I was born in White Plains, New York in 1939 but grew up in Pleasantville.

Did you attend public school?

Yes, I did. But I did not attend Hebrew school, as it was not a Jewish community. After high school I attended Dartmouth College on a scholarship.

Talk a little about your family.

My father was born in Ukraine and came to the US at the age of three. He was an auto mechanic. At first, he and his brother owned a gas station, and then he opened his own auto garage. My mother was a housewife and later on worked as a secretary in the editorial office of Reader’s Digest.

Any siblings?

My older sister passed away. She was a therapist, with a PhD in psychology. Marilynn, my younger sister lives in the UK and is a retired
English teacher.

Let’s continue to discuss your education.

I graduated from Dartmouth College undergraduate in three years and enrolled in their 2-year medical school. I then transferred to Harvard Medical School, from which I received my medical degree. My internship and residency in internal medicine were at Duke University. This was followed by a two-year fellowship in cardiology.

Would you say that you lived in an upper middle class neighborhood?

No. Definitely middle class. We did not have much money. I helped out in the garage working with my father. I also caddied for many years. I became a decent golfer and scored a “hole in one” at age 17.

How did you meet your wife?

I met Joan on a blind date in my freshman year. She attended Skidmore and later transferred to Boston University. We got married during my first year in medical school and recently celebrated our 64th year wedding anniversary.

Joan grew up in Tenafly, New Jersey. She not only raised our three children, but has been my lifelong partner in editing and overseeing the writings of my novels and managing editor of my medical journals.

Tell me about your children.

Debra is our eldest. She created a new company, Venice Estate Sales and Gallery and resides in Venice, Florida. We are fortunate to see her quite often. Jeffrey is our middle child and has two children. He lives in Indianapolis and practices law. David, our youngest, also lives in Indianapolis and has three daughters. He is a pediatric hospitalist. The two brothers meet weekly for lunch.

Seems like you have a close relationship with your children.

We really do, and it is so heartwarming that our entire family is close. We like spending time with each other.

Please lay out the career path you took after leaving Duke University.

I served two years in the Navy at Portsmouth Naval Hospital as a lieutenant. My entire medical career after training was at Indiana University Medical Center, where I retired as the head of cardiology.

This interview writeup does not allow me more than a few pages. You provided me with a CV with the following list of accomplishments
● President of 7 organizations.
● Editor of 7 cardiology journals
● Published over 1000 medical articles
● Published 16 textbooks
● Wrote 6 novels
● Over 50 awards
● Fellow of at least 11 societies.
The list goes on and is too long for this interview. I am curious to know why you wrote a 239-page memoir? And of all the accolades, which are you most are proud of?

My grandmother emigrated from the Ukraine at age 23 with two young children to join her husband in the US. She never shared the hardships she had traveling and living in the US. I regretted that. I wanted my family to know about my life. Therefore, I wrote the memoir. I most cherish the impact I’ve had helping patients live better and longer.

What motivated you to become a doctor?

I always wanted to help people. I loved biology and solving problems. Choosing medicine also meant that being a doctor generated financial stability and respect.

I was pleased to see your involvement in Jewish causes.

I founded the Friends of Israel Heart Society to fight antisemitism in academic circles.

In addition, I began an annual conference of cardiologists from many of the middle east countries to share medical information and thus promote a mutual respect beyond political and geographic lines. The conference still continues.

In your memoir I read that you, as an avid lover of opera and loaned the Indianapolis Opera money to help them out. Did you ever get repaid?

Yes, always as soon as they had the money.

Do your novels refer to your medical and/or Jewish background?

Some do. They are all different. I consider writing fiction as a lie that tells the truth. I can discuss important themes facing us today in the form of a story, such as antisemitism, terrorists, AI, and others.

How did you end up in Naples?

A wealthy patient invited us to stay at his Naple’s home during several winters, and we fell in love with the area. We live in Bonita Bay and plan to move to Moorings in 15 months. 

What is a typical day for you?

I usually get up around 7:30 AM. I then read and answer emails and do some writing on my latest novel. I still write a health column for the Saturday Evening Post. After a quick breakfast I go to the fitness center for approximately one hour.

I like to play croquet and bocce.

How often do you eat out, and what are some of your favorite restaurants?

Joan and I eat out regularly. Petar’s and C Level Bistro are two of our favorites.

What are some of the MCA activities you participate in?

I give lectures on my novels, cardiology, attend the luncheons, and participate in shooting, coed bocce and various other activities.

This interview has been a challenge. Seldom have I met someone with so many personal, professional and academic achievements. It just seems that you have squeezed every possible achievement that is out there. But I will tell you that what is most admirable is your modesty. You are a person who has and continues to help others. Your dedication to fighting antisemitism and bringing some peace and understanding among physicians in the middle east is noted. In short, you are a mensch. It is obvious that you have given future cardiologists knowledge and inspiration.

Thank you.

……..

MCA members come from all over the US and the world, from a variety of careers, arrive in the Naples area for different reasons, and many volunteer to give back to their communities.

Men’s Cultural Alliance: MCA is an affinity group of Jewish Federation of Greater Naples, fostering camaraderie among intellectually curious, physically active, socially engaged men.

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In my last column I wrote about the benefits of intermittent fasting that shifted the body’s metabolism to burn ketones instead of glucose. Repeated fasting resulted — in addition to weight loss — in lasting adaptive responses that helped fight diabetes, insulin resistance, memory loss, and even cancer. The natural question then becomes whether eating a diet rich in ketones provides similar benefits.

The ketogenic diet is a high-fat, low-carbohydrate diet that forces the body to burn fats rather than carbs. Originally used to help treat refractory epilepsy in children, the ketogenic diet has been advocated for weight loss by replacing pasta, bread, and sugar with meat, chicken, fish, shellfish, eggs, cheese, and nuts. However, except for weight loss from caloric restriction and perhaps some benefit in patients with diabetes, no consistent scientific evidence exists that this diet provides any other benefits. In fact, the ketogenic diet may raise low density lipoprotein (bad) cholesterol levels, an unwanted outcome.

More important than quantity may be the quality of the carbohydrates or fats ingested. In a dietary analysis of more than 37,000 people, investigators found that unhealthy low-carbohydrate and low-fat diets were associated with higher total mortality, whereas healthy low-carbohydrate and low-fat diet scores were associated with lower total mortality.

For example, with every 20-percentile increase in a person’s unhealthy low-carbohydrate or low-fat diet score, the total mortality increased by 6–7 percent. For each 20-percentile increase in healthy low-carbohydrate or low-fat diet score, total mortality fell by 9–11 percent. Healthy diets linked with better survival were high in plant protein and unsaturated fat, and low in carbohydrates from refined grains, added sugar, and starchy vegetables.

In addition to diet, healthy habits can lead to a life expectancy free of major chronic diseases. Healthy habits include not smoking, weight control (body mass index 18.5-24.9 kg/m2), vigorous physical activity, and moderate alcohol consumption. Women who practiced four or five of these healthy habits at age 50 lived an average of 34.4 more years free of diabetes, cardiovascular diseases, and cancer, compared to 23.7 healthy years among women who practiced none of these healthy habits. Men practicing four or five healthy habits at age 50 lived 31.1 years free of chronic disease, compared to 23.5 years among men who practiced none.

Other Healthy Habits

In addition to these five, I would add a few more such as:

1) obtaining important vaccinations for flu, measles and other diseases

2) avoiding vaping

3) avoiding so-called de-toxifying juices since they have no proven benefits and actually lose fiber during processing, which are the healthiest part of the fruit or vegetable

4) drinking healthy tap water rather than waters supplemented with a variety of ingredients alleging health benefits since no evidence exists they improve health, they are costly (tap water costs about 50 cents/year; bottled water about $1400/year), the plastic pollutes the environment, and some ends up in our bodies.

I could extend the list even more, but I’m sure you get the message. You can have a major impact on your own health — without expensive medical attention — by considering the information discussed above and taking action.

Be your own doctor and take control over your own health.

The post Your Health Checkup: Is the Keto Diet Right for You? appeared first on Doug Zipes.

I usually have a banana or yogurt and coffee for breakfast, a sandwich for lunch, and eat dinner around 7 p.m., so the longest I go in between eating is six or eight hours.

Many religions, including Buddhism, Christianity, Islam, Judaism, and Hinduism, practice some sort of dietary fasting that can last many hours or days, often with participants eating at night. So, for example, fasting can occur during Lent for Christians, Ramadan for Muslims, and the holy day of Yom Kippur for Jews.

While such fasting is performed for religious reasons, caloric restriction can increase health and lifespan. Intermittent fasting appears to duplicate these benefits. Recent information indicates not eating for 16 to 18 hours — that is, consuming a full day’s intake of food over a 6-8-hour period — can beneficially impact health by triggering the body to make a metabolic switch from burning glucose to metabolizing ketones for energy.

It happens like this: glucose and fatty acids are the body’s main sources of energy. After we eat, glucose is metabolized, and fat is stored in adipose tissue as triglycerides. When we fast, the stored triglycerides are broken down to fatty acids and glycerol. The liver converts the fatty acids to ketone bodies, which then provide the major source of energy for many tissues, especially the brain.

This means that in the fed state, blood levels of glucose are high and ketones are low. When we fast, the reverse occurs, making the body burn ketones instead of glucose. Repeated exposure to periods of fasting results — in addition to weight loss — in lasting adaptive responses that help fight diabetes, insulin resistance, memory loss, and even cancer.

The heart and blood vessels particularly benefit with reductions in blood pressure and resting heart rate; improved levels of good (HDL) and bad (LDL) cholesterol, triglycerides, glucose, and insulin; and reduced markers of systemic inflammation and oxidative stress associated with atherosclerosis.

These metabolic shifts probably began with our remote ancestors for whom life was not a sedentary experience of eating three square meals a day, with snacks in between. Homo sapiens evolved while facing a more hostile environment that required hunting large distances to stalk, catch, and eat prey, while still supporting vigorous muscle strength and brain power.

Making the change to intermittent fasting can be difficult since a diet of three meals a day, interspersed with snacks, is ingrained in the American culture, and fortified by intense marketing. Switching may be accompanied by irritability, hunger, and difficulty thinking during the initial days.

Exactly how best to achieve intermittent fasting, how long the effects last, how often fasting should be done and whether shorter fasting periods achieve similar results is not clear. More research is needed before definitive diets can be offered. In addition, sex, diet, genetic, and other factors likely influence the magnitude of the effect.

One approach is reducing the time window of food consumption gradually each day, aiming for an ultimate goal of fasting 16 to 18 hours a day. In the first month, eat in a ten-hour period five days a week; for the second month, eat in eight hours five days a week; in month three, eat in six hours five days a week; and in month four, eat in six hours seven days a week.

Another tactic could be to begin with eating 1000 calories one day per week for the first month, gradually increasing to two days per week for the second month, followed by further reductions to 750 calories two days per week and so on, ultimately reaching 500 calories two days per week for the fourth month. The switch should be done with the help of a trained dietician or nutritionist.

An important word of caution is necessary since long term studies on intermittent fasting and such caloric restriction in humans are not available. Furthermore, caloric restriction may decrease resistance against some infections in animal models and may not be appropriate for all people.

For me personally, I’m not certain I can live with the caloric restrictions — I do like to eat. But maybe I can shoot for the 16-hour food hiatus by eating an early breakfast and then a late dinner. At most, I’d probably end up with 12 hours without eating, but then I trigger all the problems of eating late, just before retiring.

Oh well. I guess there’s no such thing as a free lunch.

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Getting a proper amount of sleep is important for maintaining good health. I sometimes have trouble sleeping, probably from that second glass of red wine at dinner and coffee afterwards. I usually fall asleep rapidly and then wake up three hours later and toss and turn, eventually falling back to sleep. My sleep pattern is not a healthy one, as recent evidence indicates.

In a study of 385,292 adult men and women initially free of cardiovascular disease in the United Kingdom, people whose sleep pattern was characterized by five factors below had about a third less risk of heart disease and stroke compared to those who reported none or only one of these healthy sleep patterns:

1) being a “morning person”

2) sleeping 7-8 hours per day

3) never or rarely experiencing insomnia

4) not snoring

5) not experiencing frequent excessive daytime sleepiness

Healthy sleep behavior even reduced the risk of a genetic predisposition to heart disease for participants in this study. The conclusions have limitations, being based on an observational study, but do emphasize the importance of a good night’s sleep.

To ensure better sleep, experts recommend sleeping in a quiet, cool, dark room; increasing bright light exposure during the day and reducing blue light exposure at night; preparing to wake and sleep at consistent times; avoiding caffeine and late-night dinners; and limiting duration of daytime naps and alcohol exposure. I may have to forgo that second glass of red and espresso.

But I may be able to reduce my risk of heart disease by eating chili peppers with my dinner.

Chili peppers are a usual part of the Mediterranean diet but may be more important than previously considered. In a study of almost 23,000 men and women, regular consumption of chili peppers was associated with a lower risk of total death and death from heart disease independent of cardiovascular risk factors or adherence to a Mediterranean diet. The benefits of eating chili peppers have been ascribed to an ingredient called capsaicin, its major pungent compound. Capsaicin can improve cardiovascular function and metabolic regulation and exert anti-inflammatory and analgesic properties, but the exact beneficial action remains unknown, and none of the biological mechanisms tested could explain the health benefits in this study. However, it is not unusual in medicine for the benefits of a substance to precede understanding how it works. For example, the health benefits of penicillin were known long before we understood how it killed bacteria.

Speaking of heart disease, the holiday season increases the risk of heart attack, perhaps by overindulgence of food and drink. I was surprised to learn recently that half of the individuals in the U.S. were unaware of the constellation of common signs and symptoms caused by a heart attack, and nearly six percent were unaware of any one of the symptoms. That is unfortunate, because prompt recognition is critical to seeking emergency care that can be lifesaving. Delay in seeking medical help increases the risk of dying.

So, remember the big five:

1) chest pain or discomfort

2) shortness of breath

3) pain or discomfort in arms or shoulders

4) feeling weak, lightheaded, or faint

5) jaw, neck, or back pain.

If you experience any of them, call 911 and seek medical aid promptly.

As we enter the new year, don’t forget: moderation in all things, including moderation.

My best to all our readers for a great holiday season and 2020.

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Six months of the year I live in a small town called Carmel, just north of Indianapolis, Indiana, and spend the other six months in another small community called Bonita Springs, 25 miles north of Naples, Florida. Being surrounded by trees and grass beneficially impacts my life, not just by creating an environment of safety and serenity, but one of healthy air.

Air pollution is an avoidable risk to health that affects nearly every person on the planet and almost every organ in the body. Ambient air pollution is the most important environmental risk factor impacting morbidity and mortality, followed closely by household pollution. Breathing polluted air in particular increases pulmonary and cardiovascular complications and mortality to a degree not previously suspected. It is estimated that long term exposure to polluted air caused almost 2.5 million premature deaths from heart disease and strokes worldwide in 2015.

While the risk is greatest for those most heavily exposed, with the elderly, the sick, children, and the poor disproportionately impacted, short term exposure of healthy adults can have detrimental effects as well. Merely visiting a city with polluted air like Beijing for an extended stay can create health problems. For example, after 26 non-smoking, healthy adult residents of Los Angeles (mean age, 23.8 years, 14 women) spent ten weeks in Beijing, they developed significant inflammatory markers in their blood, consistent with increased cardiovascular risk caused by air pollution exposure. Heart transplant patients may be particularly vulnerable and suffer increased mortality in poor air quality environments.

Conversely, reducing air pollution can improve health within just a few weeks. Symptoms such as shortness of breath, cough, sore throat and phlegm production decrease. Absenteeism from school and work, clinic visits, hospitalization, premature births, cardiovascular complications and death, and mortality from any cause also diminish.

The United States has benefited from the passage of the Clean Air Act in 1970 and its subsequent amendments, which have reduced emissions of major pollutants by 73 percent between 1990 and 2015 without adversely impacting the economy. In fact, the gross domestic product grew by more than 250 percent.

Despite these improvements, climate change contributes to poor air quality in multiple ways, such as increasing ozone concentrations, polluting the air from increased stagnation and emissions from combustion of fossil fuels for power generation to combat hotter temperatures. Energy and transportation sectors of the economy add to the mix by accounting for over 80 percent of the U.S. emissions of important gases such as carbon dioxide and methane that affect climate change.

What can you do? Minimize time spent in outdoor hot spots with poor air quality, such as highly urbanized areas with increased traffic and factory emissions. Spend more time living and walking in rural environs surrounded by trees and grass. Insist on home and workplace environments free from firsthand or secondhand cigarette smoke and industrial contaminants. Wear a mask outdoors on days with increased air pollution. Write your political representative to uphold and improve clean air regulations.

However, most people think about living near big factories or busy urban areas with high levels of car emissions when considering air pollution. And, with that in mind, it’s not likely they will uproot their lives to move out of the city if that’s where their jobs, friends, and family are located. The fact is that we are an indoor generation, with most of us spending 80-90 percent of our time indoors, where the air can be even more polluted than outdoors due to humidity, mold, inadequate temperatures, secondhand smoke, cooking exhaust, and other factors.

Indoor air quality is an environmental risk factor we can control to a large degree. Try to make yours as healthy as possible.

The post Your Health Checkup: Air Pollution — Your Zip Code Can Affect Your Health appeared first on Doug Zipes.

I just returned from Churchill, Canada to photograph polar bears before they dispersed to hunt seals on the rapidly forming sea ice. Our group comprised 16 adults. We ate breakfast together, and I was struck by how many took medications. It drove home the importance of medicines that keep us healthy and, in many cases, alive. A recent flurry of publications has emphasized various aspects of medications that readers should know.

Anticoagulants

Over five million Americans have atrial fibrillation (AF), and many take oral anticoagulants such as the older drug warfarin (Coumadin) or one of the newer oral anticoagulants, apixaban (Eliquis), to reduce the risk of stroke. Many people also suffer various aches and pains for which they take nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil), or naproxen (Naprosyn), which can cause bleeding. The ARISTOTLE trial of almost 17,500 individuals, tested the risk of bleeding and major cardiovascular outcomes in AF patients taking NSAIDs and apixaban or warfarin. They found that the safety and efficacy of apixaban versus warfarin appeared not significantly altered by NSAID use, despite increased bleeding with NSAIDs. Thus, while the use of NSAIDs was associated higher bleeding rates, there appeared to be no difference in bleeding rates by adding apixaban or warfarin. However, this study warrants more investigation of the effect of NSAIDs on the outcomes of patients treated with apixaban, warfarin, or other anticoagulants since increased bleeding is a possibility.

Warfarin may be harmful to bones, however. In a comparative effectiveness cohort study of 167,275 patients with AF, oral anticoagulants such as dabigatran, rivaroxaban, and apixaban were associated with modestly lower fracture risk compared with warfarin, a finding even more pronounced among AF patients who also had osteoporosis. The fracture risk was lowest among apixaban users. Therefore, AF patients who have osteoporosis would seem to be better off taking apixaban than warfarin.

Coronary Artery Disease

Many patients with coronary artery disease (CAD) take medications. One of the most common drugs is a statin to lower cholesterol. Several studies have questioned whether statins reduce memory, cognition, and brain volume in the elderly. In a prospective, observational study, investigators compared cognitive and brain outcomes in 1,037 Australians (ages 70-90) over a six-year period and found no differences in the rate of decline of global cognition, memory, or brain volume between those taking and those not taking statins. Thus, the patient benefiting from statin therapy should be reassured that cognition will not be adversely impacted. Being physically fit may improve memory and lower the risk of dementia.

Colchicine is an old drug, used primarily to treat gout due to its profound anti-inflammatory properties. Because inflammation is now known to play a prominent role in generating CAD, investigators tested whether low dose colchicine might benefit patients after a heart attack. In 4,745 patients randomly assigned to treatment with colchicine or a placebo within 30 days after a heart attack, the authors found that over 22.6 months the colchicine group had fewer ischemic cardiovascular events, such as increased angina and strokes, than the placebo group, though they had more episodes of pneumonia. If these results are confirmed in a second trial being conducted, then colchicine will likely find its way into treating patients with CAD.

Invasive revascularization (e.g. stents, bypass surgery) has replaced drugs for many patients with CAD. Recently, investigators tested whether invasive revascularization was necessary in the ISCHEMIA trial. They found that in patients with stable CAD and moderate to severe ischemia, routine invasive therapy failed to reduce major adverse cardiac events compared with optimal medication. There was also no benefit from invasive therapy regarding deaths from any cause, including heart attacks. In fact, routine invasive therapy was associated with harm at six months (increase in heart attacks) but was associated with benefit at four years (reduction in heart attacks). These results do not apply to unstable patients, highly symptomatic patients, patients with narrowing of the left main coronary artery, or heart failure. Thus, medication can be considered for many stable patients with CAD and choices should be discussed with your cardiologist.

Check with your doctor to be sure you are taking the proper medicine for your medical condition. Tell your doctor also about any dietary supplements since many are not helpful and can actually be harmful. It’s important to stay up-to-date on drug knowledge.

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I check my blood pressure regularly because I know that keeping it under control reduces my risk for developing cardiovascular diseases such as heart attacks and heart failure, as well as strokes. In my last column, I pointed out that taking blood pressure medication in the evening rather than the morning enhanced its effectiveness.

Whether blood pressure control prevents dementia as well has been more debatable. However, a recent publication combined data from six studies totaling 31,090 dementia-free adults older than 55 years and found that those individuals receiving blood pressure medications had a 12 percent lower risk of developing dementia and a 16 percent reduced risk of Alzheimer’s disease compared with those not using blood pressure medications to treat elevated blood pressure. No particular drug class was more effective than another in reducing risk.

This is one more reason — and a good one — for taking control of your own health and making certain your blood pressure remains under control.

Bugs and Stuff
We live in a world surrounded by a sea of germs. Fortunately, our body has defense mechanisms such as our immune system that most times protects us from getting infected. However, some people are more vulnerable to infection than others, such as children, pregnant women, the elderly, and those with compromised immune systems.

One of the most contaminated places in the home is not the bathroom but the kitchen! For example, the kitchen sponge can be loaded with bacteria from cleaning up raw meat and wiping germ-laden exteriors or other soiled sources. Surfaces contaminated with E. coli, salmonella, yeast, and molds include various refrigerator compartments and refrigerator handles, food storage containers, can openers, spatulas, and cutting boards. The kitchen sink can be loaded with bacteria after cleaning vegetables, rinsing raw chicken, or defrosting meat.

What should you do? Keep clean by performing simple tasks such as changing sponges and towels often and scrubbing cutting boards, the sink, strainers, and drains with bleach. Flush the toilet with the lid closed and keep the toothbrush holder clean. Wash the pet bowl, coffee reservoir, all knobs, handles, and countertops regularly.

Antibiotic Resistance
Most of us deal with such exposures every day without problems. On occasion we do get sick and need antibiotics to combat the infection. But that raises another contemporary problem: antibiotic resistant organisms.

A new Centers for Disease Control and Prevention report noted that, while antibiotic-resistance threats in the U.S. are decreasing, nevertheless antibiotic-resistant bacteria and fungi cause more than 2.8 million infections and 35,000 deaths in the United States each year.

It stated that some miracle drugs are no longer performing miracles because of antibiotic resistance, now found in every U.S. state and every country in the world. Antibiotic-resistant germs can share their resistance genes with other germs and can make them hard or impossible to kill.

Preventing infections is something we can all help accomplish, from frequent handwashing to everyday cleaning, to using antibiotics wisely and selectively, rather than for every cold and sore throat. Vaccination should be used to prevent infection wherever possible. Antibiotics are critical medicines for treating humans, animals, and crops, but should be used judiciously to fully protect people from antibiotic resistance threats.

The post Your Health Checkup: Blood Pressure, Kitchen Germs, and Antibiotic Resistance appeared first on Doug Zipes.

Here are two simple things to do that might save your life or that of a loved one: get your measles vaccination and take your blood pressure pills in the evening rather than in the morning.

Measles and Immune Amnesia

I have repeatedly advocated for the benefits of vaccination to prevent a multitude of infections and have criticized parents who intentionally expose their children to measles so they can acquire the natural infection. A recent report stresses the importance of measles immunization, highlighting the fact that measles is far more devastating than previously considered.

While having the measles infection itself is no picnic and can even be deadly, killing more than 100,000 people (mostly children) annually worldwide, two recent studies in Science and Science Immunology have shown that the impact of the disease remains months to years after apparent recovery, helping explain why survivors of a measles infection experience increased morbidity and mortality compared to the noninfected population.

How does this happen? The measles virus, by infecting immune cells, suppresses the body’s immune response to a variety of pathogens, causing what scientists label “immune amnesia.”

Consider, for example, a 15-year-old boy whose body has synthesized an array of antibodies that have successfully fought a host of infections he’s experienced over his relatively short life span. These antibodies protect him against future infections. The measles virus can wipe out this immune defense system, erasing 11 percent to 73 percent of its history and making the boy vulnerable to the infections all over again, as well as to new ones. In fact, the measles virus can even eliminate antibodies he developed in response to other vaccinations and require him to be revaccinated.

Importantly, the measles, mumps, rubella (MMR) vaccine does not cause this response, underscoring its importance as protection not only against measles, but against a myriad of past and future infections as well. There is no excuse not to vaccinate against these and other infections.

Blood Pressure Medications

High blood pressure is one of the seven major risk factors for developing cardiovascular disease (CVD). Because nighttime blood pressure is a stronger risk predictor of CVD than daytime blood pressure, investigators tested whether it might be better to treat blood pressure at night rather than in the morning. In the the Hygia Chronotherapy Trial, they randomized over 19,000 hypertensive patients (Caucasian Spanish men and women over 18 years old) to receive their total daily dose of one or more hypertension medications at bedtime or upon waking.

They found that those randomized to bedtime dosing had better blood pressure control without any adverse effects, as well as a 45 percent reduced risk of CVD death, heart attack, coronary revascularization, heart failure, stroke, and total mortality. Since these results are so striking, they probably should be replicated in another trial to be sure the conclusions are widely applicable to other ethnic groups. Nevertheless, there would seem to be very little downside to taking blood pressure medications in the evening rather than in the morning, and it would seem a reasonable practice for patients to follow.

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