Major funding from national opioid settlements with CVS and Walgreens is coming to Garfield County. One proposal is to direct part of the funds toward providing clean syringes and the overdose prevention drug Naloxone locally.

Garfield County Public Health Specialist Mason Hohstadt outlined this proposal and two others — using settlement funds to also create public education campaigns and creating an opioid data dashboard — to county commissioners on Monday.

Hohstadt’s presentation initially ignited concern from Commissioners Tom Jankovsky and Mike Samson, while Chair John Martin chose not to offer any opinions.

“I guess I would potentially call that enabling,” Jankovsky said of harm reduction efforts like promoting needle exchange programs.

“You don’t think harm reduction encourages the use of opioids? That’s a question that’s out there.”

Colorado is earmarked to receive more than $700 million in national opioid settlement funds over the next 18 years. This includes $40 million the state secured from Walmart over its role in the opioid epidemic.

In 2021, Colorado Attorney General Phil Weiser started the Colorado Opioid Abatement Council, which divides the state into regions to receive settlement funds. Lake, Summit, Eagle, Pitkin and Garfield counties make up Region 5.

Region 5 should receive an average of $280,000 annually from settlements, Hohstadt said, while Garfield County itself should receive about $40,000 per year.

One major local development in response to the opioid crisis is the ongoing creation of a detoxification facility in Glenwood Springs, which officials now refer to as a “withdrawal management program.” Jankovsky previously proposed directing opioid funds toward the facility, which is to be operated by Mind Springs Health.

“I think most of Garfield County has committed their dollars to the detox (center),” he said.

The most recent numbers offered from the Colorado Department of Public Health and Environment (CDPHE) show Garfield County leading most rural Colorado areas in overdose deaths. Twenty-four people died from overdose-related causes in the county between 2020-2021. With the combination of all counties representing Region 5, 59 people have died of drug overdoses in this same timeframe.

Eagle County Public Health Partnership Strategist and Region 5 Rep. Chelsea Carnoali told commissioners on Monday that anyone taking advantage of harm reduction services are “already using.”

“Those needle exchange services, or Naloxone distribution or the fentanyl test strips, that is preventing overdose,” she said. “And that is preventing some viral concerns — of course, everything we know (about) using dirty needles.

“These folks are already at that point.”

Hepatitis C and Human immunodeficiency viruses (HIV) are the two most damaging, communicable diseases stemming from intravenous drug use. Hepatitis C cases specifically among Colorado’s prison inmate population became so bad in 2018, the Colorado Department of Corrections committed $41 million over two years to treat inmates living with chronic HVC, CDPHE documents state.

“I don’t want to kick somebody that’s having problems, but you make bad choices and then society pays for it, right?,” Samson said, showing slight opposition to socially treating opioid users. “That’s where we’re at in a lot of ways.”

Police in Garfield County itself have documented instances when the overdose drug brand NARCAN was deployed and successfully saved people from overdosing. In spring 2021, two people in Rifle were administered naloxone and ultimately saved by the Rifle Police Department and Colorado River Fire Rescue district.

When it comes to locally obtaining overdose-prevention drugs and clean needles without police assistance, people go to High Rockies Harm Reduction. But this nonprofit, run by founder and Executive Director Maggie Seldeen, is limited on funding and its services were temporarily suspended in 2022.

Hohstadt said that Region 5 has drafted a two-year plan for the first part of the settlement funds, and that a request for proposal to develop things like harm reduction programs and educational campaigns is now open.

Carnoali is accepting questions about the RFP, at chelsea.carnoali@eaglecounty.us, until 4 p.m. Feb. 17. Proposals are being taken at this same address until 4 p.m. March 10.

February is heart month. Almost all heart attacks are preventable, but in spite of that they remain the number one cause of death in the U.S for both men and women.

Let’s say you are a 50-year-old man and take advantage of the special IMT screen for heart disease offered by Compass Peak Imaging in Glenwood during February, and your report comes back indicating that you have arteries of an average 65-year-old American man based on thickness of the endothelium lining of your arteries. If arterial age is 8 or more years greater than your actual age, you are increased risk for a heart attack or stroke.

Let’s say the report also says you have soft plaque (plaque is “hardening of the arteries”). The presence of plaque also puts you at significant risk (even if your endothelium is not thickened), and soft (uncalcified) plaque is more worrisome than calcified plaque because it is less stable and more apt to rupture and block off an artery.

You and your medical provider need to figure out why you developed atherosclerosis, which is the cause of heart attacks and strokes and is also a huge risk factor for dementia. Atherosclerosis is not inevitable as we age — there are groups of people in the world such as the Blue Zones whose arteries are as healthy at 90 as they are at 19, making these people heart attack proof. What these societies have in common is that they eat primarily plant-based, unrefined foods including daily legumes; and they engage in frequent, low-level physical activity.

Following are measures you can take that can prevent, treat, and even reverse atherosclerosis:

DIET: Adopt a plant-based, whole food diet with no salt, sugar or added oil. Dr. Dean Ornish proved over 30 years ago that atherosclerosis can be reversed with this diet. Dr. Caldwell Esselstyn confirmed this subsequently — read his book, “Prevent and Reverse Heart Disease.”

EXERCISE: The Ornish program — which has been approved by Medicare and many insurance companies — includes regular aerobic exercise. If you’re sedentary, ease into a program of exercise such as walking for at least 30 minutes a day. If you have cardiac risk factors and/or severe atherosclerosis, talk to your provider to see if they recommend a cardiac stress test before starting vigorous exercise.

STRESS REDUCTION is also included in the Ornish program. Consider yoga or meditation. If you suffer from depression, anxiety or sleep problems, seek treatment.

BLOOD PRESSURE should be less than 120/80. For mild hypertension, weight loss, salt avoidance and exercise can help, but do whatever it takes to control it, including medication if necessary.

CHOLESTEROL: The aforementioned populations in the world who are heart attack proof have total cholesterols < 150, LDL (bad cholesterol) in the 30s and 40s, and triglycerides < 70. Plant-based, whole food nutrition lowers cholesterol, but if it doesn’t get your numbers to goal, consider medication. In their 2022 book “Healthy Heart, Healthy Brain,” heart attack prevention experts Bale and Doneen recommend a statin for anyone with plaque, no matter what their cholesterol is.

WEIGHT: Attain and maintain ideal body weight. If you look at your profile in the mirror and have even a small “belly,” lose it because that almost always means you have insulin resistance (pre-diabetes), the driver of 70% of heart disease. High triglycerides and low HDL (good cholesterol) are another indication of insulin resistance. Fasting blood sugar above the low 90s, and/or A1C above 5.6 (a measure of average blood sugar levels the previous 3 months) are also indicators of IR, but the gold standard is a 1 and two-hour glucose tolerance test (1-hour sugar of > 125 and/or 2-hour sugar of < 120 indicate insulin resistance).

SLEEP APNEA: Anyone who has atherosclerosis should have an overnight oximetry to screen for sleep apnea. This inexpensive test involves wearing a monitor on your finger all night that records oxygen level and pulse rate.

TOBACCO should be avoided in any form, including second-hand smoke.

INFLAMMATION from conditions such as rheumatoid arthritis, ulcerative colitis, and dental problems plays a large role in development of plaque, and in plaque rupture. Practice good dental hygiene, and if you have tooth or gum problems, see a dentist well-versed in the mouth-vascular connection.

REPEAT THE IMT TEST IN A YEAR: With appropriate treatment, endothelial thickening should improve; soft plaque often disappears or at least calcifies thereby becoming more stable; and the amount of calcified plaque doesn’t increase and often decreases.

Next week’s column will be about cholesterol.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market, and cooking classes. Call 970-379-5718 for appointment, or email gfeinsinger@comcast.net.

Akaljeet Khalsa, a Carbondale based end-of-life doula, knows first hand the painful experience of watching a loved one dying. In 2019, her mother was diagnosed with stage three cancer, catalyzing the overwhelming emotions humans struggle to navigate when someone we love is near the end of their life. 

Khalsa realized she didn’t know what death looked like, what conversations she was supposed to have with her mother, or what her mother’s final wishes were. She began wondering: How do I even begin to approach this? How do I sit at her bedside if she’s dying? How do I be a support?

Her mother, who is now 71, made a recovery and now spends her time “climbing mountains in Boulder,” Khalsa said. Still, the boundless questions surrounding death led her to become an end-of-life doula. 

The International End-of-Life Doula defines a death doula as someone who “guides a person who is transitioning to death and their loved ones through the dying process.” The title “death doula” and “end-of-life doula” can be used interchangeably. 

In 2020, when news of the COVID-19 pandemic started unraveling, Khalsa began taking end-of-life doula courses through Conscious Dying Institute in Boulder. 

“I think COVID really brought out something that was very obvious that needed to be brought forth, is that so many people were dying alone,” she said. 

Khalsa was one of many people who started to undergo death doula training in the wake of the pandemic. According to Time, some death doula training groups saw enrollment “more than triple” during the early months of 2020.

“Death came in such a massive wave,” said Khalsa. “So many of us were so unprepared to lose loved ones or to witness the horrors that were happening around death, because people weren’t able to be together.”

“I think it took the country and the world by storm. It really made a lot of people look at and ask the larger question of, ‘Is this how we want death to look like in this country?’ Or do we want to be able to show up with knowledge and compassion,” she said.

Before becoming a death doula, Khalsa spent over 25 years practicing massage therapy. She still operates a massage therapy private practice out of her home in Carbondale.

“So as a bodyworker, and I like to also say that I’m a healer, too, so much a part of my work is about people in transition, often in their bodies, or even just spiritually and emotionally where they are in life,” said Khalsa. 

“I show up for people in a lot of different ways when I do massage and healing work,” she said. “So this just seemed like another level of what I was doing. I see death as a healing transition, or what can be a healing transition.”

What does a death doula do?

Death doulas provide comfort, emotional and spiritual care to a dying person and their family. A large part of what they do is educating families on what they’re witnessing with their loved one and giving them guidance, Khalsa said. 

Death doulas differ from hospice workers in that they do not offer medical care, and instead take on more emotional and spiritual labor. 

“They (hospice workers) don’t have the luxury to really just sit and be with somebody and hold their hands and be with the family to help dissolve some of the fears around what’s happening to their loved one, as they’re witnessing their dying process,” said Khalsa.

While death doulas surged amid the pandemic, their work became increasingly important as Western societies have shifted from communal to more individualistic cultures, she said. 

“As death doulas, we’re really trying to bring back that knowledge and that awareness that death is communal,” said Khalsa. 

Embracing a range of religious ideologies is also an important component of being a doula. Many doulas are trained to “hold space, whatever spiritual belief system somebody has,” said Khalsa.

“Whatever their prayers are, whatever their reference to the Divine or God is, that’s the language we try to support and use,” she said.

Khalsa works with people one on one, and with couples, to create “a very personal and in-depth end-of-life care plan,” she said. 

A different approach to thinking about death

Another component of Khalsa’s work is trying to change the conversation, or lack thereof, around mortality. 

“I think it’s really powerful for people to really hear and understand — how you die is a gift to those you love,” said Khalsa.

In addition to serving as a death doula, she also co-hosts “death cafes,” an informal gathering of individuals who desire to talk about anything relating to death, once a quarter at the Basalt Library.  

To reach out to Akaljeet Khalsa, email Akaljeet970@gmail.com. For more information, Khalsa‘s  website: http://www.akaljeet.com/

To reach Kristen Mohammadi, call 304-650-2404 or email kmohammadi@aspentimes.com.

Once again during February (“heart month”), Compass Peak Imaging in Glenwood (970-665-2194) is offering a special price for carotid IMT heart disease screening — a special, FDA-approved ultrasound study that assesses artery health.

Heart attacks are the number one cause of death in the U.S. year after year, in spite of essentially all of them being preventable. Here’s what Christiaan Barnard — the South African heart surgeon who performed the first heart transplant — had to say about heart attack prevention: “I have saved the lives of 150 people by heart transplants. If I had focused on preventive medicine earlier, I might have saved 150 million.”

Unfortunately, medical training and practice in the U.S. are geared towards managing chronic diseases such as heart disease with pills and procedures instead of preventing them. Heart disease is looked at as a plumbing problem, with blockages that need to be fixed with stents and bypass procedures, rather than a medical disease (atherosclerosis — hardening of the arteries) that can be prevented, treated and reversed through simple lifestyle changes and, when necessary, non-invasive medical therapy.

About 50% of men and 70% of women who die suddenly from heart disease had no prior symptoms, making screening for diseased arteries imperative.

Risk factors for atherosclerosis/heart attacks include: smoking; blood pressure above 120/80; high total cholesterol, low good cholesterol (HDL), high LDL (bad cholesterol), high triglycerides; obesity, particularly around the waistline; pre-diabetes and diabetes; sleep apnea; inflammation including that due to dental disease; sedentary lifestyle; stress including depression; inadequate sleep; the standard American diet; age (men over 40, women over 50); family history of cardiovascular disease; gout; autoimmune disease; erectile dysfunction; migraine headaches; and sleep apnea.

Some doctors use risk calculators based on these risk factors, but as respected heart attack prevention experts Bale and Doneen point out in their 2022 book “Healthy Heart, Healthy Brain,” these risk calculators are dangerously inaccurate.

If arteries are stressed by bad genes; bad habits such as smoking or unhealthy eating; or by other aforementioned risk factors, the endothelium that lines arteries thickens, and eventually plaque (atherosclerosis) develops — 99% of which is in the walls of the arteries, not causing a blockage. If the plaque ruptures — often triggered by inflammation — a blood clot forms in the artery, blocking the blood flow, causing death of part of the heart muscle (or brain in the case of a stroke).

Twenty percent of heart attacks result in sudden death. For the other 80% of heart attack victims who make it to the hospital, an interventional cardiologist can save lives by opening the blockage with a stent. However, stents and bypass procedures don’t treat the underlying disease, and in non-heart attack settings have not been shown to save lives or improve quality of life.

There are two commonly-used methods of determining arterial health. One is coronary calcium scoring, available at most imaging centers. This is a CT scan of your heart, which shows how much calcium (atherosclerosis) you have in your coronary arteries. It involves a small amount of radiation, and can result in false-negatives because it doesn’t pick up non-calcified plaque, which is the most dangerous kind. Repeat coronary calcium scoring is not useful in determining effectiveness of treatment, because calcification of uncalcified plaque — which is a good thing — results in a higher score.

The second method is carotid IMT, which provides a soundwave picture of the carotid arteries, located just beneath the skin on both sides of the windpipe, and therefore easily assessable. It measures the thickness of the endothelial lining, and picks up both calcified and uncalcified plaque. If abnormal, IMT should be repeated a year after starting treatment — appropriate treatment should result in less endothelial thickening, stable or lesser amount of plaque, and calcification (stabilization) of uncalcified plaque. The downside of IMT is that it looks at the carotid rather than the coronary (heart) arteries, but there is a 95% correlation between the two — i.e. if you have atherosclerosis in one area you almost certainly have it in arteries throughout your body.

The Bale-Doneen Method is one of the most successful heart attack prevention methods in the U.S. Dr. Doneen recently served on a Society of Atherosclerosis Imaging and Prevention expert committee, which developed guidelines for IMT screening. They recommend carotid IMT screening on everyone at age 40, and younger if significant risk factors are present. Note that the carotid IMT is much more sensitive than the usual carotid ultrasound done at most imaging centers and by companies such as Lifeline Screening — which just pick up major blockages.

Next week’s column will be about what to do if you are found to have plaque.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market, and cooking classes. Call 970-379-5718 for appointment, or email gfeinsinger@comcast.net.

With the dawn of a new year are you interested in improving your health? PCRM’s (Physician Committee For Responsible Medicine) Food For Life classes are available locally through a licensed instructor, Laura Van Deusen, in Rifle.

PCRM was founded in 1985 by Neal Barnard, M.D., originally from Fargo, North Dakota. Dr. Barnard is certified by the American Board of Psychiatry and Neurology, is a fellow of the American College of Cardiology, and is an Associate Professor of Medicine at George Washington School of Medicine, in Washington, D.C.

Over 80% of the chronic diseases Americans suffer and die from are preventable with simple lifestyle changes (obesity, hypertension, high cholesterol, heart attacks, strokes, diabetes, dementia, inflammatory diseases, autoimmune diseases, many kinds of cancer). It has been said that the U.S. doesn’t have a health care system but rather a disease management system — we wait until diseases occur and then spend lots of effort and trillions of dollars managing them.

Dr. Barnard has been a pioneer in changing this dysfunctional and expensive system. He started PCRM to promote preventative medicine and to “make the world a better place for people and animals.” Examples of helping animals are that he has pushed medical researchers to stop using animals in experiments, and has lobbied for more humane treatment of factory-farmed animals. Because it’s relatively easy to get people to donate money for animal welfare, PCRM is well-funded and is a powerful influence in Washington.

In 2015 Dr. Barnard founded the Barnard Medical Center, which provides medical care to patients and through which he and his colleagues conduct medical and nutritional research. He has written 20 books, including “Eat Right, Live Longer,” “Breaking the Food Seduction;” “The Cancer Survivors’ Guide;” “Foods That Fight Pain;” “The Cheese Trap;” and “Your Body in Balance.” He is respected in medical, research, and plant-based circles.

PCRM offers meal delivery services, and remote and in-person cooking classes through licensed instructors such as Laura Van Deusen, a middle school math teacher in Rifle. Ms. Van Deusen was in the Peace Corps in Morocco, and has a passion for educating and helping people. She adopted a vegetarian lifestyle as a child, and later became a full-fledged plant-based, whole food advocate after learning about the health and environmental benefits.

The free “The People’s Clinic” in Carbondale for Latinos is collaborating with Laura who will give PCRM’s Diabetes Prevention and Treatment PCRM classes, which included videos and written materials such as recipes in Spanish. She is also currently offering different PCRM classes in Rifle through CMC, which anyone can sign up for, and is available to give other PCRM classes on demand. Other PCRM classes include Kick Start Your Health, Cancer Prevention and Survival, Employee Wellness Programs, and Kids Health Program.

Laura has also started a monthly plant-based cooking and social club in Rifle, similar to the plant-based potluck at 6:30 p.m. the fourth Monday of every month at the Third Steet Center in Carbondale. We are fortunate to have a licensed PCRM educator in the area. Laura can be contacted by calling 970-424-2175 or emailing rootboundcooking@gmail.com. The PCRM cooking class website is www.fflclasses.org.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market, and cooking classes. Call 970-379-5718 for appointment, or email gfeinsinger@comcast.net.

Aspirin (salicylic acid), in the form of willow bark extract, has been used for thousands of years for pain, fever, and inflammation. It has been available in pill form since 1897. Salicylic acid is also present in many fruits and vegetables, with the highest concentration being in herbs and spices, particularly chili powder, paprika, and turmeric.

Aspirin has anti-clotting properties, and daily 81 mg. baby aspirin has been used for years for heart attack and stroke prevention. Heart attacks and most strokes are caused when plaque in the walls of coronary or brain arteries ruptures, resulting in a blood clot that blocks blood flow; aspirin helps prevent the blood clot from forming. It’s important to put this in perspective, though. The value of aspirin to prevent heart attacks pales in comparison to getting cholesterol, blood pressure, blood sugars, and weight to goal, and regular exercise and tobacco avoidance.

Like all medications, aspirin in pill form can have side effects: stomach ulcers; life-threatening stomach bleeding; and hemorrhagic strokes (where a blood vessel in the brain ruptures). So, people with high risk of bleeding should not take aspirin, nor should people at very low heart attack risk — where the risk of serious side effects outweighs the potential benefit.

Recommendations for daily aspirin have varied over the years, and many people took daily aspirin just because they’d heard it was a good thing to do. Recently, the guidelines were revised.

NEW, 2022 GUIDELINES: 1. People with a history of a heart attack, stroke, coronary stent, or atrial fibrillation should continue to take 81 mg. of aspirin daily (This is what’s called secondary prevention). Some guidelines add anyone with a coronary calcium score (a CT scan of the heart, which measures the amount of calcified plaque in coronary arteries) over 100, since they are at high risk for a heart attack. 2. Adults over 59 should not take daily aspirin for primary prevention (prevention of first heart attack) because risk outweighs the benefit. 3. People with increased risk of stomach or brain bleeding should avoid aspirin. 4. People age 40-59 with cardiac risk facts such as diabetes, smoking, hypertension, high cholesterol, or positive family history of heart disease should talk to their physician about the pros and cons of taking daily aspirin. 5. People with a 10% or greater 10-year risk of a heart attack — based on a risk calculator — should talk to their doctor.

BALE-DONEEN METHOD RECOMMENDATIONS: This is one of the most successful heart attack and stroke prevention programs in the country, and Brad Bale, M.D. and Amy Doneen, DNP came out with their second book in 2022 called “Healthy Heart, Healthy Brain.” They feel the aforementioned risk calculator is inaccurate and have the following recommendations:

1. “The effectiveness of low-dose aspirin for people who have already suffered one or more heart attacks or strokes remains undisputed, and they call this tertiary prevention.

2. They consider primary prevention to be prevention of heart attacks in people with no history of a cardiovascular event (heart attack or stroke), no significant risk factors, AND no evidence of hardening of the arteries based on coronary calcium score and/or carotid IMT. In these people, the potential harm from taking daily aspirin clearly outweighs any potential benefit.

3. They use the term secondary prevention for people with no history of heart attack or stroke but with proven plaque — no matter what their risk factors (Although, most people with significant risk factors have plaque in their arteries).

4. Bale and Doneen point out that some people who have the indications for daily aspirin are resistant to 81 mg. and need higher doses or in some cases a different anticoagulant such as Plavix. They recommend that all people on aspirin to prevent a heart attacks and strokes have an inexpensive urine test called AspirinWorks to check for “aspirin resistance.”

DOCTOR GREGER’S TAKE: He is famous for his books including “How Not to Die,” and his website nutritionfacts.org. He recommends that people get their aspirin not through a daily pill but rather through daily intake of fruits and vegetables such as the ones noted in the first paragraph, which provide the benefit of aspirin without the possible side effects. He points out that “in plants, the salicylic acid appears to come naturally prepackaged with gut-protective nutrients, such as nitric oxide, that boosts blood flow and protective mucus production in the lining of the GI tract.”

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market, and cooking classes. Call 970-379-5718 for appointment, or email gfeinsinger@comcast.net.

Sulfa antibiotics were first used in the 1930s. Penicillin was discovered in 1928 and first used as a drug in the early 1940s. This class of drugs revolutionized the practice of medicine, and subsequently several additional antibiotics were developed. 

Antibiotics have saved millions of lives. For example, it is now rare for people to die from bacterial infections such as bacterial pneumonia, kidney infections, blood infections, wound infections and meningitis. However, largely because of overuse of antibiotics in humans and in farm animals, some bacteria have developed resistance to available antibiotics. 

An article in the December issue of the American Family Physician journal notes that “antibiotic resistance is among the greatest public health threats today. The CDC estimates that more than two million antibiotic-resistant infections result in at least 23,000 deaths annually in the United States.” 

Furthermore, antibiotics can have side effects such as allergic reactions, which can sometimes be fatal. In addition, antibiotics destroy good bacteria such as health-promoting bacteria in the gut microbiome, and it can take a year after a course of antibiotics for the microbiome to fully recover. You might have heard of C. diff, a harmful bacterium that can overwhelm the gut when “good” bacteria are destroyed. 

Antibiotics treat bacterial infections but have no effect on viruses, such as those that cause illnesses like the common cold, influenza and COVID. The average adult gets a few viral infections a year, and the average child more. Typical cold symptoms include low-grade fever, head and body aching, nasal congestion, sore throat and cough, which usually resolve in 7-10 days. 

Unfortunately, colds are often treated with antibiotics, even though they are useless for this condition. The American Family Physician journal article notes that “studies show that up to 10 million antibiotic prescriptions per year are inappropriately directed toward respiratory tract infections” caused by viruses. One recent study of 15,000 outpatients with acute URIs (upper respiratory infections) found that 41% of patients prescribed antibiotics did not have an indication for them. 

There are three primary reasons that inappropriate antibiotic use continues to occur:

1. Patient demand: Often patients demand antibiotics and become upset if they leave the office without a prescription for one.

2. Physicians often take the easy way out: Unfortunately, there are pressures on physicians these days to see a lot of patients quickly, and the easiest way to get a patient out the door and move on to the next patient is to write a prescription for an antibiotic, rather than taking the time to explain why antibiotics are inappropriate.

3. Eighty percent of antibiotics in the U.S. are used for farm animals. Conscientious farmers only use antibiotics for sick animals with bacterial infections, but factory farms often use them routinely and inappropriately to “prevent illness.” 

If you just have a sore throat, especially if you also have swollen, tender lymph nodes in your neck, you should have a test to see if you have an infection caused by the streptococcus bacteria, which should be treated with penicillin to avoid rheumatic fever and glomerulonephritis (a kidney disease). Other symptoms that could indicate something serious and which should lead you to seek urgent medical care include difficulty breathing, swallowing or talking; chest pain; high fever; stiff neck; or shaking chills. 

If you have typical URI symptoms noted above, there is no reason to see a doctor, and certainly no reason to take an antibiotic. If you develop red flag symptoms listed above, this could mean a complication such as pneumonia, and you should seek immediate care. Also consider getting checked out if you have less severe symptoms lasting much over 10 days. 

For aching or low-grade fever, acetaminophen is the safest thing to take. Be aware that OTC cold and cough meds often cause side effects that are worse than the cold symptoms and should generally be avoided. 

In summary: Antibiotics can be lifesaving if you have a bacterial infection, but are ineffective against viral infections such as the common cold. Don’t put pressure on your doctor to prescribe them, and if an antibiotic is appropriate, don’t demand a “big gun” antibiotic when a less strong one will do. If your provider does prescribe an antibiotic, question whether it is really necessary. 

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment, or email gfeinsinger@comcast.net

It’s the time of year when many people are thinking about New Year’s resolutions. One of the most common of these is losing unwanted weight, particularly after gaining a few extra pounds over the holidays. Following are 22 tips, from Dr. Michael Greger’s evidence-based 2020 book “How Not to Diet.”

1. EAT FOOD LOW IN CALORIE DENSITY, such as vegetables, fruit, and unprocessed grains — which also happen to be loaded with health-promoting fiber and micronutrients.

2. NUTS AND SEEDS are an exception to No. 1. Nuts are high in calorie density, but a handful a day contributes to optimal health. Nuts cause satiety (a feeling of fulness), so that fewer calories are eaten after eating nuts. Seeds are also calorie-dense but unsalted sunflower and pumpkin seeds sprinkled on salads don’t contribute very many calories, and help absorb fat-soluble vitamins. A tablespoon of ground flaxseeds a day reduces inflammation and provides healthy omega-3 fat.

3. EAT LEGUMES DAILY. Beans, lentils, chick peas, and split peas make you feel full, so you will eat fewer calories the rest of the meal. Furthermore, they feed the health-promoting bacteria in your gut microbiome, which in turn produce chemicals that cause satiety, resulting in less calorie intake for hours following eating legumes.

4. AVOID HIGH CALORIE-DENSITY FOOD such a animal products (including seafood), and added oil.

5. AVOID ADDICTIVE FOOD, such as salt, sugar and fat (the latter is often hidden in the form of added oil).

6. AVOID PROCESSED FOOD such as anything made from flour — doughnuts, pastries, cookies, cake, chips, most crackers (Wasa brand is an exception), and cereal that comes in a box.

7. WATER BEFORE MEALS: Drink 2 cups of cool or cold, unflavored water before each meal, which will cause you to eat fewer calories during the meal.

8. EAT A CUP OR BOWL OF LOW CALORIE VEGETALBE OR LEGUME SOUP BEFORE EACH MEAL, slowly with a teaspoon, which causes satiety so that you will take in fewer calories during the remainder of the meal. Another option is to pre-load meals with a salad with a low calorie, oil and sugar-free dressing (recipes found on the internet).

9. VINEGAR: 2 teaspoons before each meal causes satiety, so you will eat less. Furthermore, it decreases blood sugar and insulin levels. Using vinegar as a salad dressing is one approach — if you’re going to drink it, dilute the acidity with water.

10. EAT MINDFULLY — don’t get distracted by your phone, tablet or TV during meals.

11. EAT SLOWLY — spend at least 20 minutes eating each meal, which allows hormones to kick in that tell you you’re full. Chew your food well, and don’t drink your nutrients (smoothies enable people to unconsciously ingest a lot of calories quickly, before realizing they’re full).

12. BLACK CUMIN SEEDS (Nigella sativa) 1/4 teaspoon (buy on internet) have been shown to aid weight loss. One-half tsp of regular cumin with lunch and dinner does the same thing.

13. GARLIC POWDER — at least 1/4 tsp daily has been shown to reduce body fat.

14. GROUND GINGER — at least 1 tsp daily — reduces body weight, especially if taken in the morning.

15. BAKER’S, BREWER’S, OR NUTRITIONAL YEAST — 2 tsp a day facilitates weight loss.

16. STAY HYDRATED by drinking enough water or other calorie-free beverages to keep your urine clear to pale yellow. Avoid artificial sweeteners, which are associated with weight gain.

17. DE-FLOUR YOUR DIET: As Dr. Greger says in his book, grinding grain into powdery flour causes it to lose the fiber and resistant starch needed to feed the health and weight loss-promoting organisms in the got microbiome. Furthermore, flour enters the bloodstream rapidly, causing harmful blood sugar and insulin spikes.

18. FRONT-LOAD YOUR CALORIES: Eat breakfast like a king, lunch like a prince, and dinner like a pauper. Dr. Greger explains that “because of our circadian rhythms, food eaten at night is more fattening than the exact same food eaten earlier in the day.”

19. DON’T EAT AFTER 7 P.M., AND FAST FOR 12 HOURS BETWEEN DINNER AND BREAKFAST in order to be in sync with your natural, daily biorhythms. If you brush your teeth right after dinner, you will be less apt to eat later.

20. EXERCISE: Any exercise helps, but at least 30 minutes a day of moderate exercise such as brisk walking is important for optimal health and weight.

21. WEIGH YOURSELF daily.

22. SLEEP: Get 7-8 hours of good sleep a night.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment, or email gfeinsinger@comcast.net

Editor’s note: This column was updated to correct the year of publication of “How not to Diet.”

DENVER (AP) — The Environmental Protection Agency is investigating whether Colorado’s regulation of air pollution from industrial facilities discriminates against Hispanic residents and other racial minorities, according to a letter released Wednesday.

That’s a level of scrutiny long sought by Lucy Molina whose daughter goes to school near Colorado’s only petroleum refinery. Three years ago Molina had just stepped outdoors when she noticed a coating of ash on her Nissan Altima that wiped off on her fingers. Then she received a message that her daughter’s school was locked down and panicked. She later learned the refinery had malfunctioned, spewing a clay-like material into the air. She’d heard of lockdowns for shootings, but never for pollution.

Since then she’s pushed for community air monitoring and stronger protections, but says it all feels too late. She’s lived here for 30 years, and her kids are already young adults.

“If we would have known” years ago, she said. “We would have moved.”

Advocates say the Suncor refinery too often malfunctions, spiking emissions. They say Colorado rarely denies permits to polluters, even in areas where harmful ozone already exceeds federal standards.

Federal investigators said in the letter they will scrutinize the state’s oversight of Colorado’s biggest polluters including the Suncor oil refinery in North Denver where Molina lives, and whether the effect of that pollution on residents is discriminatory.

Suncor did not respond to a request for comment.

But it is already harder for oil and gas companies to get their air permits in Colorado than in some other energy-producing states, said John Jacus, chair of the Colorado Chamber of Commerce board of directors and an environmental compliance attorney. He said recent allegations that the state’s permit review process was faulty had the effect of slowing air permitting, a blow to business.

“It would be really good for air quality to shut everything down, but that’s not good for society,” Jacus said, adding there needed to be a balance between environmental protection and economic activity.

The EPA launched its investigation under Title VI of the Civil Rights Act of 1964. It has been going on since March but went little noticed until Wednesday’s letter, which explains its scope. The Act allows the EPA to negotiate agreements with states to promote equity. The Biden administration has stepped up its enforcement of environmental discrimination.

Colorado officials said they welcome the EPA review, more community participation and are reviewing their permitting policies to ensure they are focused on environmental justice.

“We’ve always prioritized the health and wellbeing of every Coloradan no matter their zip code, but we know we have even more to do,” said Trisha Oeth, our Director of Environmental Health and Protection in a statement.

But the EPA has found those priorities lacking at times.

The agency scrutinized the state’s handling of Suncor. Colorado’s only oil refinery is roughly 90 years old and is a major emitter of greenhouse gas emissions in the state.

In March, the EPA objected to a key air permit for the facility that state regulators were still reviewing 10 years after its original expiration date. The agency raised “significant environmental justice concerns” and said that the public wasn’t given enough opportunity to weigh in. The EPA didn’t object when the state issued a revised permit.

In July, the agency also said the state had issued permits for a mine, oil and gas wells and other small polluters even though they could contribute to violations of federal air quality standards. Colorado said it would improve its reviews, but balked at revisiting its permitting decisions.

There are some signs the agency chose Colorado because it could prove a willing partner.

“Colorado has been one of the states that has been a leader in addressing environmental justice in the legislature,” said KC Becker, the head of the EPA region that includes Colorado and a former state legislative leader.

Colorado has strengthened air monitoring requirements. It increased funding for air permit reviews. The state’s greenhouse gas reduction plan aims to reduce pollution in overburdened areas. It also worked with the EPA to ensure inspections target the most polluted areas and when companies reach settlements for wrongdoing, they pay for projects that benefit communities.

The EPA may have an easier time convincing Colorado to change than it would, say, Texas, said Jeremy Nichols, head of climate and energy programs at WildEarth Guardians.

Colorado’s changes have “given EPA an opening to say, ‘well, if that is what you are committed to then let’s really test this out, let’s see you prove your mettle here,’” said Nichols.

Nichols said Colorado is too deferential to industry. He wants to see the state deny permits much more often.

Ian Coghill, an attorney with Earthjustice that is challenging the Suncor permit, says the push and pull between the EPA and state hasn’t yielded major improvements. Revisions to Suncor’s permit, he said “didn’t change a lot.”

He is hopeful the civil rights investigation will force the state to make changes and detail the cumulative effect of pollution from industry on residents of North Denver.

“I’m definitely optimistic,” he said.

Chocolate Raspberry Tofu Pie

This is a relatively healthy holiday dessert from eatingwell.com. It does contain quite a bit of sugar, but don’t feel too guilty for splurging a few times over the holidays. If you’re a purest, you could try substituting date paste for sugar if you make your own crust, but date paste would likely change the texture of the tofu/chocolate part.

Following are the ingredients:

· 1 ½ cups of vegan semi-sweet mini chocolate chips (Enjoy Life brand available at Natural Grocers and Whole Foods)

· 12.3-ounce package of firm, shelf-stable silken tofu (unrefrigerated—Mori-Nu brand in foreign food section of City Market)

· 1 tablespoon pure maple syrup

· 1 teaspoon vanilla extract

· 1 cup raspberries, fresh or frozen (thawed), plus more for garnish

· ½ cup confectioners’ sugar

· 1, 9-inch graham cracker pie crust

Directions:

· Put chocolate chips in a medium microwavable bowl. Microwave on medium for 1 minute. Stir, then continue microwaving on medium, stirring every 20 seconds until melted.

· Place tofu in a food processor or blender and process until smooth. Add the melted chocolate, maple syrup, and vanilla. Process again until smooth. Add raspberries and confectioners’ sugar and process until very smooth; scraping down the sides as necessary. Spread the mixture into the crust. Refrigerate for at least 2 hours, until firm. Garnish with raspberries.

Makes 10 servings. Nutritional data per serving: 310 calories; 15 g fat (6 g saturated, 6 g monounsaturated); 0 mg. cholesterol; 43 g carbohydrate; 31 g added sugars; 5 g protein; 3 g fiber, 153 mg sodium, 210 mg potassium.

Pioneer Gingerbread

This is from the Fall/22 edition of Forks Over Knives magazine.

Ingredients:

· 3 cups spelt flour (Natural Grocers)

· 1 Tbsp. baking powder

· 1 tsp baking soda

· 1 tsp. ground ginger

· 1 tsp. ground cinnamon

· 1 tsp. ground allspice

· ½ tsp. ground nutmeg

· ½ tsp. ground cloves

· ½ tsp. sea salt

· 1 cup pure maple syrup

· ½ cup applesauce

· ¾ cup molasses

· 2 Tbsp. white vinegar

Directions:

· Preheat oven to 375 degrees F. Line a 3-qt. rectangular baking dish with parchment paper. In a medium bowl whisk together the first nine ingredients (through salt).

· In another—large– bowl stir together the remaining ingredients. Add 1 cup boiling water; stir to combine. Slowly add flour mixture while stirring just until combined. (The batter will be quite thin.). Pour batter into a prepared dish.

· Bake 35 minutes, or until a toothpick inserted in center comes out clean. Cool in dish 20 minutes. Remove gingerbread from dish. Cool completely on a wire rack.

· Serve with a vegan lemon sauce (find recipe online) or plant-base “whipping cream” available at most grocery stores.

Have safe, healthy, happy, tasty holidays!

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment, or email gfeinsinger@comcast.net.