species of micro-organisms. Two thirds of these were bacteria and the remainder were a mix of fungi, viruses and other kinds of microbes. They also found 10,928 viruses and 748 kinds of bacteria that had never been documented. The vast majority of the collected organisms pose little risk to humans. As one scientist reported, “We don’t see anything that we are worried about. People are in contact with these all the time.” In fact, nearly all of the new viruses are likely to be bacteriophages—viruses that infect bacteria.

The researchers also found that each city had its own distinctive microbial signature. In fact, scientists could identify, with 88 percent accuracy, where a sample had come from. Nevertheless, they did find a “core urban microbiome” that was present in nearly every sample in every city. Half of these are bacteria that typically live in and on the human body, especially the skin. The core microbiome also contained soil bacteria and a species typically associated with the ocean.

As another scientist reported, “The amount of microbial diversity is just incomprehensibly vast.” Microbes are a natural part of our environment. You can’t avoid the little creatures and you can’t get rid of them. So don’t even try.

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Gesturing: It’s linked to speech

 We Jeopardy watchers are sizing up the guest hosts who are auditioning to fill the late Alex Trebek’s shoes. My friend Betsy couldn’t stand guest host Buzzy Cohen because, she says, “his constant hand movements drive me crazy. He moves his hands to accentuate every syllable he speaks.” Well, I think Buzzy can’t help it. Gesturing is an integral part of speaking and is usually unconscious.

Gesture and language are an integrated, synchronized system in which thoughts, language, and hands are linked together. In fact, gesture and speech both originate in the same regions of our brains and both arise from a single speaking process. Each plays its own role in communication: language is linear and segmented; gesture is instantaneous and symbolic. Both reveal our thoughts.

Think about this:

• We gesture when we’re on the phone and nobody’s around to see it.
• Blind people gesture to each other.
• A woman born with no arms nevertheless senses that she’s gesturing. “When I talk, my phantoms gesticulate. In fact, they’re moving now as I speak.”

I don’t know what Buzzy Cohen’s gestures reveal about him, or whether some of his gesturing is a conscious effort on his part. Like Betsy, he doesn’t get my vote for permanent Jeopardy host, but not because of his gesturing. I didn’t even notice it.

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More sightings of blue people

My daughter Jocelyn tells me she used to see a blue woman at a market in Montana; my friend Janice reports that, when she was a child, a blue family used to attend her church in Stockton; my sister-in-law Mary sent me an article about an extended family of blue people in Kentucky. I have never seen a blue person.

 As to the blue family in Kentucky, one couple, Martin and Elizabeth Fugate, carried a recessive gene called met-H. Met-H causes a condition called methemoglobinemia, a blood disorder that causes elevated levels of methemoglobin in the blood. Methemoglobin is a form of hemoglobin that causes too little oxygen to be delivered to cells, a trait that results in blue skin. 

The Fugates had seven children, four of whom had two copies of the recessive gene. All four were blue. Because the Fugates lived in a fairly isolated region, members of the extended family began intermarrying, a situation resulting in more blue-skinned children. Who knows? Maybe some of them moved to Stockton and joined Janice's family's church, or moved to Montana and shopped at Jocelyn's market.

You can get methemoglobinemia by taking certain drugs or chemicals that oxidize hemoglobin and convert it to methemoglobin. These drugs include some antibiotics, local anesthetics, and various nitrate derivatives, such as nitroglycerin—about 90 compounds in all. If you should turn blue as a result of taking these drugs, don’t worry. It’s not permanent.

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