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Dengue Viral Infections: CDC Issues Health Advisory

The Centers for Disease Control issued a health advisory Tuesday about an increased risk for dengue virus infections in the United States. 
Aedes Aegypti Mosquito

by Mila McManus, MD

The Centers for Disease Control and Prevention issued a health advisory to clinicians, health authorities, and the public on Tuesday (6/25/24) about an increased risk for dengue (pronounced ”deng-gay”) virus infections in the United States.  Globally, there has been a record-breaking incidence of the mosquito-borne viral disease. While there is no evidence of a current outbreak in the 50 continental states, there are three times more dengue cases than at the same time last year. Countries in the Americas have already reported the highest number of cases ever recorded in a single year. Puerto Rico declared a public health emergency due to the unusually high number of reported dengue cases.

Dengue fever, a potentially severe viral infection transmitted to humans through the bite of infected mosquitoes, is not contagious. It is found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas. The mosquitoes that spread dengue are active during the day. Many dengue infections are asymptomatic or produce only mild illness, but occasionally more severe cases, including death, occur. Individuals infected for the second time are at greater risk of severe dengue, symptoms appearing after the fever has subsided. The best prevention and control is to avoid being bitten by mosquitos.

Symptoms usually begin 4-10 days after being bitten and last 2-7 days. Common symptoms include:

  • high fever
  • severe headache
  • pain behind the eyes
  • muscle and joint pain
  • nausea and/or vomiting
  • swollen glands
  • rash.

Treatment normally targets pain relief.  If you get dengue, it is important to rest, drink plenty of liquids, use acetaminophen for pain, avoid NSAIDs such as ibuprofen and aspirin, and watch for severe symptoms, contacting your doctor as soon as possible if you notice them.


AMA Morning Rounds <MorningRounds@ama.bulletinhealthcare.com>
Date: Wed, Jun 26, 2024 at 8:09 AM

World Health Organization. Fact Sheets. April 23, 2024

By |2024-07-11T15:31:57-05:00July 17th, 2024|Articles, General|

Diverticulitis: Nuts and Popcorn – Yay or Nay?

by Mila McManus, MD

We commonly meet with new patients with a diverticulitis diagnosis which is where small pouches form in the inner lining of the colon.

We frequently come across patients with a diverticulosis.  And we also have been told by these patients that a dietitian has provided a restrictive diet plan that excludes nuts, seeds, and popcorn.(And this is what we learn to tell patients in medical school as well).  We disagree with this nutritional approach as folklore, and here’s why.

Let’s start by understanding the difference between diverticulosis and diverticulitis.  Diverticulosis is a common condition where small pouches form in the inner lining of the colon. It’s usually asymptomatic, and less than five in 100 patients will experience issues. Diverticulitis occurs when one or a few of these pouches become inflamed, bleed, or develop an infection, leading to lower abdominal pain, changes in bowel function, nausea, and possibly bloody stools.

There are two known risk factors for getting diverticulitis: genetics and lifestyle.[1] Over half of a person’s risk of getting diverticulosis is genetic [i.e., inherited]. The remainder of the risk is for those who are sedentary, obese, smoke, take non-steroidal anti-inflammatory drugs [NSAIDS], and consume the Standard American Diet [SAD], which is high in refined grains, sugar, and ultra-processed foods [UPFs]. In other words, it is not nuts, seeds, or popcorn CAUSING diverticulitis. (Conventional wisdom has been that these small seeds or parts of corn kernel will get trapped in a diverticulum ‘pouch’ and create the diverticulitis)  People who eat a diet that’s rich in fruits, vegetables, nuts, seeds, quality protein, and healthy fats and are active have a much lower risk of developing diverticulitis.

Lisa L. Strate, MD, and a team of researchers conducted a comprehensive study, following roughly 47,000 men for 18 years. The findings were clear and reassuring: the risk for diverticulitis was lower – not higher-  in those who ate a lot of nuts and popcorn.[2]

Our approach is clear and straightforward: we aim to heal the gut, reduce inflammation, and recommend a whole food diet. This diet includes nuts and seeds, and yes, occasionally, even some organic, buttered popcorn. We believe in empowering our patients to make healthier dietary choices.

Be nourished. Be well.


[1] Dow, Caitlin (July 21, 2022). Should you avoid nuts and popcorn if you have diverticulitis? Center for Science in the Public Interest, Nutrition Action Newsletter.

[2] https://jamanetwork.com/journals/jama/fullarticle/1028647


By |2024-07-03T11:09:58-05:00July 4th, 2024|Articles, General|

Better than an Antidepressant?

by Mila McManus, MD

New research finds dancing and exercise to be especially effective at treating depression!

New research finds dancing to be especially effective at treating depression!

For many  people, exercise is a difficult habit to establish, and often because it is not enjoyable.  Those struggling with depression are also challenged to get motivated and into the swing of it. 

The research, published in the British Medical Journal,  was an analysis of 218 different studies with a total of 495 groups of people and over 14,000 participants.  This systematic review was one of the largest existing reviews on exercise for depression. People who engaged in dancing had the greatest reduction in depression, followed by walking, jogging, yoga, strength training, mixed aerobic exercise, and tai chi or qigong.

Another key finding was the relationship between the intensity of the movement and the benefits it yielded.  The greater the intensity of dancing, walking, or jogging, for example, the greater reduction in depression. Additionally, walking and jogging were effective for both men and women in reducing depression, while yoga was more effective for older adults. It is so important to emphasize, however, that any and all movement is better than no movement at all.  So begin where you are comfortable and increase intensity as you can.

Want to get out of the funk and fog?  Increasing blood flow through dancing and other exercises increases the release of neurotransmitters like endorphins, serotonin, and dopamine and gives those low moods a big boost.

Be Well!


Lomas, Emilina. New Research Finds Exercise – Especially Dance – to Be Effective at Treating Depression. Oura blog post, March 14, 2024


By |2024-06-19T14:57:22-05:00June 20th, 2024|General|

Nutrigenomics Should Matter to You

by Mila McManus, MD

Nutrigenomics is a relatively new field that is dedicated to understanding how food impacts the expression of your genetic make-up. 

Nutrigenomics is a relatively new field that is dedicated to understanding how food impacts the expression of your genetic make-up.   The good news is that you don’t have to accept some predetermined fate as a result of your genetic makeup.   While it is true that your genes influence your health and longevity, they don’t determine it fully. 

Think of your genes like a dimmer switch. The activity (i.e., expression) of your genes can be turned up or down.  You control that dimmer switch. You have the ability to turn your genetic health up and  your genetic disease propensities down, and it all has to do with your lifestyle choices.

What is the one, most powerful tool you can use every day to favorably impact your genes and your biology?  YOUR FORK!

“There’s no other activity you do on a daily basis that has more power to change your biology than what you eat.”*[1] 

When you choose nutrient-rich foods, you can turn on genes that promote health and longevity, while turning down genes that contribute to disease.[2] The food you put in your mouth has coded messages for your genes. This is nutrigenomics. Nutrient-rich foods will signal your body to express its wellness genes, while processed fake foods will signal your body to express sickness genes.

Processed foods change your gene expression to turn on disease causing genes through inflammation, oxidative stress, and damage to the microbiome.

Eating fruits and vegetables is key to achieving your optimal genetic potential.  The rainbow colors of fruits and vegetables are proof of the priceless polyphenols found in them. Polyphenols are phytonutrients that fight inflammation and activate longevity pathways to slow down the aging process.[3]

Another way to achieve your genetic potential is through a healthy gut microbiome.[4] Eating polyphenols, as well as fiber, omega-3 fatty acids, and resistant starch, all feed and nourish your microbiome.  These important bacteria produce compounds such as short-chain fatty acids and other metabolites that strengthen the gut lining, improve digestion, and support the immune response.

Eating a wholesome diet nourishes your body and also sends positive signals to your genes!  Consuming ultra-processed foods, stripped of gene-enhancing nutrients, disrupts these signals and contributes to disease.

Eat Real Food to Turn Up Your Healthy Switch!

[1] Hyman, Mark. What I Eat for Health and Longevity. Journal-post dated Monday, May 20, 2024.

[2] Pignatti C, D’Adamo S, Stefanelli C, Flamigni F, Cetrullo S. Nutrients and Pathways that Regulate Health Span and Life Span. Geriatrics (Basel). 2020 Nov. 19; 5(4):95. Doi:10.3390/geriatrics5040095. PMID: 33228041; PMCID: PMC7709628.

[3] Pereira QC, Dos Santos TW, Fortunato IM, Ribeiro ML. The Molecular Mechanism of Polyphenols in the Regulation of Ageing Hallmarks.  International Journal of Molecular Science. 2023 March 14;24(6):5508. Doi: 10.3390/ijms24065508. PMID:36982583; PMCID:PMC10049696.

[4] Kassem NM, Abdelmegid YA, El-Sayed MK, Sayed RS, Abdel-Aalla MH, Kassem HA.  Nutrigenomics and microbiome shaping the future of personalized medicine: a review article. Journal of Genetic Engineering Biotechnology. 2023 Nov 22;21(1):134. Doi: 10.1186/s43141-023-00599-2. PMID:37993702; PMCID: PMC10665279.

By |2024-06-13T06:30:25-05:00June 13th, 2024|Articles, General|

E-Store: Better, Faster Supplement Orders!

by Mila McManus, MD

Announcing our new e-store to make ordering easier and faster than ever.  Just bookmark the link below, click on it and start your order. 

Announcing our new e-store to make supplement ordering easier and faster than ever.  Just click on the link below and start your order.  You can also bookmark it to your browser for easy finding for future shopping! You will be given payment options including credit card, PayPal, shop Pay, G Pay, and Venmo. If you need to submit advance payments or Care Credit payments virtually, use this link, and then use the QR Code provided on the page.


Do you know why it is essential to buy only professional-grade supplements? Read this!

Have you forgotten why you need your supplements? Read this :

Be Well!

By |2024-06-05T16:09:48-05:00June 6th, 2024|General|

Beware If You Have Food Allergies!

by Mila McManus MD

The FDA may allow food companies to ignore allergen contamination when designing food safety programs to address allergen risks.

If you, or someone you love, has food allergies, you need to know that the FDA is not protecting you from exposure to allergens in processed and packaged foods!

Recently, the FDA stated it may simply allow food companies to ignore small amounts of allergen contamination when designing food safety programs to address allergen risks.  The FDA leaves it up to the food companies to decide what these thresholds might be and how to ensure that consumers are not put at too much risk by the contamination.  As a result, you need to use your own judgment regarding who you trust and to understand the risk involved when you or your children are consuming packaged and processed foods.  Labeling may not be helpful or honest. There really isn’t a comprehensive system to define what allergen labels like “may contain” really mean. 

Companies, looking for solid profit margins, are reluctant to prevent cross contamination because of the costs involved to ensure it, such as having another set of equipment.  Worse yet, some food companies are leveraging a loophole and adding some allergens to the recipes to all their foods to avoid having to prevent cross contamination.

One in ten people in the US have food allergies.  Forty percent of children with food allergies are allergic to more than one food. Allergic reactions to foods usually occur within minutes or at most, a couple of hours, after eating a food allergen.  Common symptoms include flushed skin, rash, hives, tingling or itchy sensations in the mouth, face, tongue, or lip swelling. Also, vomiting, diarrhea, and/or abdominal cramps, coughing, wheezing, dizziness, lightheadedness, swelling of the throat and vocal cords, difficulty breathing, and loss of consciousness are possible.  Food allergies are different than food sensitivities.  With food sensitivities, there’s no potential for anaphylaxis, and reactions usually manifest 3 to 7 days following ingestion. Furthermore, food sensitivities can result in a wide variety of symptoms. 

The official nine ingredients which account for at least 90% of allergic reactions in the US are eggs, soy, milk, wheat, crustacean shellfish, peanuts, tree nuts, fish, and sesame. 

 If you are interested in taking action, you can look at the FDA’s recent draft guidance, titled “Chapter 11: Food Allergy Program of the Hazard Analysis and Risk-Based Preventive Controls for Human Food: Draft Guidance for Industry“.

Here is just one more good reason to eat real whole food, shop the perimeter of the grocery store, grow your own food, go to farmers markets, and buy certified organic, non-GMO foods. For allergy or food sensitivity testing, discuss with a medical provider here at TWIHW.

Steer clear, stay well.

Reference: Crezo, Adrienne. CSPI News: “Have a food allergy? What to know about FDA’s new guidance”. March 20, 2024.

By |2024-05-30T08:12:17-05:00May 30th, 2024|General|

Plastic Cutting Boards: Are Yours Safe?

by Mila McManus, MD

Research demonstrates plastics is a public health concern and may be one of many factors contributing to chronic inflammation and disease. 

Mounting research is demonstrating that our chronic exposure to plastics is a public health concern and may be one of many factors contributing to chronic inflammation and disease.  From bottled water to kitchen cutting boards, everyone can take steps to reduce and minimize exposure and ingestion of microplastics.

According to one study, scientists cut carrots on two types of plastic cutting boards, one  made with polypropylene and the other with polyethylene.  Each time the boards were used to cut carrots, the scientist measured up to as many as 1,114 microplastic particles from the board on the carrots.  Microplastic particles are pieces of plastic less than five millimeters long.  They estimated that over the course of one year, 50 grams of  microplastics, roughly equivalent to ten plastic credit cards is released onto the food being prepped.

Microplastics are being found in human lungs, blood, and even in the placenta.  These plastics have chemical additives in them which disrupt the endocrine/hormonal and reproductive system.  All plastic objects can become a source of microplastic ingestion once they begin to degrade. Most plastics don’t break down in the environment, but they do break apart into these microparticles which then can absorb chemical pollutants and microorganisms.  In other words, microplastic particles are a vehicle on which other chemicals can hitch a ride, enter the body, and wreak havoc.  Both the plastic and its passengers pose a health threat.

                Here are a few good places to begin reducing exposure to microplastics:

  • Replace plastic cutting boards with glass, marble, bamboo, or solid wood boards.  
  • Replace all of your plastic utensils and kitchenware with glass, stainless steel, and silicone.
  • Avoid drinking from disposable plastic water bottles. These bottles, if exposed to warm, humid, sunny environments (think outside of the grocery pick up area of your favorite grocer, or on non-airconditioned delivery trucks, or in your car on a hot day), degrade very easily in response to temperature change or mechanical stress.  This causes harmful chemicals to end up in the water you’re drinking from plastic bottles.
  • Filter your city tap water. Go to ewg.org for information about water contamination, problems, solutions, and recommendations.

Avoid Plastics. Be Wise. Be Well.


Culpepper, J.R. Making meals without microplastics: Tips to safer cutting boards. Environmental Working Group, October 20, 2023.






By |2024-05-22T15:24:33-05:00May 23rd, 2024|General|

What Do Multiple Sclerosis and Epstein-Barr Virus Have to Do With Each Other?

by Mila McManus MD

Michael Levy, MD, PhD, of Harvard Medical School and Massachusetts General Hospital, said in a recent interview that new groundbreaking findings confirm that Epstein-Barr Virus is “likely the primary cause of Multiple Sclerosis [MS].

Epstein-Barr Virus [EBV] exists in 90-95% of adults.  It is a germ that, when contracted, results in flu-like symptoms, and is the cause of infectious mononucleosis, also known as”Mono” and “the kissing disease”.  Once a person has had EBV infection, the virus settles into the human body for life.  For most people, it remains dormant and harmless. However, EBV is implicated as a cause of several types of cancer (lymphoma and nasopharyngeal tumors) and MS.

Epstein-Barr Virus was first linked to MS back in 1981.  In 2022, the landmark study was published in Science. Researchers at the Harvard T.H. Chan School of Public Health and Harvard Medical School analyzed blood serum from 10 million active-duty members of the US military.  They identified 801 recruits with MS and matched them with more than 1500 controls.  They found that 800 of the 801 recruits had been infected with EBV; infection seemed to boost the risk for MS 32-fold.

In MS, the immune system attacks the protective myelin sheath and the axons it insulates. There are two main theories about why EBV causes MS.  The first is called the “molecular mimicry” theory. The thought is that EBV triggers MS when the immune system mistakes a viral protein for a myelin protein and then attacks myelin.  The second theory proposes that EBV is a driver of MS, where an ongoing, lifelong immunological response to EBV continuously causes damage in the central nervous system. There is some evidence for each one of these theories.

In theory, then, if EBV can be eradicated from the body, eradication could be a treatment and a cure for MS. It remains unclear why most people infected with EBV do not develop MS. While most of the world gets exposed to EBV, only 1 in 1000 people get MS.  

If you have MS, or have reactivated EBV or a family history of EBV or infectious mononucleosis, talk with your medical provider about possible treatments for MS, or to reduce your risk of MS.

Be well. Live Well.

Ref:   science.org


By |2024-05-09T06:38:09-05:00May 9th, 2024|General|

Essential Oils: Good for You, Dangerous for Pets?

By Mila McManus MD

Essential oils derive many potential health benefits for humans but are dangerous for your pets! They are used in many products.

Essential oils offer many potential health benefits for humans but are dangerous for your pets! Popular today, essential oils are used in many body and household products. They are in lotions, candles, and household cleaners. They can be diffused or applied directly to the human body. People all over the world are trading in their chemical-heavy household products for essential oil based products without an awareness of the potential harm to pets.

Why are they dangerous for pets, you ask?  Essential oils are very powerful, and their molecules are highly reactive compounds within our own bodies.  That is the characteristic that makes them powerful and generally favorable for humans but poisonous for pets, messing with the body chemistry of animals which is obviously different than that of humans.

In small quantities, and not applied directly to your pet or surfaces your pet inhabits, there may be no problem.  Generally however, it is recommended that you not use any essential oil on your pets or as remedies for pet maladies.  If you infuse them throughout your home, and have pets, you may want to consider if it is having a negative impact on your pet.

Common symptoms that could result from overexposure to essential oils in your pets include drooling, fatigue, pawing at the mouth or face, redness or burns on lips, tongue, skin, or gums, difficulty breathing, weakness, difficulty walking or stumbling, muscle tremors, and vomiting.  If your pet has these symptoms, contact your veterinarian or call the Pet Poison Helpline at 800-213-6680.

Several brands of household cleaners are made to be pet friendly. Take a look at Puracy, Mrs. Myers, Seventh Generation, and Biokleen brands. Also consider making your own cleaners with vinegar and baking soda, both inexpensive and safe for pets.  One cup of white vinegar to one cup of water is an excellent all-purpose surface and window cleaner.

We vote for healthy people AND healthy pets!  Be well.


newsletter@badlandsranch.com, 2/23/24.



By |2024-05-01T15:43:16-05:00May 2nd, 2024|General|

Sleep Apnea: STOP-BANG

by Mila McManus MD

Obstructive Sleep Apnea, or OSA, is a serious sleep disorder where a person’s breathing actually stops and starts while they are sleeping.

Obstructive Sleep Apnea, or OSA, is a serious sleep disorder where a person’s breathing actually stops and resumes while sleeping. STOP-BANG is a mnemonic for determining risk factors for sleep apnea.

If you answer YES to three or more of these questions, you are at high risk for moderate to severe OSA!

S – do you SNORE loudly

T – do you feel TIRED, fatigued, or sleepy during the daytime?

O – has anyone OBSERVED you stop breathing during your sleep?

P – do you have, or are you being treated for, high blood PRESSURE?


B – is your Body Mass Index [BMI]  above normal?

AAge over 50?

N Neck circumference greater than 15.7 inches?

G – is your Gender male?

Poor sleep quality can undermine all of your hard work with eating better and getting exercise. Furthermore, it puts you at significant risk for other diseases. Poor quality sleep or inadequate sleep, often caused by OSA,  is associated with high blood pressure, diabetes, heart attack, heart failure or stroke, obesity, depression, reduced immune function, and lower sex drive. 

Quality sleep is a foundational need for good health and longevity, along with a healthy diet and exercise. If you answered YES to three or more of the STOP-BANG questions, we cannot emphasize enough the importance of getting a sleep study and a targeted strategy for improving sleep. Ask one of our medical providers to order a sleep study for you and begin creating a successful sleep strategy.  Your life and health depend on quality sleep!  Making the assumption that you don’t have sleep apnea because you think you sleep well could have tragic consequences.

Be Wise. Be Well. Sleep well.


Chung, F., Yegneswaran, B., Liao, P., Vairavanathan, S., Islam, S., Khajehdehi, A., & Shapiro, C.M. (2008). STOP questionnaire – a tool to screen patients for obstructive sleep apnea. Anesthesiology, 108(5), 812-821.





By |2024-04-16T13:34:38-05:00April 17th, 2024|General|