Archive for Nicholas Veliotes

Orthopoxviruses, including smallpox, cowpox, and monkeypox

Orthopoxviruses, including smallpox, cowpox, and monkeypox, cause disease in both humans and other animals. 

Many people are familiar with smallpox, a disease caused by the variola virus that killed approximately 400 million people in the 20th century. 

The name “smallpox” originated as a description of the disease’s hallmark skin lesions, which were smaller than those of “great-pox”, or syphilis. 

Another orthopoxvirus, monkeypox, was first discovered in 1958. Despite its name, monkeypox can also be carried by rats, squirrels, and shrews, and these rodents may play a significant role in transmitting the disease to humans.

The first documented case of monkeypox in humans occurred in the Democratic Republic of the Congo in September 1970, when a 9-month-old child suspected of having smallpox was actually discovered to be infected with monkeypox instead. Monkeypox is endemic to Central Africa and West Africa, where cases likely spread from local wildlife species to humans. 

The Orthopoxviruses, including smallpox, cowpox, and monkeypox are similar to those of smallpox: after an asymptomatic incubation period of up to 3 weeks, infected patients develop fevers, headaches, swollen lymph nodes, and fatigue. These symptoms typically last 1-4 days and are then followed by the development of a rash and skin lesions. The rash typically affects the face and then spreads to the extremities, including the palms and soles. The skin lesions are distinctive in appearance and are hard, round, and typically appear to be in the same stage of development. While the skin lesions of monkeypox are hard to distinguish from those of smallpox, they are very different than the skin changes associated with varicella (chickenpox). Chickenpox infection is characterized by superficial skin lesions with irregular borders that are typically in different states of development. In addition, chickenpox skin lesions commonly affect the face and trunk (stomach, chest, and back), whereas smallpox and monkeypox skin lesions are most commonly found on the face and extremities (arms and legs).

Monkeypox is contagious and can easily spread from person to person through respiratory secretions or contact with skin lesions. Fecal transmission of monkeypox may also occur. Compared with smallpox, the mortality rate of monkeypox is relatively low (ranging from 0-11%, depending on the strain of the virus). Pregnant women, young children, and patients with weakened immune systems may be more likely to experience serious complications or death related to monkeypox infection. Complications of monkeypox infection include pneumonia, dehydration, and sepsis (blood poisoning). Scarring of scabbed skin lesions is the most common long-term complication after monkeypox infection. To prevent transmission of infection, isolation (either at home or in the hospital) is recommended for infected individuals until all skin lesions have resolved.

Sporadic outbreaks of monkeypox have occurred in the United States for years. In 2003, 71 cases of monkeypox were reported in the Midwestern United States among people who had close contact with animals that were imported into the United States from Ghana. Although there is no cure for monkeypox, previous vaccination against smallpox may provide protection against monkeypox infection. Unfortunately, the effectiveness of smallpox vaccination decreases over time, and it is unclear whether previously vaccinated individuals still have immunity against smallpox.

A newer smallpox vaccine (Jynneos®) that was approved by the United States Food and Drug Administration (FDA) in 2019 can also be used for prevention of monkeypox infection in adults 18 years of age and older. 

Antiviral drugs have also been studied as potential treatments for monkeypox.

Cidofovir, an antiviral drug used for the treatment of severe eye infections in patients with acquired immune deficiency syndrome (AIDS), is effective in treating primates affected by monkeypox, although human studies of its use in monkeypox are limited. Cidofovir is associated with significant toxic effects, including kidney damage which may be fatal and which can occur after administration of just one or two doses of the drug.

Vaccinia immune globulin (VIGIV) is an intravenous formulation of human plasma that contains antibodies to another orthopoxvirus called the vaccinia virus. The Centers for Disease Control and Prevention (CDC) states that VIGIV can be used to treat outbreaks of monkeypox virus, although there is no evidence it provides adequate treatment for monkeypox infection.

Tecovirimat (TPOXX®) is a newer antiviral drug that was approved by the FDA in 2018 as a treatment for human smallpox disease. Tecovirimat targets and inhibits a specific protein in orthopoxviruses that assists with cell-to-cell transmission and viral spread. Tecovirimat is available in capsule formulation for oral administration and can be used in both adults and children weighing at least 13 kilograms. The safety profile of tecovirimat is favorable, with headache, nausea, abdominal pain, and vomiting among the most common side effects after use of the drug. The CDC currently includes tecovirimat as a treatment option for outbreaks of orthopoxviruses, including monkeypox.

Vitamin D could reduce ovarian cancer

Vitamin D is a class of fat-soluble secosteroids that enhances intestinal absorption of calcium, magnesium, and phosphate, among other things.

Among all cancers, ovarian cancer has one of the highest mortality rates. This is due, in part, to the cancer’s ability to turn the body’s defenses against it. Vitamin D may be able to successfully block one of the major pathways used by this cancer.

Ovarian cancer often undergoes a process called peritoneal metastasis. Its cells go to a secondary implantation location, such as the peritoneal wall or diaphragm, throughout this process after detaching from their primary site in the ovary. The peritoneum protects itself against this process by forming a barrier of mesothelial cells that prevent cancer cells from adhering and spreading. 

Ovarian cancer circumvents this barrier, however, by converting the shielding mesothelial cells into cancer-associated mesothelial cells. By fostering an environment that promotes metastasis, the cancer’s ability to metastasize and spread throughout the body is improved.

Suppression of ovarian cancer is by the restoration of peritoneal mesothelial cells. Vitamin D not only hindered this process but also returned cancer-associated mesothelial cells to their initial state. This process improved the mesothelial cells’ capacity to act as barriers, limiting the spread of the cancer. Their research implies that adding vitamin D therapy to the treatment of ovarian cancer could be helpful.

The peritoneal environment can be restored to its normal state where it prevents the adhesion and growth of cancer cells.”

Vitamin D can do this because of the complicated way cancer spreads. Studies found that cancer cells secrete a protein called TGF-β1, which is associated with cell growth. This also increases the amount of protein, thrombospondin-1, through the TGF-β/Smad pathway. Thrombospondin-1 has long interested researchers of ovarian cancer because it is found in higher amounts in the later, more deadly stages of cancer. In ovarian cancer, thrombospondin-1 is a key protein that enhances the adhesion and proliferation of ovarian cancer cells to the peritoneum. As vitamin D disrupts the TGF-β/Smad pathway, it may prevent cancer. The administration of Vitamin D helps normalize the peritoneal environment. 

This suggests that the combination of Vitamin D and conventional remedies can enhance their therapeutic efficacy for ovarian cancer. This helps prevent the adhesion of cancer cells to the peritoneum, which may make it possible to prevent the recurrence of ovarian cancer.

The potential of a vitamin to combat a cancer that affects one in 75 women remains an exciting prospect, especially since it does so by restoring the natural defenses of the body. 

The creation of therapies using this research could offer new ways to combat the high death rate of ovarian cancer.

COVID-19 Update

COVID-19 affects different people in different ways. Most infected people will develop mild to moderate illness and recover without hospitalization.

Most common symptoms:




loss of taste or smell

Less common symptoms:

sore throat


aches and pains


a rash on skin, or discolouration of fingers or toes

red or irritated eyes

Insulin Resistance and Diabetes

Insulin acts like a key to let blood sugar into cells for use as energy.

Invisible changes in the body begin long before a person is diagnosed with type 2 diabetes. That’s both bad news (no symptoms mean you won’t know you have it) and good news (you can prevent or delay it if you’re at risk). One of the most important unseen changes? Insulin resistance.

Insulin, Blood Sugar, and Type 2 Diabetes

Insulin is a key player in developing type 2 diabetes. This vital hormone—you can’t survive without it—regulates blood sugar (glucose) in the body, a very complicated process. Here are the high points:

  • The food you eat is broken down into blood sugar.
  • Blood sugar enters your bloodstream, which signals the pancreas to release insulin.
  • Insulin helps blood sugar enter the body’s cells so it can be used for energy.
  • Insulin also signals the liver to store blood sugar for later use.
  • Blood sugar enters cells, and levels in the bloodstream decrease, signaling insulin to decrease too.
  • Lower insulin levels alert the liver to release stored blood sugar so energy is always available, even if you haven’t eaten for a while.

That’s when everything works smoothly. But this finely tuned system can quickly get out of whack, as follows:

  • lot of blood sugar enters the bloodstream.
  • The pancreas pumps out more insulin to get blood sugar into cells.
  • Over time, cells stop responding to all that insulin—they’ve become insulin resistant.
  • The pancreas keeps making more insulin to try to make cells respond.
  • Eventually, the pancreas can’t keep up, and blood sugar keeps rising.

Lots of blood sugar in the bloodstream is very damaging to the body and needs to be moved into cells as soon as possible. There’s lots of insulin, too, telling the liver and muscles to store blood sugar. When they’re full, the liver sends the excess blood sugar to fat cells to be stored as body fat. Yep, weight gain. And what’s more serious, the stage is set for prediabetes and type 2 diabetes.

Do You Have Insulin Resistance?

How do you find out if you’re insulin resistant? No one test will tell you, but if you have high blood sugar levels, high triglycerides (a kind of blood fat), high LDL (“bad”) cholesterol, and low HDL (“good”) cholesterol, your health care provider may determine you have insulin resistance.

Important note: Type 1 diabetes is different; it’s thought to be caused by an autoimmune reaction (the body attacks itself by mistake). People with type 1 diabetes don’t make enough insulin and need to take it to survive.

What Causes Insulin Resistance?

It isn’t clear exactly what causes insulin resistance, but a family history of type 2 diabetes, being overweight (especially around the waist), and being inactive all can raise the risk.

You do not have to be overweight to have insulin resistance. You can’t tell if someone has insulin resistance by looking at them.

How to Reverse Insulin Resistance

If you have insulin resistance, you want to become the opposite—more insulin sensitive (cells are more effective at absorbing blood sugar so less insulin is needed).

Physical activity makes you more sensitive to insulin, one reason why it’s a cornerstone of diabetes management (and good health in general!). Don’t wait until you’re diagnosed with diabetes to start moving more. The earlier you take action (literally), the better off you’ll be.

Weight loss is important too, as is avoiding high blood sugarreducing stress, and getting enough sleep (physical activity can help you get more zzz’s too).

These lifestyle changes really work. Talk with your health care provider about how to get started.

Boost your immune system

Strengthen your immune system and fight off disease

How can you improve your immune system? 

On the whole, your immune system does a remarkable job of defending you against disease-causing microorganisms. But sometimes it fails: A germ invades successfully and makes you sick. Is it possible to intervene in this process and boost your immune system? What if you improve your diet? Take certain vitamins or herbal preparations? Make other lifestyle changes in the hope of producing a near-perfect immune response?

What can you do to boost your immune system?

The idea of boosting your immunity is enticing, but the ability to do so has proved elusive for several reasons. The immune system is precisely that — a system, not a single entity. To function well, it requires balance and harmony. There is still much that researchers don’t know about the intricacies and interconnectedness of the immune response. For now, there are no scientifically proven direct links between lifestyle and enhanced immune function.

But that doesn’t mean the effects of lifestyle on the immune system aren’t intriguing and shouldn’t be studied. Researchers are exploring the effects of diet, exercise, age, psychological stress, and other factors on the immune response, both in animals and in humans. In the meantime, general healthy-living strategies make sense since they likely help immune function and they come with other proven health benefits.

Immunity in action

A healthy immune system can defeat invading pathogens as shown above, where two bacteria that cause gonorrhea are no match for the large phagocyte, called a neutrophil, that engulfs and kills them (see arrows).

Your first line of defense is to choose a healthy lifestyle. 

Following general good-health guidelines is the single best step you can take toward naturally keeping your immune system working properly. Every part of your body, including your immune system, functions better when protected from environmental assaults and bolstered by healthy-living strategies such as these:

Don’t smoke.

Eat a diet high in fruits and vegetables.

Exercise regularly.

Maintain a healthy weight.

If you drink alcohol, drink only in moderation.

Get adequate sleep.

Take steps to avoid infection, such as washing your hands frequently and cooking meats thoroughly.

Try to minimize stress.

Keep current with all recommended vaccines. Vaccines prime your immune system to fight off infections before they take hold in your body.

Increase immunity the healthy way

Many products on store shelves claim to boost or support immunity. But the concept of boosting immunity actually makes little sense scientifically. In fact, boosting the number of cells in your body — immune cells or others — is not necessarily a good thing. For example, athletes who engage in “blood doping” — pumping blood into their systems to boost their number of blood cells and enhance their performance — run the risk of strokes.

Attempting to boost the cells of your immune system is especially complicated because there are so many different kinds of cells in the immune system that respond to so many different microbes in so many ways. Which cells should you boost, and to what number? So far, scientists do not know the answer. What is known is that the body is continually generating immune cells. Certainly, it produces many more lymphocytes than it can possibly use. The extra cells remove themselves through a natural process of cell death called apoptosis — some before they see any action, some after the battle is won. No one knows how many cells or what the best mix of cells the immune system needs to function at its optimum level.

Immune system and age

As we age, our immune response capability becomes reduced, which in turn contributes to more infections and more cancer. As life expectancy in developed countries has increased, so too has the incidence of age-related conditions.

While some people age healthily, the conclusion of many studies is that, compared with younger people, the elderly are more likely to contract infectious diseases and, even more importantly, more likely to die from them. Respiratory infections, including, influenza, the COVID-19 virus and particularly pneumonia are a leading cause of death in people over 65 worldwide. No one knows for sure why this happens, but some scientists observe that this increased risk correlates with a decrease in T cells, possibly from the thymus atrophying with age and producing fewer T cells to fight off infection. Whether this decrease in thymus function explains the drop in T cells or whether other changes play a role is not fully understood. Others are interested in whether the bone marrow becomes less efficient at producing the stem cells that give rise to the cells of the immune system.

A reduction in immune response to infections has been demonstrated by older people’s response to vaccines. For example, studies of influenza vaccines have shown that for people over age 65, the vaccine is less effective compared to healthy children (over age 2). But despite the reduction in efficacy, vaccinations for influenza and S. pneumoniae have significantly lowered the rates of sickness and death in older people when compared with no vaccination.

There appears to be a connection between nutrition and immunity in the elderly. A form of malnutrition that is surprisingly common even in affluent countries is known as “micronutrient malnutrition.” Micronutrient malnutrition, in which a person is deficient in some essential vitamins and trace minerals that are obtained from or supplemented by diet, can happen in the elderly. Older people tend to eat less and often have less variety in their diets. One important question is whether dietary supplements may help older people maintain a healthier immune system. Older people should discuss this question with their doctor.

Diet and your immune system

Like any fighting force, the immune system army marches on its stomach. Healthy immune system warriors need good, regular nourishment. Scientists have long recognized that people who live in poverty and are malnourished are more vulnerable to infectious diseases. For example, researchers don’t know whether any particular dietary factors, such as processed foods or high simple sugar intake, will have adversely affect immune function. There are still relatively few studies of the effects of nutrition on the immune system of humans.

There is some evidence that various micronutrient deficiencies — for example, deficiencies of zinc, selenium, iron, copper, folic acid, and vitamins A, B6, C, and E — alter immune responses in animals, as measured in the test tube. However, the impact of these immune system changes on the health of animals is less clear, and the effect of similar deficiencies on the human immune response has yet to be assessed.

So, what can you do? If you suspect your diet is not providing you with all your micronutrient needs — maybe, for instance, you don’t like vegetables — taking a daily multivitamin and mineral supplement may bring other health benefits, beyond any possibly beneficial effects on the immune system. Taking megadoses of a single vitamin does not. More is not necessarily better.

Improve immunity with herbs and supplements?

Walk into a store, and you will find bottles of pills and herbal preparations that claim to “support immunity” or otherwise boost the health of your immune system. Although some preparations have been found to alter some components of immune function, thus far there is no evidence that they actually bolster immunity to the point where you are better protected against infection and disease. Demonstrating whether an herb — or any substance, for that matter — can enhance immunity is, as yet, a highly complicated matter. Scientists don’t know, for example, whether an herb that seems to raise the levels of antibodies in the blood is actually doing anything beneficial for overall immunity.

Stress and immune function

Modern medicine has come to appreciate the closely linked relationship of mind and body. A wide variety of maladies, including stomach upset, hives, and even heart disease, are linked to the effects of emotional stress. Despite the challenges, scientists are actively studying the relationship between stress and immune function.

For one thing, stress is difficult to define. What may appear to be a stressful situation for one person is not for another. When people are exposed to situations they regard as stressful, it is difficult for them to measure how much stress they feel, and difficult for the scientist to know if a person’s subjective impression of the amount of stress is accurate. The scientist can only measure things that may reflect stress, such as the number of times the heart beats each minute, but such measures also may reflect other factors.

Most scientists studying the relationship of stress and immune function, however, do not study a sudden, short-lived stressor; rather, they try to study more constant and frequent stressors known as chronic stress, such as that caused by relationships with family, friends, and co-workers, or sustained challenges to perform well at one’s work. Some scientists are investigating whether ongoing stress takes a toll on the immune system.

But it is hard to perform what scientists call “controlled experiments” in human beings. In a controlled experiment, the scientist can change one and only one factor, such as the amount of a particular chemical, and then measure the effect of that change on some other measurable phenomenon, such as the amount of antibodies produced by a particular type of immune system cell when it is exposed to the chemical. In a living animal, and especially in a human being, that kind of control is just not possible, since there are so many other things happening to the animal or person at the time that measurements are being taken.

Despite these inevitable difficulties in measuring the relationship of stress to immunity, scientists are making progress.

Does being cold give you a weak immune system?

Almost every mother has said it: “Wear a jacket or you’ll catch a cold!” Is she right? Probably not, exposure to moderate cold temperatures doesn’t increase your susceptibility to infection. There are two reasons why winter is “cold and flu season.” In the winter, people spend more time indoors, in closer contact with other people who can pass on their germs. Also the influenza virus stays airborne longer when air is cold and less humid.

But researchers remain interested in this question in different populations. Some experiments with mice suggest that cold exposure might reduce the ability to cope with infection. But what about humans? Scientists have performed experiments in which volunteers were briefly dunked in cold water or spent short periods of time naked in subfreezing temperatures.  They’ve studied people who lived in Antarctica and those on expeditions in the Canadian Rockies. The results have been mixed. For example, researchers documented an increase in upper respiratory infections in competitive cross-country skiers who exercise vigorously in the cold, but whether these infections are due to the cold or other factors — such as the intense exercise or the dryness of the air — is not known.

A group of Canadian researchers that has reviewed hundreds of medical studies on the subject and conducted some of its own research concludes that there’s no need to worry about moderate cold exposure — it has no detrimental effect on the human immune system. Should you bundle up when it’s cold outside? The answer is “yes” if you’re uncomfortable, or if you’re going to be outdoors for an extended period where such problems as frostbite and hypothermia are a risk. But don’t worry about immunity.

Exercise: Good or bad for immunity?

Regular exercise is one of the pillars of healthy living. It improves cardiovascular health, lowers blood pressure, helps control body weight, and protects against a variety of diseases. But does it help to boost your immune system naturally and keep it healthy? Just like a healthy diet, exercise can contribute to general good health and therefore to a healthy immune system.

Graves Disease, Thyroid Eye Disease, and COVID-19

COVID-19 has caused disease in close to 500 million people worldwide, according to the World Health Organization. While the airways are its primary target, SARS-CoV-2 may enter many organs via the protein angiotensin-converting enzyme 2 (ACE-2).  ACE-2 is highly expressed in thyroid cells, and COVID-19 has been reported to cause thyroid dysfunction both during and after infection with SARS-CoV-2. COVID-19–related autoimmune thyroid manifestations include Graves’ disease and thyroid eye disease (TED), although COVID-19 can lead to multiple other thyroid dysfunctions.

Presentation of patients with new TED to a prominent chain of Indian eye hospitals had increased 25% during the first 2 years of the COVID-19 pandemic.

This observation poses enticing questions

Is there a link between COVID-19, thyroid autoimmunity, and its complications (including TED)? 

Could COVID-19 vaccination and thyroid autoimmunity be connected? 

Might these observations be influenced by COVID-19 public health measures and delays in seeking healthcare? 

Or are these findings purely coincidental and unrelated to the COVID-19 pandemic?

Understanding Graves Disease and TED

To address these questions, we must review our understanding of how Graves disease and TED occur. Graves disease is an autoimmune disorder of the thyroid caused by stimulatory thyroid-stimulating hormone receptor antibodies, leading to hyperthyroidism.

Graves disease is the most common cause of hyperthyroidism and affects > 1% of the US population.

TED is the most common complication of Graves disease that occurs outside of the thyroid gland. TED causes a variety of eye signs and symptoms that can negatively affect patients’ quality of life, be disfiguring, and in rare cases threaten vision.

The exact events that trigger thyroid autoimmunity are not known; however, we believe a complex interplay between genetic and environmental factors occur, including:

Genetics: Genes with polymorphisms predisposing to Graves disease include human leukocyte antigens (HLA), particularly class II genes for HLA-DR; TSHR; CLTA-4; CD40; and PTPN22.

Age: Graves disease has a low incidence in childhood, rising thereafter until the age of approximately 50 years, after which the incidence plateaus or decreases slightly.

Sex: Women have an approximately five times higher risk for Graves disease than men.

Race: Black persons and possibly Asian persons/Pacific Islanders have higher rates of Graves disease, at least in the United States.

Cigarette smoking: Cigarette smoking is a clear environmental risk factor for the development of Graves disease and TED.

Two other possible triggers for Graves disease are stress and infection.

Stress and Graves Disease. Stress has been implicated as a trigger of Graves. Other autoimmune diseases have also been suggested to have increased risk after stressful events. 

One theory of how stress could cause Graves disease in susceptible people is by releasing hormones, including catecholamines and cortisol, that shift the immune response toward antibody production that is pathognomonic of Graves disease. 

Psychological stress imposed by a global pandemic is therefore a potential (although unproven) trigger for Graves disease and TED.

Infection and Graves diseaseInfection with such bacteria as Yersinia enterocolitica and Helicobacter pyloriand by viruses including parvovirus, Epstein-Barr virus, and hepatitis C virushave also been proposed to cause Graves disease.

One hypothesis for this link is that the hyperinflammatory disease state associated with COVID-19 triggers a series of immune responses in genetically susceptible individuals, leading to activation (or reactivation) of Graves disease and TED. 

Most cases have occurred in middle-aged women, the prime demographic for developing Graves disease. 

The smoking status of these individuals has not been reported.

Reactions Induced by Adjuvants?

Thyroid autoimmune phenomena have been reported after both inactivated and messenger RNA COVID-19.

Graves disease and/or TED have been reported to occur days to weeks after receipt of either a first or second dose of vaccine. Investigators have questioned whether these reactions may represent an autoimmune/inflammatory syndrome induced by adjuvants (ASIA). 

Adjuvants in vaccines are used to enhance the immune response using a reduced amount of antigen, thus creating an extended and lasting immune response. 

Potential mechanisms by which adjuvants disrupt the ‘immunologic balance’ of the host include molecular mimicry (similarities between foreign and self-antigens), excessive cytokine production (promoting inflammation), and defective immune regulation (by regulatory T cells). Association does not necessarily imply causation. Given the sheer number of people being diagnosed with COVID-19 worldwide every day, it is inevitable that some patients seeking medical attention for respiratory symptoms (or other COVID-19 complications) may have preexisting Graves disease and/or TED.

Reassuringly, cases of postvaccination ASIA leading to thyroid autoimmunity appear to be exceedingly rare, although there is potential for underreporting of cases or a lack of awareness among clinicians.

COVID-19 restrictions, lockdowns, and stay-at-home orders have also led to delayed healthcare-seeking behavior. 

“This has been observed across a spectrum of disease, including medical emergencies (eg, acute coronary syndrome), and surgical emergencies (eg, acute appendicitis), and in cancer care. “

Abnormal thyroid function is associated with more severe TED. 

Any delays in diagnosis of Graves disease and timely commencement of antithyroid therapy will undoubtedly contribute to more severe disease at presentation.

COVID-19 has presented the world with many challenges, not least in deciphering causation from association. 

However, the pandemic also presents opportunities for us to ask questions and then learn more about disease processes in many organs. 

The anecdotal data from India regarding recent TED presentations is one such example. 

With additional high-quality data, we will be able to definitively address the roles of stress, infection, possibly vaccination, and behavioral adaptations to the public health responses in the development.


A.  Foods cause inflammation 
























10 ALCOHOL >7d/w


























B. Foods to reduce inflammation




























EGGS omega3








Kidney Stones


If your doctor suspects that you have a kidney stone, you may have diagnostic tests and procedures, such as:

  • Blood testing. Blood tests may reveal too much calcium or uric acid in your blood. Blood test results help monitor the health of your kidneys and may lead your doctor to check for other medical conditions.
  • Urine testing. The 24-hour urine collection test may show that you’re excreting too many stone-forming minerals or too few stone-preventing substances. For this test, your doctor may request that you perform two urine collections over two consecutive days.
  • Imaging. Imaging tests may show kidney stones in your urinary tract. High-speed or dual energy computerized tomography (CT) may reveal even tiny stones. Simple abdominal X-rays are used less frequently because this kind of imaging test can miss small kidney stones.

Ultrasound, a noninvasive test that is quick and easy to perform, is another imaging option to diagnose kidney stones.

  • Analysis of passed stones. You may be asked to urinate through a strainer to catch stones that you pass. Lab analysis will reveal the makeup of your kidney stones. Your doctor uses this information to determine what’s causing your kidney stones and to form a plan to prevent more kidney stones.


Treatment for kidney stones varies, depending on the type of stone and the cause.

Small stones with minimal symptoms

Most small kidney stones won’t require invasive treatment. You may be able to pass a small stone by:

  • Drinking water. Drinking as much as 2 to 3 quarts (1.8 to 3.6 liters) a day will keep your urine dilute and may prevent stones from forming. Unless your doctor tells you otherwise, drink enough fluid — ideally mostly water — to produce clear or nearly clear urine.
    • Pain relievers. Passing a small stone can cause some discomfort. To relieve mild pain, your doctor may recommend pain relievers such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
    • Medical therapy. Your doctor may give you a medication to help pass your kidney stone. This type of medication, known as an alpha blocker, relaxes the muscles in your ureter, helping you pass the kidney stone more quickly and with less pain. Examples of alpha blockers include tamsulosin (Flomax) and the drug combination dutasteride and tamsulosin (Jalyn).

Large stones and those that cause symptoms

Kidney stones that are too large to pass on their own or cause bleeding, kidney damage or ongoing urinary tract infections may require more-extensive treatment. Procedures may include:

  • Using sound waves to break up stones. For certain kidney stones — depending on size and location — your doctor may recommend a procedure called extracorporeal shock wave lithotripsy (ESWL).

ESWL uses sound waves to create strong vibrations (shock waves) that break the stones into tiny pieces that can be passed in your urine. The procedure lasts about 45 to 60 minutes and can cause moderate pain, so you may be under sedation or light anesthesia to make you comfortable.

ESWL can cause blood in the urine, bruising on the back or abdomen, bleeding around the kidney and other adjacent organs, and discomfort as the stone fragments pass through the urinary tract.

  • Surgery to remove very large stones in the kidney. A procedure called percutaneous nephrolithotomy (nef-row-lih-THOT-uh-me) involves surgically removing a kidney stone using small telescopes and instruments inserted through a small incision in your back.

You will receive general anesthesia during the surgery and be in the hospital for one to two days while you recover. Your doctor may recommend this surgery if ESWL is unsuccessful.

  • Using a scope to remove stones. To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube (ureteroscope) equipped with a camera through your urethra and bladder to your ureter.

Once the stone is located, special tools can snare the stone or break it into pieces that will pass in your urine. Your doctor may then place a small tube (stent) in the ureter to relieve swelling and promote healing. You may need general or local anesthesia during this procedure.

  • Parathyroid gland surgery. Some calcium phosphate stones are caused by overactive parathyroid glands, which are located on the four corners of your thyroid gland, just below your Adam’s apple. When these glands produce too much parathyroid hormone (hyperparathyroidism), your calcium levels can become too high and kidney stones may form as a result.

Hyperparathyroidism sometimes occurs when a small, benign tumor forms in one of your parathyroid glands or you develop another condition that leads these glands to produce more parathyroid hormone. Removing the growth from the gland stops the formation of kidney stones. Or your doctor may recommend treatment of the condition that’s causing your parathyroid gland to overproduce the hormone.


Prevention of kidney stones may include a combination of lifestyle changes and medications.

Lifestyle changes

You may reduce your risk of kidney stones if you:

  • Drink water throughout the day. For people with a history of kidney stones, doctors usually recommend drinking enough fluids to pass about 2.1 quarts (2 liters) of urine a day. Your doctor may ask that you measure your urine output to make sure that you’re drinking enough water.

If you live in a hot, dry climate or you exercise frequently, you may need to drink even more water to produce enough urine. If your urine is light and clear, you’re likely drinking enough water.

  • Eat fewer oxalate-rich foods. If you tend to form calcium oxalate stones, your doctor may recommend restricting foods rich in oxalates. These include rhubarb, beets, okra, spinach, Swiss chard, sweet potatoes, nuts, tea, chocolate, black pepper and soy products.
  • Choose a diet low in salt and animal protein. Reduce the amount of salt you eat and choose nonanimal protein sources, such as legumes. Consider using a salt substitute, such as Mrs. Dash.
  • Continue eating calcium-rich foods, but use caution with calcium supplements.Calcium in food doesn’t have an effect on your risk of kidney stones. Continue eating calcium-rich foods unless your doctor advises otherwise.

Ask your doctor before taking calcium supplements, as these have been linked to increased risk of kidney stones. You may reduce the risk by taking supplements with meals. Diets low in calcium can increase kidney stone formation in some people.

Ask your doctor for a referral to a dietitian who can help you develop an eating plan that reduces your risk of kidney stones.


Medications can control the amount of minerals and salts in the urine and may be helpful in people who form certain kinds of stones. The type of medication your doctor prescribes will depend on the kind of kidney stones you have. Here are some examples:

  • Calcium stones. To help prevent calcium stones from forming, your doctor may prescribe a thiazide diuretic or a phosphate-containing preparation.
  • Uric acid stones. Your doctor may prescribe allopurinol (Zyloprim, Aloprim) to reduce uric acid levels in your blood and urine and a medicine to keep your urine alkaline. In some cases, allopurinol and an alkalizing agent may dissolve the uric acid stones.
  • Struvite stones. To prevent struvite stones, your doctor may recommend strategies to keep your urine free of bacteria that cause infection, including drinking fluids to maintain good urine flow and frequent voiding. In rare cases long-term use of antibiotics in small or intermittent doses may help achieve this goal. For instance, your doctor may recommend an antibiotic before and for a while after surgery to treat your kidney stones.
  • Cystine stones. Along with suggesting a diet lower in salt and protein, your doctor may recommend that you drink more fluids so that you produce a lot more urine,. If that alone doesn’t help, your doctor may also prescribe a medication that increases the solubility of cystine in your urine.

Foods High In Antioxidants

There’s a huge variety of foods that eliminate cancer-causing free radicals and lead to better health. Antioxidants remove free radicals from the body which can run rampant and actually damage cells, causing serious illness. Many health professionals use them for treatments of stroke and neurodegenerative diseases, such as Alzheimer’s and Parkinson’s. They have also been helpful in treating brain injury and may slow and even prevent development of cancers.

There are numerous choices for antioxidant-rich foods: small red beans, wild blueberries, pinto beans, cultivated blueberries, cranberries, artichokes, blackberries, prunes, raspberries, strawberries, red delicious apples, Granny Smith apples, pecans, sweet cherries, black plums, russet potatoes, black beans, plums, gala apples, dark leafy greens.

Don’t like any foods on the list? Not to worry. The American Dietetic Association has jumped on the band wagon with their comprehensive guide to foods highest in antioxidants arranged by food groups:


Many fruits are high in antioxidants, packed with vitamins, and beneficial in a myriad of ways. These include cranberries, red grapes, peaches, raspberries, strawberries, red currants, figs, cherries, pears, guava, oranges, apricots, mango, red grapes, cantaloupe, watermelon, papaya, and tomatoes.

Dried Fruits

With the water removed, the antioxidant ratio is higher in dried fruits than in fresh. They can easily be carried with you in your purse, briefcase or car and they make a quick healthy snack. Consider taking along dried pears, plums, apples, peaches, figs, dates and raisins. However, be careful of sugar content; avoid dried fruits that have processed sugars added to them to make them sweeter.


Didn’t your mother always tell you to eat your vegetables? Broccoli, spinach, carrots and potatoes are all high in antioxidants, and so are artichokes, cabbage, asparagus, avocados, beetroot, radish, lettuce, sweet potatoes, squash, pumpkin, collard greens and kale.

Spices and Herbs

Using lots of spices in cooking is good. Many are loaded with antioxidants, like cinnamon, oregano, turmeric, cumin, parsley, basil, curry powder, mustard seed, ginger, pepper, chili powder, paprika, garlic, coriander, onion and cardamom. Herbs include sage, thyme, marjoram, tarragon, peppermint, oregano, savory, basil and dill weed. All contribute complexity and flavor to your meals, but also are high in antioxidants.

Cereals and Nuts

Your morning corn flakes, oatmeal and granola bars pack a healthy punch, as do walnuts, hazelnuts, pistachio nuts, almonds, cashews, macadamia nuts and even that peanut butter sandwich.


Contrary to popular belief, most of our antioxidants come from beverages. Apple juice, cider, tomato juice, pomegranate juice and pink grapefruit juice seem obvious, and green tea has become very popular as a source, but black tea and plain tea have high levels also. Here’s good news for those who love that cup of joe in the morning: coffee is high but should be consumed in moderation. Note that adding milk to coffee or tea blocks antioxidants. Speaking of moderation, red wine and especially beer (since it comes from grains) provide a big dose, and the healthy effects of moderate alcohol consumption have been well documented.

“Eat a variety of fruits and vegetables in a myriad of colors. Don’t just focus on the top 2 or 3 choices. Foods with darker, richer colors like orange, yellow, blue, and red tend to be higher in antioxidants, and with all these choices, you’ll never become bored or run out of delicious, nutritious options. Variety is the spice of life.”

The Mediterranean-style diet offers a lot of health benefits

A distinct version of the Mediterranean diet is followed on the Blue Zone island of Ikaria, Greece. It emphasizes olive oil, vegetables, beans, fruit, moderate amounts of alcohol and low quantities of meat and dairy products.

Consume Fish in Abundance

Seafood fans will rejoice over a diet that recommends a minimum of 2 to 3 servings of fish each week! The benefits are right there in the filet. It’s a fact that most fish—including fresh salmon, mackerel, herring, blue and albacore tuna, sardines, and even anchovies—is a rich source of omega-3 healthy fats.

While the Mediterranean diet puts more of an emphasis on fatty fish like salmon, sardines, and mackerel, Eating Well says lean fish like cod and tilapia are still viable options. If you’re not used to eating a lot of fish, no worries. Aim for at least one fish night a week. There are tons of easy, no fuss, no mess ways to cook fish. If you don’t like eating it on its own, you can always incorporate it into other foods like a soup, salad, taco, or stir-fry.

Pour on the Olive Oil

Sure, the Mediterranean diet allows fats—if they come from heart-healthy olive oil rather than from artery-clogging saturated fats from butters, margarines, red meat, and cheese. Instead of cooking with vegetable or coconut oil, the Mediterranean diet has people using olive oil or extra-virgin olive oil.

According to Eating Well, olive oil is “rich in monounsaturated fatty acids which may improve HDL cholesterol, the ‘good’ type of cholesterol.” The best ways to incorporate olive oil into your diet is with salad dressings and vinaigrettes. You can drizzle it on dishes like chicken and fish to boost the flavour or simply swap it out in recipes of mashed potatoes, pasta, etc.

Be Moderate with Dairy

Low fat dairy products can be very healthy on a limited basis. That’s why the Greeks dismiss most high fat cheeses and cream sauces from the table in favor of Greek yogurt, which they consume in small quantities at breakfast or for snacks (i.e., tzatziki).

The problem with non-fat and low-fat dairy is that it tends to have sugar in it which is how it’s able to taste as good as those full-fat products that it’s competing with. Sydney Greene, MS, RD, talked to Eat This, Not That! and said the best thing to do is limit dairy intake to only a few times a week and choose plan, full-fat options that contain gut-friendly probiotics. “A whole-milk Greek yogurt will keep you more full than 0 percent yogurt, so you will be less likely to snack on less healthy options. Not a fan of plain yogurts? Flavor them with cinnamon or vanilla bean powder.”

Avoid Anything Processed

We’ve already established that the Mediterranean diet focuses on fresh, local, whole foods, which means anything packaged, canned, or boxed is avoided due to excess sodium, sugar, fats, and artificial additives that really do more harm than good to our bodies.

Only Healthy Whole Grains

Sure, pasta, bread, and rice can be part of your Mediterranean diet experience, as long you eat the kind that’s made using whole grains—and not the kind that’s manufactured using bleached, processed flour. Refined carbs are terrible for blood sugar, which is why the Mediterranean diet has people opting for whole grains.

Aim for about four small daily portions of whole-wheat bread, pasta or quinoa. The same source encourages eating these whole grains with some healthy fats and a protein. When it comes to eating pasta, using either whole grain pasta or legume-based noodles made out of black beans, lentils and chickpeas.

Shun Sugar

One of the most difficult parts of the Mediterranean diet is cutting out sugar. Suddenly, everything from your favorite cookie to your bar of chocolate of choice will be off limits. Focus on whole, natural sugars from sources like fresh fruit, fruit salads, and honey.

Cheers to Wine

Drinking wine, in moderation, is a big part of the Mediterranean diet. However, keep in mind that this is not an open invitation to over-imbibe. The Greeks consume only 1 to 2 glasses of wine per day, and typically only with meals. Women should only have a three-ounce serving of wine a day and men a 5-ounce serving per day.

Enjoy Regular Activities

The lifestyle portion of the Mediterranean diet focuses on a favorite physical active every day. It doesn’t matter what the activity is — biking, walking, gardening, yoga, running, or swimming — the idea is to enjoy working and moving every day.

Pass on Red Meat

If your diet consists mainly of unhealthy animal fats (i.e., beef, lamb, and pork); you’re bound to end up with high cholesterol, weight gain, and heart issues down the road. That’s why the Mediterranean diet allows small portions of lean, red meat purely in moderation. Instead, stick to white meats like fish, chicken, turkey, and seafood for lower fat, healthier meat protein sources in your meals.

Healthy Fats

Most people hear the word ‘fat’ and run in the other direction! While it’s true we don’t want to eat fatty foods, but there is such thing as healthy fats and the Mediterranean diet encourages people to make smart choices about the fats they eat. Stay away from saturated fats and hydrogenated oils (trans fats) which contribute to heart disease, and eat more monounsaturated and polyunsaturated fats which can reduce LDL cholesterol levels.

Eat more healthy fats like extra virgin olive oil, olives, avocados, and avocado oil. The Mediterranean diet also encourages eating more foods with omega-3 fatty acids which can help “lower triglycerides, decrease blood clotting, are associated with decreased sudden heart attack, improve the health of your blood vessels, and help moderate blood pressure,” writes Mayo Clinic. Since the Mediterranean diet eats lots of fish, we can’t forget those fatty fish, says Mayo Clinic, like mackerel, lake trout, herring, sardines, albacore tuna and salmon, which are all rich in omega-3 fatty acids.

Eat Lots of Fruits and Vegetables

The main components of a Mediterranean diet includings fruits, vegetables, pasta and rice. While lots of pasta and rice aren’t necessarily healthy, the majority of their diet is actually fruits and vegetables which as we all know are the best foods for us. The Mayo Clinic points out that people who live by this diet, primarily Greek residents, tend to eat meals with very little red meat and an average of 9 servings of antioxidant-rich fruits and vegetables a day! So if you’re planning on trying this diet in 2019, you’ve been forewarned that you’ll be eating lots of fruits and veggies!

Healthline suggests loading up on more tomatoes, broccoli, kale, spinach, onions, cauliflower, carrots, Brussels sprouts, and cucumbers. When it comes to fruits, try eating more apples, bananas, oranges, pears, strawberries, grapes, dates, figs, melons and peaches.

Drink Lots of Water

Possibly one of the biggest selling points about trying the Mediterranean diet is the ability to drink red wine (in moderation!), but what’s more important on this diet is drinking lots and lots of water. You may also drink coffee and tea, but do not indulge in any sugar sweeteners or beverages that are high in sugar like fruit juice and soda.

Eat More Nuts and Seeds

Usually we’re told to be cautious with nuts because they are high in fat, but they also have some awesome health benefits. The fat that they do contain is not saturated, says the Mayo Clinic, and the Mediterranean diet encourages people to eat more healthy unsaturated fats. Healthline suggests incorporating more almonds, walnuts, macadamia nuts, hazelnuts, cashews, sunflower seeds, and pumpkin seeds. Even though nuts and seeds are an important part of the Mediterranean diet, do not eat them in excess because they are high in calories. No more than a handful a day, says Mayo Clinic.

You can also add some extra flavor to meals by eating more herbs and spices like garlic, basil, mint, rosemary, sage, nutmeg, cinnamon, and pepper.

It’s Not About Counting Calories

Most people don’t like diets because they tend to focus a lot on counting calories, food points, food diaries, all that nonsense. The nice thing about the Mediterranean diet is that people who are on it don’t have to count their calories or feel like they are starving themselves. It’s more about making healthier choices than it is about limiting food. People who are on this diet are required to eat more plant-based foods and healthy fats and less processed foods which seems simple enough, and quite frankly, makes the most sense!

Another thing that is important about this diet and a good thing to keep in mind while on it is that it’s not a fad diet, it’s a lifestyle. This is a diet that could be maintained long term. “First, to set fears aside, the Mediterranean diet is not a ‘diet’ in the sense that its purpose is not to help you lose weight. Rather, it’s a style of eating that emphasizes a well-balanced eating plan,” says NYC-based registered dietitian, Natalie Rizzo, MS, RD to Eat This, Not That. It’s not about restricting a person’s diet. It’s more about living a healthier lifestyle.

The European lifestyle is known to promote good health, and it seems like a good portion of Europeans having lean bodies that can make you green with envy. Like many other European diets, the Mediterranean-style diet offers a lot of health benefits, and is worth considering incorporating into your own diet. What makes the diet so healthy is a combination of things, from fresh produce to olive oil and specific meats. When combined with the fact that Europeans tend to get regular exercise from walking pretty much everywhere, you have a complete healthy lifestyle that if mimicked, could leave you with lower risk of many serious health conditions and better overall health.

1. Lower Risk of Heart Disease

A main ingredient in Mediterranean cooking and flavoring is olive oil. Olive oil contains monounsaturated fats, which is a good component for a healthy heart. On the other hand, consuming foods high in saturated fats contribute to heart disease. Many Mediterranean dishes are cooked using oil instead of butter, and sauces and dressings include olive oil as one of the main ingredients.

Mix in different types of balsamic vinegars—whatever flavors you like—with oil, and you have a healthy salad dressing. There’s no need to buy pre-made salad dressings full of unnecessary fats when you can create a simple and easy healthy dressing with only a couple ingredients. Plus, the fresher the better, and a bit of extra virgin olive oil and balsamic vinegar makes a tasty salad topper.

2. Lower Risk of Diabetes

Olive oil has many health benefits. Since Mediterranean-style diets use olive oil in a number of ways, you’re likely to benefit from it if you follow the diet. Research studies have shown that olive oil, and specifically the Mediterranean diet, could help lower the risk of developing type 2 diabetes.

Researchers believe the high amount of rich minerals and phytochemicals found in a Mediterranean-style diet can reduce inflammation and insulin resistance. Your body needs to successfully break down sugars. If it can’t do this properly, you can be at increased risk of type 2 diabetes.

3. Prevent High Blood Pressure

What you eat directly impacts your blood pressure, and the Mediterranean diet has food that can lower your blood pressure. On top of this, the diet consists of healthy foods that won’t increase your blood pressure either. Genetics can play a role in whether or not you have high blood pressure, but an unhealthy diet containing lots of fat and salt can also greatly increase it.

With next to no processed foods in the Mediterranean-style diet, you won’t be consuming unnecessary sodium that will raise and keep your blood pressure up. High blood pressure can lead to hypertension and other cardiovascular diseases, so this diet could help prevent these serious health risks.

4. Prevent Fatty Liver Disease

Many North Americans follow a diet full of processed foods that contain unnecessary fats, sugar, calories, and sodium. When following an unhealthy diet like this, there’s a greater risk of developing obesity, a main cause of fatty liver disease. The amount of olive oil in the Mediterranean diet helps rid a lot of saturated fats from your diet, which can help reduce the risk of fatty liver disease.

The diet also doesn’t include much red meat, since it’s full of saturated fats. Instead, chicken and mineral-rich fish are the meats of choice. And what and how much you eat of something that’s hard for your liver to process (like red meat) can lead to other liver diseases.

5. Potentially Longer Lifespan

Some studies link a longer lifespan to the Mediterranean-style diet. The diet can also reduce the risk of cardiovascular disease, which could ultimately contribute to people living longer lives. So start eating more fresh produce, nuts, seeds and olive oil to reap the health benefits, including the potential to live longer and lower your chance of heart problems.

While it would obviously be ideal to start this diet when you’re young and follow it throughout your life, research has shown that it can still positively affect those who are later in life. In fact, one study focused solely on people considered high risk for heart disease experienced a lower risk when they changed to the Mediterranean diet.

6. Improved Brain Function

Research suggests there is a correlation between the foods found in the Mediterranean-style and improved brain function, as well as a lower rate of mental health decline. As you age, your cognitive function declines, sometimes leading to serious conditions like Alzheimer’s disease or dementia.

It’s also normal for slight memory loss and confusion to occur when you’re older that is not considered a symptom of a cognitive disease. The Mediterranean diet could help you stay intellectually spry as you age, so you can enjoy life to its fullest and potentially slow down the natural effects of aging.

7. Lower Risk of Cancer

On top of all the other serious conditions and diseases that the Mediterranean diet can help lower the risk of, it’s also been linked to reducing the risk of developing and dying from certain cancers. Eating a lot of fruits and vegetables is a main component of the diet, which is one of the reasons it may lower your risk of cancer—many fruits and veggies are rich in antioxidants.

Antioxidants are known to be anti-carcinogens. The nuts and oils prevalent in the Mediterranean diet also play a role in reducing inflammation and insulin, which could be a deterrent for development of some types of cancer.

8. Reduced Preservatives and Chemicals

The Mediterranean diet is full of fresh produce—vegetables, fruit, meat directly from the butcher and fish right from the ocean. This ensures you aren’t eating pre-made and processed foods that usually contain a lot of chemicals and preservatives that just aren’t good for anyone.

If you look at something as common as a box of frozen chicken, the ingredient list is usually several lines long—you aren’t just eating chicken. Pre-made foods put a lot of potentially harmful ingredients into your system, as well as extra sodium, fat, sugar and calories. By following the Mediterranean-style diet, you’ll avoid these ingredients that can be harmful to your health.

9. Increased Antioxidant Consumption

Antioxidants are all the craze right now. List after list of superfoods contain items that are high in antioxidants. They’ve been linked to reducing the risk of certain cancers but the benefits don’t stop there—they have natural anti-inflammatory properties, and may help prevent heart disease, lower the risk of developing diabetes, give the immune system a boost, and have anti-aging effects.

Healthy Foods High in Antioxidants

  • Dark Chocolate.
  • Pecans.
  • Blueberries.
  • Strawberries.
  • Artichokes.
  • Goji Berries.
  • Raspberries.
  • Kale.

That’s a big list of potential benefits, and all you have to do is eat more fresh fruits and vegetables. Try different kinds and things you’ve never had before. There’s no reason you can’t explore new foods!

10. Reduced Chance of Parkinson’s Disease

There’s some controversy about whether or not a Mediterranean-style diet could reduce your chance of developing Parkinson’s disease, but there are enough scientists out that believe there is a connection that it’s worth considering.