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Cooking without Sodium or Sugar

Executive Chef Stan Hodes Shares Secrets of the Spice Rack

The benefits of reducing sodium and sugar in the diet are compelling, backed by well- documented studies. The flip side is an equally powerful human craving for enhanced flavor, compounded by years of exposure to products boosted with salt and sugar and the ongoing quest for umami (the fifth taste, defined by experts as the essence of deliciousness).

“Salt and sugar were once basic to preserving foods, and we’re predisposed to enjoy the sweet and the salty, the yin and the yang, such as salted caramel,” explains executive chef Stan Hodes, who has spent three decades bringing the “wow” factor to hospital and senior living meals with strict nutritional requirements. In this two-part series, he shares how to coax out natural flavors with no shakers of salt or spoonsful of sugar.

Hodes encourages a holistic approach to meeting recommended limits for calories, sodium, sugar and fat.

“All too frequently, reducing sodium in a particular product or recipe can mean amping up the sugar instead, so it’s best to consider the overall nutritional value rather than a single component,” he explains. “Then, be inspired by natural substitutes from other cultures that don’t use salt to create their remarkable flavor profiles with real punch from the very first bite, such as Cajun spice mixes or Indian garam masala (a coriander, cumin, cardamom, cloves, black pepper, cinnamon and nutmeg blend).”

Hodes’ spicy recommendations

Bagel seasoning. Low-sodium versions of this blend of poppy seeds, toasted sesame seeds, dried garlic, dehydrated onions and other spices provide a welcome bit of crunch and texture as well as flavor.

Black pepper, cayenne pepper or red pepper flakes. Eliminate the need for salt with a light dusting of these pungent peppers.

Cinnamon. A peppery and semi-sweet spice ideal for tomato sauces, curries and marinades. Hodes uses a potent mix of cinnamon and coffee as the closely held keys to flavor in his popular chili.

Citrus juices. Drizzle over cooked vegetables, tenderize meats and fish, and transform vinaigrettes with an acidic zing from the juice of a lemon, lime, orange, grapefruit or yuzu (a small Japanese citrus fruit). Additionally, try grating (zesting) the peel of a lemon and mix it into soups, marinades and beverages to bring out the flavors.

Coffee. A rich source of flavor sometimes found in Mexican moles, brewed coffee can be reduced by half in a saucepan and used in sauces, stews and gravies, or try a sprinkle of instant coffee instead.

Ginger. Chop and mix fresh ginger root into stir-fries, sauces, soups and beverages; this pungent and sweet spice is also known for its possible anti-inflammatory effects.

Infused oils. Place stalks of fresh garlic, rosemary and oregano, each in a separate bottle of olive oil, for freshly flavored dressings.

Mushrooms and beets. These naturally occurring sources of umami can easily be added to recipes for a burst of flavor: Dehydrate mushrooms by roasting until crisp and store them in a jar for future use; oven-roast beets, slice, and add to salads, soups or root vegetable platters.

Nutritional yeast. This deactivated yeast, available as flakes or powder, provides a cheesy, salty flavor without using either. Ideal on roasted vegetables or baked taco chips; when blended with carrots, potatoes, lemon juice, garlic and onion powder, “It tastes exactly like Velveeta cheese,” promises Hodes. Pour it over cooked elbow noodles for a lower-sodium, non-dairy mac ’n’ cheese.

Olives. Known for their salty taste and high sodium content, olives can be used more healthily if you soak the sodium out. Cut them in half, immerse overnight in a bowl of tap water and drain the next day.

Paprika. Warm up any recipe with fresh or smoked varieties of this vibrant red spice made from a variety of red peppers.

Sage. Strongly aromatic, with an earthy taste of citrus and pine, this herb can be used fresh or dried to flavor sauces, roasted vegetables and bean dishes.
Salsa. Store-bought salsas can bring too much sodium into the mix, so make your own fruit salsa with finely diced melons and a dash of orange juice as a colorful, phytonutrient-rich topping for grilled fish, chicken or salads.

Vinegars. Another way to use the power of acidity is with rice wine vinegars for seasoning; the sweetly sharp tang of balsamic vinegar to wake up dressings, stews and marinades; and the strong kick of apple cider vinegar.

Wines. Cook red or white wine until reduced by half, let it thicken and cool, and store in a squeeze bottle to use as a glaze for proteins.

Stan Hodes served as Executive Chef and Manager of Dining Services Operations at Baptist Hospital of Miami for 27 years, and worked as chef for the Marriott Hotels, Cancun’s Casa Magna Resort, and Royal Caribbean and Norwegian cruise lines. He was recognized by HealthLeaders magazine as one of the top 20 Most Innovative Foodservice Executives in America.

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New Year’s Resolutions Are So 2020!

What are your 2021 Anti-Resolutions?

Year after year, the pattern rarely varies. Resolutions made, promptly followed by resolutions broken. The odds of sticking to New Year’s resolutions are, in fact, completely stacked against us, as research shows a paltry success rate of between 10 and 20%. But since the challenges of 2020 have reconfigured every aspect of daily living, 2021 may be the ideal time to reset this ritual as well. Perhaps it’s time we consider this upcoming new year, the year of the anti-resolution for dieting, exercising, eating healthier and managing stress.

We’ve asked therapists steeped in mindful eating, body positivity and resilient thinking to help reframe this perennial wish list. There are no checklists to mark off or milestones to meet, just inspiration to view yourself and the world around you through a new lens.

Instead of Dieting in 2021… Consider being more mindful about what you eat.

Replace the resolve to lose weight on a diet with a shift to mindful eating. “Keep in mind that while all diets work in the short run, there’s not a single plan that has long-term results for the majority of participants, and that’s why people make the same resolution every year,” says Judith Matz, nationally recognized speaker, therapist and co-author of The Diet Survivor’s Handbook and Beyond a Shadow of a Diet. “The deprivation that comes from dieting often leads to overeating or bingeing, setting into motion an endless cycle of frustration.”

Instead, learn to eat when you’re hungry and stop when you’re full, and choose from a wide variety of foods, including healthful ones.

Matz describes the essence of the process. “First, learn to recognize when you are just beginning to feel hungry. If you have a headache, are crabby, irritable, fatigued and low on energy, you’ve waited too long and are much more likely to overeat as a result.”

Next, think about what food would make you feel satisfied. “Sometimes a fresh apple or a raw carrot is exactly what you want, and at other times you might want ice cream or a bowl of pasta. Depriving yourself of foods you love can be counterproductive – there’s room for all types of food,” she says.
For patients with specific medical issues, such as high cholesterol, Matz notes that adjustments can easily be made while still respecting the process: a craving for ice cream can be met with a sorbet instead.

Finally, trust your body to let you know when to stop eating. While that may sound simple, Matz counsels patience, especially for chronic dieters. “It can take time to tune in to your natural cues for both hunger and satiety.”

The key is to stop having rules around food and to really listen to your body. “Ultimately it’s about having a healthy relationship with food rather than focusing solely on eating so-called healthful foods,” she says.

Moving from body image to body appreciation.

An equally important shift is changing the desire for a new body size to a genuine appreciation of the body you have. Matz defines this as “body positivity, relating to your body with acceptance and respect rather than self-criticism and shame.” It means rejecting ingrained cultural messages related to body embarrassment and weight stigma and replacing them with ones that reflect inclusiveness and self-compassion. It encourages taking pleasure in natural body changes throughout your life cycle and not putting off anything you might enjoy doing because you’re not the “perfect” size or shape.

Body positivity also empowers you to view exercise positively rather than as punishment for having the wrong body. “Unhook exercise from weight, and focus on choosing exercise for endurance, strength, flexibility, stress reduction, health, social connection or just the simple pleasure of moving your body,” advises Matz.

Finally, refrain from focusing on weight loss praise, which reinforces the mistaken belief that you can’t be happy, healthy and successful unless you’re a certain body size, says Matz.
“Consider that body positivity is a gift we can give to support family, friends and, most notably, the next generation.”

Find joy in what you do and who you surround yourself with to reduce stress.

Resolving to manage stress effectively is an oft-expressed but infrequently realized New Year’s wish. But it can be triggered by one pivotal question, says influential family therapist Debbie Gross, who asks it at every session with a new client: “What brings you joy?”

She explains, “It’s transformational in terms of moving out of the survival mode many experienced last year, and into thriving mode. When people are in crisis, they become overwhelmed by the thought that no one will meet their needs. Their only goal is to focus on how to get through this moment; their attitude is ‘If I don’t take care of me, who will?’”

To stop the “anxiety spiral” in the brain, Gross recommends the “5, 4, 3” grounding exercise for staying in the present: “Focus on five things you can see, four things you can hear and three things you can feel, either physically or emotionally.”

And while it’s all too easy to devolve into perpetual doom and gloom against a backdrop of unceasing anxiety, Gross says we have a choice – Eeyore or Tigger?
“We can wake up each day just waiting for the next problem to come our way, or we can look at the world with more of a ‘beginner mind’ that recognizes small, everyday miracles,” she says. “It takes real work for some to switch the channel in their brain to that mindset, but the difference it makes is astounding.”

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Start 2021 off Right by Sticking to your Winter Exercise Plan

A Winter Workout Routine Will Prepare You For Life After COVID

Exercise will reduce pain, improve function and mobility, lower blood pressure and blood sugar, decrease risk of chronic illness and death from heart disease and many forms of cancer, enhance mood and focus, and may even help reduce your risk of contracting COVID-19.

Despite those compelling benefits, only 5% of us stick to an exercise regimen. With months of staying close to home base ahead, we asked national exercise expert Dr. Josh D’Angelo, PT, of MovementX to help us beat the odds and emerge from our winter cocoons fitter, stronger and more limber than before.

“Recent research has shown that even a little bit of exercise and movement is beneficial in improving your movement, health and life,” says Dr. D’Angelo. “We start with a focus on functional strength training exercises because it provides the best protection against future injury and helps with everything from mobility to balance. To maximize your gains, we encourage supplementing with 15-20 minutes of aerobic exercise, such as walking briskly, riding a stationary bike, dancing … or anything that gets you moving and you enjoy! And remember, every little bit of movement helps.”

Following are some ways to get started, from MovementX’s “AgeProof Your Body” program:

Work toward repeating three complete sets of these fundamental exercises: squats, pushups and abdominal strengthening for your core. Start with 5-8 repetitions each, and build weekly. Rest, repeat.

Squats. Focusing on lower body and core strength, this is one of the most functional activities and will also get your heart rate going. Proper mechanics are important.

- Stand up straight, feet shoulder width apart.
- Slowly bend knees and drop your hips backward to sit in chair. Rise and repeat.
- Pro Tip: Push energy down in your heels and into the midfoot – you should be able to wiggle your toes, and you should not feel discomfort in your knees or back.
- Advanced: Add load (dumbbells or household objects) or vary your speed as your strength and endurance improve. Adding repetitions can also increase the challenge

Pushups. These are challenging, but start with this beginner position and perform 5-8 repetitions until you can advance to a lower position and more reps.

- Start by standing 18-24 inches away from a wall. Extend your arms and place your hands on the wall, shoulder width apart. Lean toward the wall, keeping your arms straight
- Bend your elbows, allowing your body to come closer to the wall – let your chest lead, and keep your body straight.
- Push away. You should feel this in your chest, shoulders and core.
- Advanced: How low can you go? As you progress with the wall pushup, start with your feet farther away from the wall. Even lower? Position your hands on a sturdy chair for a lower incline. Lower? Go to the floor on your mat, starting with your knees set on the floor. The lowest is going for the full pushup position with only your hands and toes touching the floor.

Abdominals Series. Core strength is key to developing functional fitness that helps prevent injuries, reduce back pain and make your daily activities easier to accomplish.
- Setup: Lie on your back with knees bent, feet on floor, and arms by your sides. Your lower back should not be arched at all during this exercise; push it down into the floor to tighten abs.
- Slowly bring knees up toward your chest as you bend your elbows to let your hands meet your knees (at the edge of the thigh).
- Push your hands into your thigh just where it meets your knee, pressing your hands up and toward the ceiling. Continue to do this for 20 seconds. Make sure to breathe! Work your way up to holding for 30 seconds.

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Can We Co-Exist with COVID-19?

An Epidemiologist Separates Fact from Fiction and Offers Hope for the Future

Epidemiologists seek to learn why, how and when some people contract diseases when others don’t. Their findings are used to help monitor public health status, develop new medical treatments and disease prevention efforts, and provide an evidence base to healthcare and policy leaders.

Whether you feel the coronavirus is receding or set to surge, that testing is plentiful or inadequate, or that cases are reported as too high or too low may vary considerably based on where you live and your political leanings.

For an objective, no-spin perspective, we checked in with Jodie Guest, PhD, an epidemiologist at Emory University in Atlanta. Dr. Guest’s life’s work is studying the distribution, causes, prevention and control of diseases in populations.

Her answers to some of today’s most important questions about COVID-19 are below. Please note these reflect the situation mid-September…check our website for further updates.

Q: Are we seeing a slowdown in the number of new COVID-19 cases in the U.S.?

Dr. Guest: The number of new cases has, fortunately, plateaued or slowed down, but in many places the plateaus reflect substantially higher numbers than were reported in April, when everyone was still staying home. My concern is with schools and businesses reopening and less willingness to follow safety guidelines, the numbers may creep back up.

Q: What sites do you trust for accurate reporting on COVID-19?

Dr. Guest: I compare numbers from Johns Hopkins, Centers for Disease Control (CDC) and Worldometer to see if they match.

Q: What is the significance of the latest report from the CDC that just 6% of coronavirus deaths to date have COVID-19 as the only cause of death?

Dr. Guest: It’s not at all surprising for two reasons. One is that more than 60% of Americans have an underlying condition, such as obesity or diabetes. The risk of complications and hospitalization for people with two to three underlying conditions who contracted the virus is up to five times greater than for people with no [underlying] conditions. Second, death certificates list everything that may have contributed to mortality, including comorbid conditions and conditions caused by COVID-19 such as pneumonia. This does NOT mean that any of the more than 200,000 people who had heart disease or diabetes as an underlying condition didn’t actually die of COVID-19.

Q: Why are people of color and Latinos at greater risk of death from COVID-19?

Dr. Guest: This is not about a genetic risk of death. It’s driven by multiple factors, including a higher incidence of underlying conditions, less access to proper healthcare, greater risk of infection at the workplace and crowded living conditions that preclude social distancing.

Q: What is your take on the revised CDC guidelines that say testing for people who have been exposed to COVID-19 should be limited to those with symptoms?

Dr. Guest: Many of us in the public health community feel very strongly that we need to be testing asymptomatic people. From a public health perspective, more testing of asymptomatic people, not less, must be done to control the virus. NOTE: As of 9.18.20, CDC guidelines were revised again to state: “if you have been in close contact, such as within 6 feet of a person with documented SARS-CoV-2 infection for at least 15 minutes, and do not have symptoms, you need a test.”

Q: What are the relative risks of activity as we move forward?

Dr. Guest: There’s so much variation based on how carefully an activity is done, but there are four good rules that apply to all: Outside is safer than inside, shorter time is safer than longer, small groups are safer than bigger, and distance is safer than closeness.

Q: How might COVID-19 affect the epidemic of flu we see annually?

Dr. Guest: If we take COVID-19 prevention measures seriously – masking, social distancing, handwashing – we could have a light flu season. If we don’t, COVID-19 will make it worse. The good news is that this has already spurred many people to get their flu shots.

Q: Any other silver linings you’re seeing?

Dr. Guest: For the first time, we are having a national conversation around health disparities and inequalities. We might actually come to a reckoning and take corrective action, and that would be spectacular.

Q: What is most important for people to know about getting back to normal?

Dr. Guest: Eventually we’ll have a vaccine but we’re not going to eliminate COVID-19 completely. However, there needn’t be this level of impact on our society. I can’t emphasize enough that we have control over how this virus spreads. We need strict guidelines and most importantly, a social contract with everyone in your community. This may be the first time many of us are asking “What are we willing to do for each other?” I hope we can all rise to the challenge.

When considering whether it is safe to resume an activity, there is much variation based on how carefully an activity is done. Additional details are provided in the infographic below, courtesy of www.covid19reopen.com

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Let It Go: The Ancient Art of Meditation

Finding Peace Through Mindfulness and Meditation

Mindful, compassionate, serene, happy: emotions that have been in short supply during the pandemic but can be beautifully restored to those who embrace the chance to learn the time- honored practice and art of meditation. For many, it is as easy as downloading the Headspace app on their smartphone, receiving a seamless introduction to a technique the company describes as “rooted both in ancient history and modern science.”

There’s an App For That

Meditation has been practiced for over 3,000 years, and its benefits, improving well-being, helping eliminate insomnia, enhancing focus, decreasing stress, and reducing blood pressure, among many others, have been studied for decades.

But the real democratization of meditation may have been ushered in by the proliferation of apps like Calm, Buddhify, Insight Timer and Simple Habit. Since its 2010 debut, global leader Headspace has been downloaded more than 65 million times, a number that has steadily risen during the coronavirus crisis.

Dr. Megan Jones Bell, the company’s chief science officer, reports a tenfold increase in those starting the “stressed” meditation and a twelvefold increase in “reframing anxiety at home” users from mid-March to mid-May of 2020.

Getting Started

First, choose a time to meditate, and consistently make it part of your daily routine. Find an uncluttered, quiet spot where you won’t be disturbed. Make yourself comfortable in a chair or on the floor with a pillow behind you, close your eyes and allow yourself to let go. It’s natural to wonder, “Am I doing this right?” The experts at Headspace offer some gentle guidance:

If your body is fidgeting or your mind keeps constantly chatting, you may want to walk away from the feeling. Instead of giving up, just write off the first few minutes and give your mind time to slow down. It’s not time wasted, but time spent training the mind.
Dozing off occasionally during the first few weeks of meditation is normal. If it keeps happening, try a different time of day, sit up a little straighter or splash a little cold water on your face before you meditate.
You may feel all sorts of unpleasant emotions, such as impatience, irritation and rage. Don’t suppress them, but give them the space to arise, unravel and ultimately fall away. Do the same if you’re fixated on a particular worrisome thought, or if you’re experiencing sadness. Acknowledge the feeling, even shed a few tears, and keep meditating.
If you find yourself planning incessantly in a way that is unproductive and unhealthy, let those thoughts go and come back to your focus – a breath, an image, a way that is unproductive and unhealthy, let those thoughts go and come back to your focus – a breath, an image, a sound.
Find the sweet spot between pushing yourself too hard and not applying enough focus. You may have a certain idea of what meditation should be, but it’s important to get out of your own way and give the experience room to breathe.

More Than One Way to Meditate

More than a dozen different types of meditation are taught, including:

Guided: Form mental images of places or situations you find relaxing.
Mantra: Silently repeat a calming word, thought or phrase to prevent distracting thoughts.
Mindfulness: An increased awareness and acceptance of living in the present moment; observe thoughts and emotions, but let them pass without judgement.
Calming: Cultivate a quieter, more peaceful state of mind and improved concentration.
Insight: Set an intention to develop qualities such as wisdom and compassion.
Body scan: Sync body and mind by performing a mental scan and paying attention to any discomfort or tensions.
Visualization: Focus on a mental image.
Loving kindness: Direct positive energy and goodwill to yourself and then to others.
Resting awareness: Let thoughts simply drift away.
Zen: Focus on following the breath to foster a sense of presence.
Chakra: Bring the body’s core centers of energy into balance.

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How Red Meat Went from Taboo to Acceptable and Back Again

What’s the Beef With Red Meat?

It’s long been the case that provocative headlines, unexpected findings and misinformation travel far faster than conventional wisdom, especially in the internet age. Even respected medical journals like the Annals of Internal Medicine can become caught in a crossfire of disagreement, as occurred last year when a controversial nutritional study by the NutriRECS Consortium concluded that three servings of red and/or processed meat weekly resulted in a very small increased risk of cancer or heart disease.

NutriRECS further suggested that the evidence surrounding potential harm from regular consumption of red meat was weak, and therefore people needn’t abstain from eating it for health reasons.

So misleading was the journal’s press release headline, “New guidelines: No need to reduce red or processed meat consumption for good health”, that the entire study was offered as a cautionary tale at the most recent Menus of Change conference, an influential initiative on plant-forward eating from the Harvard T.H. Chan School of Public Health and the Culinary Institute of America.

A panel headed by Walter Willett, MD, professor and past chairman of the department of nutrition at the Harvard School of Public Health, dissected why a message that flew in the face of decades of research and established guidelines from the American Heart Association and the World Cancer Research Fund, made its way into the mainstream.

According to Dr. Willett, the major flaw was the authors’ decision to disregard numerous studies done over the years regarding red meat and health as “weak evidence” because they weren’t based solely on randomized clinical trials. While these are the gold standard of scientific research, the reality for nutrition studies can be different.

“There are no double-blinded, placebo-controlled trials of red meat and its links to cardiovascular disease or cancer,” explained Dr. Willett. “It’s not really possible to get this kind of study because people won’t stay on specific diets for years to track and compare.”

The result was elimination of influential studies and meta-analyses clearly pointing to increased risk of disease for meat eaters. This included a pivotal 2015 Harvard School of Public Health study of more than 121,000 individuals followed for an average of 26 years that showed every daily serving of processed meat was associated with a 13% higher risk of death from all causes; processed red meat increased the risk to 20%. A 2019 meta-analysis in the Annals itself showed that reducing processed red meat by three servings per week decreased the incidence of diabetes by 22%; lowered mortality from cardiovascular disease by 10% and from cancer by 7%; and decreased overall mortality by 7%.

“These statistics alone could have been the basis for a blockbuster drug,” asserted Dr. Willett.

Additionally, as came to light after the study was published, the authors’ ties to food industry groups were not accurately disclosed. In January, the journal issued a correction detailing those connections, but the panel’s experts were concerned that the damage had been done, and the study’s misleading headlines had negatively affected public acceptance of traditional nutritional guidance.

“The global consensus remains unchanged: largely replacing red meat with plant protein sources and (optionally) modest amounts of fish, poultry and dairy foods will reduce the risk of coronary heart disease, diabetes and premature death,” said Dr. Willett.

Beyond the Burger: What’s Next in Plant-Based Alternatives

Also featured at Menus of Change was a look at the growing American appetite for alternative proteins. The trend, kick-started by the popularity of plant-based burgers, intensified during the pandemic as consumers sought what they perceived as healthier foods produced in safer, sterile environments. Note: plant-based items are not always nutritionally sound, so please check the labels carefully when these products become available.

Coming soon:

Plant-based ground meat, sausages, deli slices, chicken tenders, even cookie dough
Plant based seafood, including tuna, crab cakes, fish burgers, eel and shrimp
Egg substitutes and oat-based dairy products
Lamb substitutes using organic compounds to replicate the earthy taste
Cell-based seafood and cultured meats grown from the cells of fish and animals

“Plant proteins are becoming the growth story of the decade, on the cusp of replacing fish and seafood as the fourth-most-popular protein in America.”

— Zak Weston, The Good Food Institute

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Coronavirus Vaccine: Expert Says, ‘We Need Time to Get This Right’

Expert Calls for Slow & Steady Approach in Vaccine Development

While the race to develop a coronavirus vaccine may seem as if it’s being run in slow motion, with most experts predicting a 2021 launch at earliest, by historical standards it’s unfolding with incredible swiftness. Looking back at timelines for other vaccines, it becomes evident that there are numerous reasons for a slow and steady approach, according to Michael Kinch, director of Washington University’s Centers for Research Innovation in Biotechnology and Drug Discovery. Kinch, who authored the authoritative book, Between Hope and Fear: A History of Vaccines and Human Immunity, cautions that vaccine development is a long, complex process requiring gathering of laboratory and real-world evidence and extensive evaluation.

“Testing for safety and efficacy requires considerable time, even with improved technology. We need to get this absolutely right, because if we panic and rush, there may be a price to be paid in terms of toxicity,” explains Kinch. “For example, in 1976, fear of a swine flu epidemic led to rapid development of a vaccine which caused Guillain-Barre syndrome [a paralyzing neurological disorder] in a small percentage of patients. That doesn’t normally happen if you take the time to check at each step.”

Lessons Learned from Past Vaccine Development

A salient lesson can be learned by going further back to the polio vaccine of the 1950s, according to Kinch. Long heralded as one of the 20th century’s landmark immunizations, it nevertheless encountered a problem when initially released. In a situation eerily similar to today’s coronavirus pandemic, the poliovirus’s paralyzing and often deadly effects were terrifying the nation, and the threat of prolonged quarantines as the only real mode of prevention had people desperate for a solution. In 1952, Dr. Jonas Salk began his clinical investigation of a polio vaccine, and the development and distribution schedule was significantly expedited to allow for release in 1955. Unfortunately, in the rush to launch, improper manufacturing of some of the early batches led to unnecessary outcomes.

The logistical challenges of rolling out a coronavirus vaccine will be significant, predicts Kinch.

“We need to manufacture enough of the vaccine to immunize 350 million Americans, but this will also require 350 million vials, syringes, stoppers and any other parts yet to be determined,” says Kinch. “This is fundamental to success, but we’re not fully looking it in the eye. And extending it to a world population of 7.5 billion makes it even more essential to address now.”

The stakes are enormous, as Kinch believes a successful coronavirus vaccine may have the power to change medicine for a generation.

“We’re going to rethink our approach just as we did with other epidemics which defined the 20th century from a scientific standpoint. Smallpox led to awareness of the importance of sanitation, and the vaccine which was developed eliminated the disease worldwide. Spanish flu gave us the structure of DNA and the foundations of biotechnology, and HIV-AIDS led us to focus on evidence-based science and government-sponsored clinical trials,” he says.

What can be learned through development of a safe, effective and scalable vaccine for the novel coronavirus may well parallel these important breakthroughs. As Kinch recently wrote: “Vaccines come with serious medical, social and political implications. If we anticipate and address them accordingly, the coming months and perhaps years could be among the finest hours for the United States and its people.”

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Superfoods and Your Immune System

Food for Thought: Nourishing the Immune System

As football coaches and nutritionists know, the best offense is a good defense. In the fight against COVID-19, the promise of boosting the immune system with specific ‘superfoods’ is an enticing one. However, registered dietitian Linda Gigliotti, who is a fellow of the Academy of Nutrition and Dietetics and has been in practice for more than three decades, cautions that the concept is somewhat misleading. Here is what you should consider regarding superfoods and your immune system.

Balance Leads to Immune System Harmony

She explains, “We may wish there were specific foods that could make us less susceptible to illness by building up our immune system, but it doesn’t work that way. The immune system is not a single entity, and requires harmony and balance between its different components to function well.”

According to experts, although the body continually generates immune cells, with extra ones dying off in a process called apoptosis, scientists don’t yet know how many cells are needed for optimal functioning of the immune system or what the best mix of cells may be. A better approach, according to Gigliotti, is using a mix of foods that are the building blocks of a nutritionally balanced diet (e.g., the Mediterranean diet) to support or protect the immune system, not boost it.

Foods to Support & Protect the Immune System

“There’s no one ‘superfood’ or category that should be singled out to the exclusion of others,” says Gigliotti. “The typical American diet can certainly benefit from more of an emphasis on fruits and vegetables, but eat the whole rainbow of colors – red peppers, yellow corn, orange carrots, green broccoli, brown mushrooms. Chickpeas, often touted as a superfood, are excellent, but so are other legumes, such as kidney and pinto beans. Be sure to include a variety of probiotic-rich and fiber-packed foods to promote healthy gut bacteria, which also enhances your ability to maintain health and resist disease.”

Immune System of Older Adults

For older adults the picture may be a little hazier, due to “micronutrient malnutrition,” a deficiency in essential vitamins and trace minerals obtained from the diet, which is frequently seen in seniors even in affluent countries. According to Harvard Health, some lab studies have linked deficiencies in zinc; selenium; iron; folic acid; and vitamins A, B, C and D to an altered immune response in animals.

Can Vitamin Megadoses boost your Immune System?

However, it’s important to know that megadoses of vitamins and minerals are not recommended as a preventive measure for anyone. For example, studies over the years show that vitamin C supplements do not appear to lessen the possibility of getting a cold, although they may help recover from one faster and lessen the symptoms. Taking extra-large doses is not advised, because vitamin C is water soluble and excess amounts aren’t stored in the body, but excreted. The optimal way to naturally absorb vitamin C and other vitamins is by eating a variety of fruits and vegetables. If you are concerned that you may not be getting sufficient micronutrients in your diet, you may want to consider a multi-vitamin.

Flu Season and your Immune System

How can you best support your immune system as the new flu season waits in the wings? Focus on healthy lifestyle habits, advises Gigliotti, including a balanced diet rich in fruits, vegetables, high-protein foods and whole grains; adequate sleep; regular exercise; no smoking or vaping; and managing anxiety.

And … keep washing your hands!

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Navigating Uncertain Times with Hope and Optimism

How to Adjust, Adapt and Embrace the New Normal

As we emerge cautiously from the safety of home into a world that seems comfortingly familiar yet irrefutably altered, a swirl of conflicting emotions is certain to be triggered. Relief and thankfulness may mingle uneasily with fear, anxiety and uncertainty, making it difficult to cope at times. Concierge psychologist Dr. Rebecca Johnson Osei, MA, PsyD, ABPP, shares her thoughtful perspective on navigating uncertain times with hope and optimism.

Q: What are some of the short- and long-term effects of the COVID-19 crisis on our mental health?

Dr. Johnson Osei: We’re seeing increases in anxiety and depression. Loneliness has also been a concern, due to social distancing, especially for older populations who may be more isolated from family and friends. Some are feeling grief, particularly those who weren’t able to say goodbye to a loved one, and survivor’s guilt, a common reaction to traumatic events. And most of us keenly miss the sense of control over our daily lives.

Q: How can we best manage these feelings?

Dr. Johnson Osei: Most importantly, allow yourself to experience all these emotions without guilt or judgment. They’re simply part of being human. While much of what we’re feeling may be remedied with time, be mindful and address your feelings now so they don’t become long-term issues. Also realize that you can regain control of your narrative by “reframing” your decisions. For example, instead of feeling forced to stay inside, frame it as a decision you made to protect your family. It changes your mindset when you realize that, ultimately, your behavior is your choice.

Q: Are there positive behaviors you’re seeing as a result of people learning to cope with unprecedented circumstances?

Dr. Johnson Osei: A number of really significant ones. People are gaining a renewed appreciation for the people and things they love. One-on-one time and simple human touch are valued so much more now. I imagine when friends and families reunite, there will be some really great long hugs! Being more aware of our mortality is also helping people cherish life, realizing it truly is a gift that can disappear in a second.

Being solitary and alone with our thoughts is a struggle for some, but it’s emotionally healthy to be able to entertain yourself and meet your own needs. For most Americans, coping with the discomfort of not being able to do what they want, when they want to do it, is a tough lesson, but it’s a good one to learn.

The need to connect has driven a much greater acceptance of technology than existed just a few months ago. There’s a growing willingness to think outside the box for new, ingenious ways to stay connected, and I believe this will carry on in our society well beyond the current crisis.

Q: What lessons learned from previous world crises can help guide us?

Dr. Johnson Osei: Think about how 9/11 fundamentally changed the way we travel. At first, it seemed untenable – the security lines were long and slow-moving, no one had the right size toiletries. It all feels completely normal now, and we know how to navigate the lines, pack our toiletries correctly, and wear shoes that slip on and off easily. Humans are incredibly resilient, and it’s why we’ve survived as a species. We don’t know what the new normal will look like, nor can we predict if this will go on for months or maybe years. But we do know we will adapt, and it will get easier.

Q: Any recommended strategies as we move to the next phase?

Dr. Johnson Osei: Go at the pace that’s right for you as an individual, even if it may not align with your city or state’s approach. Just because you can do something doesn’t mean you should. Be an outlier if wearing a mask or working from home makes you feel more comfortable.

Finally, it’s so important to remember: Life may be different, but this is not the end of the world we knew – it’s literally a new beginning.

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Fighting the Colonoscopy Fear Factor

Colorectal Cancer awareness could save your life.

As one of the country’s most preventable illnesses, with a readily available test that is both diagnostic and therapeutic, why does colorectal cancer (CRC) stubbornly remain the second-leading cause of cancer-related deaths in the US? The key to reducing deaths is in the colonoscopy, a direct visualization test of the entire colon that enables a physician who specializes in gastroenterology to screen for abnormal growths (polyps) and remove them before they turn cancerous. Fighting the colonoscopy fear factor through knowledge is critical.

Don’t let colonoscopy prep scare you away. Fighting the Colonoscopy Fear Factor is important to your health

For many people, the rigorous prep required to thoroughly clean out the colon the night before the test has overshadowed the colonoscopy’s lifesaving impact, resulting in a third of adults 50 or older, the group most at risk of developing colorectal cancer, to not be screened. The colonoscopy reputation deserves a major turnaround, because in 2020 the colonoscopy experience is highly manageable, with more palatable prep options, a pain-free procedure and swift reporting of results … so there’s no need to dread your colonoscopy or anxiously avoid a 10-year follow-up. You can fight the colonoscopy fear factor.

Previous prep involved drinking up to 128 ounces of salty-tasting fluid over a short time, but several new colon cleansing preparations are now available that require less fluid, according to Mayo Clinic. Products such as Prepopik, Suprep and Plenvu can be mixed with a liquid of choice, and some patients might be offered a nonprescription prep of polyethylene glycol (such as MiraLAX) followed by an electrolyte-containing drink (such as Gatorade) – but note that these lower-volume prep solutions may not be appropriate for people with heart, kidney or liver disease. If higher-volume fluid solutions are needed, a split dose makes it easier and more tolerable, with half of the laxative taken in one sitting and the other half on the morning of the procedure. Even newer possibilities are on the horizon: Keep an eye out for an edible colonoscopy prep kit that incorporates active laxative ingredients into better-tasting food bars and drinks, with final phase of trials scheduled in mid-2020.

Whatever type of solution you choose, adjust your diet a few days before your colonoscopy to include smaller portions and low-fiber foods to ensure a smoother prep. On the day before your procedure, when you’ll be on a liquid diet, treat yourself to good-tasting items like organic low-sodium broth, white grape juice, flavored sparkling waters and full-bodied coffee (without creamer). Make the prep solution more palatable by refrigerating and drinking it chilled; suck on a lemon wedge or chew a piece of gum between glasses to help mask the flavor. When the solution starts to work emptying your bowels, be prepared for your time in the bathroom with wet wipes or double ply toilet paper, a fully charged phone, and some light reading.

During the 30- to 60-minute procedure, most people will be given a mild sedative drug or an anesthetic to put them in a “twilight” sleep, while a few will require general anesthesia. A thin, flexible, lighted tube is inserted into the colon, and air, CO2, sterilized water or saline is gently pumped in to inflate the colon and allow the entire lining to be viewed. Polyps are removed if present, and biopsies are taken of any abnormal areas. After the test, you’ll recover from the sedative for about an hour before you go home and consider this mission accomplished.

Still feeling uneasy about a colonoscopy?

Noninvasive, stool-based screening tests may offer an alternative if you’re considered at average risk – that is, no family or personal history of CRC, no previous polyps, no long-standing inflammatory bowel disease or the presence of certain genetic syndromes. The most well-known is FDA-approved Cologuard, which detects DNA markers for cancer and uses fecal immunochemical testing (FIT) to find blood in the stool, with less reliable results: 92% accuracy for cancer and only 69% for advanced colon polyps, plus a 13% rate of false positives. Other options include a “virtual colonoscopy” that uses CT imaging for a detailed view of the inside of the colon and rectum or a flexible sigmoidoscopy to view the lower part of the colon, which requires the colon prep described above. However, a positive result on any of these tests will result in the need for a colonoscopy, which remains the gold standard for colon cancer testing as the most accurate way to find and remove polyps and determine the right follow-up intervals.

Under 50: Are Screenings Necessary?

For people with a family history of genetic conditions that put them at increased risk, screenings may be recommended at a younger age. Additionally, in 2018, a controversial decision was made by the American Cancer Society to lower its threshold to age 45, in response to a steady rise in the cancer’s prevalence each year since the mid-1990s among ages 20 to 54. A new 2020 study appeared to provide more evidence, showing a 46% spike in colorectal cancer incidence between ages 49 and 50 – attributed to cancer that had gone undetected in younger patients until routine screening at age 50.

Research is in progress to resolve the conflicting guidelines, but current best practices* keep 50 as the age to begin colorectal cancer screening for average-risk adults; with FIT or guaiac-based fecal occult blood testing every two years or a colonoscopy every 10 years; and no testing after age 75.

Did You Know?

More than 15 million colonoscopies are performed in the United States annually. Speaking with your doctor and being armed with the right information can make fighting the colonoscopy fear factor a little easier.

Recommendation:

We recommend all adults over the age of 40, with anemia, have a gastroenterology evaluation including colonoscopy. Please call our office for more information.

*American College of Physicians

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