Eggs - good or bad for you?

I recently came across a study showing that eating 1 or 2 eggs a week modestly reduced the risk of Alzheimer’s disease, postulated to be due to the high choline content of egg yolks. (Choline goes to form a protein that carries signals between nerves.)

My immediate reaction was to think “yes, but won’t that increase your heart risk?” so I decided to dig further.

Eggs are nutrient rich, a good source of protein, lutein (important for eye health), choline and other nutrients and low in calories. (Leafy greens are another good source of lutein.) Eggs are also rich in cholesterol. One average egg yolk contains 186 mg of cholesterol, and standard diet advice is to limit our cholesterol to 300 mg/day.

Things are not so simple, however. While lowering blood cholesterol has been proven to reduce heart attack risk, blood cholesterol is much more sensitive to saturated fat in the diet than to dietary cholesterol. Most of our circulating cholesterol is manufactured in the liver, and if we eat more cholesterol, the liver makes less.

Most of us, some 70%, have no change in blood cholesterol after eating eggs. The other 30% do show an increase in cholesterol, but both HDL (good) and LDL (bad) rise.

Multiple epidemiologic studies have shown no increased heart attack risk associated with egg consumption, and a small trial using controlled diets found that increasing saturated fat in the diet raised LDL (bad) cholesterol, but eating two eggs a day did not.

So, if there is any heart risk from eating eggs, it seems to be the bacon, sausage and butter, all rich in saturated fats, that often accompany the eggs, that are the culprit.

Replacing a high carbohydrate cereal or a muffin with a couple of poached eggs will generally improve your heart health.

If you have heart disease or diabetes, get your doctor’s opinion. Otherwise, enjoy your eggs – just lay off the bacon!


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Tuberculosis? Didn't that disappear in the last century?

Tuberculosis, commonly known as TB, is one of the oldest known infectious diseases, having been found in Egyptian mummies from 3000 BC.

In 17th and 18th century Europe it was known as “consumption,” and was commonly depicted in literature and opera. Marguerite, the heroine of the novel The Lady of the Camelias and the opera La Traviata dies of TB, as do Fantine in Les Misérables and Mimi in La Boheme.

Only in 1882 did Robert Koch discover Mycobacterium tuberculosis, the bacterium that causes TB.

While TB was widespread in the US until well into the early 20th century, cases are now much less common. TB is very much a disease of poverty and crowding, and economically advanced countries see much less of it.

In the last few years, cases have been rising. There were about 8200 reported cases of TB in the US in 2022, 9600 in 2023 and 10,300 in 2024. Most of these occurred in immigrants, and most represented reactivation of old infections when the person’s immunity dropped.

Worldwide it is a different story. TB is the most common infectious cause of death in the world. In 2023, an estimated 11 million people fell ill with TB and 1.3 million died. TB is very common in southern Africa and central Asia and is a major health problem in India and China.

The best preventive measure, as with most infectious diseases, is vaccination. BCG vaccine (Bacillus Calmette-Guerin) was developed in 1921 and is particularly helpful for children, preventing the worst forms of TB. It is less effective in preventing pulmonary (lung) infection, which is by far the most common form of TB.

Once given universally, BCG vaccine is now routinely used only in Ireland and Portugal among affluent countries and is not commercially available in the US or most western countries. It is routinely given to newborns in much of Asia, southern Africa and South America.

You can still get TB, a highly transmissible illness from someone who has it in their lungs and is coughing. While you are unlikely to catch it in normal tourist sites even in high-incidence countries, it does happen.

Fortunately, active TB is usually easy to diagnose from a standard chest X-ray. Treatment is usually effective, though drug-resistant TB is not rare.

So, forgotten but not gone. As the cuts in USAID funds for disease prevention take hold, there will be a lot more TB, and some of it will hit our shores.


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Is your doctor gaslighting you?

The term "gaslighting" originates from a 1938 play and later movie which depicted a husband who manipulates his wife by dimming their gaslights and then denying that the lights have changed, making her doubt her own perception and sanity. The term has since become a psychological term for a form of emotional abuse where one person manipulates another into questioning their own reality.

In the patient safety movement, we hear the term used over and over by patients who feel their concerns are not being taken seriously by their doctors.

Many diagnoses are easy to make and verify, and that satisfies both the patient, who has an explanation for their symptoms, and the doctor, who can suggest treatment and move on to the next patient. If you have visible bleeding or an abnormal ECG or blood test, the disease can be quickly diagnosed.

Many diseases are not that easy to diagnose. The symptoms may be vague and common to many illnesses, and there may be no reliable tests to confirm or refute the diagnosis. This is particularly true for auto-immune disorders. Many such diseases are commoner in women than men, and women are much more likely to report that their doctor tried to say the symptoms were “all in their head.”

Commonly dismissed conditions include post-traumatic stress disorder (PTSD), long Covid and fibromyalgia.

A classic disease that can present in a wide variety of ways and which has no reliable blood or imaging test is endometriosis. Cells that normally line the uterus implant anywhere in the abdomen and cause recurrent pain. It has been found that it takes an average of 8.5 years between a woman first describing her symptoms and a diagnosis being made.

The way out of this dilemma is for both doctors and patients to become comfortable with uncertainty.

The worst thing a doctor can say when confronted with symptoms that have no obvious explanation is “It is all in your head. You are anxious.”

What the doctor should say is “I have no immediate explanation for your symptoms, but I believe what you are telling me, and we will work together to find out what is going on.”

This process may simply require some time to pass. A diagnosis often becomes more obvious over time. Many painful conditions are self-limited and will resolve over weeks.

Diagnosis may require a second (or third) opinion. It may require more detailed imaging or invasive testing that are not appropriate at first presentation, but which are justified as the symptoms evolve.

If you have a doctor who will work with you in this way, hold on to them.

If your doctor “gaslights” you, find another doctor!


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West Nile Virus - what it is, how to avoid it

The West Nile virus (WNV) was first identified in 1937 in Uganda, and it remained confined to East Africa for many decades. With travel and climate change, it has dramatically expanded its range since the late 1990’s, and is now found in every U.S. state, southern Canada and southern and eastern Europe.

Birds are the main host for WNV, and the virus is spread by mosquitoes, both bird to bird and bird to human. Humans are infected when a mosquito feeds on an infected bird and then bites a person. There is no direct person-to-person spread.

Fortunately, 80% of people infected have no symptoms, but about 20% develop a fever and a variety of other symptoms. Common symptoms are headache, pain behind the eyes, weakness, muscle aches, rash, nausea, vomiting and diarrhea. These come on anywhere from 2 days to 2 weeks after being bitten, so you may well not remember the bite. Symptoms may last for weeks.

A small percentage (less than 1%) of those with WNV symptoms can have much more serious illness, with the virus infecting the brain (encephalitis) and/or the tissues around the spine (meningitis).

There is no treatment for West Nile illness. For those with mild or moderate symptoms, acetaminophen, fluids and rest are advised. If you are among the severely infected, hospitalization is needed, and one in ten with neurologic disease dies, while many more are left with persistent deficits.

Since there is no treatment, and to date no vaccine, preventing mosquito bites is our best defense.

During mosquito season, avoid being outdoors at dawn and dusk or after a rainfall, when the insects are most active. Wear long-sleeved clothing. Use effective mosquito repellants, preferably those with 20-30% DEET. Do not allow standing water on your property to minimize mosquito breeding sites. When it is offered, request that local mosquito-control agencies spray your property.

Avoiding mosquito bites will also reduce the risk of many other mosquito-borne diseases. These vary with your geographic region but include Eastern Equine Encephalitis in Mass, Florida and Michigan; Zika, dengue fever and chikungunya in the southern U.S., and malaria in many parts of Africa, Asia and Central and South America.

“Better DEET than dead.”


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Blood tests for cancer screening: should I get one?

You may have seen print or television ads promoting the Galleri blood test for “early cancer detection.” Neither this test nor any others are covered by Medicare or commercial insurance, but you can have it if ordered by your doctor and you are willing to pay $949 out of pocket.

Assuming you can afford it, is it worth it?

It is considered self-evident that detecting cancer early is better than finding it late, and routine colonoscopy for the detection of early cancer or pre-cancerous polyps does prevent colon cancer deaths. Screening smokers for lung cancer with low-dose chest CT scans has also been shown to reduce the death rate from lung cancer. While somewhat controversial, there is evidence that routine mammograms reduce breast cancer deaths.

This leaves many cancers for which there is no accepted screening tool. Also, not all eligible people are able or willing to have the tests mentioned. Enter the “liquid biopsy,” a single blood test that promises to detect many cancers.

These tests work by detecting minute amounts of tumor DNA or abnormal proteins secreted by cancers.

There are many problems with these tests.

First, while they are pretty good (90%) at detecting advanced cancer, which has already spread, they are much less effective (15%) at detecting early localized cancers, the kind where early detection and surgery is expected to be life-saving.

Secondly, they have a high number of “false positives:” an abnormal test but no detectable cancer. In two large studies, enrolling over 16,000 people, 600 people had positive tests. The large majority had no cancer and only 14 had early-stage solid tumors that were treated. Most of the positive tests required extensive imaging and invasive biopsies to be sure there was no cancer.

To date, there has not been any evidence that screening with a blood test saves lives.

Bottom line: have your colonoscopy. Have your Pap and mammogram. If you are middle-aged and have smoked, have a screening chest CT.

I am sure that more precise and actionable tests are on the horizon. For the time being, do not spend your money on a blood test that is unlikely to impact your survival and that may lead to uncomfortable and possibly dangerous testing.




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Fluoride in the water - good or bad?

In April, Robert Kenedy Jr ordered the CDC to stop recommending fluoridation of the public water supply, contrary to the recommendation of the American Dental Association and most public health experts.

Why the controversy? Is fluoridation a Communist plot to weaken our society as General Jack D Ripper thundered in Dr. Strangelove?

The science behind fluoridation is solid. Fluoride helps remineralize tooth enamel and it prevents cavities. An experiment was done in Michigan beginning in 1945. Fluoride was added to the public water supply in Grand Rapids, and its citizens were carefully followed and compared to those in nearby Muskegon whose water was left alone.

The experiment was to run for 15 years, but the results were so obvious within six years, with cavities plummeting in Grand Rapids, that the residents of Muskegon demanded their water be fluoridated. The American Dental Association endorsed fluoridation in 1950 and still does.

In Utah, where Salt Lake City has fluoridated water while the rest of the state does not, dentists report about half the dental caries rate in children living in Salt Lake City. Despite this, the Utah state government recently banned fluoridation.

Those opposed to fluoridation point to the dangers of high fluoride levels, which can result in discoloration of the developing teeth, brittle bones, and, at very high levels, neurologic defects in children. All of these occur at levels of fluoride much higher than that in public water. Almost anything that is safe in usual amounts can be dangerous in excess.

Another argument revolves around choice. When the public water supply is fluoridated, parents who wish to avoid fluoride must buy bottled water.

Finally, there are now other ways to get fluoride into children’s teeth. You can buy toothpaste with fluoride or have the dentist apply it. Use of toothpaste with fluoride is not as effective. Fluoride from toothpaste is applied topically and only a few times a day. It's also often rinsed off, limiting its exposure time.

The benefit of having the public water fluoridated is that this proven effective therapy is available to all, without regard to their income or ability to get regular dental care. It saves a lot of money. Estimates are that $1 spent on fluoridation saves $38 in dental expenses.

The science is clear. Fluoridation at recommended levels of 0.7 mg/liter is safe and it dramatically reduces dental cavities. Do not let conspiracy theories or disinformation sway you.


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The United States Has a Gun Problem

In 2022, there were 48,204 gun deaths in the United States, 132/day. Of these, 27,032 were suicides, 19,651 homicides, 463 unintentional and 643 fatal shootings by law enforcement.

White males have by far the highest rate of suicide by gun while black males are much more likely to be victims of homicide. The U.S. has 33 times the rate of firearm homicide as Australia.

Among 15- to 24-year-olds, homicide is the second leading cause of death (following unintentional injuries) and suicide is third. For 25- to 34-year-olds, suicide is second after unintentional injuries and homicide third.

Worst is what we do to our children. Excluding infants, gun violence accounts for 15% of deaths among those under age 20. The firearm death rate for children 1-19 in the U.S. is 29 times that of comparable large wealthy countries.

Barring a dramatic turn-around at the Supreme Court, we are not going to get rid of guns, but that does not mean we are helpless to change this story.

Much of the laws and rules governing gun ownership and safety are still set at the state level, and this has given us “natural experiments,” as we can observe what happens in states with differing policies.

State laws vary across a variety of issues. The leading areas where states can be more or less strict include universal background checks, minimum age limits for gun purchase, waiting periods, child access rules, concealed carry and “stand your ground” laws.

Of these, three had dramatic effects on lowering gun homicides and suicides: requiring universal background checks, forbidding concealed carry and not having “stand your ground” as a legitimate excuse for firing a gun. States imposing these rules had 70-90% fewer firearm deaths than states which took the opposite position.

Children benefit from stricter gun laws. In 2010 the Supreme Court allowed states to set their own firearm rules. Researchers ranked all the U.S. states into most permissive (31 states), permissive (11) and strict (8) and compared what happened to pediatric gun death rates ten years later. In the states with the most permissive laws, death rates of children by firearms went up by roughly 50% while in the states with the strictest laws, pediatric deaths fell by about 20%.

"Red flag" laws—also known as Extreme Risk Protection Orders (ERPOs)—allow courts to temporarily remove firearms from individuals deemed to be a threat to themselves or others. These have been shown to clearly reduce the risk of death by suicide, though their effect on homicide is less proven.

If you value your life, and the lives of your children and grandchildren, demand that your state legislatures enact sensible gun restrictions.


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