POLITICAL COACHES on “The Good Wife” TV series advised against sitting with legs crossed at the knees because that position causes slumping. If legs must cross, they should do so at the ankles. Crossing legs at the knees has been blamed for an array of orthopedic problems — and may cause varicose veins, though some experts say that’s pure medical myth.
(In a Wall Street Journal article on the subject, the position called “sitting crossed-legged” is accompanied by photos of women’s legs crossed at the knees — as distinguished from the meditation position seated on the floor with legs crossed.)
Sitting crossed-legged puts pressure on the lower knee, unnaturally twists both knees, rotates and strains the pelvis, and hunches the lower back, according to Dr. Naresh Rao, osteopath at NYU Langone Medical Center and medical advisor to the 2016 U.S. Olympic water polo team. Keeping your knees in a misaligned position for a long period of time is the most common cause of knee pain, he says, advising against sitting crossed-legged “for longer than you drink a cup of coffee.”
Crossed legs can cause a temporary rise in blood pressure — which is why blood pressure techs ask you to uncross your legs for the test — but have no long-term consequences. For those at high risk for blood clots, however, sitting crossed-legged for long periods of time could lead to deep vein thrombosis, the formation of a blood clot in a deep vein that can be life-threatening if it travels to the lungs and creates the serious blockage called pulmonary embolism.
Why people get varicose veins — or the smaller spider veins — is usually explained by family history, age and sex. Women make up three-fourths of varicose vein sufferers due to hormone changes during pregnancy and menopause. Taking hormone replacement or birth control pills can increase the risk. But why some women are more at risk than others is considered something of a mystery.
Blood flows through the veins en route back to the heart after delivering oxygen throughout the body — hence its blue, deoxygenated hue. With age, tiny valves in the blood vessels designed to prevent blood from flowing back in the wrong direction can become stretched and weakened, allowing blood to pool and enlarge the veins.
Varicose veins — and the tinier spider veins that are often precursors — rarely create more than cosmetic problems, but some cause aches and pains as well as nighttime cramping and throbbing. Complications can occur with long-term fluid build-up, so that discolored spots on the skin, sudden leg swelling and bleeding all require immediate medical attention.
The best way to prevent varicose veins is to avoid standing for long periods, Johns Hopkins dermatologist Robert Weiss told WebMD. The number two tip: “Avoid sitting with your legs crossed, it puts terrible pressure on the veins.” (Other tips involve avoiding tight clothing that constricts the waist, groin or legs; high heels worn for long periods of time; and high salt-diets.) When sitting for long periods while traveling or working on a computer, the advice ranges from getting up and walking at least every hour — to every 15 minutes.
On the other hand, Dr. Rao has seen no studies that prove a correlation between unsightly veins and leg-crossing. Put more firmly, vascular surgeon Jon Modrall at the University of Arkansas writes on the university website: “Crossing your legs does not cause varicose veins.”
To ease discomfort and keep varicose veins from getting worse, the first step is compression stockings — worn all day — along with exercising, losing weight, wearing loose clothing, elevating the legs and avoiding long periods of sitting or standing. Spider veins can be worsened by sun exposure. (Varicose veins that develop during pregnancy usually improve without treatment within a year after delivery.)
Veins that become varicose are usually close to the skin’s surface — while the more important veins taking blood to the heart lie deeper — and can thus be removed or destroyed. Until the early 2000s, the main treatment called “stripping” involved inserting a metal rod into the vein, at the groin and then down the leg, and then pulling it out to destroy the vein. Since then, a thin catheter or a laser can use radio waves to shrink the vessel wall and cause it to collapse and be re-absorbed. Once the varicose veins are gone, deeper veins take over the flow.
For those who are much more comfortable with legs crossed, one study tested different positions on embalmed pelvises and found that crossing legs at the knee increased elongation in the piriformis muscle, which runs behind the hip joint — compared both with sitting with legs uncrossed and with standing — thereby increasing stability in the pelvic joints.
Getting into the minutiae of leg crossing, one study found that almost twice as many people reported crossing their right leg over the left knee rather than the other way around. And surveys have noted that, for those sitting nearby, the legs-crossed position is hands down preferable to man-spreading.
— Mary Carpenter Mary Carpenter is the well-being editor of MyLittleBird. Her most recent post was on blue-green algae’s effects on the brain.
THE NEXT TIME Florida’s blue-green algae blooms make the news, DMV residents should not be dismissive. Maryland, especially the Chesapeake Bay area, has had its own toxic blooms. Also, high levels of the neurotoxin BMAA (B-N-Methylamino-1-alanine), which can be produced by blue-green algae blooms, have been detected in clusters of patients with Amyotrophic Lateral Sclerosis (ALS) in the Chesapeake Bay area, as well as in New Hampshire and France. ALS is a motor-neuron disease linked to the “misfolding” of proteins, also called tangles, that are also found in the brains of people with Alzheimer’s and Parkinson’s diseases.
Blue-green algae, generally found in low, harmless concentrations, are in fact bacteria, “cyanobacteria” — cyan means “blue green” — called microcystis. They were originally classified as algae because they require sunlight and warmth to grow.
In conditions combining warm temperatures with water rich in nutrients — usually from fertilizer run-off — algae can proliferate into a bloom that looks bluish, brownish or like green paint floating on water. Blue-green algae blooms can contain toxins that affect the skin, the liver and the brain. In 2014, blooms in Lake Erie caused the shut-down of Toledo’s water supply.
Perhaps due to global warming, blue-green algae blooms have increased worldwide and are on the rise in the Chesapeake Bay — up from 13/year in the 1990s to 23/year in the 2000s. Like mercury, BMAA accumulates in fish, with high levels found in shellfish and the highest in shark fins. In Florida coastal waters affected by algae blooms, high BMAA levels were found in pink shrimp and blue crabs.
Florida bottlenose dolphins with high BMAA levels appeared confused and seemed to be getting lost, swimming into fresh-water rivers and lakes, said University of Miami marine biologist Larry Brand: “just like an Alzheimer’s patient.” Miami researchers are working to replicate the Dartmouth study that found “hot spots” of ALS patients tied to high BMAA levels in New Hampshire lakes contaminated with the algae.
In studies of samples from the University of Miami’s brain bank, high levels of BMAA were found in 23 of 24 samples from Alzheimer’s patients, compared to very little from the control group. From patients with ALS, all 13 samples tested positive. Importantly, samples from patients with Huntington’s Disease — also a motor-neuron disease, but 100% genetically-based and thus not susceptible to environmental influences — contained no BMAA at all.
Paradoxically, blue-green algae is sold as a healthy supplement — a source of B-vitamins, iron and dietary protein — used for weight loss, ADHD, anxiety and PMS. Research is underway to examine beneficial effects on the immune system, inflammation and viral infections. The most popular “microalgae,” spirulina — to some, pond scum — is harvested as a “superfood.” And one compound isolated from cyanobacteria, Nostoc, might actually help combat neurodegenerative diseases.
Because the toxins affect people who either inhale or come into contact with a bloom, the advice is to avoid drinking or swimming in the water — and to wash off with fresh water after any contact. Besides skin rashes, symptoms of neurotoxin poisoning due to algae blooms include numbness, tingling and dizziness while liver poisoning may cause abdominal pain and digestive problems.
The most intriguing research into BMAA began with findings by ethnobotanist Paul Cox, at the Institute for EthnoMedicine in Jackson Hole. Among the Chamorro people of Guam, almost one-fourth of adults had some type of neurological disorder similar to ALS.
Years of observation led Cox to connect the dots between the Chamorros and high concentrations of blue-green algae in the cycad fruit eaten by flying foxes (fruit bats) — which had very high levels of BMAA in their skins, 10,000 times that found in cyanobacteria. The flying foxes were, in turn, consumed in copious amounts by the Chamorros.
Cox’s next step was such a breakthrough for tangle-disease that some researchers had tears in their eyes when it was announced he’d found the first animal model for research on neurological diseases: vervet monkeys fed fruit dosed with BMAA developed both neurofibrillary tangles and amyloid deposits, the hallmarks of these diseases.
In the brains of vervets who developed ALS-like symptoms, BMAA appeared to cause the misfolding of proteins by replacing the amino acid L-serine. When L-serine was added to the diet of these monkeys, their brains had fewer tangles — although still more than the brains of the group that received placebos.
ALS was chosen as the focus for clinical research because 90% of ALS cases have no genetic link, because the disease has no treatment and little hope for survival, and because it affects healthy, predominantly middle-aged people. Lifetime risk in the U.S. is estimated at 1 in 350 men, and 1 in 450 women. ALS paralyzes its victims, who generally die within five years of diagnosis.
ALS is problematic because it’s likely not one disease but a variable disorder. (Stephen Hawking has an ALS variant with the possibility of longer survival than most.) Research on the effects of L-serine on ALS has reached the stage of human trials — now in Phase I, to determine safety — in 20 Phoenix-area patients with advanced disease.
Cautions abound in discussions of Cox’s research and of conclusions about BMAA that can be drawn at this point. Said Cox, “Our findings show that chronic exposure to BMAA can trigger Alzheimer’s-like brain tangles and amyloid deposits,” but whether the bacteria blooms are a risk factor for the tangle diseases is “an open question.”
At this point, blue-green algae is a “candidate environmental risk factor,” making it worrisome enough to warrant attention for local blooms.
— Mary Carpenter
Mary Carpenter is the well-being editor of MyLittleBird. Her last post was “Bats in the Bedroom.”
IN THE SUMMER vacation house my brother and I rented on Long Island Sound, one of his sleeping houseguests felt something wet on the back of her neck and “then woke to the dive bombing bat!” (Turned out there was a space between the roof and outside wall that no one had noticed.)
Although the incident sounds like a terrible nightmare for both host and houseguest, this particular guest was the best possible victim — because just a few years earlier she’d had a similar bad bat experience, although that time there was a visible bite. (Because that bat encounter took place in dreamy Italy, we felt a little less guilty about our slightly scruffy summer rental.)
The guest’s prior encounter meant she not only knew the CDC protocol but had a head start on treatment. Because a bat’s bite can be imperceptible, she wrote me, “anyone who has been unconscious or is unable to speak for themselves — baby, old person, drunk person, sleeping person — who has been in a room with a bat or where the possibility exists that there was contact with a bat and the person did not know it or can’t say it, must be immunized for rabies.”
The treatment, known as post-exposure prophylaxis or PEP, is always effective when given within 10 days of exposure and when given correctly: several shots of human rabies immunoglobulin to start disabling rabies virus particles; along with a course of rabies vaccines to stimulate the body’s own immune reaction. Because the houseguest’s prior treatment had occurred within five years, she could forgo the immunoglobulin and, instead of the prescribed five rabies vaccinations at recommended intervals over 28 days, needed only four shots over two weeks. (Reports on the exact number of shots vary, and the CDC protocol should be reviewed by anyone seeking treatment.) Side effects from both sets of injections include aches, fever, nausea and nightmares, but this regimen is a far cry from the 20 injections with a large needle through the abdominal wall used until the 1980s.
A final boon of the houseguest’s prior experience: knowing that the treatment could cost thousands of dollars. Calling her insurance to find a local provider, she learned that “an animal bite (even a theoretical one in this case) is considered an accident and as long as I sought treatment within the first 72 hours I’m fully covered.” The CDC estimates 40,000 to 50,000 people in the U.S. receive PEP each year, costing an average of $3,000 per person — but fees can run higher than $7,000.
With an actual bite — which can feel like a sharp needle going in — the advice is to wash thoroughly with soap and water and, if available, apply an anti-viral such as Betadine. Bite wounds can injure nerves, lacerate tendons and cause local and systemic infection.
Rabies from animals is spread through direct contact with saliva, although rare cases have occurred from air-borne exposure in bat caves. Among humans, though, rabies can be spread in saliva and tears before symptoms occur, and later in respiratory tract secretions from coughing or sneezing.
Since 2011 two people have died from rabies contracted from bats in the bedroom after which they received faulty information about the need for treatment. Just this year, a Wyoming woman woke to find a bat on her neck, swatted it away, and then consulted a local agricultural expert, who did not give her the proper warnings. When she finally made it to the hospital, she had experienced five days of progressive weakness, could no longer stand alone and had slurred speech. By the time of her death, she had exposed 15 family members and 100 health care workers both locally and at a referral hospital.
Although rabid bats have been documented in all 49 continental United States, only one to three human cases of rabies occur here each year — and some of these infections were contracted outside the U.S., for example, from dogs in Guatemala and Brazil. People planning to spend long periods of time in Latin America, Africa or India are advised to get rabies vaccines before traveling.
Without preventive treatment, symptoms of rabies begin during the disease’s incubation period, which can last three weeks or more. Brain infection or encephalitis causes the familiar fears of water and bright light as well as muscle weakness and dementia. The disease is almost always fatal, with death due to respiratory failure within a week after symptoms start.
Before 1960, the majority of U.S. rabies cases occurred in domestic animals, whereas now more than 90% are seen in wild carnivores and bats. Most of the domestic animal cases now seen each year — fewer than 100 dogs, and more than 300 cats — were in unvaccinated animals infected by wildlife.
Of the top four wild animal sources of rabies in 2014, the lowest incidence occurred among foxes, while at least 2,000 cases were reported each for skunks, bats and raccoons. In the Eastern U.S., raccoons have the highest incidence after bats.
Of human rabies cases in the U.S., 90% are caused by bats —though “of all weak and sick bats captured and tested for the disease, only about 6% have the virus,” according to the Washington Post. In recent years, more wild animals have been brought in for testing, and more rabid bats have been found in the Chicago area and in Pennsylvania than in previous years.
The presence of bats does have benefits. They voraciously consume insects, saving Americans billions of dollars each year in pest control services. Like bees, nectar-eating bats pollinate over 700 plants, spurring the creation of fruits and seeds. And while flying squirrels are restricted to gliding, bats are the only mammals that can fly — that is, in control of their flights.
— Mary Carpenter Mary Carpenter is the well-being editor of MyLittleBird. Her last post was “Addicted to Shopping.”
THE ONLY MANIA listed in my favorite bathroom book, “A Word a Day” by Anu Garg, is oniomania, defined as shopping addiction (from the Greek onios meaning sale; and mania, insanity). The entry includes a quote from Imelda Marcos: “I did not have three thousand pairs of shoes, I had one thousand and sixty.”
The suffix “mania” currently has many meanings — from excessive obsession that becomes pathological to excessive enthusiasm (Beatlemania, bibliomania). In one definition, oniomania is the compulsion to spend money regardless of need or financial means, along with feelings of being out of control.
The urge to splurge can range from “adaptive” — shopping as a mood lifter, or retail therapy — to an impulse-control or obsessive-compulsive disorder, officially labeled Compulsive Buying Disorder (CBD), becoming a riskier mania with so many purchases just a few clicks away. (Compulsive buying is considered an addiction but not a distinct disorder by the American Psychiatric Association.)
It’s estimated that CBD affects about 18 million Americans or as much as 8% of the U.S. adult population. Most say 80 to 90% are women — as opposed to alcoholism, which affects more men — although a recent poll found the sexes more equally represented. CBD is usually detected when debt piles up, although some sufferers return purchases because they feel guilty — and then the guilt triggers another shopping spree — keeping them out of debt, and their CBD well-hidden.
One episode of the reality-TV series “Intervention” (11 seasons ending in 2011) portrays Vanessa (last names not given), an actress who made several TV appearances on the series “ER.” In Vanessa’s apartment, piles of clothes with tags still on cover every flat surface and hang all over the walls, and she has unpayable credit card debt. For participating in “Intervention,” Vanessa receives one month of treatment, which in the epilogue she deems “not successful.”
CBD usually is chronic and begins in the late teens or early twenties. Addictions have been traced generally to environmental triggers for specific behaviors, such as gambling or drinking, and 10-15% of sufferers may also have a genetic predisposition. Compulsive shoppers participating in Debtors Anonymous, as compared with the general population, have lower self-esteem, a tendency toward fantasizing and vulnerability to depression and anxiety.
Shopping addiction has been traced to emotional deprivation in childhood, perfectionism, the need for control and other issues. Once a particular substance or activity has triggered the release of pleasure-producing chemicals like endorphins and dopamine in the brain, addicts are driven to repeat that experience.
CBD often occurs in conjunction with diagnoses like anxiety and eating disorders. Without associated diagnoses or until the disorder causes financial difficulties, it’s rarely taken seriously as an “emotional behavior disorder” (EBD), such as anxiety. Among the symptoms of EBD are frequent annoyance, nervousness or anger; difficulty following rules; trouble handling frustration.
Having more than four indicators from the following list can help distinguish a pleasure spree from CBD, according to what Rick Zehr of the Illinois Institute for Addiction Recovery told WebMD: spending money caused by feeling angry or depressed; arguing with others about your shopping; having withdrawal symptoms when deprived of credit cards; thinking obsessively about money; and spending a lot of time juggling accounts or bills to accommodate spending.
But other items on Zehr’s list may be shared by those without a psychological addiction, such as buying items on credit and feeling a rush of euphoria and/or guilt or embarrassment after making purchases. And lying about how much something costs can indicate either pathology or a general reluctance to satisfy nosey parkers.
Treatment for shopping addiction is often multi-faceted and includes Cognitive Behavior Therapy, medications such as antidepressants aimed at reducing impulsivity, a 12-step program like Debtors Anonymous, and credit counseling. At Zehr’s facility, the average addiction-related debt is around $70,000.
New York psychologist April Lane Benson, founder of Stop Overshopping, LLC, helps clients understand what they are “really shopping for, what are the underlying authentic needs — Shopping because you’re lonely? Shopping to celebrate? — and finding other ways to meet those important needs.”
What’s different from most other pathological obsessions is that compulsive buying is condoned by society, Benson says. “President Bush didn’t tell us to go out and drink and take drugs, but he did tell us to go out and shop. Consumption fuels our economy.”
— Mary Carpenter Mary Carpenter is the well-being editor of MyLittleBird. Her last post was about how much protein you need to eat. (This is one in an occasional series on manias, philias and phobias.)
ARGUMENTS ABOUT what to eat and how much to eat, in particular whether to eat more protein or more carbs, will not end any time soon, both because of ongoing research and because, in the end, individuals eventually discover which diet works best for them.
The one constant about protein: Well-run bodies rely on 20 amino acids, 13 of which our bodies produce. The remaining nine “essential amino acids” we get when we digest protein—which involves breaking the protein down into its component amino acids and then reassembling them to create hormones, enzymes, neurotransmitters, etc.
Some experts suggest that adults, especially those over 50, should eat twice the Recommended Dietary Allowance—.36 grams of protein per pound of body weight—which comes to about 45 to 50 grams per day for a 136-pound woman. (You can calculate your own needs here.)
Positive results from the OmniHeart study—with 164 participants, mean age 53.6 years—for the group who ate high-protein diets (25% of calories from protein) include: “Blood pressure, harmful LDL cholesterol and triglycerides all went down when people ate more protein and fewer carbohydrates.” The study concluded: Eat more protein, reduce stroke. These benefits may be gained at least in part because eating more protein means eating less of something else.
Participants ages 52 to 75, in a 2015 University of Arkansas study, who consumed double their protein RDA built more muscle and improved their “net protein balance”—i.e., they were building more muscle than they were losing. Building muscle matters for everyone as they get older because diminishing muscle mass and strength, called sarcopenia, can lead to health problems that include insulin resistance as well as low bone mineral content and density.
“Muscle plays an important role in whole-body metabolism,” Il-Young Kim, the Arkansas study lead researcher, told U.S.News.com. The more protein each participant consumed, the better their bodies were at building muscle.
Kim cites research from Pennington Biomedical Research Center, also in Arkansas, on 25 participants, ages 18 to 35, eating excess-calorie diets. For those who got 15% to 25% of their calories from protein, 45% of the excess calories were stored as muscle—compared with those who got 5% from protein; they stored 95% of the excess as pure fat.
Finally, data from a national health assessment study (NHANESIII) on 6,800 American adults showed an impressive difference in the effects of high-protein diets (20% of calories from protein) for those younger than 65 compared with those older. Participants aged 50 to 64 eating high-protein diets had significantly increased chances of dying from cancer or diabetes—although the effects were reduced, or disappeared, among participants whose high-protein diets were mostly plant-based—while for those 65 and over, the same diet reduced those chances.
For a 136-pound woman to consume 90 to 100 grams of protein per day—even spread among three meals at about 30 grams per meal—can be challenging. Some opt for the easy addition of protein powder, such as Muscle Pharm “Combat,” which packs 28 grams of protein into 130 calories, consumed with water or milk as a protein shake. Others prefer the taste of Quest bars, with 20 grams of protein for about 170 calories, but not nearly as scrumptious as Kind bars, though these come in at 6 grams of protein and about 200 calories. Enthusiasts say both the high-protein powders and bars make them feel more energetic.
Protein comparisons of different foods can be surprising (see chart right below): Three ounces of chicken have more protein and fewer calories than the same amount of meat, meaning beef, lamb and pork; six ounces of Greek yogurt have more protein than one cup (eight ounces) of plain yogurt, with both choices worth about 100 calories; and all grades of milk, from skim to whole, have the same amount of protein, 8 grams per cup, with total calories increasing from skim to whole. (In questions about high- versus low-fat dairy, one Australian study of short-term diets found that eating low-fat cheese and yogurt did not improve the inflammation associated with cardiovascular disease when compared with the full-fat products.)
Also surprising is the comparison of foods in the OmniHeart study included in the high-carb diet (58% of food consumed as carbs)—fruit and juices, fats and oils (see chart); versus those in the high-protein (25% protein) diet—legumes, nuts, seeds and other vegetable proteins, and poultry (see chart below).
When making choices among different kinds of protein, the Harvard Health Blog is equivocal, stating first that “mounting evidence shows that reducing animal-based proteins is a healthier way to go,” and then proceeding to suggest “switching just one serving of red meat per day for poultry, fish or plant-based protein.” (Who eats more than one serving of red meat per day, and why isn’t poultry considered animal-based protein?)
Diet recommendations that are confusing or conflicting give way to personal needs and preferences. On one hand, for example, granola is an inefficient means of getting sufficient protein, if eating a reasonably sized portion: Half a cup of granola (6 grams equaling 280 calories) with one cup of 2% milk (8 grams or 122 calories) equals about 14 grams of protein at about 400 calories, while ½ cup of Greek yogurt provides 18 grams at only 100 calories. For those eager to start their day with granola, however, there’s the MIND diet for brain health, which recommends three or more servings of whole grains per day.
For true protein efficiency, powdered protein has no equal—and maybe none in the terrible-taste department either, although many people come to enjoy it. There’s the rub: how far to move your diet away from personal preferences based on studies with small numbers of participants or recommendations that change more often than the seasons.
The main motivator for making diet changes is ill health. But when that’s not an issue, if caring for your mind is of greater concern than working your muscles, dig into that granola.
Just don’t forget the powdered stuff is there when you need it.
—Mary Carpenter
Mary Carpenter is the Well-Being editor of MyLittleBird. Look for her story on sunscreens coming later this fall.
IT’S THAT TIME OF YEAR for inspecting the summer’s sun damage, especially for those who’ve had trouble resisting cool pool waters or unfettered (by lanes and lane hogs) ocean waves.
The villainous rays are ultraviolet radiation A and B, which can alter genetic material in skin cells. The more commonly encountered UVA rays, which cause tanning and wrinkles and contribute to skin cancer, can penetrate clouds and windows, and protection should be applied every day. UVB rays, responsible for intense sunburns and skin cancer, are strongest in the spring and summer, between 10 a.m. and 4 p.m. and at high altitudes. Reflective surfaces like snow and ice can increase the intensity of UVB rays, as can swimming in pools where both the water surface and the pool bottom reflect the rays.
Examining Sun Spots
Before deciding on treatment, pigmented spots must be examined to see whether they have any “substance” in addition to color, writes Scottsdale, Arizona, dermatologist Charles Bollman on Quora.com. Spots with any perceptible thickening might need destructive treatments like liquid nitrogen and electrocautery, and anything suspicious should be biopsied.
Even flat, seemingly innocuous sun spots, called solar lentigos or lentigines, should be checked by a dermatologist, because they are created by a similar proliferation of melanocytes — which produce skin pigment or melanin — as that causing dangerous melanomas. Once sun spots are determined to be non-cancerous, the first treatment is often vitamin C cream or ointment to increase elastin and collagen in the skin for a smoother look. Recommended formulations should come from a dermatologist because many creams are unstable.
If topical vitamin C produces no negative or allergic reactions, a lightening agent containing hydroquinone — usually 2% concentration — can be added. Next come retinoids, vitamin A derivatives that can stimulate the sloughing off of darkened skin cells. Dark sun spots on lighter skinned individuals tend to be more superficial and respond better to topical hydroquinone or retinol. Some dermatologists recommend exfoliants containing glycolic or other acids to stimulate faster skin cell turnover.
Microneedling, IPL
To produce lighter, smoother skin over the entire face, micro-needling — PIN for percutaneous induction therapy or collagen PIN — is done with what looks like a fat pen holding 12 or 36 microneedles to create many tiny injuries that can stimulate collagen and elastin production and also be used to insert vitamin C deeper into the skin. Micro-needling is performed in a series of three to six treatments, usually one month apart — at about $300/treatment, generally not covered by insurance — and is also used for acne and scarring.
Another option, intense pulsed light (IPL), uses multiple wavelengths and is considered non-ablative or not destructive — in contrast to lasers, which deliver only one intense wavelength and are ablative. Some dermatologists recommend using IPL on flat sun spots, usually in more than one treatment, and in conjunction with topical therapies. IPL, which has a slight risk of hyperpigmentation, has other uses including hair removal.
The next, more aggressive step, the ablative treatments, include superficial chemical peels using salicylic acid and glycolic acid, dermabrasion, lasers that remove darkened layers of the epidermal or top layers of skin and can stimulate growth of new skin cells. These treatments carry slight risks of hyper- and hypo-pigmentation as well as burns and scarring; and subsequent sun exposure can cause intense burns.
Skin Cancer
Raised dark spots must be biopsied to determine if they are cancerous. Skin cancer occurs three times more often in men than women; the risk increases with age; and it is more common in people with fair skin: an estimated 40 to 50% of those with fair skin will develop at least one skin cancer by age 65, especially in places with more intense sunshine.
Skin cancers are separated into two groups: non-melanoma and melanoma. Three out of four skin cancers are basal cell carcinomas, which develop from basal cells on the surface of the skin and usually appear as pearly or waxy bumps or flat, flesh-colored or brown scar-like lesions. Basal cell cancers are usually benign and slow-growing but should be removed.
Squamous cell carcinoma, relatively uncommon and more often found in men than women, develops from keratinocytes, skin cells that lie under the top layer of the epidermis, and usually appears as firm red nodules or flat lesions with a scaly surface. When these carcinomas appear as an elevated growth with a central hole, they are called “rat-bite” tumors. Squamous cell carcinomas are likely to be malignant and invasive —spreading to local lymph nodes — and must be removed.
Melanoma, most often caused by a brief intense exposure or blistering sunburn and in those with a family history, can be aggressive and life-threatening. It generally appears first on extremities and often on the chest or the back.
The five symptoms for determining which lesions might be cancerous are known as ABCDE: Asymmetry (not symmetrical); Border (jagged or uneven); Color (more than one); Diameter (larger); and Evolving (changing in color, size and shape).
The one good thing often said about skin cancer is that it is always visible.
— Mary Carpenter Mary Carpenter is the Well-Being editor of MyLittleBird. Her last post discussed the effect of anger on the heart.
Look for Mary’s story on sunscreens coming later this fall.
DOES YOUR HEART go pitter patter when you’re mad as a hatter? Although “mad” in this song (“Alice in Wonderland” by Neil Sedaka) refers to madly in love, mad anger can seriously impact the heart. In a 2014 data analysis of nine studies, within two hours after an anger eruption, the incidence of acute coronary syndrome — anything from chest pain and shortness of breath to heart attack or stroke — was found to be five times higher than at other times. According to the analysis, published in the European Heart Journal and reported by the Washington Post, as anger increased from moderate to furious, so did the risk of a heart incident.
Also during those two hours, the chance of an ischemic stroke (rupture of a weakened blood vessel in the brain) was four times as great. Called brain aneurysm, these weakened blood vessels develop most often between ages 40 to 60 and more commonly among women. They usually cause no symptoms but, with increased blood pressure, can balloon out and rupture. If detected early, brain aneurysms are often treated with medications such as blood thinners and clot busters.
Heartbeats are controlled by electrical signals traveling through the heart to make it squeeze and pump blood. The average human heart beats about 100,000 times per day, pumping over 2,000 gallons of blood, and women’s hearts beat faster than men’s by about eight beats a minute.
If your heart rate feels speedy, do a quick pulse check using two fingers at the wrist or base of the neck next to the windpipe. Normal range is less than100 beats/minute, based on counting for 15 seconds and then multiplying by four, but your heart beats faster during exercise or under pressure. Even tachycardia, increased regular heart rate, rarely has a serious cause in the absence of other symptoms.
A heartbeat that is very fast — 80 to 100 beats per minute — or irregular, called atrial fibrillation (AFib), can be the result of damage to the heart, high blood pressure, inflammation and sometimes no perceptible cause. AFib warrants a visit to the doctor and in severe cases is treated with an implanted cardiac defibrillator. In the 2014 analysis, within 15 minutes of an outburst, defibrillators detected an arrhythmia and shocked these individuals’ hearts back into regular rhythm.
A fluttering sensation in the chest is the most common sign of AFib, a feeling that your heart is beating too fast or hard. A rapid heart rate is most worrisome when it occurs with other symptoms such as chest pain, shortness of breath and feeling dizzy or faint. Besides exercise and anxiety, common flutter generators are fever, dehydration, overactive thyroid (hyperthyroidism), binge drinking, diabetes and sleep apnea.
The risk of AFib increases with age, in particular over 60, and with a family history of AFib. When the heart isn’t pumping normally, blood can pool in the upper chambers of the heart and form clots that can travel to the brain. Untreated AFib increases the chances of a stroke by five to seven times.
Electrical shock, performed under sedation, is often the first treatment for AFib. Called electrical conversion, small quick pulses of electrical current reset the heart rhythms. Other remedies include medications as well as surgical procedures that destroy excess heart tissue or create scars in the heart that redirect the electrical current.
Heart failure occurs when a weakened heart struggles to pump enough blood to meet the body’s needs and eventually becomes unable to keep up. The kidneys respond by causing the body to retain water, which can build up in the extremities, the lungs and other organs, leading to congestive heart failure. Coronary artery disease occurs when the arteries supplying blood and oxygen to the heart become blocked, and cardiomyopathy is damage to the heart muscle caused by blood flow problems infections, and alcohol and drug abuse.
“Ideal cardiovascular health” can be achieved via seven “ideal behaviors,” as defined by an American Heart Association committee of experts: no smoking; maintaining a body mass index below 25; being physically active; following current dietary guidelines; and maintaining an untreated total cholesterol of less than 200 milligrams, untreated blood pressure of less than 120 over 80 and a fasting blood glucose level of less than 100 mg, Jane Brody wrote in her August 2016 New York Times column titled “Rediscovering the Kitchen for Heart Health.” Physical exercise should include a minimum of 150 minutes a week of moderate or 75 minutes a week of vigorous activity.
The column’s kitchen rediscovery focus is based on committee recommendations that emphasize food, rather than nutrients or calories, and suggest a version of the DASH (Dietary Approaches to Stop Hypertension) diet: daily minimums of four and a half cups of fruits and vegetables, and three ounces of whole grains; and weekly, two or more 3.5 ounce servings of fish, and four or more servings of nuts, legumes and seeds. The diet also limits weekly consumption of meat, sugar-sweetened drinks, saturated fats and sodium.
Because the 2014 analysis linking heart incidents to anger didn’t investigate other risk factors such as diet, behavior and family history, it didn’t prove a direct cause and effect relationship. On the other hand, the analysis found that both holding anger in and letting it out can have both positive or negative health consequences, and made the point that “People who regularly experience excessive anger are often urged to consider anger management or therapy sessions to learn to control outbursts.”
— Mary Carpenter Mary Carpenter is MyLittleBird’s Well-Being editor. Read more about Mary here. She recently wrote about the MIND diet.
WHEN I TOLD a friend that I sweat more than anyone I know, she said: that’s what everyone thinks. But of the next four friends I asked, all said, “Funny, I don’t sweat much at all.” One has and one thinks she might have an autoimmune disease that impairs the body’s fluid production; the other two have no explanation besides that they just don’t sweat much.
What I yearn for is a shirt I can wear on a walk or bike ride, and afterwards go indoors for coffee or lunch without dripping sweat either chilling me or making me look like I’m auditioning for a wet T-shirt contest. I’m talking not about underarm sweat, which can be allayed by antiperspirants, but about sweat that emerges from everywhere. In fact, the average human body is covered with more than 2.5 million sweat glands.
After much effort at self-education — reading whatever I could find, particularly on different fabrics, including those that wick, dry and “dri”; and purchasing an array of candidates when I could find good deals, albeit often in the worst colors — my research was obviated by the advice that rang most true: “When it comes to choosing a wicking fabric, you’ll have to trust the opinions of others.”
I did learn that “wicking” and “dri” are not necessarily what I’m looking for, because while these fabrics can transfer sweat away from the skin, they often move it visibly onto the shirt. After my regular 45-minute stationary bike ride, the Merrell “Adeeline,” which garnered the top recommendation in a GearFinder review, looked positively sopping and felt very cold — so much that I wondered if there was something terribly idiosyncratic about my body. Also sopping was the “More Ultra” from Modell’s, suspiciously inexpensive but bearing the irresistible “Speed-Dri” label. (Another factor in looking dry that doesn’t benefit from research is color, the best being white and black.)
Sweat is designed to cool the body when air hits moist skin, which brings up the question of fit. The warmer the conditions, the looser a shirt should be to allow air to circulate. When it’s cold, the “athletic” or close fit helps contain body-generated warmth, and “wicking” fibers should be close to the skin to remove chilling sweat; looser outer layers can create air pockets for added insulation. A tighter fit also works better for stop-and-start exercising, while long-distance runners do well with looser fits that leave some sweat on the skin for cooling.
Other variables are material and weave. While natural fabrics — cotton, linen and wool — breathe better, they retain all the excess moisture that doesn’t evaporate from the skin. “Synthetic fibers are, essentially, plastic — and virtually nonabsorbent,” according to REI. The theory is that moisture will travel along the surface of the fibers and drain to the outside of the clothing to evaporate when it makes contact with air.
Polyester is recommended for heat and high humidity because it holds only about 0.4 percent of moisture, and certain polyester weaves force moisture through gaps in the weave to improve wicking. Polyester, however, retains odor. Of the polyester shirts I tried, one was the terrible “Adeline,” at 97% polyester, while another was the great Athleta “Running Wild” at 93%. At 100%, both Hot Chillys “Geo Pro” and Mountain HardWear’s “Wicked Lite” looked pretty dry, though my version of the latter was white and thus hard to judge.
Where polyester is deemed “hydrophobic” because it doesn’t absorb water, nylon is “hydrophilic,” so that it absorbs some water and takes longer to dry, and its colors fade over time. On the other hand, nylon is stronger and has greater “stretchability,” according to the Luluaddict blog. Of all the shirts I tried, the Lululemon was the only one with a high nylon content, at 58%.
Blog bias notwithstanding, however, that Lululemon shirt, a dark blue “Swifty Tech” long-sleeve crew, made of the brand’s time-tested fabric with hundreds of tiny perforations worked best of all. Besides nylon, the shirt is 38% polyester and 4% “static silver nylon,” supposed to reduce the smell.
The rest of my trial shirts I divide into three categories: great and pretty great — which I continue to wear; and horrible — which I should give away. Besides the Lululemon shirt, great includes Athleta’s “Running Wild,” with alternating panels of black and salt-and-pepper gray; and Hot Chillys “Geo Pro,” which feels soft and drapes well. Both look quite dry but are a little heavy for warm weather.
Among pretty great, I put “Better than Naked” by North Face—which got top rating from OutdoorGearLab’s “Best Running Shirt For Women” five-shirt comparison, where it was evaluated as “quick to dry”—along with the Arc’teryx “Motus,” the REI “Northway” and “Dri-FIT” by Nike. Horrible includes the Merrell “Adeeline,” the Arc’teryx “24” waffle knit and the “More” from Modell’s.
My experiment was hit-or-miss, mostly due to budget constraints, as evidenced by my failure to include any of the other shirts in OutdoorGearLab’s review, according to rank best to worst: New Balance, Adidas, Salomon and Patagonia.
However, I am still taking recommendations and recently ordered an Under Armour “HeatGear” top, 97% polyester, with “pinhole mesh” fabric that may be similar to Lululemon’s perforations. Writing for Slate, Nick Schulz — “I’m the sweatiest guy I know” — found this model “stayed light and dry as sweat cascaded down my face during an hour-long run.” So I keep hoping.
ARE PEOPLE WHO PROTEST against genetically modified organisms (GMOs) similar to the people who deny climate change? How about those who reject childhood vaccines?
All three groups seem adamant in their refusal to believe the near-unanimous findings of science.
There’s paradox here: As groups, GMO protesters and climate-change deniers tend to come from opposite ends of the political spectrum and might bristle at the notion that they share anything, much less the denial of scientific evidence.
iStock photo.
When Mark Lynas, a researcher at the Cornell Alliance for Science, wrote the New York Times opinion piece “How I got converted to G.M.O. Food,” many science followers took note. Lynas previously had not only opposed the use of GMOs but had participated in vandalizing fields of GMO vegetables before being persuaded by the evidence to do an about-face.
After looking more closely at the research, he concluded that “seed genetics can make a contribution…increase disease resistance and drought tolerance, which are especially important as climate change continues to bite.… We need this technology.” Lynas accuses GE (genetic engineering) activists of “undermining public understanding of science.”
How elitist is it for those who shop at Whole Foods (like me) to oppose new technology that allows tens of thousands of hungry, low-income people to afford low-priced breads and cereals made from genetically modified grains? According to best estimates, the consumer price for grain-based foods has gone down 1% per year for the past 15 years, because of a combination of government subsidies and genetically engineered seeds, which allow farmers to harvest a lot more per acre.
Lynas noted research by the Pew Research Center and the American Association for the Advancement of Science (AAAS) that shows a gap between science and the public on GMOs that is greater than the gap on any other science controversy: “88% of association scientists agreed it was safe to eat genetically modified foods while only 37% of the public did—a gap in perceptions of 51 points,” compared with a 37-point difference on climate change and 18 points on childhood vaccines.
As with the childhood vaccine debate, the origin of the GMO scare was a scientific paper later retracted by the journal that published it due to flaws in method. Since then, reports on livestock suffering ulcers, immune system problems and increased rates of infertility and miscarriage have also been mostly discredited.
In a 2013 “meta-analysis” (research that pulls together existing research) of GMO research from the previous 10 years, 1,783 scientific studies found “no significant hazards directly connected to the use of [genetically engineered] crops.” Another meta-analysis, published in 2014, which addressed uncertainties about the impact of genetically modified crops, found, across 147 original studies, that GMO crops reduced pesticide use by 37%, and the average profit gains from GM-adopting farms were 69%.
According to an AAAS statement, “The science is quite clear: Crop improvement by the modern molecular techniques of biotechnology is safe. The World Health Organization, the American Medical Association, the U.S. National Academy of Sciences, the British Royal Society, and every other respected organization that has examined the evidence has come to the same conclusion.”
But while the war of words continues, the reality is that today more than 70% of processed grain-based foods in U.S. supermarkets contains GMO foods, among which the top three are corn, soy and cottonseed (used to make vegetable oil, margarine, etc.). By 1995, 67% of cheese produced in the U.S. was made using rennet—to curdle milk to form curds and whey, the raw material of cheese—produced by GMOs. GMO rennet, its safety approved in 1990 by the Federal Drug Administration, was created by inserting the rennet-making gene from a calf’s stomach into a bacterium.
According to the latest U.S. figures, 93% of soybeans (used as lecithin, tocopheral and hydrogenated oils) were GMO varieties, and 88% of cornfields were planted with GMO-modified corn. GMO modifications can double the average yield of corn from 150 to 300 bushels per acre.
After corn, soy and cottonseed, the top genetically modified crops in the U.S. according to most lists are: alfalfa, fed to dairy cows; papaya, grown in Hawaii; and canola and sugar beets, used to make more than half the sugar sold in America.
Most genetically engineered crops grown in the U.S. are “Roundup Ready,” meaning that when the pesticide Roundup is sprayed over thousands of acres, the weeds will die and the food plants will survive. Research to date has allayed concern that over time “superweeds” could increase the amount of pesticides that must be sprayed.
Different questions arise with genetically modified, fast-growing salmon, to be marketed as AquAdvantage Salmon, and dubbed by detractors as “Frankenfish,” which was approved by the FDA in November 2015. In addition, the FDA did not require the fish to be labeled a GMO because there is no “material difference, such as a different nutritional profile.”
This salmon is created by inserting genes from other fish species, Chinook salmon and the eel-like ocean pout. Besides questioning the risk of possible allergens to the new fish genes, protestors have speculated about the risk of gene alteration in native salmon populations, while the producers contend that GMO-salmon farms are located miles from the ocean, and that genetic engineering produces only sterile females.
To questions about whether the new salmon is kosher—because the Torah forbids mixing certain species of plants and animals—the Orthodox Union says yes, because the “new” salmon will have fins and scales. While AquAdvantage salmon appear biologically the same, and in blind taste tests have proved indistinguishable from native salmon, however, almost 10,000 grocery stores are already refusing to sell it. Even when it becomes available, the new salmon is expected to represent a very small fraction of the very large U.S. salmon market.
As if to prove that winning new battles doesn’t guarantee winning ongoing ones, in 2015 the Chipotle restaurant chain announced it would eliminate GMO-foods, in order to make its offerings safer. The same year, the chain was linked to outbreaks of food-borne illness caused by those tried-and-true threats, E.coli, norovirus and salmonella.
— Mary Carpenter Mary Carpenter is the Well-Being Editor of MyLittleBird. Read more about Mary here.
WHEN MY OLDER SON, Edmund, arrived home for a visit recently, he found me and his younger brother walking around the kitchen with the legs and tails of Beanie Baby animals hanging down over our foreheads. A physical therapist had just showed me how balancing a small bean bag on my head while walking could improve my posture—which would help relieve my aching back. Beanie Babies were the closest thing I could find around the house.
But, Edmund said, it wasn’t just the Beanies but the combination of us wearing small furry animals on our heads along with the gigantic marijuana plants clearly visible in our small garden out the back window that gave our kitchen an otherworldly feel.
With DC’s marijuana legislation, each resident can grow up to three plants and enjoy the produce, so my younger son, Oliver, told me when he moved home after college.
I had tried marijuana back in the day, but when it didn’t make me especially happy and often inspired me to eat much too much, I stopped indulging. When it came to my sons, I did my best to cast a critical eye on their interest, but I have tried to view marijuana more positively since Oliver found it a helpful supplement to his medication for occasional bouts of anxiety. Moreover, I was slightly relieved that the boys were imbibing something other than alcohol, a particular scourge in our extended family.
Oliver began with six plants—three for him and three for me. At about the same time that I was ready for my one annual gardening weekend to plant tomatoes, the marijuana had gotten large enough to move outdoors. I offered to include them in our garden plot.
When I went to Johnson’s to buy our customary eight plants, I asked for advice on fertilizer that would be good for both tomatoes and marijuana, thinking that because Johnson’s is located in DC (near the intersection of Nebraska and Wisconsin avenues), the staff would be accustomed to such a question. Not at all. I looked around to find several sales guys smirking—at me!
Then, when I had, of course, forgotten several gardening essentials, it was more convenient to go to American Plant on River Road—in Maryland—where I couldn’t resist mentioning that the netting I needed was for our marijuana plants. The responding looks included some fear and disapproval along with the smirks, even after I tried to explain about the District, etc., etc.
After that, I couldn’t stop telling random people that our family was growing marijuana—six plants, though the number fell off with a few early deaths. I noted the responses, from outright disapproval to amusement, but the biggest surprise was my discovery that No One Else seemed to be joining us. Weren’t at least some of my boomer friends starting up again?
Each morning as I cast my hose over the garden, watering the beautifully pale-green, five-point leaves along with my still-scrawny tomatoes, I began to feel a slight pride at being a lonely pioneer.
But the best surprise came the next time I encountered one of many news stories about the medical marvels of marijuana. This research suggested that THC, the active ingredient in marijuana, might reduce the production of amyloid beta protein—linked to Alzheimer’s disease, which is one of my many concerns about the future. THC might even prevent the protein from accumulating in the brain.
Now I was completely IN: our garden, our plants, although I have tried to keep paying attention to those sad, slow-growing tomatoes—and remembering to wear a Beanie Baby on my head any chance I get.
—Mary Carpenter
Mary Carpenter is the Well-Being Editor of MyLittleBird. Read more about Mary here. This is a reprise of the column that attracted a lot of attention last year.
MYTHS ABOUT HEALTH and medical conditionsare legion, but arthritis in particular has a high number associated with it. What’s surprisingly not a myth is that having a relatively shorter index finger compared to the ring finger is a risk factor. This 2D:4D ratio raises the risk of developing arthritis in the knee and hip joints, independent of other risk factors and particularly among women. Another real risk factor: flat feet.
Among the myths — that is, untruths — there’s no evidence that damp weather makes arthritis worse. Nor is there any that heat, as lovely as it feels, works better than ice, although it’s true that using heat to help relax the muscles that move stiff joints might be more helpful in the morning, while ice can ease inflammation at night.
It’s also hard to believe that some foods — especially nightshade vegetables such as tomatoes, potatoes and eggplant — don’t aggravate arthritis discomfort, an effect I thought I’d observed. But there’s no proof, nor is there any for the benefits of popular alimentary treatments, including consuming a dozen gin-soaked raisins per day; drinking cider vinegar; eating grapefruit or raw vegetables or adding spices such as turmeric or ginger to food.
Also, while combining glucosamine, found naturally in joints, with chondroitin make some people feel better, the pills don’t help everyone. Nor can this combo achieve the highly touted rebuilding of worn-out cartilage around joints without being injected directly into the problem area.
What used to be the official medical prescription, to relieve arthritis pain with rest, is now seen as not just wrong but harmful: Inactivity can cause joints to continue deteriorating, according to Elaine Husni, director of the Arthritis and Musculoskeletal Center at the Cleveland Clinic.
The best exercises are low-impact like walking, and range-of-motion like slow stretching —with the goals of increasing flexibility while lessening stiffness and pain. In addition, arthritis sufferers are advised to keep moving even when working, reading and watching TV — by frequently changing position, tilting the head from side to side, bending and stretching the legs and walking around at least once every half hour.
One myth — or simple confusion — attributes all joint pain to arthritis, but causes include tendinitis, bursitis and other soft-tissue injuries. Also, around 100 different kinds of arthritis exist, including gout, crystals, rheumatoid arthritis and arthritis caused by a virus — in addition to the most common, osteoarthritis (OA).
Osteoarthritis begins with inflammation that occurs when cartilage cushioning the joints wears away, which causes the bones to rub together. That friction leads to inflammation, pain, stiffness and other symptoms. Besides damaging the cartilage, OA can cause bony growths around the edges of joints and synovitis, mild inflammation of the tissues around the joints.
Among OA risk factors, number one is age. “As you get older, almost everyone gets some form of arthritis,” according to Mayo Clinic rheumatologist Eric Matteson. Arthritis is the most common cause of disability among American adults; Americans spend more money treating arthritis than they do cancer; and about one in 50 older Americans have had a knee replacement.
Until age 55, both genders are affected equally; after that, women are more likely sufferers than men. Besides gender and genetics, two important risk factors for OA are being overweight and working at jobs that require repetitive movements or heavy lifting. Injuries that can over time lead to arthritis include torn cartilage, dislocated joints and ligament injuries. More than 50% of people with sports-related knee injuries including ACL strains and tears later show signs of OA.
To treat the pain, NSAIDs like ibuprofen or regular doses of Alleve morning and night reduce inflammation. For more severe pain, corticosteroids are taken by mouth or injected directly into the joint. Also, injections of synthetic hyaluronic acid, a component of the synovial fluid that lubricates the joints and deteriorates with OA, appear to reduce about 70% of the pain in about 70% of patients, Nevada orthopedic surgeon Fred Redfern told AARP.
To counter the destruction that occurs with arthritis, platelet-rich plasma (PRP) injections, using a patient’s own blood from which platelets are removed and then reinjected into the joint, has shown promise as have injections of stem cells. A new possibility involves manipulating bone-marrow stem cells to act like cartilage, which would effectively replace the cartilage.
Researchers have also tried cultivating cells taken from the patient’s joint and then reinjecting them, called autologous chondrocyte implantation, though to date ACI works well only when the arthritis is contained in a small area.
A final myth, that the annoying habit of cracking knuckles and joints can accelerate arthritis damage, has not been sufficiently studied to rule out — which means it can continue to be used as a threat when begging practitioners to stop.
Mary Carpenter is the Well-Being Editor of MyLittleBird. Read more about Mary here. Her last post was on how to prevent painful kidney stones.
WOMEN WHO MAKE it past 40 without having a kidney stone are likely to be free of such potentially painful objects forever. In any case, women have less than one-half the risk compared to men. Most kidney stones occur between ages 20 and 40 and more commonly in warmer climates or with vigorous physical exercise — anything causing more fluid lost as sweat and less as urine.
On the other hand, the incidence of kidney stones has been rising slowly, more than doubling from 3.8% in the late 1970s to 8.8% in the late 2000s, according to the National Kidney Foundation. Now one in about every 10 people will have a kidney stone during their lifetime. The increase has occurred equally in women and men, with a lifetime risk of 9% for women and 19% for men — and may be related to the epidemic of obesity, along with high blood pressure and diabetes.
Dehydration is a major risk factor, making stone-causing elements like calcium more likely to clump into stones. Darker-colored urine is the best indicator of risky levels of waste product concentrations. The National Kidney Foundation recommends drinking more than 12 glasses of water/day, more during exercise or in hot weather. A family history of kidney stones also increases risk.
The most common calcium oxalate stone is created when calcium combines with oxalates while the kidneys are producing urine. The current advice is to consume oxalate-rich foods — beets, bell peppers, spinach, chard, rhubarb, peanuts and chocolate — in temporal proximity to those rich in calcium such as dairy products, with the goal of binding oxalates and calcium before they reach the kidneys, in the stomach and intestines.
Another kind, the uric acid stone, is caused by gout with the recommended diet low in purines — avoiding organ meats, excessive alcohol and high-fat foods. Struvite stones are caused by urinary tract infections. The risk for all kidney stones is increased by a diet high in animal protein that increases uric acid in the urine, which in turn provides a good environment for stone formation.
For calcium stones, the biggest dietary risk factor is salt, which effectively pulls calcium from the body into the urine. For anyone over 51, recommended limits for daily salt intake go down from 2300/day to 1500 mg/day — the equivalent of ¾ teaspoon of salt. The average American’s daily salt intake has been as high as 3266 mg/day. Sugar also increases risk, as does overconsumption of vitamin D supplements.
Kidney stones range in size from an almost imperceptible crumb to that of a ping pong-ball. They can cause intense pain in the low back, side, groin or abdomen, which is not relieved by changes in body position and often waxes and wanes in severity. Symptoms include nausea and vomiting, and sometimes difficulty urinating, urinary urgency and bloody urine. The first treatment step is OTC pain medication.
Most stones pass within 48 hours: those of 4mm or less have an 80% chance of passage, which goes down to less than 20% for stones of 5mm and more. Their passage can be speeded along by drinking large quantities of water. Juices high in natural citrate — limeade, lemonade — can help prevent chronic kidney stones and are often recommended as treatment. Larger stones that don’t pass on their own are subjected to a procedure called lithotripsy that creates shock waves to break them up. The final alternative is surgery.
At the top of the salty foods list is bread and rolls; high on the list is anything with tomato sauce, such as pizza, pasta and dishes like meatloaf, and cheese. But the best dietary advice these days for health on almost every front is to avoid processed foods, because as much as 75% of the salt consumed per person per day comes from food that’s either processed or prepared by stores and restaurants, leaving the unwelcome solution for many: stay home and cook from fresh ingredients.
Mary Carpenter is the Well-Being Editor of MyLittleBird. Read more about Mary here. Her last post was about the MIND diet.
FOR THOSE WHO have trouble following any one diet to the max, the MIND diet keeps scoring highest for a healthy brain. In the U.S. News &World Report ranking of diets, MIND was also top of the list for “Easiest diet to follow”; it combines two of the top “Best for healthy eating” diets; and it ranks in a No. 2 tie for “Best diets overall.”
In a Rush University study of 923 Chicago-area residents ages 58 to 98, the greatest impact for people who followed different diets most closely over 4½ years came from the Mediterranean diet: a 54% reduction in the risk of developing Alzheimer’s disease for the top one-third of adherents.
The MIND, though a close second in risk reduction at 53% for the best diet followers, came in at No. 1 for the most effective brain diet, because even the middle third of MIND followers had a 35% reduction of Alzheimer’s risk during the study period. By the end of the study, those who followed the MIND diet most rigorously were cognitively 7½ years younger than those who followed the diet least strictly.
The Rush study’s conclusion: The longer a person follows the MIND diet and the earlier in life they begin, the less risk they have of declining cognitive abilities. The MIND diet comes from combining components of the Mediterranean diet with those of the U.S. News Top Healthiest diet, DASH (Dietary Approaches to Stop Hypertension), to get MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay). Yes, a mouthful.
MIND “specifically includes foods and nutrients that medical literature and data show to be good for the brain, such as berries,” says Martha Clare Morris, nutritionist at Rush University Medical Center. Except for berries, fruits as a general category, which are stressed in the Mediterranean and DASH diets, have not shown an association with cognitive decline and are not recommended in the MIND diet. The same goes for vegetables: The MIND list includes only the most protective leafy greens such as spinach, collards, romaine lettuce and, of course, kale.
Some may be surprised to see “whole grains” on the MIND list because of claims by some, including David Perlmutter in his book “Grain Brain,” that gluten is bad for the brain. (see the MLB story here.) But research published in both “Clinical Nutrition” and “Alzheimer’s and Dementia” earlier this year comes down on the side of positive effects.
In fact, the first study, of 5,000 British middle-aged adults, found the “grain brain” (of someone consuming whole grains) to be a good defense against inflammatory markers for cognitive decline. In the second, a study of more than 2,000 Swedish adults at least 60 years old, consuming any one healthy diet component—these included whole grains, rice/pasta and legumes—was associated with weakening “the negative cognitive effects associated with the Western diet.”
An analysis in the “British Medical Journal” based on data from 45 studies concluded that 90 grams of whole grains per day reduces the risk of death from all causes. And for general “successful aging” health, an Australian study following 1,600 adults age 49 or older found that the main difference among the healthiest was fiber intake from both fruit and whole grains. (This study found healthy aging was not linked either to consumption of carbohydrates or sugar, or to the glycemic index, which measures blood sugar levels.)
The MIND diet recommends three daily servings of whole grains. In another formulation, daily grain consumption should reach five- to eight-ounce equivalents of grains per day, at least half from whole grains. One ounce is found, for example, in one slice of whole-grain bread, one cup of cereal or one-half cup of cooked pasta or rice.
Watch out for tricky labeling: “Multigrain” or “100% wheat” may not be the real thing if the outer layer of bran has been stripped off the whole wheat kernel. The wording must specify “whole grain” and appear at or near the top of the ingredients list. Good whole-grain sources besides wheat are oatmeal, bulgur (used in tabbouleh salad), barley and rye.
Also on the list is corn, especially yellow corn—and, most surprising, popcorn! Organic kernels popped in the microwave in an ordinary paper bag or on the stovetop the old-fashioned way are definitely great grains. (Unfortunately, the commercial microwaved option is unhealthy because of the bag’s harmful chemicals.) According to one survey, regular popcorn eaters averaged 2½ servings of whole grains per day while non-popcorn eaters got less than one serving.
Experts note that the MIND diet is also good for the heart and general health. But they all point out that, however you improve your diet, exercising regularly and keeping stress levels down are also essential for brain health.
The MIND diet recommends 10 food groups:
Green leafy vegetables (like spinach and salad greens): at least six servings a week
Sleepy or Stressed? It Could Be Your Thyroid — or Not
iStock
AROUND THE TURN of the last century, it was a trend: If you lacked energy or felt blue, try giving your thyroid a boost. When a psychiatrist I saw one time asked me about dry skin, dry hair and a few disagreeable digestive issues, I said, yes — all my life — and she right away prescribed “thyroid pills,” synthetic thyroid hormone. Within weeks I felt so jumpy and distracted in the mornings that I tossed the pills. Now people are shocked if I mention receiving the Rx without prior blood testing.
Before thyroid medication is prescribed, blood levels of thyroid hormone should be checked and then rechecked every four to eight weeks to fine-tune the dose — depending on health, weight and how an individual’s blood absorbs the hormone. Although there is a “normal” target range for thyroid-stimulating hormone (which incites the thyroid gland to produce more), each person’s range varies depending on their health.
The thyroid gland, shaped like a butterfly and located at the base of the neck, extracts iodine from food, notably salt, and converts it into the two thyroid hormones that control metabolism and thus affect every cell in the body. Directed by the pituitary gland, which is in turn regulated by the hypothalamus, the thyroid gland has so many different functions that fiddling with its operations produces an array of desirable and undesirable effects.
Hyperthyroidism — actually caused by excessive thyroid supplements as well as when overgrowth of normal thyroid tissue or thyroid nodules produce too much hormone — can lead to anxiety, nervous energy, irritable feelings and difficulty concentrating, as well as hunger, thirst, weight gain or loss and flu-like aches and pains. Hyperthyroidism can be apparent in a slight tremor of extended fingers, overactive reflexes and warm, moist skin. Its risks include heart arrhythmia and osteoporosis.
The opposite condition, hypothyroidism, results when too little thyroid hormone is circulating in the blood, often caused by Hashimoto’s disease, an autoimmune condition that leads to swelling of the thyroid gland and reduced production of thyroid hormone. In addition, particularly in those for whom low thyroid runs in the family, stress raises cortisol levels that can both interfere with thyroid production and increase vulnerability to Hashimoto’s.
Because hypothyroidism can exist at the same time as depression, and the two conditions share so many symptoms, it can be hard to tell what’s causing what. Also, hypothyroidism itself can cause feelings of depression. Common symptoms of both include fatigue, sleeping too much, sluggishness and trouble concentrating — yes, the same trouble caused by hyperthyroidism. For a person who feels depressed and also has low blood levels of thyroid hormones, thyroid-replacement medication can improve both conditions.
Thyroid nodules are present in up to 50% of the population, but most cannot be seen and only around 5% can be felt at all. Several nodules that cluster in an enlarged thyroid gland, called a goiter, can arise with no cause or from consuming too little iodine.
D.C.headhunter Jo T. first discovered two of these swellings the day she turned 50 in a yoga class, when they caused her to “choke/cough a bit” in the downward-facing dog pose. Over the years, she experiences symptoms only in the down-dog position, and these go away when she gets out of the pose. Based on regular ultrasounds, her doc determines the swellings are benign and advises doing nothing unless serious difficulties arise. Surgery to remove goiters risks damaging the nearby vocal chords.
Thyroid nodules should be evaluated by a doctor — because there is a small risk of malignancy, especially if the nodule is large, hard and causes pain — using ultrasound and/or biopsy. Those who received ionizing radiation treatments in the head and neck area, used during the first half of the 20th century for common complaints like acne, are more likely to develop thyroid nodules.
Some foods contain compounds that make it more difficult for the thyroid gland to produce hormones, including soy, peanuts, strawberries, broccoli, kale and other vegetables — although steaming vegetables can break down the goitrogenic compounds. Iodine is plentiful in dairy products and eggs, shellfish, seaweed and fish from the sea, and meat and some breads, as well as in about half of the multivitamins available in the U.S.
Iodized salt contains about 400 mcg (micrograms) of iodine per teaspoon, with the RDA (Recommended Dietary Allowance) for adults set at 150 mcg per day. Before iodine was added to salt, the greatest risk of thyroid deficiency existed among people living far from the ocean where there is less iodine in the soil, such as in the Midwest and Great Lakes —at one time dubbed the “goiter belt.” As people consume less salt, those closer to the ocean fare better: for women in the DMV, higher iodine levels in soil are the great protector.
— Mary Carpenter Mary is the Well-Being Editor of MyLittleBird. Read more about Mary here. Her last post was about hearing loss.
D.C.-AREA PSYCHOLOGIST Lisa Horowitz first noticed a problem while hiking in Peru with her husband. When he turned to her, saying, “Isn’t that a beautiful sound?” Horowitz heard nothing. The flute music he described was composed of those high-frequency sounds that are the first ones lost as hearing ages after years of exposure to noise, and especially to loud music.
Over time, tiny hairs in the inner ear responsible for most hearing are destroyed. “Presbycusis,” with presby defined as old or aging, starts with diminished clarity: Losing the soft, high-pitched sounds makes it harder to distinguish words. Signs of hearing loss include complaints that others are mumbling; requests that people repeat themselves; needs for higher volume on TV or radio; and trouble hearing at public gatherings, in conversations with a large group and when the speaker is in another room.
Among reasons to pay attention to these signs, untreated hearing loss is both an indication and a cause of dementia—another use-it-or-lose-it situation. Fewer signals reaching the brain’s auditory system allow it to atrophy—called “adult-onset auditory deprivation”—after which hearing aids can no longer work as well to improve hearing. Conversely, because symptoms associated with hearing loss are similar to those for early Alzheimer’s—depression, feelings of isolation, problems understanding what’s being said —what looked like dementia may disappear when hearing loss is addressed. For this reason, too, it’s important to get devices for both ears to keep stimulating both sets of auditory pathways.
High-frequency hearing loss affects about 15% of Americans between ages 20 and 69, and one in three by age 65. One study suggests that about 50% of U.S. baby boomers experience some hearing loss, and that boomers are losing hearing at a more rapid pace than previous generations. Of these, only about 20% get help. Anyone who encounters hearing loss also encounters an inadequate hearing-aid industry—an industry of “inadequate distribution and dispensing models that stifle innovation,” according to Jason Karlawish in a Forbes story, “Time to Clean the Wax out of the Hearing Aid Industry.”
For consumers, the obstacles to relief are money and lack of information. Hearing problems send people first to an ear, nose and throat (ENT) practice for an audiology test; then, if hearing loss is diagnosed, the practice offers a selection of hearing aids based on its relationships with one or two of the six companies that control the market. This “medical model” bundles costs for hardware with set-up and adjustments for a total that starts around $6,000, not covered by many insurers or Medicare.
Horowitz first explored the ENT route but was shocked at the $7,000 price tag. Then she discovered a recent innovation: hearing services in big box stores—notably Costco, which provides testing, hearing devices and check-ups for about $2,500 altogether, along with money back from Costco. Although all Costco stores have hearing centers, Horowitz chose the Gaithersburg store first because of the convenience and then because she “liked the lady (technician, not audiologist) there so much.”
Worried at first that the evaluation and/or the devices offered wouldn’t be good enough, Horowitz was impressed, saying the exam was “very thorough,” and the technician spent a lot of time explaining the options. Horowitz ordered aids made by Phonak and returned a week or two later to get them fitted and calibrated. The intensity is set low at first so you get used to them, Horowitz explained, and then can be reset at the next visit to be more sensitive. While her devices are digital and adjustments can be made via Bluetooth, Horowitz chose to get them done at Costco, where it took “just a few minutes, because I’m basically a technophobe.”
Good news also comes for those with milder hearing difficulties. Personal sound amplification devices (PSADs) or products (PSAPs) range from $27 on Amazon to $400 per ear for the Solo from Audicus and $600/ear for the Neutronic Ear. Unlike hearing aids, these do not require FDA approval. Some manufacturers offer packages that include an audiology test along with lifestyle questions—because different devices work better for different people or in different situations. For example, one wearer found the Soundhawk with its wireless microphone worked best in meetings, while the Sidekick helped with one-on-one conversations and in restaurants. Another preferred the Bean for opera and TV. Some have found that “smart PSAPs” can enhance sound in ways that hearing aids cannot, or that they work best when used along with hearing aids.
The difficulty arises if you embark on the PSAD route and find your hearing loss is, or becomes, serious enough to require hearing aids. At that point you need to begin the process again to be tested and get hearing aids. For people whose insurance covers the “medical model,” an audiologist (usually in an ENT practice) might be the best first step. Also, an audiologist may be needed to detect other causes of hearing loss, such as infection or wax build-up. For those whose hearing loss is too severe to be alleviated by external devices, the solution may be a cochlear implant.
Today’s hearing aids are digital and can be programmed (by an audiologist or by the wearer) to filter out wind or background noise and can be synchronized via Bluetooth to smartphones both for amplifying phone conversations and for using the phone to adjust the device’s settings. The latest technology uses algorithms that determine which sounds are amplified and which are muted to create an experience “substantially different from objective reality,” according to Ryan Budish in The Atlantic.
Hearing devices are categorized by where they’re worn, such as behind the ear or in the ear, with additional features that include a telecoil to pick up phone signals. Some devices reduce ambient noise using a directional microphone, multiple channels or a wind-noise manager. Annoying feedback noise, caused when sounds leak back to the hearing aid’s microphone, can be alleviated by tighter-fitting devices.
For help navigating the complicated choices, Hearing Aid Forums is “frequented by a grassroots community of extremely knowledgeable people,” according to Erica Manfred on Senior Planet. Manfred said she wishes she’d surfed the forums before getting a pair of analog aids for $2,500 from the audiology department at a local university, where no one mentioned digital devices.
Even people who end up with devices that suit and help them, including Horowitz, don’t love them. They don’t use them on weekends or sometimes just because they’re sick of wearing them. Horowitz said it’s “because I’m lazy or don’t think of it.” But for work and whenever she does wear them, Horowitz says, they make everything easier.
— Mary Carpenter Mary is the Well-Being Editor of MyLittleBird. Read more about Mary here. Her last post was on risky foot fashions.
IF YOU’RE STILL WALKING tall with stilettos and pretty polished toes, yay for you. But if your feet are complaining, those great heights and glamorous hues — either separately or in combination — may be at the root.
About 75% of Americans have foot pain at some point in their lives, mostly caused by shoes that fit poorly or that force the feet into unnatural shapes. The impact of each step exerts force on the foot equal to about 50% more than the person’s body weight, due to the small size of the foot in comparison to the body. Based on the average daily standing time of four hours, feet can support a combined force equal to about several hundred tons a day.
Stilettos reached dizzying heights in their day, with a record-breaking 20 inches from an Indian designer to Alexander McQueen’s Fall 2009 12-inch platform boots. In 2010, the highest heel available to regular customers was the Sky Heel at nine inches. For every inch in height, body weight bearing down on the front of the foot increases, according to what Neal Blitz, a foot surgeon at Bronx-Lebanon Hospital, told Huffingtonpost.com
In a Hotter Shoes survey of 3,000 women wearing high-heeled shoes (HHS), nearly 50% had twisted their ankles, but 60% of the total planned to continue wearing HHS. Studies have shown impaired functional mobility starting at a 7 cm (2.75 inch) heel, which can increase fatigue and cause misalignment of bones and joints. These also heighten the risk of falling and of injury to lower-body muscles, notably causing the medial calf injury (known as “tennis leg”) resulting from the foot’s frequent forceful push-offs.
While a poll of 3,000 women found broken ankles and twisted knees, and women of all ages suffer up to five times the number of bunions as men — Lady Gaga once stumbled in her enormous platforms while high-heel queen Victoria Beckham has large bunions visible when she wears sandals— six in 10 said they wouldn’t give up the heightened wobblers.
Stilettos will always be the “Beyonce of all shoes,” according to thefashiontag.com. But increasingly popular block heels, even at four inches, are easier on the feet — though some have dubbed them ’70s-inspired boho. With high-heeled booties, material around the ankle helps hold the foot steady to put you at less risk for injury, according to Blitz.
Wearing heels three inches and higher for long hours increases the risk of shortening the Achilles tendon, especially for those with flat feet, although this can be countered by calf-muscle stretches — best done on the edge of a step, with heels extending off the edge and dropping down to stretch. Also riskier for flat feet are ballet flats, with inadequate arch support and cushioning, though their flexibility can help strengthen hard-working muscles. Finally, flip-flops, with even less arch support or cushioning, can cause toe muscles to overgrip or if the big toe hangs over the edge, increase the risk of toe fractures.
Crowding the toes — wearing either high heels that push them against the front of the shoe or shoes that fit too tightly —runs the different risk of nail fungal infections. These have a variety of other causes, in particular nail polishes applied in layers that prevent the nail from breathing. Toenail fungus, or onychomycosis, is also more prevalent in those who work in a humid or moist environment, in people with circulation problems and/or family histories, and in older men.
Toenail polish can prevent moisture in the nail bed from evaporating through the nail. The risk of fungus can be lessened by drying toes completely before applying polish and by disinfecting pedicure tools, even if they are your own.
The foot-enhancing option warned against most vociferously by podiatric medical associations is cosmetic surgery to improve the fit of high-heeled shoes. Procedures include surgically shortening the toes and narrowing the feet, and injecting silicone into the pads of the feet. These are all likely to lead to severe foot pain, a major cause of general disability in women, especially as they age.
For the rest of us, in addition to wearing slightly lower heels with slightly more toe room and using slightly less polish, one unanimous suggestion: alternate shoes every day to avoid wearing the same pair day after day.
— Mary Carpenter Mary is the Well-Being Editor of MyLittleBird. Read more about Mary here. Her last post was about too-tight pants and Spanx.
IF YOU’RE HAPPY with your skinny jeans and Spanx, go for it! But if you’re looking for excuses to scale back on such constricting fashions, associated health issues abound.
Many people suffer from “tight pants syndrome”—abdominal discomfort, heartburn and belching, as Chicago’s Rush University Dr. John Michael Li told CBS Miami. He said pants are often three inches too small for the person’s waist. Pressure on the abdomen interferes with digestion.Tight clothes have also been blamed for blood clots as well as bladder and vaginal infections.
“Skinny jeans are meant to accentuate the way you look, not to make yourself look another way,” New York-Presbyterian Hospital/Columbia University vascular surgeon Nicholas Morrissey told HealthPop. “Clothing isn’t designed to give us a shape that we don’t have.”
For a 35-year-old British woman, tight pants caused her legs to swell until she collapsed at the side of the road and later at the hospital needed her pants cut off to release her legs. After squatting a lot during the day to help a family member move, she noticed numbness in her feet and then had trouble lifting them to walk. The diagnosis: extremely dangerous “compartment syndrome,” the result of increased pressure in a confined body space usually caused when limbs are crushed in massive construction accidents or during earthquakes.
As for “low-rise” pants, they can compress nerves in the hips, causing burning, tingling and numbness in the legs due to a condition called meralgia paresthetica, a nerve disorder like carpal tunnel syndrome. A teenager who wore shapewear under her soccer uniform until she felt numbness in her thigh and persistent abdominal pain was diagnosed with nerve damage caused by meralgia paresthetica.
The cause: pressure on the nerve that supplies sensation to the upper thighs. Meralgia paresthetica symptoms often occur on only one side of the body and can also be caused by nerve damage due to diabetes or seat belt injuries. Tight pants can also limit mobility of the hip joints, putting strain on the joint capsules and on the spine.
While reluctant to “Spanx-shame anyone,” Elizabeth Enochs on Bustle quotes physicians saying shapewear can cause nerve impingement and decreased circulation. And high-waisted shapewear that cover your whole abdomen can affect digestion and lead to bloating, gas and acid reflux.
Any synthetic material worn next to the skin, especially when it’s tight, can irritate the “lady bits,” according to Bustle. Wearing yoga pants all day—as well as tight underwear—can raise the risk of yeast and bacterial infections, caused when heat and moisture from your body as well as sweat remain trapped in the material and create good conditions for these to grow. Urinary tract infections, which can affect any part of the urinary tract, result when bacteria multiply in the urine and move into the bladder or kidney. Cystitis, a common UTI, inflames the bladder in response to chronic pressure or when yeast or fecal bacteria travel up the urethra.
“Super-tight jeans can push the fabric of your underwear all the way up into your crack, which transfers fecal bacteria from your butt toward your urethra and vagina,” Ob/Gyn Professor Rebecca Amaru at Mount Sinai Hospital in New York City told Cosmopolitan. “The rubbing itself could cause inflammation and break the skin, which makes it even easier for bacteria to get into your system.”
Cosmo suggests alternating between skinny jeans and looser-fitting bottoms—to “give your immune system a chance to clear out any bacteria that gets into your urinary tract during skinny jean days”—and warns that bacterial UTIs can be cured only with antibiotics, so see a physician ASAP.
Some women are genetically predisposed to UTIs while, for others, a series of infections can lead to chronic, repeating UTIs. An aggregated review of studies on cranberry juice concluded that it did not significantly reduce the incidence of UTIs.
While these may seem like extreme cases, wearing tight clothing is related less to health and more to fashion because what is compressed in one area will try to pop out somewhere else. So, when you’ve nailed the fitted look, it’s wise to change into something looser when you can.
— Mary Carpenter Mary is the Well-Being Editor of MyLittleBird. Read more about Mary here. Her last post was about sneezing.
THE ADVICE ON vitamin D keeps changing, but the evidence for upping daily intake appears stronger with every passing year as does evidence for its many health benefits. “In the last two decades, vitamin D has gone from being recognized for its importance in bone health to being investigated…for its potential as a preventive or treatment for more than 100 disorders, from cancer to diabetes and depression,” according to Berkeley Wellness.com.
Higher vitamin D blood levels have a positive impact on genes associated with cancer as well as with autoimmune and infectious diseases. And vitamin D appears to play a role in gaining and losing weight: Higher blood levels at the start of a low-calorie diet are good predictors of weight loss. Also, children given 1,200 IU (International Units) of vitamin D/day for four winter months reduced their risk of catching the flu by more than 40 percent.
Important questions about vitamin D remain: Are “desirable” vitamin D blood levels the cause or result of good health; and, if a healthy person increases blood levels of vitamin D with supplements, as opposed to natural sources like the sun, will they be better protected from disease?
As much as one-half of people worldwide may have deficient or insufficient blood levels of vitamin D , and deficiency rates in the U.S. are rising. Here the most vulnerable live above the 40 degree latitude north of the equator — north of Philadelphia or Denver — where getting adequate levels from the sun, the best vitamin D source, becomes more difficult. In a study of healthy young girls, ages 10 to 13, living in Bangor, Maine, nearly half had insufficient levels in March, when levels tend to be lowest following long winters. (Blood tests for vitamin D should be done in late winter to assess an individual’s lowest levels.)
Thus, women of the DMV can be less vigilant about D levels, although the body’s synthesis of vitamin D from sunshine is lower in those with darker skin and declines with age. From the same sun exposure, a 70-year-old can produce as little as one-quarter as much as a 20-year-old, and vitamin D deficiency is seen in more than three-quarters of hip-fracture patients.
A Danish study of the medical records of almost 10,000 individuals showed that lifelong low vitamin D (traced to genetic variants) increased the risk of cancer death by more than 40 percent and from any other cause by more than 30 percent. In the Danish study, small elevations in vitamin D levels were associated with a decrease in triglycerides and LDL cholesterol, and a corresponding decrease of death by digestive disease, metabolic and nutritional diseases and respiratory disease.
While nutrition experts have put optimal minimum blood levels of vitamin D at 20 ng/ml (nanograms/milliliter), many are now pushing for higher goals of 40 or 50 ng/ml. For cancer prevention, desirable levels appear to be 36 to 48 ng/ml. (On my recent blood test results, “sufficiency levels” are listed as 30 to 100 ng/ml, placing my 36 ng/ml on the low side.)
Because vitamin D from the sun is the best at raising blood levels, the general advice is, two to three times a week, to sit with arms and legs exposed to the sun before applying sunscreen for as little as 5 minutes — although some believe 10 to 20 minutes is more successful. Under the best conditions of weather and age, a fair-skinned person exposing their full body to the sun can synthesize up to 20,000 IU of vitamin D3 in 20 minutes.
The best ultraviolet rays for increasing vitamin D levels occur between 10 a.m. and 3 p.m., but vary depending on cloud cover and smog. And sunscreens with SPF as low as 15 can reduce the body’s production of vitamin D by almost 100 percent. Because vitamin D is fat-soluble, dietary fat is necessary for its absorption. Also, once stored in fat, vitamin D has a half-life of two weeks, so that winter levels can run low.
After sunlight, food is the best source of vitamin D3, especially fish oil and fatty fish, along with maitake mushrooms, eggs, chicken and fortified skim milk. Four ounces of swordfish provides 941 IU, but three ounces of tuna offers only 68 IU and a whole large egg, 44 IU. For the hardy, a tablespoon of cod liver oil tops the list at 1360 IU.
The natural form of vitamin D3, or cholecalciferol, is what the body makes in response to sunlight, and D3 supplements are created from fish oil or lanolin from sheep’s wool. In the past, supplements were composed mostly of vitamin D2, synthesized by irradiating fungus and plant matter, and the two forms were considered equally beneficial. But, perhaps because D3 is what the body produces, recent studies showed a 6% reduced risk of death from D3 supplements and/or higher blood serum levels, compared to a relative increased risk with D2. Most manufacturers have made the switch, but labels should still be checked on fortified milk, which used to contain D2, as well as prescription medicines that include vitamin D.
Daily recommended intake of vitamin D supplements, set most recently by the U.S. Institutes of Medicine (IOM) in 2010, is up to 600 IU for adults up to age 70, and up to 800 IU over age 70. Recent evidence, however, associates better health outcomes with at least 1,000 IU of vitamin D3/day, which can bring blood levels up to 30 ng/ml. Daily supplements as high as 3,000 IU might be recommended if blood levels of D are very low or in cases of weakening bones or bone loss.
According to one study, 800 IU (international units) can reduce the risk of fracture by 20% in populations at risk. Veterans taking more than 645 IU of vitamin D/day along with 4 grams of cereal fiber had a 40% reduced risk of developing precancerous colon polyps. While the upper level limit recommended to avoid toxicity is 4,000 IU/day, more than 2,000 IU could increase risk of kidney stones, kidney damage and other health problems.
— Mary Carpenter Mary is the Well-Being editor of MyLittleBird.com. Read more about Mary here. Her last post was about sneezing.
