Osteoporosis Is Not Just for Women

 

Osteoporosis, or brittle bones, is a condition normally associated with postmenopausal women but it is also seen in men. According to Dr. P. Peris of the University of Barcelona, "Osteoporosis in men has received much less attention; however, it is increasingly recognized as a problem in clinical medicine." According to Dr. Allan Gold, an endocrinologist and senior physician at Montreal General Hospital, a recent Canadian survey found that 20 percent of men have serious bone loss in their vertebrae, and by age 70 the figure is as high as 30 percent. Gold said that "men in their 80s have a fracture rate that is equal to women's."

The main cause of osteoporosis is aging. The sex hormones, estrogen and testosterone, hold the balance between bone renewal and deterioration. Women who are entering menopause are briefed on the tools to fight osteoporosis: exercise, a calcium-rich diet, estrogen-replacement therapy and other medications. Men in their 60s rarely receive any such medical alert even though their testosterone levels decline, and some men suffer from "male menopause", or andropause. For those men and others, osteoporosis is a real risk.

A recent study of over 10,000 people under age 60 by researchers at the University of Chicago and published in the Journal Of Clinical Endocrinology & Metabolism found that men with high levels of body fat were more likely to have lower bone density and attendant fractures than men with normal levels of body fat. "We found that higher fat mass was related to lower bone density, and these trends were stronger in men than women," said Rajesh K. Jain, M.D., of University of Chicago Medicine, one of the researchers. The review of the literature done by the researchers shows that osteoporosis and fragility fractures have a high incidence also in men; and, furthermore, the risk of fatal complications in hip fractured men is higher than that for women.

The recommendation is that men age 70 or older and men age 50 or older with high risk factors (high body fat, history of smoking, prior fractures, lack of physical activity) have a baseline screening and be tested every few years thereafter. 

Its not just for women anymore.

Vitamin D and Autoimmune Diseases

 

Autoimmune disease refers to problems with the immune system where immune cells target the body’s own healthy tissues by mistake, signaling the body to attack them. Autoimmune diseases can affect almost any part of the body. Some examples of common autoimmune diseases include rheumatoid arthritis, Type-1 diabetes, multiple sclerosis, psoriasis and lupus. There are over 80 known types of autoimmune diseases that affect over 24 million people in the US alone.

So recent study results published in The BMJ was good news. People who took 2,000 international units per day (IU/day) of vitamin D, with or without one gram of fish oil, for slightly more than five years reduced their risk of developing an autoimmune disease by 22% when compared to their counterparts who took a placebo.

"It looks like giving vitamin D will prevent autoimmune disease, which is really exciting," said study author Dr. Karen Costenbader, a rheumatologist at Brigham and Women's Hospital in Boston.

Participants were randomly assigned to receive either 2,000 IU/day of vitamin D with a 1 gram omega-3 fatty acid supplement; vitamin D with a placebo; omega-3 fatty acid with a placebo; or placebo alone. The participants then answered questionnaires about new diagnoses of autoimmune diseases, and doctors reviewed their records to confirm these diagnoses. People who took vitamin D or vitamin D and omega-3 fatty acids had a lower rate of autoimmune disease than people who took a placebo or omega-3 fatty acids alone after slightly more than five years of follow-up, and these effects were more pronounced after two years.

Still, Costenbader cautioned not everyone should jump on the vitamin D supplement bandwagon. "There are some people who need to avoid vitamin D because they have a history of kidney stones or other diseases," she said. "Check with your doctor before you start taking supplements."

Also, vitamin D is fat soluble, meaning it is not as easily expelled from the body as water soluble vitamins and can accumulate over time. The safe upper limit for supplementation with vitamin D is generally thought to be 4,000 IU daily.

Are They Serious?

 

Do you remember when a "quarter pounder" was a big hamburger? Then half pounders made them look puny. Well those days are long gone. Last October, Chili's announced some big news: Four new Big Mouth Burgers (was there ever a better name?) built upon a full pound of ground beef. Yes. A full pound. 

The Big Mouth Rancher, as just one incredible example, tops off the pound of beef with six slices of bacon and two slices of American cheese on a bulky white flour bun. And that is how you pack 1,780 calories, 53 grams of saturated fat and 2,780 mg of sodium into a single sandwich. Choose fries as a side and you are up to 2,200 calories and 3,440 mg of sodium. Instead of fries they should consider teaming it up with a defibrillator.

"We can't help you decide which one to try first," says Chili's web site, "but we do highly recommend a You Only Live Once mentality and say go for all of them!"

Just do it quickly. Because if this is the way you eat, you won't be living for very long.

Scaling Up Portion Size

 

On April 15, 1955, McDonald's opened its very first franchised restaurant in Des Plaines, Illinois. The hamburgers it sold were 1.6 ounces of ground beef. You could add a 2.4 ounce serving of fries and a "large" 7 ounce Coke if you liked. Today that would net you a half pound of beef, 6 ounces of fries and a 30 ounce soda. This sort of serving size creep is by no stretch limited to McDonalds, or to fast food restaurants generally. A plate of Mexican food is 27% larger. Snacks, whether they be potato chips, pretzels or crackers, are 60 percent larger. In 1970, Americans took in an average of 2,160 calories per day. Today, it has skyrocketed to 2,673 daily calories per person. We are now eating 20-25 percent more calories than we did in 1970.

Both plate sizes and portion sizes have expanded before our very eyes. With the introduction of processed, shelf-ready food in combination with new agriculture policies, food became cheaper and easier to get our hands on than it was in the 1970s. And today food is everywhere. If you combine this with a society that is always looking to get more bang for their buck, you end up with price wars over who can give you the most food for the least amount of money.

The results are predictable. In 2018, the age-adjusted prevalence of obesity in American adults was 42.4%, and there were no significant differences between men and women among all adults or by age group. The age-adjusted prevalence of severe obesity in adults was 9.2% and was higher in women than in men.

So we are getting bigger (you can't say fatter anymore I guess) right along with the amount of food we are consuming. Unsurprisingly, the more food we are served at one time, the more food we eat. This fact is not lost on the marketing departments of food providers either. If ordering a Medium is your habit, it is probably yesterdays Large and tomorrow's Small.

And it is not only a problem when eating out either. Portions of home made meals are swelling too.

So what can you do to defend yourself? Here are a few tips from Dr. Wendy Scinta, MD, a nationally recognized expert on adult and childhood obesity treatment, and the current president-elect of the Obesity Medicine Association.

- Try to serve or order protein, such as meat or fish, or plant-based food such as tofu, over carbohydrates such as pasta, rice and potatoes.

- When serving food at home, use smaller plates for the main course, and larger ones for the salad. It is well proven that the size of your plate influences the amount of food you end up eating.

- Limit eating out to no more than once per week, and try to cook more healthy meals at home. This may be one of the few silver linings of the Covid pandemic. You may even discover you enjoy it.

- When eating out, do not hesitate to ask for a to-go box and take half of your meal home.

Most of all, increase your awareness. Be aware of portion sizes. Be aware of how hungry you are or aren't. Be aware of what it is you are eating. Being overweight, let alone obese, leads to a long menu of health problems. How do we afford a society where 2/3 of us are?

Type-2 Diabetes Can Be Preventable

 

According to 2019 statistics, about 12% of Americans have diabetes. Less than 1% of them have Type-1 diabetes, where their body loses or never had the ability to produce insulin. The rest have developed Type-2 diabetes (no one is born with it), where their cells have become insulin resistant and cannot process it properly. But the CDC estimates that a staggering 38% of all US adults have pre-diabetes. That is, they are in the process of developing into Type-2 diabetics. That is about 96 million adults in a country with a total population of 331 million. One person in three.

Like heart disease and cancer, diabetes is a leading cause of death for Americans. And it is often the underlying reason for cardiovascular problems like heart disease and stroke. Sadly, Type-2 diabetes is largely a preventable disease and recent studies suggest that it can even be reversed with diet and lifestyle changes. For this reason it is often referred to as a "lifestyle disease". And yet it continues to afflict more and more of us.

Since more than 80% of pre-diabetics are unaware that they have the condition, your first step should be to have yourself tested for it at your next physical. Its likely that your doctor will measure your A1C as part of  your routine blood test. If your A1C level is 5.7% or less, congratulations. That is normal. Higher than that and you are already pre-diabetic. If it is above 6.5% then you are a Type-2 diabetic and need to address the situation with your doctor immediately.

If you are in the pre-diabetic range, you should undertake some serious diet and lifestyle changes to prevent things from getting worse. This would include dietary improvements, regular exercise, weight loss, effective stress management and perhaps strategic supplementation. There are hundreds of support groups online and they are most likely a better place for most people to begin than a Google search. Unfortunately, with so many people affected, diabetes "cures" and "treatments" are a rich opportunity for scams. Here is one good place to start but there are many others. As always, be very suspicious of anything claiming to be a simple way to resolve the problem.

What's Best in Bread?

 

Bread used to be just bread. It was made from refined whole wheat flour, sliced and sold in plastic packages. Not any more. Your father's wheat bread now faces a whole aisle full of competition, from whole wheat to low-carb, paleo, keto and cauliflower. It can be a little confusing but just keep your eyes on the basics: whole grains are better than refined flour; fewer additives are better than more.

Here's what to look for to keep your staff of life as good for you as possible.

100% whole grain. As long as the package says "100% whole wheat/grain" you are good to go. It doesn't matter what the grain is. Don't be fooled by misleading claims like "whole wheat", "multi-grain", "enriched" or "unbleached". They all mean refined white flour. "Sprouted" grains are the new kids on the aisle, and they usually mean whole grains.

Check the serving size. If you are watching calories, one slice is a serving size for most breads. So if you are making a sandwich you have to double everything. Some bread may list 2 or even 3 slices as a serving, so check for yourself.

Beware the sodium. Bread rarely tastes salty but it is a major source of sodium in the American diet. A single slice can easily (and commonly) deliver 300 to 400 mg of sodium.

The less sugar the better. In addition to sodium, most breads also contain added sugar. Typically it is not a lot but it can add up.

Some of the better wheat bread brands that you are likely to find in your grocery?

Nature's Own 100% Whole Wheat.
Sara Lee 100% Whole Wheat.
Pepperidge Farm Whole Grain 100% Whole Wheat.
Oroweat Organic Thin Sliced 100% Whole Wheat.

Remember, in the grocery store nobody is looking out for you except you.

And the Answers Are...

 And here are the answers to yesterday's quiz. How did you do?

1. Which restaurant dish is most likely to have fewer than 1,200 calories?

    A. Kung Pao Chicken. Non-chain restaurant main dishes averaged
        1,300 calories in a 2013 study. The other choices all contained
        more than 1,400. The worst was the tandoori chicken with
        1,850.

2. Which frozen desert has the least amount of added sugar per serving?

    A. Beyers Natural Vanilla Ice Cream. A 2/3 cup serving contained
        3.5 tsp of added sugar and 170 calories. Not great but a bargain
        compared to the sorbet. Hagen Dazs manages to squeeze 9.5
        tsp of sugar into it.

3. Which plant-based milk has about the same amount of protein as regular dairy milk?

    D. Pea. Pea milks provide 8 to 10 grams of protein per cup,
        compared to 8 grams per cup for dairy milk. Soy milk also
        come close with 6 to 8 grams but most other plant-based
        milks provide only 1 to 3 grams of protein.

4. Which of the following is most likely to interfere with many prescription medications?

    C. Grapefruit juice. It interferes with an enzyme responsible for
         metabolizing about 50% of all prescription medications.

5. Regular coffee drinkers have a lower risk of all but one of the following. Which one?

    D. Heart disease. Research is ongoing but people who regularly
        consume coffee (regular or decaf) have a lower risk of liver
        cancer and diabetes. Regular coffee drinkers also have a lesser
        risk of developing Parkinson's.

Nutrition Test Time

 I'm feeling a little lazy today so let's see how well you all know your stuff. 

1. Which restaurant dish is most likely to have fewer than 1,200 calories?

    A. Kung Pao Chicken
    B. Lasagne
    C. Chicken pad Thai
    D. Moussaka
    E. Tandoori Chicken

2. Which frozen desert has the least amount of added sugar per serving?

    A. Beyers Natural Vanilla Ice Cream
    B. Hagen-Dazs Vanilla Bean Ice cream
    C. Ben & Jerry's Vanilla Ice Cream
    D. Talenti Madagascan Vanilla Bean Gelato
    E. Hagen-Dazs Mango Sorbet

3. Which plant-based milk has about the same amount of protein as regular dairy milk?

    A. Almond
    B. Coconut
    C. Oat
    D. Pea
    E. Rice

4. Which of the following is most likely to interfere with many prescription medications?

    A. Oat milk
    B. Coconut milk
    C. Grapefruit juice
    D. Grape juice
    E. Applesauce

5. Regular coffee drinkers have a lower risk of all but one of the following. Which one?

    A. Liver cancer
    B. Parkinson's disease
    C. Type-2 diabetes
    D. Heart Disease
    E. Stroke

The point is to learn so go ahead and use Google if you want. Answers tomorrow.

Surviving the Cereal Aisle

 

When it comes to the supermarket cereal aisle, the healthy offerings have not changed very much on 50 years. They remain unsweetened oat, wheat and bran cereals. All contain little or no added sugar and a healthy dose of whole grains. You would do best by completely ignoring the cereal marketers' pitches for everything else. Whether its keto, or protein, or "real" nuts and berries, odds are its garbage dressed up as healthy.

Here is what to look for to escape the cereal aisle with your wallet and your health intact.

Look for whole grains. If the box says "100% whole grain" then go ahead and grab it. Anything less than 100% means you need to check the ingredient list. If the whole grain is far down the list it means there is very little of it in the box. Usually just enough to plaster it on the front.

Check the Serving Size. Cereal servings can range from as little as 1/2 a cup to as much as 1 1/2 cups. 1/2 cup isn't much so odds are you will eat more. Remember that all the nutrition information is per serving.

Watch for added sugar. The new nutrition labels finally have to list the sugar that is added to the product. Unlike the naturally occurring sugar in fruits (Total Sugar = Added Sugar + Naturally Occurring Sugar) added sugar is nothing but nutrition-free empty calories. To put this in perspective, the current dietary guideline for added sugar is no more than 50 grams per day.

Not all fiber is alike. The point of whole grains is that the fiber-heavy bran has not been processed away. Many cereals trumpeting their fiber content are not whole grains but just contain cheap insoluble fibers. Any bran cereal, whole grain wheat or corn and most oat cereals contain natural bran fiber.

Best bets? As I said at the beginning, the old standbys still lead the pack. Among the best choices are: unsweetened Cheerios, Wheaties, Total, unsweetened Shredded Wheat, Grape Nuts, Wheat Chex and Bran Flakes. Watch out for Raisin Bran though, it is loaded with added sugar. Better? Plain old bran flakes with your own raisins added.

Simply Awful

 

You can be forgiven for assuming that Simply Peach might be a healthy peach juice drink. After all, words like "simple" and "simply" do have a patina of healthy to them. But like "natural" and other tricky buzzwords covering food packages, it doesn't mean anything. In fact, if truthfulness sold, the whole line of Simply juices would be called Simply Sugarwater.

Take "all natural" Simply Peach juice as an example. You might think that it was simply a bottle of peach juice. Boy would you be wrong. But unless you check the nutrition label and ingredients list, you would never suspect that it is only 17% peach and lemon juice. Why lemon in a peach drink? Its cheaper. You will also be slugging down 5 teaspoons of added sugar per 1 cup serving, 10% of your daily total.

Simply Watermelon or Simply Mixed Berry are even worse, with only 10% juice.

Every time you pick up a food package that you are not already familiar with, just assume that the manufacturer/processor is lying to you - or, at best, deliberately trying to mislead you. Learn to decode the labels, and read them. And ignore claims like "natural", "simple", "gluten free" (on non-grain products), "antibiotic free" (on poultry) and all the other BS the marketing department is using to trick you.

Does It Matter When You Exercise?

 

Does it really matter what time of the day you exercise, or if you always exercise at the same time? Is morning exercise better than evening exercise? Or is this just another thing that people love to argue about?

To find out, researchers in Australia randomly allocated 40 sedentary, overweight individuals to complete a supervised, 12-week exercise program where participants walked and did resistance training three times per week for an hour. The study divided the participants into morning or evening groups.

At the end of 12 weeks, average cardiovascular fitness increased equally in both groups. Body fat and waist size also decreased equally. Both groups reported feeling less likely to overeat in response to stress than when they entered the program.

"Exercise training improved body composition and some appetite outcomes, although changes were inconsistent and largely independent of exercise-timing. In the absence of dietary manipulation, the effect of diurnal exercise timing on appetite and body composition appear trivial compared to the overall benefits of exercise participation," concluded the researchers. In other words, it makes no difference when you exercise. Just exercise at whatever time works best for you.

Does Protein "Build" Muscle

 

There is no question that protein is the key building block for muscle tissue. Or that many people are not getting enough protein in their diet. (The RDA for protein is 0.36 grams per pound of body weight, while many experts recommend 0.50 grams). But does consuming more protein promote muscle growth?

A recent study in Canada randomly assigned 22 older women to drink two cups of whole milk, skim milk or almond milk daily for three days during which they did their normal walking routine. Then three more days when they walked 50% more steps than usual. The dairy drinkers (either whole or skim) were getting about 25% more protein every day than the almond milk drinkers.

Muscle growth (as measured by muscle biopsies for protein synthesis) increased when the women did 50% more walking than usual. The amount and type of protein consumed made no difference.

This is only one study but it suggests that while it is very important to be getting at least the minimum RDA for protein every day, consuming more protein is not likely to promote muscle growth. It is the exercise that is the key.

Supplements and Depression

 

According to the National Center for Health Statistics, over 8% of Americans suffer from clinical depression during any given 2 week period. That is over 2.5 million people. But that is 2016 data. Indications are that the numbers have risen substantially during the Covid era, especially among young people. Antidepressant use has skyrocketed since 1999, leading it to become one of the most popular types of pharmaceutical drugs in the U.S., with approximately one in six Americans using them.

Given all of that, it is not a big surprise that supplement manufacturers view it as a marketing bonanza. "11 Herbs and Supplements to Help Fight Depression" offers the Healthline Nutrition web site (a dicey place to get nutrition information). "Helps Support Emotional Health" says Country Life Omega 3 Mood supplement. Do any of these actually do anything more than empty your wallet?

In a 2021 study published in JAMA Network, researchers assigned over 18,000 adults to take a daily does of fish oil. None of the participants had experienced depression in the previous 2 years. After following the participants for 5 years, the risk of depression was found to be higher in the fish oil takers (although not a lot higher). The same trial also studied the use of Vitamin D - with similar results.

If you are or think you may be suffering from depression, don't depend on supplements to help you overcome it. Don't count on them to lower your risk of developing it either. No matter what the bottle says. See your doctor or a mental health professional. Exercise. But save your money.

Supplement Labels

 

We have talked a lot about food nutrition labels, what they contain and how to decode all the misleading ways manufacturers try to trick you. Supplement labels, while very similar, have their own little tricks. Here is what to look for.

Before you even get to the details, understand that the FDA regulates dietary supplements under a different set of regulations than those covering foods and drug products. Under the Dietary Supplement Health and Education Act of 1994 (DSHEA):

• Manufacturers and distributors of dietary supplements and dietary ingredients are prohibited from marketing products that are adulterated or misbranded.  That means that these firms are responsible for evaluating the safety and labeling of their products before marketing to ensure that they meet all the requirements but are not required to submit any sort of proof to the FDA.

• The FDA has the authority to take action against any adulterated or misbranded dietary supplement product but only after it reaches the market and some harm has been caused.

Also, supplement manufacturers are prohibited from claiming that their product will treat or cure any condition or disease. Never-the-less they do not shy away from vague claims about their product's ability to "support", "boost" or "strengthen" things like memory, immunity or even slow ageing. This is perfectly legal but take such claims with a healthy dose of skepticism. Another favorite supplement claim is that is is "natural". This has no meaning and can be ignored.

Another claim you will often see on supplement labels is that the facility where they were produced is an "FDA Registered Facility".  This does mean that the facility has registered with the FDA and may occasionally be subject to an inspection. It does not mean that is is "approved" in any way by the FDA. As with food products, "USDA Organic" means that the product is free from certain ingredients and most pesticides and that only non-GMO ingredients are used.

Finally, there is the Supplement Facts panel. This corresponds to the Nutrition Facts label on food products. The FDA requires that serving size, ingredients and percent of the recommended daily value per serving for each ingredient be listed. But the agency does nothing to confirm that what is listed is what is actually in the package. So look for a certification seal from an independent testing laboratory such as ConsumerLab, UL, USP or NSF International.

It is common practice for companies to manufacture their products outside the USA where even the weak regulation of the FDA does not apply. Your best bet is to purchase only from a company that you have researched and, ideally, that manufactures its products in the US or Europe. Clearly this is not a case where shopping for the lowest price is a good strategy.

Are People Living Longer?

 

Are people living longer lives today than in the past? On first thought, the answer seems to be an overwhelming Yes! If you Google "are people living longer" you will find dozens of articles confirming it. But lets take a closer look.

Life expectancy, the number of years that the average person is expected to live, has indeed increased (at least before the Covid pandemic, which caused a decline in life expectancy). Life expectancy for a male resident of the USA has risen from about 40 years in 1800 to over 78 years in 2019. (It fell by about 2 years by 2021.) That certainly seems like people are living longer.

But averages are funny things. For any average, there are some who will be below average and some who are above, sometimes far below or above. The increase in life expectancy over the last 200 years came about primarily because fewer and fewer people died at very young ages, raising the average. But for those living above an average lifespan, there has been almost no change at all. The very oldest people in ancient Rome lived to be about 100 years old. Just as they do today. Just as they have in the interim. 

So yes, on average people are living longer but only because advances in nutrition and medicine and safety have prevented people from dying young. Of course that is not bad news.

There is some bad news though.

Life expectancy is rising, but we are also spending more time living in poor health. In fact we are now spending more years in poor health than at any time in our history. Although average global life expectancy more than doubled between 1800 and 2017 – from 30 to 73 years – the proportion of people’s lives lived in poor or moderate health has remained unchanged at about 50%. So your longer life means you are going to spend more time sick.

Again this is an average and it is not inevitable. Quality of life chronic diseases are the leading cause of death and disability in the United States. And many of these are the result of lifestyle choices that we make throughout our life. So if you want that extra life expectancy to be lived in good health, you better get on the ball now.

What Is A Portion Anyway?

 

It may seem like an obvious question, but according to the International Food Information Council (IFIC) only 45% of Americans were able to correctly define portion size. About a third of those surveyed confused portion size with serving size. This confusion serves only those selling you your food. So here is the difference. Portion Size is the amount of food you choose or are given to eat at one time. Serving Size is a standardized measure of food quantity established by the Food and Drug Administration for use on food nutrition labels.

While serving sizes have changed little over time, food portions in America's restaurants have increased by 100% to 200% over the last 20 years, a key factor that is contributing to a potentially devastating increase in obesity among children and adults. "Super-sized portions at restaurants have distorted what Americans consider a normal portion size, and that affects how much we eat at home as well," said Dr. Elizabeth G. Nabel, director of NIH's National Heart, Lung, and Blood Institute. Larger portions mean more calories, which can quickly add up to extra weight.

Food producers take advantage of something researchers call "unit bias" to encourage you to overconsume their product. When your brain sees a unit of food that could reasonably be consumed at one time, say a large plateful of food or a bag of chips, it assumed this is the right amount for a portion - regardless of how much food it may be. Combined with frequent exposure to too-large portion sizes in stores and restaurants, unit bias causes us to consume more food than we need, or even want.

For free guidance on portion sizes that are right for you, check out myplate.gov. Become aware of the serving sizes listed on all food products. Start there and adjust them to your needs. Instead of eating more than a serving, try combining foods: topping your ice cream with berries or nuts, say, or crumbling up some cookies on low fat yogurt. Remember, no one is looking out for your health but you.

Five Steps that Actually Do Boost Immunity

 

These days it can be hard to turn around without bumping into another food, supplement, elixir or magic pill that promises to boost, strengthen, support or supercharge your immune system. From late night TV commercials, to the internet, grocery store and print media amazing immunity solutions are everywhere. The real question is, do any of them work?

The reality is that there is no simple, one-size-fits-all solution to optimizing the performance of your immune system. Not everyone reacts to infections or other threats in exactly the same way. And what you often don't hear from companies selling amazing immunity boosters is that an overactive immune systems is just as bad as a weak one. Auto-immune conditions like rheumatoid arthritis, multiple sclerosis and allergies are just some of the gifts that a too-strong immune system might bestow.

Supporting the immune system then is definitely not a matter of finding the right pill or supplement. But that doesn't mean that there is nothing you can do to support a balanced, effective immune system. Here are five lifestyle factors that will help, and you don't need to buy anything special to incorporate them.

Get Enough Restful Sleep.  When you are asleep, your immune system is working hard. From reprogramming your T-cells to respond to new threats to producing proteins that they use to kill invaders, your immune system uses sleep to recharge itself. If you do not get adequate sleep, your immune system cannot work at full capacity.

Wrangle Your Stress. Stress grips everyone. It is just a part of life that is not going away. So you may as well learn to deal with it. Chronic stress, in particular, can increase your risk of many illnesses and compromise your immune system's ability to deal with them. Cortisol, glucagon and prolactin are hormones that your body produces in response to stress and persistently high levels can cause high blood pressure and chronic inflammation. Exercise is a great stress reducer, as are a meditation practice, breathing exercises and spending time doing things you find enjoyable. Drinking alcohol and scrolling social media are not.

Protect Your Microbiome. The intestinal microbiome is a signalling hub that integrates environmental inputs, such as diet, with genetic and immune signals to affect the your metabolism, immunity and response to infection. Aberrations in the communication between the innate immune system and the gut microbiota contribute to many complex diseases.The bacteria in your gut breaks down food to provide energy and repair and protect parts of the immune system. Adding fermented foods like sauerkraut, kefir or yogurt to your diet can help maintain the delicate balance in your gut. The evidence for pre or pro biotic supplements is sketchy at best, despite what the marketing department tells you.

Upgrade your nutrition. Adding more plants to your diet will feed your microbiome and benefit your health in many ways. Avoiding processed foods and, especially, sugar, will help reduce inflammation. Here is one place where a general, broad spectrum supplement may actually be helpful to close any gaps between what you eat and the nutrition your body needs to maintain and repair itself.

Detoxify Your Home. The immune system has to fight off more than just viruses and bacteria. When it encounters the harmful chemicals, pesticides or heavy metals that infect far too much of our food, water, cleaning and personal care products it responds to them as well. An environment heavy in these pollutants keeps your immune system working in overdrive. Choosing organic foods when you can helps reduce pesticide residue in your diet. Avoiding plastic packaging as much as you can, drinking filtered (not store-bought bottled) water and choosing less-toxic personal care and cleaning products lowers the toxin level and gives your immune system a rest. The Environmental Working Group (www.EWG.org) is a good source to find less toxic brands.

We would all love to find a cheap, simple, easy way to maintain a strong immune system. And many companies are happy to sell you one. Unfortunately few of them do any good. Save your money and upgrade your lifestyle instead.