Lifestyle

DEAR DR. ROACH: In 2022, my primary care doctor recommended that I get a PSA test. Even though I did not believe in it, he was a very caring doctor, so I had the test done. My result showed a PSA score of 38 ng/mL. I saw a urologist and had a biopsy that showed cancer, so I was started on Lupron.After six months, I told the urologist that I did not like Lupron because I experienced hot flashes. He recommended radiation treatment. I had more X-rays done, and they found that the cancer had spread to the bone on my left side. I received radiation to the prostate, as well as radiation to the bone where the cancer had spread.A new doctor recommended that I start a new medication regimen: abiraterone with prednisone. I feel blessed, as I have no side effects. I've had continued checkups, and my PSA score is now 0 ng/mL.My question is: Should I continue taking abiraterone and prednisone, as I really don't want to take more medicines than I need to? -- M.A.ANSWER: First off, your story shows why screening for prostate cancer is important, since it can save lives by finding cancer when it is still curable. Once the cancer has spread, it is not curable, but new treatments like what you are taking can keep the disease in check, often for a long time.Radiation is an effective way to control localized prostate cancer, but medications are the mainstay of therapy for when prostate cancer has spread. The combination has worked very well for you, as evidenced by your PSA level of 0 ng/mL. However, I strongly believe you should continue your medication, since I believe it is preventing any residual prostate cancer cells from growing.If you were to stop abiraterone (which works by blocking testosterone), it is likely that the cancer would come back more quickly. Prednisone is given to help prevent an excess of a different hormone class, called mineralocorticoids, which can lead to high blood pressure and low potassium.The fact that you are feeling great and not having side effects is great, and it makes me more likely to recommend continuing abiraterone and prednisone.DEAR DR. ROACH: Could you please comment on keto and apple cider vinegar (ACV) gummies for weight loss? They are promoted by celebrities, and the gummies supposedly get rid of belly fat. Do they work? Are there any side effects? -- J.B.ANSWER: ACV has been touted as a cure for many different conditions. Putting it in gummies makes it more palatable, but it doesn't provide a lot of ACV. More importantly, there really isn't any proven benefit for weight loss, and I doubt that even a very large study would prove it effective. (I'll change my mind if a large study does prove it effective.)Furthermore, even when a person is losing weight, it is impossible to tell your body where you want it to lose weight from, whether it's the abdomen, hips or breasts. I have had many patients get upset that they lost weight where they didn't want to.Side effects include damage to the teeth and problems from taking in sugar. (An ACV gummy contains 1 gram of sugar on average, which adds up if you are taking a lot.) The gummies are not regulated by the Food and Drug Administration, so you are relying on the manufacturer to put in what they say they do.Finally, I wouldn't want a person to take these instead of having a good diet and getting regular exercise, which provide many benefits.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

Q: I'm not sick -- I have been checked out -- but now that I am 50, I'm tired a lot of the time. How can I get my energy back? -- Darlene R., Kansas City, MissouriA: You say you've been checked out by your doctor, so we will assume you don't have hormonal imbalances, a thyroid condition, anemia or heart disease -- and you are not taking a medication that causes sleepiness. (You were screened for those possibilities, right?) So, what could be going on?Lack of get-up-and-go can have lots of causes, ranging from depression to constantly sedentary behavior, with a large dash of poor nutrition thrown in. But one common cause of chronic weariness is an overload of work, family and personal matters and the chronic stress -- and emotional distress -- those can cause. Clues that chronic stress is the cause of your fatigue include moodiness, problems with short-term memory, lack of focus and trouble sleeping. The smart move is to find ways to ask for help from friends or see a therapist and to prioritize obligations. The experts at Harvard Medical School suggest that exercise like Tai Chi, walking and swimming also can dispel stress and energize you so that your muscles, bones and heart are strengthened, and your brain is sharp. Plus, strength training two or three times a week provides a big boost in muscle strength and overall energy.As you add physical activity to your daily routine, you want to make sure that what you eat provides the energy you need. You can get that from a plant-based diet that ditches added sugars, processed foods, and red and processed meats. For great recipes, check out Dr. Mike's "What to Eat When Cookbook" and the recipes at iHerb.com/blog. For information on energizing foods and supplements, check out "Constant Fatigue: Common Causes + the Best Foods and Supplements to Boost Energy" And "Feeling Fatigued? 5 Supplements for a Natural Boost of Energy" at iHerb.com/blog.* * *Q: My whole family has Type 2 diabetes and I'm prediabetic. How can I avoid full-blown diabetes? -- Hank Y., Alexandria, Louisiana  A: Type 2 diabetes is almost always related to being overweight, sedentary and nutritionally short-changed. And you've heard -- over and over -- that you should aim for 10,000 steps a day or the equivalent, eat lots of high-fiber produce, and maintain a healthy weight. But we now know some interesting specifics about the nutritional causes of the disease that you can act on easily -- and see great results!A study in The Lancet Diabetes and Endocrinology looked at data on almost 2 million folks worldwide and found concrete evidence that eating just under 2 ounces of processed meats daily boosts the risk of Type 2 diabetes over the next decade by 15%, eating about 4 ounces of unprocessed red meat boosts the risk 10% and eating around 4 ounces of poultry increases the risk by 8%. Our advice: Enjoy fish such as salmon and sea trout, skinless poultry and make sure to have a couple of all-vegetarian/vegan days weekly, loaded with protein from legumes and 100% whole grains and nutrients and fiber from fruits and vegetables.A second study out of Florida State University found that having healthy levels of insulin and zinc protects insulin-producing beta cells in the pancreas from being damaged or destroyed. You can prevent or reduce insulin resistance by adding physical activity to your daily routine and losing weight if needed. The NIH's Diabetes Prevention Program showed that losing 5% to 7% of your weight significantly reduces the risk of developing the disease. And you can get enough daily zinc (the recommended level is 8 milligrams a day for women and 11 milligrams for men) by eating poultry, fortified cereals, whole grains, nuts, and beans. For more info on preventing Type 2 diabetes, sign up for the free newsletter at LongevityPlaybook.com and check out "How to Achieve Blood Sugar Balance: Best Foods and Lifestyle Tips" at iHerb.com/blog. * * *Dr. Mike Roizen is the founder of www.longevityplaybook.com, and Dr. Mehmet Oz is global advisor to www.iHerb.com, the world's leading online health store. Roizen and Oz are chief wellness officer emeritus at Cleveland Clinic and professor emeritus at Columbia University, respectively. Together they have written 11 New York Times bestsellers (four No. 1's). (c)2024 Michael Roizen, M.D. Distributed by King Features Syndicate, Inc.

DEAR DR. ROACH: I am writing to you about my 62-year-old wife, in the hope that you can provide an opinion on a question she has and also provide us with some advice in her quest for relief from constipation and her stomach problems. It is not unusual for her to go three to four days without a bowel movement. She has been told by two different doctors who she sees regularly (an endocrinologist and a colorectal surgeon) that it is "perfectly OK" to take laxatives every day for extended periods of time.I question this, as my own research says that this is not advisable and can potentially lead to other serious problems. Can you please provide your opinion on this? -- M.M.ANSWER: Laxatives can be abused. People can overuse laxatives, leading to diarrhea as well as fluid and electrolyte abnormalities. However, using laxatives to ensure a more regular bowel movement (every one to two days, for example) is safe. We used to teach students that laxatives of the stimulant type, like senna or bisacodyl, can lead to an inability of the colon to move properly if the laxatives are stopped, but this does not seem to be the case.Although I generally start with fiber supplements for my patients with constipation, some people do not respond to fiber and need other treatments. I have also recommended surfactants like docusate (Colace), nonabsorbable solutions like polyethylene glycol (Miralax), or sugars like lactulose.If your wife is seeing an endocrinologist, they will have been sure to check her thyroid level, but sometimes I see patients with longstanding constipation due to their low thyroid levels.DEAR DR. ROACH: I was wondering if you could address some of the causes and treatments for amyotrophic lateral sclerosis (ALS). I have a dear friend who appears to be in the final stages, although her symptoms only became obvious this past October. She refused vaccination and got COVID this past September. Could this have been a triggering factor? No one could figure out why she was so sick at the beginning, since the symptoms came on so rapidly, and ALS, in my understanding, takes years to develop. -- C.M.ANSWER: ALS, also called motor neuron disease or Lou Gehrig's disease, is a progressive degenerative disease of the nervous system. In most cases, the cause is not known. A subset of people with ALS (5%-10%) have a family history and at least two genes that have been identified. Much progress has been made in understanding how the disease causes nerve damage at a molecular level. Unfortunately, ALS is, at this time, incurable, although there are treatments to slow progression (edaravone and riluzole).Age (74 is the highest incidence) and family history are the only proven risk factors, although smoking increasingly looks like a risk factor as well. COVID has not been reported as a risk factor. Many other risk factors are suspected but unproven.ALS tends to progress from one limb to another, then to the swallowing and breathing muscles. However, the rate of progression is highly variable. Fifty percent of people with symptomatic ALS will succumb to the disease within three to five years. Ten percent will live more than 10 years, but another 10% will live less than a year from their diagnosis.I have lost patients and a very dear friend to ALS as well. It's a horrible disease.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

My 9- and 12-year-olds are heading back to school, and I want to make sure they stay healthy this year. What should my priorities be? -- Sonia Y., BostonA: Heading back to school is exciting, but it does come with increased health risks, from infections (flu, strep, and the common cold) to backpack-itis (a backpack should only be 10% of your child's weight!). There's also a change in their activity level -- they're suddenly sitting in a classroom for hours a day. Our four recommendations are:1. Keep kids active. According to a 2022 Washington Post article, only 4% of elementary schools, 7% of middle schools and 2% of high schools have daily P.E. Twenty-two percent of schools have no P.E. at all. If that's your kids' school, enroll them in after-school sports and/or make sure they get to a local park or playground for at least an hour a day.2. Provide healthy food. If they receive a prepared lunch, it may contain health-damaging ultra-processed foods. Send them to school with a piece of fresh fruit to add to the lunch and some nuts (if allowed) or dried beans to snack on. If you prepare their lunch, make sure it's free of added sugar and harmful fats, and has lean protein and fresh vegetables. 3. Establish a high-quality sleep schedule for your kids. Six- to 12-year-olds need nine to 12 hours of sleep -- starting at the same time nightly, in a cool, quiet, dark room, free of digital devices. If a child can't fall asleep in 20 minutes, let them come out of the room and read a book until they're sleepy. 4. Check on their vaccination status. Let your child have the opportunity to dodge many serious infectious diseases.For more information on helping your kids stay healthy, check out "Healthy Nighttime Ritual for Kids" and "Nutrition for Your Child and When to Supplement" at iHerb.com/blog.* * *Q: I worry I am losing it, whenever I have a momentary lapse of memory. One more time, what can I do to avoid dementia? -- Francis J., Omaha, NebraskaA: We worry about the fact that almost 10% of U.S. seniors have dementia, and another 22% have mild cognitive impairment. On top of that, 13 million folks in the U.S. are projected to have Alzheimer's by 2050. But we want you to know that your lifestyle choices can go a long way in reducing your risk. And we're discovering new ways to reduce the risk all the time. Recently a study published in The Lancet found that vision loss and high LDL cholesterol levels are risk factors for dementia. They join 12 other dementia risk factors that you have influence over: physical activity, smoking, high blood pressure, obesity, Type 2 diabetes, alcohol drinking, smoking, social isolation, depression, hearing loss, air pollution and education.There are many ways to protect your brain from lifestyle and environmental risks. You know you need to be physically active and eat healthy foods so that you control your LDL cholesterol level and blood pressure. Equally important is to have a posse and a purpose. Loneliness and depression can cause cognition problems and so can some medicines -- make sure to ask your doctor about possible side effects. Air pollution (from fires lately) can also up the dementia risk. So, use masks and HEPA air filters when necessary.Also visit your doctor regularly to spot potential trouble. Fortunately, getting an accurate diagnosis of cognition problems is becoming more possible. Recently, researchers created a blood test that correctly diagnosed patients with cognition problems as having early-stage Alzheimer's with more than 90% accuracy. In contrast, they determined that dementia specialists were only able to do that 73% of the time and primary care doctors were only correct 61% of the time. For more info on protecting your brain health, check out Dr. Mike's book "The Great Age Reboot" and Dr. Oz's iHerb.com blog, "The Impact of Lifestyle on Alzheimer's Disease." * * *Dr. Mike Roizen is the founder of www.longevityplaybook.com, and Dr. Mehmet Oz is global advisor to www.iHerb.com, the world's leading online health store. Roizen and Oz are chief wellness officer emeritus at Cleveland Clinic and professor emeritus at Columbia University, respectively. Together they have written 11 New York Times bestsellers (four No. 1's). (c)2024 Michael Roizen, M.D. Distributed by King Features Syndicate, Inc.

DEAR DR. ROACH: I was diagnosed with hypothyroidism many years ago and have since been put on Synthroid. Since I am extremely healthy other than this issue, is there any chance I can go off Synthroid ever? Are there any changes I can make on my own or holistically? -- R.P.ANSWER: Most cases of hypothyroidism that are diagnosed during adulthood are due to an autoimmune disease called Hashimoto's thyroiditis. In this condition, the body attacks the thyroid gland, initially causing high thyroid levels, then leading to a slow decline in the thyroid level. This causes classic symptoms of fatigue, intolerance of cold, weight gain, dry skin, constipation, and many other nonspecific symptoms that can make the condition go unrecognized. Thyroid replacement, such as Synthroid, reverses all of these symptoms over time.In most people with autoimmune hypothyroidism, the thyroid gland becomes fibrosed, and the gland simply cannot make thyroid hormone. In these cases, going off of the thyroid replacement is futile. The gland won't start working again, and symptoms will return if you try.In well-done clinical trials, a minority of people with low thyroid levels will be able to return to normal thyroid functioning with a slow taper of the thyroid replacement (about 1/3 in a recent review of available trials). Most thyroid experts recommend against this, but some physicians will have patients try it under careful supervision of both their symptoms and their thyroid blood tests.A brand-new study found that deficiency in the mineral selenium worsens hypothyroidism, and selenium replacement can improve the thyroid hormone (TSH) level. Selenium deficiency is quite rare in North America and more common in Europe and Asia. But I don't think selenium replacement will make it more likely for you to stop taking your thyroid replacement therapy."Holistically" means keeping all of the aspects of a person in mind: their physical, mental, spiritual, emotional and intellectual well-being. It's how all caregivers should treat their patients.DEAR DR. ROACH: I have been reading books and articles on insulin resistance and metabolic syndrome. So, I have been trying to lose weight and get my insulin level down a bit. I also have fatty liver disease and your typical beer belly, but I don't drink any liquor. My primary care doctor is kind of "old school" and is not inclined to focus on insulin level, yet I think insulin resistance is important. How do I navigate this? -- D.D.ANSWER: Metabolic syndrome has different definitions depending on the expert group, but it generally consists of two or three of the following factors: insulin resistance (defined by abnormal glucose levels); abnormal lipid levels (low HDL levels and high triglyceride counts); obesity (defined by waist size, not by BMI); and elevated blood pressure. All of these risk factors increase the risk of heart disease.Measuring insulin levels is not typically done, except in clinical trials. The goal is to improve these parameters, and an improved diet and regular exercise are the keys to improving them. In some circumstances, medications may also be useful. Metformin, for example, reduces insulin levels, tends to help with weight loss, and has been proven to prevent or at least delay diabetes. Still, the key trial on diabetes prevention found that adherence with a good diet plan and regular exercise was even better than medication.Fortunately, the key behaviors to reduce insulin levels are the same ones that will lead to overall improved risk factors, so I don't think the advice you have been reading and the advice from your old-school doctor are really at odds.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

DEAR DR. ROACH: I recently had a urinalysis done for pain that I usually get from urinary tract infections (UTIs). The results showed that some of the tests were high. My epithelial cell count was 11; my hyaline cast count was 10; and there were both red and white blood cells. There wasn't any bacteria, and the doctor never contacted me. So, I am assuming things are OK.The pain subsided after a few days, and now I don't have any. Should I be concerned about these high results? -- B.J.E.ANSWER: The finding of elevated white blood cells in the urine of a person with a history of UTIs and recurrent symptoms is suggestive of a urine infection. However, with no bacteria seen, this becomes less likely. Red cells are commonly seen in urine infections, while hyaline casts are nonspecific. Epithelial cells come from the lining of the urethra and surrounding area (the vulva in women).It is primarily symptoms that drive the decision to treat a patient, and with your symptoms gone, treatment isn't necessary. You could have cleared a UTI on your own. I would consider retesting the urine (being very careful to clean the surrounding area and let some urine drain before collecting the sample) to make sure that the urinary findings have gone. Unusually, kidney stones, tuberculosis of the kidney, and kidney inflammation can result in these findings. When no infection is found, it is prudent to do further investigation if the white cells remain high without bacteria.DEAR DR. ROACH: Six months ago, my husband had a Whipple surgery for ampullary cancer. He also received chemotherapy. He is 85 and has finally started to live again. However, he gets these shivering and cold feelings, almost like he's been outside in subzero temperatures, to the point of putting him in bed with a pile of blankets and a heating blanket, too. We have asked the surgeon about this, and he didn't really have an answer. So, I was wondering what you thought about this situation. -- P.T.ANSWER: Ampullary cancer is located at the ampulla of Vater, a structure where the common bile duct empties into the duodenum. Ampullary cancer sometimes behaves like pancreatic cancer, but it may also be derived from the bile duct or the small bowel, which has a better prognosis than pancreas cancer.A Whipple procedure removes the gallbladder, as well as parts of the bile duct, pancreas, stomach and duodenum. Then it reconnects the remainder of the organs directly into the jejunum, the next part of the small bowel. A Whipple procedure is a technically difficult surgery, but the surgery is no longer as risky as it used to be, thanks to improved techniques and surgical expertise. Surgery is the only chance of a cure for this cancer.There are numerous reasons why he may have this sensitivity to cold. Weight loss, which is nearly universal after this procedure and this type of cancer, makes it harder for people to retain body heat. Chemotherapy (especially platinum) can cause damage to the part of the nervous system that regulates temperature, but this should get better over time.I suspect there are multiple factors working against him, but over time, it should improve. Nutritional support may be very helpful, and if his doctor isn't available, a registered dietician would be a useful ally. A quick check for other medical conditions, especially anemia and thyroid disease, might be prudent.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

DEAR DR. ROACH: I am an 81-year-old male in good health. Four months ago, I was diagnosed with meralgia paresthetica, a compression of the lateral femoral cutaneous nerve. I believe this occurred when I did a leg press on an exercise machine that had way too much weight for me. This resulted in a numb right thigh that initially had a great deal of sharp pains.I have been receiving physical therapy treatments since then without a great deal of relief. The pain is less now, but the symptoms persist. According to what I have read, this condition should go away after six to seven months. Would acupuncture or a different modality help? Finally, if this continues, who should I see for further treatment? -- B.A.ANSWER: Meralgia paresthetica is an uncommon diagnosis, but by no means rare. I see one or two cases per year. You are exactly right that it is caused by the compression of a particular sensory nerve, but weight lifting is not a common cause. By far, the most common causes I see are people with recent weight gain (often with tight pants or belts) and a wallet always kept in the same pocket, which puts pressure on the nerve. Like nearly all neuropathies, it's more common in people with diabetes.When symptoms aren't going away like they usually do, it's important to redo an exam and make sure of the diagnosis. Although medications are sometimes used, my practice is to refer to a pain management specialist for consideration of a nerve block.DEAR DR. ROACH: I am 70 years old and have the dreaded toenail fungus that seems almost impossible to get rid of. Do you know of a drug or products that works effectively and quickly? -- B.M.ANSWER: No, there are no therapies that are both highly effective and fast-acting. In fact, there are no highly effective treatments at all. The best treatment is oral medication, such as terbinafine. The best estimate ofa clinical cure occurs in about 62% of patients after 12 weeks of treatment.Unfortunately, oral treatment has the potential for side effects. These are uncommon (about 5% of people had side effects compared to the placebo group), but there is a very rare risk of serious skin reactions and liver injuries, which can be fatal. I always discuss this possibility before prescribing it, even though it is rare. There are topical treatments that can be used, but they are much less effective (between 15% and 40%). They can also be extremely expensive, although there are manufacturer's coupons to help.Another big problem is that even if a person is cured, there is a high likelihood of the fungus coming back (20% to 50% in published trials). The risk can be reduced by careful foot and nail care, avoiding reexposure (especially in public places like gyms), and keeping your feet cool and dry by frequently changing your socks and shoes if they get damp from perspiration.Between the less-than-perfect results from treatment and the possibility of serious side effects, many of my patients choose not to take oral medication for nail fungus if their major concern is a cosmetic one. In people with a history of skin infections due to nail fungus or symptoms like toe pain, then treatment is reasonable if the person understands the risks.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

DEAR DR. ROACH: I am almost 96 and in good health. In June, I went to see my oncologist for my 10-year follow-up after a left breast mastectomy. The doctor noted that my heart rate was 48 bpm, and she asked if that was normal. I said I had never heard of such a low heart rate, but I felt fine. The staff took my blood pressure several more times, and it stayed low. She said she was going to call my regular doctor, but I continued to feel fine.When I called my doctor the next day, he wasn't too concerned but decided to order an EKG. I didn't panic because I saw he knew about my low heart rate and had been watching me throughout the years. My question for you, Dr. Roach, is: Is this normal for me? I am not at all afraid to die. I do not want anything to prolong my life, like a pacemaker. Will my heart just stop some day? Right now, I am allowing myself to continue my contented life as is. I'm just curious, since I have never heard about very low heart rates.Yesterday I took my blood pressure (150/63 mm Hg) and heart rate (48 bpm) after a physical therapy session where I went up and down a long flight of stairs. Today I took it after a morning of sitting and reading the daily newspaper. My blood pressure was 135/65 mm Hg, and my heart rate was 66 bpm. -- B.S.ANSWER: A low heart rate ("bradycardia") is a common condition. In athletes, it is usually the sign of a healthy heart. However, for a person in her 90s, it is more likely a sign of aging in the electrical system of the heart, specifically the sinoatrial node.Some medicines can also cause a low heart rate. Every primary care doctor and cardiologist knows to look for medicines that can slow the heart rate, especially calcium channel blockers and beta blockers, but sometimes we forget to check eye drops. Beta blocker drops are still a common treatment for glaucoma, and a few people are so sensitive that they can get very slow heart rates from their eye drops.In absence of symptoms, a pacemaker isn't required. Should you develop symptoms, then you can consider a pacemaker. The most common symptoms are lightheadedness and fainting, and a pacemaker can help with these symptoms. Your heart is unlikely to stop altogether because there are "backup" pacemaker systems in the heart. But they work at such a slow rate that you are likely to have symptoms. Pacemakers don't make people live longer.Readers may be wondering why your systolic blood pressure (the first or "top" number) went down while your heart rate went up. This is normal physiology. When the heart rate is so slow, the heart gets very full of blood and squeezes out a large volume, causing the blood pressure to go up. With a shorter filling time, the heart squeezes less blood out each beat, so the systolic blood pressure doesn't get as high. The diastolic pressure isn't affected much, as the blood vessels return to a relaxed position pretty quickly. However, it isn't physiologic that your heart rate doesn't go up with exercise; this shows a problem with your heart.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

Q: Alzheimer's runs in my family. What can I do to prevent it or at least reduce progression if I get it? -- Susan H., DenverA: You don't have to wait for some pharmaceutical treatment to prevent or roll back your risk for dementia. You have the power to do that by making smart lifestyle choices. And two very exciting new studies back up what we've been saying for years.The first was directed by Dr. Dean Ornish, the founder and president of Preventive Medicine Research Institute. The researchers enlisted 51 participants with a verified diagnosis of Mild Cognitive Impairment (MCI) or early Alzheimer's disease (AD) and randomly assigned them to either an intensive lifestyle intervention group or a usual-care control group.The group making lifestyle changes adopted a minimally processed, plant-based diet low in harmful fats, refined carbohydrates, alcohol and sweeteners and took supplements, including omega-3s, probiotics, vitamins and minerals, CoQ10, and Lion's Mane. They did daily moderate aerobic exercise and strength training for at least 30 minutes and meditation, stretching, breathing and imagery, for one hour daily. They also participated in support groups for an hour three times a week.After 20 weeks, over 70% of the folks in the intervention group had either stayed the same or had improved cognition, while none of the patients in the control group showed improvement and 68% worsened.Then, another study found that 72 sessions of high-intensity interval training (HIIT) on a treadmill over a six-month stretch noticeably improves cognition in folks ages 65 to 85. Bonus: It keeps cognition elevated for the next five years, even if you don't keep up with the exercise. (But, please do keep exercising!)For details on 40 choices that have been shown in at least two studies to prevent or reverse MCI and/or AD, pick up a copy of Dr. Mike's book "The Great Age Reboot" and delve into Dr. Oz's blogs on iHerb.com, including "More Movement May Increase Longevity -- Here's Why." * * *Q: I find myself losing focus and even nodding off at my desk around 4 p.m. What's going on and how can I prevent that? -- Alica R., Rochester, MinnesotaA: You're not alone. A survey conducted by OnePoll found that 21% of folks say they deal with an afternoon slump -- usually around three o'clock -- and for some reason, Tuesdays are the worst. (Maybe back-to-work Mondays are just too exhausting.) But there are a few solid reasons that it happens and some easy solutions. First, cortisol levels fluctuate during the course of the day and in the mid- or late afternoon, they can dip, bringing down your energy level. You may also have overeaten at lunch or have a post-lunch glucose spike then dip, leaving you drained. You may be somewhat dehydrated. You may also be snacking on high-sugar foods. And it's a good bet that you may have been sitting at your desk for far too long. The solutions are pretty simple:-- Eat a high-protein, unprocessed breakfast (egg white omelet with spinach and tomatoes, 100% whole grain toast; 4 to 8 ounces of fresh fruit). Avoid processed, sugary snacks. Stick with nuts and veggies like carrot sticks, and (if it won't keep you up at night) filtered black coffee. Also stay well-hydrated. Chewing gum is also shown to increase alertness, because it increases heart rate and blood flow to the brain. Just make sure it is free of sugar and sugar substitutes like erythritol. And check out the iHerb.com blog "Have You Heard of Mastic Gum? Here Are 8 Health Benefits." -- At work or home, go outside for a 10-minute walk, take several flights of stairs or march in place at your desk. Getting your blood pumping can wake you up. LongevityPlaybook.com's free newsletter offers great exercise suggestions.-- Use a stand-up desk to engage your muscles even when you are working. Dr. Mike loves his treadmill desk.These tips should give you the energy boost you're looking for. * * *Dr. Mike Roizen is the founder of www.longevityplaybook.com, and Dr. Mehmet Oz is global advisor to www.iHerb.com, the world's leading online health store. Roizen and Oz are chief wellness officer emeritus at Cleveland Clinic and professor emeritus at Columbia University, respectively. Together they have written 11 New York Times bestsellers (four No. 1's). (c)2024 Michael Roizen, M.D. Distributed by King Features Syndicate, Inc.

DEAR DR. ROACH: Please look into citrus bergamot. It is a beneficial supplement that lowers cholesterol very efficiently and effectively. It lowered my cholesterol by 70 points. -- R.M.ANSWER: You are right. The early data suggest that bergamot may be effective at improving cholesterol results. This was found in people who are resistant to statins and in people with the common metabolic dysfunction-associated steatotic liver disease.The results you saw are certainly dramatic. However, I have seen many promising treatments for cholesterol fail in large trials. Not only does the product need to be proven to lower cholesterol, it needs to be proven to do so with a high degree of safety. Most importantly, it needs to have a real benefit to the person taking it, meaning it reduces their risk of heart attacks, strokes, or death well enough that it makes taking the product worthwhile.A 2023 study compared a statin (low-dose rosuvastatin) to a placebo, fish oil, cinnamon, garlic, turmeric, plant sterols, and red yeast rice. None of these supplements lowered cholesterol compared to the placebo. Sadly, bergamot was not included.It may be that in larger trials, bergamot will prove to be a safe and effective means of lowering cholesterol and preventing heart disease. I'm waiting until then to prescribe or recommend it, and with my high-risk patients, I will continue to discuss the risks and benefits of statins.DEAR DR. ROACH: I had a total hip replacement 10 years ago and had no problems afterward. However, I have fallen four times since then, with the latest being in March of this year. Now my thigh bothers me, and my foot wants to turn in a way that makes walking difficult. Could I have damaged my implant? -- R.B.ANSWER: It is unlikely that you damaged the prosthesis, which is extremely hard and durable. However, it is possible that you have a long-term complication of the prosthetic, such as loosening of the prosthesis, which is caused by years of wear. This has been said to occur in about 1% of cases per year, but newer prostheses and better techniques have reduced this incidence. I hardly ever see my patients require a new hip because of this problem.Certainly, a visit to your surgeon is in order, and they are likely to do a careful exam and X-rays. I suspect that the problem may not be the prosthesis at all. There are many common problems that might be affecting your gait, including your other joints, like the knee. If you had arthritis of the hip that required surgery, you might have knee arthritis as well. If they aren't able to find a specific issue, it may be that physical therapy is in order to help you relearn how to walk and reduce your falling risk.There are many interventions that can help reduce the risk of a fall, and they are more important once a person has had multiple falls. Strength training and balance exercises (such as tai chi) have been proven to reduce falls. Your regular doctor should also carefully review any medicines you take, as different medicines can increase the risk of falls.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved