Ask Doc I can always tell when I've written something controversial...
Last week, I told readers it's time to get a flu shot. My inbox was flooded with e-mails like this one:
I understand that last year the flu vaccine worked only a very small percentage of the time, and when it did "work," it only shortened the flu by a half day or so, while the previous year the results were only marginally better. As with most vaccines, there can be risks involved. If I am wrong, I would appreciate learning why. – R.M.
I hear this a lot when I talk about the flu.
It might surprise you to know that the flu shot for last year (the 2017-2018 season) was more effective than predicted. If you remember, some December reports predicted it would only be 10% effective.
Overall, the vaccine had a 36% total effectiveness. But it depends on the type of flu...
Influenza comes in many different strains. Each year, scientists try to predict which ones will appear most often and craft the vaccine for those. So the actual breakdown by strain was:
- Influenza A (H3N2 strain): 25% effective
- Influenza A (H1N1 strain): 67% effective
- Influenza B: 42% effective
The problem here is that H3N2 was the most common type of flu last year, resulting in about 69% of all flu cases.
Unfortunately, the flu shot doesn't mean you'll have the flu for a shorter period of time. Studies show that if you have the vaccine and get the flu that year, you have fewer and less severe symptoms, but typically they could last the same amount of time. A study in 2015 from the Uniformed Services University of the Health Sciences found this in folks who came down with the H3N2 flu in particular.
The flu vaccine is never 100% effective. But it could be the difference between recovering at home versus needing a hospital stay for some folks in the high-risk groups we mentioned.
As I said last week, if you're a healthy adult, chances are you don't need the vaccine. But if you're in a group that's at a higher risk for complications, you should get a flu shot. That includes:
- Folks 65 and older
- Those with a compromised immune system (including autoimmune diseases like Crohn's and those undergoing cancer treatments)
- Those with heart disease or are at risk of heart attack
- Pregnant women
- Babies and young children
Similarly, if you're around someone who falls into one of these groups, consider a vaccine. For instance, if you're caring for someone recovering from chemotherapy, you don't want to risk exposing them. Complications for these folks can be life-threatening or fatal.
Let's get into the rest of this week's questions. And please keep sending your questions and topic suggestions to [email protected].
Q: I have just one question regarding something you mentioned in today's Bulletin. You recommended avoiding all artificial sweeteners. Where does stevia come into play here? Do you consider stevia to be an artificial sweetener that is potentially harmful to the organs, as well as white sugar? – C.M.
A: Stevia, which is sold by the brand names of Truvia and PureVia, is the only sweetener that your body breaks down like sugar. So it isn't as harmful as the other sugar substitutes. However, there is some evidence that it can lower blood pressure, which means folks on blood pressure medications should use it with caution. If you do need a sugar replacement, it's the only one we suggest using.
Keep in mind, although this is the least awful of the bunch, overall we advise against any sweeteners. That's because all of them contribute to problems like inflammation, which can cause heart disease, type 2 diabetes, and more.
Q: I recently had a bout of diverticulitis, which fortunately settled without the need for surgery on antibiotics alone.
My question relates to dietary restrictions that I should follow. I was told that roughage and seeds should be restricted. Any comments and advice? – T.S.
A: To keep your colon healthy, I recommend adding probiotics to your diet. Several research studies point to the benefits of probiotics and their role in reducing symptoms from diverticulitis. I recommend getting them through food, but supplements with multiple strains of live cultures also work. Take a look at my essay on probiotics here.
Also, swap bad fats for good fats. Eating foods high in trans fat or artificial saturated fat irritates your colon, causing inflammation and damage. For example, olive oil is not only great for heart health, it also protects the lining of your colon and reduces your risk of colon cancer.
Finally, fiber is a great way to keep your bowels regular. And there are two forms of fiber...
Insoluble fiber – the kind your body can't break down – helps food and waste move through your digestive system. However, it can also lead to bloating and gas. That's why I've recommended that you should get plenty of soluble fiber instead.
Soluble fiber is better for relieving constipation, which is a symptom (and possible cause) of diverticulitis. Plus, soluble fiber helps slow the absorption of sugar, meaning your blood sugar won't spike as much.
The best way to add soluble fiber to your diet is to start including natural sources in your meals. Good sources include split peas, black beans, green peas, and raspberries. Avoid loading up on bad sources of fiber, like processed foods and baked goods that also contain tons of starches and sugars.
Q: Be very careful with your choice of shoes, as falls can be easily triggered in unfamiliar locations, unusual staircase designs, exercise classes, unsafe paving, etc. After reaching 75, I stopped wearing flip flops, sandals with no heel strap, mule slippers, and low heels with no back (no heel cup).
In my 20 years as a Tai Chi instructor, I learned to check out the shoes of students who started classes because of balance issues or complained of balance problems. If they were wearing big sneakers with a thick sole, I would talk to them about trying a shoe with a really thin sole, so their toes and heels could actually feel the floor. Most found their balance improved immediately, even those with some peripheral neuropathy. Walmart has very cheap ones for a trial. – M.H.
A: You're absolutely right, M.H. In fact, we've written before that the soles of your shoes might be some of the most dangerous things in your home. You need to have well-fitting shoes with non-slip soles. And, as you mentioned, certain types of shoes increase your likelihood of falling.
The American Podiatric Medical Association has some tips on the safest types of shoes to buy, and other foot care tips, right here.
What We're Reading...
- Something different: $34,000 to fix a fender bender? The reason car repair bills are rising.
Here's to our health, wealth, and a great retirement,
Dr. David Eifrig and the Health & Wealth Bulletin Research Team
September 21, 2018