by W. Gifford-Jones M.D. and Diana Gifford-Jones
Common Sense Health

William I of Germany remarked on his death bed, “I have no time to be tired.” But often people suffer from being tired and having low energy years before they leave this planet. For some with fatigue, a prescription for 8-hours daily use of a pillow is the best treatment. But over three million Americans and one million Canadians have undiagnosed anemia, a condition due to low levels of red blood cells that carry oxygenated blood to the body’s tissues. Is it possible that anemia may lead to misdiagnosis of Alzheimer’s disease?

What should you do if you are feeling fatigued and weak for no obvious reason? A methodical approach is warranted. First, if the problem is anemia, then it is usually easy to correct, particularly if due to diet. Therefore, there is no need to panic. But you should see your doctor to rule out more serious problems.

For instance, anemia can be due to a cancer of the bowel when the malignant growth is bleeding. Other causes might be intestinal diseases, such as ulcerative colitis, Crohn’s disease, celiac disease, or peptic ulcer. Inherited conditions such as sickle cell or bone marrow disease can lead to anemia.

But the major cause of fatigue and anemia is iron deficiency, more commonly seen in women. This is not surprising since women lose blood menstruating. Pregnant women are at increased risk and should be taking a multivitamin with folic acid. Older women may be losing blood from a non-malignant fibroid in the uterus.

There’s good reason for a discussion about vitamin B12. A lack of this vitamin, or poor absorption, may cause pernicious anemia having serious consequences if not diagnosed and corrected.

Dr. Alice H. Lichtenstein, a professor at Tufts University’s Friedman School of Nutrition Science and Policy, says, “As we age many of us produce less stomach acid which is required for the absorption of vitamin B12.” Moreover, many elderly patients are taking acid suppressing medication decreasing the absorption of vitamin B12.

What is tragic is when a severe lack of B12 causes symptoms of dementia such as confusion, irritability, numbness, and tingling in the hands and feet.

This is a rare situation, but in some instances, these patients have been wrongly diagnosed as having Alzheimer’s disease. B12 would solve their confusion.

So, how can you prevent iron deficiency anemia? First, get rid of one misconception. Many people believe that red meat is the best source of iron. In fact, there are many other choices, including seafood, poultry, beans, lentils, tofu, dark green leafy vegetables, cashews, and fortified cereals.

Vitamin C increases iron absorption, so include foods rich in C such as strawberries, raspberries, and tomatoes. Enjoy a glass of orange juice.

Vegetarians should know that vitamin B12 is primarily found in animal products, so they may be at particular risk of developing this deficiency.

Be careful to include non-animal foods such as nutritional yeast and fortified cereals and plant-based milk substitutes in the diet. To ensure enough B12, consult a doctor to learn whether B12 supplements might be advisable.

Some people are tired all the time and have plenty of iron in the blood. These individuals may be suffering from another variety of fatigue – the kind due to a boss that cannot be stood, a family problem that would take a team of psychiatrists to settle, financial difficulties, or stress-related problems in these trying times. Or the key to resolving fatigue could be as simple as getting a better pillow for more restful sleep.

The weekly column by W. Gifford-Jones, MD has been published without interruption for 45 years. The same no-nonsense tradition now continues in a father-daughter collaboration. Sign-up at www.docgiff.com to receive our weekly e-newsletter. For comments, contact-us@docgiff.com.

by W. Gifford-Jones M.D. and Diana Gifford-Jones

Everywhere, people are fed up with enforced isolation. While adhering to stay-at-home orders at the urging of public health officials and in empathy with frontline health care workers, the restrictions are taking a toll on the physical and mental wellbeing of all.

While senior citizens can be especially impacted, it is less commonly acknowledged that younger people, particularly teens, struggle with isolation too.

For older adults, enduring long periods cut off from family and friends is known to cause depression, generalized anxiety disorders, decreased sleep, and functional impairment. Research published in Lancet Public Health warns that social isolation can also accelerate cardiovascular and brain aging, exacerbating dementia.

Likewise, students of all ages are suffering from lockdowns. They are not getting the exercise and outdoor time they need. Schooling has been repeatedly disrupted. The entire cohort of first-year university students in 2020-21 has missed a formative experience. Many in this highly social generation have shifted to virtual friendship circles and online entertainment. Others exist in boredom and loneliness, absent engagement with anyone.

Dr. David Nabarro, a Special Envoy on COVID-19 for the World Heath Organization, made headlines last October when he articulated the WHO’s position that “The only time we believe a lockdown is justified is to buy you time to reorganise, regroup, rebalance your resources, [and] protect your health workers who are exhausted.”

Yet, despite repeated regrouping, the virus is easily out maneuvering the experts. And the lockdowns and movement restrictions continue.

So what can be done?

A prescription for patience is the order. But there is ample opportunity to harness this awful pandemic to connect isolated people – young and old – in innovative, health-inducing ways using online platforms.

Research shows that matching up young people with older people on digital platforms has a remarkably positive impact on both generations.

This is not a new idea. The aging of the “baby boomers” has had many researchers advocating for policymakers to leverage this generation as a massive learning resource. There is ample evidence of benefits to the boomers. One study showed that older adults providing internet‐based tutoring to fifth‐grade students became comfortable using computers, had improvements in mood, and had an enhanced quality of life from the interactions.

In a Canadian program, older adults provided second-language coaching to young people through video conferencing. An evaluation determined that participants of all ages valued the program with youth reporting benefits from the language immersion. Older adults demonstrated high levels of motivation to participate.

The pandemic has many more programs underway. Dr. Li Feng Tan, a researcher at Alexandra Hospital in Singapore, runs intergeneration programs that bring older and younger people together for exercise, dance, charades, bingo, Pictionary, music classes, performances, and virtual tours. A comparison of in-person programs with virtual programs found that online platforms have engage more participants within the hospital, enabled engagement by patients in different wards, and eliminated the risk of cross-infection, a major concern during the current pandemic.

In addition to the health benefits, the basic skills with phones and computers that teenagers and even young children can teach to seniors enables older people to connect themselves with other online platforms they enjoy, including resources for health promotion.

The programs are low-cost, easy to scale up, and do not require expensive health care professionals, therapists, or technicians.
Generations United, a clearinghouse for information on different types of intergenerational programs, has a publication in its resource library called Staying Connected While Staying Apart. The report lists dozens of engaging programs around the world and step-by-step guidance on how to get involved or set up new virtual intergenerational programs. See www.gu.org.

The weekly column by W. Gifford-Jones, MD has been published without interruption for 45 years. The same no-nonsense tradition now continues in a father-daughter collaboration. Sign-up at www.docgiff.com to receive our weekly e-newsletter. For comments, contact-us@docgiff.com.

by W. Gifford-Jones. M.D. and Diana Gifford-Jones
Common Sense Health

While the current pandemic holds a firm grip on everyone’s attention, another killer may be getting a stronger foothold on us – and chances are, women will continue to pay a higher price. Coronary heart disease is already a leading disease for women and men. Common sense suggests the situation is getting worse.

The sedentary lifestyle imposed by lockdowns, accompanied by weight gain and higher alcohol use, is not the way to lower incidence of heart disease. But how does it affect women differently?

A report in the journal, Circulation, notes that heart disease kills ten times as many women as breast cancer. It takes the life of one in every three women, more than all cancers, chronic respiratory diseases and accidents combined.

A report from the American Heart Association confirms stunning improvements in death rates of both sexes from coronary heart disease since 1980. But women have not shared the benefits equally.

One reason is that most people still tend to think of heart attack as a male disease. That’s largely because men suffer heart attack on average earlier in life, driving more attention. But in women, after menopause, the gender gap disappears.

What are the signs of trouble? Chest pain is the most common symptom in both sexes. But at least one-third of women do not show this classic symptom during coronary attack. Rather, they complain of shortness of breath, fatigue, nausea, palpitations, dizziness, intense anxiety or pain in the jaw, neck, upper back, or arm. These problems may be mistaken for a panic attack with fatal delay in diagnosis.

But suppose careful attentiveness leads to a rapid call to emergency? Even so, for women, studies show that an immediate electrocardiogram or stress test is less likely to show the typical finding of heart attack.

If a woman has an early diagnosis of coronary attack and survives it, a bypass operation may be required. Here, too, however, women still have twice the risk of dying during the surgery or shortly thereafter.

Tirone David, an internationally renowned heart surgeon in Toronto, explains one reason why the mortality rate is higher. The coronary arteries are smaller in females. This makes surgery technically more challenging when vessels the size of spaghetti are joined together.

What should women do to decrease the risk of heart disease? First, any woman still smoking should see a psychiatrist, as the risk of heart attack is seven times greater than non-smokers.

Knowing your family history is also key. If your father or brother had a heart attack before age 55, or your mother or sister before age 65, this substantially increases risk. It’s a red flag that urges “double down on preventive measures”.

If there is a history of cardiovascular disease, a daily 81 milligram Aspirin may be helpful. But since Aspirin can cause gastrointestinal bleeding, always discuss this medication with your doctor.

Remember that obesity leads to Type 2 diabetes, which in turn increases the risk of heart attack. Women who have trouble losing weight should try and try again.

Have your blood pressure checked. It has been estimated that one-third of heart attacks in women could be prevented by controlling blood pressure.

If blood cholesterol is elevated, cardiologists and most other doctors will recommend cholesterol-lowering drugs. Discuss this with your physician. But know there are alternatives, including high doses of vitamin C and lysine, a combination that has helped keep one of us alive for more than 20 years after severe heart attack.

The weekly column by W. Gifford-Jones, MD has been published without interruption for 45 years. The same no-nonsense tradition now continues in a father-daughter collaboration. Sign-up at www.docgiff.com to receive our weekly e-newsletter. For comments, contact-us@docgiff.com.

W. Gifford-Jones, MD and Diana Gifford-Jones
Common Sense Health

King Henry VIII of England offers an excellent example of how too much wine, rich food and obesity trigger the agony of gout. But why did Leonardo da Vinci, Sir Isaac Newton, and Benjamin Franklin, to name a few, develop this excruciating disease? And how can you decrease the risk?

More than nine million North Americans suffer from gout, a type of inflammatory arthritis in which the body produces too much uric acid, or the kidneys fail to excrete enough.

Genes play an important role. Gout and diseases such as diabetes are more likely to occur if there is a family history. But given the rise from only 3 million cases just over a decade ago, more than genetics is driving the problem.

Uric acid is not friendly to joints. Dr. Larry Edwards, professor of medicine at the University of Florida, says, “People with high levels of uric acid can be accumulating crystals and damaging joints for years before they have their first gout attack.”

Dr. John Fitzgerald, professor of medicine at the University of California and co-author of the American College of Rheumatology’s latest clinical practice guidelines for gout, says, “Gout is part of the metabolic syndrome,” and that people diagnosed with gout suffer first from the early stages of Type 2 diabetes and obesity, which increase the risk of gout. It is a classic example of the Gifford-Jones Law that states one disease often leads to another and another.

The first attack of gout is a huge wake-up call. Dr. Thomas Sydenham, “The English Hippocrates”, died of gout in 1698. He wrote, “The victim goes to bed and sleeps in good health. About 2 o’clock in the morning, he is awakened by a severe pain in the great toe; more rarely in the heel, ankle or instep… Now it is a violent stretching and tearing of the ligaments – now it is a gnawing pain and now a pressure and tightening. So exquisite and lively meanwhile is the feeling of the part affected, that it cannot bear the weight of bedclothes nor the jar of a person walking in the room.”

Will one attack inevitably mean another? If you do not have high levels of uric acid in the blood, kidney disease, and are fortunate to have the luck of the Irish, there is a possibility that years may pass without another attack.

On this premise, your doctor may decide to “wait and see” alongside regular checks of uric acid levels.

But as another attack may occur at any moment with increased risk of injury to kidneys, your doctor may decide it is prudent to start urate-lowering therapy (ULT). There are several drugs that taken daily will lower uric acid and help stop crystals from forming in kidneys.

Studies from the University of California show about one-third of gout patients now receive URT. This treatment may take as long as six months to control the blood level of uric acid. Until lowered, there may be more attacks.

Other studies in the U.S. and the Netherlands have identified genes associated higher levels of uric acid in the blood, including up to a 40-fold increase in the risk of gout.

Diet can play a role in treating gout. Some doctors suggest cutting down on foods that increase uric acid such as red meat, shellfish, alcohol, and sugar. But results are limited.

Genetic testing holds promise in identifying cases before symptoms appear. For now, prevention is the best course. Adopt a healthy lifestyle to keep gout from suddenly causing a painful wakeup call during the night.

The weekly column by W. Gifford-Jones, MD has been published without interruption for 45 years. The same no-nonsense tradition now continues in a father-daughter collaboration. Sign-up at www.docgiff.com to receive our weekly e-newsletter. For comments, contact-us@docgiff.com.

W. Gifford-Jones, MD and Diana Gifford-Jones
Common Sense Health

Some vitamins don’t get the attention they deserve. Ask anyone about vitamin K2 and few people can give an answer. In Vitamin K2: The Missing Nutrient for Heart and Bone Health, Dr. Dennis Goodman says ignoring vitamin K2 can be dangerous. So here are some important points to help you understand why K2 needs more attention.

In 1929, Dr. Hendrik Dam, a Danish scientist, discovered vitamin K. Now we know there are two types of K: K1 and K2. Most people get sufficient amounts of K1 by eating leafy green vegetables, rich in this vitamin. If you’re cut, K1 plays a role in blood clotting.

K2 supports bone density. Bones, although solid structures, are not inert. Rather, they are constantly changing. Cells called osteoblasts build up bone, while other cells, osteoclasts, are breaking it down. Until around 30 years of age, osteoblasts win. But then osteoclasts take over in mid-life and we begin to lose one percent of bone mass each year.

There is a good solution. Bone must be built up early in life to ensure that it does not become like Swiss cheese later on, a condition called osteoporosis. These bones can snap like a dry twig, resulting in broken hips, which may mean ending life in a wheelchair or death.

Vitamin K2 serves the important role of helping direct calcium into bone where it belongs. A Japanese study showed that vitamin K2 decreases the risk of spinal fractures by 60 percent and hip fractures by 80 percent.

A combination of calcium and K2 is like building up money in the bank early in life. Later on, there will be enough calcium for some of it to be withdrawn from bones without causing a fracture.

K2 also supports cardiovascular health. If you have been reading this column for years, you know the benefits of vitamin C in decreasing the risk of coronary attack. But vitamin K2 also plays a role in fighting cardiovascular disease.

We all need calcium for strong bones. But too much calcium can be deposited into coronary and other arteries if there is a deficiency of vitamin K2. For instance, calcium can be deposited into the aorta, the largest artery in the body, that carries blood to all our organs. Calcium deposits in this location weaken the wall of the aorta increasing the risk of rupture and sudden death.

A Dutch study of 4,600 men aged 53 and older showed that a high intake of vitamin K2 decreased the risk of aorta calcification by 52 percent. Another study reported that K2 decreased the risk of coronary attack by 41 percent. In a study of 16,057 women, those on high doses of vitamin K2 lived 9 percent longer.

K2 can help with other health problems too. K2 acts like a traffic cop. It helps direct calcium traffic into tooth enamel decreasing the risk of dental decay. Some researchers report that K2 increases insulin sensitivity making it more effective in the fight against Type 2 diabetes.

There is no easy test to measure K2 levels. But if suffering from osteoporosis, heart disease or diabetes, you are most likely deficient in vitamin K2. Statin drugs to lower blood cholesterol inhibit K2 synthesis.

People who are taking blood thinners should not take vitamin K as it decreases the effectiveness of these drugs.

Vitamin K2 is an especially important partner to vitamin D, which controls the absorption of calcium. Various brands of K2, including in combination with D, are available, so check with a health food store and your doctor for guidance.

The weekly column by W. Gifford-Jones, MD has been published without interruption for 45 years. The same no-nonsense tradition now continues in a father-daughter collaboration. Sign-up at www.docgiff.com to receive our weekly e-newsletter. For comments, contact-us@docgiff.com.

W. Gifford-Jones, MD and Diana Gifford-Jones
Common Sense Health

When asked how they exercise, people often report jogging, bicycling or walking.

But what about weightlifting? Authorities say that picking up weights is not about winning a medal. Rather, as we age, strength exercises can help circumvent medical problems.

Take if from Arnold Schwarzenegger, who famously remarked, “The best activities for your health are pumping and humping.”

Let’s leave the humping part aside for now. When it comes to pumping weights, there are a lot of myths. First, lifting dumbbells is not just for building muscles. In fact, it helps to fight one of the problems that can change your life in a split second.

Getting older is invariably fatal. But long before the final event, we begin to lose bone density, usually starting in our thirties. By age 70, many people have lost 40 percent of their peak bone mass. This often sets the stage for a fractured hip in the event of a fall.

Osteoporosis (thinning of bones) make bones look like swiss cheese, and it can have tragic consequences. For instance, among the elderly who fall and break a hip, there is a high chance of imminent death. A large population-based study showed that one in three adults aged 50 and over died within 12 months of suffering a hip fracture.

Even when survived, hip fractures have a devastating impact on quality of life by reducing independence and increasing social isolation. Moves to assisted living are common.

No one will ever forget the telephone call that a parent has fallen and fractured a hip. And if they’re 75 years of age or over, in spite of all that can be done medically, the risk of dying within one year is 40 percent or higher.

Lifting weights decreases the risk of fractures by building up muscle strength, slowing bone loss, and helping with balance.

Muscle strength is an important factor for the elderly to maintain functional independence – the ability to carry out daily activities such as walking up a flight of stairs, going grocery shopping, and bathing without help. People who neglect basic core strength eventually find it hard to get up from a toilet seat. It comes as a terrible realization when individuals must acknowledge dependency on others to meet their daily needs.

Weightlifting slows bone loss, and some studies show that regular strength exercises can improve bone mass. How does it work? Exercises that involve use of strength – including weightlifting, but also walking, gardening and even dancing – place forces on your bones, stimulating your body do regular maintenance. Don’t forget the importance of good nutrition, including adequate calcium and vitamin D.

Strength training helps with managing or losing weight too, as it can increase metabolism to help burn more calories. Getting rid of excess fat should be high priority for those overweight, as it’s linked to chronic inflammation. Furthermore, obesity triggers type 2 diabetes, increasing the risk of blindness, kidney failure, leg amputation and heart attack.

Building muscle and stronger bones will also mean better balance since it works the systems that keep you stable, and that will reduce your risk of falls.

Strength training can have another benefit when exercises work the body’s core. Most people carrying extra weight aren’t thinking about the ineloquently named non-alcoholic fatty liver disease (NAFLD). But it affects 25 percent of the population worldwide. It’s fast becoming the number one reason for liver transplant.

NAFLD involves visceral fat, fat that accumulates around the liver and other abdominal organs, and is accompanied by inflammation. A serious problem, it can increase the risk of cirrhosis and cancer.

So, grab some weights and start pumping.

The weekly column by W. Gifford-Jones, MD has been published without interruption for 45 years. The same no-nonsense tradition now continues in a father-daughter collaboration. Sign-up at www.docgiff.com to receive our weekly e-newsletter. For comments, contact-us@docgiff.com.