Paula’s Adventure: ER and ICU

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We arrived at the ER and Paula was checked in on Tuesday morning, February 4. The cough was obvious as well as the difficulty breathing. They took her vitals, and her blood pressure was very high. Most likely because of the hallucinations, they did a CAT scan of her head, but there were no apparent issues. Also, no cats (that’s a family joke from Paula’s dad). They also took an x-ray of her lungs: mostly clear but a little sign of pneumonia in a lower lung. That seemed about all.

Then the results of her blood tests came back, and yikes. Normal sodium levels are 135-145 mEq/L; hers was 105 mEq/L. Her potassium was also below the normal range. She wasn’t going anywhere because she was in danger of having seizures, and our doctor said she’s surprised she hadn’t had one.

They immediately began to replace sodium and potassium in the ER before her admission. The trick is that it must be done slowly; if it went up too fast, she would also have been in danger of seizures and heart problems. She was transferred to a room in the ICU, because she needed constant monitoring, frequent blood draw—every two hours around the clock for the first few days—and they needed to be sure she wasn’t contagious because of the cough that was still present. (She was not.) I asked about her sodium level after each blood draw, and it consistently went up over the next five days. Once it hit 135 mEq/L, she was ready to be released.

My observation was that she was vastly improved by the day after her admission. However, that didn’t mean she was out of danger and she wasn’t going anywhere until she hit that 135 number. By that time, I had to leave for a speaking gig in Nashville. She was organizing the room, so I knew she was close to normal; still a little shaky but normal. She was on a heart monitor the whole time, and as she was organizing the room, a nurse came in and said, “What are you doing? Your heart rate’s up.” He suggested she quit futzing and sit down for a while.

She was released and brought home on Saturday by one of our pretend daughters, and I got home a few hours later.

What caused the sodium and potassium loss? More than that, what can we learn from Paula’s adventure? I’ll let you know on Saturday. I’ll also tell you when and where my next Nutrition in the 21st Century Seminar will take place.

What are you prepared to do today?

        Dr. Chet

Paula’s Adventure

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West Michigan has seen the cough and cold to end all coughs and colds. If you read “No Memos,” you know that it impacted everyone in the house. At that time, I was beginning my third week and Paula was finishing her second. By far, she had it the worst: chronic cough 24 hours a day and trouble breathing because her throat was so inflamed from coughing. She was taking OTC cough medication, ibuprofen, and throat lozenges and was on antibiotics because the nurse practitioner felt that, with such thick congestion in her chest, it had to be a sinus infection that caused post-nasal drip. Five days later, it was worse than ever.

She woke up during the night and typed out her symptoms. In addition to the cough and cold symptoms, she also had blurry vision, some dizziness, and headaches. She was walking like a drunk, and she hadn’t taken that much cough syrup! She had a couple bouts of vomiting and the chills. She then added to the list lack of focus, not remembering conversations, hearing the washing machine in the middle of the night when it wasn’t on, hearing me talking to her when I was asleep, and seeing things like a sweater on the nightstand that wasn’t there.

She called the doctor’s office and read the list to the phone nurse. When she got to the hallucination symptoms, the nurse said to go to the ER now. One thing that you don’t know about Paula is that she doesn’t leave the house unless she has at least light make-up, hair combed, and wearing appropriate clothes. Not this time; she put on a comfy dress, her coat, and was ready; something had to be really wrong and she wasn’t messing around. She had already printed out the complete list of symptoms and medications, so off we went.

The adventure continues in the ER and I’ll tell you about that on Thursday.

What are you prepared to do today?

        Dr. Chet

Watch This

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Many readers have asked me to review movies over the years such as Forks Over Knives, In Defense of Food, and Fat, Sick, and Nearly Dead. This time, I’m asking you to watch a series by Andrew Zimmern titled What’s Eating America, a five-part series which examines some of the country’s problems through the lens of food.

Zimmern is a chef who’s traveled the world tasting foods on a series called Bizarre Foods. This time, he’s looking at topics related to foods and food production. Just like the authors and producers of those films, it contains his opinions on his observations, and they may be as controversial as those films.

The series begins tonight on MSNBC at 9 p.m. Eastern Time. Based on what I’ve seen and heard so far, it will give another perspective on our food supply, and I think that’s valuable. It’s information we all need.

What are you prepared to do today?

        Dr. Chet

Research Update on Vitamin D

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Vitamin D supplementation always seems to be in the health news; one day it’s beneficial, the next not so much. One of the problems is that many studies are observational studies. They take a large group of subjects, such as the Nurses Health Study, use food frequency questionnaires to assess vitamin D intake, and report on bone health and other outcomes over time. That has serious limitations in my opinion, not least among them the reliance on food frequency questionnaires, which have been proven inaccurate. Do you remember what you had for dinner last week or the week before? Neither do I.

In a recently published study, researchers did a meta-analysis on vitamin D in observational studies, randomized controlled trials (RCT) on vitamin D supplementation alone, and RCT on vitamin D plus calcium supplementation. The outcomes were all fractures and hip fractures, and the subjects were mostly older than 65.

While there were issues in just about every observational and RCT of some sort, the analysis of each type of trial combined was that vitamin D supplementation did not have a significant effect on the rate of fractures. However, when vitamin D supplementation was combined with vitamin D and calcium supplementation, there was a 6% decrease in all fractures and a 16% decrease in hip fractures over an average of six years. The amounts of vitamin D used were 400 to 800 IU and 1000 to 1200 mg of calcium per day.

While there’s more research to go including the completion of some of randomized controlled trials used in the analysis, take vitamin D and calcium together to reduce the risk of hip fractures and other broken bones. Better together seems to be more effective than overdoing it on a single nutrient.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Network Open. 2019;2(12):e1917789.

No Time for Exercise!

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One complaint that I get all the time is this: people tell me they don’t have time to exercise. I can understand that. There are some days exercise just isn’t an option, especially when you’re sick. But that’s supposed to be the exception, not the usual situation, and it just isn’t true for most people.

A recent study was published by the CDC using survey data from the American Time Use Survey. They collected data on over 30,000 people on how they spend their time. That includes working, total leisure-time activities, and time in exercise. They collected data on gender, education, and of course, age. What they found is that in spite of what people say, they have between three to five hours per day of leisure time.

Where did they seem to be spending that time? They’re spending it on a screen: their phone, their computer, or their television. And that seems to suck up the time they could be exercising. There’s a lot more to this study and I’m going to cover that in a future Straight Talk On Health (free to Members and Insiders), but for now, I think it’s time to take an honest look at how much leisure time you really have, because it seems most of us have the 20, 30, or 45 minutes we need most days to be able to work out. No excuses. Do your job.

Reminder: there are still seats for the Nutrition in the 21st Century seminar in Chelmsford this Saturday. If you have the time, you could learn a lot about nutrition and supplementation.

What are you prepared to do today?

        Dr. Chet

Reference: Prev Chronic Dis 2019;16:190017. DOI: https://doi.org/10.5888/ pcd16.190017.

Listen to Dr. Dog

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When I’m traveling, I often scan the airline magazine. This past weekend, I found an intriguing article about dogs and disease.

A woman had an unexplained weight gain after she moved across country several years ago. She also had repeated UTIs, bladder infections, and abdominal pain unexplained by digestive issues. She was treated and seemed to recover, but her husky kept sniffing her abdomen. She tired of it and shooed the dog away, but the dog would hide in the back of a closet whimpering. When her abdominal pain came back, she put two and two together because of the dog’s actions and sought a further diagnosis. She was diagnosed with stage three ovarian cancer. It’s returned once and the dog acted the same way.

In another case, a women’s dog kept trying to bite the back of her calf. She finally looked at the area and found a dark spot. She had melanoma.

The ability of dogs to smell thousands of times better than we can seems to be related. Cancer releases proteins that dogs can smell. I’ve got more to research on this but for now, if your dog is trying to tell you something in some strange way, listen.

What are you prepared to do today?

        Dr. Chet

Reference: Southwest Travel Magazine. 02-2020.

No Memos???

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The devastating chest cold that’s been wiping out West Michigan came to our house early last week and stayed—that’s why there have been no Memos this week. We all got the congestion and cough, but other symptoms seem random: Riley had fever, Paula had chills, and I had muscle fatigue. Worse yet, it fogs the brain and if I can’t think clearly, I can’t accomplish anything. The doctor prescribed antibiotics for Paula because she has a history of sinus infections, and two weeks is a long time to have such thick congestion.

We’re recovering slowly because there’s no hurrying this recovery. My optician said she’s had the cough, albeit less severe, for six weeks. As we recover, the Memos will return on a regular basis.

We’ve focused on the Super Bowl Webinar at noon on Sunday, Super Bowl X Webinar: Energy for Life. Luckily I’d already written it, and my voice has recovered, so it’s on. Because I’m sending out the log in information later tonight, you must have signed up or contacted me by 9 p.m. Eastern Time (6 p.m. Pacific Time). If you’re occupied then, you can register and I’ll send you a link to listen later.

Our daughter-in-law Kerri is a pediatric respiratory therapist. After a couple days of restricted breathing, we have enhanced respect for what she does, so a special thank you to all the RTs, researchers, doctors, nurses, and pharmacists who keep us breathing.

I’m sorry for the inconvenience; we really hate to let you down. We’ll be back to normal soon. For those of you on the webinar, talk to you tomorrow.

What are you prepared to do today?

        Dr. Chet

HIIT Will Get You Fit

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An Insider emailed me a link to a press release about high-intensity interval training, or HIIT for short. I’ve always used interval training, when I was a serious runner, and now as a way to increase my fitness level faster. That’s why I was a little surprised that a study suggested that you have to do intervals that are at least a minute long and shouldn’t rest more than two minutes. I checked out what I could find.

The research was presented at a conference and as much as I tried, I couldn’t get the abstract. Fortunately, the press release contained just enough information to figure out what was what. The researchers recruited 26 previously sedentary subjects and put them on a HIIT program. They either took part in 60-second intervals of high intensity with 60 seconds rest or intervals that lasted 30 seconds with 120 seconds rest. While both groups saw similar changes in body composition and arterial stiffness, the 60/60 groups saw bigger improvements in max VO2, a measure of aerobic fitness. In fact, the release included comments from the lead author that the subjects didn’t improve their fitness level at all.

That didn’t make any sense to me. If the intensity was high enough, 30 seconds of all-out effort would need two minutes to recover. I found the problem. One of the purposes of the study was to use exercises people could do at home, so they used calisthenics: push-ups, squats, sit-ups and exercises such as that. That’s admirable, but it made the headline and her comments misleading—extremely misleading.

Using sedentary subjects means they had to overcome localized muscle fatigue. The localized muscle pain may get the heart rate to increase but it’s limited by muscle stamina, especially in sedentary individuals, until they could actually do enough push-ups, etc., to challenge their cardiovascular system. A six-week study is not long enough for them to really master the movements and do them fast enough in order to get a good aerobic training effect.

The Bottom Line

HIIT can be effective if done properly; running and cycling are still the best options to do that. You can reach aerobic exhaustion in 30 seconds if the intensity is high enough, and if you do, you’ll need every one of those two minutes to recover before the next interval begins. You must make sure your cardiovascular system is ready for it, so get your doctor’s clearance before you attempt it.

What are you prepared to do today?

        Dr. Chet

Resistant Starch and Your Gut

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After last week’s Memos on resistant starches, I received a couple of emails asking me to talk about related topics. I think they’re both important, so here we go.

The first was something I mentioned but didn’t focus on. You may remember that I said that resistant starches can act as prebiotic to produce short-chain fatty acids. The process is by fermentation, so that means it will produce gas. For some people, the gas production is so uncomfortable, it can negatively impact their life; they have to avoid some resistant starches. The good news is that the variety of foods that contain resistant starches is vast, so there are some foods that are less intrusive.

That leads to the second question about resistant starches and leaky gut syndrome. One of the issues with leaky gut is that the mucus layer on the inner gut is not as developed in some areas, and that leads to problems with nutrients and bacteria entering the blood stream directly. Resistant starches have been shown to be beneficial for leaky gut. However, the same issue with fermentation may happen until the bacterial colony grows sufficiently. The approach would be to slowly increase resistant starches to prevent over-fermentation.

There have been many questions, but I’ll wrap this up on Saturday and keep some questions for another time.

What are you prepared to do today?

        Dr. Chet

Thyroid Function and Cruciferous Vegetables

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A long-time friend and Memo reader asked this question: “Some Internet health experts and websites say to avoid raw broccoli if you have an underactive thyroid; I did that and my scores improved. Why?” The answer is complicated, but here’s what I found.

Raw cruciferous vegetables contain phytonutrients that are important to our health. However, in people with iodine deficiency, those phytonutrients may interfere with the production of thyroid hormones. Cooking broccoli, even a quick steam, negates that impact.

If you’re concerned, here are three things to do. First, get your iodine levels tested to see your iodine status. Most multiminerals have iodine, but you may need even more and your doctor can help you decide that. Second, if your iodine or thyroid hormone levels are low, always cook any cruciferous vegetables you eat. They’re healthy for you, but maybe just not raw.

Finally, and I think this is the most important, always take your thyroid medication without eating for at least a couple of hours (a little cream in your coffee is okay, but not a meal). How do you do that? Most of us don’t have a couple hours to wait around to eat before the day begins. You can take it at bedtime, or you can put it next to the sink and take it when you get up during the night.

Most people avoid dairy because calcium interferes with thyroid meds, and I found after researching this, there are many others foods that also interfere. Just take the thyroid medication by itself. Check with your doctor about other oral medications that may have an impact as well.

If this is a reminder that you need to eat more cruciferous veggies, I couldn’t agree more. Here’s a way to eat more in a targeted way: get my book Real-Life Detox. It includes some tasty recipes, including “I Can’t Cook” Detox Cabbage Soup that requires nothing more complicated that opening bags and turning on the cooktop. You can get both the paper book and e-book for a special price at drchet.com; as always, Members and Insiders get their discount.

What are you prepared to do today?

        Dr. Chet