Colorful Diet does NOT mean M&Ms!

In the rush of the holidays, are you grabbing handfuls of red and green M&Ms more than handfuls of strawberries and grapes? How can you keep up your 5-10 servings of fruits and veggies per day during the holidays?

Not surprisingly, the answer is the same as the rest of the year- PLAN AHEAD. Start your morning with a smoothie (the picture above was from our breakfast)- frozen fruits like strawberries stay the same price year-round, even though they are out of season. Do you notice the banana is over-ripe? No worries- in a smoothie, it doesn't matter!

BEFORE YOU HEAD OUT TO A PARTY, have a large healthy snack and a big glass of water. If you're not starving when you enter the party, you will be way less likely to overload on high calories offerings.

TAKE SNACKS TO WORK. Apples are still cheap and plentiful, so I take a couple to work each day, along with a small container of my nuts of choice (cashews or almonds, usually.) If I don't eat these, I will be way to tempted by chocolate-covered everything at the office!

BOTTOM LINE: This time of year more than any other challenges our time and waistlines; PLAN AHEAD and PUSH UP the vegetables, fruit and water in your day!

Can't stop coughing?

Cough, cough, cough...argh! Is there any point in seeing your doctor when all you have is a left-over cough after an upper respiratory infection? YES! While it is rare that you will need antibiotics, there are other medications that your doctor may recommend to help you quiet that cough.

Often, after a viral infection, we are left with a cough. Untreated, that cough might last up to six weeks. Frequently, it is worse at night and may keep you (or your spouse) from sleeping- which adds fatigue and grumpiness to the picture. At a minimum, your doctor may choose to prescribe a narcotic cough syrup (assuming the OTC dextromethorphan-containing products are not working) so that you and your loved ones can get some rest.

Additionally, it is very common to develop a transient asthma-type of reaction in your lungs after a cold. We call this reactive airways, and the extra mucus production as well as spasm can lead to some wheezing and/or cough. The good news is that this is not a permanent change, AND we can use a couple different types of inhalers to improve your cough and shortness of breath.

Traditional home remedies such as cool mist humidifiers and topical menthol products can also provide good symptomatic relief.

If you have a cold, then seem to recover, and then get broad-sided with an intense cough and fever a week later, you may indeed need an antibiotic because you have become secondarily infected. In this case, an antibiotic may be recommended, but the mainstay of treatment will still include rest, fluids, and over the counter cough suppressants such as dextromethorphan, which is designated "DM" in most combination cold products.

BOTTOM LINE: Got a tickling cough? Use OTC meds and hydration. Stuck with a nagging, lingering cough? Go see your doctor for some extra help, but don't expect antibiotics.

Beyond Chicken Soup- What Helps the Common Cold?

This week I've been talking about colds and the role of vitamins can play in treating them. We know that the common cold is caused by a virus, so therefore antibiotics (which kill bacteria, not viruses) do NOT help. What DO I recommend for my patients?
Much of what your parents may have offered you works well, by the way...

1. Oral decongestants- phenylephrine or pseudoephedrine- work well to relieve nasal stuffiness, but can have significant side effects of raising blood pressure, causing palpitations/jitteriness or insomnia
2. SHORT TERM (3 days) use of nasal decongestant sprays; also relieve nasal congestion with less side effects
3. Nasal saline sprays and washes often relieve congestion as well as the medicated versions
4. Aromatic oils (menthol, camphor, and eucalyptus) used topically provide subjective improvement in nasal congestion- don't forget about the topical "vaporub" or the forms of these oils that you add to a warm bath!
5. Analgesics: acetaminophen (tylenol) or ibuprofen (Advil/Motrin) help with headache and body aches
6. HYDRATE! Remember chicken soup? ANY liquid helps, but drinking warm broth often has the double benefit of sore throat relief along with hydration. The more you hydrate, the less headaches and looser mucus (so it will de-congest) you will have.
7. Salt water gargles ease sore throats as well; repeat several times a day for the first day or two, and don't be shy with the salt: use 2 tablespoons per 8 oz of water- it wont even all dissolve, but that's how much you really want to increase effectiveness.
8. Cough suppressant: try OTC products with "DM"- dextromethorphan. More on this tomorrow...

BOTTOM LINE: Symptomatic relief of the COMMON COLD is important, but antibiotics are NOT part of the equation.

Zinc for Colds?

If Vitamin C is not the answer to prevention or treatment of colds, what about zinc? Around 25 years ago, studies showed that zinc lozenges could significantly reduce the duration of the common cold. Since that time, the medical literature has been conflicting, with roughly half of the studies showing benefit, and half appearing equal to placebo.

Zinc nasal preparations were then released, but in 2009, the FDA issued a warning that these intranasal zinc preparations had the potential to cause permanent loss of smell, so they are no longer recommended.

It turns out that you need to have ionic zinc in the lozenges to be effective, and the vast majority of products out there do not have this type of zinc. Taking zinc supplements in pill form doesn't work either, so don't be fooled into swallowing yet another pill.

What DOES work? Well, the best prevention is what your mom most likely taught you growing up: WASH YOUR HANDS! It doesn't matter if you use the hand sanitizer or old-fashioned soap and water, but whatever you use, scrub for 20 to 30 seconds, and try not to touch your face or eyes.

BOTTOM LINE: If you are going to use zinc to try to shorten the duration of your cold, get an ionic zinc lozenge preparation. More importantly, however, WASH YOUR HANDS!

Vitamin C for Colds?

Okay, since I talked again about vitamin D last week, why not talk about a few more vitamins? What about Vitamin C for colds? Should it be taken as prevention, or as a cure? Can you get too much?


Honestly, the medical literature has gone back and forth on vitamin C and colds. Large studies have shown little benefit in prevention, unless you are an extreme athlete or living in very cold temperatures. For people in those categories, it appears Vitamin C in doses greater than 200mg per day can indeed decrease the frequency of upper respiratory infections. Skiers, perhaps you should start your morning with a big glass of juice instead of hot chocolate or coffee!

Where there does seem to be benefit across the board is when Vitamin C (again in doses greater than 200mg per day) is taken once you develop cold symptoms. At that point, Vitamin C seems to decrease the duration of symptoms.

How much is too much? The RDA is 75mg for women and 90mg for men. Supplements come in 100, 200 and 500mg tablets, plus I'm sure you've seen and maybe taken the mega-dose vitamin C packets that come in powder packets. These typically have 1000mg of Vitamin C (along with a handful of other vitamins). While C is water-soluble, which means that "extra" vitamin C not used by your body will simply exit in your urine, it is possible for megadoses (often exceding 2000mg per day) to cause kidney damage by precipitating a special type of stone formation in the kidneys.

What type of Vitamin C is best? As always, you are better off getting your vitamin C from whole foods-fruits like berries, red peppers, guavas, kiwis, and yes, oranges. You will NOT overdose from these natural sources!

BOTTOM LINE: Vitamin C may help shorten the duration of a cold, and could help with prevention for those in cold climates or if you will be doing "extreme" physical activity.

Vitamin D: Front Page News!

This week Vitamin D (aka. the Sunshine Vitamin) made front page news this week when the Institute of Medicine tripled the recommended daily dose from 200IU (International Units) to 600 IU. Interestingly enough, there were polar opposite slants on the same story. The TIMES said that extra Vitamin D and calcium are not necessary, while the Wall Street Journal quoted experts saying that that this increase is not nearly enough.

What should we believe at this point? Well, like everything in medicine, it depends. Seriously. If you are elderly or otherwise decreased in mobility; if you have increased risk of cardiac disease or cancer; if you have dark skin or live in northern locations with limited sunlight; then I think the medical evidence is solid that you likely will need Vitamin D supplementation.

I practice medicine in Austin, Texas, which is clearly a sunny locale. Despite that, I have found in the last year or two that I have been more aggressively checking vitamin D levels that 90+% of my patients were deficient. Interestingly enough, a good chunk of these patients (I would estimate a third) have had clinical improvement in some fashion after a few months of vitamin D replacement. Often it is with mood and energy, and other times it is with very nonspecific "aches and pains" that the patient previously was attributing to "aging." Initially I gave simply over-the-counter doses, but within 6 months saw minimal improvements and switched to supplementing with prescription weekly Vitamin D (at 50,000IU per week doses.) This is the dose that has yielded results both in lab tests and far more importantly, in patient symptoms.

BOTTOM LINE: The jury may still be out on Vitamin D supplementation, but we do know that replacing Vitamin D in people who are proven to be deficient can potentially improve their health in multiple organ systems (bones, cardiac, neuro/psychological.)

Are you SAD?

While everyone around you is humming Christmas songs, pulling out their Hannukah decorations or making ski vacation plans , are you left feeling sad? Perhaps it's not the holiday blues, but SAD- Seasonal Affective Disorder. This depressive disorder was formally named only a few decades ago, in the 1980's. It affects over half a million people each winter, including some symtoms in up to a third of patients seeing their primary care physicians during this season.

Who gets seasonal affective disorder? It's most common in women (3:1 over males) and young adults 20-30 years old, but it is seen in across the board. January and February are the most common months that SAD is diagnosed.

What are the complaints? Often fatigue, weight gain and recurrent illness are the primary issues, rather than simply "sadness".The simples range from a mild case of "winter blues" to serious depression.

What is the cause? There are different theories, most of which are linked to hours of sunlight. There is disruption in our circadian rhythms as well as decreased seratonin secretion during winter months, and of course, less Sunshine vitamin (Vitamin D).

Prevention? Light therapy (using full spectrum light bulbs in your home and work) or consciously spending more time outside in the sunlight can help prevent S.A.D. Of course, moving to a more southern location can help, especially if you are far north, but that is not typically feasible for most people.

Treatment? Light therapy, anti-depressant medications (Buproprion is the only one FDA indicated, but SSRI's are also used), and Vitamin D replacement (if low) all have shown effectiveness in improving symptoms.

BOTTOM LINE: If you recognize a pattern of feeling sluggish every winter and perking up in the spring and summer, talk to your doctor and see if together you can change "S.A.D." to glad this year!

PS. Happy December 1st! Change those air filters!!