A FEW seconds after Cambridge, Massachusetts sourdough bread entrepreneur J.G. tentatively took a nibble of a small cherry, he said,” yup, it’s happening”— a tingling feeling in his lips and mouth that started occurring in his mid-50s when he eats cherries and certain types of apples. Called both oral allergy syndrome (OAS) and pollen food allergy syndrome (PFAS), such reactions develop in about 70% of people who have seasonal pollen allergies: specific grasses, weeds or trees set off “cross-reactive” immune responses to specific fruits and vegetables. “Cherry allergy most often occurs when the immune system mistakes similar proteins found in cherries for those present in certain pollens,” according to the allergy-care company Wyndly. For some people, the reaction occurs only with raw cherries, because cooking can denature or render non-reactive the proteins responsible; and those with cherry allergy may also react to other fruits and nuts, which is called the Pollen Fruit syndrome. Foods that can be cross-reactive along with cherries include apples, peaches, plums, nectarines and almonds.
Most PFAS are a contact allergy, causing allergic reactions on the skin—like poison ivy—that primarily affect regions coming into direct contact with the specific food, according to the American Academy of Asthma, Allergy and Immunology. In cases of PFAS, itchiness or swelling of the mouth, face, lip, tongue and throat can vary from episode to episode, from person to person—and can occur with the fruit’s skin but not its pulp or depend on the ripeness of the fruit. And while symptoms most often are mild and brief, and occur directly after eating, reactions can arise hours later and be more severe—including swelling of the throat—and in rare cases, progress to anaphylaxis.
True food allergies—most commonly to shellfish, followed by peanuts and tree nuts—affect the whole body and have been in the news recently with the approval of “neffy,” epinephrine nasal spray, as an easier delivery method than the epi pen for emergency treatment of life-threatening allergic reactions while awaiting medical care. Like PFAS, systemic immune reactions can also range from mild, such as hives, to life-threatening very low blood pressure or swelling in the throat that makes breathing difficult. Notes ER department director Josephin Mathai at HCA Florida St. Lucie Hospital, “Allergic reactions are kind of like a spectrum…having more than one of these symptoms at a time can be cause for concern…if you have a rash and vomiting, you should go to the ER.”
PFAS can occur any time of year—although incidence and severity might increase during pollen allergy seasons—and is the most common food allergy among adults, with prevalence that increases as populations age. According to pediatric clinic researchers in Parma, Bari and Bologna, Italy, PFAS can arise starting in childhood among those suffering from pollen-induced allergic reactions.
Regional dissimilarities in PFAS depend on the prevalence of different local grasses, trees and weeds, according to the Italian researchers. While cherries are most commonly implicated in Southern Europe—along with apples and peaches, and vegetables such as celery, carrots and tomatoes—in Japan, alder pollen cross-reacts with sensitization to apples; and Japanese cedar, with fresh tomatoes. And in Australian children, watermelon is the most common triggering food.
Cherry cross-reactivity in Northern Europe that comes from birch tree pollen sensitization can also occur with plant foods, such as tree nuts and fruits in the Rosaceae, or rose, family—along with cherries that includes apples, pears, almonds, peaches, apricots, plums, strawberries, raspberries and blackberries. But NYU Dermatologist Miriam Keltz Pomeranz warns in the Washington Post, oral itching from nut allergies “can be the same symptom you’d get initially from a true food allergy…And then you could get really sick the second time you tried it. “
Like all food allergies, PFAS is an immune system reaction that usually causes more serious symptoms compared to those from “food intolerance,” which is a gastrointestinal disorder. Although histamine is a signaling molecule that plays a role in many immune system reactions, “histamine intolerance” is a different and very rare reaction that occurs in about 1-3% of the global population. For these people, histamine builds up in the body, after which foods containing large amounts of histamine can cause upset stomach, headache or even allergy symptoms. Sometimes considered a pseudoallergy, histamine intolerance creates what looks like an allergic reaction to foods naturally high in the chemical histamine—with cherries, confusingly, appearing on different lists of both low- and high-histamine foods.
I have seasonal allergies that persist through growing seasons for trees, weeds and grasses, but so far don’t seem to have any cross-reaction allergies to related foods. I have wondered, however, if my gastrointestinal reactions to spicy and fried foods might be considered “food intolerance”—similar to what many people report as intolerance to gluten. In official recognition of the confusion around this topic, a group of Italian researchers have called for “a change in the public dissemination of the correct concepts related to the common question: Is it allergy or intolerance?” Meanwhile, I have begun to note slight tingling around the mouth when eating cherries—probably an unrelated phenomena, such as group hysteria or hypochondria.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
THINNING VAGINAL tissues caused by decreased estrogen levels after menopause most often result in vaginal dryness—and torn tissue that creates “occult” hematuria or blood in the urine. Occult refers to microscopic—rather than visible, “gross”—blood in urine that can be asymptomatic as well as invisible to the eye, most often detected by urinalysis at the annual physical exam. Because hematuria can be a sign of cancer in the urinary tract, its discovery often necessitates further testing—most often a CT scan and cystoscopy—often repeated over many years.
“Being middle-aged or older” is one of six risk factors listed for blood in urine—with another being frequent UTIs by WebMD. And while hematuria can cause loss of appetite and swelling, notably around the eyes, even asymptomatic women often seek treatment because of the possibility that hematuria is causing fatigue—and the hope of avoiding more testing in the future.
Microscopic hematuria is a common finding on urinalysis—in one study, occurring in 20% of women tested; and a systemic review found prevalence above 30%, according to the American College of Gynecology (ACOG). ACOG clinical committees have recommend further testing for asymptomatic hematuria in women who have repeated urinalysis that shows elevated numbers of red blood cells, and in those who smoke or once did.
Supplemental estrogen can help with many ills related to low estrogen that can include incontinence; nocturia (nighttime urination), painful sex and brain fog. But for women who are not sexually active, the preferred form of estrogen—pellets injected into the vagina, rather than inconveniently messy vaginal creams—is expensive because of lack of insurance coverage for these diagnoses.
Increasing numbers of post-menopausal women experienced symptoms linked to low estrogen following a flawed 2002 study on Hormone Replacement Therapy (HRT) that led to a dramatic drop in HRT prescriptions—despite its well-established health benefits, such as reduced risk of heart disease and several cancers, including breast and colon; and help with menopause-related issues, especially osteoporosis. While the optimal time for starting HRT is ages 45-55, during menopause, many of the 16,608 women in the 2002 study were in their mid-60s—as well as overweight and already at risk for heart disease.)
“Our generation got screwed,” 60-something DC lawyer B.J. told MyLittleBird, referring to many doctors’ ongoing refusal to prescribe oral HRT for symptoms affected by hormones like estrogen. According to JohnsHopkinsmedicine, “Doctors are increasingly aware of how managing osteoporosis, urinary conditions…and diabetes in female patients may call for different approaches [such as supplemental estrogen] that take into account women’s physiological differences” —though for many women, “increasingly” is not fast enough.
“Vaginal dryness is the most prevalent and bothersome symptom” of GSM (genitourinary syndrome of menopause)—and affects 93% of women, according to a data overview by researchers at the University of Athens, Greece. For sexually active women, “the most predominant complaints…are reduced lubrication and dyspareunia (lasting or recurrent genital pain that occurs before, during, or after sex)”—with a prevalence of 90% and 80% respectively.
While occult hematuria causes no visible changes to the urine, gross hematuria can change its color to pink, red, brownish-red or tea colored. But these colors can also occur with red pigments from food dyes, medications—including antibiotics and painkillers—or eating a lot of beets, according to WebMD. Urine can also be darker as a result of rhabdomyolysis, breakdown of muscle that can occur during intense exercise; or hemolysis, destruction of red blood cells that can be caused by infections, medications and immune system-related conditions.
Urinary tract cancers occur more commonly in smokers—even those who have quit years or even decades before—who are three times more likely to develop bladder cancer than non-smokers. Other risk factors for cancer are exposure to chemicals such as arsenic, and chronic urinary tract inflammation that occurs with UTIs. Like most cancers, these have a much better outcome when caught early—hence the repeat exams.
Meanwhile, the radiation risks of CT scans have decreased dramatically over the years. According to Florida Mayo Clinic radiologist Patricia Mergo, “There’s no reason to forgo a [well-advised] imaging test or X-ray-assisted procedure…especially true for older adults, as potential radiation-caused cancer development may not occur for decades.” But a different risk of scans are incidentalomas, which refers to benign findings that can set off a cascade of further tests—usually involving repeat scans.
“Once a smoker” is a common refrain among women whose history has led to years of repeat testing. For me, filling in the questionnaire blank that, yes, I smoked for three years during college—fifty years ago—leads to follow-up testing for hematuria. After the first CT scan showed a so-called incidentaloma—a small nodule on my lung, probably the result of pneumonia—my doctor prescribed follow-up scans every year until, after five, I switched doctors. My current internist of more than 15 years now knows my history well enough that, following a clear CT scan and cystoscopy, she has agreed to no more testing—and prescribed the good injectable estrogen in pellet form, covered by insurance, with a diagnosis of hematuria.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
“MAMMO + HEART AI” reads a large poster on the wall of DMV-based Washington Radiology, where the check-in staff suggested adding this AI screening for a self-pay of $120. (3-D mammography, a previously suggested self-pay add-on, was no longer on offer.) A different add-on, a BAC (breast artery calcification) evaluation, involves visual assessment of mammograms for the presence and severity of BAC.
But while BAC scans may provide clues to heart health, the evaluation may be less useful than the better established screening of the coronary arteries responsible for supplying blood to the heart. Scanning coronary arteries for calcium (CAC screening) can show calcium deposits that are narrowing these important arteries even in people with good scores on other heart health indicators.
Heart-risk calculators, for example, tally responses to lifestyle questions, such as smoking, along with data that include cholesterol levels. But the calculators often fail to add relevant variables, such as family history, diet, exercise and ability to control stress—giving results that are too high or low for some patients.
Also considered an indicator of good heart health, cholesterol “ratios” provide comparisons of worrisome LDL (low-density lipoprotein) cholesterol levels with those of HDL (high-density lipoprotein) that has been considered healthier. Reliance on cholesterol ratios, however, is unproven and may be unreliable. According to the Mayo Clinic,“For predicting your risk of heart disease, many doctors now believe that determining your non-HDL cholesterol level may be more useful” than the ratio. (Obtained by subtracting the HDL number from that of total cholesterol, the non-HDL level should be below 130 mg/dL.)
What can also interfere with heart health is that most patients are unaware of their personal risks or of what symptoms might look like if they occur. For AFib (DEF) for example, few people know about the condition, and its symptoms can be silent. Even when knowledgable individuals feel their hearts speed up, they can be unsure whether to push unwilling doctors for more tests—despite AFib officially affecting some 10% of people over age 65, a number that could be much higher because of unreported or silent symptoms.
On the other hand, a CAC scan “is the finest way for those who are uncertain about their heart disease risk to make better decisions about treatment and medications,” according to Johns Hopkins heart disease prevention researcher Michael Blaha. Although Hopkins studies began documenting its usefulness in 2011, the CAC scan still has not made it onto many guidelines; most patients must first request a referral from their doctor and then pay for the test themselves, which usually costs between $40 and $150.
But physicians continue to argue about their usefulness. Calcium scans of coronary arteries are “very useful if there’s uncertainty about a person’s risk of heart disease or the need for statins,” Brigham and Women’s Hospital cardiologist Ron Blankstein told Harvard Health—but not for anyone who already has coronary artery disease or has a low risk of heart disease, which includes most people under 40. Said Blankstein, good candidates come from the “immediate-risk group…people ages 40 to 75 whose 10-year risk of heart disease or stroke ranges from 7.5% to 20%.”
As for 3D mammography, it is “a standard of care for breast cancer screening,” according to Breast Cancer.org. “A number of studies have found that 3D mammograms find more cancers than traditional 2D mammograms and also reduce the number of false positives.” Yet 3D mammography is unavailable in many screening facilities and not covered by all insurance plans.
“All of our Hopkins sites offer 3D mammography, which gives us much more information because it lets us see the layers of cells, one millimeter at a time,” according to the Johns Hopkins website. But the site also notes that “guidelines do not include recommendations for women after age 74, as there is limited data on whether mammograms save lives in that age group.”
At my recent annual mammography appointment, I said no thanks to the BAC add-on. (A recent CAC scan had given me a healthy score.) 3D mammography was not on offer, nor was it mentioned in my report of negative mammogram results—despite the statement that my “extremely dense” breast tissue “can make it harder to find cancer on a mammogram and may also be associated with an increased risk of cancer.” On the other hand, the same letter referred to a “breast cancer risk assessment analysis,” which I had completed, that put my lifetime risk of developing breast cancer at 6.4%. I will not be returning to Washington Radiology—for at least another year.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
RABBIT explosion—some say bunnies are becoming as common in DC as pigeons in New York City. All over the D.C., Maryland and Virginia area (DMV), gardens and selected streets—notably in Southwest DC— appear to be awash in bunny rabbits. Increased rainfall over the past five summers has fueled vegetation growth and may have started the proliferation by providing more food for hungry bunnies.
By 2024, multiple generations of rabbit descendants have become brazen residents of local gardens. And as one community gardener said, the rabbits don’t run…they don’t have any fear of humans.” And while gardeners complain about the rabbits’ voracious appetites for lettuce and carrots, a serious risk is tularemia—rabbit fever—most likely when landscapers and gardeners breathe in the bacteria after mowing or digging in the area where an animal has been sick or died.
Numbers of cases in the DMV are low, averaging around two/year—but a recent surge in four U.S. states (Colorado, Nebraska, South Dakota and Wyoming) included one death, and another man died recently on Martha’s Vineyard. Tularemia spread by rabbits is “well entrenched on Martha’s Vineyard,” according to Tufts University infectious disease professor Sam Telford, who reports between three and 15 cases of tularemia on the Vineyard every year going back to 1999.
In addition, tularemia is one of five diseases including anthrax considered to have the greatest potential for use in biological warfare—because it is highly infectious, with just a small number of bacteria needed to cause disease. Alarms sounded in 2005 when five air sensors on the Capitol Mall detected the tularemia pathogen, according to The Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota—but Department of Homeland Security officials concluded that “the pathogen was probably a natural occurrence and not the result of bioterrorism.
While severity varies greatly, from cases that are mild and self-limiting to those with serious complications and a small percentage—less than two percent of cases in the U.S.— is fatal, according to the National Organization for Rare Diseases. The seriousness of tularemia infections varies depending on where the bacteria enters the body: the lungs, breathing in bacteria airborne from disrupted lawns and garden soil; or the skin, through a tick bite—the most common source in the U.S. (mosquitoes are the main vectors elsewhere).
Tularemia symptoms appear three days to two weeks following exposure and can include fever and chills, muscle or joint pain, sore throat or trouble breathing. Airborne tularemia breathed in through the lungs is the most threatening and requires immediate treatment with antibiotics. According to WebMd, the most common variety of the disease—most often due to an insect bite —is ulceroglandular tularemia, which causes skin ulcers as well as swollen lymph glands, fever, chills headache and fatigue.
Where bunnies are booming, face masks can protect gardeners who are digging, mowing or clearing brush, although the CDC advises avoiding mowing in areas where sick or dead animals have been reported. Keep pets away from wild animals that might be carrying ticks, or sick or dead ones that might be infected. Precautions against tularemia-carrying ticks are the same ones for Lyme disease: Wear long pants and high socks, use DEET, check for ticks after undressing.
Squirrels—also multiplying locally—are hosts for tularemia-carrying ticks, but most carry so many diseases they rarely live for more than four years. The tularemia-causing bacteria can survive for weeks in dead animals—as well as in soil and water—making it more common in rural areas. Children and adult males are most susceptible, being more likely to play or work close to the ground but the bacteria can also infect house pets like dogs and cats.
In my back yard, at least four generations of bunnies in visibly descending sizes are eating everything in sight. Tomato and cucumber plants have limbs and roots bitten off—sometimes while people were sitting or walking a few feet away. Fortunately my son planted one easily accessible cucumber plant to serve as a “sacrifice—which has been nipped extensively and may have helped spare harder-to-reach plants to live a little longer unscathed.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
LONDON interior designer L.P. had to rearrange her schedule to eat dinner much earlier— to cope with shortness of breath during her daily long walks around London—after getting a diagnosis of acid reflux. Caused by the backflow of stomach contents into the esophagus, acid reflux is usually temporary— “caused by something like overeating or drinking too much coffee,” explains WebMD. But acid reflux can be a precursor to the more serious GERD (gastro-esophageal reflux disorder), and heartburn can be a symptom of both.
Proliferation of ads for Nexium, Prilosec, Prevacid and other proton-pump inhibitors since the early 2000s revealed GERD to be the national disease du jour—while many people use the term interchangeably with acid reflux. According to a 2011 Norwegian study, once-a-week acid reflux rose nearly 50 percent over the first decade of the 21st century—with women the least likely to have acid reflux under age 40, but by ages 60 to 69 becoming the mostly likely sufferers.
The 20% rise in antacid sales at 7-Eleven on the Monday after Super Bowl Sunday reflects the once-a-year “excuse to dig into snacks” —high quantities of chicken wings, pizza and beer, according to Pfizer. Besides heartburn, acid reflux can cause indigestion, also called dyspepsia — that includes burping, stomach bloating and upper belly pain; dysphagia, trouble swallowing; globus sensation, the feeling of a lump in your throat; chronic cough or hoarseness; and bad breath.
“Acid reflux is extremely common and rarely serious [but] don’t ignore your symptoms,” warns WebMD. When stomach acid in the airways makes them contract or narrow, acid reflux symptoms can include shortness of breath and wheezing. And acid reflux can feel similar to the chest pain of a heart attack because the same nerves affect both areas.
Chronic backflow of stomach acid over time damages the lining of the esophagus, which connects the throat and stomach. Over time, acid can weaken the muscular valve, or sphincter that separates the two, allowing stomach acid to flow up the esophagus. Composed partly of hydrochloric acid, stomach acid helps with efficient digestion and protects the stomach against bacteria. But in the esophagus, stomach acid can create painful and irritating inflammation, called esophagitis, and in rare cases leads to more serious problems, including ulcers, and increases the risk of esophageal cancer.
GERD is the diagnosis when acid reflux occurs more than twice a week for several weeks. While symptoms can be similar, they are more intense with GERD—for example, a sore throat that won’t go away or inflammation of the gums and erosion of tooth enamel. According to WebMD, “alarm” symptoms of acid reflux that require medical treatment include difficulty or pain when swallowing, nausea, blood in in vomit or stool, and “hiccups that don’t let up.”
Lifestyle changes, the first line of treatment, start with meals—both timing as related to bedtime and composition to avoid triggers. Advises WebMD, “Don’t lie down for at least two hours after you eat…Use extra pillows or blocks under the head of your bed to raise your head while you sleep.” Another site recommends three hours, and for London interior designer, the magic number was five—to prevent reflux but also to improve brain health, based on the belief that about five hours of dinner digestion must take place before the brain can turn to its restorative work clearing out the day’s detritus.
Food triggers of acid reflux vary from person to person, with the most common being rich food such as meats as well as fats, oils and sweets; fruits, vegetables and juice, especially tomatoes; grains; and beverages, including liquor, coffee and tea. According to WebMD, larger and higher-fat meals “tend to stay in the stomach longer before moving into the small intestine,” which lengthens exposure to stomach acid.
Besides lying down too soon after eating, triggers for acid reflux include increased pressure on the abdomen from wearing tight belts or clothes, and doing too many crunches or sit-ups. Acid reflux is more common in people who smoke, are overweight, or take NSAIDS, such as aspirin and ibuprofen, that irritate the stomach.
For help with acid reflux, antacids can help neutralize stomach acid, while H2-receptor blockers such as Tagamet or Pepcid can reduce stomach acid production. (H2 drugs block the release of the histamine that stimulates stomach cells to release acid and are different from antihistamine drugs that block the H1 receptors involved in allergy reactions.) H2 blockers can also protect against or aid in healing ulcers—which can result from erosion in the mucous barrier that protects the stomach lining.
Over-the-counter drugs from the list above—Prevacid, Prilosec and Nexium—can block acid production while at the same time helping to heal the esophagus. Stronger versions of these drugs are available with a doctor’s prescription. But when GERD symptoms persist, endoscopy —using a small camera attached to a flexible tube down the patient’s throat —can help guide further treatment.
Also using endoscopy—or laparoscopy—a procedure called transoral incisionless fundoplication (TIF) “helps create a new barrier to reflux from the stomach,” according to HopkinsMedicine. “Fundoplication means folding of the fundus, the tissue at the top of the stomach…around the opening between the stomach and the esophagus…which reinforces this area.”
After learning that my occasional shortness of breath might be related to acid reflux, I made a bigger effort to avoid my triggers, notably raw garlic in salads and pastas; carbonated drinks; spicy food; and rich sauces. But no matter what I eat, dining out often requires a pre-bed dose of Pepto-Bismol —which creates a protective coating for the esophagus and stomach and reduces stomach acid. And as for eating dinner earlier, despite my best efforts I often dawdle too long and need an extra pillow to prop for sleeping—sometimes two pillows.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
COFFEE drinking has moved past its old bad rap to boast a myriad of health benefits—some immediate, such as faster glucose processing that leads to decreased risk for type 2 diabetes; and other benefits over time, such as lowering risks of heart failure and stroke, according to Johns Hopkins medicine. “For women, drinking at least one cup of coffee a day is associated with lowered stroke risk…the fourth leading cause of death in women.”
In addition, “coffee drinkers — decaf or regular—were 26 less likely to develop colon cancer,” reports the Hopkins team. And coffee may lower the risk of all cancers by strengthening DNA —thereby reducing breakage in strands that “can lead to cancer or tumors if not repaired by your cells.” Coffee drinkers are also more likely to have liver enzymes within a health range than those who don’t drink coffee.
“The overall evidence has been pretty convincing that coffee has been more healthful than harmful in terms of health outcomes,” said Harvard Nutrition Department Chair Frank Hu. In an interview with Discover magazine, Hu said “moderate coffee intake —two to five cups a day—is linked to a lower likelihood of type 2 diabetes, heart disease, liver and endometrial cancers, Parkinson’s disease, and depression. It’s even possible that people who drink coffee can reduce their risk of early death.”
“One of the most striking findings is that coffee drinkers are less prone to developing type 2 diabetes,” according to the Washington Post. “Many large studies have found that people who drink three to four cups of coffee daily have about a 25 percent lower risk of the disease compared with people who drink little or no coffee. Your likelihood of developing diabetes decreases about six percent for each cup of coffee you consume daily—but only up to about six cups.”
Most notable may be coffee’s ability to lower risk of neurodegenerative diseases, such as Alzheimer’s and Parkinson’s—and with the latter, to slow progression of the disease—when these are “caused by lifestyle and environmental factors, including age, obesity, and pesticide exposure,” according to biophysicist Mahesh Narayan at the University of Texas, El Paso. Narayan explained that “caffeic acid’s anti-inflammatory and antioxidant properties may help combat the effects of lifestyle and environmental factors that increase the risk of such disorders.”
To understand how coffee might work in the cells, researchers synthesized caffeic-acid-based Carbon Quantum Dots (CACQDs) from coffee grounds, ‘bite-sized’ nanoparticles…from carbon-containing precursors such as fruit peel, waste paper, and even salmon,” Narayan explained. But he warned that while coffee may be beneficial for most cases of neurodegeneration that occurs with Parkinson’s and Alzheimer’s disease —it is likely to be effective when these are are caused by genetic or familial disorders.
“Clinical symptoms (and therefore the clinical diagnosis) of neurogenerative disorders start years or even decades after the pathophysiological processes have been initiated,” according to UT Health Houston neurologist Natalie Pessoa Rocha. “Because of the very limited capacity (or no capacity) of neurons to regenerate, disease-modifying treatments must focus on preventing neuronal dysfunction/neuronal death.”
As for immediate effects of coffee, an individual’s physiological response depends in part on genetic inheritance. About half of the population, labeled “fast-metabolizers,” feels coffee’s effects more quickly—and because coffee passes through the body quickly, fast-metabolizers can tolerate greater quantities, and thus experience more of caffeine’s health benefits, University of Toronto researcher Sara Mahdavi told CBC radio news. In her study of more than 1,100 people ages 18 to 45 with early hypertension over a 16- year period, the more coffee consumed by fast-metabolizers, the more their rate of heart attack went down.
Fast-metabolizers also experienced no ill effects on kidneys—regardless of the amount of coffee they drank, which was “really quite miraculous,” said Mahdavi. In contrast, slow-metabolizers, who have greater sensitivity to caffeine, exhibited decreased kidney function based on three markers, including hypertension.
“There’s some people they have a sip of coffee, and they get really amped up and over-jittery,” geneticist Thomas Merritt at Laurentian University told the Canadian Broadcast Company. Health Canada guidelines recommend a limit of 400 milligrams of caffeine per day: an eight ounce-cup contains 118 to 179 milligrams, depending on the brew, with a double shot of espresso containing about 150 milligrams.
With molecules similar to those of the neurotransmitter adenosine, caffeine binds to adenosine receptors —which “turns off the sleep pathway and turns on a wake-up pathway instead,” Merritt told the CBC. Caffeine also provides “a hit of dopamine..sends messages of pleasure to the brain.”
For the healthiest coffee, use paper filters, notes Harvard’s Hu. “Unfiltered coffee is associated with higher rates of early death and can contain compounds that raise levels of LDL cholesterol.” Adding cream or sugar can also detract from coffee’s benefits.
My 23andMe profile listing me as a fast-metabolizer stated that moderate amounts of caffeine could have less effect on me—also that I might have “significantly higher anxiety levels after moderate caffeine consumption.” Whether due to anxiety or caffeine jitters, more than one cup usually feels too speedy. And about the one sugar dot added to my morning cup, I tell friendly critics about how my fast-metabolizer’s better glucose processing might help combat health risks.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
After her 2021 post on workout-based electrical muscle stimulation (EMS), MyLittleBird Well-Being’s Mary Carpenter expected studio offerings to take off in the U.S., as they have in Europe. But as of summer 2024, there are few options: once highly touted franchises and studios have closed; and many that advertise “EMS” in fact offer different forms of electrical stimulation that are passive, used while lying down —mostly for pain or recovery following injury, also for passive muscle-building.
PARIS-BASED lawyer L.M. pays $55 for 20-minute studio workouts with a trainer twice a week, which she credits for greatly improved strength and body toning —more than she achieves from a daily swim of one mile, 45 minutes of hula-hooping or weight training. For “EMS workouts,” what looks like a police vest—with wide bands on the arms, quads and glutes—delivers small electric shocks purporting to offer the equivalent of 90 to 240 minutes of strength training in just 20 minutes. Trainers set the electrical dose and direct the accompanying exercises.
Resistance created by EMS makes physical movements—low-impact combination of lunges, squats and planks with some weight-lifting movements; or even Pilates or yoga—more challenging so that they feel more difficult and are more quickly fatiguing, writes Rachel Feltman in Popular Science. Doing a bicep curl with a five-pound weight while wearing the vest activates larger “fast-twitch” muscle fibers, which have more growth potential but are not stimulated by light exercises.
“The machine stimulates your muscles to make them prickle and twitch [and] my muscles would keep randomly twitching for a day or two after each session, writes Feltman. Exercise scientist Greg Nuckols told Feltman: “Your body builds muscles as it repairs damaged muscle fibers [which] will lead to growth…On the other hand, you could just do those bicep curls for more reps or with a heavier weight, and all those same fibers would eventually activate.”
EMS “indisputably cranks up the intensity of whatever you’re doing but…you could always just pick a more intense activity and save a few bucks…there’s nothing magical about electrical pulses,” writes Feltman. But she describes athletes, such as Usain Bolt, “who sometimes uses EMS while running on treadmills to increase his speed when unencumbered.”
Among potential problems with EMS are the effects may be temporary, and there is a risk of overdosing the electricity—hence the need for the presence of a trainer or other expert. And the biggest concern, rhabdomyolysis, can happen following any intense exercise, including running, as well as in spin classes and at CrossFit—any time building strength involves muscle damage. When muscles break down, toxic components of muscle fibers can impair kidney function resulting in symptoms that include muscle stiffness, pain and a change in urine color.
“Athletes and strength and conditioning coaches have been experimenting with EMS for decades now, but it’s still not very popular,” says Nuckols. His conclusion, after surveying available data, writes Feltman: “Too much comes from studies funded by companies with skin in the EMS game, while even more of it comes from small, imperfect studies impossible to generalize.”
But EMS has helped those wishing to build back muscles after an injury—as well as seniors with muscle atrophy—according to WB20 (“Whole Body EMS Workout in 20 minutes).” People who cannot do squats and lunges can do easier exercises, such as bridging. Studio workouts—with a trainer who sets the electrical dose and directs the accompanying exercises—can cost from $50 to $100 a session.
At the Washington, D.C. area-based Silafit Dimitar Pavlov has worked with athletes as well as clients scheduled for joint replacements. Despite online listings for studio classes, Silafit does not yet have a permanent location: instead, Pavlov can bring a “mobile unit” to your house at $99 for the introductory session and an additional $10 to $30 for each session after that. Also in the D.C. area, WB20 lists a studio in Ashburn, Virginia.
Shock Therapy, where Feltman tried EMS, was the first gym to offer it in the U.S., but has since closed. And although companies, including Manduu and Ohm, have over the past five years announced plans to expand throughout the country—including in D.C., Maryland and Virginia—only a handful of studios have opened, most in the western U.S.
In contrast to workout-based EMS, electrical stimulation that is employed passively comes in many forms. “E-stim” can play a role in physical therapy following injuries or surgery, while TENS—transcutaneous electrical nerve stimulation— works on nerves to help deal with chronic pain. TruSculpt Flex, another option, uses electrical stimulation but passively; while EmScupt uses electromagnetic stimulation, also passively and at such a low frequency that it may fail to stimulate muscle contractions at all.
For brain conditions from epilepsy to Parkinson’s disease, neuromodulation via electricity and magnets alternatively stimulates and inhibits neuronal activity in the cortex. Researchers have linked neuronal damage and death in the brain to depression and neurodegenerative diseases, such as MS, Parkinson’s Disease and Alzheimer’s (AD). But despite good results in small groups of patients, most neuromodulation techniques still await better documented proof of effectiveness.
“Life is nothing if not electrical,” writes Georgetown radiologist Timothy J. Jorgensen in his book Spark—as quoted in a New Yorker review by Jerome Groopman. Conditions like epilepsy and migraines may resemble “an electrical storm in the brain,” writes Groopman, who describes the early 20th century “medical craze for electrical treatments to address anything from headaches to bad thoughts.”
For me, after discovering that a strong core depends on muscles like glutes—particularly weak in my case—I hoped to try one workout-based EMS session. But the only local option that responded to my queries, Silafit, involved a trainer coming to my house, which is not a possibility for me. If I travel to a city like Houston that has a franchise studio, I might try it there—though a better option might be a trip to Paris, some day!
—Mary Carpenter regularly reports on topical subjects in health and medicine.
When I tested positive for Covid last month and kept testing positive for 16 days, I had managed to avoid the virus for so many years—since its beginning—that I thought I might be immune; also my blood type O has been suspected to confer some protection. But I worried that never having the infection made me more vulnerable, despite having obtained each vaccine almost as soon as it became available. For the first week or so my only symptom was such mild sniffles—along with fatigue, albeit hard to distinguish from the jet lag following travel to Europe—that my first positive test result was a surprise; later I developed the hacking cough that has followed previous infections such as flu, along with startling pink pink eye—a common symptom of the latest Covid variants.
“A COVID SUMMER UPTICK” read an early July Washington Post headline on recent infection rates. The prevalent JN.1 variants—one dubbed FLiRT for the locations of its mutations—are “significantly different from the dominant variant that preceded it,” according to the Post. While the currently available vaccine “still confers some protection… nearly two thirds of current infections caused by JN.1 descendants can more efficiently infect people who have been vaccinated.”
Meanwhile, across the United States, precautions taken during the recent Covid surge differ widely—from places like Massachusetts beach resorts, where people with active infections continue to socialize unmasked; to the DC metro area, where people stay away from friends like me as long as the tests results are positive.
The CDC’s updated Covid quarantine advice eliminates altogether the reliance on retesting: “People who test positive for COVID-19 should follow CDC guidance for preventing spread of respiratory viruses… stay away from others until at least 24 hours after both symptoms are improving overall and they have not had a fever without the use of fever-reducing medication. For 5 additional days, people should consider added precautions such as hygiene, use of masks, physical distancing, and steps for cleaner air.”
Symptoms of currently circulating variants—especially conjunctivitis, or pink eye, as well as a bad cough—can make it difficult to hide signs of infection. And for some people, unfamiliar symptoms accompany Covid that make it appear “more like they have food poisoning than anything else,” according to the New York Times. University of Pennsylvania medicine professor Ken Cadwell compared Covid infection to “throwing a bomb in your body…You’re going to feel that in multiple different organs, not just the lungs.”
In my case, the Paxlovid I had on hand for my travels—motivated in part by the drug’s record in possibly preventing Long Covid—tamped down symptoms for the five days I took it. After stopping Paxlovid, I felt more tired—a resurgence of symptoms that researchers now believe to be ongoing Covid infection that reemerges following cessation of Paxlovid, rather than caused by the antiviral drug as some had worried.
“People may avoid Paxlovid out of a fear of COVID rebound,” said Yale infectious disease specialist Scott Roberts. “But for high-risk patients, the benefits of Paxlovid in preventing severe disease, hospitalization, and death far outweigh the downsides of a rebound, which is usually mild, and, in most instances, will do nothing more than prolong the isolation period.”
After my 16 days of positive Covid tests, only the cough remained, but it kept me awake at night and contributed to lingering fatigue. On a call with my doctor’s office, I expected to receive the usual recommendations: Mucinex and an antihistamine, such as Benadryl. Along with advising both of those, however, my doctor suggested two prescription medications—creating a multi-drug regimen that I started gratefully, despite my usual reluctance to take so many drugs.
What motivated me above all was the two cracked ribs caused by a similar cough after a bout of flu several years earlier, which had also erupted in unstoppable bursts all day and night and could be calmed only with a steady ingestion of cough drops. Now, along with Benadryl at night, my regimen included Mucinex three times a day as well as the prescription nasal spray ipratropium bromide, a bronchodilator designed to open air passages in the lungs.
The most surprisingly effective was the prescription cough medicine, benzonatate (common brand names, Tessalon or Tessalon Perles), also three times a day, which reduces the urge to cough by numbing areas in the lungs and airways to dampen the cough reflex. As to how effectively benzonatate stopped my cough, as soon as I tried cutting back to one dose before bed, the daytime cough returned in full force—so I continued the full regimen for a few more days. Having never heard of this drug before, I have since heard from friends—with coughing following asthma as well as other infections—who received the same prescription.
Next came pink eye, or conjunctivitis—in my case, most likely viral, based on my positive Covid tests. First came puffiness that narrowed my eyes, then an itching and burning that made my eyes feel exhausted starting first thing in the morning, and finally the unmistakable pink coloring. What helped was applying cold compresses many times a day: I couldn’t use the lubricating eye drops as advised because of difficulty keeping the tip of the drops dispenser from touching my eyes—a serious issue in the case of extremely contagious conjunctivitis.
The best healer of pink eye in most cases is time. According to the CDC, whether viral or bacterial, most mild pink eye clears up without medical treatment in two days to two weeks. For bacterial pink eye, antibiotics can help shorten the length of infection and prevent the spread to others. My doctor assured me that pink eye looks obviously bacterial when the discharge, or pus, is thick and colored yellow and green.
With such an array of symptoms—each of which seemed mild in my case, but altogether lasted almost four weeks—Covid remains unpredictable, compared to other infections such as the flu, with which it is often compared. But contracting Covid should have the advantage of conferring some protection for the next few months—at least until the arrival of the next new vaccine, designed to better protect against currently circulating variants. And if that Covid shot includes the latest flu vaccine, as reported, putting off the jab until at least late September may offer the best protection against both throughout the flu season.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
THE SPECTER of Joe Biden fumbling his way through the end-of-June debate has many Democrats worrying about the future presidency and others wondering about their own cognitive health. To counter the dementia of Alzheimer’s disease (AD), the two headline-grabbing, recently approved drugs Lequembi and Kisunla (donanemab) attack amyloid plaque in the brains of AD patients. But many doctors consider the results for these drugs countering AD-related dementia to be disappointing and instead place their bets on metformin and other semaglutide or GLP-1 medications, approved to treat type 2 diabetes (T2D) via glucose control and weight loss.
“Is metformin a wonder drug?” asks Senior Faculty Editor for Harvard Health publications Robert Shmerling. “Wonder drugs” earn the title, Shmerling explains, either because they provide “tremendous health benefits” for a particular condition, or “because the drug is good for many different conditions—such as aspirin, which can relieve pain, treat or prevent cardiovascular disease and even prevent cancer.” For AD, dubbed “type 3 diabetes,” tackling insulin resistance might be the key to treatment.
“Metformin does more than just help lower blood sugar in people with diabetes [it offers] cardiovascular benefits,” Shmerling writes. And he describes investigations into metformin’s ability to lower risks for dementia and stroke, as well as to “slow aging, prevent age-related disease and increase lifespan.” But Shmerling warns, because metformin research has focused on people with diabetes or prediabetes, “it’s unclear wither these potential benefits are limited to people with those conditions.”
Metformin and similar drugs aim to protect the brain by regulating insulin resistance and glucose metabolism, and their related problems, such as neuroinflammation. By contrast, the two anti-amyloid drugs—with Kisunla approved just last week—employ monoclonal antibodies in immunotherapy that reduces the plaque in the brains of AD patients that is thought to cause dementia. But according to the New York Times, in addition to these drugs’ worrisome side effects, notably brain bleeds, their success in reducing plaque has not led to clear reduction in AD symptoms.
“There’s no correlation in any of their [anti-amyloid drug] studies between the removal of amyloid plaques and the clinical response in individual subjects,” said Stanford University neurologist Michael Greicius. Noting the risk of discouraging “patients from participating in trials for treatments that could be better,” Grecius believes that the focus on these drugs is “slowing progress.”
“We are at a crossroads where GLP-1 class drugs are emerging as a new treatment strategy” for AD and PD (Parkinson’s disease), according to Florida endocrinologist Wafa Latif and colleagues. “The future looks bright…Newer drugs that have been designed to enter the brain easier already show improved effects in preclinical studies compared with the older GLP-1 class drugs…to treat diabetes.”
The link between AD and diabetes is insulin resistance—in AD, the failure of brain cells to respond to insulin—and related effects, such as neuroinflammation. Write Chengdu, China researchers studying intranasal insulin to combat dementia, “insulin, as an important neurohormone, plays a critical role in brain energy metabolism, cognitive function [while] insulin resistance has been proved to be a pathogenic mechanism of cognitive disorders.” And type 2 diabetes increases by at least two-fold the risk of cognitive disorders and dementia for those with AD and PD.
Glucose is crucial to healthy brain function—and GLP-1 drugs “may mitigate the decline in cerebral glucose metabolism and [enhance] blood-brain glucose transport capacity… [with] potential metabolic and neuroprotective benefits,” according to the Chengdu team. Among GLP-1 drugs, two top contenders for forestalling or improving symptoms of dementia are lixisenatide, in a French study of early-stage Parkinson’s patients proving effective at both improving motor activity and preventing further deterioration; and liraglutide, which has improved cognition and reduced brain shrinkage in patients with Alzheimer’s disease.
On the negative side, metformin has appeared to “trigger AD pathology and even elevate AD risk in humans,” write Korean dementia researchers So Yeon Cho and colleagues, in the journal Nature. In mice studies, long-term treatment with metformin led to “cognitive impairment in mice at old age…despite enhanced cognition observed in… mice at a young age.” As a result, the researchers argue, “drug repurposing of metformin should be carefully reconsidered…when it is intended for individuals with AD.” And while metformin therapy had appeared to increase longevity for T2D patients over the first three years of study, benefits did not last in patients examined over longer periods of more than five years, according to Cardiff researchers Joshua Stevenson-Hoare and colleagues. The Cardiff team also noted the confounding discovery of signs that “late-life diabetes can be protective against neurodegenerative disorders (as is higher body-mass index which is associated with T2D).”
The Alzheimer’s Drug Discovery Foundation considers evidence for metformin’s positive effects on brain health to be inconclusive. And Smerling writes, “While the [metformin] research so far is promising, we need more compelling evidence before endorsing its widespread use for people without diabetes. But for clinical researchers hoping to repurpose an old medicine as a new wonder drug, metformin would seem like a great place to start.”
—Mary Carpenter regularly reports on topical subjects in health and medicine.
“FIBERS IN a variety of colors protrude out of my skin like mushrooms,” said Joni Mitchell about her Morgellons disease, which made her feel as if she were being “eaten alive.” Mitchell remained housebound following reports of a 2015 brain aneurysm but began performing in public again in 2022, appearing most recently at the 2024 Grammy awards.
Morgellons disease (MD) is a “disfiguring and distressing condition,” according to dermatology researchers at Wake Forest. Symptoms include sensations of crawling, biting and stinging on the skin that can be very painful; and multiple, non-healing skin wounds. But the existence of red, blue, black and white fibers in the skin is the most notable complaint—hence the nickname “fiber disease.” Patients bring scabs and other skin samples with embedded fibers—called “matchbox” or specimen signs —for testing.
Since the first reported U.S. cases in 2002, the estimated prevalence of Morgellons disease is about 3.6 cases/100,000, most often in white, middle-aged women,” according to a 2012 CDC analysis of 115 patients. The study also determined that the protruding fibers were made of cotton—not bodily substances—and traced the skin sores to “long-term picking and scratching the skin.”
The diagnosis of Morgellons symptoms, based on the study, was “delusional parasitosis,” a psychiatric condition in which sufferers erroneously believe bugs are infesting their skin. (Ekbom Syndrome is a related form of delusional parasitosis.) But lack of general awareness about the condition, even among doctors, can be upsetting for patients—as can receiving an unexpected psychiatric diagnosis for what had looked like a skin disease that can even make symptoms worse.
Multi-system symptoms of Morgellons, on the other hand, are similar to those of Lyme disease (LD)—fatigue, itching, joint aches, loss of short-term memory, difficulty concentrating, insomnia. But after the CDC tested for and eliminated Lyme, Morgellons researchers at Oklahoma State University agreed that “there is no evidence” linking MD to the spirochetes that cause Lyme.
Adding to a fraught history of Lyme disease research, a recent review of literature connecting MD to Lyme found “most of the studies…were published by the same group of authors,” according to Healthline. In addition, the authors “sometimes reuse participants across their studies…one researcher in this group has previously been accused of scientific misconduct.”
But supporters of the MD-Lyme connection point insist that, when employing testing that is “sensitive and specific…Borrelia spirochetes are readily detectable in MD tissue,” write Canadian microbiologist Marianne Middelveen and colleagues. The researchers also contend that MRI imaging shows alterations in gray matter that could be linked to spirochetal infection.
In addition, careful sectioning and staining of skin samples “determine the keratin and collagen nature of these fibers,” the Canadian researchers assert. Linking these fibers to Lyme, they suggest that “underlying spirochetal infection causes a filamentous dermopathy that is accompanied by an array of LD-like multisystem symptoms.”
They also contest the CDC’s link of MD to delusions. In their paper, “History of Morgellons Disease: from delusion to definition,” they say that the CDC conclusions did not meet conditions for the diagnosis of delusional disorder based on the DSM 5 —the diagnostic manual for psychiatric conditions—notably that any possible physical cause must be excluded.
Delusional disorders share overlapping symptoms with other diagnoses—notably the “overvalued ideas” present in OCD, body dysmorphic disorder and hypochondriasis. But while OCD often involves mistaken ideas, for example, about cleanliness, that diagnosis requires repetitive, ritualistic behaviors that are absent in delusional disorders.
Delusions in one sub-category, “somatic” (referring to bodily function or sensation), range from the “bizarre” —such as that one’s bones are twisted around each other; to non-bizarre—which “mirror real health conditions,” such as broken bones. With Morgellons disease, colorful fibers protruding from the skin are bizarre, but the accompanying non-bizarre itching and skin eruptions occur commonly with real skin disorders, such as allergies, dermatitis and parasitic diseases.
Other non-bizarre delusions include partial paralysis, bodily odors and pregnancy. Reported cases include a man who complained that he was unable to sleep at night, despite tests showing he slept for many hours; and a woman who could feel a foreign substance in her mouth that interfered with eating, although no such substance could be found.
Defining MD as a psychiatric condition also gained support because symptoms respond positively to antipsychotic drugs, which target the neurotransmitters dopamine and serotonin. On the other hand, “reduced growth of parasites and anti-pruritic properties” are listed as off-label effects of these medications, according to Middelveen.
Treatment for Morgellons often includes psychological approaches, such as cognitive behavior therapy. But because the belief of MD sufferers that they have a physical disease is so difficult to dislodge, many are resistant to or upset by such recommendations.
Another confounding issue: one cause of delusional parasitosis is recreational drug use—with “coke bugs” and “meth mites.” In a study of 147 patients complaining of bug infestation, 11% had a history of drug use (methamphetamines, cocaine, heroin, marijuana and other street drugs), according to Middelveen.
Among MD sufferers, Joni Mitchell has admitted to “taking a lot of drugs over the years, including mounds of coke,” according to the Daily Mail. But she was also a victim of childhood polio, a potential infectious link for MD that has not yet been pursued.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
IMAGINE FEELING well enough for daily activities—except that one side of your face droops, involuntarily produces smiles or squints, contracts, or stiffens to the point of becoming immobile and expressionless. You may also experience intense pain, and drool or shed crocodile tears (tears with no emotional cause).
Paralysis that arises suddenly, affects only one side of the face and worsens over 48 hours often signals Bell’s Palsy—in the news lately as a possible if disputed side effect of Covid vaccination, writes Apoorva Mandavilli in the New York Times. Known to occur following other vaccines, Bell’s Palsy affects about one in 60 people during their lifetime, and is becoming more prevalent.
Sudden drooping or stiffening of one side of the face could also be a worrisome early sign of stroke— though these rarely affect the forehead or eyes. Also, a stroke causes muscle weakness in other parts of the body as well, hence the early stroke-detection method FAST that includes raising both arms.
Swelling in the facial nerve leads to ischemia, a restriction of blood and oxygen to the nerve cells: the seventh cranial nerve has so many functions that any disruption can lead to symptoms that vary from person to person. One explanation for the rising incidence of Bell’s Palsy is increasing numbers of herpes zoster infections—which are present in most cases of Bell’s Palsy, although the condition is considered idiopathic (no known cause). In addition, Bell’s Palsy recurs in eight percent of sufferers.
Facial-nerve paralysis dates back at least 4,000 years, based on representations in Egyptian sculptures, and asymmetrical and distorted faces appear in paintings from the Middle Ages and Renaissance. The uneven smile of Mona Lisa’s portrait has been the subject of facial-nerve symposium presentations.
Bell’s Palsy also arises after infection with the flu or Lyme disease, in pregnant women, and in those with type 2 diabetes; and is more common between the ages of 15 and 60, with peak incidence around age 40. Stress and high blood pressure may play a role in setting off symptoms—and may themselves be exacerbated for sufferers when symptoms arise with no clear end point. Some cases take several months to resolve, although most symptoms disappear within two weeks, and 90% of sufferers recover completely.
The pain of Bell’s Palsy often occurs behind one ear or as headache, and other symptoms involve loss of taste and hypersensitivity to sound (hyperacusis). Some sufferers cannot close the eye on the affected side, even during sleep. A rare symptom, synkinesis—when facial muscles move in tandem—can cause simultaneous smiling and blinking. The label “refrigeration palsy” comes from the common memory among sufferers, soon before symptoms begin, of “cooling of the face or a cold draught,” or exposure to cold, such as driving or sleeping with a window open in cold weather.
Bell’s Palsy rates were higher during the cold seasons in a two-year study of active-duty military service members, who have a higher incidence of the condition. In this group, climate that was both cold and arid appeared to increase risk, although incidence was higher in the southern region of the United States than elsewhere. Also, sufferers spent more time indoors than the “lower-injury group,” leading to the hypothesis that dry indoor air—heated but not humidified—could “traumatize mucus membranes… in turn, induce reactivation of the herpes virus.”
Treatment for more serious Bell’s Palsy can include oral acyclovir starting within three days of the first symptoms, along with steroids to reduce inflammation. Botox has also helped speed recovery from the drooping. Famous sufferers of Bell’s Palsy include George Clooney, Roseanne Barr, Sylvester Stallone and Angelina Jolie, who believed sessions of acupuncture helped her recover.
Incidence of Bell’s Palsy rose early in the pandemic—with a 6.85 increased risk in those who had Covid, according to the Jama study. But connections to the vaccine are less clear. As of April, 2024, Americans have received nearly 677 million doses of Covid vaccine. Among these, “just over 13,000 vaccine-injury compensation claims have been filed with the federal government,” with sufferers complaining about lack of follow-up.
The CDC has documented only four serious but rare side effects of the vaccines—all of which occur after many other vaccines—with two linked to the Johnson & Johnson vaccine no longer available in the US.: Guillain-Barre syndrome and a blood-clotting disorder. Another, seen mostly in boys and young men following the mRNA vaccines, is heart inflammation or myocarditis; and the final is anaphylaxis, an allergic reaction.
Not enough evidence for the “vast majority of side effects” was the conclusion in April from a panel of experts convened by the National Academies. But FDA’s director of Evaluation and Research Peter Marks told the New York Times: “I do believe we could do better.” While any report on worrisome side effects of the Covid vaccine risks fueling the politics of anti-vaxxers, I suspect better attention could be paid to these sufferers, whose complaints are regularly dismissed by the medical profession.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
MYTHS ABOUND on the topic of poison ivy—from ways to protect yourself ahead of time, to what to do immediately after exposure and how to treat the rash—with each person swearing by different potions and solutions. But for the most important issue, how to stop the unbearable itch, one often-recommended remedy sure to be unsuccessful is Benadryl—because the immune system response it affects is unrelated to poison ivy.
(While drowsiness caused by Benedryl can offer some relief, Adnan Muhsen writes on Health.usnews.com, “I always warn people that you are just as likely to itch while sleeping as you are awake.” In addition, the rise in body temperature that can occur when asleep—as with warm showers and warm weather—can make the itching worse.)
Exposure to urushiol (oo-roo-shee-awl) oil from any of the PIOS—poison ivy/oak and sumac— plants causes a hypersensitivity reaction, mediated by T-lymphocyte cells—not the histamine response blocked by antihistamines like Benadryl, according to Wildlife Medicine magazine. From 50 to 75% of the US population is “sensitized” to PIOS plants—on the West Coast, referred to as getting “poison oaked.” PIOS plants have widespread distribution throughout the US, and all three occur in mid-Atlantic states including the DMV.
To prevent the rash—called allergic contact dermatitis or Toxicodendron dermatitis, because all PIOS plants are in the Toxicodendron genus—the best approach is to avoid exposure entirely. Again from Wildlife Medicine: “Typically, urushiol is released from damaged PIOS plants and can unknowingly get on a person’s skin, clothes, or a pet’s fur resulting in primary or secondary exposure.”
For covering the body, gloves made of leather or heavy duty vinyl (PVC) will prevent urushiol penetration, as will clothes made of woven fabric such as wool. Other clothing should be disposable or washable. But the biggest challenge is the face —especially in typically hot poison ivy weather—for anyone removing poison ivy vines.
Urushiol oil typically becomes airborne only when the plants are burned—but pulling down the vines can release small amounts of oil into the air, where it can remain just long enough for people to become exposed. A Wilderness Medicine chart —two columns showing “time of washing after exposure” and “extent of removal of poison ivy oil”—indicates 50% removal if washing 10 minutes after exposure; 25% removal after 15 minutes; and “none” for those washing 60 minutes later or longer.
After any possible contact, wash everything involved—including gloves and tools— especially the body, but that’s where disagreement begins. Wildlife Medicine Magazine advises that the most effective cleansing comes from “repetitive high-pressure, single-direction gentle washing with dish soap (e.g. Dial Ultra or Dawn) under hot running water.” When unavailable, as in an outdoor setting, the recommended product is rubbing alcohol, either the liquid in small portable bottle or alcohol wipes.
“Good old reliable Fels Naptha soap (yep, the same thing your grandmother used to wash her clothes)…does well,” according to Lancaster (PA)Pediatric Associates. After a rash develops, it “is not contagious (not even the draining blisters), but [the skin] typically has some remnant sap on it, so scratching will move the sap to a new place and cause it to spread.”
Different specialized poison ivy products have their advocates, most commonly supporting Technu for use as a wash, but also for application on dry skin “within eight hours of exposure,” reports Climbing. But according to Wilderness Medicine’s evidence, for reducing risk of a rash, Technu “is not significantly more effective than Dial Ultra dish soap and water.”
A popular if pricier alternative, Zanfel has gained a reputation as both a wash and a treatment. Says DMV-based landscape architect G.L., “Zanfel is “especially effective in a way that no other treatment is…and that is when you apply it to a full-blown case. You can have bad itchy pustules and Zanfel will resolve them.” Zanfel may also work as a pre-exposure protector.
Effective barrier creams would be the optimal approach—and have been explored for years. But the only research-supported barrier cream to date is Ivy Block, discontinued in 2018 due to problems with preservatives. While a currently available option, Ivy-X, “claims to be effective, [there are] no published randomized clinical trials reporting effectiveness at this time,” according to Wildlife Medicine—though that may mean only that no one has done the research.
To deal with the rash, people swear by a huge range of solutions—from cold compresses and oatmeal baths to steroid creams and medications, notably prednisone. Some of these aim to reduce swelling, while others dry the fluid released from blisters—which can irritate the skin enough to cause more itching.
In my childhood, not far from Lancaster, Pennsylvania, I had terrible bouts of poison ivy every spring, followed by a few decades with no problem. Now that I have a garden, despite my best efforts and using many potions on the market, I am back to having a bad case every year that wakes me up at night. Either because I spread the oil in my sleep, or from airborne urushiol when removing the vines, the rash inevitably moves to my face—after which my doctor strongly recommends prednisone.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
AT BETHESDA’S HOPE Floats, hallways painted in watery aqua shades lead to private rooms spacious enough for a shower with sumptuous towels, shampoos and candles—and the flotation tank that looks like a giant coffin with a front door that, once closed, leaves you in total darkness. Inside, salty water about a foot deep is kept at average skin temperature, around 94 degrees.
On a recent Saturday morning, DC public school teacher P.D. found flotation a trial-and-error affair, needing to get out of the tank three times: first for a head pillow, then to wash salt from his eyes, and a third time to get ear plugs, despite having been reminded several times about these at check-in. Like many people, P.S. might benefit from more than an initial session to achieve deep relaxation.
“Float tanks have become very popular over the last couple of years,” according to a recent WebMD piece. And as numbers of floatation centers have been on the rise around the world, so have average numbers of sessions for each user per year, with one source noting a rise from two sessions/year in 2015 to five in 2019.
Today’s clients are “stressed-out city dwellers—in contrast to aging hippies in the 1990s and aughts—seeking to get away from their devices,” according to Phyllis Fong in Men’s Journal. Beyond relieving stress, depression and anxiety, the tanks now appear also to help children diagnosed with autism and veterans struggling with PTSD—with clinical changes generally ascribed to the combination of sensory deprivation and magnesium sulfate (Epsom salt).
With most Americans deficient in magnesium, Epsom salt is the best way to up the levels—with each Hope Floats tank containing 850 pounds. According to the National Academy of Sciences, low magnesium levels may contribute to heart disease, arthritis, digestive maladies and chronic fatigue.
“People who are a good fit for flotation therapy are those who have been under a lot of stress…the more stress you’re under, the [better] fit for the float tank,” Florida integrative medicine specialist Leland Stillman told Forbes. “You can relax completely because you don’t need to use any of your postural muscles to maintain your body’s structure or posture…the only muscles working are the respiratory muscles, and to a certain extent, your neck and abdominal muscles.”
“Sensory deprivation”—recently updated to Reduced Environmental Stimulus Therapy (Flotation REST)—started with work done at the National Institutes of Health in the 1950s on flotation therapy’s “sensory reduction to promote relaxation and healing,” according to Hope Floats brochures. That work, spearheaded by John Lilly, focused on psychedelic experiences and other mental effects of sensory deprivation as depicted in the 1980 film Altered States. (“Chamber REST” refers to similar complete sensory deprivation without water.)
“Don’t call it “sensory deprivation,” writes Nick Youssef in Brooklyn magazine.“The float industry (which is a real thing!) no longer uses that phrase due to the torture undertones those words evoke.” A popular alternative is getting tanked.
Floating increases the brain’s production of theta waves “usually achievable only after years of deep meditation practice,” writes Fong. And according to Michael Hutchison in The Book of Floating, theta waves create feelings of conscious drowsiness usually experienced in the twilight state between waking and sleep—offering access to unconscious material, reverie, free association, sudden insight, creative inspiration.”
Cognitive effects including “an openness of mind” led to improved performance on tests of creativity, as well as a reduction in memory loss” in research by Peter Suedfeld at Princeton and the University of British Columbia in Vancouver. Also, post-floatation behavioral modifications have helped people quit smoking, curb overeating and “partially overcome a powerful fear of snakes.”
Health benefits can also include reduction of chronic pain, insomnia and the effects of stress. And while the studies are small, research has shown flotation to decrease anxiety, improve sleep quality and aid in muscle recovery. Flotation can also lower blood pressure—the reason people whose pressure is normally low need to be careful in float tanks.
“After what felt like a very long time, I finally spaced out to some kind of zen-ness for five or ten minutes, or so it seemed,” wrote DMV-based health writer CM on MyLittleBird. “And while I did not emerge feeling in full harmony with the universe, or physically reborn, I did feel good, and as though my normally revving brain had had a nice nap. I’m tempted to do it again because I’m sure I could get quite good at it, the relaxing thing, if I just work at it a little harder.”
P.D. emerged “very relaxed,” with his muscle tension noticeably reduced along with his usual levels of stress and anxiety—but wasn’t sure it was worth the time, driving the 20 minutes or so there and back, to float again. That’s my feeling as well, although two flotation experiences cleared my mind and soothed my body. And even if I had a tank in my house, I’m not sure how often I would get inside when a short nap followed by tea with a book works very well.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
FOCUSED ULTRASOUND (FU)—for treating conditions from essential tremor and breast cancer to depression and OCD—works in the same way a magnifying glass focuses beams of sunlight to cause burning in a leaf or other material, according to the Focused Ultrasound Foundation. While FU is noninvasive—causing no effect where individual beams pass through tissue—“the convergence of the multiple beams modifies or destroys tissues deep in the body.”
In recent news, firing hundreds of ultrasound waves into the brain to ease the cravings of addictions is under study at West Virginia University’s Rockefeller Neuroscience Institute, writes David Ovalle in the Washington Post. At high intensities, focused ultrasound beams burn away tissue; while lower intensity ultrasound used in neuromodulation can stimulate or restore abnormally functioning tissue and may also help the brain better absorb Alzheimer’s medications.
“It’s basically doing brain surgery without the surgery,” Rockefeller Neuroscience Institute Director Ali Resai told the Post. Since first winning FDA approval in 2004 for use on uterine fibroids, FU is now the treatment of choice for nine conditions in the U.S. and has 32 uses worldwide—with 180 additional possibilities now in research and development— versus only three uses under study 10 years ago.
Earlier uses of energy to stimulate the brain include ECT (electroshock treatment) and TES and TMS (transcranial electrical and magnetic brain stimulation). In addition, DBS (deep brain stimulation) involves implantation of a neurostimulator that delivers electrical pulses into the brain and has helped patients with Essential Tremor (ET), Parkinson’s disease and OCD.
The tremors of both conditions are the most familiar use of FU, which—compared with the energy treatments above—has “superior spatial resolution and penetration depth,” according to a Frontiers summary article. Called MRI-guided focused ultrasound (MRgFUS), the procedure employs MRI scans to pinpoint intended areas of treatment. For ET, the most common movement disorder, focused ultrasound thalamotomy uses heat from converging high-intensity sound waves to destroy a portion of the thalamus. For more than 50 years, thalamotomies using various techniques have treated both kinds of tremors—the rhythmic trembling of Parkinson’s Disease (PD) that occurs at rest and essential tremor that appears during movement.
Essential Tremor affects about one percent of the population, or an estimated ten million Americans, with Katharine Hepburn a famous sufferer. Handwriting by someone with ET tends to be large and tremulous—rather than slow and very small as in PD. And while dopamine depletion, visible on brain scans, occurs in Parkinson’s Disease, ET is usually genetic — linked to family history. For sufferers of both, the tremors can be made worse by anxiety, stress, fatigue, physical exertion and fever.
ET can cause simply the embarrassment of a wobbly teacup but people with more debilitating tremors seek treatment. Medications, such as the beta-blocker propranolol, reduce tremor amplitude in 50 to 70% of the population. But for patients with symptoms that don’t benefit or who cannot tolerate the medications, invasive surgery has been the only alternative.
For opioid addiction treatment at the West Virginia institute, a patient lies inside an MRI machine wearing high-tech goggles that show images of heroin residue on tinfoil, and pain pills scattered on a table, writes Ovalle. Seeing these images can be unbearable, even for patients who are taking medications like buprenorphine to reduce cravings. An alternative method, in research at University of Virginia (UVA), targets cocaine users. Said director of the UVA Center for Addiction Nassima Ait-Daoud Tiouririne, “There is no medication for cocaine.”
Treatment of major depressive disorder is the focus of FU research at the University of Utah with the low-intensity ultrasound device DIADEM that does not require MRI guidance—with trials expected soon on food addiction, PSTD and Alzheimer’s disease. Many physicians warn, however, that using ultrasound to treat ailments in the brain is in very early stages, would likely need to be used along with other therapies and could take years to win FDA approval.
I have mild essential tremor, not serious enough even for medication let alone more intense treatment. But I did have an experience with focused beams of energy, in this case, sunshine—not medical but accidental. As a teenager on a family ski vacation, I played hooky from skiing to sit on a sunny balcony with a friend, using a hotel quilt for warmth. After removing his very thick eyeglasses, by accident he positioned them perfectly to focus sunbeams and start a small fire in the quilt. Later, my father called to discuss the large hotel bill that itemized a burned quilt —though, to my relief, he didn’t ask me about why I skipped skiing.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
TWO WOMEN, E.C. and J.B., both in their early 70s and recently retired from executive jobs, recently lost more than 50 pounds on the new weight-loss “GLP-1” drugs. Both women had mild health issues—high blood pressure, excessive pressure on joints; both had struggled for years to lose weight; and both now face a dilemma: whether to stay indefinitely on the very expensive drugs or risk regaining the weight. After E.C. stopped the medication, despite sticking to a rigorous program of diet and exercise, her weight crept back up—about five pounds every week.
Another option—considered minimally invasive, reversible and “non-surgical,” because there are no external incisions—is endoscopic sleeve gastroplasty (ESG). Like the GLP-1 drugs, ESG alters hormones that affect feelings of fullness and hunger— helping “to stabilize your metabolism,” according to the Cleveland Clinic website. On the other hand, the procedure requires general anesthesia; a recovery period of weeks or months with reduced exercise and diet limitations; and creates scar tissue that can make reversal difficult.
(ESG surgery involves inserting an endoscope tube down the throat and suturing the stomach from the inside, which can reduce gastric volume by 40%-80%. In contrast to surgical methods that remove part of the stomach, ESG uses stitches to bring folds of the stomach together, called an accordion procedure, which could allow for reversal at a later date.)
Many people who have struggled for decades to lose excess weight long for help. But both medical and surgical interventions have restrictions in terms of eligibility and reimbursement, and both have side effects and health risks: little is known about long-term effects of the weight-loss drugs. For both women, after losing weight successfully with medication, ESG remains a step too far. Said J.B., “I’m good on the drugs…surgery scares me.”
“We know from years of studying bariatric surgery that it slashes the risks of cancer, heart disease and diabetes-related death,” writes Johann Hari, author of “Magic Pill: The Extraordinary Benefits – and Disturbing Risks – of the New Weight-Loss Drugs,” and a recent essay in the New York Times. Noting that the new drugs might increase the risk for thyroid cancer and diminish muscle mass, Hari writes, “early indications are that the new anti-obesity drugs are moving people in a similar radically healthier direction.”
“Surgery is the only obesity treatment that rewires your body’s metabolic programming after obesity to prevent weight regain,” according to the Cleveland Clinic site. “Weight loss surgery is considered successful if you lose 50% of your excess weight and keep it off. By this standard, the success rate [of surgery] is 90%…usually the weight regained is less than 25%.”
“More effective weight-loss options like ESG…have been overshadowed by the excitement about the recent GLP-1 weight loss medications,” Harvard and Mass General radiologist Jagpreet Chhatwal told the Harvard Gazette. ESG “mirrors the effect of more invasive bariatric surgeries to reduce stomach volume…but presents far fewer of the risks.”
“Lifestyle intervention and bariatric surgery represent 2 extreme ends of the spectrum of obesity treatment,” according to Jama Network. “Bariatric surgery remains underused due to its perceived invasiveness, cost and limited insurance coverage.” But according to the Gazette, because gastroplasty “can be a permanent fix…the savings continue to mount in the months and years afterward.”
“I would compare bariatric surgery to a total knee replacement,” past president of the Obesity Medicine Association Ethan Lazarus told the American Medical Association’s public health site. “It’s going to be for the more advanced patients with obesity where they’re going to get a lifespan benefit…the reason to do it is to a make the person healthier…better quality of life and spend less time seeing doctors for all the obesity comorbidities.”
Who qualifies and how to cover the costs are central issues in both medical and surgical approaches to overweight and obesity: “Statistics show that only about 1% of people who meet the basic qualifications for bariatric surgery actually move forward with it,” writes Miami gastroenterologist Okeefe Simmons. “One of the most blatant disservices that obese patients have been presented with is the BMI qualification for eligibility to have bariatric surgery,”
“According to the standard BMI scale, an individual who is 5’ 7″ and weighs 191 pounds has a BMI of 30. For them to qualify for bariatric surgery with a BMI of 35, they would have to weigh 223 pounds.” Simmons explains. “And if they didn’t have a health condition, they would have to wait until their BMI reached 40…weighing in at 255. So potentially, they would have to gain 64 pounds before they could get help.”
For weight-loss GLP-1 drugs, a BMI of at least 27 plus at least one weight-related medical condition may qualify. But Simmons points out that, even for those with a qualifying BMI plus a serious health problem, currently medical insurance does not cover ESG or other less invasive procedures —which “are not yet considered methods used to improve a patient’s health…they are considered cosmetic weight loss procedures.”
But the two retired executives also face the problem that both have now lost enough weight for their BMIs to fall from close to 35 to below 25, which is too low to be eligible for any treatment other than remaining on weight-loss drugs. And although minimal surgery might help maintain weight loss, a 2023 literature review found that “limited evidence is available on the weight loss effect of combining [GLP-1 drugs] with endoscopic bariatric therapy (EBT).”
For now, ESG seems like “a step too far” for most people who share the dilemma facing the two women—and for most people struggling with serious health issues related to overweight and obesity. In addition, questions persist about the use of BMI as a qualifying criterion for either medical or surgical intervention—and even as a measure of overall health. For me, choosing something drastic like surgery to prevent regaining weight that has been lost is understandable —based on my experience of quitting cigarette smoking, after which I never ever wanted to endure again the months of difficulties I had while stopping.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
IN GREY BEES, a recent novel by Ukrainian writer Andrey Kurkov, a bee-bed “with hundreds of thousands of bees beneath it” belongs to a fictional beekeeper living without electricity or neighbors in the “grey zone” between Ukraine and Russia. After the bee-bed attracted an important visitor—a former Governor and boss of Donbas, who paid the beekeeper huge sums of money along with a bottle of vodka and a hug—“people were now advertising bee-beds in every district centre [but] the first bee-bed remained the most popular, because no one else had ‘the governor’s bees.’”
People are discovering the therapeutic value of bees, and while a few spa bee beds have popped up around the U.S—such as one at the Savannah Bee Company —some people are also constructing their own. Posting build-your-own directions, Leo Sharashkin writes: “I call it Bed-and-Bees or B&B and it is a long horizontal hive where you are separated from the bees by thin planks and can bathe in their warmth and vibration and smells without any danger of being stung… you experience how relaxing and soothing and healing it is.”
Apitherapy usually refers to bee venom treatment (BVT), which made news during the pandemic when more than 5,000 beekeepers in a Chinese survey appeared immune to Covid infection. Along with the storied protection of beekeepers from a wide array of infections, bee venom has helped relieve joint pain caused by both rheumatoid and osteoarthritis and autoimmune diseases, such as multiple sclerosis (MS). According to the theory, bee venom, or apitoxin, causes irritation and inflammation as part of an allergic reaction—revving-up the immune system, which makes it better at fighting infection.
Among active components in bee venom—enzymes, amino acids, hyaluronidase—the most active in fighting infection may be the peptide melittin, the most toxic compound in bee venom that can “induce wide anti-inflammatory effects,” according to an article by researchers in France and Lebanon. In laboratory studies, melittin has protected mice exposed to “lethal doses of influenza A H1N1 virus.”
Most symptoms—commonly, pain, fatigue, and cognitive problems— allegedly benefiting from BVT rely on self-reporting by sufferers—as does relief and other improvements for which it is credited. The powerful placebo effect may play a significant role in these benefits, but conventional, rigorous scientific methods have failed to document measurable improvements. Extensive reviews of studies on MS patients concluded that bee venom was ineffective; and one study in the Netherlands on 24 MS patients found “no beneficial effects” evident on MRIs, and participants reported “no improvement in their disability, fatigue or quality of life.”
Renewed interest in bee venom therapy came from a 2016 episode of the Netflix series “(Un)Well” that portrayed enthusiasts of its use both in anti-aging creams and in treatments using direct stings from bees. The episode follows a young woman who reports suffering for years from undiagnosed Lyme disease, as she receives treatment at California-based Heal Hive— where bees are held against her back using tweezers until each one stings and ejects its venom.
Chronic Lyme symptoms—cognitive impairment, fatigue, and vision and other complaints—may persist when Lyme bacteria, Borrelia, remains in the body at levels undetectable by medical testing, as well as inaccessible to antibiotic treatment. Laboratory studies at the University of New Haven showed “significant effects” of bee venom on the bacteria compared to those of antibiotics. Among 40 patients with enduring Lyme symptoms who received BVT in a study published in the Journal of Clinical and Cellular Immunology, two recovered fully after 2.5 years; 8 recovered 85-90% after one year; and the rest showed lessening of symptoms.
“Bee venom acupuncture” (BVA) involves injections of venom at acupuncture points relevant to specific symptoms or diseases—with the idea of adding healing effects of the venom to the mechanical benefits of acupuncture stimulation. And homeopathic preparations such as Apis mellifica employ the entire bee—ground-up and added to a solution that is then diluted to such a degree that “so many times …we are only eating the idea and the energy of the bee,” according to Healthy With Honey.
But killing honeybees—whether using the whole bee or the venom—is a major concern with apitherapy, because these bees contribute to about 80% of the pollination of flowers, fruits and vegetables, and populations have declined dramatically in recent years. Whether venom is obtained directly from a stinging bee or extracted using an electric stimulus and then injected, the bee dies within 18 to 114 hours. (Venom from wasps, in the same order as bees, contains many of the same compounds, but not melittin.)
Apitherapy products that do not require killing the bees include royal jelly—a milky substance fed to bee larvae that could develop into the queen bee; pollen—collected in a narrow trap that removes pollen as bees return to the hive; propolis—a resin-like material, dubbed “bee glue,” collected by the bees from trees to use in creating and repairing hives; and beeswax—produced by bees’ bodies and combined with honey to create combs for hives.
“A new tool in the search for new ways to prevent infection with Covid-19” was the description of BVT by entomologist Norman Gary at a Covid-19 symposium hosted by UCDavis, a center for honeybee therapy research. Gary, “known internationally as “The Bee Man,” holds two Guinness World records: one for holding 109 bees inside his closed mouth for 10 seconds; and the other for creating the “bee suit,” a cluster of “more than 87 pounds of bees on a friend.”
“For an alternate explanation of the lower rates of beekeepers’ susceptibility to Covid and other infections, however, these researchers referred to a study on beekeeper personalities—which can combine two “archetypes:” “social” and, the more dominant, “predominantly investigative individuals, which means that they are quite inquisitive and curious people that often like to spend time alone with their thoughts.”
—Mary Carpenter regularly reports on topical subjects in health and medicine.
“UMAMI is a flavor we’re always chasing—and one we’re so often looking to add to our cooking,” writes the Serious Eats Team. Found in nonperishable items from tomato paste, Worcestershire and soy sauces, dried mushrooms and aged cheese to Marmite, according to the Team, “umami-heavy ingredients are a must when you’re stocking a pantry.”
Umami—which recently became the fifth generally accepted flavor for which humans have taste receptors or “bud”—in foods increases saliva production, according to Cleveland Clinic’s health essentials. “Literally they make your mouth water, which improves the way food tastes.”
The umami taste comes from different compounds, such as inosinate or guanylate—in meats and plants, but its purest form is MSG, or monosodium glutamate. MSG occurs naturally in vegetables—tomatoes, peas, mushrooms and garlic —as well as in yeast, green tea, soy, seaweed and kimchi.
MSG earned a bad reputation beginning in the late 1960s, based on a cluster of reported reactions ,such as headaches, that became known as MSG symptom complex, or “MSG attacks,” most often associated with Chinese food (Asian recipes often include umami, and it is an ingredient in soy sauce.) But according to WebMd, “researchers have never been able to find a clear link between MSG and these reactions.”
A small percentage of people may be sensitive to MSG, but effects should disappear in less than an hour. And though umami has been associated with higher rates of obesity, no effect of MSG has been found in cells or body parts related to weight gain. Notes Cleveland Clinic dietician Beth Czerwony, “When your food tastes better, you’re inclined to eat more of it.”
And the previously maligned MSG may now be changing its image—based on recent evidence that substituting it for table salt creates a salty flavor while reducing overall sodium consumption. MSG contains about 12 percent sodium—2/3 less than that in table salt—so that substituting MSG for salt in some foods can reduce sodium intake by 25 to 40 percent, according to George Mason University nutritionist Taylor Wallace.
Americans are beginning to understand that “MSG is completely safe,” says Wallace, who predicts “a shift toward using the ingredient as a replacement for some salt to improve health outcomes.” Umami-rich, high-protein foods may help curb the appetite because they are more filling.
In addition, a person’s ability to detect each of the five tastes can be important both for health and as a warning: sweet and salty can indicate foods rich in nutrients, while bitter or sour signals poisonous plants or protein-rich food that is rotting. The umami flavor, as it occurs in meats, aged cheeses and seafood, can signal a good source of protein.
With umami, too, the neurotransmitter glutamate plays a role in learning and memory. Variations in availability in the brain, too little or too much, can affect mood, depression and OCD; while excess has been linked to Parkinson’s and Alzheimer’s diseases.
Among other proposals for a fifth taste sensation are savory (similar to umami), calcium (bitter and chalky), kokumi (heartiness), piquance (spicy), coolness (minty, fresh), metallicity (gold and silver), fat and carbon dioxide (in carbonated soda). “There is no accepted definition of a basic taste,” said Michael Tordoff, a behavioral geneticist at the Monell Chemical Senses Center in Philadelphia. “The rules are changing as we speak.”
Smell, texture and temperature can also affect the taste sensations experienced with different foods. And spicy, while often described as a taste, is technically a pain signal sent by nerves sensitive to touch and temperature—caused by capsaicin in foods seasoned with chili peppers. Both taste recognition and sensitivity can diminish with age, with confusion occurring most often among sour, bitter and umami tastes. In a Finnish study at the Functional Foods Forum, those over age 50 and male exhibited less sensitivity generally to taste.
The FDA now classifies MSG as “generally recognized as safe” (GRAS), its category for food additives determined by experts to be safe—along with the statement that side effects can occur in someone with MSG sensitivity but only after consuming three grams or more of MSG without food. Bacon contains less than 200 mg of glutamate per 100 grams (3.5 ounces), while aged parmesan has about 2,500 mg.
Umami-based recipes are popping up everywhere—including from local DC-area umamimami Dyala Madani, who urges: “Think Parmesan, braised Beef, Chicken Soup and Shiitake Mushrooms. The deliciousness that is Umami is the flavor that we strive for when we cook and when we eat.”
What I remember from early MSG-attack days is an itchy scalp —what’s called “tingling” in the symptom list —after eating Chinese food. But since learning that MSG is present in almost all processed foods, I suspect my post-Chinese restaurant itchy scalp may be more closely linked to the power of suggestion—or to a coincidental manifestation of my perennially dry skin.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
FOUR PATIENTS —diagnosed with different autoimmune diseases and with different symptoms —shared one outstanding variable: their older age, from 59 to 71. Research by NIH Environmental Autoimmunity Group emeritus Frederick Miller found a doubling of autoimmune disease risk markers between 1988-91 and 2011-12—with the greatest rise occurring in two groups: adolescents and older adults. Miller told AARP, “Autoimmune conditions, like most diseases, are diseases of age.”
“The explosion in chemicals used—more than 80,000 approved in the past 30 years” is one of Miller’s possible explanations for the recent surge for all age groups in autoimmune diseases. For sufferers, their immune system, which should protect the body from infections and other diseases, instead attacks healthy cells and organs. Among other possible contributors to the surge, according to Miller: changes in diet, including more processed food; more sedentary lifestyles; and “a different pattern of infectious agents, even pre-Covid, with more emerging yearly.”
Normal immune defenses “have essentially gotten confused [by these changes] and set off friendly fire against your own body,” said Timothy Niewold, director of New York University’s Langone Center for Autoimmunity. According to the Langone Center report, cases of autoimmune disease “seem to be rising precipitously, especially among people over age 50 [and are now] 50 percent higher in older adults than they were 25 years ago.”
Women make up about 80% of sufferers around the world of autoimmune diseases, notably Sjogren’s syndrome—which attacks the body’s moisture-producing glands—lupus, MS and most forms of arthritis, except osteoarthritis, according to medical geneticist Karen Orstavit at the University of Oslo. In one long-standing explanation, estrogen levels affect the risk—with many autoimmune diseases in women starting shortly after puberty and often changing during pregnancy.
But a new culprit discovered earlier this year is a molecule called Xist that “triggers a chemical response [in women] that is a hallmark of autoimmune diseases,” according to a Washington Post report calling it “a major clue why 4 of 5 autoimmune patients are women.” But Xist cannot be the sole explanation—because men get autoimmune diseases such as lupus; and Type 1 diabetes has a higher incidence in men—David Karp, rheumatic diseases division chief at UT Southwestern Medical Center, told the Post, “It’s not the only answer, but it’s a very interesting piece of the puzzle.”
Also in the news, semaglutide—the active molecule in the new weight-loss drugs such as Ozempic—appears to help sufferers of “recent-onset Type 1 diabetes…to either eliminate or reduce the need for insulin,” according to the New York Times. Another recent treatment, biologic medications made from living cells, have had results as good or better than the earlier option of stem cell transplantation.
Long Covid shares many of the same “terrible debilitating symptoms”—heart palpitations, crippling fatigue, extreme brain fog, shortness of breath—reported by those with autoimmune diseases, according to a podcast conversation between Ross Douthat and Meghan O’Rourke, writers for the New York Times, the Atlantic and elsewhere. Long Covid symptoms have occurred in up to 30% of those infected by the virus—more often in younger patients, and in some who had mild cases of the disease.
Of the four patients in Miller’s NIH study, a 68-year-old woman who reported insomnia, a tight feeling in her face, and “eyes so dry that no amount of artificial tears could stop the burn,” received a diagnosis of Sjogren’s syndrome. Another, age 59, also had eye symptoms—with her vision in one eye going black for several seconds and afterwards her eyes visibly bulging. The diagnosis was thyroid eye disease, most often seen in patients with one of two autoimmune disorders: Graves’ disease and Hashimoto’s thyroiditis.
Ulcerative colitis, an inflammatory bowel disease, was the diagnosis for the 70-year old NIH patient after what he thought was a stomach bug didn’t go away. And giant cell arteritis (GCA), which affects blood vessels in the head, neck and arms, was the diagnosis in a 77-year old patient, making her arms feel so heavy she struggled to brush her teeth. In a separate report of a Maine potter, age 93, the diagnosis of polymyalgia rheumatica—inflammation causing muscle pain and stiffness—often appears concurrently with GCA, also in people age 50 and older.
Environmental triggers of autoimmunity include viruses and bacteria—but also pollutants and even specific foods that activate the immune system. Gluten is the trigger for Celiac disease; the Epstein-Barr virus for both MS and CFS (chronic fatigue syndrome); and cigarette smoke for rheumatoid arthritis.
The triggers can act by turning on inherited genes that make some individuals more susceptible to developing autoimmunity. Several diseases, such as rheumatoid arthritis, are more prevalent in people with variants of the HLA-B gene—in particular, the HLA-B27 variant, which occurs in 8 of every 100 people, though far fewer than that number have developed related autoimmune disorders.
In my family, with no history of autoimmune disease, two women in their twenties developed autoimmune conditions linked to that variant—ankylosing spondylitis, which can cause spine pain and swelling in the eyes; and lichen sclerosis. Their mother’s testing showed she also had the variant, though by age 65 she had no indication of autoimmune problems.
As happened with the two young women, symptoms of autoimmunity can come and go, and they can be mild. I only discovered long after getting to know two friends that one has Hashimoto’s and the other Sjogren’s syndrome. And genetic links are still emerging: for another friend who has Ehlers Danlos hypermobility, researchers suspect connections to genetic variants that have been found in rare forms of this disease.
The most important lesson came for me, in the same family of my relatives—with the two young women and their mother—when a 70-year-old brother developed debilitating lung issues following a serious winter bout of pneumonia. After months of tests, the most likely diagnosis involved an autoimmune reaction—especially after his symptoms responded to steroid medications, the standard first-line treatment for autoimmune disease.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
