I’ve simplified my supplements this year and now only take vitamin D and fish oil. Both of these made the news again last week, and both stories reinforced my belief that they both are uniquely powerful supplements for almost anyone, at any age.

In last week’s weekly radio interview with Paul James, we first discuss a Xinhuanet article about vitamin D and diabetes. They discuss a new study in obese children which showed that obese children with lower vitamin D levels had higher degrees of insulin resistance:

…”Although our study cannot prove causation, it does suggest that low vitamin D levels may play a role in the development of type 2 diabetes.”…”Poor dietary habits such as skipping breakfast and increased soda and juice intake were associated with the lower vitamin D levels seen in obese children,”…

It’s not a terrific study as the connection may be chicken-and-egg; in other words, is low vitamin D leading to diabetes, or is it just a marker of people that have diabetes? Stay tuned for more research, but in the meantime, I’ve always been a big fan of vitamin D, and kids are supposed to be taking supplements anyway (it’s the official position of the AAP). I and other docs at BJU have also found quite a few Beijingers with low blood levels of vitamin D, at all times of the year.

We also discuss yet another Xinhuanet story discussing a powerful research study of one of fatty fish’s major ingredients, omega-3 fatty acids. This study specifically looked at healthy younger women (50,000 Danish women), and found an astonishing 50% increase in heart disease in the women who ate zero fish when compared to those who ate the most fish. In other words, even for healthy young people at any age with no previous heart troubles, eating fatty fish can still lower your risk of heart attacks and strokes by a major amount. Powerful stuff, and certainly not the first study to show this dose-dependent cardioprotective effect:

“To our knowledge this is the first study of this size to focus exclusively on women of childbearing age,” said Marin Strom, lead researcher and post doctoral fellow at the Center for Fetal Programming, at Statens Serum Institute in Copenhagen, Denmark. ” We saw a strong association with cardiovascular disease in the women who were still in their late 30′s.”

The most common fish consumed by women in the study were cod, salmon, herring, and mackerel.

“Our study shows that for younger women, eating fish is very important for overall health, and even though we found cardio- protective effects at relatively modest dietary levels, higher levels may yield additional benefits,” Strom said.

More Podcast Information

You can always listen live to my radio interview each Wednesday around 7:35am Beijing time, on the Beijing Hour program on EZFM 91.5, which is broadcast from 7-8am every weekday by host Paul James. EZFM is the popular bilingual radio station on the China Radio International network, broadcasting here in Beijing and on multiple stations all over the world, as well as live online here.

You can listen to all my previous podcasts at the podcast archive.

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OK, let’s get the really bad news out of the way first: a major study this week which followed 39,000 women over 19 years showed that not only is there no major health benefit to taking a general multivitamin, but actually there was a 2.4% increase in deaths. In particular, as the New York Times summarizes:

Use of multivitamins, vitamin B6, folic acid, iron, magnesium, zinc and copper were all associated with increased risk of death. The findings translate to a 2.4 percent increase in absolute risk for multivitamin users, a 4 percent increase associated with vitamin B6, a 5.9 percent increase for folic acid, and increases of 3 to 4 percent in risk for those taking supplements of iron, folic acid, magnesium and zinc.

This is not a surprising finding to me, as I already stopped taking a multivitamin last year after reviewing other recent large studies which also find essentially no major benefit, and some risks, in a multivitamin. The main issue is that most healthy adults get plenty of these compounds from their diet, and excess amounts of iron, beta carotene, vitamin A, vitamin E and others can actually hurt a lot more than help. In fact, another major study this week showed how vitamin E supplements increase the risk of prostate cancer. How many of you take a multivitamin?

The second news story this week on my podcast discusses the bad news around Steve Jobs’ death, which is bringing the spotlight upon pancreatic cancer. Pancreatic cancer is one of the most deadly cancers, unfortunately, as most people are diagnosed late into the disease, and it’s extremely difficult to treat. Can lifestyle help? The data on a super-healthy diet is actually not convincing; the strongest risk factors are smoking and obesity, both which raise the risk almost twice the norm.

More Podcast Information

You can always listen live to my radio interview each Wednesday around 7:35am Beijing time, on the Beijing Hour program on EZFM 91.5, which is broadcast from 7-8am every weekday by host Paul James. EZFM is the popular bilingual radio station on the China Radio International network, broadcasting here in Beijing and on multiple stations all over the world, as well as live online here.

You can listen to all my previous podcasts at the podcast archive.

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• Most of the pills had very little of the active ingredient, lovastatin (and monacolins)
• The range of lovastatin amounts between brands was enormous, and none of the labels specifically say how much of the active ingredient is in there (which they can never state, since they are technically herbal supplements and are forbidden by the FDA to make any health claims)
• Many brands had even less of the active ingredient than they did in previous tests
• A few were contaminated with a mycotoxin called citrinin, which may be associated with kidney disease (but not proven).

I think such information is unfortunate but essential to make the supplement industry more trustworthy and accountable. I am now a lot less enthusiastic about recommending red yeast rice as a “healthy alternative” to the prescription medicines. Why waste your money on this supplement if there’s only a tiny amount of the active ingredient — and if it may be contaminated? Why take the risk when the prescription versions have overwhelming evidence of effectiveness — and don’t have toxic contaminants?

Also, there are many Chinese medicines with red yeast rice, and I had previously liked the more official Xue Zhi Kang brand; but I now would certainly like to see similar independent tests of this brand and other Chinese versions before recommending. Maybe they already exist; does anyone know of a Chinese article reviewing this issue?

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The New York Times has a nice review of this Cochrane meta-analysis, and you can download the Cochrane PDF file here and also read their original conclusions here:

The common cold is often caused by the rhinovirus. It is one of the most widespread illnesses and is a leading cause of visits to the doctor and absenteeism fromschool and work. Complications of the common cold include otitis media (middle ear infection), sinusitis and exacerbations of reactive airway diseases. There is no proven treatment for the common cold. However, a medication that is even partially effective in the treatment and prevention of the common cold could markedly reduce morbidity and economic losses due to this illness.

Zinc inhibits rhinoviral replication and has been tested in trials for treatment of the common cold. This review identified 15 randomized controlled trials, enrolling 1360 participants of all age groups, comparing zinc with placebo (no zinc). We found that zinc (lozenges or syrup) is beneficial in reducing the duration and severity of the common cold in healthy people, when taken within 24 hours of onset of symptoms. People taking zinc are also less likely to have persistence of their cold symptoms beyond seven days of treatment. Zinc supplementation for at least five months reduces incidence, school absenteeism and prescription of antibiotics for children with the common cold. People taking zinc lozenges (not syrup or tablet form) are more likely to experience adverse events, including bad taste and nausea. As there are no studies in participants in whom common cold symptoms might be troublesome (for example, those with underlying chronic illness, immunodeficiency, asthma, etc.), the use of zinc currently cannot be recommended for them. Given the variability in the populations studied (no studies from low- or middle-income countries), dose, formulation and duration of zinc used in the included studies, more research is needed to address these variabilities and determine the optimal duration of treatment as well as the dosage and formulations of zinc that will produce clinical benefits without increasing adverse effects, before making a general recommendation for zinc in treatment of the common cold.

The usual dosing is 3-4 times a day during your illness; the most common lozenges are 23-30mg, so one of these 3-4 times a day would help best. Don’t forget, it’s important to start zinc quickly and not wait a few days. As it says above, side effects are common but not severe, including bad taste and a bit of nausea.

Where To Buy In China?

I’m becoming a big fan of the Nature’s Bounty line of vitamins. Nature’s Bounty is a popular brand in the USA and they are now branching out all over China and Beijing’s top supermarkets and malls, as well as the World Health Store. All their line is imported from the US — at surprisingly reasonable prices. They stock the 23mg dissolvable zinc tablets; this could be taken 3-4 times a day during your cold.

While Nature’s Bounty is a great option, it’s still cheaper to get most vitamins back at home, so perhaps you should add zinc to your next hometown shopping trip!

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So, What Works?

There’s a good free review from Cardiovascular Therapeutics from last year, titled “Nutraceuticals in Diabetes and Metabolic Syndrome“. Also, my favorite natural medicine website, the Natural Medicines Database, yet again has a wonderful, free article on natural medicines for treating diabetes. This group provides an essential service for docs and consumers: they review all the best research and offer evidence-based advice on natural medicines — what works and what doesn’t work. At the bottom of their article is a nice summary graph, and here is a snippet:

Natural Medicines For Diabetes

There Is No Wonder-Supplement

First, the graph implies that there is as yet no officially “Effective” and “Likely Safe” natural medicine. In fact, nothing reviewed is assessed to be either “effective” or “likely effective.” The best they can state — at least,  in terms of evidence-based research — is a series of therapies that are “Possibly Effective” and “Likely Safe”. This includes psyllium (fiber), guar gum, magnesium, oat bran, and soy. Antioxidants in general such as vitamin C or E do not have strong evidence that they help with diabetes, although alpha-lipoic acid may help, especially with diabetic neuropathy. And a bunch of popular supplements are still in the “Insufficient Evidence” columns — including coenzyme Q10.

The neutraceutical review above also mentions that vitamin D and calcium may also lower risk for diabetes. I already recommend vitamin D for other reasons, so people can consider this as an added benefit.

Selenium: Do Not Use!

One surprising finding that may people don’t know is that selenium, which previously was considered good for diabetes, actually is now considered bad. Not only is it not effective, but it actually can make your diabetes worse. This latest data definitely has not made the rounds of consumer products, as almost all “diabetes” combination-herbs products such as Nature’s Bounty “Diabetes Support Pack” (available in China) still include selenium. So, if you use those expensive herbal pills, the benefits of the cinnamon and chromium may be offset from the harms of selenium — thus not helping you at all. It’s hard to say this conclusively, since all of these formulations are different, but it’s something you should consider before purchasing such combo pills.

My Bottom Line

I think those of you who are diabetic, or pre-diabetic, before considering spending your hard-earned money on any supplements, should first take care of what I mentioned last week are the most effective natural ways to help diabetes — weight loss, exercise and diet. Do not waste your money on multi-pill-pack diabetes supplements if you’re not aggressively getting your weight down 5-10%, or exercising. If you are doing these far more important steps but still have problems, it’s not a terrible idea to try the most effective natural methods:

• Fiber in all forms, including as oat bran, has the strongest evidence to lower your sugar load ~14-20% each meal
• Chromium (and cinnamon) have some evidence of effectiveness — you could consider trying for 3 months and stopping if you see no improvement
• Magnesium may help, but diet forms are much more effective than in a pill
• Vitamin D and calcium supplements may help lower your risk – I previously mentioned doses here
• Vinegar with meals also lowers your sugar load ~20%
• The popular Chinese vegetable bitter melon (kugua) can lower that meal’s blood sugar load
• Soy may help a bit — and in general, soy milk is healthier than cow’s milk, so why not switch? Better yet, make your own soy milk
• Antioxidants don’t seem to help much with diabetes, but are still a powerful concept — but you should get these from a good diet, not pills
• Selenium does not work!

Other Resources

I already mentioned that the Natural Medicines Comprehensive Database is a great start for those of you looking for evidence-based, trustworthy reviews on natural medicines. You can also use the U.S. National Library of Medicine’s PubMed Dietary Supplement Subset, a search engine focused on top research regarding natural medicines — including Chinese medicines.

Chinese Herbs?

I would love to recommend Chinese herbs or pre-packaged formulas, but I haven’t seen enough hard evidence; does anyone have good data for me to review?

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But now…one wonderfully annoying thing about medicine is that one headline will say “medicine A is great for disease X”, but wait a couple years and another famous journal will contradict it — thus frustrating doctors and confusing the public.

And now, of course, we have a long-awaited publication from the highly-esteemed U.S. Institute of Medicine, which last November published their findings about vitamin D and calcium. The IOM is very official and their papers are usually considered top quality standards of care. In this case, they were not very enthusiastic about vitamin D supplements for most people, and concluded that actual vitamin D deficiency is not so common. They specifically recommended only 600 IU a day supplement for people aged 1-70 years;  over 70 years needs 800 IU a day. That’s it; no mega-doses, not even 1,000 IU, for anyone. Not only that, but anyone taking more than 4,000 IU a day is not only getting no additional benefit but they increase their risk of kidney stones and other issues (how many of you are taking 5,000 IU a day?). Here’s the table of their official recommendations:

This more cautious review came just a couple weeks after another well-regarded review from Canada which was much more enthusiastic about supplements and recommended 400-1,000 IU for most people, and 2,000 IU or more for “high risk” people such as people prone to osteoporosis.

So, what do we do now? We have two large and well-esteemed groups reviewing the same research papers and coming up with different conclusions.

What Will I Do?

I do respect the Institute of Medicine, and perhaps the Canada study is a bit too local to apply to other areas. So I would tend to stick to the IOM’s more conservative official recommendations as the new standard of care.  But I also still like those previous papers I mentioned last year about 1,200 IU of vitamin D3 helping cut down on colds and flu by 42%, so I will personally continue to take my 2,000 IU of vitamin D3. Is the dose too high? Maybe, probably — but just wait a couple years and another study may change things yet again. Plus, 2,000 IU doesn’t seem to raise the risk of kidney stones. So, for me, the possible benefits outweigh possible harms.

However, I do think there are some take-home points for the general public:

• All children should be taking a supplement of 400 IU a day, which should also include calcium (especially for girls!), mostly for bone health
• People taking over 5,000 IU a day are wasting their money and also increasing their risk for kidney stones
• Many healthy people may not need it, but if a small dose of 1,000 IU cuts down on your winter colds and flu, then why not take it?
• Blood testing for vitamin D levels can be done but still isn’t very practical, cost-effective or useful

Those of you who want to read more can read the excellent New York Times review this week about vitamin D.

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Change #1: I stopped taking a multivitamin. I took multivitamins for years, but this year I finally decided that the hard research evidence simply wasn’t there for me. I always assumed that a multivitamin may do some good and at least couldn’t hurt, but the best studies I’ve seen still don’t show much of a benefit — at least, not with already healthy people who eat well. I wrote a post earlier this year about the latest research on multivitamins. I’ve been eating much better this year and I’m convinced enough that my multivitamin isn’t doing much for me. But I’m still very much on the fence, and further studies may indeed convince me to start again.

Change #2: I started taking vitamin D. This is my one exception for vitamins this year; I started to take 2,000 IU of vitamin D daily. As I’ve mentioned in many posts this year, a lot of research shows positive benefits of vitamin D supplements — and vitamin D is one of the very few vitamins not easily available in foods (it’s mostly created by sunlight on your skin). Although most research shows few people are seriously (“clinically”) deficient in vitamin D, most health agencies are recommending this supplement. I’ve mostly been convinced by studies showing how vitamin D can cut down on winter’s colds and flu.

Change #3: I started a protein soymilk breakfast. OK, fellow Americans, let’s be honest here: after eating the typical American breakfast of pancakes, sausage, potato and eggs, your body and brain feel very sluggish and heavy. Breakfast is the #1 meal of the day, so it’s important to get proper nutrition. As I mentioned earlier this year, I love to start my day with warm, freshly-homemade soy milk. And this year, I started to add a couple tablespoons of freshly ground protein powder to this soy milk, and this protein/nutrition boost gives me a lot of positive energy for the morning. I also start my day with a small cup of warm water with juice from half a lemon; honey; and alfalfa powder. Plus, I make a big glass of a homemade smoothie, usually fruits plus spirulina powder.

Change #4: I stopped using any plastic for leftovers. How many of you still microwave your restaurant leftovers in their plastic/styrofoam containers? I previously was trying to use only “safe” plastic codes (like #5) but I finally stopped this entirely this year and switched completely to glass containers. I mentioned earlier this year that there is increasing evidence that many plastics have harmful chemicals, mostly due to chemicals such as BPA which can cause multiple endocrine and other disorders.

There are supposed to be “safe” plastics you can reuse, but I made the switch to all-glass mostly because of scary news reports this year on the Chinese media about a review showing many Chinese restaurant take-out plastics and styrofoams containing dangerous chemicals. These unstable chemicals can easily leach out into foods — especially oily foods — and especially when microwaving. The public health groups recommended that people immediately transfer all take-out foods to different containers as soon as you get home; even sitting in the fridge overnight isn’t considered safe.

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One major problem with Beijing’s winters is the dry air. Beijing’s extremely low humidity indoors and outdoors will dry out everyone’s skin and throats. Many of us get constantly “itchy” dry throats which causes frequent coughing. Sometimes your skin can be so dry that it becomes very itchy and almost painful. To combat this annual problem, I strongly recommend indoor humidifiers in most rooms and in your office, to keep your indoor humidity levels to a pleasant 40-60%. China’s electronics stores carry many brands, but I prefer the Yadu brand, which has a good reputation with their large, 2-tank model for around 900RMB. Another crucial dry skin tip is a good lotion which you should apply just after your bath and as often as you need, if your skin is still dry and cracked. You can find many adequate moisturizers at Watsons and other stores, including my favorite brand, Neutrogena. I also find that baby oil works fine as well. More severe cases can use thicker emollients such as Vaseline.

If you are outside often, it helps to use a face warmer, called a kouzhao (口罩) in China, which is worn like a mask and comes in many patterns. It nicely warms up the air you breathe in and also helps slightly with air pollution, although not nearly as well as the N95 pollution masks. The air pollution in winter can be quite severe, so it’s a good idea to have some N95 masks handy, as well as to use indoor air purifiers.

One supplement that you may consider taking this winter is vitamin D, both for yourself and your children. This crucial vitamin is usually created in your skin via sunlight, and many northerners have low levels during the winter. There are quite a lot of new studies showing benefits of vitamin D in decreasing winter colds in children and adults, as well as strengthening bones; boosting your immune system; and helping with blood pressure, diabetes and possibly cancers. The American Academy of Pediatrics recommends 400IU of vitamin D daily for all children and adolescents, including breast-fed infants, who are more at risk of deficiency. Increasing numbers of medical groups, such as the Canadian Cancer Society, are starting to recommend that adults take 1,000 IU a day during the winter.

Winter in Beijing can be quite charming, so I encourage you to join your fellow Beijingers in their traditions of eating roasted chestnuts and roasted yams, sold on many city street corners. Both are delicious and also nutritious. Also, Beijing has many local hot springs both north and south of the city, which can really hit the spot when it’s below freezing outside. My favorite is Longxi Hot Springs Resort, one hour south of the city in Daxing.

While at home on a cold night, you can recreate the hot spring experience with a foot bath massager. It’s a wonderful, relaxing feeling to come home and soak your feet in a hot bath, add some epsom salt, and drink a warm drink with your loved ones. Epsom salt (magnesium sulfate) is now available in clinic pharmacies as well as April Gourmet. All electronics stores sell many models of foot massagers, but we bought the well-regarded Kang Li Da (康立达足浴盆) brand for a much better deal via Taobao’s website.

Another great way to fight off the winter blues is to exercise; many studies show that exercise routines can boost your mood and energy and help fight off depression as well as improve sleep. Fortunately, Beijing has many indoor gyms to choose from. If the weather is right, you can also consider continuing to bike to work.

And if you feel the winter blues really getting you down and depressed, please don’t hesitate to seek help with any of the counseling and psychology staff at the expat clinics.

Follow these steps and the winter months will fly past!

This post is a reprint from my column in Beijing-Kids magazine, published last month (November 2010)

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First, the National Center for Complementary and Alternative Medicine has a nice review of Omega-3 that readers should check out. Here’s their piece on the research:

Status of Research on Omega-3s:

Epidemiological studies done more than 30 years ago noted relatively low death rates due to cardiovascular disease in Eskimo populations with high fish consumption. Since these early studies, numerous observational and clinical trials have studied fish oil and omega-3 fatty acids for a wide variety of diseases and conditions. Overall, the evidence appears the most promising for improving cardiovascular disease risk factors. For example, studies show that increasing levels of DHA and EPA—either by eating fish or taking fish oil supplements—lowers triglycerides, slightly lowers blood pressure, may slow the progression of atherosclerosis (hardening of arteries), and may reduce the risk of heart attack, stroke, and death among people with cardiovascular disease.

Several small studies have also found that fish oil may benefit people who have rheumatoid arthritis (RA). High doses of fish oil significantly reduced RA patients’ morning stiffness, number of swollen joints, and need for corticosteroid drugs.

Additionally, omega-3s have been studied for conditions such as asthma, dementia, diabetes, inflammatory bowel disease, lupus, osteoporosis, and renal disease, as well as organ transplantation outcomes (e.g., decreasing the likelihood of rejection). However, more research is needed before conclusions can be drawn about these conditions.

The always-useful Prescriber’s Letter has a nice patient handout on omega-3 (Detail-Document on Omega 3: Prescriber’s Letter). Here are some highlights:

What are omega-3 fatty acids?

Omega-3 fatty acids include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), found in fish, and alpha-linolenic acid, found in soy, canola oil, flaxseed, and English walnuts.

For what conditions are omega-3 fatty acids effective?

There is good evidence that omega-3 fatty acids, particularly EPA and DHA, prevent heart disease. In people who already have heart disease, they help prevent death, heart attack, and stroke. They also reduce triglycerides. Omega-3 fatty acids might also help rheumatoid arthritis, high blood pressure, depression, bipolar disorder, menstrual pain, and certain kidney problems.

What is the best source of omega-3 fatty acids?

The best source of omega-3 fatty acids is fatty fish, like salmon. The American Heart Association (AHA) recommends that everyone eat at least two fatty fish meals (baked or broiled) weekly for cardiovascular health. People who have heart disease should try to eat fatty fish daily. Also add foods rich in alpha-linolenic acid (canola oil, soy, English walnuts, flaxseed) to your diet. But they are not good substitutes for fish because they do not provide enough EPA/DHA. Fish oil capsules are a convenient way to get your omega-3 fatty acids, especially if you need high doses. Fish oil capsules are sold over-the-counter or by prescription (Lovaza [formerly Omacor] in U.S.). Ask your healthcare provider if fish oil capsules are right for you.

Should I be concerned about mercury in fish?

Women who are pregnant or may become pregnant or are breastfeeding, and young children are at risk of mercury toxicity from certain fish. The EPA (U.S.) and Health Canada have specific recommendations for which fish these at-risk persons should avoid or limit. Fish low in mercury include shrimp, canned light tuna (not albacore), salmon, pollock, and catfish. Fish oil capsules are generally low in mercury and other pollutants. For more information, see http://www.epa.gov/waterscience/fishadvice/advice.html (U.S.) http://www.hc-sc.gc.ca/fn-an/securit/chem-chim/environ/mercur/cons-adv-etud-eng.php. (Canada).

How do I choose a fish oil product?

Over-the-counter fish oil is considered a supplement, not a drug, so quality and content varies. Choose products with the “USP Verified Mark” on the label. These have been tested, and have acceptable levels of mercury, other heavy metals, PCBs, and dioxins. They are confirmed to contain what the label says they contain. The omega-3 content is the labeled amount of DHA plus EPA.

Other data from Prescriber’s Letter:

Low Cholesterol: “Omega-3 has a lot of good data that it lowers cholesterol. Clinical research shows that taking fish oil in doses of up to 1-5 grams/day can reduce triglycerides by as much as 20% to 50%. But keep in mind that it is NOT effective for lowering total cholesterol or LDL-C. In fact, some people have a slight increase in LDL-C while taking fish oil. But they also tend to have a slight increase in HDL-C. Overall, the benefit outweighs the risk.”

High Blood Pressure: “there is relatively little evidence available on the use of fish oil specifically for hypertension.”

Heart Disease: “There is good evidence that routinely eating fatty fish, such as salmon, can reduce the risk of heart disease and all-cause mortality.”

My Bottom Line

I think there’s strong evidence that omega-3 helps lower heart disease risk and overall mortality, even in healthy groups such as myself, which is why I take it. Side effects in the stomach are usually minimal. However, the medical community is not in unison regarding omega-3 as a wonder-pill, at least in terms of supplements. Most people should be able to get enough omega-3 simply from eating a lot of fatty fish (salmon, mackerel, sardines), at least twice a week. This should be everyone’s first choice; those of you who hate fish, or are worried about mercury and other contaminations in your fish, should be the ones to consider a supplement.

As for which supplement to buy, be very careful about not getting a cheap supplement which may be contaminated with mercury or simply may not have enough omega-3. Stick to top brands, or try to stock up at home each year.

And just as importantly for those who take supplements: make sure your total daily intake of omega-3 DHA and EPA is at least 1 gram a day. Bottles may say something misleadingly impressive like “one gram of fish oil per pill”, but the crucial ingredient is on the back label: the total amount of omega 3 (DHA + EPA) is the key! So, if your pill has 500mg total DHA and EPA, then you’d take it twice a day.

One more thing: stick to fish oil and not flax oil. Flax oil doesn’t have enough of the DHA and EPA, which are much more potent than the omega-3 ALA that predominates in flax oil.

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Tip #6: To Every Thing, There Is A Season.

Beijing has a surprising variety of all four seasons, which I think is a great thing. Spring and fall, the best times of year here, are unfortunately short, but in general you can expect the same seasonal variations you would find in New England or northern Europe. But each season has a few particular oddities:

Winter can be monotonously cold, and last year was quite painfully drawn out. The worst health problems usually include colds and influenza, as well as winter depression. The secret to avoiding the winter blues? Pamper yourself! Here are some personal tips:

• Buy a foot soak. I bought one on Taobao for 320RMB and I love it; there’s nothing better after a cold day than to soak your feet in a warm, massaging tub with epsom salt thrown in. Add a warm brandy and a portable low-back massager, and I’m in heaven…
• Keep your skin moist. Dry skin is a major hassle in Beijing, and everyone needs to respect this, or soon enough you’ll be scratching yourself crazy. I think a humidifier in important rooms is a must-have, including at your office. And you almost definitely will need daily use of a good moisturizer.
• Visit a local hot springs. Beijing has a surprising number of hot spring resorts within an hours drive; my favorite is in the south, in Daxing. They have the added benefit of Turkish flesh-eating fish, and you can also stay overnight.
• Take a weekend break in a hotel. Forecast calls for -13? Check into a city hotel such as the classy Ritz-Carlton (Huamao) on a Saturday night and just relax all day in their plush lobby, then fall asleep after a spa massage.
• Take vitamin D. There’s growing evidence that vitamin D is an important factor in staying healthy, and since most vitamin D is created in our skin from direct sunlight, it’s easy to be deficient in vitamin D in the winter. Some studies suggest that supplements all winter can help decrease infections like the winter flu — in kids as well.
• Eat roasted chestnuts and yams. Join your local Beijingers and wait in line on the street corners for a 10 kuai bag of delicious, freshly roasted chestnuts. Also look out for the very common sweet potato/yam sellers on most streets, selling delicious roasted wares for about 2 kuai each. These are some of Beijing’s best traditions.

Spring is a visual feast: in March we get sandstorms blotting out the sun, and in May we have catkin pollen filling the air like snow. OK, it’s not that dramatic, but we definitely have some sandstorm days where the skies are orange and the grit seeps into your nostrils, clothes, bedrooms — everywhere. It actually can be a health hazard, but have a little common sense avoidance and you’ll be fine. As for the catkins, it’s dramatic but not really a health nuisance. However, many Beijingers do have allergic hayfever problems in the spring. Most expats actually have less hayfever problems in Beijing.

Otherwise, you should definitely free yourself from winter’s shackles and join the rest of Beijing by flocking to local parks for the beautiful spring blossom festivals. Enjoy the local outdoors as much as you can, before summer’s always-too-early heat kicks in.

Summer is often dreadfully long; the major health issues are a major increase in gastroenteritis as well as travel-related diseases from expats’ vacations to exotic and malaria-filled southern locales. The best way to prevent a vacation disaster is to do your homework beforehand by researching your destination’s health status on the CDC Travel website; and bring a medical travel kit to help the often-inevitable issues like diarrhea. And prepare early! You may need at least a month or more to get a full course of vaccines like japanese encephalitis, rabies or hepatitis; these are often in short supply in the expat clinics during the summer crunch.

We do get major heat waves as well, but fortunately many July and August afternoons are filled with thunderstorms to cool things off for your after-dinner stroll (another very cool China tradition you should definitely pick up). Other fun traditions include eating the excellent local watermelons and corn on the cob.

If you want a water break (and you will want one), you can drive 3 hours to Beidaihe or take an hour flight to the lovely beach cities of Dalian or Qingdao. And if you just want to cool off, take a drive into the local mountains and visit a temple. I’ve created a small list of my personal favorite local spots.

Autumn is fairly mellow, health-wise, so you should enjoy this all-too-brief moment of perfect weather by exploring Beijing’s mountains and tourist attractions.

Tip #7: Have An Anti-Inflammatory Lifestyle.

I find it useful to picture Beijing as a pro-inflammatory city; we are daily bombarded with air particles and gases both indoors and outdoors, as well as from chemicals in our foods, that are pro-inflammatory — causing free radical damage to our healthy cells, as well as setting off cascades of unhealthy hormones and enzymes that can slowly lead to many illnesses such as heart disease and cancers. So, you always need to think, “what can I do to fight off this damage?” Fortunately, you can do a lot of things:

• Don’t smoke. Smoking is, by far, the worst toxin you can put into your body. It directly destroys your lung’s membranes, and of course sets off oxidative changes that lead to the cancers and heart and lung diseases we all know about. You’re already breathing in toxins while living here — adding cigarettes will only hasten that inflammatory cascade.
• Watch your alcohol intake. Your liver is a crucial organ whose main function is to detoxify all the chemicals and pollutants you breathe in and eat. Alcohol should also be considered as a direct toxin to your liver; a moderate amount is fine and fun and may actually lower your risk of heart disease. But the binge drinking and excess daily drinking will definitely wipe out your liver, slowly but surely. Those of you who admit — or are told by loved ones — that your drinking may be a problem, should take heed and find help if needed. Beijing does have an Alcoholics Anonymous branch, and your family doctor can also help.
• Eat anti-inflammatory foods. Your mother was right — you should eat your veggies. There is overwhelming evidence that healthy foods like fruits and vegetables can dramatically lower risks of developing heart diseases as well as cancers. And some modern foods can be decidedly pro-inflammatory, such as trans-fats and certain red meats like grain-fed cows. Take control of what you put in your body!
• Consider a supplement. This is a bit more controversial, and there definitely is no medical consensus regarding the effectiveness of many commonly taken supplements — even a simple multivitamin. I personally feel that omega-3 from fish oil (not flax) has a lot of evidence supporting its use to lower risks for heart disease, and its side effects are minimal. Again, supplements are a bit controversial and some may actually harm if taken to excess or combined with certain prescriptions, so you should discuss this with your doctor.

Tip #8: Exercise

One crucial thing to remember is that Beijing may have some unique quirks with air pollution, food issues, etc — but the major diseases and risks are the same here, and China’s #1 killer is the same as all over the world: heart disease. So please keep things in perspective here – you still need to focus on the basics of good body weight, exercise, proper foods, and not smoking.

I’ve posted many articles about exercise for you to review, and a lot of it is obvious, but expats should be especially aware that it can:

• help manage your stress levels
• lower your risk of diabetes and high blood pressure
• help you sleep better
• fight off depression

How much is enough? You should shoot for at least 150 minutes a week of pulse-racing activity. As for which exercise, you should continue whatever you love. Beijing is filled with gyms and public parks for all sports, and there are many hiking and biking clubs as well. Also, don’t be afraid to exercise outside! As long as the pollution index is reasonable (somewhere way below 200), then exercise outside is still much healthier than no exercise at all. Try to stay at least 200 meters from any major road or highway to minimize pollution.

Tip #9: Take Care of Your Body and Soul.

Last spring I had a series of articles discussing what I called expatitis:

Expatitis (Expat from expatriā “to leave native land” +itis“inflammation, abnormal states, excesses, tendencies, etc”) – a syndrome of multiple physical and mental illnesses brought on by maladaptive coping mechanisms to the stressors inherent to living abroad.

I see a lot of overworked patients who rarely sleep well, are totally stressed and too busy for exercise — all of which lower people’s immune systems and set them up for illness. So I do feel that it’s crucial that we all focus on ourselves — to constantly check in with our heart and soul and ask ourselves, “am I happy here in Beijing? Am I neglecting something or someone, including myself?” For example, it really is a basic that we all need about 8 hours of sleep, and if your lifestyle is constantly preventing that, you increase your risk of more frequent and severe infections, depression and anxiety, as well as more long-term problems like heart disease.

And if you feel that your life is totally spinning out of control, or you are starting to cry often and out of nowhere, or are getting waves of panic attacks, then you should definitely consider getting some professional help. Each clinic in Beijing should have a couple counselors and family doctors who can help you through your tough times. Our clinic has Dr Mike, a psychologist who welcomes anyone to call him on his mobile phone at 158.0131.9796.

Tip #10: Watch Out For Sexually Transmitted Diseases

Beijing is not immune to the worldwide problem of sexually transmitted diseases, and it is frighteningly common here to get exposed to bugs such as chlamydia and gonorrhea. There is also an alarming resurgence of syphilis in China — plus the usual suspects like HIV, herpes, hepatitis and others. So, there are many reasons for you to practice safe sex — that means always wearing a condom with new partners. And be careful where you buy your condoms — there have been recent scares with poorly made counterfeits. Stick to the big chains like Watsons.

And don’t forget that you can carry these infections for many years and feel perfectly healthy, but you can still infect others. One of the major causes of infertility for women is uterus damage from chlamydia, and most women didn’t even know they were infected. That’s why we recommend routine screening tests for sexually active men and women, including the pelvic exam for young women, which is not as routine among Chinese women as it should be. These tests can provide you with a lot of peace of mind, especially if you are entering a new relationship and want “a clean slate”.

People always have a lot of questions about STDs (for example: yes, you can get STDs just from oral sex), so I created an online slide show about the basics of STDs.

Bonus Tip: Immerse Yourself

Many expats eventually leave Beijing feeling they’ve just finished the most rewarding and interesting times of their lives, and a common cause seems to be a deep immersion into Chinese culture. That usually means learning the Chinese language well enough to talk with anybody, and I know how difficult that is (I’m still years away), but clearly you will have a much richer time here.

Even if you can’t chat away with locals, you can still have a wonderful experience by biking around the hutongs; dancing a waltz at night in practically any local park; volunteering to help migrant schoolkids — or countless other small things that add up to a fulfilling and mind-expanding adventure.

(Click here for part one, with tips #1-5…)

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