Concierge Medicine of Jupiter

RSV INFECTION IN ADULTS

Respiratory syncytial virus (RSV) is a common respiratory virus that infects the nose, throat, lungs, and airway passages. RSV spreads via contact with respiratory droplets from an infected person or via touching surfaces contaminated with the virus and then touching your eyes, nose, or mouth.

RSV is the leading cause of lower respiratory tract infections in infants and young children.

However older adults can also contract RSV.

As per the CDC, RSV is responsible for estimated 60,000-120,000 hospitalizations and about 6,000-10,000 deaths in older adults in the United States.

Which adults are at highest risk for a severe RSV infection?
Older adults, especially over the age of 65
Adults with chronic heart or lung disease
Adults with weakened immune systems
Severe RSV Infection in Adults
Most adults who contract RSV infection develop mild cold-like symptoms such as runny nose, coughing, sneezing, fever. Healthy adults may have very mild symptoms but still can spread RSV to others. Some adults at high risk can progress to an RSV pneumonia.

Those infected with RSV are usually contagious for 3 to 8 days. People typically require 1 to 2 weeks to recover from RSV.

RSV can also lead to worsening of serious underlying lung (such as Asthma or COPD) and heart conditions ( such as Congestive heart failure).

Prevention
Cover coughs and sneezes
Wash hands often with soap and water for at least 20 seconds
Avoid close contact with others who are sick
Avoid touching the face, particularly eyes, nose, and mouth
Clean frequently touched surfaces (such as doorknobs)
Consult a healthcare professional if you have cold-like symptoms that linger or worsen.


Sources: CDC, National Foundation for Infectious Diseases, Medscape

RSV Infection in Adults | Jupiter RSV Infection in Adults. Contact us to book a consultation

The flu season is coming and the best way to protect yourself against the flu is a yearly influenza vaccination.
Flu vaccination has many important benefits such as decreasing flu illnesses, less visits to the doctor, and most importantly it can decrease the severity of the symptoms as well as decrease of flu-related hospitalizations and deaths.

As per the Center for Disease Control (CDC), people 6 months and older should get an annual influenza vaccine with certain exceptions (please talk to your doctor!).

Influenza vaccination is especially important for people who are at a higher risk of serious complications from an influenza infection. As per the CDC, this includes…

Young children
Asthma
Neurologic and neurodevelopment conditions
Blood disorders (such as sickle cell disease)
Chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis)
Endocrine disorders (such as diabetes mellitus)
Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
Kidney diseases
Liver disorders
Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
People who are obese with a body mass index [BMI] of 40 or higher
People younger than 19 years old on long-term aspirin- or salicylate-containing medications.
People with a weakened immune system due to disease (such as people with HIV or AIDS, or some cancers such as leukemia) or medications (such as those receiving chemotherapy or radiation treatment for cancer, or persons with chronic conditions requiring chronic corticosteroids or other drugs that suppress the immune system)
People with history of stroke
Pregnant people and people up to 2 weeks after the end of pregnancy
People who reside in nursing homes or other long-term care facilities
People from certain racial and ethnic minority groups are at increased risk for hospitalization with flu, including non-Hispanic Black persons, Hispanic or Latino persons, and American Indian or Alaska Native persons
Who should not get the flu vaccine?
People who SHOULD NOT get a flu shot include:

Children younger than 6 months of age.
People with severe, life-threatening allergies to any ingredient in a flu vaccine (other than egg proteins) should not get that vaccine. This might include gelatin, antibiotics, or other ingredients.
People who have had a severe allergic reaction to a dose of influenza vaccine should not get that flu vaccine again and might not be able to receive other influenza vaccines. If you have had a severe allergic reaction to an influenza vaccine in the past, it is important to talk with your health care provider to help determine whether vaccination is appropriate for you.
When is the best time to be vaccinated against flu?
For most people, September and October are generally good times to be vaccinated against flu. It takes about two weeks after vaccination to develop antibodies that protect against the flu.

Some individuals may benefit from two flu vaccines per season.

Different flu vaccines are approved for use in different age groups and patient populations. People should talk to their doctor before getting a flu shot, especially if:

you have an allergy to eggs or any of the ingredients in the vaccine. Talk to your doctor about your allergy.
If you ever had Guillain-Barré Syndrome (a severe paralyzing illness, also called GBS). Some people with a history of GBS should not get a flu vaccine. Talk to your doctor about your GBS history.
If you had a severe allergic reaction to a previous dose of any other flu vaccine, talk to your health care provider.
If you are not feeling well, talk to your doctor about your symptoms.


Please stay healthy during the upcoming flu season!

Dr. Drourr, Dr. Shtern and the staff of Concierge Medicine of Jupiter

How Often Should Someone Urinate?

It is normal to urinate about 6-8 times a day for a normal adult, assuming they consume at least about 2 liters of fluids per day.

Urinating more?
Can be due to increased intake of water as the kidneys promptly respond to the stimulus!
However certain medical conditions can increase frequency of urination, such as a urinary tract infection, an overactive bladder, or due to certain medications a person is taking for treatment of blood pressure or their heart.
In men, enlarged prostate can cause increased urination even at night.

Urinating less? Are you drinking enough fluids? Are you dehydrated? Are the kidneys working? Some people with end stage kidney failure on dialysis have been known to completely stop producing urine and when they receive a kidney transplant, they start urinating again.
An enlarged prostate and other obstruction anywhere in the urinary tract (like a kidney stone) can block urine from coming out.
Having a very low blood pressure from serious blood-Bourne infections, heart failure, or liver failure can also cause low urine production.

If you are concerned about the frequency of your urination, you should speak to your doctor.

What is Low-Dose Computed Tomography?

Low-dose computed tomography (also called a low-dose CT scan) is a screening test for lung cancer.



Who is eligible for screening? As per recommendations by the U.S. Preventive Services Task Force (USPSTF), a yearly lung cancer screening is recommended for people who

Have a 20 pack-year or more smoking history, and
Are current smokers or have quit smoking within the past 15 years, and
Are between 50 and 80 years old
Do not have any current symptoms of lung cancer
A pack-year is smoking is a calculation of # of packs smoked per day multiplied by number of years.

What are the benefits of screening?

Early Diagnosis of lung cancer
What are some of the risks of screening?

Due to certain risks associated with lung cancer screening with a low dose CT scan, the screening test is only recommended for people who are at high risk of developing lung cancer that is based on their age, smoking history, and normal anticipated life expectancy.

A False-positive result: The test can say that a person has lung cancer when no cancer is actually present. This could lead to more follow-up tests, procedures, and surgeries that are not needed and these interventions may have more risks.
Overdiagnosis: A lung cancer screening test can find cases of cancer that may never have caused a problem for the patient. This can lead to treatments/therapies that are not necessary.
Radiation exposure from repeated LDCT tests can cause cancer in otherwise healthy individuals.
When Should Screening for Lung Cancer Stop?

The USPSTF recommends stopping yearly screening for lung cancer when the person:

Turns 81 years old, or
Has not smoked in 15 or more years, or
Develops a health problem that prevents treatment for lung cancer if it was discovered.
Speak to your doctor if you are interested lung cancer screening. Remember, the best way to decrease your risk of lung cancer is to not smoke and to avoid secondhand smoke. Lung cancer screening is not a substitute for quitting smoking.

Who Should Be Screened for Lung Cancer? | CDC

THE BENEFITS OF EXERCISING
Regular exercise and physical activity has numerous benefits. Everyone benefits from exercise.
- Exercise can reduce the risk of cardiovascular disease (such as heart attack, stroke, peripheral vascular disease) by strengthening the heart, lowering cholesterol, improving circulation, and lowering blood pressure.
- It can help control weight and prevent obesity
- Exercise helps your body control insulin and blood glucose levels which can decrease the risk of diabetes Type 2 as well as obesity and metabolic syndrome
- Exercise can improve mental health by releasing chemicals that can increase relaxation, help with anxiety, depression and improves cognitive function.
- Exercise releases chemicals that improve the structure and function of the brain
- Exercise strengthens bones and muscles which can slow the loss of bone density that occurs with aging, helping to prevent osteoporosis, and improve arthritis
- Exercise can reduce the risk of some cancers especially ones associated with obesity such as colon cancer, breast cancer, and uterine cancer.
- Exercise can improve your sleep by helping you sleep longer and increasing the duration of sleep
- Exercise can improve sexual health in both men and women
- Balance and muscle-strengthening activities as well as moderate-intensity aerobic activity can help reduce the risk of falls in the elderly
- Evidence shows that physical activity can reduce your risk of dying early from the leading causes of death, like heart disease and some cancers.

Exercise has a lot of benefits however prior to initiating an exercise program, please consult with your doctor. This is especially important if you have not exercised in a long time, have chronic health conditions, or have any concerns about your health.

Potty Like a Rockstar

Constipation is a symptom rather than a disease, generally defined as when bowel movements occur less than or equal to three times a week and when the bowel movements are difficult to pass.

It is the one of the most common digestive complaints in the United States. Constipation is typically a chronic condition. New and rapid-onset constipation in older persons may suggest an obstruction in the gastrointestinal tract.

A person suffering with constipation may also experience abdominal pain, painful defecation, re**al bleeding, episodes of diarrhea, or lower back pain.

Some people may develop such severe constipation that they require medically manual removal of the stool from the lower gastrointestinal tract.

Patients who experience constipation and have abdominal pain, inability to pass gas, fever, vomiting, or bleeding from the re**um should seek immediate medical care.

Initial management of constipation involves dietary changes and exercise. Dietary changes include increasing intake of fiber and fluids while decreasing the use of constipating agents (eg, milk products, coffee, tea, and alcohol). Constipation should not be ignored and persons suffering from constipation should contact their medical provider.

Squatty potty is a stool that raises your knees above your hips to put you into a squat-like position when you are having a bowel movement.
The lower bowel is “kinked” when a person sits on a toilet. That forces you to work harder to push out the 💩. Squatting relaxes the pubore**alis muscle more and straightens out the colon, giving the 💩 a straight route out. As a result, bowel movements are produced with less straining.

A popular device that can be purchased over-the-counter is a pulse oximeter. It’s a device that can be placed on your finger (or toe) that measures the oxygen saturation level of your blood. Certain smart watches available on the market can also measure oxygen concentration of blood.
It is non-invasive, not painful, rapid, easy to use, and the measurements can be performed in the comfort of your own home.
These devices have become popular during the time of COVID-19 pandemic when knowing oxygen concentration of blood is crucial. A typical pulse oximeter also provides a reading of the heart rate.
Pulse oximeters measure changes in light absorption in blood. Amount of oxygen in the blood is measured with small beams of light passing through the blood in the digit being measured.

Healthcare professionals often use pulse oximeters to monitor blood oxygen levels of people who suffer with lung diseases (such as COPD, asthma, lung cancer, pneumonia), heart diseases (such as heart failure, coronary artery disease, or congenital heart disease), sleep apnea, and anemia. This is done at the hospital, the office, during sleep studies, during medical procedures that require anaesthesia, or at home.

How to take a reading at home
1. Remove nail polish from the digit you are using for measurement.
2. Make sure your hand is warm, relaxed, and below heart level.
3. Place the device on your finger, earlobe, or toe.
4. Keep the pulse oximeter on the digit as long as necessary to obtain a measurement. Fingertip readings may be delayed by 30 seconds and toe readings by 90 seconds.
5. Remove the device once the test is over.

Pulse oximetry readings
An oxygen saturation level of 95 percent or greater is considered typical for most healthy people.
A level of 92 percent or lower can indicate potential hypoxemia, which is a seriously low level of oxygen in the blood and considered a medical emergency.
Various factors can affect readings, including a person’s skin tone, poor arterial blood flow in the measured extremity, low blood pressure, low temperature of the measured extremity, hypothermia, nail polish, artificial fingernails, motion, and exposure to excessive light.

SAFETY OF OVER-THE-COUNTER ORAL PAIN MEDICATIONS
Whether a headache, toe pain, or a muscle ache after a prolonged tennis game, many of us has found our way into our local pharmacy with intentions to purchase over-the-counter pain medications.
Most people expect over-the-counter pain medications to be safe. However, there are several important side effects everyone should be aware of.
Two common examples are pain and fever reducing medications. These two medications can be found alone or purchased bundled with other medications in one pill for multi-symptom relief.

Acetaminophen (Tylenol)
- Used for pain and fever
- Although this medication is found over the counter, it has a black box warning issued by the FDA of “hepatotoxicity”, which means this medication can be toxic to the liver. This means there is a risk of acute liver failure which can lead to liver transplantation or death especially in doses of greater than 4000mg per day
- This medication should be avoided by patients with history of prior allergic reactions to this group of medications and patients suffering from severe active liver disease
- Caution must be taken if patient chronically uses alcohol, is dehydrated, malnourished, or has kidney disease
- Adverse reactions to acetaminophen include anaphylaxis (severe allergic reaction), hypersensitivity reactions, rash, liver toxicity, acute kidney injury, chronic kidney disease if taken for a long time, anemia, and low platelets

Ibuprofen (Motrin, Advil), Naproxen (Aleve)
- These medications belong to a class of medications called NSAIDS (Non-Steroidal Anti-Inflammatories)
- They are used for treatment of pain, fever, and some inflammatory conditions such as arthritis
- These medications also have a black box warning issued by the FDA.
o Use of NSAIDs increases risk of serious and potentially fatal cardiovascular thrombotic events (such as heart attack and stroke)
o NSAIDs also increase risk of serious and potentially fatal gastrointestinal adverse events that include bleeding, ulcers, and perforation of the stomach or the intestines.
§ Elderly patients and patients that have history of peptic ulcer disease or gastrointestinal bleeding are at a greater risk for serious gastrointestinal events.
- Serious reactions reported with use of NSAIDs include
o Gastrointestinal bleeding, ulceration, and perforation
o Heart attack, stroke, blood clots
o Hypertension
o Heart failure
o Kidney failure (many different types)
o Liver toxicity
o Anaphylaxis, allergic reactions including Stevens Johnson Syndrome
o Bronchospasm
o Rashes including sensitivity to light
o Low platelets, Anemia, and low white blood cell count
o High potassium
o Abdominal pain, nausea, constipation
o Ringing in the ears
Please consult with your doctor prior to taking any medications over the counter.

Buyer Beware!

The team of Concierge Medicine of Jupiter

Please help us wish our great boss Dr. Catherine Drourr a very HAPPY BIRTHDAY!!!

Please help us celebrate Dr. Shtern's Birthday! We hope your birthday is full of joy and excitement !!

CDC Booster Update

The CDC released new recommendations regarding COVID-19 vaccination booster shots.

For those with a moderately to severely compromised immune system who received a Pfizer-BioNTech or Moderna COVID-19 vaccine series: They should receive an additional dose of vaccine at least 28 days after completing their initial series.

For those who received a Pfizer-BioNTech or Moderna COVID-19 vaccine series:
The following groups are eligible for a booster shot 6 months or more after their initial series. The Pfizer booster is the same dose as the initial series. The Moderna booster is a half dose.
1. 65 years and older
2. Age 18 and older who live in long -term care settings (“Long-term care settings” include any location where older adults, people with disabilities, etc. receive services or support)
3. Age 18 and older who have underlying medical conditions (such as cancer, chronic kidney disease, chronic liver disease, chronic lung diseases, etc.)
4. Age 18 and older who work or live in high-risk settings . Health care workers for example.
For those who received a Johnson & Johnson COVID-19 vaccine: The CDC is recommending booster shots for individuals who are 18 years old and older and who were vaccinated two or more months ago.

Which booster to get?
Eligible individuals may choose which vaccine they receive as a booster dose. Some people may have a preference for the vaccine type that they originally received and others, may prefer to get a different booster.

Available data right now show that all three of the COVID-19 vaccines approved or authorized in the United States continue to be highly effective in reducing risk of severe disease, hospitalization, and death.

Vaccination remains the best way to protect yourself and those you love.

Stay well!

Sincerely,
Dr. Drourr, Dr. Shtern, and the staff of Concierge Medicine of Jupiter

Additional resources:
1. COVID-19 tracking: https://covid.cdc.gov/covid-data-tracker/ -home
2. Finding vaccines: https://www.vaccines.gov/search/
3. Testing sites: https://floridahealthcovid19.gov/testing-sites/

Content source: Centers for Disease Control and Prevention

Happy Fall from this great team!
We are ready for the expected, unexpected and everything in between.

Bananas are an amazing source of nutrition. They are low in calories: a medium size banana is about 105 calories! The banana has low to medium glycemic index (depending on how ripe it is) and they may help moderate blood glucose levels after meals and may reduce appetite by slowing stomach emptying.

A banana contains about 422mg of potassium which is important for cellular function and heart health! It also contains magnesium which is another mineral important for heart and muscle health. Eating bananas may decrease blood pressure in healthy people. Banana can help relieve post-exercise muscle cramps.

The banana has 3.1 grams of dietary fiber which is important for regular bowel movements and digestion. Bananas contain
resistant starch, which may feed your friendly gut bacteria and may even protect against colon cancer.

A banana also contains Vitamin C, Vitamin B6, copper, and manganese.

Everyone is going Bananas

Bananas are high in several antioxidants,
which may help reduce damage from free radicals and may lower your risk of some
diseases.

Is it better to eat a ripe or un-ripe bananas?
Unripe bananas are healthier because they have more fiber and less glucose than ripened bananas. Unripe bananas have high amounts of resistant starch which may improve insulin sensitivity.

Certain population of people should not consume bananas. People who have problems excreting potassium from their body such as patients who have advanced kidney disease or who are receiving hemodialysis can develop potassium overload which can be life-threatening.
People who suffer from diabetes may not benefit from ripe bananas due to their high glucose content.

LETS TALK ABOUT ANTIBIOTICS! The good, the bad, and the ugly!
ANTIBIOTICS are medications that are used to help us fight BACTERIAL infections.
When antibiotics are used to fight BACTERIAL infections, they help us recover, shorten duration of bacterial illness, and can save lives. It is appropriate to treat bacterial illnesses with appropriate antibiotic therapy. The type of antibiotic that is used to treat a bacterial infection depends on the type of bacteria, the location of the infection in the body, and most importantly, it depends on the patient’s specific needs.

Antibiotics are not meant to treat VIRAL infections. Not only are the antibiotics not effective if used in the wrong context, but they can cause harm. Different antibiotics have different side effects. Some people can develop allergic reactions to antibiotics that can be life threatening. Other antibiotics can alter the rhythm of the heart and can cause a life-threatening arrhythmia. There are antibiotics that can cause liver failure, kidney failure, and/or failure of other organ systems.

When antibiotics are used inappropriately, we suffer a great cost both personally and as a society. Overuse or misuse of antibiotics leads to antibiotic-resistance. What that means is that bacteria “learn” how to evade the antibiotic mechanisms of action and the medication is no longer effective when you really need it most. Consequences of this include longer duration of illnesses, more severe illnesses, more doctor visits, use of stronger antibiotics with more side effects, and higher chance of dying from a bacterial illness.

MULTIVITAMIN SUPPLEMENTATION
According to the Food and Drug Administration, Congress defined the term "dietary supplement" in the Dietary Supplement Health and Education Act (DSHEA) of 1994.
A dietary supplement is a product taken by mouth that contains a "dietary ingredient" intended to SUPPLEMENT the diet. The ingredients of these products may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites. DSHEA places dietary supplements in a special category under the general umbrella of "foods," not drugs.
Under DSHEA, the company that produces the dietary supplement is responsible for determining the supplement’s safety and that any representations or claims made about them are substantiated by adequate evidence to show that they are not false or misleading. This means that dietary supplements do not need approval from FDA before they are marketed.
Unlike drug products that must be proven safe and effective for their intended use before marketing, there are no provisions in the law for FDA to "approve" dietary supplements for safety or effectiveness before they reach the consumer. Once the product is marketed, FDA has the responsibility for showing that a dietary supplement is "unsafe," before it can take action to restrict the product's use or removal from the marketplace.

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WHO MAY BENEFIT FROM SEVERAL NUTRIENTS IN MULTIVITAMINS?
Most people who have true vitamin deficiencies have underlying medical problems that either prevent absorption of a nutrient from the diet or its metabolism. For example, patients who have undergone a gastric bypass surgery, have been afflicted with malabsorption disorders, or suffer from chronic alcoholism are unable to obtain the right nutrients in their diet. It is best for most people to obtain vitamins and minerals from eating a well-rounded healthy diet.
However, some people benefit from certain vitamin supplementation. Pregnant women and women who might be pregnant are recommended folic acid supplementation, especially in the first trimester, to prevent neural tube defects in their babies. Pregnant women may also be recommended iron supplementation by their health care provider.
Patients that have vitamin D deficiency and/or suffer from osteoporosis or osteopenia are recommended Calcium and Vitamin D supplementation to help increase bone mineral density and decrease fractures in post-menopausal women.
People over age 50 tend not to absorb Vitamin B12 as well as vegans and they should obtain recommended intakes of vitamin B12 mainly from fortified foods or dietary supplements.
Individuals with poor nutrient intakes from diet alone, who consume low-calorie diets, or who avoid certain foods (such as strict vegetarians and vegans) might also benefit from taking multivitamins.

TOO MUCH OR TOO LITTLE? HOW DO YOU CHOOSE A MULTIVITAMIN?
When you are supplementing your diet with pill-form of multivitamins, how do you know if you are taking too much or too little?
Your doctor is the best person to ask about a supplement you are planning to take. In addition, the back of the vitamin bottle contains percentage of daily allowance of recommended supplement intake.


Special Considerations for Certain Population Groups
Most basic multivitamins usually contain both vitamins and minerals, mostly at levels that do not exceed the daily recommended values for these nutrients. However, people who take multivitamins and other supplements and who eat fortified foods and beverages might consume some nutrients at levels that exceeding the upper level of recommended intake, which increases the possibility of adverse effects.
Smokers and, possibly, former smokers should avoid multivitamins that contain a large amount of beta-carotene or vitamin A due to an increased risk of lung cancer, as it has been suggested in several studies.
Taking excess vitamin A (as preformed retinol but not beta-carotene) during pregnancy can increase the risk of birth defects in infants. In general population, over-consumption of vitamin A can cause staining of skin a yellow-orange color, loss of hair, developing dry and scaly skin, mouth sores, anorexia, vomiting, nausea, abdominal pain, and headaches.
Over-consumption of Vitamin D can cause high blood calcium levels, kidney stones from high blood and urine calcium levels, anemia, and kidney failure.
Information about different dietary supplements can be obtained online by reviewing dietary supplement fact sheets at National Institute of Health website:
https://ods.od.nih.gov/factsheets/list-all/
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Dietary Supplement Fact Sheets This collection of fact sheets and other resources from the NIH Office of Dietary Supplements and other federal government sources presents information about dietary supplements and their ingredients. These include vitamins, minerals, herbs and botanicals, probiotics, and more. Many of these resourc...

Mediterranean Diet Approach
The heart-healthy Mediterranean is a healthy eating plan based on typical foods and recipes of Mediterranean-style cooking. Here's how to adopt the Mediterranean diet for a healthy lifestyle.

If you're looking for a heart-healthy eating plan, the Mediterranean diet might be right for you. The Mediterranean diet incorporates the basics of healthy eating — plus a splash of flavorful olive oil and perhaps even a glass of red wine — among other components characterizing the traditional cooking style of countries bordering the Mediterranean Sea.
Most healthy diets include fruits, vegetables, fish and whole grains, and limit unhealthy fats. While these parts of a healthy diet remain tried-and-true, subtle variations or differences in proportions of certain foods may make a difference in your risk of heart disease.
Research has shown that the traditional Mediterranean diet reduces the risk of heart disease. In fact, an analysis of more than 1.5 million healthy adults demonstrated that following a Mediterranean diet was associated with a reduced risk of death from heart disease and cancer, as well as a reduced incidence of Parkinson's and Alzheimer's diseases.
The Dietary Guidelines for Americans recommends the Mediterranean diet as an eating plan that can help promote health and prevent disease. And the Mediterranean diet is one your whole family can follow for good health.
The Mediterranean diet emphasizes:
• Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts
• Replacing butter with healthy fats, such as olive oil
• Using herbs and spices instead of salt to flavor foods
• Limiting red meat to no more than a few times a month
• Eating fish and poultry at least twice a week
• Drinking red wine in moderation (optional)
The diet also recognizes the importance of being physically active and enjoying meals with family and friends.
The Mediterranean diet traditionally includes fruits, vegetables and grains. For example, residents of Greece average six or more servings a day of antioxidant-rich fruits and vegetables.
Grains in the Mediterranean region are typically whole grain and usually contain very few unhealthy trans fats, and bread is an important part of the diet. However, throughout the Mediterranean region, bread is eaten plain or dipped in olive oil — not eaten with butter or margarine, which contains saturated or trans fats.
Nuts are another part of a healthy Mediterranean diet. Nuts are high in fat, but most of the fat is healthy. Because nuts are high in calories, they should not be eaten in large amounts — generally no more than a handful a day. For the best nutrition, avoid candied or honey-roasted and heavily salted nuts.
The focus of the Mediterranean diet isn't on limiting total fat consumption, but rather on choosing healthier types of fat. The Mediterranean diet discourages saturated fats and hydrogenated oils (trans fats), both of which contribute to heart disease.
The Mediterranean diet features olive oil as the primary source of fat. Olive oil is mainly monounsaturated fat — a type of fat that can help reduce low-density lipoprotein (LDL) cholesterol levels when used in place of saturated or trans fats. "Extra-virgin" and "virgin" olive oils (the least processed forms) also contain the highest levels of protective plant compounds that provide antioxidant effects.
Canola oil and some nuts contain the beneficial linolenic acid (a type of omega-3 fatty acid) in addition to healthy unsaturated fat. Omega-3 fatty acids lower triglycerides, decrease blood clotting, and are associated with decreased incidence of sudden heart attacks, improve the health of your blood vessels, and help moderate blood pressure. Fatty fish — such as mackerel, lake trout, herring, sardines, albacore tuna and salmon — are rich sources of omega-3 fatty acids. Fish is eaten on a regular basis in the Mediterranean diet.
The health effects of alcohol have been debated for many years, and some doctors are reluctant to encourage alcohol consumption because of the health consequences of excessive drinking. However, alcohol — in moderation — has been associated with a reduced risk of heart disease in some research studies.
The Mediterranean diet typically includes a moderate amount of wine, usually red wine. This means no more than 5 ounces (148 milliliters) of wine daily for women of all ages and men older than age 65 and no more than 10 ounces (296 milliliters) of wine daily for younger men. More than this may increase the risk of health problems, including increased risk of certain types of cancer.
If you're unable to limit your alcohol intake to the amounts defined above, if you have a personal or family history of alcohol abuse, or if you have heart or liver disease, refrain from drinking wine or any other alcohol.
The Mediterranean diet is a delicious and healthy way to eat. Many people who switch to this style of eating say they'll never eat any other way. Here are some specific steps to get you started:
• Eat your veggies and fruits — and switch to whole grains. A variety of plant foods should make up the majority of your meals. They should be minimally processed — fresh and whole are best. Include veggies and fruits in every meal and eat them for snacks as well. Switch to whole-grain bread and cereal, and begin to eat more whole-grain rice and pasta products. Keep baby carrots, apples and bananas on hand for quick, satisfying snacks. Fruit salads are a wonderful way to eat a variety of healthy fruit.
• Go nuts. Nuts and seeds are good sources of fiber, protein and healthy fats. Keep almonds, cashews, pistachios and walnuts on hand for a quick snack. Choose natural peanut butter, rather than the kind with hydrogenated fat added. Try blended sesame seeds (tahini) as a dip or spread for bread.
• Pass on the butter. Try olive or canola oil as a healthy replacement for butter or margarine. Lightly drizzle it over vegetables. After cooking pasta, add a touch of olive oil, some garlic and green onions for flavoring. Dip bread in flavored olive oil or lightly spread it on whole-grain bread for a tasty alternative to butter. Try tahini as a dip or spread for bread too.
• Spice it up. Herbs and spices make food tasty and can stand in for salt and fat in recipes.
• Go fish. Eat fish at least twice a week. Fresh or water-packed tuna, salmon, trout, mackerel and herring are healthy choices. Grill, bake or broil fish for great taste and easy cleanup. Avoid breaded and fried fish.
• Rein in the red meat. Limit red meat to no more than a few times a month. Substitute fish and poultry for red meat. When choosing red meat, make sure it's lean and keep portions small (about the size of a deck of cards). Also avoid sausage, bacon and other high-fat, processed meats.
• Choose low-fat dairy. Limit higher fat dairy products, such as whole or 2 percent milk, cheese and ice cream. Switch to skim milk, fat-free yogurt and low-fat cheese.

Adapted from Mayo clinic