A Fond Farewell

Doc Handal has always felt it her mission to share her medical wisdom and knowledge through media.  This June she will be retiring, relinquishing her medical licensure, and will no longer be taking to public media to empower you to seek the best possible medical care. Hopefully my posts have helped you to be your own advocate for your health and well-being and that of others. May you continue to seek accurate, credible, science-based medical advice.

Millennials Beware

Millennials BewareNew data showed young adults aged 20-44 years ( Millennials – born 1981-1996 (27-42 years old) in the United States need to beware! They more than ever are walking around with conditions that are placing them at high risk of cardiovascular (CV) disease and death. The study was presented on March 5 at the joint scientific sessions of the American College of Cardiology and the World Heart Federation and was simultaneously published in JAMA.

In this age group, during the last 10 years, there has been a significant increase in diabetes and obesity, no improvement in the prevalence of hypertension, but a decrease in those with hyperlipidemia.

One problem is believed to be that younger people often have a “superman or superwoman” view and don’t comprehend that what one does to their body is ‘forever’. Poor dietary habits when young definitely have an impact on future health. Lack of exercise most assuredly will result in a poor overall health state.

This invincible mentality is not unique to any one generation, but today we know more about our body’s reaction over time to environment, diet, and exertion. A sad medical insight gained from the Viet Nam war was that young soldiers upon autopsy already had fatty deposits (atherosclerosis) in their aortas.

BE sure your medical provider checks your blood pressure no matter your age, also your blood sugar and cholesterol. You can easily with modern technology check yourself.

The Mighty Potato

The Mighty Potato A recent study evaluated the benefits of a benefit of a low in energy but high in density diet specifically one with either potatoes or beans. The endpoint was to evaluate insulin resistance as you know when there is sugar in your blood your pancreas makes insulin to break it down into energy and important metabolic byproducts needed by our cells.

It is a very common, misconception that potatoes have a negative effect on our blood sugar. When actually, it can help us lose weight that is what researchers at Louisiana State University Biomedical Research Center discovered.

 The participants were either overweight, obese or had insulin resistance. The end point was to evaluate extent of insulin resistance. As you know when there is sugar in your blood your pancreas makes insulin to break it down into energy and important metabolic byproducts needed by our cells. It is a very common misconception that potatoes have a negative effect on our blood sugar.


Full of health benefits, potatoes are filled with key nutrients and DO NOT increase our risk of becoming a diabetic.  We eat pretty much the same volume of food to reach feeling full, but it is what that food consists of (calories) that determines weight gain. So it makes sense if we eat foods that are heavier in weight but less in number of calories, we’re going to lose weight. 

In this study participants became fuller faster and often did not finish their meal when a high calorie item was replaced with potatoes. Watching their blood glucose levels, no negative effect occurred when they consumed potatoes. Good news was all of those involved actually lost weight with no significant difference between the potato or bean diets.

It is well known that we typically do not stick to a diet for so many reasons. But think about compliance if potatoes, which can be prepared so many ways, were a part of the diet. Potatoes also are a fairly inexpensive vegetable as are beans.

When thinking about your diet consider the potato. Remember it is the toppings and dips thst add calories/weight.


Beware Food Allergen Labels

There is actually a law that requires accurate food labeling for possible allergens. The Food Allergen Labeling and Consumer Protection Act (FALCPA) became law in 2004 and went into effect 2 years later. Beware what that means to you.

Presently, foods are labeled to identify if eight major food allergens are present. These 8 were arrived at by looking at what causes 90% of all allergic reactions within the United States. The 8 are milk, egg, fish, crustacean shellfish, tree nuts, wheat, peanuts, and soybeans.

Beware Food Allergen Labels Another thing specified is how exactly should the labels declare food allergens going so far as to say, there is a need to specify which type of nut, be it, almond, pecan or coconut also as regards fish, the type of fish, for example, flounder or bass, and when it comes to crustaceans specifications necessary, whether it’s shrimp, crab or lobster.

Since mollusk shellfish isn’t a major allergen they do not have to be labeled that is whether it has clams, mussels, or scallops.

 I think it’s important for you to realize that the FDA regulates many types of food, for example, packaged foods, conventional foods, vitamins, dietary supplements, infant formulas, infant food, and medical foods. Yes the FDA also regulates items produced outside the US but intended for sale in the United States.  FALCPA labeling also applies to all retail and food-service establishments. This includes any foods in vending machines or packages that say individual or single use. 

You need to know that there are areas, not covered by the FDA oversight that includes over-the-counter drugs, personal care, items, cosmetic, shampoo, mouthwash, toothpaste, etc. Also beyond their eye is anything regulated by the USDA or alcohol, tobacco tax and trade bureau (ATTB), and kosher labeling. Let us not forget FDA does not cover pet foods, supplements, and supplies for pets.

It’s furthermore important if you or your loved one has a serious allergy that this law does not require advisory statements, for example, ‘may contain’ meaning there was a possibility of cross contact with a type of food allergen item. Scary!  Another caveat I found very interesting is that FALCPA does not limit use of non-diary or diary free. The term non-dairy, according to law, can appear on foods that contain milk derivatives as ingredients. So while showing non-diary it may have a listed ingredient of ‘caseinates’ with parenthesis’ (milk) ‘ next to it.  The FDA does not specifically addressed the term dairy free, so that is not affected by this law at all.

No Longer Educated Guess In Prescribing

No Longer - Educated Guess In Prescribing Doctors do make ‘educated guesses’ when it comes to prescribing. Experience and prevailing wisdom along with what has worked in past come into play. What if a simple blood test could help in some of these situations? Commonly when we become ill, let’s say sore throat, cough, running nose maybe fever, many of us think did I catch a virus, or perhaps do I need antibiotics? Remember: Antibiotics (Abx) only work when an infection is caused by bacteria. For the sake of accuracy, there are many other possible causes. It could be an allergy reaction environmental, or a hereditary illness showing up. Mostly and most commonly these symptoms are from an infectious condition. Even if that is simple to determine, the healthcare provider is often in a clinical dilemma, using their best-educated guess as to whether the symptoms are caused by a bacterial or viral infection. It’s not always as clear as oh, it’s a bacterial infection, ‘oh, it’s a virus’.

Many times they are clinically indistinguishable. You might think well it’s an infection that’s all you need to know but the question of whether or not to treat it with antibiotics versus antivirals is important. I’m sure by now you know about the overuse of antibiotics in the United States and the creation of bacteria resistance to these antibiotics. Often the decision is educated, guessing whether or not to give antibiotics or antivirals. 

Presently a new FDA-approved test is available to help. LIAISON® MeMed BV® analyzes three host immune proteins – TRAIL, IP-10, and CRP in our blood when we are infected and can identify if the illness is from a bacteria or virus. This would make the determination of what to prescribe less of an educated guess, yes, and make life so much easier for us physicians.

How does the test work? Our body makes proteins in response to acute infection, this is the immune response so by measurement of the presence and levels of the three proteins a differentiation can occur. Levels decide a bacterial or viral infection. Machine learning generates a score determining the likelihood of a bacterial immune response vs. a viral immune response. The test is carried out using the established credible technique of chemiluminescence immunoassay (CLIA).

 The test takes about 15 minutes and is already used in ERs across US, inc. Tucson, AZ, and Tulsa, OK. There are so many medical settings where this can be helpful.

As you can imagine, this will cut down on antibiotics being overprescribed and also unneeded hospitalization which both translates to better care. 

A cost-effectiveness study in Europe, Israel, and the US of 20,000 patients shows a saving of $223- $809 for healthcare providers. This was excluding test cost which is covered by insurance.

Ask next time you are in a medical setting if this test is available. 

A Important New Year Resolution – Take Care Of Your Bones

Make this one of your top resolution for 2023! Bone Health is up to you!  It makes sense, given that 20 percent of American women ages 50 and older have osteoporosis and that more than another 50% have detectable bone loss (osteopenia). For men, the respective figures are lower: 4 percent and a third. Worldwide, one out of three women over the age of 50 and one out of five older men will develop a fracture from poor bone strength (osteoporosis) — a hip, a wrist, a vertebra, or two.

Several study results on nutrition and bone health have been wildly inconsistent.
Fact: bone is constantly changing, remodeling, and reshaping hence our gut must absorb the needed building nutrients.

Calcium, Vitamin D as well as boron, and Vitamin K2 have been identified as important.

Do we get enough calcium and vitamin D in our diets? 

A New Year Resolution Take Care of Your Bones

Osteoporotic wrist fracture – poor bone density

A New Year Resolution Take Care Of Your Bones

Prevention Would Have Been Better


Today more than a third of American adults ages 60 and older pop supplements 

Surprisingly, a study published this summer in the New England Journal of Medicine, found after five years adults having the correct level of vitamin D did not improve bone density, or for that matter decrease the risk of cancer or heart.

Individuals in the study did not have osteoporosis to start with, so the question remains do adults with osteoporosis need more Vitamin D and calcium or for that matter supplements

Break out the tofu and sardines! 

Calcium recommendations are age dependent. Sadly federal surveys show only 61 percent of Americans and about half of the children meet these recommendations.

So for me to get the needed 1200mg of Calcium daily I must have three cups of plain yogurt or nearly nine cups of cottage cheese a day, I miss it! Supplements are often needed. It is always best to get nutrition from food rather than from pills because so many other wonderful things come along with it.

Other things in our diet like coffee for example affect bone health. If you have over 6 cups a day you actually will cause bone loss. Excess alcohol is not good because it does not allow vitamin D to work.

It is a MYTH that sparkling water affects bone health. However, soda pop may affect bone growth.

I don’t want to close without mentioning exercise, along with nutrition for bone health. Exercise is important because muscle action on bone helps mold, form, and reshape our bones. Because your body weight is supported by bones, simple walking helps. Studies say daily at least 4,000 steps for those over 70 or 10,000 if you are younger.  Running, up and down steps, are also helpful for good bone health.

If supplements are recommended (I use them) please recall not all are helpful. In the past, I have mentioned Consumer Lab as a reliable tested site for OTC supplements. Please reread the blog.

To a health 2023!

Dangerous Device Interference

By the year 2023, the number of individuals with pacemakers and defibrillators is expected to increase to 1.43 million units worldwide.

So do these patients or for that matter, any of us need to be concerned about the potentially dangerous effects of portable electronic devices (PEDs)? Although implanted, the pacemaker and defibrillator are PEDs. You do know PEDs depend on electromagnetic fields. Magnets can inhibit the pulse generators of these devices. The human body is alive with electromagnetic fields, most obviously, generated by our nervous system! That’s why a medical MRI scan can give you a metallic taste and even nausea and make you dizzy – but it is only short-lived. Dangerous Device Interference

Maybe you already keep PEDs away from vital organs, your brain, and gonads but what if you have a life-saving medical device planted under your skin (commonly in the chest area)? You have noticed how close proximity of PEDs to each other can causes problems and you are instructed to move further away from the ‘interference’?

Many medical devices especially implanted ones have magnetic activities. Interference, therefore, is possible. Cardiac implantable electronic devices (CIEDs), such as implantable cardioverter defibrillators (ICDs) can suspend rapid heartbeats (tachycardia) and/or cardiovert-defibrillate a failing heart. Another implanted device can pace a heart that no longer can pace itself (asynchronous pacemakers).

In a medical setting, a special magnet is placed over the chest to place the implanted devices in the Magnet mode. In this mode, the device’s operation is interfered with hence it can be tested and/or set then returned when the magnet is removed to standardized mode. 

Therefore care must be taken, with the use of any PED, not to ever place them near implanted devices as they can cause interference. 

Swiss investigators, to learn more about PEDs and implanted medical device safety, studied the Apple AirPods Pro and their wireless charging case, the Microsoft Surface Pen,  the Apple Pencil 2nd generation, and iPhone 12 Pro Max. They compared the field strength of these PEDs around implanted medical devices. This study used 3D mapping, a more realistic and accurate method than the one-axis mapping that the FDA uses to test in this area. The results were quite interesting.  For example, case open vs. case closed for the Air Pods Pro had different safe distances. It was noted that the proximity of an 8 mm difference of magnetic field effect depends if the AirPodsPros case was open or closed – a safer distance if open!

The location of each PED’s strongest magnetic field and 3D mapping of its distance to affect a medical device were measured.

Magnet reversion mode was triggered at a distance between 8 mm (.315 inches) and 18 mm ( .708 inches) for the tested devices. Pretty close I’d say! The NIH & FDA state ‘To be safe, keep your PEDs at least 6 inches away..” from implanted medical devices

Note: Electronic cigarettes are also a culprit in the malfunctioning of medically implanted devices. Vape pens contain magnetic components used in charging and can interfere with the magnetic features of certain medical devices, including pacemakers. There have been reported cases of this interference. Hence, the global statement, keep electronic magnetic devices like vape pens, at least 6 inches from where the implant lies.

Lucrative Healthcare, My Insight

Lucrative Healthcare, My Insight America spends over $3.8 trillion a year on healthcare (2019)—and more per capita than any other country in the world, despite that our life expectancy is 76.1 years at birth – the lowest level since 1996. BTW South Korea boosts 83.5! So you will not be surprised as you read on – more spending!

Amazon Has A Plan For Your Healthcare

Amazon continues inroads in healthcare delivery with a stated objective to make medical care more affordable. It had launched and closed down recently a healthcare project targeting corporations (in 2021, after 3 years). So now they will go directly to patients, not insurance billing. You pick from a list of conditions and then choose from a list of providers. As expected there is a questionnaire to complete. You will use a non-video message-based portal to contact a licensed physician for consultation. Encounters may even end in prescriptions! 

So they present this as a healthcare store allowing customers to hook up with someone in a telehealth network. The cost starts at $30.00. Again convenience and accessibility are what is being ‘sold’. At this time, Amazon has not given specifics about the medical providers they will use, however it is well known that Amazon has an existing relationship with Teladoc©, the biggest virtual care company in the U.S. Even Alexa™ has Teledoc integrated!

Another New Healthcare Trend

Elsewhere, the Cleveland Clinic says it will start to charge as much as $50.00 for messages in ‘My Chart™. patient portals when a message requires physician time and opinion. Up to now, this has been a free interaction. Relax, as refills requests, making appointments, and informing your physician of a healthcare update are still gratis. But you will see a bill if there is a medication change needed or forms to be completed. Note the fine print in your plan, some healthcare plans do not cover messaging. Cleveland Clinic plans to bill insurance companies for any interaction requiring five or more minutes of the medical provider’s time. Medicare patients with secondary insurance will not have co-pays, but some Medicare beneficiaries may see a $3 to $8 fee. Some privately insured patients will not have a copay, but if they have a deductible or their plan doesn’t cover messaging, bills might be $33 to $50 per message.

Thankfully patient portals have circumvented the Health Insurance Portability and Accountability Act of 1996 aka HIPAA concerns. You may recall one of the many papers you sign anytime you receive any healthcare. This law exists to ensure patient information privacy.

Well, it was great while it lasted but now everyone wants in!


Artificial Sweetener Bomb!

Bad news for all of us using artificial sweeteners to try and keep the pounds off. Artificial sweeteners are present in thousands of food and beverage brands worldwide, however, they remain a controversial topic and are currently being re-evaluated by the European Food Safety Authority, and the World Health Organization. FDA states ” Based on the available scientific evidence, the agency has concluded that the high-intensity sweeteners approved by FDA are safe for the general population under certain conditions of use.” But they do not go on to specify ‘certain conditions of use. “For each of these sweeteners, FDA determined that the estimated daily intake even for a high consumer of the substance would not exceed the acceptable daily intake (ADI). Generally, an additive does not present safety concerns if the estimated daily intake is less than the ADI. That word ‘generally’ to me is worrisome. Same as used in regards GMO foods.

WHO recommends that less than 5% of daily energy intake should come from free sugar.

There have been many investigational experiments both in the laboratory and prospective observed patient on studies so I’m even human randomized controlled studies to investigate early markers of cardiovascular health for example wade hypertension inflation gut microbes but many also in association with using artificial sweeteners or artificial sweetener beverages most of these studies have suggested adverse effects. Artificial sweeteners are not good for cardiovascular or cerebrovascular health. The leading cause of death worldwide is cardiovascular disease. And this study below in-depth should put to rest the controversies. Now if only the FDA and world health in the EU food safety authority will take a position to caution the public on the use of these high sugar additives.

The WHO 2022 report on the health effects of artificial sweeteners observed ” an association between consumption of beverages with artificial sweeteners (used as a proxy) and some intermediate markers of CVD, including a modest increase in the unfavourable total cholesterol to HDL cholesterol ratio (meta-analysis of four randomized control trials), and an increased risk of hypertension (meta-analysis of four prospective studies)”.

In a prospective study, carried out in France, the records of 100,000 people focused on diet and activity and do use of artificial sweeteners. The British Medical Journal looked at dietary artificial sweeteners to see if it was a risk factor for cardiovascular diseases (heart and brain). Artificial sweeteners they included were: aspartame (NutraSweet™, Equal®, and in UK Canderel®), acesulfame potassium (Ace K trade names Sunett and Sweet in EU), and sucralose (aka Splenda®). Analyzing 900,000 person-years of data (2009-2021) revealed a distinct association between the two. Researchers actually took food additive composition data and matched with consumption date to account for possible industrial reformulations and changes in the additive composition. The mg/day for each participant was measured.  The patient population included diverse breakdown however none were obese average BMI was 23.6. Varying cholesterol and glucose levels, hypertension, education level, also smokers and non-smokers were included.

Noteworthy is that the risk was greater for cerebral vascular disease (brain vessel disease). Further, the study found that not all artificial sweeteners were equally harmful, that specifically, aspartame use increased the likelihood of cerebral vascular events (ex. strokes, TIAs). Acesulfame K and sucralose were associated with increased coronary heart disease risk.

FYI: there are other sugar substitutes that are not in the high-intensity sugar substitutes. They are ‘sugar alcohols’ and include sorbitol, xylitol, lactitol, mannitol, erythritol, and maltitol. The sweetness of sugar alcohol varies greatly but they are low in calories and do not cause your teeth to rot, or pounds to be upped, and blood sugar rush. Look for them to be in sugar-free candies, cookies, and chewing gums.