Statins And Diabetes Risk

I’m an integrative physician.  I get a LOT of people coming to see me thinking that I will tell them they don’t need to take meds for this or that problem.  One of the most common is statins.  Recently more and more people have been concerned about the link between statins and diabetes risk.

Statins are drugs that are prescribed to lower cholesterol and prevent heart attacks and strokes.  It is very clear that they are effective in reducing the risk of a second heart attacks in people who have already had one.  However, many doctors prescribe them regularly for those who have no evidence of an increased heart disease risk.

Statins are generally very safe, but more recently there has been a growing awareness that they are linked to an increased risk of type 2 diabetes.  They also seem to make blood sugar control a little bit worse in some people who already have diabetes.

So what is the actual risk?  Before people flatly refuse to discuss them (or doctors blindly prescribe them) we should know the risks we are talking about.  I have been using an evidence-based medicine website called thennt.com to review treatments.  NNT refers to Number Needed to Treat.  How many people do we have to treat to benefit one patient?  Conversely NNH is Number Needed to Harm.  How many people do we have to treat to HURT one patient?

Low Cardiovascular Risk

Patients who have less than a 20% risk of a heart attack over the next 10 years did not seem to benefit from taking a statin.  It did not prevent overall deaths, and the NNT for preventing nonfatal heart attacks was 217 (313 for nonfatal stroke)

On the other hand, one in 204 patients treated with statins in the low-risk group developed diabetes, and one in 21 developed muscle pain bad enough they had to stop or switch medications.

High Cardiovascular Risk

Patients who already have had a heart attack or who have documented coronary heart disease are another story altogether.  These patients are usually treated with higher doses of statins (the highest available or highest tolerable dose, typically).

Over 5 years, one in 83 high-risk patients avoided a fatal cardiovascular event due to taking statin drugs.  One in 39 avoided a nonfatal heart attack, and one in 125 avoided a nonfatal stroke.  For those who have had a heart attack or stroke or have known heart disease, statins are lifesaving drugs.

On the other hand, because of the higher doses involved, they also have more risks.  One in 10 had significant muscle pain.  One in 50 developed diabetes (that they wouldn’t have developed if they hadn’t taken the drug).

So one in 50 developed diabetes, but one in 83 DIDN’T DIE from a cardiovascular death, due to taking a statin.  Having diabetes is NOT a fate worse than death.

Other options?

What else can we do for preventing heart attacks, instead of taking statins?  As I tell everyone, CHANGE YOUR DIET!  In fact, diet is MORE effective than statin drugs for preventing some cardiovascular events.

The Mediterranean diet (about which there are gazillions of websites, books, cookbooks, how-to’s, etc.) is effective for preventing death and cardiovascular events.  One in 61 patients avoided death or a nonfatal heart attack or stroke by following the Mediterranean diet.

In short, statins are effective in those who are at high risk of cardiovascular events, but not in those who are at lower risk.  There is a link between treatment with statins and diabetes risk.  However, in high risk patients the benefit (reducing death and nonfatal cardiovascular events) seems to outweigh the risk (diabetes and muscle pain).  In all patients, diet and lifestyle change is an integral part of cardiovascular risk reduction.

QUESTION: Do you take a statin?  Does this information make you more or less anxious about it?

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Plantar Fasciitis – Oh My Aching Heel!

I have been in pain for weeks.  Possibly for months.  I don’t recall when the pain started, it’s been so long.  The pain in the bottom of my left heel has ranged from a twinge to severe enough to make me limp badly.  I have plantar fasciitis.

Credit: drmoy.com

What is plantar fasciitis?

Plantar fasciitis is a mechanical problem that happens where the plantar fascia attaches to the front of the heel bone.  The plantar fascia is a tough band of tissue that supports the arch of the foot and acts as a shock absorber when we walk.  It runs from the ball of the foot to the front of the heel bone.

When the mechanics of the foot don’t work right, that attachment place gets inflamed and painful.  Typically the pain is worst first thing in the morning.  In fact if someone tells me their foot hurts on the bottom and the first step out of bed in the morning is the worst pain they feel all day, I know it’s plantar fasciitis.  Nothing else does that!

What causes plantar fasciitis?

The most common cause of plantar fasciitis is wearing the wrong shoes.  Flip-flops and other shoes with no arch support are the most common cause.  I bought some super cute Converse sneakers some months ago, and I think that’s when the pain started.  Tight calf muscles and Achilles tendons also contribute to the mechanical problems that start and maintain the problem.

What can be done about plantar fasciitis?

The first thing is to start wearing proper footwear.  If you have a high arch (like me) you are especially prone to this problem and should be very careful to wear supportive shoes.  Several people have advised me to never go barefoot, even in the house, especially on wood or tile floors.  I’m working on that!  It’s hard for me to wear shoes in the house, and most house slippers have no arch support.

Aggressive calf stretching is important to keep the calf muscles and Achilles tendons loose and limber.  My personal favorite stretch is to stand on the edge of a stair step on the balls of my feet and let my body weight pull me down into my heels.  Be sure to do calf stretches both with the knee straight and with the knee bent.  There are two big strong muscles in the calf and to stretch them both you need to stretch both ways.

Another measure to help heal the pain is ice.  Ice, ice, ice, and then when you’re done  ice some more.  A frozen water bottle is a good way to both stretch and massage the bottom of the foot while applying cold therapy.

What if it doesn’t work?

If I have a patient that comes in with persistent pain in spite of doing all the above simple things, it is usually time for a cortisone injection.  I haven’t done that yet, because I’m chicken, LOL!  It might be time for it soon, though.

In extremely resistant cases patients usually need to see the podiatrist (foot doctor).  Splinting, injections, massage, physical therapy, and sometimes even surgery may be needed.

Trust me when I tell you, good supportive quality shoes are definitely worth the expense!  It’s an investment in good pain-free foot health!

QUESTION: Have you ever had plantar fasciitis?  What did it take to get rid of it?

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Wound Healing And Nutrition

One of the most devastating complications of diabetes is chronic nonhealing foot wounds.  I’ve had many patients in the hospital for chronic wounds that become infected.  Unfortunately many of them are unable to heal their wounds and wind up with partial or complete amputations of their foot and lower leg.

Diabetics and other chronically ill older patients often have diets that aren’t healthy.  They don’t get enough healthy fats, protein and micronutrients from the food they eat.  These problems contribute to ill health and complications like poor wound healing.

Vitamin deficiencies are more common in older adults, especially those who don’t have a varied, healthy diet.  Inadequate intake, decreased absorption and use of medications  are among the causes of nutrient deficiencies.  Protein, vitamin D, folic acid, vitamin B12 and water are examples of nutrients that older adults may not get in adequate amounts.

In the case of diabetics, elevated levels of blood sugar over time result in the formation of advanced glycation end products (AGEs) which damage proteins and increase levels of inflammation in the cells and tissues.  This is one of the main ways diabetes contributes to end organ damage in just about every organ in the body.  AGEs are thought to contribute to a number of diseases, from Alzheimer’s disease to end stage kidney failure to cataracts to atherosclerotic cardiovascular disease.

If someone develops a chronic wound, what nutrients are needed to help in healing?  Protein, carbohydrate, fat, vitamins and minerals are all needed.  The best sources of these nutrients come from a healthy balanced diet of course.  However, studies have shown that 95% of Americans are not getting enough of one or more vitamins or minerals in their diet.  Especially if someone is trying to heal a wound, getting enough nutrients is critical and the patient likely will benefit from a supplement.

Protein

People who are sick or have a wound to heal need extra protein.  Estimates are that such people need about 1.5 grams per kilogram of body weight.  So a woman who weighs 70 kg (155 pounds) would need about 105 grams of protein per day.  One ounce of animal flesh (beef, poultry, pork or fish), one cup of dairy milk or one ounce of cheese contains about 8 grams protein.  One egg contains 6 grams, 8 ounces of Greek yogurt contains 23 grams, one cup of navy beans contains 20 grams and 4 ounces of tofu contain 16 grams of protein.

Fat

Getting extra fat in the diet helps provide energy and calories for healing and also provides building blocks for making new cells.  Omega 3 fats help mute inflammation and encourage healing, and omega 6 fats balance things out.  Fish oil has been shown to be helpful in patients with pressure ulcers in the ICU setting.

Carbohydrates

Complex carbohydrates provide fiber which feeds the healthy bacteria in the gut, as well as calories for energy.  Our gut bacteria help support a healthy immune system.  Healing wounds and getting well is hard work!  Depends on how malnourished someone is (and how sick they are) a patient may need up to 40 calories per kilogram of body weight.  That 70-kilogram woman above would need up to 2800 calories per day, plus more if she is doing more than just lying in bed.

It’s important that these carbohydrates should be whole-food complex carbohydrates like fresh fruits and vegetables, beans and whole grains like oatmeal.  Refined carbohydrates like white bread, bagels, bakery and the like are NOT helpful and increase the production of AGEs.

Vitamins and Minerals

Vitamin A, vitamin C, vitamin D, zinc, selenium and antioxidants have been investigated as being helpful in wound healing.  While supplementation with high doses of single nutrients has not been shown to help, using a good quality well-balanced multivitamin is smart.  After all, if only 5% of Americans get all the nutrients they need from their diet, who doesn’t need a multivitamin?  And if deficiencies slow down wound healing, those with slow-healing wounds would benefit even more!

Unfortunately many Americans are badly malnourished.  Those with very low or very high body mass index (BMI) are most at risk of significant malnutrition.

How do you know if someone is malnourished?  They may or may not lose a lot of weight, especially if they were obese to start with.  Low blood albumin levels are a clue, as is swelling (edema).  The edema may be mostly in the legs, but the arms and abdomen may be puffy and swollen too.  They are weak, and there may be a big change in their strength and ability to take care of themselves.

People who are malnourished will have loss of muscle and fat tissue.  A good place to look is at the temples.  If the temples look bony and it’s easy to feel the skull bones and see the bones of the eye sockets, it is suggestive of malnutrition.

If you know anyone with a chronic wound, especially if they are diabetic, encourage them to see their doctor and work hard to get their blood sugar under control.  Good blood sugar control slows the production of AGEs and decreases inflammation.

Also, make sure they are getting plenty of protein and taking a high-quality multivitamin.  Antioxidants and fish oil may be helpful as well.  If your doctor isn’t able to make recommendations about specific supplements, you’re welcome to reach out to me or get a quick assessment at jenniferwurstmd.com/healthprint.

Chronic wounds are tough to heal.  In addition to careful wound care and avoiding pressure on the wound, attention to a healthy diet and smart supplementation are practical steps you can take to speed up the healing process.

QUESTION: Have you known anyone with a chronic wound?  What did it take to heal it?

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What Is Pneumonia Anyway?

Angela is an older woman who unfortunately several years ago was diagnosed with multiple sclerosis.  She suddenly became weaker and was having trouble walking, shortly after developing some cold symptoms and a cough.  When she went to the ER, she was found on Xray to have evidence of pneumonia.

I’ve had two patients in the office this week with pneumonia and found myself having to explain exactly what that meant.  We’ve got tons of folks right now with cough and respiratory congestion, and the majority don’t have pneumonia.  What IS pneumonia, anyway?

Parts Of The Lung

To help you understand what pneumonia is and why it is so dangerous, we have to start with knowing the different parts of the lung and how they work.  When you take a deep breath, the air goes into your nose or mouth, down your throat, between the vocal folds (or vocal cords) and into the trachea.  This is an enormous airway that you can feel below the Adam’s apple in the front of your neck just below the skin.  It’s got ridges because of rings of cartilage that make sure the trachea stays wide open.

From the trachea, the airway divides into left and right main stem bronchi, the main airways leading to the left and right lungs.  The bronchi divide into smaller and smaller airways like the branches of a tree until they reach the alveoli.  Here is a really excellent diagram I found on WebMD (they own the copyright, so kudos to them!) that you can use to visualize these different parts.

Credit: WebMD.com

Where’s The Infection?

Different lower respiratory infections affect different parts of the lung.  (Lung infections are called lower respiratory infections, as opposed to colds, sinus infections, ear infections and strep throat which are upper respiratory infections.)

Croup, or tracheobronchitis, affects the largest airways, the trachea and mainstem bronchi.  It causes a very hoarse voice, horrible sore throat, dry painful “barking” cough and fever.  In children with small airways it can cause a high-pitched noise called stridor when they breathe.  Usually the symptoms are worst at night, especially in children.  Croup is so scary!  My son had it twice when he was small, and we were in the ER both times.  I’m a doctor, I KNEW what it was, and it was still scary!

Bronchitis is very common, and is usually caused by a cold virus.  This affects the bronchi inside the lungs themselves and causes a “rumbling” sound called rhonchi when breathing, a (usually) moist productive cough and can have associated cold symptoms like runny nose and congestion.

Bronchiolitis is a specific form of bronchitis that attacks the very smallest airways right before the alveoli.  Its most common cause is a virus called respiratory syncytial virus (RSV) that can be very dangerous for small babies.  For older children and adults it causes a cold or bronchitis, but small babies can get very sick and need hospitalization with wheezing and trouble breathing with this illness.

Pneumonia is an infection in the alveoli.  The alveoli are the sacs where carbon dioxide is released and oxygen is absorbed by the blood.  The are extremely delicate and can be badly damaged and scarred by infection.  We can often see evidence of pneumonia on Xray because larger areas of the lung can be infected.

Credit: www.med-ed.virginia.edu

What Is Pneumonia?

Symptoms of pneumonia include cough, chest pain with breathing, fever, shortness of breath and generally feeling unwell.

If the part of the lung that exchanges carbon dioxide and oxygen is full of pus and not functioning, the body can have trouble getting enough oxygen.  This can be very dangerous, especially in people who don’t have good lung function to start with (like asthmatics and people with COPD), those whose immune systems aren’t normal (like Angela with her MS, or like my diabetic patients) and those who are very young or very old.

Pneumonia is the number-8 leading cause of death in the US (with influenza).  Preventing pneumonia starts with good handwashing and includes staying generally as healthy as one possibly can.  Getting plenty of rest, eating healthy and taking a good quality multivitamin, exercising and managing your stress are integral to maintaining a strong immune system.  Vaccination against influenza and Streptococcus pneumoniae (the cause of the most dangerous form of pneumonia) decrease your risk as well.

We haven’t even started in to cold and flu season and I’m already seeing cases of pneumonia.  With the Farmer’s Almanac forecasting a long, cold, snowy winter we’d better start now to reduce our risk of pneumonia this season.

QUESTION: Have you had pneumonia?

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Chagas Disease From “Kissing Bugs?”

There have been new reports of concern about rising risk of a parasitic illness in the United States.  The illness is called Chagas disease, and it is transmitted by a certain type of insect.  Chagas disease has typically been found in Mexico, Central America and South America, but the carrier insect has been moving into the southern United States.

Triatomine Map

Chagas disease is caused by a parasite called Trypanosoma cruzi which is carried by a number of insects of the triatomine family.  The map above shows the states in which triatomine bugs have been found.

Triatomine bugs are called “kissing bugs” because they bite the lips and faces of sleeping people, dogs and other animals while they are sleeping.  They are generally found in poorly-maintained homes especially those made of adobe or those that have thatched roofs.  Modern American homes with plaster walls and well-sealed doorways don’t have much risk that these insects will get inside.  (Although stink bugs are only a little smaller than these triatomine bugs and they still get in my house.  So there’s that…)

The insects are a little larger than an inch in length:

Triatomine Stages

Here’s a better close-up photo of the insect:

Triatomine close-up

These insects are spreading into the US, but documented cases of Chagas disease transmitted INSIDE the United States are rare.  There are estimated to be about 300,000 people with Chagas disease in the United States, and almost all of them were infected in Mexico or South or Central America.

Chagas disease is rare.  In almost 20 years I’ve only ever seen one patient with it.  It starts with a bite from one of these insects that is infected with the T. cruzi organism.  When the insect bites, it also passes feces, which contains the organism.  When the bitten person wakes up and scratches or rubs the bite, they often spread the infected feces into their eyes.  This can cause swelling of the eyelids, called Romaña’s sign.

Romaña’s sign

Most of the time the body clears the infection without any trouble or illness at all.  However, if the infection becomes chronic it can cause problems with the heart and with the digestive tract.  It’s estimated that 20-30% of infected people will have medical problems related to the infection at some time in their life.  The infection can also lie dormant and reactivate, like shingles or tuberculosis, if an infected person becomes immune suppressed.  This is a potential concern in HIV-infected people or those who undergo chemotherapy for cancer or an autoimmune disease.

Chagas disease is treated with medication.  Because it is rare, typically an infectious disease specialist would be involved with treatment.

So for those who are seeing alarming reports about this “kissing bug” invading the US, there’s no need to panic right now.  The vast majority of these rare cases of Chagas disease are not caused by triatomine bites here in the United States.  If you’re not worried about malaria or Zika virus, you shouldn’t be worrying about Chagas disease at this point.

PS – Most of the information in this post comes from the CDC website.  You can visit and read more about Chagas disease here.

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Update From Shaklee Global Conference

Hello Shaklee family!  This week I’m in Las Vegas for our annual Shaklee Global Conference.  Three days of training, team-building and renewing connections with others who care just as much about health and wellness as I do 🙂

August also marks my sixth anniversary of this website!  I started blogging and wrote my first post in August 2012.  Interestingly enough, that year’s Shaklee Global Conference was in Las Vegas as well.  The more things change, the more they stay the same!

Product Changes

There are big changes to a few of Shaklee’s key product lines this year.  The first one is a reformulation of Shaklee’s Life Shake.  It has always been an effective protein supplement and central to the Shaklee 180 weight loss program.  Shaklee is always working on improving products though, and they have been hearing feedback that our customers feel the shake has too much sugar.

Not anymore!  The new Life Shake has ZERO added sugar and less than 1 gram of carbohydrate per serving.  It is a great choice for those on the ketogenic diet and all of our Paleo friends.  Shaklee has stopped adding probiotics to the shake (more on probiotics later) but it has a new ancient-grain-based prebiotic fiber blend to continue to support gut health.  In addition, there are digestive enzymes added to also support healthy and comfortable digestion.

The Life Shake is still gluten free (all the weight loss products are) and now is completely plant based, because Shaklee was able to find a plant source of the amino acid leucine which is critical to protecting muscle mass during weight loss.  It is available in soy and non-soy-based versions, four delicious flavors, and was taste-tested against the leading retail brand of protein shake, and WON.  9 out of 10 tasters in a blind taste test preferred the taste of the new Shaklee Life Shake 🙂

Several of the people who have been secretly testing the newly formulated Life Shake said they had less bloating and lost inches around their waist without really trying.  One man WAS trying and lost 36 pounds in 9 weeks!  Wow!

We also have four new additions to the YOUTH skin care line.  I had a number of customers try the YOUTH Anti-Aging Regimen and have to stop because it irritated their skin.  Shaklee has unveiled the YOUTH Hydrating Collection for those who have sensitive or dry skin or who aren’t as interested in anti-aging products!  These products are also available as a package to start and as individual items to replace as you use them up.

Clinical testing is part of how Shaklee rolls, and the Hydrating products are no difference.  Women had a tripling of the measurable hydration of their skin after one application of YOUTH Moisture Activating Serum.  There is also a new YOUTH Moisture Lock Day Cream to lock in the moisturizing effects.  Want to try it yourself?  I’ll be hosting after-conference events, watch your email for your invitation!  The first one will be Sunday, 8/26 at 9 AM at the Coffee Club on Broadview Road in Broadview Hts, OH.

If you enjoy pampering yourself with a facial every now and then, you’ll love these next two products.  The YOUTH Hydrating Gel Mask applies soothing deep hydration, and the YOUTH Purifying Clay Mask removes impurities to reveal healthy skin.  I haven’t used them myself, I’ll be able to try them when I get home.  Can’t wait!

As always, Shaklee’s products are backed by an unconditional guarantee.  Also, our skin care products are free of 2500 harmful or questionable ingredients so you can be confident our products are safe for your skin, responsibly sourced, and gentle for our environment.

One last product to tell you about, and that’s Shaklee’s new Optiflora DI.  This is a brand new probiotic supplement that has grown out of the explosion of recent research on the effect of our microbiome on our health.  Our microbiome consists of the trillions of bacteria that live in our digestive tract, oral cavity, genital tracts and on our skin.  They outnumber our own cells ten-to-one and influence our health in countless ways.  The research is moving FAST and it’s clear that just about every system from our digestion to our brain is affected by the health of our microbiome.

Optiflora DI contains healthy bacteria proven to support healthy digestion AND healthy immunity.  With 70% of our immune system living in our gut, a healthy population of microorganisms helps keep our immune system healthy.

Business Changes

Shaklee has also has made big improvements to our business support that will help business people like me keep connected to our customers while on the go.  Better follow up will help keep my customers supported in meeting their health goals!

If you’re one of the over 50% of people age 21 to 65 who would like to work to build your own dream instead of someone else’s, who want more time freedom or just want a side gig to earn extra income, please let me know.  Shaklee’s business opportunity may very well not be right for you, it’s not right for everyone!  But we won’t know until we talk it over 🙂

QUESTION: Which of Shaklee’s new products is most interesting to you?  Are you interested in learning more about Shaklee’s business opportunity?

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3 Ways To Stay Healthy While Traveling

Greetings from Las Vegas!  My family and I are in HOT and sunny Nevada right now having some fun.  Shaklee’s Global Conference begins in a few days and I can’t wait to find out about all the new products and services Shaklee has for our Shaklee family 🙂

Earlier this week I had asked myself what I should write about this weekend and, since I’m traveling I thought I would write about ways to stay healthy while traveling.  It’s not easy to keep your routines up while on the road!  Getting OUT of your normal routine is a stressor, and as you know stress lowers your immune system and makes you more prone to pick up germs.

So how do you keep your immune system strong while traveling?  There are 3 major ways to stay healthy while traveling.

Get enough rest

Yep.  We tend to burn the candle at both ends while traveling.  Isn’t it funny how we go on vacation to rest and rejuvenate, then cram our schedules full of activities and must-do lists!  This is normal and natural, but you have to make sure to leave enough time for healthy rest.

You should ideally try to stay on your normal sleep schedule while traveling.  For those with kids, that means doing your best to stick to their normal wake-up times, naptimes and bedtimes.  You know your kids, and you know how flexible they are.  My own kids can sleep anywhere, anytime.  (They are related to their Aunt Becky who once slept through the whole car ride from Cincinnati to Hilton Head, only emerging for meals and rest stops.)

Traveling to the West Coast time zone made me think a little about jetlag.  I’ll be here for about a week, so I won’t be able to avoid shifting my sleep cycle.  If it were just for a few days I’d do my best to stay on East Coast time.  Unfortunately for this length of trip it’s just too hard to fight my brain’s response to daylight and dark.  When I get home I’ll have to just be extra careful about my sleep so I don’t let myself get run down.

Eat and drink healthy

When you’re traveling it’s easy to eat crap.  Fast food, junk food and unhealthy restaurant fare are quick and convenient.  Some of us overindulge in alcohol if we don’t have to drive or get up for work the next day.  And often if you’re going to be trapped in an airplane seat you don’t want to drink as much water as you should.  Trust me, I get it!  Airplane lavatories are NOT where I want to spend my whole plane flight.

If you’re honest with yourself, you have to admit that you don’t FEEL well when you don’t EAT well.  And it’s not hard nowadays to find healthy alternatives.  Even at O’Hare I have been able to find a grilled portabello mushroom sandwich (without cheese!) at a little Mediterranean place.  Salads, whole-grain breads, and unprocessed foods are not too hard to find, you just have to look for them.

Depending on where you’re going and what you’re doing, make sure to adjust your water intake accordingly.  The climate is very dry in Nevada which of course means I need to pay more attention to my fluid intake.  If I were going on a hike or doing something physically challenging I would be sure to get advice from a local about how much water I would need.  Dehydration contributes to fatigue, can make motion sickness (like seasickness on cruise ships) worse, and can make you prone to mistakes.

Take supplements

This is not nearly as important as the other two!  However, even though it is a distant third I felt I should mention it because it.  This can definitely contribute to feeling well and keeping your immune system strong.

You should pack and take your high-quality multivitamins, of course.  You wouldn’t leave home without your prescription medication, right?  Well you should bring along your normal supplement regimen too.  Vitamin C and echinacea are two supplements that help to support the immune system.

Here are some examples of immune-support supplements you might consider.  I brought my Vitalized Immunity with me, along with all the other supplements I take daily!

It’s easy to get out of your routine when traveling.  Burning the candle at both ends with fun activities, not sleeping enough, eating the wrong foods, overindulging in alcohol, skimping on water, and forgetting your supplements are common enough and can put you and your family at risk of getting sick.  With a little discipline and foresight, though, you can arrive back home after your trip with only great memories and WITHOUT any unwanted souvenirs!

QUESTION:  Is there anything else you do to stay healthy while traveling?

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Back To School Health Concerns

It’s that time of year again!  Have you got kids going to school this fall?  Me too!  We’re shopping for school supplies and clothes and shoes just like everybody else.

Are your kids ready to go back?  There are a number of things you can do to set your kids up for success this school year!

Good Sleep

Did your kids get off their school sleep schedule this summer?  Don’t worry, if they did you should have plenty of time to get them back on-track before school starts.

Elementary school children need about 10 hours of sleep per night.  For instance, our kids’ bus came at 7:30 AM last year.  Since they got up between 6:30 and 7:00, that made our bedtime about 8:30 so that they were asleep by 9.

You will want to give plenty of time to adjust a child’s sleep schedule.  Move bedtime by no more than a half-hour per night, every few nights, to let your child adjust.  If they’ve become accustomed to sleeping in, start instituting a set wake-up time.  In the adjustment period if they seem tired let them take a short nap.

There are plenty of things to adjust to in the first few weeks of school.  Fatigue and sleepiness and battles over going to bed and waking up are things you just don’t need to deal with.

Doctor’s Visits

Are your kids playing sports this school year?  Summertime is a good time to get their sports physicals out of the way.  Don’t worry, the physical is good for a year and is covered by health insurance.  Make sure to bring along any medication administration forms (for asthma or other meds your child will need to take at school).

If your child will be heading into kindergarten or 7th grade, they will need vaccines prior to starting school.  You should have gotten paperwork from the school already if your child is affected.  Remember that although your rising 7th grader is required to have the DTaP, the meningitis and HPV vaccines are also recommended at this age.

I get a lot of questions about the HPV vaccine and dove a little deeper into that topic in this post.  Please discuss the vaccine recommendations with your child’s doctor in detail.

After the 7th grade shots, your child will be done with tetanus shots until after college (unless she hurts herself, gets bit by a dog, etc) but she will need a meningitis shot booster at age 16.  Other than annual flu shots those are all the shots your child will need.

Nutrition

My younger son participates in a summer day program every year that does not provide lunch.  We were a little concerned at the beginning that packing lunches would be a big hassle.  To our pleased surprise, it has been a very positive experience.

Our lunch planning guidelines have been that our child needs a sandwich (with deli meat and cheese) and a fruit, a vegetable, and a starch for his lunch.  We read labels and used a food scale to explore portions for the starch (often pretzels, corn chips or a granola bar).  Here’s a website with interesting school lunch ideas.

Now after several summers he makes his own lunches like a pro.  Even better, when we go to the market and our kids want to try a different food (like barbecue potato chips) we can look at ingredients and talk about what’s in there, portion sizes and how they’re manipulated, price versus value, and other good topics.  We’ve even gotten them to try some new vegetables!

From a health standpoint, heading back to school can be stressful from a health standpoint.  With a little planning your youngsters can transition into the school year happy and healthy.

QUESTION:  What back to school health concerns do you have that I didn’t discuss?  I can always talk about them next week, LOL!

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Teen Smoking And Alcohol Use Decreasing

When you talk to the teenagers in your life, do you feel like they don’t listen?  That your words go in one ear and out the other (or straight over their head altogether)? Don’t give up – there are positive signs that some kinds of substance use among our teens are on the decline.

FINALLY some good news about our teens!  There is evidence we are seeing teen smoking and alcohol use DECREASE in the USA!

There was a research article published last week in Pediatrics that found that high school seniors in 2014 were five times more likely to report they had never tried cigarettes or alcohol than they were in the mid-1970s.  Similar trends were seen for younger adolescents as well.

Why is this happening?  There are likely a lot of reasons.  First of all, it’s illegal for teens under 18 to buy or use tobacco products.  Granted, whether something is illegal isn’t a great deterrent for either teens or adults, but it does make it more difficult for teens to smoke cigarettes than it was in the 70s.

Same with alcohol.  Penalties for teenage drinking are increasing, as well as for parents who host parties where teens are drinking.

I’m seeing in my office that fewer and fewer teenagers report smoking cigarettes.  Even better, they will often tell me that cigarettes are “gross.”  I love hearing that!  Cigarettes ARE gross!  The social pressure to smoke cigarettes is definitely decreasing among teens.

The downside to this is that smoking hookah (tobacco in a water pipe) and vaping are hugely on the rise.  Both of these are also illegal to sell or provide to minors, but the social pressure seems to favor these behaviors over smoking cigarettes.

What really concerns me is the recent sharp increase in marijuana smoking.  More and more of my teenage patients tell me they smoke pot, and they often don’t see any problem with it.  It seems like high school social pressures have moved away from cigarettes and towards behaviors that seem safer but really aren’t.

Those of us who are parenting or have leadership roles with teens need to be aware of these trends and continue to work to educate our kids.  There is danger in ALL tobacco products, marijuana, alcohol, other recreational drugs, and electronic cigarettes.

QUESTION: Do you spend time with teens?  Would you agree that drinking and smoking are decreasing?

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The Best Way To Control Your Blood Sugar

Don’t eat fruit.  Don’t eat meat.  Don’t eat sugar.  Eat before exercising.  Exercise while fasting.  Don’t eat after 7 PM.

If you read books by the popular health gurus or look at Facebook posts you can get completely confused by all the conflicting advice offered for diabetics.  What is the best way for a diabetic to control their blood sugar?

Get To And Maintain A Healthy Weight

The most important thing to do to get blood sugar under control is to achieve and maintain a healthy weight.  Just that one thing will get most of our diabetics to good blood sugar control, even without medication.

It isn’t even all that critical to get to a “normal” weight for blood sugar to improve.  Even losing just 5% of body fat (10 pounds for those starting at 200 pounds) has been shown to improve glycemic control.

I have a lot of patients who ask me what they SHOULD weigh.  I tell them I’m not sure, but let’s start with 5 pounds.  The same skills that get rid of the first 5 pounds will get rid of the first 100 pounds, you just have to stick with it!

For those who are looking for a healthy, effective, simple weight loss program, I always recommend the Shaklee 180 program.  If you’re interested in more information, please click this link to check it out.  If you like to watch videos, here’s one on my YouTube channel that’s very informative.

Eat Real Food

A lot of people are afraid of eating carbohydrates.  So many people want to eat Paleo, keto, low-carb…  The list goes on!  There are a lot of problems with trying so desperately to avoid carbs that you swing the pendulum WAY in the other direction and eat more meat and dairy.  Any diet that gets you to avoid eating processed food is a step in the right direction, but plant foods are much healthier than animal based foods.

The only diet that has been shown to improve health in diabetics (blood sugar control AND heart and vascular health) is the plant-based diet.  That means fruits and veggies, root vegetables, beans, nuts, seeds and whole unprocessed grains.

I always laugh when keto and Paleo people try to say fruit is unhealthy.  Come on, now.  Anyone who tells you steak, bacon, sausage and cheese are healthy but apples will make you fat is either misinformed or outright lying to you!

A word on sweeteners.  Be aware that artificial sweeteners are not a good choice, and all sweeteners that contain calories are pretty much the same.  For instance, high-fructose corn syrup, table sugar, agave syrup and honey all impact the body about the same.  You should reduce ALL of them, and avoid artificial sweeteners altogether.

Smart Supplementation

There are a few nutrients that are helpful for maintaining blood sugar control.  For instance, chromium supplementation is well-known for helping to improve glycemic control.  In fact, there was a smallish study published out of Iran that found about 1/3 of diabetics actually have deficiencies in chromium.  (I think I might have to start testing my patients and prescribing a supplement!)

Other nutrients are helpful for diabetics, like vanadium and zinc.  The amino acid taurine also is protective and improves blood sugar control.  Magnesium is important for everybody but especially those with diabetes, high blood pressure, and increased cardiovascular risk.

Shaklee’s Glucose Regulation Complex is based on solid scientific research and formulated to promote healthy blood sugar levels.  If you’re interested, you can check this link to learn more about it.

Diabetes is getting more and more prevalent.  Two-thirds of Americans are overweight or obese, which seriously increases their risk of diabetes.  Losing weight, eating real food and smart supplementation are things you can do to improve blood sugar control.

QUESTION: Are you diabetic? What do you find helpful in controlling your blood sugar?

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