Geriatrician, Hospitalist, Patient Advocate, Healthcare Educator

I'll Have That Salad!

Have you ever passed on a salad for something more substantial? What we need to be aware of is that we are passing on something that is actually really good and nutritious for something that likely is not. A salad is generally known as mixed greens with a dressing. Salad is a term that originates from the Latin word “sal” which means salt, which is often an ingredient in the dressing. As far as the history is concerned, we know that salads were enjoyed by ancient Romans and Greeks. Aristotle first mentioned the health benefits of swiss chard in the 4th Century BC. It was around 1894 that iceberg lettuce was developed. The Caesar salad was created by Caesar Cardini, an Italian chef likely in 1924. It was in 1939 that a restaurant in Chicago opened the first salad bar. Since then, salads are served all over the world as appetizers, side dishes, and entrees.

Researchers have noted a link between eating lots of fruits and vegetables and lower risks of many diseases, particularly cancer. Salads are a good way to get those 5 servings of fruits and vegetables a day. The base of a salad is composed of a base of greens, be it iceberg lettuce, romaine lettuce, kale, arugula, or baby spinach. The green leafy vegetables contain nutritional benefits of fiber, vitamins, minerals, and phytonutrients. Foods with phytonutrients have antioxidant and anti-inflammatory benefits. Vitamins and phytonutrients are nutritionally dense and may naturally increase your metabolism. Here are some of the ingredients you can incorporate in your salads to reap the benefits:

Ingredient Benefits
Lettuce Natural source of fiber which helps to reduce bad cholesterol (LDL), helps with weight loss, helps control blood sugar
Tomatoes Contain lycopene which helps clear free radicals in the body
Carrots Loaded with vitamin A and beta-carotene, help keep blood sugar levels under control
Bell pepper Red is the most nutritious. Compared to green bell peppers, the red ones have almost 11 times more beta-carotene and 1.5 times more vitamin C
Broccoli Source of anti-cancer enzyme sulphoraphane
Avocado Help absorb protective compounds, phytochemicals, and lutein. Also raises HDL(good cholesterol) and lowers LDL(bad cholesterol)
Fruits (apple or pear slices, strawberries, blueberries, cranberries, pomegranates) Full of vitamins
Nuts and seeds (sunflower seeds, chopped walnuts) Good source of nutrients and antioxidants
Protein (eggs, meat, beans, edamame)
Dressing (olive oil, herbs, spices, vinegar, lemon, lime, ginger)
Herbs (basil, parsley, oregano) contain antioxidants
Super sprouts Adding sprouts to salad adds to the nutritional value of your veggies

Now a word of caution, although salads are generally felt to be healthy, it is easy to make it unhealthy. Be mindful of the calorie content on salad dressings in particular. You may want to make a salad dressing at home instead. By adding too much salad dressing, croutons, or cheese, we can load on those calories.

Next time when deciding on a meal, pick a healthy, colorful, and visually appealing salad. It can be hard to choose a salad over other favorites but find ways to incorporate salads into your diet such as making ‘to go’ mason jar salads for lunch or hosting salad competitions. May, National Salad Month, is the perfect time make the effort to eat that salad!

Laugh a Little More

A day without laughter is a day wasted

Charlie Chaplin

It is often said that laughter is the best medicine. Do you remember the last time you really laughed, whole heartedly with heart and soul?  The average adult laughs about 15 to 17 times a day whereas children laugh a lot more. The health benefits of laughter are numerous, and it is one of the easiest things to do.

It was Dr. Madan Kataria, a physician in India, who developed an exercise known as laughter yoga in the 1990s and is the founder of the worldwide Laughter Yoga movement. Laughter yoga is a modern exercise involving prolonged voluntary laughter. This type of yoga is based on the belief that voluntary laughter provides similar physiological and psychological benefits as spontaneous laughter. Dr. Kataria created World Laughter Day on May 10, 1998. Since then, World Laughter Day is celebrated every year on the first Sunday of May to raise awareness of the multiple health benefits of laughing. Some of these benefits include:

  • Strengthens immune system
  • Improves blood flow and the function of blood vessels which help protect us against cardiovascular disease and heart attacks
  • Helps burn calories
  • Reduces stress level and relaxes the body
  • Diminishes pain
  • Improves overall mood as it releases endorphins, our body’s “feel good” chemicals
  • Promotes bonding between groups and individuals

Laughing is a natural part of everyday life but we need to do more of it to actually get the benefits it can offer. So, what can we do to bring more laughter into our lives? We can smile more and gravitate towards things that make us happy. Here are some ideas:

  • Spend more time playing games be it cards, board games, or along with TV game shows
  • Watch funny movies, TV shows, or videos online
  • Gravitate towards people who are laughing and playing such as kids
  • Play with your pets
  • Bring humor into your conversations
  • Take part in activities you may like such as bowling, karaoke, playing or listening to music
  • Create something you love and brings pleasure to you, it will surely make you smile-an art piece, knitting, new dish to try
  • Check out a laughter yoga class near you or on YouTube
  • Don’t be afraid to laugh at yourself

Take a mental note of what will make you smile and laugh and do more of it!

10,000 Steps a Day - Really?

There is a lot of hype about reaching a goal of 10,000 steps which translates to about 5 miles for most individuals in a day - easily trackable if you are using a smartphone app or wearable fitness tracker. The average American walks around 3000 to 6000 steps a day. Now, although it is a good goal, it may be unrealistic due to time constraints related to schedule or perhaps physical incapacity such as arthritis.

There is no real scientific basis why 10,0000 steps is recommended. So how did this number come about? In the mid 1960s, a Japanese clock company created a marketing campaign for a pedometer called the Manpo-kei(which translates to 10,000 steps). The 1964 Tokyo Olympic Games had awakened health consciousness and coupled with an obesity epidemic, it was felt this waist step counter would decrease chronic illnesses such as obesity and heart disease. Interesting enough, the Japanese character for 10,000 looks like a person walking also.

What we do know is that with increased activity, there is an overall decrease in chronic illness such as heart disease, diabetes mellitus, hypertension, and metabolic syndrome. It is good to use a step goal to motivate you to do better every day to increase your activity, be it parking a little bit further at the grocery store, taking an evening walk, taking the stairs instead of the elevator, or getting in a more intense work out.

Dr. I-Min Lee and her colleagues studied the validity of 10,000 steps which was published in JAMA Internal Medicine:

In this cohort study of 16 741 women with a mean age of 72 years, steps per day were measured over 7 days. Women who averaged approximately 4400 steps/d had significantly lower mortality rates during a follow-up of 4.3 years compared with the least active women who took approximately 2700 steps/d; as more steps per day were accrued, mortality rates progressively decreased before leveling at approximately 7500 Step

It is important, especially in the elderly population that we encourage whatever activity and step count they can accomplish because the benefit is clearly evident at a lower step count. If you are on a weight loss journey, then 10,000 steps is a good goal - reaching a 10,000 step goal is an excellent step towards achieving this.

Walking is a good exercise which does not require any special equipment except a good pair of shoes. However, keep in mind your own individual goals and health, try your best and don’t overdo it! 10,000 steps sounds like a nice goal, but each person has to take their individual goals and health in mind. More than the 10,000 step goal, the real goal should be trying your best each day to get in a little bit more activity in a way that is enjoyable to you.

Is Sitting Really Bad for Me?

We all know certain things like smoking are bad for us. What a lot of people don’t know is how bad the simple act of sitting is. The average American spends about 6 to10 hours sitting a day. This includes working, computer time, watching television, relaxing, commuting by car, bus, or train. With the global pandemic, more and more people are working remotely and that has dramatically reduced physical activity and in turn increased sedentary time.

What is not spoken too much about are the ill effects of sitting for prolonged periods of time. “Sitting disease” has been described by the scientific community to describe the adverse effects of increased sedentary behavior.

Here are just some of the effect - by no means exhaustive:

  • Metabolic syndrome
  • Muscle weakness
  • Hypertension
  • Diabetes
  • Obesity
  • Heart disease
  • Deep vein thrombosis
  • Anxiety
  • Decrease in metabolic rate
  • Decrease in life span.

If you think by adhering to the recommended amount of activity you are counteracting the effects of “Sitting disease” you are wrong. Exercise does not negate the ill effects of prolonged sitting. Even though we cannot do much about certain sedentary activities such as needing to work at a desk or a computer, making a conscious attempt every day to prevent being sedentary is something that is in our power. Here are some of the things that can be done:

  • Stand or walk every chance you get! If you can talk on the phone standing or walking, do it
  • Look into a standing desk, treadmill desk, or bike desk as an addition to your office space if space permits. If you can work on your kitchen island standing for 30 minutes, take the opportunity
  • Take a break from sitting every 30 minutes or so and stand up and stretch. Set a reminder or alarm if you need to.
  • Listen to an audible book and take a walk instead of sitting down to read a book
  • Get up and walk during TV commercials
  • If you are going to play video games, try to incorporate some active video games

Let’s Get Vaccinated!

As we rush to vaccinate as many people we can, the COVID-19 positivity rates are increasing worldwide. France has entered a third national lockdown in an attempt to save lives and curb the COVID-19 virus. Italy has now made vaccination compulsory for healthcare workers forcing them into unpaid leave if they do not comply.

Here in the United States there has been mistrust and anxiety by many when it comes to vaccination. People are concerned regarding side effects and long term effects that we may not know of. Health care is all about managing risks. The upsides of the vaccinations far outweigh the risks. If there is a chance of not getting sick enough to get hospitalized or die, why wouldn’t we take it?

The United States currently has 3 vaccines that have been approved to use.

Pfizer-BioNTech COVID-19 Vaccine

The Pfizer vaccine currently is approved for those aged 16 and over. It is a mRNA (messenger ribonucleic acid) vaccine. It does not have a real virus, instead, it contains a molecule that instructs cells on how to make a protein. In this case, the cells make a spike protein which is found on the outside of the COVID-19 virus. The immune system then makes antibodies to fight anything with this spike protein. In this way, your body is equipped to fight off the virus if it is contracted. A second dose is required to reinforce this protection in about 3 weeks. Efficacy in the elderly is 94%. Clinical trials have deduced that the vaccine is efficacious against symptomatic disease at about 95% and against severe disease at about 100%. Some of the side effects from the vaccine include flu-like symptoms, chills, weakness, and fatigue which usually subside within 72 hours.

Moderna COVID-19 (mRNA-1273) vaccine

The Moderna vaccine is currently approved for those aged 18 and over, is a mRNA vaccine, and requires a second shot at 4 weeks. It’s efficacy in the elderly is at 86% and against symptomatic disease about 94% and is also 100% against severe disease. Neither the Pfizer nor Moderna vaccines used fetal cell lines during the development or production phases.

Johnson & Johnson Single-Shot COVID-19 Vaccine

The Johnson and Johnson has been approved for those aged 18 and over. This one shot vaccine is a viral vector. In this vaccine, a carrier virus has a coronavirus spike protein added to it which then delivers it to your body. Your cells will take the spike protein activating the immune system to create antibodies. This has been shown to have an efficacy of about 42% in the elderly but it too is 100% efficacious against severe disease.

So which one is better? Which one should I take? All three of the vaccines have 100% protection against severe disease and hospitalization. The answer is that you should take any of the three that are available to you.

We all have to do our part to protect ourselves, our loved ones, and our communities.

Lets get vaccinated!

COVID-19 Long Haulers

We as a country have been living with COVID-19 for just over a year now. By now you have probably heard of people with long lasting recoveries from COVID-19 infection. These long haulers, as they are commonly known, suffer from nagging symptoms including fatigue, shortness of breath, depression, brain fog, change in taste or smell, muscle pain, weakness, hair loss, and anxiety.

Post-COVID-19 or post-acute COVID-19 is used to describe those who have symptoms that linger for more than 12 weeks after their initial diagnosis. Unfortunately, there is no rhyme or reason as to who becomes a long hauler and who does not. It is estimated that about 10% to 30% of COVID-19 patients will become “long haulers”. There are now post-COVID 19 clinics specifically geared to help these patients.

Unfortunately, not much is known but research is underway. There is no available remedy. At the present time, what is recommended is symptom management. Most of us in the medical community are encouraging adequate sleep, nutrition, exercise, and social interaction if possible. And remember to keeping a diary of symptoms so you can provide a detail account of your situation to your physician.

Finally Keep a positive attitude. Science is on our side, we will get through this.

Don't Let Your Guard Down!

With the beginning of spring and summer on its way, we can expect more people to travel and larger crowds everywhere. It is important that we do not let our guards down as COVID-19 is not gone. 

Social distancing, masking up, hand hygiene, and being vigilant about our surroundings can save lives. Especially in places where there is a high risk of contracting the virus, consider double masking.

With more and more strains of the COVID virus emerging, double masking has been a new trend among many individuals in an attempt to protect themselves and others. Layering a surgical mask with a cloth mask can reduce transmission rate. In addition, this will also provide a snugger fit.

Some pointers on masks:

  • Snug fit is important
  • Make sure to care for your mask appropriately
    • If it is a surgical mask, it should be thrown out after each use or if soiled
    • If using a cloth mask, it should be laundered like other clothes with the use in a washer and dryer. If hand washed, try to dry in the sunlight if possible.
  • Double mask if possible