Examined

About two years ago I wrote a post about the overlooked dilemma of getting sunlight for health reasons while balancing increased skin cancer risk. This was a really difficult post to write, and two years on I think it’s worth revisiting, even though that difficulty remains! The science has moved a bit, and mostly in the direction I suspected.

Covid rates in the US are supposedly the best they have been since summer 2021. There are pockets of high prevalence as noted below, but for much of the country the Covid living is easy.

I see a lot of mouths in my practice, and not just because someone has a sore throat or justified complaints about our broken primary care system. Periodontal health keeps coming up as a quiet predictor of broader health. Gum inflammation tracks with cardiovascular risk, diabetes control, and even cognitive outcomes.

We are in the middle of a proteinaceous moment. A recent national survey found that 70% of Americans “want to eat more protein.” That’s more than any other nutrient or vitamin, including, up from 50% just two years earlier. Searches for “high protein” are peaking. I’ve heard that social media is full of people narrating their daily gram counts.

My oldest patient is 103 years of age. Her legs are not strong, but she is mentally very sharp. Of the almost 250 years the United States has existed, she has been alive for 41% of that time. My patient has another birthday coming up soon, and so does our country. Birthdays are a time for celebration and reflection, and sometimes regret. At the end of her next visit I might ask her about the narrative of her life — what she remembers most fondly, her greatest moments of happiness, the difficulties.

Finally, after dragging on for years, on Monday the FDA approved a “new” antiviral medication for Covid. It has been in use for over 3 years in other countries like Japan. It’s called Xocova, with the scientific name ensitrelvir. I already prescribed it once this week to a highly-informed, very intelligent, highly-motivated patient (who still deals with Long Covid from a previous bad infection).

The mineral everyone's talking about — and what the evidence actually shows. I think half of the patients I saw yesterday asked me about magnesium. It has overtaken vitamin D as the supplement most likely to come up in a primary care visit, and the questions have grown more specific over time. Not should I take magnesium, but how much, should I take glycinate or threonate, or does 400 milligrams work for sleep? Anxiety?

And probably aren't causing muscle aches that often either. Quick Boost #23 I haven’t done a quick boost in a while. These are shorter posts. Today’s was prompted by a question from a patient. I’m going to share a cleaned up, referenced version of how I replied to his concerns about statins.

The jarring, unhealthy, sudden arrival of temperatures in the 90's Philly hit an all-time record yesterday for heat in the month of May, and much of the Mid-Atlantic and Northeast are in for another day of baking. Many of my patients in the office were clocked with temperatures around 99 degrees as they walked in, and I expect much the same today. Our bodies are not ready for this kind of heat yet. It’s dangerous, really, for young, middle aged, and especially older bodies.

I wrote a post recently about those 7-9 hours of sleep we are supposed to get, examining the strength of the evidence as well as the tradeoffs between conscious life and health benefits. But as I endeavor to keep multiple balls juggled in the air as a doctor, newsletter writer, husband, father, laundry folder, household contributor, and adequate nighttime sleeper… sometimes I just need a nap! I know we’ve all felt the same way at times.