Scientists have developed a new, more effective cervical cancer screening method. The WID-qCIN test detects epigenetic changes in cells, significantly improving early cancer detection. Epigenetic changes in cells refer to alterations that can be influenced by factors such as environment, lifestyle, and aging. In a study of over 28,000 women, published in the June issue of the journal Nature Medicine, this test identified 100 percent of invasive cervical cancers and 93 percent of serious precancerous lesions within a year. Additionally, it predicted 69 percent of cancers and precancerous lesions up to six years later, compared with only 18 percent with current methods. The researchers reported that this advancement could reduce the need for invasive diagnostic procedures by 40 percent, potentially enhancing women’s health and quality of life.

Beetroot Juice Boosts Heart Health in Postmenopausal Women

New research highlights the heart health benefits of beetroot juice for postmenopausal women. Beetroot juice contains high levels of nitrate, which the body converts to nitric oxide. Nitric oxide helps blood vessels expand, making it easier for blood to flow through the circulatory system. The ability of nitric oxide to widen blood vessels is known to be particularly helpful during periods of limited blood flow and oxygen delivery, such as during a heart attack. A study of 24 postmenopausal women, published in the June issue of the journal Frontiers in Nutrition, showed that daily consumption of nitrate-rich beetroot juice significantly improved blood vessel function, reducing heart disease risk. The study included women considered early postmenopausal, or one to six years postmenopause, and late postmenopausal, six or more years postmenopause. Late postmenopausal women saw the same benefits as the early postmenopausal group. This non-pharmaceutical approach offers a promising way for menopausal women to support cardiovascular health naturally.

Study Links Body Fat and Muscle Strength to Alzheimer’s and Parkinson’s Risk

High body fat, especially in the abdomen and arms, increases the risk of developing Alzheimer’s disease and Parkinson’s disease, according to a study published in the July issue of the journal Neurology. Conversely, high muscle strength significantly reduces this risk. The study tracked 412,691 individuals—55 percent of whom were women—with an average age of 56, over nine years. It found that people with high abdominal fat were 13 percent more likely to develop these diseases, while those with high arm fat faced an 18 percent higher risk. High muscle strength, however, decreased the risk by 26 percent. This study highlights the potential to lessen the risk of developing these neurodegenerative diseases by improving body composition. Targeted interventions to reduce belly and arm fat while promoting healthy muscle development may be more effective for protection against these diseases than general weight control, the study’s researchers concluded.

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Sugar substitutes don’t raise your blood sugar or cause tooth decay the way sugar (sucrose) does, but that may be the extent of their health benefits.

Health Impact.

Sugar substitutes are typically used to replace sucrose in processed foods. “The consumption of sugar-sweetened foods (and beverages in particular) has been consistently linked with increased risk for a number of disorders,” says Alice H. Lichtenstein, DSc, Gershoff Professor at the Friedman School and editor-in-chief of this newsletter, “including type 2 diabetes, coronary heart disease, hypertension, excess body weight, and possibly even frailty. Use of beverages and foods made with sugar substitutes, if successful in reducing the intake of added sugars, could result in health benefits. However, the jury is still out on how successful their use is in accomplishing this goal and what the health impact will be.”

Dental Health: It is generally accepted that replacing sucrose with sugar substitutes reduces the risk of developing cavities. Some data even indicate that the sugar alcohol xylitol in chewing gum may play an active role in cavity prevention.

Weight Loss: It’s difficult to determine if sugar substitutes help with weight loss. Long-term studies are lacking, but short term randomized controlled trials (which can establish cause and effect) have shown that providing beverages sweetened with sugar substitutes in place of those sweetened with sucrose has a beneficial effect on body weight. But in one trial, a beverage sweetened with the artificial sweetener sucralose was reported to increase food cravings more than a sugar-sweetened beverage, especially in women and people with obesity.

Some observational studies (in which researchers compared people’s reported food intake to their weight) have suggested that consumption of foods made with sugar substitutes may actually be associated with higher body weight. “However, these studies cannot determine whether the sugar substitutes themselves lead to excess weight gain or if individuals with overweight or obesity are just more likely to choose products containing sugar substitutes,” says Lichtenstein. “Additionally, if low-sugar or sugar-free products are added to a high calorie diet, rather than replacing sugar-containing products, weight loss will not occur.”

Diabetes: If cutting calories by using sugar substitutes does lead to weight loss, it could help treat or decrease the risk of developing type 2 diabetes. Additionally, sugar substitutes raise blood sugar levels much less than sucrose—if at all. The American Diabetes Association cautions that some research indicates even sugar substitutes may be associated with some rise in blood sugar. “Foods and beverages made with sugar substitutes are a better option than those with added sugar for people with diabetes,” says Richard Siegel, MD, co-director of the Diabetes and Lipid Center at Tufts Medical Center, “but I encourage my patients to focus on nutrient-dense foods, like fruits, vegetables, and nuts instead of low-calorie or low-sugar versions of cookies and candy.”

Even if foods made with sugar substitutes do have some health benefits when used in place of sugar-sweetened foods, Lichtenstein says it’s best to limit their intake anyway. “Foods containing these compounds are almost always ultraprocessed,” she says, “and we know dietary patterns high in ultraprocessed foods are associated with negative health outcomes.”

Safety Concerns.

There is a large body of research looking at potential health hazards from consuming sugar substitutes, but there has yet to be any conclusive proof of danger from any products currently on the market.

Plant-derived noncaloric sweeteners (sugar alcohols, stevia, monk fruit extracts, and allulose) fall under the U.S. Food and Drug Administration (FDA) category “Generally Recognized as Safe,” or GRAS. This means experts have concluded that the substance is safe under the conditions of its intended use in the quantities typically consumed.

Artificial sweeteners (synthetic, or man-made, compounds) are regulated as food additivies and must meet a higher standard of proof of safety. The FDA establishes an acceptable daily intake (ADI) level for all artificial sweetners. An ADI is the amount of a substance that is considered safe to consume each day over the course of a person’s lifetime. Artificial sweeteners are 200 to 20,000 times sweeter than sucrose, so very little is needed to make foods taste sweet. Even people who consume a lot of these man-made sweeteners are unlikely to exceed the ADIs.

Cardiovascular Disease: Recent studies involving participants in the U.S. and Europe found that high blood levels of the sugar alcohols erythritol and xylitol were associated with increased risk of heart attack and stroke, but these findings need confirmation. At this time, there are no established links between sugar substitutes and cardiovascular disease.

Cancer: Federal legislation prohibits the approval of any compound established to cause cancer. Overall, the results of the large number of studies looking for a link between sugar substitutes and cancer have been inconsistent. A 2023 review that looked at all available data concluded that evidence associating artificially sweetened beverage intake with cancer was weak. An observational study published in 2022 found the highest reported intake of artificial sweeteners was associated with a small increase in cancer risk compared to the lowest reported intake. While there is limited evidence (not convincing) that aspartame may increase cancer risk, experts agree this artificial sweetener is likely safe at the levels at which it is typically consumed.

Looking at the body of research to date, sugar substitutes (in reasonable quantities) appear to be a safe alternative to added sugars, and may reduce tooth decay and help manage blood sugar levels—but the truly healthy choice is to cut back on ultraprocessed sweet foods. Drinking mostly water and getting one’s sweet fix from nutrient packed fruits is truly a “sweet” choice.

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On the Increase

A study presented at the 2024 Annual Meeting of the American Academy of Orthopedic Surgeons in February pointed to a significant rise in sports-related injuries over the two-decade follow-up period, with the injury rate increasing from 55,684 in 2012 to 93,221 in 2021. The data also suggested that cycling increased in popularity between 2012 and 2021. Another recent study (BMC Geriatrics, May 27) looked at data collected from 1,109 older adults who sustained a fracture and visited a trauma center between June 2020 and July 2023. Among the participants, 144 had suffered a fracture while engaged in sports. The analysis showed that the average age of people who suffered a sports-related fracture was 74. “Sports-related fractures were most likely to happen outdoors, with men particularly susceptible,” Dr. Bloom says. “This fits with previous studies indicating that older men are more likely to participate in sports compared with older women.”

Specific Sports More Risky

In the BMC Geriatrics study, the sports most likely to be associated with fractures were outdoor walking intended as exercise (as opposed to more leisurely walking to get from one place to another), cycling, and mountain hiking, all of

which were linked with lower-extremity fractures. Having an underlying disease, such as diabetes, high blood pressure, or a heart condition, did not increase the risk of injuries. “Suffering a stroke lowered the risk,” Dr. Bloom observes. “The lower risk may reflect the fact that stroke often is followed by a decrease in muscle strength. This may limit a person’s ability to participate in sports.”

Many Benefits

Dr. Bloom says it is wonderful that more older people are getting involved in sports, since there is much trial evidence underlining the benefits of vigorous physical activity. It boosts cardiovascular health, slows age-related loss of muscle mass and bone density, can reduce your risk of falls by improving your balance, eases stress, helps you sleep better, and limits weight gain. Research also has linked high levels of physical activity with better brain function in older age. “Another great thing about sports is that many of them are sociable activities: You can walk, cycle, and play pickleball or other racket sports with friends,” Dr. Bloom adds. “It’s vital to maintain those social connections as you get older, since studies have suggested that social interaction may confer protection against cognitive impairment.”

But these data also highlight the risks associated with sports—and Dr. Bloom cautions that they also likely underestimate injury rates. “Many people who sustain sprains, strains, and lacerations while playing sports often seek medical care from their primary-care doctor or a local walk-in clinic instead of attending emergency departments and trauma centers,” she says. The data also suggest that older adults are participating in a wider variety of sports and/or participating in sports that are more likely to result in injury, especially if they require a level of strength, agility and balance that you don’t have. “It would be interesting to see data that includes an assessment of the participants’ degree of mobility and individual skill level along with other factors that may contribute to injury, such as weather conditions and whether someone was wearing suitable shoes and protective clothing,” Dr. Bloom says.

Pace Yourself

Staying safe while engaged in sports starts with managing your expectations when it comes to how much you can still do. The heart and lungs work less efficiently in older age, so less oxygen is transferred to the blood. Appetite decreases, meaning that most older adults eat less than they should. As a result of these changes, endurance, muscle mass and strength decline as you age. Your balance also may be affected by age, particularly if you have vision or hearing issues or take certain medications (including some blood pressure drugs). These factors don’t mean that you cannot or should not continue to enjoy the sports you’ve always loved, but you may have to slow down slightly to conserve your energy and avoid fatigue. One thing you might want to try is alternating between vigorous sports, such as pickleball or tennis one day and more leisurely options, such as golf, the next.

Starting from Sedentary

If you’ve been leading a sedentary life and/or have chronic underlying health issues, it’s particularly important to objectively assess your fitness level before taking up a sport. “If you need help doing this, ask your doctor to refer you to a physical therapist who can work out a safe sports regimen for you,” Dr. Bloom says. “You also might want to consult a personal trainer who works with older adults—your local gym or senior center may be able to recommend one.” Be patient—instead of launching yourself into your chosen sport, you may need to gradually build up your strength and cardiovascular fitness levels, perhaps by starting a walking program and pushing yourself farther and faster over time.

If you want to try a new sport, find out about it. “You’ll need background information about whether it’s important to wear special types of footwear, a helmet, and/or safety goggles, about the level of endurance and/or agility the sport requires, whether it’s a sport that involves rapid acceleration and deceleration and relies on you having good balance,” Dr. Bloom says. “Even if you’re very fit and want to challenge yourself, you don’t want to risk injuries that might have been highly preventable with a bit of preparation.” See What You Can Do for other strategies that will help you stay safe while playing sports.

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This isn’t the first study to point to links between stroke and dementia—in fact, up to 60 percent of stroke survivors develop some degree of post-stroke cognitive impairment, according to the ASA. Laura K. Stein, MD, MPH, associate professor of neurology at Mount Sinai, says the link underlines the importance of monitoring stroke survivors for cognitive decline and educating people about strategies that may confer protection against stroke and dementia.

First-Year Risk Greatest

For the study, a Canadian research team matched 180,940 people who had suffered a recent ischemic stroke (caused by a blood clot) or an intracerebral hemorrhage (caused by bleeding within the brain) with two control groups, one including people from the general population who had not had a heart attack or stroke, and the other including people who had suffered a heart attack but not a stroke. The researchers evaluated the rate of new cases of dementia starting at 90 days after a stroke, over an average follow-up of 5.5 years. In addition, they analyzed the risk of developing dementia in the first year after a stroke and over time, up to 20 years.

The analysis showed that the risk of dementia was greatest in the first year after a stroke, with a nearly threefold

increased risk. The risk halved by the five-year mark but remained elevated 20 years later. Dementia occurred in nearly 19 percent of stroke survivors over an average follow-up of 5.5 years. After accounting for dementia risk factors such as high blood pressure, diabetes, and high cholesterol, the risk of dementia was 80 percent greater in stroke survivors compared with people who had not experienced a heart attack or stroke. A similar increase in risk was seen in stroke survivors compared with people who had experienced a heart attack. The risk of dementia in people who had suffered an intracerebral hemorrhage (bleeding in the brain) was nearly one-and-a-half times greater than those in the general population.

Small-Vessel Disease Implicated

While there still is much we don’t undertand about the connection between stroke and dementia, Dr. Stein says we are learning more about the association between vascular health and brain health. “Researchers have recently identified the importance of the ‘neurovasculome’—a fancy term for the brain’s blood vessels, cells, and lymphatic system—to overall brain health and optimal cognition,” she says. “We know there is an association between dementia and damage to the small blood vessels of the brain, and there is evidence that cognitive outcomes may be better in people whose blood pressure is more aggressively treated.” She adds that damage from a stroke can damage brain structures and the connections between them, as well as the neurovasculome, and notes that this damage is especially likely in a brain with pre-existing susceptibility due to small-vessel disease and lower reserve (essentially the brain’s capacity to withstand harm). “In people with these vulnerabilities, a smaller stroke may have a greater impact than a larger stroke would in someone with greater baseline brain reserve,” she explains.

Post-Stroke Cognitive Screening Is Vital

While people with mild post-stroke cognitive impairment may recover fully, an improvement in cognitive impairment without a return to pre-stroke levels is more likely. Persistent impairment may be too mild to warrant a diagnosis of dementia, but still can affect your independence and quality of life after a stroke. This means it is important for stroke survivors to be evaluated for cognitive decline—indeed, a 2023 American Heart Association scientific statement recommends post-stroke cognitive screenings. If you are a stroke survivor and have not been screened for cognitive impairment, Dr. Stein recommends you discuss screening with your doctor. “Screening is especially important if someone is not meeting expected post-stroke milestones and may identify potentially reversible contributors to cognitive impairment,” she says. Possible contributing factors include depression, abnormal electrolytes (minerals that affect numerous body functions), thyroid disorders, low levels of vitamin B₁₂, and medication side effects. “Even if a reversible cause of cognitive impairment following stroke is not identified, a thorough cognitive evaluation can help an individual understand their cognitive strengths and weaknesses, identify areas for lifestyle modification and targeted cognitive therapy, and plan for the future,” Dr. Stein adds.

Safeguard Yourself Against Stroke

There is evidence to support that more severe and recurrent strokes are more strongly associated with post-stroke dementia. “This means that one of the most important things we can all do for our brain health is to identify and aggressively treat risk factors for stroke,” Dr. Stein emphasizes. These include high blood pressure, high cholesterol levels, the abnormal heart rhythm atrial fibrillation, diabetes, obesity, and smoking. Research suggests that having three or more cardiovascular risk factors may increase the risk of post-stroke dementia in older adults and has indicated that diabetes and atrial fibrillation may be particularly influential. See this month’s From the Editor for strategies to manage these risk factors.

Also be aware of symptoms that may indicate a stroke, including sudden problems with your balance and/or coordination, blurred vision or loss of vision, drooping on one side of the face, numbness/weakness in one arm, and slurred or incoherent speech. “Time is brain, and you should immediately call 911 if you think you or someone you know could be experiencing a stroke,” Dr. Stein concludes.

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The Centers for Disease Control and Prevention (CDC) recommend that all Americans over the age of six months get an updated COVID-19 vaccine when these become available this fall. By now, nearly all Americans have had a COVID infection, gotten a COVID vaccine, or both, but the updated vaccines offer a timely boost as immunity wanes and the virus continues to mutate. While mutations are thought to help COVID variants evade immune defenses and spread faster, there is no evidence they cause more severe illness. Even so, people ages 65 and older remain at great risk of COVID-related complications—they account for two-thirds of COVID hospitalizations and 82 percent of in-hospital deaths, according to the CDC. Only about 40 percent of Americans in that age group were immunized with the COVID vaccines that were offered last fall. You can visit the CDC’s dedicated COVID vaccine website for more information (http://tiny.cc/CDCCovid).

Plant-Based Meats May Reduce Cardiovascular Disease Risk

Plant-based meat alternatives often are marketed as being low in harmful saturated fat compared with “real” meat—however, up to now it hasn’t been clear if the products reduce the risk of cardiovascular disease. A recent review from researchers at the University of British Columbia, in Vancouver, suggests that they do even though they are classified as ultra-processed foods. The review (Canadian Journal of Cardiology, June 25) looked at studies published from 1970 to 2023, and found that cardiovascular risk factors like total cholesterol, LDL (“bad”) cholesterol, and body weight all improved when people substituted plant-based meat alternatives for real meat in their diets. Compared with real meat, plant-based meat products tend to be higher in sodium, which contributes to high blood pressure. However, the review did not find that the meat substitutes raised blood pressure.

Ultra-Processed Food Harms

A recent study underlines the mortality risks associated with diets that are high in ultra-processed foods. The National Cancer Institute study looked at data from more than 540,000 people who provided information about their eating habits and health in the mid-1990s, when they were ages 50 to 71. Over half of the participants have since died. The researchers analyzed overall rates of death among those who were in the 90th percentile for consumption of ultra-processed foods at the start of the study versus those in the 10th percentile. Processed foods were defined according to a standard classification system, and included deli meats, snacks, ready meals, fast foods, and soft drinks. People who ate the greatest amounts of ultra-processed foods over the median 23-year follow-up were 10 percent more likely to die early than those who ate the least. The study was presented at the annual meeting of the American Society for Nutrition in June.

Stroke Mortality Worse for Black People

Overall rates of long-term survival following stroke are getting better—but not for Black people, according to a new University of Cincinnati study (Neurology, July 15). Researchers identified 8,428 cases of ischemic stroke (the type caused by a blood clot) and 1,501 cases of intracerebral hemorrhage (a less common and more severe type of stroke caused by bleeding in the brain). Among participants with ischemic stroke, five-year survival decreased from 53 percent in 1993-94 to 48 percent in 2015. There were no changes in five-year survival following an intracerebral hemorrhage. While the overall numbers improved, Black study participants were found to be 20 percent more likely to die within five years after an ischemic stroke than white people. Long-term social, economic and environmental inequities likely contribute to the disparity. See this month’s From the Editor for stroke-prevention advice.

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You may not be able to eradicate all of your individual stroke risk factors, but you likely can mitigate some of them enough to significantly reduce your chance of suffering a stroke. Along with any medications you may be prescribed to lower your blood pressure, cholesterol, and blood sugar, a healthy diet and plenty of exercise are cornerstones of stroke prevention. Eat plenty of fruits, vegetables, and whole grains, and substitute fish and poultry for red meat. Cut back on your salt intake, since too much salt raises blood pressure. Get at least 30 minutes of physical activity each day (you can break this up into smaller segments). If you’ve already had a stroke, eating more healthfully can help prevent another, and exercise can help you regain your cardiovascular fitness and cognitive function, as well as combat the depression that often follows stroke. Stroke rehabilitation programs focus closely on diet and exercise, so ask your doctor to refer you to one of these programs if he or she has not already done so.

Another crucial element of stroke protection is knowing the symptoms that can red-flag a stroke. The American Stroke Association recommends learning the “BE FAST” rubric:

• B for Balance. Do you have a sudden loss of balance or coordination? To check, walk in a straight line or touch your finger to your nose.

• E for Eyes. Are you noticing sudden vision changes, such as double vision, or loss of vision in one eye?

• F for Face drooping. Is there drooping or numbness on one side of your face? Is your smile uneven?

• A for Arm weakness. Look for weakness in one arm (raise both arms and see if one arm drifts downward).

• S for Speech difficulty. Is your speech slurred or otherwise hard to understand?

• T for Time to call 911. If you have any of the above symptoms, call 911.

Keep in mind that women may experience additional stroke symptoms, including confusion and disorientation, nausea and vomiting, and fatigue.

As our article emphasizes, time is brain. Recognizing possible stroke symptoms and seeking medical help immediately can make a huge difference to post-stroke function, since treatment with a clot-busting drug is most effective within 4.5 hours of symptom onset if your stroke is caused by a blood clot.

The post Address Your Stroke Risk appeared first on University Health News.

Troubling Shortfall

The research, led by a team from the University of Michigan Health Frankel Cardiovascular Center, tracked nearly 150,000 people who were seen at hospitals for serious heart conditions (including heart attack and heart failure) between late 2015 and early 2020. The analysis (Journal of the Academy of Nutrition and Dietetics, July) showed that clinicians documented providing dietary counseling in just 23 percent of cases within 90 days of hospitalization. Women, adults ages 65 and older, and people with chronic kidney disease were least likely to receive counseling.

Getting Help

Nutrition counseling is included in cardiac rehabilitation programs, and also can be obtained via a separate kind of care called medical nutrition therapy. “Cardiac rehabilitation programs counsel participants on diet, exercise and behavior modifications, with the aim of improving health outcomes in people with cardiovascular disease,” Dr. Darrow says. “These programs have been shown to boost physical function and reduce the risk of hospitalization and death for older adults with heart failure.” Medicare Part B covers cardiac rehabilitation for enrollees who have had a heart attack in the previous 12 months and those who have stable angina (chest pain caused by blocked heart arteries) or chronic heart failure. People who have undergone cerain heart procedures also are covered—the Medicare website has details (www.cms.gov). “Medical nutrition therapy involves working with a registered dietitian to build an eating plan tailored to your individual health needs,” Dr. Darrow says. The therapy is covered by Medicare Part B for certain individuals (check at the Medicare website). You need a doctor’s referral to utilize the program.

Eating to Support Heart Health

Dr. Darrow provides nutrition guidance to his patients just in case they are not able to attend a cardiac rehabilitation program or get medical nutrition therapy. He recommends people who have cardiovascular disease or have suffered a heart-related event follow an eating plan that is low in sodium and fat, such as the Mediterranean diet (see our chart) or DASH (Dietary Approaches to Stop Hypertension) diet. “Both diets are high in fruits, vegetables, whole grains and healthy fats, and limit the saturated fats that can contribute to elevated blood pressure and cholesterol,” he says. “They also permit enough of what you enjoy that it doesn’t feel like you are depriving yourself at every meal.”

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Body mass index (BMI) is a ratio of weight to height that has long been used to assess whether people are tipping the scales into the overweight or obese category. There are numerous online BMI calculators (the Centers for Disease Control and Prevention has one at http://tiny.cc/cdcbmicalc). A BMI below 18.5 is categorized as underweight, 18.5 to 24.9 is normal, 25 to 29.9 counts as overweight, and 30 and higher is categorized as obese. For younger people, maintaining a normal BMI is associated with better cardiovascular health and a lower risk of death—however, studies have suggested that older people who fall into the overweight category (or are even mildly obese) live longer than those whose BMI is considered normal. BMI increases for some older people because their height tends to decrease, and there is ongoing debate about whether to use a person’s adult height or their current height when calculating an older adult’s BMI. If the latter is used, BMI will increase. I tell my patients not to worry too much if they are overweight according to their BMI. However, if you reach the point where excess weight may be increasing your risk of chronic illness and disability, I recommend working with your doctor to manage weight gain.

Rosanne M. Leipzig, MD, PhD

Geriatric Medicine

I made the mistake of overusing a nasal decongestant spray a couple of years ago during a bad cold. I’m now having to use it all the time, because my nose is so stuffy without it. What can I do to stop using the spray?

Colds, the flu, COVID-19, and seasonal allergies cause the blood vessels in the nasal membranes to swell up, which manifests as a stuffy nose. Decongestant sprays clear the stuffiness by shrinking swollen blood vessels; however, it is very important to limit their use to the two or three days recommended on the medication leaflet or you may suffer from rebound congestion. The sprays that are most likely to cause this are those containing oxymetazaline (for example, Afrin®) or phenylephrine (Neosynephrine®). Long-term use of these sprays also can damage the septum (the wall between your nasal passages). You may be able to wean yourself off the spray by using it in just one nostril for as long as it takes the other side to stay clear, and then not using it in the second nostril. Using a saline spray on the untreated side may help you avoid severe congestion while your nasal blood vessels get back to normal. A vapor inhaler stick or a few drops of Olbas oil (available at pharmacies) sprinkled on a tissue also may help. If these strategies don’t make a difference, ask your doctor if it is safe for you to switch to using a steroid nasal spray instead, since these are not associated with rebound congestion. Steroid sprays take time to start working, so you’ll need to be patient.

Patricia Bloom, MD

Geriatric Medicine

I’m due for my first colonoscopy, and I have a question. Every diagram I’ve seen of the colon shows that it curves in several places. How does the colonoscope negotiate the curves?

The colon curves to the left just beyond the rectum into a section called the sigmoid colon and curves again to continue upward (a section called the descending colon). It then curves right into a horizontal section (the transverse colon) before making a final turn into a section we call the ascending colon. Rest assured that gastroenterologists receive a great deal of practical training to help them negotiate these curves with the colonoscope. The colonoscope itself is very flexible, so it can bend easily—there also is a knob at the control section of the colonoscope that your doctor uses to change the direction of the tip up/ down and left/right. Your doctor also may have a nurse press on your stomach or slightly change your position during the procedure if needed to help maneuver the colonoscope. You won’t be aware of this activity or feel any discomfort, since you will be sedated.

Brijen J. Shah, MD

Gastroenterology

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Common Shortfall Nutrients. The U.S. Dietary Guidelines identify several nutrients that are often lacking in the average diet. These include:

Calcium: Vital for bone health and muscle function, calcium is often underconsumed, which can lead to osteoporosis and higher fracture risk.

Vitamin D: Essential for calcium absorption and bone health, vitamin D deficiency is widespread due to limited dietary sources and insufficient sunlight exposure. It plays a crucial role in immune function and inflammation reduction.

Potassium: This mineral helps regulate blood pressure and fluid balance. Most people do not consume enough potassium which can contribute to hypertension and cardiovascular issues.

Fiber: Dietary fiber is often lacking in diets dominated by processed foods. Adequate fiber intake supports healthy bowel movements and can help manage cholesterol and blood sugar levels.

Iron: Essential for producing hemoglobin and red blood cells, iron deficiency can lead to anemia, fatigue, and impaired cognitive function.

Next Steps. To help meet the recommended intake of these nutrients, consider the following ideas:

Diversify Your Diet: Consume a variety of fruits, vegetables, whole grains, lean proteins, and dairy or alternatives to ensure a broad intake of nutrients.

Focus on Nutrient-Rich Foods: Choose foods that are naturally high in shortfall nutrients. For example, opt for leafy greens, nuts, and seeds for calcium and vitamin D, and include bananas or potatoes for potassium.

Consider Supplements: Supplements may help meet nutritional needs. Consult with a healthcare professional before starting any new supplement.

The Bottom Line. Understanding and addressing shortfall nutrients is key to preventing deficiencies and supporting long-term health. Aim for a balanced and varied diet to help ensure that your body gets the nutrients it needs.

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Special Functions. Bromelain has been established as a natural means to increase antibiotic potency. This has been documented in several clinical studies, but there is no standard dosage or standard of care for this specific use.

Bromelain may help improve sinus inflammation and manage pain when consumed orally.

More recently, bromelain has been explored for its use in managing the COVID-19 infection. While the laboratory and animal research are promising, there are no human data to support its use.  The research on bromelain for improvement of cardiovascular disease risk factors is mixed, with not enough evidence to warrant a recommendation at this time.

Recommended Intakes & Toxicity. Suggested doses in adults range from 40 to 400 milligrams (mg) per day and is dependent on the purity of the supplement. Safety has been confirmed for daily oral intake of up to 240 mg per day. Some bromelain doses may include Rorer units, a direct measure of the enzyme’s activity or potency. A common dosage is 50,000 Rorer units.

Oral intake is not associated with significant safety concerns. Minor side effects such as digestive discomfort and headache have been reported. Although rare, some people exhibit allergic reactions to bromelain.

Bromelain exhibits anticoagulation effects in blood, and caution should be exercised if blood thinning medications are also used.

Most clinical research has been conducted on adults, with very few studies conducted on children, pregnant and lactating women, and older adults. Thus, the current intake recommendations and safety assessment is valid for adults, but not other life stage groups.

Sources. Bromelain is found naturally occurring in pineapple.  It’s found in the fruit, the stems, and the leaves. However, the concentration of bromelain in pineapple fruit is too low for the food source to provide a therapeutic benefit.  Supplements in tablet and capsule form can deliver a range of bromelain dosages. There is currently no industry standard for bromelain dosage in supplements.

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