Open eyes, open minds.
Reducing the risks of long COVID-19
The phrase “that’s the long and short of it,” meaning something is summed up precisely, wandered into our lexicon via Shakespeare’s “The Merry Wives of Windsor,” in which Mistress Quickly uses the phrase turned around, “this is the short and long of it.”
Well, that original version works very well today when we’re talking about making short shrift of the dangers of long COVID-19.
Initial research published in Frontiers of Medicine reveals that hospitalized patients who seemingly recover from severe COVID-19 run more than double the risk of dying within the next year, compared to those with moderate symptoms who weren’t hospitalized or who never caught the illness. And now, a second study shows that patients hospitalized for COVID-19 with the most severe systemic inflammation have a 61 percent greater hazard of dying of any cause within one year of leaving the hospital than patients with the lowest markers for inflammation.
The short of it, however, is that the research also shows some of long COVID-19’s risks can be countered. How? By prescribing anti-inflammatory steroids when patients leave the hospital. That appears to reduce their risk of death in the following months by up to 51 percent.
This is an important step in understanding that COVID-19 often acts like a chronic disease. The knowledge may lead to ways to reduce the risk for later cardiovascular problems and brain dysfunction. So, if you have a serious COVID-19 infection, ask your doc if you should receive a steroid — or even an aspirin — routinely for the next few weeks.
New recommendations to identify diabetes earlier
Diabetes has swept the nation: As of 2018, there were 4.9 million people ages 18-44, 14.8 million ages 45-65, and 14.3 million who were 65 and older who had diabetes. But as Mia Isabella Aguilar’s children’s book says, “We Are Not All the Same, But We Are All Equal.” According to the Centers for Disease Control and Prevention, the prevalence of diagnosed diabetes is highest among American Indians/Alaska Natives (14.7 percent), people of Hispanic origin (12.5 percent), non-Hispanic Blacks (11.7 percent), and non-Hispanic Asians (9.2 percent), compared to non-Hispanic whites (7.5 percent). That means in order to provide across-the-board care, it is important to recognize differences and find ways to provide equal protection.
Here’s one smart way to do that. New findings published in the Annals of Internal Medicine have lead researchers to suggest that the BMI thresholds for diabetes screening should be specific to individual groups.
The researchers initially found that the prevalence of Type 2 diabetes in Black, Hispanic and Asian 35-year-olds with a BMI of at least 25 (indicating overweight) was much higher than for white adults with the same BMI — 3.5 percent, 3.05 percent and 3.8 percent, respectively, compared to 1.4 percent. They suggest that to protect each group from the ravages of undiagnosed diabetes, it would be smart to start screening Asian adults with a BMI of 20, Black adults with a BMI of above 18.5, and Hispanics at 18.5.
So check out your BMI — visit CDC.gov; search for “BMI.” If you’re at risk for diabetes, get a blood test. Early diagnosis can let you take lifestyle steps (and medication) to reverse the disease!
Do you have an inherited risk for cholesterol woes?
In large airports, the Transportation Security Administration seizes around 2,000 pounds of prohibited items every month. That’s a screening system we’re all glad is in place. Here’s another one: genetic screening. When it’s used in combo with clinical criteria, such as your LDL cholesterol level (or, even better, your apolipoprotein B level) and/or that a family member had a heart attack at a young age, it can alert you to an inherited trait that causes extremely elevated levels of lousy LDL cholesterol, called familial hypercholesterolemia.
A recent study reveals that if health screenings were combined with genetic testing, more than 1 million Americans with an increased inherited risk could be ID’d.
It appears that one of every 1,000 U.S. adults has one gene for familial hypercholesterolemia. Those folks are, on average, at risk for a heart attack at age 50 (men) and age 60 (women). That compares to age 66 for men and age 72 for women without the predisposing gene. If you happen to have two genes for the disorder? Cholesterol and cardiovascular problems start earlier — and so does heart disease.
Unfortunately, there’s no national screening program to identify who’s at risk. So it’s up to you. If you’re 16 or older, get a test for your level of apolipoprotein B and cholesterol. Find out if anyone related to you has had a heart attack before age 60. If that’s the case and you have elevated apolipoprotein B and/or LDL, talk to your doctor about lifestyle and medication steps to save your life.
New treatments bring relief to people with asthma, diabetes
When Khalil Gibran said “progress lies not in enhancing what is, but in advancing toward what will be,” he wasn’t talking about improvements in treatment of asthma and diabetes, but he could have been. Three new treatments are likely to change what will be for folks contending with those conditions.
1. For people dealing with uncontrolled moderate to severe asthma, a phase-3, double-blind, randomized study found that a combo of 180 micrograms of albuterol (a bronchodilator) and 160 micrograms of budesonide (a corticosteroid) used as rescue medication helps stop an asthma attack better than albuterol alone. Plus, it cut the risk of a severe asthma attack by 26 percent.
2. The Food and Drug Administration has recently approved a new Type 2 diabetes medication, tirzepatide. In five clinical studies, it’s been shown to lower A1c levels better than long-acting insulin degludec or insulin glargine, the GLP-1 receptor agonist semaglutide (Ozempic), or a placebo. A 15 mg dose of the once-weekly injection caused a 1.6 percent decrease in A1c vs. placebo — enough to put some folks’ A1C below 5.7 percent, the normal level.
3. Pain from diabetic neuropathy can be crippling. The SENZA-PDN trial shows patients receiving high-frequency (10-k-Hz) spinal cord stimulation using the FDA-approved implantable Senza System see meaningful relief. According to Cleveland Clinic researcher Dr. Christian Nasr, in the first six-month trial, which compared the device to conventional medical management, participants using Senza saw a 76.3 percent reduction in pain; 93 percent of participants then asked to have the device implanted permanently. Sweet relief may be in your future, too.
How to harness the powers of individual forms of fiber
“The future of our nation,” said former Tennessee governor Phil Bredesen, “depends on our ability to produce food and fiber to sustain the world.” And it is equally true that your individual future as a healthy person depends, in part, on your ability to consume fiber that sustains your inner world.
But what kind of fiber? After all, all fibers aren’t the same. Some are insoluble, meaning they pass right through you, doing a splendid job of housecleaning from mouth to exit ramp. Some are soluble, meaning you can digest them and improve your gut and heart health. But until recently, not much was known about the particular benefits of individual forms of soluble fiber.
That’s why scientists from the Stanford School of Medicine decided to look at the impact of eating two soluble fibers: AX (arabinoxylan), which is found in whole grains such as wheat, corn, rice, rye, oat and barley, and LCI (long-chain inulin), which shows up in onions, Jerusalem artichokes, garlic, leeks and bananas. Their study, published in Cell Host & Microbe, discovered that AX was associated with a significant reduction in lousy LDL cholesterol. A moderate intake of LCI was associated with a decrease in inflammation markers and an increase in a good-for-the-gut bacteria called Bifidobacterium that protect you from leaky gut and reduce the risk of colon cancer. Both provide health boosts. So, eat a variety of fiber to improve your heart and gut health and check out the Cleveland Clinic’s online article “11 High-Fiber Food You Should Be Eating.”
Mike Roizen, M.D. is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic.
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