Do nuts cause diverticulitis? Recent research is interesting

Posted on May 27, 2025 by drlesliegreenberg

Diverticulosis is a common condition affecting the large intestine in which small pouches, called diverticula, form in the colon wall. This occurs as the wall of the intestine has weak spots that when pushed against with stool, bow out.  While it is often asymptomatic, it can lead to complications like diverticulitis when inflamed or infected.

One common question is: Do nuts and seeds, increases the risk of diverticulitis? Recent research gives reassuring insights.

A study published in the Annals of Internal Medicine analyzed dietary habits from nearly 30,000 U.S. women aged 35 to 74 over a 19-year period (2003 to 2022). The data showed no significant link between the intake of nuts, seeds, or popcorn and an increased risk of diverticulitis. This suggests that nuts and seeds are not only safe for those with diverticulosis but may even offer health benefits due to their fiber, healthy fats, and essential nutrients.

The Role of Diet in Managing Diverticulosis and Preventing Diverticulitis

While nuts and seeds appear safe, adopting a high-fiber diet remains one of the most effective ways to prevent diverticulitis and promote overall colon health. Fiber adds bulk to the stool, reducing pressure on the colon walls and lowering the risk of pouch formation or inflammation. High-fiber foods include:

  • Whole grains (e.g., oats, barley, brown rice)
  • Fruits (e.g., apples, pears, berries)
  • Vegetables (e.g., broccoli, carrots, leafy greens)
  • Legumes (e.g., lentils, beans, chickpeas)

Staying well-hydrated is essential. Water softens the stool, so it is easier to pass and reduces the risk of constipation—a common trigger for diverticulitis flare-ups. The American Gastroenterological Association (AGA) recommends aiming for at least 25 to 30 grams of fiber per day for adults, accompanied by 8 to 10 cups of water daily to ensure the fiber can work effectively.

Managing Constipation: A Key Component of Diverticulosis Care

Constipation is a common concern for individuals with diverticulosis. According to the AGA’s guidelines for managing constipation, the following steps can be helpful:

  • Increase Dietary Fiber: Gradually increase fiber intake to the recommended 25 to 30 grams per day.
  • Stay Hydrated: Drink sufficient water to support proper digestion and stool formation.
  • Physical Activity: Regular exercise stimulates bowel movements and reduces constipation risk.
  • Consider Fiber Supplements: If dietary changes alone are insufficient, fiber supplements can help.  Psyllium often causes increased gas, so be aware of that side effect while your gut gets used to it.
  • Limit Processed Foods: Reduce intake of low-fiber, processed foods that can contribute to constipation.

I hope this helps.

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Sleep: Does melatonin help sleep? Which melatonin to buy?

Posted on May 20, 2025 by drlesliegreenberg

The consensus statement from sleep medicine physicians is that sleep medications should not be a chronic therapy, especially for children.

Some hints about melatonin

Melatonin.  There is no FDA-approved melatonin.  Because of this, the amount of melatonin in each tablet/gummie can vary.  Read the following compilation of studies on melatonin:

  1. If you buy melatonin, consider buying a pharmaceutical grade melatonin with a “USP-certified” medication. 
  2. A small dose of 1-5 mg is sufficient.  A stronger dose will not help.
  3. Take melatonin 3-4 hours before you want to go to sleep (because it takes that long to work)
  4. Do EVERYTHING else to improve sleep hygiene. 

I hope this helps.

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Shingles Vaccine Benefits: Lower Heart Disease Risk?

Posted on May 12, 2025 by drlesliegreenberg

I understand that vaccines are a touchy subject. But, as a 30-year family medicine physician, I LOVE vaccines! They decrease infection and save lives. Do I sound like a cheerleader?

A recent study found that people who get the shingles vaccine may have a lower risk of heart disease. The research looked at over a MILLION people aged 50 and older in South Korea. It found that those who got the vaccine had a 23% lower risk of heart problems like stroke, heart failure, and coronary heart disease. This protection lasted for up to eight years.

Shingles is a painful rash caused by the varicella zoster virus, the same virus that causes chickenpox. After a person has chickenpox, the virus can stay in their body and reactivate later as shingles. The rash can start in any dermatome of the body and it starts as blisters that can itch or burn. This can be very painful and cause serious health problems, especially in older adults and people with weak immune systems. Without vaccination, about 30% of people may get shingles in their lifetime. As we age, the shingles outbreak can cause long-standing nerve pain (even when the rash is gone) and this is called post-herpetic neuralgia. I’ve had two patients of mine not get the vaccine, and get shingles, and they would have hot, zinging pain as they sat in my office to discuss an unrelated health issue. Needless to say, the week I turned 50, I got my first shingrix vaccine. (It is a two-shot regimen.)

The researchers also found that the vaccine’s benefits were even stronger for men, people under 60, and those with unhealthy lifestyles, like smoking or drinking alcohol. They believe the shingles vaccine helps by preventing the inflammation and blood vessel damage that can lead to heart disease.

The study used a live zoster vaccine, which contains a weakened form of the virus. However, many countries now use a different type of vaccine called a recombinant vaccine, which does not contain the live virus. More studies are needed to see if this newer vaccine has the same heart benefits.

While this study is promising, the researchers noted that the results may not apply to everyone. They also pointed out that this type of study cannot prove that the vaccine directly prevents heart disease. More research is needed to confirm the link and understand how the vaccine may protect the heart.

I hope this helps.

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Sleep: Why It Matters and How to Get Better Rest?

Posted on April 28, 2025 by drlesliegreenberg

We all know sleep is important. But do we really know how important it is? Or how to get better sleep? Let’s talk about why sleep matters and some simple ways to help you rest better at night.

Start by Tracking Your Sleep

First, keep a sleep diary for two weeks.


Each day, write down when you go to bed, when you wake up, and how you feel.
This can be just as helpful as using special devices like a Whoop or Apple Watch.

Know Your Sleep Pattern

Everyone has something called a circadian rhythm — this is your body’s natural clock.
Some people are early birds and like to sleep early and wake up early.
Others are night owls and stay up late.
Knowing which one you are can help you plan your sleep times better.

Why Good Sleep Is So Important

The later part of your sleep is when you get the most REM sleep.
REM sleep is super important because it helps your body and mind feel refreshed.

If you don’t get enough sleep, it can:

  • Make it harder to lose weight.
  • Raise hunger hormones (like ghrelin).
  • Raise stress hormones (like cortisol).
  • Lower important hormones like leptin (which controls hunger) and testosterone.
  • Slow down your thyroid and make it harder for your body to use insulin.

Good sleep also helps your brain, especially a part called the amygdala, which controls your emotions.
This helps you stay calmer and handle problems better during the day.

Easy Ways to Sleep Better

Here are some simple things you can do to get better sleep:

1. Make Your Room Sleep-Friendly

  • Keep the temperature around 65°F.
  • Turn off loud noises and bright lights.
  • Make sure your room feels clean and safe.

2. Fix Your Sleep Setup

  • Sleep on a comfy mattress.
  • Use soft, clean blankets and pillows.

3. Follow Good Sleep Habits

  • Go to bed and wake up at the same time every day, even on weekends.
  • Eat and drink at least two hours before bedtime.
  • If you take naps, nap early in the day (between 12–3 PM) and keep them short (less than 40 minutes).

4. Make Sleep a Priority

  • Set a regular bedtime and stick to it!
  • If you have kids, make sure their bedtime routine matches yours.

5. Talk to Your Doctor If Needed

  • If you have trouble with restless legs or moving too much while sleeping, see your primary care doctor. They can help you find answers.

Final Thoughts

Sleep is one of the best things you can do for your body and mind.
By making a few small changes, you can start sleeping better — and feeling better — every day!

I hope this helps!

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Want to decrease your dementia risk?

Posted on April 3, 2025 by drlesliegreenberg

A new studies shows that receiving the shingles vaccine may decrease dementia risk.

The New York Times reported yesterday about a study in the journal Nature that The“found that people who received the shingles vaccine were 20 percent less likely to develop dementia in the seven years afterward than those who were not vaccinated.” Other studies like this have been done and found a decreased dementia risk, but this study was able to rule out “other dementia-protective characteristics, like healthier lifestyles, better diets or more years of education.” These results “provide some of the strongest evidence yet that some viral infections can have effects on brain function years later and that preventing them can help stave off cognitive decline.”

We suggest that shingles vaccines be given at age 50. Shingrix is a 2-vaccine shot regimen with the two doses being given 2 months or more apart. I have seen two memorable patients over my 30 years of doctoring who both had postherpetic neuralgia (after-shingles-nerve-pain) and when they would see me for unrelated issues. They would periodically jump in their seat due to zinging pain in the dermatome that their shingles rash was present years before. Consequently, the week I turned 50 I got my first shingrix vaccine. It is true that you may feel “flu-ish” the day after the shingrix vaccine. But, I urge you to not wait until you have an unencumbered 3-day weekend to get the shingles vaccine. Life happens, time gets away from us. And, not getting the shingrix vaccine may mean that you get shingles before you are vaccinated (as I have seen this scenario countless times).

In this study it “tracked people in Wales who were around 80 when receiving the world’s first-generation shingles vaccine over a decade ago.” So, this study does not specifically address what is the rate of dementia when patients get the shingles vaccine at age 50, but I can appreciate that viral illnesses may increase the strain on the brain and decrease its ability to cognitively function as we age.

​FamilyDoctor.org emphasizes that the best way to prevent shingles is through vaccination. They recommend vaccinating children against chickenpox to reduce their risk, as shingles can only occur in individuals who have previously had chickenpox. ​

The Centers for Disease Control and Prevention (CDC) recommends Shingrix for adults aged 50 and older, as well as for immunocompromised individuals aged 19 and above. Shingrix has been shown to be over 90% effective in preventing shingles and its complications.

I hope this helps.

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States Simplify Licensing for Foreign-Trained Doctors

Posted on March 4, 2025 by drlesliegreenberg

States Ease Licensing Requirements For Foreign-Trained Physicians To Ease Staff Shortages

I read this morning in my family medicine update email that per KFF Health News (3/3, Zionts) reports, “A growing number of states have made it easier for doctors who trained in other countries to get medical licenses, a shift supporters say could ease physician shortages in rural areas.”

Since 2023, at least nine states, including Florida and Illinois, have eliminated the requirement for these doctors to repeat residency training in the US. Supporters argue this change could help meet health care needs, while opponents “worry about patient safety and doubt the licensing change will ease the doctor shortage.”

The Federation of State Medical Boards and other health organizations “published its recommendations to help lawmakers and medical boards make sure these new pathways are safe and effective.”

As a medical educator, Annually, I recruit and train 8 family medicine physicians in Reno, Nevada. But, more than 8 per year locally leave medicine (retire, die, move away) and we are seemingly not making any headway.

Indeed, we do have a physician shortage in the US which is being filled (or not filled at all!) with mid-level providers (nurse practitioners and physician assistants). Foreign-trained physicians offer more extensive training and may come to the US with years (or decades!) of medical experience. This is an interesting solution to a worsening medical environment in the US. I will follow along…

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I am starting a menopause clinic!

Posted on February 19, 2025 by drlesliegreenberg

I was tasked with making a brochure to market the new clinic. This new venture has come with lots of new experiences for me: passing the Menopause certification test, winning over “stakeholders,” making a business plan, teaching residents and medical students about menopause treatment, and making informational materials and brochures.

Here’s my rough-draft of the brochure.

Renown University Health Menopause Clinic: Personalized Care for Your Menopause Journey

Are you experiencing symptoms of perimenopause or menopause? You’re not alone—millions of women experience this natural transition, but everyone is unique. That’s why Renown University Health Menopause Clinic is here to offer expert, compassionate, and personalized care to support you every step of the way.

Meet Dr. Leslie Greenberg

Leading our clinic is Leslie Greenberg MD, a highly experienced physician dedicated to helping women navigate menopause with confidence and comfort.

  • Board-Certified Family Physician with 30 years of experience
  • Certified by the Menopause Society
  • Personally sees every patient to ensure individualized care

Common Symptoms We Help Manage

  • Hot flashes and night sweats
  • Mood changes and anxiety
  • Sleep disturbances
  • Vaginal dryness and discomfort
  • Weight gain and metabolism changes
  • Decreased libido

No matter what symptoms you’re facing, we offer evidence-based treatments to help you feel your best.

Why Choose Renown’s University Health Menopause Clinic?

  • Expert Care: Specialized treatments based on the latest research
  • Personalized Approach: Every care plan is designed just for you
  • Comfortable Environment: A supportive, patient-centered experience

Location & Contact Information

University Health Family Medicine Office
745 West Moana Lane, Reno, NV

Schedule Your Appointment Today!
Call 775-657-2014 to book a consultation with Dr. Leslie Greenberg and take the first step toward a healthier, more comfortable menopause journey.

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The flu is not over for this year!

Posted on February 12, 2025 by drlesliegreenberg

How to Avoid Influenza: Expert-Backed Prevention Strategies

I have seen a lot of flu in the hospital and in the office this week. This seems LATE to me…and yet it is true. Influenza (flu) season is in full swing, but the good news is that there are proven ways to protect yourself and others. According to the American Academy of Family Physicians (AAFP) and the Centers for Disease Control and Prevention (CDC), the most effective way to prevent the flu is through vaccination. I suggest getting vaccinated every fall in October.

However, other important measures such as proper hand hygiene, staying home when sick, and wearing a mask can also significantly reduce the spread of the virus. Here’s what you need to know to stay healthy this flu season.

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1. Get Your Flu Vaccine – It’s Not Too Late!

The CDC and AAFP strongly recommend that everyone (even during pregnancy!) aged 6 months and older receive an annual flu vaccine. Even if flu season has already started, getting vaccinated now can still protect you for the remainder of the season, which can last well into the spring. The flu shot reduces the risk of severe illness, hospitalizations, and complications, particularly in high-risk groups such as young children, the elderly, pregnant individuals, and those with chronic health conditions.

Some people worry that the flu shot might give them the flu, but this is a myth. The vaccine is made from inactivated or weakened virus components that cannot cause the flu. Side effects, if any, are usually mild and temporary, such as soreness at the injection site or a slight fever.

2. Wash Your Hands Often

One of the easiest and most effective ways to prevent the flu is frequent handwashing. The flu virus spreads through droplets from coughing, sneezing, or touching contaminated surfaces. The CDC recommends washing hands with soap and water for at least 20 seconds, especially:

  • Before eating
  • After coughing or sneezing
  • After using the restroom
  • After touching shared surfaces such as doorknobs, phones, and public transportation handrails

If soap and water aren’t available, use an alcohol-based hand sanitizer with at least 60% alcohol.

3. Stay Home If You Feel Sick

One of the biggest contributors to flu spread is going to work, school, or public places while sick. The CDC advises that people with the flu stay home for at least 24 hours after their fever has gone (without the use of fever-reducing medication). This helps prevent spreading the virus to others, especially those who may be more vulnerable to severe illness.

Encourage workplaces and schools to support sick leave policies that allow people to recover at home without pressure to return too soon.

4. Wear a Mask in High-Risk Settings

Masks have become a familiar tool in reducing respiratory illness transmission. If you are feeling unwell, wearing a mask can prevent you from spreading the flu to others. In crowded areas such as public transportation, hospitals, or during flu outbreaks, wearing a mask can add an extra layer of protection, particularly for those at higher risk.

Final Thoughts

Influenza is highly contagious, but by following these expert-recommended prevention strategies, you can reduce your risk and help protect those around you. The flu vaccine remains the most powerful tool in flu prevention, and it’s not too late to get vaccinated. Combine vaccination with good hygiene, staying home when sick, and wearing a mask when necessary to navigate flu season as safely as possible.

For more information, visit the CDC website. Stay healthy and flu-free!

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Shigellosis outbreak in Northern Nevada

Posted on December 24, 2024 by drlesliegreenberg

A recent email sent to Northern Nevada physicians outlines a shigellosis outbreak in Northern Nevada.


NNPH Identifies Shigellosis Outbreak
Shigella is a bacterium that causes diarrhea and other symptoms resulting in the disease known as Shigellosis – see prevention tips   Dec. 20, 2024. Reno, Sparks, Nev. – Northern Nevada Public Health (NNPH) has identified a Shigellosis outbreak after an influx of new cases and hospitalizations were reported.

Since late October, at least 14 cases and nine hospitalizations were reported, although the actual number of cases is expected to be much higher. Based on Nevada State Public Health Laboratory analysis and epidemiologic investigation, greater than 50 percent of the Shigellosis cases were among individuals experiencing homelessness. There is currently a low risk of transmission to the public at large.

As a result of this increase, NNPH is working to educate people about the risks of infection and prevention measures. NNPH staff are working with several agencies who serve or work with affected populations to mitigate the outbreak.

Shigellosis (pronounced “shih-guh-low-suhs”) is an intestinal (bowel) infection that causes diarrhea (sometimes bloody), fever, stomach pain, and the feeling of the need to pass a stool (poop) even when the bowels are empty. If you think you might have Shigellosis, contact your doctor or other healthcare provider.

Shigellosis can be spread by coming into contact with the poop of an infected person, eating or drinking contaminated food or water, or through sexual contact (oral, hand, anus).

According to the Centers for Disease Control and Prevention (CDC), Shigellosis can be difficult to treat. Prevention is critical to reducing the spread of the infection, which includes: Hand Hygiene: Wash hands frequently with soap and water for at least 20 seconds after using the toilet, before preparing food, and after caring for a sick person.Avoid Food Preparation and Recreational Water: If you think you have Shigellosis or come into contact with it, do not prepare or share food with others, and avoid swimming in pools, lakes, or other recreational water sources while symptomatic and for at least two weeks after recovery.Safe Sex Practices: Refrain from sexual activity (vaginal, anal, oral) during illness and for two weeks following recovery. Safe sexual practices include using barriers like condoms or dental dams and washing hands after touching used barriers. Sex toys should be washed before and after use with soap and water.Stay Home from Work or School: Avoid work (especially in food service, healthcare, or childcare), school, or daycare until cleared by public health authorities. Individuals experiencing symptoms are encouraged to seek medical care.

NNPH has created flyers to help educate people in the community. Download English FlyerDownload Spanish Flyer Healthcare providers can find more information at this CDC link.
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Please note the Washoe County Health District changed its name to Northern Nevada Public Health on Aug. 31, 2023. More information is here.
 
Northern Nevada Public Health (NNPH) is nationally accredited by the Public Health Accreditation Board and has jurisdiction over all public health matters in Reno, Sparks, and Washoe County through the policy-making District Board of Health. NNPH consists of five divisions: Administrative Health Services, Air Quality Management, Community and Clinical Health Services, Environmental Health Services and Epidemiology & Public Health Preparedness. More info can be found here.
    Learn More about NNPH
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Pertussis is rampant!

Posted on November 5, 2024 by drlesliegreenberg

Pertussis is rampant!

Are you up to date on the Tdap vaccine?  The “p” of this vaccine stands for pertussis.  Pertussis is also known as whopping cough. 

The Washington Post recently stated that there are five times as many pertussis cases mid-October 2024 as compared to October 2023. 

The CDC guidelines are for DTaP to be given to children and Tdap to be given to adults.  DTAP is a 5-dose series (age 2 months, 4 months, 6 months, 15 months and 4-6 years of age).

TdaP is given at age 12 and then “once as an adult.”  Other caveats for TdaP as an adult are all pregnant persons should have one dose  in the early part of gestational weeks 27-36 or for those who have exposure to newborns.

When I was pregnant with our third child, my husband contracted pertussis.  He was treated with appropriate antibiotics and yet he whooped (coughed until he has NO air left in his lungs and then made a whooping sound as he filled his lungs back up with air) for 6 months.  He was miserable, even though he was no longer infectious or contagious.  I urge you to ask your primary care physician if you are due for a Tdap booster.

I hope this helps.

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