What's the story on Covid shots?

There was a surge in Covid infections this summer, and most predictions are for another in the coming winter. We are also facing flu and RSV outbreaks as surely as the sun rises.

The best defense against respiratory viruses is immunization.

While nothing is guaranteed 100% safe, vaccines offer the best combination of effectiveness and safety of any medical procedure offered.

Upsetting all our plans for combatting the viruses is the chaos sown by RFK Jr, our conspiracy-theorist Secretary of HHS.

Unless you have decided to ignore all available news media, you must be aware that Kennedy summarily fired the entire expert committee that was meant to advise Americans on which immunizations to receive and more recently arranged to fire the head of the CDC (Communicable Disease Center) because she refused to endorse his unsupported anti-vax ideas.

While Kennedy has zero medical or scientific training on which to base his opinions, he has made millions of dollars in recent years peddling his conspiracy theories, both as salary from the Children’s Health Defense group he founded and from generous “referral fees” paid to him by law firms when he sent plaintiffs to them claiming injury from vaccines.

The upshot is that while in past years, Covid boosters were recommended for all, Kennedy’s hand-picked FDA staff recently approved them only for people over 65 or those with medical conditions that put them at high risk for severe outcomes from Covid.

What does that mean in practical terms?

If you are over 65, you can get the shot just as in past years: from your doctor, at a community clinic or at your local pharmacy.

There is a long list of qualifying conditions that put you at high risk. Some are obvious, such as HIV, blood cancer, diabetes and immunodeficiency, which affect only a small number.

However, the list includes many other less obvious conditions that are common: obesity, current or past smoking, physical inactivity and current or recent pregnancy.

In many states, the chain pharmacies have dropped their “come on in, it is free” approach of prior years, fearing they will not be reimbursed under the new guidelines. If you fit one of the broad groups that I listed, you may have to get your shot at a medical office or ask your doctor’s office to send you a prescription outlining your eligibility to take to the pharmacy.

It is worth the extra effort. While most of us by now have been vaccinated and/or been ill with Covid, you CAN catch it again (and again) as it mutates, and vaccination is the best way to ensure it is a nuisance rather than a serious illness.


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Do you need electrolyte or "performance" drinks?

One of my favorite cartoons showed two young men walking off the basketball court, one saying, “I am bushed; I must be really low in electrolytes;” Response: “yes, we really need some electrolytes right away. “ First man: “What are electrolytes?”

Electrolytes are minerals, predominantly sodium, potassium and calcium in the human body, that both circulate in the blood and are inside our cells, that regulate our fluid balance. The body tightly regulates the levels of electrolytes under most conditions.

You lose electrolytes, predominantly sodium, along with water when you sweat. If you lose enough, you become dehydrated and can suffer low blood pressure and feel faint.

Under most circumstances, drinking water is all you need to balance the fluid loss from heavy exercise and sweating. Rarely, if you are doing an endurance exercise such as running a marathon, particularly in hot weather, and are drinking large amounts of water, you can dilute down your serum sodium to dangerous levels. There have even been deaths.

Dozens of “sports drinks” promise to replace your electrolytes and improve your athletic performance. Most also contain lots of sugar, though sugar-free varieties are available.

Do you need these? Almost certainly not. For most sports activities, simply drinking water is fine. Remember that you also get electrolytes in your food. Bananas are rich in potassium; dairy products are rich in calcium and many foods contain sodium.

If there is anything useful in these drinks, it is more likely the sugar, which will give you quick energy for exercise. The amount of electrolytes they contain is generally modest and will not have an impact on your performance or health.

There have been recorded cases of toxins such as arsenic in these commercial sports drinks.

So, save your money. Carry a water bottle when you exercise in warm conditions and have a few pretzels when you get home.

Another product of which to be wary are the “energy drinks” and “energy shots” such as Monster, Red Bull, Celsius and Rock Star. These contain large amounts of caffeine and are often consumed by people who should get off the road or put away their books and sleep rather than force themselves to stay awake. These can cause serious heart problems and are best avoided by most of us, particularly young people.


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How could I have glaucoma? My vision is fine

The top two causes of blindness world-wide are cataracts and glaucoma.

Cataracts happen to us all eventually. This clouding of the normally clear lens is the eyes’ equivalent of graying hair. If the cataract does not bother you, it can be watched. Eventually surgery may be needed, and is usually successful, but no or minimal symptoms mean no need to do anything.

Glaucoma is different. It has been called “the sneak thief of sight,” because it can be doing serious and often permanent damage without you being aware.

The exact way glaucoma damages the eye is complicated and not fully understood. One way to think of it is that the pressure inside the eye is too high, and this pressure damages the optic nerve, the nerve that carries impulses from the retina to the brain.

Most people with glaucoma have increased eye pressure, which the optometrist or ophthalmologist can easily measure.

The reason it is complicated is that a small fraction of people have high pressures but never develop damage, while others can have classic glaucoma damage with normal pressures.

Let’s leave these outliers to the specialists and focus on the large majority, who have high intra-ocular pressure and evidence of eye damage.

The damage to the optic nerve is slow – it may take 25 years between onset and blindness. It also damages the peripheral (side) vision first, sparing the straight-ahead vision. This is what makes it so sneaky. Looking straight ahead, your vision may be fine, while you are slowly developing tunnel vision. The loss is usually permanent; progression can be stopped, but what you have lost cannot be restored.

Treatment is well-studied. For most people, eyedrops at bedtime are all that is needed. Some sufferers need two or three different drops, and a minority do not respond to drops and need surgery.

The key is early detection. Even if your vision is fine, when you hit forty, get an eye exam. You cannot suspect glaucoma yourself, and early detection is the best way to preserve your vision.


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Lithium - good for the brain?

News media recently heralded a series of publications in Nature describing evidence that lithium might be a breakthrough in the fight against Alzheimer’s disease.

Lithium? Yes, that lithium – the silver-white metal that is used in batteries and which burns easily.

Lithium has been used in medicine for over 100 years. Lithium carbonate is currently widely used to stabilize the mood swings of bipolar disorder (manic-depressive illness).

There have been tantalizing clues for many decades about a possible role for lithium in preventing or treating dementia. A “meta-analysis,” which combines the findings from multiple trials, found that lithium benefited cognitive function, though each trial was small and none individually reached statistical significance.

A study from Denmark found that higher levels of lithium in the local drinking water were associated with lower rates of Alzheimer’s disease. Another study found that among bipolar patients, those given higher dose and longer duration lithium treatment had less dementia, which was not seen in those given other medications.

The new studies found evidence from human brain samples that lithium is involved in the progression of Alzheimer’s disease, that lithium-deficient mice were much more likely to develop an Alzheimer’s-like illness and that feeding lithium orotate to the mice reversed their dementia.

Should we all take lithium? Probably not quite yet. Mice are not humans, and there is no guarantee that what works in mice will work in us.

When used for bipolar disorder, lithium has a very narrow range in which it is effective but not toxic. Toxic effects of lithium are many, including underactive thyroid, inability of the kidneys to retain water, tremors, nausea, rash and heart rhythm disorders. Prescribing doctors must regularly check blood levels.

What we can do now is increase our intake of natural food sources of lithium: fruits, leafy greens, potatoes and other root vegetables and cereals. The lithium content depends on the lithium in the soil, so it can vary a lot.

Some mineral waters are very rich in lithium. These would include Vidago from Portugal and Heilwasser from Germany. Unfortunately, it is rare to see lithium content on a label (though this may now change!).


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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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