Immune Boosting Foods – Lessons from a Dietitian on the Front Lines

Allison Pingel is a registered dietitian working with the Moffit Cancer Center to provide patients with the nutritional knowledge they need to stay healthy. As we know, COVID-19 is a severe threat to those individuals with an impaired immune system. Allison talks about building a strong immune system by eating correctly on a consistent basis.

The construction of this strong immune response does not occur overnight but occurs over time when you give your body the correct nutrients. She is quick to point out that there are no scientific studies that document or prove that vitamin supplements are a good substitute for foods which provide these building blocks naturally. “Fruits and vegetables are a more economical and nutritious way to obtain your necessary vitamins and minerals as well as other nutrients that are helpful including fiber.”

“Foods high in Vitamins A, C D, E and zinc support the immune system.” She cites broccoli, berries, garlic, ginger and spinach as products containing high amounts of these vitamins which assist the body in fighting infections. She encourages yogurt and nuts as plentiful sources of probiotics and zinc, which she considers essential for building a strong immune system. Additionally, she is a strong advocate of fruits and vegetables. One and a half cups to two cups of fruit per day, plus 2-3 cups of vegetables per day, are helpful for building a strong immune response.

While eating correctly to build your immune system is essential, so is some regular exercise and activities that are social and put you in touch with others in a safe manner. As spring descends on our country, it’s a fine time to take a walk or ride a bike and say hello to your friends and neighbors from a safe distance. Just make sure you adhere to your community’s stay-at-home restrictions.

The COVID-19 pandemic is frightening but with healthy eating, regular exercise and safe social interaction we will prevail and come out of this crisis stronger.

When Can I See My Grandchild? Social Distancing – Today’s Norm

I have a neighbor down the block who is a talented internist, administrator and teacher. On his resume is a stint as the Chief Medical Officer at a large urban hospital and director of the medical doctor training program as well. We walk our dogs at a safe social distance daily and update each other on the latest news on the Coronavirus in Florida.

We are also both relatively new glowing grandparents of two-year-old boys living in Dade County. Both boys brought home a viral illness 10 days ago and, quite frankly, with no testing available, we do not know what they had. The only important item is that they both recovered, and their parents are not sick.

“Do you have any idea when I can safely see Hank,” he asked rhetorically? “The CDC told me he needs two negative Covid-19 tests at least five days apart to make sure it is safe for someone over 60 years to safely take that risk. It’s difficult enough to obtain testing for acutely Ill patients so why would I waste them in this situation”?

Initial papers out of Wuhan, China demonstrate that when a sick person recovers from this infection, they continue to shed live virus for days or even weeks. Researchers either are not sure, or do not yet know, if those viral pieces can cause illness in some other susceptible host. They are not sure how someone is still contagious after recovering?

Hopefully this information will be available soon. Until we know for sure I would advise high risk patients to stay away from recovered Covid-19 patients for a few weeks.

Tonight, my wife and I will drive down to South Miami for a family BBQ. My son-in-law, daughter and grandchild, plus their dog Mia, will be on one side of a fence in a covered area. We will be across from them separated by a fence using our own gas grill. We will stay separated by a minimum of 10 yards and prepare our own food.

We will talk in person, tell some stories, sing some songs and then make the long drive home.

 

Hugs, kisses and rides on my shoulders will have to wait for another time.

Corona Virus – Update

I have been receiving multiple calls and inquiries from patients concerned about travelling within the continental United States and exposure to Coronavirus or its new name, Covid-19. To date, there have been NO cases identified in the general population outside the high-risk groups whose exposure came in China or from exposure to sick individuals who caught their illness from someone who had been to China. While the quarantine has slowed the spread of the virus here in the continental United States, there are still many unknowns such as:

  1. What are the different ways it is transmitted?
  2. Can asymptomatic persons transmit the disease before they become ill and how far in advance of symptoms can they be contagious?
  3. How long can the untreated virus live and transmit the disease on a surface such as a tabletop or doorknob?
  4. How aggressive is this virus? What percentage of the patients who contract the illness get minimally ill? What are the unexpected risk factors for severe complications? Why is the illness sparing children – for the most part?

If you have travel plans in the USA, I suggest you go. Given the season, it’s far more likely to contract illnesses such as cold or influenza.

When you travel, as always, wash your hands frequently and keep them away from your face.  Wipe down surfaces with antiviral commercial preparations frequently.

If you still haven’t received your flu shot, get one now!  Consider a second seasonal flu shot if it has been more than 3 months since the original one. However, expect to pay for the second shot since most insurers do not cover it.  Also, most pharmacy technicians will say you don’t need it.

Do not hesitate to call me if you are my patient and have any questions.

Staying Alive and Dog Ownership

A recent article published in the Journal of Circulation and Cardiovascular Outcomes looked at the effect of owning a dog on survival and mortality. The authors looked at research studies published between 1950 and May 2019.  They reviewed studies that evaluated dog ownership with all-cause mortality and cardiovascular related deaths. The studies looked at almost 4 million patients and 515 events.

Dog ownership was associated with a 24% risk reduction for all- cause mortality when compared to non-ownership with six of the studies showing a significant reduction in the risk of death. Those individuals who previously had a cardiovascular event had an even more pronounced reduction in the risk of death of all causes. When they reviewed the issue of cardiovascular death risk in dog owners who had a previous cardiac event, the risk reduction for cardiovascular death was 31%.  They reviewers dog ownership is associated with lower risk of death over the long-term, which is possibly driven by a reduction in cardiovascular mortality.

Two years ago my wife and I lost our treasured Pug of fifteen years, “Pug sly” and his sweet mix breed partner “Chloe.”  Losing these two a year apart was like losing beloved family.  We adopted a rescue Pug and then young pup who had been returned to its breeder.  At our first dog checkup with the new pets and our vet my wife expressed concern that at our age the dogs might out-live us. Our vet told us that if that were to occur, and no family members wanted the dog, he and his family would adopt them and care for them. He said that practice is common in many practices and they encourage senior citizens who can provide a loving and caring home to not worry about that aspect of continued care and adopt a dog.  While there is no data on this topic, I suspect pet ownership of cats and birds and other domestic animals requiring care and love confers similar benefits.

Blood Test Detects Gastrointestinal Cancers

David Wolpin, M.D. MPH of the Dana-Farber Cancer Institute discussed with online periodical MedPage Today the results of his research on detecting gastrointestinal cancers with a simple blood test. The test is not yet commercially available and is still in its developmental stages. The blood test did not detect cancer in 2000 cancer free individuals but did find it in the 135 GI cancer patients being evaluated at the Dana-Farber Cancer Institute. In most cases they were able to pinpoint the location of the malignancy in the GI tract based on the testing used. The more advanced the cancer, the more accurate the blood test was.

The report was part of a larger study named the Circulating Cell-Free Genome Study. This is a multi-center trial looking at over 15,000 individual patients from over 142 different medical institutions. The hope is that as the sophistication and accuracy of the test are improved, the ability of physicians to detect cancers early would improve as well.

Dr. Wolpin reminds us that most cancers that occur in the gastrointestinal tract are difficult to find and screen for and are detected at an advanced stage. He hopes that lives can be saved by finding the cancers early with a simple blood test.

New Approaches to Early Prostate Cancer

Men today diagnosed with early prostate cancer, Gleason Stage 7 or less, have the option of a new arm of care called watchful waiting. With periodic PSA blood tests, prostate biopsies and imaging studies; urologists and oncologists can follow the patient with disease felt to be not aggressive rather than radiate the lesion or surgically remove it as was done in the past. In some cases, they can watch it even closer with an approach called Active Surveillance. This week a new research treatment was made public.

MedPage Today published work by Steve Raman, M.D., of the UCLA Medical Center on his TULSA-PRO ablation clinical trial. One hundred-fifteen men with localized and low, or intermediate, risk prostate cancer underwent ultrasound blasting of the cancer using the MRI imaging equipment to direct the therapy. In his study, prostate volume decreased from 39 cubic centimeters before treatment down to 3.8 cubic centimeters after a year. Clinically significant cancer was eliminated in 80% of the study participants and 65% had no evidence of cancer after biopsy at one year. PSA blood levels decreased by 95%. The side effects were minimal with low rates of incontinence and impotence and few bowel complications.

The study leader noted that if prostate cancer reoccurred then the modalities of repeat ultrasound treatment, surgery or radiation were still possible. In August 2019, the FDA approved the TULSA-PRO Device for use. The procedure involves placing a rod-shaped device into the urethra. The device has ten ultrasound probes which are controlled by a computer program while the patient is observed in an MRI machine. The probes shoot out sound waves that heat and destroy the tissue the sound is directed at. The procedure is an outpatient procedure which can also be used to shrink a non-cancerous enlarged prostate from benign prostatic hypertrophy.

Natural Substances That Work

In an article published in the pharmaceutical journal MPR, pharmacist Cassandra Pardini, compares the use of melatonin to provide sleep to hospitalized patients taking sleep medicine zolpidem (brand name is Ambien). The patients were hospital inpatients over 18 years of age who were unaware whether they were receiving melatonin or zolpidem to sleep. These patients completed a questionnaire using the Verran and Snyder-Halpem sleep scale to respond.

There were a total of 100 patients included in the study which showed that the favorable sleep effects of melatonin were as effective as the favorable sleep effects of the zolpidem. Both sleep aids were well tolerated and there were few, if any, adverse effects such as morning grogginess or headaches.

The authors concluded that melatonin may be a better choice for inpatient sleep aid because of the lower profile for serious adverse effects. Further studies looking at dosages and drug interactions are in the planning stages.

The same periodical presented a review of the scent Lavender used to reduce anxiety. The authors performed a literature review of all the published studies on the subject. There are over 65 randomized controlled studies and 25 non -randomized studies.

When lavender was used in an inhalation method, they found a general decline in reported anxiety. The inhalation method did not lower systolic blood pressure which is felt to be a physiological marker of anxiety. When the lavender was administered as an oil preparation (Silexan 80 mg per day), for at least six weeks, there was a reduction in anxiety as measured by an accepted Anxiety scale. In a smaller study, lavender administered by massage had a positive effect as well.

There were few if any adverse effects in these studies. Clearly lavender does reduce anxiety in subsets of patients and should be considered as part of our treatment options.