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Tips for Safe Summer Fun

Stay Safe with Sunscreen, Sunglasses and Plenty of Water

The longer, sunshine filled days of summer are upon us and without a doubt, they are one of life’s unrivaled joys, especially when you protect yourself from the powerful impact of ultraviolet rays. With that in mind, we share our tips for safe summer fun; from choosing and using the right sunscreen to staying hydrated.

The debate around sunscreen safety heated up with last year’s recall of some popular consumer products containing chemicals such as benzene, which is absorbed through the skin and into the bloodstream. Yet according to the FDA, the American Academy of Dermatology and other experts, there is minimal evidence that systemic absorption of these ingredients is toxic or harmful to health. There is, however, a mountain of proof regarding the harmful effects of sunburn – most notably its significant contribution to the risk of melanoma.

“Use of a broad-spectrum, SPF 30 sunscreen effectively blocks UVB and UVA rays to prevent sunburn,” says Dr. Andrea Murina, MD, associate professor of dermatology at Tulane University School of Medicine and director of the University Medical Center’s dermatology clinics. “This not only reduces the risk of developing skin cancer but also decreases signs of early aging on your skin (such as wrinkles, age spots, sagging skin) and stops existing melasma from darkening and new patches from appearing.”

According to Dr. Murina, while we know some ingredients in sunscreen do cross over into the bloodstream, most are rated by the FDA as GRASE, meaning generally recognized as safe and effective.

A bit of background: Earlier studies conducted by the FDA showed that common chemical ingredients used in sunscreen, including oxybenzone are absorbed into the bloodstream.

Further research on whether systemic absorption of oxybenzone was an actual concern was suggested. However, no clear links to any health problems in humans were identified.

Nevertheless, the ingredient has been eliminated from most sunscreens currently being manufactured, making it easy to find an oxybenzone-free product.
When applied correctly, a water-resistant, SPF 30 sunscreen is optimal, blocking 97% of UVB rays. “A higher SPF is fine, but only incrementally blocks more rays, and the time and duration of effectiveness is the same,” says Murina.

The best way to protect yourself is by using a combination of measures:

Wear sun-protective clothing, including a lightweight, loose-fitting, long-sleeved shirt, pants, a wide-brimmed hat and sunglasses. Darker colors, densely woven cloth, unbleached cotton and shiny polyesters are recommended by the Skin Cancer Foundation.
Judiciously apply broad-spectrum sunscreen every two hours on uncovered body parts, such as top of hands, face, neck and ears.
Swap out regular SPF 15 foundation for a tinted sunscreen. “There are so many cosmetically elegant ones available today that mimic the look of makeup but offer much more protection,” says Murina. Tinted sunscreens with an SPF of 30 or higher provide protection that blends well with all types of natural skin tones, and help prevent exposure to both UV rays and visible light from the sun.
Seek shade when the sun’s rays are strongest, between 10:00 a.m. and 2:00 p.m.

Like sunscreen, sunglasses are vital in blocking the harmful effects of UV radiation. UVA and UVB rays can cause increased risk of conditions such as cataracts, eye cancers and growths on the eye, as well as premature aging of the delicate skin around your eye. Choose sunglasses that block 99% or 100% of all UV light or are listed as having UV absorption up to 400nm. Wear them even when it’s hazy or cloudy, as UV light can pass right through clouds. And although you’ve undoubtedly heard this piece of advice before, it bears repeating: To protect your retina, never look directly at the sun.

Finally, drink up when you’re out in the sun. Water is the elixir of choice, helping to lower your body temperature and replace the fluids you lose through sweating. This is particularly important for older adults whose body’s fluid reserve becomes smaller and thirst sense decreases as they age. Be aware of the most common signs of dehydration – lightheadedness, fatigue, dizziness, less frequent urination, dark-colored urine – and rehydrate promptly with cool water.

Safe Travels
If your summer vacation includes international travel, we recommend some healthy pre-planning that includes the following:

COVID-19: Make sure you are up to date with your vaccines and boosters. Get tested for COVID-19 as close to the time of your departure as possible (no more than three days before travel). Do not travel if you have COVID-19 symptoms, if you tested positive or if you are in quarantine due to possible exposure.
Check the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) websites for the most up-to-date travel alerts, advisories and recommendations. Immunizations needed will vary based on your health condition, immunization history, countries and regions on your itinerary, and duration of your visit.
Update your routine immunizations to protect against increased risk of exposure to illnesses such as seasonal flu, diphtheria, varicella (chickenpox), measles, mumps and rubella. For quick guidance on additional immunizations you may need, try the online tool at GlobalTravEpiNet.
To protect yourself from the serious diseases spread by mosquitos, such as dengue fever and malaria, bring an EPA-registered insect repellent with an active ingredient like DEET or picaridin.
Pack your prescription medications and consider bringing over-the-counter medicines, including anti-diarrheal medicine, antacid, antihistamine, hydrocortisone cream, motion sickness medicine, cough medicine, pain and fever medicine, and mild laxative.
Also, pack supplies to prevent illness or injury, such as hand sanitizer, water purification tablets, insect repellent and sunscreen; and first aid items such as antibacterial ointment, antiseptic wound cleanser, aloe gel, insect bite cream, a digital thermometer and bandages.

We encourage you to contact your health care provider four to six weeks prior to your trip for personalized guidance … and we wish you a safe and memorable journey!

Sources: FDA, American Academy of Dermatology, Mayo Clinic, American Academy of Ophthalmology, U.S. Centers for Disease Control and Prevention, Skin Cancer Foundation

Summer Fruits and Veggies

Picking the Season’s Prime Produce

A seasonal bounty of fruits and vegetables is in bloom everywhere from your grocery’s fresh foods section to local farmers’ markets, and in your own backyard garden. The following is advice from experts on how to purchase summer fruits and veggies at its peak, and store them safely, until ready to enjoy.

Berries and Cherries. Look for plump, unblemished fruits with no dark spots or fuzzy white mold; raspberries, blackberries and strawberries should be fragrant. All are shiny when ripe – except for blueberries, which will have a dull matte finish. While most berries can be refrigerated for up to a week, raspberries can start fading more quickly; when that occurs, The Spruce Eats recommends freezing them for use in smoothies and other recipes. To extend their life, do not wash fruit when you unpack your groceries; wait until right before you eat them.

Corn. Choose uncut silks coming out of tightly closed, bright green husks that smell slightly grassy, advises Martha Stewart; and peel back a tad to make sure the kernels look plump and healthy. Refrigerate corn with husks on and use as soon as possible.

Cucumbers and Peppers. Look for firm, shiny vegetables without blemishes, wrinkles or soft spots. According to Have a Plant, cucumbers and peppers can be refrigerated in a plastic bag for up to one week.

Grapes. Choose firm, plump grapes with green healthy stems. They can last up to two weeks when refrigerated. Or try an easy frozen treat: Place on a baking sheet; freeze until firm, and enjoy. Store leftovers in a freezer-safe bag for up to 12 months.

Lettuces. Eliminate those with wilted or broken leaves. Lettuce can be stored for up to four days when refrigerated; darker lettuces tend to last longer than pale, tender varieties. Wash all lettuces just before using.

Melons. Select watermelons without flat sides or dents, and choose ones with a heavy weight for optimal juiciness. Cantaloupe and honeydew melons are best when they have a pale yellow rind and flowery smell at the stem. Harvest to Table recommends storing whole ripe melons in the refrigerator for up to a week to avoid spoiling; cut melons will keep for up to three days.

Plums, Nectarines, Peaches. Opt for vibrant colors, a firm feel, and beautifully fragrant aroma for nectarines and peaches. Store unripe plums, nectarines and peaches in a paper bag until ripe. When ripe, peaches and nectarines can be stored at room temperature for use within a few days; plums can be kept fresh for up to five days in the refrigerator.

Tomatoes. Pick vividly colored, medium-firm tomatoes with smooth, shiny skin. To preserve the freshness and natural flavor of unripe tomatoes, Master Class recommends storing them on a countertop away from direct sunlight. They will last a week on countertops and up to two weeks if stored in the refrigerator.

Zucchini and Summer Squash. Look for smooth-skinned, small to medium size vegetables. Eating Well advises storing zucchini in the crisper drawer of your refrigerator, in either a plastic or paper bag with one end open to ensure good ventilation.

Exercise Is Good Medicine

Get Up and Join the Movement

As we emerge from the doldrums of winter hibernation and COVID-19-related inertia, it’s important to remember that exercise is good medicine and there’s no better time than now, to get moving again.

“There isn’t a chronic condition that can’t be better managed with an appropriate dose of exercise,” asserts Dr. Cedric Bryant*, President and Chief Science Officer at the American Council on Exercise. “This requires good interaction with your physician, an ability to listen smartly to your body and the realization that some exercise is always better than none.”

He recommends fostering good muscular fitness and enhancing strength, flexibility and balance with the exercise routine shown below. The 15-minute investment of time needed to complete one set of 8 to 15 repetitions for each exercise provides beginners with “the minimum effective dose needed to elicit a very positive response,” says Dr. Bryant.

Add regular rounds of exercise that build endurance, helping improve the health of your heart, lungs and circulatory system. To achieve the best results, you should have enough breath to talk but not enough to sing during aerobic activities such as brisk walking or jogging, dancing, biking, swimming, climbing stairs, or playing basketball, tennis or the uber-popular pickleball. (Learn more about today’s fastest-growing sport in an upcoming newsletter.) Be sure and check with your healthcare provider before beginning an exercise program.

Dr. Bryant’s Essential Seven

1. Pushups

Benefits: Develop the large muscles of the chest and the back of arms
The basic incline pushup is done using a sturdy table or other solid surface about 3 feet high. Stand facing the table and place your hands on the edge (shoulder width apart) arms straight and elbows not locked. Walk your feet backward until your arms and body are in a straight line. Bend elbows and slowly lower chest to the edge of the table while inhaling. Keep body straight and rigid throughout the movement. Push body away from the table until elbows are extended but not locked. Exhale as you push up.

2. Bodyweight Squat

Benefits: Strengthens and tones the lower body

Stand with your feet slightly more than hip width apart, toes turned slightly outward, hands at sides with palms facing in. Pull shoulders down and back. Stiffen your core and abdominal muscles. Hold chest up and out, tilt head slightly up, shift weight back onto your heels while pushing hips toward the wall behind you.

Downward phase: Shift hips back then down to create a hinge-like movement at hips and knees. Try to control the amount of forward movement of the shinbones. Maintain tension in the core muscles and keep your back straight. Lower yourself until thighs are parallel or almost parallel with the floor. DO NOT go deep enough to cause pain. Make sure your feet don’t move, ankles don’t collapse in or out, knees remain aligned over the second toe, and body weight is evenly distributed between balls and heels of the feet.

Upward phase: Extend the hips and knees by pushing your feet into the floor. Hips and torso should rise together while heels are flat on floor and knees are aligned over the second toe. Continue extending until you reach the starting position.

Remember to inhale on the way down and exhale on the way back up.

3. Bent-Over Row

Benefits: Targets muscles in the upper and middle back and improves stability of the spine

Holding a small weight in each hand and standing with feet hip-distance apart, bend at the waist. Your back should be parallel to the floor with a neutral, not rounded, spine. Extend arms toward floor, keeping knees slightly bent. Engage abs and squeeze shoulder blades together as you bend elbows back and bring weights to your torso. Keep arms close to your torso. Slowly lower the weights back to the starting position.

4. Modified Single-Leg Deadlift

Benefits: Strengthens and tones gluteals and helps improve balance

Position yourself by a wall or chair. Stand straight, with feet aligned with hips, and shift weight to right leg. Slowly bend forward at the waist while raising your left leg behind you until your torso and leg are both parallel to the floor. Keep your head up and arms straight, perpendicular to the floor. Lower your leg as you return to an upright position. Keep your leg straight at all times. Repeat all reps on one side, then switch legs.

5. Overhead Front Press

Benefits: Increases shoulder strength and engages the core for stability

Stand upright and keep the back straight. Note: Beginners or those with back issues can perform this exercise seated. Hold a small weight in each hand at the shoulders, with an overhand grip. Thumbs are on the inside and knuckles face up. Exhale as you raise the weights above the head in a controlled motion. Pause briefly at the top of the motion. Inhale and return the weights to your shoulders.

6. Calf Raises

Benefits: Strengthen lower leg muscles, increase stability, balance and agility

Start by standing 6 to 12 inches away from a wall, facing it, with feet hip width apart. Extend arms to place your palms on the wall, level with chest or shoulders. Exhale and slowly lift heels off the floor, keeping knees extended without rotating your feet. Use your hands on the wall to support your body. Hold raised position briefly. Inhale and slowly lower heels back to the floor.

7. Plank Pose

Benefits: Strengthens the core and abdominals while increasing stability and balance

Modified version: Start in tabletop position with hands and knees on the floor. Walk your hands so your forearms and palms are facing down, keep shoulders and elbows aligned. Walk your knees away from your body until you feel your core and abdominals engaged. Keep torso straight and rigid, your body in a straight line from ears to knees with no sagging or bending, and with shoulders down, not creeping up toward your ears. You may keep your toes on the floor for extra support. Hold position for 10 seconds. Walk your knees back in, repeat. Over time, work up to 30, 45 or 60 seconds.

Sources/refer to these websites for more detailed descriptions on the exercises: American Council on Exercise, Verywell Fit, Women’s Health

*As President and Chief Science Officer at the American Council on Exercise, Cedric X. Bryant, PH.D and Fellow of the American College of Sports Medicine, stewards the organization’s exercise-science and behavior-change education. He earned both his doctorate in physiology and master’s degree in exercise science from Pennsylvania State University, where he received the Penn State Alumni Fellow Award, the school’s highest alumni honor.

What’s Keeping You Up at Night?

Breaking the Cycle of Anxiety, Insomnia and Sleep Anxiety

A good night’s sleep does more than refresh and revitalize. It’s essential to your health, so make it a priority to understand what’s keeping you up at night.

“Healthy sleep is as important as proper nutrition and regular exercise for our physical and mental well-being,” says Kannan Ramar, MD, sleep medicine physician at the Mayo Clinic’s Center for Sleep Medicine and immediate past president of the American Academy of Sleep Medicine. “Lack of sufficient sleep is associated with increased risks of type 2 diabetes, high blood pressure, cardiovascular disease, depression and anxiety.”

The sleepless nights and drowsy days previously experienced by one out of three Americans with insomnia rose to pandemic highs of almost 60% in 2021, sounding a wake-up call to address this treatable condition which profoundly impacts both mental and physical well-being.

Sleep disturbance is intricately interconnected with the presence of issues such as anxiety and depression, each influencing the others, so it’s not always possible to determine which came first. Behavioral changes that result from chronic insomnia include feelings of being overwhelmed, inability to concentrate, irritability, nervousness, restlessness, and a sense of impending danger or doom.

Of adults diagnosed with depression, 75% experience insomnia and 20% have obstructive sleep apnea. Similarly, anxiety can make it harder for the body to relax and fall asleep.

Research suggests that anxiety can also affect rapid eye movement (REM) during slumber and trigger vivid, disturbing dreams that wake the sleeper.

Completing the loop is sleep anxiety — apprehension or fear about going to sleep — which is commonly seen in those with insomnia, narcolepsy, sleep apnea or restless legs syndrome.

While insomnia can seem never-ending, a number of strategies can effectively break the cycle.

The Basics:

Set boundaries for blue light exposure by turning off tv, tablets and phones at least 30 minutes before bedtime.
Limit large meals, caffeine and alcohol within 3 to 4 hours of bedtime, which can disrupt sleep. Alcohol allows you to fall asleep quickly but not stay asleep throughout the night.
Establish a consistent wake-up time seven days a week.
Ensure your bedroom is a designated place of sleep by keeping it dark, cool and quiet. And turn around your clock so you can’t see the time if you’re tossing and turning in the middle of the night.
Pursue support if you are experiencing chronic insomnia, defined as difficulty sleeping three or more times per week for at least three months. “We know that the longer insomnia lasts, the more difficult it is to treat,” says Dr. Ramar.

Support can include:

Cognitive behavioral therapy for insomnia (CBTI), a form of talk therapy focused on learning how to create an optimal sleep environment with positive bedtime routines and avoidance of factors that trigger anxiety and negative thinking. Requiring up to 12 weeks to see results, the key is shifting from “trying hard to sleep” to “allowing sleep to happen,” according to Stanford Health.
Prescription sleep hypnotics, such as Ambien or Lunesta. Hypnotics can be considered in conjunction with CBTI, but patients must be closely monitored for adverse effects and a buildup of tolerance to the medication’s effects. Low doses of Trazodone, an antidepressant, are sometimes used, as it causes drowsiness.
Light therapy, which is especially helpful for those who need to reset their circadian rhythms; e.g., a night owl who wants to function better with an early morning rising time.

If you are experiencing too many wakeful nights, please let your healthcare provider know. It may be helpful to keep a sleep diary for several weeks to help pinpoint the habits affecting your ability to fall and stay asleep. In some cases, we may recommend a polysomnography (sleep study), where you’ll be monitored for blood oxygen levels, body position, breathing, electrical activity in the brain, eye and leg movements, heart rates and rhythms, sleep stages and snoring during an overnight stay in a sleep lab.

Finally, keep in mind that the amount of sleep needed per night – typically 7 or 8 hours on average – varies by individual. “If you function well and are fully alert during the day, you can be confident your sleep needs are being met,” says Dr. Ramar.

What Does BMI Really Tell Us?

Definitive Diagnostic Tool or Part of a Greater Health Matrix?

It’s an easily understood calculation: Body Mass Index, popularly known as BMI, computes an individual’s measure of body fat as weight in kilograms divided by height in meters squared. Levels are defined as Underweight if less than 18.5, Normal weight if between 18.5 and 24.9, Overweight if between 25.0 and 29.9, and Obese if above 30. But what does BMI really tell us?

This simple formula has nonetheless sparked controversy and continued questioning: Is BMI a quick, easy and efficient way to identify weight problems and associated risk of disease in adults? Or is it an inaccurate measure because it doesn’t consider body composition, age, sex or ethnicity?

Years of debate, research and analysis now point to using BMI in a more nuanced way, suggesting that it is best employed as just one part of an initial health screening for individuals, and not as a diagnostic tool. Much more meaningful is how BMI fits with other essential measures of an individual’s health — blood pressure, blood sugar, cholesterol levels, heart rate, inflammation, physical activity, diet, cigarette smoking and family history.

Looking at BMI alone can be misleading when you consider that:

Women tend to have more body fat than men.
Older adults have more body fat than younger ones. Aging is associated with an unhealthy increase in body fat and an associated increased risk for prediabetes and type 2 diabetes.
At the same BMI, the metabolic risks for people of Asian descent are higher than for Caucasians.
People who engage in strength training two or more times per week have higher lean muscle mass than nonathletes, which can result in a higher BMI but not necessarily a higher risk of disease.

Additionally, knowing where the fat is distributed is essential in determining disease risk. The pear shape associated with women means subcutaneous fat around the hips, thighs and buttocks; more dangerous is the apple shape, which indicates visceral fat in the abdomen (waist circumference of more than 40 inches for men or more than 35 inches for nonpregnant women), which is linked to higher risk of heart disease and type 2 diabetes.

An influential study published in Nature further revealed the flaws in categorizing people as “unhealthy” or “healthy” based on BMI alone. The authors found that more than 74 million American adults were miscategorized. Nearly half of people considered overweight and 29% of those categorized as obese were actually metabolically healthy, with normal blood pressure, cholesterol and blood glucose levels. Meanwhile, 30% of those considered “normal weight” had metabolic or heart issues.

The origins of BMI help explain its limitations. In the 1830s Belgian mathematician Lambert Adolphe Jacques Quetelet developed a test intended to identify the “l’homme moyen,” or the “average man,” by taking the measurements of thousands of Western European men and comparing them to find the ideal weight. More than a century later, American physiologist and dietician Ancel Keys promoted Quetelet’s Index as the best available way to quickly screen for obesity, identifying certain BMI ranges as associated with greater risk of disease and poor health outcomes. However, like Quetelet, Keys didn’t account for different body types or ethnicities.

One other point to consider: While more intrusive and not as commonly available, methods such as measuring skinfold thicknesses, bioelectrical impedance, underwater weighing, abdominal CT scans (for visceral fat) and dual-energy X-ray absorption are more accurate than BMI for estimating body fat.

So is BMI still meaningful?
As a discussion point, or as one tool used in combination with other assessments of metabolic and skeletal health, it can be useful.

Most importantly, body fat is just one of many factors considered when evaluating individual health and risk of disease.

We encourage you to call your healthcare provider to discuss your personal wellness profile.

Pandemic Stress Likely Compounded by Seasonal Affective Disorder

Coping With Sad This Winter As we continue to weather the storm of COVID-19, seasonal affective disorder, or SAD, is once again on our radar. More subtle than an arctic blast, SAD is just as real, with just as much potential to have a chilling effect on our mood, productivity and wellness. Similar to last...

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A Novel Approach to Behavior Change

How to Replace Bad Habits with Healthy, Sustainable Behaviors For entrepreneur physician Kyra Bobinet, MD, the typical reasons behind a failed diet served as the impetus for developing a novel approach to behavior change. “I was doing so well. I knew what to eat, when to eat, how to eat, and then I just stopped...

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Staying Well in the New Year A Proactive Guide

In the spirit of starting 2022 with healthy intention, we’ve taken a page from the U.S. Preventive Services Task Force (USPSTF) latest recommendations, long considered the gold standard for clinical preventive services, and prepared the following proactive guide to staying well in the new year. Back in 1903, Thomas Edison predicted where we were headed:...

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Color Your World with Every Hue of Fruit and Vegetable

Eating Your Fruits and Veggies May Help Reduce the Risk of Chronic Disease Fill your plate with a vibrant, colorful array of fruits and vegetables for a naturally delicious way to meet your daily requirement of vitamins, minerals and nutrients. Plant foods contain thousands of natural compounds called phytonutrients, which may have anti-inflammatory benefits that...

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COVID-19 and The Road Ahead

From Boosters & Breakthroughs to Vaccines & Variants: Where Do We Go From Here? The following reflects an 8/24/2021 discussion; please check the CDC website for real-time updates as the situation continues to evolve. Their answers may not land lightly, but epidemiologist Jodie Guest, PhD, and drug development expert Michael Kinch, PhD, have been immersed...

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