Physical Exercise with Safety

Dr. James Manos (MD)

August 19, 2018

                     Is safety a priority when working out?

Image (public domain): Photo of Arnold Schwarzenegger before defending the title for his fifth Mr. Olympia contest in 1974. Uploaded by the user: Kaldari and Light show. Source: Wikipedia. Link: https://commons.wikimedia.org/wiki/File:Arnold_Schwarzenegger_1974.jpg

I wrote this article as a doctor and physio, as my first degree is in physical therapy.  

a) Working out at the gym

From my perspective, the most important things in training are safety and avoiding overstressing the joints, as doing an exercise in the wrong way may predispose to arthritis. Protection is essential when working out and is related to how someone performs an activity and the individual's outfit and gadgets!

For example, many people talk or use their social media on their smartphones while working out, while others wear earphones to listen to music. Both are unsafe as people who train at the gym should not be distracted but concentrate on the exercise, be alert to noises, and be careful not to bump into another athlete, a training machine, or objects such as ropes and belts. 

Additionally, headphones harm the ears, as loud sounds may cause deafness. It should be mentioned that when the gym has music, the individuals wearing earphones must increase the volume (many also do it in the subway)! The loud music that many gyms have is also disruptive. Wearing earphones to listen to music is especially dangerous at the gym for people who do weightlifting or use an exercise machine. I still wonder why the trainers do not notify them that their practice is unsafe! Also important is for people not to chew gum while training, as they may choke. They must also have their shoes tied; otherwise, they may stumble. 

A naive thing some do when working out is to wear heavy clothing. Some may wear a jacket when the weather is hot and humid instead of a T-shirt (preferably sleeveless in the summer) and shorts (some wear isothermal compression tights even in the summer). Perhaps, they do it as they wrongly think they will lose weight this way. But instead, they lose water and electrolytes, which may make them collapse from dehydration, electrolyte imbalance, and hypoglycemia. Many athletes wear isothermal stockings, such as in a warm environment, even when they do not need them. People should generally need them only when exercising out in the winter. 

b) Dietary Supplements & anabolic steroids for muscle gain and improving athletic performance

Supplements are also an issue of consideration. Many, if not most, bodybuilders wish to have a beefy body fast. The same is true for many athletes. However, a stocky body and better performance are impossible without supplements, many of which have serious adverse effects. Many athletes usually consult ''Dr. Google'' and buy supplements online or ask their trainers about them. 

But they omit to ask a healthcare professional if they are safe! Anabolic steroids have numerous side effects. Many consume excessive amounts of animal products, including meat, eggs, and dairy, which are harmful as they elevate blood cholesterol and triglycerides, increasing the chance of heart disease. Processed meat is also carcinogenic, namely causing cancer! Protein supplements may also have high amounts of lipids (fats), including harmful saturated fats. 

Regarding the kidneys, creatine's safety is questioned. Protein, usually taken in powder forms, may also harm the kidneys at high doses (e.g., fifty grams). Other supplements such as ephedra, caffeine & guarana, thyroxine & iodine, and diuretics (taken to lose weight) may even cause death. People who exercise think supplements will boost their energy and build their muscles instantly, like Popeye eating spinach! But safety should count first! 

From my point of view as a medic, the only supplements that I recommend are spirulina & chlorella (both are algae), royal jelly (unless someone is allergic to honey products), arginine (people with heart problems should avoid it) & carnitine (the previous 2 are amino acids), tart cherry (helps muscle recovery), beetroot (helps oxygen utilization by the muscles), coenzyme Q10, and pycnogenol. The last is contraindicated on people taking blood thinners. Herbs such as Eleuthero and Rhodiola may help as adaptogens. 

Athletes should consult a doctor other than their personal sports medicine doctor before taking a supplement, as some dietary supplements may be deadly! In any case, they should NEVER take anabolic steroids, ephedra, thyroxine (and iodine), guarana (which has high levels of caffeine that may cause arrhythmia), and diuretics. The most hazardous supplements are ephedra and anabolic steroids, which can even cause death. 

c) The adverse effects and risks of over-exercising 

Another widespread phenomenon is training resembling the training of special forces units. Many men, even middle-aged, train as if they were members of the army special forces! The most vital thing in training is safety. However, this is not a priority for many, and personal trainers and coaches often do not focus on safety. But that is not a priority, even for the individuals who train.

Undoubtedly, most young men, especially the young, exaggerate their gym workout, especially with the CrossFit workout. I guess they are confused with the video games they play all day, watching battles with special forces or SWAT teams trained for combat. For some, the incentive may be to upload a picture or video on their social media to gain some ''likes'' from their robust appearance and six-pack. But I guarantee you that someone doing a few or not at all crunches may have perfect six-packs if they are slim, as, without superficial fat, they delineate!

An example of an exercise many young people do is lifting a weight plate above the shoulders' level, even reaching a vertical, above-the-head position. You may watch the ‘front weight plate raise exercise’ on https://www.youtube.com/watch?v=Xa1FgEZ5qAc  and https://www.youtube.com/watch?v=ujxSomtxxdE and https://www.youtube.com/watch?v=hFo-LIkCozU

Many people do crunches holding with their hands a weight plate. This exercise, along with tension to the shoulder muscles predisposing them to injury, has the additional risk of overusing the sternocleidomastoid muscles of the neck pressing major arteries and veins, and causing blood pressure elevation. You may watch the ‘weight plate crunches’ exercise on https://www.youtube.com/watch?v=QkCt6s3TGMA  and https://www.youtube.com/watch?v=z_zQsJbPM-A  and https://www.youtube.com/watch?v=pfrePDBRFiQ  But of the above two mentioned exercises predispose the shoulders to severe injury and especially the rotator cuff or the impingement syndrome. Instead, for this purpose, horizontal bar exercises or training machines are safer if done correctly.

A risky exercise for the lower back (especially the disc) is a ‘leg raise’ from a flat position for an abdominal workout. You may watch this exercise on https://www.youtube.com/watch?v=l4kQd9eWclE https://www.youtube.com/watch?v=JB2oyawG9KI   Similarly, the abdominal crunches exercise machine at the gym is not safe for the lower back. You may watch this exercise on https://www.youtube.com/watch?v=_O1xunCfYEM  and https://www.youtube.com/watch?v=YtJZcoaMHsY, and https://www.youtube.com/watch?v=NpjB_rp756Y Biomechanical research has demonstrated that bending in the sitting position exhibits greater tension to the discs of the spine predisposing to low back pain.

A dangerous exercise for the knees (and the lower back) is the ‘Barbell single leg/ split squats.’ You may watch this exercise on https://www.youtube.com/watch?v=JlTojfaAXBo https://www.youtube.com/watch?v=JOvvAbR4sBs and https://www.youtube.com/watch?v=r1jukGZPnZI  Another risky exercise for the knee is the ‘single-leg lateral (side) press’ that exhibits significant tension to the knee joint, muscles, tendons, and ligaments, predisposing to severe injury and arthritis. You may watch this exercise on https://www.youtube.com/watch?v=JvvrBu3lKpk https://www.youtube.com/watch?v=AIKPcOtxFQc  and https://www.youtube.com/watch?v=YvNrVkTkSc0  I have to remind that this exercise is done for both frontal leg press, so some invented this risky variation without thinking about the forces that the knee is exposed to. 

Squatting is a dangerous popular exercise that both men and women do as they are obsessed with their buttocks and want to make them ''bubble butts''! So, they do the squat with a bar workout that harms the lower back and the knee joints as it may cause lower back injury (especially at the disc and the facet joints) and knee arthritis, respectively. You may watch the squat exercise using a bar’ on https://www.youtube.com/watch?v=MVMNk0HiTMg  and https://www.youtube.com/watch?v=X0qC1k0Zi6k  and https://www.youtube.com/watch?v=C73Y3EsJWIk  The squat workout without a bar is also harmful to the knees and also expose the lower back to significant tensions. You may watch it at https://www.youtube.com/watch?v=zaC133_Frj0  and https://www.youtube.com/watch?v=94gqJHxjd0o  and https://www.youtube.com/watch?v=UI6lNNkkhho   

Another risky knee exercise is the dumbbell lunges, front, reverse, or lateral, walking or drag walking or still, which expose the knee joint to significant tension. You may watch the ‘dumbbell lunges’ exercise on https://www.youtube.com/watch?v=MYNWjf0qjxE  and https://www.youtube.com/watch?v=8OYsCRAb5c4   and https://www.youtube.com/watch?v=xvC10-eCuXs  and https://www.youtube.com/watch?v=D7KaRcUTQeE  A safer approach is to use this exercise for stretching or performing it without holding dumbbells.  The single-leg lunge using the Smith machine is harmful to the knee. You may watch the ‘single-leg lunge using the Smith machine’ exercise on https://www.youtube.com/watch?v=MXrSCU4P9L4  and https://www.youtube.com/watch?v=glsjsPWwGb0  and https://www.youtube.com/watch?v=73CD40T-III

Running on the treadmill may also cause problems when intense. When jogging or running is done at extreme levels, aerobic ''cardio'' exercise turns anaerobic, as galactic acid is released and free radicals harm our body. Running should adapt to the runner's age as the maximum heart rate is related to age with the equation 220 - someone's age in years. Many people are unaware of this.   Extreme incline and speed on the treadmill are inappropriate, especially for the middle-aged and the elderly. 

From my perspective, as a medic, the maximum incline should be 3 percent, while the maximum speed is ten miles per hour. To lose weight or because they feel too lazy to run, many walk on the treadmill at an extreme incline, even 10 - 12 percent, damaging their knees. Another choice with deleterious effects is jogging on the sidewalk, where the tension of the hard surface injures the knees while the athlete jogging in the city breathes smog! A safer solution is jogging at a park or a sports center with special running track surfaces/ resilient jogging track flooring.

Running continuously for 1 hour is harmful, and it is unbelievable that I have seen middle-aged people doing this as if they are long-distance runners!  As mentioned above, the maximum heartbeat is related to age, while prolonged exercise may become anaerobic, generating noxious free radicals. A safer approach I have invented and recommended is the ''double pyramid'' with a 4-5 min warm-up brisk pacing on a flat position, then running with increasing speed and incline to a maximum point, followed by a gradual decrease in speed and incline that ends up to brisk pacing. Next, the same pattern is repeated, forming the second pyramid. The exercise ends with a 4-minute cooldown with pacing. Overall, the time should be 30 - 45 min. 

Notably, many people do exercises they watch on YouTube, and the latest craze is the exercise in which the person stays still in the push-up position! You may view the ‘push up plunk’ exercise on https://www.youtube.com/watch?v=uco2g3YexwA  and https://www.youtube.com/watch?v=2kEnT-CdXyE  and https://www.youtube.com/watch?v=En8xcgrqyq8 

I would never trust a YouTube video, especially uploaded by an anonymous, as a coach or do a workout just because it is popular without asking a trainer first. 

If you ask a gymnast or trainer if the above exercises are safe, he/she may answer that they are. However, my perspective is based on my medical and physical therapy studies. That means I can debate the safety of many ‘extreme’ exercises that people do, thinking themselves Bootcamp commandos, do! Trainers should advise against dangerous exercises. But this may be a different aspect as my priority is safety while a trainer’s or an athlete’s aim may be to become, in a brief time, well-built and then a champion, regardless of the cost of health. The Bootcamp motto is ''faster, stronger, better.'' But the question is if ''safer'' is a priority. I think it is not! 

However, being a top athlete champion means the body is exposed to significant ligament, tendon, and cartilage tension, predisposing to infirmities such as arthritis. The knees and the waist are especially prone to injury. 

Excessive exercise is unhealthy, as it may cause problems such as amenorrhea (lack of menstruation|) in women. Sterility problems in males may be caused by cycling for many hours, as the genitals are pressed when sitting on a bicycle.  Running marathons is not as healthy as many believe. Long-term runners develop cardiomegaly (increased heart size) and dangerous heart irregularities (dysrhythmias). Moreover, running, especially under heat, may cause electrolyte (especially potassium and sodium) and other metabolic (especially glucose) abnormalities, such as hyponatremia, which may manifest with spasms. It may also cause heatstroke. 

Weightlifting is not so innocent; apart from causing blood pressure upsurge, it may also cause a hernia and low-back pain.  Importantly, many spend 1 - 2 hours on weightlifting, which has zero benefits apart from looking well-built or osteoporosis prevention in post-menopausal women. At the same time, they omit aerobic exercise that benefits the heart.  But even when they choose an aerobic workout, many exaggerate. For instance, you can see middle-aged people doing long-distance running with no substantial health benefits, but, as mentioned, it causes heart enlargement and heart arrhythmias.

A common mistake that many people make to lose weight fast is to run on the treadmill with a very high incline that predisposes their knees to arthritis or jog on the street instead of a park, breathing the polluted air of the city and walking on the sidewalk, they predispose their knees to arthritis. 

Moreover, many people enjoy isometric exercises, including the ''human flag on a vertical pole''!  See https://www.youtube.com/watch?v=66ZlZ44s944 and https://www.youtube.com/watch?v=ckZPkWGuvyk and https://www.youtube.com/watch?v=Cl_jIUGYh2w and https://www.youtube.com/watch?v=JmHtLycyIvQ   In my opinion, isometric exercises offer nothing to health. On the contrary, they offer extreme muscle, ligament, and joint strain and a steep elevation of blood pressure that may contribute to the hardening of the arteries (arteriosclerosis). The same effects may occur in bodybuilding when the repetitions of weightlifting or using a training machine exercise are less than 8-10 and when the weights are heavy. Contrary, aerobic exercise, which many people who train omit or perform for an abbreviated time or infrequently, is beneficial for circulation, offers longevity and well-being, and gives a sense of 'being high' because of the released endorphins!

A risky choice is when trainees lift heavy weights on weightlifting (barbell and dumbbell weight set) or a gym machine. You may watch the videos on https://www.youtube.com/watch?v=pn77iK8KzXQ  and https://www.youtube.com/watch?v=wAKa5MCIKAY and (did it turn into a cardiac arrest?) and https://www.youtube.com/watch?v=brpwQHewUw0 and (I guess he died from tension pneumothorax or cardiac arrhythmia/ tamponade) https://www.youtube.com/watch?v=rgYDfporX00

The Smith Machine bench press is just as effective as the Barbell bench press, and, most importantly, it is safer with the weight bar slides! You may watch the videos on https://www.youtube.com/watch?v=bqmo9MrWeiI  and https://www.youtube.com/watch?v=z_r6hDOYtO0  and https://www.youtube.com/watch?v=jn-WjbWQ8lo  and https://www.youtube.com/watch?v=b8DqTO6ak0k  

But you should not perform Smith machine exercises that do not use the bench, as they are unsafe! For instance, death lifts are also dangerous when using the Smith Machine. See https://www.youtube.com/watch?v=rtYH-SKh0to  and  https://www.youtube.com/watch?v=p6KK6yHxd4k  and https://www.youtube.com/watch?v=sAJnhZed51E  and https://www.youtube.com/watch?v=NBR6tozmx2I

  

Although many people do it to have muscular thighs and buttocks, I do not recommend it. The deadlifts without the Smith machine are also risky for the lower back and the knees. Simultaneously, they may raise the blood pressure steeply and cause a fatal hemorrhage in people with a brain or an abdominal aneurysm who are often unaware of its existence. For the original deadlift exercise, See https://www.youtube.com/watch?v=ytGaGIn3SjE  and https://www.youtube.com/watch?v=hCDzSR6bW10  and https://www.youtube.com/watch?v=RyJbvWAh6ec   

It is safer to lift bearable weights, less than 70-80 percent of your maximum potential (the lower, the safer). When using a barbell weight set, you should place the weight plates equidistantly on each side, considering the bar may overturn from the heavier side weight. For instance, on a bar of 10 kilograms, you can put bilaterally (on each side) a lower weight plate, such as 5 kilos on each side. Otherwise, you should place them simultaneously (alone, if applicable) or ask another trainee's help to do this.

Another common mistake most individuals make when exercising is training anaerobically or turning their aerobic exercise into anaerobic!  Anaerobic activities, including weightlifting and exercise machines at the gym, increase lactate levels (that cause tiredness and lactic acidosis) and generate free radicals implicated in a myriad of diseases, as they damage the DNA! This oxidative stress may occur when an aerobic exercise is performed anaerobically. For instance, endurance long-distance running, fast short-distance running (such as 50 or 100 meters), and treadmill pacing at an exceedingly high incline and/or speed or running for a long time on the treadmill (i.e., long-distance running) without declining the speed and/or the slope may be anaerobic rather than aerobic, meaning that free radicals are generated. Thus, the trainee is exposed to the harmful effects of oxidative stress!

d) Deaths in sports

Deaths in sports are not unusual. The primary cause, apart from congenital cardiomyopathy, is dysrhythmias (heart rate irregularities) caused by training and electrolytic and metabolic disturbances (such as in long-distance runners). An autopsy cannot attribute arrhythmias as a cause of death unless the person is wearing a Holter during an exercise, a smartwatch measuring the pulse, or if there is a pre-existing or discovered post-mortem structural heart disease. Children have died from chest blows, causing severe arrhythmia (called ''commotio cordis''). These usually happen in martial arts, when neck strikes may cause severe bradycardia (slow heart rate), leading to asystole (the heart stops).

Long-distance runners have a large heart (cardiomegaly) and slow pulse, and it is lately debated if these are without health effects. Risk, when training, is not negligible, as in my article ‘strenuous exercise is risky’ in which I say that weightlifting may even cause death in people with a brain (or abdominal) aneurysm that they are unaware of! You may visit and read my article at https://mymedicaltexts.blogspot.com/2016/02/strenuous-exercise-including.html     It may also cause aortic dissection. 

Straining may also cause Boerhaave syndrome. That is a spontaneous perforation of the esophagus that results from a sudden increase in intra-esophageal pressure combined with negative intrathoracic pressure. 

A cervical injury, such as in martial arts and other combat sports, may also be lethal as it may cause paralysis of the lower or upper and lower extremities or even death if it involves the first 2 cervical bones. Additionally, death may also occur from the ‘special’ points that martial arts teachers teach (even in children), such as above the jugular notch of the sternum’s (breastbone) manubrium (the upper part of the sternum, which is a bone that looks like a sword).

e) ''Stunts'' and Extreme sports 

Young people do foolish things because of attention-seeking behavior, trying to post a ''catchy'' video (of a jackass type) or selfie or do stupid ‘stunts.’ On the internet, you may find numerous stupid videos uploaded by young people to show off and win the 5 min of fame they deserve! However, often these ''stunts'' may turn lethal! A typical example is parkour (which consists of stupid acrobatics), a stupid (in my opinion) sport that attracts young people, even children! Wikipedia has a biased article about parkour, something like advertising of this naive ''sport,'' where people who died during parkour are not mentioned.

It should be noted that many parents allow their children to play dangerous ''stunts'' such as parkour, neglecting that a head injury may be proven lethal. A cervical (neck) injury may cause, if not death, permanent paralysis! Backflips, front flips, and skating on a skateboard or roller skates without protective gear (helmet, knee, and elbow pads) may also cause severe injuries. A bicycle helmet does not protect you from a cervical injury! It is unbelievable that people, including minors, die from these 'stunts' in their attention-seeking attempt to upload videos with their naive stunts.

Many young people enjoy risky extreme hobbies such as bungee jumping from mountains or bridges or skydiving, canoe-kayaking, or scuba diving. Unfortunately, many people do extreme sports without proper training from an expert. Moreover, many neither follow all the safety rules nor wear the appropriate safety outfit. For instance, many kids enjoy skateboarding and doing amazing ‘stunts’ but neglect wearing helmets and protective gear. Their parents neglect as well to impose safety rules and equipment. However, ironically, the supposedly more experienced people have accidents more often, perhaps because they overestimate themselves and their capabilities.


Conclusion

To sum up, ''safety comes first,'' and I was taught this motto in first aid courses as a medic. As an athlete and a physician, my top priority is safety, not predisposing my joints to arthritis or my lower back to severe damage. Regarding safe and effective training, you may visit the text at https://mymedicaltexts.blogspot.com/2015/10/the-benefits-of-aerobic-exercise.html

Thanks for reading!

Tips for a Healthy Lifestyle

Dr. James Manos (MD)

August 7, 2018

                     Tips for a healthy lifestyle

Image (free to use): Hawaii Creek (January 29, 2006). Uploaded by the user: God of WarSource: Wikipedia. Link: https://en.wikipedia.org/wiki/File:Hawaii_Creek.jpg

About complementary medicine

For many medical problems, someone can seek alternative therapies in complementary medicine such as acupuncture (useful in painful conditions as well as in cutting tobacco), homeopathy, dietary supplements, physical therapy, TENS (for pain), Tai Chi, massage (such as Shiatsu), medication, Pilates, Ayurveda, Art, Drama, Dance Therapy, the Alexander Technique, Autogenic Training, Faith Healing, Hypnosis, Reiki, relaxation techniques, Biofeedback, auricular (ear) acupuncture (Auriculotherapy), reflexology (foot), crystal therapy (healing with crystals, of precious and semiprecious stones, that with their ‘energy’ affect mood), etc.

It should be mentioned that acupuncture and hypnosis have been used effectively in selected cases for general anesthesia on patients to whom anesthetics were contraindicated! Bach Flower Remedies are based on Bach flower essences that are used to relieve stress, insomnia (difficulty with sleeping), and other mood problems. They are usually taken as sublingual (under the tongue) drops.

Quit smoking now!

Smoking is a significant cause of heart disease and stroke. It also may cause cancer, such as lung cancer, larynx cancer (in combination with alcohol), and many other infirmities. Undoubtedly, tobacco is a deadly addiction and decreases life expectancy! Importantly, many smokers develop chronic obstructive pulmonary disease (COPD), a severe lung medical condition that may become debilitating.  People who smoke and wish to cut may consult a smoking clinic where they may be administered particular medication. Nicotine patches and chewing gum may help. Smokers should keep in mind that they may die anytime from sudden cardiac death (SCD)!

About geopathology

Many scientists stress the importance of geopathology. According to geopathology, there are geopathic stress zones, underground water routes, and energy vortexes. Geopathic stress zones are places with ''negative energy'' such as natural energy grids, earth fault lines, water springs, and other geological fields. Additionally, electromagnetic fields from power poles, as well as household equipment such as TV, radio, microwaves, oven, and other domestic appliances, may also contribute to this ''negative energy.'’

The detection and measurement of geopathology nodes with negative energy can be feasible with special machines or traditionally by dowsing. Building a house in a geopathic stress zone with negative energy may become a source of many problems. Also, homes may contain toxic materials such as radioactive radon, asbestos (old pipelines), lead (colors), and dioxins.

Regarding geopathology, the point is to avoid negative energy zones. For instance, the bed or the office should not be placed in locations with negative energy, while electrical outlets should not be close to the body, for example, near beds, because of their ''negative'' electromagnetic field. Interestingly, it is said that cats seem to prefer sleeping in rooms with ‘negative energy,’ while dogs prefer ‘positive energy’ spaces! Building materials like cement and bricks may have a low radioactive activity from radon and cadmium! This minor radioactivity is also contained in phosphorescent materials, such as old, non-electronic clock indexes and old, non-flat televisions (obsolete now).  A way to eliminate this negative energy and radioactivity is to ventilate the house by opening the windows every morning.

It is essential to keep in mind that the brick house emits radon, which is radioactive. Brick houses are typical in the UK. Some believe that the bed needs to ‘look’ from east to west (our feet on the bed to ‘look’ at the west) to avoid ''negative energy.''

Geopathology has exciting aspects. But it is not new as it originates in China as the Chinese version of geopathology is Feng Shui! Someone may find a particular compass that detects negative energy on the market. There is also a specialty called holistic architecture that considers geopathology essential.

Emphasis was given to the relationship of buildings with the environment by the ancient Cretans of the Minoan period (bronze period; 3,000 B.C.). Today, eco-friendly houses, such as in Germany, have been constructed using energy from the wind (wind turbines) or the sun (solar cells). They are made with environmentally friendly materials, excluding radon, lead, asbestos, and ammonia found in modern materials, and colors with toxins such as arsenic and lead.

Preventing and treating skin aging and wrinkles

To prevent skin aging, you should avoid the sun, a significant cause of skin aging and skin cancer (including malignant melanoma). As avoiding sunlight entirely is not feasible (the sun is also triggering the production of vitamin D that prevents osteoporosis), a sunscreen of high SPF (e.g., more than 25) and a special sunblock for the face and eyes (for eyes you need to buy a specific sunblock) is necessary to prevent skin cancer. Additionally, wearing dark glasses with UV protection that absorbs ultraviolet radiation prevents cataract, an eye disease. The deficiency of the ozone layer atmosphere has increased skin cancer risk.

For treating facial wrinkles, as well as for hair loss, you may read my article at https://mymedicaltexts.blogspot.com/2018/07/dr.html

Has ozone healing effects?

Some believe that one has healing properties. However, this is debated as there is not enough scientific proof to support its usefulness. So, ozone therapy is still scientifically controversial. In fact, ozone oxidizes organic molecules, and the ozone in cigarette smoke is toxic to the respiratory system. The evidence that ozone has helped people with diseases is anecdotal (not published) and not confirmed. Further research is needed to ascertain its efficacy.

Some useful herbs

Eucalyptus for nasal congestion

Eucalyptus relieves nasal congestion, and you can find it in nasal sprays. For nasal congestion and difficulty breathing through the nose, you can find at the chemist special nasal strips that also help people with snoring caused by nasal obstruction (snoring may be associated with sleep apnea, which causes fatigue and cardiovascular problems and needs special medical care). For nasal congestion, there are remedies without the adverse effects of pharmaceutical decongestants that you cannot use for more than 5 – 7 days to avoid pharmaceutical rhinitis. These, along with eucalyptus, contain other herbs such as Echinacea. Saline or seawater nasal washes are also helpful, but you should not rinse the nose under pressure, as it may spread the microbes (germs)!

Cranberry for preventing urinary tract infections (UTIs)

Cranberry helps prevent urinary tract infections (UTIs) in women. However, it does not help with their treatment. Instead, an antibiotic should be prescribed. To prevent UTIs, women, after defecation, should always wipe from the front (urethra opening) to the back (anus). You may read the article at https://emedicine.medscape.com/article/1958794-overview  

Oral health is of crucial importance!

Healthy teeth ensure a healthy heart because dental infections may cause heart infections (endocarditis), as the mouth may nurture bacteria such as Streptococcus viridans. There is also evidence that oral bacteria such as Chlamydia pneumoniae may be responsible for atherosclerosis (hardening of the vessels and obstruction from fats, such as cholesterol and calcium deposits) of the heart vessels that may lead to a heart attack! Today, atherosclerosis is regarded as an inflammatory process!

A human study in Morocco demonstrated that positive cases for peripheral blood mononuclear cells (PBMCs) and atheroma plaques were 61 percent and 86 percent, respectively, and a significant difference between PBMCs and atheroma plaque infection was identified. Data analysis also showed that 12 percent of patients presented only Chlamydia pneumoniae infection as a risk factor. The study concluded that the high prevalence of Chlamydia pneumoniae suggests its involvement in atherosclerosis and recommended further investigation for confirmation. (Reference:  https://www.sciencedirect.com/science/article/pii/S1876034117302101  )

To ensure oral health, you should brush your teeth after every meal (mainly if you eat sweets) and in the morning, the afternoon, and the evening after meals. You should ask your dentist to show you how to brush your teeth properly, as most people brush them wrongly! You should brush your teeth with your brush at approximately 45 degrees from the horizontal axis. Every 2 to 3 months, you should change your toothbrush.

The electric toothbrush seems more efficient at cleaning the teeth and removing dental plaque than a manual toothbrush, and dentists recommend using it. Additionally, you need to clean your teeth in the evening with waxed dental floss (such as ‘Oral B™’), which applies to a special dental floss holder with a handle (you will find it from several companies such as ‘AIM (TM)’) or you can find disposable dental floss holders with attached dental floss. Along with dental floss, you also need to clean your teeth with an interdental brush. You can find these brushes on the market with attached holders for easier use. 

You should also rinse your mouth with mouthwash for oral health, but, as with toothpaste, you must not swallow it! Avoid mouthwashes with alcohol because they may cause mouth cancer (alcohol, apart from mouth cancer, can also cause larynx cancer). So, you should use mouthwash with zero percent alcohol. Antiseptics, such as povidone iodine (e.g., Betadine®) or chlorhexidine, are not recommended for oral health in healthy subjects without any medical indication, as they may kill the normal oral flora (the ''good'' bacteria that are symbiotic). At the same time, povidone-iodine may also decolorize the teeth, as well as Cola-type refreshments). The most important thing for dental health is to visit the dentist annually to prevent and treat caries with a dental cleaning for plaque removal and fluoridation.

Mattresses teeming with dust mites!

Plenty of dust mites live in the mattresses we sleep in, causing us allergies. Dust mites are tiny, not visible insects, and allergies occur from their excrement. Dust mites are killed with particular insecticides (acaricides) that you can use on beds, sofas, carpets, and curtains! An alternative to avoid chemicals is to use steam devices that kill dust mites. Prefer washable, non –non-allergenic, and anatomical (orthopedic) mattresses. Pillows should be anti-allergic and washable. Some say that when you place the sheets in the refrigerator, then dust mites are killed! Others, after wiping, put their mattress for hours in the sun, which also kills the mites. Another alternative is to use a special mattress cover and pillow protector that are anti-allergic.

Air purifying

An air purifier is an essential domestic device (there are also air purifiers for the car) that helps clean the air with special filters such as HEPA and active carbon. Additionally, as mentioned above, you should open the windows to ventilate the rooms in your home every morning.

Plants as a natural air purifier 

Plants are natural air purifiers; you can have them in pots on your balcony or indoor houseplants (there are particular indoor plants) as they enrich the environment with oxygen. However, you should not sleep with a plant in your room in the evening because, during the night, it inhales oxygen, releasing carbon dioxide!

Water filters 

A water filter purifies the water from microbes (germs), heavy metals, and toxins. From my perspective, the filter with activated carbon is the best as it may filter to 0.5 microns, while recently, the NanoCarb® filters even 0.003 microns. This system purifies the water by removing tastes and odors, including chlorine, chemicals, colors, suspended limestone particles, heavy metals, herbicides, pesticides, and microbes (including bacteria, parasites, and viruses). Some devices are attached to the kitchen’s faucet, while others are separate devices connected to the water tap via a plastic pipe.

There are also water filters for the shower. In many water filters, sterilization beyond the activated carbon is also accomplished with ultraviolet beam, ceramic (with micropores 0.01 – 0.45 microns that are sterile), and other techniques such as ozone, distillation, reverse osmosis, ionizing-alkalization. Activated carbon does not remove heavy metals, but the KDF filter does!

Smartphones: preventing adverse effects 

Many believe speaking on your cell phone only with a ‘hands-free’ device, such as Bluetooth or earphones with attached microphones, is safer. Headphones, if loud, may harm the ears, while Bluetooth may still emit energy. Having mobile phones near the head has been linked to brain tumors. However, the evidence is still inconclusive, while in the last years, the standards of the electromagnetic field that smartphones emit have been higher. But, as with radioactivity, the safest approach is zero energy as, regarding radiation, a mutation may occur even under the safety limit area! High-energy (ionizing) radiation is definitely carcinogenic.

Cell phones may cause fertility problems. Additionally, they may interfere with a pacemaker. Cell phones also interfere with MRI imaging tests. You should not have them open at a gas station because there is a risk of an explosion. They are also not allowed on air flights (in that case, there is a plane mode option). You should also turn them off or mute in halls like cinemas, theaters, and cafes, as you will annoy the others!

On the market, someone can find special systems that reduce the electromagnetic field of a cell phone, but I don't know their effectiveness. Moreover, the blue screen of smartphones and tablets is believed to disturb sleep, so you should not use them before sleep. You may choose an eye-protective mode. Another reason is that they distract you, especially if you have ''notifications'' from several sites and social media buzzing constantly!

Headphones may cause deafness!

Avoid wearing earphones (such as for your cell phone, MP3, or radio), as they may cause deafness when the volume is very loud. In a noisy urban environment, such as on the street or in the subway, we all tend to increase the volume of our earphones to listen better. But loud sounds damage the ears and may cause ear impairment or even deafness. This damage is permanent. Young individuals are prone to increase the volume of the earphones they wear daily, even at the gym!

Plastic has detrimental effects!

Avoid buying or storing food in plastic containers from PVC or other ingredients that may be carcinogenic (may cause cancer). For instance, vinyl chloride monomer (VCM) has been linked with occupational cancer development. Another concern is that tiny plastic fibers may remain in the content of liquids.

To avoid carcinogens, you should prefer paper or aluminum containers for food and Tetra Pak® containers for liquids, including juices. Tetra Pak® cartons improve food safety as they are made from paperboard and thin layers of aluminum and polyethylene.

Additionally, plastics are not friendly to the environment, and we should prefer recyclable materials instead of plastic. For instance, we can carry purchased supermarket or grocery goods in paper carrier bags as they have in the US in the last decades or bags woven from fiber, or you may use recyclable straws (to drink a beverage) from cardboard as most end up in the sea and choke marine animals. But recently, the noxious chemicals PFAS have been detected in paper straws. 

Sneakers and soles

I think the best shoes for walking are running sneakers, such as ‘NIKE’ or ‘PUMA’ or ‘Adidas’ etc. Sneakers with unique foam cushion material are useful for jogging and daily use, as the pillow supports the foot and absorbs vibrations. Many people with anatomical and functional foot problems may need to consult a podiatrist (doctor) or podologist for biomechanical assessment and, if necessary, to prescribe them special insoles. Many, if not most, athletes wear these individualized sneaker soles. 

Treating common ailments

Treating tired and swollen legs

To relieve the tired legs, you may soak them in a large round basin filled with warm (not too hot to avoid being scalded) water. You may add essential oils such as a few drops of lavender, rose, cedar, and rosemary. Then, you leave your feet in the water for 20 – 30 minutes, watching television or surfing the internet on your laptop. Before going to bed, you may use a special cream for tired legs with herbs such as grape seed polyphenols, rutin, Ruscus aculeatus, menthol, Ginkgo Biloba, chestnut, and Arnica montana.

French maritime pine bark extract, also known as Pycnogenol, is excellent for vein problems of the legs, including varicose veins. It contains the antioxidants OPCs (oligomeric proanthocyanins) that are also contained in the grape. Heparin may help, especially in varicose veins (in this case, a doctor’s advice is needed).

To decongest swollen legs, lie down or sleep with your legs resting on a soft pillow under your feet. You can find special cushions for this purpose. Elastic stockings may help, especially on swollen legs. You will find them in drug stores or stores with orthopedics.

Treating diarrhea

If you suffer from diarrhea, you need a special diet with rice, soup, mashed potatoes, beef broth, etc. The most important thing in diarrhea is preventing dehydration, so you must drink plenty of water. Cola-type refreshments (probably) replace phosphate and help people with diarrhea. However, the NHS in the UK recently advised against its use in children with diarrhea, as it is not evidence-based but may even be harmful. You should avoid anti-diarrheal antimotility drugs such as loperamide (e.g., ‘Imodium®), as they may mask abdominal signs. Additionally, this drug is an opioid! A doctor should only give it.

Loperamide is contraindicated in many cases of diarrhea as it can cause severe problems. For instance, enterohemorrhagic E. coli, especially of the O 157: H7 strain, may cause Hemolytic Uremic Syndrome (HUS), leading to kidney failure, especially in children. Antibiotics should not be used in HUS. Patients need special medical care. Loperamide may retain microbes and toxins in the gut and cause ileus, a severe medical condition of the intestines.

Preventing dehydration, hypoglycemia, and electrolyte imbalance

In fluid loss from diarrhea and vomiting or excessive sweating from strenuous exercise, heatwave or high fever, water, sugar (also called dextrose), and electrolyte (especially sodium and potassium), replacement may be needed to avoid dehydration, hypoglycemia, and electrolyte imbalance, respectively. 

Hypoglycemia (low blood sugar that may lead to coma) may occur during strenuous exercise, especially in hot weather conditions. The heat wave may cause heatstroke that predisposes to circulation problems such as heart attack, stroke, and vein thrombosis, as it increases coagulation diathesis (tendency).

Electrolyte replacement solutions can be purchased at the chemists (drug store). However, self-treatment is not recommended, as severe dehydration requires emergency hospital care. Sports drinks, such as Lucozade® and Powerade®, can efficiently replace the loss of electrolytes and sugar. Drinking plenty of water is also essential in the above situations.

Treating cough

In the case of a productive cough, antitussive agents (cough suppressant medicines, usually as syrups) should better not be used because coughing is a mechanism of getting rid of bacteria and dead immune cells of the respiratory system by spitting them. Ask your doctor before taking an antitussive drug that ceases a cough. They are contraindicated in children under six years old. Some cough suppressants contain codeine, which is an opioid! Loperamide (e.g., ‘Imodium®) is also an opioid! 

Mucolytic agents are agents that thin mucus. For example, Bisolvon® contains bromhexine hydrochloride, which thins and loosens mucus and helps to clear chest congestion. N-acetylcysteine (NAC) is another mucolytic useful in a productive cough as it aids expectoration (spitting phlegm). NAC also has hepatoprotective properties (protects the liver), and it is used as an antidote in cases of paracetamol (acetaminophen; a painkiller) poisoning. A herb that is also famous for its liver protective effects is milk thistle.

Treating hemorrhoids

You can use the special ointment ‘Preparation H®’ for hemorrhoids after defecation. After defecation, and before applying this ointment to the rectum, you should first do a sitz bath, i.e., wash the area of the anus with warm water and soap. After applying the ointment inside the rectum, you should push prolapsing hemorrhoid with your finger to return inside to avoid its painful thrombosis when it comes out (prolapse) and is strangled from the anal sphincter. Hemorrhoids usually occur due to constipation. If you have hemorrhoids, avoid foods rich in spices, especially pepper. You should also avoid wine and salt. The latter causes water retention, making the stool harder to pass.

 

Treating constipation

To treat constipation naturally, you can use dietary supplements and especially bulking agents such as psyllium (also called ispaghula husk), as well as fruit fibers such as apple pectin. You should eat plenty of fiber from fruits such as prunes (dried plum), figs, kiwifruits, and vegetables. Also, all bran cereals, such as muesli, granola, and oatmeal (porridge), are immensely helpful for preventing and treating constipation. Of course, you should drink plenty of water, which most people neglect!

Drugs like milk of magnesia and laxatives may cause adverse effects, including electrolyte disorders. Their prolonged use is discouraged as the intestines get addicted to them and become ''lazy''. A doctor's consultation is needed before taking medication for constipation. However, senna, a natural laxative, has fewer adverse effects than drugs. Laxatives should be combined with bulking agents. 

For severe constipation that may cause fecal impaction, before enemas, I have discovered that drinking a teacup of olive oil (but not tea that may increase constipation as a diuretic) along with a glass of water may soften the feces in 30 - 60 min. With the water pressure of a shower phone and using your finger in the bathroom, you may easily remove the fecal plug, avoiding visiting the emergency department. People bedridden, including Alzheimer patients, and patients taking antipsychotics and anticholinergic drugs (such as tricyclic antidepressants) may prevent constipation by taking a couple of tablespoons (or more) of olive oil, along with drinking plenty of water and eating a high-fiber diet, especially oatmeal. But avoid boiling porridge. You may just add milk, fruits, and nuts.   

Tips for emergencies

You should always have in your home a fire extinguisher (such as a 5 kg or eleven pounds) that can put out the fires of classes A, B, C, D, E, F (Australia), and K (US). Class E (or C in the US) can also be used for domestic power (E is for electricity). In case you own an automobile, you also need a fire extinguisher for your car. 

You can purchase a pulse oximeter from a drugstore that counts oxygen saturation and a small oxygen cylinder with a humidifier and an oxygen mask for emergencies. A cheap solution is to buy a one-use oxygen cylinder for emergencies, but keep in mind not to store it near heat as it is inflammable. Oxygen is needed in case of shortness of breath (SOB, dyspnea).

The ambulance system (EMS) must organize courses for citizens in BLS (Basic Life Support) that involve cardiopulmonary resuscitation (CPR) and the use of automated external defibrillation (AED) in case of cardiac arrest, as well as dealing with choking in adults (Heimlich maneuver) and infants. In these seminars, the participants use dummies. 

For administering rescue breaths in case of cardiac arrest, you can buy a face mask with a valve to prevent the regurgitation of mouth fluids. Defibrillation is giving an electric ''shock'' in case of ‘shockable’ cardiac arrest that an AED (automatic external defibrillator) detects. 

I hope AEDs will be available at all residential buildings for a cardiac arrest emergency. They should be dispersed in the community at key points such as crowded places, for instance, museums, airports, and malls. Ideally, every building should have its own defibrillator. Its cost has decreased lately and will drop further if mass production occurs. Searching eBay, I found out that the cheapest used AED is much less expensive than the latest iPhone. 

Thanks for reading!