Keep Germs From Walking Through Your Home

by Carole Jackson, Bottom Line Health

Is your home a shoe-free zone? More to the point, should it be?

I’ve been contemplating this issue, in part because we’re up to our ankles in the muddy season here on the East Coast (made all the worse by my daughters in their soccer cleats). I can’t help but wonder what besides mud comes in on their cleats, or for that matter, our everyday shoes. After all, whatever the time of year, the streets are a virtual dumping ground for animal feces, dropped and decaying foods and possibly pathogens in… ahem… various bodily fluids.

Indoor Shoes

I started asking people about shoes in their homes and quickly discovered that many people have rules. For instance, I spoke with an acupuncturist who endorsed keeping shoes on because, he says walking on cold floors is bad for the muscles. Not so, said another acupuncturist who is also a podiatrist — he assured me that cold floors won’t hurt you but does advise wearing shoes or slippers to keep feet comfortable and protected, since he sees an awful lot of needless foot injuries. And speaking of that, another vote in favor of footwear came from a restaurant-owning friend — she told me that the very first rule for chefs-in-training is to keep shoes on when preparing food. It makes sense — if you happen to drop the knife when slicing and dicing in bare feet, the damage to your toes could be permanent.

Sock It to Us…

I’ll give you the dirt on wearing outdoor shoes inside in just a minute — but let me first note that whatever you wear or don’t wear on your feet inside the house, put safety first. Socks may protect your feet from dirt — at least partially — but they can be slippery, too… so slippers may be the best solution. Look for a pair with soles that will grip the floor.

To get the inside story on the filth on shoes, I called microbiologist Philip M. Tierno, Jr., PhD, author of The Secret Life of Germs and director of clinical microbiology and immunology at New York University Langone Medical Center. Dr. Tierno says absolutely the ideal is to take your shoes off at the door. “The street is a repository for all sorts of really disgusting things,” he says, “and when you step in them while walking, your shoes accumulate those things… and bring them into your home.”

Though he said this issue hasn’t been studied, Dr. Tierno points out (rather poetically) that the absence of evidence is not evidence of absence. For example, say you step on sputum from someone who has the flu — do you have any doubt that your shoes could then transfer the pathogens to your rug where you or your child later sits? That shoe debris probably won’t kill you, says Dr. Tierno, but it can definitely make you sick.

Sanitizing Measures

Dr. Tierno acknowledges that in this country, guests generally expect to keep their shoes on. He has advice on how to be sure your house stays sanitary in spite of visiting soles…

  • Hard floors with area rugs are preferable. These are easier to clean than wall-to-wall carpeting — another problem is that the padding under wall-to-wall becomes a repository for numerous germs, bacteria and more that seeps through over time.
  • If your home is carpeted and outside shoes are worn inside, sanitize the carpeting weekly with an alcohol-based spray (Lysol works well) and vacuum with a strong machine equipped with a HEPA filter to keep what’s sucked up from flying into the air. (This applies to area rugs as well.)
  • Clean floors regularly with a disinfectant. Dr. Tierno believes that conventional cleaning products are most effective, but if you use only “green” products, be sure that the one you buy contains thymol, a component of thyme oil, the only green ingredient strong enough to do the job, he said. Products that contain thymol include the brands Seventh Generation and Benefect.
  • Clean up food and drink spills immediately to prevent decay and having resulting germs or bacteria tracked into other areas of the home.

Dr. Tierno reminds us to always wash hands after sitting on the floor or rug, especially before eating, drinking or touching your face. And, while not advocating that we all turn into “clean freaks,” he added one more bit of advice that I will be sharing with my family: That famous “five-second” rule is a no-no — if food falls on the floor even for just a second or two, it belongs in the trash, not in your mouth. You don’t know what shoe carrying what germs has walked on that spot!


Philip M. Tierno, Jr., PhD, author of The Secret Life of Germs (Atria) and director, clinical microbiology and immunology at New York University Langone Medical Center, New York City.

Best Time of Day for Exercise

by Carole Jackson, Bottom Line Health

Are you a person who likes to roll out of bed and hit the gym… or the pool, the track or the tennis court — or do you prefer an afternoon or evening workout? Exercise however you like, but according to a new study, you might want to put some planning into when you work out. Belgian researchers found that exercising before eating — on an empty stomach, something most people have only first thing in the morning or late afternoon — has several beneficial effects, including preventing weight gain and warding off a truly serious disease.

An Unusual Study — They Ate Junk Food

In the study, 27 healthy young men ate a horrible diet high in sugar, fat and calories — chosen because it was just about guaranteed to create both weight gain and a reduction in the body’s ability to process blood sugar effectively.

The Belgian men were divided into three groups. The control group had to eat the awful diet and avoid exercising. Men in the second and third groups — in addition to eating the same unhealthful diet — both exercised, performing the same workout. But the second group did it soon after breakfast and the third group did it before breakfast, exercising on an empty stomach.

How Did That Work For Them?

The results were surprising and dramatic. As one might expect, the control group (the one that simply pigged out) gained a lot of weight and also saw their ability to control blood sugar (insulin sensitivity) plunge. The “exercise after eating” group also gained weight, but not nearly as much as the control group. Their insulin sensitivity also went down, just as it did in the control group.

But the “exercise before eating” group was a whole different story. Despite eating the terrible diet, this group did not gain weight… not only that, their insulin sensitivity didn’t fall, so even their bad diet did not make them insulin resistant. A breakthrough finding? You bet. As the authors said, “This study for the first time shows that fasted (empty stomach) training is more potent than ‘fed training’ to facilitate adaptations in muscle and to improve glucose tolerance and insulin sensitivity… ”

So Don’t Eat First?

Should you forgo eating before working out? Not necessarily — it depends on your goals. I consulted exercise physiologist Liz Neporent, MS, CSCS, who serves emeritus on the executive board of the American Council on Exercise and is author of Fitness for Dummies. She said that people whose interest is in heightening their performance — who are, for instance, training for an upcoming event — might do better to eat first, since they’ll need energy to push themselves harder and harder. But, she added, if it’s weight loss or maintaining general fitness that you are after, “evidence does seem to be trending toward not eating before working out.” The benefit of the before-breakfast interval is that most of the food consumed the day before is well through the small intestine and thus the inflow of nutrients is at its ebb, but you can also benefit by being sure to work out as long after eating as possible — say, just before lunch or just before dinner.

One caveat — if you find that exercising on an empty stomach makes you feel dizzy or faint, this may not be a good approach for a vigorous workout. You might find that endurance training, where you focus on low-stress repetitive actions such as mild-to-moderate spinning, can produce benefit without driving blood sugar too low. Or you may need to have a small, healthful snack that includes protein before you do any exercising. While you won’t get the same benefits as exercising on an empty stomach, the fact that you’re exercising is still a good thing!


Liz Neporent, MS, CSCS, exercise physiologist based in New York City and author of Fitness for Dummies (Wiley) and Weight Training for Dummies (Wiley). She is a contributor to ABC National News and serves emeritus on the executive board of the American Council on Exercise.

Sleep At The Right Time and Other Stay Young Secrets

by Carole Jackson, Bottom Line Health

It’s certainly true that we live in a youth-obsessed culture, but the desire to stave off aging is long-standing and universal. Remember Ponce de Leon’s search for the Fountain of Youth? Nowadays there are lots of products and programs aimed at holding back the years — but they’re not only unproven and expensive, many are also just plain unsafe. And, of course, we’ve been writing about strategies for longevity over the years — but it isn’t often that something truly new and effective comes along… until now.

You may recall that I recently interviewed Michael Aziz, MD, an internist who practices in New York City and author of The Perfect 10 Diet. Dr. Aziz’s book also provides helpful information on how to delay aging and I thought that information was worthy of its own article. It isn’t an approach that you’ve seen before — and some of it will surely surprise you.

According to Dr. Aziz, aging degrades our bodies in several different ways:

  • The “rusting” of our bodies through oxidation. While oxygen is vital to life, it’s also oxidation in the body that produces free radicals — molecules that damage, disrupt and destroy nearby cells. Allowed to continue unchecked, free radicals eventually accumulate and inflict damage on the body to the point that many healthy cells can no longer survive properly and aging takes over. As we age, our bodies tend to lose the ability to resist oxidative challenges due to improper diet (sugar, refined vegetable oil used in fast foods), nutrient absorption issues, accumulated stress and other causes such as toxins and air pollution.
  • Suboptimal hormone levels. Normal aging brings a steep decline in certain hormones, the ones that help maintain energy, skin elasticity, recovery from injury — both physical and biochemical — and resistance to disease and infection. These include sex hormones (estrogen, progesterone, testosterone) and human growth hormone (HGH). Meanwhile cortisol, the hormone associated with stress, is the only hormone that naturally rises with age — which is especially a problem for people whose cortisol levels have been chronically elevated due to ongoing stress. Such hormonal changes accelerate the aging process.
  • Advanced Glycation End Products (AGEs). AGEs result when sugars bind (glycate) to proteins when you cook at high temperatures without using water, such as when you grill meat. Evidence is rapidly building that AGEs are implicated in wrinkles and, more importantly, heart disease, cancer, diabetes, arthritis and even Alzheimer’s disease.

The Doctor’s Plan for a Natural Antiaging Program

Dr. Aziz says that there are many lifestyle choices you can make that will diminish the impact of these three aging factors in your body…

  • Promote HGH production. HGH stimulates new tissue growth. It is produced when tissue is replaced due to normal recycling and response to injury. There has been some controversy around HGH supplementation, relating to a possible link to fast-growing cancer cells. But Dr. Aziz says that naturally produced HGH actually serves as a buffer against cancer by strengthening the immune system and increasing the size of the thymus gland, which ordinarily shrinks with age. Eating frequently suppresses HGH secretion. Dr. Aziz advocates three square meals a day, and limiting snacks to the days you work out. Since HGH also has fat-burning properties, it is no wonder that it is hard for overweight people to lose weight. Excess body fat lowers HGH — so lose weight! Another safe and easy way to bring up your HGH levels naturally without controversial HGH injections is an occasional fast. Dr. Aziz advises having a 24-hour vegetable-juice fast every two to three weeks, drinking just tomato juice or fresh vegetable juice (low-salt if you have a blood pressure problem). Fasting and reducing calories has been shown to promote longevity in insects… new research now shows it can do the same in mammals.
  • Sleep is important, too. The body produces HGH up until one or two in the morning, so if you tend to burn the midnight oil it’s best to go to bed a bit earlier to increase the length of time your body produces HGH.
  • Lift weights. Weight-training increases muscle mass and also ups HGH production — even if you train with only light weights.
  • Make protein at least 20% of your daily calorie intake. The body uses protein to manufacture hormones, so it is vital to consume it in sufficient quantity. Dr. Aziz thinks that the best proteins to consume are animal-based, as they are rich in vitamin B-12, which keeps your memory sharp, among other benefits. Many people turn to soy for a large portion of their protein, but too much soy reduces testosterone in men and raises estrogen in women, which is not good for natural hormone balance. Note: It’s best to eat your meat rare to medium rare (per FDA guidelines, rare is an internal temperature of 145°F for steaks and roasts… 160°F for ground beef) and cook protein in ways that decrease AGEs production. (For more on AGEs, see Daily Health News, April 6, 2010 “Cooking the Health Out of Your Food?”.)
  • Do not follow a vegetarian diet. Dr. Aziz cautions against a vegetarian diet because it becomes challenging to eat enough protein to serve hormones effectively — and in fact, vegetarian men’s testosterone levels tend to be 15% lower than normal. Advocates of vegetarian diets overlook the negative effect on hormones such as thyroid and HGH. Vegetable protein sources also lack vitamin B-12.
  • Sharply curtail eating sugar in all its forms. This includes not only refined sugar, but also starchy carbohydrates, such as potatoes and pasta. Sugar is harmful because it promotes oxidation… triggers the release of insulin, thus raising cortisol (both are potentially aging hormones) and also because AGEs need sugar to develop. Even natural fructose in fruits can be a problem in large amounts. The human body can effectively metabolize only 15 grams of fructose a day — about two pieces of fruit.
  • Avoid refined vegetable oils. Corn oil, soy oil and all other refined vegetable oils are chemically processed using high heat, which creates a bevy of free radicals leading to oxidation in the body. Avoid fried foods for the same reason. Dr. Aziz’s favorite oil: Macademia oil, as it has a high burning point. (For information on how to choose healthy oils, see Daily Health News, March 15, 2010 “Unsavory Truth About Vegetable Oils”.)
  • Amp up your sex life. For men, according to Dr. Aziz, having frequent sex increases sex hormone levels, especially testosterone. Research from England shows that men who have two or more orgasms a week are more likely to live seven or eight years longer! Is it a link between testosterone levels and longevity? Absolutely, says Dr. Aziz. Men with low testosterone have a 33% chance of higher mortality according to several research studies. And let’s not forget that people who have sex frequently are more relaxed and feel livelier and happier.

Other Antiaging Reminders

Must we mention smoking? For those few who continue to puff, you should know that smoking directly accelerates aging in numerous ways.

Should we take supplements? Yes, says Dr. Aziz, starting with a good multivitamin supplement via an all-natural whole-food pill that has no artificial ingredients (he likes the brand Juice Plus). Also, for much-needed youth-giving omega-3s, he prefers krill oil to fish oil because it is more potent. As a last recommendation, after the long cold winter, Dr. Aziz says to throw open your windows to let in the fresh air. The pollution in your home, from various chemicals, pesticides, cleaning products and the like, could be worse than what lurks outside. Fill your lungs with oxygen, and enjoy your newfound sense of youthful well-being.


Michael Aziz, MD, is a board-certified internist at Lenox Hill Hospital, New York City. He practices in New York City and is author of The Perfect 10 Diet (Cumberland House).

Vitamins a cure for Alzheimer’s?

Misdiagnosed Depression and Alzheimer’s

by Carole Jackson, Bottom Line Health

It may seem like an extreme form of wishful thinking to suggest that symptoms believed to signal the onset of Alzheimer’s disease could instead be due to a lack of one particular vitamin — and yet studies over the years have been telling us just that. Some people 50 and older who are suffering from memory problems, confusion, irritability, depression and/or paranoia could see those symptoms dramatically diminish simply by taking vitamin B-12.

Frighteningly, recent research shows that up to 30% of adults may be B-12 deficient — making them vulnerable to misdiagnosis of Alzheimer’s. I spoke to Irwin Rosenberg, MD, senior scientist and director of the Nutrition and Neurocognition Laboratory at Tufts University in Boston, about who is at risk and how to protect yourself. He told me that for years, doctors had believed that B-12 deficiency showed itself most significantly as the cause of anemia (pernicious anemia), but they now realize the lack of B-12 may even more dramatically be causing neurological symptoms, some of which are similar to Alzheimer’s.

Others at Risk…

Age is not the only risk factor for having a B-12 deficiency — other at-risk groups include vegetarians (dietary B-12 comes predominantly from meat and dairy products) and people who have celiac disease, Crohn’s disease or other nutrient malabsorption problems. Evidence accumulating over the past few decades shows that regular use of certain medications also can contribute to vitamin B-12 deficiency. These include antacids, in particular proton pump inhibitors (PPIs) such as esomeprazole (Nexium), lansoprazole (Prevacid) and many others which reduce stomach acid levels, making it difficult for B-12 to be fully absorbed. The diabetes drug metformin (Glucophage) also can reduce B-12 levels.

Measuring Deficiency

A common symptom of vitamin B-12 deficiency is neuropathy, a tingly and prickly sensation, sometimes felt in the hands and feet and occasionally in the arms and legs as well. Dr. Rosenberg told me that people with B-12 deficiency also tend to have problems maintaining proper gait and balance. Dr. Rosenberg recommends testing B-12 levels for a few groups of people, including those on PPIs for more than a few months… people having memory problems and/or often feeling confused — and this can include people of any age… those with neuropathy in the feet and/or legs… and those who have unexplained anemia.

As mentioned above, deficiencies of B-12 in older adults are nearly always a direct result of too little stomach acid, which is essential for absorption of B-12. This explains why powerful antacids trigger B-12 deficiency. Another problem is that sometimes, especially in older people, the stomach isn’t making enough of a protein called intrinsic factor (IF) that is needed to break down B-12 effectively. There is no way to increase IF, says Dr. Rosenberg, and so the solution is to administer B-12 in large enough quantities to override the difficulty with absorption. Traditionally this has been done with injections of B-12, but more recently doctors have found that oral supplementation with high amounts of B-12 that dissolves under the tongue also is successful and certainly easier than regular injections. Dr. Rosenberg adds that there is no reason to be concerned about “balancing” B vitamins as was once thought — B-12 is water soluble and the body can excrete what it doesn’t need.

What You Can Do

Adults can easily get the recommended daily amount of 2.4 micrograms (mcg) of B-12 from dietary sources, which includes all animal products. For example, just three ounces of steamed clams supplies 34.2 mcg and three ounces of salmon provides the necessary 2.4 mcg. However, this amount will not address the problems associated with aging and medications. Once again, the issue goes back to absorption — if you don’t have enough stomach acid and/or IF to use the B-12 you ingest, it is almost irrelevant how much animal protein you eat. This is why the Institute of Medicine says that for people over age 50 and for vegetarians, the best way to ensure meeting your body’s B-12 needs is to take a supplement or seek out foods fortified with it. Reason: The body can more easily absorb the form of B-12 used for supplementation and fortification even in people who have low levels of stomach acid. Caution: B-12 tests are sometimes insufficiently sensitive, especially for vegans. If your test indicates levels are fine in spite of symptoms, Dr. Rosenberg recommends having your doctor order a different test that will evaluate whether your B-12 system is intact. There is no need to suffer from any kind of B-12 deficiency symptoms, let alone risk misdiagnosis of Alzheimer’s, when the solution is so close at hand!


Irwin Rosenberg, MD, senior scientist and director of the Nutrition and Neurocognition Laboratory at Tufts University, Boston.

Insomnia Cure from Cherries… How Sweet

by Carole Jackson, Bottom Line Health

Can a glass of juice improve the quality of your sleep at night? Perhaps so — researchers have found evidence that drinking tart cherry juice at bedtime helps insomniacs sleep through the night.

About seven years ago, scientists at a new company called CherryPharm began studying the health benefits of juice made from fresh tart cherries, a type of cherry that is loaded with phytochemicals and antioxidants. Several company-sponsored studies indicated that this juice helps ease inflammation and sore muscles in marathoners and heavy exercisers. Coincidentally some of the people in those studies mentioned that they also slept better after drinking the juice. This prompted the company to ask the University of Rochester Medical Center’s sleep research lab to investigate whether the juice might ease insomnia in older adults. The result? They conducted an eight-week double-blind study, which included 15 men and women, average age of 71.6, in good health and of normal weight, who experienced moderate-to-severe insomnia, especially wakefulness in the night. For two weeks, one group drank two eight-ounce glasses of tart cherry juice a day (one in the morning and the other one to two hours before bed) and the other drank a placebo — then, after two more weeks to wash out any effect of the juice, the groups switched their regimens. Findings: Drinking the tart cherry juice brought significant improvement in sleep continuity. In fact, the juice worked better than the popular herbal sleep aid valerian and at least as well as melatonin, which had been evaluated in similar sleep studies. However, tart cherry juice did not help any other types of sleep problems, such as trouble falling asleep, and overall the researchers noted that engaging in cognitive and behavior modification therapies (such as adhering to a regular sleep schedule and developing a bedtime routine) work better for improving sleep in general.

Two Theories on Why It Works

But the cherry juice — simple, safe and natural — did help. When I contacted Wilfred R. Pigeon, PhD, head of the study and author of The Sleep Manual, he told me that researchers have two theories about how tart cherry juice helps keep people asleep. First, tart cherries naturally contain melatonin, which is known to improve sleep in some people. The other possibility relates to the juice’s anti-inflammatory properties — it’s known that inflammatory substances that naturally occur in the body are associated with the regulation of sleep and that poor sleep is associated with elevated levels of these substances. This was just a small study, Dr. Pigeon was quick to point out. While further investigation is needed, he said that these preliminary findings suggest that tart cherry juice may provide some aid for insomnia.

The study used Montmorency tart cherries, available at specialty and high-end supermarkets. One eight-ounce bottle of tart cherry juice contains the juice from 50 tart cherries along with a bit of apple juice and has a fresh, slightly sour taste — and, it must be noted, it packs quite a sugar wallop, with 28 grams of sugar. (You can buy tart cherry juice that is sweetened with stevia, which contains 17 g of sugar.) Another option is to take a cherry supplement that contains freeze-dried extract of tart cherries in capsule form. As always, check with your doctor first.


Wilfred R. Pigeon, PhD, director, Sleep & Neurophysiology Research Lab Orator, University of Rochester Medical Center, Rochester, New York. He is coauthor of The Sleep Manual: Training Your Mind and Body to Achieve the Perfect Night’s Sleep (New Holland).